NCD Health Guide 2014_Final (1)

HEALTHYPalau’s

Eating & Active Living Guide

Me Deluut ra Koted

HEALTHYeating & living

p1

Palau’s

HEALTHYEating & Active Living Guide

Acknowledgements

Palau’s Healthy Living Guide - Me Deluut Ra Koted was written by the Ministry of Health’s Non-communicable Disease Unit in partnership with Ulekerreuil a Klengar, Kotel A Deurreng, Palau Community Action Agency, Coalition for a Tobacco-Free Palau, and the NCD Strategic Planning - Nutrition Working Group.

Photo on page 24 courtesy of: Chanelle Emaimelei Mikel

This resource guide was published in 2014.For copies or for more information, contact the

MOH NCD Unit at 488-4612.

This resource guide is 100% federally funded by the US Centers for Disease Control and Prevention (CDC)

“Me Deluut ra Koted”

Introduction

Non-communicable diseases (NCDs) are the leading causes of premature death and disability in Palau. That is, heart disease, stroke, diabetes, kidney disease, respiratory disease, and cancer account for over 75% of deaths. NCDs are now imposing a growing burden on our health systems and budget. Eighty percent (80%) of all off-island medical referrals are NCD related, costing us over $1,200,000 annually. This is a 45% increase from the 2010 Medical Referral Program budget of $540,000. This is not sustainable! All of us must take ownership of our health, and work to reverse this unsustainable trend.

This booklet is designed to help the people in Palau live a healthy life by being informed of what one needs to do to be healthy and stay healthy. It also provides information about the four (4) risk factors for NCDs; unhealthy diet, physical inactivity, tobacco, and excessive use of alcohol. We urge you to take active ownership of your health. Someone said that most people treat their health like the way they treat their cars. They drive it until it breaks down, and then take it to a mechanic to fix. Unlike automobiles, we only have the one body and there are no spare parts.

This resource is an important step forward to support us in achieving “healthy communities with people living long, happy, purposeful lives.”

Gregorio NgirmangMinister of Health

p2 HEALTHYeating & living

Contents

About this guide ........................................................... p4

A guide to eating healthy ............................................ p5

• Eat from the 3 food groups • How much should we eat? • Foods to reduce - eat less sugar, salt and fat • Food handling and storage • Understanding food labels • Drink water, stay hydrated • Only breast milk for baby’s first 6 months

Live a healthy life ........................................................ p26

• Maintain a healthy weight • Be physically active • Types of physical activities • Limiting substance use and abuse • Alcohol use and abuse • Tobacco use and quitting

More information ......................................................... p34 • Where to get more info

• Handy tips • Estimated calorie needs • Grow your own food • Glossary

p3HEALTHYeating & living

About this guide

What is the guide about?

This guide is designed to support the people of Palau in living healthy lives.

The Palau Healthy Eating and Active Living Guide is aimed at community and health workers. This resource will support the delivery of information to the community on the 4 major risk factors of non-communicable diseases (NCD); unhealthy diet, physical inactivity, tobacco and alcohol use.

Who should use this guide?

● Anyone interested in learning how to stay healthy and preventing NCDs.● Anyone who wants to know more information on what to eat to stay healthy.● Anyone who works with community members.

Want more information?

More information on the contents of this guide can be obtained by contacting the Ministry of Health’s Non-communicable Disease Unit at 488-4612 or 488-2212.


A guide to

eating healthy

Eat from the 3 food groupsWe all make choices everyday that have a direct effect on our

health. Among these choices is choosing a balanced and healthy diet.

Our bodies need proper nutrition in order to function and maintain its balance. We all have to eat healthy, balanced meals containing a variety of foods every day from the 3 main food groups. A healthy meal should:

● Include fruits and vegetables ● Include lean meats, poultry, fish, beans, eggs, nuts, and fat-free or low-fat milk products● Include ongraol such as taro, tapioca, rice, breadfruit, and whole grains

1. Protective Food Group - Food in this group includes fruits and vegetables. They protect our body from illness and diseases.

Fresh fruits ― Don't think just apples or oranges. All fresh fruits are great choices. Be sure to eat fruits such as bananas, pineapple and mango. When your favorite fresh fruits aren't in season, try a frozen, canned, or dried variety of a fresh fruit you enjoy. But be cautious about canned fruits because most contain added sugars or syrups. If you choose canned fruits, be sure to choose those packed in water or in their own natural juice.


Fresh vegetables - All types of vegetables are essential in every meal. Vegetables you eat may be fresh, frozen, canned or dried and may be eaten whole, cut-up, or mashed. But the best vegetables we can eat are fresh and locally grown.

We should eat a variety of dark green, red and orange vegetables, as well as beans and peas. Examples include okra, cucumber, carrots, cabbage, eggplant, green beans, spinach, squash, sweet potatoes, tomatoes and kangkum.

