🚨 Call 911 for sudden breathlessness, breathlessness at rest, gasping that does not settle when you sit up, new confusion, fainting or chest pain. Get a same-day appointment for waking at night gasping for air that settles when you sit up, or for a rapid weight gain of roughly 4.4 lb (2 kg) or more over two to three days. These indicate fluid building up fast or the heart decompensating, and both are treated far more easily early than late. Never stop or reduce a diuretic, or any other heart medicine, on your own, however well you feel. Several supplements interact with heart failure medication, so talk to your prescriber or pharmacist before starting anything on this page.

Definition

What Is Heart Failure?

Not the heart stopping, and not a single disease. It is a syndrome in which the heart either cannot fill properly or cannot pump strongly enough, so blood backs up and tissues receive less than they need.

The backing up is what produces the symptoms people notice: fluid in the lungs causing breathlessness, fluid in the legs causing swelling, and fluid in the abdomen causing bloating and early fullness at meals. The reduced forward flow produces the fatigue.

Nutrition matters here in three specific ways, and they are more particular than general healthy eating. Sodium and fluid affect how much volume the circulation has to carry. Certain nutrients are lost through the very diuretics used to treat it. And appetite frequently falls just when the body needs more, which is why unintended weight loss in heart failure is a serious finding rather than a good one.

💡 Key Insight: The most useful thing most people with heart failure can do at home is not dietary at all. It is weighing yourself at the same time each morning and telling your clinician when the number climbs quickly, because that rise is fluid, and it is the earliest signal available.

A body diagram of heart failure: a weakened heart, fluid in the lungs, a swollen abdomen, kidneys holding salt and water and swollen legs, with a panel on weighing yourself daily and a list of common symptoms

🧂 The sodium trial surprised people

SODIUM-HF randomized over 800 patients to a low-sodium target or usual care. It did not reduce hospital admissions, emergency visits or deaths, though quality of life and symptoms improved modestly¹.

⚖️ Weight loss is a red flag here

Unintended loss of weight and muscle, called cardiac cachexia, is associated with worse outcomes. In heart failure the goal is usually to protect weight and muscle, which is the opposite of the advice given almost everywhere else.

💊 Diuretics remove nutrients too

Thiamine deficiency was uncommon in stable heart failure outpatients on standard therapy, under 11.6% in one study². Loop diuretics increase its loss in urine, so ask whether it has been checked.

Signs & Symptoms

Symptoms of Heart Failure

Heart failure shows up mostly as breathlessness, swelling and fatigue. The pattern of when they happen is what distinguishes it.

Symptom	What happens
Breathlessness on exertion	Doing less than before without stopping. Worth knowing: Often attributed to age or being unfit, and so presented late.
Breathlessness lying flat	Needing more pillows, or sleeping upright. Worth knowing: Fairly specific for fluid, and a useful thing to report by number of pillows.
Waking at night gasping	Suddenly, one to two hours after falling asleep. Worth knowing: Get a same-day appointment if it settles when you sit up; call 911 if it does not. It suggests fluid redistributing when lying down.
Swollen ankles, legs or abdomen	Worse by evening, better after a night lying flat. Worth knowing: Shoes and rings becoming tight is often noticed first.
Rapid weight gain	Roughly 4.4 lb (2 kg) or more in two to three days. Worth knowing: This is fluid, not fat, and it is the earliest actionable signal. Weigh daily.
Fatigue and reduced exercise tolerance	Everything takes longer and costs more. Worth knowing: Frequently the most limiting symptom, and the least visible.
Early fullness, nausea, poor appetite	Eating little and losing weight without trying. Worth knowing: Fluid in the abdomen and gut congestion. A reason to see a clinician, not to diet.
Reduced urine output, or new confusion	Particularly in older adults. Worth knowing: Can indicate worsening kidney perfusion; seek advice promptly, and call 911 for new confusion.

⚠️ Heart failure and kidney function are tied together, and that shapes the whole nutrition plan. Reduced kidney function changes how much potassium, phosphate, protein and fluid are safe, and several heart failure medicines raise potassium. This is why potassium-rich foods and salt substitutes cannot be recommended generically on this page. See chronic kidney disease.

