3. HEALTHYeating & living p1
Palau’s
HEALTHY
Eating & Active Living Guide
Acknowledgements
Palau’s Healthy Living Guide - Me Deluut Ra Koted was written by the Ministry of
Health’s Non-communicable Disease Unit in partnership with Ulekerreuil a Klengar,
Kotel A Deurreng, Palau Community Action Agency, Coalition for a Tobacco-Free
Palau, and the NCD Strategic Planning - Nutrition Working Group.
Photo on page 24 courtesy of: Chanelle Emaimelei Mikel
This resource guide was published in 2014.
For copies or for more information, contact the
MOH NCD Unit at 488-4612.
This resource guide is 100% federally funded by the
US Centers for Disease Control and Prevention (CDC)
“Me Deluut ra Koted”
4. Introduction
Non-communicable diseases (NCDs) are the leading causes of
premature death and disability in Palau. That is, heart disease,
stroke, diabetes, kidney disease, respiratory disease, and cancer
account for over 75% of deaths. NCDs are now imposing a
growing burden on our health systems and budget. Eighty
percent (80%) of all off-island medical referrals are NCD related,
costing us over $1,200,000 annually. This is a 45% increase from
the 2010 Medical Referral Program budget of $540,000. This is
not sustainable! All of us must take ownership of our health, and
work to reverse this unsustainable trend.
This booklet is designed to help the people in Palau live a
healthy life by being informed of what one needs to do to be
healthy and stay healthy. It also provides information about the
four (4) risk factors for NCDs; unhealthy diet, physical inactivity,
tobacco, and excessive use of alcohol. We urge you to take active
ownership of your health. Someone said that most people treat
their health like the way they treat their cars. They drive it until it
breaks down, and then take it to a mechanic to fix. Unlike
automobiles, we only have the one body and there are no spare
parts.
This resource is an important step forward to support us in
achieving “healthy communities with people living long, happy,
purposeful lives.”
Gregorio Ngirmang
Minister of Health
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5. Contents
About this guide ........................................................... p4
A guide to eating healthy ............................................ p5
• Eat from the 3 food groups
• How much should we eat?
• Foods to reduce - eat less sugar, salt and fat
• Food handling and storage
• Understanding food labels
• Drink water, stay hydrated
• Only breast milk for baby’s first 6 months
Live a healthy life ........................................................ p26
• Maintain a healthy weight
• Be physically active
• Types of physical activities
• Limiting substance use and abuse
• Alcohol use and abuse
• Tobacco use and quitting
More information ......................................................... p34
• Where to get more info
• Handy tips
• Estimated calorie needs
• Grow your own food
• Glossary
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6. About this guide
What is the guide about?
This guide is designed to support the people of Palau in living
healthy lives.
The Palau Healthy Eating and Active Living Guide is aimed at
community and health workers. This resource will support the
delivery of information to the community on the 4 major risk
factors of non-communicable diseases (NCD); unhealthy diet,
physical inactivity, tobacco and alcohol use.
Who should use this guide?
● Anyone interested in learning how to stay healthy and
preventing NCDs.
● Anyone who wants to know more information on what to eat
to stay healthy.
● Anyone who works with community members.
Want more information?
More information on the contents of this guide can be obtained
by contacting the Ministry of Health’s Non-communicable
Disease Unit at 488-4612 or 488-2212.
p4HEALTHYeating & living
7. A guide to
eating healthy
Eat from the 3 food groups
We all make choices everyday that have a direct effect on our
health. Among these choices is choosing a balanced and healthy
diet.
Our bodies need proper nutrition in order to function and
maintain its balance. We all have to eat healthy, balanced meals
containing a variety of foods every day from the 3 main food
groups. A healthy meal should:
● Include fruits and vegetables
● Include lean meats, poultry, fish, beans, eggs, nuts, and
fat-free or low-fat milk products
● Include ongraol such as taro, tapioca, rice, breadfruit, and
whole grains
1. Protective Food Group - Food in this group includes fruits
and vegetables. They protect our body from illness and diseases.
Fresh fruits ― Don't think just apples or oranges. All fresh fruits
are great choices. Be sure to eat fruits such as bananas,
pineapple and mango. When your favorite fresh fruits aren't in
season, try a frozen, canned, or dried variety of a fresh fruit you
enjoy. But be cautious about canned fruits because most contain
added sugars or syrups. If you choose canned fruits, be sure to
choose those packed in water or in their own natural juice.
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8. Fresh vegetables - All types of vegetables are essential in
every meal. Vegetables you eat may be fresh, frozen, canned or
dried and may be eaten whole, cut-up, or mashed. But the best
vegetables we can eat are fresh and locally grown.
