YOUR GUIDE TO Lowering Your Blood Pressure With DASH

The DASH eating plan used in the studies calls for a certain number of daily servings from various food groups. These are given in box 3 for 2,000 calories per day. The number of servings you require may vary, depending on your caloric need. Box 4 gives the number of servings for 1,600, 2,600, and 3,100 calories.

The DASH eating 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 LDL ("bad") cholesterol, which, along with lowering blood pressure, can reduce your risk for getting heart disease.

The DASH eating plan shown below is based on 2,000 calories a day. The number of daily servings in a food group may vary from those listed depending on your caloric needs. Use this chart to help you plan your menus or take it with you when you go to the store.

Box 3: Following the DASH Eating Plan
Food Group	Daily Servings	Serving Sizes	Examples and Notes	Significance of Each Food Group to the DASH Eating Pattern
Grains*	6-8	1 slice bread 1 oz dry cereal** 1/2 cup cooked rice, pasta, or cereal	Whole wheat bread and rolls, whole wheat pasta, English muffin, pita bread, bagel, cereals, grits, oatmeal, brown rice, unsalted pretzels and popcorn	Major sources of energy and fiber
Vegetables	4-5	1 cup raw leafy vegetable 1/2 cup cut-up raw or cooked vegetable 1/2 cup vegetable juice	Broccoli, carrots, collards, green beans, green peas, kale, lima beans, potatoes, spinach, squash, sweet potatoes, tomatoes	Rich sources of potassium, magnesium, and fiber
Fruits	4-5	1 medium fruit 1/4 cup dried fruit 1/2 cup fresh, frozen, or canned fruit 1/2 cup fruit juice	Apples, apricots, bananas, dates, grapes, oranges, grapefruit, grapefruit juice, mangoes, melons, peaches, pineapples, raisins, strawberries, tangerines	Important sources of potassium, magnesium, and fiber
Fat-free or low-fat milk and milk products	2-3	1 cup milk or yogurt 1 1/2 oz cheese	Fat-free (skim) or low-fat (1%) milk or buttermilk, fat-free, low-fat, or reduced-fat cheese, fat-free or low-fat regular or frozen yogurt	Major sources of calcium and protein
Lean meats, poultry, and fish	6 or less	1 oz cooked meats, poultry, or fish 1 egg***	Select only lean; trim away visible fats; broil, roast, or poach; remove skin from poultry	Rich sources of protein and magnesium
Nuts, seeds, and legumes	4-5 per week	1/3 cup or 1 1/2 oz nuts 2 Tbsp peanut butter 2 Tbsp or 1/2 oz seeds 1/2 cup cooked legumes (dry beans and peas)	Almonds, hazelnuts, mixed nuts, peanuts, walnuts, sunflower seeds, peanut butter, kidney beans, lentils, split peas	Rich sources of energy, magnesium, protein, and fiber
Fats and oils****	2-3	1 tsp soft margarine 1 tsp vegetable oil 1 Tbsp mayonnaise 2 Tbsp salad dressing	Soft margarine, vegetable oil (such as canola, corn, olive, or safflower), low-fat mayonnaise, light salad dressing	The DASH study had 27 percent of calories as fat, including fat in or added to foods
Sweets and added sugars	5 or less per week	1 Tbsp sugar 1 Tbsp jelly or jam 1/2 cup sorbet, gelatin 1 cup lemonade	Fruit-flavored gelatin, fruit punch, hard candy, jelly, maple syrup, sorbet and ices, sugar	Sweets should be low in fat

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

** Serving sizes vary between 1/2 cup and 11/4 cups, depending on cereal type. Check the product's Nutrition Facts label.

*** 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.

Box 4: DASH Eating Plan—Number of Daily Servings for Other Calorie Levels
	Servings/Day
Food Groups	1,600 calories/day	2,600 calories/day	3,100 calories/day
Grains*	6	10-11	12-13
Vegetables	3-4	5-6	6
Fruits	4	5-6	6
Fat-free or lowfat milk and milk products	2-3	3	3-4
Lean meats, poultry, and fish	3-6	6	6-9
Nuts, seeds, and legumes	3/week	1	1
Fats and oils	2	3	4
Sweets and added sugars	0	less than 2	less than 2

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

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.

