DASH diet: Healthy eating to lower your blood pressure

The DASH diet emphasizes the right portion sizes, variety of foods and 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 plan was developed to lower blood
pressure without medication in research sponsored by the National Institutes of Health.

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, the
top number of your blood pressure (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, trans fat 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 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% whole grain" or "100% 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 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 and 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 — 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 add interesting texture to
recipes and contain healthy nutrients and fiber.
 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 one-ounce 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 one-ounce
servings a day. Cutting back on your meat portion will allow room for more vegetables.

Examples of one serving include 1 egg or 1 ounce of cooked meat, poultry or fish.

 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
are healthy for your heart.

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 only a few times a week because these foods are higher in calories.

Examples of one serving include 1/3 cup nuts, 2 tablespoons seeds or nut butter, 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. Nuts are 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 foods 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 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 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 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.
 Reward successes and forgive slip-ups. Reward yourself with a nonfood 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.
Low-carbohydrate diets have fallen in and out of favor since before the days of Atkins. But now an even stricter
version of low-carb eating called the ketogenic diet is gaining popular attention, igniting a fierce scientific debate
about its potential risks and benefits.

Both the Atkins and ketogenic diets encourage followers to cut carbs from their diets. But while the Atkins diet
gradually increases carbs over time, keto places firm limits on carbs and protein. This way of eating depletes the
body of glucose, forcing it to primarily burn fat and produce an alternate source of fuel called ketones. A typical
ketogenic diet restricts carbs to less than 10 percent of calories and limits protein to 20 percent, while fat makes
up the rest.
The keto diet has been popularized in best-selling books, promoted by celebrities and touted on social media as
an antidote to various ailments. Proponents say it causes substantial weight loss and can help those with Type 2
diabetes dramatically improve their blood sugar levels, which fall when people avoid carbs.
There have been many studies of the ketogenic diet over the years, but most have been small and of fairly short
duration. A federal registry of clinical research shows that more than 70 trials looking at the diet’s impact on
brain, cardiovascular and metabolic health are either underway or in the beginning stages.

Dr. Ethan Weiss, a researcher and preventive cardiologist at the University of California, San Francisco, had
long been skeptical of low-carb diets but decided to experiment with the ketogenic diet a couple years ago. In a
typical day he skips breakfast and eats mostly salads, nuts, cheese, roasted vegetables and grilled chicken, fish or
tofu, as well as dark chocolate for dessert. The result, he says: He lost 20 pounds and had to buy a new wardrobe.

“I haven’t felt this good since I was in high school,” he said.

Dr. Weiss subsequently started a company and a weight loss app with a former Weight Watchers vice president,
raised $2.5 million from a group of Silicon Valley investors and started selling a $99 pen-size breathalyzer
device, called Keyto, that allows users to measure their ketone levels and track how the diet is working for them.

“Our mission is to make doing this diet easier and more sustainable so people can make changes that allow them
to lead a healthier lifestyle,” he said.

But the ketogenic diet has no shortage of detractors. Some doctors and health experts say it can lead to quick
weight loss but that it is no more effective than other diets in the long term. And many say they find it worrisome
because it encourages foods high in saturated fat, which have been linked to heart disease, while restricting
nutrient-rich foods supported by decades of research, like beans, fruits, starchy vegetables and whole grains.

Last month, three doctors published an essay in JAMA Internal Medicine cautioning that the enthusiasm for the
diet as a treatment for obesity and diabetes “outpaces” the evidence. They pointed to studies suggesting that it
had little advantage over lower fat diets for blood sugar control, and that it could cause adverse effects like
constipation, fatigue and, in some people, an increase in LDL cholesterol particles, a risk factor for heart disease.

“The greatest risk, however, of the ketogenic diet may be the one most overlooked: the opportunity cost of not
eating high-fiber, unrefined carbohydrates,” the authors wrote. “Whole grains, fruits and legumes are some of the
most health-promoting foods on the planet. They are not responsible for the epidemics of Type 2 diabetes or
obesity, and their avoidance may do harm.”

Dr. Shivam Joshi, a co-author of the piece, said it generated a flood of emails from people across the globe.
Some expressed praise and support, while others offered condemnation, a sign of just how polarizing the diet can
be, said Dr. Joshi, an attending physician at NYC Health + Hospitals/Bellevue and a clinical assistant professor
at New York University medical school.

“It’s a hot-button issue, and this paper struck a chord,” he added.

While the ketogenic diet can seem like the latest in an endless stream of fad diets, it has a long history of
therapeutic uses. Diabetics routinely practiced carb restriction before the discovery of insulin in the 1920s, and
doctors at Johns Hopkins and other hospitals have used the diet for almost a century to reduce seizures in
patients with epilepsy.
One of the benefits of carb restriction is that blood sugar levels remain stable after a meal, resulting in lower
levels of insulin, a hormone that causes weight gain, said Dr. David Ludwig, an endocrinologist at Harvard
Medical School and the author of a best-selling book on low-carb diets.

“Insulin is like a Miracle-Gro for fat cells,” he said. “By lowering insulin levels, fewer calories from the meal
may get stored in fat cells, leaving more to fuel metabolism and feed the brain. As a result, you may feel fuller
longer after eating.”