What do they do? - Eating more vegetables and fruits as part of a healthy diet likely reduces the risk of many diseases including non-communicable diseases. Fruits and vegetables provide nutrients that are essential for health and maintenance of our bodies.

• Eating vegetables and fruits as part of an overall healthy diet can reduce risk for heart disease, including heart attack and stroke and may protect against certain types of cancers.

• Diets rich in foods containing fiber, such as some vegetables and fruits, may reduce the risk of heart disease, obesity, and type 2 diabetes.

• Eating vegetables and fruits may also lower blood pressure.• Eating vegetables will help reduce your overall calorie intake

as they are much lower in calories than other commonly eaten food.


2. Energy Food Group - Food in this group (ongraol) are the main source of energy for our bodies. They include foods rich in carbohydrates and fiber such as taro, tapioca, breadfruit, potatoes, oatmeal, bread, pasta, and rice.

Fiber comes from plant foods such as taro and tapioca. They contain carbohydrates (carbs) that our body uses to make glucose which is the fuel that gives you energy and helps keep everything going.

What do they do? - A diet high in fiber helps to lower cholesterol, control blood sugar levels, reduce weight, and prevents some cancers.

Eating grains, especially whole grains also helps with constipation, reduce the risk of heart disease and helps with weight management.


3. Body Building Foods Group - Food in this group repair and build our body cells and tissue. They include those rich in protein such as fish, poultry, meat, eggs, milk and other dairy products, seafood, beans, and nuts.

Protein ― Proteins (Odoim) are essential for our bodies. The protein in the foods we eat replenishes proteins in our bodies.

Protein is found in the following foods:● Meats, poultry, and fish ● Nuts and seeds ● Legumes (beans and peas) ● Milk products● Tofu ● Eggs

What do they do? - Foods in the meat, poultry, fish, eggs, and nuts group provide nutrients that are vital for health and maintenance of our body. However, it is important to choose foods from this group that are low in saturated fat and cholesterol.• Foods in this group contain many nutrients. These include protein, B vitamins (niacin, thiamin, riboflavin, and B6), vitamin E, iron, zinc, and magnesium.• Proteins function as building blocks for bones, muscles, cartilage, skin, and blood. They are also building blocks for enzymes, hormones, and vitamins.


1/2 cup cooked or 1 cup uncooked

equals 1 serving.

How much

should we eat?

Healthy Foods - With fruits and vegetables, we should eat at least 5 servings every day.

Vegetable serving size - A serving size of vegetable amounts to 1/2 cup if it is cooked or 1 cup if it is uncooked. Here are examples of what 1 serving of vegetable amounts to:

4 or 5 long beans 1 cup shredded cabbage

4 okras

1 small bunch of nappa 1/2 cup of chopped

pumpkin or squash

1 medium onion

1/2 cup cooked or

1 cup uncooked kangkum1 eggplant1 corn


Fruit serving size - A serving size of fruit equals to 1 cup if diced, 1 medium piece or 2 small pieces. Here are examples of what 1 serving of fruit amounts to:

1/4 medium papaya

or 1 cup shredded1 guava 1 slice of watermelon

3 or 4 small bananas

2 slices of pineapple 1/4 soursop

A handy tip...

You can estimate serving sizes using

your hand. 1 cup of fruit or uncooked

veggies is roughly the size of a balled

up fist. fist = 1cupA cupped hand is equivalent to 1/2

cup or 1 serving of cooked vegetables.

cupped hand = 1/2 cup


Protective food tips...

When it comes to fruits and vegetables, here

are some tips to keep in mind:

›› You should fill half your plate with mostly fruits

and vegetables every meal time

›› Choose different types and colors

›› Grow your own or buy fresh local produce

›› Eat vegetables with at least 2 meals per day

›› Have fruits for snacks instead of junk food

›› Frozen vegetables can also be eaten if

there are no fresh ones available

We should eat 5 servings of fruits and

vegetables everyday. Fill 1/2 of your

plate with fruits and vegetables every meal.


Energy Foods - With energy foods, we should eat 5 to 8 servings with at least 1 ounce of fiber every day.

Ongraol & Carbs Serving Size - A serving size of energy food is about 1/2 cup of foods in the energy group. Here are examples of what 1 serving amounts to:

1/2 of medium Taro 1/2 of medium Tapioca

or 2 slices

1/4 of Breadfruit 1/2 of medium

Sweet Potato

1/2 cup cooked Rice

1 slice of Bread1/2 cup cooked Pasta1 medium Potato

A handy tip...


your hand. A cupped hand is

equivalent to 1/2 cup or 1 serving of

an energy food.

cupped hand = 1/2 cup


Energy food tips...

