Have you heard of the DASH Diet?
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What is the DASH Diet?
DASH stands for Dietary Approaches to Stop Hypertension.
It is an excellent, evidence-based, continually-researched diet, and if you or someone you love is dealing with elevated blood pressure, then I want you to know ALL about it!
DASH was first developed in the early 1990’s by researchers who were alarmed at rates of hypertension (aka high blood pressure) in the American population. High blood pressure is the major risk factor for chronic conditions including stroke, coronary heart disease, heart failure and chronic kidney disease. It is an insidious, silent condition, and many sufferers are unaware they are hypertensive until they suffer a stroke or heart attack.
Today, the DASH Diet is widely regarded as the go-to diet for people wishing to address their hypertension through diet. It is one of the most thoroughly studied dietary patterns in the world* - studies have shown that it is safe and effective to use in combination with hypertension meds** and in conjunction with other lifestyle modifications like increased exercise, stress management and weight loss.
So if you have elevated BP or hypertension, you need to know about DASH!
The team who developed DASH knew from observational studies that populations who follow vegetarian/vegan with high levels of vegetables and low or no animal foods had lower BP levels than Americans. But they knew there was no point coming up with the ultimate BP-lowering diet if the average American didn’t find it palatable and would never follow it. They knew it was highly unlikely that the average American would convert to veganism, or go to the effort of seeking out special or expensive foods, so the diet had to retain enough meat and dairy to be palatable to them, and would have to feature foods that are readily recognisable, and readily available at the local supermarket.
So these clever researchers came up with an idea to test (or in science-speak, a “hypothesis”): what if they created a diet that combines all of the individual nutrients shown to lower BP in all of these reductionist studies, and combine them into a diet that the average American would be willing to eat? Would this specially-designed diet lower BP? Long story short, the results of the original DASH Diet trials were amazing. I have included a summary of the trial and its results below***
What do you eat on the DASH Diet?
Check out this helpful table from the American National Heart Lung & Blood Institute:
Image source: https://www.nhlbi.nih.gov/health-topics/dash-eating-plan
I have included a printable version of this table in the Resources section below.
The DASH is specifically designed to deliver micro- and macro-nutrients in specific ratios and amounts that will synergistically work together to lower your BP. So the DASH Diet is lower in sodium, total fat and saturated fat than the standard Western diet, and higher in potassium, calcium, magnesium and fibre - all nutrients associated with lower BP:
Image source: https://www.nhlbi.nih.gov/health-topics/dash-eating-plan
Some things you need to know about the DASH diet
It is designed to be a way of eating you adapt to for life: DASH is not one of those diets that you go on for a few weeks or months and then revert back to your old ways of eating. If you go back to a diet that is high in salt, saturated fats, processed foods etc, your BP will most likely go right back up again.
You can get better results by closely watching your sodium intake, and keeping it to around 1,500 to 2,300mg/day. That’s no more than a teaspoon of salt per day.
DASH can be followed by anyone, with any level of BP, even people with diagnosed hypertension who are on medication(s) to control it.**
The results of DASH can be enhanced by adopting other lifestyle changes that have been shown to lower BP, including:
getting regular exercise: always get clearance and advice from your GP or Cardiologist about this;
managing your stress;
cutting right back on the booze (or cutting it out altogether); and
DASH has been extensively studied and no adverse effects have been found in anyone eating a DASH Diet.
The benefits of DASH go beyond lowered BP. Studies have found that the DASH Diet can also improve:
fasting blood sugar levels and insulin sensitivity
blood triglycerides
low-density lipoprotein (LDL) cholesterol (aka “bad” cholesterol)
insulin resistance
So if you adopt DASH to address elevated BP, you may also find your blood cholesterol levels and fasting blood glucose levels improve too - win-win!!
The DASH Diet only works if you follow it properly!
Like all diets, it is possible to undermine the effectiveness of the diet by making less than ideal choices. A few little “cheats” here and there can add up and keep your BP in the danger zone.
So here are my tips to help keep you on the DASH track:
Be REALLY vigilant about allowing your salt intake to creep up
This is actually much harder than it sounds! And that’s because 70-80% of the salt in our diet is "hidden" in processed foods - food products that are made from cheap ingredients that would be bland and unappetising without loads of salt. Salt is even in foods we don't expect to have high levels of salt like breads, breakfast cereals, tinned beans, cakes and biscuits.
So the best way to keep your sodium intake to 1,500-2,300mg/day is to:
minimise the processed foods you buy and consume (you can ready why HERE); and
read labels carefully at the supermarket to make sure you are choosing the lowest-sodium option.
