Week 1 Assignment

Let’s start with the basics- Standardisation of recipes

A standardized recipe “has been found to produce the same good results and yield
every time when the exact procedures are used with the same type of equipment and
the same quantity and quality of ingredients”.
Benefits of standardized recipes
• Consistent food quality—The use of standardized recipes ensures that menu items
will be consistent in quality each time they are prepared and served.
• Predictable yield—The planned number of servings will be produced by using
standardized recipes. This can help to reduce the amount of leftover food if there
has been overproduction, and also will help to prevent shortages of servings on the
line. A predictable yield is especially important when food is transported from a
production kitchen to other serving sites.
• Customer satisfaction—Well-developed recipes are an important factor in
maintaining consistency in every detail of ingredient, quantity, preparation, and
presentation. Standardized recipes provide this consistency and can result in
increased customer satisfaction.
• Increased employee confidence—Employees feel more satisfied and confident in
their jobs because standardized recipes eliminate guesswork, decrease the chances
of producing poor food products, and prevent shortages of servings during meal
service.
•Consistent nutrient content—Standardized recipes will ensure that nutritional
values per serving are valid and consistent.

•Food cost control—Standardized recipes provide consistent and accurate

information for food cost control because thesame ingredients and quantities of
ingredients per serving are used each time the recipe is produced.
• Efficient purchasing procedures—Purchasing is more efficient because the
quantity of food needed for production is easily calculated from the information on
each standardized recipe.
• Inventory control—The use of standardized recipes provides predictable
information on the quantity of food inventory that will be used each time the recipe
is produced.
• Labor cost control—Written standardized procedures in the recipe make efficient
use of labor time and allow for planned scheduling of foodservice personnel for the
work day. Training costs are reduced because 2 new employees are provided
specific instructions for preparation in each recipe.
• Reduced record keeping—A collection of standardized recipes for menu items
will reduce the amount of information required on a daily food production record.
Standardized recipes will include the ingredients and amounts of food used for a
menu item. The food production record will only need to reference the recipe and
portion/serving sizes along with the number of planned, offered, and served menu
items with leftover amounts.
MEASURING DRY INGREDIENTS BY VOLUME :
• Use appropriate dry ingredient measuring equipment.
• Use the appropriate size that will help you to save time and measure
appropriately.
• Fill the measuring container to overflowing and level off with a straight-edged
spatula.
• Avoid shaking or tapping themeasuring container.
MEASURING DRY INGREDIENTS BY WEIGHT :
• Scales may be digital or mechanical and the dial may be fixed or adjustable.
• Scale should be set to zero when you begin.
• Place empty container for ingredients on the scale’s platform.
• For adjustable dials, place the container on the scale and turn the pointer to zero.
• For electronic scales, press the tare button to zero out the weight of the container.
• Add the ingredients until desired weight of ingredient is achieved.

EXCHANGE LIST :
It has been provided, Keeping covid-19 situation in mind. Please refer that to
prepare the recipes.

Your assignment:
Standardize your regional (your state/ city) recipes for 1 serving under following
headings:

➢4 breakfast recipes

➢4 vegetable recipes (main course)

➢4 snacks (mid-morning/ evening snacks)

➢2 desserts

➢2 drinks

For each recipe, you need to mention serving size, energy, protein, fat and
carbohydrates. Innovation from your side will be appreciated. You can even send us
some pictures/ videos while preparing the recipes. We shall be posting the best one
on our social media with your name credits.
Best of luck!
Ps: The next assignment will be given based on your specializations and your effort
on this one

.
 FOOD EXCHANGE LIST
Ruchhi's Balance Diet

Food Group Amount (g) Measurements Energy (kcal) Carbohydrates (g) Protein (g) Fats (g)
CEREALS AND MILLETS
Cereals and Millets 30 1/2 Katori 100 21 3 0.5
Bread White 40 2 slices 100 20 5 0.3
Bread Brown 40 2 slice 100 20.5 3.2 0.8
Bread Multigrain 40 2 slice 100 19 3.6 1.6
Maize tender 95 1 100 18 3.8 1.3
PULSES AND LEGUMES
Pulses and Legumes 30 1 Katori 100 15 7.3 0.5
Green Peas Fresh 125 1 Katori 100 14.7 9 0.2
Soyabean Brown 25 1 Katori 100 3.2 9 5
Soyabean White 25 1 Katori 100 2.5 9.5 5
Red gram dal 30 1 Katori 100 16.5 6.5 0.5
MILK AND MILK PRODUCTS
Milk Buffalo 95 1/3 glass 100 7.5 3.5 6
Milk Cow 135 1/2 glass 100 7.5 3.5 5
Paneer 40 1/2 katori 100 5 7.3 5.6
Khoa 30 1/2 katori 100 5.2 5 6.5
VEGETABLES
Veg A 100 1 Katori 20 2.5 1.8 0.3
Veg B 100 1 Katori 40 5.2 2.7 0.5
Veg C 100 1 Katori 74 11.6 3 0.5
Veg D 100 1 Katori 93 16 2.5 0.2
FRUITS
Grp I 50 1/2 katori 50 11.3 1 -
Grp II 65 1/2 katori 50 10.9 1.6 -
Grp III 85 1/2 katori 50 10.3 0.6 -
Grp IV 90 1/2 katori 50 11 0.6 -
Grp V 190 1 katori 50 9 1.4 -
Grp VI 250 1 katori 50 10 1.5 -
Grp VII 30 3 100 22 - -
NUTS AND OILSEEDS
Grp I 15 1 teaspoon 100 2 3.5 8.4
Grp II 20 1 teaspoon 100 7 5 5.2
Coconut dry 15 1 teaspoon 100 1 1 8
Coconut fresh 15 1 teaspoon 100 2 0.5 10.3
FLESH FOODS
EGG AND EGG PRODUCTS
Whole egg raw 75 2 100 - 10 6.9
Egg yolk raw 30 100 - 5 8.2
Egg white raw 50 100 - 5.5 -
Egg white boiled 190 100 - 9 0.5
Egg yolk boiled 32 100 - 5.2 9
ANIMAL MEAT
Meat, goat 75 3 piece 100 - 14 8.2
Pork 75 1 slice 100 - 13 6.2
Chicken 50 1 Breast piece 100 - 9.2 5
FISH
MARINE FISH
Bombay duck 90 1 piece 100 - 12.2 0.9
Hilsa 40 1 piece 100 - 8.4 7
Mackerel 100 1 piece 100 - 21.2 1.5
Pomfret (white/black) 80 1 piece 100 - 15 4
Queen 105 1 piece 100 - 21.8 1.2
Red snapper 93 1 piece 100 - 21.2 1.2
Tuna 90 1 piece 100 - 20.5 1.3
Cat fish 92 1 piece 100 - 20.3 2
SHELL FISH
Crab, sea 145 1 piece 100 - 22.5 0.8
Lobster, king size 110 1 piece 100 - 20.5 0.8
Tiger prawn, orange 150 1 piece 100 - 22 1
Clam white, shell 165 1 piece 100 - 20 2.2
FRESH WATER FISH
Eel 92 1 piece 100 - 20 2.5
Catla 105 1 piece 100 - 19 2.2
Rohu 100 1 piece 100 - 19.3 2.3
Prawns, big 110 5 to 7 pieces 100 - 21 0.5
Prawns, small 140 5 to 7 pieces 100 - 18.4 1
Tiger prawn 145 5 to 7 pieces 100 - 21 0.9
SUGAR
Jaggery 5 1 tsp 20 5 - -
Sugar 5 1 tsp 20 5 - -
FAT
Fat 10 1 tables spoon 90 - - 10
MISCELLANEOUS
Butter Milk 100 1 glass 50 0.02 0.08 11
Cheese 32 2 cubes 100 0.5 6.2 8
Coconut Water 100 15.2 3.2 0.3 0.2
Milk (toned) 166 1/2 glass 100 7.8 5 5
Milk (double toned) 217 1/2 glass 100 10.85 6.7 3.25
Curd (Amul) 161 1 glass 100 7.08 6.6 5

