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A�TI-REFLUX DIET

Your healthcare provider has advised you to begin an anti-reflux diet. This type of diet is actually

easy to follow, requiring you to cut out just a few foods and beverages that either relax the lower part of

the esophagus or increase the amount of acid in the stomach. These include:

Caffeinated drinks, carbonated drinks, greasy or fatty foods, spicy food, citrus fruits and juices,

tomatoes or anything tomato based, onions, peppermint, chocolate, alcohol, nicotine (cigarettes,

cigars, chewing tobacco).

Here are some dietary suggestions:

Food type Foods to eat Foods to avoid

Beverages Water, fruit juices (except citrus

juice), decaffeinated tea or coffee

(use carefully, since some people

are also sensitive to decaffeinated

beverages)

Mint tea, regular coffee or tea,

citrus juices, cocoa, alcohol in

any form, carbonated drinks with

and without caffeine

Dairy products Skim milk, low fat milk, low-fat

yogurt, low fat or fat-free sour

cream and cream cheese, low fat

cottage cheese

Whole milk, butter, chocolate

milk, full fat sour cream, cream

cheese, ice cream, high fat

cheeses, such as cheddar, full fat

dips

Vegetables Any plain raw, backed, broiled or

steamed vegetable, except onions

and tomatoes

Fried, creamed or spicy vegetable

dishes, onions, tomatoes

Fruits Any plain raw, broiled or baked

fruit

Oranges, tangerines, tangelos,

grapefruit, lemons, limes, any

fried fruit, any creamy fruit dishes

Meats Any plain baked, broiled,

steamed lean beef, pork, chicken,

poultry or fish

Luncheon meat, hot dogs,

sausage, bacon, fat back, salt

pork, heavily marbled beef, any

fried, breaded or pan fried meat,

poultry, fish, shellfish or pork,

any dish with gravy or sauce,

chili, pizza, tacos, anything

marinated in spicy, tomato or

barbequed sauces

Breads and cereals Any low fat bread or cereal, plain

rice, plain pasta

Any high fat bread/cereal, any

bread made with milk, creamy or

cheesy rice dishes, past with

tomato sauce

Desserts Low fat baked goods(look for

less than 3 grams of fat per

serving), low fat or fat free

puddings, fruit pops, except citrus

pops

Chocolate desserts, creamy

desserts, high fat desserts, such as

cheesecake, pie, ice cream

Soups Any fat free or low fat soup

without tomatoes or onions

Full fat soups, tomato, onion, or

french onion soup, creamy soups

In addition to dietary changes, some other tips to help reduce heartburn and reflux include:

Avoid eating and then bending over, lying down, reclining or going to sleep for two to four hours. Eat

small meals instead of large meals, if you are still hungry simply eat more often. Raise the head of your

bed 6-8 inches, this can be done by placing the head of the bed on blocks 6-8 inches high or by sleeping on

wedge. Do not sleep on several pillows, since this will not help. Avoid tight fitting clothing. Lose weight

if you are overweight. Avoid fast food, since it is usually very high in fat.

EATING PLAN FOR HIGH CHOLESTEROL (HYPERLIPIDEMIA)Thisplanwilllimityourintakeofsaturatedfat,transfatandcholesterolwhileincreasingfruit,vegetablesandwholegrains.

Cholesterol Defined A serum lipid test is a measure of your blood cholesterol levels. Your blood sample will be measured for four different components. The total cholesterol, triglycerides, low density lipoprotein (LDL or bad cholesterol) and the high density lipoprotein (HDL or good cholesterol) are reported to your doctor. These levels are compared to target values appropriate for reducing your risk for heart disease. If your values are not at target, improving eating habits, becoming more active, avoiding smoking and taking medications can improve your cholesterol values.

10 Tips to Help Reduce Your Cholesterol Levels1. Eatplentyofvegetablesandfruits-7servingsormoreeachday2. Eatwholegrainfoodsrichinsolublefibre–oats,psylliumandbarley3. Include2Omega3richfishmealsperweek–salmon,trout,sardines4. Include2beanbasedmealsperweek–kidneybeans,chickpeas,lentils5. Eatnutssuchasalmondsandwalnuts–smallportions5timesaweek6. Improvethequantityandqualityoffatsyoueat7. Oilsarebestforaddedfat–usesmallamounts,avoidfrying8. Beactive–moveyourbody30minuteseachday9. Ifyouareoverweight,worktoreduceyourweightby10%10. Ifyourtriglyceridesarehigh,limitsugarsandalcohol.

Cholesterol Facts • Highcholesterolcanincreaseyourriskofheartdisease.• Cholesterolinyourbloodcomesfromwhatyourliverproducesand

whatyouconsumeinyourdiet.Highlevelsofcholesterolinyourbloodcanentertheliningofyourarteriesandformdepositsor“plaques”.Theseplaquescangrowovertimeandblocktheflowofbloodinyourarteries.Thisputsyouatriskforaheartattackorstroke.

• Makingchangestoyoureatingtoloweryourintakeofsaturatedfat,transfatandcholesterol,whileincreasingfibre,canloweryourcholesterolbyasmuchas35%.

Build a healthy heart from the ground up – an eating plan based on fruit, vegetables, whole grains, nuts and legumes with lean protein choices is the foundation for managing your cholesterol.

Healthier Eating Guidelines for Lowering Cholesterol• Focus on Quantity and Quality of Fat

– Quantity–1/4to1/3ofyourcaloriescancomefromfat.Thismeansthatyoucaneatbetween50to70gramsoffateachday.Thenumberoffatgramsthatarerightforyoumaybelessormorethanthisdependingonyourgender,activitylevelandweightgoals.ARegisteredDietitiancanhelpdeterminehowmuchisrightforyou.

– Quality–unsaturatedfatssupportahealthycholesterolprofile.Thesefatsareliquidorsoftsolidatroomtemperature.Oilslikeoliveoil,canolaoil,soyoilandnon-hydrogenatedmargarinesaregreatqualityfats.Useinmoderation.Oneteaspoonofoil,thesizeofyourthumbtip,adds5gramsoffat.

• Limit saturated and trans fats, or hard fats, to 15 grams or less per day.Thesefatsarefoundinfullfatdairyproducts,meats,poultryskin,lard,palmkerneloil,hydrogenatedoilsandbakedgoodsmadewiththesefatsandoils.

• Eat less cholesterol – aim for less than 300 mg of cholesterol per day. Cholesterolisfoundonlyanimalfoods.Reducingportionsofmeat,avoidinghighfatcutsofmeatandchoosinglowerfatdairychoiceswillhelp.

• Eggs–Recentstudieshaveshownthateatinganeggadaywillnotincreasecholesterolorriskforheartdisease.However,ifyouhavediabetesyoushouldlimityoureggconsumptiontonomorethan6eggsperweek.

• Nuts such as almonds, walnuts, pecans and pistachios can help lower cholesterol.Studiesshow1.5ozorabout36almonds5daysperweekhelpedreducebadcholesterol.Ifyouareworkingtoloseweightasmallerportionof10-12nutsisrecommended.

Fibre – yes, for your heart!Fibreisfoundinplantbasedfoods.Vegetables,fruit,wholegrains,nuts,seeds,beans,peasandlentilsareallgreatfibresources.Functionalor“soluble”fibrehelpstoreducecholesterolbybindingwithcholesterolinyourstomachandbowel.Thischolesterolistheneliminatedinyourstool.Studiesshowweshouldinclude10to25gramsofthisfibreeachday.Hereisalistofthesolublefibrefoodsandthegramsoffibretheyprovide.

Heart Health Mixture=1/3groundflax,1/3oatbran,1/3psyllium.Use2tbspeachdayaddedtoyourfood.Itmixeswellwithyogurt,hotcerealandsaladdressing.

Salt – Shake the HabitTips to reduce salt (sodium) intake:• Home prepared fresh or frozen foods are best. Ifusingcannedfoods,lookforlabelssuchas“noaddedsalt”or“low

sodium”.• Avoid adding salttoyourfoodandomitfromrecipeswherepossible.• Season your food with herb and spice blends. Checkingredientliststoavoidthosewithsalt.• Limit condiments such as ketchup, mustard, soy sauce etc. • Use Nutrition Facts Labels. Bestchoiceshavelessthan200mgsodiumperserving.Avoidpackagedfoodwithmorethan

400mgofsodiumperserving.Checklabelscarefully.• Use ingredient lists-foodslistingsaltorsodiumatthebeginningofthelistormultipletimesinthelistarehighinsalt.• Restaurant foods are often high in sodium. Trytoavoidfastfoodbutdousetherestaurants’NutritionInformationto

identifylowersodiumoptions.Wheneatingout,askyourserverifthemealcanbepreparedwithoutaddedsalt.Requestsaucesontheside.

Item Soluble Fibre (g) Item Soluble Fibre (g)

Barley (1/2 c) 1 Navy Beans (1/2c) 2

Oatmeal (1/2 c) 1 Chickpeas (1/2 c) 1

Oat bran (1/2 c) 2 Carrots 1

Apple 1 Brussels Sprouts 3

Citrus (oranges) 2 Psyllium Seeds (1 Tbsp) 5

Pears 2 Metamucil (1 tsp) 2

Kidney Beans (1/2c) 3 All Bran Buds (1/3c) 2

Omega-3 Fats Omega3’sareunsaturatedfatsfoundincoldwaterfattyfish(salmon,mackerel,arcticchar,sardines,troutandherring)andinplantfoodsincludingwalnutsandflaxseeds.The“fish”omega-3’sarecommonlyknownasEPAandDHA.The“plant”omega-3’sareknownasALA.ALAisconvertedtoEPAandDHAinyourbody.Foodshouldbeyourfirstchoicetoachieveyouromega3’s(seebelow).Aimtoeat2mealsincludingfisheachweekandusetheHeart Health Mixtureasnotedonthepreviouspage.Ifyouhaveheartdiseaseoryourtriglyceridesarehigh,yourdoctorordietitianmayrecommendanOmega3supplement.

If you have High TriglyceridesInadditiontotheguidelinesformanagingyourcholesterol,youmaybenefitfromthefollowingrecommendations:• Alcohol: Men-limittolessthan2drinksperdayor14perweek.Women–limitto1drinkadayor9perweek.• Dependingonyourtriglyceridelevel,yourdoctormayaskthatyoufurtherreducethisamount.• Sugars -reduceaddedsugare.g.tablesugar,syrup,jam,honey,molasses.Limitjuice,pop,candies,sweets,chocolate

andbakedgoods.• Ifyouhavediabetes,workwithyourhealthcareteamtoimproveyourbloodglucose(sugar)control• Omega 3 supplements–adding2000to4000mgofEPA+DHAfromfishoil.Thisshouldbedoneunderthesupervision

ofyourdoctor• Niacin by prescription–thisBvitaminmayberecommendedtoloweryourtriglycerides.ItalsohelpsraiseHDL(good

cholesterol)

Reducing alcohol can promote weight loss and help decrease triglyceride levels.

Decoding Food LabelsTheNutritionFactstablefoundonthesideofpackagedfoodcanhelpyoumakebetterfoodchoices.Alwayschecktheservingsizefirstandconsiderthisinrelationtohowmuchofthefoodyouusuallyeat.

Lookforchoiceswithlessfat,saturatedfat,cholesterolandsodium.Lookforchoicesthatgiveyoumorefibre.Learn more about using food labels to make healthy choices on the web:Health Canada –www.hc-sc.gc.ca/fn-an/label-etiquet/nutrition/cons/index-eng.phpHealthy Eating Is In Store for You –www.healthyeatingisinstore.ca

OMEGA 3 CONTENT OF FOODS

Fish (2.5 oz) EPA/DHA (mg) per serving

Nuts/Seeds/Oils ALA (mg) per serving

Enriched Foods Total Omega -3 (mg) per serving

Herring 1600 Almonds (1/4 c) 150 Milk + DHA (1 c) 20

Mackerel 1490 Wheat Germ (27 g) 190 Soy beverage + flax 700

Salmon 1300 Canola Oil (1tsp) 430 Eggs + DHA (2) 800

Sardines 1050 Soybeans 760 Omega 3 yogurt (3/4 c)

500

Trout 870 Flaxseed, ground (1Tbsp)

1600

Arctic Char 680 Tofu (3/4c) 2020

Tuna, white (canned)

650 English Walnuts (1/4 c) 2300

To Reduce Weight • Eatsmallerportionsoffoodsandrememberthebalanceoffoodsonyourplate:1/4protein,1/4starch(including

potatoes),1/2vegetables• Eat3mealsperday,nomorethan6hoursapart.Don’tskipmeals.Snackwithfruitbetweenmeals.• Choosefoodslowerinfatandsugar.Eatingstrategiesincludinglowglycemicindexchoicescanbehelpful.

Learnmorefromaregistereddietitian.• Aimforamaximumweightlossof1-2lbs(0.5-1kg)perweek.• “Waistloss”isasimportantasweightloss.FortipsonhowtotrimyourwaistseeourWaistingAwaynutrition

factsheet.

ForamoredetailedplanforweightlosspleasereadWaistingAway-HealthyWeightManagementavailableinourclinicoronthewebatwww.ottawacvecntre.com

Portions to Live By • Oneservingofwholegrainsis1/2cup

cooked,notthe3ormorecupsservedinmostrestaurants!Toomuchofagoodthingisnotagoodthing.

• FormoredetailsonhealthyportionsseeEating Well with Canada’s Food Guideon-lineatwww.healthcanada.gc.ca/foodguide.

Prepare for Success• Cookwithoutaddingfat–bake,broil,roast,barbeque,grill,steam• Limitpanfryingandavoiddeepfatfrying• Tryusing1/3lessfatthanyourrecipecallsfor• Addflavourtofoodwithherbsandspices–thinkgarllic,lemon,gingerandmore• Refrigeratesoupsandstewsandskimofffatwhensolid• Useasprayofoiltopreventstickingandaddflavour

Food and Medication InteractionsReviewyourmedicationswithyourDoctor,DietitianorPharmacist.• Cautionwithgrapefruit,grapefruitjuice,pomelosandSevilleorangesCertainmedicationsforcholesterol

andheartdiseaseinteractwiththesefoods.

Supplements for Cholesterol Control CheckwithyourDoctor,DietitianorPharmacistbeforestartingasupplement.• Heart Healthy Mixture=1/3groundflax,1/3oatbranand1/3psyllium.Use2Tablespoonsperdayadded

tofoodsorbeverages.• Omega 3 supplements

– ifyouhaveheartdisease:1000mgperdayasEPA+DHA– ifyourtriglyceridesareelevated:2000to4000mgperday(underthesupervisionofyourdoctor).

• PlantSterols–consuming2gramsofplantsterolsperdayfromenrichedfoods,suchasmargarinewithplantsterols,hasbeenshowntoreduceLDLcholesterol.

• Redyeastricecanbeeffectiveatloweringcholesterolbuttheseproductsareunregulated.Theircontentisunreliableandthereforetheyarenotrecommendedforuse.

• Supplementsofgarlic,soyandlecithindonotappeartoreducecholesterolbasedoncurrentresearch.• Lecithindoesnotappeartoreducecholesterol.• CoenzymeQ10–evidencetodatedoesnotshowthatCoQ10reducesmusclepainassociatedwithcholesterol

loweringmedications.

