Hypertension, Cardiovascular

Disease, Diabetes

34% ofAmericans

36% ofAmericans

Video

http://www.youtube.com/watch?v=jvE6at_i_Tw&feature=related

Volume (Cardiac Output-CO) Sodium

Increased intake, increased volume Potassium

Balances high blood sodium, promotes kidney excretion of sodium

Video

Rate-Resistance Effects heart muscle cells, rhythmic beating

Calcium Magnesium Potassium

Hypertension affects: Blood vessels Kidneys Eyes Brain

Dash Diet

Adequate potassium, calcium, magnesium whole grains, 4-5 servings/day vegetables, 4-

5 servings/day fruits, 2-3 low-fat dairy 4-5 servings/week of nuts, seeds, legumes 2-3 servings soft margarine-oil/day (1 tsp) 5 or fewer servings sweets/added sugars/week

Moderate Sodium2400 → 1500 mg/day

Atherosclerosis

• Plaque progression – Coronary Heart Disease

(CHD)

– Peripheral Vascular Disease (PVD)

– Carotid Artery Disease (CAD)

– Cerebral Vascular Disease (CVD)- strokes

• Chronic disease• Goal to stop or

prevent• 37% of Americans

Nutrition Related Modifiable Risk Factors

Obesity Elevated LDL, Cholesterol, Triglycerides Low HDL Hypertension Diabetes

Smoking Family history

Nutrition Recommendations

National Cholesterol Education Program- Adult Treatment Panel III Guidelines (NCEP-ATP III) www.nhlbi.nih.gov/guidelines/cholesterol/dskref.htm

Mediterranean Diet American Heart Association

NCEP-ATP III Blood Lipid Goals

LDL (MOST IMPORTANT TO DECREASE) < 100 mg/dL if CHD < 130 mg/dL if 2+ risk factors, < 160 mg/dL if 0-1 risk factors

Cholesterol < 200 mg/dL

HDL < 40 - low; > 60 - high

Triglycerides < 150 mg/dL

NCEP-ATP III Guidelines- TLC Diet

Saturated fat and trans fat < 7% of calories

Cholesterol < 200 mg/day

Increase soluble fiber Increase plant stanols/sterols

2 grams/day Weight Management Physical Activity

Plant Stanols/Sterols

• Modified triglyceride that prevents fat/cholesterol absorption

• Margarine like product

• 2 servings a day

American Heart Association

Weight loss Whole grains- ½ of grain intake Fatty Fish- 2 servings/week; 8 oz total Fat- 25-35% of total calories

Decrease saturated and trans fats Increase mono and polyunsaturated

DietResponse to diet varies per individualResponse depends on patient

compliance6-8 weeks

Impact on LDL and HDL

LDL Cholesterol HDL Cholesterol

Weight Loss ↓ ↑

High Saturated Fat ↑ ─

High Trans Fat ↑ ─

High Soluble Fiber ↓ ─

Smoking ─ ↓

Regular Exercise ─ ↑

Moderate Alcohol ─ ↑

Plant Sterols ↓ ─

InsulinFrom pancreas or injection

CHO from diet, glycogen

Blood Glucose (blood sugar) + Insulin

Cells

Diabetes- Blood Glucose

Hyperglycemia

Elevated fasting blood glucose (sugars) Labs

Normal- 70-110 mg/dL Pre-diabetes- 100-125 mg/dL Diabetes > 126 mg/dL fasting

Pre-Diabetes

Weight loss Exercise

150 minutes/week

General Diet Guidelines ½ grain intake whole grains Increase fiber

25+ grams for women 38+ grams for men

Type 1- Insulin Dependent Diabetes

Pancreas does not make insulin Carbohydrate (CHO) coincides with insulin therapy

@15 grams CHO: 1 unit insulin

Have a CHO intake pattern Count TOTAL grams of CHO Regular (scheduled) meals and snacks Eat more complex carbohydrates than refined

Adult Onset-Type 2 Diabetes

Insulin does not get glucose to cells Insuline resistance

Weight loss Reverses insulin resistance Calorie control, exercise

Balanced Diet Moderate CHO intake Whole grains, limit sugar

Diabetic Hypoglycemia

Low blood glucose < 70 mg/dL 15-15 rule

15 grams CHO, test 15 minutes later ½ cup juice, 1 tablespoon sugar, 1/3-1/2 cup

regular soda/pop Goal to ↑ 50-100 mg/dl in 15 minutes