The National Heart, Lung, and Blood Institute (part of the National Institutes of Health) has developed a comprehensive eating plan called the DASH (Dietary Approaches to Stop Hypertension) diet. The DASH diet is low in saturated fat, cholesterol, total fat, and sodium. It emphasizes fruits, vegetables, and low-fat dairy foods; it includes whole grain products, ?sh, poultry, and nuts; and it recommends less red meat and fewer sweets. Major studies have demonstrated that the DASH plan works better than other heart-healthy eating plans to help most people reduce their blood pressure. Most people who stick to the plan for a month can signi?cantly lower their blood pressure, and the effect lasts as long as you stay on the plan. The DASH plan also works for people with normal blood pressure who are trying to prevent an increase. In any case, along with following the DASH diet you should make or con- tinue modi?cations to your lifestyle, including exercising and stopping smoking.
Following the DASH diet may enable some people to go without medication, or to use fewer medications than they otherwise would. However, do not discontinue any medication or lower the dose with- out talking to your doctor ?rst.
The DASH plan is two-pronged, involving the eating plan itself and

lowering sodium intake as a means of treating hypertension. The diet can be adapted to different levels of sodium intake, depending on a per- son’s individual sensitivity to salt. The reduction of blood pressure is greatest at the lowest level (1,500 mg or less of dietary sodium per day).
In many instances, diets or eating plans are based on the ideas or the- ories of one or two people, sometimes doctors but not always. In the case of the DASH diet, you can be assured the bene?ts of the DASH eating plan were proven in two research studies funded by the federal government and conducted in several cities.
The DASH diet coupled with sodium reduction is a remarkable approach for treatment of high blood pressure for many reasons:
• It works for a wide variety of people—those with or without high blood pressure, old and young, men and women, blacks and other races, obese or slender, active or inactive.

• The diet is more effective in lowering blood pressure than other heart-healthy diets, and the low-sodium version is even more effective than other low-sodium diets.
• The plan works quickly, lowering blood pressure readings in as lit- tle as 2 to 4 weeks.
• In addition to its effectiveness at lowering blood pressure, it also lowers blood cholesterol levels, another important factor in pre- vention of heart disease (see page 23).
The DASH eating plan is especially rich in fresh fruits and vegeta- bles (eight or more 1?2-cup servings per day) in part because these foods are low in salt. They are also rich in potassium, calcium, and

magnesium. Grains and grain products are another major component of the diet (seven to eight servings per day) because they supply energy and ?ber. The plan limits the amount of meat, sweets, and sugary drinks in order to reduce intake of fats and sugars, as well as sodium. The plan teaches you to sharply reduce your salt intake by avoiding processed foods, which are the source of most of the salt that Americans eat.
If you are on the DASH plan, as with any other diet, the foods that you eat at one meal or over the course of a day may add up to more than the recommended servings. You also might consume more sodium on one day than on another. The important point is that your average for several days or a week should be close to the recommended amounts in order to derive the health bene?t.
You also need to keep in mind that if your doctor has prescribed medication for your high blood pressure, you should not stop taking it. If you feel that following the DASH diet (or another diet plan) may have lowered your blood pressure, have your blood pressure checked at your doctor’s of?ce and discuss the numbers with him or her.

Following the DASH Plan

The abbreviated DASH eating plan shown here gives you an idea of what types of foods are recommended and in what amounts. This plan is based on 2,000 calories per day. Servings can be adjusted depending on your calorie needs and your desired level of sodium intake. You and your doctor can tailor a plan to suit you.

Cutting Back on Salt and Sodium

Small amounts of sodium occur naturally in fresh foods, but most processed foods are high in sodium content. Most is added in manufac- turing and processing. Most restaurants add a lot of salt to foods they prepare. The only way to know for sure is to check the nutrition label carefully. You can cut back on sodium substan- tially by remembering a few general tips:
• Start by eliminating your use of table salt; an herbal salt substitute—available in a variety of flavors—is often helpful.
• Learn to use spices instead of salt. Flavor your food with herbs, spices, lemon or lime juice, vinegar, or salt-free seasoning blends.
• When you buy vegetables, choose fresh or frozen without sauce instead of sauced or canned.
• Rinse canned foods, such as beans or tuna, to remove some of the sodium.
• Always choose low-salt or no-salt prod- ucts when you can.
• Buy fresh poultry, fish, and lean meat rather than canned, smoked, or processed forms.

Limit cured foods (such as bacon or ham), foods in brine (such as pickles, olives, and sauerkraut), and condiments (such as MSG, mustard, ketchup, and barbecue sauce). Limit even low-sodium versions of soy sauce or teriyaki sauce (which contain lots of MSG); measure them as you would table salt.

• Cook rice, pasta, and hot cereals without salt. Cut back on flavored rice, grain, or pasta mixes; they are loaded with salt.

• Rely less on frozen dinners; canned soups, broths, and sauces; and bottled salad dressings. You can make a large quantity of something like tomato sauce using a low-salt recipe, and freeze it in smaller amounts for later use. You can make sim- ple vinegar-and-oil salad dressings in small quantities to use for a few days.

• Most restaurants add a lot of salt to the foods they prepare. When you eat in a restaurant, ask which items can be pre- pared without adding salt. Ask if other spices can be used.