What is the DASH Diet ?

The DASH Diet

DASH stands for Dietary Approaches to Stop Hypertension is similar to a Mediterranean-type diet ¹. It is an eating plan that is based on research studies sponsored by the National Heart, Lung, and Blood Institute ². The DASH diet eating plan includes vegetables, whole grains, poultry, fish, and nuts, and has low amounts of fats, red meats, sweets, and sugared beverages. It is also high in potassium, calcium and magnesium, as well as protein and fiber. This dietary approach has been shown to lower blood pressure, but little has been published regarding weight loss ¹. In fact, a systematic review and meta-analysis on observational prospective studies on the effects of Dietary Approaches to Stop Hypertension (DASH)-style diet, showed that the DASH diet can significantly protect against cardiovascular diseases, coronary heart disease, stroke, and heart failure risk by 20%, 21%, 19% and 29%, respectively ³, ⁴.

The DASH diet is a lifelong approach to healthy eating that’s designed to help treat or prevent high blood pressure (hypertension). The DASH diet encourages you to reduce the sodium in your diet and eat a variety of foods rich in nutrients that help lower blood pressure, such as potassium, calcium and magnesium and eating foods that are low in saturated fat, total fat, and cholesterol, and high in fruits, vegetables, and low fat dairy foods ⁵.

Blood pressure is usually measured in millimeters of mercury (mmHg) and is recorded as two numbers—systolic pressure (as the heart beats) “over” diastolic pressure (as the heart relaxes between beats)—for example, 120/80 mmHg. Both numbers in a blood pressure test are important, but for people who are age 50
or older, systolic pressure gives the most accurate diagnosis of high blood pressure. Systolic pressure is the top number in a blood pressure reading. It is high if it is 140 mmHg or above ⁶.

High blood pressure is blood pressure higher than 140/90 mmHg and prehypertension is blood pressure between 120/80 and 139/89 mmHg. Prehypertension means that you don’t have high blood pressure now, but are likely to develop it in the future unless you adopt the healthy lifestyle. High blood pressure is dangerous because it makes your heart work too hard, hardens the walls of your arteries, and can cause the brain to hemorrhage or the kidneys to function poorly or not at all. If not controlled, high blood pressure can lead to heart and kidney disease, stroke and blindness.

Being overweight or obese increases your risk of developing high blood pressure. In fact, your blood pressure rises as your body weight increases. Losing even 10 pounds can lower your blood pressure and losing weight has the biggest effect on those who are overweight and already have hypertension. Overweight and obesity are also risk factors for heart disease. And being overweight or obese increases your chances of developing high blood cholesterol and diabetes—two
more risk factors for heart disease.

The original DASH trial ⁷ consisted of 459 subjects with systolic blood pressures <160 mm Hg and diastolic blood pressures between 80 and 95 mm Hg. For three weeks, all participants were fed a control diet low in fruits, vegetables, and dairy products, and with a fat content typical of an American diet (37% of daily caloric intake). During the following eight weeks, the participants were randomized to one of three diets: the control diet, a diet rich in fruits and vegetables, or the DASH Diet.

The DASH Diet was not low in sodium (salt), but still reduced blood pressure. A meta-analysis of 56 randomized, controlled trials that included over 3,500 participants did not support universal sodium restriction, but instead only recommended dietary sodium restriction in the elderly ⁸.

The DASH Diet reduced systolic blood pressure by 5.5 mm Hg and diastolic blood pressure by 3.3 mm Hg, as compared with controls. Subgroup analysis showed that African Americans and those with hypertension had the greatest reduction in blood pressure ⁷ . The DASH diet results might be applied to a larger group due to the heterogeneous population: half of the participants were women, 60% were African American, and 37% had household incomes of <$30,000 per year. One limitation of applying the DASH Diet to the general population is that the study was carried out in a very controlled setting, where all the meals were prepared for the subjects, and thus no comments may be made regarding attrition rates for the diet.

By following the DASH diet, you may be able to reduce your blood pressure by a few points in just two weeks. Over time, your systolic blood pressure could drop by eight to 14 points, which can make a significant difference in your health risks.

Table 1. Daily Nutrient Goals Used in the DASH Studies (for a 2,100 Calorie Eating Plan)

(Source ⁹).

Note: 1,500 mg sodium* was a lower goal tested and found to be even better for  lowering blood pressure. It was particularly effective for middle-aged and older
individuals, African Americans, and those who already had high blood pressure.
g = grams; mg = milligrams

Most Americans should consume no more than 2.4 grams (2,400 milligrams) of sodium a day. That equals 6 grams (about 1 teaspoon) of table salt a day. The 6 grams includes all salt and sodium consumed, including that used in cooking and at the table. African Americans and the elderly, are especially sensitive to salt and sodium and should be particularly careful about how much they consume.

