Home / Patient / Patient Tools / Heart Failure Educational Modules / Module 2: How to Follow a Low Sodium Diet

 

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Note that while this module concentrates on following a low-sodium diet, other nutritional issues may be of concern to you as well. For example, everyone should watch the amount of fat they eat.

Also, if you have diabetes, you should watch the amount of sugar you eat. These issues are discussed in more detail in Module 8: Lifestyle Changes.

This module provides information on:

  • How to follow a low-sodium diet.
  • The sodium content of selected foods and condiments.
  • Substitutes for high-sodium foods and condiments.

It will help you:

  • Reduce your sodium intake.
  • Cook meals with low-sodium foods.
  • Make good choices when you eat in a restaurant.

This module has a lot of information in it. You don’t have to read it all at once. You may find it helpful to read it by sections and to come back whenever you have questions about a low-sodium diet.

What is a Low Sodium Diet?

What is 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.

Cutting Back on Salt

If you need to limit the amount of salt and sodium in your diet, here are some suggestions from the National Heart, Lung and Blood Institute:

  • Read the food labels to help you pick foods lower in sodium.
  • Pay attention to the serving size listed on the label. If you eat two cups of a food, but the serving size is one cup, you’ll need to double the amount of sodium listed.
  • Look for foods that use one of these terms on the label: sodium-free, very low sodium, low sodium, reduced sodium, light in sodium or unsalted.

Measurement Key

Ounce = oz.    Milligram = mg

Tablespoon = tbsp.    Teaspoon = tsp.

How Do I Follow a Low Sodium Diet?

How Do I Follow a Low-Sodium Diet?

Step 1: Stop Adding Salt to Food

To accomplish this step, try the following tips:

  • Take the saltshaker off 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. People often say food tastes bland without salt. You can make foods taste good without salt by trying the following tips:

  • Experiment with low- or no-salt herbs, spices, and seasoning mixes.
  • 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 marinade 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 here 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. Look in the spice section for seasonings labeled “salt-free”.

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

Allspice Garlic powder
Basil Ginger
Bay leaves Lemon juice
Black pepper Low-sodium ketchup (limit 1-2 tbsp.)
Cayenne pepper Mrs. DASH
Celery powder Nutmeg
Chili powder Onion powder
Chives Oregano
Cinnamon Paprika
Cloves Parsley
Cocoa powder Pimento
Cumin Red pepper
Curry Sage
Dill Salt substitute (with physician’s approval)
Dry mustard Tabasco pepper sauce (1 tbsp.)
Flavored extracts (vanilla, almond, etc.) Thyme
Fresh garlic Vinegar

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

Adobo Pickle relish
Alfredo mixes Plum sauce
Barbecue sauce Poultry seasoning
Celery salt Regular ketchup
Cocktail sauce Salt
Dry meat marinade mixes Salt sense
Dry salad dressing mixes Sazon
Fish sauce Sea salt
Garlic salt Seasoned salt
Generic saice mixes Soy sauce
Horseradish Steak sauces
Kosher salt Stir-fry mixes
Lite salt Stir-fry sauce
Lite soy sauce Taco sauce
Meat tenderizer Taco seasoning
MSG (monosodium glutamate) Teriyaki sauce
Onion salt Worcestershire sauce

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 and use the meats for sandwiches instead of packaged lunchmeats. Use fresh lettuce, tomato, and onion for flavoring.
  • 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.

These tips can help you ease up on salt:

  • Look at the labels. Sodium levels often vary widely by brand, so compare labels for the healthier option. Try to find foods where each serving size has no more than 5 percent of your recommended daily sodium.
  • Choose fresh or frozen. These products are naturally low in sodium. Cut back on processed foods, which often have higher amounts of salt.
  • Adjust your taste buds gradually. When dining out, request that your meal be served with no salt or less salt. At home, experiment with spices, herbs, garlic, and lemon juice instead of salt.

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 following charts 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 page will teach you how to read a food label for sodium content.