"I was overweight. I was told by my doctor that if I kept it up I was going to develop high blood pressure and high blood cholesterol. The doctor sent me to a dietitian. She is the one who taught me the things that I had to do in order to eat right. It was hard at the beginning because once you have bad habits they are hard to break. Once I realized it was for my own good and no one was going to take care of me except me, I decided to start eating better. At home, we keep stuff like fruits, vegetables, and low-fat or fat-free milk in the house. My three daughters are beginning to learn how to eat right, and my little one loves vegetables like I do."
— JOSE HENRIQUEZ

If you're trying to lose weight, use the foods and serving guidelines in boxes 3 and 4. Aim for a caloric level that is lower than what you usually consume. In addition, you can make your diet lower in calories by using the tips in box 5. The best way to take off pounds is to do so gradually, get more physical activity, and eat a balanced diet that is lower in calories and fat. For some people at very high risk for heart disease or stroke, medication will be necessary. To develop a weight-loss or weight-maintenance program that works well for you, consult with your doctor or registered dietitian.

Combining the DASH eating plan with a regular physical activity program, such as walking or swimming, will help you both shed pounds and stay trim for the long term. You can do an activity for 30 minutes at one time, or choose shorter periods of at least 10 minutes each. (See box 6.) The important thing is to total about 30 minutes of activity each day. (To avoid weight gain, try to total about 60 minutes per day.)

You should be aware that the DASH eating plan has more daily servings of fruits, vegetables, and whole grain foods than you may be used to eating. Because the plan is high in fiber, it can cause bloating and diarrhea in some persons. To avoid these problems, gradually increase your intake of fruit, vegetables, and whole grain foods.

This booklet gives menus and recipes from the DASH studies for both 2,300 and 1,500 milligrams of daily sodium intake. Twenty-three hundred milligrams of sodium equals about 6 grams, or 1 teaspoon, of table salt (sodium chloride); 1,500 milligrams of sodium equals about 4 grams, or 2/3 teaspoon, of table salt.

The key to reducing salt intake is making wise food choices. Only a small amount of salt that we consume comes from the salt added at the table, and only small amounts of sodium occur naturally in food. Processed foods account for most of the salt and sodium Americans consume. So, be sure to read food labels to choose products lower in sodium. You may be surprised to find which foods have sodium. They include baked goods, certain cereals, soy sauce, seasoned salts, monosodium glutamate (MSG), baking soda, and some antacidsÊthe range is wide.

Box 5: How to Lower Calories on the DASH Eating Plan

The DASH eating plan can be adopted to promote weight loss. It is rich in lower-calorie foods, such as fruits and vegetables. You can make it lower in calories by replacing higher calorie foods such as sweets with more fruits and vegetablesÊand that also will make it easier for you to reach your DASH goals. Here are some examples:

To increase fruits—

Eat a medium apple instead of four shortbread cookies. You'll save 80 calories.
Eat 1/4 cup of dried apricots instead of a 2-ounce bag of pork rinds. You'll save 230 calories.

To increase vegetables—

Have a hamburger that's 3 ounces of meat instead of 6 ounces. Add a 1/2-cup serving of carrots and a 1/2-cup serving of spinach. You'll save more than 200 calories.
Instead of 5 ounces of chicken, have a stir fry with 2 ounces of chicken and 11/2 cups of raw vegetables. Use a small amount of vegetable oil. You'll save 50 calories.

To increase fat-free or low-fat milk products—

Have a 1/2-cup serving of low-fat frozen yogurt instead of a 1/2-cup serving of full-fat ice cream. You'll save about 70 calories.

And don't forget these calorie-saving tips:

Use fat-free or low-fat condiments.
Use half as much vegetable oil, soft or liquid margarine, mayonnaise, or salad dressing, or choose available low-fat or fat-free versions.
Eat smaller portionsÊcut back gradually.
Choose fat-free or low-fat milk and milk products.
Check the food labels to compare fat content in packaged foodsÊ items marked fat-free or low-fat are not always lower in calories than their regular versions.
Limit foods with lots of added sugar, such as pies, flavored yogurts, candy bars, ice cream, sherbet, regular soft drinks, and fruit drinks.
Eat fruits canned in their own juice or in water.
Add fruit to plain fat-free or low-fat yogurt.
Snack on fruit, vegetable sticks, unbuttered and unsalted popcorn, or rice cakes.
Drink water or club sodaÊzest it up with a wedge of lemon or lime.

Box 6: Make a Dash for DASH

Thirty minutes of moderate-intensity physical activity each day can help.

If your blood pressure is moderately elevated, 30 minutes of brisk walking on most days a week may be enough to keep you off medication.
If you take medication for high blood pressure, 30 minutes of moderate physical activity can make your medication work more effectively and make you feel better.
If you don't have high blood pressure, being physically active can help keep it that way. If you have normal blood pressureÊbut are not activeÊyour chances of developing high blood pressure increase, especially as you get older or if you become overweight or obese or develop diabetes.

Getting started: Your physical activity program can be as simple as a 15-minute walk around the block each morning and evening. Gradually build up your program and set new goals to stay motivated. The important thing is to find something you enjoy, and do it safely. And rememberÊtrying too hard at first can lead to injury and cause you to give up. If you have a chronic health problem or a family history of heart disease at an early age, be sure to talk with your doctor before launching a new physical activity program.