Another DASH diet called DASH-Sodium — calls for cutting back sodium (salt) to 1,500 milligrams a day (about 2/3 teaspoon). Studies of people on the DASH-Sodium plan lowered their blood pressure as well.

To further investigate the effects of sodium restriction, the DASH-Sodium Trial ¹⁰ looked at the effect on blood pressure of a reduced dietary sodium intake as participants followed either the DASH eating plan or an eating plan typical of what many Americans consume. This second study involved 412 participants. Participants were randomly assigned to one of the two eating plans and then followed for a month at each of the three sodium levels. The three sodium levels were a higher intake of about 3,300 milligrams per day (the level consumed by many Americans), an intermediate intake of about 2,300 milligrams per day, and a lower intake of about 1,200 milligrams per day. Results showed that reducing dietary sodium lowered blood pressure for both eating plans. At each sodium level, blood pressure was lower on the DASH eating plan than on the other eating plan. Additionally, there was no significant difference between high (3,300 milligrams per day) and intermediate sodium (2,300 milligrams per day) intake on diastolic blood pressure for those on the DASH Diet. The greatest blood pressure reductions were for the DASH eating plan at the sodium intake of 1,200 milligrams per day. Those with high blood pressure saw the greatest reductions, but those with prehypertension also had large decreases ¹⁰. The DASH Diet can reduce systolic blood pressure by 5.5 mm Hg and diastolic blood pressure by 3.3 mm Hg. However, the effect of sodium reduction on hypertension remains controversial. Lowering sodium to the levels of 1.2 g/day, as achieved in the lowest sodium intake group of the DASH-Sodium Trial, would be nearly impossible without changes in the food industry, as 75% of sodium intake comes from additions made in processing ¹¹.

Detailed analysis showed that the DASH diet and reduced sodium intake reduced blood pressure for all the population subgroups studied. The following list shows the average blood pressure reduction for key subgroups:

• For those with hypertension: 12/6 mm Hg (systolic/diastolic); for those without hypertension, 7/4 mm Hg.
• For those over age 45, 12/6 mm Hg; for those 45 or younger, 6/3 mm Hg.
• For women, 11/5 mm Hg; for men, 7/4 mm Hg.
• For African Americans, 10/5 mm Hg; for non-African Americans, 8/4 mm Hg.

Other results include:

• Compared with the typical American diet, the DASH diet alone (at the higher sodium level) reduced blood pressure by about 6/3 mm Hg for African Americans, and 6/2 mm Hg for other races.
• For those with hypertension, reductions from the DASH diet alone were 7/3 mm Hg; and for those without hypertension, the reductions were 5/3 mm Hg. The effects of sodium reduction appeared in all subgroups and were greater for those who ate the typical American diet, compared with those on the DASH diet.
• The effects from sodium reduction were particularly great for those with hypertension, African Americans, women, and those over age 45. Sodium reduction in those eating the control diet resulted in lower systolic and diastolic pressures by 8.3 mm Hg and 4.4 mm Hg, respectively, in hypertensives, and 5.4 and 2.8 mm Hg, respectively, in non-hypertensives.

“The blood pressure reductions achieved from this combination came in only 4 weeks and persisted through the duration of the study”, said Dr. Denise Simons-Morton, Leader of the NHLBI Prevention Scientific Research Group and a DASH coauthor ¹².

Both versions of the DASH diet include lots of whole grains, fruits, vegetables and low-fat dairy products. The DASH diet also includes some fish, poultry and legumes, and encourages a small amount of nuts and seeds a few times a week.

The DASH diet generally includes about 2,000 calories a day. If you’re trying to lose weight, you may need to eat fewer calories. You may also need to adjust your serving goals based on your individual circumstances — something your health care team can help you decide.

Studies showed that DASH lowers high blood pressure and improves levels of cholesterol. This reduces your risk of getting heart disease.

Because the DASH diet is a healthy way of eating, it offers health benefits besides just lowering blood pressure. The DASH diet is also in line with dietary recommendations to prevent osteoporosis, cancer, heart disease, stroke and diabetes.

