DIET GUIDE Following the recommended diet for Hypertension may aggravate other health conditions such as kidney disease. Please talk to your doctor before making any changes to your diet. Sources of Information: National Heart, Lung and Blood Institute, Your Guide to Lowering Blood Pressure National Cancer Institute PREMIER Research Study Participant Manual
Step By Step EATING RIGHT FEELING RIGHT LOWERING YOUR BLOOD PRESSURE What you eat affects your chances of getting high blood pressure. A healthy eating plan can both reduce the risk of developing high blood pressure and lowering a blood pressure that is already too high. Studies showed that blood pressure could be lowered by following a particular eating plan called the Dietary Approaches to Stop Hypertension (DASH) eating plan, and by reducing the amount of sodium consumed. Blood pressures are reduced with an eating plan that is low in saturated fat, cholesterol, and total fat, and that emphasizes fruits, vegetables, and low-fat dairy foods. The DASH eating plan also includes whole grain products, fish, poultry, and nuts. It has less red meat, sweets, and sugarcontaining beverages. It is rich in magnesium, potassium, and calcium, as well as protein and fiber. By following the DASH eating plan, blood pressure reductions can be evident within 2 weeks of starting the plan. 1
BLOOD PRESSURE HOME SUPPORT PROGRAM (DASH) DIET GUIDELINES 1. Eat a diet rich in fruits and vegetables Eat 8-10 servings of fruits and vegetables every day. 2. Eat a diet with low-fat dairy or fat free foods Eat 2-3 servings of low-fat or fat free dairy foods every day. 3. Eat a low-fat diet Eat 25% less of total calories from fat and 7% or less of total calories from saturated fat. This means about 30 grams of fat for women and 40 grams of fat for men. 4. Eat a low-sodium (salt) diet Eat no more than 2400 mg of sodium every day. Individuals with high blood pressure, blacks, and middle age to older individuals should not take in more than 1500 mg of sodium each day. 5. If you drink alcohol, limit your intake Women: Drink no more than 1 alcoholic drink per day. Men: Drink no more than 2 alcoholic drinks per day. (1 drink = 12 fl oz beer, 5 fl oz wine, or 1 jigger 80-proof liquor). 6. Keep records Record your food intake at least 3 days each week. 7. Potassium intake Eat foods that provide the recommended amount of potassium. (4700 mg /day) 8. Calcium and magnesium intake Eat foods that provide the recommended amount of Calcium: 19-50 yrs old 1000 mg/day 50+ yrs old - 1200 mg/day Magnesium: Males 19+ yrs old - 350 mg/day Females 19+ yrs old - 300 mg/day 2
MAKING SUCCESSFUL DIET CHANGES IN 3 EASY WAYS READ: This Diet Guide will help you understand the changes you can make and guide you in making and sticking by those changes. WRITE: Keeping a log or diary of what you are eating will help you to stay focused and on track. FOLLOW: It takes more than keeping a record of what you eat to stop bad habits. One way to begin is to set weekly goals for yourself. ARE YOU READY TO MAKE SOME CHANGES? YOU CAN DO IT! 3
WHAT IS A SERVING? The number of daily servings in a food group may vary from those listed, depending upon your caloric needs. Food Group Grains and grain products Daily Servings (Except as Noted) Serving Sizes 7-8 1 slice bread 1 cup ready-to eat cereal* ½ cup cooked rice, pasta, or cereal Vegetables 4-5 1 cup raw leafy vegetables ½ cup cooked vegetables 6 ounces vegetable juice Fruits 4-5 Milk, Yogurt, & Cheese 2-3 1 medium apple, banana, or orange ½ cup chopped, cooked, or canned fruit ¾ cup of fruit juice 8 ounces milk 1 cup yogurt 1 ½ ounces cheese (one ounce is about the size of your thumb) Lean meats, poultry, eggs, and fish Nuts, seeds, and dry beans 2 or less 3 ounces cooked, lean meat, skinless poultry, or fish (1 egg is equal to one ounce of lean meat) 4-5 per week 1 / 3 cup or 1 ½ ounces nuts 1 tablespoon or ½ ounce seeds ½ cup cooked dry beans Fats and oils^ 2-3 1 teaspoon soft margarine 1 tablespoon low-fat mayonnaise 2 tablespoons light salad dressing Sweets 5 per week 1 tablespoon sugar 1 tablespoon jelly or jam ½ ounce jelly beans 8 ounces lemonade * Serving sizes vary between ½ cup and 1¼ cup. Check the product s nutritional label. ^ Fat content changes serving counts for fats and oils: For example, 1 tablespoon of regular salad dressing equals 1 serving, 1 tablespoon of low fat dressing equals ½ serving, and 1 tablespoon of fat free salad dressing equals 0 servings. 4
