Hypertension, or high blood pressure, is a significant public health issue in the United States. With the recent change in the definition of high blood pressure, almost half of U.S. adults are considered hypertensive. High blood pressure can be a dangerous condition; it is linked to an increased risk of stroke and heart attack.
Though there are medications that can lower your blood pressure, making some lifestyle changes can also help. Did your doctor tell you that your blood pressure is too high and you want to lower it? Are you ready to “dash” towards a healthier diet and lifestyle, but don’t know a good place to start?
Don’t miss this piece on the DASH diet, Dietary Approaches to Stop Hypertension. We’ve got your answers on all things DASH-related, including:
- What are the healthy blood pressure levels?
- Which foods should you include on the DASH diet?
- Which foods should you limit on DASH?
- Who is the DASH diet appropriate for?
- Can I lose weight with the DASH diet?
- What are some disadvantages to this way of eating?
- How can I save money on this diet?
The DASH diet ranks as the second best diet overall in the 2019 U.S. News & World Report rankings. Are you wondering why this diet did not get the top spot? No worries, we’ll cover that as well.
What are healthy blood pressure levels?
Blood pressure measurements are composed of two numbers. The top number (systolic) measures the pressure while the heartbeats. The bottom number (diastolic) measures the pressure when the heart rests between beats.
Under the most current American Heart Association guidelines, your goal should be a blood pressure under 120/80 mm Hg. Higher blood pressure readings are categorized into the following levels (all measurements in mm Hg):
- Elevated blood pressure: Systolic blood pressure of 120-129 AND diastolic blood pressure of less than 80.
- Stage 1 hypertension: Systolic blood pressure of 130-139 OR diastolic blood pressure of 80-89.
- Stage 2 hypertension: Systolic blood pressure of at least 140 OR diastolic blood pressure of at least 90.
- Hypertensive crisis: A serious condition where the systolic blood pressure is above 180, the diastolic pressure is above 120, or both. Individuals in this situation require immediate medication changes and possibly emergency hospitalization.
The DASH diet was specifically developed to help individuals lower their moderate to high blood pressure. The National Heart, Lung, and Blood Institute promotes DASH because it is heavily backed by science. Following DASH means your diet will be rich in potassium, calcium, and fiber that help bring blood pressure down.
Beyond diet, there are some other factors that can help to improve blood pressure. These include quitting smoking and increasing physical activity. Making multiple healthy lifestyle changes has the potential to make the most substantial impact on your blood pressure.
Which foods should you include on the DASH diet?
The foods that are the mainstays of the DASH diet are very similar to the foods of the Mediterranean diet. DASH promotes a diet of foods that are high in fiber and lower in sodium and saturated fat. These foods include:
- Vegetables (both starchy and non-starchy)
- Whole grains
- Nuts and seeds
- Low-fat dairy products
- Seafood, poultry, and lean meats
The foundation of the DASH diet is that you should aim to hit a daily target for each of these food categories. The amount of servings of each type of food that you should aim for depends on your calorie level. There are worksheets available online to help you track whether you are meeting these targets.
The targets in the DASH diet are where things diverge quite a bit from the more relaxed Mediterranean pattern. If you are on a 2,000-calorie plan, your goals look like this (from the NIH National Heart, Lung, and Blood Institute):
- Grains: 6-8 servings per day (choose whole grains for most grain servings)
- Vegetables: 4-5 servings per day
- Fruits: 4-5 servings per day
- Fat-free or low-fat dairy products: 2-3 servings per day
- Lean meats, poultry, fish: up to 6 ounces per day
- Nuts, seeds, legumes: 4-5 servings per week
- Fats and oils: 2-3 servings per day
- Sweets and added sugars: up to 5 servings per week (should be low in fat)
Egg yolks should be limited to a maximum of 4 per week on the DASH diet. The DASH diet tracking form also has space to record daily physical activity. The recommendation is to “aim for at least 2 hours and 30 minutes of moderate-intensity physical activity per week.”
DASH encourages a diet of balanced macronutrients that fall within the Acceptable Macronutrient Distribution Ranges (AMDR). These are the ranges that have the most evidence behind them supporting optimal health.
Which foods should you limit on DASH?
There are no foods that are entirely restricted to the DASH diet. However, you should limit individual dietary components with this healthy eating pattern:
- Caffeinated drinks
- Alcohol (up to two drinks per day for men and one drink for women)
- Sweets and sugar-sweetened beverages (limit mentioned in the previous section)
Even though you should limit sodium on DASH, it is not necessarily a very low-sodium diet. Sodium caps on DASH come at two levels, depending on the individual’s needs. Both levels are below the amount of sodium found in the average American’s diet.
The DASH limit of 2,300 mg of sodium daily is identical to current Dietary Guidelines recommendations. For those who need to lower sodium intake further, there is a 1,500 mg sodium level as well. The 1,500 mg per day sodium recommendation aligns with the American Heart Association’s “ideal limit” for most adults.
It can be challenging to meet DASH sodium goals if your diet includes a lot of pickled foods, canned soups, or cured meats. Ultra-processed foods and restaurant foods are significant sources of sodium in the U.S. diet. Cooking more at home (minus the salt shaker) may help you to stay under the sodium limit.
