A SEMINAR ON

DASH DIET

PRESENTED BY

ANNIE MITTAL
PG DIPLOMA IN NUTRITION & DIETETICS
UNIVERSITY ROLL NO-2021303202
SESSION: 2021-22

GOVT. POST GRADUATE COLLEGE

(KURUKSHETRA UNIVERSITY)
SECTOR-1, PANCHKULA
HARYANA- 134109
Diet plays an important role that only in prevention but also in management of various diseases. The
relationship between diet, health and disease is complex. While the cause of all these diseases has a
source in food and diet, the first line of treatment of this is also nutrition therapy.

Hypertension (HTN) is the most common health problems in our country, with more number of cases
in urban than in rural setup. About 25% of world population above 30 years has hypertension.
According to the National Heart, Lung and Blood Institute (NHLBI), citing data from 2002, “The
relationship between blood pressure (BP) and risk of cardiovascular disease (CVD) events is
continuous, consistent, and independent of other risk factors. The higher the BP, the greater is the
chance of heart attack, heart failure, stroke, and kidney disease. What you choose to eat affects your
chances of developing high blood pressure or hypertension. Recent studies show that blood pressure
can be lowered by following the DASH (Dietary Approaches to Stop Hypertension) eating plan and
by eating less salt, also called sodium.

The DASH study was organised and funded by the National Heart, Lung and Blood Institute
(NHLBI) to assess the impact of diet on blood pressure. The trial was an 11-week multicentre,
randomized feeding study that tested the effects of dietary patterns on blood pressure. As a trial of
dietary patterns rather than individual nutrients, DASH tested the combined effects of nutrients that
occur together in food.

The diet reduced systolic blood pressure by 6 mm Hg and diastolic blood pressure by 3 mm Hg in
patients with pre-hypertension. Those with hypertension dropped by 11 and 6 mm Hg, respectively.
The DASH diet is one of three healthy diets recommended in the 2015–2020 US Dietary Guidelines,
which also include the Mediterranean diet and a vegetarian diet.
HYPERTENSION

Hypertension (HTN or HT), also known as high blood pressure (HBP), is a long-term medical
condition in which the blood pressure in the arteries is persistently elevated.

Hypertension is often called "the silent killer" because it generally has no symptoms until serious
complications develop. It is generally symptom less, but increases the risk of various other
cardiovascular diseases like stroke, heart attack and non-cardiovascular diseases like renal damage,
end stage of renal failure etc.

Blood pressure is the pressure of circulating blood against the walls of blood vessels. It is measure in
millimetres of mercury (mmHg) and recorded as to numbers systolic pressure (when the heart beats)
over diastolic pressure (when the heart relaxes between the beats). Blood pressure rises and falls
during the day.

For most adults, a normal blood pressure is less than 120 over 80 millimetres of mercury (mmHg),
which is written as your systolic pressure reading over your diastolic pressure reading — 120/80
mmHg. Your blood pressure is considered high when you have consistent systolic readings of 130
mm Hg or higher or diastolic readings of 80 mm Hg or higher.

RISK FACTORS
Rapid lifestyle changes have led to the emergence of risk factors for hypertension such as lack of
physical activity, obesity, overweight, sedentary lifestyle and nutritional factors such as high fat
intake, alcohol and excessive salt intake and mental stress.

Apart from these factors, smoking, caffeine in tea and coffee, saturated fat intake and diabetes can
also predispose individuals to hypertension.

Rising age, sex, urban setup and high socioeconomic status are the non-modifiable risk factors
contributing to hypertension. Various modifiable risk factors such as obesity, diet, alcohol
consumption, smoking, physical inactivity etc. have been shown to be significantly related to
hypertension.

