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YOUR GUIDE TO Lowering Your Blood Pressure With DASH —
How Do I Make the DASH?

The DASH eating plan used in the studies calls for a certain number of daily servings from various food groups. These are given in box 3 for 2,000 calories per day. The number of servings you require may vary, depending on your caloric need. Box 4 gives the number of servings for 1,600, 2,600, and 3,100 calories.

The DASH eating plan used along with other lifestyle changes can help you prevent and control blood pressure. If your blood pressure is not too high, you may be able to control it entirely by changing your eating habits, losing weight if you are overweight, getting regular physical activity, and cutting down on alcohol. The DASH eating plan also has other benefits, such as lowering LDL ("bad") cholesterol, which, along with lowering blood pressure, can reduce your risk for getting heart disease.

The DASH eating plan shown below is based on 2,000 calories a day. The number of daily servings in a food group may vary from those listed depending on your caloric needs. Use this chart to help you plan your menus or take it with you when you go to the store.

Box 3: Following the DASH Eating Plan

Food Group Daily Servings Serving Sizes Examples and Notes Significance of Each Food Group to the DASH Eating Pattern
Grains* 6-8 1 slice bread
1 oz dry cereal**
1/2 cup cooked rice, pasta, or cereal
Whole wheat bread and rolls, whole wheat pasta, English muffin, pita bread, bagel, cereals, grits, oatmeal, brown rice, unsalted pretzels and popcorn Major sources of energy and fiber
Vegetables 4-5 1 cup raw leafy vegetable
1/2 cup cut-up raw or cooked vegetable
1/2 cup vegetable juice
Broccoli, carrots, collards, green beans, green peas, kale, lima beans, potatoes, spinach, squash, sweet potatoes, tomatoes Rich sources of potassium, magnesium, and fiber
Fruits 4-5 1 medium fruit
1/4 cup dried fruit
1/2 cup fresh, frozen, or canned fruit
1/2 cup fruit juice
Apples, apricots, bananas, dates, grapes, oranges, grapefruit, grapefruit juice, mangoes, melons, peaches, pineapples, raisins, strawberries, tangerines Important sources of potassium, magnesium, and fiber
Fat-free or low-fat milk and milk products 2-3 1 cup milk or yogurt
1 1/2 oz cheese
Fat-free (skim) or low-fat (1%) milk or buttermilk, fat-free, low-fat, or reduced-fat cheese, fat-free or low-fat regular or frozen yogurt Major sources of calcium and protein
Lean meats, poultry, and fish 6 or less 1 oz cooked meats, poultry, or fish
1 egg***
Select only lean; trim away visible fats; broil, roast, or poach; remove skin from poultry Rich sources of protein and magnesium
Nuts, seeds, and legumes 4-5 per week 1/3 cup or 1 1/2 oz nuts
2 Tbsp peanut butter
2 Tbsp or 1/2 oz seeds
1/2 cup cooked legumes (dry beans and peas)
Almonds, hazelnuts, mixed nuts, peanuts, walnuts, sunflower seeds, peanut butter, kidney beans, lentils, split peas Rich sources of energy, magnesium, protein, and fiber
Fats and oils**** 2-3 1 tsp soft margarine
1 tsp vegetable oil
1 Tbsp mayonnaise
2 Tbsp salad dressing
Soft margarine, vegetable oil (such as canola, corn, olive, or safflower), low-fat mayonnaise, light salad dressing The DASH study had 27 percent of calories as fat, including fat in or added to foods
Sweets and added sugars 5 or less per week 1 Tbsp sugar
1 Tbsp jelly or jam
1/2 cup sorbet, gelatin
1 cup lemonade
Fruit-flavored gelatin, fruit punch, hard candy, jelly, maple syrup, sorbet and ices, sugar Sweets should be low in fat

* Whole grains are recommended for most grain servings as a good source of fiber and nutrients.

** Serving sizes vary between 1/2 cup and 11/4 cups, depending on cereal type. Check the product's Nutrition Facts label.

*** Since eggs are high in cholesterol, limit egg yolk intake to no more than four per week; two egg whites have the same protein content as 1 oz of meat.

**** Fat content changes serving amount for fats and oils. For example, 1 Tbsp of regular salad dressing equals one serving; 1 Tbsp of a low-fat dressing equals one-half serving; 1 Tbsp of a fat-free dressing equals zero servings.



