People with heart failure do not need to go on a low carb diet, but it’s important to choose the right carbs as not all are created equal. Many carbohydrate-containing foods like berries, beans, and whole grains improve cardiovascular health, while those made with sugars and refined flours have little nutritional value and can be detrimental to heart failure patients.
What Makes a Food Good for a Person with Heart Failure?
First I’ll summarize my criteria. It’s actually very simple. In order for a food to be good for someone with heart failure, it needs to be:
- Low in sodium
- Low in saturated fats–ideally zero saturated fats
- Zero trans fats
- Zero cholesterol
- A good source of micronutrients directly correlated with heart health
The goal in heart failure is to improve blood pressure and flood the body with nutrients that have positive effects on the cardiovascular system.
Every step you take to improve your overall cardiovascular health decreases the workload on the heart and just may slow disease progression. It’s never too late to started on a heart healthy nutrition plan!
What are Carbs Anyway?
Carbs are short for carbohydrates, an important source of energy for the body. When you eat carbohydrate-containing food, your body breaks it down into glucose, fueling the brain, organs, and muscles.
I’ll put a link at the bottom of the article to a page where you can “nerd out” on the chemical properties of carbohydrates.
It’s important to note that many foods are a combination of the three macronutrients, carbohydrates, protein, and fats. For example, a potato is predominantly carbohydrates with a small amount of protein and fats. Peanut butter is mostly fat, with some protein and carbohydrate. We tend to classify foods based on the macronutrient that is dominant.
Are All Carbohydrates Created Equal?
Carbohydrates are divided into three types: complex (starches) and simple (sugars), and fiber.
Complex Carbohydrates
Complex carbohydrates are made up of long chains of sugar molecules that our bodies break down. Because of this, they are digested more slowly by the body and do not taste as sweet.
Potatoes, beans, peas, wheat, rice, and other grains are examples of complex carbohydrates. They are often referred to as starches.
Simple Carbohydrates
Simple carbohydrates are very short chains of glucose or fructose and are called simple sugars. They taste sweet and are quickly converted to energy by the body. Fruits contain naturally occurring sugar or fructose. Soft drinks and candies contain glucose and/or high fructose corn syrup. Other simple carbohydrates are maltose and lactose.
Fiber
Fiber is a type of carbohydrate that our body does not digest well. Fiber passes through the digestive tract and provides nutrition to the beneficial bacteria living in the large intestine. There are two types of fiber, soluble and insoluble.
Insoluble fiber helps prevent constipation, keeps you full, and maintains stable blood glucose levels.
Soluble fiber can actually decrease cholesterol levels. When you eat a food that is high in soluble fiber, it binds to cholesterol in the digestive tract and prevents that cholesterol from being absorbed into the bloodstream.
Both Complex and Simple Carbohydrates Can Be Healthy or Unhealthy! Both are recommended for heart failure patients. But what makes a carbohydrate good for you? Remember the criteria at the beginning of the article? It comes into play now.
The key is that healthy carbohydrate sources come from whole food sources and are either in their natural state or minimally processed. Because of this, they are high in nutrients and retain naturally occurring fiber. Healthy carbohydrate sources aren’t fried in oil. And they don’t contain added sugars and sodium.
Whole Food Carbohydrates
An example of a whole food carbohydrate is an apple, a potato, a piece of corn, or a pinto bean–that is in its natural state. Fruits, starchy vegetables, and grains are carbohydrate foods. (Non starchy vegetables like greens contain carbohydrates as well; however, they are so low in calories they don’t really fit into this category.)
Minimally Processed Foods
An example of a minimally processed food would be sprouted or whole grain bread, brown rice, homemade mashed potatoes, or a homemade fruit smoothie. These foods are close to their natural state and retain naturally occurring nutrients.
The Bottom Line
These “whole food” and “minimally processed” carbohydrates should be a primary source of calories in your diet. I’m not saying to overeat carbohydrates, but I am saying the benefits of these carbohydrates are well-researched and documented.
Heart healthy carbohydrates are full of vitamins, minerals, phytonutrients, and fiber with beautiful natural colors and pigments and many health benefits.
Refined and Highly Processed Carbohydrates
In contrast, less healthy carbohydrate sources are refined and processed bearing little resemblance to the plants they come from. For many of these foods, “less healthy” is too nice of a word!
Cakes, cookies, soft drinks, chips, syrups, sugary breakfast cereals, and pastries and examples of highly processed carbohydrate foods. Here’s why you should avoid them.
Highly processed foods are stripped of their fiber and nutrients. And they often contain many additives and preservatives with no value to human health. They are linked with increased inflammation and provide empty calories you just don’t need.
Highly processed and refined carbohydrate foods raise blood triglyceride levels, increasing the risk of diabetes, coronary artery disease, and fatty liver.
How Do Carbs Benefit Heart Failure?
Carbs don’t directly improve heart failure, but the nutrients they contain improve heart health!
- Whole food carbohydrates are naturally low in sodium while high in minerals that lower blood pressure. In addition, a diet high in whole food carbohydrates lowers blood pressure, cholesterol, and triglycerides, improving blood vessel health.
- Whole food carbohydrates are the foundation of the DASH diet, the Mediterranean Diet, and the Whole Food Plant Based diet–all diets associated with longevity and heart health.
- What’s more, the healthiest cultures in the world eat a diet very high in whole food carbohydrates. Check out the Blue Zones to read about the habits of the longest lived people in the world. https://www.livescience.com/what-are-the-blue-zones
- And finally, many heart failure patients are on medications that deplete the body’s potassium. Many carbohydrate foods are naturally high in potassium.