You can read more about the adverse health impacts of salt HERE.
Make a BIG EFFORT to eat all of your serves of veggies and fruits every day
One of the reasons DASH is so effective in lowering BP is because it gives you the right amounts and ratios of nutrients to keep BP in the healthy range. So you REALLY need to make a big effort to get in as many veggies as possible, as well as your 2-3 serves of fruit, in order to give you the right amounts of potassium, magnesium and fibre. The more sodium you consume, the more important your veggie consumption becomes.****
Click HERE for my top tips to help you increase your veg intake!
Make sure your grain products like breads, crackers and other baked goods are genuinely wholegrain
We've been urged to choose wholegrain options for decades now. We know refined carbohydrate foods like white bread are less-than-ideal choices for every day. The body treats them much like sugar, so they spike blood glucose and cause insulin to surge, which over time can contribute to insulin resistance.
But ‘healthwashing” is ubiquitous in the food industry, and researchers have noted that so many supposedly “wholegrain” breads, crackers and baked goods are not genuinely wholegrain at all.
Sometimes, highly processed foods are incorrectly labelled as "whole grain" or "wholemeal". Those sneaky food companies have managed to be pretty, ummm, flexible (or to put it less politely, downright misleading), with many products labelled as "wholegrain" that are not much better than their refined counterparts.
This makes it tough for people who just want to make the best choice for themselves and their families when they're at the supermarket. They purchase these products in good faith believing they have chosen the "healthy" option, but they are still so refined that they will spike blood-sugar and insulin.
So here is a fantastic rule of thumb for you to follow when choosing breads, crackers and other baked goods:
Step 1: Check the label, and focus on the "per 100g" column.
Step 2: Look at the amount of Carbohydrate (total carbohydrate). It will be listed there in grams.
Step 3: Look for the amount of fibre. Again, it will be listed in grams. And here's a pro tip: if fibre isn't listed you can be pretty sure it's basically non-existent in that product!
The ratio of carbohydrate to fibre should not be higher than 10:1. If it is, the product is actually too refined to legitimately be classified as "wholegrain".
Basically, if you are buying a grain-based product like bread, check the carb-to-fibre ratio, and give it a miss if it is more than 10:1. If the product has a carb:fibre raio of 7:1 or lower, it gets the green light.
Be choosy about your carbs
Check out THIS POST for my top tips on making carb-smart choices!
And that includes being mindful about added sugars in the foods you consume. Check out THIS POST for more info.
Ditch sugary sodas and soft drinks
Just stop buying them, no excuses. Need extra motivation? Read THIS post.
Drink water, or sparkling water with a squeeze of lime, or iced tea or herbal tea. Anything but that health-sabotaging sugary rubbish!
Ditch deep fried foods
Cut right back on the booze
Or cut it out altogether. Check out THIS POST for details on what alcohol does to your body.
DASH DIET RESOURCES
There are some amazing, helpful resources for anyone wanting to try the DASH diet:
Websites
https://www.nhlbi.nih.gov/health-topics/dash-eating-plan
Booklets and Brochures
Booklet: Your Guide to Lowering Your Blood Pressure with DASH from the American National Heart Lung & Blood Institute.
Printable DASH Eating Plan from the American National Heart Lung & Blood Institute.
Brochure: Getting Started on DASH from the American National Heart Lung & Blood Institute.
Brochure: Why the DASH Eating Plan Works from the American National Heart Lung & Blood Institute.
Making the Move to DASH from the American National Heart Lung & Blood Institute.
Tips to keep on track from the American National Heart Lung & Blood Institute.
DASH Diet Diaries
DASH Diet Diary to record your food intake from the American National Heart Lung & Blood Institute.
DASH: What’s on Your Plate (1,200 calories/day) from the American National Heart Lung & Blood Institute.
DASH: What’s on Your Plate (1,400-1,600 calories/day) from the American National Heart Lung & Blood Institute.
DASH: What’s on Your Plate (1,800-2,000 calories/day) from the American National Heart Lung & Blood Institute.
DASH: What’s on Your Plate (2,600 calories/day) from the American National Heart Lung & Blood Institute.
Sample Menus & Eating Plans
From Vermont Department of Health: https://www.healthvermont.gov/sites/default/files/documents/pdf/HPDP-Diabetes_dash%20eating%20plan.pdf
Mayo Clinic: https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/dash-diet/art-20047110
US News Health: https://health.usnews.com/best-diet/dash-diet/recipes
Health Link British Columbia: https://www.healthlinkbc.ca/health-topics/zp3302
EatingWell Seven Day DASH Diet Meal Plan: http://www.eatingwell.com/article/289964/7-day-dash-diet-menu/
A week with the DASH Eating Plan from the American National Heart Lung & Blood Institute.
