Y O U R G U I D E T OLowering Your BloodPressure With DASHU.S. DEPARTMENT OF HEALTH AND HUMAN SERVICESNational Institutes of HealthNational Heart, Lung, and Blood Institute
Y O U R G U I D E T OLowering Your BloodPressure With DASHU.S. DEPARTMENT OF HEALTH AND HUMAN SERVICESNational Institutes of HealthNational Heart, Lung, and Blood InstituteNIH Publication No. 06-4082Originally Printed 1998Revised April 2006
ivMy doctor noticed my blood pressure was alittle high. I try to be more aware of the foodsI eat. I limit alcohol, and watch my portions.I also work out 5–7 days a week. My son islearning from me and is doing the samethings I do.R I C A R D O E L E Y“”
1IntroductionIntroductionWhat you choose to eat affects your chances of developing highblood pressure, or hypertension (the medical term). Recent studiesshow that blood pressure can be lowered by following the DietaryApproaches to Stop Hypertension (DASH) eating plan—and byeating less salt, also called sodium.While each step alone lowers blood pressure, the combination of theeating plan and a reduced sodium intake gives the biggest benefitand may help prevent the development of high blood pressure.This booklet, based on the DASH research findings, tells howto follow the DASH eating plan and reduce the amount of sodiumyou consume. It offers tips on how to start and stay on the eatingplan, as well as a week of menus and some recipes. The menusand recipes are given for two levels of daily sodium consumption—2,300 and 1,500 milligrams per day. Twenty-three hundredmilligrams is the highest level considered acceptable by the NationalHigh Blood Pressure Education Program. It is also the highestamount recommended for healthy Americans by the 2005 “U.S.Dietary Guidelines for Americans.” The 1,500 milligram level canlower blood pressure further and more recently is the amountrecommended by the Institute of Medicine as an adequate intakelevel and one that most people should try to achieve.The lower your salt intake is, the lower your blood pressure.Studies have found that the DASH menus containing 2,300 mil-ligrams of sodium can lower blood pressure and that an evenlower level of sodium, 1,500 milligrams, can further reduce bloodpressure. All the menus are lower in sodium than what adultsin the United States currently eat—about 4,200 milligrams per dayin men and 3,300 milligrams per day in women.Those with high blood pressure and prehypertension may benefitespecially from following the DASH eating plan and reducing theirsodium intake.
2YourGuidetoLoweringYourBloodPressureWithDASHMy family’s food choices have alwaysbeen pretty good. We eat a lot of fruit,vegetables, and low-fat yogurt.L I L L Y K R A M E R“”
Blood pressure is the force of blood against artery walls. It ismeasured in millimeters of mercury (mmHg) and recorded as twonumbers—systolic pressure (when the heart beats) over diastolicpressure (when the heart relaxes between beats). Both numbers areimportant. (See box 1 on page 4.)Blood pressure rises and falls during the day. But when it stayselevated over time, then its called high blood pressure. High bloodpressure is dangerous because it makes the heart work too hard, andthe high force of the blood flow can harm arteries and organs suchas the heart, kidneys, brain, and eyes. High blood pressure oftenhas no warning signs or symptoms. Once it occurs, it usually lasts alifetime. If uncontrolled, it can lead to heart and kidney disease,stroke, and blindness.High blood pressure affects more than 65 million—or 1 in 3—American adults. About 28 percent of American adults ages 18 andolder, or about 59 million people, have prehypertension, a conditionthat also increases the chance of heart disease and stroke. Highblood pressure is especially common among African Americans,who tend to develop it at an earlier age and more often than Whites.It is also common among older Americans—individuals with normalblood pressure at age 55 have a 90 percent lifetime risk for develop-ing high blood pressure.High blood pressure can be controlled if you take these steps:■ Maintain a healthy weight.■ Be moderately physically active on most days of the week.■ Follow a healthy eating plan, which includes foods lower in sodium.■ If you drink alcoholic beverages, do so in moderation.■ If you have high blood pressure and are prescribed medication,take it as directed.All steps but the last also help to prevent high blood pressure.3WhatIsHighBloodPressure?What Is HighBlood Pressure?
4YourGuidetoLoweringYourBloodPressureWithDASHBlood PressureLevels for Adults*B O X 1NormalPrehypertensionHypertensionLess than 120120–139140 or higherLess than 8080–8990 or higherandororGood for you!Your blood pres-sure could be aproblem. Makechanges in whatyou eat and drink,be physically active,and lose extraweight. If you alsohave diabetes, seeyour doctor.You have highblood pressure.Ask your doctoror nurse how tocontrol it.Systolic† Diastolic†Category (mmHg)‡ (mmHg)‡ Result* For adults ages 18 and older who are not on medicine for high blood pressure anddo not have a short-term serious illness. Source: The Seventh Report of the JointNational Committee on Prevention, Detection, Evaluation, and Treatment of HighBlood Pressure; NIH Publication No. 03-5230, National High Blood PressureEducation Program, May 2003.† If systolic and diastolic pressures fall into different categories, overall status is thehigher category.‡ Millimeters of mercury.
