Download The DASH Diet - Dietary Approaches to Stop Hypertension

Patient & Family Guide
2015
The DASH Diet
Dietary
Approaches to
Stop
Hypertension
www.nshealth.ca
The DASH Diet:
Dietary Approaches to Stop
Hypertension
Eating a healthy diet and cutting down your sodium
(salt) intake can help lower your blood pressure.
High blood pressure can lead to heart disease,
kidney disease, and stroke.
The DASH diet is
• Dairy: high in low-fat dairy products.
• Abundant (high) in fruits and vegetables.
• Sodium (salt) restricted.
• Heart healthy: low in total fat, saturated fat,
cholesterol, and trans fat.
The DASH diet is high in potassium,
magnesium, calcium, protein, and fibre. If you
have kidney disease, talk to your doctor or
dietitian before starting this diet.
Cut back on sodium (salt) in your diet
Limit sodium intake to 1500 mg or less per day.
Most of the sodium we eat is in packaged foods,
restaurant meals, and snacks. You will need to read
food labels to see how much sodium is in a serving.
1
Choose more often from the “Best choices”
lists, and less often from the foods to “Avoid”
lists.
Good choices
•
•
•
•
•
•
Fresh, unprocessed foods.
Fresh or frozen vegetables.
Canned fruit and vegetables without added salt.
Herb and spice mixes with no salt added.
Lemon juice, garlic, or pepper.
Only use salt substitutes such as NoSalt®,
Nu-Salt® or Half Salt™ with your doctor’s
permission.
Avoid
•
•
•
•
Salt used in cooking and at the table.
Canned or pre-cooked foods high in sodium.
Processed and convenience foods.
Soy sauce, teriyaki sauce, oyster sauce, hoisin
sauce, MSG, salsa.
• Pickles, pickled vegetables, pickled eggs, olives,
and sauerkraut.
• Potato chips, salted nuts, and other salty snack
foods.
• Limit to no more than 1 teaspoon (5 ml) per day:
mustard, ketchup, relish, barbecue sauce, and
Worcestershire sauce.
2
Cut down on unhealthy fat in your diet
• Avoid butter, lard, shortening, hydrogenated
margarine, and hydrogenated oils.
• Use non-hydrogenated margarine and oils in
small amounts.
• Choose low-fat or fat-free milk products.
• Cool gravy, soups, or stews until the fat rises to
the top and hardens, and then skim it off.
• Steam, broil, boil, roast, grill, barbecue, or
microwave rather than fry.
• If you sauté, use a heart healthy oil like olive,
canola, or peanut oil.
• Take off all fat from meat and skin from poultry
before cooking.
• Drain ground meats after cooking to get rid of the
fat.
• Read food labels for fat content and type of fat.
Reading labels
Most labels show the mg (milligrams) of sodium
and g (grams) of fat, plus a % DV (percent daily
value). Where possible, look for foods with less
than 120 mg sodium per serving, or less than 5%
DV. Avoid foods with more than 360 mg sodium
per serving, or 15% DV. See our example of a high
sodium food to avoid on the next page.
3
For fat, look for foods with less than 15% DV of fat
(and ideally less than 5% DV). Choose foods with 0 g
of trans fats.
Example of a high sodium food to avoid
Sample label for macaroni & cheese
1. Check
serving
size &
calories
2. Limit
fats and
watch out
for high
sodium
content
3. Get
enough
of these
nutrients
4. Footnotes
4
Grain products
See chart on page 13 for suggested number of
servings.
1 serving = 1 slice of bread
1 ounce (30 g) dry cereal
½ pita or small bagel
½ cup (125 ml) cooked rice, pasta, or
cooked cereal or other grain.
Best choices
Avoid
• Whole grain products
(bread and rolls, pita
bread, small bagel)
• Whole grain pasta
• Brown or wild rice
• Plain, unsalted baked
crackers
• Dry cereals made
without salt such as
Shredded Wheat®,
puffed wheat, Mini
Wheats®
• Cooked cereals made
without salt
• Pre-seasoned pasta
mixes such as
Hamburger Helper®,
Kraft Dinner®, Lipton
Side Kicks®
• Pre-seasoned rice
• Canned pasta
• Instant hot cereals
• Baking mixes such as
pancake and biscuit
mixes
• Crumb coating mixes
• Store bought baked
products
• Cheese bread, egg
Look for breads,
bread
cereals, and crackers
with less than 12% DV • Bread stuffing mixes
sodium per serving. • Salted crackers
• Granola
5
Vegetables and fruits
See chart on page 13 for suggested number of
servings.
