Nutrition Protocol
Oben acknowledges the significance of food as part of Black culture. We have created a nutrition section in which we honor the culture, connection to food, and recommend small changes that would lower cardiovascular risk.
Oben’s protocols are designed to meet patients where they are at. Many of our patients live in food deserts where there is limited access to grocery stores, healthy food options, and fresh produce. Within the program, users are taught slight food modifications that can be implemented at fast food/fried food restaurants, as well as tools to counteract high salt intake i.e. increased hydration. Even these slight changes will help move the needle in improving a patient’s heart health and cardiovascular risk reduction.
We utilize the Dietary Approaches to Stop Hypertension (DASH) as our primary foundation for nutrition. Research suggests that a diet rich in vegetables, fruits, and low-fat dairy products, and reduced in sodium, total fat, saturated fat and cholesterol, lowers blood pressure (1).
Lowering salt is crucial to improving blood pressure, this is a core nutrition skill in our program. It is important to acknowledge the tendency in the black community to cook with high levels of salt. This dates back to times of slavery, when there was only access to poor quality food i.e. undesirable cuts of meat, and utilizing salt and spices made the food edible. This was highly impactful on African American cooking over generations, and thus a culture was established around foods high in salt and spice. In acknowledging this important cultural component, we derived habits that teach users to make realistic changes, i.e. swapping salt for an alternative spice or herb, without sacrificing flavor. We emphasize spices such as black pepper, paprika, cayenne, chili powder, thyme, garlic powder, onion powder, and cinnamon, as well as herbs and lemon, as these are staples to cajun, creole, west african and African American cooking.
The DASH diet promotes dairy as a low blood pressure food, however, our program does not recommend that users consume dairy. Being that many of our users are of African descent, we primarily promote foods that were eaten prior to European colonization, that are also in line with our heart healthy protocols. Dairy is often avoided in the African American diet because of reported indigestion, bloating, or perceived lactose intolerance (8).While we do not promote consumption of dairy, we do offer guidance around how to eat it in a healthy way for users that do consume it regularly. Our goal is to ensure users are consuming adequate potassium, magnesium and calcium through fruits, vegetables, and whole grains i.e. black eyed peas, collard greens, bananas, okra, and yucca (9).
In addition to decreasing salt in diets, our program also emphasizes lowering fat intake. There is an educational component around identifying foods that are high in fat, as we recognize that a lot of targeted media advertises foods as “healthy” when in reality they are not i.e. salads with heavy portions of salad dressing, etc. We also introduce reasonable alternatives for healthier fat intake; swapping out one type of oil for another, or titrating back on the amount of oil used.
Sugar intake is an area users will explore within the program. Many of our users regularly consume foods and beverages high in sugar, sugar as a whole is largely woven into the culture in Black and Brown communities. We provide suggestions for users to make alternative foods & beverages with much less added sugar, while not sacrificing flavor. The program does not require users to ignore their cravings for sugar, but rather provides alternatives to implement, while also pinpointing where their cravings are sourcing from. There is also education around natural vs. processed sugars, and where/when to swap one for the other in cooking/baking.
Water intake is potentially the most accessible tool for lowering blood pressure. Our users often do not intake enough water as it is, and when combined with high levels of sugary beverages and salty foods, it becomes a large contributor to high blood pressure. It is common for our users to drink multiple sodas/juices per day. We educate users on suggested daily water intake, and they start off drinking 5 cups per day. Users are educated on types of foods that contain water and can contribute to water intake. Caffeine is also addressed in this portion of the program. Many of our users are unaware that high caffeine intake actually increases their blood pressure. Users are taught to titrate back on caffeine consumption not only by swapping for other beverages, but also by utilizing other methods i.e. getting up to move when feeling sleepy, getting sun exposure, taking a cold shower, etc.
Eating a balanced diet is crucial to lowering blood pressure and is thus included as a skill in our program. Eating a balanced plate of vegetables, fruit, healthy carbs, and protein is essential for users to receive the proper balance of nutrients for lowering their blood pressure. In the black community there is often an emphasis on eating meat and carbs, thus an average plate of food does not contain the necessary balance of nutrients. We first teach the user what a balanced plate looks like, and then slowly encourage them to increase food groups that are missing on their plate. Eating breakfast is also targeted in this skill, as it is crucial for maintaining proper nutrient intake, managing cravings, and keeping blood sugar balanced– all important for lowering blood pressure. We teach our users to gradually add in breakfast and illustrate how it can be as simple as eating a piece of fruit. We take into account the dietary preferences of black and brown users by offering breakfast options they are familiar with. Additionally, we address emotional eating, as there is a deep connection between food and emotion, and often foods high in fat, sugar, and salt can feel like a means to self soothe when stressed. This is increased in communities that experience ongoing high stress levels. We help users understand the root of their cravings, and how specific cravings can even correlate to nutritional imbalances. We also empower users to understand their emotions while offering suggestions around utilizing self care as an alternative to emotional eating.
To help users feel connected to eating fruits and vegetables. We make it fun and relatable i.e. in the skill “Eat like your ancestors.” This skill allows users to feel connected to the foods their ancestors may have eaten that also contributed positively to their health. Patients often hear, “Eat your fruits and veggies” yet have no connection to the foods being recommended to them. In this skill we connect them back to some of the most common fruits and vegetables from West Africa and other areas of the diaspora. Fruits and vegetables like yams, sweet potato, cassava, plantains, guava, pineapple and banana are fairly accessible and affordable foods that are high in nutrients and are common in West Africa. We introduce them to these foods and teach about their value to heart health as well as some recipes they can try.