5WhatIstheDASHEatingPlan?Blood pressure can be unhealthy even if it stays only slightly abovethe normal level of less than 120/80 mmHg. The more your bloodpressure rises above normal, the greater the health risk.Scientists supported by the National Heart, Lung, and BloodInstitute (NHLBI) conducted two key studies. Their findingsshowed that blood pressures were reduced with an eating plan thatis low in saturated fat, cholesterol, and total fat and that emphasizesfruits, vegetables, and fat-free or low-fat milk and milk products.This eating plan—known as the DASH eating plan—also includeswhole grain products, fish, poultry, and nuts. It is reduced in leanred meat, sweets, added sugars, and sugar-containing beveragescompared to the typical American diet. It is rich in potassium,magnesium, and calcium, as well as protein and fiber. (See box 2for the DASH studies’ daily nutrient goals.)What Is theDASH Eating Plan?Daily Nutrient Goals Used inthe DASH Studies(for a 2,100 Calorie Eating Plan)Total fat 27% of calories Sodium 2,300 mg*Saturated fat 6% of calories Potassium 4,700 mgProtein 18% of calories Calcium 1,250 mgCarbohydrate 55% of calories Magnesium 500 mgCholesterol 150 mg Fiber 30 gB O X 2* 1,500 mg sodium was a lower goal tested and found to be even better forlowering blood pressure. It was particularly effective for middle-aged and olderindividuals, African Americans, and those who already had high blood pressure.g = grams; mg = milligrams
The DASH eating plan follows heart healthy guidelines to limitsaturated fat and cholesterol. It focuses on increasing intakeof foods rich in nutrients that are expected to lower blood pressure,mainly minerals (like potassium, calcium, and magnesium), protein,and fiber. It includes nutrient-rich foods so that it meets othernutrient requirements as recommended by the Institute of Medicine.The first DASH study involved 459 adults with systolic bloodpressures of less than 160 mmHg and diastolic pressures of 80–95mmHg. About 27 percent of the participants had high bloodpressure. About 50 percent were women and 60 percent wereAfrican Americans. It compared three eating plans: a plan thatincludes foods similar to what many Americans regularly eat; a planthat includes foods similar to what many Americans regularly eatplus more fruits and vegetables; and the DASH eating plan. Allthree plans included about 3,000 milligrams of sodium daily.None of the plans was vegetarian or used specialty foods.Results were dramatic. Participants who followed both the planthat included more fruits and vegetables and the DASH eating planhad reduced blood pressure. But the DASH eating plan had the6YourGuidetoLoweringYourBloodPressureWithDASHThe DASH studies were sponsored by the NHLBI and conductedat four medical centers. There was also a central coordinatingcenter at Kaiser Permanente Center for Health Research inPortland, OR. The four medical centers were: Brigham andWomens Hospital, Boston, MA; Duke Hypertension Center and theSarah W. Stedman Nutrition and Metabolism Center, Durham, NC;Johns Hopkins Medical Institutions, Baltimore, MD; andPennington Biomedical Research Center, Baton Rouge, LA.Who Helped With DASH?
7WhatIstheDASHEatingPlan?greatest effect, especially for those with high blood pressure.Furthermore, the blood pressure reductions came fast—within2 weeks of starting the plan.The second DASH study looked at the effect on blood pressureof a reduced dietary sodium intake as participants followed eitherthe DASH eating plan or an eating plan typical of what manyAmericans consume. This second study involved 412 participants.Participants were randomly assigned to one of the two eating plansand then followed for a month at each of the three sodium levels.The three sodium levels were a higher intake of about 3,300milligrams per day (the level consumed by many Americans), anintermediate intake of about 2,300 milligrams per day, and a lowerintake of about 1,500 milligrams per day.Results showed that reducing dietary sodium lowered blood pressurefor both eating plans. At each sodium level, blood pressure waslower on the DASH eating plan than on the other eating plan. Thegreatest blood pressure reductions were for the DASH eating planat the sodium intake of 1,500 milligrams per day. Those with highblood pressure saw the greatest reductions, but those with prehyper-tension also had large decreases.Together these studies show the importance of lowering sodiumintake—whatever your eating plan. For a true winning combina-tion, follow the DASH eating plan and lower your intake of salt andsodium.How Do I Make the DASH?The DASH eating plan used in the studies calls for a certain numberof daily servings from various food groups. These are given in box3 on page 8 for 2,000 calories per day. The number of servings yourequire may vary, depending on your caloric need. Box 4 on page10 gives the number of servings for 1,600, 2,600, and 3,100 calories.The DASH eating plan used along with other lifestyle changes canhelp you prevent and control blood pressure. If your blood pressureis not too high, you may be able to control it entirely by changingyour eating habits, losing weight if you are overweight, gettingregular physical activity, and cutting down on alcohol. The DASHeating plan also has other benefits, such as lowering LDL (“bad”)cholesterol, which, along with lowering blood pressure, can reduceyour risk for getting heart disease.
8YourGuidetoLoweringYourBloodPressureWithDASHFollowing theDASH Eating PlanGrains*VegetablesFruitsFat-free or low-fatmilk and milkproductsLean meats,poultry, and fishNuts, seeds, andlegumesFats and oils§Sweets and addedsugars6–84–54–52–36 or less4–5 perweek2–35 or lessper week1 slice bread1 oz dry cereal†1/2 cup cooked rice, pasta, or cereal1 cup raw leafy vegetable1/2 cup cut-up raw or cooked vegetable1/2 cup vegetable juice1 medium fruit1/4 cup dried fruit1/2 cup fresh, frozen, or canned fruit1/2 cup fruit juice1 cup milk or yogurt11/2 oz cheese1 oz cooked meats, poultry, or fish1 egg‡1/3 cup or 11/2 oz nuts2 Tbsp peanut butter2 Tbsp or 1/2 oz seeds1/2 cup cooked legumes (dry beansand peas)1 tsp soft margarine1 tsp vegetable oil1 Tbsp mayonnaise2 Tbsp salad dressing1 Tbsp sugar1 Tbsp jelly or jam1/2 cup sorbet, gelatin1 cup lemonadeB O X 3Food GroupDailyServings Serving Sizes* Whole grains are recommended for most grain servings as a good source of fiberand nutrients.† Serving sizes vary between 1/2 cup and 11/4 cups, depending on cereal type.Check the products Nutrition Facts label.
