DASH is an acronym for “dietary approaches to stop hypertension.” DASH is an eating plan developed experimentally by the National Institutes of Health when that agency conducted clinical trials on three distinct diet plans through five medical centers between 1993 and 1997. High blood pressure, hypertension, is too common among people with diabetes.
By some estimates two of every three people with diabetes have high blood pressure, too, in some measure because the risk factors for type 2 diabetes — overweight, lack of physical activity, and age — are also risk factors for high blood pressure.
Controlling high blood pressure with diet
Blood pressure measurements are expressed in millimeters of mercury (a measure of pressure) when the heart pumps, systolic pressure, and the pressure when the heart is resting between beats, diastolic pressure. A normal blood pressure is considered to be lower than 120/80. If you have either number higher than a systolic/diastolic 140/90, you are considered hypertensive.
The National Institutes of Health study found that the DASH eating plan lowered blood pressure by an average of 5.5 systolic and 3.0 diastolic compared to the typical U.S. diet eaten by a matched group.
Considering grains, fruit, and dairy
The DASH eating plan is typical of most healthy diet recommendations in its emphasis on more vegetables, fewer added sweets, and less saturated fat. The DASH plan is somewhat unique, however, in its strong emphasis on whole grains.
A typical DASH eating plan also incorporates several servings of fruit and low-fat dairy into a daily menu, and taken together with the grains there are a lot of carbohydrate containing foods you need to balance for blood glucose management.
The table shows the recommended number of servings from the various food groups as they’re divided in the DASH plan. For a 2,000 calories per day diet, the plan could (emphasizing could) include up to 25 carb choices per day.
A typical eating plan for diabetes management would be more likely to include closer to 15 carb choices each day (remember that a carb choice is 15 grams of carbohydrate). This kind of variation could be significant in managing blood glucose effectively, but it’s easy enough to adjust the daily carbohydrates and still follow the DASH plan.
| DASH Plan | Number of Servings (Per Day Unless Noted) Examples | Food Group |
|---|---|---|
| Grains | 6–8 servings | Whole wheat bread or rolls, whole grain pasta, cereals, grits, brown rice, quinoa, popcorn, oatmeal, pretzels |
| Vegetables | 4–5 servings | Broccoli, carrots, greens, squash, potatoes, sweet potatoes, tomatoes, peas, cucumbers, green beans |
| Fruit | 4–5 servings | Fresh, frozen, dried, canned without syrup, or juices |
| Fat free or low-fat dairy products | 2–3 servings | Milk, buttermilk, cheese, yogurt |
| Lean meats, poultry, | 6 or fewer 1 ounce | Lean meats, trim fat, broil, roast fish, eggs servings or one egg or poach, remove skin from poultry, limit eggs to four per week |
| Nuts, seeds and legumes | 4–5 servings per week | Almonds, walnuts, peanuts, sunflower seeds, peanut butter, beans, lentils |
| Fats and oils | 2–3 servings | Margarine, oil, salad dressing |
| Sweets and sugars | less than 1 serving | Candy, syrup, jelly, sugar |
All grains contain carbohydrate, so the DASH recommendation for 6 to 8 servings per day is pretty clear — always count grains as carbohydrates.
But, did you notice some starchy vegetables hiding in the vegetable category? Potatoes, sweet potatoes, peas, lima beans, and hard-shell squashes are carbohydrate foods, and you would need to account for them as carb choices.
You know that everything in the fruit category should be counted as carbs, but while cheese has no carbohydrate, both milk and yogurt in the dairy group should be accounted for in your daily carbohydrate consumption.
The sweets group is, of course, all carbohydrate, and there’s no need to look for carbs in the fat and oils or in the lean meats groups. But, the nuts and seeds group also includes the legumes beans and lentils, and these legumes are candidates for carbohydrate counting.
When following the DASH eating plan you simply need to remember your diabetes meal plan’s carbohydrate recommendations and know that carbohydrate foods are not completely segregated with grains, fruits and sweets, but also can be found in with vegetables, dairy and nuts.
Finding potassium, magnesium, and calcium
The DASH eating plan has a focus on providing three substances that can help keep blood pressure levels lower — potassium, magnesium, and calcium. And, the plan focuses on getting these elements from food.
Potassium is an electrolyte that plays a key role in important activities like helping your heart beat in rhythm, and many studies have shown that adequate levels of potassium help lower blood pressure. Fruits, vegetables, legumes, fish and dairy are all DASH sources of potassium, and the eating plan looks to provide 4,700 milligrams per day.
Magnesium has more important roles than bringing relief from constipation, however. Magnesium is involved in hundreds of biochemical processes in your body, including regulation of blood pressure and blood glucose. The DASH eating plan looks to increase your intake of magnesium by emphasizing whole grains, fruits and vegetables, nuts, seeds, and legumes.
People with type 2 diabetes tend to have lower levels of magnesium. The DASH plan’s goal for magnesium is 500 milligrams per day.
Calcium plays a complex role in blood pressure. The DASH plan aims to provide 1,250 milligrams per day from fat-free and low-fat dairy, green vegetables, fish, and beans.
Losing sodium is even better
The Centers for Disease Control and Prevention (CDC) estimate the average American diet includes 3,436 milligrams of sodium per day, compared to your body’s requirement of less than 500 milligrams. Excess sodium consumption is related to hypertension, and the DASH plan limits sodium intake to 2,300 milligrams per day.
The dietary recommendation for people with diabetes, however, is no more than 1,500 milligrams of sodium per day. Interestingly, a follow-up to the original DASH study looked at the effect on high blood pressure of a lower sodium DASH eating plan — 1,500 milligrams per day. The lower sodium plan reduced blood pressure more than the original plan.
Don’t think that throwing your salt shaker out in the yard automatically solves the challenges with reducing sodium. If your sodium intake is average, it’s likely that 70 percent comes from foods, not that shaker. The most likely culprits are canned foods, cured meats, and restaurant food, and reducing sodium is so important you should really learn to look for it in your diet.
The DASH eating plan can be consistent with effective diabetes management, but you need to locate the carbohydrate foods to balance DASH with your meal plan.