Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
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 1-1 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. 1-3 • 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. 1-4 • 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. 1-5 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. 1-7 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, 1-8 ” 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 lly provide m h. They’re especia g mineral lt a in e d h il d u o -b ny go the bone iets of ma calcium —s up short in the d en. e that com particularly wom s, n a c ri e 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.