Nutrela Soya Chunks 30 100 9.5 15 0.15

Butter 15 1 tables spoon 100 0.02 0.08 11
 Vegetables
Group A Group B Group C Group D
Amaranth leaves Brussel sprouts Parsley Colocassia
Bathua leaves Cauliflower leaves Lotus root Sweet potato
Beetel leaves Colocassia leaves Potato, big Elephant yam
Cabbage greens Fenugreek leaves Potato, small
Lettuce Beetroot Tapioca
Mustard leaves Carrot, red Baby corn
Radish leaves Mango, green, raw Jack fruit, seed
Spinach Broccoli
Radish, white
Ash gourd
Bitter gourd, short
Bottle gourd, elongate
Bottle gourd, round
Brinjal, all varieties
Broad beans
Capsicum, all
Cauliflower
Cucumber
Drumstick
Field beans
French beans
Jack fruit, raw
Knol khol
Kovai
Ladies finger
Onion
Parwar
Ridge gourd
Tomato
Tinda
Zuchini, yellow
Pumpkin, orange
 FRUITS
GROUP I GROUP II GROUP III GROUP IV GROUP V GROUP VI GROUP VII
Banana, ripe Fig Apple Mango Guava Watermelon Dates, processed
Custard apple Jackfruit Blackberry Orange pulp Lime sweet, pulp Dates, dry
Manila tamarind Cherries, red Peach Musk melon, orange Raisins
Grapes, black Pear Musk melon, yellow Avocado
Grapes, green Pineapple Papaya, ripe Blueberry
Litchi Sapota (chickoo) Star fruit
Plum Dragon fruit Strawberry
Pomegranate Gooseberry
Kiwi
 NUTS AND OILSEEDS
GROUP I GROUP II
Almonds Garden cress seed
Cashew nut Pumpkin seeds
Walnut Chia seeds
Pistachio Flax seeds
Sunflower seeds sesame seeds
Ground nut hemp seeds
Hazel nuts
Apricot
 WEIGHT LOSS

On Rising Natural Supplements

Chia Drink
Apple Cider Vinegar
Cardamom & Cardamom drink
Coriander Seed water
Cumin drink
Mint water (normal water)

Pre-workout Meals
Any fruit
Oatmeal with nuts

Breakfast
Depending on the client's 24 hr recall

Mid Morning
Fruits with nuts
Veggie Juice
Mixed seeds topped on fruits

Lunch
Weight below 75 kgs-2 Chapatis with 1 katori sabji with salad (Don't forget to add protein in major meals)
Weight above 75 kgs- 3 Chapatis with 1 katori sabji with salad (Don't forget to add protein in major meals)

Evening snack
Protein meals like kabula chana chaat, chana masala etc

Mid Evening Snack

Green Tea
Lemon Tea

Dinner
1 Bowl of Rice option with vegetables and raita
Soups & salad
 WEIGHT LOSS

Dietary Guidelines
Always maintain the nutrient chart.
Do not forget to include On rising supplements in every chart which helps in reducing the fat loss
Never skip the pre-workout meals as it provides a great amount of energy.
Give one grain at a time for major meals. No rice & chapati together
Do include protein In the major meals
For weekend you can include whole wheat pasta, noodles, risotto. Sandwiches. Etc. (It should be the healthy version)
Maintain the fiber graph, it should be atleast 18-22 g in a day
Focus more on the fat loss compared to the weight loss. As it gives more sustainable result.
Dietary guidelines for Muscle Up and Weight Gain :
1) Increase the quantities of the food gradually .
2) Eat more frequently at every interval of 1.5 -2 hr
3) Make every snack more nutrient dense like inclusion of nuts, dryfruits, starchy vegetables like potatoes, sweet potatoes, carrots , etc
4) Make every drink count - Include milkshake, freshly prepared thick fruit juices, smoothies, thick lassi, etc
5) Add more extras to the foods - Don"t eat anything plain
6) Add healthy unsaturated fats: olive/ coconut oil , nuts, seeds, peanut butter, avocados, etc as the toppings or extras
7) Include protein sources in every meal. These can be non veg sources like chicken/fish/egg whites or veg sources like low fat milk and its products, soya and pulses
Dietary Guidelines for Acidity
Do not give tea or coffee empty stomach
Achieve and maintain a healthy weight.
Eat small, frequent meals. Large meals may increase stomach pressure, and therefore reflux.

Fat takes the longest time to leave the stomach; therefore, reduce the total amount of fat that you eat at a meal by decreasing the amount of margarine, butter,
oils, salad dressings, gravy, fatty meats, and full-fat dairy/milk products such as sour cream, cheese, and whole milk.
Maintain an upright posture while eating and for 45-60 minutes afterward. Avoid bending over or reaching below your waist after meals to do things like loading
the dishwasher, tying your shoes, or picking up items from the ground.

Avoid eating before bedtime. It takes the stomach four to five hours to fully empty a meal, so wait at least three hours after eating to go to bed.
Avoid clothing that is tight in the abdominal area.
When sleeping, raise the head of the bed 6-8 inches, using wooden blocks under the bedposts. Extra pillows will not work.
Stop smoking.
Reflux triggers vary from person to person. Try eliminating possible trigger foods for two weeks, then reintroduce one food at a time to determine your tolerance
and evaluate severity of symptoms.
Your doctor may prescribe acid-reducing medications, such as proton pump inhibitors (PPIs). Do discuss with your physician.
DIETARY GUIDELINES FOR IBS(IRRITABLE BOWEL SYNDROME)
Irritable bowel syndrome (IBS) is an uncomfortable disorder characterized by dramatic changes in bowel movements.
common Symptoms:- Some people experience diarrhea, while others have constipation, Cramps and abdominal pain.
DIETARY ALLOWANCE.
1.Eat more fiber if constipated:- Fiber may improve constipation in IBS because it makes stool soft and easier to pass.
2.Consume soluble fiber like oats, boiled or steamed fruits and vegetables
3.Drink plenty of fluids.
3. Eat regular meals. Be sure to eat breakfast every day. Do not skip meals
DON'TS
1. Restrict intake of caffeinated drinks (for example, tea, coffee or cola)
2. Avoid skin, pips and pith from fruit and vegetables
3. Avoid foods high in fat, such as chips, fast foods, burgers and sausages, crisps and cakes.
4. If you are lactose intolerant, reduce the amount of lactose you consume. Milk and paneer are lactose containing foods.
5. Try not to have alcohol every day and then have no more than 2 units a day.
6. Limit insoluble fibre intake from whole grain breads, bran, cereals, nuts and seeds (except golden linseeds).
7. Limit intake of foods high in resistant starches like;-sweetcorn, green bananas and muesli that contains bran

P.S - In IBS every person may respond to different foods differently. It is important to try and test foods (see body's response) and then become liberal with their use in
daily routine.
Diabetes Guidelines
Healthy eating for people with diabetes is no different than for everyone else. In fact, good nutrition helps one grow well, reach and maintain a weight that's right for
your height, and stay healthy. But eating right helps you keep your blood sugar levels on track — something that's very important for people with diabetes.
Eat regular meals throughout the day.
HEALTHY FOOD CHOICES TO KEEP YOUR SUGAR UNDER CONTROL
Establish a routine for eating meals and snacks at regular time every day.
Do not starve or skip a meal or go on an empty stomach.
Focus on healthy carbohydrates (carbs):
Carbs are your body’s main energy fuel.
Go for the healthiest carbohydrate foods like whole grains, oats, cereals, legumes, dried beans, peas, lentils, low fat dairy products fruits, vegetables.
Importance of portion control
To help control your blood sugar, eat about the same amount of carbs every day, spaced throughout the day
Choose fibre rich foods
It helps lower blood sugar levels.
Limit saturated fats
When you have diabetes, you are at an increased risk of heart disease & stroke. Limit the amount of saturated fat (eg.animal product)
Keep low on trans fats, avoid re - heating oil.
Opt for baking, roasting, steaming or boiling instead of frying.
Seasoning & frying of all foods should be within the oil allowance.
Free foods
Can be taken between meals and also whenever there is a feeling of hunger.
Clear vegetable soup
Raw vegetable salad
Diluted skimmed buttermilk
Unsweetened lime & tomato juice
Flavoring extracts
Seasonings like onion, garlic, mint, coriander, curry leaves, mustard, spices and vinegar. (Cannot be eaten as such)

