What is an enlarged heart

An enlarged heart (cardiomegaly) isn’t a disease, but rather a sign of another condition.

The term “cardiomegaly” refers to an enlarged heart seen on any imaging test, including a chest X-ray. Other tests are then needed to diagnose the condition causing your enlarged heart.

You may develop an enlarged heart temporarily because of a stress on your body, such as pregnancy, or because of a medical condition, such as the weakening of the heart muscle, coronary artery disease, heart valve problems or abnormal heart rhythms.

Certain conditions may cause the heart muscle to thicken or one of the chambers of the heart to dilate, making the heart larger. Depending on the condition, an enlarged heart may be temporary or permanent.

An enlarged heart may be treatable by correcting the cause. Treatment for an enlarged heart can include medications, medical procedures or surgery.

Human heart

For blood to reach body cells and exchange materials with them, it must be pumped continuously by the heart through the body’s blood vessels. Your heart beats about 100,000 times every day, which adds up to about 35 million beats in a year, and approximately 2.5 billion times in an average lifetime.

The heart has two sides, separated by an inner wall called the septum. The right side of the heart pumps blood to the lungs to pick up oxygen. The left side of the heart receives the oxygen-rich blood from the lungs and pumps it to the body.

Your body depends on the heart’s pumping action to deliver oxygen- and nutrient-rich blood to the body’s cells. When the cells are nourished properly, the body can function normally. Just like an engine makes a car go, the heart keeps your body running. The heart has two pumps. The stronger pump (left side of the heart) uses arteries to send blood with oxygen away from the heart, throughout the body. The other pump (right side of the heart) uses veins to bring blood back to the heart and sends it to the lungs to get more oxygen. An electrical system in the heart controls the heart’s pumps (the heart beat or pulse).

How the Heart Works

Your heart is a muscular double pump about the size of the palm of your hand with two functions (see Figure 1):

1. Right side of the heart receives oxygen-poor blood from the body tissues and then pumps this blood to the lungs to pick up oxygen and dispel carbon dioxide. The blood vessels that carry blood to and from the lungs form the pulmonary circuit (pulmonos = lung). The right side of the heart pumps blood through the lungs, enabling blood to pick up oxygen and unload carbon dioxide. Even while you are sleeping, your heart pumps 30 times its own weight each minute, which amounts to about 5 liters (5.3 qt) to the lungs and the same volume to the rest of the body. At this rate, your heart pumps more than about 14,000 liters (3600 gal) of blood in a day, or 5 million liters (1.3 million gal) in a year. You don’t spend all of your time sleeping, however, and your heart pumps more vigorously when you are active. Thus, the actual blood volume your heart pumps in a single day is much larger.
2. Left side of the heart receives the oxygenated blood returning from the lungs and pumps this blood throughout the body to supply oxygen and nutrients to the body tissues. The blood vessels that transport blood to and from all body tissues and back to the heart form the systemic circuit. The left side of the heart pumps blood through an estimated 100,000 km (60,000 mi) of blood vessels, which is equivalent to traveling around the earth’s equator about three times.

The heart has four chambers ¹⁾, two on the right and two on the left:

• Two upper chambers are called atrium (two is called an atria). The atria collect blood as it flows into the heart.
• Two lower chambers are called ventricles. The ventricles pump blood out of the heart to the lungs or other parts of the body.

The heart also has four valves that open and close to let blood flow from the atria to the ventricles and from the ventricles into the two large arteries connected to the heart in only one direction when the heart contracts (beats). The four heart valves are:

• Tricuspid valve, located between the right atrium and right ventricle
• Pulmonary or pulmonic valve, between the right ventricle and the pulmonary artery. This artery carries blood from the heart to the lungs.
• Mitral valve, between the left atrium and left ventricle
• Aortic valve, between the left ventricle and the aorta. This aorta carries blood from the heart to the body.

Each valve has a set of flaps (also called leaflets or cusps). The mitral valve has two flaps; the others have three. Valves are like doors that open and close. They open to allow blood to flow through to the next chamber or to one of the arteries. Then they shut to keep blood from flowing backward. Blood flow occurs only when there’s a difference in pressure across the valves, which causes them to open. Under normal conditions, the valves permit blood to flow in only one direction.

The heart four chambers and four valves and is connected to various blood vessels. Veins are blood vessels that carry blood from the body to the heart. Arteries are blood vessels that carry blood away from the heart to the body.

