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Study Compares Very Low-carbohydrate Vs DASH Diets For Obese Adults With Hypertension And Diabetes
Adults with hypertension, prediabetes, or type 2 diabetes, and who are overweight or obese, are at an increased risk of serious health complications. However, experts disagree about which dietary patterns and support strategies should be recommended. Researchers randomized 94 adults with the aforementioned conditions, using a 2 x 2 diet-by-support factorial design, comparing a very low-carbohydrate (VLC) or ketogenic diet versus a Dietary Approaches to Stop Hypertension (DASH) diet. Additionally, they compared results with and without extra support activities, such as mindful eating, positive emotion regulation, social support and cooking education.
Using intent-to-treat analyses, the VLC diet led to greater improvement in estimated mean systolic blood pressure (SBP; –9.8 mmHg vs. –5.2 mmHg, P =.046), greater improvement in glycosylated hemoglobin (HbA1c; –.4 % vs. –.1 %, P = 0.034), and greater improvement in weight (–19.14 lbs vs. –10.33 lbs, P = 0.0003), compared to the DASH diet. The addition of extra support did not have a statistically significant effect on outcomes.
For adults with hypertension, prediabetes or type 2 diabetes, and are overweight or obese, a VLC diet demonstrated greater improvements in systolic blood pressure, glycemic control, and weight over a four-month period compared to a DASH diet.
What we know: Nearly half (47%) of adults in the United States have hypertension and about half have prediabetes or type 2 diabetes. Approximately 42% of adults in the United States are also obese. These conditions can trigger stroke, end-stage renal disease, myocardial infarction and premature death. While first-line treatment for these individuals should be a diet and lifestyle intervention, experts disagree about which diet should be recommended.
What this study adds: For adults who are overweight or obese, have hypertension, as well as prediabetes or type 2 diabetes, a very low carbohydrate diet demonstrated greater improvements in systolic blood pressure, glycemic control, and weight over a four-month period compared to a DASH diet.
Source:
Journal reference:
Saslow, L. R., et al. (2023) Comparing Very Low-Carbohydrate vs DASH Diets for Overweight or Obese Adults With Hypertension and Prediabetes or Type 2 Diabetes: A Randomized Trial. The Annals of Family Medicine. Doi.Org/10.1370/afm.2968.
What Is The DASH Diet?
Illustration by Mira Norian for Verywell Health
Medically reviewed by Jamie Johnson, RDN
The DASH diet is a nutritional intervention for lowering blood pressure. "DASH" stands for "Dietary Approaches to Stop Hypertension."
The DASH diet generally emphasizes a high intake of fruits, vegetables, low-fat or nonfat dairy, nuts, seeds, lentils, beans, and whole grains. It limits the consumption of red and processed meat, sweets, soda, and sodium (salt).
This article will explore the ins and outs of the DASH diet, including its health benefits and how it compares to the Mediterranean diet. A summary of specific foods to eat or avoid on the diet will also be provided.
Illustration by Mira Norian for Verywell Health
Lowering Blood Pressure Through the DASH DietScientific studies consistently support the DASH diet as an effective intervention for high blood pressure.
High blood pressure (hypertension) is a health condition that often causes no symptoms but can lead to serious complications like heart disease, stroke, and kidney disease.
The American College of Cardiology and the American Heart Association (ACC/AHA) guidelines categorize blood pressure in the following ways:
Normal: Systolic pressure (the first number) less than 120 and diastolic pressure (the second number) less than 80 millimeters of mercury (mm Hg)
Elevated (prehypertension): Systolic pressure between 120 and 129 and diastolic pressure less than 80 mm Hg
Stage 1 hypertension: Systolic pressure between 130 and 139 or diastolic pressure between 80 and 89
Stage 2 hypertension: Systolic pressure at least 140 or diastolic pressure at least 90 mm Hg
The systolic pressure is the force on the arteries that each heartbeat generates. The diastolic pressure is the force felt against the artery walls when the heart rests between beats.
Besides lowering blood pressure, research suggests the DASH diet has other health benefits, including:
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The widespread benefits of the DASH diet are attributed to its nutrient-dense components, including high amounts of fiber, magnesium, calcium, protein, and potassium.
The diet also emphasizes eating unsaturated fats. These healthy fats lower blood levels of low-density lipoprotein (LDL), a harmful cholesterol that causes fatty buildup in the arteries (atherosclerosis).
Related:How Are High Blood Pressure and Atherosclerosis Linked?
DASH Diet Food ListThe DASH diet is intended to be flexible and well-balanced. It does not emphasize special foods to eat. Instead, the diet focuses on eating a specific number of servings from various food groups.