Protein

Fruit

Protein

Vegetables

StarchStarch

Breakfast Lunch & Supper

Move your body, lower your bad cholesterol, raise your good cholesterol• Includingatleast30minutesofbriskactivity,suchaswalking,four(4)ormore

daysperweekcanloweryourLDLandraiseyourHDL.• Startwithabrisk10minutewalkafewtimesperdayandincreasegraduallyfromthere.• Gentlestretchingexercisesincreaseyourflexibilityandreleasetensioninyourmusclesandjoints.Aimfor4ormore

stretchingsessionsperweek.• Strengthexercisesimprovemuscleandbonedensitykeepingyoustrongandstable.Includethese2-4timesper

week.• Remembertostartslowlyandconsultyourphysicianbeforestartinganew

exerciseprogram

Keeping active can lower your blood sugar, cholesterol, blood pressure, help you feel better, relieve tension and stress, improve your muscle tone and help you lose weight!

Eating Plan for High CholesterolCholesterollowering–maximum15mgofsaturatedfatperday,300mgofcholesterolReadfoodlabelsforlessfat,saturatedfat,cholesterolandsodiumandmorefibre.

Vegetables and Fruit• Freshandfrozenarebest• Unsweetenedcannedfruit,unsaltedcanned

vegetables• Limitfruitjuicewithelevatedtriglycerides• Lowsodiumvegetablejuice• Avocadosandolivesinmoderationforhealthyfat

• Vegetablespreparedwithbutter,creamorsauce;batteredanddeepfried

• Fruitpackedinheavysyruporsugar;sweetenedfruitjuice,fruitdrinks,sportsdrinks

FOODS TO CHOOSE FOODS TO LIMIT OR AVOID

Whole Grains• bread,buns,rolls,pitabread,Englishmuffinsand

tortillas• lowfatcrackers,breadsticks,melbatoast,soda

crackers(unsaltedtops)• Unsweetenedhotorcoldcereal–oats,oatbran,

psylliumforsolublefibre• Brownrice,barley• Wholegrainpasta• Lowfatbakedgoods–addoatbran,groundflaxto

boostfibre

• Avoid“white”products• Cheeseoreggbread,croissants,sweetrolls• Crackersover5gramsoffatperserving,commercial

crumbcoatings• Sweetenedcereals• Pastawithbutter,creamorcheesesauce,chowmien

noodles,ramennoodles• Commercialmuffins,cakes,donuts,Danish,high-fat

cookies

Milk and Alternatives• Anywith1%MilkFat(MF)orless• Cheesewithlessthan20%MF–occasionaluse

• Allmilkproductswhicharemorethan1%MF• Cheese21%MForhigher

Beverages• Water,sodawater,mineralwater• Sugar-freesoftdrinks• Coffee,Tea–limitto4cupsperday• Cerealbeverages(e.g.Postum,Ovaltine)

• Regulartonicwater• Regularsoftdrinks,lemonade,sweetenedicedtea,

regulardrinkcrystalmixes• Flavoredinstantcoffee• Liqueurs,Cocktailmixes

Note: Underlined foods are commonly higher in salt (sodium)– limit use in cases of hypertension or other condition requiring salt restriction.


Meat and Alternatives• Fishandshellfish:fresh,frozen-unbattered,cannedinwater• Poultry:chicken,turkey–withoutskin• Meat:leancuts,fattrimmed

– Beef:round,rump,sirloin,extralean/leanground– Veal:round,rump,tenderloin– Lamb:leg,loin,shank,leanground– Pork:tenderloin,backbacon,ham– DeliMeat:ham,roastbeef,pork,turkey,turkeyorreducedfatwieners

– WildGame:moose,venison,rabbit• Legumes:chickpeas,kidneybeans,lentils,limabeans,

soybeans,splitpeas,tofu• Eggs:ifyouhavediabetes,limitto6perweek• Nuts:unsaltedalmonds,walnuts,pecans,pistachios–

limit1/4cperday• Peanutbutter:naturalornon-hydrogenatedorlight• Seeds:flax,pumpkin,sesame,sunflower

• Fishcannedinoil,commerciallyfried,frozenbatteredfish• Poultry:duck,goose,friedorbatteredchicken,chicken

wings• Meat:fattymarbledmeats,ribs,medium/regularground

meat,organmeats,bacon,sausage(unlesslowfat),cannedmeats

• Delimeat:pate,bologna,salami,high-fatluncheonmeats,wieners

• Peanutbutterwithhydrogenatedoil

Fats and OilsLimitaddedfatsto3teaspoonsperday.• Oils:olive,canola,corn,peanut,sesame,soy,sunflower• Margarine:non-hydrogenatedsoft(regularorlight)• Saladdressing/Mayonnaise:lowcalorie,caloriereduced,

oil-free,homemadewithrecommendedoils• Lowfatsourcream,creamcheese• Gravy:defatted

• Hydrogenatedorblockmargarine,butter,lard,shortening,suet

• Saladdressingsmadewithcheeseorregularsourcream• “Tropical”oils:palmkernel,coconut• Fullfatgravy,creamsauces

Sweets• Sugar:substitutes(e.g.sucralose,),lowsugarjams,jellies,

syrups• Sugarfree:candies,gelatins,gum• Bakedgoods:lowinsugar,fatandhighfibre• Frozendesserts:lowfat,lowsugaricecream,icemilk,

frozenyogurtandsherbet• Cocoapowder

• Sugar–useinmoderation• Regularjams,jellies,syrups• Regularcandies,gelatins,gum• Bakedgoods-regularcakes,pies,cookies-avoid“white”foods• FrozenDesserts:regularicecream,icemilk,frozenyogurt,

sherbet• Chocolatebars,chocolate

Snack Foods• Popcorn:hotairpoppedorlowfatmicrowave• Pretzels,bakedchips,ricecrispsandcakes

• Popcorn–regularandhighfatmicrowave,cornchips,potatochips,cheesies

Miscellaneous• Condiments(ketchupetc),herbs,spices,vinegar,pickles• Soups:preparedwithskimmilkorfat-freestock,bouillon,

broth,consommé

• Soups-cream

Eating Plan for High Cholesterol, August 2010DanielleAldous,BSc,RD(FromOriginal,2005:HeleneCharlebois,BSc,RD&JasnaRobinsonDI)©ContinuingMedicalImplementation®Inc.

Ottawa Cardiovascular Centre502-1355BankStreetOttawa,ONK1H8K7Phone: (613)738-1584Email: [email protected]

Other Nutrition Fact Sheets Available: EatingPlanforHypertensionEatingPlanforCongestiveHeartFailureEatingPlanforType2DiabetesWaistingAway–HealthyWeightManagementPotassiumModifiedEatingPlanPlease visit www.cvtoolbox.com for more information

LOW SODIUM EATING PLAN FOR HYPERTENSIONThiseatingplanwillhelpyoukeepyourdailysodium(salt)intakebetween1500and2300mg.Itislowincholesterolraisingfatsandrichinfruits,vegetablesandfibre.

Hypertension occurs when the pressure that your blood exerts on your arteries rises above normal. Blood pressure is measured and reported as the pressure when your heart contracts over the pressure when it relaxes (systolic/diastolic). Normal blood pressure is 120/ 80 mm Hg. Blood pressure is considered high when these pressures are increased above 140/90 mm Hg.

Did you know that 3 out of 10 Canadians with hypertension could have normal blood pressure if they ate less salt?

Tips To Help Reduce Your Blood Pressure – Eat “close to the farm”, the less processed the better! See‘FoodstoChoose’inthefollowingsectionforexamples.

1. Limityoursaltto1500mgperday.See “Salt - Shake the Habit”.2. Eatplentyoffruitandvegetables.Aimfor7ormoreservingseachday.3. Eathighfibre,wholegrainfoods.4. Includelow-fatdairyandalternatives.5. Includequalitylow-fatproteinchoices.6. Limitaddedfat.7. Reducealcoholtolessthan2drinksperday.8. Ifoverweight,alossof10%ofyourweightcanlowerbloodpressure.9. Balancehealthyfoodchoiceswithregularphysicalactivity.

Highbloodpressurecanincreaseyourriskofheartdiseaseandstroke.Areductioninbloodpressureof10/5mmHgcanreduceyourriskofstrokeby38%andheartfailureby50%!Suchareductionisachievablewithachangeinlifestylefactorssuchasimprovingyourdiet,quittingsmokingorbecomingmoreactive.

Did you know that more than 75% of the salt we eat comes from prepared foods including restaurant foods? Little more than 10% comes from what we add in cooking and at the table. Your choices at restaurants and in the grocery store go a long way to reducing your salt intake.

What does 1500 mg of salt look like? It is less than one teaspoon of salt.

Tips to reduce salt (sodium) intake• Homepreparedfreshorfrozenfoodsarebest.Ifusing

cannedfoods,lookforlabelssuchas“noaddedsalt”or“lowsodium”.

• Avoidaddingsalttoyourfoodandomitfromrecipeswherepossible.

• Seasonyourfoodwithherbandspiceblends...see recipe to the right. Checkingredientliststoavoidthosewithsalt.

• Limitcondimentssuchasketchup,mustard,soysauceetc.• Useingredientlists-foodslistingsaltorsodiumatthe

beginningofthelistormultipletimesinthelistarehighinsalt.• Restaurantfoodsareoftenhighinsodium.Trytoavoidfast

foodbutdousetherestaurants’NutritionInformationtoidentifylowersodiumoptions.Wheneatingout,askyourserverifthemealcanbepreparedwithoutaddedsalt.Requestsaucesontheside.

Use the Nutrition Facts table to choose packaged foods with less sodium.

Those with less than 200mg per serving are your best choices. If the product has more than 400mg of sodium per serving look for a lower sodium alternative.

Tips For Eating Away from HomeRestaurantfoodsareknownforhavinghighsaltcontent.Chooseyourmealswisely.Sometipstohelplimityoursodiumwhileeatingoutinclude:• Selectarestaurantinwhichfoodsarepreparedtoyourorderandrequestthatnosaltbeadded.• Choosesaladoversoupasanappetizerandaskfordressingontheside.• Askforfreshorsteamedvegetableswithoutsaucesorbreading.• Grilledorbakedmeat,chickenorfishwithoutsaucesorbreadingarelowersodium.• Avoidbread,biscuitsorcrackerswithvisiblesaltontop.• Limitselectionsthatincludecheese.• Askforfruitbaseddessertswithlittleornopastry.• Manychainrestaurantshavenutritioninformationavailableon-line.Checktherestaurantswebsiteforthesodium

contentofthemenuitemsbeforegoing.Selectitemslowerinsodium.• Balanceoutyourday–ifyoueatoutoften,besuretochooselowersodiumfoodsatthemealsyouprepareathome.

Cheers to lower sugar! Arecentstudyfoundthatcuttingbackonpopandsugarybeveragesmayloweryourbloodpressure.Ratherthanpoporjuice,orderwater,sparklingwater,unsweetendteaorcoffeetocomplementyourmeal.

Homemade Herb BlendThismulti-purposesaltfreeseasoningcanreplacethesaltinyourtabletopshakerandisgreatincasseroles,soupsandjustaboutanysavorydishyouwouldotherwisesalt.

1Tbspgarlicpowder1tspeachofdried,crumbled:basil,marjoram,thyme,parsley,savory,sage1tspeachofgroundmace(ornutmeg),onionpowder,pepper½tspcayenne(optional)

Inasmallbowl,mixtogetherallingredientsuntilwellblended.Storeinajarwithatightfittinglidinacool,dryplaceforupto6months.Source:AHALowSaltCookbook-2nded.

General Healthier Eating Guidelines - To Avoid Complications with hypertension. AlsoavailablefromtheOttawaCardiovascularwebsite:HyperlipidemianutritionfactssheetfordetailsonloweringyourcholesterolandWaistingAwaynutritionfactssheetforinformationonachievingahealthyweight.Gotowww.ottawacvcentre.com.• Start withabalancedbreakfastandfollow-upwithabalancedlunchanddinner.• Balance-seePortionstoLiveBybelow.• Addcolourwithfruit and vegetables.Eatyourchoicesmoreoftenthandrinkingthemasjuiceformorefibreandfewer

calories.• Whole grain starchyfoodchoicesincludewholewheatpasta,wholegrainbread,brownrice,wholewheatcouscous,barley,

quinoaoroats.• Aneatingpatternrichinplant-basedfoodsisrichinfibre.Fibrerichfoodsbalancebloodsugar,keepyoufeelingfull,lower

cholesterolandbloodpressure.(andkeepyouregular!)• Proteinchoicesincludelowfatdairyoralternativechoicessuchasmilk,yogurt,cheeseandleanmeatandalternative

choicessuchasleanbeef,pork,chicken,fish,eggs,tofu,beans,lentils,nutsandseeds.• Choosemilk and yogurtwithmilk fat percent (%MF) of 1% or less.Cheeseshouldbe20%MForless.Lowerfatfortified

soymilkisalsoagreatoption.• Lean meatshaveless“marbling”orwhitefatthroughoutthemeat.Removeskinfrompoultry.Usecookingmethodssuch

asgrilling,broiling,poachingorstir-fryinginanon-stickpantoreducefat.Trya“meatless”mealincludingbeans,tofuorlentilsforlessfatandmorefibre.

Portions to Live By • Oneservingofwholegrainsis1/2cupcooked,notthe3or

morecupsservedinmostrestaurants!Toomuchofagoodthingisnotagoodthing.

• FormoredetailsonhealthyportionsseeEating Well with Canada’s Food Guideonlineatwww.healthcanada.gc.ca/foodguide.

Avoid Portion Distortion• Oneservingofwholegrainsis1/2cupcooked,notthe3ormorecupsservedinmostrestaurants!Toomuchofagoodthing

isnotagoodthing.• FormoredetailsonhealthyportionsseeEatingWellwithCanada’sFoodGuideonlineatwww.healthcanada.gc.ca/foodguide.

Prepare for Success• Prepareyourfoodswithlimited added fat, sugar and salt.Avoidfrying.• Addflavorwithfreshordriedherbs,spices,flavoredvinegars,lowfatmarinadesandlightdressings.

Great ideas for cooking with more flavor and less salt, sugar and fat can be found at your local library, book store or on line. The Heart and Stroke Foundation of Canada, the American Heart Association, the Canadian Diabetes Association and Dietitians of Canada all have great collections of healthy recipes available. Try one today.

Fat - Less Quantity, More Quality• Menofhealthyweightshouldkeeptheirdailyfatintaketo70gramsorless.Womenofhealthyweightshouldkeeptheir

dailyfatintaketo60gramsorless.Fruit,vegetablesandwholegrainsarenaturallylowinfat.Keepaddedfatstoaminimum.Usefoodlabelstochoosefoodswithlessfat.

• Chooseliquid or soft fatssuchasoliveoil,canolaoilorsoftnon-hydrogenatedmargarine.Liquidandsoftfatshavelesscholesterol-raisingsaturatedandtransfat.Avoiddeepfriedfoodsandproductswithhydrogenatedoilsintheingredients.Thiswillhelplimityourintakeoftransfats.

