Download Eating to Stop and Control High Blood Pressure

Eating
to STOP
and CONTROL
High Blood Pressure
CM-09-10
Developed by
Joyce M. Woodson, M.S., R.D., Area Specialist
Jacqueline Black, B.S., Program Officer
Millicent Braxton-Calhoun, M.S., Program Officer
Copyright © 2009, University of Nevada Cooperative Extension. All rights reserved. No part of this
publication may be reproduced, modified, published, transmitted, used, displayed, stored in a retrieval
system, or transmitted in any form or by any means electronic, mechanical, photocopy, recording or
otherwise without the prior written permission of the publisher and authoring agency. The University of
Nevada, Reno is an equal opportunity/affirmative action employer and does not discriminate on the basis
of race, color, religion, sex, age, creed, national origin, veteran status, physical or mental disability and
sexual orientation in any program or activity it operates. The University of Nevada employs only United
States citizens and aliens lawfully authorized to work in the United States.
EATING TO STOP AND CONTROL
HIGH BLOOD PRESSURE
Introduction
Research documents that despite the progress that has been made in the
improvement in overall health of the nation, minorities are experiencing
continuing disparities in the burden of illness. Racial and ethnic minorities suffer
a disproportionately high incidence of chronic disease.
Data show that overall, while one in three Americans has hypertension; two in
five African Americans have hypertension. The effects of hypertension are more
frequent and severe in African Americans. This population develops
hypertension at an earlier age than whites. Hypertension is a leading risk factor
for stroke. Nevada, unfortunately, parallels the rest of the nation with heart
disease as the No. 1 cause of death in the state; uncontrolled hypertension is a
risk factor for heart disease. A Community Health Survey (2001) conducted in
Clark County, Nevada, through predominately African American churches, has
shown that 40 percent of respondents reported to be hypertensive and 60
percent reported hypertension in their family history.
Controllable risk factors for hypertension include excessive weight; physical
inactivity; high-fat, high-sodium food choices; and food-preparation methods. All
of these risk factors are found in the lifestyle behaviors of Americans. Many who
are diagnosed and treated for hypertension do not follow the medical
recommendations.
The Dietary Approaches to Stop Hypertension (DASH) has been found to be
most effective in lowering blood pressure in hypertensive and non hypertensive
subjects. Additional research was done to show the effects of limiting sodium
when using DASH. “DASH-Sodium” included a reduction of the use of salt and
sodium in addition to the increase in fruits, vegetables and low-fat dairy products
as in the original DASH. Sixty percent of the participants in the DASH research
and 57 percent of the participants in the DASH-Sodium research were African
Americans. This curriculum uses DASH-Sodium to modify food choices and
food- preparation methods.
The goal of the curriculum is to give participants skills and knowledge to prevent
and control hypertension.
EVALUATION
The Stages of Change Model (a transtheoretical model) is our choice for
evaluation. The Stages of Change Model looks at readiness to change a health
behavior. The stages are:
♦ Precontemplation (no intention of changing within the next 6
months)
♦ Contemplation (intent to change)
♦ Preparation (planning to change within the next month)
♦ Action (changing behavior)
♦ Maintaining (continuing changed behavior for 6 months)
To assess participants’ change as a result of this program, users may want to
consider administering pre and post tests. In addition, we have found it helpful to
re-administer the test as a post-post-test several months after conclusion to
assess movement along the stages and maintenance. The goal of the curriculum
is to assist participants to acquire the skills and knowledge necessary to utilize
the DASH eating plan.
One possible instrument may be the Eating Style Questionnaire (ESQ)
developed by Margaret K. Hargeaves and other researchers at Meharry Medical
College. The ESQ was found to be useful in working with African American
women. The ESQ can be modified to assess use of low-fat milk products, and
the intake of fruits, vegetables and fiber as recommended by the DASH diet.
This curriculum is designed to be used with any population. Included in the
curriculum is one Fact Sheet that is specific to African Americans; if the
participants are not predominantly African American, this Fact Sheet will not be
used. The curriculum is designed to be taught by nonprofessional lay or
community persons (instructors) trained by nutrition or health educators. The
overview section of each lesson is background for the instructor. Although the
lay or community instructor will be trained to teach the curriculum, this overview
will serve as a refresher on each topic.
LESSON 1
WHAT IS HIGH BLOOD
PRESSURE
LESSON 1
PREVENTION AND CONTROL
OVERVIEW:
Hypertension, or high blood pressure, is often called the “silent killer,” because
usually, as this “silent killer” advances, it has no symptoms. It is a serious
condition which lasts a lifetime once it occurs. By taking the right action and
developing a healthy lifestyle, hypertension can be controlled or prevented.
WHAT IS HYPERTENSION OR HIGH BLOOD PRESSURE?
Blood pressure is the force of blood against the walls of arteries. Blood pressure
will rise and fall throughout the day. When the pressure stays elevated over
time, it’s called high blood pressure.
The medical term for high blood pressure is hypertension. High blood pressure
is dangerous because after exposure to high blood pressure over a period of
time, small blood vessels can become narrower and therefore the heart must
pump harder to push blood throughout the body. This can result in weakening of
the heart muscle, decreasing the heart’s ability to function efficiently. Hardening
of the arteries causes the flow of oxygen-rich blood to be slowed or blocked. It
increases the risk of heart disease and stroke, the first and third-leading causes
of death among Americans. High blood pressure also can result in other
conditions, such as congestive heart failure, kidney disease and blindness.
High blood pressure affects about 73.6 million, or one in three American adults.
Some people are more likely to develop it than others. It is especially common
among African Americans, who tend to develop it earlier and more often than
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whites. African Americans suffer from a higher mortality rate than their white
counterparts (15.8 percent white males to 52.1 per cent black nonHispanic males
and 15.1 percent white females to 40.3 percent black nonHispanic females).
Many Americans tend to develop high blood pressure as they get older, but
hypertension is not a part of normal or healthy aging. Nevertheless, about 50
percent of all Americans ages 60 and older have high blood pressure.
Others at high risk of developing hypertension are people who are overweight,
people with a family history of high blood pressure and those with a high, normal
blood pressure. High blood pressure also is more common in the southeastern
United States. This part of the country is often referred to as the “stroke belt.”
HOW IS BLOOD PRESSURE CHECKED?
Blood pressure is measured using a blood pressure cuff on the upper arm.
Blood pressure usually is measured in millimeters of mercury (mm Hg) and
recorded as two numbers – systolic pressure (as the heart beats) “over” diastolic
pressure (as the heart relaxes between beats) for example: 120/80 mm Hg. Both
numbers are important, although for some Americans systolic blood pressure is
especially important. A systolic blood pressure of less than 120 and a diastolic
blood pressure of less than 80 mm Hg is considered healthy. A blood pressure
reading between 120/80 mm Hg and 139/89 mm Hg is prehypertension.
Prehypertension means that you don’t have high blood pressure at present;
however, you may develop high blood pressure in the future.
Adopting healthy lifestyle changes will decrease your risk for developing
hypertension.
1-2
CAN HIGH BLOOD PRESSURE BE PREVENTED OR CONTROLLED?
High blood pressure can be prevented. If someone has high blood pressure, it
can be controlled. The following steps are suggested:
♦ Maintain a healthy weight.
♦ Be physically active.
♦ Follow a healthy eating plan which includes foods
lower in salt and sodium.
♦ If you drink alcoholic beverages, do so in moderation.
♦ If you have high blood pressure and are prescribed
medication, take it as directed.
♦ If you smoke, get help to stop.
♦ Learn how to manage stress.
•
Maintain a healthy weight.
Overweight increases your risk of developing high blood pressure. In fact, blood
pressure rises as body weight increases. Losing even 10 pounds can lower
blood pressure. Weight loss has the biggest effect in those who are overweight
and already have hypertension.
If you need to lose weight, it’s important to do so slowly. Lose no more than onehalf to two pounds a week. Begin with a goal of losing 10 percent of your current
weight. This is the healthiest way to lose weight and, importantly, it offers the
best chance of long-term success.
There’s no magic formula for weight loss. You have to eat fewer calories than
you use in daily activities. Just how many calories you burn daily depends on
factors such as your body size and how physically active you are.
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•
Be physically active.
Being physically active is one of the most important steps you can take to
prevent or control high blood pressure. It also helps to reduce your risk of heart
disease.
It doesn’t take a lot of effort to become physically active. All you need to do is 30
minutes of moderate-level physical activity on most, and preferably all, days of
the week. Examples of moderate-level activity are brisk walking, bicycling, raking
leaves and gardening. You can divide the 30 minutes into shorter periods of at
least 10 minutes each. For instance: use stairs instead of an elevator; get off
the bus one or two stops early; or park your car at the far end of the lot at work.
If you already engage in 30 minutes a day, you can get added benefits by doing
more. Do a moderate-level activity for longer periods each day or engage in a
more vigorous activity. For example, build a 30-minute exercise period up to 60
minutes or four 15-minute periods per day.
Most people don’t need to see a doctor before they start a moderate level of
physical activity. You should check with a doctor first, however, if you have heart
trouble or have had a heart attack; if you are over age 50 and are not used to
doing a moderate level activity; if you have a family history of heart disease at an
early age; or if you have any other serious health problems.
•
Follow a healthy eating plan.
One aspect of a healthy eating plan is to choose foods low in sodium, saturated
fat, cholesterol and total fat. Also important is low-fat dairy foods and increased
intake of fruits, vegetables and whole-grain breads and cereals. Include nuts,
seeds and cooked dried beans three times weekly. If red meat is used with
beans, use moderately. Baked or broiled fish, seafood and poultry are good
choices.
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•
Drink alcoholic beverages in moderation.
Research strongly suggests a relationship between alcohol intake and blood
pressure. Consuming high levels of alcohol has been found to increase the risk
of high blood pressure. Moderation in use of alcohol is always advisable.
Moderation would be one drink daily for women and no more than two for men.
Twelve ounces of beer, 5 ounces of wine and 1 ½ ounces of distilled spirits count
as a drink.
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LESSON 1: Teaching Guide
PREVENTION AND CONTROL
OBJECTIVES:
After completing this lesson the participant will be able to:
1. Explain the normal levels for blood pressure.
2. List the uncontrollable and controllable risk factors for high blood pressure.
3. Identify steps to take to lower their risk for high blood pressure.
4. State the medical name for high blood pressure.
KEY POINTS TO COVER WHEN TEACHING THE LESSON:
1. African Americans have a high incidence of hypertension.
2. High blood pressure can be controlled and prevented.
3. Physical inactivity and unhealthy food choices are risk factors that are
controllable.
MATERIALS AND SUPPLES NEEDED:
1. Attendance sheet
2. Name tags
3. UNCE promotional items
4. Copies of pretest and consent form
5. Participant handouts:
Copies of Scenario
“High Blood Pressure in Blacks”
Blood Pressure Levels in Adults
BMI-What does it Mean?
Copies of PowerPoint slides
Sample Walking Plan
One Day Food Record
1-6
6. Wall Covering for PowerPoint Projection
7. Printout of PowerPoint handouts
8. Blood pressure record cards
9. Projector
10. PowerPoint presentation
BEFORE TEACHING THE LESSON:
1. Review procedure for administrating the pretest.
2. Review the lesson overview and teaching guide.
3. Review overheads.
4. Gather all materials and supplies.
5. Check with the facility/site, at intervals, one week, two days and the day
before, to be sure there is no problem with schedule.
WARM UP:
1. Ask participants to sign in, complete nametags, pick up notebooks and
promotional items as they arrive.
2. The pretest is to be administered at the beginning of this lesson. Please
review the procedure. The instructor or volunteer may administer the test.
3. As the lesson begins, ask each person to introduce themselves and what
they hope to learn from the workshop. If expectations are beyond the
scope of the workshop, suggest possible resource information.
4. Distribute the scenario and read the scenario for Lesson 1 to the group.
Have participants read and respond to the scenario. Divide participants
into groups to discuss the questions. After 5 minutes, each group will
select a speaker to share their group’s responses to the questions.
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PROCEDURES FOR TEACHING THE LESSON:
1. Show title PowerPoint #1 repeating the title of the workshop.
2. Show PowerPoint #2 repeat the title saying,
“In this lesson we will learn about blood pressure levels and the risk
factors for high blood pressure.”
3. Show PowerPoint #3 and repeat the objectives of the lesson.
4. Show PowerPoint #4 and explain that the medical term for high blood
pressure is hypertension. Share the following information.
o It affects about 73.6 million or 1 in 3 adult Americans.
o High blood pressure is more common in the southeastern United
States.
o African Americans have long suffered a disproportionately high
incidence of high blood pressure. This ethnic group tends to
develop it at an earlier age and more often than white Americans.
o In 2006, University of Nevada Cooperative Extension conducted a
community health survey through 15 churches in Clark County
Nevada (n=1,370). The incidence of high blood pressure was 40
percent, which was the same as national data at that time. In the
same survey, 62 percent of respondents reported having a family
history of hypertension.
o Hypertension, the medical name for high blood pressure, is often
called the “silent killer” because it has no symptoms.
5. Ask the question,
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” What is blood pressure?” Wait for a response.
6. Show PowerPoint #5, repeating the definition of blood pressure. Explain
that;
“Blood pressure rises and falls throughout the day. But when the pressure
stays elevated over time, it’s called high blood pressure.” Explain that
blood pressure is measured with a blood pressure cuff, as shown in the
slide. This is a painless procedure.
7.
Explain that blood pressure increases as we get older.
“Approximately 60 percent of people ages 60 and older have high blood
pressure. However, high blood pressure is not a natural part of healthy
aging.”
8.
Show PowerPoint #6 stating the information regarding systolic and
diastolic pressure.
9. Show PowerPoint #7 asking the participants to turn to the handout “Blood
Pressure Levels for Adults.” Go through the information given, explaining
that the levels are for people 18 years and older and state the source,
National High Blood Pressure Education Program.
“We should know our blood pressure “numbers.” Participate in blood
pressure screenings at your church, during medical annual checkups and
in the community. If you have hypertension and your doctor has
prescribed medication, it is important that you follow recommendations in
taking your medication.”
1-9
Pass out blood pressure record cards. Ask the question;
“How many of you know your blood pressure reading or numbers?” Tell
them to “write your numbers on the card. You should keep this card and
each time your blood pressure is taken the numbers should be recorded.”
10. Show PowerPoint #8, reading the definition of risk factors.
11. Show PowerPoint #9, stating that:
“There are some risk factors beyond our control.”
State these risk factors.
12. Show PowerPoint # 10, stating:
"The good news is that there are risk factors that we can control.”
State those listed on the PowerPoint.
“High levels of alcohol have been found to increase the risk of high blood
pressure. At all times alcoholic beverages should be used in moderation.
This means no more than one drink per day for women and no more than
two for men.”
13. Show PowerPoint #11 and state that:
“Hypertension can lead to more serious health conditions.”
State those listed.
14. Tell the participants:
1-10
“One of the risk factors we can control is physical inactivity.”
15. Show PowerPoint #12, discuss the information given.
16. Show PowerPoint #13., then #14, discussing the suggestions given for
moderate exercise. Tell the participants:
“You should get your doctor’s okay before beginning any exercise if you
are over 50 years of age, have not exercised in a long time or have a
health problem; also remember to pace yourself.”
Ask that they look at the handout, “A Sample Walking Program.” Review
parts of this handout.
17. Show PowerPoint # 15 and ask participants to turn to the handout “Body
Mass Index (BMI).”
“Increasing physical activity is important, as important as controlling
weight and food selections. Notice at the bottom of the page, weight is
measured with underwear but no shoes. Find your height and move
across to your body weight. Check your BMI, if your BMI is more than 25,
you have some changes to consider.”
Review information on BMI chart.
18. Show PowerPoint # 16 explaining the points covered on the slide.
1-11
This concludes this first lesson on Eating to Stop and Control High Blood
Pressure. Over the next week think of steps you may take to lower your blood
pressure.
19. Show PowerPoint # 17 and review the main points covered by Lesson 1.
20. Tell participants:
In the following lessons we will learn the key points regarding:
♦ reading food labels
♦ finding salt and sodium in foods
♦ using herbs and spices
♦ the importance of dairy products
♦ Dietary Approaches to Stop Hypertension (DASH) eating plan
21. Show PowerPoint # 18.
Next week our lesson will be “Why DASH?” We will learn about an eating plan to
stop and control high blood pressure. Please complete the one day food record
and bring it to class next week. Write everything that you eat and drink for one
entire day including amount and food preparation method. Please choose a
typical day.
