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COOPERATIVE EXTENSION

Bringing the University to You

HYPERTENSION Stop It !

Control It !

Teaching Guide

Joyce Woodson, M.S., R.D. Millicent Braxton-Calhoun, M.S.

CM-03-10 The University of Nevada, Reno is an equal opportunity/affirmative action employer and does not discriminate on the basis of race, color, religion,

sex, age, creed, national origin, veteran status, physical or mental disability and sexual orientation in any program or activity it operates. The University of Nevada employs only United States citizens and aliens lawfully authorized to work in the United States.

TABLE OF CONTENTS

I. INTRODUCTION

II. LESSONS

1. PREVENTION AND CONTROL 2. LOOKING FOR SODIUM & SALT 3. DASHING TO STOP & CONTROL HYPERTENSION

4. USING DASH IF YOU ARE LACTOSE INTOLERANT

III. OVERHEAD TRANSPARENCIES

IV. PARTICIPANT HANDOUTS

V. CERTIFICATE OF COMPLETION AND RECIPES

VI. REFERENCES

HYPERTENSION:

STOP IT ! CONTROL IT! Introduction Research documents that despite the progress that has been made in the improvement in overall health of the nation, minorities are still experiencing continuing disparities in the burden of illness. Racial and ethnic minorities suffer a disproportionately high incidence of chronic disease. African Americans have an incidence of hypertension nearly 40 percent higher than that of the white population, the effects of hypertension are more frequent and severe in African Americans. This population develops hypertension at an earlier age than whites. Hypertension is a leading cause of stroke. In Nevada, according to the Bureau of Health Planning & Statistics in 1999, the disparity in stroke incidence between African Americans and for whites, was 41.45 and 20.82 per 100,000 deaths respectively. In a Community Health Survey conducted in predominately African Americans churches, 40 percent of respondents reported to be hypertensive and 60 percent reported hypertension in their family history. Controllable risk factors for hypertension include overweight, physical inactivity, high fat, high sodium food choices and preparation methods. All of these risk factors are found in the lifestyle behaviors of African Americans. Many who are diagnosed and treated for hypertension do not follow recommendations. The Dietary Approach to Stop Hypertension (DASH) has been found to be most effective in hypertension and non-hypertension African Americans. Sixty percent of the participants in the DASH research and 57 percent of the participants in the

DASH-Sodium research were African Americans. This curriculum uses DASH-Sodium to modify food choices and food preparation methods. A train the trainer approach is used in community based education to present the curriculum to the community. EVALUATION

The Stages of Change model (a transtheoretical model) is our choice for evaluation. The Stages of Change Model looks at readiness to change a health behavior. The stages are:

♦ Precontemplation (no intention of changing within the next 6

months) ♦ Contemplation (intent to change) ♦ Preparation (planning to change within the next month) ♦ Action (changing behavior) ♦ Maintaining (continuing changed behavior for 6 months)

To assess participant’s change as a result of this program, users may

want to consider administering pre and posttests. In addition, we have found it helpful to re-administer the test as a post-post-test several months after conclusion to assess movement along the stages and maintenance.

One possible instrument may be the Eating Style Questionnaire (ESQ) developed by Margaret K. Hargeaves and other researchers at Meharry Medical College. The ESQ was found to be useful in working with African American women. The ESQ can be modified to assess use of low fat milk products, intake of fruits and vegetables and fiber as recommended by the DASH diet.

The pre-survey may identify where the group or individual is at the beginning of the series. It may also provide the trainer with information on points to emphasize as participants move through the series. By the conclusion of the class, the post survey will indicate if the group or individual has moved forward, remained the same or regressed.

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LESSON 1

PREVENTION AND CONTROL

OVERVIEW: Hypertension or high blood pressure is often called the silent killer, because usually it has no symptoms. It is a serious condition which lasts a lifetime once it occurs. By taking the right action and developing a healthy lifestyle, hypertension can be controlled or prevented. WHAT IS HYPERTENSION OR HIGH BLOOD PRESSURE? Blood pressure is the force of blood against the walls of arteries. Blood pressure will rise and fall throughout the day. When the pressure stays elevated over time, it’s called high blood pressure. The medical term for high blood pressure is hypertension. High blood pressure is dangerous because it makes the heart work too hard and contributes to hardening of the arteries. Hardening of the arteries cause the flow of oxygen rich blood to be slowed or blocked. It increases the risk of heart disease and stroke, the first and third leading causes of death among Americans. High blood pressure also can result in other conditions, such as congestive heart failure, kidney disease, and blindness. High blood pressure affects about 50 million or one in four American adults. Some people are more likely to develop it than others. It is especially common among African Americans, who tend to develop it earlier and more often than whites. Also many Americans tend to develop high blood pressure as they get

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older, but hypertension is not a part of healthy aging. About 60 percent of all Americans age 60 and older have high blood pressure. Others at high risk of developing hypertension are people who are overweight, people with a family history of high blood pressure and those with a high normal blood pressure. High blood pressure also is more common in the southeastern United States. This part of the country is often referred to as the “stroke belt”. HOW IS BLOOD PRESSURE CHECKED? Blood pressure usually is measured in millimeters of mercury (mm Hg) and recorded as two numbers – systolic pressure (as the heart beats) “over” diastolic pressure (as the heart relaxes between beats) for example: 130/80 mm Hg. Both numbers are important, although for some Americans systolic blood pressure is especially important. A systolic blood pressure of less than 120 and a diastolic blood pressure of less than 80 mm Hg is good. Blood pressures between 120/80 mm Hg and 139/89 mm Hg is pre-hypertension. Pre-hypertension means that you don’t have high blood pressure at present. However, you may develop high blood pressure in the future. Adapting healthy lifestyle changes will decrease your risk for developing hypertension. CAN HIGH BLOOD PRESSURE BE PREVENTED OR CONTROLLED? High blood pressure can be prevented. If someone has high blood pressure, it can be controlled. The following steps are suggested:

♦ Maintain a healthy weight. ♦ Be physically active. ♦ Follow a healthy eating plan, which includes foods

lower in salt and sodium. ♦ If you drink alcoholic beverages, do so in moderation.

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♦ If you have high blood pressure and are prescribed medication, take it as directed.

• Maintain a healthy weight. Overweight increases your risk of developing high blood pressure. In fact, blood pressure rises as body weight increases. Losing even 10 pounds can lower blood pressure. Weight loss has the biggest effect in those who are overweight and already have hypertension. If you need to lose weight, it’s important to do so slowly. Lose no more than ½ to 2 pounds a week. Begin with a goal of losing 10 percent of your current weight. This is the healthiest way to lose weight and, importantly, it offers the best chance of long-term success. There’s no magic formula for weight loss. You have to eat fewer calories than you use in daily activities. Just how many calories you burn daily depends on factors such as your body size and how physically active you are.

• Be physically active. Being physically active is one of the most important steps you can take to prevent or control high blood pressure. It also helps to reduce your risk of heart disease. It doesn’t take a lot of effort to become physically active. All you need to do is 30 minutes of moderate level physical activity on most, and preferably all, days of the week. Examples of moderate level activity are brisk walking, bicycling, raking leaves and gardening. You can divide the 30 minutes into shorter periods of at least 10 minutes each. For instance: Use stairs instead of an elevator; get off the bus one or two stops early; or park your car at the far end of the lot at work.

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If you already engage in 30 minutes a day, you can get added benefits by doing more. Do a moderate level activity for longer period each day or engage in a more vigorous activity. A 30 minute exercise period can build up to 60 minutes or 4 – 15 minute periods per day. Most people don’t need to see a doctor before they start a moderate level of physical activity. You should check with a doctor first however, if you have heart trouble or have had a heart attack, if you are over age 50 and are not used to doing a moderate level activity, if you have a family history of heart disease at an early age, or if you have any other serious health problems.

