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NUTRITION
WHY IS NUTRITION IMPORTANT?
Nutrition is all about food. We need to pay close attention to what we eat (nutrients) in order to maximize growth, satisfaction, and energy. Basically, it’s the foundation for good physical health, whether that be strong muscles or high immunity (ability to fight off infection).
Improper nourishment (malnutrition) has many short and long-term health effects, including hypertension (high blood pressure). It also contributes to other diet-related conditions like diabetes, stroke, and heart disease.
(Centers for Disease Control and Prevention [CDC], n.d. -b; Center for Science in the Public Interest [CSPI], n.d.; Delaney, 2009; Kiguli et al., 2019; Kyamuhangire et al., 2013; Mayo Clinic, 2020a; National Heart, Lung, and Blood Institute [NHLBI], n.d.; Norgan, n.d.; Ravishankar, 2006; The Republic of Uganda, 2011; Tufts Health Plan, 2020; Washington State University [WSU], n.d.; World Health Organization [WHO], n.d. -b; WHO, 2012; WHO, 2019; WHO, 2020b)
SIGNS OF MALNUTRITION
Malnutrition is an imbalanced state of food (nutrient) and energy consumption.
PHYSICAL TRAIT
CLINICAL TERM
DEFINITION
SHORTNESS
Stunting
Low height for age.
LIGHT-WEIGHT
Underweight
Low weight for age.
THINNESS
Wasting
Low weight for height.
HEAVINESS
Overweight
High weight for height.
EXTREME HEAVINESS
Obesity
Extremely high weight for height.
PALENESS
Pallor
Whitish, light coloring.
LOW-LIGHT BLINDNESS
Night Blindness
Little to no vision in dark places.
EYE SPOTTING
Bitot's Spots
Dark spots on the whites of the eyes.
NECK SWELLING
Goitre
Swollen, enlarged thyroid glands.
LIMB SWELLING
Oedema
Fluid build-up in the extremities (limbs).
(CDC, n.d. -a; Delaney, 2009; Krishna et al., 2016; Marie Curie Charity, n.d.; Mayo Clinic, 2017; National Health Service, n.d.; Norgan, n.d.; Ravishankar, 2006; The University of London, School of Hygiene & Tropical Medicine [LSHTM], 2009c; WHO, n.d. -b; WHO, 2020a)
NUTRITION BASICS
THE MAJOR FOOD GROUPS
GRAINS
corn (maize), rice, millet, sorghum
FRUITS
bananas, passion fruit, papaya (pawpaw), lemons, mangoes, pineapples, cranberries (kanyebwa), mulberries, tamarind, figs, palm fruit
VEGETABLES
potatoes, cassava, onions, pumpkins, tomatoes, corn, mushrooms, peas, eggplant, carrots, okra, cabbage
PROTEIN
chicken, beef, goat, pork, lamb, fish, beans, seeds, nuts
DAIRY
milk, butter
FATS & OILS
sunflower oil, sesame (sim-sim) oil, canola oil, butter, ghee, fatty animal meats, nuts
WHAT DOES GOOD NUTRITION LOOK LIKE?
A proper diet will include a variety of whole foods (unprocessed, unrefined, and natural) from all the major food groups in appropriate amounts.
The goal of healthy eating is to strike a balance through portioning (rationing). Consuming too much or too little can lead to malnutrition (imbalanced food intake) and other chronic dietary diseases that will keep you from functioning at your best. And even if you’re only eating whole foods, it’s still possible to have too much of a good thing!
(American Heart Association [AHA], n.d. -a; AHA, n.d. -c; AHA, n.d. -d; AHA, 2018; AVITA Health System, n.d.; Bendech, 2013; CDC, n.d. -a; CDC, n.d. -b; CSPI, n.d.; Cleveland Clinic, 2014; Food and Agriculture Organization of the United Nations [FAO], n.d.; Foundation for the International Medical Relief of Children [FIMRC], 2020; Harvard Medical School, 2014; Harvard Women's Health Watch, 2017; Hotz et al., 2012; Jaarin et al., 2011; Kiguli et al., 2019; LSHTM, 2009c; Mayo Clinic, 2020b; McElroy, n.d.; NHLBI, n.d.; Norgan, n.d.; Panawala, 2017; Ravishankar, 2006; The Republic of Uganda, 2011; Tufts Health Plan, 2020; United Nations Children's Fund [UNICEF], 2015; WSU, n.d.; WHO, n.d. -b; WHO, 2012; WHO, 2019; WHO, 2020a; WHO, 2020b; World Travel Guide, n.d.)
