NOTE :  Yellow Boxes to be filled by user.

NAME *

AGE *

Sex *

Male Female

Female Pregnant Female Lactating

MODE OF WORK *

NORMAL CALORIE REQUIRED

CLINICAL CONDITION

CALORIE TO BE INTAKEN

BLOOD PRESSURE (SYSTOLIC / DIASTOLIC) *

STANDARD BLOOD PRESSURE (SYSTOLIC / DIASTOLIC)

AMOUNT OF NUTRIENTS TO BE CONSUMED (gram/day) : Refer Below
(If cooking, the nutrients should be weighed and then cooked)

NATURE OF FOOD *

GRAINS

LENTILS

LOW FAT OR SKIMMED MILK ( ml / day )

DAIRY PRODUCTS

VEGETABLE OIL

GREEN LEAFY VEGETABLES

OTHER VEGETABLES

ROOTS AND TUBERS

FRUITS

FRUITS JUICE

SALT

MEAT & FISH

MULTIVITAMIN MINERAL TABLET ( One / day )

TYPE OF NUTRIENTS TO CONSUME / NOT TO CONSUME:

WHOLE GRAINS AND PRODUCTS

TO CONSUME

Rice, Wheat, Oats, Corn, Bran, Whole grain, Brown rice, Grits, Rice kanji, Wheat flour or any grain flour, Biscuits (from any grain), Brown bread, White bread (limit) Parched rice, Noodles, Semolina, Muffins from any flour.

NOT TO CONSUME

Any processed salty grain products, like salty biscuits, muffins etc. No salt to be used while cooking.

LENTILS

TO CONSUME

Whole green gram, Split green gram, Whole black gram, Split black gram, Whole chick peas, Split chick peas, Dry field beans, Dried peas, Garbanzo beans, Red lentils, Soybeans, Sprouts (from any lentils).

NOT TO CONSUME

All salty lentil preparations to be avoided. Do not use salt while cooking.

LOW FAT MILK OR SKIMMED MILK

TO CONSUME

Cow’s milk, Buffalo’s milk or goat milk. If not consuming milk, use milk powder instead.

NOT TO CONSUME

Avoid salty milk products.

DAIRY PRODUCTS

TO CONSUME

Butter, Cheese, Yogurt, Buttermilk – All unsalted. Weak Tea and weak Coffee permitted.

NOT TO CONSUME

Avoid all salty dairy products.

NUTS AND OILSEEDS

TO CONSUME

Avoid all

NOT TO CONSUME

Avoid all

VEGETABLE OILS AND FATS

TO CONSUME

Olive oil, Sunflower oil, Groundnut oil refined, Corn oil, Sesame seed oil, Grape seed oil.

NOT TO CONSUME

Coconut oil, Palm oil, Mustard oil, Ghee, Dalda, Vanaspathi, Butter (salted), Mayonnaise (salted), Margarine (salted), Lard.

GREEN LEAFY VEGETABLES

TO CONSUME

Amaranth, Cabbage, Cilantro (Coriander leaves), Curry leaves, Drumstick leaves, Fenugreek leaves, Lettuce, Mint, Spinach, Kale, Collard greens, Celery leaves, Parsley, Mustard spinach, Cress, Chard, Endive, Mustard greens.

NOT TO CONSUME

Avoid cooking leafy vegetables with salt. Sprinkle lime or lemon juice after cooking, and as a substitute for salt.

OTHER VEGETABLES

TO CONSUME

Ash gourd, Bitter gourd, Eggplants, Broad beans, Cluster beans, French beans, Double beans, Cucumber, Cauliflower, Broccoli, Asparagus, Drumstick, Kohlrabi, Green plantain, Ridge gourd, Snake gourd, Bottle gourd, Tomato (green and red), Bell peppers (Capsicum).

NOT TO CONSUME

Avoid cooking other vegetables with salt. Sprinkle lime or lemon juice after cooking, and as a substitute for salt.

ROOTS AND TUBERS

TO CONSUME

Potatoes and Onions

NOT TO CONSUME

Beetroot, Carrot, Colocasia, Yam, Radish, Sweet potato, Turnips, Tapioca. Avoid cooking with salt.

FRUITS

TO CONSUME

Gooseberry, Apple, Grapes, Guava, Pear, Tangerine, Musambi, Orange, Water melon, Ripe papaya, Pine apple (limit), Pomegranate (limit), Peaches, Grapefruit, Cantaloupes, Apricots, Nectarines, Figs, Prunes, Raisins, Banana, Plantain, Custard apple, Dates, Jackfruit, Ripe mango, Plum, Chickoo, Tender coconut water.

NOT TO CONSUME

Avoid fruits mixed with salt or any fruit salad with salt.

FRUIT JUICES

TO CONSUME

All juices from the above fruits are permitted.

NOT TO CONSUME

Avoid juices mixed with salt.

SUGAR, JAGGERY AND SUGAR PRODUCTS

TO CONSUME

All sugar and sugar products are permitted like white sugar, brown sugar, jaggery, molasses, jam, jelly, marmalades etc.

NOT TO CONSUME

Avoid sugar products with salt content.

MEAT AND FISH

TO CONSUME

Small portions of chicken without the skin, Lean meat are permitted. Meat should be boiled, steamed or baked without butter and not fried. Fresh water fish to be boiled, grilled, steamed or baked with oil and without salted butter and not fried.

NOT TO CONSUME

Red meats like pork, beef, lamb, goat. Organ meats like liver, heart, brain, and kidney. Processed meats (like salami, sausages, hot dogs, pepperoni, bacon, and ham) should be taken in limited amounts. Shell fish like crabs, prawns, shrimps, oysters, lobsters also to be taken in limited amounts. Avoid too much frying of meat or fish. Avoid cooking meat or fish with salt; instead use lime or lemon juice.

EGGS

TO CONSUME

All to be avoided.

NOT TO CONSUME

All to be avoided.

SODIUM OR SALT

TO CONSUME

5 grams per day of iodized salt.

NOT TO CONSUME

Excess of salt than 5gms per day, is not allowed. Do not add any salt while cooking a dish. Instead sprinkle salt (5gms/day) on the prepared dish, just before serving.

MULTIVITAMIN MINERAL TABLET

TO CONSUME

One tablet per day rich in Vitamin B1, B2, B6, B12 and minerals. Should contain iron in ferrous (Fe2+) form. Iron in the ferrous form is better absorbed by the body than the ferric form (Fe3+).

NOT TO CONSUME

Avoid all hypertensive drugs and tablets or else take in limited amounts. Focus on the intake of natural food ingredients as mentioned above and also practice doing moderate exercise every day. For example, walking 3 miles a day will expend about 300 calories.A low Sodium, low Fat, low Calorie diet is recommended for a hypertensive person.