• Follow a healthy eating plan A healthy eating plan is low in saturated fat, cholesterol and total fat. Also important is low fat dairy foods and increased fruit, vegetable and intake of whole grain breads and cereals. Meals are planned to include nuts, seeds and dried beans three times weekly, moderate use of red meat. Baked or broiled fish, seafood and poultry are good choices.

• Drink alcoholic beverages in moderation. Research strongly suggests a relationship between alcohol intake and blood pressure. Consuming high levels of alcohol has been found to increase the risk of high blood pressure. Moderation would be one drink daily for women and no more than two for men. Twelve ounces of beer, 5 ounces of wine and 1 ½ ounces of 80 proof whiskey count as a drink.

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LESSON 1: Teaching Guide


OBJECTIVES: After completing this lesson the participant will be able to:

1. Know the normal levels for blood pressure. 2. List the uncontrollable and controllable risk factors for hypertension. 3. Identify steps to take to lower their risk for hypertension.

KEY POINTS TO COVER WHEN TEACHING THE LESSON:

1. African Americans have a high incidence of hypertension. 2. High blood pressure can be controlled and prevented. 3. Physical inactivity and poor food choices are risk factors that are

controllable. MATERIALS AND SUPPLES NEEDED:

1. Attendance sheet. 2. Name tags. 3. UNCE promotional items. 4. Participant booklet and handouts (print of overheads). 5. Blood pressure record cards. 6. Overhead projector. 7. Overhead slides. 8. Copies of Scenario

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BEFORE TEACHING THE LESSON:

1. Review procedure for administrating the pretest. 2. Review the lesson overview and teaching guide. 3. Review overheads. 4. Gather all materials and supplies. 5. Check with church, at intervals, one week, 2 days and the day before, to

be sure there is no problem with schedule. WARM UP:

1. Ask participants to sign in, pick up notebooks, complete nametags, and promotional items as they arrive.

2. As the session begins, ask each person to introduce themselves and what

they hope to learn from the workshop. 3. The pretest is to be administered at the beginning of this lesson. Please

review the procedure. You, the Community Based Instructor IV or the Nutrition/Physical Activity Instructor may administer the test.

4. Distribute the scenario and read the scenario for Lesson 1 to the group.

Have participants read and respond to the scenario. Divide participants into groups to discuss the questions. After 5 minutes, each group will select a speaker to share their group’s responses to the questions.

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5. Ask participants what they hope to learn from the class. If expectations

are beyond the scope of the workshop, suggest possible resource information.

6. Review the goals of the workshop and objectives of lesson 1. 7. Ask participants to complete the “assessment of eating and activity

patterns” for the first class. Explain that this will help them with the changes they will make over the next weeks.

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PROCEDURES FOR TEACHING THE LESSON:

1. Show title overhead #1 repeating the title of the workshop.

2. Show overhead #2; repeat the title saying,

“in this lesson we will learn about blood pressure levels and the risk factors for hypertension.”

3. Show overhead #3. Explain that hypertension is also known as high blood

pressure. Share the following information.

o “It affects about 50 million or 1 in 4 adult Americans. o Hypertension is more common in the southeastern United States. o African Americans have long suffered a disproportionately high

incidence of high blood pressure. This ethnic group tends to develop it at an earlier age and more often than white Americans.

o In 2001, University of Nevada Cooperative Extension conducted a community health survey through 10 churches. The incidence of high blood pressure was 40%, which is as reported nationally. In the same survey 60% of respondents reported having a family history of hypertension.

o Hypertension, the medical name for high blood pressure, is often called the “silent killer” because it has no symptoms.”

4. Ask the question, ” What is blood pressure?”

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Show overhead #4, repeating the definition of blood pressure. Explain that,

“Blood pressure rises and falls throughout the day. But when the pressure stays elevated over time, then it’s called high blood pressure.”

5. Explain that blood pressure increases, as we get older.

“Approximately 60% of people ages 60 and older have high blood pressure. However, high blood pressure is not a natural part of healthy aging.”

6. Show overhead #5 stating the information regarding systolic and diastolic

pressure. 7. Show overhead #6. Ask the participants to turn to the handout “Blood

Pressure Levels for Adults”. Go through the information given, explaining that the levels are for 18 years and older and state the source, National High Blood Pressure Education Program.

“We should know our blood pressure “numbers”. Take advantage of blood pressure screenings at your church, during medical annual checkups and in the community. If you have hypertension and your doctor has prescribed medication, it is important that you follow recommendations in taking your medication.”

Pass out blood pressure recording cards. Ask the question,

“how many of you know your blood pressure reading or numbers?” Tell them “write your numbers on the card. This card should be kept, and each time your blood pressure is taken the numbers should be recorded.”

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8. Show overhead #7. Give the definition of risk factors. 9. Show overhead #8, stating that,

“there are some risk factors beyond our control.”

State these risk factors. 10. Show overhead # 9, stating,

"the good news is that there are risk factors that we can control.” State those listed on the overhead. 11. Show overhead #10 and state that

“hypertension can lead to more serious health conditions”, State those listed. 12. Tell the participants

“one of the risk factors we can control is physical inactivity.” Show overhead #11 discussing the information given. 13. Show overhead #12 and discuss the information given.

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14. Show overhead #13, discussing the suggestions given for moderate exercise. Tell the participants,

“that you should get your doctor’s okay before beginning any exercise if you are over 50 years of age, have not exercised in a long time or have a health problem. That they should pace themselves.”

Ask that they look at the handout, “A Simple Walking Program”. Review parts of this handout. Tell participants that some churches have walking clubs. Pass out the list of locations.

15. Ask participants to turn to the handout “Body Mass Index”

“Increasing physical activity is important, as important as controlling weight and food selections. Notice at the bottom of the page, weight is measured with underwear but no shoes. Find your height and move across to your body weight. Check your BMI, if you BMI is over 25, you have some changes to consider.” Review information on BMI chart.

In lessons 3 & 4 we will discuss the Dietary Approaches to Stop Hypertension (DASH), which will give some useful information.”

16. “High levels of alcohol has been found to increase the risk of high blood

pressure. At all times alcohol beverages should be used in moderation. This means no more that one drink per day for women and no more than two for men.”

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This concludes this first lesson on Hypertension: Stop It! Control It! Over the next week think of steps you may take to lower your blood pressure. Next week our lesson will be “Looking for Sodium”. Bring in a food label to our next class.

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LESSON 2

LOOKING FOR SODIUM & SALT

OVERVIEW SALT

Salt has been used as a food preservative, especially for meat and fish,

for over 200 years. Vegetables and fruits have also been preserved using salt. Salt is also used to bring out the natural flavor of food. Today, salt and sodium-containing ingredients are used in food preparation and processing.

Salt is 40 percent sodium and 60 percent chloride. Of the two minerals, sodium is the one linked to serious health problems. Research has shown that salt and sodium have been linked to high blood pressure, also known as hypertension. Sodium is needed to balance body fluids, help muscles including the heart, to contract and to conduct nerve impulses. Sodium is found in bodily fluids, tissues and bones.

An important part in healthy eating is in choosing foods that are low in salt and sodium. Decreasing sodium can reduce an elevated blood pressure. Most Americans eat too much salt and sodium, much more than the recommended limit of 2,400 milligrams or one teaspoon per day. Some people, especially Africans Americans and the elderly have been found to be salt sensitive. These people should be careful of their salt and sodium intake. If one has high blood pressure the doctor may advise less than the 2,400 milligrams per day.

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Sodium occurs naturally in many foods. Processed foods account for most of the salt and sodium Americans consume. The ingredient list of a product may show salt and three or four sodium-containing ingredients. The “Nutrition Facts” panel will show the amount of sodium in one serving of the product. Food labels should be carefully inspected for salt and sodium. One serving of a product may have over 1,000 milligrams of sodium.

