NUTRITION INSIGHTS-MAY ISSUE 2023

DIABETES AND BP

Find out how they are linked to each other?

DOES YOGA HELP IN HYPERTENSION?

Learn its impact on stress

BERRIES AND CINNAMON

Discover their health benefits

Hypertension

DID YOU KNOW ABOUT THE "DASH" THERAPY?

Read to know more

HOW CAN YOU CONTROL YOUR BP?

Find out the most effective ways to counter it

TESTING BLOOD PRESSURE

Understand and learn how to test your blood pressure

TEAM

EDITOR-IN-CHIEF/ BANSARI RAO

CO-EDITORS / SONU MISHRA, DR. DVIJ MEHTA

WEBSITE / NUTRITIONINSIGHTS.IN

CONTRIBUTORS / DR. GEETA DHARMATTI / DR. DVIJ MEHTA / ZANKHNA SHETTY / SRISHTI SAHA / CHARMI THAKKER / RIDDHI

SHAH / DR. MANSI PATIL / MEGHA KAPOOR / SHILPA CHADHA

THAKUR / DR. NEHA SANWALKA RUNGTA / NANDITA DHANAKI / RABIA MISTRY MULLA / RESHMA BHATKAR / SAMIKSHA MALUSARI / PALLAVI SAWANT PATWARDHAN/

IMAGE BY <A HREF="HTTPS://WWW FREEPIK COM/FREE-PHOTO/TOP-VIEW-TENSIOMETER-CHECKING-BLOODPRESSURE 44119345 HTM#QUERY=HYPERTENSION%20TENSIOMETER&POSITION=39&FROM VIEW=SEARCH&TRACK=ROBERTAV1 2 SIDR #POSITION=39&QUERY=HYPERTENSION%20TENSIOMETER">FREEPIK</A>

FLAT NO. 209 C WING INDRAPRASTHA 1

BLDG JITENDRA ROAD, PLOT 1 NEAR

ASHOKA HOSPITAL MALAD (E), MUMBAI, MUMBAI CITY, MAHARASTRA, 400097, INDIA

Phone - +91-9867299172

Email - nutritioninsights01@gmail.com

By Dr. Geeta Dharmatti

Zankhana V Shetty

Riddhi Shah

Megha Kapoor

Dr Mansi Patil

PATHOPHYSIOLOGY OF HYPERTENSION

RegisteredDieticianand

ConsultantNutritionist

FounderDirector:Geeta

NutrihealConsultancy

Pune

Hypertension is a major public health issue in India It is estimated over 1 6 million annual deaths account for 10.8% of the total moralities and 4.6% of disabilityadjusted life years1. Management of Hypertension in Indian Subjects is the management of risk factors through a combination of treatment approaches(2) The fourth National Family Health Survey reported hypertension in 13 8% of men vs 8 8% of women aged 15–49 and 15–54, respectively(3)

Hypertension is the result of many factors that interact to raise blood pressure and cause end organ damage. In 1940 Dr Page proposed the Mosaic Theory of Hypertension which in current concept is modified to a new concepts of oxidative stress, inflammation genetics , sodium homoesostasis and microbiome(4)

Diagram depicting revised Mosaic Theory incorporating a new understanding of environmental, genetic, and cellular mechanisms. This also depicts the interplay of factors like inflammation, oxidative stress, microbiome with PNIE (pituitary, neuro, immune and endocrine) function

With this theory of inflammatory, oxidative, and metabolic stress affecting vascular health, nutritional factors play a large role not only in reducing the risk but also post-diagnosis. Studies state DASH diets (Dietary Approaches to Stop Hypertension), a diet rich in fruits and vegetables can lower the risk of high blood pressure5 Much evidencebased research supports the management of hypertension with diet and lifestyle

Dr.GeetaDharmatti

Hypertension, usually referred to as high blood pressure, affects a significant percentage of the global populace It is characterized by consistently high blood pressure levels, which can cause several cardiovascular consequences if not managed. It is important to understand the physiology of hypertension, blood pressure regulation, and the pathophysiological factors that contribute to it