CHANGE IS GOOD AND GOOD CHANGE IS GRADUAL Here are some tips on how to change gradually: Add a vegetable or fruit serving at breakfast, lunch and dinner. Use only half the butter or margarine you do now or use a low-fat spread. If you have trouble digesting dairy products, try lactase enzyme pills or drops you can buy these at drugstores and groceries. Or, buy lactose-free milk or milk with lactase enzyme added to it. Get added nutrients such as the B vitamins by choosing whole grain foods, including whole wheat bread or whole grain cereals. Spread out the servings. Have two servings of fruits and /or vegetables at each meal, or add fruits as snacks. Treat meat as one part of the meal, instead of the focus. Try casseroles, pasta, and stir-fry dishes. Use fruits or low-fat foods as desserts and snacks. Flavor foods with herbs, spices, lemon, lime, vinegar and salt free seasoning blends. Most frozen, canned dried fruits and vegetables can be as nutritious as fresh produce. Eating fruits and vegetables in a variety of forms will ensure a balance of important nutrients as well as saving money and preparation time. 5
WEIGHT LOSS AND THE FOOD PLAN This food plan was not designed to promote weight loss. However, it is rich in low-calorie foods such as fruits and vegetables. You can make it lower in calories by replacing high-calorie foods with more fruits and vegetables- and that also will make it easier for you to reach your eating plan goals. Here are some examples of short term eating goals and ways to reach these goals: To increase fruits Eat a medium apple instead of four shortbread cookies. You ll save 80 calories. Eat ¼ cup of dried apricots instead of a 2-ounce bag of pork rinds. You ll save 230 calories. To increase vegetables Have a hamburger that s 3 ounces of meat instead of 6 ounces. Add ½ cup serving of carrots and ½ cup serving of spinach or other green leafy vegetable. You ll save more than 200 calories. Instead of 5 ounces of chicken, have a stir-fry with 2 ounces of chicken and 1½ cup of raw vegetables. Use a small amount of vegetable oil. You ll save 50 calories. To increase intake of low fat or fat free dairy products Have a ½ cup serving of low-fat frozen yogurt instead of a 1 ½ -ounce milk chocolate bar. You ll save about 110 calories. Additional calorie-saving tips Use low-fat or fat free ketchup, mustard, mayonnaise. Use half as much vegetable oil, soft or liquid margarine, or salad dressing, or choose fat free type. Eat smaller portions cut back gradually. Choose low-fat or fat free dairy products to reduce total fat intake. Check the food labels to compare fat content in packaged foods food marked low fat or fat free are not always lower in calories than their regular type. Limit foods with lots of added sugar, such as pies, flavored yogurts, candy bars, ice cream, sherbet, regular soft drinks, and fruit drinks. Eat fruits canned in their own juice OR Add fruit in plain yogurt. Snack on fruit, vegetable sticks (examples: carrots, celery). Unbuttered and unsalted popcorn, or bread sticks. Drink water or club soda. 6
