For Montana man, low-sodium diet reverses heart troubles

Bruce Simon fishing

Bruce Simon

A year after a major heart attack, followed by cardiac surgery, Bruce Simon found himself back in the hospital with continued heart problems. This time, his doctors in his hometown of Billings, Mont., began to talk about a heart transplant. Simon wasn't arguing. His congestive heart failure was so extreme that he had to sleep sitting up while wearing an oxygen mask, and he couldn't walk more than a few feet without becoming short of breath.

Yet four years later, Simon is a picture of health. He hasn't had a heart transplant or any additional heart surgery. He's on fewer medications. He's back to spending long days rowing down the Smith River to his favorite fly-fishing spot, and he can walk two miles on a treadmill at a 3.5-mile-per-hour pace. It wasn't high-tech medicine that drove his recovery:

It was simply avoiding salt.

"A lot of people with heart failure come to a cardiologist's office and expect to get medications," said Simon's doctor, Dipanjan Banerjee, MD, clinical assistant professor of cardiovascular medicine and medical director of Stanford Hospital's Mechanical Circulatory Support Program. "Probably the most important thing we do in our clinic is focus on lifestyle and dietary changes. The cornerstone of our therapy for our congestive heart failure patients is sodium restriction."

Among other electrolytes, including calcium and magnesium, sodium helps cells use and carry electrical impulses throughout the body, facilitating the absorption of nutrients and minerals. However, most Americans have too much salt in their diet — typically more than 3,000 milligrams daily. The American Heart Association recommends a limit of 2,300 mgs and a low-sodium diet for people with certain health issues like coronary artery disease and heart failure.

After suffering heart failure, Bruce Simon cut back on his salt intake. Now, he's back to spending long days rowing down the Smith River to his favorite fly-fishing spot, and he can walk two miles on a treadmill going 3.5 miles per hour.

Simon, who came to Stanford Hospital & Clinics to be evaluated for a heart transplant on the recommendation of his Montana doctors, performed just a little too well on the heart transplant evaluation tests, so Banerjee sat him down to talk about diet. Even though Simon did not have high blood pressure or high cholesterol — two key precursors of coronary artery disease — his heart was stressed by the effort needed to pump accumulated excess fluid. Sodium in excess puts more stress on the heart, Banerjee said, because it causes water retention, making the heart work harder to pump that extra fluid around the body. "For people who don't have congestive heart failure, reducing sodium is not as important," Banerjee said. "For a patient with congestive heart failure, low-sodium intake is crucial."

Rather than prescribe higher doses of diuretics to help rid Simon's body of excess fluid, Banerjee wanted him to try living by a simple rule that he often prescribes for his patients with heart failure: "Nothing out of a can, nothing out of a bag, nothing out of a box and no processed foods" is how Simon remembers it.

"I thought they were nuts," he said. "But I also recognized that I'd been sent to one of the finest medical facilities in the world, and I was under the care of some of the best doctors in the world, so I thought I should pay attention."

"Medications are important," Banerjee said, "but they can't be used in isolation. For example, we've found that coronary artery disease isn't just a passive accumulation of cholesterol in the blood vessels. Now we know that there's active inflammation in those blood vessels, and if we don't treat that inflammation, patients can have heart attacks and even strokes. We also know that sodium restriction, or a low-sodium diet, plays a role in reducing inflammation, especially in patients with heart failure."

Sticking with a low-sodium diet is not an easy change. "We realize that patients have had a certain diet for their entire lives," Banerjee said. "But patients with diabetes have to modify their diet to reduce sugar, and over time, if they're able to do that, some of those patients can come off their therapies for diabetes. We see patients with heart failure who can experience the same therapeutic benefits."

Simon had a similar experience. Not only was he able to add exercise to his daily routine — which he did at the suggestion of Banerjee — but his low-sodium diet was so effective against his heart-failure symptoms that he noticed a difference within two weeks. Soon, he was sleeping without supplemental oxygen, just as he had before his heart failure. By the end of a month on the new diet, the pressures in his heart were normal. An echocardiogram showed that the right side of his heart, once enlarged, was also back to normal size. "He was an unqualified success," Banerjee said, "largely because of the work he did. That won't be true for everyone, but we try to avoid invasive treatments and to first manage our patients' health with lifestyle changes."

Now 72, Simon has become a vigorous advocate for the low-sodium diet and delightedly accepts compliments about how good he looks. "People tell me I don't even look like the same guy," he said. "I feel great, and I can do just about anything I want. Eating carrots and celery is a whole lot better than having a heart transplant."

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