While the DASH diet is not a weight-loss program, you may indeed lose unwanted pounds because it can help guide you toward healthier food choices. A recent study showed that people can lose weight while following the DASH eating plan and lowering their sodium intake. In a randomized trial of 810 participants called the PREMIER Study ¹³, ¹⁴, who were placed into three groups to lower blood pressure, lose weight, and improve health. The groups included:

1. Advice-only group received a 30-minute individual session with a nutritionist, which did not include counseling on how to make behavior changes.
2. Established treatment plan, including counseling for 6 months to keep track of their diet, including calorie and sodium consumption, and their physical activity.
3. Established treatment plan, plus counseling and use of the DASH diet.

After 6 months, blood pressure levels declined in all three groups. The two groups that received counseling and followed a treatment plan had more weight loss than the advice-only group. However, participants in the established treatment plan who followed the DASH diet had the greatest improvement in their blood pressure ¹³, ¹⁴.

By paying close attention to food labels when you shop, you can consume less sodium. Sodium is found naturally in many foods. But processed foods account for most of the salt and sodium that Americans consume. Processed foods that are high in salt include regular canned vegetables and soups, frozen dinners, lunch meats, instant and ready-to-eat cereals, and salty chips and other snacks.

You can eat red meat, sweets and fats in small amounts. The DASH diet is low in saturated fat, cholesterol and total fat.

Because the DASH diet is a healthy way of eating, it offers health benefits besides just lowering blood pressure. The DASH diet is also in line with dietary recommendations to prevent osteoporosis, cancer, heart disease, stroke and diabetes.

Health Benefits of DASH Diet

• Following the DASH diet will provide all the nutrients you need.
• It is safe for both adults and children.
• The diet is flexible enough to follow if you are vegetarian, vegan, or gluten-free.
• It is low in fat and high in fiber, an eating style that is recommended for everyone.

The DASH diet sets the standard for a healthy diet. It has been widely studied and has many health benefits. Following this diet plan may help:

• Lower high blood pressure ¹⁵
• Reduce the risk for heart disease, heart failure, and stroke ³, ⁴
• Help prevent or control type 2 diabetes ¹⁶
• Improve cholesterol levels
• Reduce the chance of kidney stones

Can the DASH diet promote Weight Loss ?

The DASH eating plan was not designed to promote weight loss. But it is rich in low-calorie foods such as fruits and vegetables. Therefore, the DASH diet eating plan can be used to help you lose weight. To lose weight, follow the DASH diet eating plan and try to reduce your total daily calories gradually. Find out your daily calorie needs or goals use these free and useful online tools and apps:

• To find out about your body mass index (BMI), you can use a FREE online BMI calculators from the Centers for Disease Control and Prevention (CDC) – for Adults ¹⁷ and for Children ¹⁸

BMI Calculator Adults. https://www.cdc.gov/healthyweight/assessing/bmi/adult_BMI/english_bmi_calculator/bmi_calculator.html

BMI Calculator Children. https://nccd.cdc.gov/dnpabmi/Calculator.aspx

• To find out about how many calories you should eat to lose weight according to your weight, age, sex, height and physical activity, you can use a FREE online app Body Weight Planner ¹⁹

Body Weight Planner. https://www.supertracker.usda.gov/bwp/index.html

• To find out about the 5 Food Groups you should have on your plate for a meal, you can use a FREE online app ChooseMyPlate ²⁰

ChooseMyPlate. https://www.choosemyplate.gov/

• To find out What and How Much To Eat, you can use a FREE, award-winning, state-of-the-art, online diet and activity tracking tool called SuperTracker ²¹ from the United States Department of Agriculture Center for Nutrition Policy and Promotion ²¹. This free application empowers you to build a healthier diet, manage weight, and reduce your risk of chronic diet-related diseases. You can use SuperTracker ²¹ to determine what and how much to eat; track foods, physical activities, and weight; and personalize with goal setting, virtual coaching, and journaling.

SuperTracker website: https://supertracker.usda.gov

You can make your meals lower in calories by replacing high-calorie foods with more fruits and vegetables and that also will make it easier for you to reach your DASH eating plan goals.

What Foods To Eat

• Fruits
• Vegetables
• Whole-grains
• Low-fat dairy products
• Skinless poultry and fish
• Nuts and legumes
• Non-tropical vegetable oils

What Foods to Reduce or Avoid

• Saturated and trans fats
• Sodium (salt)
• Red meat (if you do eat red meat, compare labels and select the leanest cuts available)
• Sweets and sugar-sweetened beverages
• Alcohol and caffeine
• Processed foods, which are often high in fat, salt, and sugar

Drinking too much alcohol can increase blood pressure. It also can harm the liver, brain, and heart. Alcoholic drinks also contain calories, which matters if you are trying to lose weight. The Dietary Guidelines for Americans recommends that men limit alcohol to no more than two drinks a day and women to one or less.

