Almost 30 Years Later, the Benefits of the DASH Diet are Still Strong

Believe it or not, the DASH diet (Dietary Approaches to Stop Hypertension) is nearly 3 decades old! Initial research began in August of 1993 and studies continue to highlight the benefits of this heart-healthy style of eating.

A DASH diet is heavily plant-based, advising up to 10 servings of fruits and vegetables daily. The diet also encourages high-magnesium and high-calcium foods as well as restrictions in sodium and saturated fat.

New research suggests that there are even more benefits to the DASH diet when accompanied by sodium restrictions. The study published in the Journal of the American College of Cardiology used a controlled feeding study to evaluate the impact of the diet on biomarkers of cardiac injury, inflammation and strain.

Adult subjects with high blood pressure were assigned to either the DASH diet or a control diet with varying levels of sodium consumed for 4 weeks. Body weight did not change and a 2100 calorie diet was utilized. 

Levels of sodium in the diet were dubbed low (50 mmol/day), medium (100 mmol/day) and high (150 mmol/day). Observed outcomes included 3 cardiac biomarkers: high-sensitivity cardiac troponin I (hs-cTNI)- a measure of cardiac injury, N-terminal pro-B-type natriuretic peptide (NT-proBNP) (measure of strain), and measure of inflammation using C-reactive protein. Each was collected at baseline and at the close of each period.

The average age in the group of 412 subjects was 48. Of this, 56% were women and 56% were African American. Average blood pressure at baseline was 135/86.

The DASH diet, when compared to the control diet, lowered hs-cTnI by 18% and hs-CRP by 13% but not NT-proBNP. Reducing sodium from high to low amounts lowered NT-proBNP regardless of diet. It did not change hs-cTnI and mildly increased hs-CRP.

Including a sodium restriction with DASH lowered hs-cTnI by 20% and NT-proBNP by 23% although hs-CRP was not really changed (?7%;) when compared with the high sodium-control diet.

The authors concluded that including a sodium restriction along with a DASH diet can reduce 2 important subclinical indicators of cardiac damage: injury and strain. DASH by itself lowered inflammation, which also impacts risk of cardiovascular disease.

Clinicians should continue to encourage a DASH style of eating for their clients with hypertension. The guideline for those with high blood pressure, African Americans, those over the age of 50 or anyone with a cardiac history, kidney disease, or diabetes is 1500 mg of sodium per day or less.

Below are some ways to reduce sodium intake as much as possible.

  • Avoid processed meats, fast food, frozen meals, carry out food, snacks, chips, and other high-sodium foods.
  • Read labels for sodium content. Don't miss MSG, sodium citrate, sodium nitrate, etc.
  • Use fresh or frozen vegetables packed without added marinades, sauces, or dressings.
  • Avoid high-sodium sauces such as soy, teriyaki, BBQ, and ketchup.
  • Flavor food with a variety of herbs, spices, and aromatic vegetables.
  • Use plain grains in place of the seasoned grains found in boxed mixes or frozen foods.
  • Taste food before salting.

By Lisa Andrews, MEd, RD, LD

Reference:

Stephen P. Juraschek, MD, PhD Lara C. Kovell, MD Lawrence J. Appel, MD, MPH Edgar R. Miller, III, MD, PhD Frank M. Sacks, MD Alex R. Chang, MD, MHS Robert H. Christenson, PhD Heather Rebuck, MS Kenneth J. Mukamal, MD, MPH, MA Effects of Diet and Sodium Reduction on Cardiac Injury, Strain, and Inflammation: The DASH-Sodium Trial. J Am Coll Cardiol. 2021 Jun, 77 (21) 2625–2634

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