Protein and Heart Failure: What You Need to Know 

Oh Protein!!!! 

It seems like protein is everyone’s favorite macronutrient these days. And so it follows that protein is the subject of controversy in the nutrition world!

Questions about protein are also some of the most common questions I get from all of my patients, whether they have heart failure, diabetes, or food intolerances.  Everyone wants to know about protein. 

So I wrote this article to shed some light on the protein question.

Do People with Heart Failure Need More Protein?

Here’s the answer I got when I did some preliminary online research looking for articles and information on protein for heart failure. In other words, I googled it, and this is one of the many quotes I found.  I believe this was from the American Heart Association.

“The relationship between protein intake and heart failure is complex and not fully understood. Some studies have suggested that high-protein diets may be associated with an increased risk of heart failure, while others have found no significant association. More research is needed to determine the optimal protein intake for people with heart failure.”

So that answer doesn’t really answer anything.  There is a ton of research, but due to the varying and conflicting results, there isn’t enough information to give a firm answer one way or the other.  

I can give you a general number to meet your needs, but I want to help you get the optimal amount and type of protein that best supports your health. Unfortunately, there is no perfect method or magic number for someone with heart failure.

My Take On Protein

Here’s my expert take based on years of working in hospitals and in the community:

People with heart failure don’t necessarily need more protein than the average person. Still, as a dietitian, I do recommend a slightly–and I mean slightly–higher intake of heart healthy protein sources.   

My goal for optimal protein is to help people with heart failure:

• Preserve lean muscle
• Build strength (especially if you are a bit older)  
• Maintain skin integrity (especially if you have limited mobility) 
• Support immunity and healing (especially if you have been sick or spent time in the hospital) 

High Protein Diets Didn’t Help Heart Failure

I also don’t want to go any further without emphasizing that these protein sources should be genuinely heart healthy.  For example, this article reminds us that high protein doesn’t improve heart failure and that high protein diets were not found to be beneficial or healthy for people with heart failure.

https://www.cardiosmart.org/news/2018/6/protein-rich-diet-is-not-ideal-for-heart-failure-prevention

So eating very high protein will not prevent, reverse, or improve heart failure!!! In fact, it seems to have a negative effect. And there isn’t a point in eating protein for one particular benefit but doing damage to your arteries and heart!

I scrolled through many studies concluding that high protein diets were associated with an increased risk of and worsening heart disease. However, it’s not a 100% conclusion that it’s the protein itself.  Likely, the saturated fats and additives in many of the most popular protein sources are the culprit!

Healthy Protein Sources 

We want heart healthy protein sources, especially if you have heart failure!

Plant Based

Plant based sources of protein are heart healthy.  That’s not really up for debate.

I looked back in my phone and found two meals I had photographed. The first one is crusty whole grain and seeded bread, with white beans, broccoli, and assorted veggies. The second meal is a cold salad with whole grain wild rice, peas, chick peas, and veggies.

Both are rich in protein as well as healthy carbohydrates and fats. They have fiber!!! They have almost zero saturated fat and zero trans fat, and represent balanced meals all by themselves!

And many studies show that including fish several times per week can also be healthy, primarily due to their Omega 3 fats and low saturated fat content.

Once we get into animal protein sources, there is more debate. In the Mediterranean and DASH diets, animal products are included but minimized. In other words, meat and dairy portions are small and come from lean, lower fat sources. 

My advice is to always emphasize plant based sources! Here are some of my favorites:

Legumes, peas, tofu, tempeh, edamame, nuts, quinoa, oats, and seeds. And don’t forget that all foods have some protein, especially broccoli, green peas, and lima beans. Here is a fun chart that I found:

Animal Based Protein Sources

These should be lean protein with small portions 3-4 ounces several times a week–not 3-4 ounces at every meal! If you choose to eat animal protein sources, here are my recommendations:

Low-fat dairy, fish, lean poultry or other meats, egg or egg whites

(I generally recommend people move toward a plant based diet.  You can do this gradually by decreasing the portion sizes of animal foods and giving healthy, whole food plant based meals a try. Here is a great link to starting a plant-based diet.)   https://thrive.kaiserpermanente.org/care-near-you/southern-california/center-for-healthy-living/wp-content/uploads/sites/30/2020/03/plant_based_diet_e.pdf

High Fat and Salt Protein Sources

High fat meats and cheeses are not healthy protein sources.  They are fat sources.  