1-12
Lesson I Scenario
Mrs. Linda Williams is a 55-year-old female. Mrs. Williams and her husband Thomas have been married for 25
years. They have four children, a teenage daughter and three adult sons. Their daughter Toni and one son
Harry live at home with their parents. Mrs. Williams works part-time as a receptionist for a local dentist, Mr.
Williams is in building maintenance with the school district, Harry was recently hired in security at a local
hotel/casino and Toni is volunteering for the summer at the nearby Boys and Girls Club.
During a recent medical checkup, the doctor expressed concern about Mrs. Williams’ blood pressure. He said
that she needed to lower her blood pressure. Mrs. Williams enjoys cooking for her family, especially on
holidays. Mr. and Mrs. Williams maintain a practice of eating dinner out on Saturdays and going to brunch after
church on Sundays. Both have gained weight over the past five years.
Instructor: Divide participants into groups to discuss questions below.
1.
What can Mrs. William do to lower her blood pressure?
2.
How would lowering her blood pressure protect her health?
3.
What are some problems or difficulties that might get in the way of controlling her blood pressure?
4.
What suggestions do you have to help her overcome those problems or difficulties?
A group speaker will share responses to questions.
The University of Nevada, Reno is an equal opportunity/affirmative action employer and does not discriminate on the basis of race, color, religion, sex, age, creed,
national origin, veteran status, physical or mental disability and sexual orientation in any program or activity it operates. The University of Nevada employs only
United States citizens and aliens lawfully authorized to work in the United States.
Revised 11/09
1
Eating to Stop and Control
HIGH BLOOD PRESSURE
2
LESSON 1
PREVENTION
AND
CONTROL
OBJECTIVES:
3
After completing this lesson the participant
will be able to:
1. Explain the normal levels for blood pressure.
2. List the uncontrollable and controllable risk
factors for high
g blood p
pressure.
3. Identify steps to take to lower their risk for
hi h bl
high
blood
d pressure.
4. State the
t e medical
ed ca name
a e for
o high
g blood
b ood
pressure.
HIGH BLOOD
PRESSURE
IS ALSO KNOWN AS
HYPERTENSION
4
5
Blood Pressure is the
force of blood against
g
artery walls.
SYSTOLIC PRESSURE
(as the heart beats)
120
80
DIASTOLIC PRESSURE
(
(as
the
th heart
h
t relaxes
l
between
b t
beats)
6
Blood Pressure Levels for Adults
Category
Systolic†
(mmHg)‡
*
Diastolic † Result
(mmHg) ‡
Normal
less than
120
and
less than
80
Prehypertension
120-139
or
80-89
Your blood pressure could
be a problem. Make
changes in what you eat
and drink, be physically
active, and lose extra
weight. If you also have
diabetes, see your doctor.
140 or
higher
or
90 or
higher
You have high blood
pressure. Ask your doctor
or nurse how to control it.
Hypertension
Good for you!
* For adults ages 18 and older who are not on medicine for high blood pressure and do not have a short-term serious illness.
Source: The Seventh Report of the Join National Committee on Prevention, Detection, Evaluation, and Treatment of High
Blood Pressure; NIH Publication No. 03-5230, National High Blood Pressure Education Program, May 2003.
†
If systolic and diastolic pressures fall into different categories, overall status is the higher category.
‡ Millimeters of mercury.
7
8
RISK FACTORS
•Conditions or behaviors that increase
your likelihood of developing
y
p g a disease.
•The more y
you have,, the higher
g
the risk.
RISK FACTORS
BEYOND YOUR CONTROL
•AGE
AGE
•FAMILY
FAMILY HISTORY
•RACE
RACE OR ETHNICITY
9
RISK FACTORS
UNDER YOUR CONTROL
•OVERWEIGHT
•PHYSICAL INACTIVITY
•OVERUSE OF ALCOHOL
•UNHEALTHY FOOD CHOICES
•STRESS
•SMOKING
10
HYPERTENSION
11
High
g Blood Pressure can lead to:
• Stroke
• Blindness
• Kidney Failure
• Heart Attacks
•Coronary Artery Disease
12
GET UP AND MOVE!
•Check
Ch k with
i h your d
doctor
•Start slowly
•Wear
W
comfortable
f t bl shoes
h
and
d socks
k
•Warm up and cool down
•Drink
D i k plenty
l t off water
t
•Have fun
13
MODERATE LEVEL OF
ACTIVITY
Here’s a good place to start. Moderate
activities such as walking
and climbing stairs for 10 minutes, three times a
day,
y can improve
p
yyour health.
MODERATE ACTIVITIES
WALKING
GARDENING
DANCING
VACUUMING
RAKING LEAVES
CLIMBING STAIRS
BOWLING
BICYCLING
WATER AEROBICS
SWIMMING LAPS
14
15
BODY MASS INDEX (BMI)
Here is a chart for men and women that gives BMI for various heights and weights.* To use the chart, find your height in the left-hand column labeled “Height”.
Move across to your body weight. The number at the top of the column is the BMI for your height and weight.
BMI
21
22
23
24
25
26
27
28
29
30
31
HEIGHT
(FEET AND INCHES)
BODY WEIGHT (POUNDS)
*
4’ 10”
100
105
110
115
119
124
129
134
138
143
148
5’ 0”
107
112
118
123
128
133
138
143
148
153
158
5’ 2”
115
120
126
131
136
142
147
153
158
164
169
5’ 4”
122
128
134
140
145
151
157
163
169
174
180
5’ 6”
130
136
142
148
155
161
167
173
179
186
192
5’ 8”
138
144
151
158
164
171
177
184
190
197
203
5’ 10”
146
153
160
167
174
181
188
195
202
209
216
6’ 0”
154
162
169
177
184
191
199
206
213
221
228
6’ 22”
6
163
171
179
186
194
202
210
218
225
233
241
6’ 4”
172
180
189
197
205
213
221
230
238
246
254
Weight is measured with underwear but no shoes.
* For adults ages 18 and older who are not on medicine for high blood pressure and do not have a short-term serious illness. Source: The Seventh Report of the Join National
Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; NIH Publication No. 03-5230, National High Blood Pressure Education Program, May 2003.
16
Wh t Does
What
D
Y
Your BMI M
Mean??
Category
BMI
Result
Normal weight
18.5-24.9
Good for you!
Try not to gain weight.
Overweight
25 29 9
25-29.9
Obese
30 or greater You need to lose weight. Lose
weight slowly - about ½ pound to
2 pounds a week. See your doctor
or a registered dietitian if you need
help.
Do not gain any weight,
weight especially
if your waist measurement is high.
You need to lose weight if you have
two or more risk factors for heart
disease.
Source: Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: The Evidence
Report; NIH Publication No. 98-4083, National Heart, Lung, and Blood Institute, in cooperation with the National Institute of
Diabetes and Digestive and Kidney Diseases, National Institutes of Health, June 1998.
Review
Normal Blood Pressure
Less than 120 systolic
Less than 80 diastolic
Risk Factors Under Your Control
•Overweight
•Unhealthy Food Choices
•Stress
St
•Smoking
•Physical
y
Inactivityy
•Overuse of Alcohol
Get Up And Move
17
High Blood Pressure Can
Lead To
•Coronary Artery Disease
•Heart Attacks
•Stroke
Stroke
•Kidney Failure
•Blindness
Next Week
18
Dietary Approaches to Stop Hypertension
•Whyy DASH
•Using DASH
20 Years Ago
Today
•Serving Sizes and Choices
1. Please complete the one day food
record and bring it to class next week.
2 Write everything that you eat and drink
2.
for one entire day including amount and
food preparation method.
3 Please
3.
Pl
choose
h
a ttypical
i ld
day.
National Heart Lung Blood Institute
Portion Distortion Interactive Quiz
High Blood Pressure/Hypertension
What is blood pressure and why blood pressure numbers are important?
Joyce M. Woodson, MS, RD, Area Nutrition Specialist
Millicent Braxton-Calhoun, MS, Program Officer
Kristen Bourque, BS, Dietetic Intern
Blood pressure is the force of the blood against the artery walls. If blood pressure is elevated
over time it can lead to high blood pressure also referred to as hypertension. Hypertension is
dangerous because it makes the heart work too hard and contributes to hardening of the
arteries. High blood pressure puts you at risk for stroke, heart disease, heart failure and kidney
failure.
FS-08-46
Reprinted with permission from National Library of Medicine.
Blood Pressure Numbers to Know: (In mm Hg)
1. Culter J A, Sorlie P D, Wolz M, Thom T, Fields L E, Roccella E J, Trends in Hypertension Prevalance, Awareness,
Treatment and Control in United States adults between 1988- 1994 and 1999 – 2004, United States Department of
Health and Human Services National Heart, Lung, and Blood Institute, National Institute of Health http://
www.ncbi.nlm.nih.gov/pubmed
2.
Saunders E African Americans and Hypertension, Maryland Heart Center http://www.umm.edu/heart/
blood_pressure.htm
3.
What about African Americans and High Blood Pressure? American Heart Association www.americaheart.org/
presenter.jhtml?idetifier=3031987 2008
4. Who Can Develop High Blood Pressure? U. S. Department of Health and Human Services National Heart Lung and
Blood Institute, National Institute of Health www.nhlbi.nih.gov/hbp/develop.htm
5. Hypertension and African Americans, St. John Health 2008 www.stjohn.org/HealthInfoLib/swArticle.aspx
The University of Nevada, Reno is an equal opportunity/affirmative action employer and does not discriminate on the basis of race, color, religion, sex, age, creed, national origin,
veteran status, physical or mental disability and sexual orientation in any program or activity it operates. The University of Nevada employs only United States citizens and aliens
lawfully authorized to work in the United States.
Copyright © 2008, University of Nevada Cooperative Extension.
Normal (less than)
Prehypertensive
Hypertensive
120/80 mm Hg
120-139/80-89
140/90 or higher
Prehypertension is an increased risk for hypertension.
What do these numbers mean?
120/80 - The first number (120), also referred to as systolic, represents the pressure when the
heart is beating. The second number (80), referred to as diastolic, represents the pressure
when the heart is resting between beats. The systolic pressure is always stated first and the
diastolic pressure second.
Example: 120/80 (120 over 80); systolic = 120, diastolic = 80
Did You Know…
• About 72 million people in the United States age 20 and older have high blood pressure.
• Of those people with high blood pressure, 71.8 percent were aware of their condition.
• Black people are more likely to suffer from high blood pressure than the general
population.
What Are the Risk Factors?
Controllable Risk Factors
•
Obesity — People with a body mass index (BMI) of 30.0 or higher are
more likely to develop high blood pressure.
How Can I Improve or Prevent High Blood Pressure?
Decrease Sodium/Salt Intake. Less sodium helps lower blood pressure in most
people. Herbs and spices give food flavor and avoid the risk of high sodium intake.
•
Eating too much salt — A high sodium intake increases blood
pressure in some people.
DASH. Follow the eating plan of Dietary Approaches to Stop Hypertension.
•
Drinking too much alcohol — Heavy and regular use of alcohol can
increase blood pressure dramatically.
Eat for Heart Health. Consume a diet rich in high fiber products such as fruits,
vegetables and whole grains.
•
Lack of physical activity — An inactive lifestyle makes it easier to
become overweight and increases the chance of high blood pressure.
Get Regular Physical Activity. Getting regular physical activity with approval from
your doctor will help reduce blood pressure and improve overall heart health.
•
Stress — This is often mentioned as a risk factor, but stress levels are
hard to measure, and responses to stress vary from person to person.
Lose Weight if You’re Overweight. Talk to your doctor to see if this is an option.
Losing weight will reduce the strain on your heart. Often, weight loss will cause
your blood pressure to drop.
Manage Stress. Trying to relax throughout the day can help improve blood
pressure.
Stop Smoking. Smoking is another risk factor for heart disease and stroke.
Avoid Excessive Alcohol. Some studies say that drinking more than 3 to 4
ounces of 80-proof alcohol per day will raise blood pressure. Limit your alcohol
consumption to no more than 1–2 drinks a day.
Uncontrollable Risk Factors
•
Race — Black people develop high blood pressure more often than
whites people and it tends to occur earlier and to be more severe.
Black women are at greater risk compared to black men and other
racial groups.
•
Heredity — If your parents, or other close blood relatives, have high
blood pressure, you're more likely to develop it.
•
Age — In general, the older you get, the greater your chance of
developing high blood pressure. It occurs most often in people over age
35. Men seem to develop it most often between ages 35 and 55.
Women are more likely to develop it after menopause.
*
Blood Pressure Levels for Adults
Category
Systolic†
(mmHg)‡
Diastolic † Result
(mmHg) ‡
Normal
less than
120
and
less than
80
Prehypertension
120-139
or
80-89
Your blood pressure could
be a problem. Make
changes in what you eat
and drink, be physically
active, and lose extra
weight. If you also have
diabetes, see your doctor.
140 or
higher
or
90 or
higher
You have high blood
pressure. Ask your doctor
or nurse how to control it.
Hypertension
Good for you!
* For adults ages 18 and older who are not on medicine for high blood pressure and do not have a short-term serious illness.
Source: The Seventh Report of the Join National Committee on Prevention, Detection, Evaluation, and Treatment of High
Blood Pressure; NIH Publication No. 03-5230, National High Blood Pressure Education Program, May 2003.
†
If systolic and diastolic pressures fall into different categories, overall status is the higher category.
‡ Millimeters of mercury.
BODY MASS INDEX (BMI)
Here is a chart for men and women that gives BMI for various heights and weights.* To use the chart, find your
height in the left-hand column labeled “Height”. Move across to your body weight. The number at the top of the
column is the BMI for your height and weight.
BMI
HEIGHT
21
22
23
*
10”
0”
2”
4”
6”
8”
10”
0”
2”
4”
25
26
27
28
29
30
31
138
148
158
169
179
190
202
213
225
238
143
153
164
174
186
197
209
221
233
246
148
158
169
180
192
203
216
228
241
254
BODY WEIGHT (POUNDS)
(FEET AND INCHES)
4’
5’
5’
5’
5’
5’
5’
6’
6’
6’
24
100
107
115
122
130
138
146
154
163
172
105
112
120
128
136
144
153
162
171
180
110
118
126
134
142
151
160
169
179
189
115
123
131
140
148
158
167
177
186
197
119
128
136
145
155
164
174
184
194
205
124
133
142
151
161
171
181
191
202
213
129
138
147
157
167
177
188
199
210
221
134
143
153
163
173
184
195
206
218
230
Weight is measured with underwear but no shoes.
* For adults ages 18 and older who are not on medicine for high blood pressure and do not have a short-term serious illness.
Source: The Seventh Report of the Join National Committee on Prevention, Detection, Evaluation, and Treatment of High
Blood Pressure; NIH Publication No. 03-5230, National High Blood Pressure Education Program, May 2003.
What Does Your BMI Mean?
Category
BMI
Result
Normal weight
18.5-24.9
Good for you!
Try not to gain weight.
Overweight
25-29.9
Do not gain any weight, especially
if your waist measurement is high.
You need to lose weight if you
have two or more risk factors for
heart disease.
Obese
30 or greater You need to lose weight. Lose
weight slowly - about ½ pound to
2 pounds a week. See your doctor
or a registered dietitian if you need
help.
Source: Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: The
Evidence Report; NIH Publication No. 98-4083, National Heart, Lung, and Blood Institute, in cooperation with the National
Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, June 1998.