When it comes to ongraol and carbs, here


›› Eat local ongraol such as brak, kukau (taro),

sweet potato, breadfruit, tapioca

›› Choose foods high in fiber including taro,

whole wheat grains, oatmeal, and breads

›› Eating more than the recommended amount

of carbs and starchy foods every day can cause

weight gain.

We should eat 5 - 8 servings of ongraol

everyday. Fill 1/4 of your plate

with energy foods during every meal.


Body Building Foods - With body building food It is recommended that we fill 1/4 of our plates with protein foods (odoim) during every meal as part of a healthy and balanced diet.

Odoim & Proteins Serving Size - Here are some examples of what 1 serving of body building foods amounts to:

1 medium fish fillet 2 large eggs 1 small steak

1 small chicken

breast

1 glass of milk1/2 cup or 4

ounces of tofu

1 small tuna can (3.5 oz) 2 slices of low fat cheese

A handy tip...


your hand. The palm of your hand is

equivalent to 1 serving of a

body building food.

palm = 1 serving


Body building food tips...

When it comes to odoim and proteins, here


›› Eat fresh local fish and seafood

›› Prepare meats and poultry by trimming off

excess fat (especially pork and beef) and skin

›› Eat fresh fish, meats, and poultry instead of

canned and processed meats

›› Eat low fat varieties of cheese, milk and other

dairy products

We should eat 3-4 servings of odoim or

protein foods everyday. Fill 1/4 of your

plate with odoim during every meal.



Foods to reduce

Salt, Sugar and FatEating and drinking foods that are high in salt, sugar and fat can

cause many problems with our health. Most processed and “junk” food such as potato chips, hotdogs, canned meat and instant foods such as ramen noodles can contain a lot of salt, sugar, and fat.

Drinks such as iced teas, sodas, and energy drinks also contain high amounts of sugar that exceed our daily recommended intake amount.

Cutting back on foods high in salt, sugar and fat can help us manage our weight and reduce our risk of high blood pressure, high blood sugar, heart attack, stroke, diabetes, some cancers and kidney disease.

It is important that we eat mostly from the 3 food groups— fruits and vegetables, ongraol and odoim for good health. Foods that are high in salt, fat and sugar should only be eaten less often and in small amounts. We should also avoid cooking with too much salt, sugar and fat.

Sauces & CondimentsWhen it comes to taste, a lot of us choose to enhance the flavor

of our food with extra sauces and condiments. Consuming excessive amounts of condiments such as salt, ketchup, soy sauce and mayonnaise, is a dangerous habit that could lead to major health problems in the long run.

Most condiments are high in sugar, salt and fat and will increase the amount that is already present in the food we eat.

Eat less salt and monosodium glutamate (MSG)Eating too much salt is a risk for high blood pressure. Sodium is

the harmful content of salt. Eating foods with too much MSG can also trigger head and body aches and could pose long term health threats.

Foods that contain high amounts of salt and MSG include:● Soy sauce ● Instant Ramen● Canned soups and meat ● Ajinomoto● Accent ● Bouillon cubes● Kim Chee ● Ketchup● Potato Chips ● Processed meats ● Kool Aid Mix ● Pickles

We should eat less than 1 teaspoon of

salt everyday. This includes salt that is

already contained in foods.

Tips to eating less salt & MSG

When it comes to salt and MSG, here


›› Eat fresh fish, seafood and meats instead of

canned or processed meats.

›› Cook food without adding salt and MSG.

›› Choose “low sodium” or “no salt added”,

“no MSG” foods

›› Soak or wash canned vegetables before use.

›› Add herbs, spices, kingkang, garlic, ginger,

vinegar or chilies


Eat less sugar and sugary foodsAlong with salt and MSG, eating or consuming too much sugar

poses health risks. Too much sugar can lead to obesity that can cause diabetes, liver disease and heart attack.

Additionally, added sugar in foods and drinks contain no essential nutrients and can be bad for our teeth. It can also be highly addictive and raises triglyceride levels.

Foods that contain high amounts of sugar include:● Sugars and sweeteners ● Dried fruits● Drink powders ● Cookies, cakes & pies● Soft Drinks ● Jams and spreads● Candy ● Fruit canned in syrup● Ice cream & milkshakes ● Cereals● Sauces & instant gravy

Sugary drinksDespite being refreshing, most flavored drinks sold in stores

contain high amounts of sugars and additives that can be harmful to our health and cause weight gain. Most sugary drinks contain at least 10 teaspoons of sugar.

The following are major groups of sugary drinks:

Energy Drinks ― Energy drinks are usually labelled “energy drinks” or “energy supplements” and contain high levels of sugar and caffeine.

Iced Teas & Coffee ― Iced tea/coffee drinks contain added sugar. Soft Drinks ― Sodas or soft drinks are carbonated sugar-sweetened drinks with high levels of sugar.


