Notes for Dietary Approaches to Stop Hypertension (DASH) presentation
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Today I want to talk to you about Dietary Approaches to Stop Hypertension or
DASH.
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Why worry about preventing hypertension? Well, 1/3 of Americans have hypertension, and as we age, the prevalence increases so it is something many people will be faced with. DASH has been clinically proven to reduce blood pressure levels so it could help prevent or delay the onset of hypertension. Since high blood pressure increases your risk for stroke and cardiovascular disease, it is worth controlling.
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Who should try DASH? Since it is basically just healthy eating, anyone can try
DASH, but is especially helpful if you have pre-hypertension or stage 1 hypertension. If blood pressure or bp is greater than 160/100, then it is diagnosed as Stage 2 hypertension. Additional steps to reduce sodium, which we will discuss in later slides, may help control your hypertension.
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What is DASH? It is regular foods which are high in potassium, calcium, magnesium, fiber, and protein and lower in fat and cholesterol.
Slide 5 ---Food DASH includes healthy foods from all the usual food groups.
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So to get into more detail, let’s look at food groups, the number of servings and serving sizes. The food groups are on the left. The number of servings per day depends on whether you are trying to keep your intake to around 1600 or closer to 2000 calories each day. It is important to look at serving sizes - a serving is not what you happen to put on your plate. It is a specific amount of food defined by

common measurements. So until you can get accustomed to what a serving size is, it’s ok to do some measuring and even keeping food records can help.
Plenty of Grains & Produce
Food Group Servings/Day Serving Size
1 slice bread, 1 oz. dry cereal,
½ c. cooked rice/pasta/cooked cereal
This is a great place to add fiber to your diet. Insoluble fiber promotes regularity and satiety, and a good source is found in whole grains. Whole grains haven’t had their bran and germ removed by milling so they’re better sources of fiber. Start looking at labels - the first ingredient on the list should have the word “whole” in it. Words like stone ground or multigrain do not necessarily mean the product is whole grain.
New white whole wheat bread makes it easier to add fiber. It is made with an albino variety of wheat which is lighter in color.
To add fiber:
Try brown rice and or wild instead of white rice, use whole wheat pastas.
Try a breakfast that includes high-fiber cereals.
Try wild rice, barley in soups stews casseroles and salads.
Add whole grains such as whole grain bread crumbs or rolled oats or crushed bran to ground meat or poultry for extra body.
The other type of fiber you have probably heard about is Soluble fiber. It may help lower LDL (lethal) bad cholesterol and blood sugar and may protect against heart attack and stroke. Soluble fiber appears to reduce the absorption of cholesterol, and good sources include oatmeal and oat bran.
The next group is vegetables.
Food Group Servings/Day Serving Size

1 c. raw leafy veg, ½ c. cooked
Vegetables are a good source of fiber and vitamins. Choose fresh or frozen or low sodium canned to reduce sodium.
To increase the number of servings you eat daily, be creative. For instance, cut the amount of meat for a stir fry dish in half and double up on the vegetables.
Fruits are the next group.
6 oz. juice, 1 med, ¼ c. dried,
½ c. fresh, frozen, canned
Leave the peel on, when possible, to add texture, fiber and additional nutrients.
Fruits are packed with fiber, potassium, & magnesium. They are low in fat and are good on the go. Try adding fruit or juice to breakfast. Have a piece of fruit at lunch and as a snack or try fruits for dessert.
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8 oz. milk, 1 c. yogurt, 1-1/2 oz. cheese
Dairy products are a good source of calcium and nutrients. Use non-fat dairy products. Choose fat free or frozen yogurts with fruit for a sweet treat.
3 oz. cooked meat, poultry, fish
(3 oz = the size of a deck of cards)
DASH suggests that meals not be centered on meats. Cut back typical portions by
1/3 or half and pile on the vegetables instead. Trim away skin and fat before cooking. Broil, roast or poach instead of frying.
Enhance the heart health benefits of DASH by eating fish such as salmon, herring, or tuna which are rich in omega-3 fatty acids that may reduce cholesterol.
Food Group Servings/Day Serving Size

1/3 c nuts, 2 Tbl seeds
2 Tbl peanut butter, ½ c. cooked dry beans or peas
Nuts & seeds are a good source of monounsaturated fat and omega-3 fatty acids, which are thought to have health benefits so they are a good addition. But they are fairly high in calories so watch serving size. Also, look for unsalted nuts and seeds. Dry beans are an alternative to meat. They are a good source of nutrients and soluble fiber.
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Food Group Servings/Day Serving Size
1 tsp soft margarine, 1 Tbl low fat mayonnaise,
2 Tbl light salad dressing, 1 tsp. vegetable oil
Fat helps your body absorb essential vitamins and helps your body’s immune system, but too much fat increases your risk of heart disease, diabetes and obesity. The DASH plan strives for a healthy balance by providing less than 30% of calories from fat with limited amounts of unsaturated fats.
Read food labels to find those that are lowest in saturated fat and are trans fat free. Saturated and trans fat are the main dietary culprits in raising your blood cholesterol and increasing your risk of coronary artery disease. Keep your saturated fat to no more than 10% of your total calories by limiting use of meat, butter, cheese, whole milk, cream and eggs along with foods made from lard, solid shortenings and palm and coconut oils.
If a product has < 0.5 g. trans fat/serving, it can read 0 trans fat on the food label.
Choose margarines with the lowest trans fat content and < 2 g. saturated fat.
Plant Sterols may help reduce low-density lipoprotein or LDL, the bad cholesterol.
Food Group Servings/Day Serving Size
SWEETS
1 Tbl sugar, 1 Tbl jelly