A SAMPLE WALKING PROGRAM
Week 1
Session A
Warm Up
Target Zone
Exercising
Cool Down
Total Time
Walk slowly
5 minutes
Walk briskly
5 minutes
Walk slowly
5 minutes
15 minutes
Walk briskly
7 minutes
Walk briskly
9 minutes
Walk briskly
11 minutes
Walk briskly
13 minutes
Walk briskly
15 minutes
Walk briskly
18 minutes
Walk slowly
5 minutes
Walk slowly
5 minutes
Walk slowly
5 minutes
Walk slowly
5 minutes
Walk slowly
5 minutes
Walk slowly
5 minutes
Walk briskly
20 minutes
Walk slowly
5 minutes
30 minutes
Walk briskly
23 minutes
Walk slowly
5 minutes
33 minutes
Walk briskly
26 minutes
Walk slowly
5 minutes
36 minutes
Walk briskly
28 minutes
Walk slowly
5 minutes
38 minutes
Walk briskly
30 minutes
Walk slowly
5 minutes
40 minutes
Session B
Repeat
Session C
Repeat
Week 2
Week 3
Week 4
Week 5
Week 6
Week 7
Week 8
Week 9
Week 10
Week 11
Week 12
AND
BEYONd
Walk slowly
5 minutes
Walk slowly
5 minutes
Walk slowly
5 minutes
Walk slowly
5 minutes
Walk slowly
5 minutes
Walk slowly
5 minutes
Walk slowly
5 minutes
Walk slowly
5 minutes
Walk slowly
5 minutes
Walk slowly
5 minutes
Walk slowly
5 minutes
National Heart, Lung and Blood Institute.
Distributed by University of Nevada Cooperative Extension
17 minutes
19 minutes
21 minutes
23 minutes
25 minutes
28 minutes
LESSON 2
WHY DASH?
LESSON 2
Why DASH?
OVERVIEW:
Researchers have not been able to find the exact cause of high blood pressure.
However, it is known that lifestyle and dietary habits can affect blood pressure.
Lifestyle and dietary modifications have been shown to prevent or delay the
expected rise in blood pressure in susceptible people and help others to control
their blood pressure. Some of these lifestyle modifications include: dietary
habits, foods low in salt and sodium, increased physical activity and moderate
alcohol consumption.
Two studies have shown that diet affects the development of hypertension or
high blood pressure. The first was called DASH, for Dietary Approaches to Stop
Hypertension. Scientists tested nutrients in foods and found that blood pressure
levels were reduced with an eating plan that is low in saturated fat, cholesterol,
total fat, and that emphasizes fruit, vegetables, low-fat dairy foods and whole
grains.
In the first study, three groups of adult volunteers ate one of three diets for eight
weeks. The diets of the different groups were as follows:
1. A diet low in fruits, vegetables and dairy products with the same amount of fat
as in the average American diet – called the “control” diet.
2. A diet rich in fruits and vegetables – called the “fruits and vegetables” diet.
3. A diet rich in fruits and vegetables, low-fat dairy products with reduced
saturated and total fat – called the “combination” diet.
2-1
At the end of the eight weeks, the researchers compared the changes in blood
pressures of each group. The researchers found that after only eight weeks, the
people in the third group, who ate the “combination” diet, had lowered their blood
pressure more than the other groups. In fact, these changes were most
significant among people with high blood pressure. These decreases in blood
pressure were similar to the effects of medications! Included in this study were
459 adults, with 27 percent having hypertension. Approximately 50 percent were
women and 60 percent were African Americans.
The second study called DASH-Sodium focused on the effect of reduced sodium
intake on participants following the DASH diet or eating a typical American diet.
DASH-Sodium involved 412 participants; 41 percent had high blood pressure, 57
percent were women and about 57 percent were African Americans. Participants
were assigned, randomly, to follow one of the two eating plans. They were
followed for one month on the assigned plan and at each of three sodium levels.
The sodium levels were 3,300 milligrams per day (the amount consumed by
many Americans), 2,300 milligrams (considered an intermediate intake) and
1,500 milligrams per day (a lower intake). It is recommended that sodium not
exceed 2,300 milligrams per day.
The results from this study showed that reducing dietary sodium lowered blood
pressure for both the DASH and the typical American diet plan. At each sodium
level, blood pressure was lower on the DASH diet than on the other eating plan.
The biggest blood pressure reductions were for the DASH diet at the sodium
intake of 1,500 milligrams per day. Those with hypertension saw the biggest
reductions, but those without hypertension also had large decreases.
Research has shown that a diet rich in potassium may help to reduce elevated or
high blood pressure. It is important that potassium come from food sources not
supplements. Potassium is found in many fruits and vegetables, some milk
2-2
products and fish. Calcium, important in contraction of the heart muscle, plays a
role in the success of DASH, as does magnesium, which controls the relaxation
of the heart muscle as blood is pumped out. As with potassium it is important to
get these nutrients from food sources.
The DASH research was sponsored by the National Heart, Lung, and Blood
Institute. Research studies were conducted at Brigham and Women’s Hospital,
Boston, MA; Duke Hypertension Center and Sarah W. Stedman Nutrition and
Metabolism Center, Durham, NC; Johns Hopkins Medical Institutions, Baltimore,
MD; and Pennington Biomedical Research center, Baton Rouge, LA.
Blood pressure medication can cause side effects and is also expensive.
However, some people may be able to prevent or decrease their high blood
pressure through food choices, thus reducing the need for medications.
It is important to note that an individual should never stop taking blood pressure
medication or change your dosage without consulting their physician first.
2-3
LESSON 2: Teaching Guide
Why DASH?
OBJECTIVES
After completing this lesson, the participants will be able to:
1. List three DASH recommendations that can help lower blood pressure.
2. Explain appropriate serving sizes of foods.
KEY POINTS TO COVER WHEN TEACHING THE LESSON
1. The DASH Eating Plan has been shown to successfully lower blood
pressure.
2. Lowering sodium intake is an important part of this eating plan.
3. Fruits, vegetables, low-fat dairy products and whole grain foods are
emphasized in the DASH Eating Plan.
MATERIALS AND SUPPLIES NEEDED:
1. Attendance sheet
2. Name tags
3. PowerPoint presentation
4. Projector
5. Wax food models (NASCO) and deck of cards
6. Wall covering for PowerPoint Projection
7. Plain sheets of paper
8. Participant handouts:
Copies of PowerPoint slides
DASH Eating Plans, 1600 and 2000 calories
2-4
Servings Sizes and Choices, 1600 and 2000 calories
DASH Eating Plan Guide
Sample of a food label (to be brought in for next lesson)
BEFORE TEACHING THE LESSON:
1. Review lesson overview, DASH Eating Plans and teaching guide.
2. Gather all necessary materials and supplies.
WARM UP:
1. Have participants pick up name tags and sign attendance sheets.
2. Ask if there are questions about the last lesson.
3. Ask if any one used any of the information from the last lesson.
4. Collect One Day Food Record sheets.
PROCEDURES FOR TEACHING THE LESSON:
1.
Show the PowerPoint #1, the title of the workshop.
2.
Show the PowerPoint #2 Tell the group: “During this hour we will review the
recommendations for DASH, D-A-S-H, Dietary Approaches to Stop
Hypertension. We will look at food groups, daily servings, serving sizes and
note the examples of foods in the different food groups.
“Research has proven that an eating plan emphasizing using low fat dairy
products, fruits, vegetables, whole grains and limited sodium does
decrease blood pressures levels in persons with high blood pressure and
those who do not have high blood pressure. This eating plan was found
to be particularly effective with African Americans.”
2-5
3.
Show PowerPoint #3 and repeat the objectives of the lesson.
4.
Show the PowerPoint #4 and discuss the information regarding importance
of key nutrients in DASH.
5.
Show the PowerPoint #5 and pass out copies of the DASH Eating Plan
handouts asking participants to insert them in their notebooks. “Let’s review
the recommendations that resulted from the DASH study. You have a sheet
for 2,000 calories and one for 1,600 calories. In this discussion we will refer
to the 2,000-calorie plan. If you are overweight and wish to lose weight you
may want to use the 1,600 calorie plan. Regardless of the plan you find best
for you, it is important to make changes slowly. Do not try to make all of the
changes at once. The number of changes you find you need to make will be
determined by your current eating habits. This lesson and the next four
lessons will help you to follow DASH. Please look at the DASH Eating Plan
and Serving Sizes and Choices.
6.
Using the PowerPoint # 6 and the participant’s handout, review all of the
information given for grains. Remember the added notes at the bottom of the
participant handout. Share food models with the group to understand serving
sizes. Continue with a discussion of the vegetable group, using food model to
show serving sizes. Ask if there are questions regarding the grains or
vegetable groups.
7.
Using the PowerPoint # 7 and the participant’s handout, review all of the
information given for the fruit group. Share food models with the group to
understand serving sizes. Continue with a discussion of the fat-free or low-fat
milk and milk products, using food models to show serving sizes. Ask if there
are questions regarding the fruits or milk and milk products. Tell the group
2-6
that additional information on milk will be shared in the lesson on Lactose
Intolerance.
8.
Using the PowerPoint # 8 and the participant’s handout, review all of the
information given for lean meats, poultry and fish. It is important to share the
information about eggs given in the note on the participant’s handout. Share
food models with the group to understand serving sizes, show a deck of cards
to represent 3 ounces of meat. Continue with a discussion of nuts, seeds and
legumes, using food models to show serving sizes. Ask if there are questions
regarding these two groups.
9.
Using the PowerPoint # 9 and the participant’s handout, review all of the
information given for fats and oils. It is important to share the information
about fats and oils given in the note on the participant’s handout. Share food
models with the group to understand serving sizes. Continue with a
discussion of sweets and added sugars, using food models to show serving
sizes. Ask if there are questions regarding these two groups. Emphasize
that sweets and added sugars are not included on the 1,600 calorie eating
plan.
10.
Show PowerPoint #10 and review lesson. “This concludes the lesson “Why
DASH”. Limiting salt and sodium is a very important part of DASH. High
blood pressure is decreased more as sodium intake decreases, per the
DASH recommendations.
11.
Show PowerPoint #11 Next week we will practice writing menus using DASHSodium Eating Plan. Please continue to review the DASH Eating Plan during
the week.
2-7
Eating to Stop and Control
HIGH BLOOD PRESSURE
LESSON 2
Why DASH
OBJECTIVES
After completing this lesson, the
participants will be able to:
1 List 3 DASH recommendations that can
1.
help lower blood pressure.
2. Explain appropriate serving sizes of
foods.
Key Nutrients
•
Potassium—keeps a normal water balance between cells and
body, needed for contraction of muscles.
•
Magnesium—maintains
M
i
i i normall muscle
l and
d nerve
function, regular heart rhythm, and for more than 300
chemical reactions in the body.
y
•
Calcium—blood pressure regulation and works in
conjunction with potassium and magnesium
magnesium.
•
Protein—needed for chemical reactions and as foundation for
b ildi proteins
building
t i in
i the
th body.
b d
•
Fiber—decreases risk for heart disease and type 2 diabetes.
Dietary Approaches
to
Stop Hypertension
Some pictures courtesy of the National Dairy Council, www.nutritionexplorations.org
THE DASH EATING PLAN
FOOD
GROUP
Grains &
grain
products
Vegetables
SERVINGS SERVINGS
PER DAY PER DAY
1,600
2,000
6
3-4
6-8
4-5
WHAT IS A
SERVING?
EXAMPLES
IMPORTANCE
• 1 slice bread
• 1 oz. dry
cereal*
• ½ cup cooked
rice, pasta or
cereal
• cornbread
•
• English muffin
•
• grits
•
• unsalted pretzels •
• popcorn
•
• whole wheat bread
• whole grain cereals
bagel
pita bread
oatmeal
crackers
brown rice
• 1 cup raw
leafy
vegetable
• ½ cup cooked
vegetable
g
• 4 oz.
vegetable
juice
• mustard greens
• kale
• carrots
• lima beans
• broccoli
• collards
• green beans
• sweet potatoes
• Brussel sprouts
tomatoes
Rich sources of:
• potassium
potatoes
• magnesium
green peas
• fiber
squash
turnip g
greens
spinach
artichokes
cabbage
*Equals ½ - 1 ¼ cup depending on cereal type. Check the product’s Nutrition Facts panel.
•
•
•
•
•
•
•
•
Major source of:
• energy
• fiber
THE DASH EATING PLAN
FOOD
GROUP
Fruits
Lowfat or
Fat Free
Dairy
Foods
SERVINGS SERVINGS
PER DAY PER DAY
1 600
1,600
2 000
2,000
4
2-3
4-5
2-3
WHAT IS A
SERVING?
EXAMPLES
• 4 oz. fruit
juice
• 1 medium
fruit
• 1/4 cup dried
fruit
• 1/2 cup fresh,
frozen or
canned fruit
• apples
• bananas
• grapes
• grapefruit
• melon
• pineapple
• raisins
• tangerines
• cherries
• grapefruit juice
•
•
•
•
•
•
•
•
•
• 8 oz. milk
• 1 cup yogurt
• 1 1/2 oz.
cheese
• fat free (skim milk)
• low fat milk
• fat free buttermilk
• low fat buttermilk
• fat free regular or frozen yogurt
• low
lo fat regular
reg lar or fro
frozen
en yogurt
og rt
• fat free cheese
• low fat cheese
apricots
dates
oranges
mangos
peaches
prunes
strawberries
watermelon
orange juice
IMPORTANCE
Important
sources:
• potassium
• magnesium
• fiber
Major sources
of:
• calcium
• protein
THE DASH EATING PLAN
FOOD
GROUP
Meats,
poultry and
fish
SERVINGS SERVINGS
PER DAY PER DAY
1,600
2,000
1-2
per week
Nuts, seeds 3 p
and dry
beans
2 or less
WHAT IS A
SERVING?
EXAMPLES
• 3 oz. cooked ¾ select only lean
Rich sources of:
• protein
meats, poultry ¾ trim away visible fats
• magnesium
or fish
¾ remove skin from poultry
¾ instead of frying, try one of these
• broil
• roast
• bake
per
4-5 p
week
IMPORTANCE
• 1/3 cup or 1
1/2 oz. nuts
• 2 Tbsp.
p or 1/2
oz. seeds
• 1/2 cup
cooked dry
beans or peas
• almonds
• filberts
• sunflower seeds
• lentils
• black-eyed peas
• split peas
• poach
• boil
•
•
•
•
•
hazelnuts
walnuts
kidney
y beans
peas
black beans
Rich sources of:
• energy
• magnesium
g
• potassium
• protein
• fiber
THE DASH EATING PLAN
FOOD
GROUP
Fats and
Oilsh
Sweets
SERVINGS SERVINGS
WHAT IS A
PER DAY
PER DAY
SERVING?
1,600
2,000
• 1 tsp.
p soft
2
2-3
margarine
• 1 Tbsp. lowfat
mayonnaise
• 2 Tbsp. light
salad dressing
• 1 tsp.
vegetable oil
0
5 or less per • 1 Tbsp. sugar
week
• 1 Tbsp. jelly or
jam
• 1/2 oz. jelly
beans
• 8 oz.
lemonade
EXAMPLES
IMPORTANCE
•
•
•
•
soft margarine
g
lowfat mayonnaise
light salad dressing
vegetable oil (such as olive,
corn, canola or safflower)
DASH has 27
percent of
calories as fat,
including fat in
or added to
foods
•
•
•
•
•
•
•
•
•
•
maple syrup
sugar
jelly
jam
fruit flavored gelatin
jelly beans
hard candy
fruit punch
sorbet
ices
Sweets should
be low in fat
hThe amount of fat in salad dressings changes based upon the fat content. One tablespoon of regular salad dressing equals one serving, 1 Tbsp. of lowfat dressing equals ½ serving, 1 Tbsp. of
fat free dressing equals 0 servings.
Review
Research has proven that an eating plan using:
low fat dairy products
grains
vegetables
fruits
u s
limited sodium
does decrease blood pressures levels in persons with high
blood pressure and those who do not have high blood
p
pressure.
Next Week
• Practice writing menus using DASH—Sodium Eating
Plan
• Please continue to review the DASH Eating Plan
during the week
week.