The number of servings depends on how many calories you need to consume daily, with calories ranging from 1,600 to 3,200 per day for adults.
Recommended daily caloric intake depends on gender, age, weight, and activity level. Use a calorie calculator or speak with a healthcare provider if you need help determining how many calories to eat in a day.
For a 2,000-calorie diet per day, the DASH diet advises the following servings and foods:
Four to five servings of fruit per day
Four to five servings of vegetables per day
Six to eight servings of whole grains per day
Two or three servings of low-fat or fat-free dairy per day
Six or fewer servings per day of meat, chicken, or fish
Two or three servings per day of heart-healthy fats and oils
The diet also encourages four or five servings of nuts, seeds, dry beans, peas, and five or fewer sweets per week.
Regarding salt intake, the DASH diet allows for 2,300 milligrams (mg) daily. This is equivalent to about 1 teaspoon of table salt.
Some people (under the guidance of a healthcare provider) opt for an even lower sodium goal of 1,500 mg. This lower salt limit goal can lower blood pressure even more.
Related:Eating Salt When You Have High Blood Pressure
DASH Diet Recommendations and RestrictionsThe DASH diet encourages a high intake of certain food groups and a limited intake of others.
Here is a visual summary of what foods are encouraged vs. Restricted in the DASH diet.
EatVegetables and fruits (e.G., broccoli, potatoes, spinach, apples, oranges, and raisins)
Whole grains (e.G., oatmeal, whole wheat pasta, brown rice)
Low-fat or fat-free dairy (e.G., fat-free milk and low-fat yogurt)
Lean protein (e.G., skinless chicken, fish, and eggs)
Nuts, seeds, and legumes (e.G., almonds, peanuts, green beans, and chickpeas)
Healthy fats and oils (e.G., soft margarine, olive oil, and light salad dressing)
Low-fat sweets (e.G., fruit-flavored gelatin, maple syrup, sorbet, and hard candy)
High-salt foods (e.G., processed meats like bacon, frozen dinners, pizza, and canned soups)
Red meat (e.G., beef, pork, lamb veal)
Full-fat dairy (e.G., butter, heavy cream, whole milk)
Added sugars (e.G., soda, sweets)
The DASH and Mediterranean diet share some features. They both encourage the consumption of whole grains, fruits, and vegetables and discourage the consumption of foods high in salt, added sugar, or saturated fats like red meat and processed foods.
Both diets also help protect against several chronic diseases, notably stroke, heart disease, and diabetes.
There are subtle differences, however, between the diets. These differences include:
The Mediterranean diet emphasizes the nearly exclusive use of olive oil, whereas the DASH diet promotes the intake of olive oil, but not exclusively.
In the DASH diet, dairy products are allowed and should be either low-fat or nonfat choices. The traditional Mediterranean diet limits dairy consumption, but there are no restrictions on the type of dairy product.
The Mediterranean diet allows for moderate consumption of wine with meals. The DASH diet provides no specific guidance about alcohol intake.
The DASH and Mediterranean diets are both excellent, well-balanced ways of eating. To ensure the diet is appropriate for your care, talk with a healthcare provider or a registered dietitian before starting one.
Related:Dietitian vs. Nutritionist: Similar But Different
Are There Any Risks on the DASH Diet?The DASH diet is not recommended for individuals with decompensated cirrhosis (sudden loss of liver function).
The diet may also need to be modified to accommodate certain health condition. Here are key examples:
With a peanut allergy, avoid peanuts, perhaps replacing them with seeds.
With celiac disease, choose gluten-free foods, such as brown rice, corn, and tapioca, and avoid gluten-containing grains (e.G., wheat, barley, and rye).
With lactose intolerance, choose lactose-free products or take a lactase pill when eating lactose-containing food.
With type 2 diabetes, you would choose foods with a low glycemic index and plan out a low-carbohydrate version of the DASH diet with a dietitian.
Incidentally, the DASH diet contains many high-fiber foods, which can cause bloating. Slowly incorporate high-fiber foods (e.G., fruits, vegetables, and whole grains) into your diet over several weeks to combat this uncomfortable symptom.
What's Not on the DASH Diet?The DASH diet has no specific guidelines regarding alcohol. This is interesting because alcohol intake, especially heavy drinking, has been linked to high blood pressure. As such, your healthcare provider or dietitian will likely recommend limiting alcohol consumption.
The European Society of Hypertension and the European Society of Cardiology (ESH/ESC) guidelines recommend limiting daily alcohol consumption to two or fewer drinks for men and one or fewer drinks for women. (The terms for sex or gender from the source are used.)
