DASHing to Lower Blood Pressureby J. Anderson, S. Prior, D. Braithwaite, and B. Sherman1
- DASH stands for Dietary Approaches to Stop Hypertension.
- The DASH Eating Plan is rich in fruits, vegetables, and whole grains and focuses on consuming low-fat and fat-free dairy products, along with nuts, seeds, dry beans, and limited amounts of lean meats, poultry, and fish.
- Compared to the typical American diet, the DASH Eating Plan is lower
in saturated fat, cholesterol, and total fat and higher in potassium,
magnesium, calcium, fiber, and protein.
The DASH Eating Plan has been shown to be effective for the prevention
and management of hypertension. Hypertension is a clinical term used for
high blood pressure. Even if a person does not have hypertension at the
age 55, they have a 90 percent lifetime risk of developing the condition
at some point in their life. This silent killer, which often
lacks overt symptoms, can increase the risk for heart disease, stroke,
kidney disease, and blindness.
Often, hypertension, a chronic disease, is treated with prescription
medications. However, diet and lifestyle changes can significantly reduce
blood pressure. Research shows that in some individuals, the DASH Eating
Plan may reduce blood pressure as much or more than prescribed drugs (See
fact sheet 9.318,
Diet and Hypertension). The DASH Eating Plan, in combination
with a sodium restricted diet (1500mg/day), can produce even greater results
in lowering blood pressure. This is great news, especially considering
that diet is a safer alternative to medication, and also costs less!
As you may notice, the DASH Eating Plan is similar to many of the recommendations
included in the 2005 Dietary Guidelines for Americans (See fact sheet
Dietary Guidelines for Americans). The 2005 Dietary Guidelines
for Americans based many recommendations on the DASH Diet Eating Plan.
Take note, however, that the DASH Eating Plan measures food intake by
daily servings in each food group, whereas the Dietary Guidelines
focus on total amounts of foods from each group, rather than
numbers of daily servings.
|Table 1. The DASH Eating Plan.|
Daily Servings (Except as noted)
|1 slice bread
1 cup read-to-eat cereal
½ cup cooked rice, pasta, or cereal
| 1 cup raw leafy vegetables
½ cup cooked vegetable
½ cup vegetable juice
|1 medium fruit
¼ cup dried fruit
½ cup fresh, frozen or canned fruit
½ cup fruit juice
|Fat-free or low-fat dairy products||
|1 cup milk
1 cup yogurt
1½ ounces cheese
poultry, and fish
6 or less
|1 ounces cooked meats, poultry,
|Nuts, seeds, and
4-5 per week
|1/3 cup or 1 ½ ounces nuts
2 tablespoons or ½ ounce seeds
½ cup cooked legumes (dried beans or peas)
|Fats and oils||
|1 teaspoon soft margarine
1 tablespoon low-fat mayonnaise
2 tablespoons light salad dressing
1 teaspoon vegetable oil
|Sweets and added sugars||
5 or less per week
| 1 tablespoon sugar
1 tablespoon jelly or jam
½ cup sorbet, gelatin
1 cup lemonade
Making the Change
For many Americans, the DASH Eating Plan is dramatically different from
their normal diet. If a person chooses to adopt the DASH Eating Plan,
the road to change can seem quite daunting. However, the most successful
and lasting changes are a result of gradual change. So, first things first:
1. Start by creating a food diary. This simply means writing down
everything (including amounts) of what, when, and why you eat and drink
throughout the course of the day. After several days of record-keeping,
you will probably start to notice a pattern emerging in your eating habits.
2. Identify areas which need improvement. Chances are it will
be easy to spot areas where your diet does not meet DASH Diet recommendations.
Identify these areas for improvement.
3. Choose what you want to change. Based on your identified areas
for improvement, choose the places where you feel the most motivated and
committed to change. Many factors could influence this decision, such
as food preferences or time/preparation required to make the change. Chances
are you will experience a greater degree of success if you make gradual
changes, rather than overhauling your entire diet. When in doubt, make
small changes, rather than drastic ones.
4. Make a plan. In order to reach your goal, you will need a plan.
Try to identify barriers which may keep you from success. Then, come up
with practical solutions which will help you navigate past these roadblocks.
As you transition to the DASH Eating Plan, you may be eating more fruits,
vegetables, and whole grain products than you typically do. These foods
are rich in fiber, which can cause bloating and diarrhea in some individuals.
So again, make gradual changes to prevent negative side-effects.
Choosing Whole Grains
Whole grains are higher in fiber, vitamins, and minerals compared to refined grains (See fact sheet 9.333, Dietary Fiber). Whenever possible, choose whole grain bread, cereals, pasta, tortillas, and rice. Whole grain should be the first ingredient listed if the product is truly whole grain. When you bake, try substituting whole wheat flour or whole white flour for at least half the amount of all-purpose flour in your recipe.