RESTRICT THESE FOODS TO MAINTAIN YOUR SUGAR

Refined & simple carbohydrates like sucrose, glucose or fructose, white rice, white bread, table sugar, jaggery, sweets, honey, corn-syrup.
Fruits like banana, mango, custard apple, jack fruit, sapota and grapes.
Root vegetables like potato, tapioca, sweet potato, yam, colocasia etc.
High fat food like dry nuts & oilseeds, full cream milk, butter, cheese, ghee, red meat, egg yolk and bakery products etc.
Alcohol - Higher quantities can cause health problems like liver damage and also increase risk of heart disease.
Take a control over your diabetes with a healthy life style!!!!!
DIETARY GUIDELINES FOR PCOS
Have small frequent meals
Include omega-3 rich foods like flaxseeds, walnuts, fish etc.
Include lean meat and low fat dairy products since they are low in saturated fats.
Include wholegrain/ fiber rich carbs like whole wheat flour, millets, oats, quinoa etc
Include atleast 2 fruit a day
Include 3-4 servings of vegetables daily
Include cinnamon powder on a regular basis, this helps to regulate insulin levels
Restrict processed and packaged food
Restrict intake of chocolates, alcohol, caffeine,carbonbated beverages
Avoid refined carbs like refined flour, foods rich in high fructose corn syrup, cakes, pastries, sugary beverages etc.
Avoid deep fried items since it may be very high in trans fats
Drink 2.5-3 ltrs of water per day

Seed cycle
Start seed cycling from day 1 of your periods. If your cycle isn’t regular or you don’t have a cycle, use the days corresponding to the phases of the moon.
From Day 1-14 of the menstrual cycle (or new moon to full moon)

1 Tbs. per day of ground flax seeds

1 Tbs. per day of ground pumpkin seeds

From Day 15-28 of the menstrual cycle (or from full moon to new moon)

1 Tbs. per day of ground sesame seeds

1 Tbs. per day of ground sunflower seeds
Dietary guidelines for Hypertension:

Eat lots of fruits and vegetables. A diet rich in fruits and vegetables can increase important cholesterol-lowering compounds in your diet.
· Be aware of alcohol intake. Alcohol can increase your blood pressure, as well.
A high-sodium diet increases blood pressure in many people. In fact, the less sodium you eat, the better blood pressure control you might have.
· To lower the sodium in your diet, try these suggestions:
Aim for less than 2,300 milligrams (about 1 teaspoon of salt) each day. Ask your doctor if you should go lower, to 1,500 milligrams.
Read the nutritional facts label on every food package.
Select foods that have 5% or less of the “Daily Value” of sodium.
Avoid foods that have 20% or more Daily Value of sodium.
Avoid canned foods, processed foods, lunch meats, and fast foods.
Use salt-free seasonings.
· Know What to Eat
Potassium, magnesium, and fiber, on the other hand, may help control blood pressure. Fruits and vegetables are high in potassium, magnesium, and fiber, and
they’re low in sodium. Stick to whole fruits and veggies. Juice is less helpful, because the fiber is removed. Also, nuts, seeds, legumes, lean meats, and poultry are
good sources of magnesium.
· To increase the amounts of natural potassium, magnesium, and fiber you take in, select from the following:
Apples, apricots, bananas ,broccoli, carrots, green beans, dates, grapes, green peas,
mangoes,melons,oranges,peaches,pineapples,raisins,spinach,strawberries,tomatoes,yogurt (fat-free)
Dietary guidelines for Cholesterol:
A. Eat plenty of soluble fiber. Foods high in soluble fiber help prevent your digestive tract from absorbing cholesterol. These foods include
1.Whole-grain cereals such as oatmeal and oat bran
2. Fruits and vegetables
3. Legumes such as kidney beans, lentils, chick peas, black-eyed peas, and lima beans
B. Eat lots of fruits and vegetables. A diet rich in fruits and vegetables can increase important cholesterol-lowering compounds in your diet.
C. Eat fish that are high in omega-3 fatty acids. These acids won't lower your LDL level, but they may help raise your HDL level. They may also protect your heart from
blood clots and inflammation and reduce your risk of heart attack. Fish that are a good source of omega-3 fatty acids include salmon, tuna (canned or fresh), and
Limit foods with cholesterol. If you are trying to lower your cholesterol, you should have less than 200 mg a day of cholesterol. Cholesterol is in foods of animal origin,
such as liver and other organ meats, egg yolks, shrimp, and whole milk dairy products.
Nutritional management for

Name:

Case:

Patients profile:
Sex: Ethnic background:
Age: Occupation:
Veg./non-veg: Activity pattern:
Height: Weight (g):

BMI (kg/m2):

BMI classification:

Body Fat:
General Guidelines:
 Daily food guide:
Foodstuff No. of Amt Energy CHO Protein Fats
exchanges (g) (kcal) (g) (g) (g)

TOTAL
ENERGY
FAT
PROTEIN
CARBOHYDRATE

Animal protein (g): Plant protein (g):

Menu plan
Meal & Menu Ingredients Amount (g) Exchanges
timing
Meal & Menu Ingredients Amount (g) Exchanges
timing
Nutritional recommendation for the patients:
Foods to be included Foods to be used in Foods to be avoided
restricted amount

Type of oil recommended:

(1) Akshata, 35 years old. Height is 5'8". Weight is 109 kgs. Loves Maharashtrain food, had C-section
operation. She is married with 2 year old kid. She has no BP, thyroid or diabetes. She is a non-vegetarian.
Plan one day meal for her.

Body measurements:

Chest- 48 inches

Neck- 16 inches

Stomach- 42 inches

Waist- 50 inches

Thighs- 30 inches

Hip- 51 inches

(2) Nitesh, 45 years old. Height is 5'3". Weight is 125 kgs. Completely foodie, loves sweet food. Very less
activity level. He is married with no kid. Plan one day meal for him. Include some sweet healthy dish.

Chest- 46 inches

Neck- 17 inches

Waist- 44 inches

Thighs- 25 inches

Hips- 46 inches

24 hour recall- Wakes up at 8 am, have cow mutra early morning. Drinks lauki juice in the breakfast.
Takes lunch at 1 pm, rice dal and Sabji with 1 chapati. Takes sweet dish daily after lunch. Evening snack-
chai and biscuit. Dinner at 9:30 pm, takes fast food either Sandwich, frankie pac bhaji. Takes ice cream
after dinner.

(3) Uttkarsha, 25 year old. Leaves in a PG.No one there to cook. Has hectic office schedule. Height is 5'2".
Weight is 67 kgs. Has no disorder. Plan a day meal for her.

Body measurements:

Breast- 32 inches

Stomach- 38.6 inches

Waist- 39 inches

Thighs- 27 inches

Hip- 44 inches

Neck- 12 inches

(4) Meena, a 48 year old lady. Lives in a joint family. Can't cook separately for herself. Has 2 kids school
going. Has no disorder. Had fracture in leg 3 years ago. Plan a day meal for her. Height is 5'2". Weight is
84 kgs. Main concern is face fat. Suggest any exercise for her.

