Shireen Abdullah 0:00
Managing heart failure often comes down to the daily choices we make, especially around sodium. In this episode, we break down why sodium plays such a powerful role in heart health, how it impacts blood pressure and fluid buildup and the hidden high sodium foods that can make symptoms worse. Listeners will learn practical, flavorful ways to cut back on sodium, what to eat instead, and how quickly these changes can improve symptoms like swelling and shortness of breath. Whether you’re living with heart failure or supporting someone who is, this conversation offers simple, evidence-based strategies to take control of health through nutrition.

Shireen Abdullah 0:45
Podcasting from Dallas, Texas. I am Shireen, and this is the Yumlish Podcast. Yumlish is working to empower you to take charge of your health through diet and exercise and reduce the risk of chronic conditions like type 2 diabetes and heart disease. We hope to share a unique perspective and a culturally relevant approach to managing these chronic conditions with you each week.

Shireen Abdullah 1:17
Julia Zumpano has been a registered dietitian with preventive cardiology and rehabilitation at the Cleveland Clinic for 20 years. Her time in patient care is spent counseling on a cardioprotective diet with focus on lipid, hypertension, diabetes, and weight management. She also serves as the nutrition media liaison, where she manages the media requests to the outpatient nutrition therapy department, and played an integral role in the development of the Cleveland Clinic diet app, and is a co-host of the Nutrition Essentials podcast. Welcome, Julia.

Julia Zumpano 1:53
Thank you. Thanks for having me today.

Shireen Abdullah 1:55
Such a pleasure to have you on. So Julia, we want to talk to you a little bit about nutrition. And we’ll get into some of the things around heart failure in just a second. But before we jump into the topic itself, one we’re really excited to have you on. To start things off, can you help walk us through just a little bit of your background and what just led you to become a registered dietitian? And from there, I want to go a little bit into the work that you are doing as well.

Julia Zumpano 2:24
Sure. So I’ve always been very focused on health. My mother, unfortunately, had a heart condition most of my childhood, and, you know, I watched her struggle with that, and she actually did have heart failure. So I, you know, helped her manage her sodium, and a lot of you know, her medications, and a lot of different cardiac issues she had, you know, really influenced me to value health care. And then, you know, as I evolved and created some of my own interests, nutrition was always a huge interest of mine. Being an athlete, struggling with some gut issues, I was able to utilize, you know, what I put on my plate to better manage my symptoms and my overall health.

Shireen Abdullah 3:10
Super helpful. So you know, you mentioned your own personal story, and thank you for sharing that. Can you help us understand? This, you know, we constantly hear about sodium when it comes to heart health. Can you help us really walk us through why sodium itself plays such a critical role in managing heart failure, and what really happens in the body when we consume too much of it? I mean, again, we hear constantly, the, you know, “Lower your sodium.” But what is it really doing within our bodies?

Julia Zumpano 3:40
Sure. So sodium is an essential mineral. It is really important for the balance of fluid. So it helps your body maintain fluid levels. We do need sodium too much sodium can really lead to some negative outcomes, especially with heart failure. So when you consume sodium, your body absorbs and holds on to the fluid it needs. So when you take in too much sodium, this can cause you to retain excess amount of water or fluid, and that can be a big issue when you have heart failure, because your heart is already struggling to adequately pump your blood throughout your body. And then when you’re adding this extra fluid, it’s only causing more strain on your heart. So then your heart starts to carry this extra fluid and pocket this extra fluid in certain areas, maybe your hands or your feet, maybe even your chest or your lungs, so that can lead to fluid retention and, of course, worsening the condition of your heart.

Shireen Abdullah 4:50
Which takes me to the next question around heart failure itself. So why does sodium matter when it comes to heart failure management?

Julia Zumpano 4:59
Sure so, when you consume too much sodium, more than your heart can handle, you’re retaining extra fluid. So we want to try to reduce the sodium to help reduce the amount of fluid retention. That’s the key. So sodium can cause you to retain more fluid, or if you decrease the sodium, it can help you get rid of some of the fluid or retain less. So it’s very essential to have a good, proper balance of the amount of sodium you’re consuming.

