Fruit and vegetables in a market

Lower Your Blood Pressure with DASH – What You Need to Know

Yet again this year US News & World Report named the DASH eating pattern one of the best overall diets in its annual ranking. 

DASH, which stands for Dietary Approaches to Stop Hypertension (high blood pressure), started out as a blood pressure lowering plan, but is now considered one of the best heart-healthy and overall approaches to eating.

The first DASH study was published in 1997, more than 25 years ago, but many people still tell me that they don’t know anything about DASH. So let’s fix that! 

We’ll look at benefits of DASH, what you eat, where to find sample menus and recipes, and some important variations on the original.

Is the DASH approach for you?

Before we get into details, let’s look at who might be a good candidate for DASH. Where this eating pattern reliably performs is in blood pressure lowering, if that’s high on your health priority list.

Blood pressure control is nothing to sneeze at. The World Health Organization estimates that globally, high blood pressure is estimated to cause 7.5 million deaths, or about 12.8% of the total of all deaths.

But if your blood pressure is well controlled and you’re just looking for a general heart-healthy way of eating, you may prefer the Mediterranean approach. Let’s look at how they compare.

How does DASH compare to the Mediterranean diet?

With respect to blood pressure lowering, DASH is consistently the winner

On the other hand, we often recommend the Mediterranean eating pattern because it has been shown to reduce cardiac events compared to a low-fat diet. Ask your local cardiologist and they’ll tell you that that’s a more important outcome.

Surprisingly, to my knowledge, there hasn’t been a study of DASH in a similar randomized clinical trial looking at heart disease or mortality. However, there have been a number of papers analyzing population studies suggesting that DASH also reduces heart disease and all-cause mortality.

DASH and Mediterranean have more similarities than differences. They both feature plenty of plant-based foods – vegetables, fruit, whole grains, nuts, and legumes. Both suggest a limited intake of sweets.

What’s different? Mediterranean diets are typically higher in fat, thanks to olive oil, fish, and nuts. You may find that more palatable and thus easier to follow.

DASH, on the other hand, includes dairy daily, while with the Mediterranean approach, it’s included “daily to weekly,” as per your preference. 

The Mediterranean diet allows for red wine with meals, if desired, while DASH doesn’t. (Note that more studies are finding that there is no safe level of alcohol consumption. The role of red wine in Mediterranean diet benefits isn’t clear.)

Also, as you’ll see below, the DASH eating plan gives specific guidance for number of servings and serving size. Some people like that structure and direction. The Mediterranean pattern of eating, on the other hand, is more flexible. 

So what do you think? If it seems like DASH is worth trying for you, read on for details…

So what do you eat on DASH?

Start by figuring out which calorie level to aim for

The DASH plan varies by calorie level, so the first question is, approximately how many calories do you need in a day? 

If you’re not sure, take a look at the Daily Calorie Needs for Women and Daily Calorie Needs for Men sections on this page. (I find people typically need more calories than they think. Listen to your body.)

Studies have looked at whether people can lose weight by following the DASH plan. The answer is yes, at least in the short run, but weight loss from diet is so tough to maintain, I don’t recommend doing making this your focus.

Daily Servings

So let’s say you decide to follow the 2000-calorie plan. You’d aim for the following:

Food groupNumber of servings / day
Grains6-8 
Meats, poultry, and fish6 or less
Fruit4-5 
Vegetables4-5 
Low-fat or fat-free dairy products2-3
Fats and oils2-3
Nuts, seeds, dry beans, and peas4-5 servings / week
Sweets5 or fewer servings / week

Source: National Institutes of Health (NIH) National Heart, Lung, and Blood Institute DASH Eating Plan

Think you need more or less than 2000 calories? Recommended daily servings for other calorie levels are on this page.

The next question that inevitably arises is…

“What’s a serving?” 

Food GroupServing size
Grains1 slice bread
1 oz dry cereal
½ cup cooked rice, pasta, or cereal
Vegetables1 cup raw leafy vegetable
½ cup cut-up raw or cooked vegetable
½ cup vegetable juice
Fruit1 medium fruit
¼ cup dried fruit
½ cup fresh, frozen, or canned fruit
½ cup fruit juice
Fat-free or low-fat dairy products1 cup milk or yogurt
1½ oz cheese
Lean meats, poultry, and fish1 oz cooked meats, poultry, or fish
1 egg
Nuts, seeds, and legumes⅓ cup or 1½ oz nuts
2 Tbsp peanut butter
2 Tbsp or ½ oz seeds
½ cup cooked legumes (dried beans, peas)
Fats and oils1 tsp soft margarine
1 tsp vegetable oil
1 Tbsp mayonnaise
2 Tbsp salad dressing
Sweets and added sugars1 Tbsp jelly or jam
½ cup sorbet or gelatin dessert
1 cup lemonade

Source: NIH National Heart, Lung, and Blood Institute DASH Eating Plan

A few considerations…

Whole grains are recommended

It strikes most people that the number of grain servings is on the high side. If you make most of them whole grain, including intact grains like barley, farro, and rolled oats, it’s actually reasonable. At the 2000 calorie level it equates to about a cup of cooked grain or two small slices of bread at every meal. 

