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You’ve just returned home from the hospital after having a heart attack. The hospitalization fresh in your mind, and loaded with a set of medical instructions, you’ve now had a few moments to breathe and take everything in.
But in the back of your mind is that nagging reminder from your doctor that your diet may have played a part in what happened. You’re finally faced with the big question: “If my diet contributed to this heart attack, will it cause another one? Then what can I eat to avoid another heart attack?”
If this scenario rings true for you, or if you’re going to be caring for someone in a situation like this, learning how to plan a diet to manage heart disease may seem like a daunting task. You may be wondering if you’ll ever be able to eat your favorite foods again, and if you’ll have to force yourself to eat many foods that you don’t like.
In reality, a heart-healthy diet doesn’t have to be that harsh or overwhelming. As a dietitian specializing in heart health nutrition, I’m here to help make the process of moving toward a heart-healthy diet pattern more understandable and doable.
In this series of posts (there will be more than one post to ensure we cover everything), we’ll discuss the key dietary changes that can help you manage life with heart disease and reduce the risk for further heart attacks.
Our first aim will be to discuss foods to cut back on after a heart attack. But we’ll also discuss ideas for substitutions, so that you don’t feel that there is nothing left to eat.
Quick disclaimer—although I am a registered dietitian nutritionist, your reading of this or any articles on this website does not constitute medical nutrition therapy advice nor create a practitioner-client relationship. The information I provide here on this website is for educational and informational purposes only. Please see my full disclaimer for more information.
Nutrients to Decrease: Sodium
As you look to improve your heart health and reduce the risk for another heart attack, you will likely want to work on cutting back on foods that are higher in 3 main types of nutrients: sodium, added sugars, and certain types of fats (saturated fats and trans fats). These nutrients tend to have a fairly significant impact on the health of your heart and vascular system.
Our first nutrient to discuss is sodium, and this post will cover as many details about sodium intake as possible to help you feel more confident in your food choices after a heart attack.
Background on Sodium
A recommendation you may be familiar with when it comes to your diet after a heart attack is to work on reducing how much sodium you’re taking in each day. This can be a great first step for people, especially if high blood pressure is a concern.
One of the common suggestions for reducing sodium intake is avoiding the salt shaker. While doing so can certainly provide benefit to your heart health, for most people, it helps to go further than foregoing the salt shaker. And understanding sodium in a little more detail can help us understand why.
Chemical Background
The terms “sodium” and “salt,” although used interchangeably, are technically not the same thing. Sodium itself is an element (think back to the periodic table from high school chemistry class). Our typical salt (like table salt or sea salt or kosher salt) is a compound (combination) of 2 elements: sodium and chloride.
But sodium can also be joined to other elements from the periodic table to create other types of compounds. And while advanced chemistry is far beyond my knowledge or ability to explain, let’s just say that sodium can be found as a part of many different food preservatives on our shelves today.
This is why many foods that we might not expect to taste salty can still be higher in sodium, because they have other ingredients that contain sodium, but not necessarily in the form of table salt. Some examples of foods like this might include deli meats, boxed rice mixes, crackers, cereals, etc.
Medical Background
You may be wondering—is this bad? Not necessarily. But there can be opportunity for manufacturers to include larger than desirable amounts of sodium in some of these products.
And why is that fact important? Because oftentimes having multiple higher sodium products in a day can cause us to exceed the daily recommendations1 (1500-2300 milligrams per day) for sodium. And for people who have had a heart attack and need to manage their blood pressure, consuming excess sodium may be working against them.
You may be wondering how all of this works. If you are, here’s the explanation. When blood pressure increases, it can put extra strain on your heart and blood vessels as they work to transport nutrients throughout your body.
Over time, higher blood pressure levels can cause blood vessels to lose their elasticity and begin to harden. Damage to the blood vessels can allow sticky plaque to accumulate and potentially start to cause blockages.2-3 The result? Potential risk for further heart-related issues.
So if you’ve been told that you’ve already had some damage to your heart and blood vessels from your heart attack, keeping your blood pressure managed is very helpful in reducing the risk for further damage. And being mindful in how much dietary sodium you’re taking in is one of the ways you can help to manage your blood pressure.
How to Decrease Your Sodium Intake
How then can you cut back on extra sodium in your diet? A first step is to take a look at the foods you eat on a daily basis and see if a majority of them fall into any of these categories1:
- Restaurant foods
- Packaged pasta, rice, and noodle mixes with seasoning packets
- Frozen entrees and appetizers
- Pizza
- Dried meats/jerkies
- Deli meats/lunch meats
- Pre-marinated meats or other pre-marinated items
- Soups
- Chips, crackers, pretzels, flatbreads, wraps, rolls, breads
- Cheeses, especially the more aged ones, like Parmesan
- Salad dressings, sauces, marinades, etc.
