How Can the DASH Diet Improve longevity?

Highlights:

• The DASH diet has been proven effective at reducing blood pressure
• Research also suggests other benefits, such as weight loss, lower risk of cancer, heart disease, and type 2 diabetes
• The reduction of processed foods and increased plant protein, fiber, and vegetable intake make the DASH diet a good choice for clients interested in longevity
• There are other longevity-friendly and easier to follow diets for clients without hypertension issues

Introduction

While DASH (Dietary Approaches to Stop Hypertension) is not as famous or well-known as the Mediterranean diet or vegetarian diet, it routinely appears in conversations about the healthiest diets. The DASH diet has been developed with a single goal in mind, to reduce high blood pressure. It focuses on foods high in potassium, calcium, and magnesium while restricting sodium-rich foods to achieve this goal. According to a number of clinical trials, it is very successful in this aspect. It does help patients meaningfully lower their blood pressure. The question is what impact the DASH diet has on healthy aging and longevity. Should you be recommending this dietary pattern to your clients?

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What is the DASH diet?

The DASH diet is often defined by its sodium reduction. Western pattern diets typically contain 3400 mg of sodium per day or more. The DASH diet limits sodium to 2300 mg of  recommended daily intake, or even 1500 mg per day in the lower sodium version. This is important for helping patients with hypertension. But DASH outlines a dietary approach that goes beyond just sodium. It emphasizes the intake of nutritious, minimally processed foods such as whole grains, cereals, fruits, and vegetables while advocating the reduction of refined foods, mainly those containing added sugar and saturated fat. To illustrate, we will look at what an average patient with a daily requirement of 2000 calories would eat on the DASH diet.

Per day:

• 7 servings of carbohydrates: oats, bread, rice, pasta, or potatoes
• 5 servings of vegetables: leafy greens, raw or cooked colorful vegetables
• 4 servings of fruit: fresh, frozen, or canned fruit
• 2 servings of low-fat dairy; milk, yogurt, or some cheeses
• 6 servings of lean meats, fish, or eggs; one serving is about 30 grams, no salt added
• 2 servings of fats and oils per day; one serving can be 1 teaspoon of olive oil

Per week:

• 5 servings of nuts, seeds, and legumes: one serving can be 1/3 cup of nuts, 2 tablespoons of seeds, or 1/2 cup of cooked legumes
• 5 or fewer servings of sweets: one serving can be 1 tablespoon of sugar or jam or 1 cup of soda

The patient would also be instructed to avoid intake of highly processed foods, fatty meats, and full-fat dairy as well as to focus on limiting sugar-sweetened beverages, sweets, and salt. It is clear that eating as described is likely to be beneficial compared to a Western pattern diet. Research highlights several possible health benefits.

Blood pressure

The DASH diet delivers when it comes to its main goal. Research shows that it reduces systolic blood pressure by an average of 12 mmHg and diastolic blood pressure by 5 mmHg in people with high blood pressure. It manages to lower blood pressure even in people with normal values by a modest 4 mmHg of systolic and 2 mmHg of diastolic blood pressure (1). Studies also show that people on the DASH diet experience lower blood pressure even if they do not lose weight or restrict salt specifically (2). The DASH diet is most effective at lowering blood pressure when combined with physical activity (3). The low-sodium version of DASH limits salt intake to ¾ teaspoons or 1500 mg of sodium, per day. However, research is not showing any clear benefits to reducing salt intake this low, not even for people with high blood pressure (4).

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Weight loss

Research shows that people on the DASH diet can lose weight (5). That is an important benefit for healthy aging and longevity. However, there is a caveat to keep in mind. The participants in this study were in a controlled calorie deficit, men were limited to 1800 kcal and women to 1600 kcal. This calorie reduction almost guarantees weight loss. On the other hand, it is fair to say that the DASH diet itself can help people spontaneously reduce calorie intake because it limits the consumption of calorie-dense foods such as fatty meats, full-fat dairy, and sugary foods. We would need more data to know for certain if this effect is significant enough.

Other potential health benefits

The benefits associated with the DASH diet likely go beyond just blood pressure and weight loss. A review of the literature found a lower prevalence of various cancers among people following the DASH diet due to its high content of fiber, vitamins, minerals, and antioxidant capacity (6). The DASH diet has also been linked with improved insulin resistance, a lower risk of type 2 diabetes (7), and metabolic syndrome (8). Several studies have also shown that the DASH diet helps lower triglycerides and LDL cholesterol which are both risk factors for cardiovascular disease (9).

It can be hard to follow

Studies highlight a notable drawback of the DASH diet which is the difficulty for people to follow it. The DASH diet eliminates or significantly limits many popular food groups such as fatty meats, fatty dairy, and sugary snacks and treats. This is likely why the most significant barriers are social and environmental such as different dietary preferences of family members and at gatherings. Among other factors were palatability, cost, and psychological factors (10). Understanding what makes it hard for clients to follow a diet can help nutritionists guide them to overcome these.

