HFSA Patient Education: How to Follow a Low-Sodium Diet

A low-sodium diet includes no more than 2,000 to 3,000 milligrams (mg) of sodium per day. That is the same as 2 to 3 grams of sodium a day. To give you an idea of how much that is, 1 teaspoon of salt = approximately 2,300 mg sodium.

People with mild heart failure (no or mild symptoms with vigorous or moderate exercise) are usually asked to limit their sodium intake to 3,000 mg per day.

People with moderate to severe heart failure (symptoms with light exercise, household chores or at rest) are usually asked to limit their sodium intake to 2,000 mg per day.

Check with your health care provider on the sodium limit that is best for you. Too low sodium intake may also be harmful.

Measurement Key

Ounce = oz.
Milligram = mg
Tablespoon = tbsp.
Teaspoon = tsp. 

You can take four basic steps to reduce the amount of sodium in
your diet:

Step 1: Stop Adding Salt to Food

To accomplish this step, try the following tips:

• Remove saltshakers from the table.
• Do not add salt when cooking.

You can reduce your sodium intake by as much as 30 percent by following the first two tips above. People often say that food tastes bland without salt. It may take weeks before you enjoy the taste of low-sodium foods, but your taste buds will adjust. Eventually you may not even miss the salt. You can also make foods taste good without salt by trying the following tips:

• Experiment with low- or no-salt herbs, spices, and seasoning mixes. Avoid Kosher and “designer” salts like sea salt. While they can be lower in overall sodium content, it’s not that much lower.
• Try using seasonings like black, cayenne, or lemon pepper. Dried and fresh herbs such as garlic, garlic or onion powder (not salt), dill, parsley, and rosemary are also naturally very low in sodium. Combination spice mixes in a bottle are great as long as sodium or salt is not one of the ingredients.
• Sprinkle fresh lemon juice over vegetables and salads. Season or marinate meat, poultry, and fish ahead of time with onion, garlic, and your favorite herbs before cooking to bring out the flavor.
• Avoid spices and seasoning mixes with the word salt or sodium in the name. They will be high in sodium. For example, just a teaspoon of a seasoned salt, such as garlic salt or celery salt, contains about 1,500 mg of sodium. The chart below lists high-sodium seasonings. 

It can be fun learning new ways to eat. The following table lists low-sodium seasonings to use when cooking. There are many salt-free seasoning mixes in your supermarket. Some are high in potassium, so avoid them if your health care provider has also instructed you to watch your potassium levels. Look in the spice section for seasonings labeled “salt-free.” Also, check the seasoning labels in your kitchen for sodium levels.

Examples of low-sodium spices, herbs, and seasonings.

Examples of high-sodium spices, herbs, and seasonings.

Step 2: Adapt Your Preferred Foods to Low-Sodium Versions

To do this, try these tips:

• Consider getting a low-salt cookbook. You can find excellent low-salt cookbooks at your local library. You can also buy one at a bookstore or on the Internet.
• After getting used to low-sodium eating, you will be able to adapt your favorite recipes to low-sodium versions. For example, if you like soup, make your own low-sodium version with fresh meat and vegetables. Toss the ingredients into a slow cooker, and use herbs and spices for seasonings. Make extra and freeze some for later meals.
• Use low-sodium substitutes for foods that you like. For example, prepare a fresh, lean pork roast instead of a country ham. You can cook fresh chicken, turkey, roast beef, or pork without adding salt. Then, use the meats for sandwiches instead of packaged lunchmeats. Use fresh lettuce, tomato, and onion for flavoring.
• The chart on page 14 lists a variety of low-sodium alternatives for high-sodium foods.
• Look for low-sodium versions of the foods you like. Many types of canned goods are now available in low-sodium versions. Look for canned foods labeled sodium-free, no-salt, low-sodium, light in sodium, very low-sodium, reduced-sodium, less-sodium, or unsalted. You can also remove some sodium from canned foods by rinsing them. Keep in mind that this does not remove all of the sodium.
• Select low-sodium cheeses or yogurt when making sauces.

