6 foods to avoid on Entresto

In this article:

• How Entresto works
• Foods to avoid
• Foods to prioritize
• Gastrointestinal side effects

In this article

• How Entresto works
• Foods to avoid
• Foods to prioritize
• Gastrointestinal side effects

Entresto is a brand-name prescription drug approved by the Food and Drug Administration (FDA) to treat heart failure. It combines sacubitril, a neprilysin inhibitor, and valsartan, an angiotensin II receptor blocker (ARB). Entresto is categorized in a new drug class called angiotensin receptor-neprilysin inhibitors (ARNIs).

People taking Entresto should consult their healthcare providers to determine if any dietary changes are necessary to support the medication’s effectiveness and enhance heart health. In many cases, patients taking Entresto are advised to avoid processed foods and those high in potassium, salt, or fat.

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How Entresto works

Entresto (sacubitril/valsartan) reduces the risk of heart-related death and hospitalization in people with heart failure. How? Relaxing and widening blood vessels, which increases blood flow and lowers blood pressure. The drug’s active ingredients also have a secondary effect of decreasing sodium and fluid levels in the body, which can help prevent symptoms of heart failure, such as swelling and shortness of breath. 

6 foods to avoid with Entresto

People take Entresto because they have a heart condition. Although no foods directly interact with Entresto, it’s essential to follow healthcare professionals’ recommendations for dietary changes that support heart health and minimize the risk of Entresto side effects, such as hyperkalemia (high blood potassium) and dizziness.

Here are some foods your prescriber might recommend avoiding or limiting while taking Entresto:

1. Potassium-rich foods
2. Salty foods
3. Salt substitutes
4. Fatty foods
5. Processed foods
6. Alcohol

1. High potassium foods

Hyperkalemia (high blood potassium levels) is a serious side effect that develops in approximately 12% of Entresto users. Entresto can reduce the body’s ability to eliminate potassium, creating a buildup in the bloodstream. Given that, limiting potassium-rich foods and potassium supplements can reduce the risk of side effects on Entresto.

The Dietary Guidelines for America outlines the amount of potassium in many common foods. Foods with the most potassium include:

• Dark green vegetables such as beet greens, Swiss chard, and spinach
• Legumes such as lima beans and adzuki beans
• Skin-on baked potatoes and yams
• Fruits such as jackfruit, kiwi, cantaloupe, and banana
• Fruit juices such as prune juice, passionfruit juice, and pomegranate juice

It’s important to know that many people do not experience symptoms until high potassium levels get dangerously high, even life-threatening. Signs of high levels of potassium include an irregular heart rhythm, muscle weakness, trouble breathing, and, in some cases, cardiac arrest (heart attack). 

2. High sodium foods

Consuming too much sodium can undermine the benefits of Entresto. The drug works to lower blood pressure, but sodium intake has been linked to high blood pressure. Additionally, excessive sodium intake can exacerbate swelling, a side effect of Entresto, according to Dani Dominguez, RDN, a registered dietitian nutritionist and founder of SunBright Wellness.

High-sodium foods to avoid include the following:

• Processed and cured meats such as bacon, ham, cold cuts, and hot dogs
• Canned soups
• Potato chips
• Pickles
• Pasta sauces
• Fast food

3. Salt substitutes

Unfortunately, salt lovers can’t simply swap their table salt for salt substitutes while on Entresto. Many salt substitutes contain potassium chloride, so consuming them can lead to hyperkalemia while taking Entresto. 

Salt substitutes that contain potassium include (but are not limited to):

• No Salt
• Nu-Salt
• Morton’s Salt Substitute 

Entresto users should check the nutrition label on any salt substitutes before using them to season their food.

4. Fatty foods

Healthcare providers typically tell patients with heart disease to limit their saturated fat intake. “Saturated fats are found mainly in animal products such as fatty cuts of meat, cheese, and butter, and are common in fried foods,” Dominguez says.

If you have heart failure, your heart is already working extra hard, says Barbara Sparacino, MD, a triple board-certified healthcare provider. “Swapping in olive oil, nuts, or fish keeps the pipes [aka arteries] clean and the job easier. Cleaner pipes equal a lighter load on your heart,” Dr. Sparacino explains. 

5. Processed foods

Processed foods are not a food group. Instead, it’s an umbrella term for prepackaged foods and snacks, which tend to be high in sodium, sugar, saturated fat, or all three. High sodium intake, in particular, can raise blood pressure and cause fluid retention, two issues that Entresto is prescribed to help manage in people with heart failure. Processed foods may also contain additives that make it harder to maintain a balanced diet, which is essential for supporting overall heart health. Choosing fresh, whole foods instead helps Entresto work more effectively while lowering the risk of worsening heart symptoms.

6. Alcohol

It’s common to wonder if drinking alcohol is okay on Entresto since many drugs shouldn’t be mixed with alcohol. Dr. Sparacino says a glass of wine “now and then” while taking Entresto is usually fine, but regular or heavy drinking is bad news. “Alcohol stresses the heart and can mess with your meds,” she adds. This is especially true of older adults on Entresto, as the effects of alcohol can hit faster and last longer in adults ages 65 and older, according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA). “This ups the risk of falls, confusion, medication problems, even depression or accidents,” Dr. Sparacino says.

Possible drug interactions to be aware of include:

• Aliskiren (in individuals with diabetes)
• ACE inhibitors should not be taken within 36 hours of taking Entresto.
• Lithium toxicity may occur if lithium is taken with Entresto. 
• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, can cause kidney problems, including reduced kidney function and possible kidney failure, when combined with Entresto. 
• Taking Entresto with potassium-sparing diuretics, such as triamterene and spironolactone, may lead to high levels of potassium in the blood. 

What should you eat while taking Entresto?

There is no specific dietary recommendation for people taking ARNIs. That said, Dominguez recommends the DASH diet (Dietary Approaches to Stop Hypertension) to anyone with heart failure. “The idea behind this diet is to promote heart health and lower high blood pressure, which can lower risk factors of heart failure,” she says. “The DASH diet focuses on eating fruits, vegetables, whole grains, low-fat and fat-free dairy products, lean protein, beans, nuts, and seeds.”

Since Entresto can reduce the fluid in your body, it’s also important to stay hydrated. That means watching your intake of beverages like coffee, because caffeine has a mild diuretic effect. Additionally, you should drink water or unsweetened liquid throughout the day, and snack on nourishing, water-rich foods like watermelon and cucumber. If you have any questions about what to eat or drink while taking Entresto, seek personalized medical advice from a healthcare professional familiar with a complete list of your other prescription and over-the-counter (OTC) medications and medical conditions.

Gastrointestinal side effects of Entresto

The only common gastrointestinal Entresto side effect is diarrhea. The good news is that limiting alcohol and eating a heart-healthy diet of whole grains and lean protein can help with gut health, too. In other words, following the dietary advice in this article might help prevent or minimize Entresto-related diarrhea in addition to supporting the benefits of the drug itself.

Beyond diarrhea, Entresto isn’t known for causing stomach problems— but hyperkalemia might. Possible signs of hyperkalemia include nausea, vomiting, and diarrhea, as well as muscle weakness and irregular heartbeat. Still, it’s important to remember that not everyone experiences symptoms of hyperkalemia until potassium levels are dangerously high. If you are on Entresto and experience sudden or severe nausea, vomiting, or diarrhea, seek medical advice from a healthcare professional.