Many, although not all, people struggle with unintentional weight loss following a heart failure diagnosis. While it’s not always reversible, there are things you can do to help stabilize your weight, manage this condition, and stay within the framework of a heart healthy diet.
Heart failure, especially as it advances, can lead to malnutrition. In some cases, fatigue, medications, and poor appetite are the primary cause. A more severe condition called cardiac cachexia occurs in advanced heart failure, leading to muscle, bone, and fat loss.
No matter the cause, nourishing foods, adequate calories, and a good balance of macronutrients are vital to managing this condition. This article will show why you may have trouble maintaining your weight and what you can do about it. Read on!
Why Heart Failure Patients Experience Weight Loss
Fatigue
One thing that heart failure patients tell me is that they feel TIRED–like BONE TIRED!
And many of you still have jobs and obligations that can’t be missed. Grocery shopping and cooking healthy meals take time and energy.
This is a challenge if you are EXHAUSTED.
Here is what I typically see:
The thought of cooking and prepping meals becomes overwhelming. And it takes energy. So you slowly start cooking less and eating out more. Diet quality suffers as fast food is often the most accessible option for dining out.
Some people have meals delivered. You’ve only changed the location but not the nutrition. I also see people begin to rely on frozen meals and ready-to-eat foods, which are often high in salt and fat, while low in nutrition.
I get it. The temptation is real. But…
Diet quality suffers, and fatigue actually gets worse!
Fatigue also leads to meal skipping. (I can’t tell you how many people tell me they only eat twice per day!) Infrequent meals and meal skipping actually slow your metabolism. The more meals you skip, the more likely you will lose your appetite as your body stops sending hunger cues.
So everything snowballs…
Fatigue leads to decisions that worsen fatigue!
Depression
Depression is common when you are diagnosed with a chronic condition. If you are experiencing depression, the last thing you may want to do is go to the grocery store, push around a cart, drag the groceries home, and cook a bunch of food.
I get it.
In addition, people who are depressed sometimes sleep through meals. Depression can cause you to lose your appetite. This is just one of many reasons to get your depression treated. Treating your depression will help your mental AND physical health and help you cope with your disease.
Here is another reason to get your depression treated.
Poor nutrition makes depression worse? The research is clear!
A well-balanced diet with fresh, healthy whole foods is vital for treating depression.
It does not take the place of medication; instead, it is a part of a good treatment plan. There are a lot of good articles and research studies on the internet. I’ll cite one of them at the bottom of this article.
If you are having feelings of depression or anxiety, don’t wait. Be honest with your doctor and get the help you need.
Sluggish Digestion
Heart failure lead to decreased blood flow to your stomach and intestines. Reduced blood flow can slow down the digestion of food and the absorption of nutrients, leading to weight loss.
You may feel full longer or feel indigestion after eating that you didn’t experience before your diagnosis. You may be prone to constipation. (Be sure to read my article on heart failure and constipation.)
All of this causes you to eat less food and eat less often, leading to unintended weight loss.
Cardiac Cachexia
Cardiac cachexia causes more than fat loss.
- Muscles break down
- Bone loss occurs
Managing it is much more complicated than simply giving people more food.
Cardiac cachexia is a process that describes changes in metabolic processes and hormones that affect all of the body’s systems. The causes of cardiac cachexia are complex and can signify worsening heart failure. Your resting energy expenditure, or the number of calories you burn at rest, increases.
Even if you can eat the same amount of food that you always did, you lose weight.
While we can’t just fix cardiac cachexia with extra calories, a high calorie and high protein diet is needed. That’s because your energy needs are higher. And extra protein can help combat the muscle loss associated with cardiac cachexia.
- Eat Frequently
- Eat lean, heart healthy protein at every meal.
- Use the tips in this article to help you fill your body with nourishing foods.
Optimal nutrition is the best chance you have to help your body cope.
NEVER GIVE UP, AND NEVER MISS A CHANCE TO NOURISH YOUR BODY WITH GOOD NUTRITION!
What Can You Do to Gain Weight Healthfully?
As a dietitian, I will never advocate for weight gain “any way you can” by eating whatever extra calories you can cram down.
I’ve heard this before, and I JUST DISAGREE!
I BELIEVE in the power of healthy food.
No matter what stage of heart failure you have, nutrition is just too important. While no food is 100% off limits, I want you to focus on heart healthy foods that are high in calories and nutrition.
That means we want food that is CALORICALLY DENSE AND NUTRIENT DENSE.
Let’s focus on healthful weight gain with nourishing foods that are good for you and your heart!
I can think of a whole lot of high calorie foods like cookies, cake, butter, french fries, chocolate, and ice cream….You won’t find me sending you off for those.