SPICE IT UP: USE MORE SPICES and LESS SODIUM An important part of healthy eating is choosing foods that are low in salt (sodium chloride) and other forms of sodium. Using less sodium is key to keeping blood pressure at a healthy level. Most Americans, in particular African Americans and the elderly, are especially sensitive to salt and sodium and should be particularly careful about how much they consume. Before trying salt substitutes, you should check with your doctor, especially if you have high blood pressure. These contain potassium chloride and may be harmful for those with certain medical conditions. Examples of salt substitutes are Nu Salt and No Salt. Tips to Reduce Salt and Sodium Buy fresh, plain frozen, or canned with no salt added vegetables. Use fresh chicken, fish and lean meat, rather than canned or processed types. Use herbs, spices, and salt-free seasoning blends in cooking and at the table Cook rice, pasta, and hot cereal without salt. Cut back on instant or flavored rice, pasta, and cereal mixes, which usually have added salt. Choose convenience foods that are low in sodium. Cut back on frozen dinners, pizza, packaged mixes, canned soups or broths, and salad dressings these often have a lot of sodium. Rinse canned foods, such as tuna, to remove some sodium. When available, buy low- or reduced-sodium or no-salt-added foods see box 11 for guidance on how to use food labels. Choose ready-to-eat breakfast cereals that are low in sodium. 7
SHOPPING FOR FOODS THAT WILL HELP LOWER YOUR BLOOD RESSURE: Understanding Food Labels By paying close attention to food labels when you shop, you can consume less sodium (salt). Sodium is found naturally in many foods. But processed foods account for most of the salt and sodium that Americans eat. Processed foods that are high in salt include regular canned vegetables and soups, frozen dinners, lunchmeats, instant and ready-toeat cereals, and salty chips and other snacks. As you read food labels, you may be surprised that many foods contain sodium, including baking soda, soy sauce, monosodium glutamate, (MSG), seasoned salts, and some antacids. Use food labels to help you choose products that are low in sodium. Phrase What It Means Sodium Sodium free or salt free Very low sodium Low sodium Less than 5 mg per serving 35 mg or less of sodium per serving 140 mg or less of sodium per serving Low sodium meal 140 mg or less of sodium per 3½ oz (100 g) Reduced or less sodium At least 25 percent less sodium than the regular type of the same food Unsalted or no salt added No salt added to the product during processing Fat Fat free Low saturated fat Low-fat Reduced fat Light in fat Less than 0.5 g per serving 1 g or less per serving 3 g or less per serving At least 25 percent less fat than the regular type Half the fat compared to the regular type 8
Read the Nutritional Fact on food labels to compare the amount of sodium in products. Aim for foods that are less than 5 percent of the Daily Value of Sodium. Compare the food labels of these two types of canned tomatoes. The regular canned tomatoes (right) have 10 times as much sodium as the unsalted canned tomatoes. Canned, Diced Tomatoes, No Salt Added Nutrition Facts Serving Size ½ cup Serving Per Container approx. 3 ½ Amount Per Serving Calories 25 Calories in Fat 0 % Daily Value* Total Fat 0g 0% Saturated Fat 0g 0% Cholesterol 0mg 0% Sodium 20mg 1% Total Carbohydrates 6g 2% Dietary Fiber 2g 8% Sugar 4g Protein 1g Vitamin A 10 % Vitamin C 15% Calcium 2 % Iron 2% *Percent Daily Values are based on a 2,000 calorie diet Canned, Diced Tomatoes Nutrition Facts Serving Size ½ cup Serving Per Container approx. 3 ½ Amount Per Serving Calories 25 Calories in Fat 0 % Daily Value* Total Fat 0g 0% Saturated Fat 0g 0% Cholesterol 0mg 0% Sodium 200mg 8% Total Carbohydrates 6g 2% Dietary Fiber 2g 8% Sugar 4g Protein 1g Vitamin A 10 % Vitamin C 15% Calcium 2 % Iron 2% *Percent Daily Values are based on a 2,000 calorie diet Compare the food labels of frozen peas to canned peas. The canned peas have 3 times as much sodium than the frozen peas. Frozen Peas Nutrition Facts Serving Size ½ cup Serving Per Container about 3 Amount Per Serving Calories 60 Calories in Fat 0 % Daily Value* Total Fat 0g 0% Saturated Fat 0g 0% Cholesterol 0 mg 0% Sodium 125 mg 5% Total Carbohydrates 11g 5% Dietary Fiber 6g 22% Sugar 5g Protein 5g Vitamin A 15% Vitamin C 30% Calcium 0% Iron 6% *Percent Daily Values are based on a 2,000 calorie diet Canned Peas Nutrition Facts Serving Size ½ cup Serving Per Container about 3 Amount Per Serving Calories 60 Calories in Fat 0 % Daily Value* Total Fat 0g 0% Saturated Fat 0g 0% Sodium 380 mg 8% Total Carbohydrates 12g 2% Dietary Fiber 3g 8% Sugar 4g Protein 4g Vitamin A 6% Vitamin C 10% Calcium 2% Iron 8% *Percent Daily Values are based on a 2,000 calorie diet 9