The heart pumps blood to the lungs and to all the body’s tissues by a sequence of highly organized contractions of the four chambers. For the heart to function properly, the four chambers must beat in an organized way.

When the heart’s valves open and close, they make a “lub-DUB” sound that a doctor can hear using a stethoscope ²⁾.

• The first sound—the “lub”—is made by the mitral and tricuspid valves closing at the beginning of systole. Systole is when the ventricles contract, or squeeze, and pump blood out of the heart.
• The second sound—the “DUB”—is made by the aortic and pulmonary valves closing at the beginning of diastole. Diastole is when the ventricles relax and fill with blood pumped into them by the atria.

Figure 1.Heart function – double pump

Figure 2. The anatomy of the heart

Figure 3. The anatomy of the heart chambers

Figure 4.  Normal heart blood flow

Enlarged heart complications

The risk of complications from an enlarged heart depends on the part of the heart that is enlarged and the cause.

Complications of an enlarged heart can include:

• Heart failure. One of the most serious types of enlarged heart, an enlarged left ventricle increases the risk of heart failure. In heart failure, your heart muscle weakens, and the ventricles stretch (dilate) to the point that the heart can’t pump blood efficiently throughout your body. This results in fatigue and shortness of breath and some people have coughing. Everyday activities such as walking, climbing stairs or carrying groceries can become very difficult.
• Blood clots. Having an enlarged heart may make you more susceptible to forming blood clots in the lining of your heart. If clots enter your bloodstream, they can block blood flow to vital organs, even causing a heart attack or stroke. Clots that develop on the right side of your heart may travel to your lungs, a dangerous condition called a pulmonary embolism.
• Heart murmur. For people who have an enlarged heart, two of the heart’s four valves — the mitral and tricuspid valves — may not close properly because they become dilated, leading to a backflow of blood. This flow creates sounds called heart murmurs. Although not necessarily harmful, heart murmurs should be monitored by your doctor.
• Cardiac arrest and sudden death. Some forms of an enlarged heart can lead to disruptions in your heart’s beating rhythm. Heart rhythms too slow to move blood or too fast to allow the heart to beat properly can result in fainting or, in some cases, cardiac arrest or sudden death.

What causes an enlarged heart

An enlarged heart can be caused by conditions that cause your heart to pump harder than usual or that damage your heart muscle. Sometimes the heart enlarges and becomes weak for unknown reasons (idiopathic).

A heart condition you’re born with (congenital), damage from a heart attack or an abnormal heartbeat (arrhythmia) can cause your heart to enlarge. Other conditions associated with an enlarged heart include:

• High blood pressure. Your heart may have to pump harder to deliver blood to the rest of your body, enlarging and thickening the muscle. High blood pressure can cause the left ventricle to enlarge, causing the heart muscle eventually to weaken. High blood pressure may also enlarge the upper chambers of your heart (atria).
• Heart valve disease. Four valves in your heart keep blood flowing in the right direction. If the valves are damaged by conditions such as rheumatic fever, a heart defect, infections (infectious endocarditis), connective tissue disorders, certain medications or radiation treatments for cancer, your heart may enlarge.
• Disease of the heart muscle (cardiomyopathy). As this thickening and stiffening of heart muscle progresses, your heart may enlarge to try to pump more blood to your body.
• High blood pressure in the artery connecting your heart and lungs (pulmonary hypertension). Your heart may need to pump harder to move blood between your lungs and your heart. As a result, the right side of your heart may enlarge.
• Fluid around your heart (pericardial effusion). Accumulation of fluid in the sac (pericardium) that contains your heart may cause your heart to appear enlarged on a chest X-ray.
• Low red blood cell count (anemia). Anemia is a condition in which there aren’t enough healthy red blood cells to carry adequate oxygen to your tissues. Untreated, chronic anemia can lead to a rapid or irregular heartbeat. Your heart must pump more blood to make up for the lack of oxygen in the blood.
• Thyroid disorders. Both an underactive thyroid gland (hypothyroidism) and an overactive thyroid gland (hyperthyroidism) can lead to heart problems, including an enlarged heart.
• Excessive iron in the body (hemochromatosis). Hemochromatosis is a disorder in which your body doesn’t properly metabolize iron, causing it to build up in various organs, including your heart. This can cause an enlarged left ventricle due to weakening of the heart muscle.
• Rare diseases that can affect your heart, such as amyloidosis. Amyloidosis is a condition in which abnormal proteins circulate in the blood and may be deposited in the heart, interfering with your heart’s function and causing it to enlarge.

