Dietary consideration for heart disease

Sodium content of foods

Certainly, the most critical factor is that the patient eats.  Diet changes during times of illness are not a good idea, it is better to wait until they are feeling better then gradually introduce any new food.  It is best not to put medication in food as they can develop a food aversion or not recieve all their medication.

Sodium (Na) – There has been much discussion about low sodium diets in heart disease.  The current recommendation is

1. Asymptomatic heart disease (isachc 1a) – mild sodium restriction (less than 100 mg/100kcal)

2. Mild heart disease(isachc 1b) – less than 80 mg/100kcal

3. Moderate heart disease (isachc stage 2) – 50-80 mg/100kcal

4. Severe heart disease and congestive failure – less than 50 mg/100kcal

Protein – it is common for muscle wasting to occur as heart disease progresses.  This can be due to loss of appetite, increased energy requirement, increased production of inflammatory cytokines and “muscle-sparing” vascular shunting.  A high quality (very bioavailable) protein should be fed, unless there is concurrent kidney or liver failure.

Canine – 5.1g/100kcal and feline – 6.5 g/100kcal.

Fat – Most canine and feline diet contain primarily n-6 fatty acids.  Higher concentrations of N-3 fatty acids can be beneficial in reducing the production of cytokines and other inflammatory mediators.  Current dosing recommendations are 40 mg/kg of EPA (eicosapentoic acid) and 25 mg/kg of DHA.  Most capsules contain 180 mg of epa and 120 mg of DHA, so a dose of 1 capsule/10 pounds is used.  Fish oil supplements should always contain Vitamin E as an anti-oxidant, but not other nutrients to avoid toxicity.  Cod liver oil and flaxseed oil should not be used.

Supplements – Remember that dietary supplements do not require proof of safety, efficacy or quality control to be sold.  If used, careful selection of type and brand should be employed.  Regular cardiac medication or pharmaceuticals should always come first in terms of budget and administration.

Taurine – deficiencies of this can lead to dilated cardiomyopathy and were problematic in the 1980’s. The deficient diets have been corrected and this is less of a problem than before.  Measurement of plasma and whole blood taurine concentrations is considered in dogs with DCM in at-risk breeds such as cocker spaniels, newfoundlands, golden retrievers or dogs that eat lamb meal and rice-based diets, high-fiber diets, or highly protein restricted diets.  Supplementation at 500-1000 mg every 8-12 hours is current recommendation.

L-Carnitine– A family of boxers with dilated cardiomyopathy were found to be deficient from this in 1991. No blinded, prospective studies have been done in veterinary medicine at the time of this writing. A human study with DCM showed improved survival in patients recieving carnitine supplementation.  Canine dose is 50-100 mg/kg orally every 8 hours.

Diets kcal Na mg/100kcal Protein gm/100kcal
Hills Science Diet Adult orig (dry) 365kcal/cup 59 6.3
Hills n/d 569kcal/13oz can 51 7.0
Royal Canin EC (dry) 291 kcal/cup 43 6.1
Purina JM (dry) 351 kcal/cup 40 7.9
Purina felin CV (can) 223kcal/5.5oz can 40 8.8
Iams max cal (can) 333kcal/6oz can 38 7.2

Low Sodium Treats

Dogs kcal/treat Na mg/treat
Science Diet Adult Treats

(medium)

20 13
Iams Original Form Biscuits

(small)

22 10
Hill’s Presciption Diet K9

Treats

13 5
Stewart Fiber Formula Dog

Biscuits (medium)

25 5
Baby carrots 4 4
Alpo Healthy Snacks Variety

Snaps with Real Meat

13 1
Apple, 1 slice raw or

orange, 1 section

10 0
Cats kcal/treat Na mg/treat
Purina Whisker Lickin’s

Brand Crunchy Cat Treats

Tartar Control(all flavors)

3 3
Stewart Fiber Formula

Cat Treats

1 1

Reference – various writings, lectures by J. Rush, DVM, MS, DACVIM (cardiology), DACVEC and L. Freeman, DVM, PhD, DACVN

Miscellaneous Foods and sodium content

Bread, Cereals and Potatoes Sodium (mg) Amount
recommended:
potato(small) 1
polished rice ½ cup 1-10
macaroni 1 cup 1-10
puffed wheat 1oz 1-10
spaghetti 1 cup 1-10
not recommended:
bread 1 slice 200
pretzel 1 275

Margarine and Oil

Sodium (mg) Amount
Recommended:
unsalted margarine 1tsp 0-1
vegetable shortening 1 tbsp 0-1
not recommended:
mayonnaise 1 tbsp 60-90

Dairy Products

Sodium (mg) Amount
not recommended:
milk (regular) 1 cup 122
milk (skim) 1 cup 122
cream cheese 1 1/2 oz 100-120
cottage cheese 3 oz 200-300
american cheese 1 oz 200-300
butter 1 tsp 50

Meats, Poultry and Fish

Sodium (mg) Amount
recommended:
beef (fresh) 3 1/2 oz 50
pork (fresh) 3 1/2 oz 62
lamb (fresh) 3 1/2 oz 84
veal 3 1/2 oz 67
chicken (no skin)
light meat 3 1/2 oz 64
dark meat 3 1/2 oz 86
turkey (no skin)
light meat 3 1/2 oz 82
dark meat 3 1/2 oz 98
not recommended:
egg 1 70
bacon 2 slices 385
ham (processed) 3 oz 940
frankfurter 1 560

Vegetables (fresh or dietetic canned)

Sodium (mg) Amount
recommended:
asparagus <5 1/2 cup
green beans <5 1/2 cup
peas <5 1/2 cup
green pepper <5 1/4 cup
tomato <5 1
lettuce  1/4 head <5
corn <5 1/2 cup
cucumber <5 1/2 cup

Fresh fruits

Most are low in sodium and are permitted

Desserts

Sodium (mg) Amount
recommended:
sherbert 1/2 cup 15-25
not recommended:
gelatins 1/2 cup 60-85
ice cream 1/2 cup 60-85
puddings 1/2 cup 100-200