Dietary Approaches to Stop Hypertension
Dietary
Approaches to
Stop
Hypertension
Start the DASH
• Recommended Servings From the Various Food Groups for DASH
• Lower Your Sodium• Increase Your Potassium• Increase Your Magnesium• Increase Your Calcium
Start the DASH (cont.)
• Increase Fruit and Vegetable Consumption
• Consume More Legumes• Increase Your Fiber Intake• Reduce Your Fat Intake
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 0
*For 1,600 calories
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 week
*For 2000 calories
Lower Sodium
• The 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
Lower Sodium
• Limit processed foods: canned, boxed, frozen meals; canned soups; boxed cereals; bread; deli meat; cheese
• Limit “fast food” meals• Limit salt in cooking and at the table– use more herbs and spices in cooking
– limit use of condiments
• Check labels for sodium content
Lower Your Sodium Intake
Tomato juice 820Cheese 600Ham 1020Bread 175Potato chips 155Cereal 300Pizza 1200
Fresh vegetables50
Skim milk 120Roasted chicken30Brown rice 10Baked potato 15Oatmeal 10Spaghetti* 390
*with low-sodium sauce
Compare Labels!
Increase Your Potassium
• High intakes of potassium have been shown to lower blood pressure
• The DASH diet contains about 4,700 mg potassium
• The average American diet contains about 3,000 mg
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Food Sources of Potassium
• Fruits, especially bananas, oranges and prunes
• Vegetables, especially potatoes, broccoli, peas and spinach
• Dried beans• Nuts• Whole grains
Increase Your Magnesium
• High intakes of magnesium have been shown to lower blood pressure
• The DASH diet contains about 500 mg magnesium
• The average American diet contains about 180-230 mg
Magnesium
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Food Sources of Magnesium
• Nuts• Seeds• Seafood• Legumes (beans and peas)
• Dark green leafy vegetables
• Whole grain breads and cereals
• Chocolate
Calcium and Blood Pressure
• Diets low in calcium have been associated with high blood pressure
• The DASH diet contains about 1,240 mg calcium
• The average American eats about 700-800 mg of calcium per day
Calcium
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Calcium
Calcium and Blood Pressure
• Read food labels to determine how much calcium you aregetting
• The label pictured here shows 40% daily value or 400 mg of calcium
Increase Your Calcium
• Make it a goal to eat a lowfat, high-calcium dairy food two to three times a day– If dairy does not agree with you try lactase tablets, or buy lactose-free products
– There are several calcium-fortified soyfoods including: soymilk, tofu and soy cheese
Food Sources of Calcium
• Skim milk• Nonfat yogurt• Fat-free ricotta• Salmon and sardines with bones
• Broccoli• Kale• Bok choy
• Dried beans• Lowfat pudding• Turnip greens• Calcium fortified foods such as orange juice, cereal, soymilk
• Almonds• Tofu with calcium
Increase Fruit and Vegetable Consumption
• Plan a minimum of three meals per day– At each meal have 1 fruit serving– Have 2 vegetables at lunch and 2-3 at dinner
• Plan 1-2 fruit servings for snacks– Try dried fruits mixed with nuts and seeds
Consume More Legumes
• Try bean, pea or lentil soup for lunch• Replace meat in casseroles, pasta dishes and stir-fry dishes with beans
• Add beans to your salad; eat baked beans
• Use nuts for snacks; add them to salads and casseroles
• Sprinkle seeds on bread, cereal and salad
Fiber and Blood Pressure
• High fiber diets have been shown to lower blood pressure
• A high-fiber diet will help you control your weight
• The DASH diet contains on average, 30-40 grams of fiber per day
• The average American eats 10-15 grams of fiber per day
Fiber
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DASH Diet
Fiber
DASH Daily Fiber Report
Food group Servings Fiber(g)Grains 7-8 14-24Vegetables 4-5 8-15Fruits 4-5 8-12Nuts, beans, seeds4-5 per week 3-8
Total 23-59
Increase Your Fiber
• Use whole grains rather than foods made with white flour– Look for the word whole in the ingredient list
– Compare the fiber content on grains and cereals
– Enriched wheat flour is the same as white flour
– Try whole wheat pastas– Try brown rice instead of white
Bran
Endosperm
Germ
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 mayonnaise