½ oz. jelly beans, 8 oz. lemonade
Try to eat fat-free or low fat sweets sorbets, fruit ices and hard candy.
Although high in calories, dark chocolate contains flavonoids and antioxidants which may have health benefits. Remember, the serving size is 1 oz.
Drinking too much alcohol can raise your blood pressure. DASH recommends limiting alcohol to 2 or fewer drinks/day in men and 1 drink/day for women.
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Side Benefits: Similar to Dietary Guidelines, may help prevent cancer (some research has shown that the nutrients and antioxidants in the foods DASH promotes may result in lower rates of cancer).
Anyone can follow DASH. It’s not a “diet.”
Slide 10 Getting started
You can start with Small Steps.
Focus on 1-2 changes. You don’t have to do everything all at once. Maybe start by adding an extra serving of vegetables each day or changing a snack to a fruit.
Don’t forget to increase fluid. If you increase fiber, you need more fluid to get it moved through your system.

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Plan ahead. It is hard to increase fruits & vegetable intake if you don’t have any in the house. A well stocked kitchen makes it easier to stick with DASH. Make a list before you go to the store and don’t forget to plan for breakfast and snacks.
Eat before you go to the store so everything doesn’t look so appealing.
Buy fresh and fewer processed boxed foods to control how much fat and salt go into your meals.
And as I mentioned earlier, it may be helpful at first to keep a food record.
Slide 12 Read Labels
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When reading labels, check the serving size listed. See how many servings are in the container and what the serving size is. (Show an example of a label on a food package). So on this particular product, the serving size is 1 package and there is
1 serving per container. However, if you see on a label the serving size is ½ cup and the container holds 1 cup, then there are 2 servings in the package. So if you ate the whole thing, you would have to double everything on the label.
When looking at a label, you want it to be low in saturated fat and cholesterol and sodium.
It’s good to aim for 25-35 grams of fiber/day.
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Since DASH is an eating plan and not a strict diet, there’s room to be flexible in your food choices.
Try out DASH for six months and see if it works for you. After six months, many behaviors become a habit.

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Moving toward DASH Breakfast. Here’s an example of how a typical breakfast can be modified to fit the DASH guidelines.
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Moving toward DASH snacks (ask attendees for other examples of healthy snacks). Many of us eat about 1/3 of our daily calories as snacks. Try to include fruit and vegetables as snack options.
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Moving toward DASH sack lunch
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Moving toward a DASH dinner
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Moving toward a DASH dessert
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Additional information on DASH can be found at these links.
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Sodium reduction: Combining the DASH Eating Plan with foods lower in sodium or salt can really lower your blood pressure, which can reduce your risk of a heart attack or stroke. 1500 mg/day is the recommended maximum sodium intake for those with hypertension, diabetes or chronic kidney disease in addition to African
Americans and adults older than aged 50 (that amounts to a majority of the population). The Dietary Guidelines recommend no more than 2300 mg/day (1 tsp salt/day) for those 2 years and older. The average American consumes more than 3400 mg sodium/day.

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What are the main sources of sodium in a typical American diet? A majority comes from processed foods and restaurant foods. Salt added at the table only accounts for about 5 percent of our sodium intake, but it is still a place where you can watch your sodium intake. Make sure you taste the food before adding more salt.
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In order to decrease sodium intake, you’ll need to eat fewer processed (boxed, frozen) foods. Many food manufacturers now offer reduced-sodium soup and canned vegetables that have less, or even no, salt. Also, watch your intake of processed or cured meats like bacon, ham and lunch meats. Avoid salt when boiling rice or pasta. In baking (except for yeast breads), you can often use half the salt that’s called for in a recipe. Minimize high-sodium condiments like soy sauce, steak sauce and pickles.
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Cooking from scratch is a great way to control your sodium intake. Instead of salt, be creative and think of tart or intense flavors like orange zest (from the peel), jalapenos, lime juice, sautéed garlic and onions, or wine and vinegar for salsas and marinades. Fresh herbs are more pungent and flavorful than dried herbs.
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Learn what the various sodium terms are on a food label. For example, if a food has a “low sodium” claim on the label, by law it can’t have more than 140 milligrams of sodium per serving. “Light in sodium” means it has 50% less sodium than the original product, but that doesn’t necessarily mean it’s low sodium.
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Need help with learning how to modify what you eat so it’s lower in sodium and models the DASH Diet? A registered dietitian can help fine tune your eating

habits. Enlist the support of your family so you’re not preparing separate meals or buying different foods.
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With DASH and a lower-sodium diet, you get to eat MORE of these delicious foods.
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If you have questions, my contact information is…