1 serving = ½ cup (125 ml) cooked vegetables
1 cup (250 ml) raw, leafy vegetables
½ cup (125 ml) cut up fruit
1 medium piece of fresh fruit
¼ cup (60 ml) dried fruit
Best choices
• Fresh or frozen
vegetables
• Vegetables canned
without salt
• No salt-added tomato
sauce, tomato paste,
or canned tomatoes
• Low sodium V8® juice
• Fresh fruit
• Unsweetened frozen
fruit
• Canned fruit in its own
juice or water
• Unsweetened fruit
juice (limit to 4 oz a
day)
• Dried fruit without
added sodium
6
Avoid
• Regular canned
vegetables
• Vegetable juices
(tomato, Clamato®,
regular V8®)
• Dried potato mixes
such as scalloped or
mashed
• Fruits canned in
syrup
• Sauerkraut
Milk and alternatives
See chart on page 13 for suggested number of
servings.
Choose lower fat milk products.
1 serving = 1 cup (250 ml) low-fat milk or soy
beverage
1 cup (250 ml) yogurt
1 ½ ounces (50g) cheese
Best choices
Avoid
• Milk (skim, 0.5%, or
1%)
• Yogurt (less than 1.4%
milk fat (M.F.)
• Cottage cheese with
1% M.F.
• Fat-free and low-fat
cheese (less than 10%
M.F.); use less often
because of their high
salt content
• Evaporated skim milk
• Fat-free or low-fat
frozen yogurt
• Processed cheese
spreads such as
Cheese Whiz®
• Processed cheese
slices
• Blue, feta, Romano,
and parmesan cheese
• Chocolate milk
• Malted milk
• Buttermilk
• Milkshakes
• Milk puddings
7
Meat and alternatives
See chart on page 13 for suggested number of
servings.
Choose lean cuts of meat and use low-fat cooking
methods such as: baking, barbecuing, broiling, or
roasting.
Replace meat, poultry, or fish with nuts, seeds,
or pulses 4-5 times a week. Pulses include
dried beans, peas, and lentils.
1 serving = 3 ounces (90 g) of cooked fish, poultry or
lean meat
½ cup (125 ml) tofu or cooked pulses
2 eggs
2 tbsp (30 ml) peanut butter
1/3 cup (75 ml) nuts
2 tbsp (30 ml) seeds
8
Meat and alternatives
Best choices
• Fish
• Poultry with skin
removed
• Canned tuna and
salmon in water, rinsed
• Lower-fat cuts of meat,
visible fat taken off
• Eggs (limit to 2 egg
yolks per week)
• Unsalted dry roasted
nuts and seeds
(almonds, mixed nuts,
peanuts, walnuts,
sunflower seeds)
• Dried pulses (dried
beans, peas and
lentils). Avoid canned
beans and lentils
because of their high
sodium content.
• Unsalted natural
peanut butter
9
Avoid
• High fat cuts of meat
• All meat, fish, or
poultry that has
been smoked, cured,
pickled, salted, or
dried. This includes:
bacon, bologna,
corned beef, ham,
kosher meats, deli
meats, sausage,
wieners, sardines,
salt cod, smoked
herring
• Canned meats
• Frozen dinners
• Frozen meat pies
• Frozen, breaded fish,
or chicken
• Canned beans and
stews
• Salted seeds and
nuts
• Salted peanut butter
• Limit shellfish due to
natural salt content
Fats and oils
See chart on page 13 for suggested number of
servings.
1 serving = 1 tsp (5 ml) of soft margarine or
vegetable oil
1 tbsp (15 ml) low-fat mayonnaise
2 tbsp (30 ml) light salad dressing
Best choices
• Salt-free soft (nonhydrogenated)
margarine such as
Becel Salt-Free®
• Cooking oil such as
canola oil, olive oil, or
soybean oil
• Salt-free salad
dressing (see recipe)
• Mayonnaise
• Salt-free, low-fat
homemade gravy
• Vegetable oil cooking
sprays
Avoid
• Lard, shortening,
butter, hard
(hydrogenated)
margarine, bacon fat,
cocoa butter
• Hydrogenated palm
and coconut oils
• Store-bought salad
dressings
• Canned gravy and
gravy mixes
10
Sweets and added sugars
See chart on page 13 for suggested number of
servings.
1 serving = 1 tbsp sugar, syrup, or jam
½ cup sherbet or Jell-O®
1 cup lemonade or fruit punch
3 pieces of hard candy
Best choices
• Low-sugar jams and
jellies such as Triple
Fruit® or Double
Fruit®
• Mineral waters
• Sugar-free drinks,
candy, and Jell-O® in
moderation
• Postum®, Ovaltine®
• Ground flax seed
• Herbs, spices
without salt
• No salt-added
seasoning blends
such as Mrs. Dash®
• Vinegar
• Tabasco Sauce®
• Unsalted air-popped
popcorn
Avoid
• Softened water
• Sports drinks such as
Gatorade®
• Regular pop
• Sugar, honey, corn
syrup, maple syrup,
molasses, regular jams
and jellies
• Salt, seasoning salt,
sea salt, Accent®
• Flavoured salts such as
garlic salt, onion salt,
celery salt
• Pickles and olives
• Soy sauce (including
less/low sodium soy
sauce), hoisin, teriyaki,
oyster sauce
• Salsa, picante, taco
sauces
11
Best choices
• Cocoa
• No more than 5 ml (1
tsp) a day with less
than 2.5% DV sodium
for condiments:
Worcestershire sauce,
ketchup, relish, or
mustard
• Unsalted soup and
broth
• Canned soups with
less than 2.5% DV
sodium per serving
Avoid
• Poultry and meat
coatings
• Potato and nacho
chips
• Cheezies® and
pretzels
• Salted microwave
popcorn
• Party snacks
• Regular canned soups
• Dried soup mixes,
OXO®, bouillon, and
consommé
• Split pea soup made
with ham bone
• Bean and bacon soup
• Canned or bottled
pasta and pizza
sauces
The right DASH eating plan for you
The number of servings of each food group that you
need depends on the amount of calories you need
to maintain a healthy weight.
