Dietary Approaches to Stop Hypertension (DASH)

by Robin Allen MSPH, RDN, LDN

Frequently when I go out to eat with friends, fellow workers or new acquaintances I am confronted with “don’t let the Dietitian see what I am eating”.  Or “look how healthy she is eating”. Or “What is your secret”?  I usually respond with the tried and true, moderation is the key which usually ends the conversation and they eat whatever they were going to anyway.  Well I do not always eat “right”.   However if you have a chronic disease such as Hypertension, you should be watching your diet.  But with new diets coming out all the time what should a person with Hypertension be eating?

Evidence from epidemiological studies and randomized trials indicate that a diet low in sodium and rich in fruits and vegetables, such as the Mediterranean and DASH-style diets, reduce stroke risk. Dietary Approaches to Stop Hypertension (DASH) is a flexible and balanced eating plan that is based on research studies sponsored by the National Heart, Lung, and Blood Institute (NHLBI). These studies showed that DASH lowers high blood pressure and improves levels of blood lipids (fats in the bloodstream), which reduces the risk of developing cardiovascular disease. The DASH Diet has been used successfully for weight loss.

The DASH eating plan:

• Emphasizes vegetables, fruits, and fat-free or low-fat dairy products
• Includes whole grains, fish, poultry, beans, seeds, nuts, and vegetable oils
• Limits sodium, sweets, sugary beverages, and red meats
• Low in saturated and transfats
• Rich in potassium, calcium, magnesium, fiber, and protein

The DASH eating plan is lower in sodium (mostly from salt) than the typical American diet. The DASH research showed that an eating plan containing 2,300 milligrams (mg) of sodium per day lowered blood pressure. An eating plan containing only 1,500 mg of sodium per day even further lowered blood pressure.

Below are 2 tables that shows the daily nutrient goals used in the DASH studies.

Daily Nutrient Goals Used in the DASH Studies (for a 2,000-Calorie Eating Plan)

Total fat	27% of calories
Saturated fat	6% of calories
Protein	18% of calories
Carbohydrate	55% of calories
Cholesterol	150 mg
Sodium	2,300 mg*
Potassium	4,700 mg
Calcium	1,250 mg
Magnesium	500 mg
Fiber	30 g

Table from https://www.nhlbi.nih.gov/health/health-topics/topics/dash

The DASH diet has also been used for weight loss which helps with controlling hypertension. 

DASH Eating Plan—Number of Food Servings by Calorie Level

Food Group	1,200 Cal.	1,400 Cal.	1,600 Cal.	1,800 Cal.	2,000 Cal.	2,600 Cal.	3,100 Cal.
Grains	4–5	5–6	6	6	6–8	10–11	12–13
Vegetables	3–4	3–4	3–4	4–5	4–5	5–6	6
Fruits	3–4	4	4	4–5	4–5	5–6	6
Fat-free or low-fat dairy products	2–3	2–3	2–3	2–3	2–3	3	3–4
Lean meats, poultry, and fish	3 or less	3–4 or less	3–4 or less	6 or less	6 or less	6 or less	6–9
Nuts, seeds, and legumes	3 per week	3 per week	3–4 per week	4 per week	4–5 per week	1	1
Fats and oils	1	1	2	2–3	2–3	3	4
Sweets and added sugars	3 or less per week	3 or less per week	3 or less per week	5 or less per week	5 or less per week	≤2	≤2
Maximum sodium limit	2,300 mg/day	2,300 mg/day	2,300 mg/day	2,300 mg/day	2,300 mg/day	2,300 mg/day	2,300 mg/day

See the original table for footnotes and more information.

The National Institute of Health (NIH) has many resources that Dietitians and health care providers can use to help promote a healthy eating plan for patients with hypertension or other chronic diseases.  Simply providing   information is generally not enough to change behaviors. Nutrition mis-information is abundant and the patient may be hearing conflicting messages. Sometimes small incremental changes or goals such as 5 fruits and vegetables per day, or don’t add salt at the table can help achieve a positive change.  Understanding that change is difficult for everyone, including Dietitians, is essential when trying to achieve a healthy lifestyle

What resources are you using?

Hypertension Update: Nutritional Guidelines and Strategies please tune into our Webinar on July 22, 11:00 am ET.

 

JF Meschia, C. Bushnell, B Boden-Albala… The new guidelines for the primary prevention of stroke: a statement for healthcare professionals from the american heart association/American stroke association. Stroke. 2013 Jul;44(7):2064-89. doi: 10.1161/STR.0b013e318296aeca. Epub 2013 May 7.

http://www.nhlbi.nih.gov/health/health-topics/topics/dash/followdash

Table from https://www.nhlbi.nih.gov/health/health-topics/topics/dash

 

 

This post was written by Robin Allen, member of OneOp (MFLN) Nutrition and Wellness team which aims to support the development of professionals working with military families.  Find out more about the OneOp Nutrition and Wellness concentration on our website, on Facebook, on Twitter and on LinkedIn.