Cindy Cassel, PhD, RD, LDCindy Cassel, PhD, RD, LD

Cindy Cassel, PhD, RD, LD
Owner and President, Nutrition Access LLC

The prevalence and pathopshiology of congestive heart failure is 25% of patients with heart disease. Evidence based dietetics practices approved by the American Dietetics Association (ADA) have been developed to guide the medical nutrition therapy for patients with heart failure.

Cindy Cassel educated the audience on how the ADA uses workgroups to develop disease specific guidelines, which recommend what should be done in terms of nutrition and then how it should be delivered. In addition, the ADA has developed a guideline rating system that helps guide the dietician and patient on the strength of the guideline based on evidence base.

The ADA recommends that the treatment of heart failure symptoms should be based on a comprehensive nutrition assessment to maximize adequate intake and control for the symptoms of disease. In general the nutrition assessment of a heart failure patient should focus on protein needs (should be higher to save muscle) and energy needs.

Nutrition intervention in the heart failure patient should focus on fluid intake, sodium intake, folate, B12, magnesium, thiamine, limiting alcohol, and supplements. Focusing on these areas has been shown to be very important in the recovery of the patient with congestive heart failure (CHF). The goal of the treatment of CHF is to improve symptoms, increase functional capacity, improve quality of life, slow progression, decrease need for hospital and prolong survival. Control of the symptoms of CHF is done by focusing on weight, sodium and movement.

Cindy shared the following guidelines from each of these areas:


Clinically stable and depleted patient-1.37g protein per kg

Normally nourished patient-1.12g protein per kg

Fluid intake:

1.4 to 1.9 L per day (48-64 oz) Fluid restriction will improve clinical symptoms and quality of life. This includes coffee, water in foods, alcohol, etc.

Sodium intake:

Less than 2000mg per day

1 sausage=2000mg

2 pieces of bacon=2000mg

pizza w/ pepperoni=3200mg


At least the daily recommended intake for folate through food and a combination of B6 and B12.

Foods high in folate include: Pinto beans, avocado and oranges.

Vitamin B12:

Should be supplemented to 200-500mcg day

Foods high in B12 include eggs, fish, baked poultry, diary low fat milk and greek yogurt.


Should provide the patient food and supplementation at least the daily recommended intake (DRI) for magnesium.

Foods high in magnesium are wheat products, trail mix with seeds, beans,


Patients should have at least the DRI

Foods high in Thiamine include cereals (non-sweeted), brewer's yeast, white rice, nuts and seeds


Patients not drinking alcohol at the onset of CHF should not start drinking.

Alcohol should be limited to a maximum of one drink per day for women and up to two drinks per day for men.

L-Arginine, Carnitine, Coenzyme Q10, and Hawthorn Supplements:

Limited evidence that these supplements benefit the heart failure patient is available; though Cindy shared, some research shows that Coenzyme Q10 has been shown to be beneficial in patients taking statins. Overall, Cindy recommends patients spend their money on foods that meet the evidence based best practices.