Prevalence of hypertension is low in populations consuming less than 3g salt per day.
CLASSIFICATION OF HYPERTENSION
It is classified into following types:

1. Primary/Essential Hypertension
2. Secondary Hypertension
3. Gestational Hypertension

Blood pressure SBP DBP

classification (mmHg) (mmHg)
Normal <120 and <80
Pre-hypertension 120-139 or 80-89
Hypertension ≥140 or ≥90
Stage 1 140-159 or 90-99
Stage 2 ≥160-180 or ≥100
SBP: Systolic blood pressure
DBP: Diastolic blood pressure
Figure 1 BP CLASSIFICATION (Source: NHLBI)

The most common of HT is essential or primary hypertension. Over 90% of individuals with
hypertension have essential hypertension. Secondary hypertension may occur due to diseases of
kidney, hormonal glands or mechanical obstruction of blood flow or may be due to some medication,
which can be cured if we can treat the cause.

PRIMARY HYPERTENSION
Primary hypertension is the form of hypertension that by definition has no identifiable secondary
cause.

It is the most common type affecting 85% of those with high blood pressure.

Primary hypertension tends to be familial and is likely to be the consequence of an interaction

between environmental and genetic factors. Prevalence of essential hypertension increases with age,
and individuals with relatively high blood pressure at younger ages are at increased risk for the
subsequent development of hypertension.

SECONDARY HYPERTENSION
Secondary hypertension results from an identifiable cause. Kidney disease is the most common
secondary cause of hypertension.

The different forms of secondary hypertension are:

  Cardiovascular hypertension: It is produced due to
a) Atherosclerosis- hardening and narrowing of blood vessels
b) Coarctation of aorta- narrowing of aorta.
 Renal hypertension: It is produced due to
a) Stenosis renal arteries- narrowing of one or both renal arteries, so that the renal
function is impaired.
b) Glomerulonephritis- nephritis with inflammation of the capillary loops in the renal
glomeruli.
 Endocrine hypertension: It occurs due to
a) Pheochromocytoma- tumour in adrenal medulla
b) Hyperaldosteronism- excess secretion of aldosterone from adrenal cortex Conn’s
syndrome.
c) Cushing’s syndrome- excess secretion of cortisone.
d) Gigantism or Acromegaly- excess secretion of growth hormone.
 Neurogenic hypertension: Acute hypertension can be caused by strong stimulation of the
sympathetic nervous system.
a) Section of the baroreceptors nerves.
b) Lesions in tractus solitarius.
c) Increased intracranial pressure.

GESTATIONAL HYPERTENTION
Gestational Hypertension also referred to as Pregnancy-Induced Hypertension (PIH) is a condition
characterized by high blood pressure during pregnancy. It develops after week 20 in pregnancy and
goes away after delivery.

Blood pressure ≥140/90 mmHg for first time during pregnancy and there is absence of proteinuria.
DASH DIET
DASH diet is an eating plan designed to lower the blood pressure.
The DASH eating plan is recommended by the NIH’s National Heart, Lung, and Blood Institute
(NHLBI). Scientists at NHLBI conducted two key studies. Their findings showed that blood
pressures were reduced with an eating plan that is low in saturated fat, cholesterol, and total fat and
that emphasizes fruits, vegetables, and fat-free or low-fat milk and milk products.
In fact, according to the report, sticking to the DASH eating plan can be as effective as some
medications in lowering your blood pressure.

Sweets
(5/week))

Beans, Oils,
Nuts & Mayo
Seeds (2-3/ day)
(1/day)

Low-Fat Seafood,
Dairy Poultry, Lean
(2-3 per day) Meat
(0-2/day)

Grains
(preferably whole)
(7-8 per day)

Vegetables & Fruits

(8-10 per day)

Figure 2 DASH DIET FOOD PYRAMID

The DASH eating plan is rich in fruits, vegetables, fat-free or low-fat milk and milk products, whole
grains, fish, poultry, beans, seeds and nuts. It also contains less salt and sodium; sweets, added sugars
and sugar-containing beverages; fats; and red meats.
This heart healthy way of eating is also lower in saturated fat, trans-fat and cholesterol and rich in
nutrients that are associated with lowering blood pressure - mainly potassium, magnesium and
calcium, as well as protein and fiber. It includes nutrient-rich foods so that it meets other nutrient
requirements as recommended by the Institute of Medicine.

