1. Healthy Eating 2009 Preventing Strokes One at a Time

2. Managing Stroke Risk Factors Upon completion, participants will be able to:  Counsel patients about a healthy balanced diet according to the Canadian Best Practice Recommendations for Stroke Care, 2008.  Partner with patients & families to develop an individualized plan for cooking and eating healthier. LEARNING OBJECTIVES

3. 2.1 Lifestyle and Risk Factor Management  Persons at risk of stroke and patients who have had a stroke should be assessed for vascular disease risk factors and lifestyle management issues:  Diet, Sodium intake, Exercise, Weight, Smoking, Alcohol intake  They should receive information and counseling about possible strategies to modify their lifestyle and risk factors. CMAJ 2008;179(12 Suppl):E1-E93. #2.1

4. Healthy Balanced Diet  Fat  Cholesterol  Fibre  Canada’s Food Guide  Other tips  How to balance a meal  BMI and Waist Circumference  Resources

5. Canadian Best Practice Recommendations for Stroke Care, 2008 #2.1i) Healthy balanced diet  High in fresh fruits, vegetables, low fat dairy products, dietary and soluble fibre, whole grains, proteins from plant sources, and low in saturated fat, cholesterol and sodium, in accordance with Canada’s Food Guide to Healthy Eating CMAJ 2008;179(12 Suppl):E1-E93 #2.1

6. Canadian Best Practice Recommendations for Stroke Care, 2008 #2.1 ii) Sodium  The recommended daily sodium intake from all sources is the Adequate Intake by age.  For persons 9 – 50 years, the Adequate Daily Intake is 1500 mg. Adequate Intake decreases to 1300 mg for persons 50 – 70 years and to 1200 mg for persons > 70 years.  A daily upper consumption limit of 2300mg should not be exceeded by any age group  See www.sodium101.ca for sodium intake guidelines. CMAJ 2008;179(12 Suppl):E1-E93 #2.1

7. Recommendations for Adequate Sodium Intake by Age AgeSodium Intake per Day (mg) 0-6 months120 7-12 months370 1-3 years1000 4-8 years1,200 9-50 years1,500 50-70 years1,300 > 70 years1,200 CMAJ 2008;179(12 Suppl):E1-E93 #2.1

8. Equivalent Measurements of Sodium and Salt Sodium (mg) Sodium (mmol) Salt (g) 500221.25 1,500653.75 2,000875.0 2,3001005.8 2,4001046.0 3,0001307.5 4,00017410 For example: Two slices (292 grams total) of a Pepperoni Lover's large stuffed crust pizza at Pizza Hut contain 3,000 mg of sodium, double the recommended intake for a full day.. http://www.marketwire.com/press- release/Canadian-Stroke-Network- 944176.html CMAJ 2008;179(12 Suppl):E1-E93 #2.1

9. Types of Salt  Table salt =fine-grained, we get it from salt mines. In 1920 iodine was added.  Sea salt =evaporated seawater  Kosher salt =table salt but with no additives, made to prepare meat according to Jewish dietary regulations  Pickling salt= fine grained like table salt but doesn’t contain iodine, used to pickle food. 1 teaspoon contains 2300 mg sodium

10. Dietary Fat Overall…choose low fat  Use less butter and margarine.  Use skim, 1% or 2% milk.  Choose low fat yogurt (<2%) and cheese (<20% MF)  Choose lean meat/poultry and trim fat before cooking  Items to limit: bacon, cold cuts, sausages, gravy, chips, fried food, pastries  Use small amounts of canola (cooking) or olive oil.  Eat more vegetables and fruit.

11. GOOD versus BAD fat Good Fats/Healthy (mono & polyunsaturated)  Non-hydrogenated margarine  Oils: canola, olive, corn, avocado, olives  Nuts: almonds, peanuts, pecans, walnuts  Seeds: flax, sunflowers, sesame  Fish: salmon, trout, tuna, sardines  Eggs: Omega-3 Bad fats/Unhealthy (trans and saturated fats)  Red meat, poultry  Whole milk, cheese, cream  Butter, cream cheese  Ice cream, sour cream  Palm oil, coconut oil, hydrogenated vegetable oil, shortening  Fried foods  Processed food