Causes

Causes of Heart Failure

Heart failure is where other heart and circulation problems end up rather than something that starts on its own, and the usual routes into it are a damaged or overworked heart muscle, a faulty valve or a rhythm problem⁸.

Cause	How It Contributes to Heart Failure	What Helps
Coronary heart disease and heart attack	A blocked coronary artery starves heart muscle, and a heart attack can leave scar that does not contract; the NHS lists a heart attack and long-term strain from coronary heart disease among the main causes⁸	Treatment of the coronary disease by your clinical team, with the food pattern and the activity described in the sections below alongside it, never instead of it
Long-term high blood pressure	Years of pumping against a raised pressure thicken and stiffen the heart muscle, and the NHS names long-term strain from high blood pressure as a cause of heart failure⁸	Blood pressure treatment from your prescriber, plus the sodium moderation set out in the diet section, following the fluid and potassium limits your own clinician gave you
Alcohol	Alcohol is directly toxic to heart muscle, and the NHS lists drinking a lot of alcohol among the things that raise the risk of heart failure⁸	Cutting down or stopping, as the diet section advises; where alcohol is the cause, stopping is part of the treatment rather than an optional extra
Heart valve disease and heart rhythm problems	A leaking or narrowed valve makes the heart move the same blood twice, and a fast or irregular rhythm gives it too little time to fill; the NHS lists both among the possible causes⁸	These are treated by a cardiology team, with procedures or rhythm control where indicated; nothing in the diet or supplement sections substitutes for that
Reduced kidney function, anemia and thyroid problems	Each makes the heart work harder or the circulation carry more, and the NHS lists all three among the possible causes; reduced kidney function also decides how much potassium and fluid are safe for you⁸	Having kidney function, blood count, iron studies and thyroid tests done and repeated, as your clinician advises, and taking no potassium supplement or potassium salt substitute unless your clinician has told you to
Age, excess weight and smoking	The NHS lists being 65 or older, living with overweight or obesity, and smoking among the things that raise the risk⁸	Stopping smoking, and the protein and energy advice in the diet section; do not diet to lose weight here unless a clinician has said to, because unintended weight loss in heart failure is a warning sign

Diagnosis

How Heart Failure Is Diagnosed

Diagnosis is one thing. What matters for nutrition is which type it is, how the kidneys are and what the diuretics are doing.

Test	What it shows
Echocardiogram	How the heart fills and empties, and which type of heart failure it is. Worth knowing: A single snapshot; function varies with fluid status.
Natriuretic peptide blood test	Whether breathlessness is likely to be cardiac. Worth knowing: Affected by kidney function, age, weight and rhythm.
Daily weight at home	Fluid accumulating, days before symptoms appear. Worth knowing: Only works if done consistently, same time, same clothing.
Kidney function and electrolytes	What is safe regarding potassium, fluid and protein. Worth knowing: Changes with diuretic dose, so it needs repeating rather than assuming.
Iron studies including ferritin and transferrin saturation	Iron deficiency, which is common in heart failure and worth treating even without anemia. Worth knowing: Ferritin rises with inflammation, so it can look falsely reassuring; see iron-deficiency anemia.
Thiamine status, where diuretic use is long-standing	Loop diuretics raise urinary thiamine loss, though one stable cohort found deficiency uncommon². Worth knowing: Rarely tested unless someone asks.
Sleep assessment	Sleep apnea, which is common in heart failure and treatable. Worth knowing: Questions alone cannot confirm or rule it out; a sleep study is needed for the diagnosis.
Weight trend over months	Cachexia, the loss of weight and muscle that predicts worse outcomes. Worth knowing: Easily hidden by fluid gain masking muscle loss on the scale.

💡 Ask specifically about iron. Iron deficiency is common in heart failure, contributes to fatigue and breathlessness, and is treatable. It is assessed differently here than elsewhere, because inflammation raises ferritin and can make deficiency look absent. It is worth asking whether your transferrin saturation has been checked, not just your hemoglobin.

