Dietary Recommendations for Better Management

By Brittany Poulson, MDA, RDN, CD, CDCES 

 Medically reviewed by Anisha Shah, MD

Following a heart-healthy diet is important if you have hypertrophic cardiomyopathy (HCM). Hypertrophic cardiomyopathy is a condition in which the heart muscle becomes thicker than normal.

HCM usually is due to abnormal genes that cause the walls of the heart to pump harder and become thicker and stiffer than normal. Because of this, the amount of blood pumped in and out of the heart with each heartbeat is reduced.

A balanced and varied diet that includes whole grains, vegetables, fruits, and lean protein is part of a heart-healthy diet. Eating foods low in saturated fat and trans fats, while including small amounts of unsaturated fats, is also important. Choosing and preparing foods with low sodium (salt) can also benefit your heart and blood pressure.

This article will discuss the benefits of a heart-healthy diet for hypertrophic cardiomyopathy, how it works, foods to include or avoid, modifications, and considerations.

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Benefits

Currently, there is no specific dietary plan recommended to reduce your chances of getting HCM or directly improve your HCM symptoms. Nevertheless, most experts agree that the basic principles of heart health apply—including following a heart-healthy diet. This is especially true for people with HCM who don't have symptoms. 

The American Heart Association (AHA) says a heart-healthy lifestyle that includes being physically active, eating healthy, maintaining a normal weight, getting quality sleep, and not smoking is recommended for people with HCM who don't have symptoms.1

If you have HCM with symptoms, the AHA recommends treatment to manage symptoms through medications and procedures.

There isn't a lot of research on diets specific to HCM. However, a review study and case report show a possible benefit of diet as a supplemental treatment for HCM.

One review study looked at the combined effect of the Mediterranean diet (which emphasizes healthy fats, whole grains, fruits, vegetables, and legumes) and aerobic exercises on weight loss in people with obesity and HCM. The study revealed that participants with symptomatic HCM and obesity who followed a Mediterranean diet and an aerobic exercise program showed clinical improvement.2

A single case study followed a 3-year-old female with mitochondrial disease (a genetic condition affecting the powerhouses of cells) and HCM.3 She was prescribed antioxidant supplementation with a ketogenic diet (very low-carbohydrate, high-fat diet).

Three years later, at age 6, the child had improved HCM, with normal heart wall thickness. This case report suggests that a ketogenic diet may improve HCM in children with coexisting mitochondrial disease.3

Some people with HCM are at risk of developing heart failure. This is when the heart doesn't pump enough blood for the body's needs.1 If you have HCM complicated with heart failure, additional dietary restrictions may be recommended.

Guidelines for managing heart failure suggest that healthful eating patterns, particularly those that are weighted toward eating foods derived from plants, such as the Mediterranean diet, whole grain, plant-based diet, and the DASH (Dietary Approaches to Stop Hypertension) diet (high in vegetables, fruits, and whole grains and low in sodium), may decrease the chances of developing heart failure.4

Regardless of the few studies available on diet and HCM, many studies have shown a benefit of a heart-healthy eating pattern for heart health in general. Many experts agree that following a basic heart-healthy diet may benefit those with HCM.1 

How It Works

The AHA recommends lifestyle changes, including following a healthy diet to help manage cardiomyopathies.5 This includes eating a variety of fruits, vegetables, and whole grains. Consuming foods that are low in saturated fat and trans fats is an important part of a heart-healthy diet, as well as choosing and preparing foods low in sodium.

Other healthy food choices include lean meats, poultry without skin, fish, beans, and fat-free or low-fat dairy products. Additionally, it’s recommended to decrease added sugar intake from foods and beverages. Avoid drinking alcohol or drink in moderation.

Duration

A heart-healthy eating pattern for HCM is meant to be a permanent lifestyle change. To fully reap the benefits, choose healthful dietary changes that can be made into everyday habits. Build upon one small change after another until you can look back and see all the progress you have made to enjoy heart-healthy eating habits.

What to Eat

There are several different heart-healthy dietary plans you can choose to follow. Two of them are the Mediterranean diet and the DASH diet, which share many similar characteristics. Find what works best for you by adding in encouraged foods and swapping out foods to limit or avoid.

