COUNSELING AFRICAN AMERICAN IN TREATMENT & CONTROL OF HYPERTENSION (CAATCH) STUDY

 Usual Care

Group Curriculum

Usual Care Flow Diagram

Usual Care Sessions

- Should have no relation or reference to hypertension and hypertension management.

        No weight loss tips        No stress reduction tips        No cholesterol reduction tips        No mention of diabetes

Usual Care Sessions

I. Vitamins

II. Minerals

III. Macronutrients Part1 (Carbohydrates & Proteins)

IV. Macronutrients Part 2 (Fats) & Herbs and Botanicals

Usual Care Sessions

Structure:

I. Vitamins: Video Module Discussion

II. Minerals: Video Module Discussion

III. Carbs and Protein: Module

IV. Fats & H&B: Module

Vitamins

• What are vitamins?

Vitamins are nutrients you must get from food because your body can’t make them from scratch.

Vitamins

• 1.     What are the different vitamins?• Four vitamins are fat-soluble and tend to

accumulate in the body. These are vitamins A, D, E, and K.

•  • The others are water-soluble, such as Vitamins C,

and the eight B vitamins (thiamin, riboflavin, niacin, biotin, pantothenic acid, pyridoxine, folate, and cobalamin).

What are the sources of these vitamins?

Vit. A

Fortified breakfast cereal, dairy, liver & organ meats, squash, cantaloupe, cod liver

Vit. D

Fortified cereals, milk & other dairy products, eggs, fish, cod liver oil, the sun*(!)

Vit. E

Vegetable oils, nuts and seeds, avocados, eggs, whole grain cereals

Vit. K

Green leafy vegetables, liver and animal sources

What are the sources of these vitamins?

Vit. B1 (thiamin)Whole grain cereals, bread, rice, organ meat, peas, bananas, peanutsVit. B2 (riboflavin)Whole grains, liver, fish, lean meats, milk, yogurt, almonds, sunflower seedsVit. B3 (niacin)Lean meats, beans, fish, chicken, legumes, nutsVit. B6 (pyridoxine)Chicken, fish, liver, eggs, rice, soybeans, oats, whole wheat, nuts, bananas, avocadosVit. B9 (folate)Fortified breads and cereals, green leafy vegetables, organ meats, orange juice, beans, legumesVit. B12 (cobalamin)Sunflower seeds, kelp, bananas, nutsBiotinLiver, egg yolk, milk, yeastPantothenic acidLiver, yeast, egg yolk, broccoliVit. CCitrus fruits, vegetables

What, exactly, do I need vitamins for?

In most cases, the lack of a vitamin causes severe problems. The following list shows diseases associated with the lack of different vitamins:

• Lack of Vitamin A: Night blindness, xerophthalmia • Lack of Vitamin B1: Beriberi • Lack of Vitamin B2: Problems with lips, tongue, skin, • Lack of Vitamin B3: Pellagra • Lack of Vitamin B12: Pernicious anemia • Lack of Vitamin C: Scurvy • Lack of Vitamin D: Rickets • Lack of Vitamin E: Malabsorption of fats, anemia • Lack of Vitamin K: Poor blood clotting, internal bleeding

If I eat a healthy diet, should I take a vitamin pill?

• still best to consult with your doctor.

• some individuals with certain medical conditions may need nutritional supplements: a woman who might become pregnant or is pregnant; for a person who is a heavy smoker or drinker; for vegans; and for poor urban dwellers

Can taking large amounts of vitamins cure or prevent a particular disease?

• The present evidence does not support the idea that taking a large amount of a certain vitamin will cure a particular condition (for example, taking high doses of vitamin C for the flu)

• Vitamin D – an RDA of 400 IU per day is recommended to reduce the risk of osteoporosis and fractures.

• Elderly persons – they do not absorb vitamin B12 from the stomach as efficiently as they used to.

What will happen if I take too much of a vitamin?

