DASH diet: Healthy eating to lower your blood pressure

Published:  08/01/2013

The DASH diet emphasizes portion size, eating a variety of foods and getting the right amount of nutrients. Discover how DASH can improve your health and lower your blood pressure.

The DASH diet focuses on lowering your blood pressure and keeping it under control. DASH, which stands for Dietary Approaches to Stop Hypertension, could lower your blood pressure by a few points in just two weeks. Over time, your blood pressure could drop by eight to 14 points.

The DASH diet offers other health benefits, too, such as protection against osteoporosis, cancer, heart disease, stroke and diabetes. The DASH diet is especially effective in reducing blood pressure in blacks and older adults. If adopted early and combined with other lifestyle changes such as exercising more and quitting smoking, the DASH diet can prevent high blood pressure (hypertension).

The DASH diet: What to eat
The key to the DASH diet is variety, including lots of whole grains, fruits, vegetables and low-fat dairy products. It also includes some fish, poultry and legumes. You can eat red meat, sweets and fats in smaller amounts. This variety means the DASH diet is low in saturated fat, cholesterol, total fat and sodium, while rich in protein, fiber and healthy nutrients, particularly magnesium, potassium and calcium.

The DASH diet now has two versions: the standard DASH diet and the lower sodium DASH diet. Both DASH diets aim to reduce the amount of sodium in your diet, but the lower sodium DASH diet encourages an even further reduction in the amount of sodium you eat. This can help to reduce blood pressure even more than can the standard DASH diet. You don't need to modify the DASH diet any further than reducing the amount of salt you eat to follow the lower sodium version.

DASH diet components
Here are the food groups in the DASH diet and tips on incorporating them into your meals:

Food group Servings Serving sizes
Whole grains6 to 8 a day1 slice bread
1 ounce (oz.) dry cereal
1/2 cup cooked rice, pasta or cereal
Fruits and vegetables8 to 10 a day1 cup raw leafy vegetables
1/2 cup fruit or low-sodium vegetable juice
1 medium piece of fruit
1/2 cup fresh, frozen or canned fruit
Fat-free or low-fat dairy2 to 3 a day1 cup milk or yogurt
1 1/2 oz. cheese
Lean meats, poultry and fish6 or fewer a day1 oz. cooked meats, poultry or fish (3 oz. of meat is about the size of a deck of cards) Avoid beef, lamb and pork.
Nuts, seeds and beans4 to 5 a week1/3 cup walnuts or almonds
2 tablespoons (tbsp.) peanut butter
2 tbsp. unsalted sunflower or pumpkin seeds
1/2 cup cooked dry beans or peas
Fats and oils2 to 3 a day1 teaspoon (tsp.) soft margarine
1 tsp. olive oil or canola
1 tbsp. mayonnaise (use reduced fat)
2 tbsp. salad dressing (use reduced fat)
Sweets5 or fewer a week1 tbsp. sugar
1 tbsp. jelly or jam
1/2 cup sorbet, gelatin
1 cup lemonade
Sodium1,500 to 2,400 milligrams (mg) a day (the lower the amount of sodium, the greater the blood pressure lowering effect)1,500 mg of sodium equals about 4 grams, or 2/3 tsp., of table salt