Shireen Abdullah 5:33
Now related, how does sodium then impact blood pressure, and why is that especially dangerous for someone again, with heart failure?

Julia Zumpano 5:45
Sure. So your blood pressure can also be influenced by the amount of fluid you’re retaining. So when you’re consuming high amounts of sodium, it puts more tension and more volume of fluid in your body, and you know, throughout your bloodstream, so it can increase blood volume. And therefore, more blood volume can cause more blood pressure on your vessels, and that higher blood pressure creates more work for your heart to move this extra volume of blood and fluid throughout the body. So that can worsen, of course, your effects of heart failure.

Shireen Abdullah 6:25
What are some now, when we’re talking about sodium, I feel we always think about, you know, the salt that we add to season our foods and things like that. So let’s start there. But I also want to get into some hidden salt and sodium sources as well. But starting there, what are some common high-sodium foods that heart failure patients might not even realize is putting them at risk?

Julia Zumpano 6:50
So processed foods are going to be the biggest source. So packaged foods, box-prepared meals, box-prepared side dishes, and anything that has maybe a dry powder packet in it that is used as a seasoning is a culprit for high sodium. Any frozen meals, processed meats, and cheeses are a big source of sodium. Snack foods, condiments are a very high source of sodium. And then when we’re eating out at restaurants, whether they’re fast food or even sit-down restaurants, restaurant food is very high in sodium, also because it’s a main preservative that is being used.

Shireen Abdullah 7:32
That’s an interesting perspective, because, again, we usually just think about sodium in terms of the salt that is being added or that we add to food, but there’s so much hidden sodium within what we consume that we may not even be consciously aware of that.

Julia Zumpano 7:45
Absolutely, one thing I think is very important to clear up is that sodium is table salt is made of sodium chloride. And you know, we always think of a low-sodium diet, or low-salt diet, meaning just not adding table salt, sodium chloride. Although studies have shown that most people who exceed their intake of sodium are not doing it from salt alone. It’s mainly from processed foods, and you’re better off eating a whole foods diet and adding a little bit of salt to your food. You’ll add more flavor. There’ll be a lot more nutrition there. And studies show that those types of diets that have fresh food but add a little salt tend to stay within their level of sodium better and have better-controlled heart failure and blood pressure.

Shireen Abdullah 8:38
Makes sense, because you’re also controlling, right? Like, that’s something in your control. That makes so much sense. What are some staple ingredients someone should try to eat to manage their heart condition, specifically, heart failure?

Julia Zumpano 8:42
Correct.

Julia Zumpano 8:52
We want to look at whole foods. So whole foods are usually one-ingredient foods, or simple foods that we put together to include more than one ingredient, but it could be, you know, chicken or beef or fish. You know, we want to look at protein sources that are fresh eggs, dairy such as Greek yogurt, those are great sources of protein, and they don’t have much sodium. So what’s naturally occurring in food, in its natural state, we’re very rarely concerned with its more of what’s being added or how it’s being processed. So when we look at some of those protein sources, the more that they’re processed, the more that they’re going to contain sodium. So when you’re looking at deli meat, or, you know, rotisserie chicken that you purchase, it’s already going to be cooked and seasoned, and it’s a culprit for sodium. But when you’re looking at fresh chicken that you’re cooking yourself, there’s no concern there. Or deli meats are going to be very high in sodium.

Julia Zumpano 9:51
And then on the other side of the plant-based foods, again, they’re very low in sodium. Naturally, like fruits and vegetables, fresh fruits and vegetables, nuts and seeds, fresh, unsalted, very low in sodium. Even salted nuts are usually not a culprit for people to consume too much salt, so usually just have them choose lightly salted. I do think it can enhance flavor. And then grains, so plain grains, like noodles or brown or wild rice or potatoes, which is a starchy vegetable but still falls in that starch category. You know, those are naturally low in sodium, but when we’re purchasing them again, premade or with a seasoning or with a sauce, that’s where the sodium comes in, such as maybe a macaroni and cheese type of noodle, or, you know, fried rice, where there’s going to be a lot more sodium, because what of what’s being added. French fries, you know, that’s where we’re adding so much extra stuff that’s going to add the sodium. But the core food itself really is very low in sodium. So we’re looking back at, like, basic foods: whole grains, fruits, vegetables, starchy vegetables as well, lean sources of protein, and healthy fats; all of those are naturally low in sodium.

