an average salt reduction of 32% on 48 food catego-
ries. In June 2006, the American Medical Association
(AMA) appealed for a minimum 50% reduction in the
amount of sodium in processed foods, fast food prod-
ucts, and restaurant meals to be achieved over the next
ten years.
Researchers have evaluated other dietary modi-
fications, such as the role of potassium, magnesium,
and calcium on blood pressure. Substantial evidence
shows individuals with diets high in fruits and vege-
tables and, hence, potassium, magnesium, and cal-
cium, such as vegetarians, tend to have lower blood
pressures. However, in studies where individuals
have been supplemented with these nutrients, the
results on their effects on blood pressure have been
inconclusive.
There is some debate on whether patients can
follow the diet long-term. The 2003 premier study (a
multi-center trial), which included the DASH diet
when looking at the effect of diet on blood pressure,
found that the DASH diet results were less than the
original study. This difference is thought to be because
in the DASH study participants were supplied with
prepared meals, while participants on the premier
study prepared their own foods. As a result, only half
the fruit and vegetable intake was achieved in the
premier study, which affected the overall intakes of
potassium and magnesium. The researches concluded
that compliance to the DASH diet in the long term is
questionable, but agreed that patients should still be
encouraged to adopt healthy interventions such as the
DASH diet, as it does offer health benefits.
In terms of heart health, the Dash diet lowered
total cholesterol and LDL cholesterol, but it was asso-
ciated with a decrease in high-density lipoprotein
(HDL), the ‘‘good’’ cholesterol. Low HDL levels are
considered a risk factor forcoronary heart disease
(CHD) while high levels are thought to be protective
of heart disease. The decrease was greatest in individ-
uals who started with a higher level of the protective
HDL. Researchers agree that the reasons for the
decrease in HDL levels needs further review, but con-
cluded that the overall effects of the DASH diet are
beneficial to heart disease.
While long term health effects of the DASH diet
are yet to be established, the diet closely resembles
theMediterranean diet, which has been shown to
have other health benefits including a reduced risk
for heart disease andcancerrates. It is thought that
the DASH diet is likely to offer similar health
benefits.
Resources
BOOKS
Hella, Marla.The DASH Diet Action Plan: Based on the
National Institutes of Health Research: Dietary
Approaches to Stop Hypertension. Deerfield, IL: Amidon
Press, 2007.
Moore, Thomas.The DASH Diet for Hypertension. New
York: Pocket Books, 2003.
PERIODICALS
Appel, Lawrence J., C. M. Champagne, D. W. Harsha, et al.
‘‘Effects of Comprehensive Lifestyle Modification on
Blood Pressure Control: Main Results of the PREMIER
Clinical Trial.’’The Journal of the American Medical
Association (JAMA)289, no. 16 (2003): 2083-2093.
Appel, Lawrence J., Michael W. Brands, et al. ‘‘Dietary
Approaches to Prevent and Treat Hypertension A Scien-
tific Statement From the American Heart Association.’’
Hypertension47 (2006): 296. [cited May 5, 2007].<http://
hyper.ahajournals.org/cgi/content/full/47/2/296>.
He, F. J., and G. A. MacGregor. ‘‘Effect of Longer-term
Modest Salt Reduction on Blood Pressure (Review).’’
Cochrane Database of Systematic Reviewsno. 1 (2004).
Lasser, V. I., J. M. Raczynski, et al. ‘‘The Trials of Hyper-
tension Prevention TOHP Collaborative Research
Group.’’Annals of Epidemiology5, no. 2 (1995): 156-164.
Obarzanek, E., Frank M. Sacks, et al. ‘‘Effects on Blood Lipid
of a Blood Pressure Lowering Diet: The Dietary
Approaches to Stop Hypertension (DASH) Trial.’’Amer-
ican Journal of Clinical Nutrition74, no. 1 (2001): 80-89.
Sacks, Frank M., Bernard Rosner, and Edward H. Kass.
‘‘Blood Pressure in Vegetarians.’’American Journal of
Epidemiology100, no. 5 (1974): 390-398
Sacks, Frank M., Laura P. Svetkey, et al. ‘‘Effects on Blood
Pressure of Reduced Dietary Sodium and the Dietary
Approaches to Stop Hypertension (DASH) Diet.’’The
New England Journal of Medicine344, no. 1 (2001): 3-10.
OTHER
National Institute of Health (NIH).Your Guide to Lowering
Your High Blood Pressure with DASH. 1998. NIH
Publication No. 06-4082. 2006. [cited May 5, 2007].QUESTIONS TO ASK YOUR
DOCTOR How will the Dash diet impact my need for
blood pressure medication?
What foods are recommended for the DASH diet?
What is your opinion on using the DASH diet for
weight loss?
What modifications are necessary to
accommodate vegetarians?
How long will I need to stay on the DASH diet?DASH diet