Bringing Down Blood Pressure with More Plant Foods and Less Salt

Bringing Down Blood Pressure with More Plant Foods and Less Salt Getting Started 1. Review lesson plan before each session. 2. Copy handouts: a. Blood Pressure Basics b. A Healthy Meal Plan c. Lower Sodium for Life d. Checking Sodium Content of Foods e. Blood Pressure Goals, Lets Get Started f. Recipe (1) 3. Gather supplies needed for lesson and activities. Supplies Needed 1. Food Guide Pyramid poster (optional). 2. Ingredients for recipe demonstration. 3. Supplies for tasting recipe, such as plates, forks or spoons, and napkins. Beginning the Lesson 1. Introduce yourself and the organization you represent. 2. Summarize the lesson by reading the objectives. 3. Let the group know the lesson will be informal and they can ask questions any time. Objectives: The participants will: 1. Understand the basics of blood pressure. 2. Learn about a healthy eating plan. 3. Learn ways to decrease sodium intake. 4. Learn the risk factors associated with high blood pressure and how to prevent them. 5. Set goals for a heart healthy life. 1

Script Today we are going to learn about ways to bring down high blood pressure. How many of you know what high blood pressure is? Collect answers. Ask participants to refer to handout titled Blood Pressure Basics. When your heart beats, the blood that is pumped from the heart pushes on artery walls. This causes pressure on the artery walls known as blood pressure. Blood pressure is measured in two stages. The first stage is when the heart beats (systolic pressure), and the second stage is when the heart relaxes (diastolic pressure). When blood pressure is measured the number on the top is systolic pressure and the number on the bottom is diastolic pressure. Now let s talk about what our blood pressure levels should be. Does anyone know the suggested level for blood pressure? Collect answers. The American Heart Association s recommendations are located on the handout titled Blood Pressure Basics. As you can see the target range for blood pressure is less than 120/80. Numbers higher than this are considered prehypertensive or hypertensive. It is important to note that hypertension and high blood pressure mean the same thing. In people aged 40 to 70 years, increases in systolic blood pressure of 20 mm Hg or diastolic pressure of 10 mm Hg doubles the risk of cardiovascular disease. Review the following chart with participants. Blood Pressure Category Systolic Diastolic Normal Less than 120 and Less than 80 Prehypertension 120-139 or 80-89 HIGH Stage 1 140-159 or 90-99 Stage 2 160 or higher or 100 or higher The latest statistics shows one in every four adults have high blood pressure and one of every three of them does not know it. Studies also suggest that persons with normal blood pressure at age 55 have a 90 percent lifetime risk of developing high blood pressure. Does anyone know why it is so important to keep your blood pressure within normal range? Keeping your blood pressure in the normal range is so important because as blood pressure increases the chance for heart attacks, heart failure, stroke, and kidney disease also increases. There are several risk factors linked to high blood pressure. The risk factors for high blood pressure include obesity, excess dietary salt (sodium) and alcohol, physical inactivity, stress, minority group status (such as African American or Hispanic), genetics, and age. Some of these risk factors are controllable, meaning you can change them, so let s discuss ways we can change our risk. 2