Sports Drinks ― Sports drinks are marketed as drinks that should accompany physical activity. They carry the label “sports drink” and suggest that they should be consumed around physical activity. These drinks are not suitable for children.

Fruit Drinks ― Fruit drinks are fruit-flavored beverages that contain no more than 50% fruit juice. These products are labelled as juice drinks, juice beverages, fruit cocktails, nectars, and fruit-flavored drinks. While these drinks often have pictures of fruits on the package, they may contain no actual fruit juice at all.

Flavored Water ― Flavored water products include noncarbonated drinks described as a “water beverage” or “vitamin water”. Typically, these products are clear and colorless. Most flavored water products contain added sugars.

The amount of sugar we consume daily

should not exceed 10 teaspoons.

Tips to eating less sugar

Cutting back on sugar is better for our health, here


›› Avoid sugary drinks - soda, iced teas & coffee,

vitamin waters, fruit drinks, energy & sports drinks

›› Be careful– fruit drinks ARE NOT 100% fruit juice

›› Drink water or fresh coconut juice instead

›› Cut down on treats and dessert

›› Use natural sweetness in foods

›› Eat fruit for snacks


Fats & OilsEating food high in bad fat clogs your arteries– like a clogged

pipe. This can lead to high blood pressure and high cholesterol, causing heart attacks and strokes.

When it comes to fats and oils, it’s always a better choice to cook with those that are made from olive, canola, vegetable , sunflower and local oil made from coconuts.

When cooking, we should avoid using animal products such as butter and instead use margarine or vegetable shortening.

Cut down on saturated fatsSaturated fat is also referred to as the “bad fat” that mostly

comes from animal or processed foods.Saturated fats can be found in fatty meat, canned meat, hot

dog, sausages, chips, french fries, burgers, mayonnaise, turkey tail, fried food, cookies, cakes, ice cream and dessert.

Tips to eating less fatty foods

When it comes to fats and oils, here are some tips

to keep in mind:

›› Use vinegar, lemon juice, garlic and other herbs

with olive oil for salad dressings

›› Try BBQ, stir-fry, baking and steaming instead of

deep frying foods

›› Use margarine instead of butter

›› Choose reduced fat or low fat variety of foods

›› Cut down on eating meat and adding oil to foods


Understanding Food labelsIn addition to looking at the expiration date on food and drink

packages, we should also make it our habit to take the time and look at the “Nutrition Facts” labels.

Apart from letting us know what ingredients or additives are contained in food, food labels contain important dietary information that we should pay attention to when choosing or buying food.

Things to look for...1. Serving size2. Number of servings per package/container3. Amount per servingAccording to the label on

the left, if you eat the entire package, you will be eating 7 servings. This means that the amount per serving is multiplied by 7.

We should aim for less than 10g of total fat; 3g of saturated fat; and less than 300mg of sodium per serving in all foods we consume.

Tips for food labels

Paying attention to food labels helps you to:

›› Know what ingredients food contain

›› Work out how many calories and nutrients are in

foods

›› Compare products and pick healthier foods

›› Know how much salt, sugar and fats are in food


Food handling and storageWhen preparing and storing food, we should always keep

health and safety in mind. Food poisoning can cause illness that ranges from mild to very severe . Gastrointestinal illness, such as: vomiting and diarrhea, are common food borne illnesses in Palau. Here are some ways we can prevent food poisoning:

Clean ― We should always wash our hands with soap and water before and after food preparation. We should also keep cooking utensils, equipment and surfaces clean and disinfected.

Cook ― All foods should be cooked completely, especially poultry and meat products, which should be cooked until all juices are clear.

Cover ― We should keep all foods covered and away from insects and vermin.

Chill ― Foods should not be left at room temperature for more than 2 hours. Leftover food should be refrigerated or kept in the freezer.

Hot foods should be kept hot at over

140°F while cold foods should be kept

below 40°F.


Drink water, stay hydratedStaying properly hydrated is very important to our health. Our

body is made up of approximately 70% water. It is critical that we keep ourselves hydrated to prevent illness and injuries.

Staying hydrated keeps our immune system strong and allows our bodies to function properly throughout the day.

Instead of drinking sugary drinks, we should always drink water.

Clean Water ― When using water for drinking or cooking, it’s important to also ensure that it is clean and uncontaminated. Water should be boiled for at least 1 minute before use, especially if it’s tap water or water stored in tanks.

We should drink 6 to 8 glasses (8 oz.)of water everyday


Breast feeding for babiesWhen it comes to babies, their best source of nutrition for their

first 6 months is natural breast milk. Breast feeding not only benefits the baby, it’s also good for the mother as well.

What are the benefits? For babies:• Provides all energy and nutrients to meet baby’s needs• Gives baby immunity • Reduces risk of asthma, rashes and allergies• Promotes speech development and body growth• Protects baby from future risk of being overweight, obese and reduces risk of NCDs like diabetes, cancers, heart attack and stroke.

