Proponents of the DASH diet, which stands for Dietary Approaches to Stop Hypertension, say that taking on this lifestyle can decrease blood pressure, weight and cholesterol levels by cutting back on the amount of sodium from food and drinks.
The DASH diet was developed specifically to help people lower high blood pressure, and is promoted by the National Heart, Lung and Blood Institute, a part of the National Institutes of Health, which claims that a DASH diet is healthy for most Americans – and can be healthy for the entire family.
This guide takes a comprehensive look at the DASH diet, including what it is, foods you can eat and food you should avoid, the overall benefits, and how to get started.
We’ve gathered input from two experts for this topic, including an exercise physiologist with more than 25 years of experience ranging from basic fitness instruction to working with members of the U.S. Olympic team; and a Registered Dietitian and Certified Diabetes Educator in Southern California.
Keep in mind that this article is not intended as medical advice. Before you decided to try the DASH diet, talk to your medical provider, first.
- What Is the DASH Diet?
- Different Kinds of DASH Diets
- DASH Diet Benefits
- Scientific Studies of the DASH Diet
- Are there Side Effects with the DASH Diet?
- Who Should Avoid the DASH Diet?
- How to Get Started with the DASH Diet
- Foods You Can Eat on the DASH Diet
- Foods to Avoid on the DASH Diet
- DASH Diet for a Vegetarian, Vegan or Someone with Cancer
- Additional Tips and Factors for Success
The term DASH means Dietary Approaches to Stop Hypertension, and it cuts back on the amount of sodium from your food and drinks, explained Dr. Annthea Fenwick, an exercise physiologist and owner of Achieving Fitness After 50 in Nevada City, California.
“This healthy diet emphasizes fruits, vegetables, and fat-free or low-fat dairy products,” explained Dr. Fenwick, adding that the DASH diet includes whole grains, fish, poultry, beans, nuts, and vegetable oils while limiting sodium, sweets, processed foods, sugary beverages, and red meats.
As a fitness expert with a Ph.D. in Holistic Nutrition, Dr. Fenwick has used the DASH diet with clients for many years with great success.
“It has helped them lower their blood pressure to the point of no longer needing medication to maintain normal levels,” she said. “They have lost significant amounts of weight and overall improved their health with this diet program.”
Researchers funded by National Institute of Health’s National Heart, Lung and Blood Institute developed the DASH diet to prevent and treat high blood pressure, said Ruth Pupo Garcia, a Registered Dietitian and Certified Diabetes Educator who works at Adventist Health White Memorial in Los Angeles.
“Some DASH plans are slightly lower in sodium recommendations, but basically they are very similar,” Garcia said. “The DASH diet can be accommodated for vegetarians as well.”
The DASH diet is recommended for people who want to lower blood pressure, “but it's also a great option for anyone who wants to adopt a healthy diet,” Dr. Fenwick said. “It can aid in weight loss because it emphasizes eating whole foods that are naturally low in unhealthy fats and added sugars, as well as moderate portions.”
According to Dr. Fenwick, the 2 primary forms of the DASH diet will vary slightly depending on your health needs:
- Standard DASH Diet: This plan limits sodium consumption to 2,300 milligrams (mg) per day.
- Lower-Sodium DASH Diet: This version calls for limiting sodium consumption to 1,500 mg per day.
Since the DASH diet includes more nutritious foods that are lower in fat, people also lose weight, said Garcia, adding that the overall benefit is reduced cardiovascular disease.
According to Dr. Fenwick, the benefits to following the DASH diet include the following:
Long-Term Potential: The diet offers variety and is easy to follow as a lifelong dietary choice.
Lower Blood Pressure and Improve Healthy Cholesterol Levels: Studies have shown that people who stick to this diet can lower their blood pressure and — when eating low-fat rather than high-fat dairy — also lower their LDL, or “bad,” cholesterol, according to a study published in February 2016 in the American Journal of Clinical Nutrition.