DASH
2,000 Calorie
Eating Plan
Food Group
Daily Servings
Grains*
6-8
Vegetables
4-5
Fruits
4-5
Fat-free or lowfat milk and milk
products
Serving Sizes
1-2 3-ounce
servings
Nuts, seeds, and
legumes
4-5 per week
Fats and oils****
2-3
Sweets and
added sugars
5 or less per
week
Significance of Each
Food Group to the
DASH Eating Pattern
1 slice bread
1 oz dry cereal**
½ cup cooked rice, pasta, or
cereal
Whole wheat bread and rolls, whole
wheat pasta, English muffin, pita
bread, bagel, cereals, grits, oatmeal,
brown rice, unsalted pretzels and
popcorn
Major sources of
energy and fiber
1 cup raw leafy vegetable
½ cup cut-up raw or cooked
vegetable
½ cup vegetable juice
Broccoli, carrots, collards, green
beans, green peas, kale, lima beans,
potatoes, spinach, squash, sweet
potatoes, tomatoes
Rich sources of
potassium,
magnesium, and fiber
1 medium fruit
¼cup dried fruit
½ cup fresh, frozen, or canned
fruit
½ cup fruit juice
Apples, apricots, bananas, dates,
grapes, oranges, grapefruit, grapefruit
juice, mangoes, melons, peaches,
pineapples, raisins, strawberries,
tangerines
Important sources of
potassium,
magnesium, and fiber
1 cup milk or yogurt
1½ oz cheese
Fat-free (skim) or low-fat (1%) milk or
buttermilk, fat-free, low-fat, or reducedfat cheese, fat-free or low-fat regular or
frozen yogurt
Major sources of
calcium and protein
3 oz cooked meats, poultry, or
fish
1 egg***
Select only lean meat; trim away
visible fats; broil, roast, bake or poach;
remove skin from poultry
(bottom round roast, top sirloin, white
meat of chicken and turkey)
Rich sources of
protein and
magnesium
⅓ cup or 1 ½ oz nuts
2 Tbsp peanut butter
2 Tbsp or ½ oz seeds
½ cup cooked legumes (dry
beans and peas)
Almonds, hazelnuts, mixed nuts,
peanuts, walnuts, sunflower seeds,
peanut butter, kidney beans, lentils,
split peas
Rich sources of
energy, magnesium,
protein, and fiber
1 tsp soft margarine
1 tsp vegetable oil
1 Tbsp mayonnaise
2 Tbsp salad dressing
Soft margarine, vegetable oil (such as
canola, corn, olive, or safflower), lowfat mayonnaise, light salad dressing
The DASH study had
27 percent of calories
as fat, including fat in
or added to foods
1 Tbsp sugar
1 Tbsp jelly or jam
½ cup sorbet, gelatin
1 cup lemonade
Fruit-flavored gelatin, fruit punch, hard
candy, jelly, maple syrup, sorbet and
ices, sugar
Sweets should be low
in fat
2-3
Lean meats,
poultry, and fish
Examples and Notes
* Whole grains are recommended for most grain servings as a good source of fiber and nutrients.
** Serving sizes vary between ½ cup and 1¼ cups, depending on cereal type. Check the product's Nutrition Facts label.
*** Since eggs are high in cholesterol, limit egg yolk intake to no more than four per week; two egg whites have the same protein
content as 1 oz of meat.
**** Fat content changes serving amount for fats and oils. For example, 1 Tbsp of regular salad dressing equals one serving; 1
Tbsp of a low-fat dressing equals one-half serving; 1 Tbsp of a fat-free dressing equals zero servings.
An EEO/AA institution
Reviewed 11/09
DASH
1,600 Calorie
Eating Plan
Food Groups
Daily Servings
Grains*
6
Vegetables
3-4
Fruits
4
Fat-free or lowfat milk and milk
products
Serving Sizes
Examples and Notes
1 slice bread
1 oz dry cereal**
½ cup cooked rice, pasta, or
cereal
Whole wheat bread and rolls, whole
wheat pasta, English muffin, pita
bread, bagel, cereals, grits, oatmeal,
brown rice, unsalted pretzels and
popcorn
Major sources of
energy and fiber
1 cup raw leafy vegetable
½ cup cut-up raw or cooked
vegetable
½ cup vegetable juice
Broccoli, carrots, collards, green
beans, green peas, kale, lima beans,
potatoes, spinach, squash, sweet
potatoes, tomatoes
Rich sources of
potassium,
magnesium, and fiber
1 medium fruit
¼cup dried fruit
½ cup fresh, frozen, or canned
fruit
½ cup fruit juice
Apples, apricots, bananas, dates,
grapes, oranges, grapefruit, grapefruit
juice, mangoes, melons, peaches,
pineapples, raisins, strawberries,
tangerines
Important sources of
potassium,
magnesium, and fiber
1 cup milk or yogurt
1½ oz cheese
Fat-free (skim) or low-fat (1%) milk or
buttermilk, fat-free, low-fat, or reducedfat cheese, fat-free or low-fat regular or
frozen yogurt
Major sources of
calcium and protein
3 oz cooked meats, poultry, or
fish
1 egg***
Select only lean meat; trim away
visible fats; broil, roast, bake or poach;
remove skin from poultry
(bottom round roast, top sirloin, white
meat of chicken and turkey)
Rich sources of
protein and
magnesium
⅓ cup or 1 ½ oz nuts
2 Tbsp peanut butter
2 Tbsp or ½ oz seeds
½ cup cooked legumes (dry
beans and peas)
Almonds, hazelnuts, mixed nuts,
peanuts, walnuts, sunflower seeds,
peanut butter, kidney beans, lentils,
split peas
Rich sources of
energy, magnesium,
protein, and fiber
1 tsp soft margarine
1 tsp vegetable oil
1 Tbsp mayonnaise
2 Tbsp salad dressing
Soft margarine, vegetable oil (such as
canola, corn, olive, or safflower), lowfat mayonnaise, light salad dressing
The DASH study had
27 percent of calories
as fat, including fat in
or added to foods
2-3
Lean meats,
poultry, and fish
1-2 3-ounce
servings
Nuts, seeds, and
legumes
3 per week
Fats and oils****
2
Significance of Each
Food Group to the
DASH Eating Pattern
* Whole grains are recommended for most grain servings as a good source of fiber and nutrients.
** Serving sizes vary between ½ cup and 1¼ cups, depending on cereal type. Check the product's Nutrition Facts label.
*** Since eggs are high in cholesterol, limit egg yolk intake to no more than four per week; two egg whites have the same protein
content as 1 oz of meat.
**** Fat content changes serving amount for fats and oils. For example, 1 Tbsp of regular salad dressing equals one serving; 1
Tbsp of a low-fat dressing equals one-half serving; 1 Tbsp of a fat-free dressing equals zero servings.
An EEO/AA institution.
Reviewed 11/09
SERVING SIZES AND CHOICES
2,000 Calories
6 - 8 Servings of Grains per Day
1 Slice of Bread
½ Cup Pasta or Rice
½ Cup Cooked Cereal
3-4 Small Crackers
1 oz Dry Cereal*
4 - 5 Servings of Vegetables per Day
1 Cup Green, Leafy Vegetables
½ Cup Cooked Vegetables
½ Cup (4 oz) Vegetable Juice
4 - 5 Servings of Fruits per Day
1 Medium Piece of Fruit
½ Cup Canned Fruit
½ Cup Chopped Fresh Fruit
½ Cup (4 oz) Fruit Juice
2 - 3 Servings of Low or Fat Free Dairy per Day
1 Cup (8 oz) Low-Fat Milk
1 ½ oz Low-Fat Cheese
1 Cup Low-Fat Yogurt
1 - 2 Servings of Meats per Day
3 oz Meat, Fish or Poultry
4 - 5 Servings of Nuts, Seeds & Dry Beans per Week
⅓ Cup or 1 ½ oz Nuts
½ Cup Beans, Peas
2 Tablespoons or ½ oz Seeds
Limit Fat to 2 - 3 Servings each Day
1 Teaspoon Soft Margarine
1 Tablespoon Low-Fat Salad Dressing/Mayonnaise
2 Tablespoons Light Salad Dressing
5 or Less Per Week
1 Tablespoon of Sugar
1 Tablespoon Jelly or Jam
½ oz. Jelly Beans
8 oz. Lemonade
*Serving size varies, ½ - 1 ¼ cup, depending on the cereal. Check the Nutrition Facts Label of product
Some pictures courtesy of the National Dairy Council, www.nutritionexplorations.org
Adapted from the National Heart, Lung, and Blood Institute
Revised 11/09
SERVING SIZES AND CHOICES
1,600 Calories
6 Servings of Grains per Day
1 Slice of Bread
½ Cup Pasta or Rice
½ Cup Cooked Cereal
3-4 Small Crackers
1 oz Dry Cereal*
3 - 4 Servings of Vegetables per Day
1 Cup Green, Leafy Vegetables
½ Cup Cooked Vegetables
½ Cup (4 oz) Vegetable Juice
4 Servings of Fruits per Day
1 Medium Piece of Fruit
½ Cup Canned Fruit
½ Cup Chopped Fresh Fruit
½ Cup (4 oz) Fruit Juice
2 - 3 Servings of Low or Fat Free Dairy per Day
1 Cup (8 oz) Low-Fat Milk
1 ½ oz Low-Fat Cheese
1 Cup Low-Fat Yogurt
1 - 2 Servings of Meats per Day
3 oz Meat, Fish or Poultry
3 Servings of Nuts, Seeds & Dry Beans per Week
⅓ Cup or 1 ½ oz Nuts
½ Cup Beans, Peas
2 Tablespoons or ½ oz Seeds
Limit Fat to 2 - 3 Servings each Day
1 Teaspoon Soft Margarine
1 Tablespoon Low-Fat Salad Dressing/Mayonnaise
2 Tablespoons Light Salad Dressing
*Serving size varies, ½ - 1 ¼ cup, depending on the cereal. Check the Nutrition Facts Label of product.
Adapted from the National Heart, Lung, and Blood Institute
Some pictures courtesy of the National Dairy Council, www.nutritionexplorations.org
Revised 11/09
LESSON 3
FOLLOWING DASH
LESSON 3
FOLLOWING DASH
OVERVIEW:
Background for the DASH Eating Plan is discussed in overview for Lesson 2.
Menus can be created using the DASH Eating Plan for any ethnic or cultural
population. In this lesson there will be an opportunity to practice creating menus
following the DASH-Sodium recommendations. It is important to select foods low
in sodium as well as low in fat. DASH stresses eating more fruits and
vegetables, including low- and non-fat dairy products, limiting saturated fats,
eating plenty of whole grains, and eating more beans, nuts and seeds.
Take one step at a time when making changes in food choices or food
preparation. Select those changes that would be easy to accomplish first.
3-1
LESSON 3: Teaching Guide
FOLLOWING DASH
OBJECTIVES:
After completing this lesson the participant will be able to:
1. Develop a menu using the DASH-Sodium recommendations.
2. Develop personal objectives for following DASH.
KEY POINTS TO COVER WHEN TEACHING THE DASH LESSON:
1. Make changes one or two steps at a time.
2. Focus on the choices to include more than those to be excluded.
MATERIALS AND SUPPLIES NEEDED:
1.
Name Tags
2.
Attendance Sheet
3.
PowerPoint presentation
4.
Projector
5.
Wall Covering for PowerPoint Presentation
6.
Measuring Cups
7.
10 oz sectional paper with food illustrated
8.
Food Models
9.
Participant’s handouts
Create A Menu
Create a Weekly Menu
My Personal Plan to Follow DASH
Keeping Track Booklets
PowerPoint
3-2
BEFORE TEACHING THE LESSON:
1. Review DASH-Sodium Eating Plan, lesson overview and teaching
guide.
2. Review PowerPoint presentation.
3. Gather materials and supplies.
WARM UP:
1. Have participants pick up name tags and sign attendance sheets.
2. Ask if there are questions about the last lesson.
3. Ask if any one used any of the information from the last lesson. Repeat
the key points of the last lesson.
PROCEDURE FOR TEACHING THE LESSON:
1.
Show PowerPoint #1
2.
Show PowerPoint #2 repeating title of lesson “Following DASH”.
3.
Show PowerPoint #3 and state objective for the lesson.
4.
Pass out the One Day Food Intake sheets to each participant. Ask
participants to take out copies of DASH Eating Plan. Tell the group
to compare their one day intake to DASH recommendations. Allow
three minutes for this activity, Ask two to three participants to share
their results.
5.
“Now we are going to practice planning a menu that meets the
DASH guidelines.”
3-3
At this point, show PowerPoint #4, Create a Menu”. Ask
participants to take out their copies of “Create a Menu”. It is
important to follow DASH recommendations and include foods from
each food group in correct amounts. We will create three menus
and list foods we would select as snacks. Suggest participants
work in groups of two or three. Assist participant as needed
through this activity.
“Use the “Serving Sizes and Choices”, 1,600 or 2,000 handout and
the DASH Eating Plan to help you decide which foods and how
much of each food you will eat. Write your choices on the “CreateA-Menu” form and check off the food groups as you go. Once you
are finished, total up all of the food groups to determine if you have
met the DASH guidelines.”
6.
Have a discussion with the group about the menus they created.
Ask if anyone is having problems completing their menus. Ask if
they have all of the recommended servings in each food group.
Share with the group the meals on the paper plates, stressing that
you have put the same amount of food on each plate. Ask which
size plate they use or would prefer to use.
You will now show the PowerPoint menu selections indicating the
servings on each.
7.
Show PowerPoint #5 and #6. Read selections on this breakfast
menu.
8.
Show PowerPoint #7 and #8. Read selections on this lunch menu
3-4
9.
Show PowerPoint #9 and #10. Read selections on this dinner
menu.
10.
Show PowerPoint #11. Read snack selections.
11.
Show PowerPoint #12. Summarize DASH recommendations.
“To help decrease your risk of developing high blood pressure or to
lower your blood pressure if you already have high blood pressure,
here are some things you can do”:
•
Limit sodium intake.
•
Eat more fruits and vegetables
•
Include low- and non-fat dairy products in your diet.
•
Limit the amount of saturated fat in your diet by reducing whole
milk dairy products and high-fat meats, such as ground beef.
12.
•
Eat plenty of grains, especially whole grains.
•
Eat more beans, nuts and seeds.
Have the participants use Create a Weekly Menu to start creating a
weekly menu following DASH.
13.
Ask participants to take out “Keeping Track”, explain that they may
use these to track their success in following DASH.
14.
Next, refer to the sheet “My Plan to Follow Dash”. Each participant
should complete this form. Allow necessary time and ask two or
three participants to share their plan.
15.
Positive Outcomes to Reinforce:
Show PowerPoint # 13
3-5
•
By changing your eating habits, you may be able to
decrease the amount of blood pressure medications
required.
•
If you don’t already have high blood pressure, you may
be able to prevent it by changing your eating habits.
•
By eating according to the DASH recommendations, you
are not only decreasing your risk for high blood pressure,
but also for cancer, heart disease, osteoporosis and
diabetes.
16.
Show PowerPoint # 14 Tell the group that next week we will have a
discussion on looking for salt and sodium, reading food labels, and
recipe testing.
3-6
2
LESSON 3
Following DASH
3
OBJECTIVES:
After completing
p
g this lesson the participant
p
p
will be able to:
1. Develop a menu using the DASH-Sodium
recommendations.
2. Develop personal objectives for following
DASH.
CREATE-A-MENU
4
List foods you will eat for an entire day. Check off each food group that applies to your food choices. Once you are finished planning
meals and snacks, compare
p yyour total number of servings
g for each of the food ggroups
p with the DASH recommendations.
Food Choices
Breakfast
Lunch
Dinner
Snacks
Total
Fruits
Veggies
Dairy
Grains
Meats
Legumes
DASH SAMPLE MENU
BREAKFAST
4 oz
oz. orange juice
1 fruit
1 medium banana
1 fruit
8 oz
oz. 1% milk
1 dairy
1 ½ cups corn flakes
2 grains
1p
piece whole wheat toast
1g
grain
1 tsp. soft margarine
1 fat
5
DASH SAMPLE MENU
BREAKFAST
(2)
4 oz. low sodium tomato juice/vegetable juice 1 fruit/1 vegetable
1 medium banana
1 fruit
8 oz. 1% milk
1 dairy
1 cup cooked cereal
(oatmeal/cream of wheat)
2 grains
1 piece whole wheat toast
1 grain
1 tsp. soft margarine
1 fat
6
DASH SAMPLE MENU
LUNCH
2 oz. tturkey
k (2 slices)
li
)
1 meatt
2 slices whole wheat bread
2 grains
6 – 8 sticks carrots and celery
1 vegetable
1 slice low fat cheese
1 dairy
8 oz
oz. 1% milk
1 dairy
1 medium apple
1 fruit
7
DASH SAMPLE MENU
LUNCH
(2)
2 oz. llow ffat/low
t/l
sodium
di
h
ham
1 meatt
2 slices whole wheat bread
2 grains
6 – 8 sticks carrots and celery
1 vegetable
½ cup low fat yogurt
1 dairy
8 oz
oz. 1 % butter milk
1 dairy
1 medium apple
1 fruit
8
DASH SAMPLE MENU
DINNER
3 oz h
herbed
b db
baked
k d cod
d
1 meatt
1 cup rice pilaf
2 grains
1 small whole wheat dinner roll 1 grain
½ cup steamed broccoli
1 vegetable
1 cup spinach salad
1 vegetable
1 tbsp. light dressing
½ fat
½ cup
p melon
1 fruit
9
DASH SAMPLE MENU
DINNER
(2)
3 oz h
herbed
b db
baked
k d catfish
tfi h
1 meatt
1 cup cooked grits
2 grains
1 small corn muffin
1 grain
½ cup cooked collard greens
1 vegetable
1 cup cucumber,
cucumber tomato & lettuce salad
1 vegetable
1 tbsp. light dressing
½ fat
½ cup
p melon
1 fruit
10
DASH SAMPLE MENU
SNACKS
¼ cup dried apricots
1 fruit
¾ cup unsalted pretzels
1 grain
1/3 cup unsalted peanuts
1 nut
12 oz diet soda
DIET
SODA
11
12
Review
Research has proven that an eating plan using:
low fat dairy products
vegetables
grains
fruits
limited sodium
does decrease blood pressures levels in persons with high
blood pressure and those who do not have high blood pressure.
