DASH Diet Overview

DASH stands for Dietary Approaches to Stop Hypertension, which is the name of the research study that looked at the effects of eating patterns on blood pressure. From this study came the DASH diet—a diet rich in fruits, vegetables, and low-fat dairy foods, and low in saturated fat, total fat, and cholesterol. The DASH diet is an example of what is generally considered to be a heart-healthy diet. This diet was shown to significantly reduce blood pressure and is often recommended to people with hypertension. The DASH diet combined with a low sodium intake can reduce blood pressure even further, as well as reduce bone loss and homocysteine levels. (Reducing sodium works for some but not all people. For more information, see "Reducing Your Sodium Intake," below.)

In addition to helping you manage your blood pressure, the DASH eating plan is a healthy one that will help you manage your weight and possibly reduce your risk of other chronic diseases. For example, research suggests that women who follow the DASH diet can reduce their risk of heart failure and osteoporosis.

Modifying your diet is worthwhile, but it can be challenging, especially if you need to make big changes. In addition to consulting with your physician, consider working with a nutritionist, dietitian or health coach to help customize meal plans, find suitable and exciting recipes, and build new, healthy habits.

The eating pattern outlined in the DASH diet promotes healthier blood pressure levels (and heart health in general) because of what it includes and excludes.¹ Specifically:

• Magnesium, potassium, and calcium all help reduce blood pressure
• B vitamins like folic acid help reduce homocysteine, which plays a role in atherosclerosis (hardening of the arteries)
• This diet includes little cholesterol and saturated fats, both of which are known to be a threat to heart health
• By discouraging sweets and highly processed snacks ("junk foods"), the diet reduces intake of trans fats, which are known to be a threat to heart health, as well as sugar, which encourages unhealthy spikes in blood sugar and insulin, encouraging the development and worsening of heart disease

The following is a guide to foods that are recommended on the DASH diet, as well as guidance on how much food equals a single serving. (To learn how many servings you should aim for in each category, see "How Many Servings Do I Need?" below.)

Grains and Grain Products

Grains are rich in carbohydrates, which provide quick energy for exercise. If you choose whole grains, you will also get a good dose of fiber and several vitamins and minerals. (Be aware though that many bread products are quite high in sodium. It may be better to make your own salt-free bread or buy baked goods with minimum added salt or baking powder.) See "How to eat healthy grains" for more info and tips.

One serving equals:

• 1 slice of bread
• 1 ounce of dry cereal (½ to 1-¼ cup; check the Nutrition Facts label on the cereal box)
• ½ cup of cooked rice, pasta, or cereal

Good choices include:

• Whole wheat bread
• English muffin
• Pita bread
• Brown rice
• Whole grain cereals
• Grits
• Oatmeal
• Low-fat, whole grain crackers and bread sticks
• Air-popped popcorn

Vegetables

Vegetables are low in calories and have almost no fat. They are also excellent sources of fiber, phytochemicals, vitamins, and minerals, such as potassium and magnesium. Choose local and/or organic vegetables and fruits whenever you can. Know which foods are in season where you live, and choose accordingly--your food will be fresher and less expensive. See "How to eat a diet rich in fruits and vegetables" for more info and tips.

One serving equals:

• 1 cup of raw leafy vegetables
• ½ cup of cooked vegetables
• 6 ounces of vegetable juice

Good choices include:

• Tomatoes
• Carrots
• Squash
• Broccoli
• Turnips
• Greens, like collards, kale, and spinach
• Artichokes
• Beans, including green beans and lima beans
• Sweet potatoes
• Potatoes

Fruits

Not only are they low in fat and calories, but fruits are good sources of potassium, magnesium, and fiber. Choose local and/or organic vegetables and fruits whenever you can. Know which foods are in season where you live, and choose accordingly--your food will be fresher and less expensive. See "How to eat a diet rich in fruits and vegetables" for more info and tips.

One serving equals:

• 6 ounces of fruit juice
• 1 medium piece of fruit
• ¼ cup of dried fruit
• ½ cup of fresh (cut up), frozen, or canned fruit

Good choices include:

• Apricots
• Bananas
• Dates
• Grapes
• Citrus, such as oranges and orange juice, and grapefruit and grapefruit juice
• Mangoes
• Melons
• Peaches
• Pineapples
• Prunes
• Raisins
• Strawberries
• Tangerines

Low-fat or Fat-free Dairy Foods

Dairy foods are excellent sources of calcium and protein. Choose hormone-free and organic dairy products if possible.

One serving equals:

• 8 ounces of milk
• 1 cup of yogurt
• 1-½ ounces of cheese

Good choices include:

• Fat-free (skim) or low-fat (1%) milk
• Fat-free or low-fat buttermilk
• Fat-free or low-fat regular or frozen yogurt
• Fat-free or low-fat cheese (Remember, though that most cheeses—including cottage cheese—can be quite high in salt.)

Meats, Poultry, and Fish

Meats, poultry, and fish are packed with protein and magnesium. Be sure to buy lean cuts of meat and poultry. Choose natural, hormone-free, antibiotic-free, and organic meats if possible.