Treatment Comparison

Conventional and Holistic Treatment for Heart Failure

🌿 HOLISTIC

💊 CONVENTIONAL

🌿

Holistic / Functional Approach

Daily weights, moderate sodium, protecting muscle and treating what is deficient

Highest-Value Habit

Daily morning weights, which detect fluid accumulating before symptoms do

Sodium

Moderation for symptoms and quality of life, which is what SODIUM-HF actually showed, rather than for survival¹

Protein and Muscle

Protected deliberately. Unintended weight loss here is a poor prognostic sign, not a success

Limitation, stated plainly

No dietary measure substitutes for the medicines that reduce mortality in heart failure

Full Holistic Approach Includes

Weighing daily at the same time and reporting a rapid rise rather than waiting for breathlessness.
Moderating sodium, mostly by reducing processed food rather than by removing the saltshaker.
Following the fluid advice you were actually given, since restriction is individual and not universal.
Enough protein and energy to protect muscle, in small frequent meals if fullness limits intake.
Treating iron deficiency where present, which improves symptoms.
Limiting alcohol, which weakens heart muscle directly and is a cause of heart failure in its own right.
Physical activity and cardiac rehabilitation, which improve capacity and quality of life.

🌿 Worth knowing: nutrition here is about symptoms, muscle and avoiding deficiency. The survival benefit in heart failure comes from the medicines, and that is not a close call.

💊

Conventional / Medical Approach

Medicines that prolong life, diuretics for symptoms, devices where indicated

Disease-Modifying

Several medicine classes reduce hospital admission and death in heart failure with reduced ejection fraction (a weakly pumping heart), used together and titrated up

Diuretics

Control fluid and symptoms. They do not themselves prolong life, and doses are adjusted rather than fixed

Devices and Procedures

For selected people, alongside medication rather than instead of it

Alongside Either

Treating iron deficiency, sleep apnea, rhythm problems and reviewing medicines that worsen fluid retention

Conventional Approach Includes

Taking the disease-modifying medicines as prescribed, and at the dose reached by titration. This page names no specific drug, because the combination is a clinical decision.
Never stopping a diuretic or heart medicine independently, including when you feel well, which is when they are working.
Reporting rapid weight gain so the diuretic can be adjusted early.
Regular kidney function and potassium monitoring, since several of these medicines affect both.
Reviewing medicines that worsen heart failure, including some anti-inflammatory painkillers, with your prescriber.

⚠️ The key trial result, and it is not what most heart failure diet sheets say. SODIUM-HF randomized 806 patients across six countries to a dietary sodium target below 100 mmol a day or to usual care. Over 12 months there was no significant difference in the combined endpoint of cardiovascular admission, emergency visit or death. Symptoms and quality of life improved modestly¹. The honest reading is that sodium moderation is worth doing for how you feel, and severe restriction has not been shown to keep people alive or out of hospital.

Nutritional Strategy

Diet for Heart Failure

More individual than almost any other page on this site, because kidney function and diuretic dose change what is safe.

Why heart failure diet advice has to be individual

⚠️ Follow the fluid and potassium advice your own clinician gave you, not a general rule from a website. Fluid restriction is appropriate for some people with heart failure and unnecessary or harmful for others. Potassium is beneficial in some and dangerous in others, depending on kidney function and which medicines you take. Low-sodium salt substitutes are usually potassium chloride, and can cause dangerously high potassium in people on common heart failure medicines or with reduced kidney function⁹. This is a page where generic advice is genuinely unsafe.

What to eat or do	Details
Weigh daily	Detects fluid before symptoms. Practical note: Same time, after using the bathroom, before breakfast. Get a same-day appointment for a rise of about 4.4 lb (2 kg) over two to three days.
Moderate sodium	Helps symptoms and quality of life¹. Practical note: Mostly processed foods, bread, sauces and takeout food rather than the saltshaker. Not severe restriction.
Protein and energy	Protects muscle, because losing it predicts worse outcomes. Practical note: Small frequent meals if early fullness limits intake. Do not diet unless a clinician has said to.
Fluid	Individual to you. Practical note: Ask what your limit is, if any. Do not adopt one from the internet.
Alcohol	Directly toxic to heart muscle. Practical note: A cause of heart failure in its own right. Where that is the cause, stopping can improve function substantially.
Iron-containing foods, plus treatment if deficient	Iron deficiency is common here and worsens symptoms. Practical note: Food alone rarely corrects an established deficiency; see iron-deficiency anemia.
Potassium-rich foods	Depends entirely on your kidney function and medicines. Practical note: Beneficial for some, hazardous for others. Ask before increasing them.
Licorice, and some herbal products	Cause sodium and fluid retention. Practical note: Whole licorice raises blood pressure and lowers potassium¹⁰; avoid it here.