Daily Nutrient Goals Used in the DASH Studies

(for a 2,100 Calorie Eating Plan)

Total fat 27% of calories Sodium 2,300 mg*

Saturated fat 6% of calories Potassium 4,700 mg
Protein 18% of calories Calcium 1,250 mg
Carbohydrate 55% of calories Magnesium 500 mg
Cholesterol 150 mg Fiber 30 g
 1,500 mg sodium was a lower goal tested and found to be even better for lowering
blood pressure. It was particularly effective for middle-aged and old individuals, who
already had high blood pressure.
G= grams; mg= milligrams

All food substances contain sodium, but added salt (sodium 40%, chloride 60%) is the major source
of sodium in our diet. Sodium content in natural diets, in general will be about 300-400 mg a day.
Cereals, pulses, vegetables, milk; animal and sea foods are the major sources of sodium.

The DASH eating plan used in the studies calls for a certain number of daily servings from various
food groups. The number of servings you require may vary, depending on your caloric need.
 Daily Servings for DASH Eating Plan

Servings/Day

1,600 calories/day 2,600 calories/day 3,100

calories/day
Food Groups

Grains* 6 10-11 12-13

Vegetables 3-4 5-6 6

Fruits 4 5-6 6

Fat-free or low-fat 2-3 3 3-4

milk and milk products

Lean meats, poultry 3-6 6 6-9

and fish

Nuts, seeds and 3/week 1 1

legumes

Fats and oils 2 3 4

Sweets and added 0  ≤2 ≤2

sugars

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

This 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 bad cholesterol, which,
along with lowering blood pressure, can reduce your risk for getting heart disease.

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.
The DASH eating plan shown below is based on 2,000 calories a day. The number of servings in a
food group may vary from those listed depending on your caloric needs.
The following chart can help you to plan your meals.

Significance of Each Food Group to the

Examples and Notes DASH Eating Pattern

Whole wheat bread and rolls, whole wheat pasta, Major sources of energy and fiber
English muffin, pita bread, bagel, cereals, grits,
oatmeal, brown rice, unsalted pretzel and popcorn

Broccoli, carrots, collards, green beans, green peas, Rich sources of potassium, magnesium and
kale, lima beans, potatoes, spinach, squash, sweet fiber
potatoes, tomatoes

Apples, apricots, bananas, dates, grapes, oranges, Important sources of potassium,

grapefruit, grapefruit juice, mangoes, melons, magnesium and fiber
peaches, pineapples, raisins, strawberries, tangerines

Fat- free (skim) or low fat (1%) milk or buttermilk, Major source of calcium and protein
fat-free, low-fat or reduced fat cheese, fat-free or low-
fat regular or frozen yogurt

Select only lean; trim away visible fats; broil, roast or Rich sources of protein and magnesium
poach; remove skin from poultry

Almonds, hazelnuts, mixed nuts, peanuts, walnuts, Rich sources of energy, magnesium,
sunflower seeds, peanut butter, kidney beans, lentils, protein and fiber
split beans

Soft margarine, vegetable oil (such as canola, corn, The DASH study had 27 per cent of
olive or sunflower), low-fat mayonnaise, light salad calories as fat, including fat in or added to
dressing foods

Fruit-flavoured gelatine, fruit punch, hard candy, Sweets should be low in fat
jelly, maple syrup, sorbet and ices, sugar

≠ 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.
Because DASH diet is rich in fruits and vegetables, which are naturally lower in sodium than many
other foods, the 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.

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. However, fruits
and vegetables are rich in the form of potassium that favourably affects acid-base metabolism. This
form of potassium may help to reduce risk of kidney stones and bone loss.
SODIUM IN FOOD

Food Groups Sodium (mg)

Whole and other grains & grain products*

Cooked cereal, rice, pasta, unsalted, ½ cup 0-5
Ready-to-eat cereal, 1 cup 0-360
Bread, 1 slice 110-175

Vegetables
Fresh or frozen, cooked without salt, ½ cup 1-70
Canned or frozen with sauce, ½ cup 140-460
Tomato juice, canned, ½ cup 330

Fruit
Fresh, frozen, canned, ½ cup 0-5

Low-fat or fat-free milk and milk products

Milk, 1cup 107
Yogurt, 1 cup 175
Natural cheeses,1½ oz 110-450
Process cheeses, 2 oz 600

Nuts, seeds and legumes

Peanuts, salted, ½ cup 120
Peanuts, unsalted, ½ cup 0-5
Beans, cooked from dried or frozen, without salt, ½ cup 0-5
Beans, canned, ½ 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.

