DASHing down your blood pressure: a diet you can LIVE with!

Kathryn Kolasa, PhD, RD, LDN, Professor, Family Medicine, East Carolina University, Greenville, North Carolina comments on the DASH diet. Kathryn serves as Society for Nutrition Education representative on the National High Blood Pressure Education Program Coordinating Committee.Media reports these days are filled with advice about adding or restricting a single nutrient or food to keep blood pressure in tow. The DASH (Dietary Approaches to Stop Hypertension) research study, funded by NHLBI, took a different approach by examining a whole dietary pattern. The outcome of the research, published in the April 1997 New England Journal of Medicine (336:1117), made headlines. The New York Times called it “the anti-hypertension diet you can live with, in every sense of the word.”The DASH diet is rich in fruits, vegetables and lowfat dairy products while being low in total fat and saturated fat. It is not vegetarian nor does it use specialty foods containing fat substitutes.It can reduce blood pressure to the same extent as a single antihypertensive medication, without requiring weight loss or a reduction in sodium intake. Results can be expected in about 2 weeks.The DASH combination diet, does specify serving sizes from the specific food groups. A 2,000 calorie diet would be made up of 7-8 daily servings of grain and grain products, 4-5 daily servings of vegetables, 4-5 daily servings of fruit,  2 or fewer daily servings of nonfat dairy foods, 2 or fewer daily servings of meats, poultry, and fish, 4-5 weekly servings of nuts, seeds and legumes. Added fats are limited to 2.5 servings per day while sweets are limited to 1 serving per day.Although salt reduction wasn’t tested, the DASH researchers recommend no more than 2,400 mg. of  sodium (1 teaspoon table salt) per day.The initial reaction from my patients is that I’ve suggested that they eat a lot of fruits and vegetables. They are right. (This equates to 2-3 servings of fruits and vegetables per meal.) This is about double the amount of fruits and vegetables most Americans eat. Additionally,  I introduce lactose-free dairy products and enzyme products  to patients with lactose intolerance in order to follow DASH.The Joint National Committee in Prevention, Detection, Evaluation and Treatment of High Blood Pressure is expected to issue its sixth report (JNC VI) in November 1997. The DASH diet is included in its appendix. Generally, life-style modification is recommended for individuals with high-normal or high blood pressure as well as all patients on drug therapy. Weight reduction, moderation of alcohol intake, moderation of sodium intake and increased physical activity are all thought to be efficacious and safe.Visit the DASH web site at http://dash.bwh.harvard.edu/ or call 800-575-WELL.Tips on eating the DASH way:• Center your meal around carbohydrates, such as pasta, rice, beans, or vegetables.• Treat meat as one part of the whole meal, instead of the focus.• Increase the number of fruits and vegetables you eat each day, for meals and snacks.• Use fruits for desserts.• If you use the DASH diet to help prevent or control high blood pressure, make it part of a life-style that includes: choosing foods lower in sodium, keeping a healthy weight, being physically active and drinking alcohol in moderation or not at all.• Consult your doctor before making any dietary changes if you are currently on medication for hypertension.