12. Fibre (25-35 g a day)  Eat a variety of soluble and insoluble  Insoluble Fibre: Bran Cereals, Whole Grains  Soluble Fibre: Dried Beans, Peas, Lentils, Rolled Oats, Oat Bran, Barley, Psyllium  Soluble fibre can lower LDL cholesterol  Provides a feeling of fullness ( ↓ intake )  Help control blood glucose levels (diabetes) (up to 50g fibre with diabetes)

13. Grains Grain Products (1/4 Plate):  Whole Grain Breads  Brown Rice, Whole Wheat Pasta, Barley  1-2 Tbsp Ground Flaxseed  High Fibre Cereals – Shredded Wheat, Oatmeal, All Bran Buds with Psyllium

14. Cholesterol (300mg or less a day)  Little effect on blood cholesterol  Genetics, diabetes, physical activity  Found only in animal products  Focus on decreasing unhealthy fats in the diet instead of decreasing cholesterol intake  Increase fibre intake

15. Canada’s Food Guide Food Group Vegetables & Fruit Grain Products Milk & Alternatives Meat & Alternatives 19-5051+ FMFM 7-88-1077 6-7867 2233 2323

16. Other Tips to a Healthy Balanced Diet Vegetables (1/2 Plate):  7-8 servings daily  (Fresh/Frozen) vegetables vs juice  Brighter is better  Choose one green and one orange daily (Broccoli, Spinach, Peppers, Squash, Sweet Potatoes, Carrots)

17. Healthy Eating  Include 3 of 4 food groups at each meal  Choose fruits vs juices  Low fat dairy

18. 1 fruit 1 milk 2-3 grain products Meat and alternatives Meal planning : Breakfast

19. 1 fruit1 Milk 2-3 grain products Meat and alternatives 2-3 vegetables (fibres) Meal Planning: Lunch & Dinner

20. Portion Sizes and Tableware  Dinner plate 23cm/9inches  Soup bowl 250 ml /1cup  Cereal Bowl 250ml /1 cup  Drinking glass150 ml /2/3 cup  Dessert Bowl 150 ml /2/3 cup  Wine glass 125ml /1/2 cup

21. Eat Smart When Eating Out Better choices:  Condiments on the Side  Salad vs Fries (caution: Caesar Salad)  Tomato vs Cream Sauce for Pasta  Plainer Burger vs. “House” Specialty  Smaller / Share / Take Home Portions

22. Resources  www.sodium101.ca www.sodium101.ca  www.heartandstroke.ca www.heartandstroke.ca  www.dietitians.ca www.dietitians.ca  www.hc-sc.gc.ca www.hc-sc.gc.ca  www.dairygoodness.ca www.dairygoodness.ca  www.hypertension.ca www.hypertension.ca

23. Healthy Eating “Station” The following slides will be referred to at “healthy eating” station with a chance to read labels.

24. Label reading  Learn how to read a label at Health Canada website www.hc-sc.gc.ca/fn-an/label- etiquet/nutrition/cons/interactive-eng.php  Label reading specific to sodium at Canadian Stroke Networks sodium 101 website www.sodium101.ca/en/takecontrol/reading labels.html www.sodium101.ca/en/takecontrol/reading labels.html

25. Shop Smart  Plan Meals Using Canada’s Food Guide  Use a shopping list  Don’t shop hungry  Periphery of the store  Read labels  Health Check Symbol on food

26. Shop Smart  Snacks, Cereals, Cookies  < 3 g Total Fat, <2 g Saturated & Trans Fat  < 200 mg Sodium (10% DV)  Cereals, Grains  > 3 g Fibre; Whole Grain 1 st Ingredient  < 4 g Sugar (For TG)  Frozen Dinners  < 600 mg Sodium

27. Shop Smart Ingredient List – watch out for:  Saturated and Trans Fat  Hydrogenated or Partially Hydrogenated Shortening  Saturated fats  Palm, Palm Kernel, Coconut, Tropical Oils  Lard, Tallow, Butter  Sodium  Salt, Flavoured Salts, Sea Salt, Sodium, MSG, Brine, Soy Sauce, Baking Soda, Baking Powder

28. Canadian Best Practice Recommendations for Stroke Care, updated 2008 www.canadianstrokestrategy.ca