We should eat a variety of dark green, red and orange
vegetables, as well as beans and peas. Examples include okra,
cucumber, carrots, cabbage, eggplant, green beans, spinach,
squash, sweet potatoes, tomatoes and kangkum.
What do they do? - Eating more vegetables and fruits as part
of a healthy diet likely reduces the risk of many diseases
including non-communicable diseases. Fruits and vegetables
provide nutrients that are essential for health and maintenance
of our bodies.
• Eating vegetables and fruits as part of an overall healthy diet
can reduce risk for heart disease, including heart attack and
stroke and may protect against certain types of cancers.
• Diets rich in foods containing fiber, such as some vegetables
and fruits, may reduce the risk of heart disease, obesity, and type
2 diabetes.
• Eating vegetables and fruits may also lower blood pressure.
• Eating vegetables will help reduce your overall calorie intake
as they are much lower in calories than other commonly eaten
food.
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9. 2. Energy Food Group - Food in this group (ongraol) are the
main source of energy for our bodies. They include foods rich in
carbohydrates and fiber such as taro, tapioca, breadfruit,
potatoes, oatmeal, bread, pasta, and rice.
Fiber comes from plant foods such as taro and tapioca. They
contain carbohydrates (carbs) that our body uses to make
glucose which is the fuel that gives you energy and helps keep
everything going.
What do they do? - A diet high in fiber helps to lower
cholesterol, control blood sugar levels, reduce weight, and
prevents some cancers.
Eating grains, especially whole grains also helps with
constipation, reduce the risk of heart disease and helps with
weight management.
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10. 3. Body Building Foods Group - Food in this group repair
and build our body cells and tissue. They include those rich in
protein such as fish, poultry, meat, eggs, milk and other dairy
products, seafood, beans, and nuts.
Protein ― Proteins (Odoim) are essential for our bodies. The
protein in the foods we eat replenishes proteins in our bodies.
Protein is found in the following foods:
● Meats, poultry, and fish ● Nuts and seeds
● Legumes (beans and peas) ● Milk products
● Tofu ● Eggs
What do they do? - Foods in the meat, poultry, fish, eggs, and
nuts group provide nutrients that are vital for health and
maintenance of our body. However, it is important to choose
foods from this group that are low in saturated fat and
cholesterol.
• Foods in this group contain many nutrients. These include
protein, B vitamins (niacin, thiamin, riboflavin, and B6), vitamin
E, iron, zinc, and magnesium.
• Proteins function as building blocks for bones, muscles,
cartilage, skin, and blood. They are also building blocks for
enzymes, hormones, and vitamins.
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11. 1/2 cup cooked or 1 cup uncooked
equals 1 serving.
How much
should we eat?
Healthy Foods - With fruits and vegetables, we should eat at
least 5 servings every day.
Vegetable serving size - A serving size of vegetable amounts to
1/2 cup if it is cooked or 1 cup if it is uncooked. Here are
examples of what 1 serving of vegetable amounts to:
4 or 5 long beans 1 cup shredded
cabbage
4 okras
1 small bunch
of nappa 1/2 cup of chopped
pumpkin or squash
1 medium
onion
1/2 cup cooked or
1 cup uncooked kangkum
1 eggplant1 corn
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12. Fruit serving size - A serving size of fruit equals to 1 cup if diced,
1 medium piece or 2 small pieces. Here are examples of what 1
serving of fruit amounts to:
1/4 medium papaya
or 1 cup shredded 1 guava 1 slice of watermelon
3 or 4 small
bananas 2 slices of pineapple 1/4 soursop
A handy tip...
You can estimate serving sizes using
your hand. 1 cup of fruit or uncooked
veggies is roughly the size of a balled
up fist. fist = 1cup
A cupped hand is equivalent to 1/2
cup or 1 serving of cooked vegetables.
cupped hand = 1/2 cup
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13. Protective food tips...
When it comes to fruits and vegetables, here
are some tips to keep in mind:
›› You should fill half your plate with mostly fruits
and vegetables every meal time
›› Choose different types and colors
›› Grow your own or buy fresh local produce
›› Eat vegetables with at least 2 meals per day
›› Have fruits for snacks instead of junk food
›› Frozen vegetables can also be eaten if
there are no fresh ones available
We should eat 5 servings of fruits and
vegetables everyday. Fill 1/2 of your
plate with fruits and vegetables every meal.
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14. Energy Foods - With energy foods, we should eat 5 to 8
servings with at least 1 ounce of fiber every day.
Ongraol & Carbs Serving Size - A serving size of energy food
is about 1/2 cup of foods in the energy group. Here are examples
of what 1 serving amounts to:
1/2 of medium Taro 1/2 of medium Tapioca
or 2 slices
1/4 of Breadfruit 1/2 of medium
Sweet Potato
1/2 cup cooked Rice
1 slice of Bread1/2 cup cooked Pasta1 medium Potato
A handy tip...