The DASH diet doesn’t address caffeine consumption. The influence of caffeine on blood pressure remains unclear. But caffeine can cause your blood pressure to rise at least temporarily. If you already have high blood pressure or if you think caffeine is affecting your blood pressure, talk to your doctor about your caffeine consumption.

The DASH Diet

• 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. The American Heart Association recommends 1,500 mg a day of sodium as an upper limit for all adults.

One teaspoon of table salt has 2,325 mg of sodium. When you read food labels, you may be surprised at just how much sodium some processed foods contain. Even low-fat soups, canned vegetables, ready-to-eat cereals and sliced turkey from the local deli — foods you may have considered healthy — often have lots of sodium

Along with DASH, other lifestyle changes can help lower your blood pressure. They include staying at a healthy weight, exercising, and not smoking.

The Role of Exercise

DASH diet recommends at least 30 minutes of exercise a day, most days of the week. Do exercises that get your heart pumping. To help prevent weight gain, exercise for 60 minutes a day. Exercise helps you lose weight and weight loss can help lower blood pressure ²².

Dash Diet Guidelines

DASH Diet is a flexible and balanced eating plan that helps you create a heart-healthy eating style for life.

The DASH diet eating plan requires no special foods and has no hard-to-follow recipes. It simply calls for a certain number of daily servings from various food groups to provide your daily and weekly nutritional goals. This plan recommends:

• Eating vegetables, fruits, and whole grains
• Including fat-free or low-fat dairy products, fish, poultry, beans, nuts, and vegetable oils
• Increase potassium intake
• Limiting foods that are high in saturated fat, such as fatty meats, full-fat dairy products, and tropical oils such as coconut, palm kernel and palm oils
• Limiting sugar-sweetened beverages and sweets.

The number of servings depends on the number of calories you’re allowed each day. Your calorie level depends on your age, sex, the amount of lean body mass (muscular, athletic, average or overweight), height and, especially, how active you are. Think of this as an energy balance system—if you want to maintain your current weight, you should take in only as many calories as you burn by being physically active. If you need to lose weight, eat fewer calories than you burn or increase your activity level to burn more calories than you eat.

What is your physical activity level ? Are you mostly:

• Sedentary: You do only light physical activity that is part of your typical day-to-day routine.
• Moderately active: You do physical activity equal to walking about 1 to 3 miles a day at 3 to 4 miles per hour, plus light physical activity.
• Active: You do physical activity equal to walking more than 3 miles per day at 3 to 4 miles per hour, plus light physical activity.

Use the Tables ²³ below to estimate your daily calorie needs. „

Table 2. Estimated Calorie Needs per Day, by Age, Sex, and Physical Activity Level

Daily Calorie Needs for Women

Daily Calorie Needs for Men

Notes:

Within each age and sex category, the low end of the range is for sedentary individuals; the high end of the range is for active individuals. Due to reductions in basal metabolic rate (resting energy requirement) that occur with aging, calorie needs generally decrease for adults as they age.

Estimates for females do not include women who are pregnant or breastfeeding.

These are only estimates, and approximations of individual calorie needs can be aided with online tools such as those available at www.supertracker.usda.gov ²⁴. To find out What and How Much To Eat, you can use a FREE, award-winning, state-of-the-art, online diet and activity tracking tool called SuperTracker ²¹ from the United States Department of Agriculture Center for Nutrition Policy and Promotion ²¹. This free application empowers you to build a healthier diet, manage weight, and reduce your risk of chronic diet-related diseases. You can use SuperTracker ²¹ to determine what and how much to eat; track foods, physical activities, and weight; and personalize with goal setting, virtual coaching, and journaling.

After figuring out your daily calorie needs, go to the table below and find the closest calorie level to yours. The tables below estimates the number of servings from each food group that you should have. Serving quantities are per day, unless otherwise noted.

Table 3. DASH Diet Eating Plan—Number of Food Servings by Calorie Level

^a Whole grains are recommended for most grain servings as a good source of fiber and nutrients.

^b For lactose intolerance, try either lactase enzyme pills with dairy products or lactose-free or lactose-reduced milk.

^c Fat content changes the serving amount for fats and oils. For example, 1 Tbsp regular salad dressing = one serving; 1 Tbsp low-fat dressing = one-half serving; 1 Tbsp fat-free dressing = zero servings.

^d The DASH diet eating plan has a salt (sodium) limit of either 2,300 mg or 1,500 mg per day. 1,500 milligrams (mg) sodium lowers blood pressure even further than 2,300 mg sodium daily.