“That’s a lot of fruit and veg!”

It sure is. That’s likely one reason it works so well for blood pressure lowering. You don’t need that much for good heart health, but if you’re trying to get your blood pressure down, it’s worth aiming for. 

If you think about it as 2 cups of fruit and 2 cups of vegetables per day, it might feel more doable. Split that between three meals and a snack or two, and you’ve got this. But it can be quite a change for some people. Take baby steps there if you need to.

Although DASH allows you to count dried fruit and fruit juice as fruit servings, those are higher sugar options, so I wouldn’t rely on them too heavily. 

Don’t forget the dairy

The DASH plan at 2000 calories includes 2-3 servings of milk products. In the original DASH study, researchers also tested a diet high in fruits and vegetables, but without the dairy, which resulted in only about half of the blood pressure lowering effect. So the dairy matters!

A jar of yogurt, fruit, and oats.

They always say “low-fat dairy,” but it’s worth noting that in the original DASH study, there was a 30 gram (1 ounce) serving of cheese every day. The rest was low-fat milk and yogurt. (See below for a DASH variation based on higher-fat dairy.)

If you can’t do dairy, consider alternatives like soy milk. While I don’t believe these have been studied for blood pressure effect, it’s worth a try. 

“That’s so low in sugar!”

The DASH plan is both high and low in sugars. It’s high in that 59% of fruit servings in the original DASH study were juice, which has a comparable sugar content to pop. (!)

The original study also considered a quarter-cup of dried fruit a fruit serving, but that adds a lot of sugar (29 grams for dried cranberries, for example).

On the other hand, researchers kept added sugars to just five times a week, in amounts as small as a tablespoon of jam or a half-cup of sorbet. Most people don’t even think of jam as contributing added sugar! (It does.)

If it helps, the examples given by NIH range from about 10 grams of added sugar (for the tablespoon of jam or jelly) to about 30 grams (for the cup of lemonade or half-cup of sorbet).

American and Canadian guidelines for added sugar range from 25 to 48 grams per day respectively, so the high end of the DASH plan is in the ballpark. 

While I couldn’t find any studies where researchers tested a DASH-like diet with higher sugar levels, I imagine if you stuck to mostly whole fruit for your fruit servings and skipped the lemonade, that would give you more wiggle room for dessert now and then. 

What I would avoid is regular consumption of sugar-sweetened beverages like pop, sweetened iced tea, and uh, lemonade, which has been convincingly linked to worse heart health and an increase in high blood pressure. 

Realistically following the DASH plan

Get started with small steps

If DASH is a big change from how you’re eating now, you might start with small steps versus feeling like you have to do it all. Could you have a piece of fruit with lunch every day? That’s one step closer. Could you make sure to have a glass of milk with supper every night? That’s another step.

The plate model, an easier way

Many people find it difficult to track the number of servings from so many food groups all day long. You’ve probably got other things to spend your mental energy on.

The plate model, which you’ve likely seen, is an easier way to get to a DASH-like eating pattern. The idea is to fill half of your plate (or bowl or whatever) at each meal with vegetables and fruit, a quarter with protein-rich foods, and a quarter with whole grains and starches. 

A plate indicating vegetables & fruit on one side, whole grains & starches in the upper right quarter, and protein foods in the lower right quarter. A glass of water sits next to it.

The protein foods group can include the usual suspects, like chicken and fish, but also make sure to include legumes or nuts (and/or seeds or peanut butter) most days. Milk products are also an important contributor to the protein foods. 

If you do this for three meals a day, you’ll end up in the ballpark of the DASH plan, without all of the counting. If you’re short on something (say not enough vegetables at lunch), you can always have it for a snack later.

Recipes and sample menus

If you want sample menu plans and recipes, there are plenty of free ones available online from trustworthy sources. 

The NIH has developed a generous collection of resources to help people adopt DASH, including these sample menus: A Week With The DASH Eating Plan and this collection of recipes

The Mayo Clinic also has a collection of DASH-friendly recipes.

