DASH diet: Healthy eating to lower your blood pressure

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.

By Mayo Clinic staff

DASH stands for Dietary Approaches to Stop Hypertension. 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.

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 blood pressure could drop by eight to 14 points, which can make a significant difference in your health risks.

Because the DASH diet is a healthy way of eating, it offers health benefits besides just lowering blood pressure. The DASH diet may offer protection against osteoporosis, cancer, heart disease, stroke and diabetes. And while the DASH diet is not a weight-loss program, you may indeed lose unwanted pounds because it can help guide you toward healthier meals and snacks.

DASH diet: Sodium levels

A key goal of the DASH diet is reducing how much sodium you eat, since sodium can dramatically increase blood pressure in people who are sensitive to its effects. In addition to the standard DASH diet, there is also a lower sodium version of the diet. You can choose the version of the diet that meets your health needs:

Standard DASH diet. You can consume up to 2,300 milligrams (mg) of sodium a day.
Lower sodium DASH diet. You can consume up to 1,500 mg of sodium a day.

Both versions of the DASH diet aim to reduce the amount of sodium in your diet compared with what you might get in a more traditional diet, which can amount to a whopping 3,500 mg of sodium a day or more. That level is far beyond the recommendation of the 2005 Dietary Guidelines for Americans of a maximum of 2,300 mg of sodium a day.
Studies show that the lower sodium version of the DASH diet is especially helpful in lowering blood pressure for adults who are middle-aged or older, for African-Americans and for those who already have high blood pressure. If you aren't sure which version of the DASH diet is best for you, talk to your doctor.

DASH diet: What to eat

Both sodium 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. You can eat red meat, sweets and fats in small amounts. The DASH diet is low in saturated fat, cholesterol and total fat.
Here's a look at the recommended servings from each food group for the 2,000-calorie-a-day DASH diet.

Grains (6 to 8 servings a day)Grains include bread, cereal, rice and pasta. Examples of one serving of grains include 1 slice whole-wheat bread, 1 ounce (oz.) dry cereal, or 1/2 cup cooked cereal, rice or pasta.

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."
Grains are naturally low in fat, so avoid spreading on butter or adding cream and cheese sauces.

Vegetables (4 to 5 servings a day)

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 or 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.

Fruits (4 to 5 servings a day)

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 — exceptions include avocados and coconuts. Examples of one serving include 1 medium fruit or 1/2 cup fresh, frozen or canned fruit.

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

Dairy (2 to 3 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 that you choose dairy products that are low-fat or fat-free because otherwise they can be a major source of fat. Examples of one serving include 1 cup skim or 1% milk, 1 cup yogurt or 1 1/2 oz. 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.

Lean meat, poultry and fish (6 or fewer servings a day)

Meat can be a rich source of protein, B vitamins, iron and zinc. But because even lean varieties contain fat and cholesterol, don't make them a mainstay of your diet — cut back typical meat portions by one-third or one-half and pile on the vegetables instead. Examples of one serving include 1 oz. cooked skinless poultry, seafood or lean meat, 1 egg, or 1 oz. water-packed, no-salt-added canned tuna.

Trim away skin and fat from meat and then broil, grill, roast or poach instead of frying.
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.

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 weekly because these foods are high in calories. Examples of one serving include 1/3 cup (1 1/2 oz.) 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. They also contain isoflavones, a type of natural plant compound (phytochemical) that has been shown to have some health benefits.

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 providing 30 percent or less of daily calories from fat, with a focus on the healthier unsaturated fats. Examples of one serving include 1 teaspoon soft margarine, 1 tablespoon low-fat mayonnaise or 2 tablespoons light salad dressing.

Saturated fat and trans fat are the main dietary culprits in raising your blood cholesterol and increasing your risk of coronary artery disease. DASH helps keep your daily saturated fat to less 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.
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.

Sweets (5 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 (8 oz.) 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 DASH diet recommends that men limit alcohol to two or fewer drinks a day and women 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.

DASH diet and weight loss

The DASH diet is not designed to promote weight loss, but it can be used as part of an overall weight-loss strategy. The DASH diet is based on a diet of about 2,000 calories a day. If you're trying to lose weight, though, you may want to eat around 1,600 a day. You may need to adjust your serving goals based on your health or individual circumstances — something your health care team can help you decide.

Tips to cut back on sodium

The foods at the core of the DASH diet are naturally low in sodium. So just by following the DASH diet, you're likely to reduce your sodium intake. You also can cut back on sodium in your diet by:

Using sodium-free spices or flavorings with your food instead of salt
Not adding salt when cooking rice, pasta or hot cereal
Rinsing canned foods to remove some of the sodium
Buying foods labeled "no salt added," "sodium-free," "low sodium" or "very low sodium"

One teaspoon of table salt has about 2,300 mg of sodium, and 2/3 teaspoon of table salt has about 1,500 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 — all foods you may have considered healthy — often have lots of sodium.
You may not notice a difference in taste when you choose low-sodium food and beverages. If things seem too bland, gradually introduce low-sodium foods and cut back on table salt until you reach your sodium goal. That'll give your palate time to adjust. It can take several weeks for your taste buds to get used to less salty foods.

Putting the pieces of the DASH diet together

Try these strategies to get started on the DASH diet:

Change gradually. To boost your success, avoid dramatic changes in your eating approach. 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 fruits, vegetables and whole grains gradually can also help prevent bloating or diarrhea that may occur if you aren't used to eating a diet with lots of fiber. You can also try over-the-counter products to help reduce 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. Combining both the DASH diet and physical activity makes it more likely that you'll reduce your blood pressure.
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. And with the DASH diet, you can have both.

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Wednesday, February 20, 2013