Transcript Do you DASH? - J.W. Terrill

Do you DASH?
Blood Pressure Awareness
Lunch ‘n’ Learn
J.W. Terrill
Presented by Delaney Lundeen
Saint Louis University Dietetic Intern
Pre-Quiz
1. I know my blood pressure
T/F
2. 1 out of 3 Americans suffers with high blood
pressure.
3. The normal range for blood pressure is
considered 120/80.
4. A high blood pressure reading is considered
hypotension.
T/F
5. Managing weight, reducing sodium intake, and
exercise can help reduce high BP.
T/F
6. Sea salt has less sodium than table salt T/F
7. 1 tsp. of salt= 2,300 mg of sodium
Objectives
• Understand high blood pressure (BP) and the
consequences
• Determine causes of high BP
• Determine lifestyle changes that can
improve high BP
• Understand the DASH diet
What is blood pressure?
• Blood pressure is the “force of blood against
your artery walls as it circulates through your
body. Blood pressure normally rises and falls
throughout the day, but it can cause health
problems if it stays high for a long time.”
-Center for Disease Control
What Do These Numbers Mean?
140/90 mmHg
Systolic (upper): This is the amount of pressure it takes for the
heart to squeeze blood to the body.
Diastolic (lower): This is the amount of pressure when the heart
is relaxed and filling with blood.
Normal and Elevated Values
Top Number
(Systolic)
Bottom Number
(Diastolic)
Your Category
What to do
Below 120
Below 80
Normal blood
pressure
Good for you!
120-139
80-89
Pre-hypertension
Main/adopt a
healthy lifestyle.
140-159
90-99
Stage 1
Hypertension
Your BP could be a
problem. Make
changes. If you
also have diabetes,
see your doctor.
160 or more
100 or more
Stage 2
Hypertension
You have high BP.
Talk to doctor or
nurse about how to
control it.
www.mayoclinic.com/health/blood-pressure/HI00043
• heartbeats.
Two Types of Hypertension
Primary or Essential
• No cause is
identified
Secondary
• High blood
pressure that is
caused by another
medical condition
or medication
Why does High Blood Pressure
Matter?
• 1 out of 3 American adults affected
– 65 million people
• The heart works too hard
• High BP increases the risk for heart disease
and stroke
• Oftentimes, there are no warning symptoms
– “The silent killer”
Influencing Factors
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Race
Gender
Obesity/Physical Inactivity
Drinking alcohol
Family history of high blood pressure
Smoking
Having Diabetes
Consuming excessive amounts of salt in your diet
Sodium Intake
• The 2010 Dietary Guidelines for Americans
recommend limiting sodium to less than 2,300
milligrams (mg) per day.
• 1,500 mg for certain individuals
• The average daily sodium intake for
Americans age 2 years and older is more than
3,400 mg.
--Center for Disease Control
Daily Sodium Intake Over 1,500 mg
Linked to Higher Stroke Risk
• AHA recommends sodium maximum of 1,500
mg vs. USDA’s 2300 mg
• 2657 participants of Northern Manhattan
Study over 10 years
• 88% consumed more than AHA recommended
• 235 strokes occurred
• Highest sodium consumption associated with
higher risk for stroke
Beneficial for All
• “Our study supports the
importance of reducing sodium
consumption (to a maximum of
1,500 mg a day) for most
Americans.”
• http://www.foodnavigator-usa.com/content/view/print/630909
Culprits…
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Frozen dinners
Ready-to-eat cereals
Canned vegetables
Packaged deli meats
Canned soups
Spaghetti sauce
Nuts
Obvious Offenders
• Cheese puffs=240 mg
• Pretzels= 385 mg
• Doritos= 180 mg
In a one ounce bag
What’s in A Name
Monosodium glutamate (MSG)
Used in home, restaurant and hotel cooking and in many packaged, canned and frozen
foods as a seasoning.
Baking soda (sodium bicarbonate)
Sometimes used to leaven breads and cakes; sometimes added to vegetables in
cooking; used as alkalizer for indigestion. 1 teaspoon of baking soda = 1,000 mg
sodium
Baking powder: Used to leaven quick breads and cakes.