Body measurements:

Breast- 34 inches

Stomach- 40 inches

Waist- 38 inches

Hip- 42 inches

Neck: 14 inches

Last Date of Submission: 4th July 2021

 ACIDITY

Acidity refers to a set of symptoms caused by an imbalance between the acid secreting mechanism of
the stomach and proximal intestine and the protective mechanisms that ensure their safety. The
stomach normally secretes acid that is essential in the digestive process. This acid helps in breaking
down the food during digestion.
When there is excess production of acid by the gastric glands of the stomach, it results in the condition
known as acidity.

Causes:
* Consumption of Alcohol
* Smoking
* Prolonged duration of fasting
* Stress
* Highly spicy food
* Non-vegetarian food
* Medicines eg-Non Steroidal Anti-Inflammatory Drugs (NSAID's)
* H.Pylori infection

Signs and Symptoms:

* Epigastric pain
* Dyspepsia
* Regurgitation
* Heartburn
* Nausea

Investigations:
* Upper Gastrointestinal Endoscopy.
* Barium Meal studies

* H.Pylori blood/breath test

Medicines:
*Lifestyle modifying measures
*Antacids
*H2 Receptor Blockers, Proton Pump Inhibitors.

Nutrition and Lifestyle Therapy:

- Aerated drinks, alcohol as well as the caffeine to be avoided as they are major cell dehydrators and
make the body pH extremely acidic.
- Include alkaline foods/liquids to neutralize the acidity and to balance out the pH. E.g. Lemon water,
broccoli, bottlegourd, cucumber, apple cider vinegar, barley water, aloe vera juice, wheatgrass juice, etc.
- They keep the body super alkaline.
- Tip: Have a glass of lemon water with mint leaves 1 hour after the meal (lunch and dinner) to keep the
body alkaline.

- Chewing fennel seeds post meal is also of great help.

- Banana, watermelon, coconut water, yoghurt, buttermilk, basil seed (sabja) water, etc have a nice
soothing effect. One can have any of these on a regular basis to get some relief.
- A glass of milk with a tsp of home made ghee makes a good recipe to heal acidity and burning
sensation.
- Sucking on a piece of clove is another effective remedy.
- Keeping long intervals between meals is another cause for acidity. Consuming large meals at a time can
result in too much of acid production in the stomach. It’s best to have small meals at a time in frequent
intervals (keep a gap of not more than 3-4 hours between each meal).
- Keep the intake of pickles, spicy chutneys and other preserved and processed food at bay.
- Excessive smoking and drinking increases acidity. It’s best to give up on.
- Ensure adequate hydration throughout the day.
 CONSTIPATION

Constipation is defined medically as fewer than three stools per week and severe constipation as less
than one stool per week.

Symptoms -
• Abdominal discomfort & pain
• infrequent bowel movements
• straining to have a bowel movement
• Hard or small stools
• rectal bleeding and/or anal fissures caused by hard stools
• Bloating
• Flatulence

Causes:
• Poor bowel habits
• less water intake
• Low fiber diet
• Possibly abuse of laxatives
• Hormonal disorders
• Stress
• Pelvic floor dysfunction
• Pregnancy

Treatment:
• Dietary fiber
• Physical activity
• Laxatives
• Enemas
• Suppositories

Nutrition and Lifestyle Therapy

Nutritional recommendations:
1) Adequate Hydration- Water ensures a good productive of digestive juices in the stomach and
intestine and the smooth passage of food through the intestines. It even makes the stool softer to
ensure they are passed out easily. One must ensure adequate hydration throughout the day. Though the
requirement differs from person to person, an average of 3-3.5 liters of water is recommended. One
must space out the intake very well and not consume too much at a go. Be careful with caffeine as it
leads to dehydration and thus constipation. Excessive intake of coffee, tea, green tea needs to be
avoided. Best to drink a glass of water after every cup of tea/coffee.

2) Dietary Fiber- Soluble fiber softens the stools whereas the insoluble fiber adds bulk and roughage to
the stools. This ensure smooth bowels. Our diet should contain a mix of soluble and insoluble fiber both.
The best ones are whole cereals and pulses including oats, jowar, bajra, ragi, whole beans, all the fruits,
vegetables especially the greens, nuts and seeds.
The recommended intake of fiber is 25-30gm/day. However, due to unhealthy lifestyle today, the
requirement has gone up to 35-40 gm/day.
3) Avoid Packaged foods- Fresh home cooked food is the way to go.Packaged foods are loaded with
refined flour, Tran’s fats, sodium and other preservatives and are very low in fiber or lack fiber
completely. A frequent intake of packaged foods definitely affects the digestive system which creates
difficult bowels. It is best to stick to fresh home cooked balanced meals which are eaten at regular
intervals. Our body is designed in a way that it processes the simple home cooked meals just perfectly.
4) Good fats help- Another important food to make sure you get in your diet for constipation relief is
healthy fats. If you aren't getting enough fat in your diet, your stools are likely to be dry and hard. This
type of stool is much harder for your colon to shift along. Fats make the stools softer and give some
lubrication. If you're avoiding fat thinking that it will make you fat, think again. Fats are necessary for a
healthy metabolism, along with proteins and carbohydrates in the proper ratio. If you avoid fat entirely,
you'll actually slow your metabolism along with your bowel movements. Always choose healthy fats
from whole foods, like nuts, seeds and avocados.

5) Remedial tips-
* 2 tbsp. of black raisins every night or every morning act as a natural laxative. Prunes are also a great
laxative.

* Grease it Right- 1 tbsp. castor oil or cold pressed virgin coconut oil before going to bed, helps in
smooth passage of stools
* Ayurveda to the Rescue- 1 tbsp. triphala powder in a glass of warm water before going to bed, helps
detoxifying and cleansing the colon and rectum

* Fizzle it Out - The answer lies in baking soda. When sodium bicarbonate reacts with the acids in the
stomach, it produces salt, carbon dioxide and water. This facilitates bowel movement and cleanses the
colon.

How to have it: Take 1 teaspoon of baking soda and about 1/4th cup of warm water. This mix also works
for acidity and mild stomach pain.
* A cup of warm organic milk with ghee or licorice tea or ginger juice are also of great help when it
comes to relieving constipation.

Lifestyle changes:
1) Regular Exercise- Any form of exercise improves the blood circulation, which in turn ensures better
digestion and thus, lesser chances of constipation. Cardio exercises/aerobic workouts like brisk walking,
jogging, running, swimming, floor workouts, etc. enhance the intestinal muscle contractions which helps
move the stools out well. Certain Yoga asanas boost the blood flow towards the intestine, ensuring
better digestion and intestinal movements. Eg: Vajrasana.
2) Avoid any type of exercise immediately after mealsIt directs the blood flow towards the required
muscles and heart, rather than the stomach for digestion. This leads to weaker intestinal contractions
and lesser production of digestive enzymes. Consequently, it results in constipation and other digestive
problems like indigestion and bloating.
3) Managing Stress- Stress increases the production of stress hormone called Cortisol in the body and
activates sympathetic nervous system that helps is fight or flight response. This has a negative impact on
the blood circulation and thus digestion, which eventually leads to constipation and other digestive
issues like bloating. That’s one reason why managing stress is very important. Deep breathing and
meditation are the best stress relieving techniques. One must practice it regularly to deal with stress.
Indulging in hobbies, playing a favorite sport, visiting a favorite place are some other ways to bust the
stress
 DIARRHEA

When you have diarrhea, your bowel movements (or stools) are loose and watery. It’s common and
usually not serious.

Causes:

Stomach flu

Intestinal flu

Over eating of junk or outside food

Symptoms:

• Bloating

• Cramps

• Thin or loose stools

• Watery stools

• Nausea and throwing up

Nutritional Treatment:

• Include cereals like rice with curd.

• such patients are unable to tolerate foods rich in fat, fiber and milk which are best when avoided.

• Soft diet is recommended rich in protein and calories with liberal amounts of vitamins and mineral and
large amounts of fluids is recommended.

•light soups and fruit juices can be given.