Recipes
Mayo Clinic: https://www.mayoclinic.org/healthy-lifestyle/recipes/dash-diet-recipes/rcs-20077146
Scientific Studies
I have included a selection of studies at the end of this article. If you are a fellow science nerd, I encourage you to look up these and other studies!
***
* In the “References” section below, I have included a selection of studies into the DASH Diet. This is by no means the complete list of studies into DASH!
** If you are on medication(s) for elevated blood pressure and want to try the DASH Diet, it is very important that you firstly let your GP or cardiologist know in advance, and that you set up a program with your doctor where you can have your BP and medication levels regularly monitored.This is because the DASH diet - if properly followed - can be VERY effective in lowering your blood pressure, so you may need to have your dosage adjusted downwards.
*** The graph below sets out the results of the original DASH trials. Researchers recruited 459 people who had elevated BP or moderate hypertension (BP≤160/80-95mmHg) and who were not on BP-lowering medication. They were randomly assigned to consume of three diets for eight weeks:
a “typical American” diet, comprising refined grains, full-fat dairy, red meat and sugar, with low amounts of fruit, vegetables, nuts and legumes – this was the “control group”;
a “fruit and vegetable diet”, similar to the above diet but high in fruits and vegetables; or
the specially designed DASH diet. The DASH diet features higher levels of vegetables, fruit, whole grains, low-fat dairy, and plant-based protein, with lower amounts of red meat, full-fat dairy, and refined grain products than the typical American diet. The aim was to reduce saturated fat, whilst providing higher levels of calcium, potassium, magnesium, protein and fibre.
To ensure they properly followed the diet, they were provided with all food, and to keep the playing field level, each diet contained exactly the same amount of sodium - 3,000mg.
The results of this trial were remarkable. DASH outperformed both diets and confirmed the effectiveness of the DASH diet for BP reduction. And DASH worked fast! Within 2 weeks BP dropped, and by the end of the 8 week intervention BP was lowered by an average of 5.5/3.0mmHg, with larger reductions seen in the people with the highest BP (~11.4/5.5mmHg).
Image ref: Appel L, Moore T, Obarzanek E, Vollmer W, Svetkey L, Sacks F, Bray G, Vogt T, Cutler J, Windhauser M, Lin P, Karanja N, Simons-Morton D, McCullough M, Swain J, Evans M, Harsha D. A clinical trial of the effects of dietary patterns on blood pressure. New England Journal of Medicine. 1997;336:1117–1124.
**** PLEASE don’t think adding in a few extra serves of veggies is your “get out of jail free card” if you happen to go to town on the salty processed and/or snack foods.
REFERENCES
Sacks F, Obarzanek E, Windhauser M, Svetkey L, Vollmer W, McCullough M, Karanja N, Lin P-H, Steele P, Proschan M, Evans M, Appel L, Bray G, Vogt T, Moore T, Investigators D. Rationale and design of the Dietary Approaches to Stop Hypertension trial (DASH): a multicenter controlled-feeding study of dietary patterns to lower blood pressure. Annals of Epidemiology. 1995;5:108–118.
Appel L, Moore T, Obarzanek E, Vollmer W, Svetkey L, Sacks F, Bray G, Vogt T, Cutler J, Windhauser M, Lin P, Karanja N, Simons-Morton D, McCullough M, Swain J, Evans M, Harsha D. A clinical trial of the effects of dietary patterns on blood pressure. New England Journal of Medicine. 1997;336:1117–1124.
Svetkey L, Simons-Morton D, Vollmer W, Appel L, Conlin P, Ryan D, et al. Effects of dietary patterns on blood pressure: subgroup analysis of the Dietary Approaches to Stop Hypertension (DASH) randomized clinical trial. Archives of Internal Medicine. 1999;159:285–293.
Conlin P, Erlinger T, Bohannon A, Miller E, Appel L, Moore T, et al. The DASH diet enhances the blood pressure response to losartan in hypertensive patients. American Journal Of Hypertension. 2003;16(5):337-342.
Sacks F, Moore T, Appel L, Obarzanek E, Cutler J, Vollmer W et al. A dietary approach to prevent hypertension: A review of the dietary approaches to stop hypertension (DASH) study. Clin Cardiol. 1999;22(S3):6-10.
Appel L, Champagne C, Harsha D, Cooper L, Obarzanek E, Elmer P, et al. Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER clinical trial. Journal of the American Medical Association. 2003;289(16):2083–2093.
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