You can estimate serving sizes using
your hand. A cupped hand is
equivalent to 1/2 cup or 1 serving of
an energy food.
cupped hand = 1/2 cup
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15. Energy food tips...
When it comes to ongraol and carbs, here
are some tips to keep in mind:
›› Eat local ongraol such as brak, kukau (taro),
sweet potato, breadfruit, tapioca
›› Choose foods high in fiber including taro,
whole wheat grains, oatmeal, and breads
›› Eating more than the recommended amount
of carbs and starchy foods every day can cause
weight gain.
We should eat 5 - 8 servings of ongraol
everyday. Fill 1/4 of your plate
with energy foods during every meal.
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16. Body Building Foods - With body building food It is
recommended that we fill 1/4 of our plates with protein foods
(odoim) during every meal as part of a healthy and balanced
diet.
Odoim & Proteins Serving Size - Here are some examples of
what 1 serving of body building foods amounts to:
1 medium fish fillet 2 large eggs 1 small steak
1 small chicken
breast
1 glass of milk 1/2 cup or 4
ounces of tofu
1 small tuna can (3.5 oz) 2 slices of low fat cheese
A handy tip...
You can estimate serving sizes using
your hand. The palm of your hand is
equivalent to 1 serving of a
body building food.
palm = 1 serving
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17. Body building food tips...
When it comes to odoim and proteins, here
are some tips to keep in mind:
›› Eat fresh local fish and seafood
›› Prepare meats and poultry by trimming off
excess fat (especially pork and beef) and skin
›› Eat fresh fish, meats, and poultry instead of
canned and processed meats
›› Eat low fat varieties of cheese, milk and other
dairy products
We should eat 3-4 servings of odoim or
protein foods everyday. Fill 1/4 of your
plate with odoim during every meal.
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18. p16 HEALTHYeating & living
Foods to reduce
Salt, Sugar and Fat
Eating and drinking foods that are high in salt, sugar and fat can
cause many problems with our health. Most processed and
“junk” food such as potato chips, hotdogs, canned meat and
instant foods such as ramen noodles can contain a lot of salt,
sugar, and fat.
Drinks such as iced teas, sodas, and energy drinks also contain
high amounts of sugar that exceed our daily recommended
intake amount.
Cutting back on foods high in salt, sugar and fat can help us
manage our weight and reduce our risk of high blood pressure,
high blood sugar, heart attack, stroke, diabetes, some cancers
and kidney disease.
It is important that we eat mostly from the 3 food groups—
fruits and vegetables, ongraol and odoim for good health. Foods
that are high in salt, fat and sugar should only be eaten less often
and in small amounts. We should also avoid cooking with too
much salt, sugar and fat.
Sauces & Condiments
When it comes to taste, a lot of us choose to enhance the flavor
of our food with extra sauces and condiments. Consuming
excessive amounts of condiments such as salt, ketchup, soy
sauce and mayonnaise, is a dangerous habit that could lead to
major health problems in the long run.
Most condiments are high in sugar, salt and fat and will increase
the amount that is already present in the food we eat.
19. Eat less salt and monosodium glutamate (MSG)
Eating too much salt is a risk for high blood pressure. Sodium is
the harmful content of salt. Eating foods with too much MSG can
also trigger head and body aches and could pose long term
health threats.
Foods that contain high amounts of salt and MSG include:
● Soy sauce ● Instant Ramen
● Canned soups and meat ● Ajinomoto
● Accent ● Bouillon cubes
● Kim Chee ● Ketchup
● Potato Chips ● Processed meats
● Kool Aid Mix ● Pickles
We should eat less than 1 teaspoon of
salt everyday. This includes salt that is
already contained in foods.
Tips to eating less salt & MSG
When it comes to salt and MSG, here
are some tips to keep in mind:
›› Eat fresh fish, seafood and meats instead of
canned or processed meats.
›› Cook food without adding salt and MSG.
›› Choose “low sodium” or “no salt added”,
“no MSG” foods
›› Soak or wash canned vegetables before use.
›› Add herbs, spices, kingkang, garlic, ginger,
vinegar or chilies
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20. Eat less sugar and sugary foods
Along with salt and MSG, eating or consuming too much sugar
poses health risks. Too much sugar can lead to obesity that can
cause diabetes, liver disease and heart attack.
Additionally, added sugar in foods and drinks contain no
essential nutrients and can be bad for our teeth. It can also be
highly addictive and raises triglyceride levels.
Foods that contain high amounts of sugar include:
● Sugars and sweeteners ● Dried fruits
● Drink powders ● Cookies, cakes & pies
● Soft Drinks ● Jams and spreads
● Candy ● Fruit canned in syrup
● Ice cream & milkshakes ● Cereals
● Sauces & instant gravy
Sugary drinks
Despite being refreshing, most flavored drinks sold in stores
contain high amounts of sugars and additives that can be harmful
to our health and cause weight gain. Most sugary drinks contain
at least 10 teaspoons of sugar.
