The Best Nutritional Interventions for Heart Failure 

Congestive heart failure is a chronic heart disease that affects the whole body. It is a serious public health concern due to its high prevalence, high risk of hospitalizations, mortality risk, cost of care, and reduced quality of life. 

The progressively weakened heart muscle is unable to pump enough blood to sustain normal blood circulation making basic functions such as breathing, eating, walking, and sleeping very difficult to perform. 

As a result of the weakened heart, fluid will accumulate in the body. The fluid accumulation offsets the delicate balance of filtration pressures and causes fluid to collect within intracellular spaces instead of flowing in the blood vessels. 

The kidneys also get a decreased renal blood flow, which, under healthy conditions, occurs when a person is dehydrated (insufficient fluids in the blood). So the kidneys respond by increasing blood pressure which is important when there is dehydration but detrimental when there is heart failure. Antidiuretic hormone is released, and it stimulates the resorption of water in the kidneys. The hormone aldosterone is also released (by the adrenal glands), which causes the resorption of sodium (and water which follows the sodium) in the kidneys. Consequently, there is more fluid retention, and edema, especially in the legs, is worsened. 

The most common causes of heart failure are coronary heart disease, heart attack, and chronic high blood pressure. 

The prevalence of congestive heart failure varies between 6.3% and 13.3% of the population and is expected to rise. 

With almost 30% of people with heart failure not surviving their first year after hospitalization, the mortality rate is high. [1]

From a pharmaceutical perspective, there are minimal therapeutic options mainly aimed at controlling fluid imbalance that results in pulmonary edema (excess fluids in the lungs). 

Heart failure patients are a growing population. Even if medical advances may prolong life, their quality of life must be cared for, which is best done through lifestyle and dietary changes. 

Poor diet and malnutrition are often linked to heart failure, hospitalization, and mortality. Because food choices increase the risk for heart disease and high blood pressure, the risk factors for the disease, transitioning to healthier food options, and lifestyle changes have shown promising results in improving heart failure-related outcomes and quality of life. 

Here are the best lifestyle and nutritional interventions for heart failure: 

1. Exercise training 

Exercise in heart failure can be used as a diagnostic tool to determine heart failure and as a predictive tool regarding the course of the disease. But exercise is also considered a valuable method for stabilizing patients with heart failure. 

Before the onset of heart failure, epidemiological studies consistently show an inverse connection between heart fitness and the risk of heart disease and mortality. [2]

One study recently reviewed the science behind the heart benefits of exercise. The study concludes that there is no lower exercise threshold for heart benefits, meaning any training is better than none. [3]

In another study led by the National Taiwan University Hospital, researchers observed 95 participants diagnosed with heart failure. The researchers concluded that exercise helped stabilize patients with heart failure and decreased the occurrence of hospitalization and readmission. [4] 

Generally, the best exercise for heart failure includes endurance sports such as walking, light jogging, swimming, cycling, and other low-impact aerobic activities. Exercises also help strengthen the muscles, improving the muscles’ ability to draw oxygen from the blood and reducing the heart’s load. 

The heart has functional, structural, cellular, and molecular improvements in response to exercise. Thus, I advise light activity for a minimum of 20 consecutive minutes four times a week. [5]

 2. Heart-healthy diet 

Hypertension, obesity, an abnormal amount of fats in the blood, insulin resistance, diabetes, and systemic  (whole-body) inflammation lead to heart failure. Nutritional factors have been proven to be the main contributors to these diseases.

People with heart failure often have a poor nutritional status that will profoundly affect the progression of the disease and its related prognosis. 

People with heart failure break down more tissues and have an increased resting energy expenditure requiring about 250 calories more per day than healthy sedentary people. [6] 

If they do not consume sufficient energy, this is often accompanied by low essential micronutrient consumption leading to nutrient deficiencies.

Superfoods that support heart health are important as they are rich in essential nutrients and antioxidants. These foods include leafy green vegetables, nuts, broccoli, oats, barley grass, and berries. However, it is not enough to eat more of these foods. 


