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2001 Volunteer Leader Training Guide
The DASH Diet

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Introduction

It has been estimated that as many as 50 million Americans have high blood pressure or "hypertension," which is the medical term. If you know you have high blood pressure, you are one step ahead of many Americans. Millions don’t know they have high blood pressure.

High blood pressure is often called the "silent killer" because it has no warning signs. Many people do not know they have high blood pressure until they have trouble with their heart, brain or kidney.

High blood pressure plays a role in about 700,000 deaths a year from stroke and heart and kidney disease. This illness costs Americans billions of dollars each year.

Research has shown that diet affects the development of high blood pressure or hypertension. A research study found that a particular eating plan can lower elevated blood pressure; that plan is known as the DASH (Dietary Approaches to Stop Hypertension) Diet.

Objectives

Participants will:

• learn the relationship between fruit and vegetables to high blood pressure.

• learn ways to increase fruit and vegetable consumption.

• increase fruit and vegetable consumption.

What Is High Blood Pressure?

Blood is carried from the heart to all of your body’s tissues and organs in vessels called arteries. Blood pressure is the force of the blood pushing against the walls of those arteries. Each time the heart beats – about 60 to 70 times a minute at rest – it pumps out blood into the arteries. Your blood pressure is at its greatest when the heart contracts and is pumping blood. This is called systolic pressure. When the heart is at rest, in between beats, your blood pressure falls. This is the diastolic pressure.

ýBlood pressure is always given as these two numbers Ð the systolic and diastolic pressures. Usually they are written one above or before the other, such as 120/80 mm Hg, with the top number being the systolic and the bottom the diastolic (see chart below).

High blood pressure can be controlled by the following steps:

– lose weight, if overweight
– become physically active
– eat healthy, including choosing foods lower in salt and sodium
– limit alcohol intake
– take high blood pressure medication, if prescribed

All steps but the last also help prevent high blood pressure.

What Is The DASH Diet?

Even slight elevations of blood pressure above the optimal level of less than 120/80 mm Hg are not healthy. The higher the blood pressure above normal, the greater the health risk.

Researchers tested various single nutrients, such as calcium and magnesium, seeking clues to what affects blood pressure. These studies were done mostly with dietary supplements, and the findings were not conclusive. More research was conducted, supported by the National Heart, Lung and Blood Institute (NHLB), that tested nutrients as they occur together in food. The results were dramatic. The clinical study known as "DASH" found that elevated blood pressure can be reduced with an eating plan low in saturated fat, total fat, cholesterol and rich in fruits, vegetables and lowfat dairy foods. The plan is also rich in magnesium, potassium, calcium, as well as protein and fiber.

The DASH Diet participants who had high blood pressure lowered their high blood pressure to the Õame extent as taking an antihypertensive medication. If you have high blood pressure and are taking blood pressure medications, don’t stop your medication and start the diet. Talk it over with your doctor first.

Getting Started

When you follow the DASH plan, you will get more servings of fruits, vegetables and grains, which makes the diet high in fiber. Be aware that this increase in fiber may cause bloating and diarrhea. To get use to the plan, gradually increase your servings of fruits, vegetables and grains. Look at Handout 1, "Following the DASH Diet," for the servings and food groups. The DASH plan is based on a 2,000-calorie diet. Depending on your caloric needs, the number of daily servings in a food group may vary from those listed.

The DASH plan requires no special foods and has no hard-to-follow recipes. There are easy-to- follow recipes included in this teaching outline. One way to begin is by seeing how DASH compares with your current food habits. Do the activity on Handout 2, "What’s on Your Plate?" Do this activity for a day or two to see how your eating habits compare to the DASH plan. This will make it easier for you to see the changes you need to make.

Keep in mind that some days you may eat more than what’s recommended from one food group and less of another. Don’t let that worry you. Just be sure that the average of several days a week comes close to what’s recommended.

Make Changes Gradually

If you already eat one or two vegetables a day, add another serving of a vegetable at lunch and another at dinner.

If you don’t eat fruit or have juice at breakfast, add a serving of fruit to your meals or eat it as a snack.

Use only half the butter, margarine or salad dressing you do now.

Try lowfat or fat-free condiments, such as fat-free salad dressings.

Gradually increase dairy products to three servings a day. For example, drink milk with lunch or dinner instead of soda, alcohol or sugar-sweetened tea. Choose lowfat (1 percent) or fat-free (skim) dairy products to reduce total fat intake.

Treat meat as one part of the whole meal, instead of the focus. Buy less meat. If it’s not there, you won’t eat it. Limit meat to two servings per day (six ounces). Three to four ounces is about the size of a deck of cards. If you eat large portions of meat, cut them back gradually – by a half or a third at each meal. Eat two or more vegetarian-style (meatless) meals each week. Increase servings of vegetables, rice, pasta and dry beans in meals. Try casseroles and pasta and stir-fry dishes, having less meat and more vegetables, grains and dry beans.

Use fruits or lowfat foods as desserts and snacks. Use fruits canned in their own juice. Fresh fruits require little or no preparation. Dried fruits are easy to carry with you.

Try these snack ideas – unsalted pretzels or nuts mixed with raisins; graham crackers; lowfat and fat-free yogurt; plain popcorn with no salt or butter added and raw vegetables.

The DASH plan makes it easier to eat less salt and sodium because it is rich in fruits and vegetables, which are naturally lower in sodium than many other foods. You can lower your salt and sodium intake by using fewer already prepared foods and use less salt in cooking and at the table.

The DASH plan is rich in other nutrients believed to benefit blood pressure and in other factors involved in good health. If you eat about 2,000 calories a day on the plan, the nutrients you get will include:

4,700 milligrams of potassium
500 milligrams of magnesium
1,240 milligrams of calcium

Those totals are about two to three times the amount most Americans usually get.

Other Helpful Tips on Eating the DASH Way

• Start small. Make gradual changes in your eating habit.
   

• Center your meals around carbohydrates such as pasta, rice, beans or vegetables.
   

• Treat meat as one part of the whole meal, instead of the focus.
   

• Use fruits or low-fat, low-calorie foods such as sugar-free gelatin for desserts and snacks.

Remember!

If you use the DASH plan to prevent or control high blood pressure, make it a part of a lifestyle that includes choosing foods lower in salt and sodium, keeping a healthy weight, being physically active and, if you drink alcohol, do so in moderation.

Suggested Activities

1. Do the "What’s On Your Plate" activity 
    

2. Demonstrate one of the recipes from the DASH Plan Recipes for the group.
    

3. Show the salt vials and discuss the amount of salt in those foods.

Materials adapted from The DASH Diet, NIH Publication No. 98-4082, September 1998. U.S. Department of Health and Human Services, Public Health Service, National Institute of Health, National, Heart, Lung and Blood Institute.

Easter H. Tucker, Family and Consumer Sciences Specialist

Back to 2001 Leader Training Guide