Whole grains (six to eight servings a day)
These include breads, cereals, rice and pasta. They're a good source of energy and fiber.
  • Choose 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."
  • Grains are naturally low in fat, so avoid spreading on butter or adding cream and cheese sauces.
Vegetables and fruits (eight to 10 servings a day)
Vegetables. Tomatoes, carrots, broccoli, sweet potatoes and other vegetables are full of fiber, vitamins, and such minerals as potassium and magnesium. Don't think of them as mere 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 or frozen vegetables are both good choices. For maximum benefit from canned vegetables, make sure they don't have added salt.
  • To increase the number of servings you fit in daily, be creative. In a stir-fry, for instance, cut the amount of chicken in half and double up on the vegetables.
Fruits. Fresh or dried, many fruits need little preparation to become a healthy part of a meal or an on-the-go snack. Like vegetables, they're packed with fiber, potassium and magnesium and are almost always low in fat — coconut is one exception.
  • Add berries to your cereal. Have a piece of fruit at lunch and one as a snack, then round out your day with a dessert of fresh fruits topped with a splash of low-fat yogurt. Remember that grapefruit juice can interact with certain medications, such as statins, so check with your doctor before drinking it.
  • Leave on edible peels whenever possible. The peels of apples, pears and most fruits with pits add interesting texture to recipes and contain nutrients and fiber.
Dairy (two to three servings a day)
Milk, yogurt, cheese and other dairy products are major sources of calcium, vitamin D and protein. But the key is to make sure they're low in fat or fat-free, since dairy products can also be a major source of fat.
  • 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, you may benefit from over-the-counter products that contain the enzyme lactase, which can reduce or prevent the symptoms of lactose intolerance. Or choose lactose-free products. Even people who have trouble tolerating milk can generally tolerate yogurt. Some people tolerate milk if they drink it with a meal in small portions, 4 ounces (120 milliters, or mL) at a time or less.
Meats, poultry and fish (six or fewer servings a day)
Meats are rich sources of protein, B vitamins, iron and zinc. But because even lean varieties contain fat and cholesterol, try to limit animal-based foods.
  • Keep in mind that the DASH diet considers a serving of meat to be small — about 1 ounce (oz.). A piece of lean meat the size of a deck of cards is about 3 oz (85 grams).
  • The DASH diet suggests that meals not be centered on meats. Cut back typical meat portions by one-third or one-half and pile on the vegetables instead.
  • Trim away skin and fat before cooking, then broil, grill, roast or poach instead of frying.
  • You can enhance the heart-health benefits of DASH by eating fish such as salmon, herring or tuna. These types of fish are high in omega-3 fatty acids, which can help lower your total cholesterol.
Nuts, seeds and beans (four to five servings a week)
Almonds, sunflower seeds, kidney beans, lentils and other foods in this family are good sources of magnesium, potassium and protein. They're also full of fiber and phytochemicals, plant compounds that may protect against some cancers and cardiovascular disease.
  • Nuts may have gotten a bad rap over their fat content, but they contain good types of fat — monounsaturated fat and omega-3 fatty acids. They're high in calories, however, so they should be eaten 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. They also contain isoflavones, a type of natural plant compound (phytochemical) that has been shown to have some health benefits.
Fats and oils (two to three 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 providing 30 percent or less of daily calories from fat, with a focus on the healthier unsaturated fats.
  • Become a savvy shopper and read food labels on margarines and salad dressings so that you can choose those that are lowest in saturated fat and are trans fat-free.
  • Saturated fat and trans fat are the main dietary culprits in raising your blood cholesterol and increasing your risk of coronary artery disease. Keep your daily saturated fat to no more than 10 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. You should avoid trans fats — a type of fat found mainly in processed foods such as crackers, baked goods and fried items — as much as possible.
Sweets (five or fewer a week)
Even on the DASH diet, you can have sweets in small amounts.
  • Try to eat fat-free or low-fat sweets, such as sorbets, fruit ices, jelly beans, hard candy, graham crackers or low-fat cookies.
  • Although it can be high in calories, dark chocolate is another good choice if you're craving something sweet. Dark chocolate contains a substance that can help lower your blood pressure and can enhance your results from the DASH diet. Just be sure to keep your portion size small (about 1 oz. or 28 grams).
  • Artificial sweeteners such as aspartame (NutraSweet, Equal) and sucralose (Splenda) or Erythritol 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 milk or low-sodium vegetable juice.
Cutting back on sodium
The fruits, vegetables and low-fat dairy products that have center stage in the DASH diet are naturally low in sodium. That means it'll take less effort to reduce the sodium and salt in your diet.

The recommended upper limit of salt you can eat each day is 2,400 milligrams (mg). If you have prehypertension (120/80 millimeters of mercury, or mm Hg, to 139/89 mm Hg) or high blood pressure (140/90 mm Hg to 159/99 mm Hg), it's recommended to reduce the amount of salt you eat to 1,500 mg to help control the condition.