Risk factors for developing an enlarged heart

You may have a greater risk of developing an enlarged heart if you have any of the following risk factors:

• High blood pressure. Having a blood pressure measurement higher than 140/90 millimeters of mercury puts you at an increased risk of developing an enlarged heart.
• A family history of enlarged hearts or cardiomyopathy. If an immediate family member, such as a parent or sibling, has had an enlarged heart, you may be more susceptible to developing the condition.
• Blocked arteries in your heart (coronary artery disease). With this condition, fatty plaques in your heart arteries obstruct blood flow through your heart vessels, which can lead to a heart attack. When a section of heart muscle dies, your heart has to pump harder to get adequate blood to the rest of your body, causing it to enlarge.
• Congenital heart disease. If you’re born with a condition that affects the structure of your heart, you may be at risk of developing an enlarged heart.
• Heart valve disease. The heart has four valves — aortic, mitral, pulmonary and tricuspid — that open and close to direct blood flow through your heart. Conditions that damage the valves may cause the heart to enlarge.
• Heart attack. Having a heart attack increases your risk of developing an enlarged heart.

Enlarged heart prevention

Tell your doctor if you have a family history of conditions that can cause an enlarged heart, such as cardiomyopathy. If cardiomyopathy or other heart conditions are diagnosed early, treatments may prevent the disease from worsening.

Controlling risk factors for coronary artery disease — tobacco use, high blood pressure, high cholesterol and diabetes — helps to reduce your risk of an enlarged heart and heart failure by reducing your risk of a heart attack.

You can help reduce your chance of developing heart failure by eating a healthy diet and not abusing alcohol or using illicit drugs. Controlling high blood pressure with diet, exercise and possibly medications also prevents many people who have an enlarged heart from developing heart failure.

Enlarged heart signs and symptoms

In some people, an enlarged heart causes no signs or symptoms. Others may have these signs and symptoms:

• Shortness of breath
• Abnormal heart rhythm (arrhythmia)
• Swelling (edema)

Enlarged heart diagnosis

If you have symptoms of a heart problem, your doctor will perform a physical exam and order tests to determine if your heart is enlarged and to find the cause of your condition. These tests may include:

• Chest X-ray. X-ray images help your doctor see the condition of your lungs and heart. If your heart is enlarged on an X-ray, other tests will usually be needed to find the cause.
  Electrocardiogram. This test records the electrical activity of your heart through electrodes attached to your skin. Impulses are recorded as waves and displayed on a monitor or printed on paper. This test helps your doctor diagnose heart rhythm problems and damage to your heart from a heart attack.
• Echocardiogram. This test for diagnosing and monitoring an enlarged heart uses sound waves to produce a video image of your heart. With this test, the four chambers of the heart can be evaluated. Your doctor can use the results to see how efficiently your heart is pumping, determine which chambers of your heart are enlarged, look for evidence of previous heart attacks and determine if you have congenital heart disease.
• Stress test. A stress test, also called an exercise stress test, provides information about how well your heart works during physical activity. An exercise stress test usually involves walking on a treadmill or riding a stationary bike while your heart rhythm, blood pressure and breathing are monitored.
• Cardiac computerized tomography (CT) or magnetic resonance imaging (MRI). In a cardiac CT scan, you lie on a table inside a doughnut-shaped machine called a gantry. An X-ray tube inside the machine rotates around your body and collects images of your heart and chest. In a cardiac MRI, you lie on a table inside a long tube-like machine that uses a magnetic field and radio waves to produce signals that create images of your heart.
• Blood tests. Your doctor may order blood tests to check the levels of certain substances in your blood that may point to a heart problem. Blood tests can also help your doctor rule out other conditions that may cause your symptoms.
• Cardiac catheterization and biopsy. In this procedure, a thin tube (catheter) is inserted in your groin and threaded through your blood vessels to your heart, where a small sample (biopsy) of your heart, if indicated, can be extracted for laboratory analysis. Pressure within the chambers of your heart can be measured to see how forcefully blood pumps through your heart. Pictures of the arteries of the heart can be taken during the procedure (coronary angiogram) to ensure that you don’t have a blockage.