For mothers:• Decreases risk of breast and ovarian cancer• Helps mother get back to pre-pregnancy weight• Cheap and convenient- no need for clean bottles, water or formula• Exclusive breast feeding can be a natural form of birth control• Helps form close bond with baby.

Only breast milk for baby’s first 6 months.


Breast milk storage and use

Did you know that breastmilk can be pumped and stored for later use?

How long will breast milk last?

directly into container =

6 - 8 hoursin a double container with

water in another container =

8 - 10 hours

stored in fridge =

3 - 5 days

stored in freezer =

3 - 6 months

Defrosted breast milk

Defrosted breast milk that has been stored in the freezer must be stored in the fridge and must be used within 24 hours. If power goes out, defrosted breast milk can be refrozen only within 8 hours.


Live a Healthy Life

Maintain a Healthy weightMaintaining our weight is crucial in order to live a healthier life.

Keeping track of our weight allows us to prevent risk for illness and diseases, especially noncommunicable diseases such as heart disease, stroke, cancer, and diabetes.

We can maintain our weight by eating healthy and staying active. Knowing your Body Mass Index (BMI) enables you to adjust your diet and physical activities to achieve your weight maintenance goals.

Nutrition/Calories ― We all have our personal calorie limit but experts suggest that we should consume no more than 2000 calories per day. The amount of calories our body needs depends on our:• Height • Age • Gender • Physical activity level • Weight

Weight loss ― If we are overweight or obese, losing between 5% to 10% of our current body weight can improve your health.


Tips to maintaining

a healthy weight

›› Change the way you eat if you’re not eating healthy• Eat a healthy breakfast every day!

• Eat slowly, enjoy every mouthful

• When eating out choose healthy meals and water

only

• Choose grilled or steamed foods and avoid

creamy sauces

• Ask for salad dressings on the side

• Choose water instead of a sugary or alcoholic

drinks

• Choose fruit and vegetables when hungry

• Drink water before and with your food.

›› Change what you do.• Don’t shop when you’re hungry

• Listen to your body

• Stop when or before you feel your stomach is full

• Don’t over eat

• Plan healthy, quick and easy meals for busy days

• Never eat in front of the TV

• Don’t spend a long time sitting down

• Turn off the computer, TV or electronic device

• Be physically active every day in as many

ways as possible


Be Physically ActiveBeing physically active everyday not only helps us maintain our

weight but also has many health benefits. Being active will help you:

• Stay healthy • Look and feel good• Help you sleep better • Relax• Help maintain a healthy weight • Decrease risk of diseases (i.e. hypertension and diabetes)

Types of activity ― When it comes to physical activity, not all of us are into sports or exercise and some of us don’t have the time. Luckily, physical activity is not just limited to sports or exercise and includes a lot of other fun and practical activities.

Regular everyday activities such as gardening, sweeping, fishing and walking can help us fulfil our daily physical activity needs.

Moderate Activities ― Walking briskly, biking on flat ground, traditional dancing, farming, spear fishing. If you choose moderate level activities, do at least 2 hours and 30 minutes of that activity each week. This can be done at 10-minute intervals.

Vigorous Activities ― Jump rope, basketball, soccer,swimming laps, fast dancing, zumba. If you choose to do vigorous activities, do it at least 1 hour and 15 minutes a week. This can be done at 10-minute intervals

We can also combine moderate and vigorous activities. 1 minute of vigorous activity is equal to 2 minutes of moderate activity.


Calories burned per activityThe following are types of activities and the number of calories

burned every 30 minutes for a 150lbs person:• Hiking = 185 • Stretching = 90• Light Gardening = 165 • Walking (3.5mph) = 140• Dancing = 165 • Playing catch = 92• Being intimate = 50 • Paddling = 128• Softball/baseball = 183 • Dancing = 165• Snorkelling = 183 • Jogging = 214• Tennis = 257 • Swimming = 183• Volleyball = 293 • Jump Rope = 293• Spear fishing = 240-250 • Running (10mph) = 572 • Cooking/household chores = 92

Adults should have at least 30 minutesand kids at least 60 minutes of

moderate physical activity everyday.

Tips for physical activity

The talk test during physical activity:

›› If you can comfortably talk, but not sing, you’re

doing moderate-intensity activity.

›› If you can only say a few words without gasping

for breath, this is vigorous-intensity.


Limiting substance use

Alcohol useAlthough alcohol is a legal substance for adults, its excessive

use and abuse can lead to many health and social problems. Drinking too much alcohol can cause you to :

• Have a car crash and injure or kill yourself or someone else• Get involved in violent or risky acts• Smoke or use other drugs• Operate vehicles and machinery while intoxicated• Cause stress or trouble for others around you• Get in trouble with the law• Eat unhealthy foods• Be less active• Develop liver disease or cancer• Cause worry for your family and friends

What should be my limit? - For men, the recommended limit is 2 standard drinks per day. For women, it’s 1 standard drink a day.