Blood pressure regulation

Many different physiological processes interact together to regulate blood pressure. An individual's heart, blood vessels, and kidneys are critical to maintaining normal blood pressure The heart is responsible for pumping blood throughout the body, creating systolic pressure as the heart muscle contracts and diastolic pressure when the heart is at rest. Blood pressure, which is the pressure of the blood on the walls of the arteries (blood vessels), is affected by factors such as peripheral resistance and heck lood and m to

System of Sympathetic Nerves (SNS)

The sympathetic and parasympathetic branches of the nervous system are responsible to control blood pressure. The sympathetic branch is activated during times of stress or physical exertion, which results in vasoconstriction (narrowing of the blood vessels) and an increase in heart rate In contrast, the parasympathetic branch provides relaxation and vasodilatation (widening of the blood vessels) helping to lower blood pressure. The SNS comes into play for short-term blood pressure regulation like when faced with stress or other stimuli The SNS releases norepinephrine, which binds to receptors on blood vessels causing vasoconstriction and raising blood pressure Additionally, the SNS prompts the heart to beat faster and contract more forcefully, boosting cardiac output.

Renin-Angiotensin-Aldosterone System (RAAS):

The RAAS is a vital player in blood pressure regulation When the blood pressure falls, special cells in the kidney release an enzyme called renin. Renin acts upon angiotensinogen, a protein, converting it into angiotensin I.

BY DR. DVIJ MEHTA MBBS, CDE

HYPERTENSION AND DIABETES MELLITUS

Zankhana V Shetty

Diabetes Educator

Fortis Hospital, Mulund

Diabetes and hypertension prevalence is increasing in India and they are overlapping each other. Obesity and a sedentary lifestyle are the major cause of both diabetes and hypertension in India The recommended blood pressure target is usually below 140/90mmHg for people with diabetes For diagnosis of hypertension in people with diabetes as per the position statement released by the American Diabetes Association (ADA) in 2021 cut-off of 140/90 mm Hg. Hypertension is the silent killer. Nearly two-thirds of adults with diabetes have blood pressure greater than 130/80 mm Hg or taking medications for hypertension and one-third of people with high blood pressure are unaware of it Hence your blood pressure is one of the most important markers of health, especially for a person with diabetes. Hypertension and diabetes are components of metabolic syndrome. Diabetes and hypertension often go hand-in-hand as both are lifestyle diseases High blood pressure affects two times more people with diabetes than normal people

Why is controlling blood pressure important for people with diabetes?

Uncontrolled High blood sugar levels can cause high blood pressure and high blood pressure can cause organ damage to the eye, heart, brain, and kidneys

There is a strong link between diabetes and hypertension They share common metabolic pathways such as sympathetic nervous system fight or flight response, Renin- AngiotensinAldosterone-System(RAAS), oxidative stress, resistance, and regulation of inflammation, these pathways will interact with others and form a vicious twin cycle Nitric oxide helps in expanding the blood vessels And high sugar will inhibit NO which leads to the narrowing of the blood vessel and cause high blood pressure. There is a strong genetic influence in the development of diabetes, hypertension, and metabolic syndrome

HTN In Pediatric

SRISHTI SAHA

MSC CLINICAL NUTRITION, NET,SET

Prevalence of Pediatric Hypertension:

Recent data from national surveys shed light on the increasing prevalence of hypertension in children and adolescents. In the United States, the prevalence of prehypertension or hypertension among teenagers has risen by 38% compared to previous data from the late 1980s and early 1990s(1) The survey revealed that 19 2% of adolescent boys and 12 6% of teenage girls exhibited prehypertension or hypertension Similarly, the Comprehensive National Nutrition Survey (CNNS) conducted in India highlighted a concerning trend, indicating that 35% of 10- to 12-year-olds and 25% of 13- to 19-year-olds had stage 1 or 2 hypertension, based on the 2017 American Academy of Pediatrics cut points(2)

Diagnostic Criteria for Pediatric Hypertension:

Pediatric hypertension is defined as systolic or diastolic blood pressure exceeding the 95th percentile for age, gender, and height, confirmed on at least three separate occasions, spaced 1-3 weeks apart Prehypertension is categorized as systolic or diastolic blood pressure falling between the 90th and 95th percentiles. Additionally, adolescents with blood pressure value higher than 120/80 mm Hg but below the 95th percentile are also considered to have prehypertension The severity of hypertension determines the management approach, and it can be further classified into stages