THE ANTI-HYPERTENSION DIET
YOU SHOULD EAT:
FRESH FRUITS & VEGETABLES
Lowers susceptibility to disease.
bananas, passion fruit, papaya (pawpaw), lemons, mangoes, pineapples, cranberries (kanyebwa), mulberries, tamarind, figs, palm fruit, potatoes, cassava, eggplant, mushroom, cabbage, onions, tomatoes, carrots, okra
LEAN MEAT &
FISH
Strengthens the heart muscle.
chicken, fish
*If only red meats like beef, pork, goat, and lamb are available, make sure to trim off the excess fat/skin and eat smaller portions.
NUTS, SEEDS,
BEANS
Decreases levels of bad bodily fats.
groundnuts, sesame (sim-sim), pumpkin seeds, cowpeas (emagira), pinto beans, black beans, white beans, navy beans, kidney beans, mung beans, Tanzania K20 beans (haragwe), soy beans
HEARTY WHOLE GRAINS
Improves gut health to prevent weight gain.
millet, sorghum, corn (maize), white or brown rice
*Aim for unrefined and unprocessed varieties.
(AHA, n.d. -a; AHA, n.d. -d; CDC, n.d. -a; Cleveland Clinic, 2014; Daisy, 2019; Delaney, 2009; FAO, n.d.; FIMRC, 2020; Harvard Medical School, 2014; Harvard University, n.d.; Harvard Women’s Health Watch, 2017; Hotz et al., 2012; Kiguli et al., 2019; Kyamuhangire et al., 2013; Mayo Clinic, 2020b; McElroy, n.d.; NHLBI, n.d.; Peace Corps, n.d. -a; Raschke, 2005; The Republic of Uganda, 2011; WSU, n.d.; WHO, 2012; WHO, 2019; WHO, 2020a; WHO, 2020b; World Travel Guide, n.d.)
YOU SHOULD LIMIT:
SODIUM
salt
Consuming too much salt worsens hypertension by increasing bodily water retention, which in turn raises blood pressure. If you have hypertension, you should limit yourself to 1 teaspoon (2,300 milligrams) of salt per day.* Try to use iodized salt or other savory seasonings instead.
*Check out the "Measuring Salt Intake" infographic (linked at the bottom of this section) to visualize this amount.
REFINED OILS
Butto, Mukwano
Although refined oils contain significantly less healthy fats (unsaturated) than unrefined oils, they can still be safely consumed in small amounts.* In particular, refined and fortified vegetable oils provide crucial amounts of vitamin A to account for deficiencies.
Unrefined oils can be expensive and difficult to find—when available/affordable, substitute refined oils with unrefined varieties.
*Check out the “Heart-Healthy Cooking” informational sheet (linked at the bottom of this section) for a comprehensive list of recommended oils.
ALCOHOL
beer (pombe), gin (waragi)
While the exact mechanism behind alcohol-induced high blood pressure is still unknown, there’s significant evidence to show that consumption of alcohol is linked to higher rates of hypertension. Try to limit yourself to 1 drink per day (or less).
SMOKING
tobacco, cigars, cigarettes
The nicotine in tobacco products raises blood pressure by narrowing the blood vessels and increasing heart rate. If you don’t smoke, don’t start—but if you have a bad habit, gradually reduce your tobacco intake (ideally until you can stop altogether).
(AHA, n.d. -a; AHA, n.d. -c; AHA, 2016; AHA, 2018; Beilin & Puddey, 2006; CDC, n.d. -a; CDC, n.d. -b; Cleveland Clinic, 2014; Daisy, 2019; Delaney, 2009; FAO, n.d.; Go Ask Alice, n.d.; Greer et al., 2019; Harvard University, n.d.; Hotz et al., 2012; Jaarin et al., 2011; Kaddumukasa et al., 2016; Kaddumukasa et al., 2017; Kiguli et al., 2019; Kyamuhangire et al., 2013; LSHTM, 2009b; LSHTM, 2009c; Mathur & Pillai, 2019; Mayo Clinic, 2020b; McElroy, n.d.; NHLBI, n.d.; Peace Corps, n.d. -a; Raschke, 2005; The Republic of Uganda, 2011; U.S. Food and Drug Administration, n.d.; WHO, 2019; WHO, 2020a; WHO, 2020b; World Travel Guide, n.d.)
