Presentation on theme: "Dietary Approaches to Stop Hypertension"— Presentation transcript:
1 Dietary Approaches to Stop Hypertension This show is by Nancy Kennedy, MS, RD and Food and Health Communications, Inc. We are going to teach you about the DASH diet – a simple diet that uses inexpensive every-day foods for better health.The DASH program that has been documented in clinical research to reduce blood pressure as effectively as one drug therapy...especially effective in people with high blood pressure, but also reduces blood pressure in those with normal pressures!Speaker: We suggest you read and prior to giving this show. Both are free and available on the internet.
2 Dietary Approaches to Stop Hypertension Acronym DASH- stands for Dietary Approach to Stop HypertensionReferences from both studies are:-Appel LJ, Moore TJ, Obarzanek E, et al. A clinical trial of the effects of dietary patterns on blood pressure. N Engl J Med 1997;336:-Sacks FM, Svetkey LP, Vollmer WM, et al. Effects on blood pressure of reduced dietary sodium and the dietary approaches to stop hypertension (DASH) diet. N Engl J Med 2001;344:3-10
3 Start the DASHRecommended Servings From the Various Food Groups for DASHLower Your SodiumIncrease Your PotassiumIncrease Your MagnesiumIncrease Your CalciumHere are the topics for this section. We will show you how to follow the DASH diet.
4 Start the DASH (cont.) Increase Fruit and Vegetable Consumption Consume More LegumesIncrease Your Fiber IntakeReduce Your Fat IntakeContinued – what is covered in the Start the DASH section. You will see that you have to concentrate on eating MORE of the right foods.
5 Recommended Servings From the Various Food Groups for DASH* Food Group: Daily Servings:Whole grains, (ounce) 6Vegetables, (half cup) 3-4Fruits, (half cup) 4Lowfat/nonfat milk, (cup) 2-3Lean meats, fish, poultry, (ounce) 3-6Nuts, seeds, dry beans 3 per weekOils (tsp) 2Sweets, added sugars 0These serving recommendations are consistent with a caloric intake of about 1600 calories. That is a close estimate for the amount of calories necessary for an adult male who wants to lose weight or an adult female who is active and does not need to lose weight. If you have a different caloric requirement you will need to adjust your servings. There is a chart in your handouts which will help you do that.Also, refer to the chart in your handout for appropriate serving sizes in each category. THIS IS VERY IMPORTANT. 7-8 grains a day may seem like a lot but most people eat double the serving size of cereal; 1 bagel for example would count for 2 grain servingsSpeaker: USE FOOD MODELS HERE TO SHOW APPROPRIATE PORTION SIZES or refer to the handout for serving sizes.*For 1,600 calories
6 Recommended Servings From the Various Food Groups for DASH* Food Group Daily ServingsGrains 6-8Vegetables 4-5Fruits 4-5Lowfat/nonfat dairy 2-3Meats, fish, poultry 6 oz or lessNuts, seeds, dry beans 4-5 per weekFats and oils 2-3Sweets 5 or less per weekThese serving recommendations are consistent with a caloric intake of about 2000 calories. That is a close estimate for the amount of calories necessary for an adult male who wants to lose weight or an adult female who is active and does not need to lose weight. If you have a different caloric requirement you will need to adjust your servings. There is a chart in your handouts which will help you do that.Also, refer to the chart in your handout for appropriate serving sizes in each category. THIS IS VERY IMPORTANT. 6-8 grains a day may seem like a lot but most people eat double the serving size of cereal; 1 bagel for example would count for 2 grain servingsSpeaker: USE FOOD MODELS HERE TO SHOW APPROPRIATE PORTION SIZES or refer to the handout for serving sizes.*For 2000 calories
7 Servings for a 2000 Calorie Diet: 7-8 servings Grains and Grain Products per day4-5 servings Vegetables per day4-5 servings Fruits per day2-3 servings Low fat or Nonfat Dairy Foods per day2 or fewer servings of Meats, Poultry and Fish per day (you should try to have 2 servings of fish per week)4-5 servings Nuts, Seeds and Legumes per week2-3 servings of added fatLess than 1 sweet per day (5 per week)The amount for sodium is the average between the 2400 mg sodium diet and the 1600 mg sodium diet. If someone has high blood pressure then they should keep the sodium to 1600 mg a day or less.
