Healthy Living NT

Dietary Updates in the Management of Chronic Heart Failure

23/04/2015 Written byGerard Wong, Dietitian, Darwin

Chronic heart failure (CHF) is a complex clinical syndrome with typical symptoms, such as shortness of breath and fatigue, that can occur at rest or on effort. It is characterised by an underlying structural abnormality or cardiac dysfunction that impairs the ability of the ventricle to fill with or eject blood (particularly during physical activity).

Common causes of CHF are ischaemic heart disease (present in over 50% of new cases), hypertension (about two-thirds of cases) and cardiomyopathy (around 5–10% of cases).

CHF is a disabling and deadly condition that directly affects more than 300,000 Australians at any one time. Regardless of patients’ clinical status (around one-third are hospitalised each year), the presence of CHF requires complex management and treatment protocols that place pressure on both the patient and their family/care givers. The stress imposed on all concerned is, therefore, substantial.

Figure 1 shows the typical ‘trajectory of illness’ associated with CHF compared to a terminal malignancy (typically rapid decline).

Patients, their care givers and families can limit worsening of symptoms if they understand the basic principles of CHF management and learn to monitor daily the symptoms and signs of deterioration.

Some of the dietary strategies (highlighted in the Heart Foundation of Australia and Cardiac Society of Australia and New Zealand Guidelines for the prevention, detection and management of chronic heart failure in Australia, 2006) include a reduction in dietary saturated fats, increasing fibre intake, reducing excessive sodium/salt intake and managing fluid intake. However a recent update to those guidelines suggested some new approaches / dietary strategies.

Polyunsaturated Fatty Acids
A recent trial showed a small reduction in mortality and hospital admissions for cardiovascular reasons for patients with CHF who were treated with omega-3-acid (1g daily) versus placebo.

Polyunsaturated fatty acids should be considered as a second-line agent for patients with CHF who remain symptomatic (Grade B recommendation).

In order to achieve the above recommendation clients/patients will have to consume two to three serves of 150 grams of oily fish (e.g. salmon, mackerel, sardines, tuna) every week (which equates to ~500mg/day) and by supplementing their intake with fish oil capsules and/or omega-3 enriched foods and drinks.

Some plant-based omega-3 can also be found in canola oil and margarines, nuts and seeds (particularly walnuts), flaxseeds (linseeds), soybeans and dark green vegetables.

Iron deficiency is common in patients with CHF, and is usually associated with anaemia. A recent study has demonstrated reduced symptoms, improved exercise tolerance (on the 6-minute walk test) and improved quality of life with use of supplemental iron injected in iron-deficient patients with CHF. It was interesting to note in the study that improvements similar in both patients with and without anaemia.

Iron deficiency should be looked for and treated in patients with CHF to reduce symptoms and improve exercise tolerance and quality of life (Grade B recommendation).

Some of the strategies to increase iron intake is including good sources of iron in the diet such as lean red meat, iron-fortified breads and having breakfast cereals (as these are mostly fortified already).

Certain foods and drinks also help your body to absorb greater amounts of iron:

  • Vitamin C (found in fruits and vegetables) increases iron absorption. 
  • Including meat in the same meal boosts iron absorption from plant sources. 
  • In most cases, cooking increases the amount of iron absorbed from vegetables. For example, the body absorbs six per cent
  • of the iron from raw broccoli, compared to 30 per cent from cooked broccoli.

Certain foods and drinks can also reduce your body’s ability to absorb iron:

  • Tannins from tea, coffee and wine reduce iron absorption by binding to the iron and carrying it out of the body. 
  • The phytates and fibres in wholegrains such as bran can reduce the absorption of iron and other minerals.

The updated version of the guidelines is available on the National Heart Foundation of Australia
website ( and the Medical Journal of Australia (

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