Shireen Abdullah 11:13
Super helpful. Are there any tips that you can give to patients who are wanting to stick to a low-sodium diet? Who you know who may say, “Well, the deli meat is tasty,” or “The rotisserie chicken is tasty,” right? Because of the way it is processed. Again, perhaps the sodium is what was making it so flavorful. But what kind of advice can you give to individuals who are like, looking for a palette of taste and flavor? You know that they’re not willing to or don’t want to sacrifice because they’re having to, you know, sort of manage that. So what would you say? What can a person do to sort of elevate that flavor profile still?

Julia Zumpano 11:53
Sure, great question. I generally recommend you encouraging herbs and seasoning. Fresh herbs tend to have a stronger, more robust taste, if that’s an option for you. You know, if you’re able to maybe plant a little herb garden that you have so you can constantly have them fresh or, you know, go to a farmers market or even the local grocery store. So fresh herbs are excellent. Dried herbs are also wonderful. So using dried herbs, using any other seasonings that you may like. So you garlic and onion are phenomenal seasonings. They have so much flavor any of the peppers, so there’s a lot of heat-based peppers and more mild-based peppers. So those are phenomenal to use. Things like turmeric and cumin are great spices to use. They have a lot of flavor. Freely using extra virgin olive oil, there have been a lot of studies that show they’re very supportive of heart health and diabetes health and overall, just longevity.

Julia Zumpano 12:51
So Extra Virgin Olive Oil. Sometimes we might be missing some more of that fat-based component of a meal, and then or encouraging the use of salt-free seasonings or salt-free condiments; even so, looking at maybe sauces that are low sodium, I recommend coconut aminos, often for a soy sauce alternative. I recommend nutritional yeast, often to add to foods to enhance the flavor, even as a cheese alternative. So those are two main ones I tend to recommend, quite often, different kinds of vinegars as well. There’s, you know, balsamic or white wine or rice vinegar. They all have different flavors. It may require a little bit more time in the kitchen, and homemaking sauces from scratch will allow you to be able to reduce the sodium or eliminate it based on what your needs are.

Julia Zumpano 13:42
And same with baked goods. So you know, a lot of baked goods can be very high in sodium. It’s one of the highest sources of sodium in the American diet because of the quantity that we eat and consume of those baked items. But making them at home can significantly decrease the amount of sodium. So it doesn’t have to equal a bland diet. You may just need to look for a different flavor other than salt. You might be looking for maybe a little more spice or a little more savory from different sources of savory versus just the sodium. For certain people and most people who on heart failure, salt substitutes are not advised. But if your doctor does recommend a salt substitute, and it’s acceptable with your medication regimen, that is another option is using a potassium-based salt substitute.

Shireen Abdullah 14:36
Coming back to, and you know, talking about the heart failure piece. So let’s say, Julia, we’re at the best behavior that we can, and we’re controlling our sodium intake. How quickly can reducing sodium really impact symptoms like swelling, shortness of breath? How long does it take to really be able to see that impact?

Julia Zumpano 14:57
It’s tough to say, because you know, every person responds to things differently. It also depends on how much you know, fluid are you retaining? You know, how bad is your shortness of breath? The severity of your symptoms can play a role. But I’d say anywhere from a couple days to a week, you should be able to see an impact. Typically, it’s pretty immediate, so you should be able to see it within a couple of days, starting to feel better with some of those symptoms. For sure. As you continue to progress and to adhere to more of a stricter, low-sodium diet, you’ll continue to feel better.

Shireen Abdullah 15:34
Are there specific foods or types of diets that can help prevent? You’ve been talking about that fluid buildup, but that can really help prevent that fluid buildup or even fluid release in heart failure?