A long time ago, when I was in college, we had to memorize the “food exchanges”: protein, carbohydrate, and fat.  There were gigantic and intimidating lists.  While we no longer use these lists, they did provide good insight. The best part was that they did not lump all protein sources together, and there was a clear distinction between low fat, medium fat, and high fat protein sources.

Here is a link to two different sites’ version of those exchanges so you can see for yourself! https://www.nhlbi.nih.gov/health/educational/lose_wt/eat/fd_exch.htm, http://www.diabetesed.net/page/_files/THE-DIABETIC-EXCHANGE-LIST.pdf

Bacon and sausage are listed as either fat sources or high fat meats with a lot of saturated fat, and a tiny amount of protein.  The same goes for cheese. (Peanut butter is also in the “fat” category, although the fat comes from a heart healthy source.)

Cured and processed meats like bacon, sausage, ham, jerky, hot dogs, and pepperoni are usually high in sodium and unhealthy fat. In addition, they contain a lot of unhealthy preservatives, so they are not heart healthy either.

Cheese is high in salt and fat, especially hard cheeses. I recommend eliminating or significantly limiting cheese. If you do choose to have some cheese, unsalted softer cheeses like mozzarella, cottage cheese, or feta are generally healthier than other options.

I know that people don’t give up these foods overnight; I just want to emphasize that they are not heart healthy or good for someone with heart failure.

What Does Protein Do Anyway?

There’s no doubt protein is essential for everyone! I mentioned it in the introduction, but I wanted to expand it!

Protein is involved in nearly all of the body’s chemical reactions, and proteins are part of the structure of every single cell in the body. For example, proteins are necessary for growth, repair of tissues, immune function, and muscle growth. Proteins also help transport nutrients in the body.

So…we need good sources of protein.  That’s not up for debate.  Here’s the BUT, and here’s where all of the debate rages. 

Most People Get More Protein Than They Need

According to research, most people already get more protein than they need.  And much of it is from sources that also have a lot of fat, like ground beef, chicken nuggets, breakfast meats, and cheeses. 

A well-known study of European adolescents called the HELENA study showed that the mean protein intake was 96g which far exceeds the needs of most. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4334414/

And according to the 2005-2006 National Health and Nutrition Examination Survey (NHANES), a huge survey that is generally the “gold standard” of health and nutrition, men were getting an average of 110g per day and women were getting an average of 70g.

It is estimated that currently, Americans are eating even more protein, and getting about twice what they actually need.

So…How Much Does One Need????

The general recommendation is .8g/kg per day for someone whose weight is in a healthy range. However, as a dietitian, I evaluate each person individually so that I may adjust those numbers slightly for someone underweight or overweight. I also adjust if they have certain conditions, diseases, or medications.

Here’s how this works: 

For a woman who is 65” tall and weighs 154#, I convert this to kilograms.  

154# is 70kg  

Multiply this by .8

70 * .8 = 54g

Protein needs are 54g per day.

Very few people eating a Western diet do not get 54g per day. Yet, people come in to see me with protein goals well over 100g–sometimes 200g– and I’m not sure why the popular belief is that we need sooooo much.

What is My Recommended Protein Intake for Someone with Heart Failure?

Protein is Just One Part of a Heart Healthy Diet

I don’t want to prioritize protein over the other parts of the diet!

Don’t forget! We want low saturated or trans fats and high in fruits, vegetables, and whole grains.  

• Protein should be lean protein sources and heart healthy–ideally plant based.
• Carb sources should be varied and be from whole foods.
• Fat sources should be plants, foods, or fish.
• And don’t forget fiber. Fiber is technically a type of carbohydrate and it is vital. You can only get fiber from plant foods.

It’s Individual!