Desserts and treats have their place–they are allowed–but they are not my focus and should not be the foundation of your diet or your strategy to gain weight.
Be sure to check out my post titled “Snack Ideas”. I’ll give you the basics on this page and put all the details and recipes there.
Strategies to Increase Calories and Nutrition
Meal Timing and Frequency
Get out a calendar or place a chart on the fridge. (Drop me a note and let me know if you need a meal chart, and I will send one to you.)
Set yourself up for success and create a realistic schedule for you!
Don’t schedule breakfast at 7 am if you sleep in every day. And if you nap in the middle of the day, don’t schedule a snack at that time.
Create a schedule with FOUR eating opportunities-three meals and one snack.
I don’t care what time you do this.
I really don’t!
Just pick the times that make sense for you.
If you hate breakfast, eat non-breakfast foods. If you love breakfast, make two of your meals breakfast foods. You can have cereal at 10am and 4pm. It doesn’t matter as long as you create a schedule and make a promise to follow it. Here is a sample schedule.
All meals don’t have to be the same size either. You may like a large lunch, a light breakfast, and a light dinner. You may want a heartier snack, like a peanut butter sandwich at 3 pm. It’s all good as long as there are four eating opportunities. Here is a sample based on my schedule.
(Keep in mind that large meals can worsen digestive issues.)
Fill Your House with Healthy Food
Go to the grocery store, or better yet, use a grocery shopping service. Plan to shop with a neighbor or friend to make it more enjoyable and hold yourself accountable. Take a look at the suggestions below and make a plan to get these foods into your house.
Balance Your Macronutrients
Protein, Carbohydrates, Fats…at every meal.
They are all important.
For protein, plant protein sources are better for your cardiovascular health. Less red meat and less white meat–less meat! Fatty fish is a good source of Omega 3 and protein, but this should be consumed in moderation. There are so many great plant sources of protein–think beans, peas, lentils, chick peas, black eye peas, lima beans…Blend them into a spread. Give tofu and tempeh a try. They absorb all any spices or flavors you add to them and are delicious. Sprinkle nuts and seeds on your oatmeal, salads, and vegetables. Pumpkin sees are especially nutritious, but all nuts have protein, minerals, vitamins, and heart healthy fats.
Carbohydrates from whole foods are health foods. Do not let common narratives about carbs being “bad” lead you to avoid them. Carbohydrates give us energy and fuel our brain.
Fats contain nine calories per gram which is more than double the calories per gram in protein and carbohydrate. Heart healthy fats should be in every meal, especially if you are trying to gain weight.
Check out my other articles on heart failure nutrition for more details!
Incorporate High Calorie Foods into Your Diet
Drink Your Calories
If you struggle with unintentional weight loss, everything you drink should contain calories. Stay within your fluid restriction, but make those fluids count. Juice and plant milks are 80-100 calories a cup. Add beet juice to your diet (and check out my article on beets and heart failure). Add a scoop of protein powder to plant milks to make a shake.
And you really must learn to make smoothies!
It’s not difficult. As long as you have a blender, you can make a smoothie. The ingredients are broken down before you eat them, making all those fruits and veggies easier to digest. This is good news for people struggling to get enough calories.
I can easily get a whole lot of calories into a 12-ounce smoothie. And you can put all sorts of healthy foods into a smoothie. You can add in protein powder too. Smoothies are nutritional powerhouses, and they taste great.
Think of all the amazing nutrition in these foods:
- Spinach
- Berries
- Bananas
- Avocados
- Mango
- Carrots
- Ground Flax Seed
My favorite smoothie is a mixture of the following ingredients: banana, spinach, almond milk, protein powder, ground flax seed, orange, and blueberries. I don’t measure! I just throw it all in the blender and mix it up.
(I estimate this smoothie to have 600 calories and 30g of protein. It’s pretty big, so if you make a giant smoothie, it’s okay to split it up and save half in the fridge for later.)
Use Add-Ins to Increase Calories
Boost the calories in the dishes you are already eating with plant fats!
Think about the EASIEST ways to add calories to your main dish and all side dishes.
Common heart healthy add-ins include
- Oils, preferably olive oil 120 calories a tablespoon
- Avocado 320 calories per avocado
- Plant milks 80-100 calories a cup
- Nut butters 200 calories a serving (2Tbsp or 32g)
- Nuts 170 calories per ounce (28g)
- Ground flax or chia seeds 60 calories a tablespoon (10.3g)
- Honeys and maple syrup 60 calories a tablespoon (20g)
A Note on Plant Milks
Soy, almond, and oat milk give you calories without unhealthy saturated fats. They have a mild taste and can be subbed for water in dishes like grits or oatmeal to add 80+ calories per cup. Due to high saturated fat content, cow’s milk and coconut milk are not my recommended choices.