Disodium phosphate: Found in some quick-cooking cereals and processed cheeses.
Sodium alginate: Used in many chocolate milks and ice creams to make a smooth
mixture.
Sodium benzoate: Used as a preservative in many condiments such as relishes, sauces
and salad dressings.
Sodium hydroxide: Used in food processing to soften and loosen skins of ripe olives
and certain fruits and vegetables.
Sodium nitrite: Used in cured meats and sausages.
Sodium propionate: Used in pasteurized cheese and in some breads and cakes to
inhibit growth of molds.
Sodium sulfite: Used to bleach certain fruits such as maraschino cherries and glazed
or crystallized fruits that are to be artificially colored; also used as a preservative in
some dried fruits such as prunes.
Sodium is Everywhere!
Source: Mattes, RD, Donnelly, D. Relative contributions of dietary sodium sources.
Journal of the American College of Nutrition 1991;10(4):383–393.
Don’t fret! The good news is…
We can take control!
• Dietary Approach to Stop Hypertension
(DASH)
• Rich in fruits, vegetables, whole grains, fish,
poultry, nuts, and legumes, and low-fat dairy.
• High in key nutrients
…What are the key differences between the
“typical American diet” and the DASH diet?
Interesting…
DASH Approach
MyPlate
DASH Diet
• Recommended by Healthy People 2010 as a
“shining example” of a healthy diet.
• Used with other lifestyle changes
– Achieve and maintain a healthy weight
– Engage in physical activity
– No hard to follow recipes or rules
• This diet can be as effective as medication
DASH Diet Based on Research
• “Effects on blood pressure of reduced dietary
sodium and the DASH diet.”
• Conclusion: The reduction of sodium intake
from the high to the intermediate level
reduced systolic BP by 2.1 mmHg.
• Reducing the sodium from intermediate to
low caused a reduction of 4.6 mmHG
• DASH + low sodium= 11.5 mmHg reduction!
http://www.ncbi.nlm.nih.gov/pubmed/11136953
Tips for Getting Started
• Who should follow this diet?
– Any adult who wants to eat healthier
– Specifically those at risk for high BP
• It’s easy to adopt!
– No expensive products
– Not time consuming
• Start gradually
– Family and friends can participate
Overview
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Whole grains (6 to 8 servings a day)
Vegetables (4 to 5 servings a day)
Fruits (4 to 5 servings a day)
Low-fat or fat-free milk and milk products (2 to 3
servings a day)
Lean meats, poultry and fish (2 servings a day)
Nuts, seeds and beans (4 to 5 servings a week)
Fats and oils (2 to 3 servings a day)
Sodium (no more than 2,300 mg a day)
What is a Serving?
SERVING SIZES
Food/amount
1/2 cup cooked rice or pasta
1 slice bread
1 cup raw vegetables or fruit
1/2 cup cooked vegetables or fruit
8oz. of milk
1 teaspoon olive oil
3 ounces cooked meat
3 ounces tofu
Starting Gradually
• Treat meat as one part of the whole meal,
instead of the focus
– Limit meat to 6 oz day (2 servings)
– Cut back on meat gradually—by ½ or 1/3
• Start increasing your use of fat free and lowfat
dairy products to 3 servings per day.