Convenience packaged foods and processed frozen foods are high in sodium and frequently used to save time in food preparation. Rinsing canned vegetables will reduce the sodium content. However, there will be a loss of water-soluble Vitamin C and B vitamins (thiamin, riboflavin, niacin, B12 and folic acid).

Low-salt and no-salt food items are appearing in supermarkets in increasing numbers. Lowering salt and sodium is possible by food choices and preparation.

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Lesson II: Teaching Guide

LOOKING FOR SODIUM

SODIUM OBJECTIVES After completing this lesson the participant will be able: 1. Recognize that salt and sodium are linked to high blood pressure. 2. Know how to use the ingredient list and nutrition facts label to limit use

of salt and sodium. KEY POINTS TO COVER WHEN TEACHING THE LESSON: 1. Salt has been associated with hypertension. 2. Convenience packaged foods and processed frozen foods are usually high in

sodium. 3. The ingredient list and the “Nutrition Facts” panel on the food label will give

information regarding the presence of salt and sodium in a product and the amount contained in a serving.

MATERIALS AND SUPPLIES NEEDED:

1. Sodium overheads. 2. Overhead projector. 3. Sodium handouts. 4. Salt display. (NASCO) 5. Name tags. 6. Recipe for Sloppy Turk.

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7. Ingredients for recipe – Sloppy Turk, Tossed Salad, Low Fat Dressing

8. Electric frying pan and other necessary utensils 9. Paper supplies for food testing.

10. Attendance Sheet.


1. Gather materials and supplies. 2. Review lesson overview, lesson plan and overhead slides

PROCEDURE FOR TEACHING THE LESSON: Remember this lesson includes recipe preparation and tasting. The recipe may be done as the lesson is presented or prepared before class begins and tasting would occur during presentation.

1. As participants arrive, they should pick up nametags and sign attendance sheet.

2. Ask if there are questions about the last lesson. Question participants

about how they used information from the last lesson. 3. Showing overhead #1 announce the title of the lesson.

4. Mention the fact that salt and sodium have been linked to high blood

pressure, also known as hypertension. 5. Show overhead #2 and repeat

“Limit our sodium intake, this is what we must do.”

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6. Ask participants

“Why should sodium be limited?” Many people are salt sensitive, especially people who have hypertension. As we eat salt, sodium goes into our bloodstream, making it saltier. The body responds to this by adding more water to the blood, to maintain the normal level of salt. This extra fluid increases the volume of blood and blood pressure is increased. After responses are given, show #3 slide and state why sodium should be limited. Ask the participants, “On a scale from 1 to 10 (with 1 the most difficult) where would you rate your ability to limit sodium? Why?” Limit the discussion to 5 minutes.

7. Showing overhead #4 give information on where sodium is found. Refer to handout “Limit These Foods and Condiments” and “Low Sodium and Reduced Sodium Products”.

8. Overhead #5, tell the group that using fresh fruits and vegetables as well

as fresh meats, fish and poultry is best way to limit sodium. 9. “Most of the sodium and salt we take in comes from packaged processed

foods." Showing overhead #6, explain that

“it is a good practice to check the ingredient label on packaged foods. Ingredients are listed by weight, from the greatest to the least. Look for salt and sodium as part of the name of an ingredient.”

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10. Show overhead #7, ask

“Looking at this ingredient label, how many times does salt or sodium appear? Name the sources of salt and sodium.”

11. Show overhead #8 – State sources of sodium and salt as they are

underlined on the label.

“Reading the nutrition facts panel is another way to find sodium or salt in the product.”

12. Show overhead #9, “Label Reading for Better Eating”, and point out key

sections on the nutrition facts panel. Ask the group to turn to the handout on “Compare Food Labels”. Ask the group to look at the sodium content of each label for canned tomatoes. Ask them to look at the second handout set of labels showing a nutrition facts panel for peas. Ask which peas, frozen or canned, is lower in sodium.

13. Have group view the salt display; mention foods on display making

comments about the sodium content of different foods.

14. Ask if anyone brought food labels. Have 3 people give information on their labels. Refer to handouts giving list of foods high in sodium. Tell the group that low sodium and reduced sodium products can be found in supermarkets. Review the handouts with group.

15. Ask the question

“Does anyone know the difference between an herb and a spice?”

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After responses show overhead #10 explaining the difference. Put up the next overhead #11 and say

“that herbs and spices can be used in place of salt to season foods.” Ask if anyone is using herbs and spices to season foods. Limit discussion. Ask group to take out handout on using herbs and spices. Review handout. 16. Final note

“Reduce sodium and salt gradually. You will not notice the change. Each week use less salt in foods. The taste for salt is learned and can be unlearned. Soon salty foods will taste too salty.”

17. Tell the group that next week we will have a discussion of the DASH

Eating Plan. DASH stands for Dietary Approaches to Stop Hypertension and the recommendations are low fat and sodium.

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LESSON 3

DASHING to STOP And

Control Hypertension

LESSON OVERVIEW: Researchers have not been able to find the exact cause of high blood pressure. However, it is known that lifestyle and dietary habits can affect blood pressure. Lifestyle and dietary modifications have been shown to prevent or delay the expected rise in blood pressure in susceptible people and help others to control their blood pressure. Some of these lifestyle modifications include: dietary habits, foods low in salt and sodium, increase physical activity, and moderate alcohol consumption. Two studies have been completed showing that diet affects the development of hypertension or high blood pressure. The first was called DASH, for Dietary Approaches to Stop Hypertension. Scientists tested nutrients as they occur together in food. The finding showed that blood pressure levels were reduced with an eating plan that is low in saturated fat, cholesterol, and total fat, and that emphasizes fruit, vegetables and low fat dairy foods. In the first study, three groups of adult volunteers ate one of three diets for eight weeks. The diets of the different groups were as follows: 1. A diet low in fruits, vegetables and diary products with the same amount of fat

as in the average American diet – called the “control” diet. 2. A diet rich in fruits and vegetables – called the “fruits and vegetables” diet.

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3. A diet rich in fruits and vegetables, low-fat dairy products with reduced saturated and total fat – called the “combination” diet.

At the end of the eight weeks, the researchers compared the changes in blood pressures of each group. The researchers found that after only eight weeks, the people in the third group who ate the “combination” diet had lowered their blood pressure more than any other group. In fact, these changes were most significant among people with high blood pressure. These decreases in blood pressure were similar to the effects of medications! Included in this study were 459 adults, 27 percent had hypertension. Approximately 50 percent were women and 60 percent were African Americans. The second study was called DASH-Sodium focused on the effect of reduced sodium intake on participants following the DASH diet or eating a typical American diet. DASH sodium involved 412 participants, 41 percent had high blood pressure, 57 percent were women and about 57 percent were African Americans. Participants were assigned, randomly, to follow one of the two eating plans. They were followed for one month on the assigned plan and at each of three sodium levels. The sodium levels were 3,300 milligrams per day (the amount consumed by many Americans), 2,400 milligrams considered an intermediate intake, and 1,500 milligrams per day, a lower intake. It is recommended that sodium not exceed 2,400 milligrams. The results from this study showed that reducing dietary sodium lowered blood pressure for both the DASH and the typical American diet plan. At each sodium level, blood pressure was lower on the DASH diet than on the other eating plan. The biggest blood pressure reductions were for the DASH diet at the sodium intake of 1,500 milligrams per day. Those with hypertension saw the biggest reductions, but those without hypertension also had large decreases.

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Blood pressure medication can cause side effects and is also expensive. However, some people may be able to prevent or decrease their high blood pressure through food choices, thus reducing the need for medications. It is important to note that you should never stop taking blood pressure medication or change your dose without consulting your physician first.

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DASHING TO STOP AND

CONTROL HYPERTENSION OBJECTIVE After completing this lesson, the participants will be able to:

1. Understand the DASH eating plan. 2. List 3 dietary changes that can help lower blood pressure. 3. Understand appropriate serving sizes of foods.