Who is the DASH diet appropriate for?
The DASH diet is safe to use with both healthy children and adults. This diet is appropriate even if the individual does not have a goal to lower blood pressure. The increases in calcium, potassium, and magnesium in this diet, relative to sodium, can benefit a variety of age groups.
Children should not have to track their intake, assuming the caregiver follows DASH and serves DASH foods in the household. Exposing children to varied healthful foods often and early, but in a relaxed manner, should be the primary goal. Worksheets are not necessary to promote healthy eating in this age group.
Low-fat dairy foods are an essential component of DASH since they are an easy way to increase potassium intake. If you are lactose intolerant, you can still meet the daily targets in this way of eating. Choose lactose-free milk or use lactase enzyme pills so that you can enjoy these health-promoting foods.
There are certain individuals with severe medical conditions who may not be good candidates for DASH. Since DASH is high in potassium, protein, and phosphorus, it is not recommended for those with end-stage renal disease (ESRD). If you are on blood pressure-lowering medications, keep taking them, but let your doctor know you are going on DASH.
Always consult with your physician or dietitian if you have questions about whether a diet may be right for you. This is particularly critical for those who are managing certain medical conditions that are impacted by nutrition. Generalized nutrition information found online should never replace individualized medical care from licensed health professionals.
Can I lose weight with the DASH diet?
The DASH diet is an evidence-based intervention that supports weight loss, as long as it is coupled with calorie restriction. As with the Mediterranean diet, DASH does not eliminate any foods or food groups. Since DASH originally had no energy limit, a person could eat in excess of their needs on this diet.
Creating a satiating diet pattern using nutrient-rich, energy-poor DASH foods can help to create a calorie deficit for fat loss. Combining DASH with weight loss may promote lower blood pressure than the blood pressure lowering effects of weight loss alone.
Like the Mediterranean approach, DASH focuses more on lifestyle shifts and adding healthful foods in rather than on restrictions. Exercise is recommended as part of DASH and may be particularly helpful for those with weight loss goals.
When a recommended serving range is offered on DASH, choosing the lower number of servings may promote weight loss. For example, if the target for grains is 6-8 servings per day on a 2,000 calorie DASH diet. Aim for the six servings (or possibly fewer) if you have a weight loss goal.
What are some disadvantages to this way of eating?
At this point, you may be thinking that the DASH diet sounds pretty great. Yet, as mentioned earlier, it is the Mediterranean diet that took first place for the best overall diet. Why might that be?
The main reason is that DASH involves a lot of “grunt work” compared to the Mediterranean diet. You may need to plan your meals, at least initially, to hit the desired goals for fruits and vegetables. Some people prefer a more relaxed dietary strategy than they get with DASH.
The Mediterranean diet does not (generally) involve tracking daily intake of each food group. Using the food record with the DASH diet may feel too complicated or like too much work for some people. For this reason, DASH may not be the right approach for everyone.
This diet may seem overwhelming at first but can be achievable by making small changes over time. One initial goal may be to include a vegetable or fruit with each of your meals. An additional example is to replace the salt in your recipes with flavorful combinations of spices and herbs.
Another advantage of tapering on to DASH is that it may contain far more fiber than you are accustomed to. Rapidly increasing fiber intake with this diet may lead to bloating and uncomfortable digestive experience. Going slowly gives your body time to adapt to the change.
The second criticism of DASH is that diets high in fruits and vegetables tend to be rather pricey. Thankfully, there are some strategies that can help mitigate the potential increase to your grocery bill, which we’ll cover next.
How can I save money on this diet?
Eating a health-promoting diet does not have to break the bank. There are many ways to keep your diet, both low-cost and high in plant foods. These include:
- Purchasing mostly in-season fresh fruits and vegetables
- Choosing frozen fruits and vegetables or those canned in water or 100% juice (aim for the varieties that have no added salt)
- Using the bulk section of your grocery store to stock up on whole grains, nuts, seeds, and legumes
- Splitting large packages of food from bulk discount stores with friends or extended family
- Choosing whole food plant-based proteins more often (especially dried legumes and whole grains)
- Taking advantage of the weekly grocery store sales
- Joining a Community-Supported Agriculture (CSA) program (note: CSA prices may vary widely by region)
- Cooking more at home
You don’t need special foods or expensive supplements with this diet, nor do you need to cook complicated recipes. Sticking with primarily minimally processed whole foods will help you to be DASH compliant and save you money.
Final Thoughts About Dash Diet For Hypertension
Dietary Approaches to Stop Hypertension utilizes science-backed information to craft a dietary pattern that can help to lower blood pressure. Dietitians and other health professionals tend to feel very positively about this balanced lifestyle approach. DASH is appropriate for most members of the family and can support fat loss when paired with a calorie deficit.
Planning can help to make this diet seem less overwhelming and can also bring your grocery bill down. If you need help with meal planning, be sure to “dash” over to the recipe pages. Plenty of tasty DASH-friendly meal ideas are waiting for you!
Summer is a registered dietitian located in Avon, Connecticut where she specializes in weight management, special diets, general nutrition, and avoidant/restrictive food intake disorder (ARFID). She is the developer and content creator behind the Summer Yule Nutrition website, where she shares evidence-based information on hot topics in food and nutrition.