• Omega 3fatsarehearthealthyfatsfoundincoldwaterfattyfishincludingsalmon,mackerel,arcticchar,sardines,troutandherring.Two(2)servingsoffishperweekisrecommendedaspartofahealthybalanceddiet.PlantsourcesofOmega3’sincludeflaxseeds,walnutsandvegetablesoilssuchascanola.

Protein

Fruit

Protein

Vegetables

StarchStarch

Breakfast Lunch & Supper

In Moderation - sweets, caffeine & alcohol. • Limit sweets,candy,sugar,jam,honey,syrupregularsoftdrinkandsweetenedfruitdrinks.Cakes,pies,cookies

andmanypre-packagedsnackfoodsarehighincaloriesandlowonnutrients.Savechoicesofthesefoodsforspecialoccasions.

• Drinknomorethanfour (4) cups of coffeeorcaffeine-containingbeveragesperday.Carefulwithwhatyouadd:cream,sugarandflavoredsyrupscanaddalotofcaloriestoyourcup.

• Limit alcohol tolessthan2drinksperday.One(1)drink=12ozbottleofbeer,1.5ozliquor,4ozwine.

Reducing alcohol can promote weight loss and help you lower your blood pressure.

Supplements for Hypertension Control • CheckwithyourDoctor,DietitianorPharmacistbeforestartingasupplement.• HeartHealthyMixture=1/3groundflax,1/3oatbranand1/3psyllium.Use2Tablespoonsperdayaddedtofoods

orbeverages.• Omega3supplementshaveasmalleffectonreducingbloodpressure.Thiseffectisnotstrongenoughto

recommendfishoilsupplementtocontrolhypertension.

Food and Medication Interactions• ReviewyourmedicationswithyourDoctor,DietitianorPharmacist.• Saltsubstitutesbasedonpotassiumsuchas“NoSalt”or“HalfSalt”arenotrecommendedwithsomehypertension

medications.• Cautionwithgrapefruit,grapefruitjuice,pomelos,Sevilleorangesandnaturallicorice(glycyrrhizaeglabra).Certain

medicationsforhypertension,cholesterolandheartdiseaseinteractwiththesefoods.

Move your body, lower your blood pressure • Includingatleast30minutesofbriskactivity,suchaswalking,four(4)

ormoredaysperweekcanloweryourbloodpressure.• Startwithabrisk10minutewalkafewtimesperdayandincrease

graduallyfromthere.• Gentlestretchingexercisesincreaseyourflexibilityandreleasetensionin

yourmusclesandjoints.Aimfor4ormorestretchingsessionsperweek.• Strengthexercisesimprovemuscleandbonedensitykeepingyoustrong

andstable.Includethese2-4timesperweek.• Remembertostartslowlyandconsultyourphysicianbeforestarting

anewexerciseprogram

To Reduce Weight • Eatsmallerportionsoffoodsandrememberthebalanceoffoodsonyourplate:1/4protein,1/4starch(including

potatoes),1/2vegetables• Eat3mealsperday,nomorethan6hoursapart.Don’tskipmeals.Snackwithfruitbetweenmeals.• Choosefoodslowerinfatandsugar.Eatingstrategiesincludinglowglycemicindexchoicescanbehelpful.

Learnmorefromaregistereddietitian.• Aimforamaximumweightlossof1-2lbs(0.5-1kg)perweek.• “Waistloss”isasimportantasweightloss.FortipsonhowtotrimyourwaistseeourWaistingAwaynutrition

factssheet.

For more information on hypertension and healthy eating on the net go to:www.hypertension.ca,www.lowersodium.ca,www.sodium101.ca,www.dietitians.ca

Note: These guidelines are for people wanting to reduce the amount of salt or sodium in their diet. If a salt “restriction” is needed to help control more severe medical conditions, please consult with a Registered Dietitian to develop a more personalized low-salt/sodium meal plan.

Keeping active can lower your blood sugar, cholesterol, blood pressure, help you feel better, relieve tension and stress, improve your muscle tone and help you lose weight!

Vegetables and Fruit – with lots of colour!• Allfruitsandfruitjuices• Anyvegetablesexceptthoseon“Avoid”list• Lowsalttomatoorvegetablejuice• Lowsaltcannedvegetables,tomatosauce,tomato

paste

• Regularcannedvegetables• Pickledvegetables(e.g.sauerkraut)• Tomatoandvegetablejuiceswithmorethan400mg

sodium/serving• Instantorcannedpotatoes


Soup• Homemadesoupsmadewithoutsalt• Lowsodiumbrothorcannedsoups

• Meatextracts(e.g.bouillon,Oxo)• Regularcannedsoups,driedsoupmixes

The DASH Eating Plan – Dietary Approaches To Stop HypertensionFollowingtheDASHEatingPlanhasbeenshowntolowerbloodpressureandcholesterolbyemphasizingfruits,vegetables,andlow-fatdairy.DASHalsoincludeswholegrains,fish,poultryandnutsandbeans.Itislowinredmeats,sweetsandsugar-containingbeverages.

Tips for Following the DASH Eating PlanThenumberofservingsperdaylistedarefora2000calorieeatingplan.Rememberthatifyouaretryingtoloseweightyoushouldchooselower-caloriefoodsfromeachgroupandreplaceservingsofhigher-caloriefoodswithfruitandvegetables.MoredetailsonDASH,includingalowercalorieversion,areavailableonlineatwww.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf

Lay a Healthy Foundation of fruit, vegetables and whole grains. Add protein and healthy fat choices. Use sweets sparingly.

Whole Grains• Wholeandmulti-grainbread,cereal,rice,pasta• Mostdrycereals,unsaltedcookedcereals• Unsaltedorlowsodiumcrackers

• Saltedcrackers,breadorrollswithsaltedtops• Packagedbreadcrumbs,breadingmixesandstuffing

mixes• Pre-seasonedriceorpasta“sidedish”packages• Instanthotcereals,wafflesandpancakes

Eating Plan for HypertensionNo added salt/sodium: 1500mgto2300mgofsodiumperdayReadfoodlabelsforsodiumcontent.Lookforlessthan400mgperserving.Lessthan200mgisbest!

Sweets(no more

than 5/week)

What’s a Serving?• 1 cup fat-free or low-fat fruit yogurt• 1/2 cup fat-free or low-fat frozen yogurt• 1 tbsp maple syrup, sugar or jam

• 1/2 cup cooked beans• 1/3 cup nuts• 2 tbsp sunflower seeds

• 1 cup fat-free or low-fat fruit milk or yogurt

• 43 g fat-free or low-fat cheese

• 1 slice bread• 1/2 cup dry cereal• 1/2 cup cooked rice,

pasta or cereal

• 1 cup lettuce• 1/2 cup other

vegetables

• 1 tsp oil or soft margarine• 1 tsp regular mayonnaise• 1 tbsp low-fat mayonnaise• 1 tbsp regular salad dressing• 2 tbsp light salad dressing

• 85 g broiled or roastedseafood, skinless poultry, or lean meat

• 1 medium fruit• 1/2 cup fresh, frozen,

or canned fruit• 1/2 cup dried fruit• 3/4 cup fruit juice

Beans,Nuts,

Seeds(1/day)

Low-FatDairy

(2-3/day)

Grains(preferably whole)

(7-8/day)

Vegetables,Fruits

(8-10/day)

Oils,SaladDressing,Mayo(2-3/day)

Seafood,Poultry,Lean Meat(0-2/day)

Here’showtheDASHdietwouldlooklikeifittooktheshapeofapyramid.Ifyouwanttofollowit,makesureyoupayattentiontotherathersmallservingsizes.

Aservingofgrainsforexample,isjusthalfacupofcereal,pastaorriceora28-gramsliceofbread.That’sfarlessthanatypicalbagel(110to140grams),aservingofmostcereals(onecup),orarestaurant-sizeservingofspaghetti(aboutthreecups).Servingsofseafood,poultry,meat,oils,fruits,andvegetablesarealsopetite.


Seasonings and Condiments • Unsaltedherbs,spicesandseasoningblends• Vanillaextract,lemon,lime,vinegar,cocoa,drymustard• Salt-freecondiments(e.g.salt-freeketchup)• Limitof1tsp(15ml)perdayof:barbeque,steakand

Worcestershiresauces,horseradish,ketchup,preparedmustard,relish,salsa

• Salt,seasalt,saltsubstitutescontainingsalt(e.g.HalfSalt)• Saltedherbsandseasoningblends-checkingredients• Meattenderizers• MSG(mono-sodiumglutamate)• Regularpickles,olivesandrelishes• Soysauceandorientalsauces(e.g.teriyaki)

Milk and Alternatives• Anyexceptthoseon“Avoid”list-chooselowfat• Limitof1.5oz(45g)hardcheeseperday-20%MForless• Limit1cup(250ml)perdayofoneofthefollowing:

buttermilk,maltedmilk,BreakfastAnytimeshake

• Milkshakes,MaltedMilkservingsover1cupperday• Chocolatemilkunlesshomemadewithcocoa• Processedcheeseslicesandspreads

Meat and Alternatives• Anyexceptthoseon“Avoid”list• Chooseleanorlow-fatchoices• Cannedfishwithoutaddedsalt-tuna,sardines• Driedbeans,peas,lentils.• Cannedbeans,rinsewellbeforeusingorchooselowsalt

versions.

• Salted,smoked,curedorpickledmeat,fish,poultryandeggs:luncheonmeats,

• Bacon,ham,sausages,wieners,cannedandsaltedfish• Saltednuts,nutbuttersandseeds• Conveniencefoods-cannedstews,pastas,chili

Fats and Oils• Anyliquidoil-canola,olive,“vegetable”• Non-hydrogenatedsoftmargarine• Limitcommercialsaladdressingto1tbsp(15ml)perday

• Baconfat• Cannedordriedgraviesandsaucemixes• Drymixesforsaladdressingsanddips

Sweets• Anyexceptthoseonthe“Avoid”list(inmoderation) • Commercialcakes,pies,pastries,dessertandinstant

puddingmixes

Snack Foods• Unsaltedpopcorn,unsaltedpretzels• Lowsodiumsnackcrackers

• Saltedchips,cheezies,pretzels,popcornandsnackcrackers

Beverages• Anyexceptthoseonthe“Avoid”list • Watertreatedwithwatersoftener

• Mineralwaterwithsodiumcontentgreaterthan200mgperliter

• SportsbeveragessuchasGatorade-unlessprolonged,intenseactivity

Low Sodium Eating Plan for Hypertension, September 2010DanielleAldous,BSc,RD(FromOriginal,2005:HeleneCharlebois,BSc,RD&JasnaRobinsonDI)©ContinuingMedicalImplementation®Inc.


Other Nutrition Fact Sheets Available: EatingPlanforHighCholesterolEatingPlanforCongestiveHeartFailureEatingPlanforType2DiabetesWaistingAway–HealthyWeightManagementPotassiumModifiedEatingPlanPlease visit www.cvtoolbox.com for more information

EATING PLAN FOR TYPE 2 DIABETES

Thiseatingplanislowinrefinedgrainsandsugar,lowinsaturatedandtransfatandhighinfibre.Itfocusesoneatingregularlytimedmealsandselectinglowglycemicindexfoods.

Type 2 Diabetes affects how your body uses and stores glucose. Glucose comes from digestion of sugars and starches in the foods we eat. Our body produces a hormone called insulin that it uses to remove glucose from our blood. In Type 2 diabetes our body may not be making enough insulin or our body is not properly responding to the insulin it is making. Glucose levels in our blood rise and can cause both short term and long-term effects on our body.

• Symptoms include: unusual thirst, frequent need to urinate, weight change, lack of energy, blurred vision, frequent infections, cuts and bruises that are slow to heal, tingling in the hands and feet.

• Risk factors include: being overweight, a parent or sibling with diabetes, having diabetes while pregnant (gestational diabetes), impaired glucose tolerance or impaired fasting glucose, high blood pressure, high cholesterol, polycystic ovary syndrome, being of Aboriginal, Hispanic, Asian, South Asian or African descent.

Did You Know? Morethan3 million Canadians have diabetesandmorethan90% of these have Type 2 Diabetes.

Tips to Help Keep Your Blood Sugar levels in a Healthy Range1. Eatthreebalancedmealsperday,nomorethansixhoursapart.

Limitaddedsugarsandsweets.2. Eatacombinedtotalofatleast7servingsofvegetablesandfruit

eachday.3. Eatyourfruitratherthandrinkingitasjuice.4. Includesmallportionsofwhole-grainstarchyfoodsateachmeal.5. Eatlowerglycemicindexfoods.See ‘Go Low GI’.6. Drinkwaterinsteadofregularpopandfruitdrinks.Tea,coffeeandlow

caloriejuicesandbeveragesaregreattoo.7. Includeleanproteinchoicesateachofyourmeals.8. Makelowerfatchoices,avoidfryingyourfoodsandlimitaddonfats

suchasbutter,margarineandoil.9. Moveyourbodyforatleast30minuteseveryday–walkingisgreat!10. Ifyouareoverweight,trytolose5to10%ofyourpresentweight.

Blood Glucose Target Ranges Fasting: 4.0 -7.0 (empty stomach or no food for at least 3 hours)Postprandial: 5.0-10.0 (2 hours after a meal)

Type 2 Diabetes FACTS – Focus on Carboyhdrate, Fibre and Glycemic Index• Overtime,highbloodsugarcausesdamagetoyourbloodvesselsandcanresultinblindness,heartdisease,kidney

problems,circulationproblems,nervedamageanderectiledysfunction.• Bychoosingappropriateportionsofcarboydratecontainingfoodsandselectingonesthathavemorefibreandalower

glycemicindex,youhelpimproveyoubloodglucosecontrol.

Go Low GI – Foods and Their Glycemic IndexGlycemicindexisascale(0-100)rankinghowquicklyacarbohydratecontainingfoodwilldigestintoglucoseinourblood.HighGIfoodsbreakdownquicklywhereaslowGIfoodsbreakdownslowly.WithlowGIfoodsyoufeelfulllongerandyoubody’sinsulinhasmoretimetoperformitsjobandremoveglucosefromtheblood.

Hint: HintlowGIfoodsaregenerally‘closetothefarm.’

LOW GI FOODS (55 OR LESS) CHOOSEMOSTOFTEN

MEDIUM GI FOODS (56-69) HIGH GI FOODS (70+) CHOOSELESSOFTEN

Whole grain bread Couscous White bread

Pumpernickle bread Rye bread Instant mashed potatoes

Oatmeal Instant Oatmeal Corn Flakes, Rice Krispies

All-Bran cereal Shredded Wheat Refined, sweetened cereals

Converted rice Cream of Wheat Instant rice

Brown & Basmati rice Whole grain crackers Bagels

Bulgur, Barley, Quinoa Pita bread Waffles/pancakes – made with white flour

Firm cooked pasta Long grain white rice Soda crackers

Beans, peas, lentils Apricot, banana French fries

Apples, peaches, pears Cantaloupe Dried dates/figs

Grapefruit, oranges Pineapple, raisins Sweetened fruit juice

Berries, cherries, grapes Canned fruit in juice Parsnips, pumpkin

Kiwi, Mango, Plum Cranberry juice Rutabaga, turnip

Avocado New potatoes Broad beans

Sweet Potato Beets Refried beans

Carrots, broccoli Sweetened condensed milk Ice cream

Cauliflower, corn Soft drinks

Leafy vegetables Glucose

Low fat milk, soymilk, yogurt and cottage cheese

Tips for using the Glycemic Index• Thinklowandslow-choosefromthelowandmediumGIfoodsmostoften.• Balanceyourchoiceswithleanproteinchoicesandhealthyfats.Proteinandfatalsoslowthedigestion,keepyoufeeling

fullandslowthereleaseofglucoseintoyourblood.• Moredetailscanbefoundonlineatwww.gidiet.comorwww.diabetes.ca/files/glycemicindex_08.pdf

Did you know?TheGlycemicIndexdietwasdevelopedbyDavidJenkins,aprofessorofnutritionandreasearcherattheUniversityofToronto.