Increasing Fruits and Vegetables
Like whole grains, fruits and vegetables are an excellent source of fiber
in the diet. Fruits and vegetables are also a rich source of potassium,
which is protective against high blood pressure (See fact sheet 9.355,
Potassium and Health). This food group is a source of magnesium,
as well. Focus on fresh or frozen vegetables, as they do not contain as
much sodium as canned products. Also, choose fruits canned in their own
juice to reduce sugar intake. If youre struggling to add more fruits
and vegetables to your diet, try these easy approaches:
- Top your cereal or yogurt with fresh banana slices, berries, or
- Have a fresh fruit or vegetable for a snack. (Add a yogurt dip!)
- Cover your sandwich with lettuce, tomatoes, or a few thin avocado
- Center your meal around vegetables: try a meatless meal several
times a week.
- Stir some cooked veggies, like broccoli, zucchini, or carrots,
into your spaghetti sauce, soup, or casserole.
- Reduce the amount of meat in a recipe and then replace it with vegetables.
Also, be adventurous: try new fruits and vegetables to add variety to the choices you normally select. Smoothies are a fun way to experiment with a variety of fruit flavors and add a serving of dairy to your diet.
Fruit Smoothie RecipeYield: 4 servings
- 2 cups of fruit (berries, melon, peaches, or any combination of fruits)
- 1 ½ cups low-fat or fat-free yogurt (plain, vanilla, or fruit flavor)
Directions: Puree fruit in a blender. Add yogurt and milk. Blend until smooth. Yogurt may be replaced by milk for a thinner smoothie.
Including Fat-free or Low-fat Dairy Products
Low-fat and fat-free dairy products are an excellent source of calcium
and protein. Potassium and magnesium are also found in dairy products.
Remember, cheese is a considerable source of sodium in the diet, so go
easy on cheese. Boost your fat-free and low-fat dairy product intake with
the following tips:
- Have a cup of low-fat or fat-free fruit yogurt mixed with granola.
- Sprinkle low-fat mozzarella cheese on your pizza, quesadilla, or
- Grab a cool, refreshing glass of low-fat or fat-free flavored milk
with a snack.
- Enjoy low-fat frozen yogurt for dessert.
If dairy products are difficult for your body to digest, try cultured
dairy foods, such as buttermilk, yogurt, or cottage cheese. Lactose-free
milk or milk which has added lactase enzyme are available, as well. If
problems persist, lactase enzyme pills or drops (found at drug store or
grocery store) are several options.
Selecting Lean Meats
The DASH Eating Plan also emphasizes consuming protein from lean meats.
Meats contribute protein and magnesium to the diet. Red meat can be included
in the DASH Eating Plan, but limit the amount you consume and choose more
lean varieties, such as 90 percent lean ground beef. Also, trim the fat
from your meats before cooking or set up a pan for fat to drip into during
cooking. Processed meats, such as hot dogs, breakfast meats, and deli
meats are a significant source of sodium, so chose wisely.
Incorporating Nuts, Seeds, and Legumes
Nuts, seeds and legumes contribute magnesium and potassium, along with
protein and fiber, to the diet. Legumes include dry beans, peas, lentils,
and peanuts. Be careful to select no-salt added nuts and seeds. Also,
go easy on portion sizes (one serving is approximately the palm of your
hand, or 1/3 of a cup); nuts are high in calories! You can incorporate
foods from this group in a variety of ways:
- Spice up your salads by adding roasted nuts or seeds, such as walnuts
or sunflower seeds.
- Coat chicken or fish with a crushed nut mixture.
- Add nuts to low-fat or fat-free yogurt.
- Try breads with nuts or seeds in them.
- Grab a handful of unsalted nuts for a snack.
Sample One-Day Menu
Menu Item ( Sodium (mg))
1 cup spoon-size Shredded Wheat (4)
1 slice whole wheat bread (149)
1 medium banana (1)
½ cup fruit yogurt, fat-free, no sugar added (86)
1 cup low-fat milk (107)
1 tsp soft (tub) margarine, unsalted (0)
Chicken breast sandwich: 2 slices (3 oz) chicken breast-skinless(65)
2 slices whole wheat bread(299)
1 slice (3/4 oz) Swiss cheese, reduced sodium (3)
1 large leaf romaine lettuce (1)
2 slices tomato (2)
1 Tbsp mayonnaise, low-fat (101)
1 cup cantaloupe (26)
1 cup apple juice (21)
3 oz cod baked with:1 tsp olive oil (700)
1 tsp lemon juice (1)
1 cup spinach, sautéed with: 1 tsp canola oil (1840)
1 Tbsp almonds, slivered (0)
1 small corn bread muffin made with canola oil (119)
1 tsp soft margarine (26)
1 cup milk, low-fat (107)
2 Tbsp peanuts, unsalted (1)
2 graham cracker squares (156)
¼ cup dried apricots (3)
(Adapted from Your Guide to Lowering Blood Pressure, NHLBI available at www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf)
Other DASH Eating Plan Guidelines
The DASH Eating Plan includes approximately 27 percent of calories from fat. Fat is an important part of our diet, but too much may contribute to unwanted weight gain and increase the risk for developing chronic diseases, like heart disease. Refer to fact sheet 9.319, Cholesterol and Fats, to learn more about the types of fat and how to reduce fat in the diet.