8 Lower SodiumThe DASH-Sodium trial found that reducing sodium from 3,300 to 1,500 mg on the American diet lowered blood pressure more than adopting the DASH diet without sodium reduction(6.7 mmHg) – BP lowered on American diet with 1500 mg sodium(5.9 mmHg) – BP lowered on DASH without sodium reduction
9 Lower SodiumLimit processed foods: canned, boxed, frozen meals; canned soups; boxed cereals; bread; deli meat; cheeseLimit “fast food” mealsLimit salt in cooking and at the tableuse more herbs and spices in cookinglimit use of condimentsCheck labels for sodium contentDo you think you don’t consume that much salt because you rarely use the salt shaker? Think again!! Only 10% of the salt consumed in the American diet comes from the salt shaker. Most of the sodium in the food you eat comes from processed foods and meals eaten away from home.
10 Lower Your Sodium Intake Tomato juice 820Cheese 600Ham 1020Bread 175Potato chips 155Cereal 300Pizza 1200Fresh vegetables 50Skim milk 120Roasted chicken 30Brown rice 10Baked potato 15Oatmeal 10Spaghetti* 390*with low-sodium sauceFresh and whole is always a better choice than processed foods. Look at the foods on the left and compare them to the foods on the right. Using fresh, whole foods that are minimally processed will always yield a lower sodium intake.
11 Compare Labels!It pays to compare labels when you are shopping. Look at these two examples. On the left is a label from a can of ordinary tomato sauce. The sodium is 370 mg. But on the right is a label from a can of tomato sauce that does not contain added salt. The sodium is only 15mg.If the sodium from a product has a daily value of 5% or less, that product is considered to be low in sodium. Another good way to see if a product is low in sodium is to compare the amount of sodium per calorie.
12 Increase Your Potassium High intakes of potassium have been shown to lower blood pressureThe DASH diet contains about 4,700 mg potassiumThe average American diet contains about 3,000 mgThe average American diet contains more sodium than potassium. As you can see by these figures, the average American needs to consume one and a half times the amount of potassium that he or she is currently consuming. The following slide will show you were to get it!
13 Food Sources of Potassium Fruits, especially bananas, oranges and prunesVegetables, especially potatoes, broccoli, peas and spinachDried beansNutsWhole grainsThese were all key foods on the DASH diet.
14 Increase Your Magnesium High intakes of magnesium have been shown to lower blood pressureThe DASH diet contains about 500 mg magnesiumThe average American diet contains about mgThe average American is also low on magnesium consumption – it looks like we have to double or even triple our consumption of this important mineral!
15 Food Sources of Magnesium NutsSeedsSeafoodLegumes (beans and peas)Dark green leafy vegetablesWhole grain breads and cerealsChocolateYou can see that many of the foods that are good sources of magnesium were also good sources of potassium. These foods were all key foods on the DASH study. Everyone will love the last choice here on this slide!
16 Calcium and Blood Pressure Diets low in calcium have been associated with high blood pressureThe DASH diet contains about 1,240 mg calciumThe average American eats about mg of calcium per dayAs you can see, we need to increase calcium by about 50%.
17 Calcium and Blood Pressure Read food labels to determine how much calcium you are gettingThe label pictured here shows 40% daily value or 400 mg of calciumYou will usually get 300 mg of calcium from foods that you eat. The rest must come from sources that are high in calcium such as skim milk, yogurt, cheese, dark leafy greens, calcium-fortified grains, fortified orange juice and fortified soy products.
