DASH
Robert Russell, M.D., and Marjorie McCullough, Sc.D., R.D.
Dr. McCullough reports no commercial conflict of interest.
In our recent Cyberounds®, Dr. Paolo Suter and I
discussed the role of nutrition and hypertension. In that discussion,
DASH diet was referred to as a proven means to control hypertension
in many individuals. Since that Cyberounds®, there
have been many questions with regard to the DASH diet, for example,
"what is it?" and "how does one follow it?" Marjorie McCullough,
Sc.D., R.D., was one of the original investigators involved in the
DASH diet study and is my guest today.
Russell
Marjorie, in a brief paragraph, can you explain the DASH diet to
Cyberounds® participants?
McCullough
The "DASH diet" has become a well-known phrase among both health
professionals and the public. DASH, which stands for
Dietary Approaches to Stop Hypertension, was a multi-center feeding
study funded by the National Heart, Lung and Blood Institute (NHLBI)
of the National Institutes of Health (NIH). The purpose of DASH was
to identify whether certain overall diet patterns would lower blood
pressure.
Participants in the DASH study either had blood pressure in the
high-normal range, or mild hypertension. After following a 3-week
control diet designed to mimic a "typical American" intake,
participants were randomly assigned to follow one of three diets for
the next eight weeks: the control diet, a "fruits and vegetables
diet" similar to the control diet but higher in fruits and
vegetables, or the "combination diet," also referred to as the "DASH"
diet. The combination diet was similar to the fruit and vegetable
intervention diet but it was also low in fat and saturated fat yet
higher in low fat dairy products.
The interventions were specifically designed not to vary in sodium
content; alcohol, weight and physical activity levels were kept
constant. The DASH diet significantly lowered blood pressure in all
groups studied: young/old, African-American/Caucasian, normotensive
and hypertensive. The strongest effect was observed in those with
and hypertensive. The strongest effect was observed in those with
hypertension: systolic and diastolic blood pressure dropped an
average of 11.4/5.5 mm Hg -- similar to the effects of taking one
antihypertensive medication.
Those wishing to learn more about the DASH study are referred to
the original study results and the following figures:
Following the Dash Diet
The DASH eating plan shown below is based on 2,000 calories a day. The
number of daily servings in a food group may vary from those listed
depending on your caloric needs.
Use this chart to help you plan your menus or take it with you when you go
to the store.
| Food Group |
Daily Servings (except as noted) |
Serving Sizes |
Examples and Notes |
Significance of Each Food Group to the DASH Eating Plan |
| Grains & grain products |
7-8 |
1 slice bread; 1 cup dry cereal*; 1/2 cup cooked rice, pasta, cereal |
whole wheat bread, English muffin, pita bread, bagel, cereals, grits, oatmeal, crackers, unsalted pretzels and popcorn |
major sources of energy and fiber |
| Vegetables |
4-5 |
1 cup raw leafy vegetable; 1/2 cup cooked vegetable; 6 oz vegetable juice |
tomatoes, potatoes, carrots, green peas, squash, broccoli, turnip greens, collards, kale, spinach, artichokes, green beans, lima beans, sweet potatoes |
rich sources of potassium, magnesium, and fiber |
| Fruits |
4-5 |
6 oz fruit juice; 1 medium fruit; 1/4 cup dried fruit; 1/2 cup fresh, frozen or canned fruit |
apricots, bananas, dates, grapes, oranges, orange juice, grapefruit, grapefruit juice, mangoes, melons, peaches, pineapples, prunes, raisins, strawberries, tangerines |
important sources of potassium, magnesium, and fiber |
| Lowfat or fat free dairy foods |
2-3 |
8 oz milk; 1 cup yogurt; 1 1/2 oz cheese |
fat free (skim) or lowfat (1%) milk, fat free or lowfat buttermilk, fat free or lowfat regular or frozen yogurt, lowfat and fat free cheese |
major sources of calcium and protein |
| Meats, poultry, and fish |
2 or less |
3 oz cooked meats, poultry, or fish |
select only lean; trim away visible fats; broil, roast, or oil, instead of frying; remove skin from poultry |
rich sources of protein and magnesium |
| Nuts, seeds, and dry beans |
4-5 per week |
1/3 cup or 1 1/2 oz nuts; 2 Tbsp or 1/2 oz seeds; 1/2 cup cooked dry beans |
almonds, filberts, mixed nuts, peanuts, walnuts, sunflower seeds, kidney beans, lentils and peas |
rich sources of energy, magnesium, potassium, protein, and fiber |
| Fats & oils** |
2-3 |
1 tsp soft margarine; 1 Tbsp lowfat mayonnaise; 2 Tbsp light salad dressing; 1 tsp vegetable oil |
soft margarine, lowfat mayonnaise, light salad dressing, vegetable oil (such as olive, corn, canola or safflower) |
besides fats added to foods, remember to choose foods that contain less fat |
| Sweets |
5 per week |
1 Tbsp sugar; 1 Tbsp jelly or jam; 1/2 oz jelly beans; 8 oz lemonade |
maple syrup, sugar, jelly, jam, fruit-flavored gelatin, jelly beans, hard candy, fruit punch, sorbet, ices |
sweets should be low in fat |
* serving sizes vary between 1/2-1 1/4 cups. Check the product's nutrition label.