💡 If you are losing weight without trying, say so. In most conditions on this site that would be neutral or welcome. In heart failure, unintended loss of weight and muscle is associated with worse outcomes, and the usual causes (poor appetite, early fullness from abdominal congestion and the effort of eating while breathless) are all treatable once someone knows about them.

Supplement Protocol

Evidence-Based Supplements for Heart Failure

A short list, and an unusually long set of interactions, because heart failure medicines are unforgiving.

🚨 Do not take potassium supplements or potassium-based salt substitutes unless your clinician has told you to. Several heart failure medicines raise potassium already, and reduced kidney function raises it further. High potassium can cause dangerous heart rhythm disturbances and often produces no warning symptoms first. This is the most likely serious harm on this page, and it is placed at the top for that reason. Tell your clinician about every supplement you take.

Supplement	What it is for	Typical range	Timing	Notes & cautions
Thiamine (vitamin B1)	Loop diuretics increase urinary thiamine loss, but deficiency was uncommon in stable outpatients on standard therapy, under 11.6% in one study, and did not track diuretic dose. Test before treating².	Discuss with your clinician, particularly on long-term loop diuretic therapy	With food	Cheap, safe and easily missed. It is a correction of a drug-induced loss rather than a treatment for heart failure itself. Severe deficiency can itself cause a form of heart failure, which is why it is worth asking about.
Iron, only if deficient and as directed	Treating iron deficiency, which is common in heart failure and worsens fatigue and breathlessness.	Assessed and prescribed by your clinician; intravenous iron is often used here rather than tablets	As advised	Do not self-supplement iron. Deficiency is diagnosed differently in heart failure because inflammation raises ferritin. See iron-deficiency anemia.
Vitamin D3	Correcting a deficiency. Not a heart failure treatment.	Set a daily dose with your clinician; most adults need no blood test first	With a fat-containing meal	Correct a deficiency because it is a deficiency. Avoid large intermittent doses; see osteoporosis. Discuss first if your blood calcium is raised.
Omega-⁠3 (EPA and DHA)	Food first, fatty fish. Modest evidence in heart failure and not a substitute for anything.	Agree on any supplement dose with your clinician	With a fat-containing meal	Tell your clinician if you take an anticoagulant or antiplatelet, which many people with heart failure do, and before any planned procedure. In heart trials, fish oil supplements raised the risk of atrial fibrillation, an irregular heartbeat, more so above 1 g a day¹¹, so check this dose with your clinician first.

🚨 What to avoid, specifically. Potassium supplements and potassium salt substitutes, unless prescribed. Whole licorice, which causes sodium and fluid retention and lowers potassium. Hawthorn and other cardiac herbal preparations, which interact with heart medicines. High-dose vitamin E. Effervescent and soluble tablets of any kind, which frequently carry a substantial sodium load that nobody counts. Ephedra and stimulant-containing products. And any product promising to strengthen the heart, since none has been shown to reduce admissions or deaths the way the prescribed medicines do.

💡 Where the real leverage is. Taking the medicines at the doses reached by titration, weighing daily and reporting a rise early, moderating sodium enough to feel better, protecting muscle, and getting iron deficiency found and treated. Those five cover almost everything nutrition can contribute here.

What to Expect

What to Expect Over Time

Prescribed treatment, daily weights and food work together here; this is the pace.

Treatment and supportive care, together

First Weeks

Severe difficulty breathing, passing out or a sudden weight gain from fluid needs emergency or same-day care, as set out under When to Seek Care⁸. Daily morning weights begin at once, and doses are set by your prescriber, not by how well you feel.