- Canned items, like corned beef hash or canned stews or beans
While there are lower sodium options available for many of these types of foods, usually the “regular” versions of these foods are fairly high in sodium. This is because sodium functions in both flavoring and preservative roles in these items.
If you’re noticing that the above-mentioned foods do tend to make up a large amount of your daily food choices, there are several strategies you can use to start to change this.
General Tips
Although restaurant foods are first on the list of higher sodium foods, I’d first like to focus your attention on the foods that likely make up more of your day or week, and leave the restaurant tips till the end of our sodium discussion.
Boxed/Packaged Items
Let’s start with boxed/package items like the pasta and rice mixes or the noodles with seasoning packets. If the item has a separate seasoning packet, you could try to use just a little bit of the packet instead of adding the entire packet to the mix. On the flip side, you could instead choose plain rice, pasta, or noodles and add flavor with herbs and spices or lower sodium sauces (which we’ll discuss in a bit).
A quick tip—if you’re choosing microwaveable packets or containers, check the label to see if they contain any added sodium (this may show up in the ingredients list as “sodium __” or as a number of milligrams higher than zero on the sodium line). Aim for as little sodium as possible, preferably zero.
For more details on label reading, visit my post as linked below:
Heart-Healthy Eating Label Reading Tips: Using the Food Label to Improve Your Heart Health
Crackers and Snack Items
Moving on to crackers and other snack items, these types of foods will require more careful label reading and comparison among brands. You may not see a “low sodium” or “reduced sodium” designation on the package when in fact the sodium content is actually reasonable.
It may take some effort, but given time you’ll learn which types of crackers and snack items will work best for you.
Canned Items
Let’s discuss canned items next. Canned items can be tricky, because there are so many different foods that can be canned. As a general strategy, look for cans that display the “no salt added” or “reduced sodium” types of phrases as a starting point.
Then take a look at the actual sodium content on the label. Sodium content can vary widely depending on the item that you’re looking at. No-salt-added canned vegetables would likely have a far lower amount of sodium than a canned soup or stew, even if it is reduced sodium.
Think too about what purpose the item you’re looking at will serve in your meal. Is it an entree, or some sort of side item, or is it a vegetable or fruit?
If you’re using the canned product as a main part of your meal, allowing this to be higher, perhaps around 400-600 milligrams of sodium per serving, could be appropriate. In contrast, if the canned item is serving as a side dish, you may want to keep this much lower, such as <200 milligrams of sodium per serving. We’ll discuss this in more detail a little later on.
Deli Meats and Processed Meats
Transitioning to deli meats and other types of processed meats, I would suggest trying to keep these to a minimum most of the time. While a few of them are approved by the American Heart Association, the majority are high in sodium and may not be as beneficial for overall health due to some of the other ingredients they contain.
Examples of more processed meats to keep to a minimum include: salami, bologna, ham, sausages, bacon, and similar items. Deli meats that might be more reasonable could include lower sodium turkey and chicken, along with roast beef.
A quick note if you are on any medications that keep potassium in your body (potassium retaining)—some of the lower sodium deli meats use a potassium-based salt substitute. For some people, this could be a potential concern. Check with your healthcare provider to be sure that lower sodium deli meats containing potassium-based salt substitute are okay for you to have.
Marinades, Sauces, and Dressings
Moving on to marinades, sauces, dressings, and similar items, you may need to do some careful label reading to find lower sodium options. Companies do seem to be offering more lower sodium options these days, but it may take some time to find them.
Do consider how much of the item you’ll be using when you’re checking the sodium content. If you really like a certain condiment and typically use a larger amount of it, you will want to find the lowest sodium possible version of that condiment, because increased portions can cause sodium to add up.
If, however, you will be using less than the serving size or only very occasionally, it may be okay to choose a product that is a little higher in sodium and enjoy it in very small amounts.
Label Reading Tips
Having made some general comments on most of the categories so far, I feel it’s important to actually outline what to look for when you’re checking the label to bring our discussion full circle.
Some tips I suggest to my patients typically go like this. If you’re choosing a frozen meal or similar canned or boxed item for your entree and plan to pair it with a small side or no side at all, then you could consider a sodium value for that meal of 500-800 milligrams. If you’re planning to have a side dish as well, aim for the lower end of this range, or even under that.
If you’re choosing side dish or snack items, consider aiming for the lowest amount of sodium per serving that you can find. An example range would be <250-300 milligrams.
When looking for a salad dressing or marinade, I would suggest keeping it <200 milligrams of sodium per serving, especially if you typically use greater amounts than the listed serving size. And if you really enjoy certain items that are higher in sodium, try to be mindful of the rest of your day and keep sodium lower in the other meal and snack items you’re choosing.