POSITIVE
OUTCOMES
1. By changing your eating habits, you may be able to
decrease the amount of blood p
pressure medications
required.
2. If you don’t already have high blood pressure, you
may be able to prevent it by changing your eating
habits.
3 Y
3.
You also
l d
decrease your risk
i k ffor cancer, h
heartt
disease, osteoporosis and diabetes.
13
Next Week
Looking for foods high in
salt and sodi
sodium
m
·
·
Reading food labels
·
Recipe
p Tasting
g
Please bring to class a
l b l ffrom a ffood
label
d th
thatt you
commonly use.
·
14
CREATE-a-Weekly Menu
BREAKFAST
LUNCH
DINNER
SNACKS
HELPFUL TIPS
• Fruits, fresh, frozen or
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY
SUNDAY
canned make great
desserts or snacks. Top
with yogurt or cottage
cheese on lettuce for
salad.
• Fresh fruit is a great way
to start the day.
• Top your cereal with
fruit.
• Remember whole grain
breads and cereals.
• Wheat crackers and
lowfat cheese for
snacks.
• Lowfat or fat free dairy
products; milk, cheese,
yogurt, frozen yogurt at
mealtime and for snack.
• Vegetables are
important, fresh or
cooked. Steam and stir
fry are best when
cooking veggies. Use a
variety of veggies
especially dark green
and yellow. These are
great as side dishes,
salads and raw as a
snack with or without
dip.
• Dry beans and peas are
excellent substitute for
meat, add rice.
• Nuts are great as
snacks or in salads.
November 09
1
Eating to Stop and Control
HIGH BLOOD PRESSURE
Dietary Approaches
to
Stop Hypertension
Some pictures courtesy of the National Dairy Council, www.nutritionexplorations.org
DASH
BREAKFAST
1 Medium Banana
8 oz. 1% Milk
1 ½ cups Corn Flakes
1 slice Whole Wheat Toast
1 tsp. Soft Margarine
1 Fruit
1 Dairy
2 Grains
1 Grain
1 Fat
DASH
BREAKFAST 2
½ cup Orange Juice
8 oz. 1% Milk
1 cup cooked Cereal
(oatmeal/cream of wheat)
1 slice Whole Wheat Toast
1 tsp. Soft Margarine
1 Fruit
1 Dairy
2 Grains
1 Grain
1 Fat
DASH
LUNCH
3/4 cup Chicken Salad
2 slices Whole Wheat Bread
6 - 8 sticks Carrots and/or Celery
1 Lettuce Leaf
8 oz. Lowfat Milk
1 Medium Apple
1 Meat
2 Grains
1 Vegetable
1 Dairy
1 Fruit
DASH
LUNCH 2
3 oz. Turkey
2 slice Whole Wheat Bread
1 cup Tossed Green Salad
1 Lettuce leaf for sandwich
1 cup Lowfat Yogurt
½ cup Fresh Strawberries
1 tsp. Mayonnaise
1 tsp. Fat Free Salad Dressing
1 Meat
2 Grains
1 Vegetable
1 Dairy
1 Fruit
1 Fat
DASH
DINNER
3 oz Herbed baked Cod
1 cup Rice Pilaf
1 small Whole Wheat Dinner Roll
½ cup steamed Broccoli
1 cup Spinach Salad
1 tbsp. Light Dressing
½ cup Melon
1 Meat
2 Grains
1 grain
1 Vegetable
1 Vegetable
½ Fat
1 Fruit
DASH
DINNER 2
3 oz. Roasted Chicken
½ cup cooked Pasta
2 small Corn Muffins
½ cup cooked Collard Greens
1 cup cucumber, tomato & lettuce salad
½ cup Melon
1 Meat
1 Grain
2 Grains
1 Vegetables
1 Vegetable
1 Fruit
DASH
SNACKS
1 medium Peach
¼ cup dried Apricots
1 Apple and 1½ oz. Cheese
1 cup Frozen Yogurt
¾ cup Unsalted pretzels
⅓ cup Unsalted peanuts
12 oz. Diet soda
1 Fruit
1 Fruit
1 Fruit, 1 Dairy
1 Dairy
1 Grain
1 Nuts, Seeds, Legumes
EATING TO
STOP AND CONTROL
HIGH BLODD
PRESSURE
The University of Nevada, Reno is an equal opportunity affirmative action employer and
does not discriminate on the basis of race, color, religion, sex, age, creed, national origin,
veteran status, physical or mental disability, sexual orientation, in any program or activity it
operates. The University of Nevada employs only United States citizens and aliens lawfully
authorized to work in the United States.
Keeping Track
November 09
EATING TO
STOP AND CONTROL
HIGH BLODD
PRESSURE
The University of Nevada, Reno is an equal opportunity affirmative action employer and
does not discriminate on the basis of race, color, religion, sex, age, creed, national origin,
veteran status, physical or mental disability, sexual orientation, in any program or activity it
operates. The University of Nevada employs only United States citizens and aliens lawfully
authorized to work in the United States.
November 09
Keeping Track
FOOD CHOICES
FRUITS VEGGIES DAIRY GRAINS MEATS LEGUMES
TOTAL
FOOD CHOICES
TOTAL
FRUITS VEGGIES DAIRY GRAINS MEATS LEGUMES
FOOD CHOICES
FRUITS VEGGIES DAIRY GRAINS MEATS LEGUMES
TOTAL
FOOD CHOICES
TOTAL
FRUITS VEGGIES DAIRY GRAINS MEATS LEGUMES
FOOD CHOICES
FRUITS VEGGIES DAIRY GRAINS MEATS LEGUMES
TOTAL
FOOD CHOICES
TOTAL
FRUITS VEGGIES DAIRY GRAINS MEATS LEGUMES
FOOD CHOICES
FRUITS VEGGIES DAIRY GRAINS MEATS LEGUMES
TOTAL
FOOD CHOICES
TOTAL
FRUITS VEGGIES DAIRY GRAINS MEATS LEGUMES
FOOD CHOICES
FRUITS VEGGIES DAIRY GRAINS MEATS LEGUMES
TOTAL
FOOD CHOICES
TOTAL
FRUITS VEGGIES DAIRY GRAINS MEATS LEGUMES
FOOD CHOICES
FRUITS VEGGIES DAIRY GRAINS MEATS LEGUMES
TOTAL
FOOD CHOICES
TOTAL
FRUITS VEGGIES DAIRY GRAINS MEATS LEGUMES
FOOD CHOICES
FRUITS VEGGIES DAIRY GRAINS MEATS LEGUMES
TOTAL
FOOD CHOICES
TOTAL
FRUITS VEGGIES DAIRY GRAINS MEATS LEGUMES
FOOD CHOICES
FRUITS VEGGIES DAIRY GRAINS MEATS LEGUMES
TOTAL
FOOD CHOICES
TOTAL
FRUITS VEGGIES DAIRY GRAINS MEATS LEGUMES
FOOD CHOICES
FRUITS VEGGIES DAIRY GRAINS MEATS LEGUMES
TOTAL
FOOD CHOICES
TOTAL
FRUITS VEGGIES DAIRY GRAINS MEATS LEGUMES
FOOD CHOICES
FRUITS VEGGIES DAIRY GRAINS MEATS LEGUMES
TOTAL
FOOD CHOICES
TOTAL
FRUITS VEGGIES DAIRY GRAINS MEATS LEGUMES
FOOD CHOICES
FRUITS VEGGIES DAIRY GRAINS MEATS LEGUMES
TOTAL
FOOD CHOICES
TOTAL
FRUITS VEGGIES DAIRY GRAINS MEATS LEGUMES
FOOD CHOICES
FRUITS VEGGIES DAIRY GRAINS MEATS LEGUMES
TOTAL
FOOD CHOICES
TOTAL
FRUITS VEGGIES DAIRY GRAINS MEATS LEGUMES
FOOD CHOICES
FRUITS VEGGIES DAIRY GRAINS MEATS LEGUMES
TOTAL
FOOD CHOICES
TOTAL
FRUITS VEGGIES DAIRY GRAINS MEATS LEGUMES
FOOD CHOICES
FRUITS VEGGIES DAIRY GRAINS MEATS LEGUMES
TOTAL
FOOD CHOICES
TOTAL
FRUITS VEGGIES DAIRY GRAINS MEATS LEGUMES
FOOD CHOICES
FRUITS VEGGIES DAIRY GRAINS MEATS LEGUMES
TOTAL
FOOD CHOICES
TOTAL
FRUITS VEGGIES DAIRY GRAINS MEATS LEGUMES
FOOD CHOICES
FRUITS VEGGIES DAIRY GRAINS MEATS LEGUMES
TOTAL
FOOD CHOICES
TOTAL
FRUITS VEGGIES DAIRY GRAINS MEATS LEGUMES
FOOD CHOICES
FRUITS VEGGIES DAIRY GRAINS MEATS LEGUMES
TOTAL
FOOD CHOICES
TOTAL
FRUITS VEGGIES DAIRY GRAINS MEATS LEGUMES
FOOD CHOICES
FRUITS VEGGIES DAIRY GRAINS MEATS LEGUMES
TOTAL
FOOD CHOICES
TOTAL
FRUITS VEGGIES DAIRY GRAINS MEATS LEGUMES
FOOD CHOICES
FRUITS VEGGIES DAIRY GRAINS MEATS LEGUMES
TOTAL
FOOD CHOICES
TOTAL
FRUITS VEGGIES DAIRY GRAINS MEATS LEGUMES
FOOD CHOICES
FRUITS VEGGIES DAIRY GRAINS MEATS LEGUMES
TOTAL
FOOD CHOICES
TOTAL
FRUITS VEGGIES DAIRY GRAINS MEATS LEGUMES
FOOD CHOICES
FRUITS VEGGIES DAIRY GRAINS MEATS LEGUMES
TOTAL
FOOD CHOICES
TOTAL
FRUITS VEGGIES DAIRY GRAINS MEATS LEGUMES
KEEPING TRACK
List the foods you have eaten for the entire day, including snacks. Check off the food
group for each to your food choices. Once you are finished, compare your total number
of servings for each of the food groups with the DASH recommendations.
KEEPING TRACK
List the foods you have eaten for the entire day, including snacks. Check off the food
group for each to your food choices. Once you are finished, compare your total number
of servings for each of the food groups with the DASH recommendations.
MY Personal Plan to Follow DASH
My Name _____________
Today’s Date _____
One change I will make in my eating habits to Follow DASH within the next week:
1.
Two changes I will make in my eating habits within the next month to Follow DASH:
1.
2.
Success comes one step at a time. Select changes that are right for you. As you accomplish one
change, congratulate yourself and move on to the next change.
Other changes I could make:
1.
2.
3.
4.
5.
November 09 LESSON 4
LOOKING FOR SALT
AND SODIUM
LESSON 4
LOOKING FOR
SODIUM & SALT
OVERVIEW:
SALT:
Salt has been used as a food preservative, especially for meat and fish, for more
than 2,000 years. Vegetables and fruits have been preserved using salt. Salt is
also used to bring out the natural flavor of food. Today, salt and sodiumcontaining ingredients are used in food preparation and processing.
Salt is 40 percent sodium and 60 percent chloride. Of the two minerals, sodium
is the one linked to serious health problems. Research has shown that salt and
sodium have been linked to high blood pressure, also known as hypertension.
Sodium is needed to balance body fluids, help muscles including the heart to
contract and to conduct nerve impulses. Sodium is found in bodily fluids, tissues
and bones.
An important part of healthy eating is to choose foods that are low in salt and
sodium. Decreasing sodium intake can reduce an elevated blood pressure.
Most Americans eat too much salt and sodium, much more than the
recommended limit of 2,300 milligrams or one teaspoon per day. Some people,
especially Africans Americans and the elderly, have been found to be salt
sensitive. These people should be careful of their salt and sodium intake. If one
has high blood pressure the doctor may advise less than 2,300 milligrams per
day.
4-1
Sodium occurs naturally in many foods. Processed foods account for most (77
percent) of the salt and sodium Americans consume. Convenience packaged
processed foods and canned foods are usually high in sodium and frequently
used to save time in food preparation. Rinsing canned vegetables will reduce the
sodium content. However, there will be a loss of water-soluble vitamin C and B
vitamins (thiamin, riboflavin, niacin, B12 and folic acid). Simply draining canned
vegetables would also be helpful and lessen nutrient loss.
Low-salt and no-salt food items are appearing in supermarkets in increasing
numbers. Lowering salt and sodium is possible by food choices and preparation
methods.
Using the Food Label to Look for Salt and Sodium
The food label, with the “Nutrition Facts” panel, is a very useful resource to limit
sodium and make healthy food choices when purchasing packaged, bottled or
canned foods. The label tells us what is in the packaged, bottled or canned food
item. It not only gives the name of the food but how it is prepared (whole, sliced,
diced). We become better consumers as we make use of and understand food
labels. The label may claim the food to be low sodium, which would mean less
than 140 mg of sodium per serving.
A frequently overlooked part of the food label is the ingredient list, often in small
print on the back, bottom or side of the package, bottle or can. If there is more
than one ingredient in a product, ingredients must be listed. The ingredient list
on the food label will give ingredients in descending order by weight, the main
ingredient is listed first and the ingredient found in the lowest amount by weight is
listed last. We may see salt, sodium-containing ingredients, sugars, fats and oils
4-2
in this list. The ingredient list of a product may show salt and three or four other
sodium containing ingredients.
The “Nutrition Facts” panel will show the amount of sodium in one serving of the
product. Food labels should be carefully inspected for the amounts of salt and
sodium. One serving of a product may have more than 1,000 milligrams of
sodium.
The first item on the label is the serving size for one serving of the food. The
number of servings per container is given, as well as calories in one serving and
number of calories from fat. The percent of fats, saturated fat, trans fat,
cholesterol and sodium are listed on the “Nutrition Panel”. We must limit our
intake of these, a percentage of 5 or less is low. Vitamin A, C and minerals,
calcium and iron are also listed; 20 percent or more of these indicate the food to
be a high source of that nutrient.
Food labels must meet the regulations of the Food and Drug Administration of
USDA.
4-3
Lesson 4: Teaching Guide
LOOKING FOR
SALT AND SODIUM
OBJECTIVES:
After completing this lesson the participant will be able to:
1. Explain the connection between salt, sodium and high blood pressure.
2. Explain how to use the ingredient list and nutrition facts label to limit
use of salt and sodium.
3. Identify the presence of salt and sodium in the product.
KEY POINTS TO COVER WHEN TEACHING THE LESSON:
1. Salt has been associated with hypertension.
2. Convenience packaged foods and processed frozen foods are usually high in
sodium.
3. The ingredient list and the “Nutrition Facts” panel on the food label will give
information regarding the presence of salt and sodium in a product and the
amount contained in a serving.
MATERIALS AND SUPPLIES NEEDED:
1.
Name tags
2.
Attendance Sheet
3.
Sodium PowerPoint presentation
4.
Projector
5.
Salt display (NASCO)
6.
Recipe for Sloppy Turk
4-4
7.