*Adaptedfrom“TheGIDiet”RickGallop

See it to Believe it!1 tsp = 5 grams sugar

Balancing Carbohydrates (‘Carbs’)Alongwiththeglycemicindexapproach,itisimportanttounderstandandcontroltheamountofcarbohydratesyoueatanddrinktobettermanageyourbloodglucose.

Herearesometips:1. Carbohydrateisthenutritiontermusedforstarch,sugarandfibre.2. Spacingyourcarbohydratesoverthedayhelpsyourbodytokeepastableglucoselevel.3. Starchchoicesthatarehigherinfibrecontributelesstoraisingyourbloodglucose.UsetheNutritionFactspaneltochoose

cereal,bread,crackers,riceandothergrainorstarchchoicesthathaveatleast2gramsoffibreperserving.4. Breakfastshouldbe1/3starchorgrain,1/3fruitand1/3protein.5. Lunchandsuppershouldbe1/2vegetables,1/4starchand1/4protein.6. Snackchoicescanhelppreventdipsinbloodglucosethatcanoccurifyourmealsaremorethan4hoursapartorifyouare

veryactive.7. Choosesnackswithabout20gramsofcarbohydrate.Fruit,vegetables,highfibregranolabars,wholegraincrackerswith

cheeseorpeanutbutterarejustafewoptions.

Sugar and Refined Starches • Tablesugar,brownsugar,honey,maplesyrupandmolasses

areallsimplesugarsandtheyallhave5gramsofcarbohydratesor“carbs”inateaspoon.

• Simplesugarssuchastheseand‘white’orrefinedstarchesbreakdownquicklyandcausebloodglucosetorisequickly.

• Aquickriseinbloodglucosecanoftenbefollowedbyanequallyquickdrop.• Thiscanleadtocravingsformoresugaryfoodsandfeelingsofhungerandfatigue.• Aimtochoosepackagedfoodswithlessthan10gramsofsugarperserving• Avoidaddingsugar,reducetheamountorsubstituteanon-sugarsweetenerforbakingsuchasSplenda(sucralose)

The Canadian Diabetes Association has an excellent summary sheet on sugars and sweetners. Finditonlineatwww.diabetes.ca/files/en_sweeteners_final.pdforcall1-800-BANTINGtorequestacopy.

Did you know?Astandardcanofregularpopcontainstheequivalentof10tspofsugaranda2Lbottleofpophas1½cupsofsugar!Wateristhebestbeverageforquenchingyourthirst.

Decoding Food LabelsTheNutritionFactstablefoundonthesideofpackagedfoodcanhelpyoumakebetterfoodchoices.Alwayschecktheservingsizefirstandconsiderthisinrelationtohowmuchofthefoodyouusuallyeat.

Lookforchoiceswithlessfat,saturatedfat,cholesterolandsodium.Lookforchoicesthatgiveyoumorefibre.Learn more about using food labels to make healthy choices on the web:Health Canada –www.hc-sc.gc.ca/fn-an/label-etiquet/nutrition/cons/index-eng.phpHealthy Eating Is In Store for You –www.healthyeatingisinstore.ca

Did you know?Fibreisacarbohydratethatdoesnotraisebloodsugar.UsingtheNutritionFacts,youcansubtractthegramsofFibrefromthegramsofCarbohydrate.Onlycounttheremainingcarbohydratetowardyourmealplan.

How Many carbs are right for me?• Carbsareoneoftheenergynutrients.Weallhavediferentenergyneedsbasedonouractivities,age,gender,goals

tomaintainorloseweightjusttonameafew.• Ingeneral,mostadultsneed45to60gramsofcarbohydratespermeal.• Usingfoodlabelswillhelpyoutochoosefoodstoprovideaboutthisamountofcarbohydratepermeal.• Toplanyourmealyoushouldknowthatineachofthefollowingfoodsthereareabout15gramsofcarbs:

– 1sliceofbread(thesizeofaCDcase)– ½cupofcereal– 1pieceoffruit(thesizeofatennisball)– 1cupoflowfatmilk

• Vegetablesareverylowincarbsandareoftenconsidered‘free’–loadup!

Exchangelistsindicatingtheportionsoffoodtoprovide15gramsofcarbohydrateareavailable.Askaregistereddietitianformoredetails.

Ifyouareusinginsulintocontrolyourbloodsugars,youmaywanttolearnmoreaboutbalancingyourcarbohydrateswithanapproachcalledCarbohydrateCounting.Asktospeakwitharegistereddietitian.

Fibre• Whenreadingfoodlabelslookforfoodshigherinfibre.• Breadchoicesshouldhaveatleast2gramsperslice.Cerealchoicesshouldbe4gramsormoreperserving.• Granduallyincreaseyourfibreintakeandaimfor30gramseachday.• Fibreisacarbthatdoesnotdigest.WhenreadingtheNutritionFactstable,subtractthefibregramsfromthetotal

gramsofcarbstodeterminethecarbsthatcontributetoyourmeal.

To Reduce WeightIfyouareoverweightagradualreductionof5-10%ofyourinitialweightcaninprovebloodglucosecontrol.Suggestionsinclude:• Eatsmallerportionsoffoodsandrememberthebalanceoffoodsonyourplate:1/4protein,1/4starch(including

potatoes),1/2vegetablesforlunchandsupper• Eat3mealsperday,nomorethan6hoursapart.Don’tskipmeals.Snackwithfruitbetweenmeals.• Choosefoodslowerinfatandsugar.Eatingstrategiesincludinglowglycemicindexchoicescanbehelpful.Learn

morefromaregistereddietitian.• Aimforamaximumweightlossof1-2lbs(0.5-1kg)perweek.

“Waist loss” is as important as weight loss. For tips on how to trim your waist see our ‘Waisting Away – Healthy Weight Management’ nutrition fact sheet. Staying Healthy with DiabetesBeingoverweightorobesemakesyourbodymoreinsulinresistant.Thismakescontrollingbloodsugarsmorechallenging.Excessweightanddiabetesarebothrisksfactorsforheartdisease.

FormoredetailsonWeightManagement,CholesterolorHypertensionsee:Eating Plan for Hypertension,Eating Plan for High CholesterolandWaisting Away - Healthy Weight Management.AllareavailablefromtheOttawaCardiovascularCentrewebsite.Gotowww.ottawacvcentre.com.

Protein

Fruit

Protein

Vegetables

StarchStarch

Breakfast Lunch & SupperPortions to Live By • Oneservingofwholegrainsis1/2cupcooked,notthe

3ormorecupsservedinmostrestaurants!Toomuchofagoodthingisnotagoodthing.

• FormoredetailsonhealthyportionsseeEating Well with Canada’s Food Guideonlineatwww.healthcanada.gc.ca/foodguide.


Whole Grains• Wholeandmultigrainbreads,wholewheatpasta,

brownrice• Low-fatandmultigraincrackers• Low-sugar,whole-graincereals• Oatmeal,bran,bulgur,buckwheat• Low-fat,wholegrainbakedgoodswithaddedbran

oroatbran

• Whitebreads,croissants,sweetrolls,high-fatwhitecrackers,waffles

• Short-grainandminuterice– whiterice• Sweetenedrefinedcereals• Commercialmuffins,cakes,doughnuts,Danish

pastries,high-fatcookies• Avoid“white”foods(whiteflour,whitesugar)

Milk and Alternatives• Dairyproductswithlessthan1%fat• Cheeseshouldbe10-20%MF

• Milkproductshigherthan1%fat• Cheesehigherthan21%MFandcreams

Type 2 Diabetes Eating PlanChoose Low Glycemic Index Foods Whenever Possible!

Vegetables and Fruit – with lots of colour• Darkgreenleafyvegetables• Eatanabundancefresh/frozenvegetables• Unsweetened,fresh,frozenorcannedfruits

• Parsnip,pumpkin,whitepotatoes(highGI)• Driedfruitsandfruitsinheavysyrup• Sweetenedfruitjuices

Meat and Alternatives• Fish(cannedinwater,fresh,frozen),seafood• Skinlesschickenandturkey• Leanmeatswithfattrimmed,wildgame• Leancoldcuts(butwatchthesaltcontent)• Legumes,tofu• Eggs(uptoeightperweek)

• Fishwithbutterorbreading• Friedchicken,poultrywithskin,wings• Fattymarbledmeats,ribs,regulargroundmeats,

organmeats• Highfatprocessedandcannedmeats:bacon,

sausages,patés,bologna,salami,wieners

Meat and Alternatives• Olive,canola,soybean,sesame,sunfloweroils(3tsp• orlessperday)• Non-hydrogenatedsoftmargarinesLow-calorie

dressingsandmayonnaise• Lightpeanutbutter,nuts(watchsaltandcalories)• Unsaltedseeds:flax,pumpkin,sunflower• Defattedgravyandlow-sugarcondiments• Cocoapowderorasmallpieceofdarkchocolate

• Hydrogenatedoils,coconutandpalmoils• Shortening,butter,lard,hardmargarines• Peanutbutterwithpalmorhydrogenatedfat• Nomorethan1/4cupnutsperday(highcalories)• Heavygravy,creamsauces,high-sugarcondiments• Chocolateandcarob

Sweets (in very small amounts)• Sugarsubstitutesandartificialsweeteners,lowsugar

jams/jellies/syrups• Sugar-freecandies,gelatins,gum• Low-sugarandhighfiberbakedgoods• Low-fatandlow-sugarfrozendessert

• Sugarandregularjams,jellies,syrups,candies,gelatins,gum,honey

• Regularcakes,pies,cookies• No“white”foods(whiteflour,whitesugar)• Regularfrozendesserts

Snack Foods• Popcornwithoutsalt,butter,orhydrogenatedoils• Chooselowfat,lowsugarsnackfoods

• Regularpopcorn,chips,pretzels,cheesies,cornchips

Eating Plan for Type 2 Diabetes, December 2010DanielleAldous,BSc,RD(FromOriginal2006HeleneCharlebois,BsC,RD&JasnaRobinson,DI)©ContinuingMedicalImplementation®Inc.


Other Nutrition Fact Sheets Available: EatingPlanforHypertensionEatingPlanforHighCholesterolEatingPlanforHeartFailureHealthyWeightManagementPotassiumModifiedEatingPlanPlease visit www.cvtoolbox.com for more information

Alcohol• Limitalcoholtolessthan2drinksperday(1drink=12ozbeeror1.5ozliquoror4ozwine)• Alcoholisnotrecommendedifyou:

– havehightriglycerides(typeofbloodfat)– haveliverproblems– arepregnantorbreastfeeding

• Ifyouchoosetodrinkalcohol,remember:– Todrinkwithyourmealorsnack(notonanemptystomach)– Todrinkslowlyordilutewithwaterordietsoda– Thatliqueurs,sweetwinesanddessertwineshavemoresugar– TowearyourMedicAlertindicatingthatyouhavediabetes–alcoholcancausealowbloodsugarreactionwhich,ifleftuntreated,mayrequiremedicalattention

SupplementsCheck with your Doctor, Dietitian or Pharmacist before starting a supplement. • Heart Healthy Mixture =1/3groundflax,1/3oatbranand1/3psyllium.Use2Tablespoonsperdayaddedtofoods

orbeverages.Thefibreinthisblendisgoodforbothyourheartandbloodglucosecontrol.• For high triglycerides (atypeoffatinthebloodmorecommonlyhighwithdiabetes):

Omega 3 supplements –adding2000to4000mgofEPA+DHAfromfishoil.Thisshouldbedoneunderthesupervisionofyourdoctor.

Move your body, burn the glucose• Aimtobeactivefor30minutesatleast5daysperweek(150minutes/wk).Startwithbriskwalkingfor10minutes

afewtimesperdayandincreasegraduallyfromthere.Besuretohaveyourdoctorsapprovalbeforeengaginginanexerciseprogram.

• Strengthexercisescanbeincluded2-4timesperweektokeepthebonesstrongandbuildleanmuscle.• Aleanerbodyisbetterabletousetheinsulinitproducestomanagebloodglucose.• Measureyourbloodsugarbeforeandafterexercise.Typicallyyourreadingsafterexercisewillbelower.• Bepreparedincaseyourbloodsugardropstoolowduringorafterexercise.Treatmentsarelistedbelow.• Ifyoutakemedicationsthathaveariskofcausinglowbloodsugaritisbesttoexercisewithsomeoneandtakeacellphone

withyouforemergencies.Letsomeoneknowwhereyouwillbeandapproximatelywhenyouwillreturn.TakeemergencyglucosewithyouandwearyourMedicAlert.

Keeping active can lower your blood sugar, lower your blood pressure, help you lose weight, help you feel better reduce the amount of medication you need, relieve tension or stress, improve your heart and lung function and improve your muscle tone! Look at all those benefits!

Recognize and be ready to treat low blood glucoseUsuallyweareconcernedaboutbloodglucosebeingtoohighbutcertainmedications*,exercise,amissedmealoranillnesscancauseyoutoexperiencealowbloodsugar.• Whatislow?Abloodglucosebelow4.0• Symptoms:shakiness,fatigue,excessivehunger,headache,blurredvisionordizziness,coldclammyorsweatyskin,pale

colourinface,weakness.• Treatment:

– Take15gramsoffastactingcarbohydratesuchasglucosetabs,3packetsofsugardissolvedinwater,¾cfruitjuiceorregularpop,6LifeSavercandiesor1tablespoonofhoney.Wait15minutes.Ifsymptomsdonotresolvetreatagain.

– Ifsymptomsresolvebutthenextmealismorethananhouraway,haveasnackwith15to20gramsofcarbohydrateandsomeproteinsuchas½asandwichorcheeseandcrackers.

* Medications more likely to cause a low blood sugar include Amaryl, Diabeta, Diamicron, Gluconorm and Insulin.

Understanding FODMAPs

What are FODMAPs?FODMAPs are a group of small carbohydrate (sugar)

molecules found in everyday foods. Carbohydrates are

made up of carbon, hydrogen and oxygen and provide an

important source of energy for the body. FODMAPs are

carbohydrates that may be poorly absorbed in the small

intestine of some people. FODMAPs move through the

digestive tract to the large intestine (colon), where they

can draw water into the colon and are rapidly fermented

(digested) by naturally-occurring gut bacteria. The

fermentation of FODMAPs produces gas and other

by-products.