18 Increase Your CalciumMake it a goal to eat a lowfat, high-calcium dairy food two to three times a dayIf dairy does not agree with you try lactase tablets, or buy lactose-free productsThere are several calcium-fortified soyfoods including: soymilk, tofu and soy cheeseDairy- use lowfat or nonfat products at meals or snacks; drink skim milk, lowfat cheese and crackers for a snack; lowfat yogurt as a dessert or snack (frozen yogurt does not really have a lot of calcium in it).You have a list of good food sources of calcium in your handouts.The label shown in the picture is for Skim Plus milk. This is skim milk with added calcium – it contains 40% of the daily value which is equal to 400 mg of calcium. For comparison purposes, skim milk contains 30% of the daily value or 300 mg.
19 Food Sources of Calcium Skim milkNonfat yogurtFat-free ricottaSalmon and sardines with bonesBroccoliKaleBok choyDried beansLowfat puddingTurnip greensCalcium fortified foods such as orange juice, cereal, soymilkAlmondsTofu with calciumOn DASH need 2 servings per day – we have listed non-fat dairy since these contain the least amount of saturated fat. Cheese is also a good source of calcium but it is high in sodium and saturated fat.
20 Increase Fruit and Vegetable Consumption Plan a minimum of three meals per dayAt each meal have 1 fruit servingHave 2 vegetables at lunch and 2-3 at dinnerPlan 1-2 fruit servings for snacksTry dried fruits mixed with nuts and seedsIn order to DASH you have to EAT!Buy little cans of fruit for packed lunchesUse fruit with a meal as a salad or dessertUse fresh and frozen vegetables or unsalted cannedUse raw vegetables and dip with a meal or a snackKeep vegetables cut up in the refrigeratorStock up on produce in the grocery store and buy less meat
21 Consume More Legumes Try bean, pea or lentil soup for lunch Replace meat in casseroles, pasta dishes and stir-fry dishes with beansAdd beans to your salad; eat baked beansUse nuts for snacks; add them to salads and casserolesSprinkle seeds on bread, cereal and saladSome examples of vegetarian meals. You have the recipes in your packet. There are many excellent vegetarian cookbooks available. Vegetarian cookbooks are great because they usually use
22 Fiber and Blood Pressure High fiber diets have been shown to lower blood pressureA high-fiber diet will help you control your weightThe DASH diet contains on average, grams of fiber per dayThe average American eats grams of fiber per dayThe DASH diet contains plenty of fiber. Current recommendations are g of fiber per day. Most Americans need to DOUBLE or TRIPLE their fiber consumption. The key DASH foods will help you do this.
23 DASH Daily Fiber Report Food group Servings Fiber(g)GrainsVegetablesFruitsNuts, beans, seeds 4-5 per week 3-8Total 23-59These are all foods on the DASH diet! You can see that the DASH diet is adequate in fiber.
24 Increase Your FiberUse whole grains rather than foods made with white flourLook for the word whole in the ingredient listCompare the fiber content on grains and cerealsEnriched wheat flour is the same as white flourTry whole wheat pastasTry brown rice instead of whiteMany times whole grains will have more fat than white flour counterparts. That’s OK, it is the fat from the grain- a healthy type of fatWheat bread and crackers do not mean whole wheat. You have to look for products that state made from whole grains or 100% whole wheat. Read the ingredients – a whole grain should be listed first. FDA law currently states that if a product claims made from whole grains it has to contain at least 51% whole grain products.Rye bread is not necessarily a whole grain because rye bread is made mostly from white flour.Also experiment with other grains such as amaranth, bulgur, grahamSee the handout on whole grains.
