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DASH diet: go for a slow DASH. But go now.

The DASH diet is an approach to healthy eating specifically developed as part of a study to find ways to lower blood pressure without medication. Study organizers aimed to take the best elements of vegetarian diets, which were known to be associated with lower blood pressure, and design a plan that would be appealing enough to the majority of Americans. The end result is an eating plan that’s high in dietary fiber, moderate in total fat and protein, and low on bad fats and sodium that has, on successive studies, been shown to reduce blood pressure and lower bad (LDL) cholesterol. 

The first DASH trial showed that a two month diet plan rich in fruit, vegetables, low-fat dairy foods and with reduced saturated and total fat can substantially lower blood pressure compared to a typical American diet.  A follow up study found that the DASH diet and sodium reduction  (of less than 2,300 mg/day) may be more effective in combination. As compared with the control diet with a high sodium level, low sodium DASH diet led to an average systolic blood pressure that was 11.5 mm Hg lower in participants with hypertension. In an individual, that’s almost the equivalent of taking a medication to lower blood pressure. A panacea through dietary changes!

Accordingly, since the seminal study was published in 1997 (and the follow up study in 2001), doctors and nutritionists have been enticing patients with handouts promoting low sodium DASH. The pamphlets generally feature fruits, alongside heapings of fresh vegetables, whole grains, a few low fat dairy products, with splattering of lean meats, garnished with legumes, seeds, and nuts. Pamphlet in hand, and the hope of weaning a few blood pressure medications, many patients leave with resolve and a plan for dietary changes. Few, however, stick to the DASH diet.

Despite the known benefits of the DASH diet, adherence in the general population has been limited. A study of over 4000 hypertensive patients’ diets, found that less than 20% of subjects followed the DASH dietary plan. For many Americans who grew up thinking that fruit only comes in foil labeled with “Roll-Ups” and Doritos as a major food group, eating a low sodium diet rich in fruits, vegetables, and whole grains is incredibly hard. Our brains have been trained to perceive only certain food groups (particularly those high in sugar, salt, and fats) as delicious. It’s almost unfathomable to think of fresh fruits, vegetables, whole grains, lean meats flavored by herbs and spices as delicious. But it can be. This healthy approach to eating takes time to make it palatable, even delicious. There are many inventive DASH recipes publicly available. But go too fast, and the attempt at DASH will likely fail.

Consider the Slow DASH approach:

  • Decrease salt consumption gradually. 

    • Reduce daily salt consumption by 15% every 3-4 months. The goal here is to eventually meet total sodium consumption of less than 2,300mg per day (or lower) without your taste receptors taking much notice. 

  • Herbs are your friend

    • Highlight your meals with aromas from fresh herbs

  • Spice up your life

    • Let spices fill the void that the lack of salt left behind. 

  • Introduce increased servings of fruit and vegetables slowly.

    • Increasing fiber into your diet too quickly can make us feel bloated. If you now eat one or two servings of vegetables a day, add a serving at lunch. In the following week or so, add another serving at dinner. Aim to fill half your plate with fresh vegetables and fruit. 

  • Cut out the fat in dairy products… over time. 

    • If you drink whole milk, take a stepwise approach (whole→ reduced fat→ low fat→ fat free) to fat-free dairy.

  • Vary your proteins

    • Choose lean cuts of meat

    • Serve fish instead of meat or poultry once or twice a week

    • Include two or more vegetarian meals each week

The DASH diet is an excellent dietary plan especially for those with hypertension. DASH slowly for a sustainable, healthier life.

DASH diet infographic. DASH diet requires sodium reduction of less than 2,300 mg/day. This is a heart-healthy diet with a focus on blood pressure control


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