Foods to Encourage:

Vegetables

Fruits

Whole grains

Legumes, including beans

Nuts and seeds

Lean cuts of poultry

Lean cuts of meat

Fish and seafood

Eggs

Low-fat or fat-free dairy products

Vegetable oils (small to moderate amounts)

Herbs and spices

Foods to Limit or Avoid:

Alcohol

Foods and beverages high in added sugars

Salt and foods high in sodium (discuss with your healthcare provider before strictly limiting)

Deep-fried or greasy foods

High fat cuts of red meat

Processed meats

Foods high in saturated fat

Foods with trans fats

Highly processed foods

Large amounts of fluid (with current heart failure, depending on healthcare provider recommendations)

Foods to Encourage

Include a variety of the foods listed below in your diet:

• Vegetables and fruits: These are rich in vitamins, minerals, and other nutrients such as dietary fiber. They may help reduce cardiovascular (heart) disease risks. Choose from all colors and varieties of produce and include them in your diet daily.6

• Whole grains: Make at least half of your grains whole grains. Whole grains don't just mean whole wheat bread and brown rice. Other whole grains include quinoa, whole wheat pasta, whole wheat and corn tortillas, corn, barley, rye, buckwheat, and oats. Vitamins, minerals, phytochemicals, and fiber abound in whole grains, which can promote heart health.7

• Legumes, nuts, and seeds: Nuts and seeds are good sources of healthy unsaturated fats, fiber,8 and antioxidants, such as vitamin E. They may also help protect the heart with their anti-inflammatory compounds.9 Legumes, including beans and lentils, are also good sources of dietary fiber and many vitamins and minerals that support a healthy heart.

• Lean protein: Lean proteins have less saturated fat and often provide healthier unsaturated fats, especially when it comes to seafood. Good sources include skinless chicken breast, white turkey meat, tuna, salmon, halibut, tilapia, trout, sardines, and even pork loin.

• Eggs: Eggs are not only an excellent source of protein but also of vitamins A, D, E, B12, folate, selenium, lutein, choline, and iron. Eggs were once thought harmful to heart health due to their cholesterol content. But research indicates they do not increase heart disease risks when included in a balanced diet.10

• Dairy: Low-fat and fat-free dairy products can be eaten as part of a heart-healthy diet, including milk, yogurt, cheese, and cottage cheese.

• Vegetable oils: A heart-healthy diet can include small to moderate amounts of vegetable oils. Those containing mostly unsaturated fats include canola, olive, and avocado oils.

• Herbs and spices: Salt is widely known to raise blood pressure levels. As an alternative, use fresh or dried herbs and spices to add flavor.

Foods to Limit or Avoid

Limit or avoid these foods as part of your overall diet:11

• Alcohol: It is generally recommended to avoid alcohol on a heart-healthy diet. If you do drink alcohol, do so only in moderation. This means one drink or less than a full drink per day for women and two drinks or less per day for men.

• Added sugars: There is little to no nutritional value in added sugars, just calories. They are found in sugar-sweetened beverages (soft drinks, punch, sports drinks, etc.), desserts, bakery items, candy, jam, and more. The AHA recommends limiting added sugars to no more than 6% of your daily calories.12 That's about 6 teaspoons of sugar per day for women and about 9 teaspoons per day for men.

• Salt and foods high in sodium: The amount of sodium you take in can influence your blood pressure levels. As part of a heart-healthy diet, limit or avoid using salt when preparing foods at home and choose low-sodium or no-salt-added store-bought foods.

• Red meat and processed meats: Red and processed meats tend to be higher in saturated fats. It's recommended to include them in your diet only occasionally as part of a heart-healthy eating pattern.

• Foods high in saturated fat and trans fat: Foods high in saturated and/or trans fats include red meats, butter, coconut oil, palm oil, margarine, shortening, and highly processed foods such as pastries, chips, deep-fried foods, ice cream, cakes, cookies, and some frozen convenience foods.

• Large amount of fluids: Fluids can build up in the body if you have heart failure. This makes it hard for your heart to work properly. Limiting the fluids you take in might be recommended. Talk with your healthcare provider to see whether you need to make modifications.

Recommended Timing

A heart-healthy eating pattern doesn't have a specifically recommended timing of daily meals and snacks. However, it's still good to follow a consistent eating pattern by evenly spacing your meals.