While some people are able to consume FODMAPs without

experiencing gastrointestinal side effects, many people with

digestive disorders, such as Irritable Bowel Syndrome (IBS),

find that FODMAPs triggers symptoms including abdominal

pain, cramping, bloating, excess gas, constipation and/or

diarrhea.

<http://www.cdhf.ca>

What does FODMAP mean?FODMAP is an acronym for Fermentable – Oligosaccharides – Disaccharides – Monosaccharides – And – Polyols. Each of these

is explained below:

F Fermentable: Fermentable carbohydrates are sugars that are broken down and digested by bacteria in our

intestines, producing gas and other by-products.

O Oligosaccharides: Oligosaccharides are short chains of carbohydrate molecules linked together.

• Fructans (a chain of fructose molecules) and galacto-oligosaccharides (a chain of galactose molecules) are

oligosaccharides that humans cannot break down and properly absorb in the small intestine.

D Disaccharides: Disaccharides are two carbohydrate molecules linked together.

• Lactose, the sugar found in milk and dairy products, is a disaccharide composed of glucose and galactose.

Lactose must be broken down by the digestive enzyme lactase before it can be absorbed in the small intestine.

In people with lactose intolerance, the level of lactase enzyme is insufficient to properly digest lactose and

lactose travels to the colon where fermentation occurs.

M Monosaccharides: Monosaccharides are single carbohydrate molecules.

• Fructose, the sugar found in many fruits and some vegetables, is a monosaccharide and does not require any

digestion before it is absorbed. When foods containing equal amounts of fructose and glucose are eaten,

glucose helps fructose to be completely absorbed.

However, when fructose is present in greater quantities than glucose, fructose absorption depends upon the

activity of sugar transporters located in the intestinal wall. The ability to absorb excess fructose varies from

person to person. In people with fructose malabsorption, the capacity of sugar transporters is limited and excess

fructose travels to the colon where fermentation occurs.

A And

P Polyols: Polyols, or sugar alcohols, are a type of carbohydrate that humans can only partially digest and absorb in the

small intestine.

• Polyols, such as sorbitol, mannitol, xylitol, maltitol and isomalt, mimic the sweetness of sucrose (table sugar),

however, because their absorption is much slower, only a small amount of what is eaten is actually absorbed.

Polyols are often used as low-calorie sweeteners in sugar-free and diet products.

FODMAPs

2 / 3

How do FODMAPs affect people with digestive disorders?Although FODMAPs are not

the cause of digestive disorders

such as IBS, they can trigger

gastrointestinal symptoms.

When FODMPAPs reach the

colon, they draw fluid into the

bowel and bacteria ferment

the FODMAP molecules

to produce hydrogen and

methane gases. The liquid

and gas distend (stretch) the

intestine and signal nerves

surrounding the digestive

organs.

For many people with IBS,

the nerves of the gut are

unusually sensitive and even a

small change in the intestinal

volume can cause the nerve

network to overreact and

trigger IBS symptoms.

What foods contain FODMAPs? FODMAPs are found in a wide

variety of everyday foods

including fruits, vegetables,

legumes, milk products and

sweetening agents. Each

person has an individual

threshold for tolerating

FODMAPs and some foods

may pose more of a problem

than others. A diet that

reduces the intake of high

FODMAP foods (shown

in Table 1) and manages the

total FODMAP load at each

meal, may help to improve

gastrointestinal symptoms

for some people.


FRUCTANS GALACTO- OLIGO-

SACCHARIDES

LACTOSE EXCESS

FRUCTOSE

POLYOLS

Vegetables artichokes, asparagus, beetroot, chicory, dandelion leaves, garlic, leek, onions, onion and garlic salt or powders, radicchio lettuce, spring onions (white part)

Grains barley, rye or wheat (in large amounts), fructo-oligosaccharides, inulin

Nuts cashews, pistachios

Legumes baked beans, bortolotti beans, kidney beans, chickpeas, lentils, soybeans, soy flour and some soy milk

Milk Products milk (cow, goat or sheep), custard, condensed and evaporated milk, dairy desserts, ice cream, margarine, powdered milk, yogurt

Cheese soft and unripened cheese (ricotta, cottage, cream, mascarpone)

Fruits apples, boysenberries, figs, mangoes, pears, watermelon

Sweeteners agave, corn syrup solids, high-fructose corn syrup, honey

Alcohol Rum

Fruits apples, apricots, blackberries, cherries, longons, lychees, nectarines, peaches, pears, plums, prunes

Vegetables avocados, cauliflower, green pepper, mushrooms pumpkin, snow peas

Sweeteners sorbitol (420), mannitol (421), isomalt (953), maltitol (965), xylitol (967)

Table 1: HigH FODMAP FOODs

FRUCTANS GALACTO-OLIGO-

SACCHARIDES

LACTOSE EXCESS

FRUCTOSE

POLYOLS

Vegetables bok choy, bean sprouts, bell peppers, butter lettuce, carrots, celery, chives, corn, eggplant, green beans, tomatoes, potatoes, spinach

Garlic or onion-infused oil

Gluten-free* breads/cereals, rice and corn pasta, rice cakes, potato chips, tortilla chips

Legumes firm tofu

Milk Products lactose-free milk and lactose-free milk products including cottage cheese, ice cream and sorbet

Cheesecertain cheeses such as cheddar, parmesan, swiss, mozzarella

Fruits ripe bananas, blueberries, grapefruit, grapes, honeydew, lemons, limes, passion fruit, raspberries, strawberries, tangelos

Sweetenerstable sugar, maple syrup

Fruits bananas, blueberries, grapefruit, grapes, honeydew, kiwi, lemons, limes, oranges, passion fruit, raspberries

Sweetenerstable sugar, glucose, aspartame

Adapted from sources: Dr. Sue Shepherd, 2012 Shepherd Works http://shepherdworks.com.au Kate Scarlata, Registered Dietitian http://blog.katescarlata.com/fodmaps-basics/fodmaps-checklist/

Table 2: LOW FODMAP FOODs

* Examine ingredients on gluten-free breads and cereals to ensure other FODMAPs such as honey and agave are not present. Adapted from source: Kate Scarlata, Registered Dietitian http://blog.katescarlata.com/fodmaps-basics/fodmaps-checklist/

High FODMAP foods can be replaced with choices from the low FODMAP foods list (shown in

Table 2) to help maintain a nutritious and well-balanced diet.

FODMAPs

3 / 3

Does reducing FODMAP intake relieve digestive symptoms?

The low FODMAP diet, originally developed in Australia

by dietitian, Dr. Sue Shepherd, and gastroenterologist,

Dr. Peter Gibson, is increasingly recognized as an effective

dietary treatment for IBS. An Australian study has shown

that a low FODMAP diet may reduce gastrointestinal

symptoms in 75% of IBS patients.1 The low FODMAP diet is

intended for people with functional bowel disorders, such

as IBS, and may provide no benefit for healthy individuals.

Who should follow a low FODMAP diet? If you experience any of the symptoms commonly

associated with IBS, consult your physician. In addition to

other treatments your doctor may recommend, following

a low FODMAP diet may be an effective strategy to ease

the pain, gas and altered bowel patterns commonly

experienced in IBS.

When reducing FODMAPs in the diet, it is important to

replace restricted foods with nutritious alternatives and

ensure that your diet is healthy and well-balanced. A

re-introduction of FODMAP foods should be done

gradually to help identify which FODMAPs can be

tolerated over the long term.

The low FODMAP diet is best implemented under the

supervision of a qualified health care professional, such

as a registered dietitian. This diet is a new and evolving

area of nutritional science. Additional research into the

role of FODMAPs in IBS and the FODMAP content of

specific foods is continually emerging. We encourage

you to seek additional sources that are supported by

recent scientific evidence.

1. Gibson, P. R., & Shepherd, S. J. (2010). Evidence-based dietary management of functional gastrointestinal symptoms: The FODMAP approach. Journal of Gastroenterology and Hepatology, 25, 252-258. Click <http://onlinelibrary.wiley.com/doi/10.1111/j.1440-1746.2009.06149.x/abstract>

Partnering for best health. Working collaboratively with your health care professional

will help you protect your body from digestive diseases and

maximize your digestive health. When you report your

health status completely, concisely and accurately, your

physician can provide you with the best care and treatment

plan. Be sure to stay informed on ways to maintain your

health and well-being, track and record your symptoms,

and write down questions and concerns to discuss at your

next appointment.

Learning more about digestive health.The Canadian Digestive Health Foundation provides

information, tools and support to help you take control of

your digestive health with confidence and optimism. Visit

www.CDHF.ca to view on-line seminars, personal stories

and helpful resources about digestive disorders including

IBS, diarrhea and constipation.

Videos and presentations about IBS are available at:

http://www.cdhf.ca/digestive-disorders/ibs-living.shtml

• Understanding Irritable Bowel Syndrome…

Let’s Talk

This video features interviews and comments from

physicians and patients

• More than Gas and Bloating. IBS –

the Mind-Gut Connection

This on-line seminar, presented by Dr. Stephen Vanner,

provides an in-depth overview of IBS, symptoms, possible

causes and suggested treatments.

• IBS with Dr. Adam Weizman

This public presentation provides an overview of IBS.

Please note: The information contained in this fact sheet is not a substitute for medical care and the advice of your physician. There may be variations in treatment that your physician may recommend based on your individual facts and circumstances. Always consult with your physician when you have concerns about your health.

<http://www.cdhf.ca>The CDHF is the foundation of the Canadian Association of Gastroenterology.

YEs! I want to donate to the Canadian Digestive Health Foundation

Please accept my donation to support:

[ ] Canadian Digestive Health Foundation Programs as needed

[ ] Canadian Digestive Health Foundation Endowment Fund

My donation is:

[ ] Personal [ ] In honour of [ ] In memory of

_____________________________________________________ (person’s name)

[ ] Yes, please send notification of my gift to:

Full name: ______________________________________________________

Email: __________________________________________________________

Mailing address: _________________________________________________

Personal message: _______________________________________________

________________________________________________________________

________________________________________________________________

Donate by Cheque:

[ ] I have enclosed a cheque for $ _________

[ ] I have enclosed a blank cheque marked “VOID” and authorize

the Canadian Digestive Health Foundation to deduct $ _________

from my account on the 28th day of each month

Signature: __________________________ Date: ____ /____ /_____ (dd/mm/yy)

Donate by Credit Card:

I would like to make a donation using my credit card. Please charge my

[ ] VISA [ ] MasterCard

[ ] $ 100 [ ] $ 250 [ ] $ 500 [ ] $ 1000 [ ] Other $_________.

I want to support the Canadian Digestive Health Foundation with a monthly donation charged to my credit card on the 28th day of each month. My signature below is authorization for this transaction. [ ] $ 250 [ ] $ 100 [ ] $ 75 [ ] Other $ _______ per month

Card #: ___________________________________________________

CCV2 __________ Exp. ______ / ______ mm/yy

Signature: ___________________________________________________

Tel: (__________) ___________ – ____________________

Name: _______________________________________________________

Email: _______________________________________________________

Address: _____________________________________________________

City: ______________________________Prov: _____ PC: ____________

[ ] Please send me information about protecting and improving

my digestive health.

Ch.Reg.No.: 88996 8269 RR0001

Over 20 million Canadians suffer from

digestive disorders every year. The Canadian

Digestive Health Foundation believes this is

unnecessary and unacceptable.

We reduce suffering and improve quality of

life by empowering Canadians with trusted,

up to date, science-based information about

digestive health and disease.

As the Foundation of the Canadian

Association of Gastroenterology, we work

directly with leading physicians, scientists,

and other health care professionals to help

you understand and take control of your

digestive health with confidence and optimism.

Through research and public education, we

aim to:

Request for supportThe Canadian Digestive Health Foundation

is a national charity governed by a volunteer

board of directors. We rely on donations from

the public and the generosity of our partners

to develop and deliver our programs. Please

consider including our Foundation as one of

your chosen charities.

Contact us/Donate toCanadian Digestive Health Foundation

1500 Upper Middle Road, Unit 3,

PO Box 76059, Oakville, ON L6M 1G0

Tel and Fax: 905-829-3949

[email protected]

or donate on line at www.CDHF.ca.

DONATE ABOUT US


Understanding GASTROESOPHOGEAL REFLUX DISEASE (GERD)What is gastroesophogeal reflux disease (GERD)?Gastroesophageal reflux disease (GERD) is the result of

a disordered valve mechanism between the esophagus

(swallowing tube) and the stomach. The valve, or lower

esophageal sphincter (LES), opens during swallowing

to allow food to enter the stomach and then closes to

prevent food and stomach secretions from moving

backward into the esophagus. When the LES fails to

close correctly, the stomach contents—which are acidic

and contain digestive secretions—can flow back into the

esophagus. This reverse flow (reflux) of food, acids and

the digestive enzyme pepsin, can cause damage to the

esophageal lining and resulting heartburn.

GERD is a common disorder that has a significant impact

on the community. In Canada, people suffering from

GERD symptoms are absent from work 16% of each year,

representing $21 billion in costs or 1.7 billion hours of lost

productivity annually.

On average, five

million Canadians

experience heartburn

and/or acid

regurgitation at

least once each

week. Reflux is

common during

pregnancy and

one-quarter of

pregnant women

experience daily <http://www.cdhf.ca>

heartburn. Recent studies show that GERD in infants and

children occurs more frequently than previously thought and

may produce repeated vomiting, failure to grow, coughing

and other respiratory problems.

What are the symptoms of GERD?GERD symptoms are caused by the reflux, of stomach

contents into the esophagus and the associated damage to

the esophageal mucosa or lining. The two most common

symptoms of GERD are heartburn and acid regurgitation.

• Heartburn: A burning sensation in the centre of the chest

behind the breastbone, which has an upward moving

quality toward the throat. Heartburn often becomes

worse after eating, bending over, lying down or physical

activity. Sometimes, the pain of heartburn may be

confused with the pain experienced during a heart attack.

• Acidregurgitation: The awareness of acid or partially

digested food from the stomach backing up into the

esophagus, and occasionally into the throat and mouth.

Other GERD symptoms may include:

• Difficulty swallowing

• Excessive burping or belching

• Sour or bitter taste in the mouth

• Chest pain

• Abdominal pain

• Nausea or gagging

• Cough, sore throat or hoarseness

People suffering from GERD symptoms are absent from work 16%ofeachyear, representing $21billion in costs or 1.7billionhours of lost productivity annually.

GASTROESOPHAGEAL REFLUX DISEASE (GERD)

2 / 5

separates the abdominal and chest

cavities). A hiatus hernia leads to LES

dysfunction and may act as a reservoir

(above the diaphragm) for stomach

acid, increasing reflux into the

esophagus and prolonging the exposure

time of the esophagus to acid.

Risk Factors FOR GERD• Obesity • Pregnancy

• Hiatus hernia • Food choices

• Smoking • Family history of GERD

How do I know if I have GERD? Most of the time, symptoms alone can provide doctors with

the information they need to diagnose GERD. If symptoms

respond quickly to treatment, further investigation is

usually not necessary. However, if symptoms are slow to

improve or persistent (long-term) treatment is required

and diagnostic tests, including those listed below, may be

needed.

