What to eat with heart failure:
diet, salt, and fluids

Article written and reviewed by Dr Luca Moretti

Heart failure does not require a "special diet" made up of only a few permitted foods. The goal is to follow a heart-healthy diet, avoid excess salt, recognize foods that are very high in sodium, and adapt fluid intake to the individual clinical situation. Extreme restrictions, especially of water or salt, are not appropriate for everyone.
Management needs to be more individualized in patients with edema, hyponatremia, kidney disease, low blood pressure, intensive diuretic therapy, or advanced heart failure.

In practical terms, it is advisable to:

• favor fresh and minimally processed foods;
• limit very salty foods and industrial products high in sodium;
• use herbs, spices, lemon, and other flavorings instead of large amounts of salt;
• not impose a fluid restriction unless it has been recommended by the treating team;
• monitor weight and signs of congestion when advised;
• avoid potassium-rich salt substitutes without discussing them with the doctor.

Current recommendations are less rigid than in the past. The aim is not to "drink as little as possible" or eliminate salt completely, but to maintain a balance that reduces the risk of congestion without causing excessive thirst, dehydration, or a nutritionally inadequate diet.

How much salt can be consumed

Sodium retains water, and a very high intake can make congestion more difficult to control. European guidance recommends avoiding excessive salt intake and uses approximately 5 g of salt per day, equivalent to about 2 g of sodium, as a reference.
This amount includes all salt consumed during the day, not only salt added from the salt shaker. A substantial proportion in fact comes from processed foods.

There is, however, no convincing evidence that very severe restriction improves clinical outcomes in most stable patients. In the SODIUM-HF trial, reducing sodium intake to less than 100 mmol per day did not reduce the composite of death, cardiovascular hospitalization, and emergency department visits compared with usual care.
The 2024 HFA consensus therefore emphasizes that a diet with a normal, non-excessive sodium intake is generally preferable to extreme restrictions, which can reduce quality of life and adherence.

Which foods contain the most sodium

"Hidden" salt is often more important than salt added during cooking. Cured meats, very salty cheeses, olives and pickled foods, snacks, potato chips, bouillon cubes, meat extracts, ready-made sauces, frozen or packaged meals, industrial soups, preserved foods, and many baked products can provide large amounts of sodium.
Bread, crackers, and breakfast cereals can also contribute significantly when eaten every day, even though they may not always taste particularly salty.

Reading the label helps compare similar products. In the European Union, the nutrition table generally reports salt content per 100 g or 100 ml. Choosing the version with less salt, reducing the frequency of highly processed foods, and using more fresh foods is often more effective than completely eliminating salt from home-prepared meals.
A Mediterranean-style dietary pattern, with vegetables, fruit, legumes, whole grains, fish, extra virgin olive oil, and minimally processed protein sources, fits well with these goals.

How much water to drink: why there is no single limit for everyone

One of the most common questions is whether people with heart failure should drink only 1 liter or 1.5 liters per day. The answer is no, not automatically. In stable patients, a normal fluid intake, often around 1.5-2.5 liters per day, may be appropriate and is adjusted mainly according to thirst, weather conditions, and fluid losses.
Restriction to approximately 1.5-2 liters per day may be considered in selected patients, for example those with severe heart failure, congestion that is difficult to control, or dilutional hyponatremia.

Drinking too little can cause hypotension, dizziness, worsening kidney function, and electrolyte disturbances, especially in people taking diuretics. Conversely, very large amounts of fluid can make congestion more difficult to control in susceptible individuals.
The ideal amount must therefore be individualized and can change over time. During intense heat, fever, diarrhea, or vomiting, it may be necessary to temporarily reassess both fluid intake and diuretic therapy together with the doctor.

Potassium, salt substitutes, and foods that should not be eliminated without reason

Many salt substitutes contain potassium chloride. This may appear beneficial, but several heart failure drugs tend to increase potassium, particularly spironolactone, eplerenone, finerenone, ACE inhibitors, ARNIs, and ARBs. Kidney disease can also promote hyperkalemia.
For this reason, freely using potassium-rich low-sodium salts or potassium supplements is not recommended without first checking treatment, kidney function, and blood tests.

It is also incorrect to eliminate fruit and vegetables automatically because they contain potassium. In most people, they are important components of a healthy diet. A true dietary potassium restriction is indicated only when hyperkalemia is present or when there is a concrete risk related to kidney function and treatment.
Excessive dietary restrictions can themselves contribute to malnutrition, loss of muscle mass, and, in frail patients, a worse prognosis.

Weight, alcohol, and practical meal planning

In patients with an established diagnosis of heart failure, weight also serves as an indicator of fluid retention. A rapid increase over a few days does not necessarily represent accumulated fat: it may reflect water retention. For this reason, when advised, it is useful to weigh oneself regularly under the same conditions and report unexpected changes together with edema or worsening breathlessness.
Conversely, progressive unintentional weight loss may indicate malnutrition or, in advanced forms, cardiac cachexia and requires assessment.

Alcohol should not be used as a "protective" part of the diet. Excessive intake can increase blood pressure, arrhythmias, and myocardial damage; when heart failure is caused by alcoholic cardiomyopathy, abstinence is particularly important.
From a practical standpoint, it is useful to build meals around simple foods: vegetables, legumes, fish, unprocessed meats, whole grains, fruit, and unsaturated fats. This naturally reduces sodium intake compared with a diet rich in cured meats, very salty cheeses, snacks, and ready-made foods.

Frequently asked questions about diet, salt, and fluids

How much salt can you eat with heart failure?
European recommendations advise avoiding excessive intake and use approximately 5 g of salt per day as a reference upper limit. Much stricter restrictions have not shown an overall benefit and can make the diet difficult to follow.

How much water should you drink with heart failure?
Not all patients need to limit themselves to 1 or 1.5 liters. In stable patients, a normal intake guided by thirst is often appropriate, generally around 1.5-2.5 liters per day. Restrictions to 1.5-2 liters are mainly reserved for selected situations, such as severe heart failure or hyponatremia.

Which high-salt foods should be limited?
Much of the salt intake comes from processed foods: cured meats, very salty cheeses, snacks, potato chips, bouillon cubes and stock preparations, sauces, ready-made foods, preserved foods, industrial baked products, and some restaurant dishes.

Can low-sodium salt be used in heart failure?
Not automatically. Many salt substitutes contain potassium chloride and can increase the risk of hyperkalemia in patients taking mineralocorticoid receptor antagonists, ACE inhibitors, ARNIs, or ARBs, or in those with kidney disease.

Does salt need to be completely eliminated in heart failure?
No. The goal is to avoid excess sodium, not to follow a salt-free diet. Extreme restriction can be difficult to sustain, and contemporary evidence does not show a general clinical benefit from very severe sodium restriction in stable patients.