Nutrition

Eat a healthy diet
Eat "real food." This means avoiding processed foods (think of packaged foods that you put in the microwave that often have a lot of long or unpronounceable words on the label). The more you can prepare your own food from ingredients like fresh or frozen vegetables, meat, fish, chicken, etc., the healthier your food will be. Avoid sugar. This includes candy, cookies, and sweets in excess, but also drinks like sugar sodas and fruit juices. Incorporate healthier carbohydrates, such as green vegetables rather than starchy carbohydrates (breads, cookies, pasta, rice).

Eat in a way that is satisfying enough to not need continuous snacking throughout the day and avoid eating overnight. Our bodies work on circadian rhythms, where we are supposed to be awake during the day and asleep at night. During the night, when we are fasting, the body does maintenance to improve our health. This is disrupted when we wake up and eat in the middle of the night. Maintaining a fasting state during our sleep is important to overall health. If you have dietary restrictions, talk with your pulmonary hypertension team to work to make a healthy eating plan that works for you.

Manage salt intake
People living with pulmonary hypertension often struggle with fluid retention. Sometimes you see this as ankle swelling or fullness in the abdomen, or weight gain on the scale, and at other times it may not be as visible, but we may know based on the numbers on a right heart catheterization or findings on an echocardiogram. This extra fluid can make you short of breath and make your heart pump blood less effectively.

Your doctor may prescribe medicines that help you get rid of extra fluid by urinating more. You can also reduce your risk of retaining fluid by minimizing salt intake. How does salt intake lead to fluid retention? The human body likes to maintain "homeostasis." This is a medical word that means the body should be in balance, with all electrolyte levels in range, including sodium. When a person takes in sodium in the form of a salty meal or foods that are higher in salt, the kidneys go into action to make sure the sodium level in the blood does not rise to dangerous levels by holding on to fluid and diluting out the sodium. This is why “water follows salt” and also how eating a diet lower in sodium may help reduce fluid retention.

What does it take to eat a diet lower in sodium? First, your PH team may provide you with diet goals for how many milligrams of salt and how much fluid to take in per day. That is a good starting point so try to follow these recommendations and track sodium and fluid intake.

Second, avoid salting your food and know the foods that are high in sodium. Olives, pickles, cheeses, and cured meats are usually high in sodium. Anything packaged or canned may also contain sodium. Restaurant food often has a lot of sodium, especially pizza, French fries, sandwiches, soups, tacos, burritos, and savory snacks such as chips and salted nuts. Looking at labels and looking up sodium content in milligrams or grams often becomes second nature for those who live with pulmonary hypertension.

Third, get as close as possible to eating healthy, real foods, as discussed earlier.

Is sodium the same thing as salt? Not exactly. Table salt is a food that contains sodium chloride, which is a mineral. There are other types of salt, like Kosher salt and Himalayan sea salt, but for all intents and purposes, the sodium chloride contents are not drastically different and salt is salt when it comes to minimizing sodium in the diet. This should also include spices or food additives that contain the word “salt” like garlic salt or seasoned salt.

For more information about sodium here are some resources from the CDC and FDA:
Sources
Sodium in your diet

How much fluid should I take in per day?
The best amount of fluid for a person to take in is highly individualized. For many people, it is important to limit fluid intake to less than 2 L per day (or less than eight 8 ounce glasses of liquid per day) including all drinks and soups. Some people need to be more restrictive and others less restrictive. It is important to discuss your daily fluid intake goal with your PH team.

Also, know that if you are in a strenuous situation, like being outside in the heat or in another circumstance like an GI illness that may lead to being dehydrated, you may need to take in extra fluid to make up for losses. If you have such a situation, it is a good idea to talk to your PH team.

How often should I check my weight?
If fluid retention is a significant issue for you, checking your weight everyday, first thing in the morning after you use the restroom for the first time of the day and before you take in food or drink, and writing it down on to track it on a sheet of paper or a small pocket calendar (along with your heart rate and blood pressure, if you track those as well) can be super helpful. You may pick up on a small weight gain on the scale before you see increased swelling, and your PH team may then want to adjust your fluid medications (diuretics). Picking up on early weight changes can help you keep your symptoms in check.