The DASH Diet

  • Medical Author:
    Erica Oberg, ND, MPH

    Dr. Erica Oberg, ND, MPH, received a BA in anthropology from the University of Colorado, her doctorate of naturopathic medicine (ND) from Bastyr University, and a masters of public health (MPH) in health services research from the University of Washington. She completed her residency at the Bastyr Center for Natural Health in ambulatory primary care and fellowship training at the Health Promotion Research Center at the University of Washington.

  • Medical Editor: Melissa Conrad Stöppler, MD
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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What is the DASH diet?

DASH stands for Dietary Approaches to Stop Hypertension, and the diet was developed for a research study in the early 1990s.1 The purpose of the study was to identify a food-based strategy to lower blood pressure. Even though the original research was quite a long time ago, scientists recently conducted a meta-analysis for a DASH diet review to summarize how much blood pressure can be reduced by the DASH diet. The study found, on average, people reduce their blood pressure by 6.7 mmHg systolic and 3.5 mmHg diastolic in just two weeks. The more sodium is restricted, the lower blood pressure goes.

Or more simply stated, the DASH diet plan includes eating more

  • fruits and vegetables,
  • low-fat or nonfat dairy,
  • beans, and
  • nuts.

And eating less

Since the original research, scientists also have found that they could apply the DASH diet plan for weight loss.2 When people follow the Dash diet in addition to increasing exercise, they lose weight and improve metabolic measures such as insulin sensitivity. However, in comparison to low-carbohydrate diets, the DASH diet alone was not as effective a strategy for weight loss. When the DASH diet is followed along with exercise and caloric reduction, people improved their blood pressure even more; lowering it by 16 mmHg systolic and 9mmHg diastolic; plus, they lost some weight.2 As people adopt the DASH diet and lower their blood pressure, they may have a reduced need for medication. Discuss the diet-based changes you are making with your health-care professional, and if your blood pressure is at or below goal (<140/80), you can discuss reducing your medications and maintaining your blood pressure with diet alone.

What is the recommended daily allowance of sodium?

The National Institutes of Health's 2015-2020 Dietary Guidelines for Americans recommend consuming less than 2,300 mg of salt each day as part of a healthy diet.

Quick GuideHigh Blood Pressure Symptoms, Causes, Treatments

High Blood Pressure Symptoms, Causes, Treatments

Blood Pressure Symptoms

High blood pressure (hypertension) has been referred to as the "silent killer" because it most commonly occurs without any symptoms. Uncomplicated high blood pressure can persist for years, even decades, without causing symptoms. However, when complications of hypertension begin to develop, symptoms can occur.

Symptoms of complicated high blood pressure can include

  • dizziness,
  • shortness of breath,
  • headache...

How does the DASH diet lower blood pressure and promote weight loss?

The DASH diet is rich in potassium, magnesium, calcium, and fiber; and has a low content of sodium (salt) and saturated fat. Adding more of these nutrients improve the electrolyte balance in the body, allowing it to excrete excess fluid that contributes to high blood pressure. These nutrients also promote relaxation of the blood vessels, reducing blood pressure. These nutrients are often deficient in overweight and obese people, so the DASH diet can help correct those deficiencies and help people feel better. By itself, some people may lose weight with the DASH diet, but most will need to add exercise or further reduce carbohydrates to see big weight losses. The good news for people with diabetes, prediabetes, or insulin resistance is that the DASH diet does improve insulin sensitivity.

The DASH diet guidelines from the original research study specified two levels of sodium reduction.

  • The DASH diet phase 1 limited sodium to 2300mg, or about 1 teaspoon per day.
  • The DASH diet phase 2 further reduced sodium to 1500mg.

To reach the goal of phase 2, the person should avoid all table salt and avoid adding any salt to cooking. We tend to get more than the recommended amount of sodium when we eat packaged or processed foods or when eating or dining out. Salt is the major source of sodium in the diet, and we can usually refer to the two words interchangeably unless we are discussing specific biochemical processes.

What foods are allowed in the DASH diet eating plan?

People often ask what foods are on the DASH diet eating plan. The good news is that it includes a wide variety of foods, and many options. The DASH diet is simple. Eat more fruit, and especially vegetables, and eat fewer foods high in salt (sodium). For example:

  • Eat a salad with protein for lunch instead of a burger and fries.
  • Choose low-fat dairy products such as Greek yogurt instead of fruity, sweetened yogurt.
  • Choose snacks such as fruit, raw veggie sticks, bean-based spreads like hummus or black bean dip, and raw unsalted nuts.

Whole grains are encouraged, such as brown rice or quinoa along with lean proteins such as chicken, lean pork, and fish.

What foods and drinks should be avoided while following a DASH diet?