A Reduced Risk of Certain Diseases: A stronger heart can result in improvements of other aspects of your health, such as kidney function, blood sugar management, and eye health. Following the DASH diet may also reduce your risk for stroke, the NHLBI notes.
Improved Management of Type 2 Diabetes: According to an article published in the journal Current Hypertension Reports, when paired with a weight-loss plan and exercise regimen, the DASH diet may result in reduced insulin resistance, which is the hallmark of type 2 diabetes.
Weight Loss: The DASH diet works by limiting not only salt, but also saturated fat and cholesterol, both of which can contribute to heart disease; and by increasing foods that provide fiber, protein, and other nutrients.
“Important to note is people who want to lower their blood pressure should combine the diet with other healthy lifestyle approaches to managing hypertension, such as getting more exercise, losing weight, and cutting back on alcohol consumption,” Dr. Fenwick recommended. “Quitting smoking is also crucial for lowering blood pressure and maintaining good heart health.”
» For Further Reading: 18 Best Exercises for Seniors: Safe Balance, Strength and Flexibility Routines
There are hundreds of studies that have reinforced the benefits of the DASH diet, according to Dr. Fenwick, who added that this is the eighth consecutive year that DASH received top honors in U.S. News and World Report, ranking among nearly 40 diets it reviewed.
“This year, however, that ranking was shared with another – the Mediterranean Diet,” Dr. Fenwick said. “The Mediterranean diet gets its name from the region where this well-balanced pattern of eating was inspired. It’s similar to the DASH diet in that it includes an abundance of whole grains, vegetables, beans, nuts and fish.”
Garcia noted an NHLBI-funded study of more than 400 adults with pre-hypertension, or stage 1 high blood pressure, found that the combination of a low-salt diet with DASH substantially lowers blood pressure.
“In the study, persons who had the highest blood pressure or most severe, had the best results,” Garcia said.
According to Dr. Fenwick, there are almost no drawbacks to the DASH diet.
“Some people may not like the fact that is does not say exactly what to eat every day, instead it offers overall guidelines for you to develop your own eating plan,” she said.
Additionally, it can be difficult to adjust to eating as much fiber as the DASH diet recommends.
“It’s a good idea to gradually add high-fiber foods, such as whole grains, fruits, and vegetables, to your diet and drink plenty of water while doing so to help avoid bloating and physical discomfort,” Dr. Fenwick advised.
For those who wonder if the DASH diet is dangerous, Garcia said “not at all,” adding that the DASH diet is recommended by the National Heart, Lung and Blood Institute, the American Heart Association, the Dietary Guidelines for Americans, and the U.S. guidelines for the treatment of high blood pressure.
“And it’s healthy for the whole family,” Garcia emphasized.
If there was a “con” associated with the DASH diet, Garcia said it’s not being applied by many Americans living with pre-hypertension or hypertension.
“Some experts believe that the recommended foods aren’t as accessible as fast food and processed foods,” Garcia said. “For example, it may be much easier and convenient to attain a fast-food meal than a green salad with berries.”
Individuals with renal disease, on dialysis and on certain blood thinning medications should consult with a doctor or dietitian before applying the DASH diet, Garcia advised.
The DASH diet is actually high in potassium, Dr. Fenwick said.
“For most people, that helps their kidneys regulate blood pressure more efficiently,” explained Dr. Fenwick, adding that people with advanced kidney disease may need to limit the potassium with this diet.
“If you’re gluten intolerant, you need to modify a bit, but there are plenty of gluten-free, healthy grains, including buckwheat, quinoa, millet, and wild rice,” Dr. Fenwick suggested. “If you’re lactose intolerant, yogurt and other dairy products may not be right for you, so consider calcium-fortified soy milk, almond milk, and other such products.”
And despite the fact that most people eat way too much salt, certain individuals will actually need more, she added.
