DASH stands for Dietary Approaches to Stop Hypertension. This eating plan was designed by the National Institutes of Health (NIH) to lower the risk of and treat high blood pressure. High blood pressure affects nearly half of American adults and is a significant risk factor for heart disease and stroke, two leading causes of death in the United States. Only one in four people with high blood pressure have it under good control. Lifestyle interventions, including a heart-healthy diet, are first-line treatments for managing high blood pressure. Research supports the use of the DASH diet as a healthy eating pattern that can begin to lower blood pressure, as well as reduce the risk of other health problems.
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What is the Dash Diet?
The DASH diet is a Whole foods diet focused on incorporating fresh fruits and vegetables, whole grains, beans, nuts, low-fat dairy, fish, and poultry. It is considered to be a heart-healthy diet, as it is naturally low in saturated and trans fats, sodium, and refined sugar. It increases the intake of potassium, magnesium, calcium, fiber, and antioxidants - all important for cardiovascular function. Following the DASH diet and staying physically active will provide the most significant benefit in lowering blood pressure.
Understanding Blood Pressure
Blood pressure measures the force exerted onto blood vessels as blood flows through them. Blood pressure is recorded as systolic pressure over diastolic pressure in units of millimeters of mercury (mmHg) (i.e., 120/80 mmHg). Systolic blood pressure, the top number, is the pressure in the vessels when the heart beats. Diastolic blood pressure, the bottom number, is the pressure in the vessels when the heart is relaxed between beats.
The American College of Cardiology guidelines classify blood pressure as follows:
- Normal: less than 120/80 mmHg
- Elevated: systolic 120-129 mmHg and diastolic less than 80 mmHg
- Stage 1 Hypertension: systolic 130-139 mmHg or diastolic 80-89 mmHg
- Stage 2 Hypertension: systolic 140+ mmHg or diastolic 90+ mmHg
- Hypertensive Crisis (medical emergency): systolic over 180 mmHg and/or diastolic over 120 mmHg
9 Health Benefits of the DASH Diet
Reduce High Blood Pressure
The origins of the DASH diet date back to the 90s when the NIH funded several studies to find a therapeutic diet effective at treating high blood pressure. They concluded that the DASH diet could lower blood pressure even without weight loss or intentional sodium restriction. Utilizing the DASH diet in conjunction with weight loss and sodium restriction can magnify blood pressure reductions.
Reduce High Cholesterol
The DASH diet is effective at improving markers of LDL and VLDL (“bad”) cholesterol and triglycerides; however, the DASH diet also results in decreased HDL (“good”) cholesterol. Further research has shown that a higher fat DASH diet, substituting 10% of total daily carbohydrates calories with unsaturated fat, is effective at lowering blood pressure, LDL cholesterol, and triglycerides to the same extent as the original DASH diet without resulting in unwanted reductions of HDL cholesterol.
Reduce Cardiovascular Diseases
Hypertension is a significant risk factor for most cardiovascular diseases, such as heart attack and stroke. Given its efficacy at lowering and normalizing blood pressure, the DASH diet can significantly protect against cardiovascular disease by 20%. Specifically, it is associated with a 19% lower risk of stroke and a 29% lower risk of heart failure.
Weight Loss
The DASH diet is a good choice for weight management, particularly for weight reduction in overweight and obese participants. A recent meta-analysis revealed that adults on the DASH diet lost more weight than those following a calorie-restricted standard American diet over 24 weeks.
Reduce Type 2 Diabetes
The DASH diet is associated with a 20% risk reduction in future type 2 diabetes. Insulin resistance, the desensitization of the body to insulin and the consequent rise in blood sugar, is a precursor to prediabetes and type 2 diabetes. The DASH diet effectively improves insulin sensitivity, especially when implemented as part of a comprehensive lifestyle modification program, including weight loss and exercise. Interestingly, utilizing glycemic index (GI) to make carbohydrate food choices on the DASH diet does not appear to be necessary, as both high- and low-GI DASH diets resulted in the same effects on insulin sensitivity.
Improve Metabolic Syndrome
Metabolic syndrome is the presence of at least three: high blood pressure, high blood sugar, abdominal obesity, low HDL cholesterol, and high triglycerides. Utilizing the DASH diet to improve these biomarkers can help prevent and manage metabolic syndrome.
Reduce Cancer Risk
Adherence to the DASH diet results in a lower risk of some cancers, including colorectal and breast cancer, due to its high content of vitamins, minerals, fiber, and antioxidants.
Reduce Gout Risk
Compared to a Standard American Diet, DASH can lower serum uric acid levels, translating to a lower risk of gout. With a popular understanding that gout is a metabolic disease, often co-occurring with high blood pressure and other cardiovascular diseases, the DASH diet would be helpful in addressing all conditions.