– i.e.: try milk with lunch or dinner
– Choose 1% or skim
…Continued
• Increase your consumption of fruits and
vegetables
• Choose whole wheat bread or whole grain
cereals
– Key: to replace refined products (like white bread,
white rice)
Sample DASH Diet Menus
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Breakfast
3/4 cup bran flakes cereal:
1 medium banana
1 cup low-fat milk
1 slice whole wheat bread:
1 tsp soft (tub) margarine
1 cup orange juice
Sodium
220 mg
1 mg
107 mg
149 mg
26 mg
5 mg
Lunch Menu
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Lunch
3/4 cup chicken salad
2 slices whole wheat bread
1 Tbsp Dijon mustard
salad:
1/2 cup fresh cucumber slices
1/2 cup tomato wedges
1 Tbsp sunflower seeds
1 tsp Italian dressing, low calorie
1/2 cup fruit cocktail, juice pack:
Sodium
179 mg
299 mg
373 mg
1 mg
5 mg
0 mg
43 mg
5 mg
Dinner Menu
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Dinner
3 oz beef, eye of the round:
2 Tbsp beef gravy, fat-free
1 cup green beans, sautéed with:
1/2 tsp canola oil
1 small baked potato:
1 Tbsp sour cream, fat-free
1 Tbsp grated natural cheddar
cheese, reduced fat
1 Tbsp chopped scallions
1 small whole wheat roll:
1 tsp soft (tub) margarine
1 small apple
1 cup low-fat milk
Sodium
35 mg
165 mg
12 mg
0 mg
14 mg
21 mg
67 mg
1 mg
148 mg
26 mg
1 mg
107 mg
Snacks
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Snacks
1/3 cup almonds, unsalted
1/4 cup raisins
1/2 cup fruit yogurt, fat-free,
no sugar added
0 mg
4 mg
86 mg
Total for the 3 meals= 2,101 mg Sodium
The Good Guys
Potassium:
• Counters salt’s ability to raise blood pressure
• Reduces the risk of developing kidney stones
• Decreases bone loss
• Recommended 4,700 mg from food
• Not from supplements!
Calcium:
• Maintains strong bones
• Helps blood vessels and muscles function properly
Fiber:
• Helps promote good digestion
“My doctor noticed my blood pressure
was a little high. I try to be more aware of
the foods I eat. I limit alcohol, and watch
my portions. I also work out 5–7 days a
week. My son is learning from me and is
doing the same things I do.”
RICARDO ELEY
http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf
Tips for Lowering Sodium
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Cooking at home vs. going out to eat
Having sauces and condiments on the side
Purchase fresh poultry, fish, and lean meat
Choose low or reduced-sodium versions of
foods
– This is good, but don’t be fooled!
• Key message: if you can lower sodium, you
can lower BP!
Soy Sauce
Regular
Low Sodium
Phrase
What it Means
Sodium free or salt free
Very low sodium
Low sodium
Low sodium meal
Reduced or less sodium
Less than 5 mg per serving
35 mg or less of sodium per serving
140 mg or less of sodium per serving
140 mg or less of sodium per 3.5 oz (100 g)
At least 25 percent less sodium than the
regular version
50 percent less sodium than the regular
version
No salt added to the product during
Light in sodium
Unsalted or no salt added
processing
http://www.wellnessproposals.com/nutrition/handouts/dash-diet/DASHdiet-eating-plan.pdf
Seasoning Tips
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Basil (meat)
Cinnamon (on fruits)
Curry Powder
Garlic (not garlic salt!)
Lemon juice
Nutmeg
Paprika
Parsley
Rosemary
Thyme
When Eating Out
• Ask how foods are prepared
– Ask for no added salt
• Move the salt shaker away
• Limit condiments
• These indicate higher sodium content:
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Pickled
Cured
Smoked
Soy Sauce
Broth
Oops…
• If you slip from the eating plan, get back on
track!
• Ask yourself WHY you got off track.
• Everyone slips when learning something new!
• Break the process down
• Write it down
• Celebrate success
Conclusion
• High BP is a “silent killer”
• Many consequences
• Reducing sodium intake + DASH diet makes
significant improvements
• DASH diet is easy-to-follow
• DASH diet is not “a diet for one disease.”
• It is a “diet for all diseases.”
• Make the DASH today! 
Resources
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American Heart Association
Center for Disease Control
National Heart Lung and Blood Institute
http://dashdiet.org/default.asp
http://www.nhlbi.nih.gov/health/public/heart
/hbp/dash/new_dash.pdf
Link to Recipes
• http://www.nhlbi.nih.gov/health/public/heart
/hbp/dash/new_dash.pdf
– Chicken Salad
– Vegetarian Spaghetti Sauce
– Vinaigrette Salad Dressing
– New Potato Salad
– Chicken and Spanish Rice
– Turkey Meatloaf and many more!