The DASH Eating Plan also recommends limiting sugars and added sweets. So, be mindful of the amount of sugar you consume from desserts, sweetened beverages, and other sweets (see fact sheet 9.301, Sugar and Sweeteners).
What about cost?
One common misconception is that eating according to the DASH Dietresults in higher grocery bills. However, reaching the daily serving recommendation for each food group in the DASH Eating Plan without emptying your wallet is possible. Look for grocery coupons and specials; stock up on items which are on sale. Choose generic brands and produce which is in season to save money.
Blood pressure decreases in response to a sodium-restricted diet. For the greatest benefit, 1500 mg of sodium/day is recommended. Processed foods contribute the greatest amount of sodium to the diet (77 percent); foods which naturally contain sodium account for approximately 12 percent of sodium in the diet. Of course, adding salt to foods during cooking or at mealtime is yet another source of dietary sodium. Foods high in sodium include canned foods (i.e., vegetables), tomato products, frozen pizza and microwave dinners, cheese, processed meats (deli and breakfast meats), and some condiments, salad dressings, snack foods, and instant cereals. Bread, bagels, and English muffins also contribute sodium to the diet. However, low-sodium alternatives are becoming more readily available. Whenever you have the choice, choose low-sodium and no-sodium products!
Read labels to determine which foods are lower in sodium. If you cant find a low-sodium option, consider substituting with a low-sodium food. For example, choose fresh or frozen green beans instead of canned green beans. Refer to fact sheet 9.354, Sodium in the Diet, to learn more about choosing low-sodium alternatives, sodium content in various foods, and approaches to reduce sodium in your diet, including seasoning ideas. Enhancing the flavor of your food through the use of herbs and spices is one very useful approach to reducing sodium in your diet.
|Table 2: Savor the flavor in your food.|
|Herb/Spice||Flavor and Aroma||Uses|
|Allspice||Blend of cinnamon and clove||Sauces, pumpkin, roasts, baked goods, teas, seasonings|
|Anise||Licorish-like (similar to fennel)||Baked goods (cookies, cakes, breads), cheese, stews, fish, shellfish|
|Basil||Sweet fragrance||Tomato-based sauces, pesto, pizza, cheese, vegetables|
|Bay Leaves||Aromatic, pungent||Soups, stews, stocks, tomato dishes, meats|
|Black Pepper||Hot, biting||Almost any food|
|Celery Seed||Celery-like||Vegetables, salad dressings, breads, soups|
|Cilantro||Waxy, citrus||Mexican dishes (salsa, chutney, beans, soups), salads|
|Cinnamon||Sweet, pungent||Baked dishes, fruits|
|Coriander||Mildly sweet, spicy||Beans, lentils, onions, potatoes, stews|
|Cumin||Aromatic, pungent||Mexican, Thai, Vietnamese, Indian dishes|
|Dill Weed||Fresh, green||Fish, shellfish, cottage and cream cheese, tomatoes|
|Ginger||Pungent, aromatic||Curries, fruits|
|Marjoram||Minty, aromatic, slightly bitter||Meats (lamb, beef, pork, chicken, fish), tomato dishes, breads, salad dressings, chowders|
|Nutmeg||Strongly aromatic, citrus, piney||Sweet foods, baked goods|
|Oregano||Strongly aromatic, slightly bitter||Italian dishes (tomato based), Mexican dishes|
|Parsley||Clean, green vegetable||Soups, stews, stocks, egg dishes (often used as a garnish)|
|Rosemary||Sweet and fresh||Poultry, lamb, vegetables|
|Thyme||Warming and pungent||Meats, fish, stews, stuffings|
|(Adapted from McCormick Spice Encyclopedia, available at: www.mccormick.com/content.cfm?ID=8219|
Resources & References
- National Heart, Lung, and Blood Institute: www.nhlbi.nih.gov/health/public/heart
- National Heart, Lung, and Blood Institute. Your Guide to Lowering Blood Pressure. NIH Publication NO 03-5232. May 2003. Available at www.nhlbi.nih.gov/health/public/heart
- National Heart, Lung, and Blood Institute. Facts about the DASH Eating Plan. NIH Publication NO 03-4082. May 2003. Available at www.nhlbi.nih.gov/health/public/heart
- The Enspicelopedia. McCormick and Company, Inc. 2006.
Available at www.mccormick.com/content.cfm?ID=8219
1 J. Anderson, Ph.D., R.D., Colorado State University Extension foods and nutrition specialist and professor; S. Prior and D. Braithwaite, former graduate interns, food science and human nutrition; and B. Sherman, Extension Agent, Golden Plains Area. 10/07.
Colorado State University, U.S. Department of Agriculture, and Colorado counties cooperating. CSU Extension programs are available to all without discrimination. No endorsement of products mentioned is intended nor is criticism implied of products not mentioned.
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Updated Tuesday, July 22, 2014