Question

Robert Reid, a 48-year-old African American computer programmer, is 5 feet 9 inches tall and weight 240 pounds. He sits for long hours at work and is too tired to exercise when he gets home at night. His meals usually includes fatty meats, eggs, and cheese, and he likes dairy desserts such as pudding and ice cream. He has a family history of CHD and HTN. His recent laboratory tests show that his blood pressure is 160/100 mmHg, and LDL and HDL levels are 160 mg/dl and 35 mg/dl, respectively. He smokes a pack of cigarettes each day and usually has two glasses of wine at both lunch and dinner.

What dietary changes would you recommend that could help to improve Nr. Reid’s blood pressure and his LDL cholesterol? Explain the rationale for each dietary change. Prepare a day’s menu for Mr. Reid using the DASH eating plan as an outline for your choices?

Answer 1

Patients BMI is 35.44 kg/m2   (Obese Class II)

Foods to reduce blood pressure, reduce LDL and increase HDL.

A. Limit the intake of foods full of saturated fats, trans fats, and dietary cholesterol

Restrict the intake of foods with a lot of saturated fat like butter, fatty red meat or organ meats, full-fat and low-fat dairy products, palm oil, and coconut oil, egg yolks, and shellfish.

Avoid foods with trans fats (partially hydrogenated fat in the Ingredient List of a food label) like bakery items.

Improve intake of omega-3 fatty acids to provide protection against heart disease. Best sources are cold-water fish like salmon, mackerel, halibut, trout, herring, and sardines.

Include nonfat dairy foods in the diet, only 2 servings daily.

Limit the intake of meat, poultry, and fish to no more than 3.5 to 4 ounces per day.

B. Increase the intake of fibre-rich foods mainly soluble fibre

Include foods oats, oat bran, barley, peas, yams, sweet potatoes and other potatoes, as well as legumes or beans, such as pinto beans, black beans, garbanzo beans, and peas in the diet as they are the rich source of fibre.

The best Vegetable sources of soluble fibre include carrots, Brussels sprouts, beets, okra, and eggplant.

The best fruit sources are berries, passion fruit, oranges, pears, apricots, nectarines, and apples.

Foods naturally rich in soluble fibre are effective in lowering cholesterol.

C. Plant sources of protein-

The pertinacious legumes include lentils, peas, and beans, such as pinto beans, red beans, white beans, and soybeans.

They are the healthy protein-packed alternative to meat. Legumes help in lowering LDL cholesterol, non-HDL cholesterol like triglyceride.

Nuts and seeds will improve HDL level and lower LDL cholesterol levels.

To reduce blood-pressure limit salt intake as the increased salt in the body will hold more water and which in turn increases the cardiac workload.

To avoid gaining weight limit the intake of nuts to 1 ounce daily as they are dense with calories.

D. Reduce excess weight

Losing excess weight will help in improving the cholesterol profile.

DASH stands for Dietary Approaches to Stop Hypertension or high blood pressure.

On DASH the dietary sodium should be reduced either 2,300 or 1,500 milligrams a day, depending on the health, age, race, and medical conditions.

• Choose low- or no-sodium foods and condiments.
• Eat foods that are cured, smoked, or pickled with caution.
• Limit the intake of processed foods.
• Increase your physical activity
• Quit smoking
• Lose weight
• Drink alcohol in moderation

Daily diet plan for Mr Reid based on DASH diet

Breakfast

• 1 store-bought whole-wheat bagel with 2 tablespoons peanut butter without salt added.
• 1 medium apple
• 1 cup fat-free milk
• Decaffeinated coffee

Lunch

• Curried chicken wrap made with:
  • 1 medium whole-wheat tortilla
  • 2/3 cup cooked, chopped chicken, about 3 ounces
  • 1/2 cup chopped apple
  • 1 1/2 tablespoons light mayonnaise*
  • 1/2 teaspoon curry powder
• 1/2 cup, or about 8, raw baby carrots
• 1 cup fat-free milk

Dinner

• Herb-crusted baked cod, 3 ounces cooked or about 4 ounces raw
• 1/2 cup brown rice pilaf with vegetables
• 1/2 cup fresh green beans, steamed
• 1 small sourdough roll
• 2 teaspoons olive oil
• 1 cup fresh berries with chopped mint
• Herbal iced tea

Snack ( A.M. or P.M )

• 1 cup fat-free, low-calorie yoghurt
• 4 vanilla wafers