KEY POINTS TO COVER WHEN TEACHING THE LESSON

1. The DASH eating plan has been shown to successfully lower blood pressure.

2. Lowering sodium is an important part of this plan. 3. Fruits, vegetables, low-fat dairy products and whole grain comprise the

DASH eating plan. MATERIALS AND SUPPLIES NEEDED:

1. Easel and flipcharts 2. Wide tip black and dark green markers. 3. Participant handouts 4. Wax food models (NASCO) 5. Attendance sheet. 6. Name tags. 7. Portion Doctor Serving Kit (NASCO)

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1. Review overview and teaching guide. 2. Gather all necessary materials and supplies.

WARM UP:

1. Ask if there are questions about the last lesson. 2. Ask if any one used any of the information from the last lesson. 3. Pass out lesson handouts.

PROCEDURES FOR TEACHING THE LESSON: The Portion Doctor Serving Kit is to be used in this lesson. You may choose to use the kit as you proceed through the lesson or to reinforce serving sizes as you conclude the lesson.

1. Tell the group:

“So far in our lesson we have talked about the definition of hypertension and blood pressure levels. How many of you know your blood pressure level? (comment on the number, ask 2 -3 people to give their blood pressure level). If your blood pressure is 120/80. This means that your systolic blood pressure (SBP) or the pressure on the vessel walls as the heart beats, is 120 and your diastolic blood pressure (DBP) or the pressure on the vessel walls as the heart is relaxing, is 80.”

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Write 120/80 on the flip chart or use overhead transparency (in Lesson 1).

“Having high blood pressure places you at increased risk for certain diseases, such as heart disease and stroke, which are leading causes of death in Americans. However, many people are unaware that they have high blood pressure because they may not experience any symptoms. Undiagnosed high blood pressure can lead to death or serious health problems. That is why it is known as the “silent killer.”

2. “The next two lessons will focus specifically on food choices. Regardless of how well you do in food selection and food preparation, you should continue taking medication as prescribed by your doctor.

The title of this lesson is “Dashing to Stop and Control High Blood Pressure”.

3. Share information from the overview regarding the DASH diet.

“Research has proven that an eating plan using low fat dairy, fruits, vegetables, grains and limited sodium does decrease blood pressures levels in persons with high blood pressure and those who do not have high blood pressure. This eating plan was found to be particularly effective with African Americans.”

4. Show the overhead #1 DASH. Ask participants if they know what does DASH mean?

5. Show overhead #2 explaining that DASH stands for Dietary Approaches to

Stop Hypertension

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6. Ask the group to take out the DASH Eating Plan. “Let’s review the recommendations that resulted from the DASH study. The chart shows recommendations for 1,600 calories a day and 2,000 calories a day. In this discussion we will refer to the 2,000-calorie plan.”

“Eat 7-8 servings of grains each day. Grains provide a lot of energy and fiber. One serving is equal to 1 slice of bread or ½ C dry cereal, cooked rice, pasta or grits.”

Use food models to show serving size of foods.

7. “Eat a diet that includes a lot of vegetables for potassium. This means 4-5

servings of fruits and 4-5 servings of vegetables each day.”

“One vegetable serving is equal to ½ cup cooked vegetables such as broccoli, corn, greens or carrots or ¾ C vegetable juice. One serving is also 1-cup green, leafy vegetables, 1 tomato, and 1 stalk of celery or 1 large baked potato.” Use food models to show serving sizes.

8. “Eat lots of fruits for potassium (helps to maintain normal blood pressure, contract muscles, transmit nerve impulses, or signals, regulate fluids and mineral balance in and out of body cells). This means 4-5 servings of fruits each day.” One serving of fruit is a medium banana, apple or pear; ½ cup of chopped fruit or ¾ C of juice. Use food models to show serving sizes.

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9. “Eat 2-3 servings of low or non-fat dairy products each day. A serving size

is equal to 1 cup of low-fat yogurt, 1-cup skim or low-fat milk or 1-1/2 ounces of low-fat cheese, such as part-skim mozzarella. These foods are important sources of calcium (plays a role in normal nerve function, helps muscles contract and heart beat.)”

Use food models to show serving sizes.

10. ”Eat 4-5 servings of beans, lentils, nuts and seeds each week. These

foods are rich in magnesium (helps maintain body cells in nerves and muscles, part of body enzymes which regulate body functions), protein and fiber. One serving is equal to ½ C of cooked beans or 1/3 C peanuts or sunflower seeds. Just remember that nuts and seeds are high in fat and should be limited. A better choice would be cooked beans such as lima, great northern, pinto, black, kidney beans or black-eyed peas.” Use food models to show serving sizes.

11. “Meats can be high in saturated fat. Two, 3-ounce servings per day is

recommended. Be sure to select only lean cuts of meat such as sirloin beef, tenderloin pork and leg of lamb. Chicken, turkey and fish are excellent low fat choices. Remove the skin and trim away all visible fat before cooking and try broiling or roasting instead of frying to decrease the amount of fat in any meat dish. One serving of meat is about the size of a deck of cards. One serving is equal to 3 ounces of cooked beef, poultry or fish.”


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12. “Fats should be limited to 2-3 servings per day. One serving is equal to 1-teaspoon (t) oil, margarine or regular mayonnaise; 1-tablespoon (T) low-fat mayonnaise or regular salad dressing or 2 T low-fat salad dressing.”


13. “Also, limit the amount of sweets and alcohol in your diet. These foods

contain a lot of calories but few nutrients.”

This may seem like a lot of food, but by choosing lower fat options and not adding fat, you can eat all these foods and not exceed 2,000 calories.

“This concludes the lesson “Dashing to Stop and Control High Blood Pressure.” In our next lesson, we look at planning menus using the DASH diet. We will also discuss lactose intolerance, an inability to digest milk sugar. Please bring your copy of the DASH diet to class next week."

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LESSON 4 USING DASH TO STOP AND PREVENT HYPERTENSION OVERVIEW: Background for the DASH diet is discussed in Lesson 3. Menus can be created using the DASH diet for any ethnic cultural population. In this lesson there will be an opportunity or practice creating menus following the DASH-Sodium recommendations. It is important to select foods low in sodium as well as low in fat. DASH stresses eating more fruits and vegetables including low and non-fat dairy products, limiting saturated fats, eating plenty of grains, eating more beans, nuts and seeds.

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USING DASH TO STOP AND PREVENT HYPERTENSION OBJECTIVES: After completing this lesson the participant will be able to:

1. Create a menu using the DASH-Sodium recommendations. 2. Understand Lactose Intolerance. 3. Understand that most people with Lactose Intolerance can still drink some

milk and eat some dairy products. KEY POINTS TO COVER WHEN TEACHING THE DASH LESSON:

1. Dietary modifications can help to lower your blood pressure. 2. The components of the DASH-Sodium eating plan.

MATERIALS AND SUPPLIES NEEDED:

1. Overheads. 2. Overhead Projector. 3. Erasable markers. 4. Handouts. 5. Recipe for Yogurt Pudding or Chicken or Turkey Broccoli Casserole. 6. Samples of lactose reduced milk. 7. Samples of anti lactase pills or drops. 8. Paper bowls and spoons. 9. Portion Doctor Serving Kit (NASCO)

4-3


1. Review DASH diet and lesson overview. 2. Review suggested menus. 3. Review overheads. 4. Gather materials and supplies. 5. Review handout on Lactose Intolerance.

PROCEDURE FOR TEACHING THE LESSON:

1. Show overhead #1 repeating title of lesson.

2. Ask participants to take out copies of DASH diet and if they have tried to follow any of the recommendations during the past week.