Step 3: Pick Foods Naturally Low in Sodium 

To accomplish this step, try the following tips:

• Choose fresh foods. Fresh fruits and vegetables, including freshly squeezed fruit and vegetable juices, have very little sodium. The same is true for fresh meat, poultry, and fish. Generally, you can eat as much fresh food as you want without counting the sodium content. So, think fresh when choosing foods.
• If you are not eating fresh foods, choose other low-sodium foods as much as possible.
• Other good options include canned fruits and plain frozen vegetables. Dried beans, peas, rice, and lentils are also excellent low-sodium foods, but make sure not to add salt or other ingredients such as salt pork when cooking them. 

Step 4: Learn to Read Food Labels

By reading food labels, you can learn which foods are high and low in sodium. As a rule, most processed foods whether they are frozen, canned, or boxed, are high in sodium. For example, most frozen TV dinners, frozen snack foods such as pizza rolls and egg rolls, canned vegetables, and instant hot cereals are high in sodium and should be avoided.

But not all processed foods are high in sodium. Some packaged foods are available in low- or no-salt versions.

Sometimes it is hard to know what to eat. The only way to know for sure is to read the food label. It is especially important to read the labels of processed foods or any foods with which you are unfamiliar. 

The charts below list some high- and low-sodium foods, so you can get an idea of which foods you should choose and which ones you should avoid.

The next section will teach you how to read a food label for sodium content.

Low-Sodium Foods

High-Sodium Foods

Begin by reviewing the serving size and sodium content information (see the circled areas on the sample in the downloadable PDF). The serving size for the food is 1 cup. The sodium content for that serving is 130 mg.

If you eat the same sized serving as the one listed on the label, then you are eating the amount of sodium
that is listed. For example, if you drink 1 cup (1 serving size) of the milk, you will consume 130 mg of sodium. But if the amount you actually eat is either larger or smaller, the amount of sodium you will be eating will also be larger or smaller. For example, if you drink half a cup of the milk, you will consume 65 mg of sodium (130 ÷ 2 = 65).

For example, if you eat a double portion of the food shown on the label, you will also be eating twice as much sodium as listed on the label. A 2-cup serving of the food would contain 260 mg of sodium (130 X 2). Remember, when looking at nutritional facts, if the sodium is listed near the front of the list, that item will be higher in sodium.

To find out how much sodium you are eating, keep a record of everything you eat and drink for four days. Do not forget to include snacks. From time to time, similar foods can include different amounts of sodium.
The amount or size of foods also influences amount of sodium. It is better to describe the foods you eat in as much detail as possible. Write the food name, the amount (or size), and a detailed description of what you ate. Below you can see some examples of how to record foods.

You can use the chart on the downloadable PDF to track what you eat. A full-page version of
the chart can be printed from our website: www.hfsa.org.

If you don’t know the sodium content of a particular food, write down the food anyway. Your nurse or dietitian will work with you to estimate the sodium content. You can also look up the sodium content of foods on the Internet.

Add up the amount of sodium you eat each day. If you find that you ate more than 2,000-3,000 mg of sodium each day, look at each item on the list to figure out which foods caused the trouble. Think about where you might be able to cut down on sodium.

Sodium intake may influence your body weight and symptoms. For example, if you eat high sodium foods, your body weight may increase. You may also experience shortness of breath and swelling in your legs, ankles, and feet. Therefore, you must monitor your sodium intake and whether sodium intake
influences your body weight and symptoms.

You can also review the list of what you ate with your nurse, doctor, or dietitian to find out how your sodium intake compares to what is best for you.

There are several free nutrition programs online to help you track your sodium
intake such as:

• MyFitnessPal: www.myfitnesspal.com
• Loseit: www.loseit.com
• SparkPeople: www.sparkpeople.com

What is my sodium limit per day?

Reason for asking this question: Most people with heart failure should limit their sodium intake, even if they do not have symptoms. Following a low-sodium diet will help prevent fluid from building up in your body and
may even decrease your need for some medications. In fact, a water pill (or diuretic) will work better and be more effective when the diet is low in sodium.