MAKE HEALTHIER FOOD CHOICES Choose More Often: Chicken and Turkey (take off skin) Lean cut meat Fish: Fresh or Frozen Skim or 1% milk, evaporated skim milk Cheese: lower or reduced in sodium Whole grain loaf breads, dinner rolls, English muffins, bagels, pita and salt-free chips Cereal: some hot cereals and some ready-to-eat cold cereals lowest in sodium (read the food labels to choose which are lowest in sodium) Plain rice and noodles Fresh, frozen, or no salt added canned vegetables Fruits Soups: lower or reduced in sodium Margarine, vegetable oils Spices, herbs, and flavorings like oregano, garlic powder, onion powder, salt free seasoning blends, vinegar, and fruit juices. Fresh garlic, onions, thyme, and parsley. Choose Less Often: Hog maws, ribs, and chitterlings Smoked or cured meats like bacon, bologna, hot dogs, ham, corned beef, luncheon meats, and sausage Canned fish like tuna, salmon, sardines, and mackerel, cured fish Buttermilk Most cheese spreads and cheeses Salty chips, pastries, nuts, pretzels, or pork rinds Some cold (ready to eat) cereals highest in sodium, instant hot cereals Quick cooking rice and instant noodles, boxed foods such as rice, scalloped potatoes, macaroni and cheese, some frozen dinners, pot pies and pizza Regular canned vegetables Pickled foods like herring, pickles, relish, olives, or sauerkraut Regular canned soups, instant soups Butter, lard, coconut oil, palm oil, fatback, and salt pork Soy sauce, steak sauce, salad dressing, ketchup, barbeque sauce, garlic salt, onion salt, seasoned salts like lemon pepper, bouillon cubes, meat tenderizers, and monosodium glutamate (MSG) 10
FOOD EXCHANGE LIST Within each group, these foods can be exchanged for each other. You can use this list to give yourself more choices. VEGETABLES contain 25 calories and 5 grams of carbohydrate. One serving equals: 1/2 cup Cooked vegetables (carrots, broccoli, zucchini, cabbage, etc.) 1 cup Raw vegetables or salad greens 1/2 cup Vegetable juice If you re hungry, eat more fresh or steamed vegetables. FRUITS contain 15 grams of carbohydrate and 60 calories. One serving equals: 1 small Apple, banana, orange, nectarine 1 medium Fresh peach 1 Kiwi 1/2 Grapefruit 1/2 Mango 1 cup Fresh berries (strawberries, raspberries or blueberries) 1 cup Fresh melon cubes 1/8 th Honeydew melon 4 ounces Unsweetened Juice 4 teaspoons Jelly or Jam VERY LEAN PROTEIN choices have 35 calories and 1 gram of fat per serving. One serving equals: 1 ounce Turkey breast or chicken breast, skin removed 1 ounce Fish fillet (flounder, sole, scrod, cod, etc.) 1 ounce Canned tuna in water 1 ounce Shellfish (clams, lobster, scallop, shrimp) 3/4 cup Cottage cheese, non fat or low fat 2 each Egg whites 1/4 cup Egg substitute 1 ounce Fat-free cheese 1/2 cup Beans- cooked (black beans, kidney, chick peas or lentils): count as 1 starch/bread and 1 very lean protein 11
LEAN PROTEIN choices have 55 calories and 2-3 grams of fat per serving. One serving equals: 1 ounce Chicken- dark meat, skin removed 1 ounce Turkey- dark meat, skin removed 1 ounce Salmon, Swordfish, herring 1 ounce Lean beef (flank steak, London broil, tenderloin, roast beef)* 1 ounce Veal, roast or lean chop* 1 ounce Lamb, roast or lean chop* 1 ounce Pork, tenderloin or fresh ham* 1 ounce Low fat cheese (3 grams or less of fat per ounce) 1 ounce Low fat luncheon meats (with 3 grams or less of fat per ounce) 1/4 cup 4.5% cottage cheese 2 medium Sardines * Limit to 1-2 times per week MEDIUM FAT PROTEINS have 75 calories and 5 grams of fat per serving. One serving equals: 1 ounce Beef (any prime cut), corned beef, ground beef ** 1 ounce Pork chop 1 each Whole egg (medium) ** 1 ounce Mozzarella cheese 1/4 cup Ricotta cheese 4 ounces Tofu (note this is a Heart Healthy choice) ** Choose these very infrequently FAT-FREE and VERY LOWFAT MILK contains 90 calories per serving. One serving equals: 1 cup Milk, fat-free or 1% fat 3/4 cup Yogurt, plain non fat or low fat 1 cup Yogurt, artificially sweetened 12