Set a schedule and try to keep it.
Get a friend or family member to join you. Motivate each other to keep it up.
Cross-train. Alternate between different activities so you don't strain one part of your body day after day.
Set goals.
Reward yourself. At the end of each month that you stay on your exercise program, reward yourself with something new—new clothes, a compact disc, a new book—something that will help keep you committed. But don't use food as a reward.

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

Boxes 7, 8, and 9 offer tips on how to reduce the salt and sodium content in your diet, and boxes 10 and 11 show how to use food labels to find lower sodium products.

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. (See box 12.) However, fruits and vegetables are rich in the form of potassium (potassium with bicarbonate precursors) that favorably affects acid-base metabolism. This form of potassium may help to reduce risk of kidney stones and bone loss. While salt substitutes containing potassium are sometimes needed by persons on drug therapy for high blood pressure, these supplements can be harmful to people with certain medical conditions. Ask your doctor before trying salt substitutes or supplements.

Start the DASH eating plan today—it can help you prevent and control high blood pressure, has other health benefits for your heart, can be used to lose weight, and meets your nutritional needs.

Only a small amount of sodium occurs naturally in foods. Most sodium is added during processing. The table below gives examples of sodium in some foods.

Box 7: Where's the Sodium?
Food Groups		Sodium (mg)
Whole and other grains and grain products*	Cooked cereal, rice, pasta, unsalted, 1/2 cup	0-5
Whole and other grains and grain products*	Ready-to-eat cereal, 1 cup	0-360
Vegetables	Fresh or frozen, cooked without salt, 1/2 cup	1-70
	Canned or frozen with sauce, 1/2 cup	140-460
	Tomato juice, canned, 1/2 cup	330
Fruit	Fresh, frozen, canned, 1/2 cup	0-5
Low-fat or fat-free milk and milk products	Milk, 1 cup	107
	Yogurt, 1 cup	175
	Natural cheeses, 11/2 oz	110-450
	Process cheeses, 2 oz	600
Nuts, seeds, and legumes	Peanuts, salted, 1/3 cup	120
	Peanuts, unsalted, 1/3 cup	0-5
	Beans, cooked from dried or frozen, without salt, 1/2 cup	0-5
	Beans, canned, 1/2 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.

Box 8: Tips To Reduce Salt and Sodium

Choose low- or reduced-sodium, or no-salt-added versions of foods and condiments when available.
Choose fresh, frozen, or canned (low-sodium or no-salt-added) vegetables.
Use fresh poultry, fish, and lean meat, rather than canned, smoked, or processed types.
Choose ready-to-eat breakfast cereals that are lower in sodium.
Limit cured foods (such as bacon and ham); foods packed in brine (such as pickles, pickled vegetables, olives, and sauerkraut); and condiments (such as mustard, horseradish, ketchup, and barbecue sauce). Limit even lower sodium versions of soy sauce and teriyaki sauce. Treat these condiments sparingly as you do table salt.
Cook rice, pasta, and hot cereals without salt. Cut back on instant or flavored rice, pasta, and cereal mixes, which usually have added salt.
Choose "convenience" foods that are lower in sodium. Cut back on frozen dinners, mixed dishes such as pizza, packaged mixes, canned soups or broths, and salad dressings—these often have a lot of sodium.
Rinse canned foods, such as tuna and canned beans, to remove some of the sodium.
Use spices instead of salt. In cooking and at the table, flavor foods with herbs, spices, lemon, lime, vinegar, or salt-free seasoning blends. Start by cutting salt in half.

Box 9: Reducing Salt and Sodium When Eating Out

Ask how foods are prepared. Ask that they be prepared without added salt, MSG, or salt-containing ingredients. Most restaurants are willing to accommodate requests.
Know the terms that indicate high sodium content: pickled, cured, smoked, soy sauce, broth.
Move the salt shaker away.
Limit condiments, such as mustard, ketchup, pickles, and sauces with salt-containing ingredients.
Choose fruit or vegetables, instead of salty snack foods.

Box 10: Compare Nutrition Facts Labels on Foods

Read the Nutrition Facts labels on foods to compare the amount of sodium 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 percent or more Daily Value of sodium are considered high. You can also check out the amounts of the other DASH goal nutrients.

Compare the food labels of these two versions of canned tomatoes. The regular canned tomatoes have 15 times as much sodium as the low-sodium canned tomatoes.

Low-Sodium Canned Diced Tomatoes contains 10 grams of Sodium, 1% of Daily Value.
Canned Diced Tomatoes contains 150 grams of Sodium, 6% of Daily Value.