Box 4: DASH Eating Plan—Number of Daily Servings for Other Calorie Levels

  Servings/Day
Food Groups 1,600 calories/day 2,600 calories/day 3,100 calories/day
Grains* 6 10-11 12-13
Vegetables 3-4 5-6 6
Fruits 4 5-6 6
Fat-free or lowfat milk and milk products 2-3 3 3-4
Lean meats, poultry, and fish 3-6 6 6-9
Nuts, seeds, and legumes 3/week 1 1
Fats and oils 2 3 4
Sweets and added sugars 0 less than 2 less than 2

* Whole grains are recommended for most grain servings as a good source of fiber and nutrients.


If you need to lose weight, even a small weight loss will help to lower your risks of developing high blood pressure and other serious health conditions. At the very least, you should not gain weight. A recent study showed that people can lose weight while following the DASH eating plan and lowering their sodium intake. In a study of 810 participants, one-third were taught how to lower their sodium intake and follow the DASH eating plan on their own. Most of them needed to lose weight as well. They followed the DASH eating plan at lower calorie levels and they increased their physical activity. Over the course of 18 months, participants lost weight and improved their blood pressure control.

"I was overweight. I was told by my doctor that if I kept it up I was going to develop high blood pressure and high blood cholesterol. The doctor sent me to a dietitian. She is the one who taught me the things that I had to do in order to eat right. It was hard at the beginning because once you have bad habits they are hard to break. Once I realized it was for my own good and no one was going to take care of me except me, I decided to start eating better. At home, we keep stuff like fruits, vegetables, and low-fat or fat-free milk in the house. My three daughters are beginning to learn how to eat right, and my little one loves vegetables like I do."
— JOSE HENRIQUEZ

If you're trying to lose weight, use the foods and serving guidelines in boxes 3 and 4. Aim for a caloric level that is lower than what you usually consume. In addition, you can make your diet lower in calories by using the tips in box 5. The best way to take off pounds is to do so gradually, get more physical activity, and eat a balanced diet that is lower in calories and fat. For some people at very high risk for heart disease or stroke, medication will be necessary. To develop a weight-loss or weight-maintenance program that works well for you, consult with your doctor or registered dietitian.

Combining the DASH eating plan with a regular physical activity program, such as walking or swimming, will help you both shed pounds and stay trim for the long term. You can do an activity for 30 minutes at one time, or choose shorter periods of at least 10 minutes each. (See box 6.) The important thing is to total about 30 minutes of activity each day. (To avoid weight gain, try to total about 60 minutes per day.)

You should be aware that the DASH eating plan has more daily servings of fruits, vegetables, and whole grain foods than you may be used to eating. Because the plan is high in fiber, it can cause bloating and diarrhea in some persons. To avoid these problems, gradually increase your intake of fruit, vegetables, and whole grain foods.

This booklet gives menus and recipes from the DASH studies for both 2,300 and 1,500 milligrams of daily sodium intake. Twenty-three hundred milligrams of sodium equals about 6 grams, or 1 teaspoon, of table salt (sodium chloride); 1,500 milligrams of sodium equals about 4 grams, or 2/3 teaspoon, of table salt.

The key to reducing salt intake is making wise food choices. Only a small amount of salt that we consume comes from the salt added at the table, and only small amounts of sodium occur naturally in food. Processed foods account for most of the salt and sodium Americans consume. So, be sure to read food labels to choose products lower in sodium. You may be surprised to find which foods have sodium. They include baked goods, certain cereals, soy sauce, seasoned salts, monosodium glutamate (MSG), baking soda, and some antacids╩the range is wide.

Box 5: How to Lower Calories on the DASH Eating Plan

The DASH eating plan can be adopted to promote weight loss. It is rich in lower-calorie foods, such as fruits and vegetables. You can make it lower in calories by replacing higher calorie foods such as sweets with more fruits and vegetables╩and that also will make it easier for you to reach your DASH goals. Here are some examples:

To increase fruits—

To increase vegetables—

To increase fat-free or low-fat milk products—

And don't forget these calorie-saving tips:


Box 6: Make a Dash for DASH

Thirty minutes of moderate-intensity physical activity each day can help.