25 BranGermThis is a rough diagram of a whole kernel of wheat. The white signifies the endosperm which is used to make white flour. The germ and the bran are left off. These both contain important minerals and fiber – this is why you should always choose 100% whole grain products.Endosperm
26 Reduce Your Fat Intake The DASH diet contained 27% of calories as fat in foods (meats, dairy and grains and mixed dish recipes)added to foods (approximately 2.5 servings per day of added fats, oils, and salad dressing)To maintain fat intake at roughly the same level as the DASH diet, we recommend not exceeding 2-3 servings daily of added fat such as margarine or mayonnaiseThe DASH diet contained 27% of calories as fat. The fat in this diet was present both in foods (meats, dairy and grains and mixed dish recipes) and added to foods (approximately 2.5 servings per day of added fats, oils, and salad dressing). To maintain fat intake at roughly the same level as the DASH diet, we recommend not exceeding 2-3 servings daily of added fat such as margarine or mayonnaise. Amounts in parentheses are considered one serving.soft margarine or butter (1 teaspoon)regular mayonnaise (1 teaspoon) or low fat mayonnaise (1 tablespoon)salad dressing (1 tablespoon) or light salad dressing (2 tablespoons)1 teaspoon oil (olive, corn, canola, safflower or other vegetable oils)
27 Reduce Your Fat IntakeReduce the amount of butter, margarine and salad dressing you useTry lowfat or fat-free versions of high fat items such as margarine, dairy or meat productsLimit “fast food” eating and snackingCheck food labels for fat contentBake, broil, poach, grill or roast rather than fryBe careful not to get carried away with fat free foods- they still have calories!
28 Eat Less Saturated FatBuy less meat and choose leaner cuts or white poultry without the skinChoose fish a couple times a weekLimit any animal protein to the size of a deck of cards (3-4 ounces)Include two or more vegetarian meals each weekYou have a handout with the lower fat cuts of meatGradually cut down the portion of meat you eatTry some new fish recipes and experiment with different types of fish
29 Eat Less Saturated Fat Use lowfat or nonfat dairy products When adding fat choose olive or canola oils; liquid or soft margarinesLimit rich desserts and chocolateRead labelsWhile meat is a significant source of saturated fat, it is also found in other places. Here are tips to help you avoid hidden saturated fats.
30 Eat Less Trans FatRead labels – limit or avoid foods that are made with partially hydrogenated oils:CrackersCookiesShorteningCandyFried foodsAvoid full fat dairy products and fatty meatsTrans fatty acids, also known as trans fat, are made during partial hydrogenation of vegetable oils. Usually the hydrogen atoms at a double bond are positioned on the same side of the carbon chain. However, partial hydrogenation reconfigures some double bonds and the hydrogens end up on different sides of the chain. This type of configuration is called "trans" (means "across" in Latin).Trans fatty acids are also found in the milk and meat of ruminant animals: cattle, goats, sheep.The new trans fat label is shown – this may be put into effect soon by the FDA. The trans fat will have to be listed with saturated fat instead of total fat as it is now.
31 Limit Consumption of Sweets The DASH diet contained, on average, less than one serving per day of sweets or about 5 servings per weekMost of the sweets were low in fat:Maple syrup, sugarJello®Jam, jelly, marmaladeJelly beans, hard candiesSorbet, sherbet, popsicle, frozen yogurtAmounts in parentheses are considered one serving.maple syrup (1 tablespoon)sugar (1 tablespoon)jelly or jam (1 tablespoon)Jello (1/2 cup)jelly beans (1/2 oz.)sugared lemonade or fruit punch (8 fl. oz.)hard candies (3 pieces)sherbet (1/2 cup)popsicle (1)low fat or nonfat frozen yogurt (1/2 cup)
32 Appendix Other Risk Factors for Hypertension The Role of Caffeine The Role of StressThe Effects of Stress on the BodyDrugs That Can Raise Blood PressureWe will discuss other factors of blood pressure here