Low-Sodium Canned Diced Tomatoes

Canned Diced Tomatoes

Nutrition Facts Serving Size 1/2 cup (130g) Servings Per Container 3 1/2
Amount Per Serving
Calories	25	Calories from Fat	0
% Daily Value*
Total Fat 0g			0%
Saturated Fat 0g			0%
Trans Fat 0g
Cholesterol 0g			0%
Sodium 10g			1%
Potassium 270mg			8%
Total Carbohydrate 5g			2%
Dietary Fiber 1g			4%
Sugar 3g			2%
Protein 1g			4%
Vitamin A	5%	Vitamin C	30%
Calcium	4%	Iron	4%
*Percent Daily Values are based on a 2,000 calorie diet.

Nutrition Facts Serving Size 1/2 cup (130g) Servings Per Container 3 1/2
Amount Per Serving
Calories	25	Calories from Fat	0
% Daily Value*
Total Fat 0g			0%
Saturated Fat 0g			0%
Trans Fat 0g
Cholesterol 0g			0%
Sodium 150g			6%
Potassium 270mg			8%
Total Carbohydrate 5g			2%
Dietary Fiber 1g			4%
Sugar 3g			2%
Protein 1g			4%
Vitamin A	5%	Vitamin C	30%
Calcium	4%	Iron	4%
*Percent Daily Values are based on a 2,000 calorie diet.

Food labels can help you choose items lower in sodium, saturated fat, trans fat, cholesterol, and calories and higher in potassium and calcium. Look for the following label information on cans, boxes, bottles, bags, and other packaging:

Box 11: Label Language
Phrase	What It Means*
Sodium
Sodium free or salt free	Less than 5 mg per serving
Very low sodium	35 mg or less of sodium per serving
Low sodium	140 mg or less of sodium per serving
Low-sodium meal	140 mg or less of sodium per 31/2 oz (100 g)
Reduced or less sodium	At least 25 percent less sodium than the regular version
Light in sodium	50 percent 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 0.5 g per serving
Low saturated fat	1 g or less per serving and 15% or less of calories from saturated fat
Low-fat	3 g or less per serving
Reduced fat	At least 25 percent 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.

Potassium comes from a variety of food sources. The table below gives examples of potassium in some foods.

Box 12: Where's the Potassium?
Food Groups	Potassium (mg)
Vegetables
Potato, 1 medium	926
Sweet Potato, 1 medium	540
Spinach, cooked, 1/2 cup	290
Zucchini, cooked, 1/2 cup	280
Tomato, fresh, 1/2 cup	210
Kale, cooked, 1/2 cup	150
Romaine lettuce, 1 cup	140
Mushrooms, 1/2 cup	110
Cucumber, 1/2 cup	80
Fruit
Banana, 1 medium	420
Apricots, 1/4 cup	380
Orange, 1 medium	237
Cantaloupe chunks, 1/2 cup	214
Apple, 1 medium	150
Nuts, seeds, and legumes
Cooked soybeans, 1/2 cup	440
Cooked lentils, 1/2 cup	370
Cooked kidney beans, 1/2 cup	360
Cooked split peas, 1/2 cup	360
Almonds, roasted, 1/3 cup	310
Walnuts, roasted, 1/3 cup	190
Sunflower seeds, roasted, 2 Tbsp	124
Peanuts, roasted, 1/3 cup	120
Low-fat or fat-free milk and milk products
Milk, 1 cup	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

YOUR GUIDE TO Lowering Your Blood Pressure With DASH —
How Do I Make the DASH?

Box 3: Following the DASH Eating Plan

Box 4: DASH Eating Plan—Number of Daily Servings for Other Calorie Levels

Box 5: How to Lower Calories on the DASH Eating Plan

Box 6: Make a Dash for DASH

Box 7: Where's the Sodium?

Box 8: Tips To Reduce Salt and Sodium

Box 9: Reducing Salt and Sodium When Eating Out

Box 10: Compare Nutrition Facts Labels on Foods

Box 11: Label Language

Box 12: Where's the Potassium?

Contents

YOUR GUIDE TO Lowering Your Blood Pressure With DASH — How Do I Make the DASH?

Box 3: Following the DASH Eating Plan

Box 4: DASH Eating Plan—Number of Daily Servings for Other Calorie Levels

Box 5: How to Lower Calories on the DASH Eating Plan

Box 6: Make a Dash for DASH

Box 7: Where's the Sodium?

Box 8: Tips To Reduce Salt and Sodium

Box 9: Reducing Salt and Sodium When Eating Out

Box 10: Compare Nutrition Facts Labels on Foods

Box 11: Label Language

Box 12: Where's the Potassium?

Contents

YOUR GUIDE TO Lowering Your Blood Pressure With DASH —
How Do I Make the DASH?