The DASH Eating Diet

One of the toughest issues facing patients with high blood pressure/ hypertension are questions regarding what types of foods to eat. Patients are frequently told to avoid “salt” by their physician, but beyond that they receive little guidance in terms of how to achieve this. The DASH diet, which stands for Dietary Approaches to Stop Hypertension, is a well-studied diet plan whose primary aim is to promote healthy eating and designed to help treat and prevent high blood pressure. The primary focus of the plan is to incorporate foods such as whole grains, fruits, vegetables and low-fat dairy products into people’s diets. According to American Heart Association, American adults should limit sodium intake to a maximum of 2,300 milligrams (mg) per day with 1500 milligrams being a more ideal target. Studies have shown that these restrictions can potentially lower systolic blood pressure (top number) by as much as 11.5 points. Including foods that are a part of the DASH diet can help patients achieve these goals. Sodium restriction along with portion control and increases in physical activity with a focus on healthy weight loss can go a long way in helping people with hypertension better control their blood pressure. 

DASH create a heart-healthy eating life style, which has a flexible and balanced eating plan. The DASH eating plan gives daily and weekly nutritional goals and there is no special food requirement.

This plan recommends:

  • Eating vegetables, fruits, and whole grains
  • Including fat-free or low-fat dairy products, fish, poultry, beans,
    nuts, and vegetable oils
  • Limiting foods that are high in saturated fat, such as fatty meats,
    full-fat dairy products, and tropical oils such as coconut, palm kernel, and
    palm oils
  • Limiting sugar-sweetened beverages and sweets.

The below table shows examples of daily and weekly servings, based on above recommendations, that meet DASH eating plan targets for a 2,000-calorie-a-day diet.

Food Group Daily Servings
Grains 6–8
Meats, poultry, and fish 6 or less
Vegetables 4–5
Fruit 4–5
Low-fat or fat-free dairy products 2–3
Fats and oils 2–3
Sodium 2,300 mg*
  Weekly
Servings
Nuts, seeds, dry beans, and peas 4–5
Sweets 5 or less

*1,500 milligrams (mg) sodium lowers blood pressure even further than 2,300 mg sodium daily.

When following the DASH eating plan, it is important to choose foods that are:

  • Low in saturated and trans fats
  • Rich in potassium, calcium, magnesium, fiber and protein
  • Lower in sodium

Health Benefits of the DASH Eating Plan

Four NHLBI-funded studies tested the health benefits of the DASH diet by comparing different variations of the DASH diet or by comparing the DASH diet with the typical American diet. Another NHLBI-funded study, the PREMIER clinical trial, measured the health benefits of following the DASH diet and increasing physical activity. The results of these studies showed that the DASH diet lowers blood pressure and LDL cholesterol in the blood and shaped the NHLBI’s DASH eating plan recommendations, which includes following a DASH diet with reduced sodium intake.

a. Dietary Approaches to Stop Hypertension (DASH) Trial

This study consisted of 459 adults, some with and some without confirmed high blood pressure. The study compared three diets, each containing 3,000 milligrams (mg) of sodium per day:

  • Typical
    American diet
  • Typical
    American diet plus more fruits and vegetables
  • DASH diet

For Eight weeks the study provided all foods and beverages to participants. The diets were not using vegetarian or specialty foods. After two weeks, participants who added fruits and vegetables to a typical American diet or those on the DASH diet had lower blood pressure than those who were following a typical American diet alone. It was observed that the participants who were on the DASH diet had the greatest effect of lowering their high blood pressure. In addition to improving blood pressure, the DASH diet also lowered LDL cholesterol levels. High blood pressure and high blood levels of LDL cholesterol are two major risk factors for cardiovascular disease.

b. DASH Diet, Sodium Intake, and Blood Pressure (DASH-Sodium) Trial

This study consisted of 412 adults who followed either a typical American diet or the DASH diet. Foods and beverages were provided to all the participants for one month. Their daily sodium intake levels were either high, at 3,300 mg, which is similar to the current average U.S. daily sodium intake of about 3,600 mg; medium at 2,300 mg; or low at 1,500 mg.

The DASH-Sodium study made several findings:

  • At all three daily sodium levels, the DASH diet lowered blood pressure
    more than the typical American diet at all three daily sodium levels.
  • Blood pressure decreased with each reduction of sodium.
  • Reducing sodium intake and following the DASH diet is more beneficial
    for lowering blood pressure than following the DASH diet alone or reducing
    sodium alone.