33 Other Risk Factors for Hypertension SmokingDrinkingSedentary lifestyleBeing overweightespecially if you carry your weight around the middleDRINKING:According to the researchers, in 72 percent of hypertensive subjects, alcohol abstention resulted in blood pressure falling to normal levels.On average, the men's systolic blood pressure (the first number in a blood pressure reading) dropped an average of 7.2 mm Hg, while their diastolic pressure (the second number) declined by 6.6 mm Hg, after they gave up alcohol. Heart rate also dropped significantly during the 1-month program, by an average of 7.9 beats per minute.Men who were considered hypertensive at the start of the study appeared to derive greater benefit from alcohol abstention than did men with normal blood pressure readings. Among hypertensives, systolic and diastolic blood pressure dropped an average of 12.2 and 10.6 mm Hg, respectively, according to the authors."These results show that heavy alcohol consumption has an important effect on blood pressure," the Spanish researchers conclude. They add that the findings "strengthen the recommendation of alcohol- intake reduction as a priority for those patients with essential hypertension who are usual alcohol drinkers.” Source: Hypertension 1999;33: ,NOT EXERCISING:Blood flow is also affected by exercise through the production of nitrous oxide in the blood stream. When muscle tissue requires additional nutrients, it produces nitrous oxide to signal the blood vessels to dilate, which then allows more blood (and nutrients) to flow to the muscles. This reaction takes place during exercise, but has a lasting effect on the body. Even after exercise is completed, blood vessels may remain dilated, with greater blood flow, throughout the day. This naturally increased dilation will cause a reduction in blood pressure level, and can also provide relief for patients with weaker hearts, as less strain is put on the heart muscle. Thickened hearts have been associated with an increased risk of arrythmia and sudden death, and have traditionally been treated with dilating medications; an exercise routine seems to provide that benefit, naturally.
34 The Role of CaffeineHeavy coffee consumption may trigger a rise in blood pressureThe effect is more pronounced in younger peopleEach cup of coffee consumed per day increased systolic and diastolic blood pressure by 0.8 and 0.4 mm Hg, respectivelyIn the second study, an international team of researchers led by Dr. Michael J. Klag of Johns Hopkins University in Baltimore, Maryland, report that chronic, heavy coffee consumption may also trigger a rise in blood pressure.Klag and colleagues conducted a detailed review of 11 studies of coffee consumption. In total, these studies involved more than 500 participants consuming an average of five cups of coffee per day over almost 2 months.The investigators found that, "on average, coffee drinking was associated with a 2.4 mm Hg higher systolic blood pressure and 1.2 mm Hg higher diastolic blood pressure." They calculate that each cup of coffee consumed per day increased systolic and diastolic blood pressure by 0.8 and 0.4 mm Hg, respectively.The team also note that the effect of coffee on blood pressure was more pronounced in younger people.These "findings provide support for a relationship between coffee intake and higher blood pressure," the study authors conclude. They call for more research on the coffee-blood pressure connection, especially in people who already have high blood pressure, in smokers, and in people who experience stress.Source: Hypertension 1999;33: ,Hypertension 1999; 33: ,
35 The Role of StressThere is no definitive proof that ongoing stress is a cause of hypertensionFeeling tense or angry causes a transient rise in blood pressureFeeling tense or angry causes a transient rise in BPSuppressed or buried feelings may be more tied to hypertension alpha and beta blockers affect the sympathetic nervous system and would be good for someone under a lot of emotional stressJ. Psychosom Res 1998; 45:
36 The Effects of Stress on the Body Increased oxygen demand equals increased heart rate and blood pressureIncreased stickiness of plateletsIncreased mobilization of triglycerides and LDLLowered threshold for disturbances in cardiac rhythmActivation of macrophage cells from the immune systemStress can have a profound effect on your cardiovascular system – especially over a long period of time.
37 Drugs That Can Raise Blood Pressure Oral contraceptivesSteroidsNSAIDSNasal decongestantsAppetite suppressantsCyclosporineSome antidepressantsOral contraceptives- hypertension 2-3 xs more common in women taking; risk increases with age; problem is aggravated by smoking; may also be true for menopausal women on HRTNSAIDS-nasal decongestants: contain ephedrine or phenylpropolamine, which increase BPappetite suppressants- also contain ephedrine or pseudoephedrineCyclosporine: used for transplantpatients, causes vasoconstriction and salt-retention
38 Putting It In Action Take Small Steps BreakfastLunchDinnerDessert/SnacksAchieving and Maintaining Behavior ChangeThis section will offer tips on making DASH work for you.