There also isn't a prescribed number of meals you should eat per day. Depending on your daily schedule, you might choose three meals a day with one to two snacks or five to six smaller meals throughout the day. Determine what fits best with your lifestyle and do your best to keep a fairly consistent meal schedule.

Cooking Tips

These suggestions may help you when following a heart-healthy diet:

• When possible, cook from scratch or mostly from scratch at home. This can help you decrease the prepackaged and highly processed foods you consume. They are often high in sodium, saturated fat, and/or added sugars.

• Remove the salt shaker from the table. Even a little “shake” can add more sodium than you think to your meal. Increase the flavor of your meals by cooking with a variety of herbs and spices and other flavorful ingredients like vinegar, garlic, onion, and citrus.

• Choose to boil, steam, roast, or lightly sauté your vegetables with olive oil instead of cooking with butter.

• When cooking fish and poultry, it is preferred to bake, broil, stir-fry, sauté, or grill over deep-frying.

• Don’t be afraid to tweak recipes to be more heart-healthy. This might mean substituting a healthier fat for butter, decreasing the amount of salt called for, or using whole grains instead of refined grains.

Dietary Restrictions and Modifications

Most people can benefit from a heart-healthy eating pattern. It can usually be safely followed by children and adults alike. However, modifications may be needed in some circumstances. This includes people who follow a vegetarian or vegan diet, have food allergies, or have certain medical conditions, such as diabetes (chronic condition affecting the way your body processes blood sugar) or celiac disease (immune reaction to eating gluten).

Before adjusting your eating habits, talk with your healthcare provider. They will help you decide what is best for you and your medical condition(s) and explore the potential side effects of the new eating pattern.

If you require additional dietary restrictions or modifications, your healthcare provider may also refer you to a registered dietitian who can provide more detailed nutrition education, counseling, and support.

Considerations

Before changing your diet, it's important to take into account the following considerations:

General Nutrition

Following a heart-healthy diet can be a nutritious and satisfying way of eating. A simple way to help keep a balanced diet is to follow the U.S. Department of Agriculture (USDA) MyPlate recommendations.

This means one-half of your plate is filled with vegetables and fruits, one-quarter is filled with lean protein, and the remaining one-quarter is grains. You may choose to include a serving of low-fat or fat-free dairy.13

Safety

The 2020–2025 Dietary Guidelines for Americans recommend that adults consume no more than 2,300 milligrams (mg) of sodium per day.14 The AHA goes further to recommend no more than 1,500 mg of sodium per day for most adults.15  However, they point out that this may not be safe for everyone.

People who lose large amounts of sodium in their sweat, such as competitive athletes and workers subjected to high heat, such as foundry workers and firefighters, or those directed otherwise by their healthcare provider should not follow a low-sodium diet.

Because sodium depletion may be particularly dangerous in people with hypertrophic cardiomyopathy, it would be worthwhile discussing your sodium intake with your healthcare provider before adopting a strict low-sodium diet.

There is also some evidence that a low-sodium diet could be harmful to certain people with congestive heart failure. A study of people with chronic heart failure found that limiting sodium to less than 2,500 mg per day was associated with a significantly higher risk of death or hospitalization than people following a nonrestricted-sodium diet.16

However, a 2014 review of 23 studies found that both high and low sodium intake was associated with a higher risk of all-cause mortality (death) and heart disease events.17

A 2020 review also found mixed results on sodium restriction in people with current congestive heart failure. Some studies suggested a beneficial effect of decreased sodium intake, while others found worsening symptoms.18

Nevertheless, it is important to note that there may be multiple factors that could play a role in whether sodium restriction is beneficial or not. These include the extent of sodium restriction, the stage of heart failure, any fluid restrictions, medications, and other comorbidities (other health conditions the person has).

If you have heart failure or other medical conditions along with HCM, talk with your healthcare provider about whether you should restrict your sodium intake.

Flexibility

You can customize a heart-healthy diet according to your nutritional needs and personal tastes. Many dining establishments offer heart-healthy options. If you are concerned, you can look up the restaurant menu online before dining out to find foods that fit your eating pattern.

If you find yourself frustrated with its limitations or feel it prevents you from being able to eat socially, talk to your healthcare provider or dietitian. They can help you find ways to adjust your eating pattern or provide tips to help you cope with these situations.