3. “Now we are going to practice planning a menu that meets the

DASH guidelines.” At this point, show overhead #2. Ask participants to take out their copies of “Create a Menu”. It is important to follow DASH recommendations and include foods from each food group and correct amounts. We will create 3 menus and list foods we would select as snacks. Suggest participants work in groups of 3 or 4. “Use the “Serving Sizes and Choices” handout to help you decide what types of foods and how much of each food you will eat. Write your choices on the “Create-A-Menu” form and check off the food groups as you go. Once you are finished, total up all of the food groups determine if you have met the DASH guidelines.” Using food models create a menu with the Portion Doctor.

4-4

4. After everyone is finished, ask them to take out copies of the DASH diet to compare their menus with the DASH recommendations.

5. Have a discussion with the group about the menus they created.

Ask if anyone is having problems completing their menus. Ask if they have all of the recommended servings in each food group.

6. Show overhead #3. Review selections on this breakfast menu.

7. Show overhead #4. Review selections on this lunch menu

8. Show overhead #5. Review selections on this dinner menu.

9. Show overhead #6. Review snack selections.

10. Summarize DASH recommendations.

“To help decrease your risk of developing high blood pressure or to lower your blood pressure if you already have high blood pressure, here are some things you can do”:

• Limit sodium intake. • Eat more fruits and vegetables • Include low and non-fat dairy products in your diet. • Limit the amount of saturated fat in your diet by reducing whole

milk dairy products and high-fat meats, such as ground beef. • Eat plenty of grains. • Eat more beans, nuts and seeds.

4-5

CONCLUSION: DASH recommended suggestions include 2 to 3 servings of low and non-fat dairy products per day. Some people have problems digesting milk or dairy products. We will now discuss Lactose Intolerance.

4-6

LACTOSE INTOLERANCE OVERVIEW: Lactose is a natural sugar that occurs in milk and milk products. Lactase is the intestinal enzyme necessary to break lactose down into smaller, more easily digested sugars in the process of digestion. Lactose intolerance occurs when too little lactase is produced by the digestive system to adequately digest the lactose in milk and milk products. Lactose that is left undigested is fermented by “healthy bacteria” in the small intestine. As a result of the fermentation, nausea, cramping, bloating, abdominal pain, gas and diarrhea may occur. These uncomfortable symptoms may occur from 15 minutes to several hours after ingestion of the milk product. The time and amount of discomfort will vary from person to person, the amount ingested and if it ingested with other foods. People with lactose intolerance can eat milk products or drink milk in varying degrees.. Most infants produce the lactase enzyme, as we age the body may produce less lactase. Lactose intolerance is an inherited condition. About 80- percent of Asians and Native Americans tend to be the most lactose intolerant group in the United States. Seventy five percent of African Americans, 50 percent of Hispanic Americans and 20 percent of Caucasian Americans have varying degrees of lactose intolerance. Medications may lower lactase production and lactose intolerance can be a side effect of intestinal disease. In these cases, lactose intolerance will be short term. Very lactose intolerant people should read labels. Lactose is in milk solids and milk. A “non-dairy” food may contain lactose as dry milk solids, lactose, malted milk , whey sour or sweet cream or cheese. It becomes important to read labels.

4-7

Most people even if diagnosed as lactose intolerant can consume some lactose. It is just knowing one’s personal tolerance level. Eliminating milk is eliminating an important source calcium, protein, riboflavin, vitamin A & D, magnesium, phosphorus and many other nutrients.

4-8

LACTOSE INTOLERANCE At this point have participants taste Yogurt Pudding. Share recipe. Briefly discuss recipe preparation.

1. Ask the question: “What is Lactose Intolerance?” 2. Ask if anyone thinks they are lactose intolerant and why? 3. Explain lactose intolerance. Ask participants to take out “Lactose

Intolerant” handout and review the portion of the handout that explains lactose intolerance.

4. If you think you may be lactose intolerant, see your doctor for a proper medical diagnosis. Lactose intolerance in adults may be diagnosed by a blood test or a hydrogen breath test. Your symptoms may be caused by other conditions such as medications or intestinal disease.

5. Mention the tips for managing lactose intolerance. Mention that often combining milk and milk products with other foods may ease your digestion while providing calcium for your body. Mention some food combinations.

6. It is possible to buy milk with reduced lactose. We will sample Lactaid milk. There are also pills and drops that will help reduce discomfort in digesting milk and milk products. Display these products and discuss them among the group.

7. Remember there are positive outcomes in following the DASH diet. Show overhead #7 and repeat information given.

POSITIVE OUTCOMES TO REINFORCE:

1. By changing your eating habits, you may be able to decrease the amount of blood pressure medications required.

4-9

2. If you don’t already have high blood pressure, you may be able to prevent it by changing your eating habits.

3. By eating according to the DASH recommendations, you are not only decreasing your risk for high blood pressure, but also for cancer, heart disease, osteoporosis and diabetes.



Southern Area

HYPERTENSION

STOP IT !!

CONTROL IT !!!

Participants Handouts

Developed by Joyce M. Woodson, M.S., R.D.

And Millicent Braxton-Calhoun, M.S.

The University of Nevada, Reno is an equal opportunity affirmative action employer and does not discriminate on the basis of race, color, religion, sex, age, creed, national origin, veteran status, physical or mental disability, sexual orientation, in any program or activity it operates. The University of Nevada employs only United States citizens and aliens lawfully authorized to work in the United States.

LESSON 1


A SAMPLE WALKING PROGRAM

National Heart, Lung and Blood Institute .

Warm Up

Target Zone Exercising

Cool Down Total Time

Week 1 Session A Session B Session C

Walk slowly

5 minutes

Repeat

Repeat

Walk briskly

5 minutes

Walk slowly

5 minutes

15 minutes

Week 2 Walk slowly 5 minutes

Walk briskly 7 minutes

Walk slowly 5 minutes

17 minutes




19 minutes




21 minutes




23 minutes




25 minutes




28 minutes




30 minutes




33 minutes




36 minutes




38 minutes

Week 12 AND

BEYOND




40 minutes

You have high blood pressure. Ask your doctor or nurse how to control it.

Your blood pressure could be a problem. Make changes in what you eat and drink, be physically active, and lose extra weight. If you also have diabetes, see your doctor.

Good for you!

Result

90 or higher

80-89

less than 80

Diastolic †

(mmHg) ‡

or140 or higher

Hypertension

or120-139Prehypertension

andless than 120

Normal

Systolic†

(mmHg)‡ Category

Blood Pressure Levels for Adults*

* For adults ages 18 and older who are not on medicine for high blood pressure and do not have a short-term serious illness. Source: The Seventh Report of the Join National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; NIH Publication No. 03-5230, National High Blood Pressure Education Program, May 2003.

† If systolic and diastolic pressures fall into different categories, overall status is the higher category. ‡ Millimeters of mercury.

B O D Y M A S S I N D E X ( B M I ) Here is a chart for men and women that gives BMI for various heights and weights.* To use the chart, find your

height in the left-hand column labeled “Height”. Move across to your body weight. The number at the top of the column is the BMI for your height and weight.

BMI 21 22 23 24 25 26 27 28 29 30 31 HEIGHT

(FEET AND INCHES) BODY WEIGHT (POUNDS) 4’ 10” 100 105 110 115 119 124 129 134 138 143 148 5’ 0” 107 112 118 123 128 133 138 143 148 153 158 5’ 2” 115 120 126 131 136 142 147 153 158 164 169 5’ 4” 122 128 134 140 145 151 157 163 169 174 180 5’ 6” 130 136 142 148 155 161 167 173 179 186 192 5’ 8” 138 144 151 158 164 171 177 184 190 197 203 5’ 10” 146 153 160 167 174 181 188 195 202 209 216 6’ 0” 154 162 169 177 184 191 199 206 213 221 228 6’ 2” 163 171 179 186 194 202 210 218 225 233 241 6’ 4” 172 180 189 197 205 213 221 230 238 246 254

* Weight is measured with underwear but no shoes.

* For adults ages 18 and older who are not on medicine for high blood pressure and do not have a short-term serious illness. Source: The Seventh Report of the Join National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; NIH Publication No. 03-5230, National High Blood Pressure Education Program, May 2003.

