Ask the DOC

It has been 20 years since the first publication of the Dietary Approaches to Stop Hypertension (DASH) diet. This diet emphasizes foods rich in protein, fiber, magnesium and calcium such as fruits and vegetables, beans, nuts, whole grains, fish (salmon, herring, and tuna) and low-fat dairy. It limits foods rich in saturated fat and sugars. The DASH diet has been proven in study after study to reduce both systolic and diastolic blood pressure across a wide range of ethnic groups. While not specifically a weight-loss diet or a low sodium diet, DASH has been proven to cause moderate weight loss and, because of the types of foods used, reduce dietary sodium intake.

Yet adherence to DASH on a national level is poor, with studies showing that only one percent of the U.S. population was fully adherent to the diet in 1998 and that number has not risen very much. The public health consequences of poor adherence to DASH cannot be overstated. Of the 80 million U.S. residents with hypertension, only half have controlled blood pressure. Uncontrolled high blood pressure is directly linked to heart disease and strokes, two of the leading causes of death in this country. Poor adherence to DASH may be attributed to the current U.S. food environment. Energy dense, nutrient-deficient foods (fast foods) are readily available and cheap. Fruits and vegetables tend to be more expensive and less available in some areas, especially in low-income neighborhoods, but foods like dried beans and frozen vegetables are DASH compliant and inexpensive.

Additionally, many healthcare providers tend to emphasize low sodium intake over proper food consumption. While salt is everywhere and in everything these days (a teaspoon of salt contains 2325 mg, or 325 mg more than the daily recommended intake of two grams), the type of food consumed accounts for a large proportion of dietary blood pressure control. At the individual level, innovative strategies are being created to improve dietary behavior. For example, most adults have a cellphone and 77 percent have a smartphone so apps and devices have been created to promote lifestyle changes and behavioral modification. The DASH diet represents a potentially affordable and scalable intervention that could almost immediately produce considerable improvements to population health. The potential benefits of promoting DASH are substantial. A study from 2003 suggested that if individuals were fully adherent to DASH, an estimated 400,000 cardiovascular disease events could be prevented over 10 years. While this may represent an overestimation as the incidence of cardiovascular disease has been declining in the U.S. (mostly attributed to smoking cessation efforts), there is no doubt that better adherence to DASH will improve the health of the population and cause a further decline in heart disease and strokes.

While I try not to promote products and services to my readers, there is a book called, “The DASH Diet Weight Loss Solution” by Marla Heller, MS, RD that is well written and very informative for those seeking more information on DASH.

I also suggest www.dashdiet.org/default.asp

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