What to recommend to your clients?

The DASH diet is a very good choice for clients dealing with hypertension. And it is worth considering even for those who are not dealing with blood pressure issues. There are several characteristics that make this diet valuable for longevity. The focus on the reduction of processed foods as well as increased plant protein, fiber, and vegetable intake are the crucial ones. Here are several recommendations based on the DASH diet that you can offer to your clients.

• Find a way to include more vegetables such as vegetable soups, smoothies, or replacing rice with cauliflower or pasta with zucchini slices
• Include a wider variety of lean protein sources like beans, peas, lentils, poultry, or fish
• Swap refined grains for whole grains
• Choose fat-free or low-fat dairy products
• Replace processed sugary snacks with whole foods like nuts or fruits
• Eliminate sugar-sweetened beverages in favor of low-calorie drinks like water, tea, or coffee

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Conclusion

The DASH diet is an effective way to reduce blood pressure. It can help your clients eat less processed food and increase plant protein, fiber, and vegetable intake. This is likely why research connects it to other potential benefits such as a lower risk of cancer, heart disease, and type 2 diabetes. The DASH diet can be a good choice for those interested in healthy aging and longevity but it is a relatively restrictive diet that can be hard to stick to long-term. Clients that are not dealing with hypertension might have little reason to choose the DASH diet over other, easier-to-follow diets such as the Mediterranean, flexitarian, or vegetarian diets.

References

1) Sacks FM, Appel LJ, Moore TJ, Obarzanek E, Vollmer WM, Svetkey LP, Bray GA, Vogt TM, Cutler JA, Windhauser MM, Lin PH, Karanja N. A dietary approach to prevent hypertension: a review of the Dietary Approaches to Stop Hypertension (DASH) Study. Clinical cardiology 1999;22(7 Suppl):III6-10. 10.1002/clc.4960221503

2) Saneei P, Salehi-Abargouei A, Esmaillzadeh A, Azadbakht L. Influence of Dietary Approaches to Stop Hypertension (DASH) diet on blood pressure: a systematic review and meta-analysis on randomized controlled trials. Nutrition, metabolism, and cardiovascular diseases : NMCD 2014;24(12):1253-61. 10.1016/j.numecd.2014.06.008

3) Blumenthal JA, Babyak MA, Hinderliter A, Watkins LL, Craighead L, Lin PH, Caccia C, Johnson J, Waugh R, Sherwood A. Effects of the DASH diet alone and in combination with exercise and weight loss on blood pressure and cardiovascular biomarkers in men and women with high blood pressure: the ENCORE study. Archives of internal medicine 2010;170(2):126-35. 10.1001/archinternmed.2009.470

4) Van Horn L. Dietary Sodium and Blood Pressure: How Low Should We Go. Progress in cardiovascular diseases 2015;58(1):61-8. 10.1016/j.pcad.2015.05.008

5) Shenoy SF, Poston WS, Reeves RS, Kazaks AG, Holt RR, Keen CL, Chen HJ, Haddock CK, Winters BL, Khoo CS, Foreyt JP. Weight loss in individuals with metabolic syndrome given DASH diet counseling when provided a low sodium vegetable juice: a randomized controlled trial. Nutrition journal 2010;9:8. 10.1186/1475-2891-9-8

6) Onvani S, Haghighatdoost F, Azadbakht L. Dietary approach to stop hypertension (DASH): diet components may be related to lower prevalence of different kinds of cancer: A review on the related documents. Journal of research in medical sciences : the official journal of Isfahan University of Medical Sciences 2015;20(7):707-13. 10.4103/1735-1995.166233

7) Shirani F, Salehi-Abargouei A, Azadbakht L. Effects of Dietary Approaches to Stop Hypertension (DASH) diet on some risk for developing type 2 diabetes: a systematic review and meta-analysis on controlled clinical trials. Nutrition (Burbank, Los Angeles County, Calif.) 2013;29(7-8):939-47. 10.1016/j.nut.2012.12.021

8) Saneei P, Fallahi E, Barak F, Ghasemifard N, Keshteli AH, Yazdannik AR, Esmaillzadeh A. Adherence to the DASH diet and prevalence of the metabolic syndrome among Iranian women. European journal of nutrition 2015;54(3):421-8. 10.1007/s00394-014-0723-y

9) Challa HJ, Ameer MA, Uppaluri KR. DASH Diet To Stop Hypertension. [Updated 2021 May 19]. In: StatPearls. 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482514/

10) Mahdavi R, Bagheri Asl A, Abadi MAJ, Namazi N. Perceived Barriers to Following Dietary Recommendations in Hypertensive Patients. Journal of the American College of Nutrition 2017;36(3):193-9. 10.1080/07315724.2014.966176

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