Another quick tip—if you prefer to shop online, you may be able to access a picture of the product label to check the sodium content. This may help save time spent in the grocery store comparing labels.
Restaurant Tips
After discussing some major shopping tips, I’d like to comment briefly on how to manage in restaurants. For additional tips on restaurant eating, visit my other posts at the following links below:
Low Sodium Restaurant Options: Navigating the Menu
Eating at Home vs Eating Out: Which Is Better for Your Heart?
7 Healthy Eating Habits for Heart Patients When Dining Out
One of the top strategies I and other dietitians typically recommend to our patients is to ask restaurant staff to help you out with the menu options. How this is done may look different at more casual versus fast food restaurants.
In a casual restaurant, the staff may be able to ask the cooks to leave off extra salt when they make your food. You can also ask for them to substitute herbs and spices in place of salt or other salted herb/seasoning blends.
If you’re at a fast food establishment, finding the menu’s nutrition facts online (especially if it’s a chain restaurant) will be most helpful to figure out which items are highest in sodium and which are more reasonable options for you to choose. Some fast food restaurants have paper copies of the nutrition facts, so feel free to ask a staff member if there is one you could look at.
If you know the nutrition facts from the fast food restaurant (or even if you don’t), ask the staff member if it’s possible to leave off higher sodium condiments or switch out a side item to help make the meal even lower in sodium.
Pizza
Although there are multiple food modifications that I could probably reference, I do want to briefly discuss pizza, since I do receive questions about it quite often. Pizza is an item you could get either from a restaurant or from the frozen (or sometimes refrigerated) section of the grocery store. Some people also choose to make their own.
When you’re having pizza, consider a more conservative approach to the toppings you choose. Pepperoni, sausage, ham, and other similar meats will likely be higher in sodium.
If at all possible, consider having just cheese pizza or perhaps enjoying some veggies as your extra topping, like mushrooms, onions, peppers, and tomatoes. You may also want to avoid extra sauces or “themed” types of pizzas like BBQ pizza to better manage your sodium intake.
Foods to Choose
If you’re still feeling a little confused after reading this far, I’d like to offer some general tips on what would be great lower sodium options for you to add into your diet as substitutes for higher sodium options. Take a look through some of these suggested items and consider how you might want to add in 1 or 2 new items per week or every other week to your current eating pattern.
Fruits, Vegetables, and Whole Grains
Starting with fruits and vegetables, fresh and frozen options (without added sauces, marinades, or flavorings) are generally low in sodium or nearly sodium free. The same goes for plain whole grains, pastas, rice, and similar items that are not flavored or seasoned.
Nuts and Seeds
Additionally, nuts and seeds can be lower in sodium if you’re purchasing raw unsalted or roasted without extra salt. Sometimes very lightly salted nuts/seeds can be a good option.
Beans and Other Legumes
In regards to beans and other legumes, dried ones that you cook yourself should be basically sodium free. If you’re buying canned versions, keep in mind that they may or may not have extra sodium. You can choose no-salt-added or reduced sodium versions to keep the sodium content low.
Meat, Fish, Poultry
As for protein sources, meat, fish, and poultry that have not been seasoned or marinaded or injected with a saline solution be very low in sodium. If you’re purchasing canned chicken or fish, check the label for sodium content, and look for reduced sodium versions.
Dairy Products
In the category of dairy products, milk and yogurt are generally low in sodium. When it comes to cheeses, label reading can be helpful.
Some aged or hard cheeses can be higher in sodium; but some softer cheeses like cottage cheese can also have a fair amount of sodium added. Consider aiming for <250 milligrams of sodium per serving.
A Note About Miscellaneous Items
A quick note about candies and other snack foods—some are lower in sodium, but it would be wise to consider overall nutritional value of these items. This is a topic we’ll discuss further in this series, but just be aware of this reality as you plan out your meals and snacks.
Conclusion
This wraps up our sodium recommendations for your diet after a heart attack. Stay tuned for the next post on added sugars.
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Sources
- American Heart Association Editorial Staff. Shaking the Salt Habit to Lower High Blood Pressure. Heart.org. Updated May 9, 2024. Accessed August 6, 2024. https://www.heart.org/en/health-topics/high-blood-pressure/changes-you-can-make-to-manage-high-blood-pressure/shaking-the-salt-habit-to-lower-high-blood-pressure.
- American Heart Association Editorial Staff. What Is High Blood Pressure? Heart.org. Updated May 20, 2024. Accessed August 6, 2024. https://www.heart.org/en/health-topics/high-blood-pressure/the-facts-about-high-blood-pressure/what-is-high-blood-pressure.
- American Heart Association Editorial Staff. What Is Atherosclerosis? Heart.org. Updated February 16, 2024. Accessed August 6, 2024. https://www.heart.org/en/health-topics/cholesterol/about-cholesterol/atherosclerosis.
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