For the eighth year in a row, a panel of health experts has named the heart-healthy DASH diet the best overall eating plan, according to U.S. News & World Report’s 2018 Best Diets ranking.
The DASH (Dietary Approaches to Stop Hypertension) diet was designed to lower blood pressure and cholesterol levels by limiting fats, red meat and sugar in favour of healthy grains, poultry, low-fat dairy and nuts, the U.S. National Heart, Lung, and Blood Institute says.
Two major dietary factors that can influence hypertension are salt or sodium intake (which increases blood pressure) and potassium intake (which decreases blood pressure). The WHO recommends sodium to potassium ratio in the diet of 1. In our black population the sodium intake is very high (up to 8 gram per day – compared to the recommended maximum of 6 gram per day), while potassium intake is very low (50-60 mmol/day). It is, therefore, understandable that South African black people struggle to achieve the sodium to potassium ratio of 1 as recommended by the WHO.
The Dash Diet has provided sound scientific evidence that eating plenty of fruit, vegetables and whole-grains together with moderate quantities of low-fat or fat-free dairy products, can improve potassium, magnesium and calcium intakes, while reducing sodium intake to acceptable levels to reduce blood pressure.
Note: While more affluent members of our society can easily apply the principles of the Dash Diet, the less economically advantaged sectors of our population tend to have low intakes of fruit, vegetables and dairy products because of poverty and consequent food insecurity.
The body of this text has been written by the 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 systolic 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 is also in line with dietary recommendations to prevent osteoporosis, cancer, heart disease, stroke and diabetes.
DASH diet: Sodium levels
The DASH diet emphasizes vegetables, fruits and low-fat dairy foods — and moderate amounts of whole grains, fish, poultry and nuts.
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 typical American diet, which can amount to a whopping 3,400 mg of sodium a day or more.
The standard DASH diet meets the recommendation from the Dietary Guidelines for Americans to keep daily sodium intake to less than 2,300 mg a day.
The American Heart Association recommends 1,500 mg a day of sodium as an upper limit for all adults. If you aren’t sure what sodium level is right for you, talk to your doctor.
DASH diet: What to eat
Both 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, and encourages a small amount of nuts and seeds a few times a week.
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 dry cereal, or 1/2 cup cooked cereal, rice or pasta.
- Focus on whole grains because they have more fibre 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 labelled “100 percent whole grain” or “100 percent whole wheat.”
- Grains are naturally low in fat. Keep them this way by avoiding butter, cream and cheese sauces.
Vegetables: 4 to 5 servings a day
Tomatoes, carrots, broccoli, sweet potatoes, greens and other vegetables are full of fibre, 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 and frozen vegetables are both good choices. When buying frozen and canned vegetables, choose those labelled 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 fibre, potassium and magnesium and are typically low in fat — coconuts are an exception. Examples of one serving include one medium fruit, 1/2 cup fresh, frozen or canned fruit, or 4 ounces of juice.
- 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 dollop 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 fibre.
- Remember that citrus fruits and juices, such as grapefruit, can interact with certain medications, so check with your doctor or pharmacist to see if they’re OK for you.
- If you choose canned fruit or juice, make sure no sugar is added.
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 — and most of it is saturated. Examples of one serving include 1 cup skim or 1 percent milk, 1 cup low fat yogurt, or 1 1/2 ounces part-skim 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 servings or fewer a day
Meat can be a rich source of protein, B vitamins, iron and zinc. Choose lean varieties and aim for no more than 6 ounces a day. Cutting back on your meat portion will allow room for more vegetables.
- Trim away skin and fat from poultry and meat and then bake, broil, grill or roast instead of frying in fat.
- 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 fibre 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 only a few times a week because these foods are high in calories. Examples of one serving include 1/3 cup 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.
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 limiting total fat to less than 30 percent of daily calories from fat, with a focus on the healthier monounsaturated fats.
Examples of one serving include 1 teaspoon soft margarine, 1 tablespoon mayonnaise or 2 tablespoons salad dressing.
- Saturated fat and trans fat are the main dietary culprits in increasing your risk of coronary artery disease. DASH helps keep your daily saturated fat to less than 6 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 servings 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 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 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.
DASH diet and weight loss
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.
The DASH diet generally includes about 2,000 calories a day. If you’re trying to lose weight, you may need to eat fewer calories. You may also need to adjust your serving goals based on your 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 reduce sodium further by:
- Using sodium-free spices or flavourings 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 labelled “no salt added,” “sodium-free,” “low sodium” or “very low sodium”
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.
You may 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.
Using salt-free seasoning blends or herbs and spices may also ease the transition. 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.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 diarrhoea that may occur if you aren’t used to eating a diet with lots of fibre. You can also try over-the-counter products to help reduce gas from beans and vegetables.
- Reward successes and forgive slip-ups.Reward yourself with a non-food treat for your accomplishments — rent a movie, purchase a book or get together with a friend. 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.
- 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.
The overall goal of the DASH Diet — short for Dietary Approaches to Stop Hypertension — is to lower your consumption of sodium, which aids in lowering your blood pressure. Since the diet focuses on eating the right foods with the right portions, it’s also effective for short- and long-term weight loss.
Dietician Marla Heller’s version of the DASH Diet, from her book The DASH Diet Weight Loss Solution, is divided into two phases:
Phase 1: Two Weeks to Shrink Your Waistline
During the 14 days of Phase 1, you will learn how to satisfy your hunger and, as a result, feel fuller longer. To regulate your blood sugar and help curb your cravings, avoid fruit and whole grains, which have a lot of natural sugar, and alcohol, which also contain sugars. That said, you can enjoy 2-3 servings of low-fat dairy per day. This would include 1 cup of skim milk or low-fat yogurt. Avoid regular or even fat-free cheese because they are often high in sodium.
By avoiding starchy foods with sugar, you’re helping to regulate your blood sugar and diminish cravings. Try leafy greens like lettuce and spinach or cruciferous vegetables like broccoli or cabbage. You can also eat cucumbers, squash, peppers, and tomatoes.
You can also enjoy up to 6 ounces of lean meats, fish, and poultry a day. Aim for 4 to 5 servings of beans or lentils a week.
Opt for protein-rich foods that have healthy fats, like fresh nuts and seeds, or fatty fish like salmon or mackerel. Avocados are loaded with monounsaturated fats as well as antioxidants lutein, vitamin E and beta-carotene. Toss them in a salad along with vegetable oils, especially olive, canola and nut oils, which you can use as salad dressing.
Phase 2: Kick It Up a Notch!
After the first 14 days, you will continue to eat the foods from Phase 1 but re-introduce some other healthy foods that will help you continue your weight loss. How long does Phase 2 last? It’s your life plan, so it should last forever so you can keep your blood pressure low and keep weight off.
Whole Grains: Choose from cereals, breads, and pasta. Aim for 6 to 8 servings a day.
Fruit: Make fruit (fresh or frozen) a part of your diet every day. Aim for 4 to 5 servings a day. Try making these low-sugar fruits part of your diet.
Low-Fat Milk or Yogurt: Stick to 2 to 3 servings a day as in Phase 1.
Sugar: You can have 3 to 4 servings of sugary foods each week.
Alcohol: You can have a small glass of red wine occasionally, which represents one fruit serving.