Table 6. Daily and Weekly DASH Diet Eating Plan Goals for a 2,000-Calorie-a-Day Diet

* Whole grains are recommended for most grain servings as a good source of fiber and nutrients.

** Serving sizes vary between 1/2 cup and 11/4 cups, depending on cereal type. Check the product’s Nutrition Facts label.

*** Since eggs are high in cholesterol, limit egg yolk intake to no more than four per week; two egg whites have the same protein content as 1 oz of meat.

**** Fat content changes serving amount for fats and oils. For example, 1 Tbsp of regular salad dressing equals one serving; 1 Tbsp of a low-fat dressing equals one-half serving; 1 Tbsp of a fat-free dressing equals zero servings.

(Source ²⁶).

When following the DASH diet eating plan, it is important to choose foods that are:

• Low in saturated and trans fats
• Rich in potassium, calcium, magnesium, fiber, and protein
• Lower in sodium

Table 7. DASH Diet Eating Plan—Number of Daily Servings for Other Calorie Levels

* Whole grains are recommended for most grain servings as a good source of fiber and nutrients.

(Source ²⁶).

Dash Diet Eating Plan

To benefit from the DASH diet eating plan, it is important to consume the appropriate amount of calories to maintain a healthy weight.

The DASH diet eating plan can be used to help you lose weight. To lose weight, follow the DASH eating plan and try to reduce your total daily calories gradually. Find out your daily calorie needs or goals with the Body Weight Planner and calorie chart. Talk with your doctor before beginning any diet or eating plan.

General tips for reducing daily calories include:

• Eat smaller portions more frequently throughout the day.
• Reduce the amount of meat that you eat while increasing the amount of fruits, vegetables, whole grains, or dry beans.
• Substitute low-calorie foods, such as when snacking (choose fruits or vegetables instead of sweets and desserts) or drinking (choose water instead of soda or juice), when possible.

Tips for Following DASH Diet

It’s easy to follow the DASH diet. But it might mean making some changes to how you currently eat. To get started:

• DO NOT try to make changes all at once. It’s fine to change your eating habits gradually.
• To add vegetables to your diet, try having a salad at lunch. Or, add cucumber, lettuce, shredded carrots, or tomatoes to your sandwiches.
• There should always been something green on your plate. It’s fine to use frozen vegetables instead of fresh. Just make sure the package does not contain added salt or fat.
• Add sliced fruit to your cereal or oatmeal for breakfast.
• For dessert, choose fresh fruit or low-fat frozen yogurt instead of high-calorie sweets, such as cakes or pies.
• Choose healthy snacks, such as unsalted rice cakes or popcorn, raw vegetables, or yogurt. Dried fruits, seeds, and nuts also make great snack choices. Just keep these portions small.
• Choose whole grain foods for most grain servings to get added nutrients, such as minerals and fiber. For example, choose whole wheat bread or whole grain cereals.
• Think of meat as part of your meal, instead of the main course. Limit your servings of lean meat to 6 ounces (170 grams) a day. You can have two 3-ounce (85 grams) servings during the day. If you now eat large portions of meats, cut them back gradually by a half or a third at each meal.
• Try these snacks ideas: unsalted rice cakes; nuts mixed with raisins; graham crackers; fat-free and low-fat yogurt and frozen yogurt; popcorn with no salt or butter added; raw vegetables.
• Try cooking without meat at least twice each week. Instead, eat beans, nuts, tofu, or eggs for your protein.
• If you are allergic to nuts, use seeds or legumes (cooked dried beans or peas).

Here’s a look at the recommended servings from each food group for the 2,000-calorie-a-day DASH diet plan.

A) Grains: 6 to 8 servings a day (Note: A standard grain (cereal) serve is about 500kJ).

Grains include bread, cereal, rice and pasta. Examples of one serving of grains include 1 slice whole-wheat bread, 1 ounce dry cereal, or 1/2 cup cooked cereal, rice or pasta.

Grains are naturally low in fat. Keep them this way by avoiding butter, cream and cheese sauces.

Focus on whole grains because they have more fiber and nutrients than do refined grains. For instance, use brown rice instead of white rice, whole-wheat pasta instead of regular pasta and whole-grain bread instead of white bread. Look for products labeled “100 percent whole grain” or “100 percent whole wheat.”

B) Vegetables: 4 to 5 servings a day (Note: A standard vegetable serve is about 75g (100–350kJ)).

Tomatoes, carrots, broccoli, sweet potatoes, greens and other vegetables are full of fiber, vitamins, and such minerals as potassium and magnesium. Examples of one serving include 1 cup raw leafy green vegetables or 1/2 cup cut-up raw or cooked vegetables.