Stages of Pediatric Hypertension:

Hypertension, commonly known as high blood pressure, has emerged as a leading cause of premature death worldwide. Alarmingly, the prevalence of hypertension among children and teenagers has significantly increased in the past 15 years Epidemiological studies indicate a noticeable rise in the occurrence of high blood pressure in this age group, posing a substantial health concern This article delves into the prevalence, diagnostic criteria, and management strategies for pediatric hypertension, highlighting the importance of lifestyle modifications for its prevention and treatment

Stage 1 Hypertension: This stage refers to systolic or diastolic blood pressure values exceeding the 95th percentile and up to 5 mm above the 99th percentile Blood pressure readings falling within this range should be rechecked at least twice within the next 1-3 weeks, or sooner if symptomatic, before a diagnosis of sustained hypertension is made.

Stage 2 Hypertension: In this stage, systolic or diastolic blood pressure values are 5 mm or more above the 99th percentile Confirmation of stage 2 hypertension requires a repeat measurement during the same visit Patients falling into this category require further evaluation within one week, or immediately if symptomatic(3).

HYPERTENSION MANAGEMENT IN ATHLETES

Hypertension (High Blood Pressure) is a condition that affects the arteries, where the force of the blood pushing against the artery is consistently high Blood Pressure is measured in millimetres of mercury, the normal range should be 130/80 mmHg.

Hypertension is a very common condition in the general population as well as athletes Regular physical activities cause fluctuation in blood pressure Hence, hypertension remains the most common condition in athletes. Athletes are usually thought to be free of heart-related issues because of their high level of fitness. However, the risk has increased in the past few years, commonly in heavy weight category sports and wheelchair athletes Hypertension can also occur in female athletes who are into oral contraceptive pills The on and off season also contributes

ByCharmiThakker

to this condition, as the intake of non-steroidal antiinflammatory drugs, caffeine, diet pills, etc can cause an increase in blood pressure Epidemiology studies have shown that physical activity and cardio respiratory fitness are inversely related to blood pressure and the prevalence of hypertension. World Antidoping Agency has banned certain substances which contribute to elevating blood pressure Example: Beta blockers

Few risk factors:

High sodium intake: high sodium in diet disrupts the natural sodium balance in the body, which causes fluid retention which increases the blood pressure

Excess alcohol consumption: during drinking alcohol can cause a temporary increase in heart rate and blood pressure.

CAN YOGA AND MEDITATION REDUCE BLOOD PRESSURE?

By Riddhi Shah Founder of Nutriyog Clinical Dietitian at Lilavati Hospital and Research Center

Yoga and meditation have long been associated with reducing stress and promoting overall health and wellbeing. In recent years, research has shown that these practices can also have a positive impact on hypertension, or high blood pressure We will explore the connection between yoga, meditation, and hypertension, and how these practices can benefit individuals who are living with high blood pressure

What is hypertension?

Hypertension, also known as high blood pressure, is a condition in which the force of blood against the walls of the arteries is consistently too high This can lead to a range of health problems, including heart disease, stroke, and kidney failure Hypertension is a common condition, affecting an estimated one in three adults around the globe.

How can yoga help with hypertension?

There are several ways in which yoga can help to lower blood pressure and manage hypertension First, yoga can reduce stress, which is a major contributor to high blood pressure The physical postures, breathing techniques, and relaxation practices that are part of yoga can help to calm the nervous system and reduce feelings of anxiety and tension.

Second, yoga can improve circulation and help to lower blood pressure Certain yoga postures such as forward bends and inversions, can improve blood flow to the brain and other organs, which can help to reduce blood pressure In addition, the deep breathing techniques that are part of yoga can help to relax blood vessels and improve circulation.

