Disclaimer: This article should not substitute for professional medical advice. When starting a new diet or exercise plan, always consult your physician first.
- Obesity and chronic disease related to obesity continues to rise in the United States.
- The DASH diet is a non-restrictive way of eating that encourages the consumption of a
variety of fresh, whole foods. - The DASH diet is a positive lifestyle change that is recommended for almost everyone to improve blood pressure and overall cardiovascular health.
Over the last 50 years, trends in American obesity levels continue a steady incline. Nearly two in every three Americans are considered overweight or obese. Obesity rates tend to be slightly higher in those with low incomes or low education levels, showing that socioeconomic status is a factor in health, though this gap is closing.
Rising trends in obesity correlate with a dramatic shift in diet and lifestyle culture. According to the United Nations, Food and Agriculture Organization, a shift away from fresh, seasonal foods has occurred in the past few decades as a result of globalization and urbanization. The fast pace of our current society has given rise to a fast-food culture, where a diet high in sodium, saturated fats, and processed meats is now considered the norm.
Chronic diseases such as metabolic syndrome, cardiovascular disease, Type II diabetes, and certain cancers are the result of these unhealthy eating habits and have become more prevalent, accounting for more than 1.7 million deaths per year in the U.S. alone. Not only that, but healthcare costs related to chronic disease continue to soar, contributing $2 trillion in spending per year, according to the Centers for Disease Control (CDC).
To combat the rise in obesity and related chronic conditions, the National Institute of Health and the National Heart, Blood, and Lung Institute funded and heavily researched a project called the DASH diet. It is now considered one of the best, most effective lifestyle diets that encourage healthy eating without restriction among all Americans.
History of the DASH diet
Developed in the early 1990s as an integrative approach to lowering blood pressure without the use of medication, the DASH diet (Dietary Approaches to Stop Hypertension) has been popularized for its promotion of eating a balanced diet, promoting the importance of consuming fresh, whole foods and limiting the consumption of salty, processed, and sugary foods.
DASH is based on extensive research studies that show the diet’s effectiveness in reducing blood pressure among those with hypertension and stabilizing blood pressure among those without the preexisting condition.
The DASH diet is constantly being evaluated and studies show that long-term adherence has positive outcomes, decreasing the risk of developing chronic cardiovascular conditions such as high blood pressure and gout, the most common form of inflammatory arthritis.
In recent years, studies have concluded that DASH is most effective when combined with a low-sodium diet, which has led to provisions within the DASH guidelines to focus on reducing salt intake when following this eating plan. Following the 2015-2020 Dietary Guidelines for Americans, DASH recommends limiting sodium intake to 2,300 mg/day for healthy individuals, and for individuals with pre-hypertension or hypertension, the CDC recommends reducing sodium intake to 1,500 mg/day.
The DASH diet is recommended by the American Heart Association (AHA) and The National Heart, Lung, and Blood Institute (NHLBI). The NHLBI provides a wide array of information on the DASH diet including the health benefits, ways to get started, and discusses the science behind why the DASH diet works in lowering blood pressure and LDL (bad) cholesterol.
Who can benefit from the DASH diet?
As the name suggests, the DASH diet is recommended for individuals with high blood pressure or those that are pre-hypertensive. Pre-hypertension and hypertension can be precursors to more serious chronic conditions such as metabolic syndrome, Type II diabetes, heart failure, and kidney failure.
It is important to note that for those with chronic kidney or liver disease, as well as those who are prescribed renin-angiotensin-aldosterone system antagonists, physician consultation is recommended prior to any changes with diet. There may be additional limitations to following the DASH diet with these conditions.
Those that suffer from chronic health conditions can benefit from switching to a diet rich in fresh, whole foods with a focus on increasing fiber intake and reducing sodium intake. This style of eating will not only lower blood pressure, but also blood glucose levels and triglycerides. Studies show that the DASH diet helps to improve insulin sensitivity in those with diabetes when combined with a healthy lifestyle including exercise and weight loss.
Individuals with a history of heart failure (HF) have shown incredible improvements in health by following the nutrient-rich DASH diet as it emphasizes reducing sodium and increasing the intake of certain minerals like potassium, magnesium, and calcium.
Several epidemiological studies since the early 2000s outline a 45-81% decrease in HF incidence in those that adhere to a healthy lifestyle. A healthy lifestyle includes performing regular physical activity, consuming a nutrient-rich diet, obtaining normal blood pressure (120/80), and a normal BMI (19-25 for most individuals), limiting alcohol intake and refraining from smoking.
A study published in 2009 followed 38,987 Swedish men aged 45-79 to determine the consistency of adherence to the DASH diet and rates of hospitalization from HF. The study concluded that those men that followed the DASH diet had a 22% decrease in HF risk than those who had not.
A similar study with just over 36,000 Swedish women of similar age range as the all-male cohort showed that consistent adherence to the DASH diet decreased their risk of HF by 37%.
Finally, the DASH diet is not simply for individuals with underlying health conditions. All individuals that are looking to improve their eating habits can benefit from this eating plan. As the plan outlines, its focus is on promoting the consumption of fresh, whole fruits and vegetables, complex carbohydrates, lean protein, increased fiber intake, and reduced-sodium and added sugar intake.
If you are looking for a lifestyle intervention that you can stick with, without feeling too restricted or confused by “tracking macros”, keep reading about the simple ways you can incorporate DASH specific changes into your eating plan.
DASH and heart health
The DASH diet emphasizes the consumption of minimally processed and fresh food. The idea is to consume less sodium, cholesterol, and saturated and trans fats, and to consume more fresh fruits and vegetables, fiber, potassium, and low-fat dairy products.