Getting started: Your physical activity program can be as simple as a 15-minute walk around the block each morning and evening. Gradually build up your program and set new goals to stay motivated. The important thing is to find something you enjoy, and do it safely. And remember╩trying too hard at first can lead to injury and cause you to give up. If you have a chronic health problem or a family history of heart disease at an early age, be sure to talk with your doctor before launching a new physical activity program.

  1. Set a schedule and try to keep it.
  2. Get a friend or family member to join you. Motivate each other to keep it up.
  3. Cross-train. Alternate between different activities so you don't strain one part of your body day after day.
  4. Set goals.
  5. Reward yourself. At the end of each month that you stay on your exercise program, reward yourself with something new—new clothes, a compact disc, a new book—something that will help keep you committed. But don't use food as a reward.

Because it is rich in fruits and vegetables, which are naturally lower in sodium than many other foods, the DASH eating plan makes it easier to consume less salt and sodium. Still, you may want to begin by adopting the DASH eating plan at the level of 2,300 milligrams of sodium per day and then further lower your sodium intake to 1,500 milligrams per day.

Boxes 7, 8, and 9 offer tips on how to reduce the salt and sodium content in your diet, and boxes 10 and 11 show how to use food labels to find lower sodium products.

The DASH eating plan also emphasizes potassium from food, especially fruits and vegetables, to help keep blood pressure levels healthy. A potassium-rich diet may help to reduce elevated or high blood pressure, but be sure to get your potassium from food sources, not from supplements. Many fruits and vegetables, some milk products, and fish are rich sources of potassium. (See box 12.) However, fruits and vegetables are rich in the form of potassium (potassium with bicarbonate precursors) that favorably affects acid-base metabolism. This form of potassium may help to reduce risk of kidney stones and bone loss. While salt substitutes containing potassium are sometimes needed by persons on drug therapy for high blood pressure, these supplements can be harmful to people with certain medical conditions. Ask your doctor before trying salt substitutes or supplements.

Start the DASH eating plan today—it can help you prevent and control high blood pressure, has other health benefits for your heart, can be used to lose weight, and meets your nutritional needs.

Only a small amount of sodium occurs naturally in foods. Most sodium is added during processing. The table below gives examples of sodium in some foods.

Box 7: Where's the Sodium?

Food Groups Sodium (mg)
Whole and other grains and grain products* Cooked cereal, rice, pasta, unsalted, 1/2 cup 0-5
Ready-to-eat cereal, 1 cup 0-360
Vegetables Fresh or frozen, cooked without salt, 1/2 cup 1-70
Canned or frozen with sauce, 1/2 cup 140-460
Tomato juice, canned, 1/2 cup 330
Fruit Fresh, frozen, canned, 1/2 cup 0-5
Low-fat or fat-free milk and milk products Milk, 1 cup 107
Yogurt, 1 cup 175
Natural cheeses, 11/2 oz 110-450
Process cheeses, 2 oz 600
Nuts, seeds, and legumes Peanuts, salted, 1/3 cup 120
Peanuts, unsalted, 1/3 cup 0-5
Beans, cooked from dried or frozen, without salt, 1/2 cup 0-5
Beans, canned, 1/2 cup 400
Lean meats, fish, and poultry Fresh meat, fish, poultry, 3 oz 30-90
Tuna canned, water pack, no salt added, 3 oz 35-45
Tuna canned, water pack, 3 oz 230-350
Ham, lean, roasted, 3 oz 1,020

* Whole grains are recommended for most grain servings.



Box 8: Tips To Reduce Salt and Sodium


Box 9: Reducing Salt and Sodium When Eating Out


Box 10: Compare Nutrition Facts Labels on Foods

Read the Nutrition Facts labels on foods to compare the amount of sodium in products. Look for the sodium content in milligrams and the Percent Daily Value. Aim for foods that are less than 5 percent of the Daily Value of sodium. Foods with 20 percent or more Daily Value of sodium are considered high. You can also check out the amounts of the other DASH goal nutrients.

Compare the food labels of these two versions of canned tomatoes. The regular canned tomatoes have 15 times as much sodium as the low-sodium canned tomatoes.

Low-Sodium Canned Diced Tomatoes contains 10 grams of Sodium, 1% of Daily Value.
Canned Diced Tomatoes contains 150 grams of Sodium, 6% of Daily Value.