“Competitive athletes and people working outdoors in the heat will need to add sodium to this diet,” Dr. Fenwick recommended. “People that suffer from low blood pressure will also need extra salt.”
The DASH diet calls for a certain number of servings daily from various food groups, Dr. Fenwick said.
“The number of servings you require may vary, depending on how many calories you need per day,” she explained.
You can make gradual changes, Dr. Fenwick noted.
“For instance, start by limiting yourself to 2,400 milligrams of sodium per day – about 1 teaspoon,” she said. “Then, once your body has adjusted to the diet, cut back to 1,500 milligrams of sodium per day – about 2/3 teaspoon. These amounts include all sodium eaten, including sodium in food products as well as in what you cook with or add at the table.”
Garcia said in general, people can start to incorporate more salads and vegetables in their diet by starting by consuming more vegetables that they already like.
“Also starting to cook without added oil and fat is recommended, for example try baking or grilling instead of frying,” Garcia advised. “Choose fruits that are in season, and try fruit instead of dessert after meals.”
Dr. Fenwick provided the following list of foods that a person can eat on the DASH diet:
Grains: Breads and cereals, especially those mad with whole grains such as oats, barley, rye, or whole wheat. Pasta, especially when made with whole grains. Brown rice. Low-fat, low-sodium crackers and pretzels.
Vegetables: Fresh, frozen, or canned vegetables without added fat or salt. Highly colored vegetables, such as broccoli, greens, sweet potatoes, and tomatoes.
Fruits: Fresh, frozen, canned (in fruit juice), or dried fruit.
Dairy: Fat-free (skim), or low-fat (1%) milk. Nonfat or low-fat yogurt. Nonfat, low-sodium cottage cheese. Nonfat and low-fat, low-sodium cheese.
Protein: Fish, especially fatty fish, such as salmon, fresh tuna, or mackerel. Lean cuts of beef and pork (loin, leg, round, extra lean hamburger). Low-sodium cold cuts made with lean meat or soy protein. Skinless poultry. Venison and other wild game. Unsalted nuts and nut butters. Beans and peas. Low-sodium meat alternatives made with soy or textured vegetable protein. Egg whites or egg substitute.
Fats and Oils: Unsaturated oils (soybean, olive, canola, sunflower, and safflower). Soft or liquid margarines and vegetable oil spreads. Salad dressings (nonfat or made with unsaturated oil). Seeds. Avocado.
Other: Herbs and spices to add flavor to replace salt. Unsalted, low-fat snack foods, such as unsalted pretzels or plain popcorn. Fat-free or low-fat sweets, such as maple syrup, jelly beans, hard candy, or sorbet.
Dr. Fenwick offered the following example of a typical meal on the DASH Diet:
- 3 ounces of turkey meatloaf
- 1 small baked potato topped with 1 tablespoon each of fat-free sour cream and low-fat cheese, and a chopped scallion
- 1 small whole-wheat roll
- Cooked spinach
- 1 peach
Dr. Fenwick said the following foods should be avoided on the DASH diet:
Grains: Baked goods made with hydrogenated fat or saturated fat. Any grain foods that are high in sodium or added sugar.
Vegetables: Canned vegetables (unless they are low sodium or salt free). Pickles and vegetables packed in brine, such as sauerkraut or olives. Fried or breaded vegetables. Vegetables in cream or butter sauces.
Fruits: Fried fruits, fruits in cream or butter sauces.
Dairy: Whole and 2% fat milk, cream. Cheese (except for nonfat or low-fat, low sodium types). Processed cheese products. Foods made from whole milk or cream (such as ice cream or half-and-half).
Protein: Canned or smoked meat or fish. Marbled or fatty meats (such as bacon, sausage, hot dogs, regular hamburgers). Whole eggs and egg yolks. Poultry with skin. High-sodium lunch or deli-meats (such as salami). Canned beans (unless they are low-sodium or salt-free).