Ingredients for recipe – Sloppy Turk
8.
Electric frying pan and other necessary utensils
9.
Paper supplies for food tasting
10.
Product food labels
11.
Participant’s handouts:
PowerPoint slides
Sloppy Turk recipe
Compare Food Labels
Better Health with Less Salt and
Sodium
BEFORE TEACHING THE LESSON:
1. Gather materials and supplies.
2. Review lesson overview, lesson plan and overhead slides
WARM UP:
1. Have participants pick up name tags and sign attendance sheets.
2. Ask if there are questions about the last lesson. Question participants
about how they used information from the last lesson.
3. Ask if any one used any of the information from the last lesson.
PROCEDURE FOR TEACHING THE LESSON:
Remember this lesson includes recipe preparation and tasting. The recipe may
be done as the lesson is presented or prepared before class begins and tasting
would occur during presentation.
1.
Show PowerPoint #1 showing the title of the curriculum.
2. Showing PowerPoint #2, announce the title of the lesson.
3. Show PowerPoint #3, read the objectives of the lesson.
4. Show PowerPoint #4 and mention the fact that salt and sodium have been
linked to high blood pressure, also known as hypertension. Limiting salt
and sodium is an important part of the DASH Eating Plan.
4-5
“Limit sodium intake; this is what we must do.”
5. Ask participants
“Why should sodium be limited?” Wait for responses. Then say, many
people are salt sensitive, especially people who have hypertension. As we
eat salt, sodium goes into our bloodstream, increasing the sodium
concentration. The body responds to this by adding more water to the
blood, to maintain the normal level of salt. This extra fluid increases the
volume of blood and blood pressure is increased. After responses are
given, show PowerPoint #5 and state why sodium should be limited.
6. PowerPoint #6, give information on where sodium is found. Take out the
Fact Sheet titled “Better Health with Less Salt and Sodium.” Refer to the
sections titled “Limit These Foods and Condiments” and “Low Sodium and
Reduced Sodium Products.” Discuss some of these foods that were
included in the one day food record.
7. PowerPoint #7, tell the group that using fresh fruits and vegetables as well
as noncured fresh meats, fish and poultry is best way to limit sodium.
“Most of the sodium and salt we consume comes from packaged
processed foods."
8. Ask the question
Herbs and spices can be used to season food instead of salt. “Does
anyone know the difference between an herb and a spice?”
4-6
After responses, show PowerPoint #8 explaining the difference between the
two.
9. Put up the next PowerPoint #9 and say
“Herbs and spices can be used in place of salt to season foods.”
Ask if anyone is using herbs and spices to season foods. Limit discussion to
three minutes.
10. Ask group to take out handout “Better Health with Less Salt and Sodium.
Review the section of herbs and spices as well as other sections not
covered.
11. Ask the participants, “On a scale from 1 to 10 (with 1 the most difficult)
where would you rate your ability to limit sodium? Why?” Limit the
discussion to five minutes and steer the conversation towards
brainstorming solutions.
12. Final note
“Reduce sodium and salt gradually to make the change less noticeable.
Each week use less salt in foods. The taste for salt is learned and can be
unlearned. Soon salty foods will taste too salty. Limiting salt and sodium
is an important part of DASH.”
13. Prepare recipe and have participants taste. Review the recipe ingredients
and nutrition facts. Discuss its flavor. Discuss the availability of low salt
spaghetti sauce.
4-7
14. Tell the participants that next week we will look more at food labels for salt
and sodium.
PART B
USING FOOD LABELS to LOOK for SALT AND SODIUM
1. Showing PowerPoint #10, explain that
“It is a good practice to check the ingredient label on packaged foods.
Ingredients are listed by weight, from the greatest to the least. Look for
salt and sodium as part of the name of an ingredient. Try to eat fewer of
these foods.”
2. PowerPoint #11, say
“Let’s practice. Looking at this ingredient label, how many times does salt
or sodium appear? Name the sources of salt and sodium.” Wait for a
response.
3. Show PowerPoint #12 – State sources of sodium and salt as they are
underlined on the label.
“Reading the Nutrition Facts panel is another way to find sodium or salt in
the product.” On the Nutrition Facts panel you will see the actual amount of
sodium per serving.
4. Ask the group to turn to the handout “Compare Food Labels.” Ask the
group to look at the sodium content of each label for canned tomatoes.
4-8
Read the sentence at the top of the label that says to “aim for foods with
less than 5 percent of daily value for sodium.” Ask which tomatoes are
lower in sodium. Ask them to look at the second handout set of labels
showing a Nutrition Facts panel for peas. Ask which peas, frozen or
canned, are lower in sodium. Emphasize that frozen vegetables are
usually lower in sodium than canned. Tell the group to notice that the
serving size is the same in both.
5. Have group view the salt display; mention foods on display making
comments about the hidden salt in different processed foods.
6. Ask if anyone brought food labels and which food labels did they bring.
Have three people give information from their labels. Discuss the labels
containing high amounts of sodium. Tell the group that low sodium and
reduced sodium products can be found in supermarkets. If no participants
bring labels, the instructor will share the labels from her materials and
supplies.
7. Pass out the handout “Read Labels and Eat Better.” Read the different
section of the Nutrition Facts label.
Restate the objectives in the lesson
and ask participants respond to their ability.
8. Show PowerPoint #13 and review the points of the lesson
9. Show PowerPoint #14 and tell the group that next week we will have a
discussion on Lactose Intolerance and will taste another recipe.
4-9
1
Eating to Stop and Control
HIGH BLOOD PRESSURE
2
LESSON 4
LOOKING FOR
SODIUM AND SALT
Objectives
j
3
After completing this lesson the participant
will be able to:
1 Explain the connection between salt
1.
salt, sodium
and high blood pressure.
2 Explain how to use the ingredient list and
2.
nutrition facts label to limit use of salt and
sodium.
sodium
3. Identify the presence of salt and sodium in the
product.
product
4
Limit
Li
it Your
Y
S di
Sodium
IIntake
t k
5
Wh li
Why
limit
it sodium?
di
?
• If yyou eat a lot of foods high
g in sodium, yyou
may increase your blood pressure.
• High blood pressure is found in 1 out of 3
people in the general population (total of 76.3
million 20 years and older).
• 22.5
22 5 percentt N
Non-Hispanic
Hi
i whites
hit h
have
hypertension
• 32.0
32 0 percentt off African
Af i
Americans
A
i
have
h
hypertension.
Where is sodium found?
• Sodium occurs in many foods we eat.
Packaged or Canned Vegetables
Dairy products
Processed Eggs, meat, poultry
• Processed foods are high in sodium.
6
7
Use more fresh fruits, fresh
vegetables
bl and
d noncured
d
fresh meats and poultry
poultry.
8
Herb (urb,
(
hurb)) n. leaves off
plants and shrubs with nonwoodyy stems.
Spice (spis) n. comes from
bark, roots, fruits, seeds or
fl
flavors
off plants.
l t
Use herbs and spices in place
of salt.
•
Spices and herbs enhance the flavor of food.
•
Check your supply of spices and herbs.
•
A spice or herb bought for one special recipe may be used in
others.
•
The label on the container usually suggests uses of the spice or
herb.
•
Dried herbs are stronger than fresh herbs. Powdered herbs are
g than crumbled.
stronger
•
If a recipe calls for 1/4 teaspoon powdered herb, use 2
teaspoons fresh herb or 3/4 to 1 teaspoon crumbled or flaked
9
10
Check the ingredient labels on
packaged foods.
Look for ingredients
g
that have sodium or salt as p
part
of their name.
Many seasoning mixes contain salt.
Ingredients are listed by weight, from greatest to least.
You will want to eat fewer of these foods.
Read the label
INGREDIENTS: Potatoes, vegetable oil, whey, salt,
dried milk solids, sour cream, onion
salt, monosodium glutamate, dried
parsley, lactic acid, sodium citrate,
artificial flavors.
flavors
This food contains four different sodium ingredients. Notice that salt is
the fourth ingredient in the product by weight. Therefore, this product is
probably high in sodium.
11
Read the label
INGREDIENTS: Potatoes, vegetable oil, whey, salt,
dried milk solids, sour cream, onion
salt, monosodium glutamate, dried
parsley, lactic acid, sodium citrate,
artificial flavors.
flavors
This food contains four different sodium ingredients. Notice that salt is
the fourth ingredient in the product by weight. Therefore, this product is
probably high in sodium.
12
Review
1. If you eat a lot of foods high in sodium, you may
increase your blood pressure.
2. Processed foods are higher in sodium
3 Use more fresh fruits
3.
fruits, fresh vegetables and noncured
fresh meats and poultry.
4. Look for ingredients that have sodium or salt as part
of their name, such as onion salt, garlic salt,
seasoning salt.
5. Many seasoning mixes contain salt.
p
in p
place of salt.
6. Use herbs and spices
13
14
Next Week
• Importance of Dairy Products
• What is Lactose Intolerance
• Recipe Testing
Take control of your health use these steps to...
Modify YOUR SODIUM/SALT INTAKE
Use more fresh fruits, vegetables and fresh meats and
poultry.
Check claims on food labels.
Claims must meet strict government definitions.
By:
Joyce M. Woodson, M.S., R.D.
Kristen Bourque, B.S.
Millicent Braxton-Calhoun, M.S.
LESS SALT AND SODIUM
BETTER HEALTH
WITH
Factsheet 96-42
Updated 11-07
Sodium Free
Very Low Sodium
Low Sodium
Light Sodium
Less than 5 milligrams sodium
35 milligrams or less sodium
140 milligrams or less sodium
50% less sodium
Low-sodium and reduced-sodium products can be found
in the supermarket.
Try the following products made with less sodium.
References: Sodium Recommendations: American Heart Association http://www.americanheart.org,
Dietary Guidelines for Americans, 2005 USDA Publication number: Home & Garden Bulletin No. 232
Sodium Recommendations: National Heart, Lung, and Blood Institute http://www.nhlbi.nih.gov
Your Guide to Lowering Your Blood Pressure with DASH, USD of Health Human Service (NHL) NIH
Publication No. 06-4082, Revised April, 2006, Reprinted September, 2006
Complete Food and Nutrition Guide, Roberta L. Duyff, MS RD, American Dietetic Association 3rd edition
Contact:
Joyce M. Woodson, MS, RD
[email protected]
(702) 257-5508
The University of Nevada, Reno is an equal opportunity/affirmative action employer and does not discriminate on the basis of race, color, religion, sex, age, creed, national origin, veteran status,
physical or mental disability and sexual orientation in any program or activity it operates. The University of Nevada employs only United States citizens and aliens lawfully authorized to work in
the United States.
• Canned low sodium vegetables,
vegetable juices and sauces
• Canned low sodium soups
• Dried soup mixes
• Condiments
• Snack foods (baked chips, plain
nuts)
•
•
•
•
•
•
Ready-to-eat cereals
Bread, bakery products
Butter, margarine
Cheeses
Tuna
Processed meats
Check the ingredient labels on packaged foods.
Look for ingredients that have sodium or salt as part of its name. Ingredients are listed
by weight, from greatest to least.
INGREDIENTS: Potatoes, vegetable oil, whey, salt, dried
milk solids, sour cream, onion salt, monosodium
glutamate, dried parsley , lactic acid, sodium citrate,
artificial flavors.
This food contains four different
sodium ingredients. Notice that
salt is the fourth ingredient in the
product by weight. Therefore, this
product is probably high in sodium.
Use herbs and spices in place of salt.
Spices and herbs can be used to enhance the
natural flavor of food. Powdered herbs are
stronger than crumbled, and dried herbs are
stronger than fresh herbs. If a recipe calls for
1/4 teaspoon powdered herb, you can use 3/4
to 1 teaspoon crumbled or flaked, or 2
teaspoons fresh herb.
How much Sodium Is Too Much?
Herb (urb, hurb) n. leaves
of plants and shrubs with
non-woody stems
Spice (spis) n. comes
from bark, roots, fruits,
seeds or flavors of plants
You should consume no more than 2,300 milligrams (equivalent to 1 teaspoon) of sodium
each day. Currently most Americans consume a much larger amount 4,200 milligrams per
day in men and 3,300 milligrams per day in women. The measuring spoon below shows 1
teaspoon of table salt. Table salt is 40 percent sodium and 60 percent chloride. Potassium
sodium and chloride work as electrolytes performing important functions in the body. Too
much sodium can be harmful causing high blood pressure or hypertension which frequently
goes undiagnosed.
Great examples of spices and herbs include
oregano, basil, cumin, cinnamon, rosemary,
cloves, dill, nutmeg, paprika, ginger, mustard,
and allspice.
Why Limit Sodium?
Reducing the amount of sodium you consume may help you reduce or avoid high blood
pressure. This is important because people with high blood pressure are more likely to
develop heart disease, stroke and kidney disease. Heart disease is the No. 1 killer in the
United States today and stroke is No. 3.
High sodium foods.
Bacon
Bologna
Bouillon cubes or granola
Buttermilk
Canned or powdered soup
Canned vegetables
Cheese
Corned beef
Frankfurters
Luncheon meats
Salted nuts and seeds
Olives
Packaged foods
Pickles
Pork rinds
Powdered drink mixes
Pretzels
Salad dressings
Salted chips
Salted crackers
Salt pork
Sauerkraut
Sausage
Smoked or canned meats
Spaghetti or tomato juice
(commercial)
Tomato juice
Tips to Reduce Sodium when Eating Out
•
•
•
Don’t use the salt shaker. Use the pepper shaker or mill.
Be familiar with low-sodium foods and look for them on restaurant menus.
When you order, be specific about what you want and how you want your food
prepared. Request that your dish be prepared without salt.
• Add fresh lemon juice to fish and vegetables instead of salt.
High sodium condiments.
Barbecue sauce
Bouillon
Catsup
Celery salt
Chili sauce
Hot sauce
Iodized Salt
Meat tenderizer
Monosodium glutamate (MSG)
Onion salt
Pickles
Relish
Salad dressings
Salt
Seasoned salt
Soy sauce
Worcestershire sauce
Did You Know…
According to the American Heart Association, Americans consume at least 75
percent of their sodium from processed foods such as tomato sauce, soups,
condiments, canned foods and prepared mixes. Blood pressure is directly linked to
sodium intake for most people, a high sodium intake will cause an increase in blood
pressure. Many people are sodium sensitive, especially African Americans and
older adults.
SLOPPY TURK
(16 SERVINGS 1/2 CUP EACH)
2 1/2 pounds
1 cup
1/2 cup
1
1 1/2 teaspoon
1 teaspoon
1 teaspoon
1 teaspoon
1/2 cup
ground turkey
chopped onions
chopped green and red peppers
42 ounce jar spaghetti sauce (low salt)
cumin
garlic powder or 2 cloves of minced fresh garlic
black pepper
dash of oregano
vegetable oil
water
Brown ground turkey in skillet with ¼ cup of water. Remove from pan after all the
meat is browned. Pour off excess fat and put ground turkey in a bowl. In same
pan, sauté onions and the green and red peppers in 1 teaspoon of oil for about 2
minutes. Add spaghetti sauce and the remaining seasonings. Add browned turkey
to the mixture. Stir in well. Heat to boiling. Reduce heat and simmer 10 minutes,
stirring occasionally.
Nutritional Analysis per serving:
Diabetic Exchange:
Calories ...........................................187
Carbohydrate ............................ 8 grams
Protein .................................... 14 grams
Fat .......................................... 11 grams
Saturated fat .......................... 2.6 grams
Dietary Fiber ......................... 2.2 grams
Cholesterol ..................... 56 milligrams
Sodium……………….... 83 milligrams
2 med fat meat
1 vegetable
November 09
COMPARE FOOD LABELS
Read the Nutrition Facts on food labels to compare the amount of sodium in products.
Look for the sodium content in milligrams and the % Daily Value. Aim for foods that are
less than 5 percent of the Daily Value of sodium.