STARCHES contain 15 grams of carbohydrate and 80 calories per serving. One serving equals: 1 slice Bread (white, pumpernickel, whole wheat, rye) 2 slice Reduced calorie or "lite" Bread 1/4 (1 Ounce) Bagel (varies) 1/2 English muffin 1/2 Hamburger bun 3/4 cup Cold cereal 1/3 cup Rice, brown or white- cooked 1/3 cup Barley or couscous- cooked 1/3 cup Legumes (dried beans, peas or lentils)- cooked 1/2 cup Pasta- cooked 1/2 cup Bulgur- cooked 1/2 cup Corn, sweet potato or green peas 3 ounce Baked sweet or white potato 3/4 ounce Pretzels 3 cups Popcorn, hot air popped or microwave (80% light) FATS contain 45 calories and 5 grams of fat per serving. One serving equals: 1 teaspoon Oil (vegetable, corn, canola, olive, etc.) 1 teaspoon Butter 1 teaspoon Stick margarine 1 teaspoon Mayonnaise 1 Tablespoon Reduced fat margarine or mayonnaise 1 Tablespoon Salad dressing 1 Tablespoon Cream cheese 2 Tablespoons Lite cream cheese 1/8th Avocado 8 large Black olives 10 large Stuffed green olives 1 slice Bacon Source: Based on American Dietetic Association Exchange List 13
LIST OF TERMS The following terms are used in this Diet Guide: Calories Fat Saturated Fat (Sat. Fat) Sodium Grams (g) Milligram (mg) Processed A measure of the energy contained in food. Excess energy from food is stored as body fat. To lose one pound of body fat, a person must eat 3500 fewer calories and/or increase physical activity by the same amount. The most concentrated source of food energy (calories). Excess intake of dietary fat has been linked to heart disease, obesity, and certain types of cancer. Type of fat found mainly in animal products, palm and coconut oils. Saturated fat is highest in red meats, dairy foods, and baked goods, and lowest in fish, poultry, and grains. Saturated fat raises blood cholesterol and may raise blood pressure. A mineral required by the body in small amounts. Too much sodium causes high blood pressure. Most sodium in the diet comes from salt added to food during processing and cooking. A measure of weight. Listings for fat in this guide are in grams. One ounce is equal to about 28 grams. A measure of weight used for sodium and other nutrients. One gram equals 1000 milligrams. Listings for sodium in this guide are in milligrams. The treatment of food for the purpose of changing one or more of the properties of the food. 14
HIDDEN SALT: HIGH SODIUM FOODS One of the first steps in controlling high blood pressure is to reduce the extra sodium in your diet. Two grams (2,000 mg; 2,000 milligrams; 2 g) or less each day is the usual recommendation for persons who have high blood pressure. Regular use of high sodium foods often provides more than 2,000 mg per day, even if no salt is used. Use this list of common foods and products to see if too much sodium might be part of your high blood pressure problem. If so, ask a registered dietitian or nurse to help you learn more about reading food labels and substitutions for high sodium foods. Table salt (1 teaspoon provides about 2,000 mg of sodium) Seasonings that contain salt; for example, celery salt, garlic salt, onion salt, seasoned salt, Lite Salt Sauerkraut or other vegetables prepared in brine (pickles) Regular canned soups Breads and rolls with salted toppings Potato chips, corn chips, pretzels, saltines, salty crackers, salted popcorn Salty or smoked meats; bacon, bologna, chipped or corned beef, frankfurters, ham, meats koshered by salting, luncheon meats, salt pork, sausage, smoked tongue, canned or pickled meats Salty or smoked fish; anchovies, caviar, salted and dried cod, herring, sardines Processed cheese, cheese spreads, or any cheese such as Roquefort, Camembert, Gorgonzola, or Parmesan Salted nuts, olives, bacon and bacon fat Regular peanut butter Bouillon, catsup, chili sauces, meat extracts, meat sauces, meat tenderizers, monosodium glutamate, prepared mustard, relishes, soy sauce, Worcestershire sauce Antacids containing sodium, such as Alka Seltzer Baking soda toothpaste Adapted from: Mississippi State University www.ext.msstate.edu 15