On page 13 you can see the recommended number
of servings for different calorie diets.
12
Food
group
Recommended daily servings
1600
Kcal
diet*
Grains
6
Vegetables
3-4
Fruits
4
Fat-free or
2-3
low-fat milk
and milk
products
Lean meats,
1-2
poultry,
and fish
Nuts,
3 per
seeds, and week
legumes
(instead
of meat,
poultry, or
fish)
Fats and
2
oils
Sweets
0
and added
sugars
2000
Kcal
diet
6-8
4-5
4-5
2-3
No
more
than 2
4-5 per
week
2-3
2600
Kcal
diet
10-11
5-6
5-6
3
2
12-13
6
6
3-4
2-3
1 per
day
1 per
day
3
4
No
No
more
more
than
than 2
5 per
per day
week
*Kcal diet = calories consumed each day
13
3100
Kcal
diet
No
more
than 2
per day
Extra help
There are many cookbooks to help you add
variety to what you eat. Cookbooks by the Heart
and Stroke Foundation, Dietitians of Canada,
or the Canadian Diabetes Association have very
good information.
Hold the Salt and Watch That Hidden Salt are two
books by Maureen Tilley, a local dietitian, that
may be helpful.
Books and cookbooks by Marla Hiller, MS, RD
include plans based on the newest DASH Diet
research, as of 2014. They can be found in many
libraries and bookstores.
Visit these websites and look for recipes for free
online info:
›› www.heartandstroke.com
›› www.eatrightontario.ca
›› www.diabetes.ca
14
You can make your own recipes lower in salt
and fat with a few changes:
• Don’t add salt to homemade soups, sauces, and
casseroles.
• Replace salt with different herbs and spices.
• Use low-sodium or homemade broth or bouillon
in soups.
• Replace canned vegetables with fresh or frozen
vegetables.
• Cut back on the amount of salt in baked goods
recipes or don’t use it at all. You probably won’t
notice the difference.
• Use non-hydrogenated margarine instead of
butter, shortening, or lard.
• If a recipe calls for ¾ of a cup of fat, use only ½ or
1/3 of a cup of fat.
• Fruit juice, puréed fruit, or low-fat yogurt can be
used for half of the fat in muffin recipes calling for
more than ½ cup of oil.
• Refrigerate juices from roast meats and poultry
until the fat rises to the top, and skim it off before
making gravy.
• Sauté with water, juice, broth, vegetable oil
cooking sprays, or wine instead of fats.
• Use less meat, eggs, or cheese than a recipe calls
for.
15
How to get started
• Change your eating habits bit by bit over time.
• Work on 1 or 2 changes at a time.
• Focus on vegetables, fruit, and grains instead of
meat.
• Choose fruit or low-fat foods for snacks and
desserts.
• Cook more foods at home from scratch.
More ways to lower blood pressure:
• Achieve and maintain a healthy weight.
• Limit alcohol:
›› No more than 2 standard drinks per day for
men.
›› No more than 1 standard drink per day for
women.
• Don’t smoke.
• Be active 30 minutes or more every day.
• Limit caffeine to no more than 3 drinks per day
(e.g. coffee, tea, and cola).
16
Content adapted from DASH diet information from the National
Heart Lung and Blood Institute of the National Institutes of Health
and the U.S. Department of Health and Human Services.
For more detailed info check out:
www.nhlbi.nih.gov/health/public/heart/hbp/dash/
new_dash.pdf
www.heartandstroke.on.ca/site/c.pvI3IeNWJwE/
b.4119695/k.9ECB/The_DASH_Diet_to_lower_
blood_pressure.htm
Notes:
17
My goals:
Dietitian:
Phone:
18
Looking for more health information?
Contact your local public library for books, videos, magazines, and other resources.
For more information go to http://library.novascotia.ca
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Nova Scotia Health Authority
www.nshealth.ca
Prepared by: Food & Nutrition Services
Designed by: Nova Scotia Health Authority, Central Zone Patient Education Team
Printed by: Dalhousie University Print Centre
The information in this brochure is for informational and educational purposes only.
The information is not intended to be and does not constitute healthcare or medical advice.
If you have any questions, please ask your healthcare provider.
LC85-1158 Updated December 2015
The information in this pamphlet is to be updated every 3 years or as needed.