Now that you know what the DASH plan looks like, we’ll look at a few variations and some frequently asked questions.

Variations on DASH

DASH-Sodium

In the original DASH study, every diet provided approximately 3000 mg of sodium. They wanted to see the effect of the DASH foods independent of sodium. 

The next question to be answered was “Does sodium matter with DASH?” In 2001 they published results of the DASH-Sodium trial

Participants were provided with food corresponding to either the DASH or the typical American (control) diet. Within each group, people were further divided into high, medium, and low sodium groups. 

The exact amount of sodium varied with the amount of food a participant got, with the 2100-calorie level targeting 3300 mg for high sodium, 2300 mg for medium, and 1500 mg for low.

The results? At every sodium level, DASH lowered blood pressure more than the control diet. And results improved the lower the sodium got. DASH and sodium had additive effects.

So if you’re able to do both DASH and keep your sodium in the 1500-2000 mg level, that’s the best case scenario for blood pressure lowering.

Omni-Heart

In 2005, members of the DASH Research Group published a study comparing two variations to the original DASH plan. The idea was to slightly decrease the carbohydrate content and increase (1) the protein or (2) the unsaturated fat content. 

The carbohydrate was decreased by “replacing some fruits with vegetables, reducing sweets, and using smaller portions of grain products”. The higher protein variation had more plant protein as well as meat and dairy food sources. The unsaturated fat was increased for that variation by using more “olive oil, canola oil, and olive oil spread.”

It should be noted that these variations were based on relatively small changes. The characteristics of DASH – high in fruit and veg, whole grains, legumes, nuts, dairy, etc. – were the same. 

Both variations further reduced blood pressure and improved lipids, particularly triglycerides. 10-year coronary heart disease risk, a theoretical construct, was lower on both the protein and unsaturated fat diets versus the one modelled after the original DASH plan.

I actually wonder why DASH continues to dominate when both OmniHeart variations are superior. 

If you’d like to see the details of the OmniHeart plan, including sample menus, this is a good source.

High-fat dairy

A later study, by a different group of researchers, supported by funding from the dairy industry, looked at what would happen if they used high-fat milk products in a DASH-like diet. 

The results? Blood pressure was reduced similarly with the high-fat DASH pattern and the original DASH, compared with the control diet. 

The high-fat DASH also reduced triglycerides, while the standard DASH reduced LDL and HDL-cholesterol.

Making sense of the variations

More variations have been studied, but these are the big ones. I don’t share them to overwhelm, but rather to show that you have some flexibility. As long as you stick with the core characteristics of DASH, you should see blood pressure lowering.

So keep plenty of fruit, veg, dairy, legumes, nuts, and whole grains in the mix and you can dial up the protein or fat if you prefer. The bonus is a possibility of triglyceride lowering, if that’s something you need. 

Frequently asked questions

How much can DASH lower blood pressure?

In the original DASH study, blood pressure was lowered by 5.5 mm Hg (systolic) and 3.0 mm Hg (diastolic) more than the control diet. 

Participants with high blood pressure saw greater reductions in blood pressure. 

Otherwise, the reduction in blood pressure was similar for men, women, and members versus nonmembers of minority groups.

Keep in mind that all study food was provided to participants, to achieve the highest possible adherence. Would your blood pressure drop as much, given you have to buy and prepare your own food? Only one way to find out.

How long does it take DASH to lower blood pressure?

The reductions in blood pressure were achieved after two weeks.

How does DASH affect lipids?

A 2001 study looked at cholesterol and triglycerides on the DASH plan. 

Their findings: “Relative to the control diet, the DASH diet resulted in lower total (−0.35 mmol/L, or −13.7 mg/dL), LDL- (−0.28 mmol/L, or −10.7 mg/dL), and HDL- (−0.09 mmol/L, or −3.7 mg/dL) cholesterol concentrations,” without significant effects on triglycerides.

I left the numbers in there so you could see that while they’re statistically significant, they’re not that big in the grand scheme of things. 

How does DASH work?

The DASH plan is thought to reduce blood pressure thanks to a combination of potassium, magnesium, calcium, fibre, and protein. 

Note though that these nutrients in supplement form don’t lower blood pressure significantly. There’s something about the combination of nutrients in food that makes the difference.

Giving it a try?

As I’ve hopefully made clear, the original DASH isn’t for everyone. You may prefer the Mediterranean approach. But if you need to get your blood pressure down, it’s worth a try! (Or try one of the variations.)

I love to hear from readers, so if you give it a go, or you have in the past, let me know how it goes! You can chime in on our Facebook group, or email me

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