Months 1 to 3

In a trial of 459 people with heart failure and iron deficiency, 50% given intravenous iron were much or moderately better at 24 weeks against 28% on placebo⁶, as an add-on to the prescribed medicines, not instead of them.

Months 3 to 12

Exercise-based cardiac rehabilitation belongs here: pooled across 23 trials, all-cause hospital admissions were 15.9% against 23.8% with usual care, with better quality of life⁷.

Long Term

In a UK primary care cohort, five-year survival rose from 41.0% for diagnoses in 2000 to 48.2% in 2012 ⁵. Stay on the prescribed medicines at the titrated doses, keep weighing and have kidney function, potassium and iron rechecked.

When to Seek Care

Call 911 for severe difficulty breathing, gasping, choking or not being able to get words out, for lips or skin turning pale, blue or gray, and for anyone who has passed out and is not responding normally; do not drive yourself⁸. Get a same-day appointment for breathlessness on everyday activity or lying flat that settles when you sit up, and for a sudden weight gain⁸. Call 911 for breathlessness at rest or that does not settle when you sit up, for coughing up frothy pink phlegm and for new confusion, fainting or chest pain. Never stop or reduce a heart medicine on your own.

📬

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References & Evidence Notes

Each numbered entry below is either a source you can follow or a note setting out what the evidence does and does not support. Both are numbered together so the markers in the text line up.

Last reviewed October 20, 2026. Supplement entries are cross-checked against the NIH National Center for Complementary and Integrative Health and the Linus Pauling Institute Micronutrient Information Center.¹² This page is nutrition education, not medical advice, and it does not replace your doctor. Nutrition does not treat heart failure. The survival benefit comes from prescribed medicines, and nothing here is a reason to stop, reduce or delay them. Fluid and potassium advice in particular must come from the clinician who knows your kidney function and your prescriptions, because generic advice on those two is genuinely unsafe. What nutrition education can do is help you understand the evidence well enough to have a better conversation with the clinician who does treat you.