Assignment:

Case 1 : Acidity
Manisha Jiwani, 27 years old, weight is 71 kgs and height is 5'2" inches. Severe acidity, after eating food.
Loves sweet food and looking for a sustainable diet plan which can give her a relief from acidity. Plan a
day diet for manisha recommending foods to be taken and avoided. Non vegetarian and loves non veg
too.

Case 2 : Constipation

Harshali Pawar, 32 years old, weight is 62 kgs and height is 5 inches. Loves junk food and does not like
doing exercise. Facing constipation problem, stools passes after every 4 days. Forgets to drink water too.
Suggest her a day diet recommending foods to be included to cure constipation.She is a non vegetarian.

Case 3: Diarrhea

Himani mehta, 22 years old, weight is 54 kgs & height is 5'4" inches. Due to family wedding last night,
got diarrhea. Suggest her a day diet to cure. She is a vegetarian.
Diabetes
It is a metabolic disorder and not a disease. It is a condition where the amount of glucose in our blood is
too high because the body cannot use it properly. This is because the pancreas doesn’t produce any
insulin, or not enough insulin. Insulin is a hormone which facilitates the transfer of glucose from the
blood to the cells (to provide energy to the cells). In some cases, the insulin that is produced may not
function properly or the cells are not sensitive to insulin (known as insulin resistance or insensitivity).
There are majorly three types of diabetes:
Type 1 Diabetes: In type 1 diabetes, the body does not produce insulin. The body breaks down the
sugars and starches you eat into a simple sugar called glucose, which it uses for energy. However, since
there’s a lack of insulin in the body, the glucose is not taken to the cells and hence the blood glucose
levels stay elevated.
Type 2 Diabetes: In type 2 diabetes, the body does not use insulin properly. The cells are not sensitive
enough to insulin and hence don’t take up the glucose that is carried by the insulin. This is called insulin
resistance. At first, your pancreas makes extra insulin to make up for it. But, over time it is not able to
keep up and can't make enough insulin to keep your blood glucose at normal levels.
Gestational Diabetes: During pregnancy, usually around the 24th week, many women develop
gestational diabetes. A diagnosis of gestational diabetes doesn't mean that you had diabetes before you
conceived, or that you will have diabetes after giving birth. This can be temporary and reversible too.

Causes and risk factors

Insulin resistance - Insulin resistance is a common condition in people who are overweight, obese and
are physically inactive. Muscle, fat, and liver cells stop responding properly to insulin, forcing the
pancreas to compensate by producing extra insulin. When insulin production falters because of beta cell
dysfunction, glucose levels rise, leading to prediabetes or diabetes.
Obesity and Physical Inactivity - An imbalance between caloric intake and physical activity can lead to
obesity, causing insulin resistance. Central obesity, in which a person has excess abdominal fat, is a
major risk factor for diabetes.
Age: The risk for type 2 diabetes increases with age, especially after 45 years of age.
Family history: It is important for you and your doctor to know if diabetes runs in your family. Your risk
for diabetes is higher if your mother, father or sibling has diabetes.
Stress: Stress leads to the release of cortisol hormone which favours fat deposition thereby increasing
insulin resistance.

Signs and Symptoms

• Polydypsia (Increased thirst)
• Polyuria (Urinating often)
• Polyphagia (Increased hunger)
• Feeling very tired
• Losing weight
• Sores that heal slowly
• Dry, itchy skin
• Tingling sensation
• Blurry eyesight

Diagnostic tests:

Test Normalrange

Fasting 70-100mg/dl

PostPrandial Less than140mg/dl

HbA1C Less than6.3%

Randomsugarlevel Less than140mg/dl

Nutrition and Lifestyle Therapy
Nutrition therapy and counselling are an integral part of the treatment and self-management of
diabetes. The goals of nutrition therapy are to maintain or improve quality of life and nutritional and
physiological health. Following is the triad of diabetes:

• Diet
A. Activity
B. Drugs

• Diet:
1. Carbohydrates: Carbohydrates are classified in two major parts:

• Simple carbohydrates are broken down and digested very rapidly. E.g: Refined sugar, honey, jaggery,
fruits and fruit juices, molasses, rice, refined products like breads, maple syrup, etc.
Diabetics should go easy with the simple carbohydrates. Refined sugar is something that needs to be
completely out of the diet. If needed, one can opt for the natural sources of sugar like jaggery and
organic honey but should be careful with the time of consumption and must compliment it with a
fibrous meal to take care of the blood sugar.

• Complex carbohydrates take longer to digest as they are packed with fiber. E.g: Whole grains, legumes,
sweet potatoes, vegetables, millets, oatmeals, etc.
• Resistant Starch: A significant proportion of starch in the normal diet escapes digestion in the stomach
and small intestine and is labeled 'resistant starch' but this portion is difficult to measure and depends
on a number of factors including the form of starch and the method of cooking prior to consumption.
Resistant starch may modify postprandial glycemic response, prevent hypoglycemia (drop in blood
sugar), reduce hyperglycemia (spikes in blood sugar). Examples of resistant starch are raw potatoes,
green unripe bananas, cooked brown rice stored for some time. For a diabetic person, the focus should
be more on complex carbohydrates as it helps in gradual release of sugar in the blood. Simple
carbohydrates can be consumed in combination with complex carbohydrates (fiber) and/or resistant
starch.
Moreover, diabetic diet should include more of low to moderate glycemic index foods.Glycemic index
(GI) is a ranking system for carbohydrates based on their effect on blood glucose levels.
Glycemic index is categorized as low, moderate and high GI. E.g: Low GI Foods (GI of 55 or less) - Most
fruits (apple, orange, peach, citrus fruits) and vegetables (except potatoes, watermelon), whole cereals,
legumes/pulses, milk, yoghurt, foods that are extremely low in carbohydrates (fish, eggs, meat, nuts,
oils), nuts and seeds, mushrooms, etc.
Medium GI Foods (GI of 56 to 69) - Whole wheat products, basmati rice, sweet potato, muesli, banana,
unpeeled boiled potato, etc.
Low GI Foods (GI of 70 and above) -Refined sugar, baked potato, watermelon, croissant, white bread,
extruded cereals (e.g. rice crispies), etc.

2. Proteins:

Proteins help to reduce the glycemic index of the meal in which they are present in adequate amount
and also of the following meal, as they are processed slowly in the body. Thus, adding a good amount of
protein in every meal is of great help when it comes to regulating the blood sugar level.
Proteins are made from the pool of amino acids and are divided into two categories:

First class proteins contain all the essential amino acids. E.g. Meat, fish, chicken, eggs, dairy products
Second class proteins lack one or two amino acids: E.g. Cereals, pulses, soya, etc. It’s best to consume
the first class proteins to reap the benefits of all the amino acids. If the meal contains a second class
protein source, then the only way to make it complete is to combine it with other second class protein
source. E.g. A cereal-pulse combination makes a complete protein (brown rice and kidney bean
combo/Roti and dal/Moong khichdi/Sprouts-ncous cous salad).

3. Fats:
Like proteins, fats also help to reduce the glycemix index of the current meal and the following meal. It’s
important to choose the good fats (MUFA and PUFA) and go easy with the bad ones that disturb the
blood lipids (saturated fats, trans fats, etc). Bad fats tend to increase insulin resistance and decrease in
insulin sensitivity.
• It’s best to choose lean cuts of meat.
• Avoid deep frying the foods. Instead, you can bake, broil, grill, roast, or boil/steam or stirfry.
• Choose low-fat or fat-free dairy foods.
• Pick unrefined oils and not the refined ones.

4. Vitamins and minerals: There are certain trace minerals which help improving the insulin sensitivity.
Few examples are selenium, chromium, zinc, magnesium. These are found in whole grain cereals,
legumes, dairy products. Though they are required in small quantities, they play an indispensable role in
regulating the blood sugar.
5. Functional foods: There are some super foods that provide benefits beyond basic nutrition.E.g.
Fenugreek seeds, cinnamon powder, green coffee, paneer phool (Indian rennet), jamun seed powder,
psyllium husk (fiber), bittergourd, etc. These foods need to be essentially added to a diabetic diet as
they have some wondrous effects on blood sugar. Nature offers a lot that can cure/heal/improve the
condition without being dependent on the medications that usually have side-effects in the long run.