• Endoscopy: This safe test involves passing a slim, flexible

tube (endoscope) equipped with a light and tiny camera

into the esophagus. The endoscope allows your doctor to

examine the esophagus and stomach and collect tissue

samples (biopsies) for further examination under a

microscope.

• BariumX-ray(upperGIseries): A barium drink coats

the lining of the upper digestive tract so it can be seen

on an X-ray. X-rays allow your doctor to visualize the

esophagus, stomach and small intestine and locate areas

of damage or inflammation.

• 24-hourpHmonitoring: A small tube (catheter)

equipped with a pH sensor is positioned in the

esophagus. The sensor monitors the acidity in the

esophagus over a 24-hour period and the data is stored

on a small computer worn around the waist for later

analysis.

• Esophagealmotilitystudy(EMS): A small tube

(catheter) equipped with a sensor is positioned in the

esophagus. During this test, the sensor measures

movement and pressure within the esophagus and

stomach and can evaluate if the LES is functioning

properly. <http://www.cdhf.ca>

Hiatus Hernia

LES valve closes to prevent reflux of acidic

stomach contents.

Normal

What causes GERD?The causes of GERD are complex. Several factors may cause

the LES to relax inappropriately, allowing the reflux of

stomach contents into the esophagus. Some food and drinks,

including

chocolate,

peppermint,

fried or fatty

foods, coffee

and alcohol

may reduce

the LES

pressure or

prevent it

from closing

properly.

Cigarette

smoking also

relaxes the

LES and may

worsen

symptoms.

GERD is associated with obesity, pregnancy and the

presence of a hiatus hernia. A hiatus hernia occurs when

the upper part of the stomach and the LES move up into

the chest through the diaphragm (the flat muscle that

LES valve does not close and stomach

contents reflux into esophagus.

Abnormal


3 / 5

How is GERD treated?The treatment for GERD may involve a combination of

approaches.

Lifestyle/dietarychangesYour doctor will usually recommend lifestyle and dietary changes to reduce or relieve GERD symptoms and help reduce acid reflux and potential damage to the lining of your esophagus. Suggested changes may include:• Avoid food and beverages known to lower LES pressure

including chocolate, peppermint, fried or fatty foods, coffee and alcohol

• Avoid spicy and acid-containing foods that can irritate the esophageal lining

• Eat small, frequent meals, rather than large meals

• Have nothing to eat and little or nothing to drink for 3 to 4 hours before going to bed

• Raise the head of the bed or elevate the upper body with a foam wedge

• Achieve and maintain an ideal body weight

• Stop smoking

MedicationMany people living with GERD symptoms require medication. The choice and combination of medications your doctor recommends will depend upon the frequency and severity of your symptoms.

• Antacids quickly neutralize stomach acid and are readily available without a prescription at a pharmacy.

• Histamine H2-receptor antagonists (H2-RAs) reduce the production of stomach acid and these drugs are available in prescription strength or lower dose, over-the-counter formulations.

• Protonpumpinhibitors(PPIs) are prescription medications that block the production of stomach acid. This reduces heartburn symptoms and also heals damage to the esophagus. PPIs are safe when taken appropriately, and are the most effective drugs to control GERD symptoms.

• Prokinetic(promotility)agents are prescription medications that strengthen the LES pressure and help the stomach empty more rapidly. Side effects such as fatigue, depression, anxiety and other neurological problems, limit the usefulness of these medications.

Over 70% of GERD patients respond well to treatment with acid-reducing medications (such as H2-RAs or PPIs) taken


once a day, in the morning about thirty minutes before breakfast. About 15 to 25% of patients require a higher or more frequent dosing of medication to relieve their symptoms. For a small number of people, prokinetic agents may be beneficial.

SurgerySurgery may be an option for people with severe GERD symptoms or complications, especially young patients with high-volume reflux. Nissenfundoplication surgery is performed laparoscopically (through small incisions in the upper abdomen) to tighten the LES and prevent the reverse flow of stomach contents into the esophagus. This procedure works best for those who have responded well to medical therapy especially those who have had a good response to acid-lowering drugs. A full assessment of esophageal function should be undertaken before undergoing surgery and the decision to have surgery is an important one that you should discuss with your physician and consider carefully.

What are the complications of GERD?GERD is a chronic disease and so treatment usually needs to be maintained on a long-term basis, even after symptoms have been brought under control. Untreated GERD can sometimes result in serious damage to the esophagus. A narrowing (stricture) of the esophagus may occur from chronic scarring and an esophageal ulcer and bleeding may develop from repeated exposure to stomach acid. Some patients with prolonged, uncontrolled GERD may have Barrett’s esophagus, a condition that results in changes to the esophageal lining which increase the risk of developing esophageal cancer.

Alarm symptoms

Alarm symptoms are not typical of GERD and can

signal additional, more serious health concerns.

Consult a health care professional if you notice a

change in your current symptoms or experience

any of the following:

• Sudden weight loss

• Difficulty swallowing or a feeling that food

is trapped in the chest

• Nausea

• Vomiting

• Bloody stools (tarry black or red)

• Anemia

!


4 / 5

How can I tell if my treatment is working?Once you begin treatment, your GERD symptoms should

become less frequent and less severe. However, in some

cases, reflux symptoms may be made worse or confused by

abnormal motility or other conditions such as Helicobacter

pylori gastritis (a common bacterium that can cause

stomach inflammation and peptic ulcers), celiac disease

(wheat or gluten intolerance), diabetes mellitus,

gastroparesis (delayed gastric emptying), gallstones or

pancreatitis (inflammation of the pancreas).

If your GERD symptoms

persist, speak to your

doctor, as you may

need further

investigation to

rule out other causes

or complications or

alternative treatment

options.

Partnering for Best Health – Preparing for your next appointmentGood communication with your doctor is an important

part of effective management of GERD. Before your

appointment, take the time to keep a symptom journal that

can help you and your doctor see patterns in your activities

and identify specific triggers for your symptoms. Include the

following information in your journal:

• Write down the symptoms that are bothering you, and

for how long you have had them

• Make a note of the frequency and severity of your

symptoms and their relationship with your meals.

• Write down key personal and medical information,

including any recent changes or stressful events in your

life.

• Make a list of the triggers (food, stress, activity,) that

seem to make your symptoms worse.

• Make a list of all of the medications you are taking

including the dose and time you take them and the

conditions you take them for. Also, note if any of your

medications seem to affect your symptoms.

• Talk to your family members and find out if any relatives

have been diagnosed with GERD, Barrett’s esophagus or

esophageal cancer.

• Create a list of 3 to 6 questions to ask your doctor during

your appointment. Specifically, you may want to ask your

doctor some of the following:

• What do you think is causing my symptoms?

• Are there other possible causes for my condition?

• What diagnostic tests do I need?

• Do these tests require any special preparation?

• What treatment approach do you recommend

trying first?

• If the first treatment doesn’t work, what will we

try next?

• Are there any side effects associated with these

treatments?


CDHF App helps track information The CDHF has developed a smart phone app for iPhone

and Android called

GiBodyGuardto

help you quickly,

easily and privately

track and share your

digestive symptoms with

your physician.

GiBodyGuard has a

built-in symptom tracker

(stool, pain, blood), food,

fitness and medication

trackers, a health history

form and appointment/medication

reminders. Using GiBodyGuard is

quick, easy and private.

As well, GiBodyGuard lets you produce comprehensive

reports so you can share important information with

your physician during your next appointment. You

can download GiBodyGuard for free at:

www.cdHf.ca/GIbodyguard

Once youbegintreatment, your GERD symptoms shouldbecome lessfrequent andlesssevere.


5 / 5

Living positively with GERDAlong with medications, your doctor may recommend

dietary and lifestyle changes which are an important part

of effectively managing GERD. Achieving and maintaining

a healthy weight, eating small, frequent meals, raising the

upper body during sleep, avoiding trigger foods and not

smoking can reduce reflux and the discomfort associated

with GERD symptoms.

Learning more about GERDThe Canadian Digestive Health Foundation provides

information, tools and support to help you take control of

your digestive health with confidence and optimism.

Visit www.cdHf.ca to view WebSeminars, personal stories

and helpful resources about GERD and other digestive

disorders or browse the links below:

LivingwithGERd:Agastroenterologistspeaksabout

options-video

Niki Travers has suffered with GERD for years. In this

video you will learn about Niki’s journey and hear the

reassuring insights of Dr. Richard Hunt who addresses the

complications of GERD and speaks about safe therapeutic

option. http://www.cdhf.ca/en/videos/video/14

LivingSuccessfullywithGERd–on-line seminar

Learn from Dr. David Armstrong and a patient living with

the disease how to take control of their GERD - and life -

with confidence and optimism.

http://www.cdhf.ca/en/videos/video/76

GERdwithdr.RichardHunt

At the 2012 CDHF Digestive Health Public Education Forum,

Dr. Richard Hunt gave an interesting and educational

presentation on acid reflux and Gastroesophageal Reflux

Disease (GERD) to a capacity crowd.


UnderstandingandTreatingGERd

Douglas Bryant blamed himself for his acid reflux but after

visiting his doctor, he learned that by not taking action, he

would continue to suffer and possibly put himself at risk

of developing cancer. Dr. David Armstrong explains GERD,

how it can be treated and why seeking the advice of your

physician is important.


Please note: The information contained in this digestive disorder guide is not a substitute for medical care and the advice of your physician. There may be variations in treatment that your physician may recommend based on your individual facts and circumstances. Always consult with your physician when you have concerns about your health.

<http://www.cdhf.ca>The CDHF is the foundation of the Canadian Association of Gastroenterology.

YES! I want to donate to the Canadian Digestive Health Foundation

Please accept my donation to support:

[ ] Canadian Digestive Health Foundation Programs as needed

[ ] Canadian Digestive Health Foundation Endowment Fund

My donation is:

[ ] Personal [ ] In honour of [ ] In memory of

_____________________________________________________ (person’s name)

[ ] Yes, please send notification of my gift to:

Full name: ______________________________________________________

Email: __________________________________________________________

Mailing address: _________________________________________________

Personal message: _______________________________________________

________________________________________________________________

________________________________________________________________

Donate by Cheque:

[ ] I have enclosed a cheque for $ _________

[ ] I have enclosed a blank cheque marked “VOID” and authorize

the Canadian Digestive Health Foundation to deduct $ _________

from my account on the 28th day of each month


Donate by Credit Card:

I would like to make a donation using my credit card. Please charge my

[ ] VISA [ ] MasterCard

[ ] $ 100 [ ] $ 250 [ ] $ 500 [ ] $ 1000 [ ] Other $_________.


Card #: ___________________________________________________

CCV2 __________ Exp. ______ / ______ mm/yy

Signature: ___________________________________________________

Tel: (__________) ___________ – ____________________

Name: _______________________________________________________

Email: _______________________________________________________

Address: _____________________________________________________

City: ______________________________Prov: _____ PC: ____________

[ ] Please send me information about protecting and improving

my digestive health.

Ch.Reg.No.: 88996 8269 RR0001

Over 20 million Canadians suffer from

digestive disorders every year. The Canadian

Digestive Health Foundation believes this is

unnecessary and unacceptable.

We reduce suffering and improve quality of

life by empowering Canadians with trusted,

up to date, science-based information about

digestive health and disease.

As the Foundation of the Canadian

Association of Gastroenterology, we work

directly with leading physicians, scientists,

and other health care professionals to help

you understand and take control of your

digestive health with confidence and optimism.

Through research and public education, we

aim to:

Request for supportThe Canadian Digestive Health Foundation

is a national charity governed by a volunteer

board of directors. We rely on donations from

the public and the generosity of our partners

to develop and deliver our programs. Please

consider including our Foundation as one of

your chosen charities.

Contact us/Donate toCanadian Digestive Health Foundation

2525 Old Bronte Road

Oakville, ON L6M 4J2

Tel: 905.847.2002

[email protected]

or donate on line at www.CDHF.ca.

DONATE ABOUT US


Understanding IRRITABLE BOWEL SYNDROME (IBS)

What is irritable bowel syndrome (IBS)?

Irritable bowel syndrome (IBS) is a disorder affecting the intestine. IBS involves problems with motility (movement of digested food through the intestines) and sensitiv-ity (how the brain interprets signals from the intestinal nerves), leading to abdominal pain, changes in bowel patterns and other symptoms. Although often disruptive, debilitating and embarrassing, it may be some comfort to know that IBS is not life-threatening, nor does it lead to cancer or other more serious illnesses.

Canada has one of the highest rates of IBS in the world. It is estimated that at least 5 million Canadians suffer from IBS, with an additional 120,000 people developing the condition every year. About 40% of people with IBS seek medical attention, while those with milder symptoms typically self-treat their condition with lifestyle changes, food avoidance and the purchase of non-prescription remedies. IBS is more common in women than men.

In Canada, the economic and health-care related costs of IBS exceed $6.5 billion annually. Causing frequent work and school absenteeism, IBS can significantly erode an individual’s productivity and quality of life. Canadians suffering from IBS symptoms are absent from work an average of 13 days each year, representing an additional $8 billion of lost productivity.

What are the symptoms of IBS?• Abdominal pain

(cramping): IBS pain can be felt anywhere through-out the abdomen. Each bout of pain can vary in length and severity, and pain may increase and decrease over time. IBS pain is often relieved following a bowel movement.

• Constipation:

Symptoms of constipation can include passing three or fewer stools in one week, passing hard, dry stools, the passage of only small amounts of stool, and frequent straining during a bowel movement.

• Diarrhea: Symptoms of diarrhea can include passing stools three or more times per day, passing loose, watery stools or feeling an urgent need to have a bowel movement.

• Other IBS symptoms may include: • Gas • Heartburn

• Bloating • Nausea

• A feeling of incomplete emptying of the bowels

• Whitish mucus (a fluid made in the intestines) within

or around the stools

<http://www.CDHF.ca>

The most common symptoms of IBS are

abdominal pain and irregular bowel patterns that result

in constipation,diarrhea, or alternating

periods of both.

IBS ~ IRRITABLE BOWEL SYNDROME

2 / 6

While most people experience digestive troubles once in a while, what sets IBS apart is abdominal pain and diarrhea or constipation that comes back again and again. At times, the pain and discomfort of IBS symptoms may be severe and debilitating, and at other times, they may improve or even disappear completely.

What causes IBS?The exact cause of IBS is unknown, however, it is believed that IBS may be caused by one of several factors. In some patients, it may be linked to a prior infection or event which disrupts the normal functioning of the intestines. It is common for people to develop IBS following a gastrointestinal infection, food poisoning, traveller’s diarrhea, surgery, a change in diet or the use of antibiotics or new medications. In others, an imbalance of intestinal bacteria or a change in the body’s level of hormones, immune signaling in the bowel wall or neurotransmitters (brain chemicals) may also lead to the development of IBS. Currently, there is a great deal of interest in possible alterations in the number or type of bacteria within the intestine, but the exact role this may play in IBS is not yet known. In people with IBS, bowel function can be altered in several ways:

• Motility (movement of contents through the intestines): Normally, waves of coordinated intestinal muscle contractions (peristalsis) transport digested food through the intestines. In people with IBS, the rhythm and coordination of these contractions may be al-tered. This altered motor function can result in the bowel moving too quickly (causing diarrhea) or too slowly (causing constipation) and can lead to spasm and pain.