The following are major groups of sugary drinks:
Energy Drinks ― Energy drinks are usually labelled “energy
drinks” or “energy supplements” and contain high levels of sugar
and caffeine.
Iced Teas & Coffee ― Iced tea/coffee drinks contain added
sugar.
Soft Drinks ― Sodas or soft drinks are carbonated
sugar-sweetened drinks with high levels of sugar.
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21. Sports Drinks ― Sports drinks are marketed as drinks that
should accompany physical activity. They carry the label “sports
drink” and suggest that they should be consumed around
physical activity. These drinks are not suitable for children.
Fruit Drinks ― Fruit drinks are fruit-flavored beverages that
contain no more than 50% fruit juice. These products are labelled
as juice drinks, juice beverages, fruit cocktails, nectars, and
fruit-flavored drinks. While these drinks often have pictures of
fruits on the package, they may contain no actual fruit juice at all.
Flavored Water ― Flavored water products include
noncarbonated drinks described as a “water beverage” or
“vitamin water”. Typically, these products are clear and colorless.
Most flavored water products contain added sugars.
The amount of sugar we consume daily
should not exceed 10 teaspoons.
Tips to eating less sugar
Cutting back on sugar is better for our health, here
are some tips to keep in mind:
›› Avoid sugary drinks - soda, iced teas & coffee,
vitamin waters, fruit drinks, energy & sports drinks
›› Be careful– fruit drinks ARE NOT 100% fruit juice
›› Drink water or fresh coconut juice instead
›› Cut down on treats and dessert
›› Use natural sweetness in foods
›› Eat fruit for snacks
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22. Fats & Oils
Eating food high in bad fat clogs your arteries– like a clogged
pipe. This can lead to high blood pressure and high cholesterol,
causing heart attacks and strokes.
When it comes to fats and oils, it’s always a better choice to
cook with those that are made from olive, canola, vegetable ,
sunflower and local oil made from coconuts.
When cooking, we should avoid using animal products such as
butter and instead use margarine or vegetable shortening.
Cut down on saturated fats
Saturated fat is also referred to as the “bad fat” that mostly
comes from animal or processed foods.
Saturated fats can be found in fatty meat, canned meat, hot
dog, sausages, chips, french fries, burgers, mayonnaise, turkey
tail, fried food, cookies, cakes, ice cream and dessert.
Tips to eating less fatty foods
When it comes to fats and oils, here are some tips
to keep in mind:
›› Use vinegar, lemon juice, garlic and other herbs
with olive oil for salad dressings
›› Try BBQ, stir-fry, baking and steaming instead of
deep frying foods
›› Use margarine instead of butter
›› Choose reduced fat or low fat variety of foods
›› Cut down on eating meat and adding oil to foods
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23. Understanding Food labels
In addition to looking at the expiration date on food and drink
packages, we should also make it our habit to take the time and
look at the “Nutrition Facts” labels.
Apart from letting us know what ingredients or additives are
contained in food, food labels contain important dietary
information that we should pay attention to when choosing or
buying food.
Things to look for...
1. Serving size
2. Number of servings per
package/container
3. Amount per serving
According to the label on
the left, if you eat the entire
package, you will be eating
7 servings. This means that
the amount per serving is
multiplied by 7.
We should aim for less
than 10g of total fat; 3g of
saturated fat; and less than
300mg of sodium per
serving in all foods we
consume.
Tips for food labels
Paying attention to food labels helps you to:
›› Know what ingredients food contain
›› Work out how many calories and nutrients are in
foods
›› Compare products and pick healthier foods
›› Know how much salt, sugar and fats are in food
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24. Food handling and storage
When preparing and storing food, we should always keep
health and safety in mind. Food poisoning can cause illness that
ranges from mild to very severe . Gastrointestinal illness, such as:
vomiting and diarrhea, are common food borne illnesses in
Palau. Here are some ways we can prevent food poisoning:
Clean ― We should always wash our hands with soap and water
before and after food preparation. We should also keep cooking
utensils, equipment and surfaces clean and disinfected.
Cook ― All foods should be cooked completely, especially
poultry and meat products, which should be cooked until all
juices are clear.
Cover ― We should keep all foods covered and away from
insects and vermin.
Chill ― Foods should not be left at room temperature for more
than 2 hours. Leftover food should be refrigerated or kept in the
freezer.
Hot foods should be kept hot at over
140°F while cold foods should be kept
below 40°F.
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25. Drink water, stay hydrated
Staying properly hydrated is very important to our health. Our
body is made up of approximately 70% water. It is critical that we
keep ourselves hydrated to prevent illness and injuries.