** fat content changes serving counts for fats and oils: For
example, 1 Tbsp of regular salad dressing equals 1 serving; 1 Tbsp of
lowfat dressing equals 1/2 serving; 1 Tbsp of a fat free dressing equals 0
servings.
Reprinted from NHLBI, NIH Publication no. 98-4082; Sept 1998.
Getting Started
It's easy to adopt the DASH eating diet. Here are some ways to get
started:
Change gradually.
- If you now eat one or two vegetables a day, add a serving at lunch and another at dinner.
- If you don't eat fruit now or have only juice at breakfast, add a serving to your meals or have it as a snack.
- Use only half the butter, margarine, or salad dressing you do now.
- Try lowfat or fat free condiments, such as fat free salad dressings.
- Gradually increase dairy products to three servings per day. For example, drink milk with lunch or dinner, instead of soda, alcohol, or
sugar-sweetened tea. Choose lowfat (1 percent) or fat free (skim) dairy products to reduce total fat intake.
Treat meat as one part of the whole meal, instead of the focus.
- Buy less meat. If it's not there, you won't eat it.
- Limit meat to 6 ounces a day (two servings) -- all that's needed. Three to four ounces is about the size of a deck of cards.
- If you now eat large portions of meat, cut them back gradually -- a half or a third at each meal.
- Include two or more vegetarian-style (meatless) meals each week.
- Increase servings of vegetables, rice, pasta, and dry beans in meals. Try casseroles and pasta, and stir-fry dishes, having less meat and more
vegetales, grains, and dry beans.
Use fruits or lowfat foods as desserts and snacks.
- Fruits and lowfat foods offer great taste and variety. Use fruits canned in their own juice. Fresh fruits require little or no preparation.
Dried fruits are easy to carry with you.
- Try these snack ideas: unsalted pretzels or nuts mixed with raisins; graham crackers; lowfat and fat free yogurt and frozen yogurt; plain
popcorn with no salt or butter added; and raw vegetables.
Sample Menus from the DASH Diet
Here are two sample menus from the DASH eating plan. The menus are based
on 2,000 calories a day -- serving sizes should be increased or decreased
for other caloric levels. Also, to ease the calculations, some of the
serving sizes have been rounded off.
Day 1
| Food |
Amount |
Servings Provided |
|
|
Grains |
Vegetables |
Fruits |
Dairy foods |
Meat, poultry, & fish |
Nuts, seeds, & dry beans |
Fats and oils |
Sweets |
| Breakfast |
| apple juice |
1 cup |
|
|
1/2 |
|
|
|
|
|
| bran cereal; ready-to-eat |
2/3 cup |
1 |
|
|
|
|
|
|
| raisins |
2 Tbsp |
|
|
1/2 |
|
|
|
|
|
| fat free milk |
1 cup |
|
|
|
1 |
|
|
|
|
| whole wheat bread |
1 slice |
1 |
|
|
|
|
|
|
|
| soft margarine |
1 1/2 tsp |
|
|
|
|
|
|
1 1/2 |
|
| Lunch |
| chicken sandwich: |