Source: Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: The Evidence Report; NIH Publication No. 98-4083, National Heart, Lung, and Blood Institute, in cooperation with the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, June 1998.

You need to lose weight. Lose weight slowly - about ½ pound to 2 pounds a week. See your doctor or a registered dietitian if you need help.

30 or greaterObese

Do not gain any weight, especially if your waist measurement is high. You need to lose weight if you have two or more risk factors for heart disease.

25-29.9Overweight

Good for you! Try not to gain weight.

18.5-24.9Normal weight

Result BMICategory

What Does Your BMI Mean?

LESSON 2

LOOKING FOR SODIUM AND SALT

LIMIT THESE FOODS AND CONDIMENTS

Bacon

Barbecue sauce

Bologna

Bouillon

Bouillon cubes

or granola

Buttermilk

Canned or

Powdered soup

Canned

Vegetables

Catsup

Celery salt

Cheese

Chili sauce

Corned beef

Frankfurters

Iodized Salt

Luncheon meats

Meat tenderizer

Monosodium

glutamate

(MSG)

Olives

Onion salt

Packaged foods

Pickles

Pork rinds

Powdered drink

mixes

Pretzels

Relish

Salad Dressings

Salt

Salt pork

Salted chips

Salted crackers

Salted nuts and

seeds

Sauerkraut

Sausage

Seasoned salt

Smoked or

canned meats

Soy sauce

Spaghetti or

tomato juice

(commercial)

Tomato juice

Worcestershire

sauce

Low-sodium and reduced-sodium

products can be found in the

supermarket. Try the following products

made with less sodium.

• Canned vegetables, vegetable juices and sauces

• Canned soups

• Dried soup mixes, bouillon

• Condiments

• Snack foods (chips, nuts, pretzels)

• Ready-to-eat cereals

• Bread, bakery products

• Butter, margarine

• Cheeses

• Tuna

• Processed meats

Tips to Remember When Using Herbs & Spices

• Start with 1 teaspoon of a mild herb (dried) or spice (such as oregano, basil, cumin, and cinnamon) per six servings.

• Use only 1/4 teaspoon of a strong herb or spice (such as rosemary, cloves, nutmeg, ginger, mustard, allspice) per six servings.

• Use spices or herbs sparingly until you decide the taste level that best suits your family.

Use herbs and spices in place of salt.

• Spices and herbs enhance the flavor of food.

• Check your supply of spices and herbs.

• A spice or herb bought for one special recipe may be used in others.

• The label on the container usually suggests uses of the spice or herb.

• Dried herbs are stronger than fresh herbs. Powdered herbs are stronger than crumbled.

• If a recipe calls for 1/4 teaspoon powdered herb, use 2 teaspoons fresh herb or 3/4 to 1 teaspoon crumbled or flaked.

Dietary Approaches

to

Stop Hypertension

THE DASH EATING PLAN

Vegetables

Grains & grain products

FOOD GROUP

3 - 4

6

DAILY SERVINGS

Based on

1,600 calories a

day

Rich sources of potassium, magnesium and fiber

Mustard greens, tomatoes, kale, potatoes, carrots, green peas, lima beans, squash, broccoli, turnip greens, collards, spinach, green beans, sweet potatoes, artichokes

1 cup raw leafy vegetable ½ cup cooked vegetable 6 oz. vegetable

juice

4 – 5

Major source of energy and fiber

Cornbread, bagel, whole wheat bread, English muffin, whole grain cereals, pita bread, grits, oatmeal, crackers, unsalted pretzels and popcorn

1 slice bread 1 oz. Dry cereal* ½ cup cooked rice, pasta or cereal

7 – 8

SIGNIFICANCE OF EACH FOOD AND GROUP TO THE DASH EATING

PLAN

EXAMPLES AND NOTES

SERVING SIZES

DAILY SERVINGS

Based on

2,000 calories a

day

*Equals ½ - 1 /1/4 cup depending on cereal type. Check the product’s Nutrition Facts panel.


Lowfat or Fat Free Dairy

Foods

Fruits

FOOD GROUP

2 - 3

4

DAILY SERVINGS

Based on

1,600 calories a

day

Major sources of calcium and protein

Fat free (skim) or lowfat (1%) milk, fat free or lowfat buttermilk, fat free or lowfat regular or frozen yogurt, lowfat and fat free cheese

8 oz. Milk 1 cup yogurt 1 ½ oz cheese

2 - 3

Important sources of potassium, magnesium and fiber

Apricots, cantaloupe, bananas, dates, grapes, oranges, grapefruit, mangos, melons, peaches, pineapples, prunes, raisins, strawberries, tangerines, watermelon, orange juice, grapefruit juice

6 oz fruit juice 1 medium fruit ¼ cup dried fruit ½ cup fresh, frozen or canned fruit

4 - 5


PLAN

EXAMPLES AND NOTES

SERVING SIZES

DAILY SERVINGS

Based on

2,000 calories a

day


Nuts, seeds and dry beans

Meats, poultry and fish

FOOD GROUP

3 per week

1 - 2

DAILY SERVINGS

Based on

1,600 calories a

day

Rich sources of energy, magnesium, potassium, protein and fiber

Almonds, filberts, mixed nuts, peanuts, walnuts, sunflower seeds, kidney beans, lentils, peas, black-eyed peas, black beans

1/3 cup or 1 ½ oz. of nuts 2 Tbsp. or ½ oz. seeds ½ cup cooked dry beans or

peas

4 – 5 per week

Rich sources of protein and magnesium

Select only lean; trim away visible fats; broil, roast or boil, instead of frying; remove skin from poultry

3 oz. Cooked meats, poultry or fish

2 or less


PLAN

EXAMPLES AND NOTES

SERVING SIZES

DAILY SERVINGS

Based on

2,000 calories a

day

LOWFAT LOWFAT


Sweets

Fats and oils

FOOD GROUP

0

2

DAILY SERVINGS

Based on

1,600 calories a

day

Sweets should be low in fat

Maple syrup, sugar, jelly, jam, fruit flavored gelatin, jelly beans, hard candy, fruit punch, sorbet, ices

1 Tbsp sugar 1 Tbsp jelly or jam ½ oz. Jelly beans 8 oz. Lemonade

5 per week

DASH has 27 percent of calories as fat, including fat in or added to foods

Soft margarine, lowfat mayonnaise, light salad dressing, vegetable oil (such as olive, corn, canola or safflower)

1 tsp. Soft margarine 1 Tbsp. Lowfat mayonnaise 2 Tbsp. Light salad dressing 1 tsp. Vegetable oil

2 – 3


PLAN

EXAMPLES AND NOTES

SERVING SIZES

DAILY SERVINGS

Based on

2,000 calories a

day

Corn oil

fat content changes servings count for fats, oils 1 tablespoon. Regular salad dressing equals 1 serving, 1 tbsp of lowfat dressing equals ½, 1 tbsp of fat free dressing equals 0 servings.

LOWFAT

Dietary Approaches

to

Stop Hypertension LOWFAT

CREATE-A-MENU List foods you will eat for an entire day. Check off each food group that applies to your food choices. Once you are finished planning meals and snacks, compare your total number of servings for each of the food groups with the DASH recommendations.