Eat a Healthy Diet Ask participants to refer to handout titled A Healthy Meal Plan. We all know that following a healthy eating plan helps prevent and control diseases. This rings true for high blood pressure also. The healthy eating plan is developed from the 2005 Dietary Guidelines. Researchers found that diets high in fruits and vegetables, combined with low fat dairy foods and low saturated fat, total fat, and cholesterol intakes did lower blood pressure levels. Let s review the basics of this plan. How many of you eat fruits and vegetables every day? How many of you eat 7 to 10 servings of fruits and vegetables every day? Remember that a fruit serving is ½ cup, a raw vegetable serving is 1 cup, and a cooked vegetable serving is ½ cup. An important step in healthy living is consuming 7 to 10 servings of fruits and vegetables every day. I know this seems like a lot, but if you have about two servings of a fruit or vegetable at every meal and two servings as a snack you should be able to get eight servings of fruits and vegetables a day. The Dietary Guidelines (2005) recommends 7 fruits and vegetables for older people who live a sedentary life and up to 10 for those who are more active. How many of you eat whole grain foods? The healthy eating plan suggests having 3 to 3 ½ whole grain foods every day. Some examples of a whole grain serving are ½ cup of oatmeal or 1 slice of whole wheat bread. BE SURE TO CHECK THE INGREDIENT LIST on products you think are whole grain. Remember just because it is brown does not mean it is a whole grain. Foods that are whole grain will have a whole grain as the first ingredient (such as whole wheat flour) or will have a whole grain logo with the words whole grain on the package. Low fat or fat free dairy foods are also an important part of a healthy eating plan. Does anyone know what two minerals found in dairy foods have been shown to lower blood pressure? Collect answers. Both potassium and calcium have been linked to lower blood pressure levels and dairy foods are good sources of both of these minerals. So make sure to get three servings of low fat or fat free dairy foods every day. The healthy eating plan also suggests 5 to 6 ounces of lean meat, poultry, or fish OR 1 ¼ to 1-½ cups of beans or (legumes) a day. This plan also limits oils or soft margarines to only 4 to 7 teaspoons (tsp) and discretionary calories (desserts, alcoholic beverages, etc.) to 132 to 290 calories or less per day. 3

Lifestyle Factors Effecting Blood Pressure Diet is only one part of the puzzle in lowering blood pressure. What are some other life style factors that affect your blood pressure? Collect answers. 1. Loosing weight if you are overweight is very important in lowering blood pressure. The best way to loose weight is to eat fewer calories and increase your physical activity. 2. Limit alcohol intake. For those who consume alcohol, men can have up to 1 ounce of ethanol, which is the amount in 24 ounces of beer, 10 ounces of wine, or 2 ounces of 100- proof liquor. Women should limit their intake to half of this, about.5 ounces of ethanol per day (12 ounces of beer, 5 ounces of wine, or 1 ounce of 100-proof liquor). 3. Increasing aerobic physical activity is also important in lowering blood pressure levels. We should get 30 to 45 minutes of aerobic physical activity most days of the week. Aerobic physical activity is activity that raises your heart rate and helps to keep your heart strong and healthy. What are some examples of aerobic physical activity? Collect answers. As you can see there are many things you can do to help lower your blood pressure or to help prevent the development of high blood pressure. When starting a new health plan it is important to set goals for yourself. Make sure you don t set goals that are to hard to reach, but start small and keep adding them up. For example set a goal to eat seven servings of fruits and vegetables a day. Once you have achieved this, set a goal to exercise three days a week and so forth until you have reached all the goals needed to lead a heart healthy life. We only have one heart so let s keep it healthy. Low Sodium Lifestyle Studies also show that combining a healthy eating plan with a low salt intake has even greater effects on lowering blood pressure levels. Now let s talk about how to incorporate a low sodium diet into your eating plan. Does anyone know the recommended amount of sodium that you should get daily? Collect answers. Ask participants to refer to handout titled Low Sodium for Life. The amount of sodium a healthy person needs daily to replace the amount of sodium lost in perspiration or sweat varies by age. If you are between the age of 19 and 50 you need about 1,500 mg of sodium daily; if you are over 50 years old you need about 1,300 mg of sodium daily; and if you are over 70 years old you need about 1,200 mg of sodium daily. The maximum amount, or upper limit, of sodium is up to 2,300 mg daily. 4