B. Activity: Any kind of physical activity will increase insulin sensitivity and lower insulin resistance. As
simple as a daily briskwalk for 30-45 minutes serves the purpose too. A regular exercise routine can help
one reduce the dosage of insulin releasing pills or insulin shots. Exercise opens up the cell receptors to
pass the sugar from the bloodstream to the cells.

C. Drugs: Drugs should be last line of treatment. The person can be on OHA’s (oral hypoglycemic drugs)
or on insulin or on both. In case of insulin, it has to be administered exogenously in the subcutaneous fat.
Nutrition and lifestyle therapy works the best! It can be used in line with the medical treatment and one
can be slowly weaned off the medicines over time.

Assignment:

(1) Ravi Sahay, age is 45 years old. Weight is 86 kgs. Recently done the reports, HbA1c is 6.2 %

Pure Vegetarian but eats eggs white. Plan a day diet for him, food aversions- soyabean, curd, tofu.

Body measurements :

Stomach- 113 cms

Waist- 106 cm

Hips- 121 cm

Neck- 7 cm

(2) Yogesh Sharma, age is 32 years old. Weight is 68 kgs. Blood sugar level is 232 mg/dl. Plan a
vegetarian diet for a day. Wants blood sugar in control.

Body measurements:

Stomach- 107 cm

Waist - 99 cm

Hips- 102 cm

Neck- 9 cm
 PCOS (Polycystic Ovarian Syndrome)

It is characterized by
1. Many small cysts in the ovaries
2. Irregular or missed periods
3. High level of testosterone causing Hirsutism (increased facial hair)
4. High level of insulin due to insulin resistance

Cause:

Genetic factors & hormonal imbalance

Symptoms:
1. Irregular/absent menstrual periods often causing infertility

2. Hirsutism: increased hair growth on face & chest

3. Pelvic pain
4. Weight gain, especially extra weight around the waist
5. Acne, oily skin, dandruff
6. Hyperpigmentation: dark brown/black patches on skin around the neck, arms, breasts or thighs

7. Anxiety & depression.

CONFIRMATION OF DIAGNOSIS:
1. ULTRASONOGRAPHY of the pelvis which shows > 12 cysts in either of the ovaries or both the ovaries.
Transvaginal ultrasound has more sensitivity.

2. Blood tests :
a. Testosterone levels > 9 ng/ml or > 2.6nmol/L.
b. Luteinizing Hormone levels > 80 U/L.

TREATMENT OPTIONS:
1. Nutrition and Lifestyle modification
2. Weight loss/fat loss- Obesity (high body fat %) results in hormonal imbalances, which in turn leads to
PCOD. PCOD further leads to weight gain and the vicious cycle continues. Hence, losing weight the right
way (fat loss) is extremely important.
3. Metformin in the dose of 1 gm twice a day
4. Menstrual cycles can be regularized by using combined oral contraceptive pills, though the cycles will
become irregular again on discontinuation of the pills.
5. Fertility medication: clomiphine.
6. Medication for hirsutism: spironolactone, finasteride.

Nutrition and Lifestyle Therapy:

1. Foods to be included: Complex carbohydrates, high fiber foods, healthy fats, protein rich foods.
Include a variety of vegetables, fruits, dry fruits, nuts, berries and seeds (sunflower seeds, pumpkin
seeds, watermelon seeds, flaxseeds, etc.).
2. Foods to be avoided: Refined sugar, processed foods, refined products, high fructose corn syrup,
aerated drinks, MSG, artificial sweeteners, salt loaded products. Avoid soya and its products completely,
to avoid estrogen dominance.

3. Tips for scanty menses:

• Sesame Seeds: Take handful of roasted sesame seeds and grind them well till they turn into a powder.
You can store this powder in a container and consume 1 tsp of it regularly with a tsp of raw organic
honey or a piece of jaggery.
• Turmeric and Jaggery: Take one tsp turmeric and mix it with 1 tsp jaggery. Take this mixture every
morning for a couple of weeks and see the results. It induces menstruation due to its warming effect. It
also relieves pain.
• Ginger: Boil 1 tbsp. fresh ground ginger in a cup of water for 5 minutes. Take it off the flame and add
1/2 tsp raw organic honey and drink the mixture three times a day after the meals. Continuing this for
around one month (or more) can help regulate the menses. It helps relieve the pain as well.
• Jeera (Cumin seeds): Boil 1 tsp jeera in 250 ml water for 5 minutes and strain it. Add a tsp of jaggery
and sip it warm twice a day- First in the morning on an empty stomach and second time at night, before
going to bed.
• Saunf (Fennel seeds): Take 1-2 tsp fennel seeds with half to one tsp jaggery. Boil it in water for 5
minutes. Strain it and drink it warm twice a day.
• Thyme (H. Ajwain) herbal tea: It increases the flow of menstruation. In case of menstrual pain, apart
from tea, make a poultice of ground seeds of thyme and apply externally.
• Beet root syrup: Boil fresh beetroots until they are very soft. Then remove the beets but boil the liquid
till it becomes syrup. Drink a cup of this liquid twice a day.

4. Tips to reduce the menstrual pain:

• Heating Pads
• 1 tbsp. sesame seeds mixed with 1 tbsp. jaggery and an inch piece of ginger helps reduce the pain
• Basil- Add 1 tbsp. of basil leaves to one cup of boiling water. Cover tightly and allow it to cool. Drink
this every few hours to ease the cramps.
• Alternatively, crush a handful of basil leaves to extract the juice. Add 2 tsps. of the juice to one cup of
warm water. Drink this three times daily while having the pain.
• Fennel Seeds- Add 1 tsp of fennel seeds to a cup of boiling water. Simmer the mixture on low heat for
5 minutes. Remove from heat and strain the tea. Add 1 tsp of raw organic honey and mix well. Drink this
tea two times daily beginning three days before the expected start date of the cycle. Continue drinking it
as needed for pain. Drink it warm for best results.

Tips to regulate menses:

• 1 glass unripe papaya juice OR carrot juice with a dash of garlic-ginger: These juices play a great role in
regulating the menses. Best to use unripe papaya. It helps contract muscle fibers in the uterus. Avoid it
when the periods are on. Have the carrot juice then.
• Having saunf (fennel seeds) daily also helps in regulating monthly periods. 3-4 tsp in a day post meals
can help.
• One can have a cup of decoction made of bitter gourd (karela) roots at least one or two times a day.
This can assist in getting regular monthly periods.
• Parsley is considered to be the most effective home cures for menstruation related issues because of
its high content of vitamin C. It’s recommended to consume parsley juice daily to regularize the menses.

• Take 2-3 radish and blend them into a fine paste using water. Add a cup of buttermilk to this paste.
Keep sipping this juice throughout the day. Best to have it on a daily basis for positive results.
• A decoction made of coriander (cilantro) leaves or seeds can also be very useful in getting regular
periods. This should be had at least 3 times a day for better results.
• Take 4-5 figs (anjeer) and boil them in a cup of water. Now filter this decoction and have it on a daily
basis. This remedy if followed regularly will normalize menstrual cycle.

5. Yoga for regulating menses:

• Badhakonasana (Butterfly pose)
• Marjaryasana and Bitilasana (Cat and Cow Pose)
• Mill Churning Pose (Chakki Chalanasana)

.• Child's Pose (Balasana)

• Superman Pose (Viparita Shalabhasana)

• Dhanurasana (Bow pose) Supta Badhakonasana (Reclining Butterfly Pose)

6. Lifestyle modifications:

• Drink plenty of water

• Exercise: Regular exercise will not only help reduce weight, but will also keep the stress at bay as it
releases the feel-good hormones.