Low-Sodium Canned Diced Tomatoes Canned Diced Tomatoes
Nutrition Facts
Serving Size 1/2 cup (130g)
Servings Per Container 3 1/2
Amount Per Serving
Calories 25 Calories from Fat 0
% Daily Value*
Total Fat 0g 0%
Saturated Fat 0g 0%
Trans Fat 0g
Cholesterol 0g 0%
Sodium 10g 1%
Potassium 270mg 8%
Total Carbohydrate 5g 2%
Dietary Fiber 1g 4%
Sugar 3g 2%
Protein 1g 4%
Vitamin A 5% Vitamin C 30%
Calcium 4% Iron 4%
*Percent Daily Values are based on a 2,000 calorie diet.
Nutrition Facts
Serving Size 1/2 cup (130g)
Servings Per Container 3 1/2
Amount Per Serving
Calories 25 Calories from Fat 0
% Daily Value*
Total Fat 0g 0%
Saturated Fat 0g 0%
Trans Fat 0g
Cholesterol 0g 0%
Sodium 150g 6%
Potassium 270mg 8%
Total Carbohydrate 5g 2%
Dietary Fiber 1g 4%
Sugar 3g 2%
Protein 1g 4%
Vitamin A 5% Vitamin C 30%
Calcium 4% Iron 4%
*Percent Daily Values are based on a 2,000 calorie diet.


Food labels can help you choose items lower in sodium, saturated fat, trans fat, cholesterol, and calories and higher in potassium and calcium. Look for the following label information on cans, boxes, bottles, bags, and other packaging:

Box 11: Label Language

Phrase What It Means*
Sodium
Sodium free or salt free Less than 5 mg per serving
Very low sodium 35 mg or less of sodium per serving
Low sodium 140 mg or less of sodium per serving
Low-sodium meal 140 mg or less of sodium per 31/2 oz (100 g)
Reduced or less sodium At least 25 percent less sodium than the regular version
Light in sodium 50 percent less sodium than the regular version
Unsalted or no salt added No salt added to the product during processing (this is not a sodium-free food)
Fat
Fat-free Less than 0.5 g per serving
Low saturated fat 1 g or less per serving and 15% or less of calories from saturated fat
Low-fat 3 g or less per serving
Reduced fat At least 25 percent less fat than the regular version
Light in fat Half the fat compared to the regular version

* Small serving sizes (50 g) or meals and main dishes are based on various weights in grams versus a serving size.



Potassium comes from a variety of food sources. The table below gives examples of potassium in some foods.

Box 12: Where's the Potassium?

Food Groups Potassium (mg)
Vegetables
Potato, 1 medium 926
Sweet Potato, 1 medium 540
Spinach, cooked, 1/2 cup 290
Zucchini, cooked, 1/2 cup 280
Tomato, fresh, 1/2 cup 210
Kale, cooked, 1/2 cup 150
Romaine lettuce, 1 cup 140
Mushrooms, 1/2 cup 110
Cucumber, 1/2 cup 80
Fruit
Banana, 1 medium 420
Apricots, 1/4 cup 380
Orange, 1 medium 237
Cantaloupe chunks, 1/2 cup 214
Apple, 1 medium 150
Nuts, seeds, and legumes
Cooked soybeans, 1/2 cup 440
Cooked lentils, 1/2 cup 370
Cooked kidney beans, 1/2 cup 360
Cooked split peas, 1/2 cup 360
Almonds, roasted, 1/3 cup 310
Walnuts, roasted, 1/3 cup 190
Sunflower seeds, roasted, 2 Tbsp 124
Peanuts, roasted, 1/3 cup 120
Low-fat or fat-free milk and milk products
Milk, 1 cup 380
Yogurt, 1 cup 370
Lean meats, fish, and poultry
Fish (cod, halibut, rockfish, trout, tuna), 3 oz 200-400
Pork tenderloin, 3 oz 370
Beef tenderloin, chicken, turkey, 3 oz 210



Contents

Introduction

What Is High Blood Pressure?

What Is the DASH Eating Plan?
- How Do I Make the DASH?
- How Can I Get Started on the DASH Eating Plan?

A Week With the DASH Eating Plan

Recipes for Heart Health

To Learn More