9WhatIstheDASHEatingPlan?Whole wheat bread and rolls, whole wheatpasta, English muffin, pita bread, bagel,cereals, grits, oatmeal, brown rice, unsaltedpretzels and popcornBroccoli, carrots, collards, green beans, greenpeas, kale, lima beans, potatoes, spinach,squash, sweet potatoes, tomatoesApples, apricots, bananas, dates, grapes,oranges, grapefruit, grapefruit juice,mangoes, melons, peaches, pineapples,raisins, strawberries, tangerinesFat-free (skim) or low-fat (1%) milk or butter-milk, fat-free, low-fat, or reduced-fat cheese,fat-free or low-fat regular or frozen yogurtSelect only lean; trim away visible fats; broil,roast, or poach; remove skin from poultryAlmonds, hazelnuts, mixed nuts, peanuts,walnuts, sunflower seeds, peanut butter,kidney beans, lentils, split peasSoft margarine, vegetable oil (such as canola,corn, olive, or safflower), low-fat mayon-naise, light salad dressingFruit-flavored gelatin, fruit punch, hard candy,jelly, maple syrup, sorbet and ices, sugarMajor sources of energyand fiberRich sources of potassium,magnesium, and fiberImportant sources of potassi-um, magnesium, and fiberMajor sources of calciumand proteinRich sources of protein andmagnesiumRich sources of energy,magnesium, protein, andfiberThe DASH study had 27 per-cent of calories as fat,including fat in or addedto foodsSweets should be low in fatExamples and NotesSignificance of Each FoodGroup to the DASH EatingPatternThe DASH eating plan shown below is based on 2,000 calories a day. Thenumber of daily servings in a food group may vary from those listed depend-ing on your caloric needs. Use this chart to help you plan your menus ortake it with you when you go to the store.‡ Since eggs are high in cholesterol, limit egg yolk intake to no more than four perweek; 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 ofregular salad dressing equals one serving; 1 Tbsp of a low-fat dressing equalsone-half serving; 1 Tbsp of a fat-free dressing equals zero servings.
If you need to lose weight, even a small weight loss will help tolower your risks of developing high blood pressure and other serioushealth conditions. At the very least, you should not gain weight.A recent study showed that people can lose weight while followingthe DASH eating plan and lowering their sodium intake. In a studyof 810 participants, one-third were taught how to lower theirsodium intake and follow the DASH eating plan on their own.Most of them needed to lose weight as well. They followed theDASH eating plan at lower calorie levels and they increased theirphysical activity. Over the course of 18 months, participants lostweight and improved their blood pressure control.10YourGuidetoLoweringYourBloodPressureWithDASHDASH Eating Plan—Number of Daily Servings forOther Calorie LevelsB O X 4Grains*VegetablesFruitsFat-free or low-fat milk and milkproductsLean meats,poultry, and fishNuts, seeds, andlegumesFats and oilsSweets andadded sugars63–442–33–63/week2010–115–65–63613≤212–13663–46–914≤2Food Groups1,600calories/day3,100calories/dayServings/Day2,600calories/day* Whole grains are recommended for most grain servings as a good source offiber and nutrients.
11I was overweight. I was told by my doctor thatif I kept it up I was going to develop high bloodpressure and high blood cholesterol. The doctorsent me to a dietitian. She is the one whotaught me the things that I had to do in order toeat right. It was hard at the beginning becauseonce you have bad habits they are hard tobreak. Once I realized it was for my own goodand no one was going to take care of me exceptme, I decided to start eating better. At home,we keep stuff like fruits, vegetables, andlow-fat or fat-free milk in the house.My three daughters are beginningto learn how to eat right, and mylittle one loves vegetableslike I do.J O S E H E N R I Q U E Z“”
12YourGuidetoLoweringYourBloodPressureWithDASHIf you’re trying to lose weight, use the foods and serving guidelinesin boxes 3 and 4 on pages 8 and 9. Aim for a caloric level that islower than what you usually consume. In addition, you can makeyour diet lower in calories by using the tips in box 5. The best wayto 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 somepeople at very high risk for heart disease or stroke, medicationwill be necessary. To develop a weight-loss or weight-maintenanceprogram that works well for you, consult with your doctor orregistered dietitian.Combining the DASH eating plan with a regular physical activityprogram, such as walking or swimming, will help you both shedpounds and stay trim for the long term. You can do an activityfor 30 minutes at one time, or choose shorter periods of at least10 minutes each. (See box 6 on page 14.) The important thing is tototal 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 dailyservings of fruits, vegetables, and whole grain foods than you maybe used to eating. Because the plan is high in fiber, it can causebloating and diarrhea in some persons. To avoid these problems,gradually increase your intake of fruit, vegetables, and wholegrain foods.This booklet gives menus and recipes from the DASH studies forboth 2,300 and 1,500 milligrams of daily sodium intake. Twenty-three hundred milligrams of sodium equals about 6 grams, or1 teaspoon, of table salt (sodium chloride); 1,500 milligrams ofsodium equals about 4 grams, or 2/3 teaspoon, of table salt.The key to reducing salt intake is making wise food choices. Onlya small amount of salt that we consume comes from the salt addedat the table, and only small amounts of sodium occur naturally infood. Processed foods account for most of the salt and sodiumAmericans consume. So, be sure to read food labels to chooseproducts lower in sodium. You may be surprised to find whichfoods have sodium. They include baked goods, certain cereals, soysauce, seasoned salts, monosodium glutamate (MSG), baking soda,and some antacids—the range is wide.
