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
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 Nova Scotia Health Authority promotes a smoke-free, vape-free, and scent-free environment. Please do not use perfumed products. Thank you! 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.