What is considered a standard drink? - The following alcoholic beverages are considered equivalent to 1 standard drink.

12fl. oz. of

regular beer

5 fl. oz. of

table wine

1.5 fl. oz. shot of

80-proof spirits


What is excessive use of alcohol? - Excessive alcohol use includes:

• Binge drinking • Heavy drinking• Any alcohol use by • Underage drinking pregnant women

What is binge drinking? - Binge drinking corresponds to 5 or more drinks on a single occasion for men or 4 or more drinks on a single occasion for women, generally within about 2 hours or during one sitting.

What is heavy drinking? - For men, heavy drinking is typically defined as consuming 15 drinks or more per week. For women, heavy drinking is typically defined as consuming 8 drinks or more per week

Do I have a drinking problem? - Drinking is a problem if it causes trouble in your relationships, in school, at work, in social activities, or in how you think and feel.

If you are concerned that either you or someone in your family might have a drinking problem, consult your health care provider or the Behavioral Health Division of the Bureau of Public Health for assistance.

Tips for limiting alcohol use

The following are tips to keep in mind:

›› Keep track of how much you drink.

›› Pace yourself when you drink. Don’t drink more

than a drink per hour.

›› Don’t drink on an empty stomach. Eat some food

so the alcohol is absorbed slowly.

›› Find alternative activities instead of drinking. Find

new hobbies and interests that keep you busy.

›› Learn to say “no” to pressure and know your limit.


Tobacco useUsing tobacco, in any form or amount, wether it’s smoking or

chewing harms nearly every organ of the body, causing many diseases and negatively affects our health in general. Quitting tobacco use has immediate as well as long-term benefits for you and your loved ones.

What does tobacco do? - The risk of developing lung cancer is about 23 times higher among men who smoke cigarettes and about 13 times higher among women who smoke cigarettes compared with never smokers.

Cigarette smoking increases the risk for many types of cancer, including cancers of the lip, oral cavity, pharynx, esophagus, pancreas, larynx (voice box), lung, uterine cervix, urinary bladder, and kidney.

Smokers are 2 to 4 times more likely to develop heart disease than nonsmokers and their risk of having a stroke is doubled.

Even nonsmokers who are exposed to second hand smoke are at risk for heart disease and lung cancer.

Is tobacco use safe during pregnancy? - No. Tobacco use during pregnancy causes health problems for both mothers and babies, such as:● Pregnancy complications ● Premature birth● Low-birth-weight infants ● Stillbirth● Sudden infant death syndrome (SIDS)

What does chewing betel nut with tobacco do? - The following conditions and cancers have been associated with using betel nut and tobacco● Oral precancerous lesions, including erythroplakia (a reddened patch in the mouth) and leukoplakia (a white patch on the mucous membranes in the mouth that cannot be wiped off).● Oral cancers—predominantly carcinomas of the lip, mouth, tongue, and pharynx and cancer of the esophagus.● Reproductive health outcomes such as increased risk of having a low birth-weight infant.● Nicotine addiction


How can I quit tobacco use? - A quit plan is key to your success with quitting tobacco use. Develop a plan that suits your needs:1. Establishing your reasons for quitting.2. Write down tips to help you quit and have them around when you need them3. Set your quit date.4. Identify who can help you when you need support.5. Adopt new skills and behaviors you’ll need to help you cope.6. Ask your healthcare provider about medications that will help you quit.7. Be prepared for hard times and difficulties, including relapse.

Where can I get more info on how to quit tobacco? - For general information on tobacco use, its health effects and more information on how to quit tobacco use, contact the Behavioral Health Division of the Bureau of Public Health.

Tips on tobacco use and quitting

When it comes to tobacco use, here


›› If you don’t use tobacco– don’t start

›› Keep in mind that every chew or puff is doing

you harm

›› Stop chewing or smoking tobacco during

pregnancy or breast feeding

›› Quitting tobacco is hard but not impossible

›› If you use tobacco and want to QUIT get help


Want more info?

NutritionFor more information about nutrition, contact the Non-communicable Disease Unit at the Bureau of Public Health at 488-4612. For information about home gardening and farming, contact the Bureau of Agriculture at 622-5804.

Food handling and safetyFor more information about food safety and food handling certification, contact the Division of Environmental Health at 488-6073.

Physical activityFor more information about physical activity, contact the Non-communicable Disease Unit at the Bureau of Public Health at 488-4612 or for local sports and exercise programs, contact the Palau National Olympic Committe at 488-4491.

Tobacco, Alcohol and other substance useFor more information about quitting alcohol and tobacco use, contact the Behavioral Health Division at 488-1907.


Handy Tips...

