It is important that you understand the nature and severity of your pet's heart condition before selecting a suitable diet. This distinction is important because a pet with heart disease may have vastly different medical and nutritional requirements than a pet with heart failure. Ask your veterinarian if you have questions.

Heart disease is diagnosed when a pet has evidence of a heart abnormality such as a heart murmur, enlarged heart, valve changes, or other heart abnormalities–but is not showing any outward clinical signs. Heart failure occurs when a pet with heart disease (as previously defined) shows signs such as difficulty breathing, coughing, belly distention, edema or fluid buildup.

This is the reason that there is not one single "best diet" for managing pets with heart disease. Several high quality commercial diets are likely appropriate for managing your pet with heart disease but as your pet advances into more severe heart failure, he or she may feel better on a specific veterinary prescription diet. Following are the most important considerations when selecting a diet for managing a pet with heart disease or heart failure. It is important to select a diet that:

• Helps your pet maintain muscle mass and an ideal body weight
• Has mild, moderate or severe salt restriction depending on the stage of heart disease
• Helps your pet avoid nutritional deficiencies
• Contains supplemental nutrients that may have positive effects on heart function

Maintain ideal body weight

It is important for your pet to maintain an ideal body weight as both weight loss and obesity can be detrimental to a pet with heart disease. Muscle wasting is commonly seen in pets with heart failure. Weight loss that occurs in animals with heart failure is different than that seen in healthy dogs or cats that lose weight. When a healthy pet loses weight, fat stores are used up first. In animals with heart disease, muscles are broken down before the body turns to its fat stores. This leads to severe muscle wasting and loss of lean body mass which have negative effects on strength, immune function, overall quality of life and length of survival. Pets lose weight when they are in heart failure because of poor appetites, increased energy requirements and the production of inflammatory hormones.

Protein levels in heart failure

Outdated resources may suggest protein restriction for pets with heart failure to prevent "metabolic stress" on the liver and kidneys. There is no evidence that protein restriction is necessary for pets with heart failure. In fact, protein restriction can have negative consequences because pets can lose valuable muscle mass, which can lead to decreased survival times. Unless severe accompanying kidney disease is present, a protein-restricted diet is not recommended for dietary management of heart failure. A high quality diet with at least 25-30% (dogs) and 40-50% (cats) meat-based protein (on dry matter basis) is recommended.

The salt (sodium) story

While severe sodium restriction was historically recommended for pets, it is now known that in earlier stages of heart disease and heart failure, this approach may actually be detrimental. If a pet has no outward signs of heart disease, only mild sodium restriction is recommended. At this stage, more important than sodium restriction is to keep the sodium intake THE SAME every day so that your pet's body adapts to that particular level of sodium. High sodium foods, which cause sudden spikes in blood sodium levels, should always be avoided. These include many human snack foods (chips, pretzels, crackers, etc.), bread, pizza, cheese, other dairy products, deli meats, hot dogs, bacon, condiments (ketchup, mayonnaise), etc. The majority of commercial pet treats are also very high in sodium and best avoided. If the sodium information is not readily available on the package of treats you are giving your pet, contact the company to determine if the treats are low enough in sodium for their pet with heart disease. An excellent option to commercial treats is fresh vegetables or lean meats. Water can also contain high levels of sodium. Contact your water department for information and consider bottled water as a substitute if necessary.

Sodium restriction guidelines:

• No signs of heart disease, mild restriction: <100 mg/100kcal or 0.35?0.50% DM
• Early heart failure, moderate restriction: <80 mg/100 kcal or 0.1-0.35% DM
• Advanced heart failure, severe restriction: <50 mg/100 kcal or <0.10% DM
• Note: high sodium diets or treats are those than contain >0.50% DM

The first two levels of sodium restriction can be met by many high quality natural commercial pet foods. The level of sodium restriction required in advanced heart failure is usually only found in veterinary prescription diets, however, many pets will not accept the palatability of foods this restricted. It is important to keep your heart failure pet eating a consistent amount of a high-quality diet versus demanding they eat a food that will lead to muscle loss because they are not consuming enough calories.

Address possible nutrient deficiencies

Certain types of heart disease may rarely be caused by taurine or carnitine deficiencies. Your veterinarian may recommend testing these levels. Even if your pet's heart disease is not caused by a specific taurine or carnitine deficiency, many pets may still benefit from supplementation. For example, supplementation of carnitine helps support heart muscle energy production and metabolism. Most veterinary prescription heart diets supplement with high levels of taurine and carnitine to support healthy heart function. These supplements are also available from health food stores.

Certain electrolytes can become deficient, particularly if a pet is on diuretics (aka water pills) for heart failure. Supplementation of B vitamins and magnesium are often necessary to replenish the lost nutrients. Most veterinary prescription heart diets supplement these nutrients or a good vitamin supplement can be used.

Potentially beneficial supplements

Giving your pet with heart disease or heart failure supplemental omega 3 fatty acids (fish oils) can help improve appetite and decrease production of negative inflammatory hormones that often lead to weight loss. In clinical studies, dogs in heart failure taking omega 3 fatty acids have been proven to survive longer. Studies have also proven the benefits of additional taurine and carnitine in patients with heart failure. Other supplements commonly recommended for heart failure patients include Co-enzyme Q10, vitamin E and several other antioxidants. While there is rationale about why these supplements may be beneficial, there is no scientific proof. Talk to your veterinarian about the possible benefits to your pet if you are considering these supplements.

In summary, my feeding and dietary tips for pets with heart disease or heart failure include:

• Provide your pet a high-quality natural meat-based diet with at least 25-30% protein (DM basis) for dogs and 40% protein (DM basis) for cats.
• Make sure your pet LIKES the food. If the food isn't palatable, your pet will lose valuable muscle mass and body weight by not taking in enough calories.
• Mild to moderate salt (sodium) restriction can be achieved by many high quality commercial diets. You can also cut sodium out of your pet's diet by using fresh vegetables and fresh lean or freeze-dried meats as treats and avoiding certain human snacks that are very high in sodium. Only in advanced cases of heart failure should a severely sodium-restricted diet be considered. At that point, a pet owner can consider a veterinary prescription diet or make a well-balanced, nutritionally complete, low-sodium home-cooked diet (most recipes provide between 0.05%-0.1% sodium DM).
• Supplements (either provided in the diet or a separate pet supplement): omega 3 fatty acids, taurine, carnitine, B vitamins and Magnesium.

There are several high-quality natural commercial pet foods that provide good protein levels and sodium levels acceptable for dogs and cats with heart disease or even heart failure. Many of these foods are also supplemented with omega 3 fatty acids. A few examples include: Acana, Orijen, EVO (some varieties), Halo (some varieties), Canidae, Felidae...but there are many others. In fact, there are too numerous pet foods to list here...so don't be talked into a prescription diet as soon as your pet is diagnosed with heart disease. Usually sodium information is not readily available on the package label but all that is needed is a quick phone call to the company to ensure the sodium level falls within the guidelines listed above. Discuss all possible diet choices with your veterinarian to make sure they agree that the food will be suitable for your pet and address any other potential issues your pet may be having.