Dr.Rittu Chandel 1

Role of Diet in Hypertension, Anemia, Rickets, Osteomalacia

Dr. Rittu Chandel,Grant Government Medical College, Mumbai

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HYPERTENSION

• Leading causes of global burden of disease• Approximately 7.6 million deaths a year and 92 million

Disability Adjusted Life Years• Doubles the risk of Congestive Heart Failure, Cardiovascular

Diseases, Stroke, Renal failure• Man is the only animal suffering from hypertension• INTERSALT study -1988

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HYPERTENSION

• ↑ salt intake, simultaneous ↓ potassium intake

Expansion of extracellular fluid

• ↑ Cardiac Output

Autoregulation - ↑ Peripheral resistance

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BLOOD PRESSURE CLASSIFICATIONSystolic mmHg Diastolic mmHg

Normal <120 And <80

Pre Hypertension 120-139 Or 80-89

Hypertension Stage 1 140-159 Or 90-99

Hypertension Stage 2 ≥ 160 Or ≥ 100

Isolated Systolic Hypertension

>140 And <90

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Dr.Rittu Chandel 6Quit smoking

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DASH DIET (DIETARY APPROACHES TO STOP HYPERTENSION)

• DASH diet formed the basis for the new USDA MyPyramid

• Also adopted by:• The National Heart, Lung, and Blood Institute

• The American Heart Association

• The 2005 Dietary Guidelines for Americans

• US guidelines for treatment of high blood pressure

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DASH Diet

DASH Diet– Dietary Approaches to Stop Hypertension– Promotes fruits, vegetables, whole grains and low fat dairy

products– Adequate Calcium, Potassium, Magnesium– Low in red meat, sweets and sugar beverages

DASH Reduces Homocysteine Levels

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Magnesium• Evidence suggests an association between lower dietary

magnesium intake and high blood pressure• Not enough evidence exists to justify a recommendation of

increased Mg intake• vasodilatorCalcium• American Heart Association Statement

– Increasing calcium intake may preferentially lower blood pressure in salt-sensitive people

– Benefits more evident with low initial calcium intakes

(300-600 mg/day)

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• 1 tsp salt = 6 grams and contains about 2400 mg. of sodium (and 3600 mg. of chloride).

• Recommendation: everyone reduce daily sodium intake to 2400 mg. • Those with high blood pressure get only a modest decrease at 2400 mg • For significant results sodium to 1500 mg. a day.

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POTASSIUM

• POTASSIUM INTAKE IS CRITICAL. • A good balance between potassium & sodium is 3/1.• For 1500 mg. sodium one should aim for 4500 mg. potassium. • Clinical trials and meta-analyses indicate potassium (K)

supplementation lowers BP• 2005 Dietary Guidelines 4.7 grams/day

9 - 10 servings of fruits and vegetables

1.Reduces peripheral vascular resistance by direct arteriolar dilatation

2.Increase loss of water and sodium from body

3.Suppression of renin angiotensin secretion

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POTASSIUM

• Potatoes

• Soups with natural meat broth and veggies, tomatoes

• Fish -- halibut, salmon, flounder, tuna are rich in K+

• International cuisines..lentil soups, chick peas, black beans

• Fruits - berries, bananas, citrus, melons, grapes, raisins, apricots

• Nuts - peanuts, almonds

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Garlic

its bioactive sulphur compound S-allyl cysteine sulphoxide (SACS) - antihypertensive and cardioprotective activities  

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CHOCOLATE -Possibly Effective for Hypertension (Nat. Med.Database)

Dark or milk chocolate 46-105 grams/day, -provides 213-500 mg of cocoa polyphenols,

-modestly lowers systolic by 4.7 mmHg and -diastolic by 2.8 mmHg in normo- and hypertensive people.• Kuna Indians

activation of nitric oxide and antioxidant and antiinflammatory effects

After oral intake of cocoa, both the flavanol content and the total antioxidant capacity in plasma increase

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• A 45-year-old woman • a 3-month history of generalized body pains that were

nonresponsive to analgesic agents• low back pain, progressive difficulty in getting up from sitting

and supine positions and in walking• no history of trauma or any medication intake• wears a black veil outdoors and is completely covered, with

little exposure to the sun, even in her courtyard

On examination• a waddling gait with painful movements of both thighs• serum calcium level = 8.4 mg per deciliter• phosphate level 1.5 mg per deciliter• alkaline phosphatase level 916 U per liter • the 25-hydroxyvitamin D level 9 nmol per liter (reference range,

18 to 100).

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An anteroposterior radiograph of the pelvis showed an undisplaced transverse fracture of the shaft of both femurs .

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Rickets

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Rickets and Osteomalacia

Dairy products- milk, yogurt and cheese are all good sources of calcium.

Pulses, nuts, dried fruit and green vegetables, such as spinach, provide calcium

In the UK, white flour is fortified with calcium

Vitamin D

Calcium

sunlightcod liver oil, egg yolks, butter and oily fish

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• Chronic alcoholic are more predisposed to Vit D def

• Chronic ingestion of ethanol deficiency

• Stimulates hepatic Cyto P450

• Accelerated bio degradation of Vit D

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Prevalance of anaemia

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unprocessed whole foods

fresh fruits and vegetables, unrefined grains, lean animal protein, legumes, nuts, seeds and beans

The foods with the highest iron content, containing a minimum of 5 mg of iron per serving, are kidney beans, liver and beef, oysters, rice bran, raw beet , mustard

Dried apricots, dates, cooked spinach, peas and lean meats are moderately high in iron

1.8 mg iron must be absorbed daily

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• Cobalamin – fish, meat and dairy products• Folate – liver, spinach, nuts

• Vitamin C - fruits and vegetables• It's best to combine vegetables with fish, as that

combination is thought to produce a synergetic effect and maximize iron absorption.

• In U.S., 20 mg iron added/lb of flour

• Baked bread contains ~28 mg iron/kg

• Equivalent to the iron content of beef

• Iron cooking pots

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• Plants are generally not good sources because of oxalate, phytate, tannins

• Other -carbonates, phosphates

• - tea (reduces absorption by 50%)

• - EDTA ( food preservative – reduces absorption by 50%)

• - egg yolk ( phosvitin)

• Spinach has a lot of iron, but has ~780 mg oxalate/100 g

Heme iron absorption from diet not affected by ascorbate or phytate

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THANK YOU