Don’t think of vegetables only as side dishes — a hearty blend of vegetables served over brown rice or whole-wheat noodles can serve as the main dish for a meal.

Fresh and frozen vegetables are both good choices. When buying frozen and canned vegetables, choose those labeled as low sodium or without added salt.

To increase the number of servings you fit in daily, be creative. In a stir-fry, for instance, cut the amount of meat in half and double up on the vegetables.

C) Fruits: 4 to 5 servings a day (Note: A standard fruit serve is about 150g (350kJ)).

Many fruits need little preparation to become a healthy part of a meal or snack. Like vegetables, they’re packed with fiber, potassium and magnesium and are typically low in fat — coconuts are an exception. Examples of one serving include one medium fruit, 1/2 cup fresh, frozen or canned fruit, or 4 ounces of juice.

Have a piece of fruit with meals and one as a snack, then round out your day with a dessert of fresh fruits topped with a dollop of low-fat yogurt. Leave on edible peels whenever possible. The peels of apples, pears and most fruits with pits add interesting texture to recipes and contain healthy nutrients and fiber.

Many fruits need little preparation to become a healthy part of a meal or snack. Like vegetables, they’re packed with fiber, potassium and magnesium and are typically low in fat — coconuts are an exception. Examples of one serving include one medium fruit, 1/2 cup fresh, frozen or canned fruit, or 4 ounces of juice.

If you choose canned fruit or juice, make sure no sugar is added.

Leave on edible peels whenever possible. The peels of apples, pears and most fruits with pits add interesting texture to recipes and contain healthy nutrients and fiber.

Remember that citrus fruits and juices, such as grapefruit, can interact with certain medications, so check with your doctor or pharmacist to see if they’re OK for you.

D) Dairy: 2 to 3 servings a day (Note: A standard dairy serve is about 500-600kJ).

Milk, yogurt, cheese and other dairy products are major sources of calcium, vitamin D and protein. But the key is to make sure that you choose dairy products that are low fat or fat-free because otherwise they can be a major source of fat and most of it is saturated. Examples of one serving include 1 cup skim or 1 percent milk, 1 cup low fat yogurt, or 1 1/2 ounces part-skim cheese.

Low-fat or fat-free frozen yogurt can help you boost the amount of dairy products you eat while offering a sweet treat. Add fruit for a healthy twist. If you have trouble digesting dairy products, choose lactose-free products or consider taking an over-the-counter product that contains the enzyme lactase, which can reduce or prevent the symptoms of lactose intolerance.

Go easy on regular and even fat-free cheeses because they are typically high in sodium.

E) Lean meat, poultry and fish: 6 servings or fewer a day (Note: A standard lean meat, poultry and fish serve is about 500-600kJ).

Meat can be a rich source of protein, B vitamins, iron and zinc. Choose lean varieties and aim for no more than 6 ounces a day. Cutting back on your meat portion will allow room for more vegetables.

Trim away skin and fat from poultry and meat and then bake, broil, grill or roast instead of frying in fat.
Eat heart-healthy fish, such as salmon, herring and tuna. These types of fish are high in omega-3 fatty acids, which can help lower your total cholesterol.

F) Nuts, seeds and legumes: 4 to 5 servings a week

Almonds, sunflower seeds, kidney beans, peas, lentils and other foods in this family are good sources of magnesium, potassium and protein. They’re also full of fiber and phytochemicals, which are plant compounds that may protect against some cancers and cardiovascular disease.

Serving sizes are small and are intended to be consumed only a few times a week because these foods are high in calories. Examples of one serving include 1/3 cup nuts, 2 tablespoons seeds, or 1/2 cup cooked beans or peas.

Nuts sometimes get a bad rap because of their fat content, but they contain healthy types of fat — monounsaturated fat and omega-3 fatty acids. They’re high in calories, however, so eat them in moderation. Try adding them to stir-fries, salads or cereals.
Soybean-based products, such as tofu and tempeh, can be a good alternative to meat because they contain all of the amino acids your body needs to make a complete protein, just like meat.

G) Fats and oils: 2 to 3 servings a day

Fat helps your body absorb essential vitamins and helps your body’s immune system. But too much fat increases your risk of heart disease, diabetes and obesity. The DASH diet strives for a healthy balance by limiting total fat to less than 30 percent of daily calories from fat, with a focus on the healthier monounsaturated fats.

Examples of one serving include 1 teaspoon soft margarine, 1 tablespoon mayonnaise or 2 tablespoons salad dressing.