|
| chicken breast, no skin |
3 oz |
|
|
|
|
1 |
|
|
|
| American cheese, reduced fat |
2 slices (1 1/2 oz) |
|
|
|
1 |
|
|
|
|
| loose leaf lettuce |
2 large leaves |
|
1/2 |
|
|
|
|
|
|
| tomato |
2 slices (1/4" thick) |
|
1/2 |
|
|
|
|
|
|
| light mayonnaise |
1 Tbsp |
|
|
|
|
|
|
1 |
|
| whole wheat bread |
2 slices |
2 |
|
|
|
|
|
|
|
| apple |
1 medium |
|
|
1 |
|
|
|
|
|
| Dinner |
| vegetarian spaghetti sauce |
3/4 cup |
|
1 1/2 |
|
|
|
|
|
|
| spaghetti |
1 cup |
2 |
|
|
|
|
|
|
|
| Parmesan cheese |
4 Tbsp |
|
|
|
1 |
|
|
|
|
| green beans |
1/2 cup |
|
1 |
|
|
|
|
|
|
| spinach salad: |
|
| spinach, raw |
1 cup |
|
1 |
|
|
|
|
|
|
| mushrooms, raw |
1/4 cup |
|
1/4 cup |
|
|
|
|
|
|
| croutons |
2 Tbsp |
1/4 cup |
|
|
|
|
|
|
|
| Italian dressing, lowfat |
2 Tbsp |
|
|
|
|
|
|
1 |
|
| dinner roll |
1 medium |
1 |
|
|
|
|
|
|
|
| frozen yogurt, lowfat |
1/2 cup |
|
|
|
1/2 |
|
|
|
|
| Snack |
| orange juice |
1 cup |
|
|
1 1/2 |
|
|
|
|
|
| banana |
1 large |
|
|
1 1/2 |
|
|
|
|
|
| Totals
| 7 1/4 |
4 3/4 |
6 |
3 1/2 |
1 |
0 |
3 1/2 |
0 |
| Per Day: |
| Calories |
1,995 mg |
Magnesium |
458 mg |
| Total Fat |
50 gm |
Potassium |
4,254 mg |
| Saturated Fat |
15 gm |
Calcium |
1,384 mg |
| Cholesterol |
124 mg |
Sodium |
3,127 mg |
Day 2
| Food |
Amount |
Servings Provided |
|
|
Grains |
Vegetables |
Fruits |
Dairy foods |
Meat, poultry, & fish |
Nuts, seeds, & dry beans |
Fats and oils |
Sweets |
| Breakfast |
| orange juice |
1 cup |
|
|
1 1/2 |
|
|
|
|
|
| yogurt, fat free |
1 cup |
|
|
|
1 |
|
|
|
|
| fruit granola bars, lowfat |
2 |
2 |
|
|
|
|
|
|
|
| fat free milk |
1 cup |
|
|
|
1 |
|
|
|
|
| banana |
1 small |
|
|
1/2 |
|
|
|
|
|
| Lunch |
| turkey sandwich: |
|
| turkey breast |
3 oz |
|
|
|
|
1 |
|
|
|
| loose leaf lettuce |
1 leaf |
|
1/4 |
|
|
|
|
|
|
| tomato |
2 slices (1/4" thick |
|
1/2 |
|
|
|
|
|
|
| light mayonnaise |
1 Tbsp |
|
|
|
|
|
|
1 |
|
| whole wheat bread |
2 slices |
2 |
|
|
|
|
|
|
|
| carrots |
7 sticks |
|
1/4 |
|
|
|
|
|
|
| orange, fresh |
1 medium |
|
|
1 |
|
|
|
|
|
| Dinner |
| spicy baked fish |
3 oz |
|
|
|
|
1 |
|
|
|
| brown rice |
1 cup |
2 |
|
|
|
|
|
|
|
| spinach, cooked |
1 cup |
|
2 |
|
|
|
|
|
|
| zucchini, cooked |
1/2 cup |
|
1 |
|
|
|
|
|
|
| dinner roll |
1 medium |
1 |
|
|
|
|
|
|
|
| soft margarine |
2 tsp |
|
|
|
|
|
|
|
2 |
| fat free milk |
1/2 cup |
|
|
|
1/2 |
|
|
|
|
| melon balls |
1 cup |
|
|
2 |
|
|
|
|
|
| Snacks |
| peanuts |
1/4 cup (1 oz) |
|
|
|
|
|
3/4 |
|
|
| apricots, dried |
1/3 cup (1 1/2 oz) |
|
|
1 1/2 |
|
|
|
|
|
| Totals
| 7 |
4 |
6 1/2 |
2 1/2 |
2 |
3/4 |
3 3/4 |
0 |
| Per Day: |
| Calories |
2,028 mg |
Magnesium |
575 mg |
| Total Fat |
51 gm |
Potassium |
5,265 mg |
| Saturated Fat |
9 gm |
Calcium |
1,364 mg |
| Cholesterol |
115 mg |
Sodium |
2,411 mg |
|