You can estimate serving sizes of food

using your hands.

=

=

=

=

A cupped hand - Is equivalent to 1/2 cup of energy foods (ongraol).

A balled up fist - Is equivalent to 1 cup for fruits, vegetables and dairy products.

A palm - Is equivalent to 3 ounces of protein food (odoim) or 1 serving of seafood, chicken or meat.

=

A thumb - Is equivalent to 1 tablespoon or 1 ounce.

Thumb tip - Is equivalent to 1 teaspoon.


Estimated Calorie Needs

Estimated daily calorie needs by age, gender

and physical activity level*.

Age (years) Sedentary

Moderately

Active Active

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101112131415161718

19-2021-2526-3031-3536-4041-4546-5051-5556-6061-6566-7071-7576+

1,0001,2001,2001,2001,4001,4001,4001,6001,6001,8001,8002,0002,0002,2002,4002,4002,4002,6002,4002,4002,4002,4002,2002,2002,2002,2002,0002,0002,0002,000

1,0001,4001,4001,4001,6001,6001,6001,8001,8002,0002,2002,2002,4002,6002,8002,8002,8002,8002,8002,6002,6002,6002,6002,4002,4002,4002,4002,2002,2002,200

1,0001,4001,6001,6001,8001,8002,0002,0002,2002,2002,4002,6002,8003,0003,2003,2003,2003,0003,0003,0003,0002,8002,8002,8002,8002,6002,6002,6002,6002,400

Male


Age (years) Sedentary

Moderately

Active Active

23456789

101112131415161718

19-2021-2526-3031-3536-4041-4546-5051-5556-6061-6566-7071-7576+

1,0001,0001,2001,2001,2001,2001,4001,4001,4001,6001,6001,6001,8001,8001,8001,8001,8002,0002,0001,8001,8001,8001,8001,8001,6001,6001,6001,6001,6001,600

1,0001,2001,2001,4001,4001,6001,6001,6001,8001,8002,0002,0002,0002,0002,0002,0002,0002,2002,2002,0002,0002,0002,0002,0001,8001,8001,8001,8001,8001,800

1,0001,4001,4001,6001,6001,8001,8001,8002,0002,0002,2002,2002,4002,4002,4002,4002,4002,4002,4002,2002,2002,2002,2002,2002,2002,2002,0002,0002,0002,000

Female

*Source: www.cnpp.usda.gov/publications/usdafoodpatterns/estimatedcalorieneedsperdaytable.pdf


Grow your own food

Seasonal fruits by month

January - Breadfruit, Cantaloupe, Cashew, Sweet Orange, Tangerine, Pomelo, Football Fruit, Honeydew, Jackfruit, Mango, Bignay, Giant Granadilla, Mangosteen, Papaya, Dragon Fruit, Seeded Breadfruit, Sweetsop, Tamarind.

February - Cantaloupe, Cashew, Citron, Pomelo, Honeydew, Giant Granadilla, Papaya, Dragon Fruit, Tamarind, Watermelon.

March - Cantaloupe, Cashew, Citron, Pomelo, Honeydew, Giant Granadilla, Papaya, Dragon Fruit, Tamarind, Watermelon.

April - Cantalope, Cashew, Citron, Honeydew, Mango, Japanese Sweet Melon, Papaya, Tamarind, Titiml, Watermelon.

May - Breadfruit, Citron, Japanese Sweet Melon, Sweetsop, Tamarind, Titiml.

June - Breadfruit, Avocado, Jackfruit, Mangosteen, Sweetsop.

July - Breadfruit, Avocado, Jackfruit, Mangosteen, Papaya, Dragon Fruit, Rambutan, Seeded Breadfruit, Sweetsop, Watermelon.

August - Breadfruit, Avocado, Cashew, Football Fruit, Giant Granadilla, Papaya, Dragon Fruit, Rambutan, Rollinia, Seeded Breadfruit, Soursop, Watermelon, Pineapple.

Growing your own food not only feeds your family, it will save you money, is good for the environment and can give you the physical activity you need to stay healthy.


September - Cashew, Football Fruit, Giant Granadilla, Papaya, Dragon Fruit, Pineapple.

October - Sweet Orange, Tangerine, Football Fruit.

November - Sweet Orange, Tangerine, Football Fruit.

December - Avocado, Sweet Orange, Tangerine, Jackfruit, Mangosteen.

Year round fruits - Banana, Bilimbi, Lime (Big), Wort Lime, Kinghang/Calamansi/Calamodin, Yellow Medium Lime, Rangpur Lime, Aromatic Lime, Green Coconut, Mature Coconut, Polynesian Chestnut, Star Fruit/Carambola, Polynesian Almond, Palauan Plum, Wax Apple, Water Apple, Maylay Apple, Passion Fruit, Soursop, Star Apple.