Saturated fat and trans fat are the main dietary culprits in increasing your risk of coronary artery disease. DASH helps keep your daily saturated fat to less than 6 percent of your total calories by limiting use of meat, butter, cheese, whole milk, cream and eggs in your diet, along with foods made from lard, solid shortenings, and palm and coconut oils.

Avoid trans fat, commonly found in such processed foods as crackers, baked goods and fried items.
Read food labels on margarine and salad dressing so that you can choose those that are lowest in saturated fat and free of trans fat.

H) Sweets: 5 servings or fewer a week

You don’t have to banish sweets entirely while following the DASH diet — just go easy on them. Examples of one serving include 1 tablespoon sugar, jelly or jam, 1/2 cup sorbet, or 1 cup lemonade.

When you eat sweets, choose those that are fat-free or low-fat, such as sorbets, fruit ices, jelly beans, hard candy, graham crackers or low-fat cookies.

Artificial sweeteners such as aspartame (NutraSweet, Equal) and sucralose (Splenda) may help satisfy your sweet tooth while sparing the sugar. But remember that you still must use them sensibly. It’s OK to swap a diet cola for a regular cola, but not in place of a more nutritious beverage such as low-fat milk or even plain water.
Cut back on added sugar, which has no nutritional value but can pack on calories.

DASH diet: Alcohol and caffeine

Drinking too much alcohol can increase blood pressure. The Dietary Guidelines for Americans recommends that men limit alcohol to no more than two drinks a day and women to one or less.

The DASH diet doesn’t address caffeine consumption. The influence of caffeine on blood pressure remains unclear. But caffeine can cause your blood pressure to rise at least temporarily. If you already have high blood pressure or if you think caffeine is affecting your blood pressure, talk to your doctor about your caffeine consumption.

Your Guide to Lowering Your Blood Pressure and Weight Loss With DASH Diet— A Week With the DASH Eating Plan

Here is a week of menus from the DASH eating plan. The menus allow you to have a daily sodium level of either 2,300 mg or, by making the noted changes, 1,500 mg. You’ll also find that the menus sometimes call for you to use lower sodium, low-fat, fat-free, or reduced fat versions of products.

The menus are based on 2,000 calories a day—serving sizes should be increased or decreased for other calorie levels. To ease the calculations, some of the serving sizes have been rounded off. Also, some items may be in too small a quantity to have a listed food group serving. Recipes for starred items are given on the later pages. Some of these recipes give changes that can be used to lower their sodium level. Use the changes if you want to follow the DASH eating plan at 1,500 milligrams of sodium per day.

Abbreviations:
oz = ounce
tsp = teaspoon
Tbsp = tablespoon
g = gram
mg = milligram

Table 8. A Week With the DASH Eating Plan

(Source ²⁷).

Summary

The DASH diet eating plan is just one key part of a heart-healthy lifestyle, and combining it with other lifestyle changes such as physical activity can help you control your blood pressure and LDL-cholesterol for life.

To help prevent and control high blood pressure:

• Be physically active.
• Maintain a healthy weight.
• Limit alcohol intake.
• Manage and cope with stress.

Other lifestyle changes can improve your overall health, such as:

• If you smoke, quit.
• Get plenty of sleep (7-9 hours/day).

To help make lifelong lifestyle changes, try making one change at a time and add another when you feel that you have successfully adopted the earlier changes. When you practice several healthy lifestyle habits, you are more likely to achieve and maintain healthy blood pressure, healthy body weight and cholesterol levels.

