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Preventing Strokes One at a Time. Healthy Eating. 2009. Managing Stroke Risk Factors. LEARNING OBJECTIVES. Upon completion, participants will be able to: Counsel patients about a healthy balanced diet according to the Canadian Best Practice Recommendations for Stroke Care, 2008.

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Preventing Strokes

One at a Time

Healthy Eating


managing stroke risk factors
Managing Stroke Risk Factors


Upon completion, participants will be able to:

  • Counsel patients about a healthy balanced diet according to the Canadian Best Practice Recommendations for Stroke Care, 2008.
  • Partner with patients & families to develop an individualized plan for cooking and eating healthier.
2 1 lifestyle and risk factor management
2.1 Lifestyle and Risk Factor Management

Persons at risk of stroke and patients who have had a stroke should be assessed for vascular disease risk factors and lifestyle management issues:

Diet, Sodium intake, Exercise, Weight, Smoking, Alcohol intake

They should receive information and counseling about possible strategies to modify their lifestyle and risk factors.

CMAJ 2008;179(12 Suppl):E1-E93. #2.1

healthy balanced diet
Healthy Balanced Diet




Canada’s Food Guide

Other tips

How to balance a meal

BMI and Waist Circumference


canadian best practice recommendations for stroke care 2008 2 1i
Canadian Best Practice Recommendations for Stroke Care, 2008 #2.1i)

Healthy balanced diet

High in fresh fruits, vegetables, low fat dairy products, dietary and soluble fibre, whole grains, proteins from plant sources, and low in saturated fat, cholesterol and sodium, in accordance with Canada’s Food Guide to Healthy Eating

CMAJ 2008;179(12 Suppl):E1-E93 #2.1

canadian best practice recommendations for stroke care 2008 2 1 ii
Canadian Best Practice Recommendations for Stroke Care, 2008 #2.1 ii)


The recommended daily sodium intake from all sources is the Adequate Intake by age.

For persons 9 – 50 years, the Adequate Daily Intake is 1500 mg. Adequate Intake decreases to 1300 mg for persons 50 – 70 years and to 1200 mg for persons > 70 years.

A daily upper consumption limit of 2300mg should not be exceeded by any age group

See for sodium intake guidelines.

CMAJ 2008;179(12 Suppl):E1-E93 #2.1

recommendations for adequate sodium intake by age
Recommendations for Adequate Sodium Intake by Age

CMAJ 2008;179(12 Suppl):E1-E93 #2.1

equivalent measurements of sodium and salt
Equivalent Measurements of Sodium and Salt
  • For example:
  • Two slices (292 grams total) of a Pepperoni Lover's large stuffed crust pizza at Pizza Hut contain 3,000 mg of sodium, double the recommended intake for a full day.
  • .

CMAJ 2008;179(12 Suppl):E1-E93 #2.1

types of salt
Types of Salt

Table salt =fine-grained, we get it from salt mines. In 1920 iodine was added.

Sea salt =evaporated seawater

Kosher salt =table salt but with no additives, made to prepare meat according to Jewish dietary regulations

Pickling salt= fine grained like table salt but doesn’t contain iodine, used to pickle food.

1 teaspoon contains 2300 mg sodium

dietary fat overall choose low fat
Dietary FatOverall…choose low fat
  • Use less butter and margarine.
  • Use skim, 1% or 2% milk.
  • Choose low fat yogurt (<2%) and cheese (<20% MF)
  • Choose lean meat/poultry and trim fat before cooking
  • Items to limit: bacon, cold cuts, sausages, gravy, chips, fried food, pastries
  • Use small amounts of canola (cooking) or olive oil.
  • Eat more vegetables and fruit.
good versus bad fat
GOOD versus BAD fat

Good Fats/Healthy

(mono & polyunsaturated)

Non-hydrogenated margarine

Oils: canola, olive, corn, avocado, olives

Nuts: almonds, peanuts, pecans, walnuts

Seeds: flax, sunflowers, sesame

Fish: salmon, trout, tuna, sardines

Eggs: Omega-3

Bad fats/Unhealthy

(trans and saturated fats)