Julia Zumpano 15:48
Well, we know that the Mediterranean diet and the DASH diet, which stands for Dietary Approaches to Stop Hypertension. We know those two diets have been shown to be very beneficial from a blood pressure and heart failure management standpoint; the benefits there are those diets are very plant-heavy. They’re very whole-food heavy. So there’s a lot of fruits, a lot of vegetables, a lot of, you know, fresh dairy in the form of like yogurt and milk. So some forms of dairy, like, such as cheese or cottage cheese, can pack in some sodium, but still, you can choose mild or lower sodium cheeses, Beans, legumes, are a very integral part of both of those diets, and, you know, whole grains, so all of those foods and then minimizing meat. So meat is not a foundational piece on either of those diets; it’s certainly included in both, but it’s in smaller and more controlled portions, and fresh is encouraged. So both of those diet plans are essential and excellent for the management of heart failure.

Julia Zumpano 16:56
But aside from a specific diet, I think that a high-potassium diet can help. So just in general, increasing potassium-rich foods, because potassium actually helps our bodies get rid of sodium, and it’s an extremely important mineral, and most Americans are not consuming enough potassium because we’re not consuming enough plant-based foods. And potassium is mainly found in plant-based foods such as avocados or bananas, potatoes, leafy greens, beans, nuts. It is found in some dairy and some meat as well. But, you know, I think we’re just not consuming enough of an abundance of those plant-based foods to consume enough potassium. So when I see patients that are, you know, struggling with heart failure or high blood pressure, I do advise on a low-sodium diet. But more importantly, I really advise on increasing potassium, and I guide them specifically through that low-sodium and high-potassium.

Shireen Abdullah 18:00
So we always think about sodium, but this is interesting that you’re also mentioning potassium.

Julia Zumpano 18:05
Yeah, it’s such an important mineral that is, I think, commonly overlooked, and especially commonly overlooked in the importance of the role that it can play in managing blood pressure as well as heart failure, and there has been some just recent studies showing that potassium can also help. Again, the studies are very preliminary and nothing very conclusive, but it can help decrease the rates of depression, which I thought that was fascinating.

Shireen Abdullah 18:37
That is so related; all of these elements just kind of come together and is all so interrelated, right?

Julia Zumpano 18:43
Yes, so much.

Shireen Abdullah 18:44
Tell us. Talk to us about the importance of reading labels. Now, a little bit ago, we were talking about you controlling your foods, trying to eat, making your own foods, for instance. But if we are getting foods from you know, we’re getting processed foods, for instance. What are the types of things that we should look for when we’re reading the nutritional labels for them?

Julia Zumpano 19:04
Wonderful question. So reading labels is essential when following a sodium-restricted diet. So first off, we want to glance at the serving size, because we want to know what amount is this label based on, right? So let’s say it’s a half a cup. So we glance at the serving size, and then we look at the values underneath. We’re looking specifically at sodium. So sodium intake for one individual food item should be around 140, 150, or less. As a single food item, that means one serving of that food. When we look at meals, we try to keep our meals under 600 milligrams, six to 700 milligrams of sodium. So if you’re going to consume whatever this packaged food is as a meal, as long as it’s, you know, below about 600 to 700, it would be considered an acceptable choice. Now that varies, because, you know, sometimes we may be consuming more sodium in one meal and significantly reducing our sodium for the other meals just to be able to have some flexibility for that third meal. And in that case, if you’re tracking and monitoring, you can certainly consume more than that.

Julia Zumpano 20:21
And that would also be the same if you’re looking at one individual food. You know, if you’re going to be choosing that individual food with several whole foods that really have no sodium, then you could probably consume a little more sodium in that. So a good example would be bread. Bread is a hard thing to find that’s low-sodium, so I generally say, well, let’s just focus on what we’re putting in our bread. Let’s put give ourselves a bigger allotment of sodium for the bread, but try to use fresh meats as a sandwich, or maybe we use some, you know, like a natural peanut butter. And we switch what we’re going to put on there—some unsalted butter or some extra virgin olive oil. We choose to make the larger amount of sodium coming from the bread and reduce the other sources of sodium in that meal to be able to have what you want. I think that’s also key, there is being able to understand where you want your sodium to come from, so you’re able to properly adjust your food choices to allow for the things you really do want.