13WhatIstheDASHEatingPlan?How to Lower Calories onthe DASH Eating PlanThe DASH eating plan can be adopted to promote weight loss. It isrich in lower-calorie foods, such as fruits and vegetables. You canmake it lower in calories by replacing higher calorie foods such assweets with more fruits and vegetables—and that also will make iteasier 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 save80 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 ofchicken and 11/2 cups of raw vegetables. Use a small amount ofvegetable oil. Youll 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-cupserving 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 portions—cut back gradually.● Choose fat-free or low-fat milk and milk products.● Check the food labels to compare fat content in packaged foods—items marked fat-free or low-fat are not always lower in calories thantheir 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 soda—zest it up with a wedge of lemon or lime.B O X 5
14YourGuidetoLoweringYourBloodPressureWithDASHMake a Dash for DASHThirty minutes of moderate-intensity physical activity each day can help.● If your blood pressure is moderately elevated, 30 minutes of briskwalking on most days a week may be enough to keep you offmedication.● If you take medication for high blood pressure, 30 minutes ofmoderate physical activity can make your medication work moreeffectively and make you feel better.● If you don’t have high blood pressure, being physically active canhelp keep it that way. If you have normal blood pressure—but arenot active—your chances of developing high blood pressureincrease, especially as you get older or if you become overweightor obese or develop diabetes.Getting started: Your physical activity program can be as simple as a15-minute walk around the block each morning and evening. Graduallybuild up your program and set new goals to stay motivated. Theimportant thing is to find something you enjoy, and do it safely. Andremember—trying too hard at first can lead to injury and cause youto give up. If you have a chronic health problem or a family history ofheart disease at an early age, be sure to talk with your doctor beforelaunching a new physical activity program.1. Set a schedule and try to keep it.2. Get a friend or family member to join you. Motivate each otherto keep it up.3. Cross-train. Alternate between different activities so you don’tstrain one part of your body day after day.4. Set goals.5. Reward yourself. At the end of each month that you stay on yourexercise program, reward yourself with something new—newclothes, a compact disc, a new book—something that will help keepyou committed. But dont use food as a reward.B O X 6
Because it is rich in fruits and vegetables, which are naturally lowerin sodium than many other foods, the DASH eating plan makes iteasier to consume less salt and sodium. Still, you may want to beginby adopting the DASH eating plan at the level of 2,300 milligramsof sodium per day and then further lower your sodium intake to1,500 milligrams per day.Boxes 7, 8, and 9 on pages 16–18 offer tips on how to reduce thesalt and sodium content in your diet, and boxes 10 and 11 on pages19 and 20 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 levelshealthy. A potassium-rich diet may help to reduce elevated or highblood pressure, but be sure to get your potassium from foodsources, not from supplements. Many fruits and vegetables, somemilk products, and fish are rich sources of potassium. (See box 12on page 21.) However, fruits and vegetables are rich in the form ofpotassium (potassium with bicarbonate precursors) that favorablyaffects acid-base metabolism. This form of potassium may help toreduce risk of kidney stones and bone loss. While salt substitutescontaining potassium are sometimes needed by persons on drugtherapy for high blood pressure, these supplements can be harmfulto people with certain medical conditions. Ask your doctor beforetrying salt substitutes or supplements.Start the DASH eating plan today—it can help you prevent andcontrol high blood pressure, has other health benefits for your heart,can be used to lose weight, and meets your nutritional needs.15WhatIstheDASHEatingPlan?
16YourGuidetoLoweringYourBloodPressureWithDASHWhere’s the Sodium?B O X 7Whole and other grains and grain products*Cooked cereal, rice, pasta, unsalted, 1/2 cupReady-to-eat cereal, 1 cupBread, 1 sliceVegetablesFresh or frozen, cooked without salt, 1/2 cupCanned or frozen with sauce, 1/2 cupTomato juice, canned, 1/2 cupFruitFresh, frozen, canned, 1/2 cupLow-fat or fat-free milk and milk productsMilk, 1 cupYogurt, 1 cupNatural cheeses, 11/2 ozProcess cheeses, 2 ozNuts, seeds, and legumesPeanuts, salted, 1/3 cupPeanuts, unsalted, 1/3 cupBeans, cooked from dried or frozen, withoutsalt, 1/2 cupBeans, canned, 1/2 cupLean meats, fish, and poultryFresh meat, fish, poultry, 3 ozTuna canned, water pack, no salt added, 3 ozTuna canned, water pack, 3 ozHam, lean, roasted, 3 oz0–50–360110–1751–70140–4603300–5107175110–4506001200–50–540030–9035–45230–3501,020Only a small amount of sodium occurs naturally in foods. Most sodium isadded during processing. The table below gives examples of sodium insome foods.Food Groups Sodium (mg)* Whole grains are recommended for most grain servings.
17WhatIstheDASHEatingPlan?Tips To Reduce Salt andSodium● Choose low- or reduced-sodium, or no-salt-added versions of foodsand 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 inbrine (such as pickles, pickled vegetables, olives, andsauerkraut); and condiments (such as mustard, horseradish,ketchup, and barbecue sauce). Limit even lower sodium versionsof soy sauce and teriyaki sauce. Treat these condiments sparinglyas you do table salt.● Cook rice, pasta, and hot cereals without salt. Cut back on instantor flavored rice, pasta, and cereal mixes, which usually haveadded salt.● Choose “convenience” foods that are lower in sodium. Cut back onfrozen dinners, mixed dishes such as pizza, packaged mixes,canned soups or broths, and salad dressings—these often have alot of sodium.● Rinse canned foods, such as tuna andcanned beans, to remove some ofthe sodium.● Use spices instead of salt.In cooking and at the table,flavor foods with herbs,spices, lemon, lime,vinegar, or salt-freeseasoning blends. Startby cutting salt in half.B O X 8
18YourGuidetoLoweringYourBloodPressureWithDASHReducing Salt and SodiumWhen Eating Out● Ask how foods are prepared. Ask that they be preparedwithout added salt, MSG, or salt-containing ingredients. Mostrestaurants 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, andsauces with salt-containing ingredients.● Choose fruit or vegetables, instead of salty snack foods.B O X 9
19WhatIstheDASHEatingPlan?Compare Nutrition FactsLabels on FoodsRead the Nutrition Facts labels on foods to compare the amount ofsodium in products. Look for the sodium content in milligrams and thePercent Daily Value. Aim for foods that are less than 5 percent of theDaily Value of sodium. Foods with 20 percent or more Daily Value ofsodium are considered high. You can also check out the amounts ofthe other DASH goal nutrients.Compare the food labels of these two versions of canned tomatoes.The regular canned tomatoes (right) have 15 times as much sodium asthe low-sodium canned tomatoes.B O X 1 0Nutrition FactsServing Size 1/2 cup (130g)Servings Per Container 31/2Amount Per ServingCalories 25 Calories from Fat 0% Daily Value*Total Fat 0g 0%Saturated Fat 0g 0%Trans Fat 0gCholesterol 0mg 0%Sodium 10mg 1%Potassium 270mg 8%Total Carbohydrate 5g 2%Dietary Fiber 1g 4%Sugar 3gProtein 1gVitamin A 5% Vitamin C 30%Calcium 4% Iron 4%*Percent Daily Values are based on a 2,000 caloriediet.Low-Sodium CannedDiced TomatoesNutrition FactsServing Size 1/2 cup (130g)Servings Per Container 31/2Amount Per ServingCalories 25 Calories from Fat 0% Daily Value*Total Fat 0g 0%Saturated Fat 0g 0%Trans Fat 0gCholesterol 0mg 0%Sodium 150mg 6%Potassium 230mg 6%Total Carbohydrate 5g 2%Dietary Fiber 1g 4%Sugar 3gProtein 1gVitamin A 5% Vitamin C 20%Calcium 4% Iron 6%*Percent Daily Values are based on a 2,000 caloriediet.Canned Diced Tomatoes