Third, yoga can help to improve overall cardiovascular health. Regular yoga practice can help to lower cholesterol levels, reduce inflammation, and improve the function of the heart and blood vessels. All of these factors can help to lower blood pressure and reduce the risk of cardiovascular disease

Asana with maximum benefit to reduce hypertension

SetuBandhasana (Bridge Pose)

Vajrasana (Diamond Pose)

Balasana (Child's Pose)

·ViparitaKarani (Legs up in the Air)

·AdhoMukhaSvanasana (Downward Dog Pose)

BaddhaKonasana (Butterfly Pose)

The Role Of

BERRIES

In Hypertension Management

Hypertension, or high blood pressure, is a prevalent and potentially life-threatening condition affecting millions of people worldwide While medications are commonly prescribed to manage hypertension, there is growing interest in exploring natural dietary interventions Berries, with their rich nutritional profile and numerous health benefits, have emerged as potential allies in the battle against hypertension. This article delves into the scientific evidence surrounding the role of berries in hypertension management and highlights their potential benefits

Antioxidant and Anti-inflammatory Properties

Berries, such as strawberries, blueberries, raspberries, and blackberries, are renowned for their potent antioxidant and anti-inflammatory properties. Chronic inflammation and oxidative stress play significant roles in the development and progression of hypertension

The high levels of antioxidants, including anthocyanins, flavonoids, and vitamin C, found in berries help neutralize free radicals, reducing oxidative stress and inflammation in blood vessels. These properties contribute to improved endothelial function, which promotes blood vessel dilation and regulation of blood pressure

Nitric Oxide Production and Blood Pressure Regulation

Nitric oxide (NO) is a critical signaling molecule that helps regulate blood pressure by promoting blood vessel relaxation Studies have shown that berries, particularly strawberries, and blueberries, can enhance NO production in the body

By Dr. Mansi Patil

The bioactive compounds found in berries stimulate the production of NO, leading to improved vasodilation and reduced blood pressure Furthermore, increased NO levels inhibit the activity of the angiotensinconverting enzyme (ACE), which is involved in blood pressure regulation By modulating NO production and ACE activity, berries contribute to maintaining healthy blood pressure levels.

Numerous studies have demonstrated the effectiveness of berries in reducing inflammation and oxidative stress markers associated

with hypertension

For example, a study published in the Journal of the Academy of Nutrition and Dietetics found that consuming blueberries for eight weeks significantly reduced markers of inflammation and oxidative stress in obese participants with metabolic syndrome, a condition closely linked to hypertension

FOODS TO INCLUDE AND AVOID IN HYPERTENSION

Lifestyle changes may include adopting a healthy diet (such as the Dietary Approaches to Stop Hypertension (DASH) diet), regular physical activity, weight management, limiting alcohol consumption, quitting smoking, and reducing stress levels The dietary approach plays a crucial role in managing and controlling hypertension. Also, dietary changes help in reducing the risk of cardiovascular diseases, including heart attacks, stroke, and kidney disease.

AHA (American Heart Association) recommends a heart-healthy diet, DASH Diet to help manage blood pressure levels(2) DASH stands for “dietary approaches to stop hypertension ”The DASH diet is high in fruits, vegetables, and low-fat dairy products which are rich in potassium, magnesium, calcium, and fiber. The DASH diet has reduced SBP (systolic blood pressure) to 11 mm Hg and 3 mm Hg in both hypertensive and non-hypertensive patients respectively(3)

Beware of Fat!!!

Hypertension is a major health concern in India, and its prevalence has been increasing over the years. According to a study published in The Lancet, in 2019, the estimated prevalence of hypertension in India was around 29 8%, with higher rates in urban areas compared to rural areas The same study mentioned above reported that around 50% of individuals with hypertension in India were previously undiagnosed, indicating a lack of awareness and screening(1).

Management of hypertension involves a multi-modal approach including lifestyle modifications and antihypertensive medications

Total dietary fat should be between 25-35% of total calories. Of this, saturated fatty acids (SFA) should not be more than 6% Replace SFA with monounsaturated fatty acids (olive oil, canola oil, peanut oil, gingelly oil, nuts, and oilseeds) and polyunsaturated fatty acids (sunflower and corn oil) Choose low-fat dairy products. Avoid high saturated fats and trans-fat ghee, coconut oil, vanaspati, palm oil, full-fat dairy products, fried foods (deep-fried samosas, pakoras, vadas, and puris), red meat, processed foods (packaged snacks and sweets) Healthy ways to cook fish, chicken, and lean meats like broiling, grilling, poaching, and baking should be considered Avoid adding high-fat dressings or sauces.