In a series of studies over the years, Dr. Ludwig has found that low carb diets cause people to burn more calories
and lose more weight compared to lower fat diets. According to the carb and insulin theory of obesity, whole
grains, starchy vegetables and tropical fruits are more healthful than processed carbs. But they can still cause
swings in blood sugar and insulin after a meal, and that can be particularly problematic for people with diabetes,
said Dr. Ludwig.
In May, the American Diabetes Association published a consensus statement on nutrition strategies for people
with diabetes. It found that a variety of diets rich in unprocessed foods, like the Mediterranean and vegetarian
diets, could help people prevent and manage the disease. But it also concluded that reducing overall carb intake
“has demonstrated the most evidence” for improving blood sugar control.

“Carbohydrate is the macronutrient that most contributes to your blood sugar, and so it makes sense that
reducing it is going to give you the biggest bang for your buck,” said the lead author of the report, Dr. William S.
Yancy, Jr., an associate professor at Duke medical school and the director of the Duke Diet and Fitness Center.

But the carb and insulin explanation for obesity is the subject of much debate. Scientists at the National Institutes
of Health have published research showing that people actually burn more calories on low-fat diets, and many
experts contend that in the end, people will lose weight on any diet so long as they consume fewer calories.

Ultimately it is hard to reach definitive answers on any diet because nutrition studies tend to be short-term and
not very rigorous, and there is tremendous variation in how people respond to different diets, said Dr. Steven B.
Heymsfield, the president of the Obesity Society and the director of the Body Composition-Metabolism
Laboratory at the Pennington Biomedical Research Center in Baton Rouge, La. Studies show that while some
people who adopt a very low-carb diet experience a significant increase in their LDL cholesterol levels, for
example, others see little or no change at all.

Dr. Heymsfield said he recommends a few things to people who try the ketogenic diet. He suggests limiting
foods high in saturated fat like butter, meat and cheese and focusing on foods with unsaturated fats like olive oil,
seafood, nuts, chicken and avocado. Consult a dietitian or doctor for their guidance, he said, and ask yourself if
you are willing to commit to the diet for the long term.

“You have to set down a lifestyle and a healthy eating plan that you think you can adhere to for the rest of your
life, because these things only work while you’re doing them,” he said.
 MEDITERRANEAN DIET BETTER THAN EXERCISE AT PREVENTING HEART DISEASE,
REGARDLESS OF YOUR AGE OR GENDER, STUDY FINDS

By Antonia Molloy

Scientists at Harokopio University in Athens are the first to track heart disease in a general population
You've heard the evidence before but one can never be too sure – yet another study has shown that
adopting a Mediterranean diet is good for your health.

Filling up on oily fish, nuts, whole grains and fruit and vegetables – and even the odd glass of red wine
– could cut your risk of developing heart disease by almost half over a 10-year period.

Scientists at Harokopio University in Athens found that the benefits even outweigh those of regular
exercise - and it doesn't matter whether you're a man or a woman, old or young.
The study, which will be presented at the American College of Cardiology's 64th Annual Scientific
Session in San Diego later this month, reinforces previous research.

But it is also the first of its kind, in that it tracked heart disease risk in a general population. Most other
studies have focused on middle-aged people.

Ekavi Georgousopoulou, a PhD candidate, who conducted the study along with Professor
Demosthenes B Panagiotakos, said: "Our study shows that the Mediterranean diet is a beneficial
intervention for all types of people - in both genders, in all age groups, and in both healthy people and
those with health conditions.

"It also reveals that the Mediterranean diet has direct benefits for heart health, in addition to its
indirect benefits in managing diabetes, hypertension and inflammation."

More than 2,500 Greek adults, aged 18 to 89, provided researchers with details about their health each
year from 2001 to 2012. The participants also completed comprehensive surveys about their medical
records lifestyle and dietary habits three times throughout the study: at the start, after five years and
after 10 years.

Additionally the researchers scored the participants' diets on a scale of 1 to 55, according to their
intake of the 11 food groups.

During the decade almost a fifth (20 per cent) of the men and 12 per cent of the women who took part
in the study developed or died from heart disease.

Overall, those who most closely adhered to a Mediterranean-style diet (participants that scored in the
top-third on the scale) were found to be 47 per cent less likely to develop heart disease than those who
did not (participants that scored in the bottom-third on the scale). Each one-point increase represented
a three per cent drop in heart disease risk.

This figure was the same regardless of other risk factors such as age, gender, family history and
smoking habits, all of which the researchers accounted for.

The results of the study also bolster previous research showing that being male, older, and having
diabetes or high C-reactive protein levels - a measure of inflammation - are increased risk factors for
developing heart disease.

"Because the Mediterranean diet is based on food groups that are quite common or easy to find, people
around the world could easily adopt this dietary pattern and help protect themselves against heart
disease with very little cost," Georgousopoulou said.
According to the study, women are more likely to adopt a Mediterranean diet than men.
Georgousopoulou also pointed out that although Greece is in the Mediterranean, may Greeks have
adopted a more Western diet - also known as the meat-sweet diet - over the past 40 years. This diet
includes large amounts of red meat, sugary desserts, high-fat foods, and refined grains.