If you are starting the DASH diet, follow a healthcare provider's recommendations regarding alcohol. Their guidance may differ based on your medical history.
Related:How Alcohol Affects Blood Pressure
Summary"DASH" stands for "Dietary Approaches to Stop Hypertension." As its name suggests, the DASH diet is an effective strategy for helping lower blood pressure. It has other health benefits, too, like losing weight, if needed, and protecting your heart from disease.
The DASH diet focuses on eating a specific number of servings from different food groups. The diet is generally rich in fruits, vegetables, whole grains, low-fat or nonfat dairy, beans, nuts, seeds, and lean proteins like fish or chicken. It limits the intake of red and processed meat, soda, sweets, and salt.
The DASH and Mediterranean diet are both hearty-healthy eating patterns. However, unlike the Mediterranean diet, the DASH diet does not promote alcohol intake. Also, while the DASH diet encourages consuming olive oil, it's not an exclusive component as it is with the Mediterranean diet.
Study Suggests DASH Diet May Improve Mental Well-being In Addition To Lowering Blood Pressure
The Dietary Approaches to Stop Hypertension (DASH) diet has been shown to significantly lower blood pressure levels among hypertensive patients. However, despite available evidence supporting the beneficial effects of the DASH diet for physical health, only a few studies have examined the psychological effects of this diet.
In a recent study published in the journal Nutrition Reviews, researchers explore the effect of the DASH diet on mental well-being.
Study: Dietary Approaches to Stop Hypertension (DASH) diet and mental well-being: A systematic review. Image Credit: Wachiwit / Shutterstock.Com
Between May 2021 and July 2021, researchers performed a thorough search for articles from PubMed, Web of Science, and PsycINFO databases. These databases were systematically searched up to May 2021.
The searched terms included dietary approaches to stop hypertension or DASH diet and mental health, depression, psychology, emotion, psychosocial, mood, anxiety, mental, quality of life, body image, eating disorders, affect, binge eating, bulimia, anorexia, eating disorders not otherwise specified, or EDNOS.
Abstracts and titles of all searched articles were examined for eligibility. Studies that involved an intervention cohort of the DASH diet or a score estimating the compliance to the DASH diet estimated a minimum of one relevant outcome related to mental well-being, were interventional or observational studies, and were performed on human subjects were included in the current analysis.
ResultsThe final sample consisted of 16 studies, 10 observational studies and six randomized controlled trials (RCTs). Of the 10 observational studies, five were cross-sectional, four were longitudinal, and one was both cross-sectional and longitudinal. The sample size in the studies ranged from 36 to 19,270.
None of the RCTs assessed the incidence of clinically diagnosed depression. One observational study examined the correlation between DASH diet compliance and the development of clinically diagnosed depression by studying longitudinal information of healthy adult residents of Spain and controlling for sex, age, socioeconomic variables, total energy intake, health behaviors, weight alterations, and personality traits of dependency and competitiveness. A weak positive correlation was noted between incident depression and the Dixon DASH index.
A nonlinear and U-shaped association was observed between clinically diagnosed depression and Fung's, Gunther's, and Mellen's DASH diet indices. Medium compliance to the DASH diet estimated by these indexes was related to significantly lower hazard ratios of depression development.
When DASH diet compliance was divided into two groups of low and high adherence, only Fung's DASH index exhibited an inverse correlation with incident depression for less conservative and more conservative definitions.
One study revealed a negative correlation coefficient for the relationship between depressive symptoms and the DASH diet when examined by the Depression Anxiety Stress Scale-21 (DASS-21) without any covariate adjustment. Two RCTs noted that the DASH diet was associated with a positive effect on mood and emotions.
In one study wherein emotional symptoms were defined as "downhearted" and "unhappy" in comparison to their counterparts from the cohort, children from the DASH diet cohort exhibited significant improvements in their emotional symptoms after controlling for sociodemographic variables, energy consumption, baseline values, and parental education and occupation.
Studies that assessed the relationship between quality of life and the DASH diet revealed conflicting findings. Two RCTs noted that the DASH diet improved scores for the Subjective Symptoms Assessment Profile.
One study also reported that after the administration of the six-month intervention, DASH diet participants significantly enhanced their quality of life compared to their counterparts from the control cohort who consumed their usual diet.
ConclusionsThe study findings showed that the DASH diet can have a positive influence on mental well-being. However, some findings were inconsistent, which could be accounted for by variations in assessment methods of the DASH diet and outcomes associated with mental health.
Future studies with effective methodological quality could verify the positive effects of the DASH diet on mental health, which, in turn, could help health practitioners design more comprehensive health techniques. A combination of nutritional and psychological perspectives is likely to improve overall well-being.
Journal reference:
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