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

Potassium

0

1000

2000

3000

4000

5000

AverageAmerican

Diet

DASH Diet

Potassium

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

0

100

200

300

400

500

600

AverageAmerican Diet

DASH Diet

Magnesium

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

0

200

400

600

800

1000

1200

1400

AverageAmerican Diet

DASH Diet

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

05

10152025303540

Average AmericanDiet

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