1. Journal of the American College of Cardiology Volume 45, Issue 9, 3 May 2005, Pages 1379-1387. Diets and Cardiovascular Disease: An Evidence-Based Assessment. http://www.sciencedirect.com/science/article/pii/S0735109705003670[↩][↩]
2. National Institutes of Health. National Heart, Blood and Lung Institute. Description of the DASH Eating Plan. https://www.nhlbi.nih.gov/health/health-topics/topics/dash[↩]
3. Salehi-Abargouei A, Maghsoudi Z, Shirani F, Azadbakht L. Nutrition. 2013 Apr;29(4):611-8. doi: 10.1016/j.nut.2012.12.018. Effects of Dietary Approaches to Stop Hypertension (DASH)-style diet on fatal or nonfatal cardiovascular diseases–incidence: a systematic review and meta-analysis on observational prospective studies. http://www.nutritionjrnl.com/article/S0899-9007(13)00007-5/fulltext[↩][↩]
4. Fung TT, Chiuve SE, McCullough ML, Rexrode KM, Logroscino G, Hu FB. Adherence to a DASH-style diet and risk of coronary heart disease and stroke in women. Arch Intern Med. 2008 Apr 14;168(7):713-20. PMID: 18413553. http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/414155[↩][↩]
5. National Institutes of Health. National Heart, Blood and Lung Institute. Your Guide To Lowering Your Blood Pressure With DASH. https://www.nhlbi.nih.gov/files/docs/public/heart/dash_brief.pdf[↩]
6. National Institutes of Health. National Heart, Blood and Lung Institute. Your Guide to Lowering Blood Pressure. https://www.nhlbi.nih.gov/files/docs/public/heart/hbp_low.pdf[↩]
7. L.J. Appel, T.J. Moore, E. Obarzenek, et al.A clinical trial of the effects of dietary patterns on blood pressure. N Engl J Med, 336 (1997), pp. 1117-1124[↩][↩]
8. J.P. Midgley, A.G. Matthew, C.M. Greenwood, A.G. Logan. Effect of reduced dietary sodium on blood pressure: a meta-analysis of randomized controlled trials. JAMA, 275 (1996), pp. 1590-1597[↩]
9. National Institutes of Health. National Heart, Blood and Lung Institute. Your Guide to Lowering Blood Pressure with DASH. https://www.nhlbi.nih.gov/files/docs/public/heart/new_dash.pdf[↩]
10. F.M. Sacks, L.P. Svetkey, W.M. Vollmer, et al.Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) DietN Engl J Med, 344 (2001), pp. 3-10[↩][↩]
11. P.K. Whelton, J. He, L.J. Appel, et al.Primary prevention of hypertension: clinical and public health advisory from the National High Blood Pressure ProgramJAMA, 288 (2002), pp. 1882-1888[↩]
12. National Institutes of Health. National Heart, Blood and Lung Institute. NHLBI Study Finds DASH Diet And Reduced Sodium Lowers Blood Pressure For All. https://www.nhlbi.nih.gov/news/press-releases/2001/nhlbi-study-finds-dash-diet-and-reduced-sodium-lowers-blood-pressure-for-all[↩]
13. National Institutes of Health. National Heart, Lung and Blood Institute. PREMIER Study. https://www.nhlbi.nih.gov/research/resources/obesity/completed/premier.htm[↩][↩]
14. Appel LJ, Champagne CM, Harsha DW, et al. Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER clinical trial. JAMA 2003;289:2083-93. [↩][↩]
15. Blumenthal JA, Babyak MA, Hinderliter A, Watkins LL, Craighead L, Lin PH, Caccia C, Johnson J, Waugh R, Sherwood A. 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. PMID: 20101007. https://www.ncbi.nlm.nih.gov/pubmed/20101007[↩]
16. de Koning L, Chiuve SE, Fung TT, Willett WC, Rimm EB, Hu FB. Diet-quality scores and the risk of type 2 diabetes in men. Diabetes Care. 2011 May;34(5):1150-6. PMID: 21464460. https://www.ncbi.nlm.nih.gov/pubmed/21464460[↩]
17. BMI Calculator Adults. https://www.cdc.gov/healthyweight/assessing/bmi/adult_BMI/english_bmi_calculator/bmi_calculator.html[↩]
18. BMI Calculator Children. https://nccd.cdc.gov/dnpabmi/Calculator.aspx[↩]
19. Body Weight Planner. https://www.supertracker.usda.gov/bwp/index.html[↩]
20. ChooseMyPlate. https://www.choosemyplate.gov/[↩]
21. https://supertracker.usda.gov/[↩][↩][↩][↩][↩][↩]
22. U.S. National Library of Medicine. Medline Plus. Understanding the DASH diet. https://medlineplus.gov/ency/patientinstructions/000784.htm[↩]
23. National Institutes of Health. National Heart, Blood and Lung Institute. Following the DASH Eating Plan. https://www.nhlbi.nih.gov/health/health-topics/topics/dash/followdash[↩]
24. SuperTracker: https://www.supertracker.usda.gov/[↩]
25. National Institutes of Health. National Heart, Blood and Lung Institute. Your Guide to Lowering Your Blood Pressure With DASH. https://www.nhlbi.nih.gov/health/resources/heart/hbp-dash-how-to[↩]
26. National Institutes of Health. National Heart, Lung and Blood Institute. Your Guide to Lowering Your Blood Pressure With DASH. https://www.nhlbi.nih.gov/health/resources/heart/hbp-dash-how-to[↩][↩]
27. National Institutes of Health. National Heart, Lung and Blood Institute. Your Guide to Lowering Your Blood Pressure With DASH — A Week With the DASH Eating Plan. https://www.nhlbi.nih.gov/health/resources/heart/hbp-dash-week-dash-html[↩]