What You May Not Know About DASH
Key Clinical Takeaways
Amid an ever-changing landscape of dietary fads and information, it is important to remember that the health benefits of DASH are supported by decades of evidence that demonstrate its benefits for lowering BP, as well as diabetes management, cholesterol management, and cancer prevention. Not all dietary patterns, especially newer ones, have the same level of evidence to back their utility, said Dr Steinberg.
“I would like to reiterate that DASH is not just about sodium. In fact, when it comes to counseling patients who need to lower their BP, reducing salt intake is not always the key to success. When increased consumption of important nutrients like potassium, magnesium, protein, and phosphorous takes center-stage, the synergy between these dietary components may make lowering sodium intake much less necessary in many cases,” she said.
“If the principles of DASH are followed appropriately, DASH can be very beneficial even to patients who consume higher amounts of salt,” she added.
However, Dr Steinberg noted, it is important for dietitians to keep in mind that DASH can be difficult for patients to follow. Population-level data show that less than 1% of the US population fully adhere to DASH, and only 20% get about halfway there.7 In order to fully adhere to the principles and recommendations of DASH, patients often require extra care and support from dietitians to ensure they are able to meet appropriate nutrient targets, she said.
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2. Appel LJ, Moore TJ, Obarzanek E, et al. A clinical trial of the effects of dietary patterns on blood pressure. N Eng J Med. 1997;336:1117-1124. doi:10.1056/NEJM199704173361601.
3. Dietary guidelines for Americans 2015-2020, 8th ed. US Department of Agriculture. https://www.dietaryguidelines.gov/sites/default/files/2019-05/2015-2020_Dietary_Guidelines.pdf. Accessed June 24, 2019.
4. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71:e13-e115. https://doi.org/10.1161/HYP.0000000000000065.
5. Tyson CC, Lin PH, Corsino L, et al. Short-term effects of the DASH diet in adults with moderate chronic kidney disease: a pilot feeding study. Clinical Kidney Journal. 2016;9(4):593-598. https://doi.org/10.1093/ckj/sfw046.
6. Nutrition and dialysis. National Kidney Foundation. https://www.kidney.org/nutrition/Dialysis. Accessed June 24, 2019.
7. Mellen PB, Gao SK, Vitolins MZ, Goff DC Jr. Deteriorating dietary habits among adults with hypertension: DASH dietary accordance, NHANES 1988-1994 and 1999-2004. Arch Intern Med. 2008;168(3):308-14. doi:10.1001/archinternmed.2007.119.