YOU SHOULD AVOID:
FRIED, BUTTERY FOODS
Rolex, fried flatbread (chapati), egg rolls, donuts (mandazi)
FATTY RED MEATS
beef, pork, lamb, goat
SWEETENED FOODS
molasses/sugary teas and coffee (kawa), cookies, pancakes (kabagala)
PROCESSED FOODS
soft drinks (soda), chips/crisps, peanut butter
What's so bad about them?
Consuming these foods (especially in large amounts) can lead to excessive weight gain and obesity, which forces your heart to work harder. This strain raises your blood pressure and worsens hypertension. On top of that, many of these foods contain harmful, unnatural chemicals and fats that can degrade your body and prevent it from functioning properly.
(American Academy of Family Physicians, 2004; AHA, n.d. -a; CDC, n.d. -a; CDC, n.d. -b; Cleveland Clinic, 2014; CSPI, n.d.; Daisy, 2019; Delaney, 2009; FAO, n.d.; Greer et al., 2019; Harvard University, n.d.; Hotz et al., 2012; Kiguli et al., 2019; Kyamuhangire et al., 2013; LSHTM, 2009b; LSHTM, 2009c; LSHTM, 2009d; Mathur & Pillai, 2019; Mayo Clinic, 2020b; McElroy, n.d.; NHLBI, n.d.; Peace Corps, n.d. -a; Raschke, 2005; The Republic of Uganda, 2011; WHO, 2012; WHO, 2019; WHO, 2020a; WHO, 2020b; World Travel Guide, n.d.)
NEXT STEPS
STEP 1
Talk to your family about your diagnosis.
Make sure that everyone in your household understands your medical condition and dietary restrictions, especially those who are in charge of seasoning and preparing your food.
Oftentimes, you may need to modify traditional recipes to make them more nutritious; this can be challenging when cooking dishes that are served communally (lusania) since others may not like the altered flavor. In that case, consider separating a small portion of food from the larger pot before adding any seasoning, and request that your share be free of certain fats or other ingredients that may increase your blood pressure. That way, everyone can enjoy their meal in their own preferred ways.
STEP 2
Plan your meals.
Creating your own routine meal plan can help you make and maintain healthy long-term eating habits, plus hold yourself accountable for your nutrition.
Get creative and incorporate a variety of dishes to ensure that you’re consuming all of the different nutrients that you need. Food diversity also keeps meals interesting and allows you to be flexible in times where certain items might not be available due to changing seasons, economic conditions, natural disasters or other external complications.
Here are some anti-hypertensive meal ideas you can try (and remember to portion accordingly):
BREAKFAST
Unsweetened ugali/posho (unrefined maize, sorghum, soy or millet flour) with fresh fruit
Katogo with fresh vegetables, beans, and/or groundnuts
Unsweetened black or green tea
LUNCH OR SUPPER
Boiled or steamed matooke
Ugali/Posho (unrefined corn flour) with cooked beans, chicken, and/or vegetables
Chaloko with tomatoes, onions, peppers, and/or beans
Luwombo with chicken, fish, carrots, potatoes, mushrooms, groundnuts, and/or rice (unrefined white or brown)
Mugoyo with cranberries, beans, and/or fresh vegetables
Chickennat with onions, groundnuts (no butter)
Tomato soup with vegetables
Any bean, nut, seed, and/or vegetable-based sauces
Roasted, raw or steamed vegetables
SNACKS
Fresh seasonal fruit
Raw or steamed vegetables
(AHA, n.d. -a; AHA, n.d. -d; Cleveland Clinic, 2014; Daisy, 2019; FAO, n.d.; Go Visit Kenya, 2014; D. Haines, 2020; Harvard Medical School, 2014; Harvard University, n.d.; Harvard Women’s Health Watch, 2017; Hotz et al., 2012; Kiguli et al., 2019; Kyamuhangire et al., 2013; Mayo Clinic, 2020b; McElroy, n.d.; Musoki, 2020; NHLBI, n.d.; Peace Corps, n.d. -a; Peace Corps, n.d. -b; Raschke, 2005; Schlabach, 2020; Slow Food Uganda, 2018; Taste of Home, n.d.; World Travel Guide, n.d.)
STEP 3
Find others to eat with.
Even with dietary restrictions, mealtimes can still be enjoyable with good company, whether that be family, friends or neighbors. Reaching out to others who are hypertensive can also be useful if you need tips or general support.
Although hypertension can be difficult to manage, just remember that your community can help you out!