Dear Dietitian,

My husband was recently in the hospital and diagnosed with congestive heart failure. He has been instructed to follow a 1500 mg sodium diet.  He’s trying, but it’s very difficult.  I’m afraid he will get frustrated and give up.  Any words of wisdom?

--Deborah

Dear Deborah,

A new diagnosis can be overwhelming and often brings about the need for a lifestyle change. 

For readers who are not familiar with congestive heart failure (CHF), it’s a chronic condition where the fluid builds up around the heart, causing it to pump inefficiently. As we know, salt draws water; therefore, a low sodium (1,500 mg) diet is prescribed to help manage the condition. To put that in perspective, most Americans consume 3,400 mg of salt each day.

Behavior change is a process that takes time; it is not an event. A realistic timeframe for one to follow a 1,500 mg sodium diet on a regular basis is 2-3 months. However, healthy changes toward the goal may begin much sooner. Following are the stages of change, which have been adapted for the current topic (Prochaska and DiClemente, 1986):

1. Precontemplation – Person does not have any plans to change in the near future. The positives of using salt outweigh any negatives, so he keeps salting his food. 
2. Contemplation. – In this stage, the patient is able to consider the possibility of cutting down on salt but may be indecisive about taking the first step.
3. Preparation- Person sees the ‘cons’ of continuing behavior as outweighing the ‘pros’ and is more willing to take the first step.
4. Action- Actively involved in taking steps to change behavior. There is still ambivalence about change, and relapse is possible.
5. Maintenance- Able to avoid temptations to return to using salt.  May have slips, but doesn’t tend to see this as failure.

There are several things you can do to support your husband in his lifestyle change. First, you can educate yourself on a low salt diet.  Most hospitals offer outpatient Cardiac Rehabilitation classes where diet and exercise are taught.  You may have already attended these classes with your husband. 

Although patients are educated on their diet while in the hospital, it is not the best time to learn. I strongly recommend making an outpatient appointment with a Registered Dietitian (R.D.).  The environment is much more relaxed than in the hospital, and at that time, the patient usually feels better, so it’s easier to learn. Most insurances will cover the cost.  Also, interview the dietitian over the phone to see if it’s a good fit before making an appointment.  Any dietitian will have the information to teach you, but styles and attitudes vary widely.

Second, if you are the cook, prepare tasty meals that use herbs for seasoning instead of salt. There are numerous recipes on the internet. When dining out, your husband can ask that his meals be prepared without salt.  I waited tables for years, and any sit-down restaurant will be happy to accommodate his needs.

Finally, don’t forget about yourself.  The American Heart Association provides an online support network for families and caregivers.  Go to www.heart.orgfor more information.

Good health to you!

Dear Dietitian