Cut down Salt!!!!

The DASH diet aims to limit sodium to less than 2300 mg/day which is equal to 1 teaspoon of salt 1500 mg a day of sodium has shown a better effect on the blood pressure levels(4) Reduce the amount of salt added during cooking, baking, or eating.

Clinical Dietitian, Tata Memorial Hospital MSc Specialized Dietetics

HYPERTENSION IN CKD

BY SHILPA CHADHA THAKUR

RENAL CORE GROUP MEMBER

Hypertension (HTN) and chronic kidney disease (CKD) are similar pathophysiological diseases Chronic hypertension can lead to kidney failure and kidney failure can lead to blood loss pressure (BP). High blood pressure in CKD results from the interaction of many factors, including salt and water retention, increased cellular expansion volume, brain overactivity, activation of the renin-angiotensin system-aldosterone, and endothelial dysfunction However, blood pressure in the CKD population is highly variable and should therefore be carefully monitored.

Diagnosis and management of HTN in CKD have improved over the past decade with increasing evidence As chronic kidney disease (CKD) becomes a global health concern, strategies to slow kidney disease and reduce cardiovascular risk in CKD are important goals in the management of kidney patients. Management of arterial hypertension is important in these patients because blood pressure (BP) is an important determinant of cardiovascular and renal failure Achieving blood pressure targets recommended by international guidelines is imperative and often requires multi-level management, including various medications and lifestyle measures.

Blood Pressure Targets in CKD Patients Blood pressure (BP) targets in CKD patients have been problematic for years This difference is reflected in the latest international guidelines targeting Values [2018 European Society of Hypertension, American College of Cardiology-American Heart Association (ACC/AHA), International Society of Hypertension (ISH), ESC Guidelines for the Prevention of Heart Disease] <140/90 mmHg to <130/80 mmHg as recommended in the KDIGO statement, recently <120/80 mmHg, say new In conclusion, the diagnosis and treatment of hypertension in CKD should be individualized.

Blood pressure should be reduced to at least <140/90 mmHg in all patients A threshold of <130 mmHg is far from the best CV protection and safety and should be considered, especially for young people or protein uric individuals. Blood Pressure Management in CKD Patients In addition to prescribing blood pressure medications, we must also consider the 24-hour blood pressure profile

Although the diagnosis and management of arterial hypertension rely on office blood pressure measurements, patients with CKD have abnormal blood pressure patterns when using out-of-office blood pressure measurements (ABPM) The main observation is that both reduced eGFR and proteinuria are associated with high nocturnal BP and a nonsloping pattern. Some of the mechanisms underlying the elevated nighttime blood pressure values observed in CKD patients are elevated blood pressure, salt sensitivity and volume overload, and sleep deprivation Lifestyle changes are recommended in all hypertension procedures and are considered the first step in hypertension control, even in patients with CKD.

Highlights:

·Very high prevalence of hypertension is seen in India (38.9% women and 45.7% men)

·Hypertension is also prevalent in children and adolescents

·Less than 20% of hypertensive patients have their blood pressure under control

·Indian Hypertension Control Initiative is a multi-stake holder initiative to bring blood pressure levels under control in Indian hypertensive patients

R E S E A R C H

Hypertension is a precursor for many complicated diseases and a person is often remain undiagnosed. A person is said to have hypertension if the blood pressure of a person is ≥140/90 mmHg on at least 2 consecutive measurements. The prevalence of hypertension in India is on the rise. As per the National Family Health Survey-5 (NFHS-5)conducted by the International Institute for Population Sciences, Mumbai under the leadership of the Ministry of Health and Family Welfare, Government of India, 38.9% of women and 45.7% of men in India suffer from mild to severe hypertension. Prevalence is shown to be higher in urban as compared to rural India(Ministry of Health and Family Welfare, n d )

It is not just the adults who suffer from hypertension in India. Based on a recent systematic and meta-analysis of studies in children up to 18 years, 7% of Indian children are hypertensive whereas 12% children are pre-hypertensive. The prevalence of hypertension in children is slightly more in girls and in urban children as compared to boys or rural children respectively. Prevalence of paediatric hypertension has also been demonstrated to have an upwards trend with the highest prevalence in the state of Delhi (11%) followed by Uttar Pradesh and Tamil Nadu (10% each) The lowest prevalence of paediatric hypertension was observed in Rajasthan (1%) and Telangana (3%)(Meena et al., 2021).