POTASSIUM IN FOOD

Food Groups Potassium (mg)

Vegetables
Potato, 1 medium 926
Sweet potato, 1 medium 540
Spinach, cooked, ½ cup 290
Zucchini, cooked, ½ cup 280
Tomato, fresh, ½ cup 210
Kale, cooked, ½ cup 150
Lettuce, 1cup 140
Mushrooms, ½ cup 110
Cucumber, ½ cup 80

Fruit
Banana, 1 medium 420
Apricots, ¼ cup 380
Orange, 1 medium 237
Cantaloupe chunks, ½ cup 214
Apple, 1 medium 150

Nuts, seeds and legumes

Cooked soybeans, ½ cup 440
Cooked lentils, ½ cup 370
Cooked kidney bean, ½ cup 360
Cooked split beans, ½ cup 360
Almonds, roasted, ⅓ cup 310
Walnuts, roasted, ⅓ cup 190
Sunflower seeds, roasted, 2 tbsp. 124
Peanuts, roasted, ⅓ cup 120

Low-fat or fat-free milk and milk products

Milk, 1cup 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
 FOOD LABELS
Read the Nutrition Facts labels on foods to compare the amount of sodium and potassium 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% or more
daily value of sodium are considered high. The Daily Value for sodium is less than 2,300 milligrams
(mg) per day.
Comparing the food labels of two versions of canned tomatoes:

The regular canned tomatoes (right) have 15 times as much sodium as

the low-sodium canned tomatoes; i.e. 6.5% of your daily value.
 Label Language

Food labels can help you choose items lower in sodium, saturated fat, trans fat, cholesterol, and
calories and higher in potassium and calcium.

Phrase What it means*

Sodium
Sodium free or salt free Less than 5mg per serving
Very low sodium 35mg or less of sodium per serving
Low sodium 140mg or less of sodium per serving
Low-sodium meal 140mg or less of sodium per 100g
Reduced or less sodium At least 25% less sodium than the regular
version
Light in sodium 50% 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 0.5g per serving
Low saturated fat 1g or less per serving and 15% or less of
calories from saturated fat
Low-fat 3g or less per serving
Reduced fat At least 25% 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.
Customised DASH meal plan:

Food No. of Amount Energy Carb Protein Fat Sodium Potassium

Group Exchange (g) (kcal) (g) (g) (g) (mg) (mg)
Milk 1+¼ +⅔ 485 349 23.2 15.5 21.3 87 393

Pulses ⅔ 20 66 25.5 4.6 0 7.4 161

GLV ½+⅓ 20 24 2 2.4 0 46 112.9

Other 3-4 80 90 7 6 0 46.9 382

veg
Roots & 3-4 300 145 29 4.35 0 76.3 340
tubers
Fruits 1-2 290 130.5 11 1.1 0 28 75

