D.A.S.H. Diet (Dietary Approaches to Stop Hypertension)

Hypertension (high blood pressure) affects about 1 out of every 3 American adults (an estimated 67 million Americans).  Blood pressure is the force of blood against artery walls.  It is measured in millimeters of mercury (mmHg) and recorded as two numbers--systolic pressure (when the heart beats) over diastolic pressure (when the heart relaxes between beats).  Both numbers are important.  Normal blood pressure is lower than 120/80 mmHg.  High blood pressure (hypertension) is when your blood pressure is 140/90 mmHg or above.  Blood pressure between 120/80 and 140/90 is called prehypertension.  If you have prehypertension, you are more likely to develop high blood pressure.  Almost 30 percent of American adults ages 18 and older, or about 59 million people, have prehypertension.  

High blood pressure is dangerous because it makes the heart work too hard, and the high force of the blood flow can harm arteries and organs such as the heart, kidneys, brain, and eyes.  If uncontrolled, it can lead to heart and kidney disease, stroke, blindness and early death.  If you have heart or kidney problems, or if you had a stroke, your doctor may want your blood pressure to be even lower than that of people who do not have these conditions.  You are more likely to be told your blood pressure is too high as you get older because your blood vessels become stiffer as you age.

There are many things you can do to help control your blood pressure:

• Eat a heart-healthy diet, including potassium and fiber, and drink plenty of water.

• Limit the amount of sodium (and salt) you eat--aim for less than 1,500 mg per day.

• Reduce stress--try to avoid things that cause you to stress.

• Stay at a healthy body weight.

• Limit how much alcohol you drink--one drink a day for women, two a day for men.

• If you smoke, quit!

• Exercise regularly--at least 30 minutes of aerobic exercise a day (all at once or "piecemeal" in 10-minute bouts).  If your blood pressure is moderately elevated, 30 minutes of brisk walking on most days of the week may be enough to keep you off medication.  If you don’t have high blood pressure, being physically active can help prevent it.  If you have normal blood pressure but are not active, your chances of developing high blood pressure increase, especially as you get older.  If you have been sedentary, gradually build up the amount of exercise and do something you enjoy.  If you have a chronic health problem or a family history of heart disease, talk with your doctor before beginning a new physical activity program.

The DASH Diet (Dietary Approaches to Stop Hypertension) issued by the U.S. Dept. of Health and Human Services, National Institutes of Health, National Heart, Lung, and Blood Institute (NHLBI) is proven to lower blood pressure.  The DASH Diet emphasizes fruits (4-6/day, depending on body weight), vegetables (3-6 servings/day), nuts (approximately a handful of nuts most days of the week) and fat-reduced milk products, and includes whole grain products, fish and poultry.  The diet is low in saturated fat (6%), cholesterol (150 mg), and total fat (27%) and is lower in lean meat, sweets, added sugars, and sugar-containing beverages than the typical American diet.  The eating plan is rich in potassium, magnesium, calcium, protein and fiber.  Studies conducted by scientists supported by the National Heart, Lung, and Blood Institute (NHLBI) and performed at 4 major medical centers found that the DASH Diet significantly reduces blood pressure.  The results were dramatic and fast, achieving reduced blood pressure within 2 weeks.  Even a modified plan that just added more fruits and vegetables to a typical American diet reduced blood pressure.  Another benefit of eating the DASH eating plan is that it reduces (bad) LDL cholesterol, further reducing your risk for cardiovascular disease.  You should be aware that since the DASH eating plan has more daily servings of fruits, vegetables, and whole grain foods than you may be used to eating and is high in fiber, it can cause bloating and diarrhea in some persons.  To avoid these problems, gradually increase your intake of fruit, vegetables, and whole grain foods.

While the studies show that eating the DASH Diet lowers blood pressure, the combination of the eating plan and a reduced sodium intake gives the biggest benefit and may help prevent the development of high blood pressure.  The highest level of sodium intake considered acceptable by the National High Blood Pressure Education Program and U.S. Dietary Guidelines for Americans is 2300 milligrams (the equivalent of 1 tsp. of table salt, or sodium chloride).  The 2010 Dietary Guidelines for Americans recommends that sodium intake be reduced to 1,500 mg (2/3 tsp. of table salt) among persons who are 51 and older and those of any age who are African American or have hypertension, diabetes, or chronic kidney disease.  The 1,500 recommendation applies to about half of the U.S. population overall and the majority of adults and is the amount recommended by the Institute of Medicine as an adequate intake level and one that most people should try to achieve.  Adult men in the U.S. currently eat about 3,100 - 4,200 mg/day (that's 2-3x the recommendation!).  Adult women in the U.S. eat about 2,500- 3,000 mg/day.  Furthermore, the average daily sodium intake for Americans age 2 years and older is 3,436 mg.  Only a small amount of salt that we consume comes from the salt added at the table, and only small amounts of sodium occur naturally in food.  Processed foods account for most of the sodium Americans consume so read food labels--you may be surprised to find which foods have sodium.  For example, which McDonald’s product has more sodium—the french fries, vanilla shake or apple pie?  The 16-oz. vanilla McCafe shake (200 mg) and the apple pie (170 mg) both have more sodium than the small french fries (160 mg)!  It tastes like there is more sodium in the french fries because the salt is on the surface.

The DASH eating plan also emphasizes potassium from fruits and vegetables.  A potassium-rich diet helps reduce elevated blood pressure, but be sure to get your potassium from food sources not from supplements. Many fruits and vegetables, some milk products, and fish are rich sources of potassium.  While salt substitutes containing potassium are sometimes needed by persons on drug therapy for high blood pressure, these supplements can be harmful to people with certain medical conditions.  People who have kidney problems or who take certain medicines must be careful about how much potassium they consume.  If this is you, before you increase the potassium in your diet or use salt substitutes which contain potassium, check with your doctor.

The hypertension-reducing DASH Diet is similar to the health-supporting Mediterranean Diet and the metabolic syndrome-preventing Syndrome X Diet discussed in previous blog entries.  All are based on the same idea--more plant, less animal food.  While they approach the healthy diet from different perspectives (reducing hypertension, a healthy culture, resolving metabolic syndrome) they really are all quite similar in composition.  The good news is there is not one diet for heart disease, one diet for cancer, one diet for diabetes, etc.  A healthy diet has significant impact on our overall health, and all of the public health organizations reflect that truth in their dietary recommendations.  The American Heart Association, National Cancer Institute, American Diabetes Association, Dietary Guidelines for Americans and others have always had variable but similar recommendations, but in recent years they have all become the same: eat a plant-based monounsaturated fat-rich diet based on whole grains, beans, nuts and seeds, fruits and vegetables with small portions of lean meat, poultry and dairy, generous amounts of fish (3-4x/week) and olive oil to prevent cardiovascular disease, cancer, diabetes, hypertension, intestinal disease and more.  What always has been, still is, and always will be an optimal diet.  It is not going to change—it is only our rather limited understanding that has been changing over the years.  

Changing your lifestyle is a process—be gentle with yourself and don’t let slip-backs deter you from your long-term goal.  Take it in small steps—perhaps add one fruit or vegetable each day for the first week, then a second fruit or vegetable each day for the second week, and so on. 

Important note:  If you take medication to control high blood pressure, do not stop using it.  Follow the DASH eating plan and talk with your doctor about your medication treatment—it will very likely need to be adjusted, soon!

Thank you for sharing this post with others who might benefit from the information shared herein.  Please contact me if you are interested in hosting a 10-week  N.E.W. LIFE program on Long Island.

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