1. Hypertension, Cardiovascular Disease, Diabetes

2. 34% of Americans 36% of Americans

3. Video http://www.youtube.com/watch?v=jvE6at_i_T w&feature=related http://www.youtube.com/watch?v=jvE6at_i_T w&feature=related Volume (Cardiac Output-CO) Sodium Increased intake, increased volume Potassium Balances high blood sodium, promotes kidney excretion of sodium

4. Video Rate-Resistance Effects heart muscle cells, rhythmic beating Calcium Magnesium Potassium Hypertension affects: Blood vessels Kidneys Eyes Brain

5. 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 Sodium 2400 → 1500 mg/day

7. 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

8. Nutrition Related Modifiable Risk Factors Obesity Elevated LDL, Cholesterol, Triglycerides Low HDL Hypertension Diabetes Smoking Family history

9. 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

10. 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 60 - high Triglycerides < 150 mg/dL

11. 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

12. Plant Stanols/Sterols Modified triglyceride that prevents fat/cholesterol absorption Margarine like product 2 servings a day

14. 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

15. Diet Response to diet varies per individual Response depends on patient compliance 6-8 weeks

16. Impact on LDL and HDL LDL CholesterolHDL Cholesterol Weight Loss↓↑ High Saturated Fat↑─ High Trans Fat↑─ High Soluble Fiber↓─ Smoking─↓ Regular Exercise─↑ Moderate Alcohol─↑ Plant Sterols↓─

17. Insulin From pancreas or injection CHO from diet, glycogen Blood Glucose (blood sugar) + Insulin Cells Diabetes- Blood Glucose

18. Hyperglycemia Elevated fasting blood glucose (sugars) Labs Normal- 70-110 mg/dL Pre-diabetes- 100-125 mg/dL Diabetes > 126 mg/dL fasting

19. 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

20. 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

21. 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

22. 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