Your health care provider is the best person to tell you exactly how much sodium you can eat each day, but they may forget to discuss this important aspect of your care. So ask them about your sodium limit.

The chart below shows the sodium content of selected foods to give you an idea of how much sodium you consume each day.

Examples of Sodium Content of Selected Foods

Foods with less than 10 mg of sodium per serving

Foods with 10-40 mg of sodium per serving

Foods with 40-65 mg of sodium per serving

Foods with 65-120 mg of sodium per serving

Foods with 120-175 mg of sodium per serving

Foods with 175-350 mg of sodium per serving

Foods with 350-500 mg of sodium per serving

Foods with 500-800 mg of sodium per serving

Foods with more than 800 mg of sodium per serving

I hear a lot about sodium, but what about potassium?
Should I be on a diet that is high or low in potassium?

Reason for asking this question: Your body needs potassium to work properly, so it is important that you have the right amount in your blood.

Some heart failure medicines can cause potassium levels to go either up or
down. For example:

• Water pills may cause a drop in potassium.
• Angiotensin-converting enzyme (ACE) inhibitor and spironolactone pills may cause an increase in potassium. (See Module 3: Heart Failure Medicines for definitions and more information.)

Your health care provider should check your blood potassium level and tell you if you need to do anything special to keep your potassium level normal. They may also prescribe a potassium pill to make sure you are getting enough potassium.

If your potassium level is high, your health care provider may advise you to avoid eating foods high in potassium. Foods high in potassium include:

• Avocados 
• Bananas
• Beans
• Coconut water
• Dried fruits (prunes, dates, raisins)
• Nuts
• Oranges and other citrus fruits
• Potatoes and sweet potatoes
• Spinach
• Tomatoes
• Winter squash

On the other hand, if you have low potassium, your health care provider may advise you to eat foods high in potassium.

Question: Are there sources of sodium that I need to watch out for?

Answer: Most of the sodium we eat comes from salt, but sodium can also be
found in many foods, drinks, and medicines.

Some things you should know about sodium that can help you eat less of it:

• If your health care provider prescribes an antibiotic, ask for one without sodium.
• The chemical symbol for sodium is Na. You may also see the symbol NaCl for sodium chloride.
• Watch for the word soda on food labels. For example you may see sodium bicarbonate (baking soda) or sodium carbonate on packages. These products contain sodium compounds. Try to avoid them if possible.
• Preservatives account for much of the sodium in processed foods. The names of some high-sodium preservatives are: sodium alginate, sodium sulfite, sodium caseinate, and sodium benzoate.
• Some over-the-counter drugs have large amounts of sodium. Carefully read the labels. Avoid products such as fizzing drugs. 

Reduce your sodium intake—and boost your heart health—with a few simple steps:

• Choose fresh vegetables and foods that are fresh whenever possible. Or, look for canned or frozen foods without added sauces or salt.
• Cut back on convenience foods that are typically high in sodium, such as frozen pizza, TV dinners, instant rice mixes, and canned soups.
• If you must buy packaged or processed foods, check the label first. Whenever possible, choose foods that have less than 100 mg of sodium per 100 grams.
• Try not to use salt in cooking water and remove the saltshaker from the table.
• Limit salty snacks such as chips, pretzels, and salted nuts.
• Eat at home more often to better control your intake of sodium.
• When dining out, request that your meal be prepared with little salt.

Question: How can I follow a low-sodium diet when I eat out?

Answer: Many people go out to eat several times each week. Eating out, whether it is at a restaurant, a friend’s house, or a party, can be challenging if you are on a low-sodium diet. But you can go out to eat and maintain a low-sodium diet, if you are careful.