Red meat, poultry

Whole milk, cheese, cream

Butter, cream cheese

Ice cream, sour cream

Palm oil, coconut oil, hydrogenated vegetable oil, shortening

Fried foods

Processed food

fibre 25 35 g a day
Fibre(25-35 g a day)
  • Eat a variety of soluble and insoluble
    • Insoluble Fibre: Bran Cereals, Whole Grains
    • Soluble Fibre: Dried Beans, Peas, Lentils, Rolled Oats, Oat Bran, Barley, Psyllium
  • Soluble fibre can lower LDL cholesterol
  • Provides a feeling of fullness (↓ intake)
  • Help control blood glucose levels (diabetes)

(up to 50g fibre with diabetes)


Grain Products (1/4 Plate):

  • Whole Grain Breads
  • Brown Rice, Whole Wheat Pasta, Barley
  • 1-2 Tbsp Ground Flaxseed
  • High Fibre Cereals – Shredded Wheat,

Oatmeal, All Bran Buds with Psyllium

cholesterol 300mg or less a day
Cholesterol(300mg or less a day)

Little effect on blood cholesterol

Genetics, diabetes, physical activity

Found only in animal products

Focus on decreasing unhealthy fats in the diet instead of decreasing cholesterol intake

Increase fibre intake

canada s food guide
Canada’s Food Guide

Food Group

Vegetables & Fruit

Grain Products

Milk & Alternatives

Meat & Alternatives

other tips to a healthy balanced diet
Other Tips to a Healthy Balanced Diet

Vegetables (1/2 Plate):

  • 7-8 servings daily
  • (Fresh/Frozen) vegetables vs juice
  • Brighter is better
  • Choose one green and one orange daily

(Broccoli, Spinach, Peppers, Squash,

Sweet Potatoes, Carrots)

healthy eating
Healthy Eating
  • Include 3 of 4 food groups at each meal
  • Choose fruits vs juices
  • Low fat dairy
meal planning breakfast
Meal planning : Breakfast

1 fruit

1 milk

Meat and alternatives

2-3 grain products

meal planning lunch dinner
Meal Planning: Lunch & Dinner

1 fruit

1 Milk

Meat and alternatives

2-3 vegetables


2-3 grain products

portion sizes and tableware
Portion Sizes and Tableware
  • Dinner plate 23cm/9inches
  • Soup bowl 250 ml /1cup
  • Cereal Bowl 250ml /1 cup
  • Drinking glass150 ml /2/3 cup
  • Dessert Bowl 150 ml /2/3 cup
  • Wine glass 125ml /1/2 cup
eat smart when eating out
Eat Smart When Eating Out

Better choices:

  • Condiments on the Side
  • Salad vs Fries (caution: Caesar Salad)
  • Tomato vs Cream Sauce for Pasta
  • Plainer Burger vs. “House” Specialty
  • Smaller / Share / Take Home Portions

healthy eating station

Healthy Eating “Station”

The following slides will be referred to at “healthy eating” station with a chance to read labels.

label reading
Label reading
  • Learn how to read a label at Health Canada website

  • Label reading specific to sodium at Canadian Stroke Networks sodium 101 website
shop smart
Shop Smart
  • Plan Meals Using Canada’s Food Guide
  • Use a shopping list
  • Don’t shop hungry
  • Periphery of the store
  • Read labels
  • Health Check Symbol on food
shop smart1
Shop Smart
  • Snacks, Cereals, Cookies
    • < 3 g Total Fat, <2 g Saturated & Trans Fat
    • < 200 mg Sodium (10% DV)
  • Cereals, Grains
    • > 3 g Fibre; Whole Grain 1st Ingredient
    • < 4 g Sugar (For TG)
  • Frozen Dinners
    • < 600 mg Sodium
shop smart2
Shop Smart

Ingredient List – watch out for:

  • Saturated and Trans Fat
    • Hydrogenated or Partially Hydrogenated Shortening
  • Saturated fats
    • Palm, Palm Kernel, Coconut, Tropical Oils
    • Lard, Tallow, Butter
  • Sodium
    • Salt, Flavoured Salts, Sea Salt, Sodium, MSG, Brine, Soy Sauce, Baking Soda, Baking Powder

Canadian Best Practice Recommendations for Stroke Care, updated 2008