Staying hydrated keeps our immune system strong and allows
our bodies to function properly throughout the day.
Instead of drinking sugary drinks, we should always drink water.
Clean Water ― When using water for drinking or cooking, it’s
important to also ensure that it is clean and uncontaminated.
Water should be boiled for at least 1 minute before use,
especially if it’s tap water or water stored in tanks.
We should drink 6 to 8 glasses (8 oz.)
of water everyday
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26. Breast feeding for babies
When it comes to babies, their best source of nutrition for their
first 6 months is natural breast milk. Breast feeding not only
benefits the baby, it’s also good for the mother as well.
What are the benefits?
For babies:
• Provides all energy
and nutrients to meet
baby’s needs
• Gives baby immunity
• Reduces risk of
asthma, rashes and
allergies
• Promotes speech
development and body
growth
• Protects baby from
future risk of being
overweight, obese and
reduces risk of NCDs like
diabetes, cancers, heart
attack and stroke.
For mothers:
• Decreases risk of breast and ovarian cancer
• Helps mother get back to pre-pregnancy weight
• Cheap and convenient- no need for clean bottles, water or
formula
• Exclusive breast feeding can be a natural form of birth control
• Helps form close bond with baby.
Only breast milk for baby’s first 6
months.
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27. Breast milk storage and use
Did you know that breastmilk can be pumped and stored for
later use?
How long will breast milk last?
directly into container =
6 - 8 hours
in a double container with
water in another container =
8 - 10 hours
stored in fridge =
3 - 5 days
stored in freezer =
3 - 6 months
Defrosted breast milk
Defrosted breast milk that has been stored in the freezer must
be stored in the fridge and must be used within 24 hours. If
power goes out, defrosted breast milk can be refrozen only
within 8 hours.
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28. Live a Healthy Life
Maintain a Healthy weight
Maintaining our weight is crucial in order to live a healthier life.
Keeping track of our weight allows us to prevent risk for illness
and diseases, especially noncommunicable diseases such as
heart disease, stroke, cancer, and diabetes.
We can maintain our weight by eating healthy and staying
active. Knowing your Body Mass Index (BMI) enables you to
adjust your diet and physical activities to achieve your weight
maintenance goals.
Nutrition/Calories ― We all have our personal calorie limit but
experts suggest that we should consume no more than 2000
calories per day. The amount of calories our body needs depends
on our:
• Height • Age • Gender • Physical activity level • Weight
Weight loss ― If we are overweight or obese, losing between
5% to 10% of our current body weight can improve your health.
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29. Tips to maintaining
a healthy weight
›› Change the way you eat if you’re not eating
healthy
• Eat a healthy breakfast every day!
• Eat slowly, enjoy every mouthful
• When eating out choose healthy meals and water
only
• Choose grilled or steamed foods and avoid
creamy sauces
• Ask for salad dressings on the side
• Choose water instead of a sugary or alcoholic
drinks
• Choose fruit and vegetables when hungry
• Drink water before and with your food.
›› Change what you do.
• Don’t shop when you’re hungry
• Listen to your body
• Stop when or before you feel your stomach is full
• Don’t over eat
• Plan healthy, quick and easy meals for busy days
• Never eat in front of the TV
• Don’t spend a long time sitting down
• Turn off the computer, TV or electronic device
• Be physically active every day in as many
ways as possible
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30. Be Physically Active
Being physically active everyday not only helps us maintain our
weight but also has many health benefits. Being active will help
you:
• Stay healthy • Look and feel good
• Help you sleep better • Relax
• Help maintain a healthy weight
• Decrease risk of diseases (i.e. hypertension and diabetes)
Types of activity ― When it comes to physical activity, not all of
us are into sports or exercise and some of us don’t have the time.
Luckily, physical activity is not just limited to sports or exercise
and includes a lot of other fun and practical activities.
Regular everyday activities such as gardening, sweeping, fishing
and walking can help us fulfil our daily physical activity needs.
Moderate Activities ― Walking briskly, biking on flat ground,
traditional dancing, farming, spear fishing. If you choose
moderate level activities, do at least 2 hours and 30 minutes of
that activity each week. This can be done at 10-minute intervals.
Vigorous Activities ― Jump rope, basketball, soccer,
swimming laps, fast dancing, zumba. If you choose to do vigorous
activities, do it at least 1 hour and 15 minutes a week. This can be
done at 10-minute intervals
We can also combine moderate and vigorous activities. 1 minute
of vigorous activity is equal to 2 minutes of moderate activity.