Use the following tips while eating out:

• Choose restaurants that offer fresh food choices.
• Go online to check sodium content of meals and food items at chain restaurants before you arrive—or check via smartphone before ordering.
• Pick preparations without breading, because breading contains salt.
• Be specific about what you want and how you want it prepared when ordering. For example, ask that your food be prepared without added salt, monosodium glutamate (MSG), or soy sauce.
• Do not be afraid to question your waiter about how the food is prepared.
• Choose foods without sauces or ask for sauce and salad dressing “on the side.” If you use salad dressing, dip the tines of your fork into the dressing cup and then pierce your food, instead of pouring the dressing over your food. That way you get the flavor without all the sodium. Use the same technique with other types of sauces and gravies. 
• Limit use of condiments that are high in sodium such as Worcestershire sauce, steak sauce, or ketchup. 
• Avoid dishes named au gratin, Parmesan, hashed, Newberg, casserole, and Devonshire, because they are high in sodium.
• Be careful of foods that are labeled as good for your heart. These foods are usually low-fat, but they may be high in sodium. In many cases, salt is used to flavor low-fat foods.
• Choose the salad bar. It can be an excellent way to eat a low-sodium meal in a restaurant. But remember the following guidelines when selecting items:
  • Choose fresh vegetables, fruits, and eggs served in their natural state. That includes lettuce greens, spinach greens, tomatoes, cucumbers, onions, radishes, green peppers, red peppers, alfalfa sprouts, fresh mushrooms, broccoli, cauliflower, carrots, red cabbage, and hard-boiled eggs.
  • Avoid high-sodium foods including croutons, green olives, black olives, shredded cheese, bacon bits, macaroni salad, potato salad, coleslaw, sunflower seeds, pepperoni, Chinese noodles, pickles, and creamy salad dressings.
  • Choose the following salad dressings: oil and vinegar, lemon, and flavored vinegars such as balsamic and raspberry.
  • Avoid the regular, light, and fat-free dressings unless you order on the side and dip your fork tines in the dressing. They are all high in sodium.
  • If you are at a party, eat fresh fruits and raw vegetables instead of snack foods such as potato chips, salted popcorn, pretzels, or peanuts. Avoid the dips and party spreads because of their high sodium content. If you decrease your sodium intake before and after a big event where you may be eating a lot of high-sodium foods, you can help prevent your body from retaining fluid.

Question: What can I do to stay on my diet at a fast food restaurant, pizza parlor, or deli?

Answer: Eating at a fast food restaurant, pizza parlor, or deli can be especially difficult, because most of the menu items are very high in sodium. The following chart below lists the sodium content in some typical types of fast foods. Still it is possible to make lower sodium choices, if you try the following.

At fast food restaurants, choose:

• A hamburger or grilled chicken sandwich without condiments. Add small amounts of mustard or mayonnaise yourself.  
• French fries without salt.
• The salad bar.

At a deli, choose:

• The salad bar.
• Vegetarian sandwiches with fresh vegetables, including lettuce, spinach, tomato, onion, fresh mushrooms, radishes, cucumbers, and sprouts.
• Use small amounts of mayonnaise (1 tablespoon contains 75 mg of sodium) or mustard (1 teaspoon contains 55 mg of sodium) as condiments.
• Avoid items such as the deli meat and cheese sandwiches, sardines, caviar, and pickled or brined foods such as olives.

At a pizza parlor, choose:

• Less sauce.
• More vegetable toppings.
• Ask for fresh mushrooms, green peppers, fresh tomatoes, onions, and other fresh vegetables.
• Part-skim mozzarella cheese.
• Avoid pepperoni or sausage and processed cheeses such as Parmesan.

Examples of sodium content of fast foods

Patients and caregivers may wish to download and read this PDF on a screen or to print and read this module on paper. HFSA has created a simplified printable version that makes it easy for you to print at home or from any printer on 8.5" x 11" standard paper. See options below.

Providers may wish to use this file in several ways: 

1. Download and read this PDF on a screen or email to patients and caregivers
2. Print professionally using a printer such as Minuteman Press in a high resolution, pamphlet format at an additional fee to your institution (see additional instructions below)
3. Print quickly and for free in-house using a simplified version that minimizes ink usage and uses an 8.5" x 11" standard paper size

Explore options below.

Instructions for Professional Printing

If you choose professional printing, HFSA recommends sending these details to your printer along with the file that you can download below:

1.    Dimensions: 5.5" x 8.5"
2.    Binding: Saddle Stitch
3.    Bleeds/Crop: 0.125"