20YourGuidetoLoweringYourBloodPressureWithDASHLabel LanguageB O X 1 1SodiumSodium free or salt freeVery low sodiumLow sodiumLow-sodium mealReduced or less sodiumLight in sodiumUnsalted or no salt addedFatFat-freeLow saturated fatLow-fatReduced fatLight in fatFood 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:Phrase What It Means** Small serving sizes (50 g) or meals and main dishes are based on variousweights in grams versus a serving size.Less than 5 mg per serving35 mg or less of sodium per serving140 mg or less of sodium per serving140 mg or less of sodium per 31/2 oz (100 g)At least 25 percent less sodium than theregular version50 percent less sodium than the regularversionNo salt added to the product duringprocessing (this is not a sodium-freefood)Less than 0.5 g per serving1 g or less per serving and 15% or less ofcalories from saturated fat3 g or less per servingAt least 25 percent less fat than theregular versionHalf the fat compared to the regular version
21WhatIstheDASHEatingPlan?Where’s the Potassium?B O X 1 2VegetablesPotato, 1 mediumSweet Potato, 1 mediumSpinach, cooked, 1/2 cupZucchini, cooked, 1/2 cupTomato, fresh, 1/2 cupKale, cooked, 1/2 cupRomaine lettuce, 1 cupMushrooms, 1/2 cupCucumber, 1/2 cupFruitBanana, 1 mediumApricots, 1/4 cupOrange, 1 mediumCantaloupe chunks, 1/2 cupApple, 1 mediumNuts, seeds, and legumesCooked soybeans, 1/2 cupCooked lentils, 1/2 cupCooked kidney beans, 1/2 cupCooked split peas, 1/2 cupAlmonds, roasted, 1/3 cupWalnuts, roasted, 1/3 cupSunflower seeds, roasted, 2 TbspPeanuts, roasted, 1/3 cupLow-fat or fat-free milk and milk productsMilk, 1 cupYogurt, 1 cupLean meats, fish, and poultryFish (cod, halibut, rockfish, trout, tuna), 3 ozPork tenderloin, 3 ozBeef tenderloin, chicken, turkey, 3 oz92654029028021015014011080420380237214150440370360360310190124120380370200–400370210Potassium comes from a variety of food sources. The table below givesexamples of potassium in some foods.Food Groups Potassium (mg)
22YourGuidetoLoweringYourBloodPressureWithDASHJ E A N E T T E G U Y T O N - K R I S H N A NA N D F A M I L YThere’s a history of cardiovascular disease inmy family and I also know that good habitscan start when the childrenare very young. In myfamily, we are physicallyactive, we drink water andlow-fat or fat-free milk,and we rarely keepsugary snacks inthe house. Imalso very awareof portion sizesand how manycalories are inthe portions weeat. We are teach-ing them goodeating habitsright now.“”
How Can I Get Started on the DASH Eating Plan?It’s easy. Reading the “Getting Started” suggestions in box 13 shouldhelp you along the way. The DASH eating plan requires no specialfoods and has no hard-to-follow recipes. One way to begin is byseeing how DASH compares with your current food habits. Use the“What’s On Your Plate?” form. (See box 14 on page 26.) Fill it in for1–2 days and see how it compares with the DASH plan. This willhelp you see what changes you need to make in your food choices.Remember that on some days the foods you eat may add up to morethan the recommended servings from one food group and less fromanother. Similarly, you may have too much sodium on a particularday. But dont worry. Try your best to keep the average of severaldays close to the DASH eating plan and the sodium level recom-mended for you.Use the menus that begin on page 30 if you want to follow themenus similar to those used in the DASH trial—or make up yourown using your favorite foods. In fact, your entire family can eatmeals using the DASH eating plan. Use box 3 on page 8 to chooseyour favorite foods from each food group based on your calorieneeds as described in the 2005 “U.S. Dietary Guidelines forAmericans.”The Dietary Guidelines determined that the DASH eating plan is anexample of a healthy eating plan and recommends it as a plan thatnot only meets your nutritional needs but can accommodate variedtypes of cuisines and special needs.Remember that the DASH eating plan used along with other lifestylechanges can help you prevent and control your blood pressure.Important lifestyle recommendations for you include: achieve andmaintain a healthy weight, participate in your favorite regularphysical activity, and, if you drink, use moderation in alcoholconsumption (defined as up to one drink per day for women andup to two drinks per day for men).One important note: If you take medication to control high bloodpressure, you should not stop using it. Follow the DASH eating planand talk with your doctor about your medication treatment. The tipsin box 15 on page 27 can help you continue to follow the DASHeating plan and make other healthy lifestyle changes for a lifetime.23WhatIstheDASHEatingPlan?
24YourGuidetoLoweringYourBloodPressureWithDASHGetting StartedIt’s easy to adopt the DASH eating plan. Here are some ways toget started:Change gradually● If you now eat one or two vegetables a day, add a serving atlunch and another at dinner.● If you dont eat fruit now or have juice only at breakfast, add aserving to your meals or have it as a snack.● Gradually increase your use of fat-free and low-fat milk and milkproducts to three servings a day. For example, drink milk withlunch or dinner, instead of soda, sugar-sweetened tea, oralcohol. Choose fat-free (skim) or low-fat (1 percent) milk andmilk products to reduce your intake of saturated fat, total fat,cholesterol, and calories and to increase your calcium.● Read the Nutrition Facts label on margarines and salad dressingsto choose those lowest in saturated fat and trans fat.Treat meats as one part of the whole meal, instead ofthe focus● Limit lean meats to 6 ounces a day—all thats needed. Haveonly 3 ounces at a meal, which is about the size of a deckof cards.● If you now eat large portions of meats, cut them back gradually—by a half or a third at each meal.● Include two or more vegetarian-style (meatless) meals eachweek.● Increase servings of vegetables, brown rice, whole wheat pasta,and cooked dry beans in meals. Try casseroles, whole wheatpasta, and stir-fry dishes, which have less meat and morevegetables, grains, and dry beans.B O X 1 3
25WhatIstheDASHEatingPlan?Use fruits or other foods low in saturated fat, trans fat, cho-lesterol, sodium, sugar, and calories as desserts and snacks● Fruits and other lower fat foods offer great taste and variety. Usefruits canned in their own juice or packed in water. Fresh fruitsrequire little or no preparation. Dried fruits are a good choice tocarry with you or to have ready in the car.● Try these snacks ideas: unsalted rice cakes; nuts mixed withraisins; graham crackers; fat-free and low-fat yogurt and frozenyogurt; popcorn with no salt or butter added; raw vegetables.Try these other tips● Choose whole grain foods for most grain servings to get addednutrients, such as minerals and fiber. For example, choosewhole wheat bread or whole grain cereals.● If you have trouble digesting milk and milk products, try takinglactase enzyme pills (available at drugstores and groceries) withthe milk products. Or, buy lactose-free milk, which has thelactase enzyme already added to it.● If you are allergic to nuts, use seeds or legumes (cooked driedbeans or peas).● Use fresh, frozen, or low-sodium canned vegetables and fruits.Use the form in box 14 to track your food and physical activitieshabits before you start on the DASH eating plan or to see howyoure doing after a fewweeks. To record morethan 1 day, just copy theform. Total each daysfood groups and comparewhat you ate with theDASH eating plan. To seehow the form looks com-pleted, check the menusthat start on page 30.