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31. Calories burned per activity
The following are types of activities and the number of calories
burned every 30 minutes for a 150lbs person:
• Hiking = 185 • Stretching = 90
• Light Gardening = 165 • Walking (3.5mph) = 140
• Dancing = 165 • Playing catch = 92
• Being intimate = 50 • Paddling = 128
• Softball/baseball = 183 • Dancing = 165
• Snorkelling = 183 • Jogging = 214
• Tennis = 257 • Swimming = 183
• Volleyball = 293 • Jump Rope = 293
• Spear fishing = 240-250 • Running (10mph) = 572
• Cooking/household chores = 92
Adults should have at least 30 minutes
and kids at least 60 minutes of
moderate physical activity everyday.
Tips for physical activity
The talk test during physical activity:
›› If you can comfortably talk, but not sing, you’re
doing moderate-intensity activity.
›› If you can only say a few words without gasping
for breath, this is vigorous-intensity.
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32. Limiting substance use
Alcohol use
Although alcohol is a legal substance for adults, its excessive
use and abuse can lead to many health and social problems.
Drinking too much alcohol can cause you to :
• Have a car crash and injure or kill yourself or someone else
• Get involved in violent or risky acts
• Smoke or use other drugs
• Operate vehicles and machinery while intoxicated
• Cause stress or trouble for others around you
• Get in trouble with the law
• Eat unhealthy foods
• Be less active
• Develop liver disease or cancer
• Cause worry for your family and friends
What should be my limit? - For men, the recommended limit
is 2 standard drinks per day. For women, it’s 1 standard drink a
day.
What is considered a standard drink? - The following
alcoholic beverages are considered equivalent to 1 standard
drink.
12fl. oz. of
regular beer
5 fl. oz. of
table wine
1.5 fl. oz. shot of
80-proof spirits
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33. What is excessive use of alcohol? - Excessive alcohol use
includes:
• Binge drinking • Heavy drinking
• Any alcohol use by • Underage drinking
pregnant women
What is binge drinking? - Binge drinking corresponds to 5 or
more drinks on a single occasion for men or 4 or more drinks on
a single occasion for women, generally within about 2 hours or
during one sitting.
What is heavy drinking? - For men, heavy drinking is typically
defined as consuming 15 drinks or more per week. For women,
heavy drinking is typically defined as consuming 8 drinks or more
per week
Do I have a drinking problem? - Drinking is a problem if it
causes trouble in your relationships, in school, at work, in social
activities, or in how you think and feel.
If you are concerned that either you or someone in your family
might have a drinking problem, consult your health care provider
or the Behavioral Health Division of the Bureau of Public Health
for assistance.
Tips for limiting alcohol use
The following are tips to keep in mind:
›› Keep track of how much you drink.
›› Pace yourself when you drink. Don’t drink more
than a drink per hour.
›› Don’t drink on an empty stomach. Eat some food
so the alcohol is absorbed slowly.
›› Find alternative activities instead of drinking. Find
new hobbies and interests that keep you busy.
›› Learn to say “no” to pressure and know your limit.
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34. Tobacco use
Using tobacco, in any form or amount, wether it’s smoking or
chewing harms nearly every organ of the body, causing many
diseases and negatively affects our health in general. Quitting
tobacco use has immediate as well as long-term benefits for you
and your loved ones.
What does tobacco do? - The risk of developing lung cancer
is about 23 times higher among men who smoke cigarettes and
about 13 times higher among women who smoke cigarettes
compared with never smokers.
Cigarette smoking increases the risk for many types of cancer,
including cancers of the lip, oral cavity, pharynx, esophagus,
pancreas, larynx (voice box), lung, uterine cervix, urinary bladder,
and kidney.
Smokers are 2 to 4 times more likely to develop heart disease
than nonsmokers and their risk of having a stroke is doubled.
Even nonsmokers who are exposed to second hand smoke are
at risk for heart disease and lung cancer.
Is tobacco use safe during pregnancy? - No. Tobacco use
during pregnancy causes health problems for both mothers and
babies, such as:
● Pregnancy complications ● Premature birth
● Low-birth-weight infants ● Stillbirth
● Sudden infant death syndrome (SIDS)
What does chewing betel nut with tobacco do? - The
following conditions and cancers have been associated with
using betel nut and tobacco
● Oral precancerous lesions, including erythroplakia (a reddened
patch in the mouth) and leukoplakia (a white patch on the
mucous membranes in the mouth that cannot be wiped off).
● Oral cancers—predominantly carcinomas of the lip, mouth,
tongue, and pharynx and cancer of the esophagus.
● Reproductive health outcomes such as increased risk of having
a low birth-weight infant.
● Nicotine addiction
p32 HEALTHYeating & living
35. How can I quit tobacco use? - A quit plan is key to your
success with quitting tobacco use. Develop a plan that suits your
needs:
1. Establishing your reasons for quitting.
2. Write down tips to help you quit and have them around when
you need them
3. Set your quit date.
4. Identify who can help you when you need support.
5. Adopt new skills and behaviors you’ll need to help you cope.
6. Ask your healthcare provider about medications that will help
you quit.
