The DASH Eating Plan

InformalJohnJohn A. Patterson MD, MSPH, FAAFP
September 2013

Would you like to lower your blood pressure without drugs in just 2 weeks?

High blood pressure (hypertension) is defined as a pressure equal to or greater than 140/90. It can lead to stroke, kidney failure and heart failure.  Pre-hypertension is defined as a pressure greater than or equal to 120/80 and may also increase the risk of developing serious disease.
Compared to the typical American diet, DASH (Dietary Approaches to Stop Hypertension) is lower in saturated fat, cholesterol, total fat, sweets, sugary beverages and red meats. It is higher in fruits, vegetables, fat-free or low-fat dairy products, whole grains, fish, poultry, beans, seeds, and nuts. Though the DASH Eating Plan is designed to treat or prevent hypertension, it also can help prevent or control obesity, diabetes, osteoporosis, cancer, heart disease and stroke.
Excessive dietary sodium raises blood pressure and reducing sodium intake can help lower high blood pressure. DASH encourages foods low in sodium (salt) and high in nutrients that lower blood pressure- especially potassium, calcium and magnesium. Since the DASH Eating Plan can begin lowering blood pressure in just two weeks, discuss the addition of DASH with your primary care provider, especially if you take medication for hypertension.
The typical American diet contains about 4,000 milligrams of sodium daily (about 1½ teaspoon of salt). Reducing daily sodium intake to 2,300 milligrams (about 1 teaspoon of salt) can lower blood pressure. Limiting daily sodium to only 1,500 milligrams (about 2/3 teaspoon) can lower blood pressure even further and is advised in people who already have hypertension, diabetes or chronic kidney disease as well as African Americans and middle-aged and older adults. Sodium intake can be reduced by using sodium-free spices or flavorings in place of salt, not adding salt when cooking rice, pasta or hot cereal, rinsing canned foods to remove added salt and buying foods labeled “no salt added,” “sodium-free” and “low sodium”.
DASH emphasizes whole grains, fruits, vegetables, low-fat dairy products, fish, nuts, seeds and legumes. Whole grains have more fiber and nutrients than refined grains. When choosing bread, cereal, rice and pasta, select whole wheat, brown rice, whole (‘old-fashioned’) oats and look for ‘whole grain’ on the label.
Many vegetables provide fiber, vitamins, and blood pressure-lowering minerals such as potassium and magnesium. Serve steamed or lightly stir-fried vegetables over brown rice or whole-wheat noodles. Many fruits provide fiber, potassium and magnesium. Have fruit as a snack between meals and as a dessert after your meal. I recommend stewed unsweetened fruit (prunes, apricots, apples, cranberries) as a sweet snack or dessert. Despite having no added sugars, stewed fruit is incredibly sweet and satisfying.
Dairy products are major sources of calcium. Choose dairy products that are low fat or fat-free. Add fruit to unsweetened yogurt for a healthier dessert. Fish, such as salmon, herring and tuna are high in heart-healthy omega-3 fatty acids and should be favored over beef, pork and other meats. Nuts, seeds and legumes are good sources of magnesium and potassium, as well as other healthy micronutrients. In particular, soybean products, such as tofu and tempeh, contain high quality protein suitable as a meat substitute.
     Compared to the 35-40 percent fat intake of the average American diet, the DASH Eating Plan limits total fat to 27 percent or less of daily calories, with a focus on the healthier monounsaturated rather than saturated fat. Monounsaturated oils include olive, canola, peanut, sunflower and sesame. DASH limits daily saturated fat to less than 6 percent of total calories by limiting use of meat, butter, cheese, whole milk, cream, eggs, lard, solid shortenings, and palm and coconut oils.
Weight loss can be a positive side benefit of the DASH Eating Plan, especially if you cut back on sugar with its ‘empty calories’- calories that are not accompanied by healthful nutrients. When you eat sweets, choose those that are fat-free or low-fat, such as sorbets, hard candy, graham crackers or low-fat cookies. Avoid the sugar of pop by limiting your beverages to water, low fat milk and unsweetened fruit juice diluted half and half with water. Combining the DASH Eating Plan with physical activity makes it more likely that you’ll reduce both your weight and your blood pressure.
Drinking too much alcohol can increase blood pressure. Although I never advise non-drinkers to begin drinking alcohol for their health, the DASH Eating Plan recommends that men limit alcohol to two or fewer drinks a day and women to one or less.
If you have hypertension, discuss the DASH Eating Plan with your provider and make food part of your treatment plan.

Resources-

NHLBI- What is the DASH Eating Plan?

http://www.nhlbi.nih.gov/health/health-topics/topics/dash
NHLBI- Flavor that food
http://www.nhlbi.nih.gov/hbp/prevent/sodium/flavor.htm Mayo Clinic- Sample menus for the DASH Eating Plan
http://www.mayoclinic.com/health/dash-diet/HI00046Mayo Clinic- DASH Diet: Healthy eating tot lower your blood pressure
http://www.mayoclinic.com/health/dash-diet/HI00047

About the Author-
Dr Patterson is past president of the Kentucky Academy of Family Physicians and is board certified in family medicine and integrative holistic medicine. He is on the family practice faculty at the University of Kentucky College of Medicine and the University of Louisville School of Medicine, Saybrook University’s School of Mind Body Medicine (San Francisco) and the Center for Mind Body Medicine (Washington, DC). He operates the Mind Body Studio in Lexington, where he offers integrative medicine consultations. He can be reached through his website at www.mindbodystudio.org.