More High Calorie Plant Foods
You NEED plant foods for their health benefits. Here are some of the higher calorie versions!
Fresh Fruits
High calorie fruits include bananas, mango, and avocado.
Dried Fruits
Dried fruits are exceptionally high in calories. Think about it! If you eat four prunes, you have actually eaten four whole plums.
Apricots, raisins, cranberries, dates, figs, pineapple, prunes, and mango are delicious when dried. ¼ cup (45g) of dried fruit has 80-110 calories.
Grains
Oats, whole grain breads, rice, barley, farro, and quinoa are high calorie, high nutrition grains. While grains sometimes get a bad rap, nothing is further from the truth.
All grains are good sources of nutrition and should not be eliminated from your diet unless you have an allergy or intolerance or allergy. Diabetes is not a reason to eliminate grains.
Cooked grains are relatively easy to digest. Grains can be added to soups and stews to give a nutritional boost. Plus they readily soak up added oils.
A half cup of rice with a tablespoon of olive oil gives you 220 calories.
Vegetables/Beans/Peas/Legumes
Potatoes, butternut squash, sweet potatoes, parsnips, lima beans, corn, beans, lentils, and green peas are the highest in calories, with around 100-300 calories a cup. They are super easy to prepare.
I just throw white potatoes right onto the oven rack and cook at 400 degrees for 50 minutes. Frozen versions just need to be boiled on the stove or thrown in the microwave.
Don’t forget to a add a plant oil and further bump up the calories!
Supplements and Nutrition Shakes
While homemade foods are best, commercially available supplements play a role. They are convenient and high in calories. There is research to show that supplements help with weight gain.
They are typically made from a protein source, a sugar, and a fat. Vitamins are added. I recommend a plant based shake for optimal nutrition and heart health. My favorite shakes are Kate Farms, Ensure Plant Based, and Orgain Shake, but there are a lot of good shakes out there.
Do your research and read the labels. Some have quite a bit of sodium and you will need to factor that into your totals.
Ideally, supplements are used in between meals for a snack or calorie boost rather than using them as a meal replacement. Most supplements and shakes have less than 300 calories which are a lot less than you need for a meal!
Snack or Energy Bars
There are so many snack bars and protein bars that I need to make a separate post. Here is another instance where you need to check the label to be sure they are not high in saturated fats or sodium. Snack bars are typically very energy dense and good options for extra calories.
For now, I’ll give you my top pick. Lara Bars are my favorite healthy snack bar that gives you lots of calories in a small package, without the stuff you don’t need. An “apple pie” flavored Lara Bar has 180 calories and just 5mg of sodium.
Exercise, Strength, and Movement
Moving your body is important, and weight loss is usually not a reason to stop. Resistance training can help maintain muscle. And exercise can stimulate hunger, get the blood flowing, and help nutrients reach the cells in your body.
You don’t want to overexert yourself or do anything that is not safe. Think gentle exercise and slow, deliberate movements.
Have your doctor set you up with a recommended exercise program. Ideally, you can attend cardiac rehab, where experts can monitor you and create a program unique to your needs.
Professional guidance is a must.
Medications
This is a tricky subject.
Check with your doctor to see if an appetite-stimulating medication like mirtazapine or megesterol is right for you. The research is unclear on whether these medications are effective, and like all medications, they can have side effects.
I have seen them used successfully for weight gain.
Action Plan
Let’s sum all of this up with an action plan.
- Commit to making nutrition a priority! (This is the most important step.)
- Get healthy food into your house
- Make a structured eating schedule
- Increase your calorie intake healthfully:
- Make sure your liquids contain calories
- Use add-ins to increase calories
- Eat high-calorie plant foods and use add-ins like olive oil
- Make a smoothie every day
- Use convenience foods like bars and supplements so that you always have something on hand.
- Talk to your doctor about medications and exercise.
Drop me a line and let me know how this works for you. And don’t forget to check out my articles on beets and high calorie snacks! The Heart Healthy Benefits of Beets for Heart Failure Patients and The Dietitan’s Guide to Low Sodium Snacks
This post is not a substitute for personalized medical advice. Be sure your doctor knows about any dietary changes you make.
Okoshi, M. P., Capalbo, R. V., Romeiro, F. G., & Okoshi, K. (2017). Cardiac Cachexia: Perspectives for Prevention and Treatment. Arquivos Brasileiros de Cardiologia, 108(1), 74-80. https://doi.org/10.5935/abc.20160142
Tello, Monique MD, PhD (2018) Diet and Depression. Harvard Health, https://www.health.harvard.edu/blog/diet-and-depression-2018022213309