A follow-up report found that combining the DASH diet with sodium reduction benefited people who had higher than normal blood pressure readings. The report also found that people who started out with the highest blood pressure readings experienced the greatest benefits.

c. Optimal Macronutrient Intake Trial for Heart Health (OmniHeart)

This study consisted of 164 adults who had systolic blood pressure readings of 120 to 159 millimeters of mercury (mm Hg). The study compared the following three diets, each containing 2,300 mg of sodium per day:

  • DASH diet alone
  • DASH diet substituting 10 percent of total daily carbohydrates with protein
  • DASH diet substituting 10 percent of total daily carbohydrates with unsaturated fat

Foods and beverages were provided to the participants for six weeks. The participants stayed the same weight, during the study.

OmniHeart found that either variation of the DASH diet one substituting protein or one substituting unsaturated fat for 10 percent of daily carbohydrates—reduced blood pressure and improved lipid levels more than the original DASH diet.

d. Effect of Amount and Type of Dietary Carbohydrates on Risk for Cardiovascular Heart Disease and Diabetes (OmniCarb) Trial

The OmniCarb trial consisted of 163 adults who had systolic blood pressure readings of 120 to 159 mm Hg and who were overweight. The study compared the following four DASH-type diets, each containing 2,300 mg of sodium per day:

  • DASH diet high in carbohydrates with a high glycemic
    index
  • DASH diet high in carbohydrates with a low
    glycemic index
  • DASH diet low in carbohydrates with a high
    glycemic index
  • DASH diet low in carbohydrates with a low
    glycemic index

All foods and beverages were provided to the participants for five weeks, during the study and it was observed that participants maintained a constant body weight.

OmniCarb found that diets with a low glycemic index did not improve blood pressure, blood cholesterol, or insulin resistance compared to diets with a high glycemic index.

e. PREMIER clinical trial

The PREMIER trial consisted of 810 participants and was assigned to one of three groups. Each group participated in a different program to lower blood pressure, lose weight, and improve health for six months:

  • An advice-only program that did not include counseling on behavior changes
  • An established treatment program that included counseling on behavior changes
  • And established treatment plan that included both counseling and use of the DASH diet

The PREMIER trial did not provide food and beverages to participants, unlike the other studies listed above.

After six months PREMIER trial found that, blood pressure levels declined in all three groups. The two groups that received counseling and followed a treatment plan had more weight loss than the advice-only group. Participants who received counseling and followed the DASH diet had the greatest reductions in their blood pressure. The study results showed that people can lose weight and lower their blood pressure by following the DASH diet and increasing their physical activity.

Following the DASH Eating
Plan

The DASH eating plan is simple to follow with common foods available in grocery store. The plan includes daily servings from different food groups. The number of servings you should have depends on your daily calorie needs.

You need to consider your age and physical activity level, to find out your calorie needs. If you want to maintain your current weight, you should eat only as many calories as you burn by being physically active. This is called energy balance. If you need to lose weight, you should eat fewer calories than you burn or increase your activity level to burn more calories than you eat.

Consider your physical activity level. Are you sedentary, moderately active, or active?

  • Sedentary
    means that you do only light physical activity as part of your typical daily
    routine.
  • Moderately
    active means that you do physical activity equal to walking about 1.5 to 3
    miles a day at 3 to 4 miles per hour, plus light physical activity.
  • Active
    means that you do physical activity equal to walking more than 3 miles per day
    at 3 to 4 miles per hour, plus light physical activity.

Use the chart below to estimate your daily calorie needs.

Daily Calorie
Needs for Women

Age (years) Calories Needed for Sedentary Activity Level Calories Needed for Moderately Active Activity Level Calories Needed for Active Activity Level
19–30 2,000 2,000–2,200 2,400
31–50 1,800 2,000 2,200
51+ 1,600 1,800 2,000–2,200

Daily Calorie
Needs for Men

Age (years) Calories Needed for Sedentary Activity Level Calories Needed for Moderately Active Activity Level Calories Needed for Active Activity Level
19–30 2,400 2,600–2,800 3,000
31–50 2,200 2,400–2,600 2,800–3,000
51+ 2,000 2,200–2,400 2,400–2,800

The DASH Eating Plan as
Part of a Heart-Healthy Lifestyle

Combining DASH eating plan with other lifestyle changes such as physical activity can help you control your blood pressure and LDL-cholesterol for life.

Following below things will help prevent and control high blood pressure:

  • Be
    physically active.
  • Maintain a
    healthy weight.
  • Limit
    alcohol intake.
  • Manage and
    cope with stress.

Other lifestyle changes can improve your overall health, such as:

  • Quit
    smoking
  • Get enough
    of sleep.

To help
make lifelong lifestyle changes, try making one change at a time and add
another when you feel that you have successfully adopted the earlier changes.
When you practice several healthy lifestyle habits, you are more likely to
achieve and maintain healthy blood pressure and cholesterol levels.

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