Ezekowitz JA, et al. Reduction of dietary sodium to less than 100 mmol in heart failure (SODIUM-HF): an international, open-label, randomised, controlled trial. Lancet. 2022;399(10333):1391-⁠1400. PubMed 35381194. 806 patients across six countries; no significant difference in the composite of cardiovascular admission, emergency visit or all-cause death at 12 months, with modest improvement in symptoms and quality of life. Open-label, and the usual-care group also reduced sodium somewhat, which narrows the contrast. It is the largest randomized test of this question and the reason moderation, rather than severe restriction, is the advice for most people. ↩ ↩ ↩ ↩ ↩
Prevalence of thiamine deficiency in a stable heart failure outpatient cohort on standard loop diuretic therapy. Clin Nutr. 2016;35(6):1323-⁠1327. PubMed 26923517. In 30 stable outpatients receiving standard loop diuretic therapy, the estimated prevalence of thiamine deficiency was under 11.6%, and thiamine levels did not correlate with diuretic dose. Loop diuretics increase urinary thiamine loss, which is the proposed mechanism, but this study found deficiency uncommon, and it says nothing about whether supplementing improves heart failure outcomes. ↩ ↩ ↩
On how common heart failure is: a 2023 review of the global epidemiology reports that heart failure affects more than 64 million people worldwide, and that prevalence is rising as populations age and as treatment keeps more people alive, PubMed 35150240. ↩
On heart failure in later life: a 2018 systematic review protocol on survival in community heart failure describes it as a common condition affecting more than 10% of people over 70 years of age, PubMed 30285876. ↩
On survival after a diagnosis: a UK population cohort of 55,959 people aged 45 and over with a new heart failure diagnosis found one-year survival rising from 74.2% in 2000 to 80.8% in 2016, five-year survival from 41.0% in 2000 to 48.2% in 2012, and ten-year survival from 19.8% in 2000 to 26.2% in 2007. The authors describe the improvement as modest and behind that seen in other serious conditions, PubMed 30760447. ↩
On iron deficiency in heart failure: a randomized trial in 459 people with chronic heart failure, reduced ejection fraction and iron deficiency, with or without anemia, found that 50% of those given intravenous iron reported being much or moderately improved at week 24 against 28% on placebo, with gains in walking distance and quality of life and similar rates of adverse events. This was given alongside standard heart failure treatment, not instead of it, PubMed 19920054. ↩
On exercise-based cardiac rehabilitation: a 2024 Cochrane review of 60 randomized trials in 8,728 people with heart failure found no clear difference in deaths within 12 months, a reduction in all-cause hospital admissions from 23.8% to 15.9% across 23 trials, and a clinically meaningful improvement in quality of life. Effects were similar for center-based and home-based programs, PubMed 38451843. ↩
On causes and on when to get help: NHS guidance lists a heart attack, infection and long-term strain from high blood pressure or coronary heart disease as causes of heart failure, along with heart valve disease, cardiomyopathy, heart rhythm problems, chronic kidney disease, anemia, hemochromatosis and thyroid problems, and lists being 65 or older, overweight or obesity, pregnancy, smoking, drinking a lot of alcohol and cocaine use as things that raise the risk. It advises calling emergency services for severe difficulty breathing, for lips or skin turning pale, blue or gray, and for anyone who has passed out and is not responding normally, and it lists breathlessness lying down or on everyday activity, coughing up frothy pink phlegm and sudden weight gain as warning signs of worsening heart failure, NHS, heart failure. ↩
On potassium: several heart failure medicine classes reduce potassium excretion, and reduced kidney function compounds this. Potassium-based salt substitutes are a recognized route to hyperkalemia in exactly this population, and high potassium can cause dangerous arrhythmia with little warning. See the NIH Office of Dietary Supplements potassium fact sheet, ods.od.nih.gov, and chronic kidney disease. ↩
On licorice: glycyrrhizin causes sodium and water retention and potassium loss, raising blood pressure and worsening fluid overload, which is why whole licorice is listed as one to avoid here. See the NIH National Center for Complementary and Integrative Health entry on licorice root, nccih.nih.gov. ↩
Gencer B, Djousse L, Al-Ramady OT, Cook NR, Manson JE, Albert CM. Effect of long-term marine omega-⁠3 fatty acids supplementation on the risk of atrial fibrillation in randomized controlled trials of cardiovascular outcomes: a systematic review and meta-analysis. Circulation. 2021;144(25):1981-⁠1990. PubMed 34612056. Seven trials with 81,210 people followed for about 5 years: omega-⁠3 supplements were linked to a higher risk of atrial fibrillation (hazard ratio 1.25), more so in trials of more than 1 g a day (1.49), and the risk rose with each additional gram. ↩
National Center for Complementary and Integrative Health (NIH), nccih.nih.gov, and the Linus Pauling Institute Micronutrient Information Center, lpi.oregonstate.edu/mic. ↩

Heart Failure

What Is Heart Failure?

🧂 The sodium trial surprised people

⚖️ Weight loss is a red flag here

💊 Diuretics remove nutrients too

Heart Failure by the Numbers

Symptoms of Heart Failure

Causes of Heart Failure

How Heart Failure Is Diagnosed

Conventional and Holistic Treatment for Heart Failure

Holistic / Functional Approach

Full Holistic Approach Includes

Conventional / Medical Approach

Conventional Approach Includes

Diet for Heart Failure

Evidence-Based Supplements for Heart Failure

What to Expect Over Time

Weigh Daily, Stay on Treatment

References & Evidence Notes

Heart Failure

What Is Heart Failure?

🧂 The sodium trial surprised people

⚖️ Weight loss is a red flag here

💊 Diuretics remove nutrients too

Heart Failure by the Numbers

Symptoms of Heart Failure

Causes of Heart Failure

How Heart Failure Is Diagnosed

Conventional and Holistic Treatment for Heart Failure

Holistic / Functional Approach

Full Holistic Approach Includes

Conventional / Medical Approach

Conventional Approach Includes

Diet for Heart Failure

Evidence-Based Supplements for Heart Failure

What to Expect Over Time

Related Conditions

Weigh Daily, Stay on Treatment

References & Evidence Notes