Fats and Oils: Solid cooking fats (shortening, butter, stick margarine). Tropical oils (palm, palm kernel, or coconut oil).
Other: Salt, seasoning mixes made with salt. Soy sauce, miso. Canned or dried soups (except for low-fat, low-sodium types). Bouillon cubes. Ketchup, barbecue sauce, Worcestershire sauce. Jarred or bottled salsa (homemade without salt is fine). Sugary drinks (such as soda or fruit drinks). Snack foods made with hydrogenated oil, shortening, or butter. High-sodium snacks foods (chips, pretzels, salted nuts). High-fat, high-sugar desserts. High-fat gravies and sauces. Premade foods (boxed pasta mixes, frozen dinners, and so on) if high in sodium or fat.
Alcohol: Women, no more than 1 drink per day. Men, no more than 2 drinks per day. One drink is 5 ounces of wine, 12 ounces of beer, or 1½ ounces of liquor.
Vegetarians will need to adjust their protein intake away from animal products to the other recommended protein sources, Dr. Fenwick advised.
Garcia said a vegetarian may substitute animal proteins with low fat plan protein substitutes such as tofu, tempeh or beans.
“Vegans will need to make the above adjustment in addition to removing dairy and eggs,” Dr. Fenwick said.
“Cancer patients have shown good results with the DASH diet because it is low in red meat, rich in fruits and vegetables, emphasizes low-fat dairy, and has plenty of whole grains and limits fats and oils.”
Garcia added that a diet high in nutrients and anti-oxidants, such as DASH, “is also considered anti-cancer.”
Dr. Fenwick offered the following tips that can help with the success of the DASH diet:
- Add a serving of vegetables at lunch and at dinner.
- Add a serving of fruit to your meals or as a snack. Canned and dried fruits are easy to use, but check that they don't have added sugar.
- Use only half your typical serving of butter, margarine, or salad dressing, and use low-fat or fat-free condiments.
- Drink low-fat or skim dairy products any time you would normally use full-fat or cream.
- Limit meat to 6 ounces a day. Make some meals vegetarian.
- Add more vegetables and dry beans to your diet.
- Instead of snacking on chips or sweets, eat unsalted pretzels or nuts, raisins, low-fat and fat-free yogurt, frozen yogurt, unsalted plain popcorn with no butter, and raw vegetables.
- Read food labels to choose products that are lower in sodium.
Diet changes take time, said Garcia, who recommends trying to add vegetable and fruits to your favorite recipes, and consider alternate cooking methods.
“Start small and cook for the whole family, so that the changes are sustainable,” Garcia advised. “For example use a grill instead of frying foods. Try adding spinach to your soup. Cut up fruits and have them accessible instead of a plate of cookies.”
Dr. Fenwick recommends starting out by making adjustments slowly, following the recommended food guidelines.
“They will quickly find that the DASH diet will allow them to enjoy good, healthy, wholesome food,” Dr. Fenwick said.
The DASH Diet is simple to follow by removing the items that we already know are unhealthy, Dr. Fenwick said.
“You do not need to remove food groups or make drastic changes to live a healthy lifestyle,” she emphasized. “Eat the foods that you know are healthy, stay away from the processed and packaged junk, and enjoy real meals.”
The DASH diet has been one of the best diets in America, as stated by the U.S. News and World Reports, Garcia said.
“However, people must take a diet, even DASH, as a new lifestyle change rather that a temporary diet plan.”
Eating more fruits and vegetables and reducing fat in the diet is always favorable, Garcia added.
“We must consider that as far as food, our environment is toxic, and most Americans will end up with Heart disease – the #1 killer,” she said. “Keep fast food to a limit, eat more plant based foods and get some physical activity.”
» For Further Reading:
- Mediterranean Diet: A Comprehensive Beginner’s Guide
- Ketogenic Diet: A Comprehensive Beginner’s Guide
- Intermittent Fasting for Women: A Comprehensive Guide