Foods and drinks to avoid when following the DASH diet include high sugar, high fat snacks, and foods high in salt such as:

  • Candy
  • Cookies
  • Chips
  • Salted nuts
  • Sodas
  • Sugary beverages
  • Pastries
  • Snacks
  • Meat dishes
  • Prepackaged pasta and rice dishes (excluding macaroni and cheese because it is a separate category)
  • Pizza
  • Soups
  • Salad dressings
  • Cheese
  • Cold cuts and cured meats
  • Breads and rolls
  • Sandwiches
  • Sauces and gravies
  • Soups

Using a salt substitute made with potassium not only works as a substitute in cooking and on the table, but the additional potassium can help lower blood pressure. People who are on blood pressure medications that increase potassium should ask their doctors to help them monitor the blood level of potassium (K) while they are making changes.

What about red meat and heart disease?

While not specifically recommended, grass-fed beef and buffalo would fit within these parameters. Grass-fed beef has a very different composition than conventional grain-fed beef. Grass-fed beef is high in omega-3s and is more similar to fish, nutritionally. Grain-fed red meat is high in omega 6s and saturated fat, both of which are promote inflammation and contribute to heart disease, high blood pressure, and obesity. Red meat that is not grass-fed is not allowed.

Quick GuideHigh Blood Pressure Symptoms, Causes, Treatments

High Blood Pressure Symptoms, Causes, Treatments

What is a sample DASH diet sample menu?

A typical 1600 calorie DASH diet menu plan would include the following:

  • 2 cups of vegetables
  • 2 servings of fruit
  • 2 servings of low-fat/fat-free dairy products
  • 6 oz. whole grains ( 1 slice multi-grain bread plus 1 small serving brown rice)
  • 5 oz. lean meat, poultry or fish (the size of 1 ½ playing cards)
  • 2 teaspoons healthy oils such as olive oil
  • 1 oz. nuts and seeds

Rare, mini servings of sweets, salty foods, and alcohol (once/week)

A typical daily DASH diet sample menu might look like this

  • Breakfast: Steel cut oatmeal with chopped pecans, ½ a chopped apple and cinnamon, black coffee
  • Morning snack: other half of apple with 1 tsp peanut butter, large glass of water
  • Lunch: spring greens salad with mixed vegetables, grilled chicken breast and vinaigrette dressing on the side. Dip your fork in dressing to get flavor with every bite without saturating the salad with salt and fat. Drink unsweetened iced tea or water.
  • Afternoon snack: unsweetened fruity iced tea or carrot sticks with hummus
  • Dinner: spiralizer-made zucchini pasta with marinara made with ground turkey and Italian spices, sparkling mineral water
  • Dessert: strawberries, 1 tbsp. vanilla yogurt, dusting of cocoa powder

What are some DASH diet recipes?

Breakfast

  • Whole grain toast, avocado, smoked salmon
  • Night before muesli - in a glass refrigerator container combine equal parts quick oats, unsweetened coconut flakes, raw sunflower seeds, and frozen blueberries. Mix and cover with ½” unsweetened almond/oat/coconut milk or low-fat dairy milk if you aren't intolerant.

Lunch

  • Make it easy. Make your lunch a salad plus protein and enjoy the millions of variations on the theme.
  • From home: leftover roasted veggies and grilled chicken on a bed of butter lettuce with extra-virgin olive oil and quality balsamic vinegar and chopped walnuts drizzled on top
  • If you are out: A mixed greens salad, hold the cheese, add chicken, hard-boiled egg, or grass-fed steak. Put the dressing on the side, and dip your fork in to get flavor with each bite without overdoing it.

Dinner

  • Keep it simple. Focus on a healthy flavorful vegetable recipe, complement it with a protein, and add a side of whole grains.
  • Brown rice pilaf made with pine nuts, celery, onion, and herbs de Provence.
  • Grilled wild salmon with cracked pepper
  • Steamed broccolini with small pat of butter or olive oil drizzle

Snacks

  • Fresh fruit and nuts and small servings of low fat dairy are the mainstays of the DASH diet snacks.

How can I make the DASH diet tastier?

While the DASH diet includes solid nutrition recommendations, it can be hard for someone new to these recommendations to make food palatable. We are used to sugar and salt as the major "flavors" of our meals. To make the healthy foods in the DASH diet more appealing, be generous with herbs and spices. There are a number of salt-free spice blends that can be used for many recipes. Some options include

  • herbs de Provence blends,
  • Italian herb blend, Indian
  • curry blend, and
  • Baja fish taco blend (check that they are salt-free or you are derailing your good efforts).

These spice blends can be sprinkled on proteins while grilling, turned into a salad dressing with extra virgin olive oil and white wine vinegar, or sprinkled on a sandwich to reduce the mayonnaise or cheese we typically add for flavor.

