Cardiovascular diseases: hypertension and atherosclerosis
Hypertension is blood pressure of 140/90 mmHg or more; atherosclerosis is fatty plaque narrowing the arteries. Both need less salt, less saturated and trans fat, more fibre and potassium.
At a glance
Draw it: how a plaque forms
Antioxidant-rich foods, fibre and less saturated and trans fat slow this process.
Dietary principles
| Nutrient | Recommendation | Why |
|---|---|---|
| Sodium | Salt under 5 g a day; no added salt at the table; avoid salty processed foods | Salt holds water and raises BP |
| Potassium, calcium, magnesium | Plenty of vegetables, fruits, pulses, low-fat milk, nuts (DASH pattern) | Potassium helps excrete sodium and relaxes vessels |
| Energy | To reach a healthy weight and waist | BP falls as weight falls |
| Fat | 20-30% of energy; saturated fat under 7-10%; trans fat under 1% (WHO); cholesterol under 200 mg a day; use a mix of oils | Saturated and trans fats raise LDL; trans fat also lowers HDL |
| Omega-3 fats | Fish twice a week; flaxseed, walnuts, mustard or soybean oil | Lower triglycerides and protect the heart |
| Fibre | 25-40 g a day, with 10-25 g soluble fibre (NCEP): oats, barley, pulses, methi, guava, apple | Soluble fibre binds cholesterol and bile acids |
| Alcohol and smoking | Avoid | Both raise BP and damage arteries |
Foods to include and avoid (with hidden salt)
| Food group | Include | Avoid or limit |
|---|---|---|
| Cereals | Whole wheat, oats, barley, millets, brown or hand-pounded rice | Bread, biscuits and bakery items (salt and baking soda), instant noodles |
| Protein foods | Dals, sprouts, toned milk, curd, egg white, fish, chicken without skin | Red meat, organ meats, processed meats, salted dried fish, cheese, full-fat milk |
| Vegetables and fruits | Greens, tomato, carrot, beans, cucumber; banana, orange, guava, papaya, amla | Pickles, salted vegetables |
| Fats and oils | Small amounts of groundnut, sesame, mustard, rice bran or soybean oil, in rotation | Vanaspati, ghee, butter, coconut oil in large amounts, deep-fried foods, re-used frying oil |
| Hidden salt | Herbs, lemon, garlic, pepper, jeera for taste | Papad, chips, namkeen, salted nuts, sauces, ketchup, soup cubes, ajinomoto (MSG), salted butter, baking soda |
Sample one-day menu (heart-healthy, low-salt)
| Meal | Menu |
|---|---|
| Early morning | Tea with toned milk; 4-5 soaked almonds or walnuts |
| Breakfast | Oats or vegetable dalia upma with little salt; mint chutney |
| Mid-morning | Banana or orange |
| Lunch | Brown rice or phulka (2), dal, spinach poriyal, cucumber-tomato salad with lemon, curd |
| Evening | Sprouts sundal; buttermilk without salt, with jeera and coriander |
| Dinner | Jowar roti (2), grilled fish or rajma, mixed vegetable curry (little oil, little salt) |
| Bedtime | Toned milk |
In the cardiac ward, the dietitian can send small measured salt sachets instead of salting the food, so the patient learns what 5 g a day looks like. Teach families to read labels for 'sodium' and to cut papads, pickles and namkeen first.
2 marks: “What is the DASH diet?” Dietary Approaches to Stop Hypertension: a diet rich in fruits, vegetables, low-fat dairy, whole grains, pulses and nuts, and low in salt, saturated fat and sweets.
5 marks: “List hidden sources of sodium in the Indian diet.” Pickles, papad, chips, namkeen, salted nuts, bakery items with baking soda, sauces, ketchup, soup cubes, ajinomoto, cheese, salted butter, dried fish.
10 marks: “Discuss the causes, symptoms and dietary management of hypertension and atherosclerosis.” Define both with BP classification and lipid goals, risk factors, plaque diagram, principles table (salt, potassium, fat types, omega-3, fibre), foods, menu.
Heart diet = 'Less SALT, Less SAT, More FIBRE': salt under 5 g, saturated fat under 7-10%, trans fat near zero, fibre 25-40 g.