Cereals 8 110 750 150 20 5 20 315

Fat 6 200 184.5 0 6.7 16.7 0 0

Sugar 1 33.5 16 4.1 0 0 0 0

TOTAL 5 1755 251.8 60.65 g 43 g 311.6 mg 1778.9 mg

kcal g

All food substances contain sodium, but added salt (sodium 40%, chloride 60%) is the
major source of sodium in our diet. Sodium content in natural diets, in general will be
about 300-400 mg a day.
Sample Menu:
Meal Menu Ingredients Food group No. of Amount
exchange
Early Roasted flax Flax seeds Fat ½ 2.5g
Morning seeds
Tea Milk Milk & milk ¼ 65ml
Sugar products 1 5g
Sugar
Toast Multigrain Cereals 1 30g
Bread
Breakfas 2 Stuffed Carrot Roots & Tubers ⅓ 30g
t parantha Spinach GLV ½ 50g
Whole-wheat Cereals 2 60g
flour
Ghee Fat 2 10g
Curd Curd Milk & Milk ⅓ 85g
Products
Mid- Apple/ Apple/ Orange/ Fruits 1 80-100g
morning Orange/ Banana/ Guava
Banana/
Guava
Green tea - - - -
Lunch Vegetable Rice Cereals 1 30g
Rice Onion Roots & tubers ⅓ 30g
Tomato Other vegetables ⅓ 30g
Potato Roots & tubers ⅓ 30g
Peas Other vegetables ¼ 20g
Carrot Roots & tubers ⅓ 30g
Groundnut oil Fat 1 5g
Veg. Raita Curd Milk & milk ⅓ 85g
Cucumber products ¼ 20g
Tomato Other vegetables ¼ 20g
Onion Other vegetables ¼ 20g
Roots & tubers
Broccoli Salad Broccoli Other vegetables ½ 50g
Beetroot Roots & tubers ½ 50g
Lettuce GLV ⅓ 30g
Cucumber Other vegetables ⅓ 30g
Lemon Fruit ⅓ 30g
Evening Green tea - - - -
Puffed rice Puffed rice Cereals 2 40g
(unsalted)
Dinner Chapatti Whole-wheat Cereals 2 40g
flour
Mix vegetable Carrot Roots & tubers ½ 50g
Peas Other vegetables ⅓ 30g
Mustard oil Fat 1 5g
Dal Bengal gram, Pulses ⅔ 20g
 whole
Ghee Fat 1 5g
Salad Cucumber Other vegetable ½ 50g
Onion Roots & tubers ½ 50g
Tomato Other vegetable ½ 50g
Bed time Milk Milk Milk & milk 1 250ml
products
Soaked Almonds Nuts & seeds ½ 6g
almonds

CONCLUSION

DASH (Dietary Approaches to Stop Hypertension) eating plan is a meal pattern designed by the
National Heart, Lung and Blood Institute (NHLBI) to lower blood pressure or hypertension (HTN).

This pattern is rich in fruits, vegetables, low-fat dairy products, whole grains, lean meats and fish,
with reduced sugar sweetened desserts and beverages. The diet is heart-friendly as it limits saturated
and trans-fat, while increasing the intake of potassium, magnesium, calcium, protein, and fiber. It
effectively lowers blood pressure in 14 days or two weeks but also normal blood pressure even
without lowering sodium intake. It can produce greater reductions in blood pressure if sodium is
restricted to less than 2300 mg a day, and even more so with a 1500 mg sodium restriction.

DASH diet with low sodium helps you to reduce your systolic blood pressure by 8.9 mmHg and
diastolic blood pressure by 4.5 mmHg. It is not only for control of blood pressure but it also helps in
reduction of weight and lowers serum uric acid levels and prevents or reduces the risk of
cardiovascular diseases, diabetes, kidney disease, and gout.

The diet does not list specific foods to eat. Instead, it’s a dietary pattern focused on servings of food
groups.
 References

 https://www.who.int/news-room/fact-sheets/detail/hypertension
 https://www.nhlbi.nih.gov/education/dash-eating-plan
 https://www.researchgate.net/publication/
8236879_The_DASH_diet_for_high_blood_pressure_From_clinical_trial_to_dinner_tabl
e
 https://www.nejm.org/doi/full/10.1056/nejm199704173361601#:~:text=The%20Dietary
%20Approaches%20to%20Stop,that%20occur%20together%20in%20food.
 https://en.wikipedia.org/wiki/DASH_diet
 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5808587/
 https://my.clevelandclinic.org/health/articles/15426-sodium-controlled-diet
 https://www.fda.gov/media/84261/download
 https://www.nhlbi.nih.gov/files/docs/public/heart/new_dash.pdf
 Your Guide to Lowering High Blood Pressure With DASH
DHHS Web site: www.healthfinder.gov
 Diseases and Conditions A–Z Index:
www.nhlbi.nih.gov/health/dci/index/html
 Dietary Guidelines for Americans 2005 and A Healthier You:
www.healthierus.gov/dietaryguidelines/
 https://www.researchgate.net/publication/
288592053_DASH_Diet_in_Preventing_Hypertension#:~:text=DASH%20stands%20for
%20Dietary%20Approaches,which%20hypertension%20can%20be%20prevented.