Remember this: When you have heart failure, your heart does not pump as efficiently. High blood pressure and clogged or hardened arteries put even more strain on your heart. But, healthy blood vessels and optimal blood pressure decrease the workload of the heart. Heart failure patients need to keep their blood vessels as healthy as possible, and healthy whole food carbs are one of the best ways to accomplish this!
Fruits
Let’s cover fruits first. Nearly all fruits are heart healthy. An exception may be those high in saturated fats like coconuts. Whole fruits are good sources of fiber, potassium, and micronutrients. They decrease inflammation in the body and are hydrating–this is especially helpful if you are on a fluid restriction.
Let’s cover my favorites:
Apple
Yes apples! They have many antioxidants and minerals like magnesium. Apples have been studied for their potential to lower blood pressure. The soluble fiber helps lower cholesterol too. So the old adage is true. “An apple a day helps keep the doctor away.”
Berries
Blueberries, raspberries, and blackberries are packed full of nutrition. They are one of the fruits highest in fiber and lowest in calories. Those little berries are packed full of vitamin C, B vitamins, minerals, and antioxidant compounds. Blueberries, in particular, have been shown to improve cognition.
Furthermore, the compounds that give berries their beautiful reds, purples, and blues have many health benefits and are considered anti-inflammatory. And berries have iron too!
Berries are truly a superfood in my book. I recommend you buy them fresh in season or frozen when they are out of season. They can be pricey but are worth it for their nutritional punch.
Oranges and Citrus
Citrus fruits are high in vitamin C and potassium. Potassium is known for its role in lowering blood pressure. Furthermore, many heart failure medications like lasix and other diuretics can deplete potassium. (An exception to this would be if you have kidney disease or high potassium levels. Check with your doctor to be sure.) And citrus makes a great flavoring alternative to salt. See my article: ***
Pomegranate
The pomegranate is an interesting fruit. It can be a little annoying to get to the actual fruit, but when you do, you’ll see it’s worth it. Pomegranate is very high in fiber–you actually eat the seeds! Eat the seeds on their own, or sprinkle them on a salad or yogurt for a sweet juicy crunch.
Pomegranate has anti-inflammatory properties and is high in folate, and Vitamin K. Folate is especially beneficial for your heart as optimal folate levels keep homocysteine (an amino acid) levels in check. Elevated homocysteine is associated with health disease, stroke, and dementia.
Purple Grapes
All grapes are delicious. Aside from fiber, they have compounds called polyphenols which may help prevent type 2 diabetes. Purple grapes are especially high in a compound called resveratrol. Resveratrol might help prevent damage to blood vessels, reduce low-density lipoprotein (LDL) cholesterol, and prevent blood clots.
Pro tip: Try frozen grapes for a thirst quenching treat.
What About Juice?
As with all fruits, the juice may retain some of the nutrients, but you lose the fiber. For this reason, I recommend limiting juice and eating whole fruit whenever possible. If you do choose juice, read the labels carefully to be sure it doesn’t contain sugars and other unnecessary ingredients.
My Favorite Starchy Carbohydrates that are Good For Your Heart
Whole Grains
Examples of whole grains include brown rice, whole wheat, oats, quinoa, barley, and millet. Whole grains have many health benefits and are nutritional powerhouses. Their fiber helps lower cholesterol and keep you fuller for longer. Eating whole grains is actually associated with weight loss. And whole grains contain many vitamins, minerals, and antioxidants that decrease inflammation in the body and improve blood pressure.
Beans and Legumes
Beans and legumes pack a nutritional punch for so many reasons. They are very high in fiber and are a great source of protein as well as carbohydrate. Beans and legumes are high in potassium, magnesium, calcium, and iron.
Unlike many animal sources of protein, beans have no cholesterol and very little fat. Their balance of carbohydrates and fats makes them a main dish or feature ingredient in soups and stews.
Examples of my favorite beans and legumes are black beans (versatile and delicious), chick peas (great roasted or in salads), kidney beans (my favorite for minestrone and pasta fagioli), and lentils (great in soups or as a substitute for meat in tomato sauce). Remember to get the unsalted canned versions or use bagged dried beans.
Pro tip: If you find that beans upset your stomach, start with very small portions until your body adjusts!
Sweet Potatoes, White Potatoes, and Root Vegetables
Boy do potatoes get a bad rap! They are a starchy vegetable with many health benefits. The truth is that they are quite healthy until we dump butter or other fats all over them when serving.
A potato is filling and satisfying. Both white and sweet potatoes are great sources of potassium and vitamin C. They are high in fiber if you eat the skin. And sweet potatoes also contain beta-carotene.
Other starchy root vegetables like turnips and parsnips have similar health benefits.
Then we have beets, the superstar of root vegetables!
Eating beets can actually relax blood vessel walls, decrease blood pressure, and increase blood flow. Beets may even play a role in repairing damaged blood vessels and improving atherosclerosis. See my article on beets for the down-and-dirty on what is probably the most heart healthy root vegetable of them all! https://thechfdietitian.com/are-beets-good-for-heart-failure/
Summary
Don’t let all of the mixed messages about carbohydrates confuse you. Not all carbohydrates are created equal. It’s important that you recognize the difference between healthy and unhealthy carbohydrates so you can get the most from your heart failure nutrition plan.
Remember that nutrition can help or hurt your condition. Including whole food carbohydrates from fruits, vegetables, and whole grains in your diet is one of the easiest and most delicious things you can do for your heart health.
Final Tips:
- Eat whole food carbs every day at all of your meals.
- Keep your portions reasonable.
- Vary your carbohydrate foods to maximize your nutrition.
Link to Carbohydrate Metabolism: https://www.sparknotes.com/health/carbohydrates/section3/
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