7. Be prepared for hard times and difficulties, including relapse.
Where can I get more info on how to quit tobacco? - For
general information on tobacco use, its health effects and more
information on how to quit tobacco use, contact the Behavioral
Health Division of the Bureau of Public Health.
Tips on tobacco use and quitting
When it comes to tobacco use, here
are some tips to keep in mind:
›› If you don’t use tobacco– don’t start
›› Keep in mind that every chew or puff is doing
you harm
›› Stop chewing or smoking tobacco during
pregnancy or breast feeding
›› Quitting tobacco is hard but not impossible
›› If you use tobacco and want to QUIT get help
p33HEALTHYeating & living
36. Want more info?
Nutrition
For more information about nutrition, contact the
Non-communicable Disease Unit at the Bureau of Public Health
at 488-4612. For information about home gardening and
farming, contact the Bureau of Agriculture at 622-5804.
Food handling and safety
For more information about food safety and food handling
certification, contact the Division of Environmental Health at
488-6073.
Physical activity
For more information about physical activity, contact the
Non-communicable Disease Unit at the Bureau of Public Health
at 488-4612 or for local sports and exercise programs, contact
the Palau National Olympic Committe at 488-4491.
Tobacco, Alcohol and other substance use
For more information about quitting alcohol and tobacco use,
contact the Behavioral Health Division at 488-1907.
p34 HEALTHYeating & living
37. Handy Tips...
You can estimate serving sizes of food
using your hands.
=
=
=
=
A cupped hand - Is
equivalent to 1/2 cup of
energy foods (ongraol).
A balled up fist - Is
equivalent to 1 cup for
fruits, vegetables and
dairy products.
A palm - Is equivalent
to 3 ounces of protein
food (odoim) or 1
serving of seafood,
chicken or meat.
=
A thumb - Is equivalent
to 1 tablespoon or 1
ounce.
Thumb tip - Is
equivalent to 1
teaspoon.
p35HEALTHYeating & living
40. Grow your own food
Seasonal fruits by month
January - Breadfruit, Cantaloupe, Cashew, Sweet Orange,
Tangerine, Pomelo, Football Fruit, Honeydew, Jackfruit,
Mango, Bignay, Giant Granadilla, Mangosteen, Papaya,
Dragon Fruit, Seeded Breadfruit, Sweetsop, Tamarind.
February - Cantaloupe, Cashew, Citron, Pomelo,
Honeydew, Giant Granadilla, Papaya, Dragon Fruit, Tamarind,
Watermelon.
March - Cantaloupe, Cashew, Citron, Pomelo, Honeydew,
Giant Granadilla, Papaya, Dragon Fruit, Tamarind,
Watermelon.
April - Cantalope, Cashew, Citron, Honeydew, Mango,
Japanese Sweet Melon, Papaya, Tamarind, Titiml,
Watermelon.
May - Breadfruit, Citron, Japanese Sweet Melon,
Sweetsop, Tamarind, Titiml.
June - Breadfruit, Avocado, Jackfruit, Mangosteen,
Sweetsop.
July - Breadfruit, Avocado, Jackfruit, Mangosteen, Papaya,
Dragon Fruit, Rambutan, Seeded Breadfruit, Sweetsop,
Watermelon.
August - Breadfruit, Avocado, Cashew, Football Fruit, Giant
Granadilla, Papaya, Dragon Fruit, Rambutan, Rollinia, Seeded
Breadfruit, Soursop, Watermelon, Pineapple.
Growing your own food not only feeds your family, it will save
you money, is good for the environment and can give you the
physical activity you need to stay healthy.
p38 HEALTHYeating & living
41. September - Cashew, Football Fruit, Giant Granadilla,
Papaya, Dragon Fruit, Pineapple.
October - Sweet Orange, Tangerine, Football Fruit.
November - Sweet Orange, Tangerine, Football Fruit.
December - Avocado, Sweet Orange, Tangerine, Jackfruit,
Mangosteen.
Year round fruits - Banana, Bilimbi, Lime (Big), Wort Lime,
Kinghang/Calamansi/Calamodin, Yellow Medium Lime,
Rangpur Lime, Aromatic Lime, Green Coconut, Mature
Coconut, Polynesian Chestnut, Star Fruit/Carambola,
Polynesian Almond, Palauan Plum, Wax Apple, Water Apple,
Maylay Apple, Passion Fruit, Soursop, Star Apple.
p39HEALTHYeating & living
42. Glossary
Blood Pressure - Blood pressure is the force of your blood
pushed against your main blood vessel walls. Some pressure is
needed to move blood around your body but when pressure is
too high it can lead to serious health problems.
Body building foods (odoim) - One of the 3 food groups.
