Role of Diet in Hypertension,
Anemia, Rickets, Osteomalacia

Dr.Rittu Chandel
Dr. Rittu Chandel,Grant Government Medical C...
HYPERTENSION
• Leading causes of global burden of disease
• Approximately 7.6 million deaths a year and 92 million
Disabil...
HYPERTENSION
• ↑ salt intake, simultaneous ↓ potassium
intake
Expansion of extracellular fluid

•

↑ Cardiac Output

Autor...
BLOOD PRESSURE CLASSIFICATION
Systolic

mmHg

Diastolic

Normal

<120

And <80

Pre Hypertension

120-139

Or 80-89

Hyper...
Dr.Rittu Chandel

5
Quit smoking

Dr.Rittu Chandel

6
DASH DIET (DIETARY APPROACHES TO STOP
HYPERTENSION)

• DASH diet formed the basis for the new USDA MyPyramid
• Also adopte...
8
DASH Diet
DASH Diet
– Dietary Approaches to Stop Hypertension
– Promotes fruits, vegetables, whole grains and low fat dair...
Magnesium
• Evidence suggests an association between lower dietary
magnesium intake and high blood pressure
• Not enough e...
•

•
•
•

1 tsp salt = 6 grams and contains about 2400 mg. of sodium (and 3600 mg. of
chloride).
Recommendation: everyone ...
Dr.Rittu Chandel

12
POTASSIUM
• POTASSIUM INTAKE IS CRITICAL.
• A good balance between potassium & sodium is 3/1.
• For 1500 mg. sodium one sh...
Dr.Rittu Chandel

14
POTASSIUM
•

Potatoes

• Soups with natural meat broth and veggies, tomatoes
• Fish -- halibut, salmon, flounder, tuna are...
Garlic

its bioactive sulphur compound S-allyl cysteine sulphoxide (SACS) antihypertensive and cardioprotective activities...
CHOCOLATE -Possibly Effective for
Hypertension (Nat. Med.Database)
Dark or milk chocolate 46-105 grams/day,
-provides 213-...
• A 45-year-old woman
• a 3-month history of generalized body pains that were
nonresponsive to analgesic agents
• low back...
An anteroposterior radiograph of the pelvis showed an undisplaced transverse fracture of the
shaft of both femurs .
Dr.Rit...
Rickets

Dr.Rittu Chandel

20
Rickets and Osteomalacia
Calcium
Dairy products- milk, yogurt and cheese are all good sources of
calcium.
Pulses, nuts, dr...
• Chronic alcoholic are more predisposed to Vit D def
• Chronic ingestion of ethanol deficiency
• Stimulates hepatic Cyto ...
Dr.Rittu Chandel

23
Prevalance of anaemia

Dr.Rittu Chandel

24
Dr.Rittu Chandel

25
Dr.Rittu Chandel

26
unprocessed whole foods
fresh fruits and vegetables, unrefined grains,
lean animal protein, legumes, nuts, seeds and
beans...
• Cobalamin – fish, meat and dairy products
• Folate – liver, spinach, nuts

• Vitamin C - fruits and vegetables
• It's be...
• Plants are generally not good sources because of oxalate,
phytate, tannins
• Other -carbonates, phosphates
•
- tea (redu...
THANK YOU

Dr.Rittu Chandel

30
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Role of diet in hypertension, anemia,

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Role of diet in hypertension, anemia,

  1. 1. Role of Diet in Hypertension, Anemia, Rickets, Osteomalacia Dr.Rittu Chandel Dr. Rittu Chandel,Grant Government Medical College, Mumbai 1
  2. 2. 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 Dr.Rittu Chandel 2
  3. 3. HYPERTENSION • ↑ salt intake, simultaneous ↓ potassium intake Expansion of extracellular fluid • ↑ Cardiac Output Autoregulation - ↑ Peripheral resistance Dr.Rittu Chandel 3
  4. 4. BLOOD PRESSURE CLASSIFICATION Systolic mmHg Diastolic 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 mmHg And <90 Dr.Rittu Chandel 4
  5. 5. Dr.Rittu Chandel 5
  6. 6. Quit smoking Dr.Rittu Chandel 6
  7. 7. 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 Dr.Rittu Chandel 7
  8. 8. 8
  9. 9. 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 Dr.Rittu Chandel 9
  10. 10. 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 • vasodilator Calcium • 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) Dr.Rittu Chandel 10
  11. 11. • • • • 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. Dr.Rittu Chandel 11
  12. 12. Dr.Rittu Chandel 12
  13. 13. 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 Dr.Rittu Chandel 13
  14. 14. Dr.Rittu Chandel 14
  15. 15. 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 Dr.Rittu Chandel 15
  16. 16. Garlic its bioactive sulphur compound S-allyl cysteine sulphoxide (SACS) antihypertensive and cardioprotective activities Dr.Rittu Chandel 16
  17. 17. 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 Dr.Rittu Chandel 17
  18. 18. • 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). Dr.Rittu Chandel 18
  19. 19. An anteroposterior radiograph of the pelvis showed an undisplaced transverse fracture of the shaft of both femurs . Dr.Rittu Chandel 19
  20. 20. Rickets Dr.Rittu Chandel 20
  21. 21. Rickets and Osteomalacia Calcium 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 sunlight cod liver oil, egg yolks, butter and oily fish Dr.Rittu Chandel 21
  22. 22. • Chronic alcoholic are more predisposed to Vit D def • Chronic ingestion of ethanol deficiency • Stimulates hepatic Cyto P450 • Accelerated bio degradation of Vit D Dr.Rittu Chandel 22
  23. 23. Dr.Rittu Chandel 23
  24. 24. Prevalance of anaemia Dr.Rittu Chandel 24
  25. 25. Dr.Rittu Chandel 25
  26. 26. Dr.Rittu Chandel 26
  27. 27. 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 Dr.Rittu Chandel 27
  28. 28. • 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 Dr.Rittu Chandel 28
  29. 29. • 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 Dr.Rittu Chandel 29
  30. 30. THANK YOU Dr.Rittu Chandel 30

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