Compare the food labels of these two versions of canned tomatoes.*
CANNED DICED TOMATOES,
NO SALT ADDED
CANNED DICED TOMATOES
Nutrition Facts
Serving Size 1/2 cup
Servings Per Container approx. 3 1/2
Nutrition Facts
Serving Size 1/2 cup
Servings Per Container approx. 3 1/2
Amount Per Serving
Calories 25
Calories from Fat 0
%Daily Value*
Total Fat 0 g
0%
Saturated Fat 0 g
0%
Trans fat 0 g
0%
Cholesterol 0 mg
0%
Sodium 20 mg
1%
Carbohydrate 6 mg
2%
Dietary Fiber 2 g
8%
Sugars 4 g
Protein 1 g
Amount Per Serving
Calories 25
Calories from Fat 0
%Daily Value*
Total Fat 0 g
0%
Saturated Fat 0 g
0%
Trans fat 0 g
0%
Cholesterol 0 mg
0%
Sodium 200 mg
8%
Carbohydrate 6 mg
2%
Dietary Fiber 2 g
8%
Sugars 4 g
Protein 1 g
Vitamin A 10% • Vitamin C 15%
Calcium 2%
• Iron 2%
*Percent Daily Values are based on a
2,000 calorie diet.
Vitamin A 10% • Vitamin C 15%
Calcium 2%
• Iron 2%
*Percent Daily Values are based on a
2,000 calorie diet.
* The regular canned tomatoes have 10 times as much sodium
as the unsalted canned tomatoes.
November 09
FROZEN PEAS
CANNED PEAS
Nutrition Facts
Serving Size 1/2 cup
Servings Per Container approx. 3 1/2
Nutrition Facts
Serving Size 1/2 cup
Servings Per Container approx. 3
Amount Per Serving
Calories 60
Calories from Fat 0
%Daily Value*
Total Fat 0 g
0%
Saturated Fat 0 g
0%
Trans fat 0 g
0%
Cholesterol 0 mg
0%
Sodium 125 mg
5%
Carbohydrate 11 mg
4%
Dietary Fiber 6 g
22%
Sugars 5 g
Protein 5 g
Amount Per Serving
Calories 60
Calories from Fat 0
%Daily Value*
Total Fat 0 g
0%
Saturated Fat 0 g
0%
Trans fat 0 g
0%
Cholesterol 0 mg
0%
Sodium 380 mg
16%
Carbohydrate 12 mg
4%
Dietary Fiber 3 g
14%
Sugars 4 g
Protein 4 g
Vitamin A 15% • Vitamin C 30%
Calcium 0%
• Iron 6%
*Percent Daily Values are based on a
2,000 calorie diet.
Vitamin A 6% • Vitamin C 10%
Calcium 2%
• Iron 8%
*Percent Daily Values are based on a
2,000 calorie diet.
November 09
Read Labels
And
Eat Better
Serving Sizes are in
common household
measurements. Serving sizes are the same
for similar products.
% Daily Value shows
how a food fits into
the overall daily diet.
These percentages
can help you avoid
eating too much fat,
saturated fat, trans
fat, cholesterol and
sodium.
These numbers can
help to avoid eating
too much fat, saturated
fat, cholesterol and
sodium.
These numbers can
help you get enough
dietary fiber, protein,
Vitamin A, Vitamin
C, calcium and iron.
Ingredients are listed
in descending order—
main ingredient is
listed first, smallest
ingredient is listed last.
INGREDIENTS: Enriched macaroni
(flour, niacin, ferrous sulfate, thiamine
mono nitrate, riboflavin); cheese sauce
mix (whey, dehydrated cheese [granular
and cheddar (milk, cheese culture, slat,
enzymes)], whey protein concentrate,
skim milk, buttermilk, sodium phosphate, citric acid, yellow 5 (color), yellow 6 (color), lactic acid)
Daily values are
based on recommended nutrient intakes when eating
2,000 calories per
day. Daily Values
are also listed for
persons eating 2,500
calories per day.
Adapted from U.S. Food and Drug Administration
November 09
LESSON 5
MILK AND LACTOSE
INTOLERANCE
Lesson 5
MILK and LACTOSE INTOLERANCE
OVERVIEW:
Milk and milk products are the major source of calcium, an essential mineral needed for
growth, the building of strong bones and repair of bones at all ages. Calcium also plays
an important role in regulating heart function, blood clotting and in the function of the
nervous system and enzymes. Although calcium can be provided from supplements, it
must be remembered that milk and milk products provide other minerals and protein
important for good health.
The minerals calcium, potassium and magnesium are found in dairy foods. Research
has found that this trio of minerals plays a very important role in maintaining blood
pressure. The research with the DASH Eating Plan concluded that including low-fat
dairy foods as part of the DASH Eating Plan helped reduce high blood pressure. The
DASH Eating Plan contains twice as much of these minerals than the average American
intake. Many people exclude dairy products, especially milk from their diets, thinking
they are lactose intolerant.
Lactose is a natural sugar that occurs in milk; yogurt contains a smaller amount of
lactose. Lactase is the intestinal enzyme necessary to break lactose down into smaller,
more easily digested sugars in the process of digestion. Lactose intolerance occurs
when too little lactase is produced in the digestive system to adequately digest lactose.
Lactose that is left undigested is fermented by “healthy bacteria” in the small intestine.
As a result of the fermentation, nausea, cramping, bloating, abdominal pain, gas and
diarrhea may occur. These uncomfortable symptoms may occur from 15 minutes to
several hours after ingestion of lactose. The time and amount of discomfort will vary
5‐1 from person to person, depending on the amount ingested and if the lactose was
ingested with other foods.
People with lactose intolerance can eat milk products or drink milk in varying degrees.
Most infants produce the lactase enzyme, but as we age the body may produce less
lactase. Currently, doctors are referring to people with low lactase levels as having
“maldigestion.” A small number of people with lactose maldigestion experience
intolerance symptoms when they eat dairy foods. Approximately 25 percent of the U.S.
adult population is estimated to be lactose intolerant. In the past, many minorities have
been reported to be lactose intolerant. According to a report by the National Medical
Association, only approximately 24 percent of African Americans consider themselves
to be lactose intolerant. Another survey showed that less than 10 percent of Hispanics
reported avoiding dairy foods.
Lactose intolerant people should read labels to see if milk or milk solids are in the foods.
Foods labeled as Kosher with a “P” (there are several symbols used) or the word
pareve does not contain milk. A “non dairy” food may contain lactose as dry milk solids,
lactose, malted milk, whey sour or sweet cream or cheese.
Most people even if diagnosed as lactose intolerant can consume some lactose. One
must know one’s personal tolerance level. The following is recommended by the
National Dairy Council: drink milk with food, select aged cheeses (cheddar and swiss)
which contain less lactose, introduce dairy into the diet slowly, use yogurt with active
cultures and try lactose-free milk and milk products. Eliminating milk is eliminating an
important source calcium, protein, potassium, riboflavin, vitamins A & D, magnesium,
phosphorus and many other nutrients.
5‐2 Lesson 5: Teaching Guide
Milk and Lactose Intolerance
OBJECTIVES:
After completing this lesson the participant will be able to:
1.
Explain lactose intolerance.
2.
Explain that most people with lactose intolerance can still drink some milk and eat
some dairy products.
3.
Demonstrate specific steps to including milk and milk products in the diet.
KEY POINTS TO COVER WHEN TEACHING THE LESSON:
1. Milk and milk products contain nutrients important to good health.
2. Lactose intolerance is the inability or insufficient ability to digest the milk sugar,
lactose.
3. Most people with lactose intolerance can tolerate some milk or milk products.
4. Low fat dairy products are an important part of the DASH Eating Plan.
MATERIALS AND SUPPLES NEEDED:
1. Attendance sheet
2. Name tags
3. Participant handouts:
“Lactose Intolerant? Tips for keeping dairy in your diet:”
“The Lowdown on Lactose Intolerance Making the Most”
4. Follow DASH bracelets
5.
Yogurt Pudding Recipe
5‐3 WARM UP:
Put up the PowerPoint showing the topic of the workshop.
Ask the group if they have questions from last week’s lesson. Allow five minutes for this
discussion.
PROCEDURES FOR TEACHING THE LESSON:
1.
Ask the group to raise their hands if they drink milk or eat milk products. Wait for
responses.
2.
Ask if they think milk is important for good health. Wait for responses. Share
information in the overview regarding milk and milk products. Stress that milk and milk
products are an important part of the DASH Eating Plan.
3.
Ask if anyone thinks they are lactose intolerant and why. Wait for responses.
4.
Ask the question: “What is Lactose Intolerance?” Wait for responses.
5.
Explain lactose intolerance. Ask participants to take out “The Lowdown on Lactose
Intolerance” handout and read through this handout that explains lactose intolerance.
Tell the participants: If you think you may be lactose intolerant, see your doctor for a
proper medical diagnosis. Lactose intolerance in adults may be diagnosed by a blood
test or a hydrogen breath test. Your symptoms may be caused by other conditions such
as a reaction or side effect to medications or intestinal disease.
6.
Tell the Participants the tips for managing lactose intolerance using the handout
“Lactose Intolerant Tips for Keeping Dairy in Your Diet”. Mention that combining milk or
dairy products with other foods may ease your digestion while providing calcium for your
body. Mention some food combinations.
5‐4 7.
It is possible to buy milk with reduced lactose. We will sample Lactaid milk and swiss
cheese and cheddar cheese. There are also pills and drops that will help reduce
discomfort in digesting milk and milk products. Display these products and discuss them
among the group.
8.
At this point have participants taste Yogurt Pudding. Share recipe. Briefly discuss
recipe preparation, sharing the amount of calcium in the pudding.
9.
At this point the post-survey will be administered and participants may sign after
completion to receive the post-post survey in the mail.
After the surveys are collected, distribute bracelets and thank the participants for their
attendance. At this time if a post post test is planned, ask those who are interested to sign a
sheet giving their name and address. Emphasize that once the post post test is mailed out, the
sheet with their name and address will be destroyed.
5‐5 THE
D
NO
N L ACTO S E I N T
E
OL
Making The Most
Lactose intolerance is one type of food sensitivity —
it’s not an allergy. It is the result of not having enough
lactase, an enzyme that digests the natural sugar in
milk, lactose. The amount of lactase a person
has is genetic. People who have low
levels of the lactase enzyme may
It’s A Matter
experience intolerance symptoms
Of Degree
such as gas, bloating, or diarrhea
if they consume more lactose
Lactose intolerance is not an “all-or-nothing”
than
their system can handle at
condition. Find the portion size
one time. Not everyone diagnosed
that is right for you.
with lactose intolerance will
experience symptoms.
Today, doctors say people
with low lactase levels have
“maldigestion.” Only a small
fraction of people with lactose
maldigestion have intolerance
symptoms when they eat
dairy foods.
URT…
ND YOG nts for
A
E
S
E
E
ie
MILK, CH y important nutr rich in
an
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provide m h. They’re especia g mineral
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Am
0157N 4 2007, Copyright © 1997, NATIONAL DAIRY COUNCIL,® Rosemont, IL 60018-5616. All rights reserved. Printed in the U.S.A.
OW FOR
■
TOR WILL
IF
YOU
L A C T O'R E
INTOL SE
ERAN
T
OC
KN
Sometimes an intolerance to milk is
only temporary, brought on by certain
medications or by illnesses such as
the flu. Talk to your doctor if you
suddenly develop symptoms.
Y YOUR D
NL
■
Studies have identified simple
strategies to make dairy foods easier
to digest. If testing shows you’re
lactose intolerant, use the tips on the
other side to help manage
your symptoms.
O
Those who have been diagnosed with
lactose intolerance still produce lactase
at a low level and can digest some of milk’s
natural sugar. Most can enjoy at least
one 8 oz. glass of milk with a meal without
any problems.
RE
■
If you think
you may be
lactose intolerant,
talk to your doctor.
Avoid self-diagnosis.
There may be
another cause for
your symptoms.
Of Milk
LET’S LOOK
AT THE FACTS
The facts about lactose intolerance
may surprise you. For starters, it’s not as
widespread as many people think. And, it
does not require avoidance of dairy foods.
In fact, research shows that people who
have trouble digesting lactose can enjoy
dairy foods daily.
GET A MEDICAL
DIAGNOSIS
R
SU
W
AN
CE
LO
OW
A few lifestyle changes may be all it takes.
In fact, you can likely still drink milk.
The best way to find out how much you
can have without symptoms is to start
with small portions at meals. Then,
gradually increase your portion size
to find your comfort level.
Tips For
Tolerance
BE CALCIUM CONSCIOUS
Most degrees of lactose
intolerance are easy to manage.
Try these tips to help you
enjoy dairy foods.
Calcium is one of milk’s most
important nutrients. Because it’s
a mineral so essential to health, don’t let
lactose intolerance keep you from consuming enough of it. To get enough calcium
and other nutrients, the Dietary Guidelines
encourages children and adults to enjoy
three daily servings of low-fat, or fat-free
milk, cheese, or yogurt each day.
START SMALL.
ADVICE FROM THE EXPERTS
Try small portions of milk and milk
products. This allows whatever lactase
is there to do its job of digesting the
lactose before it starts causing problems.
WORK IT IN.
Start with a smaller portion and slowly
increase the serving size of the dairy foods
you eat. When you notice symptoms, that
may signal your limit for the amount of
lactose you can handle at one sitting.
PAIR THE DAIRY.
■
For individuals who are lactose
intolerant, the 2005 Dietary Guidelines
states that milk alternatives within the
milk food group, such as yogurt and
lactose-free milk, are the most reliable
and easiest way to derive the health
benefits associated with milk and
milk products.1
■
According to the 2004 Consensus Report
by the National Medical Association,
African Americans should get three to
four servings of low-fat dairy foods a day
to reduce the risk of chronic diseases.
Lactose-free milk is an alternative option
for those who have difficulty digesting
dairy foods.2
■
In their 2006 report, the American
Academy of Pediatrics (AAP)
recommends children with lactose
intolerance still consume dairy foods in
order to get enough calcium, vitamin D,
protein and other nutrients essential
for bone health and overall growth.3
It’s the Whole Package
Milk, cheese and yogurt are important
sources of essential nutrients and
together provide calcium, potassium,
phosphorus, protein, vitamins A, B12,
riboflavin and niacin. Milk and some
yogurts also provide vitamin D, which
helps the body absorb calcium.
Drink milk with other foods, not on an
empty stomach. Solid foods slow digestion
and allow the body more time to digest the
lactose, which helps prevent symptoms.
OLDER IS WISER.
That’s true with cheese! When milk
is made into cheese, most of the
lactose is removed. Aged hard
cheeses, such as Cheddar,
Colby, Swiss and Parmesan,
are particularly low in lactose.
GET A LITTLE “CULTURE.”
Look for cultured milk products such
as yogurt with live, active cultures, which
contain “friendly” bacteria that help
digest lactose.
REDUCE IT.
Look for lactose-free milk in the dairy case.
It has all the nutrients of regular milk.
MAKE IT EASY.
Look for lactase enzyme pills at your
drugstore. Take them with your first sip or
bite of dairy foods. These can help you
digest lactose easily.
GO TO THE PROS.
These tips may not apply to everyone.
Follow the advice of your doctor and see a
registered dietitian.
For more information about nutrition education
materials, contact your local DAIRY COUNCIL®.
Call 1-800-426-8271 for the Dairy Council office
nearest you.
WHAT HAPPENS WHEN
DAIRY FOODS ARE LACKING?
Milk, cheese, and yogurt
provide a unique nutrient
package. Studies show dairy
foods, when consumed
as part of a healthy diet,
contribute to better bone
health, improve overall
diet quality and may
help reduce the risk of
osteoporosis, hypertension,
obesity, kidney stones
and colon cancer.
1
DHHS/USDA, Dietary Guidelines for Americans, 2005. 6th Edition.
2
Wooten, WJ and Price, W. The role of dairy and dairy nutrients in the diet
of African Americans. JNMA, 96(12) Supplement, 2004.
3
American Academy of Pediatrics, Lactose intolerance in infants, children,
and adolescents. Pediatrics. 2006; 118 (3):1279-1286.
This brochure was reviewed by the
LACTOSE INTOLERANT?
Tips for keeping dairy in your diet:
D
A
rink milk with food.
www.3aday.org
ged cheeses like Cheddar
and Swiss are low in lactose.
I
ntroduce dairy slowly.
Gradually increase the amount.
R
Y
educe it. Enjoy lactose-free
milk and milk products.
ogurt with active cultures
helps digest lactose.
