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What you choose to eat affects your chances of developing high blood pressure, or hypertension (the medical term). Recent studies show that blood pressure can be lowered by following the Dietary Approaches to Stop Hypertension (DASH) eating plan—and by eating less salt, also called sodium.
While each step alone lowers blood pressure, the combination of the eating plan and a reduced sodium intake gives the biggest benefit and may help prevent the development of high blood pressure.
This article, based on the DASH research findings, tells how to follow the DASH eating plan and reduce the amount of sodium you consume. It offers tips on how to start and stay on the eating plan, as well as a week of menus and some recipes.
The menus and recipes are given for two levels of daily sodium consumption 2,300 and 1,500 milligrams per day. Twenty-three hundred milligrams is the highest level considered acceptable by the National High Blood Pressure Education Program. It is also the highest amount recommended for healthy Americans by the 2005 “U.S. Dietary Guidelines for Americans.”
The 1,500 milligram level can lower blood pressure further and more recently is the amount recommended by the Institute of Medicine as an adequate intake level and one that most people should try to achieve.
The lower your salt intake is, the lower your blood pressure. Studies have found that the DASH menus containing 2,300 milligrams of sodium can lower blood pressure and that an even lower level of sodium, 1,500 milligrams, can further reduce blood pressure.
All the menus are lower in sodium than what adults in the United States currently eat—about 4,200 milligrams per day in men and 3,300 milligrams per day in women. Those with high blood pressure and pre-hypertension may benefit especially from following the DASH eating plan and reducing their sodium intake.
What Is the DASH Eating Plan?
Blood pressure can be unhealthy even if it stays only slightly above the normal level of less than 120/80 mmHg. The more your blood pressure rises above normal, the greater the health risk.
Scientists supported by the National Heart, Lung, and Blood Institute (NHLBI) conducted two key studies. Their findings showed that blood pressures were reduced with an eating plan that is low in saturated fat, cholesterol, and total fat and that emphasizes fruits, vegetables, and fat-free or low-fat milk and milk products.
This eating plan known as the DASH or Dietary Approaches to Stop Hypertension eating plan also includes whole grain products, fish, poultry, and nuts. It is reduced in lean red meat, sweets, added sugars, and sugar-containing beverages compared to the typical American diet.
It is rich in potassium, magnesium, and calcium, as well as protein and fiber. The DASH eating plan follows heart healthy guidelines to limit saturated fat and cholesterol.
It focuses on increasing intake of foods rich in nutrients that are expected to lower blood pressure, mainly minerals (like potassium, calcium, and magnesium), protein, and fiber. It includes nutrient-rich foods so that it meets other nutrient requirements as recommended by the Institute of Medicine.
The first DASH study involved 459 adults with systolic blood pressures of less than 160 mmHg and diastolic pressures of 80–95 mmHg.
Daily Nutrients Used In DASH Studies (2100 Calories)
| Total fat | 27% of calories | Sodium | 2,300 mg* |
| Saturated fat | 6% of calories | Potassium | 4700 mg |
| Protein | 18% of calories | Calcium | 1250 mg |
| Carbohydrate | 55% of calories | Magnesium | 500 mg |
| Cholesterol | 150 mg | Fiber | 30 g |
g = grams; mg = milligrams
About 27 percent of the participants had high blood pressure. About 50 percent were women and 60 percent were African Americans.
It compared three eating plans: a plan that includes foods similar to what many Americans regularly eat; a plan that includes foods similar to what many Americans regularly eat plus more fruits and vegetables; and the DASH eating plan. All three plans included about 3,000 milligrams of sodium daily.
None of the plans was vegetarian or used specialty foods. Results were dramatic. Participants who followed both the plan that included more fruits and vegetables and the DASH eating plan had reduced blood pressure. But the DASH eating plan had the greatest effect, especially for those with high blood pressure.
Furthermore, the blood pressure reductions came fast within 2 weeks of starting the plan. The second DASH study looked at the effect on blood pressure of a reduced dietary sodium intake as participants followed either the DASH eating plan or an eating plan typical of what many Americans consume.
This second study involved 412 participants. Participants were randomly assigned to one of the two eating plans and then followed for a month at each of the three sodium levels.