Did you know that uncontrolled blood pressure is a high risk for cardiovascular diseases such as heart attack and stroke? Considering the high risk of disease that is attached with hypertension, one would assume that patients with hypertension would be take due care of themselves, consume medication diligently, and adopt appropriate lifestyle modifications to keep blood pressure under control

Bursting Myths &Debunking Facts around Hypertension

-Rabia Mistry Mulla

Hypertension which is commonly known as high blood pressure is a common medical condition in today's times which is affecting millions of people all over the world. Unfortunately, many myths and misconceptions surrounding hypertension can lead to confusion and misunderstanding. In this article, let's explore some of the most common myths and facts about hypertension.

Myth: Hypertension is not a severe condition

Fact: Hypertension is a severe medical condition that can lead to various complications, including heart disease, stroke, and kidney damage It is essential to manage hypertension through lifestyle changes and medication to prevent these complications

Myth: Hypertension only affects older people

Fact: While it is true that hypertension is more common in older adults, it can affect people of all ages. Hypertension is becoming increasingly common in younger adults due to poor diet and lifestyle choices.

CINNAMON

DID YOU KNOW?

Did you know? Sri Lanka alone produces around 90% of the cinnamon used across the world.

In Sanskrit Dalchini is known as ‘Darusheela’ and ‘Twaka’. Ayurveda knew the beneficial properties of cinnamon and described them thousands of years ago. They used it as an herb for making medicines for diabetes, heart attack, and digestive ailments. The reason why it was not used as a spice could have been that the taste and smell of Indian cinnamon then were not appealing for cooking. On the other hand, Sri Lanka was famous for its aromatic and flavorful cinnamon. Cinnamon was also used by Egyptians for the mummification process of their royalty and was considered a precious gift from the gods – the choice of kings and emperors.

PROCEDURE

STUFFED BELL PEPPERS

BY RESHMA BHATKAR

NUTRITIONIST

INGREDIENTS

Boneless chicken- 100 grams

Onion- 50 grams

Bell peppers- 200 grams

Walnut- 50 grams

Ginger garlic paste- 1 tsp

Black pepper powder- 1 tsp

Chilly flakes- 1 tsp

Salt- low sodium salt

Olive Oil - 1 Tsp

Wash the chicken and boil it for 15 minutes. Remove the chicken pieces in a dish and shred them .keep the shredded chicken aside. Take 50 grams walnuts and coarsely ground them. Heat olive oil in a large skillet over medium-low heat. Add onions and cook for about 10 minutes, stirring occasionally, until onion turns golden brown. Add ginger garlic paste, cook them well. Now Add boiled and shredded chicken and coarsely ground walnuts and little salt to it .Stir all the ingredients well. Add chilly flakes and black pepper powder. Mix them well . Turn off the stove.

Transfer the mixture to a large bowl and let cool slightly.

Preheat oven 350F° and grease an 13 X 9-inch baking dish.

Wash peppers and cut in half lengthwise. Remove seeds and veins and place cut side up in baking dish. Place equal amounts of mixture into each bell pepper half. Tent with foil and bake for 30 minutes. Remove foil and bake for 10 minutes more or until peppers are soft. Garnish with coriander, if desired. You can serve it with masala oats or pulao or khichri

COME & JOIN WITH US!

YearlyPrint/E-Copy

Half

DISCLAIMER: The views, information or opinions expressed in this issue are solely those of the individuals involved and do not necessarily represent those of the Nutrition Insights (NI) and it’s partners, associates, employees. Any action you take based on the said information in this magazine is strictly at your own risk. NI will not be liable for any losses or damages. You may not copy, reproduce, extract, edit, modify or redistribute or in any way use the information without the consent of the editors involved. The primary purpose of this magazine is to educate and inform the public at large. The publisher, authors and contributors reserve their rights with regards to copyright of their work.