One serving equals three ounces of cooked meats, poultry, or fish. Three ounces is about the size of a deck of cards or the palm of a woman's hand.

Tips for eating the healthiest meats:

• Select lean meats
• Trim away visible fat
• Use lowfat cooking methods, such as broiling, roasting, or boiling
• Remove skin from poultry before eating

Nuts, Seeds, and Dry Beans

These foods are great sources of magnesium, potassium, protein, and fiber.

One serving equals:

• 1/3 cup or 1-½ ounces of nuts
• 2 tablespoons or ½ ounce of seeds
• ½ cup of cooked dry beans

Good choices include (in most cases you will want to choose unsalted varieties):

• Nuts: almonds, filberts, mixed nuts, peanuts, and walnuts
• Sunflower seeds
• Dry beans: kidney beans, black beans, lentils, peas

Fats and Oils

Fats and oils should be used sparingly. When choosing fats, select those lowest in saturated fat, such as oils.

One serving equals:

• 1 teaspoon of butter or margarine (not recommended, because margarine, especially of the more solid variety, is a source of harmful trans fats)
• 1 tablespoon of lowfat mayonnaise
• 2 tablespoons of light salad dressing
• 1 teaspoon of vegetable oil

Better choices include:

• Low-fat mayonnaise
• Light salad dressing
• Vegetable oils: olive, corn, canola, safflower

Sweets

Sweets rarely provide any nutrients. Select those that are low in fat and limit your overall intake of them.

One serving equals:

• 1 tablespoon of sugar
• 1 tablespoon of jelly or jam
• ½ ounce of jelly beans
• 8 ounces of lemonade or fruit punch

Better choices include:

• Maple syrup
• Honey
• Jellies and jams
• Fruit-flavored gelatin
• Candy: jelly beans and hard candy
• Fruit punch
• Sorbet

Depending on your daily calorie needs, these are the number of servings of each food group you should strive for each day:

1,600 Calories:

• Grains and grain products: 6
• Vegetables: 3-4 servings
• Fruits: 4 servings
• Low-fat or fat-free dairy: 2-3 servings
• Meats, poultry, and fish: 1-2 servings
• Nuts, seeds, and dry beans: 3 servings per week
• Fats and oils: 2 servings
• Sweets: 0 servings

2,000 Calories:

• Grains and grain products: 7-8 servings
• Vegetables: 4-5 servings
• Fruits: 4-5 servings
• Low-fat or fat-free dairy: 2-3 servings
• Meats, poultry, and fish: 2 or less servings
• Nuts, seeds, and dry beans: 4-5 servings per week
• Fats and oils: 2-3 servings
• Sweets: 5 servings per week

3,100 Calories:

• Grains and grain products: 12-13 servings
• Vegetables: 6 servings
• Fruits: 6 servings
• Low-fat or fat-free dairy: 3-4 servings
• Meats, poultry, and fish: 2-3 servings
• Nuts, seeds, and dry beans: 1 serving
• Fats and oils: 4 servings
• Sweets: 2 servings

Traditionally, doctors have advised patients with hypertension to cut down on salt in the diet. Today, however, the value of this stressful dietary change has undergone significant questioning. Reducing sodium may not be helpful or necessary, at least for many people. Considering how rapidly our knowledge is evolving, it's a good idea to consult with your physician to learn the latest recommendations.

If reducing sodium is on your to-do list, consider that it may take a little time for your taste buds to adjust to eating less sodium. Here are some tips to help you reduce your intake:

• Choose low- or reduced-sodium versions of foods and condiments when available.
• Buy fruits and vegetables fresh, frozen plain, or canned in water, with no salt added.
• Use fresh meats, poultry, and fish rather than canned, smoked, or processed versions.
• Check the Nutrition Facts label on breakfast cereals and snacks, choose those lowest in sodium.
• Limit cured foods, such as bacon and ham.
• Limit foods packed in brine, such as pickles, pickled vegetables, olives, and sauerkraut.
• Limit condiments, such as MSG, mustard, horseradish, ketchup, and barbecue sauce.
• Add half the amount of salt than you normally would to your foods; gradually decrease this amount.
• Instead of seasoning with salt, use other sources of flavor—herbs, spices, lemon, lime, vinegar, or salt-free seasoning blends.
• Do noy add salt when you are cooking rice, pasta, and hot cereal. Cut back on instant mixes of these foods; they are usually high in salt.
• Rinse canned foods, such as tuna, to remove some sodium
• Cut back on convenience foods, such as frozen dinners, packaged mixes, and canned soups or broths.

1. Rakel, David. (2007). Integrative Medicine. 2nd Ed. Chapter 89: The DASH Diet. Philadelphia, PA: Saunders Elsevier.

National Heart, Lung, and Blood Institute, National Institutes of Health website. Available at: http://www.nhlbi.nih.gov.

7/6/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Levitan EB, Wolk A, Mittleman MA. Consistency with the DASH diet and incidence of heart failure. Arch Intern Med. 2009;169:851-857.