Does anyone want to guess what percent of American men consume more than the upper limit (2,300 mg) of sodium daily? If you guessed 95% you were correct. What about American women? The correct answer is 75%. What does this tell us about our sodium intake? We consume way too much sodium!! You might be asking, how do I know how much sodium is in the food that I eat, and how can I cut back on the amount of sodium in my diet? Let s review some tips to reduce sodium that are listed on your handout titled Low Sodium for Life. 1. Buy fresh and frozen vegetables because they are usually low in sodium. 2. Buy canned products that are labeled reduced sodium or no-salt-added. For example regular canned tomatoes have 10 times more sodium than unsalted canned tomatoes. 3. Use fresh meats, poultry, and fish instead of processed types. 4. Flavor foods with spices, instead of salt. 5. When possible, rinse canned foods to remove excess sodium. It is also important to read food labels to see which foods are lower in sodium and to see how much sodium you consume daily. Look at both the serving size and the amount of sodium. Compare the two products on your handout titled Checking Sodium Content of Foods. First look at the serving size. As you can see the canned diced tomatoes, no salt added and the regular canned diced tomatoes are the same serving size of ½ cup. Next, look at the amount of sodium in each product. The sodium in the canned diced tomatoes, no salt added is 20 mg, and the amount in the regular canned diced tomatoes is 200 mg. Which would be the better choice of the two? When starting a low sodium diet remember to take it one step at a time. Cutting back slowly may be easier than going cold turkey for some. Just remember you are striving for a goal of between 1,200 to 1,500 mg of sodium daily, depending on your age. Activity - Okay, let s review before we try a heart healthy recipe. (Prepare one recipe in advance for participants to sample, or demonstrate how to make the recipe) 1. What are some controllable risk factors for high blood pressure? Obesity, excess dietary salt and alcohol, and physical inactivity 2. How can you reduce your blood pressure through diet? Follow the DASH eating plan, which is high in fruits, vegetables, low fat dairy foods, and whole grains, combined with a low salt diet. 3. What would be considered a normal level for blood pressure? 120/80 mmhg 5

References The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. U.S. Department of Health and Human Services. National Institutes of Health. National Heart, Lung, and Blood Institute. NIH Publication NO. 03-5233. May 2003 <http://www.nhlbi.nih.gov/guidelines/hypertension/express.pdf> High Blood Pressure. American Heart Association. 26 August 2004 <http://www.americanheart.org/presenter.jhtml?identifier=2114>. High Blood Pressure. Medline Plus. 26 August 2004 <http://www.nlm.nih.gov/medlineplus/highbloodpressure.html>. Your Guide to Lowering High Blood Pressure. National Heart, Lung, and Blood Institute. 26 August 2004 <http://www.nhlbi.nih.gov/hbp/index.html>. "A Clinical Trial of the Effects of Dietary Patterns on Blood Pressure," New England Journal of Medicine, 336; 1117-1124, April 17, 1997. Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate. Institute of Medicine. 11, February 2004. http://www.nap.edu. Dietary Guidelines for Americans (USDHHS & USDA, 2005): Executive summary: http://www.health.gov/dietaryguidelines/dga2005/document/html/executivesummary.htm Report for professionals (the eggplant report): http://www.health.gov/dietaryguidelines/dga2005/document/pdf/dga2005.pdf Report from the Dietary Guidelines Scientific Advisory Committee: http://www.health.gov/dietaryguidelines/dga2005/report/ Consumer brochure: http://www.health.gov/dietaryguidelines/dga2005/document/pdf/brochure.pdf 6

The Food Stamp Program provides nutrition assistance to people with low income. It can help buy nutritious foods for a better diet. To find out more, contact your local food stamp office, food bank, or senior center. Primary author: Sarah M. Burnett, MS, RD, LD NOAHnet@uga.edu Primary reviewer: Mary Ann Johnson, PhD, Tiffany Sellers, BS, and Emily Aspinwall, Undergraduate Research Assistant This material, including artwork, was developed with support from the Department of Foods and Nutrition at The University of Georgia, the Northeast Georgia Area Agency on Aging and the USDA Food Stamp Nutrition Education Program. Permission is granted to reproduce, translate, abstract, review or quote these materials in whole or in part for educational purposes only (not for profit beyond the cost of reproduction) provided that the author(s) and The University of Georgia receive acknowledgement as shown in this example notice: Reprinted with permission from The University of Georgia, Department of Foods and Nutrition, Athens, GA. Authors, Title, Date. 7