• Free your life of stress: The stressors will not vanish, but regular meditation is great to keep yourself
from feeling stressed. Since stress is a contributing factor to weight gain and PCOD, learning to unwind
helps. Smelling lavender/ peppermint oil while deep breathing helps soothing the mind & will help to
sleep better.

• Quit smoking for good: Experts say that smoking stimulates androgen production, the main culprits of
PCOD characteristics. It is better to stop!

• Say NO to alcohol: It is true that alcohol affects the liver function, which in turn affects the hormone
balance. If one can't quit completely, then work on reducing the amount taken at a time and also the
frequency of the intake. Drink a glass of water between 2 drinks and end the drinks with a glass of
lemon water to make the body alkaline again.

• People suffering from PCOS/PCOD tend to develop insulin resistance which results in diabetes. Thus, it
is advisable to choose low-moderate glycemic index foods as they will cause a slower rise in blood sugar.
The low glycemic carbohydrates tend to have more fiber than the high glycemic carbs. For example,
select whole grains like whole wheat, jowar, oats, bajra, ragi that are as unprocessed as possible. They
are super rich in fiber which make them a low glycemic index food.

• Go easy with red meat and include more of lean meat, fatty fish, whole eggs, organic dairy products
and whole beans for protein. A diet rich in essential amino acids may reduce hirsutism. Hence, including
these first class protein sources is important.

• Avoid eating tandoori items specially non-veg (eg: Tandoori chicken) as the meat is partially
undercooked with charred skin. The charring effect produces a chemical in the body which further
aggravates the PCOS symptoms.
ASSIGNMENTS :

Case 1: Minal, age 33 years has one kid. Planning for another kid but could not conceive due to
diagnosed with PCOS since 3 years. Height is 5'2" , weight is 69.8 kgs. Plan a day diet for her. She is a
Non-vegetarian.

Symptoms: Facial hair, irritation, weight gain

Body measurements:

Stomach: 102 cm

Chest: 100 cm

Waist : 108 cm

Neck: 6 cm

Hips: 104 cm

Case 2: Rishika, 27 years old. Height is 159 cm and weight is 71.4 kgs. Taking medication for stress,
periods are missing , anxiety, got diagnosed in the lockdown. Consulting a homeopathy doctor. She is an
Eggetarian. Acidity is also a problem. Sleep is disturbed. Plan a day diet for her, curing acidity and
sleeping problems too.

Body measurements:

Stomach: 94 cm

Waist: 100 cms

Hips: 114 cm

Thighs: 64 cm

Chest: 98 cm

Neck: 7 cm
Case 3: Shweta Kothari, 23 years old. Height is 5'4" and weight is 62 kgs. Tried every diet since last 2
years can't move her weight from 62 kgs. Got diagnosed with PCOS 2 years back. Food aversions- brinjal,
cauliflower, kiwi. Hunger strikes in the evening a lot. Plan a day diet for her helping her lose weight. She
is a vegetarian.

Body measurements:

Chest: 99 cm

Neck: 10 cm

Stomach: 90 cm

Thighs- 49 cm

Hips: 100 cm
Hypertension

WHO defines Hypertension/also known as high or raised blood pressure, is a condition in which the
blood vessels have persistently raised pressure, putting them under increased stress.

Routine screening laboratory test for hypertension :

● Complete blood count

● Blood chemistries (Sodium , potassium , creatinine ,fasting glucose)
● Fasting lipid profile
● Urine analysis
● 12 lead electrocardiogram

Risk factors-
*Age
*Family History/genetics
*Being overweight / obese
*Low physical activity
*Using tobacco
*Too much salt(sodium) in your diet
*Too little potassium in your diet
* Alcohol

Pathophysiology-
● Genetics- Single gene mutations can cause hypertension. These mutations affect blood pressure by
altering kidney salt handling
● Autonomic nervous system- The autonomic nervous system plays a central role in maintaining
cardiovascular homeostasis via pressure , volume and chemoreceptors sig

How much salt is needed?

Babies more than 6 months and less than 12 months need: <1gm
1-3 yrs: 2 gm(0.8g Na)
4-6 yrs :3 gm (1.2g Na)
7-10 yrs: 5gm(2g Na)
11 yrs and over : 5-6gm (2.4 g Na)
Adults should consume less than 2,000 mg of sodium(less than 1 tsp salt), or 5 grams of salt, and at least
3,510 mg of potassium per day, according to new guidelines issued by the WHO.
Effect of high salt in diet:
When people take in more sodium than they need, kidneys try to remove the excess through the urine.
If the kidneys cannot remove enough sodium, it begins to build up in the fluid between cells, known as
the interstitial fluid.
This causes both water volume and blood volume to increase, putting additional strain on the heart and
blood vessels. A number of serious health conditions are linked to high sodium intake, including:

High blood pressure

Heart diseases
Stroke
Liver damage
Osteoporosis
Kidney disease
Consuming too much salt might even contribute to autoimmune diseases, such as multiple sclerosis,
rheumatoid arthritis, lupus, and psoriasis, as it overstimulates the immune system.

Foods rich in Sodium:

Known foods: These are the foods that are known to be high in salt due to natural presence of salt in
them/ or salt added during processing.

● Smoked, cured, salted or canned meat, fish or poultry including bacon, cold cuts, ham, frankfurters,
sausage, sardines, caviar and anchovies.
● Frozen meats and dinners/meals, such as burritos and pizza.
● Canned foods, such as ravioli, pasta, and chili.
● Salted nuts
● Beans/veggies canned with salt/brine added.
● Marine fish, poultry, dairy foods, eggs, smoked meats, olives, and pickled foods
● All foods that come from animals/sea foods contain sodium naturally. Most fresh fruits and vegetables
also contain some sodium but in smaller size.

DASH Diet:
The DASH dietary pattern is
● High in fruits and vegetables, low fat dairy products
● Moderate amount of whole grains,some fish,poultry, nuts and seeds

● Low in red meat, sugar and added fats

The DASH diet encourages you to reduce the sodium in your diet and eat a variety of foods rich in
nutrients that help lower blood pressure, such as potassium, calcium and magnesium.
• Standard DASH diet. You can consume up to 2,300 milligrams (mg) of sodium a day.
• Lower sodium DASH diet. You can consume up to 1,500 mg of sodium a day.

Here is the sample plan for 2000 calories daily:

• 6-8 servings of grains or grain products (preferable whole-grain)
• 4-5 servings of fruits
• 4-5 servings of vegetables
• 2-3 servings of low-fat dairy foods
• 2-3 servings of fats and oils

• 2 or fewer servings of meat, poultry or fish

With the following weekly limitations:

• 4-5 servings of nuts, seeds or dry beans
• sweets and food with added sugars restricted
 Cholesterol

Cholesterol is a waxy, fat-like substance that is found in all cells of the body.

Our body needs some cholesterol to make hormones, vitamin D, and substances that help us digest
food. Our body makes all the cholesterol it needs. However, cholesterol also is found in some of the
foods we eat.

High blood cholesterol (Hypercholesterolemia) is a condition in which there is excessive cholesterol in

the blood. By itself, the condition usually has no signs or symptoms. Thus, many people don’t know that
their cholesterol levels are too high.

People who have high blood cholesterol have a greater chance of getting coronary heart disease, also
called coronary artery disease

Causes:

1) Poor diet

Four things in the diet can increase the bad blood lipids (cholesterol, LDL, Triglycerides, VLDL) and can
reduce the good cholesterol (HDL) in the body-

• Saturated fat, a type of fat found mostly in foods that come from animals. E.g Red meat, egg yolk,
crustaceans, full fat dairy, etc. Saturated fat raises the total cholesterol and low-density lipoprotein (LDL)
cholesterol in the blood.

• Trans fat, found mostly in foods made with hydrogenated oils and fats such as stick margarine,
crackers, french fries, packaged foods, cookies, crackers, snack cakes, etc. Don’t rely on the food labels
which mention that the food is transfat free. If a food contains less than 0.5 gm of trans fat in a serving,
it can be labeled as “transfer fat-free.” Remember, even small amounts of trans fat can add up. Read the
ingredient list and avoid foods with partially hydrogenated oils.