The three sodium levels were a higher intake of about 3,300 milligrams per day (the level consumed by many Americans), an intermediate intake of about 2,300 milligrams per day, and a lower intake of about 1,500 milligrams per day.
Results showed that reducing dietary sodium lowered blood pressure for both eating plans. At each sodium level, blood pressure was lower on the DASH eating plan than on the other eating plan.
The greatest blood pressure reductions were for the DASH eating plan at the sodium intake of 1,500 milligrams per day. Those with high blood pressure saw the greatest reductions, but those with pre-hypertension also had large decreases.
Together these studies show the importance of lowering sodium intake whatever your eating plan. For a true winning combination, follow the DASH eating plan and lower your intake of salt and sodium.
How Do I Make the DASH?
The DASH eating plan used in the studies calls for a certain number of daily servings from various food groups. The number of servings you require may vary, depending on your caloric need.
The DASH eating plan used along with other lifestyle changes can help you prevent and control blood pressure. If your blood pressure is not too high, you may be able to control it entirely by changing your eating habits, losing weight if you are overweight, getting regular physical activity, and cutting down on alcohol.
The DASH eating plan also has other benefits, such as lowering LDL (“bad”) cholesterol, which, along with lowering blood pressure, can reduce your risk for getting heart disease If you need to lose weight, even a small weight loss will help to lower your risks of developing high blood pressure and other serious health conditions. At the very least, you should not gain weight.
DASH Eating Plan
| Food Group | Daily Servings | Serving Sizes |
|---|---|---|
| Grains | 6-8 | 1 slice bread 1 oz dry cereal 1/2 cup cooked rice, pasta, or cereal |
| Vegetables | 4-5 | 1 cup raw leafy vegetable 1/2 cup cut-up raw or cooked vegetable 1/2 cup vegetable juice |
| Fruits | 4-5 | 1 medium fruit 1/4 cup dried fruit 1/2 cup fresh, frozen, or canned fruit 1/2 cup fruit juice |
| Fat-free or low-fat milk and milk products | 2-3 | 1 cup milk or yogurt 11/2 oz cheese |
| Lean meats, poultry, and fish | 6 or less | 1 oz cooked meats, poultry, or fish 1 egg |
| Nuts, seeds, and legumes | 4-5 per week | 1/3 cup or 11/2 oz nuts 2 Tbsp peanut butter 2 Tbsp or 1/2 oz seeds 1/2 cup cooked legumes (dry beans and peas) |
| Fats and oils | 2-3 | 1 tsp soft margarine 1 tsp vegetable oil 1 Tbsp mayonnaise 2 Tbsp salad dressing |
| Sweets and added sugars | 5 or less per week | 1 Tbsp sugar 1 Tbsp jelly or jam 1/2 cup sorbet, gelatin 1 cup lemonade |
A recent study showed that people can lose weight while following the DASH eating plan and lowering their sodium intake. In a study of 810 participants, one-third were taught how to lower their sodium intake and follow the DASH eating plan on their own. Most of them needed to lose weight as well. They followed the DASH eating plan at lower calorie levels and they increased their physical activity.
Over the course of 18 months, participants lost weight and improved their blood pressure control. If you’re trying to lose weight aim for a caloric level that is lower than what you usually consume.
The best way to take off pounds is to do so gradually, get more physical activity, and eat a balanced diet that is lower in calories and fat. For some people at very high risk for heart disease or stroke, medication will be necessary.
To develop a weight-loss or weight-maintenance program that works well for you, consult with your doctor or registered dietitian.
Combining the DASH eating plan with a regular physical activity program, such as walking or swimming, will help you both shed pounds and stay trim for the long term. You can do an activity for 30 minutes at one time, or choose shorter periods of at least 10 minutes each.
The important thing is to total about 30 minutes of activity each day. (To avoid weight gain, try to total about 60 minutes per day.) You should be aware that the DASH eating plan has more daily servings of fruits, vegetables, and whole grain foods than you may be used to eating.
Because the plan is high in fiber, it can cause bloating and diarrhea in some persons. To avoid these problems, gradually increase your intake of fruit, vegetables, and whole grain foods.
Twenty three hundred milligrams of sodium equals about 6 grams, or 1 teaspoon, of table salt (sodium chloride); 1,500 milligrams of sodium equals about 4 grams, or 2/3 teaspoon, of table salt.