• They are not only potentially harmful but also unnecessary and a waste of money!– Large doses of vitamin A can damage your

liver – Excess water-soluble vitamins such as vitamin

C are just removed by the kidney

The bottom line about vitamins?

• Never a substitute for a healthy diet and lifestyle.

• There are lots of other nutrients and other healthful substances in fruits, vegetables, or whole grains that are not present in a vitamin pill.

• Ask your doctor whether or not you need to take vitamin supplements.

Minerals

What are nutrient minerals?

Minerals are inorganic elements (salts), that are smaller than vitamins, and are essential for growth and maintenance of the different systems in the body.

Minerals

What are the functions of minerals?

• They build body tissue

• They regulate body processes and metabolism

Minerals

• Excess amounts can be harmful!

and• They are needed only

in small quantities!

What are the minerals needed by the body?

• Macrominerals = 100mg/d or more• Calcium • Phosphorus• Sodium• Potassium• Magnesium• Chloride Sulfur

What are the minerals needed by the body?

• Microminerals (trace minerals) = needed in very small amts

• Iron

• Iodine

• Fluoride

• Other: selenium, zinc, manganese, cobalt, copper, molybdenum, chromium

Why do I need these minerals? What are their functions?

Here are some of the more common minerals our bodies need:

• Calcium - used by teeth, bones

• Fluorine - strengthens teeth

• Iodine - combines with tryosine to create the hormone thyroxine

• Iron - transports oxygen in red blood cells

• Magnesium - healthy bone formation

• Phosphorus - bone, teeth, and nerve cell formation

• Potassium - important ion in nerve cells

• Sodium - fluid regulation and acid-base balance

• Zinc - proper wound healing, growth, cell and tissue repair, and sexual development

How can I get my daily amount? • Calcium- Green leafy vegetables, fortified orange

juice, dairy products, tofu, sardines• Iron - organ and red meats, beans, peas, dried

apricots, green leafy vegetables• Potassium - Fruits, vegetables, grains• Phosphorus - Widely available in plant and animal

foods• Iodine - Seaweed, swiss chard, turnip greens, garlic,

watercress, seafood and fish liver oils• Zinc - Wheat bran, pumpkin seeds, sunflower seeds,

brewer’s yeast, onions, oysters, green leafy vegetables

Food Pyramid Chart (old & new)

Carbohydrates

• What are carbohydrates?

- grains, sugars, fibers and starches

- primary source of fuel for the body

Bad Carbs and Good Carbs

• Glycemic Index (GI) - higher the glycemic index is, the faster it

raises your blood sugar levels- more processed the food is, the higher the

glycemic index

Ex. white bread = 70spaghetti = 42

How do I choose my carbs?        Fiber content.

• Fiber - shields the starchy carbohydrates in food immediate and rapid attack by digestive enzymes; this slows the release of sugar molecules into the bloodstream.

        Ripeness. • Ripe fruits and vegetables = more sugar than unripe ones; higher glycemic index.         Type of starch. • Some starches are easier to break into sugar molecules than others. The starch in

potatoes, for example, is digested and absorbed into the bloodstream relatively quickly.

        Fat content and acid content. • The more fat or acid a food contains, the slower its carbohydrates are converted

to sugar and absorbed into the bloodstream.         Physical form. • Finely ground grain is more rapidly digested, and so has a higher glycemic index,

than more coarsely ground grain.

So is it healthy to follow a low-carbohydrate diet?

• long-term effects of it has not yet been clarified

• a lot of low-carb diets encourage eating worrisome amounts of unhealthy fats

• best to get most of your carbs from whole-grains, fruits, and vegetables!

Proteins

• Proteins = amino acid + amino acid + …

• body - able to store carbohydrates and fats, but it is unable to store amino acids

• needs a daily supply of amino acids in order to make new protein

Where do I get my protein?

• Meats, fish, nuts, beans….

All protein created equal?