Enlarged heart treatment

Treatments for an enlarged heart focus on correcting the underlying cause (see enlarged heart causes above).

Medications

If cardiomyopathy or another type of heart condition is to blame for your enlarged heart, your doctor may recommend medications. These may include:

• Diuretics to lower the amount of sodium and water in your body, which can help lower the pressure in your arteries and heart
  Angiotensin-converting enzyme (ACE) inhibitors to lower your blood pressure and improve your heart’s pumping capability
• Angiotensin receptor blockers (ARBs) to provide the benefits of ACE inhibitors for those who can’t take ACE inhibitors
• Beta blockers to lower blood pressure and improve heart function
• Anticoagulants to reduce the risk of blood clots that could cause a heart attack or stroke
• Anti-arrhythmics to keep your heart beating with a normal rhythm

Medical procedures and surgeries

If medications aren’t enough to treat your enlarged heart, medical procedures or surgery may be necessary.

• Medical devices to regulate your heartbeat. For a certain type of enlarged heart (dilated cardiomyopathy), a pacemaker that coordinates the contractions between the left and right ventricle may be necessary. In people who may be at risk of serious arrhythmias, drug therapy or an implantable cardioverter-defibrillator (ICD) may be an option (see Figure 5 below). Implantable cardioverter-defibrillators (ICDs) are small devices — about the size of a pager — implanted in your chest to continuously monitor your heart rhythm and deliver electrical shocks when needed to control abnormal, rapid heartbeats. The devices can also work as pacemakers. If the main cause of your enlarged heart is atrial fibrillation, then you may need procedures to return your heart to regular rhythm or to keep your heart from beating too quickly.
• Heart valve surgery. If your enlarged heart is caused by a problem with one of your heart valves or it has caused heart valve problems, you may have surgery to repair or replace the affected valve.
• Coronary bypass surgery. If your enlarged heart is related to coronary artery disease, your doctor may recommend coronary artery bypass surgery.
• Left ventricular assist device (LVAD). If you have heart failure, you may need this implantable mechanical pump to help your weakened heart pump (see Figure 6 below). You may have an left ventricular assist device (LVAD) implanted while you wait for a heart transplant or, if you’re not a heart transplant candidate, as a long-term treatment for heart failure.
• Heart transplant. If medications can’t control your symptoms, a heart transplant may be a final option. Because of the shortage of donor hearts, even people who are critically ill may have a long wait before having a heart transplant.

Figure 5. Implantable cardioverter-defibrillator (subcutaneous)

Note: A subcutaneous implantable cardioverter-defibrillator (S-ICD) is a less invasive alternative to a traditional implantable cardioverter-defibrillator (ICD). Using a special insertion tool, your doctor implants the subcutaneous implantable cardioverter-defibrillator (S-ICD) device under the skin at the side of the chest below the arm pit and connects it to an electrode that runs along the breastbone.

Figure 6. Left ventricular assist device (LVAD)

Lifestyle and home remedies

There are ways to improve your condition, even though you can’t cure it. Your doctor may recommend the following lifestyle changes:

• Quit smoking.
• Lose excess weight.
• Limit salt in your diet < 1500mg/day (less than half a teaspoon of salt per day).
• Eat a healthy diet.
• Control diabetes.
• Monitor your blood pressure.
• Get modest exercise, after discussing with your doctor the most appropriate program of physical activity.
• Avoid or eliminate alcohol and caffeine.
• Try to sleep eight hours nightly.

Enlarged heart treatment diet

DASH stands for Dietary Approaches to Stop Hypertension is similar to a Mediterranean-type diet ³⁾. It is an eating plan that is based on research studies sponsored by the National Heart, Lung, and Blood Institute ⁴⁾. 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 ⁵⁾. 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 ⁶⁾, ⁷⁾.

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 ⁸⁾.

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 ⁹⁾.

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 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 ¹⁰⁾ . 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 ¹¹⁾).

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.

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⁾.

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.

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 ¹³⁾.

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 ¹⁴⁾ 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 ¹⁵⁾. 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 ¹⁶⁾ from the United States Department of Agriculture Center for Nutrition Policy and Promotion ¹⁷⁾. 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 ¹⁸⁾ 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 ²⁰⁾).

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 ²¹⁾).

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).