B O X 1 426YourGuidetoLoweringYourBloodPressureWithDASHFoodAmount(servingsize)VegetablesMilkProductsGrainsFruitsMeats,fish,andpoultry2,300or1,500mgperday6–8perday4–5perday4–5perday2–3perday6orlessperday4–5perweek2–3perday5orlessperweekNuts,seeds,andlegumesSweetsandaddedsugarsExample:whole wheat bread, withsoft (tub) margarineBreakfastLunchDinnerSnacksDay’s TotalsPhysical Activity LogRecord your minutes perday for each activity. Aimfor at least 30 minutes ofmoderate-intensity physi-cal activity on most daysof the week.2 slices2 tsp29952 22Number of Servings by DASH Food GroupDate:Sodium(mg)Compare yours withthe DASH eating planat 2,000 calories.What’s on Your Plate?How Much Are You Moving?Fatsandoils
27WhatIstheDASHEatingPlan?Making the DASH toGood HealthThe DASH plan is a new way of eating—for a lifetime. If you slip fromthe eating plan for a few days, dont let it keep you from reaching yourhealth goals. Get back on track. Here’s how:Ask yourself why you got off-track.Was it at a party? Were you feeling stress at home or work? Find outwhat triggered your sidetrack and start again with the DASH plan.Don’t worry about a slip.Everyone slips—especially when learning something new. Rememberthat changing your lifestyle is a long-term process.See if you tried to do too much at once.Often, those starting a new lifestyle try to change too much at once.Instead, change one or two things at a time. Slowly but surely is thebest way to succeed.Break the process down into small steps.This not only keeps you from trying to do too much at once, but alsokeeps the changes simpler. Break complex goals into smaller, simplersteps, each of which is attainable.Write it down.Use the table in box 14 to keep track of what you eat and what you’redoing. This can help you find the problem. Keep track for several days.You may find, for instance, that you eat high-fat foods while watchingtelevision. If so, you could start keeping a substitute snack on handto eat instead of the high-fat foods. This record also helps you besure you’re getting enough of each food group and physical activityeach day.Celebrate success.Treat yourself to a nonfood treat for your accomplishments.B O X 1 5
29AWeekWiththeDASHEatingPlanA Week Withthe DASH Eating PlanHere is a week of menus from the DASH eating plan. The menusallow you to have a daily sodium level of either 2,300 mg or, bymaking the noted changes, 1,500 mg. Youll also find that themenus sometimes call for you to use lower sodium, low-fat, fat-free,or reduced fat versions of products.The menus are based on 2,000 calories a day—serving sizes shouldbe increased or decreased for other calorie levels. To ease thecalculations, some of the serving sizes have been rounded off.Also, some items may be in too small a quantity to have a listedfood group serving. Recipes for starred items are given on the laterpages. Some of these recipes give changes that can be used to lowertheir sodium level. Use the changes if you want to follow the DASHeating plan at 1,500 milligrams of sodium per day.Abbreviations:oz = ouncetsp = teaspoonTbsp = tablespoong = grammg = milligram
30YourGuidetoLoweringYourBloodPressureWithDASH2,300 mg Sodium MenuSubstitution To ReduceSodium to 1,500 mgSodium(mg)Sodium(mg)Day 1* Recipe on page 45Nutrients Per DayCaloriesTotal fatCalories from fatSaturated fatCalories from saturated fatCholesterolSodium2,300 mg2,06263 g28 %13 g6 %155 mg2,101 mg1,500 mg2,03759 g26 %12 g5 %155 mg1,507 mgSodium Level3/4 cup shredded wheat cereal1 tsp unsalted soft (tub) margarineRemove salt from the recipe*1 Tbsp regular mustard1 Tbsp natural cheddar cheese,reduced fat, low sodium1 tsp unsalted soft (tub) margarine220110714926517929937315043535165120142167114826110704862,10110120175101,507Breakfast3/4 cup bran flakes cereal:1 medium banana1 cup low-fat milk1 slice whole wheat bread:1 tsp soft (tub) margarine1 cup orange juiceLunch3/4 cup chicken salad:*2 slices whole wheat bread1 Tbsp Dijon mustardsalad:1/2 cup fresh cucumber slices1/2 cup tomato wedges1 Tbsp sunflower seeds1 tsp Italian dressing, low calorie1/2 cup fruit cocktail, juice packDinner3 oz beef, eye of the round:2 Tbsp beef gravy, fat-free1 cup green beans, sautéed with:1/2 tsp canola oil1 small baked potato:1 Tbsp sour cream, fat-free1 Tbsp grated natural cheddarcheese, reduced fat1 Tbsp chopped scallions1 small whole wheat roll:1 tsp soft (tub) margarine1 small apple1 cup low-fat milkSnacks1/3 cup almonds, unsalted1/4 cup raisins1/2 cup fruit yogurt, fat-free,no sugar addedTotals
