Dietary Approaches to Stop Hypertension

As health care providers, we do not like the word “diet”, as it is used in the fad sense. We encourage small changes, over a longer period of time, and focus on a healthy lifestyle. We also advocate sitting with a dietician or nutritionist, to find a plan that suits the individual and steering clear of diet sheets.

The (DASH) diet, however, is a lifelong approach to healthy eating that is designed to help treat or prevent hypertension (high blood pressure). It encourages you to reduce the sodium in your diet and eat a variety of foods rich in nutrients that help lower the blood pressure — such as potassium, calcium and magnesium.

By following the DASH diet, you may be able to reduce your blood pressure by a few points within just two weeks. Over time, the systolic blood pressure (top number) could drop by seven to 12 points. This can make a significant difference in your health risks. The DASH diet offers health benefits besides just lowering blood pressure. It is also in line with dietary recommendations to prevent osteoporosis, cancer, heart disease, stroke, and diabetes.

DASH DIET

This diet emphasises vegetables, fruits, and low-fat dairy foods, whole grains (moderate amounts), fish, poultry, and nuts.

SODIUM LEVELS

Though the new nutrition guidelines have revised the recommended daily allowance for sodium intake, there is a lot of evidence suggesting that a low salt intake can help to lower blood pressure. The traditional diet will have 3,500 mg or more of sodium. The culprit is not just salt added to food, but hidden sources of salt, in processed foods, such as bread, crackers, etc.

* Standard DASH — up to 2,300 mg of sodium per day.

* Lower sodium DASH diet — up to 1,500 mg per day.

WHAT TO EAT?

* Whole grains: six to eight servings a day

Grains include bread, cereal, rice, and pasta. Whole grain is recommended over refined grains because of higher fibre and nutrient content. For example, one serving of whole grains include one slice wholewheat bread, or one ounce dry cereal or, 1/2 cup cooked brown rice or wholewheat pasta. In our setting, sweet potato and yam is also high in fibre and can be substituted.

* Vegetables: four to five servings per day

Tomatoes, carrots, greens, and other vegetables are full of fibre, vitamins and minerals, such as potassium and magnesium.

Examples of one serving of vegetables: one cup raw leafy vegetables or 1/2 cup cooked vegetables.

In Jamaica, vegetables are usually the smallest portion on the plate, we need to increase our portions and use vegetables as main, rather than side dishes.

* Fruits: four to five servings per day

Try to have fruits at breakfast and throughout the day as a healthy snack. Mix fruits with vegetables for tasty and healthy salads.

* Lean meat, poultry and fish: six or less servings per day

Meat can be a rich source of protein, B vitamins, iron, and zinc. They are also key sources of fat and cholesterol, so do not make meat the mainstay of your diet. Cut back your typical meat portions by a third or a half, and replace with vegetables instead. Trim away fat when preparing chicken, and choose baking or grilling instead of frying or “brown stew”, where the meat is fried first then stewed.

* Dairy: two to three servings per day

Milk, yogurt, cheese, and other dairy products are major sources of vitamin D and calcium and protein. Choose fat-free or low-fat options, because they are also major sources of fat (including cholesterol). Consume a small amount of cheese, because of the salt content.

* Fats and oils: two to three servings per day

Fat helps your body absorb essential vitamins and helps your body’s immune system. Too much fat, however, increases your risk of heart disease, diabetes, and obesity. Fat should be less than 25 per cent of your daily calories — focus on healthy “monounsaturated fat”, such as avocado. Saturated fat is the biggest dietary culprit in raising cholesterol level and coronary heart disease risk. Limit meat, butter, cheese, whole milk.

* Nuts, seeds legumes: four to five servings a week

Almonds, sunflower seeds, red peas and lentils are good sources of protein, magnesium and potassium, as well as fibre. Serving sizes are small and intended to be consumed weekly because they also have high calorie counts. Nuts contain healthy fat.

* Sweets: five or less servings per week

One tablespoon sugar, jelly or jam per week. Choose fat-free or low-fat sweets, such as sorbet or low-fat cookies. Cut back on sodas and other sweet drinks, exchange for water, low-fat milk and natural (unsweetened) juices.

In our next Heart Talk, we will talk about alcohol and caffeine, and some more details on the low-sodium diet and new guidelines regarding sodium.

Dr Claudine Lewis is an adult cardiologist and medical director at Heart Smart Centre in Montego Bay. She is also a cardiologist at the Cornwall Regional Hospital and an associate lecturer with the University of the West Indies. Questions may be sent to questions@heartsmartcentre.com and for additional information call 684-9989 or visit the website www.heartsmartcentre.com.