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 — all foods you may have considered healthy — often have lots of sodium. Choose low-sodium varieties, and you may find you don't even notice the difference.

Still, some people may find it hard to abruptly cut back to 1,500 mg a day. If you have trouble cutting back on sodium and table salt, do it gradually. That'll give your palate time to adjust. It can takes six weeks or more for your taste buds to get used to less salty foods, but the drop in your blood pressure will be worth the adjustment.

Here are some ways to reduce the sodium and salt in your diet without sending your taste buds into a panic:
  • Add spices or flavorings to your food instead of salt. Season broccoli with lemon juice or oregano and popcorn with curry or garlic powder, for instance. Try salt-free seasoning blends.
  • Don't add salt when cooking rice, pasta or hot cereal.
  • Rinse canned foods, such as tuna, to remove some sodium.
  • Buy foods labeled"no salt added,""sodium-free,""low sodium" or"very low sodium." Be cautious of foods marked"reduced sodium" or"light sodium." These labels mean that the sodium has been reduced by 25 percent to 50 percent, compared with the regular version, but these foods may still be very high in salt.
Alcohol and the DASH diet
Aside from salt, drinking too much alcohol can increase blood pressure. The DASH diet recommends limiting alcohol to two or fewer drinks a day in men, and one drink a day for women.

DASH nutrient mix
By following the DASH diet, you'll be getting more nutrients that can help lower your blood pressure. The mix of potassium, calcium and magnesium in the DASH diet acts as a diuretic, helping the body excrete salt.

Mineral What it does Where it's found
PotassiumBalances the amount of sodium in your cellsMany fruits and vegetables, whole grains, legumes, dairy products
CalciumNot proved to prevent high blood pressure, but eating too little is linked with high blood pressureDairy products, green leafy vegetables, fish with edible bones, calcium-fortified foods
MagnesiumDeficiency linked with higher blood pressureLegumes, green leafy vegetables, nuts and seeds, whole grains, lean meats

Putting it all together
The DASH diet is based on a diet of 2,100 calories a day. If you're trying to lose weight, though, you may want to eat around 1,600 a day. The DASH diet is not designed to promote weight loss, but it can be used as part of an overall weight-loss strategy. You may need to adjust your serving goals based on your health or individual circumstances — something your health care team can help you decide.

Use the DASH food group guidelines and the guide to recommended daily servings to get started with your own menu planning. Consult the guidelines to help plan some sample menus for yourself, or talk to your doctor or a registered dietitian if you need more help creating menus.

To help you get started on the DASH diet, consider these strategies:
  • Change gradually. People seeking healthier lifestyles often try to change too much at once. Instead, change one or two things at a time. If you now eat only one or two servings of fruits or vegetables a day, try to add a serving at lunch and one at dinner. Rather than switching to all whole grains, start by making one or two of your grain servings whole grains. Increasing the amount of fruits and vegetables you eat gradually will also help prevent bloating or diarrhea that may occur in some people who aren't used to eating a diet with lots of high-fiber grains, fruits and vegetables. You can also try over-the-counter products to help reduce the gas from beans and vegetables.
  • Forgive yourself if you backslide. Everyone slips, especially when learning something new. Remember that changing your lifestyle is a long-term process. Find out what triggered your setback and then just pick up where you left off with the DASH diet.
  • Reward successes. Reward yourself with a nonfood treat for your accomplishments.
  • Add physical activity. To boost your blood pressure lowering efforts even more, consider increasing your physical activity in addition to following the DASH diet. These two interventions together are more successful at lowering blood pressure than either alone.
  • Get support if you need it. If you're having trouble sticking to your diet, talk to your doctor or dietitian about it. You might get some tips that will help you stick to the DASH diet.
Remember, healthy eating isn't an all-or-nothing proposition. What's most important is that, on average, you eat healthier foods with plenty of variety — both to keep your diet nutritious and to avoid boredom or extremes.

By Mayo Clinic staff

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