31AWeekWiththeDASHEatingPlanNuts,Seeds,andLegumesFatsandOilsGrainsVegetablesFruitsMilkProductsMeats,Fish,andPoultrySweetsandAddedSugarsNumber of Servings by DASH Food GroupNutrients Per DayCarbohydrateProteinCalciumMagnesiumPotassiumFiber2,300 mg284 g114 g1,220 mg594 mg4,909 mg37 g1,500 mg284 g115 g1,218 mg580 mg4,855 mg36 gSodium Level1121511215121116111/221/23361/2111/2111/2131/2 0
32YourGuidetoLoweringYourBloodPressureWithDASH2,300 mg Sodium MenuSubstitution To ReduceSodium to 1,500 mgSodium(mg)Sodium(mg)Day 2* Recipe on page 46† Recipe on page 47Nutrients Per DayCaloriesTotal fatCalories from fatSaturated fatCalories from saturated fatCholesterolSodium2,300 mg2,02764 g28 %13 g6 %114 mg2,035 mg1,500 mg2,07868 g30 %16 g7 %129 mg1,560 mgSodium LevelBreakfast1/2 cup instant oatmeal1 mini whole wheat bagel:1 Tbsp peanut butter1 medium banana1 cup low-fat milkLunchchicken breast sandwich:3 oz chicken breast, skinless2 slices whole wheat bread1 slice (3/4 oz) natural cheddarcheese, reduced fat1 large leaf romaine lettuce2 slices tomato1 Tbsp mayonnaise, low-fat1 cup cantaloupe chunks1 cup apple juiceDinner1 cup spaghetti:3/4 cup vegetarian spaghetti sauce*3 Tbsp Parmesan cheesespinach salad:1 cup fresh spinach leaves1/4 cup fresh carrots, grated1/4 cup fresh mushrooms, sliced1 Tbsp vinaigrette dressing†1/2 cup corn, cooked from frozen1/2 cup canned pears, juice packSnacks1/3 cup almonds, unsalted1/4 cup dried apricots1 cup fruit yogurt, fat-free,no sugar addedTotals548481110765299202121012621147928724191115031732,0351/2 cup regular oatmeal with1 tsp cinnamon1 slice (3/4 oz) natural Swisscheese, low sodiumSubstitute low-sodium tomatopaste (6 oz) in recipe*532531,560
33AWeekWiththeDASHEatingPlanNuts,Seeds,andLegumesFatsandOilsGrainsVegetablesFruitsMilkProductsMeats,Fish,andPoultrySweetsandAddedSugarsNumber of Servings by DASH Food GroupNutrients Per DayCarbohydrateProteinCalciumMagnesiumPotassiumFiber2,300 mg288 g99 g1,370 mg535 mg4,715 mg34 g1,500 mg290 g100 g1,334 mg542 mg4,721 mg34 gSodium Level112261/41/211/211/21/2151/412211711/21/213331/2111/211/211/2 0
34YourGuidetoLoweringYourBloodPressureWithDASH2,300 mg Sodium MenuSubstitution To ReduceSodium to 1,500 mgSodium(mg)Sodium(mg)Day 3* Recipe on page 48Nutrients Per DayCaloriesTotal fatCalories from fatSaturated fatCalories from saturated fatCholesterolSodium2,300 mg1,99756 g25 %12 g6 %140 mg2,114 mg1,500 mg1,99552 g24 %11 g5 %140 mg1,447 mgSodium LevelBreakfast3/4 cup bran flakes cereal:1 medium banana1 cup low-fat milk1 slice whole wheat bread:1 tsp soft (tub) margarine1 cup orange juiceLunchbeef barbeque sandwich:2 oz beef, eye of round1 Tbsp barbeque sauce2 slices (11/2 oz) natural cheddarcheese, reduced fat1 hamburger bun1 large leaf romaine lettuce2 slices tomato1 cup new potato salad*1 medium orangeDinner3 oz cod:1 tsp lemon juice1/2 cup brown rice1 cup spinach, cooked from frozen,sautéed with:1 tsp canola oil1 Tbsp almonds, slivered1 small cornbread muffin, madewith oil:1 tsp soft (tub) margarineSnacks1 cup fruit yogurt, fat-free,no added sugar:1 Tbsp sunflower seeds, unsalted2 large graham cracker rectangles:1 Tbsp peanut butterTotals22011071492662615640518312170701518400119261730156812,1142 cups puffed wheat cereal1 tsp unsalted soft (tub) margarine11/2 oz natural cheddar cheese,reduced fat, low sodium1 tsp unsalted soft (tub) margarine10901,447
35AWeekWiththeDASHEatingPlanNuts,Seeds,andLegumesFatsandOilsGrainsVegetablesFruitsMilkProductsMeats,Fish,andPoultrySweetsandAddedSugarsNumber of Servings by DASH Food GroupNutrients Per DayCarbohydrateProteinCalciumMagnesiumPotassiumFiber2,300 mg289 g103 g1,537 mg630 mg4,676 mg34 g1,500 mg283 g104 g1,524 mg598 mg4,580 mg31 gSodium Level11211171/41/22243/4121411132351/41/21/211/41113 0
36YourGuidetoLoweringYourBloodPressureWithDASH2,300 mg Sodium MenuSubstitution To ReduceSodium to 1,500 mgSodium(mg)Sodium(mg)Day 4* Recipe on page 49Nutrients Per DayCaloriesTotal fatCalories from fatSaturated fatCalories from saturated fatCholesterolSodium2,300 mg2,02459 g26 %12 g5 %148 mg2,312 mg1,500 mg2,04559 g26 %12 g5 %150 mg1,436 mgSodium Level02342151,4361 tsp unsalted soft (tub) margarine2 oz roast beef tenderloin1 slice (3/4 oz) natural cheddarcheese, reduced fat, low sodiumsubstitute low-sodium tomatosauce (4 oz) in recipe*Breakfast1 slice whole wheat bread:1 tsp soft (tub) margarine1 cup fruit yogurt, fat-free,no added sugar1 medium peach1/2 cup grape juiceLunchham and cheese sandwich:2 oz ham, low-fat, low sodium1 slice (3/4 oz) natural cheddarcheese, reduced fat2 slices whole wheat bread1 large leaf romaine lettuce2 slices tomato1 Tbsp mayonnaise, low-fat1 cup carrot sticksDinnerchicken and Spanish rice*1 cup green peas, sautéed with:1 tsp canola oil1 cup cantaloupe chunks1 cup low-fat milkSnacks1/3 cup almonds, unsalted1 cup apple juice1/4 cup apricots1 cup low-fat milkTotals1492617304549202299121018434111502610702131072,312