Improve Kidney Health
DASH dietary patterns of reduced consumption of red meat and processed foods and higher intake of nuts, legumes, and low-fat dairy products are associated with a lower risk of kidney disease. The affiliated high intake of calcium, phytates, magnesium, and citrate with eating fruits and vegetables on the DASH diet is also associated with decreased risk of kidney stones.
DASH Diet: Recommended Servings
The DASH diet is built with flexibility and recommends daily/weekly servings of food groups instead of requiring that specific food be eaten or avoided. The number of servings of each food type varies depending on daily caloric needs. The recommended servings based on a 2,000-calorie diet are:
- Grains: 6-8 servings daily
- Meat, Poultry, and Fish: 6 or fewer servings daily
- Vegetables: 4-5 servings daily
- Fruit: 4-5 servings daily
- Fat-Free or Low-Fat Dairy: 2-3 servings daily
- Fats and Oils: 2-3 servings daily
- Nuts, Seeds, and Legumes: 4-5 servings weekly
- Sweets and Added Sugars: 5 or fewer servings weekly
What is a Serving?
Grains
- 1 slice bread
- 1 ounce or ½ cup dry cereal
- ½ cup cooked rice, pasta, or cereal
Meat, Poultry, Fish
- 1 ounce cooked seafood, skinless poultry, or lean meat
- 1 whole egg or 2 egg whites
Vegetables
- 1 cup raw leafy green vegetables
- ½ cup cut raw or cooked vegetables
- ½ cup vegetable juice
Fruit
- 1 medium fruit
- ½ cup fresh, frozen, or canned fruit
- ½ cup fruit juice
- ¼ cup dried fruit
Dairy
- 1 cup milk or yogurt
- 1.5 ounces cheese
Fats and Oils
- 1 tsp soft margarine
- 1 tbsp mayonnaise
- 2 tbsp salad dressing
Nuts, Seeds, Legumes
- ½ cup cooked beans
- ⅓ cup nuts or 2 tbsp nut butter
- 2 tbsp seeds
Sugars
- 1 tbsp sugar or maple syrup
- 1 tbsp jam or jelly
- ½ cup low-fat frozen yogurt or sorbet
Micronutrient Recommendations
Sodium
You will likely lower your sodium intake by following the DASH diet, as whole foods are naturally lower in sodium. The low-sodium version of the DASH diet can result in more dramatic drops in blood pressure. If you are unsure which DASH version is best for you, talk with your doctor. (1)
Standard DASH Diet: 2,300mg daily. This equates to 6 grams, or 1 tsp, of table salt.
Low-Sodium DASH Diet: 1,500mg daily. This equates to 4 grams, or ⅔ tsp, of table salt.
Potassium
People should aim to consume 4,700mg of potassium daily while following the DASH protocol. Foods naturally high in potassium include leafy green vegetables, lentils, potatoes, apricots, and bananas. (1)
Calcium
The daily intake goal for calcium is 1,250mg daily. Foods naturally high in calcium include dairy products, bone-in sardines, leafy green vegetables, and tofu. (1)
Magnesium
The daily target for magnesium on the DASH diet is 500mg. Foods naturally high in magnesium include nuts and seeds, green leafy vegetables, and whole grains. (1)
If you are interested in the DASH diet but don’t know how to start, this sample menu can help.
FAQ About DASH
Is Salt Bad for You?
Not necessarily! Salt is a compound made of sodium and chloride, two minerals that are essential for life. Both support vital body functions like fluid balance, nerve conduction, muscle contraction, and acid-base balance. However, excess sodium can pull too much water into the blood vessels, increasing blood volume and pressure. This is why DASH guidelines limit (not eliminate) sodium intake to 1,500-2,300mg daily.
Processed foods account for the majority of salt and sodium Americans consume. Very little sodium occurs naturally in whole foods. Reading nutrition labels and choosing food items lower in sodium is an excellent place to start if trying to meet DASH sodium intake goals.
How Long Should One Follow a DASH Diet?
The DASH diet can improve blood pressure in just two weeks after starting. However, the DASH diet was actually designed to be a long-term eating plan implemented to form dietary habits rather than a short-term diet or cleanse. Long-term compliance is associated with improved blood pressure control, better markers of cardiovascular health, and a lower risk of chronic disease.
Summary
If you have been diagnosed with high blood pressure, your doctor may have recommended the DASH diet as a well-proven eating plan for blood pressure management. However, you don’t need to have high blood pressure to follow the DASH diet. With its whole foods approach, DASH is flexibly designed and lays a solid nutritional foundation for optimal wellness and disease prevention.
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