The DASH diet is an evidence-based way of eating designed to help treat or prevent high blood pressure.
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- Labeled the “silent killer,” hypertension is a significant cause of premature death globally.
- The DASH diet is an evidence-based way of eating designed to help treat or prevent high blood pressure.
- Research shows that following a DASH diet alone is enough to reduce blood pressure by 6-11 mmHg.
May 17 is World Hypertension Day. Hypertension affects approximately 1.28 billion adults aged 30-79 and is a significant cause of premature death globally and in South Africa. It is estimated that one in three adults in our country we live with high blood pressure, and it is responsible for one out of two strokes and two out of five heart attacks.
Labeled “the silent killer” due to a lack of clear-cut symptoms, the good news is that there are ways to reduce your risk of developing high blood pressure and manage it if diagnosed. One such way is to change our diet, which has recently become a key focus for dietitians and doctors in preventing and treating the condition.
But what exactly is hypertension?
Simply put, think of blood pressure as a burden for your heart to lift. If the weight is too heavy, the heart muscle cannot lift the load, resulting in fatigue or heart failure.
Hypertension is defined as a systolic blood pressure consistently above 140 mmHg and/or a diastolic blood pressure consistently around 90 mmHg (see table below for more details).
Because it’s the number one risk factor for heart disease, stroke, kidney (kidney) complications, and premature death, it’s important to monitor your blood pressure because, in many cases, it can be prevented and managed through regular testing and treatment. If you don’t know your current blood pressure, it’s worth having it checked by a doctor or nurse at a pharmacy. The Heart and Stroke Foundation South Africa recommends having your blood pressure checked at least once a year. Those with risk factors such as obesity or a family history should have it checked more often. Talk to your doctor about your risk.
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A Dietary Approach to Stop Hypertension (DASH)
The Dietary Approaches to Stop Hypertension (DASH) diet is an evidence-based way of eating designed to help treat or prevent high blood pressure. This flexible dietary approach emphasizes the intake of fruits, vegetables, low-fat dairy products, whole grains, lean meats and nuts, and reduces the consumption of ultra-processed foods high in salt (sodium). This way of eating is considered the gold standard for the treatment and prevention of hypertension.
Research indicates that following a DASH diet, without making other lifestyle adjustments (more exercise and less smoking and alcohol), is enough to reduce blood pressure by 6-11 mmHg.
Salt and DASH
But how much salt is too much? Eating more than the recommended 2000 mg of sodium per day puts us at risk of developing hypertension. To put this into context, 1 teaspoon (5 g) of salt contains approximately 2,000 mg of sodium. A teaspoon of salt may seem like little, but we easily consume it when preparing food or adding salt to food at the table. Those with high blood pressure may want to aim for even less sodium in their diets; so some versions of the DASH diet focus on reducing your sodium intake to as low as 1,500 mg per day.
Because we don’t just get salt from what we knowingly add to food, the DASH diet warns against ready-to-eat and over-processed foods and spices. Deli meats, sausages, biltongs, bacon, cheese, hamburgers and salty snacks such as chips, pretzels, crackers and salted nuts often contain high amounts of sodium. Many flavorings, such as braai spices, bouillon cubes and vegetable condiments, also contain high amounts of sodium. It is therefore easy to eat more than the sodium limit per day if you consume these foods regularly.
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What’s the hype around salt?
Excessive salt consumption, defined by the World Health Organization (WHO) as greater than 5 g per day (or 2,000 mg sodium), has been shown to significantly increase blood pressure and is directly linked to the development of high blood pressure and , subsequently, heart disease.
When you eat a salty meal, your body responds by retaining water to dilute the excess sodium in your blood. This water retention increases blood volume and puts extra pressure on blood vessels.
On the other hand, reducing salt intake not only reduces blood pressure and the risk of hypertension, but also reduces the risk of death associated with heart disease. The evidence supporting salt restriction in the treatment and prevention of hypertension is widely agreed among experts.
How to reduce salt intake?
DASH effectively reduces salt intake through its focus on whole foods and elimination of ultra-processed and ready-to-eat foods.
The Heart and Stroke Foundation South Africa (HSFSA) provides five easy ways to reduce your salt intake:
– Gradually reduce the amount of salt added to food.
– Flavor meals with herbs, spices, garlic, ginger, chilli and lemon instead of salt.
– Check labels to identify low-salt foods and look out for the Heart Mark logo (foods approved as part of the Heart and Stroke Foundation Meal Plan).
– Remove the salt shaker and savory sauces from the table.
– Eat more fruits and vegetables, as the minerals in these, as well as whole grains, lentils, beans, and low-fat dairy products, help lower blood pressure.
Micronutrients and hypertension
Another hallmark of the DASH diet is to increase your intake of fruits, vegetables and low-fat dairy products. These foods contain specific micronutrients that have been shown to affect blood pressure.
Potassium and magnesium are two such micronutrients that have been shown to have a positive effect on lowering blood pressure for everyone. Potassium-rich foods include bananas, nuts, beans and lentils, potatoes, butter, and avocados, among others. Many sources of potassium are also sources of magnesium, such as beans, bananas, raisins and potatoes. Other good sources of magnesium include pumpkin seeds, whole grains, oats, beef, salmon, almonds and peanut butter.
Calcium is another important micronutrient in blood pressure management and can be found in dairy products such as low-fat milk and yogurt, green leafy vegetables, nuts, beans such as chickpeas and kidney beans, and lentils.
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Why Low Fat?
The DASH eating pattern promotes the consumption of low-fat foods and lean meats. This feature is supported by observational studies, which highlight the relationship between the low prevalence of hypertension and heart disease among people whose diets are low in animal products and unhealthy fats (saturated fat, polyunsaturated fat, and cholesterol).
In addition to reducing blood pressure, a low-fat approach can also support weight loss and weight management. Obesity has become a global crisis and has been independently associated with elevated blood pressure levels.
What should my blood pressure be?
The table below shows normal blood pressure values, as recommended by the American Heart Association.
It is important to know the difference between normal and elevated blood pressure.
- The DASH Diet is a non-restrictive dietary approach that emphasizes healthy eating patterns. This strategy has been shown to be effective in the prevention and management of hypertension.
- Reducing your salt intake is one of the most crucial dietary modifications.
- Intake of high-fat foods and ultra-processed foods should be drastically reduced as there is strong evidence that they can undermine attempts to lower blood pressure.
- Don’t forget the micronutrients. Specific micronutrients, such as potassium, calcium and magnesium, have been shown to have a positive impact on the management of high blood pressure.
Following DASH is an evidence-based way to prevent and treat hypertension. Talk to your dietitian to help you find a DASH diet that’s right for your needs.
Gia Harper and Jade Curnick are final year Dietetics students at Stellenbosch University.
This resource is for educational purposes only and is not a substitute for individual assessment by a healthcare professional. ADSA is the Association for Dietetics in South Africa. Visit www.adsa.org.za to find other dietitians in your area.
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