• Some foods contain all the amino acids needed to build protein; other sources such as vegetables and nuts lack one or two essential amino acids

• Vary protein sources

• Vegans – consult with nutritionist

General Recommendations on Protein:

- Get a good mix of protein

- Pay attention to what comes with the protein.

stick with the lean cuts

remove any skin and fat

choose skim or low-fat milk

- Balance the carbs and protein

Fats

Fats

• Saturated fats - normally solid at room temperature; lard and shortening, animal fat

• Unsaturated fats - liquid at room temperature; vegetable oils

Fats

• Also a source of energy

• Needed for fat-soluble vitamin absorption

• Essential fatty acids

Good vs. Bad Fats

• Saturated Fats bad fat!- animal fats: meat, seafood, whole-milk dairy products (cheese, milk, and ice cream), poultry skin, and egg yolks

Trans Fats another bad fat!produced by heating liquid vegetable oils in the presence of hydrogen; commercially prepared baked goods, margarines, snack foods, and processed foods

Good vs. Bad Fats

• Unsaturated Fats--Polyunsaturated and Monounsaturated good fats- plant sources, such as vegetable oils, nuts, and seeds. -polyunsaturated fats: found in high concentrations in sunflower, corn, and soybean oils) -monounsaturated fats: found in high concentrations in canola, peanut, and olive oils)

Tips for lowering trans fat intake:

        Choose liquid vegetable oils or a soft tub margarine - little or no trans fats.

        Reduce intake of commercially prepared baked goods, snack foods, and processed foods, including fast foods.

        When foods containing hydrogenated or partially hydrogenated oils can't be avoided, choose products that list the hydrogenated oils near the end of the ingredient list.

        To avoid trans fats in restaurants, one strategy is to avoid deep-fried foods, since many restaurants continue to use partially hydrogenated oils in their fryers.

Herbs and Botanicals

• Being sold as dietary supplements

• Little or no FDA regulation: “not intended to treat, diagnose, mitigate, prevent, or cure disease.”

Tips before buying a dietary supplement

        Remember: Safety First. Some supplement ingredients, including nutrients and plant components, can be toxic

        Think twice about chasing the latest headline. Be wary of results claiming a "quick fix" that depart from scientific research and established dietary guidance.

Tips before buying a dietary supplement

        Learn to Spot False Claims. Remember: "If something sounds too good to be true, it probably is." Some examples of false claims on product labels:

       Quick and effective "cure-all."       Can treat or cure disease.       "Totally safe," "all natural," and has "definitely no

side effects."       Limited availability, "no-risk, money-back

guarantees," or requires advance payment.

Tips before buying a dietary supplement

•              More may not be better. Some

products can be harmful when consumed in high amounts, for a long time, or in combination with certain other substances.

Tips before buying a dietary supplement

   The term "natural" doesn't always mean safe.

• - interact with medicines, be dangerous for people with certain health conditions, or be harmful in high doses.

Tips before buying a dietary supplement

• - Is the product worth the money? Resist the pressure to buy a product or treatment "on the spot."

• -Some supplement products may be expensive or may not provide the benefit you expect.

• - For example, excessive amounts of water-soluble vitamins, like vitamin C and B vitamins, are not used by the body and are eliminated in the urine.

Ginger

• Analgesic

• Sedative

• Antipyretic

• Antibacterial

• GI tract motility effects.

Garlic

• infections (especially chest problems)

• digestive disorders

• fungal infections

Fish Oil

• now recommended for a healthy diet • American Heart Association recommends

the consumption of 1g of fish oil daily, preferably by eating fish, for patients with coronary heart disease

• help protect the brain from cognitive problems associated with Alzheimer's disease.

Glucosamine

• synthetic version of a compound the human body makes to stimulate the growth of cartilage

• help rebuild cartilage and reduce the symptoms of arthritis.

The Bottom Line

• Check with your health care providers before taking a supplement, especially when combining or substituting them with other foods or medicine.

• Some supplements can help you meet your daily requirements for certain nutrients, but others may cause health problems.

• Do not self diagnose any health condition. • Dietary supplements are not intended to treat, diagnose,

mitigate, prevent, or cure disease, or to replace the variety of foods important to a healthful diet.