YOGURT PUDDING
(8 SERVINGS 1/2 CUP EACH)
1/4 cup
2% fat free milk or reconstituted nonfat dry milk
1 small package (3 1/6 ounce) instant pudding mix (any flavor)
2 cups (16 ounce)
plain low fat yogurt
Add milk to the pudding mix in a mixing bowl. Stir until smooth. Add yogurt and
stir. Refrigerate until ready to serve.
Nutritional Analysis per serving:
Diabetic Exchange:
Calories .............................................84
Protein ................................... 3.5 grams
Carbohydrates ..................... 15.4 grams
Fat ............................................. 1 gram
Dietary Fiber ............................ 0 grams
Cholesterol .................... 3.8 milligrams
Sodium……………….. 196 milligrams
Calcium………………..122 milligrams
1 non-fat milk
November 09
REFERENCES
1) Dressler WW, “Hypertension in the African American Community: Social,
Cultural, and Psychological Factors,” Seminars in Nephrology, 16 (2), 1996, 71-82.
2) Erlinger, Thomas P., Vollmer, William M., Svetkey, Laura P., Appel, Lawrence J,
“The Potential Impact Of Nonpharmacologic Population-Wide Blood Pressure
Reduction on Coronary Heart Disease Events: Pronounced Benefits in African
Americans and Hypertensives,” Preventive Medicine, 37 (4), 2003, 327-333.
3) Fortman, Stephen, M.D., and Breitrose, “The Blood Pressure Book: How to Get It
Down and keep It Down,” Bull Publishing Company, Second Edition, 2001.
4) Larson Duyff, Roberta, American Dietetic Association: “Complete Food and
Nutrition Guide,” John Wiley and Sons Publishers, Second Edition, 2002.
5) Peterson, Jane, Ph.D., Atwood, Jan R., Ph.D., Yates, Bernice, Ph.D., “Key Elements
for Church-Based Health Promotion Programs: Outcome-Based Literature
Review,” Public Health Nursing, 19 (6), 2002, 401.
6) U.S. Department of Health and Human Services, National Institutes of Health,
National Heart, Lung, and Blood Institute: “Facts About The DASH Eating Plan,”
National Institutes of Health Publication, No. 03-4082, Updated, 2003, 24 pages.
7) U.S. Department of Health and Human Services, National Institutes of Health,
National Heart, Lung, and Blood Institute: “Your Guide to Lowering Blood
Pressure,” National Institutes of Health Publication, No. 03-5232, 2003, 20 pages.
8) Vollmer, William M., Sacks, Frank M., Svetkey, Laura P., “New Insights into the
Effects on Blood Pressure of Diets Low in Salt and High in Fruits and Vegetables
and Low-Fat Dairy Products,” Current Control Trials Cardiovascular Medicine,
2 (2), 2001, 71-74.
9) Woodson, Joyce, Christiansen, Elizabeth., Rye, Alyssa, Black, Jacqueline,
Constantino, Nora, Marinelli, Rosalie, “A Comparison of Findings from
Community Health Surveys: 2001 and 2006”, (2008) Special Publication,
University of Nevada Cooperative Extension SP-08-03
10) (2009). High Blood Pressure Statistics. Retrieved August 13, 2009, from American
Heart Association Web site:
http://www.americanheart.org/presenter.jhtml?identifier=4621
11) (2008, November). High Blood Pressure. Retrieved August 13, 2009, from National
Heart Lung and Blood Institute Web site:
http://www.nhlbi.nih.gov/health/dci/Diseases/Hbp/HBP_WhatIs.html
1
11/ 09
12) Read Label and Eat Better Adapted from Retrieved August 2009, U.S. Food and
Drug Administration Web Site:
www.fda.gov/Food/LabelingNutrition/ConsumerInformation/ucm078889.htm
13) (2006, September 20). High Blood Information Added to NIHSeniorHealth.
Retrieved August 13, 2009, from NIH News Web site:
http://www.nih.gov/news/pr/sep2006/nia-20.htm
14) U.S. Department of Health and Human Services, National Center for Health
Statistics. (2008). Health, united states, 2008 with special feature on t he health of
young adults (76-641496). Washinton D. C.: U. S. Government Printing Office.
Retrieved from http://www.cdc.gov/nchs/data/hus/hus08.pdf
2
11/ 09
Eating
to
STOP
and
CONTROL
High Blood Pressure
Recipes
Developed by
Joyce M. Woodson, M.S., R.D., Area Specialist
Jacqueline Black, B.S., Program Officer
Millicent Braxton-Calhoun, M.S., Program Officer
The University of Nevada, Reno is an equal opportunity affirmative action employer and does not discriminate on the basis of race, color, religion, sex, age,
creed, national origin, veteran status, physical or mental disability, sexual orientation, in any program or activity it operates. The University of Nevada employs
only United States citizens and aliens lawfully authorized to work in the United States.
C O N T E N T S
I.
Main Meal
Chicken/Turkey Broccoli Casserole…
Sloppy Turk…………………….........
Spaghetti Sauce (to accompany Sloppy Turk).......
1
2
3
Chicken Fruit Salad…………….........
Garden Potato Salad…………............
4
5
Silken Pineapple “Cheese” Cake…….
Yogurt Pudding..........................…….
6
7
II. Salads
III. Dessert
IV. Condiments
Herb Spread…………………………. 8
Hot and Spicy Seasoning……………. 9
Seasoning Mixes…………………….. 10
V. Beverages
Fruit Smoothie………………………. 11
Good Old Fashion Lemonade……….. 12
Chicken/Turkey Broccoli Casserole
(8 SERVINGS 1 CUP EACH)
1 lb
1 cup
1 can
1 cup
fresh broccoli or 1 (10 oz) package frozen broccoli cooked
cooked chicken or turkey
cream of chicken soup
shredded cheddar cheese
Wash and cook broccoli. Dice cooked chicken/turkey. Cover bottom of
casserole dish with cooked broccoli. Cover broccoli with chicken and cream
soup (undiluted). Sprinkle with grated cheese. Bake at 350° for 20 – 30
minutes.
Nutritional Analysis per serving:
Diabetic Exchange:
Calories ...........................................153
Protein ................................. 18.2 grams
Carbohydrate ......................... 6.5 grams
Fat ............................................ 6 grams
Saturated fat .......................... 4.2 grams
Dietary Fiber ............................ 1 grams
Cholesterol ..................... 47 milligrams
Sodium……………….. 314 milligrams
2 lean meat
1 vegetable
1
SLOPPY TURK
(16 SERVINGS ½ CUP EACH)
2 ½ lbs
1 cup
½ cup
1
1 ½ tsp.
1 tsp.
1 tsp.
1 tsp.
½ cup
ground turkey
chopped onions
chopped green and red peppers
42 oz jar spaghetti sauce (low salt)
cumin
garlic powder or 2 cloves of minced fresh garlic
black pepper
dash of oregano
vegetable oil
water
Brown ground turkey in skillet with ¼ cup of water. Remove from pan after
all the meat is browned. Pour off excess fat and put ground turkey in a bowl.
In same pan, sauté onions and the green and red peppers in 1 teaspoon of oil
for about 2 minutes. Add spaghetti sauce and the remaining seasonings. Add
browned turkey to the mixture. Stir in well. Heat to boiling. Reduce heat and
simmer 10 minutes, stirring occasionally. Spoon over hamburger bun.
Nutritional Analysis per serving:
Diabetic Exchange:
Calories ...........................................187
Carbohydrate ............................ 8 grams
Protein .................................... 14 grams
Fat .......................................... 11 grams
Saturated fat .......................... 2.6 grams
Dietary Fiber ......................... 2.2 grams
Cholesterol ..................... 56 milligrams
Sodium……………….... 83 milligrams
2 med fat meat
1 vegetable
2
SPAGHETTI SAUCE
Alternate Spaghetti Sauce for Sloppy Turk
(10 SERVINGS ½ CUP EACH)
1
1 cup
1 cup
2
1 tsp.
1 tsp.
28 oz. can tomatoes, cut up
finely chopped sweet green pepper
finely chopped onion
cloves garlic, minced
dried oregano, crushed
black pepper
In a non stick skillet, stir in tomatoes with their juice, green pepper, onion,
garlic, oregano, and black pepper. Bring to boiling; reduce heat. Simmer,
covered for 15 minutes, stirring occasionally. Remove cover; simmer for 15
minutes more.
Nutritional Analysis per serving:
Diabetic Exchange:
Calories .............................................27
Carbohydrate ............................ 5 grams
Protein ...................................... 2 grams
Fat ............................................ 0 grams
Dietary Fiber ......................... 1.2 grams
Cholesterol ....................... 0 milligrams
Sodium……………….. 125 milligrams
1 vegetable
3
CHICKEN FRUIT SALAD
(8 SERVINGS ½ CUP EACH)
1 cup
2 medium
1 cup
8 oz.
¾ tsp.
¼ tsp.
cooked diced chicken breast
apples, diced
pineapple chunks drained
low fat vanilla yogurt
curry powder
chopped walnuts
Chop chicken and apples.
Mix all ingredients until coated with yogurt.
Chill.
Nutritional Analysis per serving:
Diabetic Exchange:
Calories .............................................98
Carbohydrate .......................... 12 grams
Protein ...................................... 8 grams
Fat ............................................ 2 grams
Dietary Fiber ............................. 1 gram
Cholesterol ..................... 18 milligrams
Sodium……………….. 37 milligrams
1 very lean meat
1 fruit
4
GARDEN POTATO SALAD
(10 SERVINGS ½ CUP EACH)
3lbs
1 cup
1 cup
½ cup
2 tbsp
1 cup
2 tbsp.
½ tsp.
½ tsp.
½ tsp.
potatoes (russet, red, all purpose, or Yukon Gold (6 large)
chopped celery
mixed bell and red peppers
sliced scallions (green onions)
chopped parsley
low-fat mayonnaise
prepared mustard
celery seed
dill weed
white pepper
Scrub potatoes; boil in jackets until tender. Cool; peel. Cut into ½ inch cubes.
Add celery, red and green peppers, green onion, celery seed dill week parsley
and white pepper.
Combine prepared mustard and mayonnaise; pour mixture over vegetables,
mix well. Chill before serving
Nutritional Analysis per serving:
Diabetic Exchange:
Calories ...........................................151
Carbohydrate .......................... 30 grams
Protein ...................................... 6 grams
Fat .......................................... 0.5 gram
Saturated fat ........................... 0.2 gram
Dietary Fiber ......................... 3.1 grams
Cholesterol .................... 2.3 milligrams
Sodium……………….. 118 milligrams
2 Bread/starch
5
SILKEN PINEAPPLE “CHEESE” CAKE
(8 SERVINGS)
One
1lb
2 cans (8oz each)
1/3cup + 1 tbsp
2 tbsp.
1/8 tsp.
1
1 ½ tsp.
½ tsp.
reduced fat graham cracker crust
soft tofu or firm silken tofu, crumbled
crushed pineapple packed in juice, drained
granulated sugar
all purpose flour
salt
large egg white
vanilla extract
grated orange peel
Preheat oven to 325°F. In a food processor fitted with a steel blade, or blender,
process the tofu and pineapple for 25 seconds or until blended – stopping to
scrape down sides of container with rubber spatula as needed. Add remaining
ingredients and process for 10 seconds, or until blended. Scrape the batter into
the prepared pan and spread evenly. Bake until set, about 50 to 60 minutes; a
knife inserted in center should come out almost clean. Cool in pan on a wire
rack for 1 hour. Refrigerate for 3 hours. Run a small metal spatula around
edge of cake and release side.
Nutritional Analysis per serving:
Diabetic Exchange:
Calories ...........................................227
Carbohydrate .......................... 35 grams
Protein ...................................... 6 grams
Fat ............................................ 7 grams
Dietary Fiber ............................ 1 grams
Cholesterol ....................... 0 milligrams
Sodium……………….. 178 milligrams
2 bread
1 fat
6
Yogurt Pudding
(8 SERVINGS ½ CUP EACH)
¼
1
2
cup milk or reconstituted nonfat dry milk
small package (3 1/6 oz.) instant pudding (any flavor)
cups (16 oz.) plain low fat yogurt
Add milk to the pudding in a mixing bowl. Stir until smooth. Add yogurt and
stir. Refrigerate until ready to serve.
Nutritional Analysis per serving:
Diabetic Exchange:
Calories .............................................87
Protein ................................... 3.4 grams
Carbohydrates ..................... 16.1 grams
Fat ............................................. 1 gram
Dietary Fiber ............................ 0 grams
Cholesterol .................... 3.8 milligrams
Sodium……………….. 225 milligrams
1 non-fat milk
7
HERB SPREAD
Mix one tablespoon of fresh minced herbs or ½ teaspoon crushed dried herbs
with 4 tablespoons margarine. Parsley, garlic or chives are especially good. If
dried herbs are used, add a squeeze of lemon juice. Let stand for fifteen
minutes before using. Store covered in refrigerator. Use on hot breads,
vegetables, baked potato, noodles, etc.
8
HOT AND SPICY SEASONING
(MAKES 1/3 OF A CUP)
¼ cup
2 tbsp.
2 tsp.
1 tsp.
1 tsp.
½ tsp.
½ tsp.
paprika
crushed dried oregano
chili powder
garlic powder
black pepper
red (cayenne) pepper
dry mustard
Mix together all ingredients. Store in airtight container.
Use seasoning to add extra flavor to low fat meat, fish, poultry, and bean
dishes.
Add 1 ½ to 2 tsps. to coat 1 lb. of meat, fish, or poultry before cooking or add
to bean dishes to taste when other herbs and spices are added.
9
SEASONING MIXES
MIX #1
MIX #2
2 teaspoons thyme
2 ½ teaspoons savory
2 teaspoons sage
2 teaspoons rosemary
2 ¼ teaspoons marjoram
3 teaspoons thyme
1 ½ teaspoons sage
2 ½ teaspoons rosemary
3 teaspoons marjoram
MIX #1
2 tablespoons basil
1 teaspoon oregano
2 tablespoons onion powder
½ teaspoon dried grated lemon peel
1/8 teaspoon ground black pepper
1 teaspoon celery seed
Crush dried herbs and place in a jar or shaker. Use for seasoning salads, soups,
vegetables, meat, seafood and poultry.
10
FRUIT SMOOTHIE
(4 SERVINGS 1 CUP EACH)
1 (6 oz.) can frozen orange juice
3 (6 oz.) cans of water
1 Banana
1 (10 oz.) pkg. Frozen fruit of choice (strawberries, peaches, etc.)
1 (8 oz.) low fat yogurt of choice
6 – 8 ice cubes
Combine all ingredients in a blender. Blend until smooth and creamy – about
10 seconds. Serve.
For a thicker smoothie, use less water.
Nutritional Analysis per serving:
Diabetic Exchange:
Calories ...........................................182
Carbohydrate .......................... 41 grams
Protein ...................................... 4 grams
Fat ............................................ 1 grams
Dietary Fiber ............................ 0 grams
Saturated Fat ................... .5 milligrams
Calcium ........................ 124 milligrams
Sodium……………….. 40 milligrams
3 fat free milk
Recipe Courtesy of Nurturing Partners
11
GOOD OLD FASHIONED LEMONADE
AGUAS FRESCAS
(2 SERVINGS 10 OZ EACH)
2
2 cups
2 tbsp.
lemons
water
Sugar
Squeeze the juice from 2 lemons. Mix with water and sugar. THAT’S IT!
ENJOY!!
Variations: For Mexico’s version of lemonade, use limes instead of lemons (2
limes for every lemon). They can also be made with pineapple, watermelon,
strawberries, or even dried Jamaica flowers.
Nutritional Analysis per serving:
Diabetic Exchange:
Calories .............................................68
Carbohydrate .......................... 23 grams
Protein ................................... 1.2 grams
Fat .......................................... 0.3 gram
Saturated fat ........................... 0.0 gram
Dietary Fiber ............................ 0 grams
Cholesterol .................... 0.0 milligrams
Sodium……………….. 10.4 milligrams
1 fruit
12
Developed by Joyce M. Woodson, M.S., R.D.
and
Millicent Braxton-Calhoun, M.S.
The University of Nevada, Reno is an equal opportunity/affirmative action
employer and does not discriminate on the basis of race, color, religion, sex,
age, creed, national origin, veteran status, physical or mental disability and
sexual orientation in any program or activity it operates. The University of
Nevada employs only United States citizens and aliens lawfully authorized to
work in the United States.