Gives you protein to build muscle, and repair hair, skin etc. Dairy
foods (milk and cheese) give you calcium for strong bones, teeth
and nails. Choose local types like fish, chicken or eggs.
Body Mass Index (BMI) - Body Mass Index is calculated from
your height and weight to estimate body fat. The higher the
number the higher your risk of getting a noncommunicable
disease (NCD). What your BMI means: Less than 18.5 is
underweight; 18.5 less than 25 healthy weight; 25 less than 30
overweight; 30 less than 40 obese; Over 40 is very obese.
Calorie - Calories come from the food and drinks we eat. We
need calories to feed our body and make it work- like gas for a
car. Eating too many calories and not doing enough physical
activity causes weight gain. The average adult needs about 2000
calories per day. Calories are also called kilojoules.
Diabetes - High blood sugar gives symptoms of frequent
urination, increased thirst, and increased hunger. If left
untreated, diabetes can be serious causing heart disease, kidney
failure, amputation and damage to the eyes. Causes of diabetes
include: Obesity (BMI over 30) or extra body fat, lack of physical
activity, unhealthy diet, especially high in sugar and saturated
fat, and stress.
Energy foods (ongraol) - One of the 3 food groups. Important
source of energy known as carbohydrate. Eat more local ongraol like
taro, prak or tapioca that are high in fiber. Should be eaten with every
meal. Be careful not to eat too much as it can cause weight gain.
p40 HEALTHYeating & living
43. Fiber - Also called dietary fiber or roughage. It is found mainly
in fruits, vegetables, whole grains, seeds and legumes. Fiber
comes from plants and acts as roughage as your body can’t
digest it. Fiber helps to: prevent constipation, maintain bowel
health, lowers cholesterol, controls blood sugar levels, achieve
healthy weight, prevent some cancers. We should aim to have at
least 1 ounce of fiber every day.
High blood - Also called high blood pressure or hypertension,
can lead to heart attack, stroke and possible death. Poor lifestyle
habits can cause high blood pressure. Blood pressure of 140/90
is considered high blood. Causes of high blood pressure include:
Tobacco use, being overweight or obese, not being active, eating
salty foods and adding salt to foods, drinking alcohol, stress, and
kidney disease.
Local foods - Food or drink grown or caught locally. This
includes traditional food and food that has been introduced to
the island. Can include vegetables, fruit and animals or fish
caught and slaughtered here in Palau.
Mono-unsaturated fat - Also called a “healthy fat”. Is a type of
unsaturated fat. These fats are liquid at room temperature.
Comes from plant sources, like canola oil, olive oil, nuts, and
avocados. Replacing unhealthy saturated fats with
monounsaturated fats helps to lower cholesterol.
Non-communicable diseases (NCDs) - Also called Chronic
illness. A medical condition or disease that you cannot catch but
rather occurs due to poor lifestyle habits like tobacco use,
alcohol consumption, poor diet or lack of physical activity. These
include: cancer, diabetes, heart attack and stroke. High blood
pressure, high blood sugar, cholesterol and overweight and
obesity are early warning signs of NCD.
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44. Poly-unsaturated fat - Also called a “healthy fat”. Is a type of
unsaturated fat. These fats are liquid at room temperature.
Come from plant sources, like: vegetable oil, canola oil, flaxseed
oil and fatty fish. Eating fatty fish, like tuna, decreases risk of
heart disease.
Protective foods - Vegetables and fruit. One of the 3 food
groups. This food group provides you with essential vitamins and
minerals that your body needs to help it work and build your
immunity so that you don’t get sick. This group are very low in
energy (calories). Aim to eat 5 servings a day.
Salt - Also known as Sodium Chloride. Traditionally used to
preserve foods it is now food in high amounts of packaged and
canned foods. Too much salt causes high blood pressure. Sodium
is the unhealthy part of salt. Aim to eat no more than 1 teaspoon
per day.
Saturated fat - Considered a “bad fat”. Found in foods that
come from animalsespecially cows and pig, including: fatty meat,
cream, butter, cheese, mayonnaise. This fat is solid at room
temperature. A diet high in saturated fat causes build-up of
plaque in arteries causing high blood pressure, high cholesterol
and obesity.
Sodium - Sodium is part of salt - sodium chloride. We need
very small amounts of sodium to help regulate fluid in our body
and nerve and muscle contraction. Too much sodium causes high
blood pressure, heart attack and stroke. Aim for no more than
2000 mg sodium per day. This equals 1 teaspoon of salt.
Unsaturated fat - Also called “Good or healthy fat”, include:
poly-unsaturated and monosaturated fat. These fats can help to
reduce risk from heart disease and lower cholesterol.
Unsaturated fats are liquid are room temperature. Replace bad
fats (saturated) with good fats (unsaturated).
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