The recommended protein for someone with heart failure depends on their needs, medical history, and current condition. It should be individualized and based on factors such as age, sex, body weight, and degree of heart

failure. 

A protein intake of around 1.0 to 1.4 g/kg of body weight per day is appropriate for most people. That’s quite a range, but I will note that it is higher than the baseline protein needs of .8g/kg of body weight, but not a ton higher!  

Let’s take that same 154# woman.  She is 70kg.  Depending on her activity level, age, and kidney function, she would need 1.0 – 1.4g/kg daily. So that’s a range of 70-98g per day.  

If she has mild to moderate heart failure, good kidney function, and is starting cardiac rehab, or a similar exercise program, I would recommend 1.2-1.4g/kg.

70 * 1.2 = 84g

70 * 1.4 = 98g

So my recommendation is 84-98g per day

If she had early stage renal disease, I would likely decrease this to a max of 1g/kg per day.

70 * 1.0 = 70g

If this client were hospitalized and confined to bed, she would benefit from more protein, provided kidney function is good. That’s because muscles quickly “atrophy” or waste away when your are confined to bed. Higher protein intake and physical therapy aid recovery.

Why A Range and Not an Exact Number?

Since you don’t eat the same things every day, this range is acceptable.  I don’t want you measuring every gram and worried about hitting an exact number.  Life just doesn’t work that way!

Additional Factors That May Affect Protein Needs

Several factors can influence how much protein you need, including your overall health status, medication use, and kidney function. 

Kidney Disease

If you have kidney problems, too much protein can hurt your kidneys. So many people with kidney disease are put on a low or moderate protein diet.  The general recommendation for someone with kidney disease is .6-.8g/kg per day.

Underweight

If you are underweight, your protein needs may be higher. Also, your protein needs may temporarily increase if you have recently been sick.

Overweight/Obese

There are many factors to consider when estimating protein needs for obese adults, but often weight is adjusted. So, if someone is 64″ and 264#, we would not use 120kg when calculating needs. We would use either an “adjusted” weight or estimate “lean body mass”. A good rule of thumb is 80-100g if kidney function is good.

Medications

Certain diuretics used for heart failure, like Lasix, increase protein needs as some protein is lost in the urine.

Other medications like corticosteroids, immunosuppressants, and anticonvulsants also increase the need for protein.  Discuss this with your doctor or an RD who has access to your medication list.

Too Much Protein Can Be Bad for People with Heart Failure

The main risk to people with heart failure involves the kidneys.  And a diagnosis of heart failure is a risk for kidney disease.

High protein intake leads to an increase in the production of urea, which is a waste product excreted by the kidneys. If the kidneys are not functioning correctly due to heart failure or other medical conditions, an excess of urea can build up in the blood, causing a condition known as azotemia.

Azotemia can worsen heart failure symptoms.  And poor kidney function most definitely worsens heart failure and hurts the body’s ability to get rid of excess fluid.

It’s Important To Be Evaluated

It is essential to consult with a registered dietitian or healthcare provider to determine the appropriate protein intake for you!

What Does the Research Say About Protein and Heart Failure?

There is limited research focused explicitly on protein needs and heart failure. However, several studies have examined the effects of dietary protein on various aspects of heart health.  

1. A 2017 systematic review and meta-analysis of 28 randomized controlled

trials found that higher protein intake was associated with lower blood

pressure. The review also found that higher protein intake was associated with a lower risk of developing coronary heart disease.

2. A 2015 study published in Circulation Heart Failure found that

a high-protein diet may worsen heart failure. The authors used mice and found that a high-protein diet increased cardiac stress and impaired cardiac function in mice with pre-existing heart failure.

3. Another study published in the Journal of the American College of

Cardiology in 2018 found that a moderate protein intake (around 1.2 grams per

kilogram of body weight per day) was associated with a lower risk of death from

heart failure, compared to both low and high protein intake.

More research is most certainly needed.  

Sources of Protein for People with Heart Failure

When it comes to protein, quality is just as important as quantity! 

Animal-based protein sources, such as meat, poultry, and fish, are typically high in protein. However, these foods are often high in saturated fat and cholesterol.