The DASH diet is designed to be a long-term eating plan that doesn’t focus on food or nutrient restriction but is a simple, heart-healthy diet that allows you to stay in control of what you eat by promoting portion control and serving sizes.
The DASH diet can be divided into eight different “food groups” focused on serving size.
- Carbohydrates: 5-8 servings per day
- Vegetables: 4-6 servings per day
- Fruits: 3-5 servings per day
- Dairy: 2-3 servings per day
- Lean meats, fish, and poultry: two 3 oz. servings per day (or 6 oz./day)
- Fats and oils: 2-3 servings per day
- Nuts and seeds: 4-5 servings per week
- Sweets: Less than 5 servings per week
While the DASH diet is not considered a “restrictive diet”, there are some basic guidelines to follow and foods you should try to avoid. First, it is important to stick within the serving limits and try to fill your plate with a variety of foods from each daily group listed above. You could even try to add a vegetable into your meal at breakfast to include more variety throughout your day.
Next, avoid fast, processed, and prepackaged foods. Foods such as candy, salted nuts, pizza, sauces and gravies, and packaged rolls can be very high in saturated and trans fats, cholesterol, and sodium. Included in this list are cold cuts/deli meats as they are generally high in sodium. If you do consume deli meats, limit your intake to once or twice a week, and opt for the low or no-sodium added options.
Finally, drinks such as soda (yes, even diet!) and other sugary beverages are filled with additives and chemicals (obesogens) that have been shown to contribute to unwanted weight gain.
Potential challenges to DASH adherence
Following the DASH diet does not come without its challenges. To thoroughly succeed in creating new, healthy habits, you must understand that it will take work. The key to success is making small, incremental positive changes one at a time.
When changing your diet, it may be hard to figure out what to eat. For so long you have become accustomed to eating a certain way or a certain meal on designated days and this will be a hurdle you’ll have to overcome. It is important to create a meal plan that works for you.
Prior to your weekly trip to the grocer, sit down and decide what you want to have for breakfast, lunch, dinner, and snacks for the entire week. This will help you identify what you should add to your grocery list, and it will help keep you on track as your week progresses.
Another challenge may be finding the time to cook. One-third of Americans dine out on any given day. It may seem easier to jump in that drive-thru line on the way home from work than it is to start cooking a meal when you get home.
If you have planned out your weekly menu, chances are this may be easier than you think. Many times, with a minimal amount of prep work on the weekend, you’ll be able to get dinner on the table in less than 30 minutes—eating a healthier, and likely cheaper meal than you would if you had gotten your dinner to-go.
Prepping for the week can be as easy as pre-slicing your vegetables and sealing them in air-tight containers, cooking your grains for the week, and even making a batch of shredded chicken in the crockpot.
Finally, many individuals and families find it hard to eat healthy without going over budget. To this we say, shop smart! You can make healthy and wallet-friendly choices at the grocery store by simply taking your time.
Identify the produce that is in season. In season produce is much cheaper than out of season produce. You can also check the frozen section. Frozen fruits and vegetables can be a great alternative to fresh, and you won’t have to worry about them spoiling.
Bulk bins have a lot of great, healthy choices, and many times you can find grains, beans, and nuts at a discount versus what you may find in the aisles.
Remember, small changes are key. If you can simply switch from white rice and refined pasta to brown rice and whole-wheat pasta, then that is great! Perhaps the next week you can focus on adding one more serving of vegetables into your day.
Check out this sample meal plan for inspiration toward healthy eating following the DASH diet.
Sample DASH Diet Menu
Breakfast:
- 3/4 cup bran flakes cereal (Total Cereal) with 1 medium banana and 1 cup low-fat milk
- 1 slice whole-wheat bread with 1 tsp. unsalted butter
- 1 mandarin orange
- 1 cup coffee
Lunch:
- Sandwich:
- 2 slices whole-wheat bread
- 3 oz. grilled thin chicken breast
- 2 slices low-fat cheese
- 1 tbsp. mustard
- Salad:
- 1/2 cup diced cucumbers
- 1/2 cup diced tomatoes
- 1 tablespoon sunflower seeds
- 1 teaspoon low-calorie non-creamy dressing (Italian)
- 1/2 cup fruit cocktail, no sugar added
Snack:
- 1/3 cup almonds, unsalted
Dinner:
- 3 oz. lean beef with 2 tbsp. fat-free, low sodium beef gravy
- 1 cup sautéed broccoli with 1/2 tsp. olive oil
- 1 small baked potato topped with:
- 1 tbsp. fat-free sour cream (or plain Greek yogurt)
- 1 tbsp. shredded, reduced-fat, natural (low-sodium) cheddar cheese
- 1 tbsp. chopped scallions
- 1 small apple
Dessert:
- 1/2 cup low-fat plain Greek yogurt topped with:
- 1/2 cup fresh berries
- Sprinkle of cocoa powder
Final thoughts
Is the DASH Diet right for you? The DASH Diet promotes the consumption of real, fresh, whole foods. Unless you have a specific dietary restriction (i.e. gluten intolerance) or your doctor has prescribed a certain diet (such as a high-protein, low-carb diet) the DASH Diet is a great way to improve your current eating habits. It is to be used simply as a guide to ensure you are eating a variety of foods and in the right portions.
The DASH diet allows for individual food preferences by providing simple guidelines. Research shows that “when compared to some other diet patterns, it has an added advantage of having clear guidelines on the serving sizes and food groups, which makes it easier for the physicians to prescribe and monitor their patient’s improvement.”
If the DASH diet is something that you think looks reasonable for you to stick with, please talk with your doctor, dietitian, or nutritionist to discuss if it is right for you.
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Nicole Pepper is a health and wellness professional with a passion for improving the lives of those around her. She enjoys cooking, baking, running, and likes to balance her obsession with murder mystery shows with Disney movies.