Low-Sodium Foods

Beans, peas, rice, lentils, or pasta (dried and fresh, cooked without salt) Milk (chocolate skim)
Cereals (hot, regular cooking) Milk (svaporated skim)
Club soda Milk (nonfat dry)
Coffee (regular and decafinated) Milk (skim, low-fat, and regular)
Fruits (fresh, frozen and canned) Selzter water (flavored)
Fruit drinks Soda pop (regular and diet)
Herbs and sauces (non-salt) Soymilk
Lemonade Tea (iced)
Meat, fish, and poultry (fresh) Vegetables (fresh and plain frozen)
Yogurt (plan and fruit flavored)

High-Sodium Foods

 

Meats Sauerkraut
Anchovies Spaghetti sauce
Bacon Stewed tomatoes
Beef Jerky Tomato and vegatable juice
Bologna Tomato sauce
Braunschweiger
Breaded meat (frozen) Milk products
Breakfast sausage Buttermilk
Chipped ham Canned milk
Corned beef
Dried beef (jarred) Starches
Herring (jarred) Baked beans (canned)
Hot dogs Batter mixes
Hot sausage Biscuit and pancake mixes
Knockwurst Corn and potato chips
Kielbasa Hot cereals (instant)
Pastrami Macaroni and cheese (boxed)
Pepperoni Popcorn (regular microwave)
Pickled loaf Stuffing mixes
Pot pies (frozen) Waffles (frozen)
Salami
Sardines Other
Tuna, salmon, and chicken (canned regular) Bouillon cubes and broth
Vienna sausage Soups (canned regular)
Vegetables
Pickles (sweet and dill)
Pizza sauce
Regular canned vegetables
Regular jarred and canned tomatoes
Reading a Food Label for Sodium?

Reading a Food Label for Sodium Contentfood_label_new

 

Begin by reviewing the serving size and sodium content information (see the circled areas on the sample label to the right). 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. 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 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.

Tips to Help You Get Started on a Low Sodium Diet

Tips to Help You Get Started on a Low-Sodium Diet

It can be difficult to change your eating habits. It may be weeks before you enjoy the taste of low-sodium foods, but your taste buds will adjust. Eventually you may not even miss the salt.

These tips can help you get off to a good start

  • Make changes slowly instead of all at once.
  • Adapt things you like to eat so they are lower in sodium, rather than trying to totally change your diet.
  • Keep a list of low-sodium foods in the kitchen. The refrigerator is a good spot. The chart on page 9 lists some low-sodium foods.
  • Learn which foods are high-sodium, and do not buy them. That way you will not be tempted to eat them. The chart on this page lists some high-sodium foods.
  • When picking entrees or main food items, no more than one food item should have more than 500 mg of sodium.
  • Think about it this way – if your doctor or nurse recommended that you eat 2,000 mg of sodium in a day, 500 mg is one-fourth of your daily amount.
  • Make a list of the amount of sodium you eat with each meal for a few days.
Tracking Sodium in Your Diet

Tracking the Sodium in Your Diet

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.

You can use this chart to track what you eat. (PDF 31 KB)

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 are eating each day. If you find that you are eating 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.

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.

Examples of High-Sodium Foods and Low-Sodium Alternatives
Instead of these high-sodium foods Amount of sodium
Consider these low-sodium alternatives
Baking powder (1 tsp.) 400-500 mg
Low sodium baking powder (1 tsp.) 5 mg
Garlic salt (1 tsp.) 1,480 mg
Garlic powder (1 tsp.) 1 mg
Peanut butter (2 tsbp.) 150-250 mg
Unsalted peanut butter (2 tsbp.) 0 mg
Canned pasta sauce (1/4 cup) 125-275 mg
No salt added pasta sauce (1/4 cup) 25 mg
French fries (small order) 150-700 mg
Unsalted french fries 10-20 mg
Salted nuts (1 oz.) 120-250 mg
Unsalted nuts (1 oz.) 3-10 mg
Saltine crackers (1 cracker) 70 mg
Low-sodium saltine crackers (1 cracker) 7 mg
Self-rising flour (1 cup) 1,600 mg
Enriched white of whole wheat flour (1 cup) 3-6 mg
Ham (3 oz.) 1,025 mg
Fresh pork (3 .oz) 60 mg
Instant oatmeal (3/4 cup) 180 mg
Regular cooking oatmeal (3/4 cup) 5 mg
Turkey ham (3 oz.) 865 mg
Turkey (3 oz.) 75 mg
Corned beef (3 oz.) 800 mg
Roast beef (3 oz.) 60 mg
Questions to Ask Your Doctor or Nurse

Question: 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.

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 next section shows the sodium content of selected foods to give you an idea of how much sodium you consume each day.

Question: 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.