Meats and fish average 6-10g protein per ounce (~30g), so they are really good protein sources. But if you end up clogging your arteries, or making your heart failure worse, it’s worth minimizing these and looking at plant sources of protein.

Plant-based protein sources, such as beans, lentils, and nuts, are generally lower in protein but have nearly zero saturated fat. While you get a bit less protein, you get fiber!!! And that’s awesome.

You also get a whole lot of vitamins, minerals, and phytonutrients associated with longevity and decreased inflammation in the body. Soy products, such as tofu and tempeh, are another excellent source of protein for people with heart failure.

Here is a link to a chart that has the protein content of many common foods! https://www.hopkinsmedicine.org/bariatrics/_documents/nutrition_protein_content_common_foods.pdf

And here is an article about vegan protein. https://www.medicalnewstoday.com/articles/321474#15-best-vegan-proteins

Lentils– ½ cup–   9g

Chick Peas– ½ cup–   8g

Black Beans– ½ cup–   8g

Tofu–   ½ cup– 10g 

Tempeh– ½ cup–  16g

Almonds– ¼ cup *–   7g

Black eye peas– ½ cup–         7g

Cooked Spinach– ½ cup–   5g

Green Peas– ½ cup–   4g

And other plant-based protein sources include cereal, tortillas, high protein pasta, and high protein almond milk.  Read those labels, as there are too many to list. 

Check out the 20g per serving in this high protein pasta!

Are Protein Shakes Good for Someone with Heart Failure?

Not necessarily!

The use of protein shakes/supplements by people with heart failure should be individualized based on the person’s overall health status, nutritional needs, and any medical conditions or medications.

Some protein shakes may be high in sodium or added sugars, which is not great for anyone, especially people with heart failure. Additionally, some protein powders may contain high levels of potassium or phosphorus, which can be harmful if you have some kidney disease as well as heart failure.

Therefore, if you are considering protein shakes and supplements, it crucial to choose a protein powder that is low in sodium and added sugars. And let your dietitian or physician know.

Here are some of my recommended protein shakes:

Orgain Chocolate Shake– 16g protein,       180mg sodium

Kate Farms Vanilla Nutrition Shake– 16g protein,       260mg sodium       

Kate Farms Renal Support 1.8 Nutrition Shake–     20g protein,       250mg sodium  

*for people with kidney problems who need a meal replacement or are on dialysis

Ensure Plant Based Protein– 20g protein,     300mg sodium

Iconic Protein, Greens, and Cacao– 20g protein,       70mg sodium

Premier Protein– 30g protein,     180mg sodium

Boost High Protein with Fiber– 20g protein,       220mg sodium

Tips for Meeting Protein Needs While Managing Heart Failure!

You don’t have to stress yourself out, measure everything you eat, and count every gram of protein.  You can meet your needs easily by eating a heart healthy diet with lots of whole, unprocessed foods.

Here are some tips to help you get started:

• Plan your meals ahead of time and include a protein source at each meal.  
• Eat plenty of nonstarchy vegetables, especially grains, as they contain protein.
• Eat whole grains, as these are also good sources of protein.
• Eat beans or legumes at least once a day.
• Eat a small portion of nuts or seeds every day.
• If you like numbers and really want to add it all up, use an app like “My Fitness Pal” https://www.myfitnesspal.com/ for one or two days to get an idea.
• Work with a registered dietitian to analyze and personalize your diet to meet your requirements.

This is usually enough to get your protein needs in the proper range. 

Conclusion

Protein is an essential nutrient that plays a critical role in heart health. While the optimal protein intake for people with heart failure is not yet fully understood, it’s important to aim for a balanced and varied diet that includes a mix of high-quality protein sources.

I hope you enjoyed this article. Remember that this does not substitute for medical care and all recommendations should be discussed with your medical team.

Be sure to check out my high protein recipes like Slow Cooker Pinto Beans: Low Sodium and Low Sodium Veggie Rice Bowls, and be sure to sign up for my email list so you don’t miss out on future posts!

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