Overview

Definition of heart enlargement and heart failure

Heart failure (HF) is a serious health problem, with its occurrence continuing to rise steadily and its life-threatening potential.¹,³ It is the last phase of many cardiac malfunctions and manifests in the heart's inability to supply blood to the body sufficiently.^1,3 Conditions like high blood pressure and narrowed arteries can lead to stiffness or weakness in the heart making it unable to circulate blood properly.³

On the other hand, heart enlargement (cardiomegaly) is not a disease itself; rather, it is a symptom of other health issues, such as heart failure, which weakens the heart and leads to its enlargement. This makes it harder for the heart to pump blood to the body.⁴

The role of nutrition in managing these conditions

Nutrition was once associated with preventing heart-related diseases (cardiovascular diseases); however, it is now increasingly viewed as a treatment rather than just a supplement to existing medications.⁵

Importance of diet in heart health

The British Heart Foundation emphasises the importance of healthy eating habits in reducing the risk of heart diseases and high blood pressure, lowering cholesterol levels, and benefiting heart health if you already have a heart problem.⁶

Nutritional strategies for managing heart enlargement and heart failure

Control portion size

It is not only about the type of food you eat but also the amount you eat. You don’t want to consume more than your body needs. This can be done by the following methods:

• Use smaller plates
• Have more vegetables and fruits as they are high in nutrients and low in calories
• Have less processed and fast foods as they are high in sodium and calories²
• Track the number of servings (amounts of food measured by standard units like cups, pieces, or ounces). In the beginning, you may need to use measuring tools like measuring spoons, cups, and a scale until you are confident in relying on your judgment²

Consume more vegetables and fruits 

They are full of substances that prevent heart diseases and eating more of them prevents you from eating too much high-calorie food. To encourage eating more fruits and vegetables, you can:

• Keep your vegetables washed and cut 
• Keep fruits visible in the kitchen
• Cook recipes that have vegetables or fruits as their main ingredients²

Choose whole grains 

Whole grains contain nutrients that can benefit the heart and are good for blood pressure. You can include more whole grains in your diet by:

• Making changes in your diet from refined grains to whole grains 
• Trying new whole grains 

You can still have refined grains but ensure half of your grain intake is whole grains.

Some grains to choose from are whole grains (barley, brown rice, and buckwheat) whole-wheat flour, whole-grain pasta, whole-grain pasta, oatmeal, and high-fibre cereal.²

Decrease unhealthy fats 

Heart attacks and strokes can happen because of high cholesterol in the blood which can form atherosclerosis (plaque build-up) in the arteries. To lower your blood cholesterol and reduce the chance of developing coronary artery disease, two types of fats you should limit in your diet, trans fats and saturated fats.²

You can decrease your intake of unhealthy fats by:

• Eating meat with less than 10% fat
• Use less margarine, shortening, and butter while cooking
• Using low-fat alternatives as much as possible
• Check the labels of snacks as they may contain saturated fats and trans fats (also referred to as partially hydrogenated fats)²

Is important to reduce certain fats like cottonseed, palm, palm kernel, and coconut oils, as well as lard, butter, gravy, bacon fat, cocoa butter (in chocolate), hydrogenated shortening and margarine, non-dairy creamer, and cream sauce.² You can opt for healthier fats, like olive, canola, vegetable, and nut oils, cholesterol-lowering margarine, and margarine that does not contain trans fats in addition to avocados, seeds (like flaxseed), and nuts.²

While healthy unsaturated fats can help lower your blood cholesterol when used instead of saturated fats, remember that they are still high in calories. Hence, you still need to limit your intake.²

Choose low-fat protein sources

Among the best protein sources are eggs, fish, poultry, lean meat, and fat-free or low-fat dairy products.²

Some fish have a lot of omega-3 like herring, mackerel, and salmon. Omega-3 fats can cut fats in your blood known as triglycerides.²

You can cut the fat and cholesterol you eat by changing animal protein to plant protein; this might also increase your fibre intake. 