Reduce Your Fat Intake
• Reduce the amount of butter, margarine and salad dressing you use
• Try lowfat or fat-free versions of high fat items such as margarine, dairy or meat products
• Limit “fast food” eating and snacking
• Check food labels for fat content• Bake, broil, poach, grill or roast rather than fry
Eat Less Saturated Fat
• Buy less meat and choose leaner cuts or white poultry without the skin
• Choose fish a couple times a week
• Limit any animal protein to the size of a deck of cards (3-4 ounces)
• Include two or more vegetarian meals each week
Eat Less Saturated Fat
• Use lowfat or nonfat dairy products
• When adding fat choose olive or canola oils; liquid or soft margarines
• Limit rich desserts and chocolate
• Read labels
Eat Less Trans Fat
• Read labels – limit or avoid foods that are made with partially hydrogenated oils:– Crackers– Cookies– Shortening– Candy– Fried foods
• Avoid full fat dairy products and fatty meats
Limit Consumption of Sweets
• The DASH diet contained, on average, less than one serving per day of sweets or about 5 servings per week
• Most of the sweets were low in fat:– Maple syrup, sugar
– Jello®
– Jam, jelly, marmalade
– Jelly beans, hard candies
– Sorbet, sherbet, popsicle, frozen yogurt
Appendix
• Other Risk Factors for Hypertension
• The Role of Caffeine• The Role of Stress• The Effects of Stress on the Body
• Drugs That Can Raise Blood Pressure
Other Risk Factors for Hypertension
• Smoking• Drinking• Sedentary lifestyle
• Being overweight– especially if you carry your weight around the middle
The Role of Caffeine
• Heavy coffee consumption may trigger a rise in blood pressure– The effect is more pronounced in younger people
– Each cup of coffee consumed per day increased systolic and diastolic blood pressure by 0.8 and 0.4 mm Hg, respectively
Hypertension 1999; 33:647-652, 653-657
The Role of Stress
• There is no definitive proof that ongoing stress is a cause of hypertension
• Feeling tense or angry causes a transient rise in blood pressure
J. Psychosom Res 1998; 45:139-148
The Effects of Stress on the Body
• Increased oxygen demand equals increased heart rate and blood pressure
• Increased stickiness of platelets
• Increased mobilization of triglycerides and LDL
• Lowered threshold for disturbances in cardiac rhythm
• Activation of macrophage cells from the immune system
Drugs That Can Raise Blood Pressure
• Oral contraceptives• Steroids• NSAIDS• Nasal decongestants• Appetite suppressants• Cyclosporine• Some antidepressants
Putting It In Action
• Take Small Steps– Breakfast– Lunch – Dinner– Dessert/Snacks
• Achieving and Maintaining Behavior Change
Take Small Steps• This diet is higher in fruits and vegetables than the typical American diet
• It is much higher in fiber• Add high-fiber foods gradually
• Drink lots of water• Small changes are more likely to become permanent
Breakfast
• Choose oatmeal or whole grain cereal
• Read labels to find low-sodium cereal – many packaged cereals are high in sodium
• Include fruit• Include high-calcium dairy product like yogurt or skim milk
Lunch• Large salad
– Use oil & vinegar to reduce sodium– Lots of veggies– Nuts and seeds, too
• Soup or stir fry dish with veggies
• Limit deli sandwiches – bread, cheese, condiments and deli meats are high in sodium
• Consider low-sodium tuna, fresh roasted/baked chicken, lean meat or baked/grilled fish
Dinner
• Include vegetables• Large salad
– Use oil and vinegar to reduce sodium
– Lots of veggies– Nuts and seeds too
• Vegetarian entrée: pasta, stir fry, soup, chili
• Consider low-sodium tuna, fresh roasted/baked chicken, lean meat or fish
Snack or Dessert
• Fruit or vegetables• 100% whole grain bread
• Nut butter• Nonfat yogurt• Use skim milk for smoothie
• Light use of nuts
Achieving and Maintaining Behavior
Change• Break the process into small steps
• Write things down• If you slip, ask yourself why you got off track– See if you tried to do too much too fast
– Don’t worry about a slip
“Flaming enthusiasm, backed by horse sense and persistence, is the quality that most frequently makes for success.”
– Dale Carnegie
Dietary Approaches to Stop Hypertension
Questions and Answers
• Start the DASH• Appendix• Putting It In Action
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