Johns Hopkins Health Alert
Tweaking the DASH Diet
Johns Hopkins professor, Lawrence Appel, M.D., suggests improvements to the DASH diet to help lower blood pressure and improve lipids.
If you have hypertension, your doctor most likely recommended that you make changes in your diet. That’s because a variety of dietary factors -- from salt and alcohol to fruits and vegetables -- can influence blood pressure, and getting the right amounts of these foods can go a long way toward keeping your blood pressure under control.
In fact, for the past 10 years, research has been accumulating that a carbohydrate-rich diet that emphasizes fruits, vegetables, and low-fat dairy products and limits saturated fat and cholesterol -- the so-called DASH diet -- can substantially lower blood pressure. The DASH diet also lowers low-density lipoprotein (LDL) cholesterol.
But can the DASH diet be improved? While following the DASH diet can help lower both your blood pressure and LDL cholesterol, it won’t do much for the other lipids (fats) in your blood. For example, the DASH diet reduces levels of high-density lipoprotein (HDL) cholesterol (the “good” cholesterol that protects against heart attacks and strokes). In addition, the DASH diet has no effect on triglycerides (another blood lipid that increases the risk of heart attacks and strokes).
So Lawrence Appel, M.D., (coauthor of the Johns Hopkins Hypertension and Stroke White Paper) and his colleagues decided to investigate whether these drawbacks to the DASH diet might be minimized with a little tweaking of the DASH diet’s components -- specifically, the mix of carbohydrate, fat, and protein. Here are what they did and what they found.
The researchers compared three different healthy diets in 164 adults with prehypertension or mild hypertension. The first diet resembled the traditional DASH diet -- rich in carbohydrates. In the second diet, some of the carbohydrates were replaced with protein, about half of which came from plant sources such as beans. For the third diet, unsaturated fat, primarily healthy monounsaturated fat, substituted for a portion of the carbohydrates.
All three diets were low in saturated fat, cholesterol, and sodium and rich in fruits, vegetables, fiber, potassium, and other minerals. The participants were then randomly assigned to one of the three diets for six weeks. After a two- to four-week break, participants began a six-week trial of another diet and continued until they had eaten all three diets. The participants’ blood pressure, cholesterol, and triglyceride levels were measured during each phase of the study.
What Was Found -- All three diets lowered blood pressure, but the protein-rich diet and the one that emphasized monounsaturated fat lowered blood pressure even more than did the carbohydrate-rich, DASH diet. What’s more, both the protein- and monounsaturated- fat diets lowered triglycerides -- which the traditional DASH diet did not. In addition, the monounsaturated-fat diet raised HDL levels.
Posted in Hypertension and Stroke on August 7, 2007
Reviewed September 2011
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Like the previous comment,If you want to help, spell out the specifics of the superior diet. Else it looks like a marketing tease to sell a paper.
I believe you want people to find answers and implement them.
Thanks
Posted by: springsrick | August 7, 2007 6:13 PM
The article would have been more useful if an example of a tweak to the DASH diet had been given, i.e. - adding some walnuts or almonds and a little olive oil or their equivalent to the diet would probably be helpful. It would help improve the impression that the Johns Hopkins Health Alerts exist just to sell publications.
Provide practical and useful, basic information in the articles in lieu of teases and "questions". For more detailed information order the publication.
Posted by: Leon | August 8, 2007 4:30 AM
This health alert is an excerpt from a longer article that appeared in the 2007 Hypertention & Stroke White Paper. The original article did include diet recommendations. Here they are:
General Diet Tips
• Eat 1–2 servings of fruit at every meal and have
an extra fruit at breakfast.
• Have 2–3 servings of vegetables at lunch and
dinner.
• Make up a fruit-and-nut trail mix for snacks:
1?4 cup dried fruit with 1 oz unsalted nuts.
• Have a serving of fat-free or low-fat milk, yogurt,
or cheese at 2 meals each day.
• Use whole grains rather than refined grains as
often as possible.
• Select lean versions of meats and remove skin
from poultry.
Tips To Increase Protein
• Have a serving of legumes, nuts, seeds, highprotein
grains (such as bulgur wheat or millet),
lean meats, fish, or poultry with skin removed at
2–3 meals each day.
• Have a serving of fat-free or low-fat milk or milk
products at each meal.
• Use egg whites or egg substitutes at breakfast
and other meals and in recipes.
• Top whole-grain cereals with 1 oz unsalted
nuts.
• Spread unsalted peanut butter on whole-grain
toast.
• Add different kinds of beans to salads, recipes,
and main dishes.
• Try vegetarian meat substitutes in sandwiches,
salads, mixed dishes (such as chili), and as a
main course entrée.
Tips To Increase Monounsaturated Fat
• Have 1 tsp of olive oil or canola oil–based
margarine on bread at lunch.
• Have 1–2 Tbsp of salad dressing made with olive
or canola oil and drizzle on salads.
• Add 1 tsp of olive or canola oil or canola
oil–based margarine to vegetables at dinner.
• Use olive or canola oil to sauté vegetables and in
recipes.
• Have 1 oz of unsalted nuts rich in monounsaturated
fat (for example, almonds, peanuts, and
pecans) each day as a snack or add to cereals.
• Add avocado to salads, sandwiches, and dips.
From Johns Hopkins Health Alert editor
Posted by: Marjorie | August 8, 2007 1:47 PM
Thank you for Johns Hopkins Health Alerts and all you do to help improve our health with your authoritative articles and in-depth reports.
I'm uncertain about the value of nuts like almonds. If almonds are lightly toasted and lightly salted, is this likely to negate their value in a DASH diet? It's sometimes difficult to find (and eat) unsalted nuts. Your thoughts?
Posted by: sundance | June 30, 2009 6:15 AM
I believe eating more vegetable and limited amount of fruit is better as fruits tend to increase your triglycerides which is a risk factor for CVD. The meat substitutes has been positively linked to increase in IGF1 which is a risk factor for cancer. I would stay with whole plant foods and not the processed plant foods like meat substitutes. Genistein a soy isoflavone has been found to be beneficial to breast cancer when consumed as a whole soy food but when isolated from their cofactors as in processed soy food and protein it has the opposite effect. The key is whole plant foods to better health including hypertension, CVD, cancer and other chronic diseases. Limiting free fats, vegetable fats included will also lower blood pressure.
Posted by: banpwong | June 30, 2009 2:07 PM
For the person who said it is hard to find unsalted nuts...
Unsalted nuts, like almonds, are easily found by going to the grocers cooking nuts isle rather than the snack isle. Generally a variety of raw nuts are available there. If you want toasted just pop in the toaster oven for a few minutes.
Health food and "natural food" stores are also a good place to find nuts and seeds without salt -- roasted or unroasted.
Wholesale clubs like Sams also have a limited variety of raw nuts, again with cooking rather than snack items. I also recently noticed that our local Sam's club has an unsalted trail mix.
Good luck!
Posted by: Mikey | December 1, 2009 10:02 AM
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Where can I find the 3rd DASH diet which replaces carbs with unsat fats??
Posted by: charliekhouryjr | August 7, 2007 7:20 AM