• Sensitivity (how the brain interprets signals from the intestinal nerves): The network of nerves surrounding the digestive organs may become unusually sensitive. For some people with IBS, even a small change in

intestinal activity can trigger the nerves to send messages to the brain causing abdominal pain.

• Brain-gut dysfunction: In IBS, there may be problems in how the brain receives and processes sensations com-ing from the intestines. A malfunction may occur along the many different pathways that connect the brain and

gut, interfering with the normal function of the intestines.

Many aspects of everyday living can trigger or aggravate IBS symptoms. Triggers vary from person to person, but the most common ones include certain foods, medications, emotional stress and hormone fluctuations. In particular, foods such as caffeine, alcohol, carbonated drinks, fatty foods, certain fruits and vegetables, as well as lactose, fructose and gluten (wheat protein) can cause problems for people with IBS.


Risk Factors

n Age: IBS can affect people of all ages, but it often begins in the teen years or early adulthood.

n Gender: IBS affects more women than men.

n Family history of IBS: People with a first-degree relative (parent or sibling) with IBS are at greater risk of developing the condition.


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How do I know if I have IBS? Often, symptoms alone can provide doctors with the infor-mation they need to diagnose IBS. Your doctor will perform a physical examination and take a complete medical history that includes a careful review of your symptoms. For this reason, it is important to be candid and specific with your doctor about the problems you are having.

A set of specific symptom criteria (referred to by physicians as the Rome Criteria) has been developed to help physicians diagnose IBS. According to these criteria, IBS is suspected based on the symptoms shown to the right.

In a young person, the diagnosis can be confidently made based on symptom criteria, absence of any “red flags” in the history or physical exam (e.g. blood in the stools, symptoms awakening patients from their sleep, a strongfamily history of colon cancer, unexplained weight loss). There is no laboratory test, X-ray or scope to diagnose IBS, however, your doctor may order tests, particularly if there are red flags. To rule out other infections or underlying medical problems, these tests may include some of those listed below:

• Blood tests: Blood tests can help to rule out anemia, diabetes, abnormal thyroid function, changes in the calcium level that can affect the gastrointestinal tract, and celiac disease.

• Stool sample tests: A stool analysis can detect blood in the stool and rule out bacterial infection, malabsorption, parasites and other digestive problems.

• Imaging tests: Your doctor may order tests to see inside your lower digestive organs. This is done to rule out potential, more serious health problems. These safe tests can help to identify problems such as ulcers, polyps (growths on the lining of the intestines), colon cancer or inflammatory bowel disease (IBD) and include:


Rome Criteria

• Symptoms for at least 3 days per month during the previous 3 months

• Symptoms first started at least 6 months ago

• Symptoms are improved with a bowel movement or associated with a change in the stools (number or appearance).

Colonoscopy

Sigmoidoscopy

o Colonoscopy: A slim flexible tube equipped with a light and a tiny camera is guided through the rectum into the large intestine (colon). The colono-scope allows your doctor to examine the lining of both the upper

and lower sections of the colon.

o Flexible sigmoidoscopy: In a procedure similar to a colonoscopy, a flexible scope allows your doctor

to view the lining of lower part of the colon only.

o CT (computed tomography) colonography: In most centers, barium enemas have been replaced by CT colonography. This scan takes cross-sectional pictures of the abdomen and uses special computer software to create a 3D image of the entire colon. It is very accurate at detecting larger polyps and cancers.

• Dietary tests: o Lactose intolerance: Lactose intolerance (an inability

to digest the sugar in milk) can cause gastrointes-tinal symptoms similar to IBS. Your doctor can rule out lactose intolerance by performing a hydrogen breath test or by asking you to eliminate lactose from your diet for 2 weeks, and then reintroducing lactose and recording your symptoms.

o Celiac Disease: Celiac disease (a condition where the immune system reacts against gluten, a protein found in wheat) causes damage to the lining of the small intestine and may also cause symptoms similar to IBS. Celiac disease can be ruled out with a simple blood test performed at the doctor’s office or with a home kit that you can purchase at the pharmacy. You must be eating gluten at the time of the test in order for the results to be accurate. If the blood test is positive, a biopsy is needed to confirm a diagnosis of celiac disease.


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How is IBS treated?Take comfort in knowing that IBS is an extremely common problem, and in many cases, simple changes in your life-style and diet can provide symptom relief. However, no one treatment works for everyone and treatment will depend on the types of symptoms you have, their severity and how they affect your daily life.

Lifestyle changes The following lifestyle changes may help to prevent or ease your IBS symptoms:

• Exercise regularly to promote movement of the colon and reduce stress. Exercise can take many forms, but 20 to 30 minutes of activity at least three times per week can be helpful.

• Get enough rest. A lack of sleep and fatigue can worsen the symptoms of IBS.

• Minimize stress and tension. The brain and colon are linked through many complex pathways and emotional stress can disrupt intestinal function and cause pain. Yoga, meditation, and slow, relaxed breathing techniques can help people with IBS manage stress.

• Limit intake of caffeine, alcohol, carbonated drinks and fatty foods.

• Follow through on an urge to have a bowel movement, if at all possible.

Dietary changes Food intolerances have been linked to IBS symptoms for many years, however conflicting information often creates confusion and frustration as to what foods IBS patients should include, or avoid, in their diet. Recent research has identified six key strategies for the successful dietary management of IBS.

1) Rule out lactose intolerance.

The symptoms of lactose intolerance (an inability to digest the sugar in milk) and the symptoms of IBS often overlap.

2) Limit insoluble fibre. The type of fibre in the diet is important for people with IBS. Insoluble fibre (cannot dissolve in water) which is found primarily in wheat bran, brown rice, seeds, nuts, dried fruit and whole grain breads, adds bulk to the stool and can aggravate IBS symptoms in some people. Peeling fruits and

vegetables to remove the high insoluble fibre skin or peel can be beneficial.

3) Supplement with linseeds for constipation.Linseeds (also known as flaxseed) may help to relieve constipation, abdominal discomfort and bloating. For IBS patients with constipation, adding ground linseeds to the diet for a 3-month trial may help bowel function.

4) Reduce fermentable carbohydrates (FODMAPs).Fermentable carbohydrates (also known as FODMAPs), are small carbohydrate (sugar) molecules found in everyday foods that may be poorly absorbed in the small intestine of some people. FODMAPs are fermented (digested) by intestinal bacteria, which can lead to symptoms of abdominal pain, excess gas, constipation and/or diarrhea. Following a low-FODMAP diet may help to reduce gastrointestinal symptoms in 75% of IBS patients.

5) Try a probiotic.Probiotics are live microorganisms that, when taken in adequate amounts over sufficient time, may provide a health benefit. They are natural, ‘healthy’ bacteria that may help with digestion and offer protection from harmful bacteria in the intestines. Studies have found that, in some cases, probiotics may help to improve symptoms of IBS. If other dietary strategies have not been successful, a 4-week trial of a probiotic (in the dose recommended by the manufacturer) may be helpful.

Probiotics are not medicine. They are available to purchase as capsules, tablets or powders, and can also be found in some fortified yogurts and fermented milk products. However, not all probiotics are the same. It is important to choose a product that is reliable, proven to be safe and offers benefits for the specific symptoms you want to relieve. Speak to your doctor or pharmacist about which probiotic may be right for you. It is important to take the probiotic in the dose and duration recommended by the manufacturer to achieve the best results.

6) Eliminate a suspected trigger food for 2-4 weeks.If a particular food seems to trigger IBS symptoms, eliminate the food from your diet for a period of 2 to 4 weeks. If symptoms do not improve during that time, the food is unlikely the cause of IBS symptoms.



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MedicationYour doctor may recommend prescription or over-the- counter products if your IBS symptoms are severe and if lifestyle and dietary strategies have not helped. Typically, medications are targeted at the dominant symptom – diarrhea, constipation or pain.

• Antispasmodic medications may help reduce muscle spasms, abdominal pain and cramping.

• Antidepressant medications, in low doses, act on the chemical messengers in the digestive tract and can help relieve diarrhea, pain and cramping. In higher doses, these medications help to relieve depression and anxiety that may accompany IBS.

• Antidiarrheal medications, such as Loperamide, can help control diarrhea by reducing stool frequency and slowing

the movement of the intestines.

• Laxatives speed up the motion of stool through the intestines and may be prescribed for people who have IBS with constipation. Laxatives are available in prescription or over-the-counter formulations. Speak to your doctor

about which one is best for you.

• Prosecretory and analgesic agents, which increase the amount of fluid in the digestive tract as well as reduce the sensitivity of pain nerves in the intestines. They have been shown to soften bowel movements and make them occur more often, reduce the amount of bloating and to decrease abdominal pain in patients with IBS.

How can I tell if my treatment is working?For some people, IBS symptoms will significantly improve within a short time after making lifestyle and dietary changes. For others, finding relief from IBS symptoms is a slow process and it may take longer for a definite improvement to be noticed. It is important for you and your doctor to work together to determine what triggers your symptoms and to find the right treatment to help your bowel function return to a more normal state.

Are there any complications of IBS?While IBS can cause pain and stress, it does not cause any permanent damage to the bowel or lead to cancer or any other major illness.

Living positively with IBS.IBS is a chronic (long term), but manageable condition. Over time, the symptoms of IBS typically do not get worse, and with an effective treatment plan, as many as one-third of IBS patients may eventually become symptom-free.

Preparing for your health care professional appointment.Good communication with your doctor is an important part of effective management of a functional GI disorder like IBS. Before your appointment, take the time to keep a symptom journal that can help you and your doctor see patterns in your activities and identify specific triggers for your symptoms.

Include the following information in your journal:• Write down the symptoms that are bothering you and

how long you have had them.

• Write down key personal and medical information, in-cluding any recent changes or stressful events in your life.

• Make a list of the triggers (food, stress, activity, menstrualcycle) that seem to make your symptoms worse.

• Make a list of medications are you taking, including theconditions you take them for. Also note if any of yourmedications seem to affect your symptoms.

• Talk to your family members and note if anyrelatives have been diagnosed with IBS, inflammatorybowel disease (IBD), celiac disease or colon cancer.

• Questions to ask your doctor during your appointment.You may want to ask:

• What do you think is causing my symptoms?• Are there other possible causes for my condition?

• What diagnostic tests do I need?

• Do these tests require any special preparation?

• What treatment approach do you recommend

trying first?

• If the first treatment doesn’t work, what will

we try next?

• Are there any side effects associated with these

treatments?



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The CDHF has a SmartPhone app called Gi BodyGuard, featured on the following page, that can help you manage and share information about your symptoms with your doctor.

Learning more about IBS. The Canadian Digestive Health Foundation provides information, tools and support to help you take control of your digestive health with confidence and optimism. Visit www.CDHF.ca to view WebSeminars, personal stories and helpful resources about IBS and other digestive disorders or browse the links below.

The CDHF has videos, on-line seminars, personal stories and other resources about IBS that you can access anytime you have an internet connection. Please visit: http://www.CDHF.ca/IBS

• Understanding Irritable Bowel Syndrome…Let’s Talk

This video features interviews and comments from physicians and patients

• More than Gas and Bloating. IBS – the Mind-Gut Connection

This on-line seminar, presented by Dr. Stephen Vanner, provides an in-depth overview of IBS, symptoms, possible causes and suggested treatments.

• IBS with Dr. Adam Weizman

This public presentation provides an overview of IBS.

Please note: The information contained in this digestive disorder guide is not a substitute for medical care and the advice of your physician. There may be variations in treatment that your physician may recommend based on your individual facts and circumstances. Always consult with your physician when you have concerns about your health.

<http://www.CDHF.ca>The CDHF is the foundation of the Canadian Association of Gastroenterology.

CDHF App helps track information The CDHF has developed a smart phone app for iPhone and Android called Gi BodyGuard to help you quickly, easily and privately track and share your digestive symptoms with your physician. Gi BodyGuard has a built-in symptom tracker (stool, pain, blood), food, fitness and medication trackers, a health history form and appointment/medication reminders. Using Gi BodyGuard is quick, easy and private.

As well, Gi BodyGuard lets you produce comprehensive reports so you can share important information with your physician during your next appointment. You can download Gi BodyGuard for free at:www.CDHF.ca/GIbodyguard

Alarm symptoms Alarm symptoms are not typical of IBS and can signal additional, more serious health concerns. Consult your physician if you experience any of the following: • Symptoms that first begin after the age of 50

• Rectal bleeding with dark red blood mixed in with the stool

• Unexplained weight loss

• Fever

• Nausea, vomiting

• Abdominal pain that wakes you at night

• Symptoms worsen over a short period of time

Note: People with a family history of colon cancer, celiac disease, or inflammatory bowel disease (IBD) may also require additional testing.

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WAISTING AWAYHealthy Weight Management

So, you want to lose some weight? Food is something you need to live withevery day of your life so trying to avoid it is not easy, it is impossible! Youneed to replace old habits with new, healthier food behaviors.

The goal is to choose good, wholesome, healthy foods more often tonourish that powerhouse body of yours and to keep treats for your trulyspecial times.

Your health belief mantra should be, “I want to keep my body functioning at its best so that I can feel great and prevent diseases as much as I can.”YOU ARE WHAT YOU EAT so eat well and stay well!

WAISTING AWAYYes, it is all about the WAIST. Studies show that being overweight in the abdominal area, often referred to as “the big belly syndrome” puts youat increased risk of having cardiovascular disease, diabetes, hypertensionand the syndrome. Did you know that a simple 10% weight loss canimprove your health by as much as 30%? What a good trade off! So, let’sget started.

STEP 1 Making changes: Being and staying healthy is not a destination; it is a journey towards your good health. It is much easier to lose weightthan to keep the weight OFF permanently. The trick is that you must beready to make some changes to your lifestyle patterns.

STEP 2 Getting Ready: You need to get yourself and your environmentready for the long term goal of getting healthy, being healthy and stayinghealthy.• Purge your kitchen cupboards and fridge of unhealthy processed foods. These foods are usually very sweet and/or salty and are usuallymade of white sugar / white flour.

• Create a positive health environment. Do not keep your “danger foods”(foods that are just too tempting to resist) in the house or at work. Reserve your treats for occasions outside the home or office but make sure these danger foods do not come home with you.

STEP 3 Setting up for Success: Keep your kitchen full of great tastinghealthy foods!• Fruits (fresh, canned and unsweetened or canned in fruit’s own juices) • Vegetables (fresh, frozen, bagged and canned - keep some everywhere!)• Whole grain, whole wheat starches – breads, cereals, pasta, brown rice• Lean meats, poultry & fish, nuts/seeds, eggs, low fat dairy products,legumes, soy products, etc.

• At work, keep healthy foods in your desk drawer for those late daymunchies. Try some individual fruit packs, nuts and seeds, tuna andgranola bars (100 calories).

NOW, YOU ARE READY TO START THE FIRST DAY OF THEREST OF YOUR HEALTHY LIFE!