Good picks are legumes like lentils, peas, and beans as they hold no cholesterol.²

Cut down on sodium

Sodium isn’t just in salt but also in foods like milk and celery and is often added to processed foods.² While limiting the amount of salt you add during cooking is a good start, much of the sodium you eat comes from processed or canned foods, so it's better to eat fresh foods and prepare your meals. If you prefer ready meals, choose ones with no added salt or reduced sodium, and consider using condiments (soy sauce, mayonnaise, and ketchup) with reduced sodium content. Also remember that sea salt is not a better option, as it has the same nutrients as table salt.²

Have a treat from time to time 

There is no harm in treating yourself occasionally, the important thing is to stick to your healthy diet most of the time in the long run.²

Generally, limit added sugar to no more than 10% of your total daily calorie intake, and don’t give products with added sugar to children younger than 2 years of age.²

Limit fluid intake when advised by your doctor 

Although conclusive evidence is lacking, fluid restriction remains one of the most commonly recommended practices for individuals with heart failure.⁸ The Scientific Societies of Cardiology guide people with chronic heart failure to reduce fluid intake as a non-medicinal strategy.⁷ 

A 2015 meta-analysis of randomised controlled trials on the effect of fluid intake reduction on laboratory and clinical outcomes in patients with chronic heart failure showed that unrestricted fluid intake does not negatively affect all-cause mortality and rehospitalization. However, more research is needed on this matter.⁷

6 randomised controlled trials have attempted to answer this question, using various populations, methods, and levels of fluid restriction.⁸Owing to the discrepancy in outcomes, and low-quality data, cardiology scientific societies do not state conclusive guidance regarding the everyday fluid limitation.⁸

Dietary patterns beneficial for heart health

Mediterranean diet

The Mediterranean diet is all about what people eat in countries by the Mediterranean Sea. It focuses on plant-based foods and healthy fats the most and mainly consists of fruits, vegetables, beans, and whole grains. The diet uses olive oil as its top fat pick in addition to seeds, nuts, spices, and herbs.^9,10

Eating this way might reduce the risk of getting heart issues and other long-term (chronic) sicknesses.⁹ When you eat like this, you don't count calories or use hard maths. You just focus on the ingredients and overall eating habits.⁹

To embrace this diet you can:

• Make sure to have legumes, beans, eggs, fish, and poultry each week
• Have fruits, vegetables, plant-based fats, and whole grains every day
• Limit dairy (e.g. yoghurt and cheese) intake
• Cut down on red meat
• Limit foods that contain added sugars
• If you drink alcohol, it's okay to have a bit of wine with your meals^9,10
• Work out often
• Enjoy meals with your family and friends¹⁰

DASH (Dietary approaches to stop hypertension) diet 

The DASH diet is one of the heart-healthy eating plans that aim to reduce high blood pressure and low-density lipoprotein (LDL) cholesterol, the crucial risk factors for heart disease and stroke. This diet is high in minerals like magnesium, calcium, and potassium, in addition to protein, and fibre. It emphasises fruits, vegetables, beans, nuts, whole grains, poultry, fish, and dairy products with little to no fat while minimising salt (sodium), added sugar, and saturated fats found in full-fat diaries, and fatty meat.¹¹

Since alcohol raises blood pressure, this diet recommends consuming less than one drink/day for women and less than two/day for men.¹¹

On this diet, there is no restriction on caffeine; but if you think that it affects your blood pressure, consider reducing your consumption.¹¹

Low-carbohydrate diets

Low-carbohydrate diets restrict carbohydrate intake to several levels ranging from very low (less than 50 grams per day) to moderate (about 150 grams per day).¹³

A 2020 meta-analysis examining 12 randomised controlled trials revealed that low-carbohydrate diets might benefit short-term health (up to 11 months), but fail to significantly affect heart health risk factors over the long term (2 years).¹²

Although optimal cardiovascular health is linked to diets rich in fruits, vegetables, whole grains, pulses, beans, and nuts, maintaining these foods can be challenging on a low-carbohydrate diet. However, moderately low carbohydrate diets permit the inclusion of more of these foods.¹³

Summary

Nutritional strategies play a vital role in managing heart enlargement and heart failure. Key dietary approaches include controlling portion size, increasing fruits and vegetables, opting for whole grains, and limiting unhealthy fats, sodium, and fluids. Incorporating low-fat protein sources and allowing occasional treats may also be beneficial. Diets, such as the DASH and Mediterranean have proven benefits for heart health. Conversely, low-carbohydrate diets may offer short-term benefits, but their long-term impact on heart health remains inconclusive. By following these nutritional guidelines, individuals can aim to improve their heart health and reduce the risks associated with these conditions.