What heart-healthy lifestyle interventions are part of the DASH diet?

While the original DASH diet research didn't include other lifestyle changes, it makes sense to include them, and the combination has since been researched and shown to be effective.

Physical activity and high blood pressure

It is important to be physically active every day, such as taking a walk after dinner. The more activity and exercise a person does the more benefits the body receives. As we exercise, the muscles demand oxygen, and nitric oxide is released to relax the blood vessels to allow more blood and oxygen in. Over time, this becomes a permanent effect, lowering blood pressure even when you are not physically active. For blood pressure and weight loss, physical activity should include regular walking, dancing, swimming, cycling, or other cardiovascular (aerobic) activity, but it also should include some strength training. Building more muscle through weight or strength training has the best effect on weight loss and increasing metabolism.3

Quick GuideHigh Blood Pressure Symptoms, Causes, Treatments

High Blood Pressure Symptoms, Causes, Treatments

Stress management and high blood pressure

Stress can raise blood pressure even if you are following a healthy DASH diet plan. Many times, the things that cause stress are outside of our control and we feel we cannot change it (boss at work, family situations, and our health worries). What we can change is how we let stress impact us. By learning to be more stress resilient, we can reduce the impacts of stress, such as high blood pressure and weight gain. Stress management techniques such as courses in meditation (which can be found online or in person) are a good option. Two types of mediation, transcendental meditation and mindfulness-based stress reduction, have been studied and proven to lower blood pressure as well as increase peace of mind and stress resiliency.

Mind and body exercises such as yoga and Tai Chi also may help decrease stress. Check with your health-care professional if one of these is an option for you.

Sleep and high blood pressure

You may not have realized that poor sleep increases blood pressure. For example, people who have sleep apnea have higher blood pressure than those without the condition, and when that is treated (using a device to ease breathing), blood pressure comes down.

Alcohol use and high blood pressure

Alcohol increases blood pressure and should be consumed in moderation in the DASH diet plan. The recommendations for alcohol are to limit it to one drink per day for women, and two per day for men.

Smoking and high blood pressure

Smoking raises blood pressure as well as contributing to other chronic diseases. It is difficult to quit smoking, so ask for help if you need it. Options to help you quit range from support groups to medications to hypnosis.

Weight management and high blood pressure

Losing weight is difficult for most people, but it ultimately improves more than your just blood pressure. With weight loss, most cardiovascular (heart) risk factors improve, your risk for cancers, diabetes, dementia, and many other chronic diseases decreases. Social support is very important to be successful in weight loss. Make a commitment with several friends or join a program that helps keep you accountable and provides support. If you are struggling to lose weight despite eating a DASH diet and being physically active, there might be problems with your metabolism or other underlying factors. Discuss the situation with your health-care professional to see if other conditions may be impacting your metabolism.

Where can I find more information about low sodium foods, diet plans, and low sodium shopping lists?

The following resources provide more information about how to lower sodium in your diet, and other healthy food choices that help lower blood pressure.

  • Get the Facts: Sources of Sodium in Your Diet
    <http://www.cdc.gov/salt/pdfs/sources_of_sodium.pdfhttp://www.cdc.gov/salt/pdfs/sources_of_sodium.pdf>
  • ChooseMyPlate.gov
    http://www.choosemyplate.gov/sodiumhttp://www.choosemyplate.gov/sodium
  • Low Sodium Foods: Shopping List
    <https://healthfinder.gov/HealthTopics/Category/health-conditions-and-diseases/heart-health/low-sodium-foods-shopping-list>

REFERENCES:

Appel, L. J., et al. "A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group." N Engl J Med. 1997 Apr 17;336(16):1117-24.

Blumenthal, J. A. et al. "Effects of the DASH diet alone and in combination with exercise and weight loss on blood pressure and cardiovascular biomarkers in men and women with high blood pressure: the ENCORE study." Arch Intern Med. 2010 Jan 25;170(2):126-35.

Cano-Montoya, J. et al. "Interaction between antihypertensive therapy and exercise training therapy requires drug regulation in hypertensive patients." Rev Med Chil. 2016 Feb;144(2):152-61.

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Reviewed on 5/10/2016
References
REFERENCES:

Appel, L. J., et al. "A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group." N Engl J Med. 1997 Apr 17;336(16):1117-24.

Blumenthal, J. A. et al. "Effects of the DASH diet alone and in combination with exercise and weight loss on blood pressure and cardiovascular biomarkers in men and women with high blood pressure: the ENCORE study." Arch Intern Med. 2010 Jan 25;170(2):126-35.

Cano-Montoya, J. et al. "Interaction between antihypertensive therapy and exercise training therapy requires drug regulation in hypertensive patients." Rev Med Chil. 2016 Feb;144(2):152-61.

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