SUPER SAVVY WEIGHT LOSS TIPS

Try these super savvy weight loss tips. Start with a few at a time and keep adding new tips. These strategies will allow you tobuild your own healthy lifestyle pattern. Make sure that you try each tip for at least 2 weeks. This gives you a chance to see whatworks and what does not work for you.

TIP 1: Eat only whole wheat, whole grain starchy foodsWhy? Eating whole grain, high fibre foods will keep you feeling full, longer and will help stave off those hunger pangs. Starchy

foods made of refined, processed, bleached flours/sugars will be digested quickly and leave you feeling empty and hungry.How? When buying starchy foods, stick to whole wheat, whole grain breads, pasta, cereals, crackers and brown rice. Be label

savvy: choose whole grains that have more than 3 grams of fibre per serving.

TIP 2: Eat foods with a low Glycemic Index (GI)What is the Glycemic Index (GI)? The GI is a scale that ranks carbohydrate-rich foods by how much they raise blood sugar levels(resource- Canadian Diabetes Association). Why? Eating lower GI foods will help you:

• control your appetite = will keep you feeling full, longer• control your blood sugar levels• control your cholesterol levels

How? See the GI Table in our Eating plan for Type 2 Diabetes, go to www.diabetes.ca for more details • Eat lots of vegetables. Include fruit with meals or a snack. Choose low fat dairy products. All of these foods containcarbohydrates and have a low glycemic index.

• Plan your meals with foods in the low/medium GI categories.• Try different lower GI grains such as barley, bulgur, millet, quinoa which have lower GI values.

Hint: High fibre and unprocessed foods are best as they digest slowly.

TIP 3: Meal balancingTry to have 3 balanced meals per day which include fruits, vegetables, proteins and starches. Why? Many diets fail in the long run because they do not satisfy you, leaving you feeling hungry and frustrated. Meal balancing

is the key to healthy eating and to keeping you on track. You need the right combination of foods: adequate protein,whole grain starch and colorful vegetables & fruits.

How? Plan on eating 3 meals per day, everyday. Make sure that all meals include an adequate portion of protein as protein willslow down the digestion of your meal and help keep you full, longer. *See meal/plate examples.

TIP 4: Plan your snacksWhy? A small snack between meals will keep your meal-time eating in check. Snacking keeps your blood sugars more stable

so that you do not get home and “rip the fridge door off”. Being over-hungry usually means making unhealthy foodchoices and/or eating larger portions.

How? Try to plan a small snack 1 hour before lunch and 1 hour before supper. *See snack examples.• Morning snack – 80 calories = a fruit or yogurt.• Afternoon snack – This is the important one! The goal of the afternoon snack is to “ruin your supper” as this is thetime we tend to overeat. Try to keep your snacks between 100-150 calories. A piece of fruit and a small protein sourcelike a handful of nuts, a piece of cheese, a yogurt or even some hummus are great choices.

• You should snack on a regular basis but not too much. Research shows that snacking can make up more than 40% ofour total calories for the day. Our snack choices are just too high in calories and usually not very nutrient dense.

• Evening snack – Try to keep this snack to under 100 calories. Whether you have a salty tooth or a sweet tooth, now isthe time to indulge in your favorite snack food. Buy the 100 calorie snack bags; try to keep it to one bag per night. Ifthis is too much of a problem, remember to not keep your danger foods in the house.

• Granola bars – for a healthy choice, make sure to read the label. A healthy granola bar will have more than 3 g of fibreand less than 10 grams sugar.

TIP 5: Watch your portion sizes or “PORTION DISTORTION”Why? The bottom-line in weight management is “We just eat too much”. The term used today is “portion distortion” which

was more or less created by the food industry: supersizing, meal deals, etc. The average restaurant plate size is almostdouble what it was 20 years ago. Be aware and be conscious of what a true portion size should be and what it shouldlook like.

How? • When reading food labels, the portion size is displayed at the top of the Nutrition Facts Panel. Measure it out on yourplate. We are usually not very good at eyeballing a portion size so it is always best to measure. Be portion savvymainly with your protein, starch and treat servings. You can load up on those veggies and try to have 2-3 fruit per day.

• For treats, divide larger snacks into individual portions. Don’t think that you will “leave some on my plate once I amfull”: chances are, you will eat more.

TIP 6: Beverages have calories too!Why? Remember that specialty coffees, teas, alcoholic drinks, soda, fruit punch, power drinks, etc. are high in calories, while

water and diet sodas are ‘calorie-free’. Even though diet drinks are free of calories (or may contain <5 mg of sugar), theyare not healthy; your goal is to be healthier so choose these less often.

How? Water, water, water! Often, we are thirsty and not hungry so try some water first. If you drink a high calorie beverage,start with a small portion (250 ml) and then, have a glass of water to follow. If you do not like the “taste” of water, add afew flavor crystals or a twist of lemon, lime or orange.

EXERCISE

TIP 1: Start Walking—every little bit counts!• Walking will help you feel better about yourself which in turn will drive you towards wanting to be healthier. Count yoursteps with a pedometer or keep track of your walking time.

• To start, try to reach 150 minutes per week of activity = 2.5 hours. Why? By exercising regularly, you will not only feel better but you will also reduce your risk of certain diseases. Even without

weight loss, regular exercise such as walking will benefit your health.How? Start slowly: go for 15 minutes every day = 105 minutes per week. Your goal is to achieve 20 minutes of walking 7 days per

week = 140 minutes ( so add 10 minutes on the weekend) or you can do 30 minutes 5 days per week. Every little bit counts. • No time during the week? Be a “weekend warrior” to get your activity completed. Try to do 1 hour on Saturday andthen 1 hour on Sunday; the remaining 30 minutes can be done over your mid-week lunch hour.

• For weight maintenance: Research shows that once you lose the weight and want to keep it off, you will need to do270 minutes of activity per week = 4.5 hours.

• Remember, this is gradual; keeping variety in your activity selection will be key to your long term goal.

TIP 2: Use a pedometer to count your stepsWhy? Health Canada suggests walking 10,000 steps per day for optimal health. This is the eventual step goal but go slowly at

first. By walking more, you will diminish your waist line and decrease your total body fat. This is a great way to helpprevent and/ or treat disease states such as diabetes and heart disease.

How? • Buy and wear a pedometer on your pant waistband. It is best to place it between your belly button and your hip boneas it works like a pendulum. As you walk, the pendulum will swing back and forth, counting your steps. You may needto move it forward or backward on your waistband for maximum step counting.

• Record your steps for a few days to establish a baseline step count. Once you have your average daily steps, try toincrease at intervals of 500 steps daily for one week; continue to increase until you reach 10 000 steps every day. Thismay take a month or two so go slowly.

TIP 3: Use your muscles; keep fit through muscle building.Why? New research shows that as we age, we lose 10% of muscle mass per decade. “If you do not use it, you will lose it.”How? Start slowly with arm weights around the house. You can use small hand weights, a can of soup or a filled bottle of water.

For the legs, simply put a boot on your foot and do some side and back leg raises. You can do these while sitting orstanding. To maximize your workout, sit on a stability ball in front of the TV for a 30 minute program. At all commercialbreaks, lift some hand weights and do some leg lifts; stop once the program restarts. Just by sitting on the ball, you willbe exercising your “core” = abdominals.

Note: For a 30 minute TV program, there are usually 4 commercial breaks. WHAT A GREAT, EASY WORKOUT!

DRINK YOUR WATERKeep well hydrated as you exercise and all day long. Recommendations: 2-3 litres of fluids per day; half (1/2) of this amount should be WATER with the other half being any othertype of fluid for example: juice, milk, coffee, tea, soup, jello, etc.

Beverage Calories

Low fat milk (250 mL) 100 calories

Light Beer 67 to 100

While wine (175 mL) 115 calories

Red wine (175 mL) 120 calories

Beer (1 bottle = 350 mL) 150 calories

Coolers 200 calories

Beverage Calories

Pop (1 bottle = 460 mL) 240 calories

Beer on Tap (600 mL) 250 calories

Chai Tea Latte 250+ calories

Large ‘Energy’ Drinks 280 Calories

Specialty Coffee Latte 90 to 400 calories

Fruit Smoothie 400 to 800 calories

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Weekly Goals:

How did you feel about your food choices this week?

How did you feel about your exercise this week?

WEEKLY FOOD JOURNAL

Name:

Week Starting:

Comments:

WEEKLY FOOD JOURNAL DETAILSJOURNALING BRINGS SUCCESS!

Protein

Fruit

Protein

TwoVegetables

StarchStarch

SNACKwith protein

Protein

TwoVegetables

Starch

SNACK SNACK

80 calories 100-150calories

no more than100 calories

PROTEIN• Low fat milk/yogurt• Peanut butter/eggsSTARCH• High fibre cereal• Whole grain toastFRUIT• Berries/whole fruit• 125ml pure fruit juiceSNACK• Fruit or yogurt

PROTEIN• Lean meats/deli/fish• Legumes/cheese/nuts/eggsSTARCH• Whole grain wrap/pita bread• Grain crackers/breadVEGETABLES• Lettuce, tomato, cucumber& vegetable juice

• Vegetable soup/salad/cruditésSNACK• Fruit + cheese or yogurt• Veg sticks + hummus or low fatcream cheese

PROTEIN• Lean meats/fish/poultry/legumes/tofu

STARCH• Brown rice• Whole grain pasta• Potato – white/sweet/yams(Avoid starch at supper for bonus weight loss)VEGETABLES• Tons of vegetables (fresh, frozen or bagged are best)

SNACK• 100 calories (treat!)

Meal Balancing and Examples

Vegetables and Fruit• 125 mL (½ cup) fresh, frozen or canned vegetable orfruit or 100% juice

• 250 mL (1 cup) leafy raw vegetables or salad• 1 piece of medium-sized fruit

Grain Products• 1 slice (35 g) bread or ½ bagel (45 g)• ½ pita (35 g) or ½ tortilla (35 g)• 125 mL (½ cup) cooked rice, pasta, any grains• 30 g cold cereal or 175 mL (¾ cup) hot cereal

Milk and Alternatives• 250 mL (1 cup) milk or fortified soy beverage• 175 g (¾ cup) yogurt• 50 g (1½ oz.) cheese

Meat and Alternatives• 75 g (2 ½ oz.) 125 mL (½ cup) cooked fish, shellfish,poultry or lean meat

• 175 mL (¾ cup) cooked beans• 2 eggs• 30 mL (2 Tbsp) peanut butter

For more information on healthy eating, please see www.cvtoolbox.com, www.dietitians.ca, www.eatrightontario.ca, www.heartandstroke.com Call 1-877-510-5102 to speak to a Dietitan.

Portion Sizes According to 2008 Eating Well with Canada’s Food Guide

Tips to Help You!• Eat foods as close to the ‘farm’ as possible• Eat whole foods = fruits, vegetables, grains• Eat nutrient dense foods (powerhouse foods)• Eat good fats = unsaturated fats (avoid trans & saturatedfats)• Eat lower Glycemic Index Foods (GI) –see www.glycemicindex.com

Snacks• Important to include snacks to avoid being ‘over-hungry’at meal-time. Simple snacking = a protein source with apiece of fruit.

Read food labels (see the ‘Nutrition Facts’ panel)Grains:More than 3 grams fibre, less than 10 grams sugarper servingFruits: All are great; canned (in own juices and unsweetened)Vegetables: All are great; if canned less than 400 mg sodiumper servingDairy: less than5 grams fats, less than10 grams sugarper servingProtein: Choose lean meats, fish, poultry and alternatives

Exercise• Every time you move, it all adds up; walk, skip, jump,lift, dance. ENJOY!

www.cvtoolbox.com

Ottawa Cardiovascular Centre502-1355 Bank Street, Ottawa, ON K1H 8K7Phone: (613) 738-1584Email: [email protected]

Waisting Away November 2010Danielle Aldous, BSc, RD (From Original 2009Helene Charlebois Hélène Charlebois, B.Sc., R.D.)© Continuing Medical Implementation ® Inc.

Other Diet Sheets Available:Eating Plan for HypertensionEating Plan for CholesterolEating Plan for Congestive Heart FailureEating Plan for Type 2 DiabetesPotassium Modified Eating Plan

JOURNALING AND PARTY TIPS

JOURNALINGThe research is conclusive; journaling brings successful weight loss for the short and long term. See our website atwww.ottawacvcentre.com for more journaling sheets.

Don’t like journaling? Start with writing down only the really challenging “danger times” of your eating pattern. For example, if you are a night time eater and just cannot stop, start writing down everything you eat and drink after the supper meal. This will help bring more awareness around your behavior and eventual understanding and change. Try it for one week!

TIP 1: Journaling can also help in meal planningWhy? To optimize your success at weight loss and being healthier, it is a good idea to plan your meals and snacks ahead

of time. This will help you avoid the last minute rush for food ideas and food preparation. Failure to plan usually leads tothe purchase of fast food, high fat and high salt unhealthy food choices.

How? Use the journal sheet to plan the night before for the following day. Write down all your 3 meals and your snack choicesdepending on your home and work schedule for the next day. Remember, all days are different; we are more out ofroutine in this fast paced world than in routine. Planning 1, 2 or 3 days ahead is smart goal setting.

YES YOU CAN...PARTY HEALTHYFestive occasions do not equal “weight gain”. You can eat without ruining your weight loss efforts by following some simple tips.

TIP 1: Focus on keeping your weight stable instead of trying to lose weightWhy? With all the tasty treats available, avoiding weight gain is a big enough challenge without worrying about losing weight.

Don’t set yourself up for failure by making unrealistic goals for yourself.How? Weigh yourself at the same time everyday to watch how your weight changes. Give yourself permission to gain a few

pounds (two or three) but no more.

TIP 2: Make a planWhy? • If you give yourself permission to “cheat”, then you won’t have feelings of guilt or failure when you sample your

favourite foods. Decide ahead of time what you will and will not eat. • You will then be able to enjoy the foods you love, avoid the foods that you can live without and help prevent bingeing.

How? Think ahead about where you will be, what types of foods will be there and which foods you really want to eat. Decideon reasonable portions of your favourites and arrive at the party with a plan.

TIP 3: Don’t go to parties hungry Why? Usually, parties are full of foods that are high fat and high calorie. If you’re “starving” when you get to the party, you’ll

be much more likely to overeat, and less likely to make healthy food choices.How? Spoil your appetite before going to the party. Have a small meal or a big snack with a serving of protein. This tip will help

your brain make better choices when faced with all the goodies.

TIP 4: Keep a drink in your hand Why? At holiday parties, the eating tends to be social, which means that you are eating while you socialize, and not paying

attention to what you are putting in your mouth. Having a drink in your hand keeps your hands busy, and you’re lesslikely to eat without thinking.

How? Keep a drink in the hand that you would use to grab food, and sip it slowly throughout the evening (but don’t forget tokeep in mind the calories found in popular drinks).

Go to www.ottawacvcentre.com for more information on party tips, meal and menu planning, snack lists and food labels.

The EMERALD® Weight Management Program can help you with your weight loss efforts and get you healthier. Please see our website at www.ottawacvcentre.com for more information andmore SUPER SAVVY WEIGHT LOSS TIPS. Please ask your family doctor for a referral to EMERALD.

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