What is Blood Pressure? BLOOD PRESSURE BASICS When an individual s heart beats, the blood that is pumped from the heart pushes on the walls of our arteries. This causes pressure on the artery walls known as blood pressure. Blood pressure is measured in two stages, when the heart beats (systolic pressure) and when the heart relaxes (diastolic pressure). EXAMPLE: 120 (Systolic) 80 (Diastolic) Blood Pressure Goals: Blood Pressure Systolic Diastolic Category Normal Less than 120 and Less than 80 Prehypertension 120-139 or 80-89 HIGH Stage 1 140-159 or 90-99 Stage 2 160 or higher or 100 or higher High Blood Pressure Risk Factors: Controllable Risk Factors: obesity, excess dietary salt and alcohol, physical inactivity, stress Uncontrollable Risk Factors: race, ethnicity, genetics, and age 8

A HEALTHY DIET MEAL PLAN (Daily recommended servings) Food Group Low Fat Milk and Milk Products Vegetables Fruit Whole Grains Other Grains Protein: Meats, Poultry, and Fish OR Beans (legumes) Oils or soft margarines Discretionary calories (desserts, alcoholic beverages, etc.) Source: 2005 Dietary Guidelines Daily Amounts 3 servings 4-6 servings 3-4 servings 3-3.5 servings 2-3.5 servings 5-6 oz. Meat OR 1 ¼ - 1 ½ cups beans 4-7 tsp. 132-290 calories Other Lifestyle Factors Effecting Blood Pressure: 1. Loose Weight if Overweight 2. Limit Alcohol Intake 3. Increase Aerobic Physical Activity 4. Stop Smoking 9

LOW SODIUM FOR LIFE Recommended Sodium Intakes: Age Lower Limit (GOAL) Upper Limit 19-50 years 1,500 mg 2,300 mg 50 to 69 years 1,300 mg 2,300 mg 70 + years 1,200 mg 2,300 mg Tips for Lowering Sodium Intake: 1. Buy fresh and frozen vegetables because they are usually low in sodium. 2. When buying canned products look for the ones labeled reduced sodium or no-salt-added. For example regular canned tomatoes have 10 times as much sodium as the unsalted canned tomatoes. 3. Use fresh meats, poultry, and fish instead of processed types. 4. Flavor foods with spices instead of salt. 5. When possible, rinse canned foods to remove excess sodium. 10

CHECKING SODIUM CONTENT OF FOODS Canned Diced Tomatoes, No Salt Added Nutrition Facts Canned Diced Tomatoes Nutrition Facts Serving Size: ½ cup Serving Size: ½ cup Amount per Serving Amount per Serving Calories 25 Calories 25 Total Fat 0 g Total Fat 0 g Saturated Fat 0 g Saturated Fat 0 g Cholesterol 0 g Cholesterol 0 g Sodium 20 mg Sodium 200 mg Total Carbohydrate 6 g Total Carbohydrate 6 g Dietary Fiber 2 g Dietary Fiber 2 g Sugars 4 g Sugars 4 g Protein 1 g Protein 1 g Serving Size of both products: ½ cup Amount of sodium in products: Canned Diced Tomatoes with no salt added has 20 mg of sodium, and the regular Canned Diced Tomatoes have 200 mg of sodium. 11

Fruit and Juice Breakfast Shake 1 banana, peeled 3/4 cup orange juice* 1/2 cup low-fat vanilla yogurt 1/2 cup fresh or frozen blueberries or strawberries 1. Break banana into small pieces and place in a blender container. 2. Add orange juice, yogurt, and berries to blender. Place lid on blender container and blend on medium speed until smooth. Serve immediately. Makes 2 servings. *Can substitute pineapple or purple grape juice for orange juice. Nutrition Facts per serving Serving size: 1 cup Calories 168 Total fat Total carbohydrate 1 g 35 g Adapted from AboutProduce.Com, www.aboutproduce.com/recipes. 12