Examples of Sodium Content of Selected Foods

Foods with less than 10 mg of sodium per serving

Fruit and fruit juices
(fresh, frozen or canned)
Sugar
Honey Unsalted nuts
Hot cereals such as oatmeal, wheat, and oat bran
(regular cooking, not instant which is high in sodium, 1 cup with no salt added while cooking)
Unsalted peanut butter
Jelly beans
(10 large)
Unsalted butter or margarine
(not regular)
Marcaroni, noodles, rice, and barley
(cooked in unsalted water with no added salt, 1 cup)
Unsalted dry curd cottage cheese (1/2 cup)
Salt-free herbs and spices Vegetables
(most types fresh or frozen except those in the 10-40 mg section)
Shredded wheat or puffed rice type cereals
(1 cup)
Vinegar (most)

Foods With 10-40 mg of Sodium Per Serving

Beets (1/2 cup) Kale (3/4 cup)
Beet greens (1/3 cup) Soda pop (8 oz.)
Carrots (1 cup) Spinach (1/2 cup cooked)
Celery (2 stalks) Vanilla wafers (2 cookies)
Club soda (8 oz.) White wine (4 oz.)
Granola type cereal (1/2 cup)

Foods With 45-65 mg of Sodium Per Serving

Beef, pork, lamb, and poultry
(fresh, 3 oz.)
Fish (fresh, 3 oz.)
Corn tortilla (1) Fruit-filled cookies (1)
Egg (1) Shrimp (2 oz.)

Foods With 65-120 mg of Sodium Per Serving

Clams, steamed (3 oz.) Milk (evaporated, 1/2 cup)
Ice cream (1/2 cup) Mustard, chili, and hot sauce
(1 tsp.)
Mayonnaise (1 tbsp.) Yogurt (1 cup)
Milk
(whole or skim, 1 cup)

Foods With 120-175 mg of Sodium Per Serving

Bread (some types, 1 slice) Olives (ripe, 5)
Chocolate covered
peanut butter cups (2)
Sardines
(1 large)
English muffin (1/2) Peanut butter
(regular, 2 tbsp.)
Ketchup and steak sauce(1 tsp.)

Foods With 175-350 mg of Sodium Per Serving

Buttermilk (1 cup) Cereal (ring, nugget, and flaked, 2/3 to 1 cup)
Cheese (grated, packaged 1/4 cup) Tuna (canned, 3.oz)
Clams (canned, 1/4 cup) Vegetables (canned, 1/2 cup)

Foods With 350-500 mg of Sodium Per Serving

Beans (canned, 1/2 cup) Cottage cheese (low-fat, 1/2 cup)
Cheese
(2 oz. cheddar,
3/4 cup of cottage cheese,
1/2 cup of Parmesan,
1 1/2 oz. of processed cheese,
2 oz. Swiss cheese)
Pancake (1, 6-inch)
Tomato juice (canned, 3/4 cup)

Foods With 500-800 mg of Sodium Per Serving

Chicken broth, canned and reduced sodium (1 cup) Salad dressing (average, 2 tbsp.)
Chili beans (1/2 cup) Soups (some canned, 1 cup)
Cornbread (2-inch square) Soy sauce (lower sodium, 1 tbsp.)
Hot dog (beef and chicken, 1) Stuffing mix (boxed and prepared, 1/2 cup)
Pork sausage (2 links)
Pot pie (beef and chicken, 1/3 of 9-inch diamter)

Foods With More Than 800 mg of Sodium Per Serving

 

Baking soda (1 tsp.) Main dishes (canned or frozen)
Bouillon cubes (1 cube) Pork and beans (canned, 1 cup)
Chicken broth (canned, regular, 1 cup) Pudding (instant chocolate, 1 cup)
Corned beef (3 oz.) Sauerkraut (2/3 cup)
Dill pickle (1 large) Soup (canned, 1 cup)
Ham (lean, 3 oz.) Soy sauce (regular, 1 tbsp.)
Lunchmeats (2 oz.) Spaghetti sauce (bottled, 1 cup)
Macaroni and cheese (packaged, 1 cup)
Questions and Answers About a Low-Sodium Diet

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 doctor or nurse 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.
  • 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 such as barbecue, steak, creamed, cheesy, Hollandaise, Alfredo, or red spaghetti sauces. It also works with gravies.
  • Limit the 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.

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 Food
Food Sodium content per serving
Fried chicken (1 piece or serving) 500-800 mg
Mashed potatoes with gravy 297 mg
Small hamburger 506 mg
Small cheeseburger 742 mg
Large cheeseburger 1,220 mg
Chef salad 850 mg
Bean burrito 922 mg
Taco 273 mg
Enchilada 1,260 mg
Taco salad 1,368 mg

Return to full module index.

 

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