To strengthen heart function and prevent heart failure, you need to eat a heart-healthy diet that includes a variety of nutrient-dense, antioxidant, high fiber, low saturated, and no trans fat foods. A heart-healthy diet emphasizes whole plant-based foods, including fruits, vegetables, whole grains, and healthy protein sources, including legumes, nuts, and seeds. There is observational and interventional evidence supporting this. [7, 8] Higher dietary quality provides protective qualities. At the same time, red or processed meats, eggs, and refined carbohydrates are harmful. [7-10]

Potential mechanisms that prevent and help support people with heart failure include:

  • Decreasing oxidative stress by eating fewer animal proteins and processed foods.
  • Lowering homocysteine and inflammation levels (see my article on lowering homocysteine levels and my article for lowering inflammation levels)
  • Higher antioxidant levels and nitric oxide bioavailability through more consumption of fruits and vegetables, which I will cover here.
  • Supporting foods for a healthy gut microbiome by increasing fiber intake.
  • Eating healthy cooked foods until they are soft makes eating less laborious and uncomfortable. Frequent small meals (five to six per day) are better suited than large meals to prevent more energy needs and, thus, higher heart output needed for eating.
  • Fluid intake should be limited to 2 liters per day for people with mild symptoms of heart failure. For advanced stages, fluid is restricted to 1000 to 1500 mL per day. Alcohol intake should be avoided as it contributes to heart disease.


Lycopene, in particular, is beneficial for heart failure and edema. Lycopene is among the most abundant dietary carotenoids functioning as a potent antioxidant blocking free radical damage. [11-13]

The best sources of dietary lycopene are tomato-based pasta sauces, tomato soup, fresh tomatoes, tomato paste, and tomato juice. [14]

Add these foods to your diet regularly to reduce edema common in heart failure. You may also supplement with lycopene capsules at 20–25 mg [15] five times a week with breakfast. 

Vitamin C

Vitamin C lowers oxidative stress and is a potent antioxidant. Vitamin C-rich fruits include citrus fruits and berries. Vitamin C-rich vegetables include bell peppers, potatoes, tomatoes, and cruciferous vegetables such as broccoli, Brussels sprouts, cabbage, cauliflower, and maca. 

Salt reduction

It is crucial to alleviate volume overload (excess fluid). Heart failure triggers the release of aldosterone (a hormone stimulating the absorption of sodium by the kidneys), angiotensin (which promotes aldosterone secretion), and vasopressin (antidiuretic hormone), all-cause sodium and fluid retention resulting in edema. [16]

Excess sodium intake has been implicated in several studies as the precipitating factor for most hospital admissions due to symptoms of decompensated heart failure. [17]

Dietary sodium restriction is necessary. [18] 

Lessen sodium in your diet. Your body only needs so much sodium for it to function effectively. The main source of dietary sodium is common table salt or sodium chloride. Eating too much salt can increase blood pressure, causing fluid retention. In a study on peripheral edema, the swelling of the lower legs or hands common in heart failure, researchers associate sodium and water retention with edema formation. They express that limiting sodium and water excretion promotes edema. [19] You can also reduce sodium in your diet by carefully reading food labels. Look for foods advertised as “no salt added” or “low sodium.” Rather than adding salt to your dishes, look for healthier alternatives for adding flavors, such as garlic, spices, herbs, or a dash of citrus fruit.

You may also replace all salt added to foods and used in cooking with a natural vegetable salt made from vegetables that naturally have a higher salt content, such as celery, carrots, and beets. 

The taste for salt is acquired. Some people heavily salt their food out of habit without tasting it first, thereby habituating their taste to high salt levels. Others acquire a taste for less salt by gradually using smaller and smaller amounts. When you reduce your salt intake, within three days, you will reduce the need for salt.

Sufficient levels of sodium in your diet are 1500 mg per day for adults up to the age of 50 years, and then slightly less. Most people consume double or more of this amount. Reducing processed food intake (pickles, olives, bacon, and chips) and stopping any addition of salt to foods is crucial for reducing salt intake. Flavor your foods with herbs, onions, and garlic.  

Dairy and eggs

Dairy intake is also associated with an increased heart failure risk. [20-21]

Prospective studies report an increased incidence of heart failure associated with egg consumption. [22-25], especially when consuming six or more eggs per week. [22] 


Studies have established the association between trans fat consumption and heart disease. The recognition that trans fat harms heart health has led some countries to restrict industrial trans fat from food products. [26] Trans fats are also found in all animal products. Therefore these should be limited, including dairy and eggs, as mentioned above, as a preventative measure and abstained from during healing. Instead, consume the healthy protein sources mentioned above.