Glossary

Blood Pressure - Blood pressure is the force of your blood pushed against your main blood vessel walls. Some pressure is needed to move blood around your body but when pressure is too high it can lead to serious health problems.

Body building foods (odoim) - One of the 3 food groups. Gives you protein to build muscle, and repair hair, skin etc. Dairy foods (milk and cheese) give you calcium for strong bones, teeth and nails. Choose local types like fish, chicken or eggs.

Body Mass Index (BMI) - Body Mass Index is calculated from your height and weight to estimate body fat. The higher the number the higher your risk of getting a noncommunicable disease (NCD). What your BMI means: Less than 18.5 is underweight; 18.5 less than 25 healthy weight; 25 less than 30 overweight; 30 less than 40 obese; Over 40 is very obese.

Calorie - Calories come from the food and drinks we eat. We need calories to feed our body and make it work- like gas for a car. Eating too many calories and not doing enough physical activity causes weight gain. The average adult needs about 2000 calories per day. Calories are also called kilojoules.

Diabetes - High blood sugar gives symptoms of frequent urination, increased thirst, and increased hunger. If left untreated, diabetes can be serious causing heart disease, kidney failure, amputation and damage to the eyes. Causes of diabetes include: Obesity (BMI over 30) or extra body fat, lack of physical activity, unhealthy diet, especially high in sugar and saturated fat, and stress.

Energy foods (ongraol) - One of the 3 food groups. Important source of energy known as carbohydrate. Eat more local ongraol like taro, prak or tapioca that are high in fiber. Should be eaten with every meal. Be careful not to eat too much as it can cause weight gain.


Fiber - Also called dietary fiber or roughage. It is found mainly in fruits, vegetables, whole grains, seeds and legumes. Fiber comes from plants and acts as roughage as your body can’t digest it. Fiber helps to: prevent constipation, maintain bowel health, lowers cholesterol, controls blood sugar levels, achieve healthy weight, prevent some cancers. We should aim to have at least 1 ounce of fiber every day.

High blood - Also called high blood pressure or hypertension, can lead to heart attack, stroke and possible death. Poor lifestyle habits can cause high blood pressure. Blood pressure of 140/90 is considered high blood. Causes of high blood pressure include: Tobacco use, being overweight or obese, not being active, eating salty foods and adding salt to foods, drinking alcohol, stress, and kidney disease.

Local foods - Food or drink grown or caught locally. This includes traditional food and food that has been introduced to the island. Can include vegetables, fruit and animals or fish caught and slaughtered here in Palau.

Mono-unsaturated fat - Also called a “healthy fat”. Is a type of unsaturated fat. These fats are liquid at room temperature. Comes from plant sources, like canola oil, olive oil, nuts, and avocados. Replacing unhealthy saturated fats with monounsaturated fats helps to lower cholesterol.

Non-communicable diseases (NCDs) - Also called Chronic illness. A medical condition or disease that you cannot catch but rather occurs due to poor lifestyle habits like tobacco use, alcohol consumption, poor diet or lack of physical activity. These include: cancer, diabetes, heart attack and stroke. High blood pressure, high blood sugar, cholesterol and overweight and obesity are early warning signs of NCD.


Poly-unsaturated fat - Also called a “healthy fat”. Is a type of unsaturated fat. These fats are liquid at room temperature. Come from plant sources, like: vegetable oil, canola oil, flaxseed oil and fatty fish. Eating fatty fish, like tuna, decreases risk of heart disease.

Protective foods - Vegetables and fruit. One of the 3 food groups. This food group provides you with essential vitamins and minerals that your body needs to help it work and build your immunity so that you don’t get sick. This group are very low in energy (calories). Aim to eat 5 servings a day.

Salt - Also known as Sodium Chloride. Traditionally used to preserve foods it is now food in high amounts of packaged and canned foods. Too much salt causes high blood pressure. Sodium is the unhealthy part of salt. Aim to eat no more than 1 teaspoon per day.

Saturated fat - Considered a “bad fat”. Found in foods that come from animalsespecially cows and pig, including: fatty meat, cream, butter, cheese, mayonnaise. This fat is solid at room temperature. A diet high in saturated fat causes build-up of plaque in arteries causing high blood pressure, high cholesterol and obesity.

Sodium - Sodium is part of salt - sodium chloride. We need very small amounts of sodium to help regulate fluid in our body and nerve and muscle contraction. Too much sodium causes high blood pressure, heart attack and stroke. Aim for no more than 2000 mg sodium per day. This equals 1 teaspoon of salt.

Unsaturated fat - Also called “Good or healthy fat”, include: poly-unsaturated and monosaturated fat. These fats can help to reduce risk from heart disease and lower cholesterol. Unsaturated fats are liquid are room temperature. Replace bad fats (saturated) with good fats (unsaturated).


Documents

NCD Health Guide 2014_Final (1)