Food Choices Fruits Veggies Dairy Grains Meats Legumes Breakfast Lunch Dinner Snacks Total

SERVING SIZES AND CHOICES

2,000 Calories

4-5 Servings of Fruits per Day 1 Medium Piece of Fruit ½ Cup Canned Fruit ½ Cup Chopped Fresh Fruit ¾ (6 oz) Cup Fruit Juice 4-5 Servings of Vegetables per Day

1 Cup Green, Leafy Vegetables ½ Cup Cooked Vegetables ¾ Cup (6 oz) Vegetable Juice 2-3 Servings of Low or Nonfat Dairy per Day

1 Cup (8 oz) Low-Fat Milk 1 ½ oz Low-Fat Cheese 1 Cup Low-Fat Yogurt 7-8 Servings of Grains per Day

1 Slice of Bread ½ Cup Pasta or Rice ½ Cup Cooked Cereal 3-4 Small Crackers 1 oz Dry Cereal 2 or Fewer Servings of Meats per Day

3 oz Meat, Fish or Poultry 4-5 Servings of Nuts, Seeds & Dry Beans per Week

1/3 Cup or 1 ½ oz Nuts ½ Cup Beans, Peas 2 Tablespoons or ½ oz Seeds Limit Fat to 2-3 Servings each Day

1 Teaspoon Soft Margarine 1 Tablespoon Low-Fat Salad Dressing/Mayonnaise 2 Tablespoons Light Salad Dressing 5 Per Week 1 Tablespoon of Sugar 1 Tablespoon Jelly or Jam ½ oz Jelly Beans 8 oz. Lemonade

4 oz. Orange Juice 1 Fruit 1 Medium Banana 1 Fruit 8 oz. 1% Milk 1 Dairy 1 ½ Cups Corn flakes 2 Grains 1 piece Whole wheat toast 1 Grain 1 tsp. Soft Margarine 1 Fat

DASH SAMPLE MENU BREAKFAST

DASH SAMPLE MENU BREAKFAST 2

4 oz. low sodium vegetable juice 1 Fruit

1 Medium Banana 1 Fruit

8 oz. 1% Milk 1 Dairy

1 Cup cooked cereal 2 Grains (oatmeal/cream of wheat)

1 piece Whole wheat toast 1 Grain

1 tsp. Soft Margarine 1 Fat

DASH SAMPLE MENU LUNCH

2 oz. Turkey (2 slices) 1 Meat 2 slices Whole wheat bread 2 Grains 6 – 8 sticks Carrots and celery 1 Vegetable 1 slice low fat cheese 1 Dairy 8 oz. Low fat Milk 1 Dairy 1 medium Apple 1 Fruit

DASH SAMPLE MENU LUNCH 2

2 oz. low fat/low sodium ham 1 Meat

2 slices Whole wheat bread 2 Grains

6 – 8 sticks Carrots and celery 1 Vegetable

½ Cup low fat yogurt 1 Dairy

8 oz. 1 % butter milk 1 Dairy

1 medium Apple 1 Fruit

LOW FAT

DASH SAMPLE MENU DINNER

3 oz Herbed baked Cod 1 Meat 1 Cup Rice pilaf 2 Grains 1 small Whole wheat dinner roll 1 grain ½ Cup steamed Broccoli 1 Vegetable 1 Cup Spinach salad 1 Vegetable 1 tbsp. Light dressing ½ Fat ½ Cup Melon 1 Fruit

DASH SAMPLE MENU DINNER 2

3 oz Herbed baked Catfish 1 Meat

1 Cup cooked grits 2 Grains

1 small corn muffin 1 grain

½ Cup cooked collard greens 1 Vegetable

1 Cup cucumber, tomato & lettuce salad 1 Vegetable

1 tbsp. Light dressing ½ Fat

½ Cup Melon 1 Fruit

DIET SODA

DASH SAMPLE MENU SNACKS

¼ Cup Dried apricots 1 Fruit ¾ Cup Unsalted pretzels grain 1/3 Cup Unsalted peanuts 1 nut 12 oz Diet soda

HYPERTENSION PREVENTION AND CONTROL

My goal after participating in this session.

I will I will work on my goal in this way:

1. 2.



Southern Area

CERTIFICATE OF COMPLETION

Presented to

__________________________

for your participation in the

Hypertension STOP IT!! CONTROL IT!!! Program ________________ ________ _____________ Community Based Instructor II Date



HYPERTENSION Stop It !

Control It !

Recipes

Joyce Woodson, M.S., R.D. Millicent Braxton-Calhoun, M.S.

CM-03-10 The University of Nevada, Reno is an equal opportunity/affirmative action employer and does not discriminate on the basis of race, color, religion, sex, age, creed, national origin, veteran status, physical or mental disability and sexual orientation in any program or activity it operates. The University of Nevada employs only United States citizens and aliens lawfully authorized to work in the United States.

C O N T E N T S

I. Main Meal Chicken/Turkey Broccoli Casserole… 1 Sloppy Turk……………………......... 2 Spaghetti Sauce (to accompany Sloppy Turk)....... 3 II. Salads Chicken Fruit Salad……………......... 4 Garden Potato Salad…………............ 5 III. Dessert Silken Pineapple “Cheese” Cake……. 6 Yogurt Pudding..........................……. 7 IV. Condiments Herb Spread…………………………. 8 Hot and Spicy Seasoning……………. 9 Seasoning Mixes…………………….. 10 V. Beverages Fruit Smoothie………………………. 11 Good Old Fashion Lemonade……….. 12

1

Chicken/Turkey Broccoli Casserole (8 SERVINGS 1 CUP EACH)

1 lb fresh broccoli or 1 (10 oz) package frozen broccoli cooked 1 cup cooked chicken or turkey 1 can cream of chicken soup 1 cup shredded cheddar cheese Wash and cook broccoli. Dice cooked chicken/turkey. Cover bottom of casserole dish with cooked broccoli. Cover broccoli with chicken and cream soup (undiluted). Sprinkle with grated cheese. Bake at 350° for 20 – 30 minutes. Nutritional Analysis per serving: Calories ...........................................153 Protein .................................18.2 grams Carbohydrate.........................6.5 grams Fat ............................................6 grams Saturated fat ..........................4.2 grams Dietary Fiber ............................1 grams Cholesterol ..................... 47 milligrams Sodium……………….. 314 milligrams

Diabetic Exchange: 2 lean meat 1 vegetable

2

SLOPPY TURK (16 SERVINGS ½ CUP EACH)

2 ½ lbs ground turkey 1 cup chopped onions ½ cup chopped green and red peppers 1 42 oz jar spaghetti sauce (low salt) 1 ½ tsp. cumin 1 tsp. garlic powder or 2 cloves of minced fresh garlic 1 tsp. black pepper dash of oregano 1 tsp. vegetable oil ½ cup water Brown ground turkey in skillet with ¼ cup of water. Remove from pan after all the meat is browned. Pour off excess fat and put ground turkey in a bowl. In same pan, sauté onions and the green and red peppers in 1 teaspoon of oil for about 2 minutes. Add spaghetti sauce and the remaining seasonings. Add browned turkey to the mixture. Stir in well. Heat to boiling. Reduce heat and simmer 10 minutes, stirring occasionally. Spoon over hamburger bun. Nutritional Analysis per serving: Calories ...........................................187 Carbohydrate............................8 grams Protein ....................................14 grams Fat ..........................................11 grams Saturated fat ..........................2.6 grams Dietary Fiber .........................2.2 grams Cholesterol ..................... 56 milligrams Sodium……………….... 83 milligrams

Diabetic Exchange: 2 med fat meat 1 vegetable

3

SPAGHETTI SAUCE Alternate Spaghetti Sauce for Sloppy Turk

(10 SERVINGS ½ CUP EACH)

1 28 oz. can tomatoes, cut up 1 cup finely chopped sweet green pepper 1 cup finely chopped onion 2 cloves garlic, minced 1 tsp. dried oregano, crushed 1 tsp. black pepper In a non stick skillet, stir in tomatoes with their juice, green pepper, onion, garlic, oregano, and black pepper. Bring to boiling; reduce heat. Simmer, covered for 15 minutes, stirring occasionally. Remove cover; simmer for 15 minutes more. Nutritional Analysis per serving: Calories .............................................27 Carbohydrate............................5 grams Protein ......................................2 grams Fat ............................................0 grams Dietary Fiber .........................1.2 grams Cholesterol ....................... 0 milligrams Sodium……………….. 125 milligrams