• Cholesterol, which comes only from animal products. E.g Red meat, egg yolk, crustaceans, full fat
dairy, etc.

2) Physical Activity and Body Weight

Lack of physical activity can lead to weight gain. Being overweight tends to raise the LDL level, lower the
HDL level, and increase the total cholesterol level.

Regular physical activity can help lose weight which in turn lowers the LDL cholesterol. Being physically
active also can raise the good cholesteol (HDL cholesterol).

3) Heredity
High blood cholesterol can run in families. An inherited condition called familial hypercholesterolemia
causes very high LDL cholesterol.

Signs:

High blood cholesterol usually has no signs or symptoms. That’s the main reason why people miss out
identifying if their blood lipids are high. Hence, period checking of blood lipids is very essential, so that
the necessary remedial measures can be taken in case the levels are high.

Triglycerides (TGs):

Triglycerides are the end product of digesting and breaking down fats in meals. Some triglycerides are
made in the body from other energy sources such as refined carbohydrates.

Factors that can raise your triglyceride level include:

• Overweight and obesity

• Lack of physical activity
• Cigarette smoking
• Excessive alcohol consumption
• Refined carbohydrates (maida, sugar, polished rice, etc)
• Certain diseases and medicines
• Some genetic disorders

Investigations:

Blood test- Complete Lipid Profile

• Total cholesterol:

Optimal: 200 mg/dL or below;

Borderline: 200-239 mg/dL, and

High: 240 mg/dL or above.

• Triglycerides

Optimal: 149 mg/dL or lower

Borderline: 150 to 199 mg/dL

High: 200 mg/dL or higher

Check Lipid profile once in 3 months if the TG/Cholesterol are abnormal.

 Also check for ECG & BP if TG & Cholesterol are Abnormal.

Medicines-

Lipid-lowering medicines, eg- Statins, Fibrates etc. However, these have side-effects in the long run. It’s
best to manage it through dietary and lifestyle modification and slowly wean off from the medications.

Nutrition and Lifestyle Therapy-

* Nutrition

1) Adding adequate fiber to the diet:

Adding soluble fiber to the diet is of huge benefit when it comes to reducing cholesterol. Soluble fiber
when consumed absorbs water and forms a gel in the intestine. This gel binds with the cholesterol
lingering in the blood and help to excrete it out of the body.

Sources of soluble fiber- Oats & barley, whole fruits and berries, vegetables, beans like black, kidney,
pinto, cluster beans, frenchbeans, etc.

Oats and barley are rich soluble fiber, called beta-glucan which forms a gel in the intestine and prevents
cholesterol from being absorbed into the bloodstream. 5-10 gm of soluble fiber a day is good enough to
take care of the cholesterol levels. One and half cup of cooked oatmeal supplies 6 gm of fiber, top it with
an apple or a banana to get the extra 3-4 gm of fiber and we are sorted.

Adding vegetable salads in the meals, having unstrained vegetable juices and soups, consuming whole
fruits, choosing whole flour over the refined one etc. would also help.

2) Choose leaner cuts of meat or white meat. Egg yolk needs to be avoided only if the triglycerides (TGs)
are high. We can definitely have egg yolks if the TGs are in range. Fatty fish is good to go. Take it easy
with the crustaceans (prawns, mussels, clamps, shrimps, etc).

3) Choose low fat organic dairy products including milk, paneer/cottage cheese, yoghurt and buttermilk.

4) Choose healthier fats- Mono-unsaturated fats (MUFA) found in olive oil, avocados, etc and Omega 3
rich foods like fatty fish (salmon, mackerel, tuna, herring- non-fried), flaxseeds, chia seeds, walnuts,
pumpkin seeds, etc. Omega 3, apart from being anti-inflammatory in nature, also plays a pivotal role in
reducing total cholesterol, LDL, triglycerides, VLDL and helps increasing HDL.

As per the American Heart Association guidelines, we need to eat minimum 2 servings of fish a week to
get maximum Omega 3 for healthy cholesterol levels. Since Omega 3 is heat susceptible, make sure you
do not overcook the fish, you can simply bake it or grill it.
 If you do not eat fish, you can get your Omega 3 dose from 1 tbsp flaxseed once a day OR a handful of
walnuts on a regular basis.

5) Adding Green Tea

This antioxidant packed herbal beverage does good to our body in multiple ways. A regular intake of
sugarless green tea has been shown to reduce cholesterol by 2-5% keeping the HDL levels untouched.

To make the cholesterol reducing efficacy of green tea even better (and to enhance its flavor), we can
add half a tsp of cinnamon into it which has also shown to reduce triglycerides, LDL and total cholesterol
levels.

6) Unstrained bottle guard juice with a dash of crushed garlic-

It’s the perfect mix for cholesterol reduction. Rich in soluble fiber and highly alkaline in nature, bottle
guard is very well appreciated in the weight loss segment. However, regular consumption of bottle
guard also helps keeping the lipid profile in check. Adding crushed garlic while juicing this fiber rich
veggie enhances the cholesterol reducing properties to a great extent.

7) Fenugreek seeds-

They provide a 3 way benefit- They contain saponins that reduce body’s absorption of cholesterol.
These saponins also reduce cholesterol synthesis in the body. Apart from saponins, the fiber component
of fenugreek also helps fight cholesterol in all the ways.

The best way to incorporate fenugreek is: To consume 1 tbsp of seeds soaked in 1 cup water overnight
on an empty stomach in the morning OR you can dry roast 1 tbsp of seeds until they turn brown,
powder it and add it in our meal preparations.

* Exercise

Being physically inactive contributes to overweight and can raise LDL and lower HDL.

Exercise can improve the overall lipid profile. Moderate physical activity can help raise HDL and lower
LDL. It’s best to work up to at least 30 minutes of exercise a day.
Adding physical activity, even in 10-minute intervals several times a day, can help you begin to lose
weight. Just be sure that you keep up the changes you decide to make. Regularity is the key!
Consider:

• Taking a brisk daily walk before your lunch hour

• Riding your bicycle
• Swimming laps
• Playing a favorite sport
• Taking the stairs instead of the elevator or doing a few situps while watching television

* Fat loss
Carrying even a few extra pounds contributes to high cholesterol. Losing as little as 5 to 10 percent of
your weight (fat loss) can improve cholesterol levels.
Making the right food choices, consuming balanced meals, eating mindfully, staying regular with
exercise can help you lose the right way.
Not just food and exercise, but also your sleep, stress levels, water intake need to be in check. High
stress levels and lesser hours of sleep than what your body requires, is strongly connected to increased
cholesterol levels. Poor water intake reduces the volume and the flow-rate of blood, which may increase
the risk of cholesterol accumulating in the arteries. A sound sleep, better ways of managing stress and a
good water intake of 3-3.5 liter is essential to have a healthy lipid profile.

* Quit smoking gradually

Quitting smoke definitely helps improve HDL cholesterol level and reduces cholesterol. Within 20
minutes of quitting, your blood pressure and heart rate decrease. Within one year, your risk of heart
disease is half tha, that of a smoker. Within 15 years, your risk of heart disease is similar to someone
who never smoked.

* Drink alcohol only in moderation

If you drink alcohol, do so in moderation. Too much alcohol can lead to serious health problems,
including high blood pressure, heart failure and stroke. Just like we recommend eat your food mindfully,
we also recommend drinking mindfully- in controlled quantities. It’s best to end the drink with a glass of
lemon water to re-alkalize the body. Red wine in moderation is known to be a cardio-protective drink, as
it helps lower blood pressure and cholesterol. So the choice of alcohol really matters here.
These lifestyle changes can certainly prevent the need to get onto cholesterol-lowering medications.
If you’re already on medications, these lifestyle changes can help you reduce the dosage of it and slowly
get you off it too.