39 Take Small StepsThis diet is higher in fruits and vegetables than the typical American dietIt is much higher in fiberAdd high-fiber foods graduallyDrink lots of waterSmall changes are more likely to become permanentThis diet is higher in fruits and vegetables than the typical American diet so it is also higher in fiber. This can cause gas and bloating, so add foods gradually and drink lots of waterResearch shows that small changes are nore likely to result in PERMANENT behavior changes than trying to do it all at once
40 Breakfast Choose oatmeal or whole grain cereal Read labels to find low-sodium cereal – many packaged cereals are high in sodiumInclude fruitInclude high-calcium dairy product like yogurt or skim milkBreakfast is an excellent opportunity to add whole grains, dairy and fruit to your diet. Missing breakfast is a big nutritional mistake – if you are in a hurry you can experiment with
41 Lunch Large salad Soup or stir fry dish with veggies Use oil & vinegar to reduce sodiumLots of veggiesNuts and seeds, tooSoup or stir fry dish with veggiesLimit deli sandwiches – bread, cheese, condiments and deli meats are high in sodiumConsider low-sodium tuna, fresh roasted/baked chicken, lean meat or baked/grilled fishLunch should include 2 servings of grains and 2 servings of vegetables. It may include protein such as meat, fish or chicken, nuts, seeds, beans, lowfat dairy ors fruit too.
42 Dinner Include vegetables Large salad Use oil and vinegar to reduce sodiumLots of veggiesNuts and seeds tooVegetarian entrée: pasta, stir fry, soup, chiliConsider low-sodium tuna, fresh roasted/baked chicken, lean meat or fishDinner should include 2-3 servings of grains and at least 2 servings of vegetables. It may also include a lean protein, beans, nuts, seeds, lowfat dairy or fruit.
43 Snack or Dessert Fruit or vegetables 100% whole grain bread Nut butter Nonfat yogurtUse skim milk for smoothieLight use of nutsSnacks and desserts should include lowfat dairy, whole grains, fruit, vegetables and or nuts. Concentrate on putting enough of the DASH foods into your diet – make snacks and desserts count. Remember, on the DASH diet, sweets were limited to 5 or less per week. When you fill up on sweets and other refined foods, you limit the room you have for the DASH foods.
44 Achieving and Maintaining Behavior Change Break the process into small stepsWrite things downIf you slip, ask yourself why you got off trackSee if you tried to do too much too fastDon’t worry about a slipMaking a major change in your diet is not easy. Work on getting each meal more healthful. For example, work on breakfast for a week, then shift to lunches and finally dinner. Another way to approach this change is to work on each section of the DASH pyramid. For example, work one week on getting enough fruits and vegetables then shift to leaner protein and finally get used to having lowfat dairy products. Wean yourself off sweets and processed snack foods slowly.
45 “Flaming enthusiasm, backed by horse sense and persistence, is the quality that most frequently makes for success.” – Dale CarnegieDale Carnegie has a great saying that will help you with your success. You need enthusiasm, common sense and persistence.
46 Dietary Approaches to Stop Hypertension Make the DASH to better health!! Thank you for watching our show. In the next slide you will see a summary of what we just covered and I will answer questions.
47 Questions and Answers Start the DASH Appendix Putting It In Action Speaker – here is an overview of what you just covered. Now is the time to accept questions on your presentation.Introduction to hypertension – we will give you the basic information about hypertension and high blood pressureDASH Details – here we will examine the details of the 2 DASH studiesStart the DASH – you will learn how to eat the DASH dietAppendix – here is more information on diet and lifestyle with regards to hypertension and blood pressurePutting it in action – you will gain valuable success tips for changing your diet and lifestyle