Diabetic Exchange: 1 vegetable

4

CHICKEN FRUIT SALAD (8 SERVINGS ½ CUP EACH)

1 cup cooked diced chicken breast 2 medium apples, diced 1 cup pineapple chunks drained 8 oz. low fat vanilla yogurt ¾ tsp. curry powder ¼ tsp. chopped walnuts Chop chicken and apples. Mix all ingredients until coated with yogurt. Chill. Nutritional Analysis per serving: Calories .............................................98 Carbohydrate..........................12 grams Protein ......................................8 grams Fat ............................................2 grams Dietary Fiber ............................. 1 gram Cholesterol ..................... 18 milligrams Sodium……………….. 37 milligrams

Diabetic Exchange: 1 very lean meat 1 fruit

5

GARDEN POTATO SALAD (10 SERVINGS ½ CUP EACH)

3lbs potatoes (russet, red, all purpose, or Yukon Gold (6 large) 1 cup chopped celery 1 cup mixed bell and red peppers ½ cup sliced scallions (green onions) 2 tbsp chopped parsley 1 cup low-fat mayonnaise 2 tbsp. prepared mustard ½ tsp. celery seed ½ tsp. dill weed ½ tsp. white pepper Scrub potatoes; boil in jackets until tender. Cool; peel. Cut into ½ inch cubes. Add celery, red and green peppers, green onion, celery seed dill week parsley and white pepper. Combine prepared mustard and mayonnaise; pour mixture over vegetables, mix well. Chill before serving Nutritional Analysis per serving: Calories ...........................................151 Carbohydrate..........................30 grams Protein ......................................6 grams Fat .......................................... 0.5 gram Saturated fat ........................... 0.2 gram Dietary Fiber .........................3.1 grams Cholesterol .................... 2.3 milligrams Sodium……………….. 118 milligrams

Diabetic Exchange: 2 Bread/starch

6

SILKEN PINEAPPLE “CHEESE” CAKE (8 SERVINGS)

One reduced fat graham cracker crust 1lb soft tofu or firm silken tofu, crumbled 2 cans (8oz each) crushed pineapple packed in juice, drained 1/3cup + 1 tbsp granulated sugar 2 tbsp. all purpose flour 1/8 tsp. salt 1 large egg white 1 ½ tsp. vanilla extract ½ tsp. grated orange peel Preheat oven to 325°F. In a food processor fitted with a steel blade, or blender, process the tofu and pineapple for 25 seconds or until blended – stopping to scrape down sides of container with rubber spatula as needed. Add remaining ingredients and process for 10 seconds, or until blended. Scrape the batter into the prepared pan and spread evenly. Bake until set, about 50 to 60 minutes; a knife inserted in center should come out almost clean. Cool in pan on a wire rack for 1 hour. Refrigerate for 3 hours. Run a small metal spatula around edge of cake and release side. Nutritional Analysis per serving: Calories ...........................................227 Carbohydrate..........................35 grams Protein ......................................6 grams Fat ............................................7 grams Dietary Fiber ............................1 grams Cholesterol ....................... 0 milligrams Sodium……………….. 178 milligrams

Diabetic Exchange: 2 bread 1 fat

7

Yogurt Pudding (8 SERVINGS ½ CUP EACH)

¼ cup milk or reconstituted nonfat dry milk 1 small package (3 1/6 oz.) instant pudding (any flavor) 2 cups (16 oz.) plain low fat yogurt Add milk to the pudding in a mixing bowl. Stir until smooth. Add yogurt and stir. Refrigerate until ready to serve. Nutritional Analysis per serving: Calories .............................................87 Protein ...................................3.4 grams Carbohydrates .....................16.1 grams Fat ............................................. 1 gram Dietary Fiber ............................0 grams Cholesterol .................... 3.8 milligrams Sodium……………….. 225 milligrams

Diabetic Exchange: 1 non-fat milk

8

HERB SPREAD

Mix one tablespoon of fresh minced herbs or ½ teaspoon crushed dried herbs with 4 tablespoons margarine. Parsley, garlic or chives are especially good. If dried herbs are used, add a squeeze of lemon juice. Let stand for fifteen minutes before using. Store covered in refrigerator. Use on hot breads, vegetables, baked potato, noodles, etc.

9

HOT AND SPICY SEASONING (MAKES 1/3 OF A CUP)

¼ cup paprika 2 tbsp. crushed dried oregano 2 tsp. chili powder 1 tsp. garlic powder 1 tsp. black pepper ½ tsp. red (cayenne) pepper ½ tsp. dry mustard Mix together all ingredients. Store in airtight container. Use seasoning to add extra flavor to low fat meat, fish, poultry, and bean dishes. Add 1 ½ to 2 tsps. to coat 1 lb. of meat, fish, or poultry before cooking or add to bean dishes to taste when other herbs and spices are added.

10

SEASONING MIXES

MIX #1 MIX #2 2 teaspoons thyme 3 teaspoons thyme 2 ½ teaspoons savory 1 ½ teaspoons sage 2 teaspoons sage 2 ½ teaspoons rosemary 2 teaspoons rosemary 3 teaspoons marjoram 2 ¼ teaspoons marjoram MIX #1 2 tablespoons basil 1 teaspoon oregano 2 tablespoons onion powder ½ teaspoon dried grated lemon peel 1/8 teaspoon ground black pepper 1 teaspoon celery seed Crush dried herbs and place in a jar or shaker. Use for seasoning salads, soups, vegetables, meat, seafood and poultry.

11

FRUIT SMOOTHIE (4 SERVINGS 1 CUP EACH)

1 (6 oz.) can frozen orange juice 3 (6 oz.) cans of water 1 Banana 1 (10 oz.) pkg. Frozen fruit of choice (strawberries, peaches, etc.) 1 (8 oz.) low fat yogurt of choice 6 – 8 ice cubes Combine all ingredients in a blender. Blend until smooth and creamy – about 10 seconds. Serve. For a thicker smoothie, use less water. Nutritional Analysis per serving: Calories ...........................................182 Carbohydrate..........................41 grams Protein ......................................4 grams Fat ............................................1 grams Dietary Fiber ............................0 grams Saturated Fat ................... .5 milligrams Calcium........................ 124 milligrams Sodium……………….. 40 milligrams Recipe Courtesy of Nurturing Partners

Diabetic Exchange: 3 fat free milk

12

GOOD OLD FASHIONED LEMONADE AGUAS FRESCAS

(2 SERVINGS 10 OZ EACH)

2 lemons 2 cups water 2 tbsp. Sugar Squeeze the juice from 2 lemons. Mix with water and sugar. THAT’S IT! ENJOY!! Variations: For Mexico’s version of lemonade, use limes instead of lemons (2 limes for every lemon). They can also be made with pineapple, watermelon, strawberries, or even dried Jamaica flowers. Nutritional Analysis per serving: Calories .............................................68 Carbohydrate..........................23 grams Protein ...................................1.2 grams Fat .......................................... 0.3 gram Saturated fat ........................... 0.0 gram Dietary Fiber ............................0 grams Cholesterol .................... 0.0 milligrams Sodium……………….. 10.4 milligrams

Diabetic Exchange: 1 fruit

Developed by Joyce M. Woodson, M.S., R.D.

and

Millicent Braxton-Calhoun, M.S.

The University of Nevada, Reno is an equal opportunity/affirmative action employer and does not discriminate on the basis of race, color, religion, sex, age, creed, national origin, veteran status, physical or mental disability and sexual orientation in any program or activity it operates. The University of Nevada employs only United States citizens and aliens lawfully authorized to work in the United States.

REFERENCES

1) Dressler WW, “Hypertension in the African American Community: Social, Cultural, and Psychological Factors,” Seminars in Nephrology, 16 (2), 1996, 71-82.

2) Erlinger, Thomas P., Vollmer, William M., Svetkey, Laura P., Appel, Lawrence J,

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