The key to reducing salt intake is making wise food choices. Only a small amount of salt that we consume comes from the salt added at the table, and only small amounts of sodium occur naturally in food.
Processed foods account for most of the salt and sodium Americans consume. So, be sure to read food labels to choose products lower in sodium. You may be surprised to find which foods have sodium. They include baked goods, certain cereals, soy sauce, seasoned salts, monosodium glutamate (MSG), baking soda, and some antacids—the range is wide.
Because it is rich in fruits and vegetables, which are naturally lower in sodium than many other foods, the DASH eating plan makes it easier to consume less salt and sodium. Still, you may want to begin by adopting the DASH eating plan at the level of 2,300 milligrams of sodium per day and then further lower your sodium intake to 1,500 milligrams per day.
The DASH eating plan also emphasizes potassium from food, especially fruits and vegetables, to help keep blood pressure levels healthy. A potassium-rich diet may help to reduce elevated or high blood pressure, but be sure to get your potassium from food sources, not from supplements. Many fruits and vegetables, some milk products, and fish are rich sources of potassium.
Where to Find Potassium
| Food Groups | Potassium (mg) |
|---|---|
| Vegetables Potato, 1 medium Sweet Potato, 1 medium Spinach, cooked, 1/2 cup Zucchini, cooked, 1/2 cup Tomato, fresh, 1/2 cup Kale, cooked, 1/2 cup Romaine lettuce, 1 cup Mushrooms, 1/2 cup Cucumber, 1/2 cup | 926 540 290 280 210 150 140 110 80 |
| Fruit Banana, 1 medium Apricots, 1/4 cup Orange, 1 medium Cantaloupe chunks, 1/2 cup Apple, 1 medium | 420 380 237 214 150 |
| Nuts, seeds, and legumes Cooked soybeans, 1/2 cup Cooked lentils, 1/2 cup Cooked kidney beans, 1/2 cup Cooked split peas, 1/2 cup Almonds, roasted, 1/3 cup Walnuts, roasted, 1/3 cup Sunflower seeds, roasted, 2 Tbsp Peanuts, roasted, 1/3 cup | 440 370 360 360 310 190 124 120 |
| Low-fat or fat-free milk and milk products Milk, 1 cup Yogurt, 1 cup | 380 370 |
| Lean meats, fish, and poultry Fish (cod, halibut, rockfish, trout, tuna), 3 oz Pork tenderloin, 3 oz Beef tenderloin, chicken, turkey, 3 oz | 200–400 370 210 |
However, fruits and vegetables are rich in the form of potassium (potassium with bicarbonate precursors) that favorably affects acid-base metabolism. This form of potassium may help to reduce risk of kidney stones and bone loss.
While salt substitutes containing potassium are sometimes needed by persons on drug therapy for high blood pressure, these supplements can be harmful to people with certain medical conditions.
Ask your doctor before trying salt substitutes or supplements. Start the DASH eating plan today—it can help you prevent and control high blood pressure, has other health benefits for your heart, can be used to lose weight, and meets your nutritional needs.
How Can I Get Started on the DASH Eating Plan?
The DASH eating plan requires no special foods and has no hard-to-follow recipes. One way to begin is by seeing how DASH compares with your current food habits. Remember that on some days the foods you eat may add up to more than the recommended servings from one food group and less from another. Similarly, you may have too much sodium on a particular day.
But don’t worry. Try your best to keep the average of several days close to the DASH eating plan and the sodium level recommended for you.
The Dietary Guidelines determined that the DASH eating plan is an example of a healthy eating plan and recommends it as a plan that not only meets your nutritional needs but can accommodate varied types of cuisines and special needs.
Remember that the DASH eating plan used along with other lifestyle changes can help you prevent and control your blood pressure.
Important lifestyle recommendations for you include: achieve and maintain a healthy weight, participate in your favorite regular physical activity, and, if you drink, use moderation in alcohol consumption (defined as up to one drink per day for women and up to two drinks per day for men).
One important note: If you take medication to control high blood pressure, you should not stop using it. Follow the DASH eating plan and talk with your doctor about your medication treatment.
High blood pressure is a risk factor for heart disease, stroke and kidney disease. The risk of high blood pressure rises steadily with age. It affects around one in three persons aged 25 years and older.