Side Effects

You might notice changes in your digestion when altering how or what you eat, including when starting a heart-healthy diet. For example, if you increase the amount of fiber in your diet too quickly, you'll likely see a direct effect on your bowel habits.  

Over the course of a couple of a week or two, your body should adjust as it gets used to your new way of eating. However, if your symptoms do not improve or they get worse, you may need to visit your healthcare provider. Drinking more water, adding a fiber supplement, and/or participating in regular physical activity might be enough to resolve constipation. 

Summary

There is no specific diet recommendation for people with hypertrophic cardiomyopathy. However, experts generally recommended a heart-healthy eating pattern. This includes consuming a variety of vegetables, fruit, whole grains, lean protein, and unsaturated fats while limiting or avoiding saturated and trans fats, alcohol, added sugars, and highly processed foods. 

Consuming less salt and sodium can also benefit your heart and blood pressure. However, people with certain conditions should talk to their healthcare provider before following a low-sodium diet. A heart-healthy eating pattern is widely accepted as a safe and healthful way of eating for most people.

18 Sources

American Heart Association. Hypertrophic cardiomyopathy (HCM).

Limongelli G, Monda E, D'Aponte A, et al. Combined effect of mediterranean diet and aerobic exercise on weight loss and clinical status in obese symptomatic patients with hypertrophic cardiomyopathy. Heart Fail Clin. 2021;17(2):303-313. doi:10.1016/j.hfc.2021.01.003

Deberles E, Maragnes P, Penniello-Valette MJ, Allouche S, Joubert M. Reversal of cardiac hypertrophy with a ketogenic diet in a child with mitochondrial disease and hypertrophic cardiomyopathy. Can J Cardiol. 2020;36(10):1690.e1-1690.e3. doi:10.1016/j.cjca.2020.04.024

Heidenreich Paul A., Bozkurt Biykem, Aguilar David, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure. Journal of the American College of Cardiology. 2022;79(17):e263-e421.

American Heart Association. Prevention and treatment of cardiomyopathy.

Slavin JL, Lloyd B. Health benefits of fruits and vegetables. Adv Nutr. 2012;3(4):506-516. doi:10.3945/an.112.002154

Hollænder PL, Ross AB, Kristensen M. Whole-grain and blood lipid changes in apparently healthy adults: a systematic review and meta-analysis of randomized controlled studies. Am J Clin Nutr. 2015;102(3):556-72. doi:10.3945/ajcn.115.109165

Soliman GA. Dietary fiber, atherosclerosis, and cardiovascular disease. Nutrients. 2019;11(5):1155. doi:10.3390/nu11051155

Ros E. Nuts and CVD. Br J Nutr. 2015;113(S2):S111-20. doi:10.1017/S0007114514003924

Carson JAS, Lichtenstein AH, Anderson CAM, et al. Dietary cholesterol and cardiovascular risk: a science advisory from the American Heart Association. Circulation. 2020;141(3):e39-e53. doi:10.1161/CIR.0000000000000743

Lichtenstein AH, Appel LJ, Vadiveloo M, et al. 2021 dietary guidance to improve cardiovascular health: a scientific statement from the American Heart Association. Circulation. 2021;144(23). doi:10.1161/CIR.0000000000001031

American Heart Association. Added sugars.

Department of Agriculture. Myplate.

Department of Agriculture. 2020-2025 dietary guidelines for Americans. 

American Heart Association. How much sodium should I eat per day?

Doukky R, Avery E, Mangla A, et al. Impact of dietary sodium restriction on heart failure outcomes. JACC Heart Fail. 2016;4(1):24-35. doi:10.1016/j.jchf.2015.08.007

Graudal N, Jürgens G, Baslund B, Alderman MH. Compared with usual sodium intake, low- and excessive-sodium diets are associated with increased mortality: a meta-analysis. Am J Hypertens. 2014;27(9):1129-1137. doi:10.1093/ajh/hpu028

Billingsley HE, Hummel SL, Carbone S. The role of diet and nutrition in heart failure: A state-of-the-art narrative review. Prog Cardiovasc Dis. 2020;63(5):538-551. doi:10.1016/j.pcad.2020.08.004

By Brittany Poulson, MDA, RDN, CD, CDCES
Brittany Poulson, MDA, RDN, CDCES, is a registered dietitian and certified diabetes care and education specialist.