Shireen Abdullah 21:29
We’re coming to the end of the episode over here. I did want to touch on one important item when it comes to heart failure, in particular, Julia. So we know that, for instance, fatigue and a poor or just loss of appetite are common symptoms of heart failure, right? Which is, which is unfortunate, because then you have this frustration of, I don’t have the energy to do these things, but at the same time, I want to make sure that I’m cooking or eating well enough so that I can also, you know, manage my health better. How? What would you say to someone like that? Who is, you know, trying to manage all of these other things at the same time?

Julia Zumpano 22:08
That is very tough. But, you know, I would start with just very simple meals and simple foods, things that you can manage. So we know fresh fruits and vegetables are naturally low in sodium. So if you we incorporate a fruit and a vegetable with every meal, that gives us just the other portion of what we are going to consume, we get gives us a little more sodium there. I would focus on healthy fats, increasing a lot of good healthy fats, like avocado, extra virgin olive oil, nuts and seeds, nut butters. Those can carry a lot of good calories, good healthy fat, but not a lot of sodium. So it can also help, you know, decrease the likelihood of weight loss. And then another thing would be just simplify very much.

Julia Zumpano 22:56
Simplify what you’re consuming. Keep it very simple. Do what’s with whatever is in your means, but if you are able to commit, let’s say, three or four days to a low-sodium diet, you may find that you’ll be able to get rid of some of that fluid you’re retaining. You may find that you get a boost of energy. You may find that you’ll be feeling better if you’re able to just do a couple days, and then your energy level may increase, where you can manage a little bit more if you wanted to do a little bit more cooking and a little bit more specialty foods, but in the beginning, just keep it very, very simple. Read labels. Another big suggestion would be keeping a food diary. I think that is so essential, especially in the beginning, writing down everything you’re eating, how much sodium is in it, and then tallying up the total and seeing where you fall. I generally recommend keeping it under 2000 milligrams of sodium for the day. So let’s say you’re just, you know, let’s say you’re at 2400. Well, then all you need to do is focus on how to get 400 out of your diet and see how you feel. So it’s also a matter of just looking at where you’re starting, where is your baseline sodium intake.

Julia Zumpano 24:13
And then you can even see on paper where those heavy hitters are. And really just focus on maybe the top three largest, you know, most prevalent sources of sodium in your diet, and come up with low-sodium replacements for just those three versus looking at the whole diet. So oftentimes, it can be very much simplified if we know what we’re our baseline is and what we’re starting with.

Julia Zumpano 24:40
I’m on LinkedIn, so certainly can find me on LinkedIn. I also run a Nutrition Essentials Podcast. I’m the co-host. It’s a monthly podcast for the Cleveland Clinic, and it’s all about helping people feel empowered about food, not overwhelmed. We explore health topics through the lens of nutrition. And we talk with physicians from all different specialties about the role of nutrition in prevention, healing, and everyday living. And that can be found on any Apple Podcast, Spotify, or at the on the Cleveland Clinic website.

Shireen Abdullah 25:17
Thank you for listening to the Yumlish podcast. Make sure to follow us on social media @Yumlish_ on Instagram and Twitter and @Yumlish on Facebook and LinkedIn for tips about managing your diabetes and other chronic conditions, and to chat and connect with us about your journey and perspective. You can also visit our website, Yumlish.com, for more recipes, advice, and to get involved with all of the exciting opportunities Yumlish has to offer. If you like this week’s show, make sure to subscribe so you can hear more from us every time we post. Thank you again, and we’ll see you next time. Remember, your health always comes first. Stay well.

Connect with Yumlish!
Yumlish Website: Yumlish
Yumlish on Instagram: @yumlish_
Yumlish on Facebook: Yumlish
Yumlish on Twitter: @yumlish_
Yumlish on LinkedIn: Yumlish 

Connect with Julia Zumpano!
LinkedIn: https://www.linkedin.com/in/zumpano-julia-4757482a
Nutrition Essentials Podcasts: https://www.youtube.com/playlist?list=PLMG0zKOgNqNmoVhXKP1zvIuFS5BcVXJyG