Monounsaturated fats and polyunsaturated fats help lower heart disease and heart failure risk. One study reported a 65% decrease in left ventricular systolic dysfunction risk with olive oil consumption. [27]

Studies reported that heart failure patients with higher saturated and trans fat intake had higher levels of inflammation. [28-29] A large prospective study of 15,362 male physicians reported a dose-response association between fried food and heart failure incidence. They found a 103% increase in heart failure risk in people with the highest fried food consumption compared to the lowest levels. [30]

The best sources of healthy fats include seeds (such as chia, flax, and hemp), nuts (walnuts, almonds, Brazil nuts, and pistachios), avocados, and olives. 

Overall, the best diet for treating and preventing heart failure is a whole food plant-based diet, as is the Guerrilla Diet based on scientific evidence. This diet contains heart-protective nitrates and nutrients, including magnesium, potassium, and antioxidants. It is a diet rich in foods that support a healthy gut microbiome, with the right food combinations of foods for health, and is low in saturated and trans fats.

Stop smoking 

Smoking is a risk factor for many diseases, particularly heart disease. In a study to establish the link between smoking and heart failure, researchers from Tongmyong University in Korea analyzed smokers and non-smokers to determine whether smoking increases the risk for heart failure. The studies concluded that smoking adversely affects heart function and heart failure risk. 

Cigarette smoke has nicotine, volatile compounds like aldehydes, toxic polycyclic aromatic hydrocarbons, N-nitrosamines, aromatic amines, heterocyclic amines, and heavy metals, including arsenic, cadmium, and lead, causing genetic mutations, DNA damage, and oxidative damage. [31-32] All of these lead to irritation, inflammation, cancer, heart disease, hypertension, coronary atherosclerosis, plaque buildup in artery walls, and decreased organ function. [33]

Another study concluded that doctors should support smoking cessation as early as possible and young people and that non-smokers should be encouraged not to start smoking. [34] I recommend joining a program to stop smoking if you are still a smoker. I have seen many people succeed in Alan Carrs program. 

Boost blood circulation

You may have a job that keeps you seated or standing for long periods. Unfortunately, sitting or standing in one position too long can increase the pressure inside the blood vessels, causing fluid to leak into the tissues in your legs and feet. The result is puffy or swollen legs and ankles. To prevent this, keep your blood circulating throughout the day. Take a break from work and walk around the office or your home. As mentioned earlier in this chapter, exercising has also been identified as efficient in reducing lower limb edema. [35] Walking is great for edema because it promotes blood circulation and shifts the collected fluid.

Supplement with vitamin D when necessary

One 2012 study reported a high prevalence of Vitamin D deficiency among patients with heart failure. Low vitamin D levels are predictive of poor outcomes for heart failure patients. [36] 

Recently, the supplementation of 2000 IU for six weeks has been reported to lower plasma renin activity in people with heart failure. [37] 

Another study revealed that vitamin D supplementation in people with heart failure with low baseline vitamin D levels had lowered aldosterone concentration. [38]

Overall, supplementing with vitamin D is beneficial for heart failure. [39-40]

However, a high one-off dose of Vitamin D supplementation (50,000 IU) showed no improvement. [41]

Therefore I recommend regularly supplementing with 2000IU of vitamin D when necessary. To learn more about vitamin D supplementation, please read the chapter on vitamin D (#67).

Coenzyme Q10

Studies show that CoQ10 supplementation benefits people with heart failure. CoQ10 enhances heart muscle contractility and influences endothelial function. [42-43] Other studies show that long-term supplementation with CoQ10 can improve heart failure symptoms and reduce all-cause mortality. [44-45]

To conclude

A high fiber whole-food plant-based diet (such as the Guerrilla Diet) with little animal protein, accompanied by exercise, smoking cessation, and supplementing with CoQ10, vitamin C, and vitamin D (when necessary), is very beneficial and recommended for people suffering from heart failure.

ll references are found at this link: I keep this list updated. 

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