37AWeekWiththeDASHEatingPlanNuts,Seeds,andLegumesFatsandOilsGrainsVegetablesFruitsMilkProductsMeats,Fish,andPoultrySweetsandAddedSugarsNumber of Servings by DASH Food GroupNutrients Per DayCarbohydrateProteinCalciumMagnesiumPotassiumFiber2,300 mg279 g110 g1,417 mg538 mg4,575 mg35 g1,500 mg278 g116 g1,415 mg541 mg4,559 mg35 gSodium Level12141/41/22243/411221711/21131/2235111113 0
38YourGuidetoLoweringYourBloodPressureWithDASH2,300 mg Sodium MenuSubstitution To ReduceSodium to 1,500 mgSodium(mg)Sodium(mg)43536674111,519Day 5* Recipe on page 50† Recipe on page 51‡ Recipe on page 50Nutrients Per DayCaloriesTotal fatCalories from fatSaturated fatCalories from saturated fatCholesterolSodium2,300 mg1,97657 g26 %11 g5 %158 mg2,373 mg1,500 mg2,10052 g22 %11 g5 %158 mg1,519 mgSodium LevelBreakfast1 cup whole grain oat rings cereal:1 medium banana1 cup low-fat milk1 medium raisin bagel:1 Tbsp peanut butter1 cup orange juiceLunchtuna salad plate:1/2 cup tuna salad*1 large leaf romaine lettuce1 slice whole wheat breadcucumber salad:1 cup fresh cucumber slices1/2 cup tomato wedges1 Tbsp vinaigrette dressing1/2 cup cottage cheese, low-fat:1/2 cup canned pineapple, juice pack1 Tbsp almonds, unsaltedDinner3 oz turkey meatloaf‡1 small baked potato:1 Tbsp sour cream, fat-free1 Tbsp natural cheddar cheese,reduced fat, grated1 scallion stalk, chopped1 cup collard greens, sautéed with:1 tsp canola oil1 small whole wheat roll1 medium peachSnacks1 cup fruit yogurt, fat-free, no added sugar2 Tbsp sunflower seeds, unsaltedTotals2731107272815171114925133459102051421671850148017302,3731 cup frosted shredded wheat1 Tbsp peanut butter, unsalted6 whole wheat crackers,low sodium2 Tbsp yogurt dressing, fat-free†substitute low-sodium ketchupin recipe‡1 Tbsp natural cheddar cheese,reduced fat, and low sodium6 small melba toast crackers,unsalted
39AWeekWiththeDASHEatingPlanNuts,Seeds,andLegumesFatsandOilsGrainsVegetablesFruitsMilkProductsMeats,Fish,andPoultrySweetsandAddedSugarsNumber of Servings by DASH Food GroupNutrients Per DayCarbohydrateProteinCalciumMagnesiumPotassiumFiber2,300 mg275 g111 g1,470 mg495 mg4,769 mg30 g1,500 mg314 g114 g1,412 mg491 mg4,903 mg31 gSodium Level121151/4211261/41211511/4121/43361/21/4113/4112 0
40YourGuidetoLoweringYourBloodPressureWithDASH2,300 mg Sodium MenuSubstitution To ReduceSodium to 1,500 mgSodium(mg)Sodium(mg)1 Tbsp regular mustardDay 6* Recipe on page 52† Recipe on page 53Nutrients Per DayCaloriesTotal fatCalories from fatSaturated fatCalories from saturated fatCholesterolSodium2,300 mg1,93958 g27 %12 g6 %171 mg1,671 mg1,500 mg1,93557 g27 %12 g6 %171 mg1,472 mgSodium LevelBreakfast1 low-fat granola bar1 medium banana1/2 cup fruit yogurt, fat-free,no sugar added1 cup orange juice1 cup low-fat milkLunchturkey breast sandwich:3 oz turkey breast2 slices whole wheat bread1 large leaf romaine lettuce2 slices tomato2 tsp mayonnaise, low-fat1 Tbsp Dijon mustard1 cup steamed broccoli, cooked fromfrozen1 medium orangeDinner3 oz spicy baked fish*1 cup scallion rice†spinach sauté:1/2 cup spinach, cooked from frozen,sautéed with:2 tsp canola oil1 Tbsp almonds, slivered, unsalted1 cup carrots, cooked from frozen1 small whole wheat roll:1 tsp soft (tub) margarine1 small cookieSnacks2 Tbsp peanuts, unsalted1 cup low-fat milk1/4 cup dried apricotsTotals81186510748299126737311050189200841482660110731,6711751,472
41AWeekWiththeDASHEatingPlanNuts,Seeds,andLegumesFatsandOilsGrainsVegetablesFruitsMilkProductsMeats,Fish,andPoultrySweetsandAddedSugarsNumber of Servings by DASH Food GroupNutrients Per DayCarbohydrateProteinCalciumMagnesiumPotassiumFiber2,300 mg268 g105 g1,210 mg548 mg4,710 mg36 g1,500 mg268 g105 g1,214 mg545 mg4,710 mg36 gSodium Level122161/41/221253/4121151/21121/23361/41/23/42/32132/311
42YourGuidetoLoweringYourBloodPressureWithDASH2,300 mg Sodium MenuSubstitution To ReduceSodium to 1,500 mgSodium(mg)Sodium(mg)Day 7* Recipe on page 54† Recipe on page 47Nutrients Per DayCaloriesTotal fatCalories from fatSaturated fatCalories from saturated fatCholesterolSodium2,300 mg1,99364 g29 %13 g6 %71 mg2,069 mg1,500 mg1,98860 g27 %13 g6 %72 mg1,421 mgSodium LevelBreakfast1 cup whole grain oat rings:1 medium banana1 cup low-fat milk1 cup fruit yogurt, fat-free, nosugar addedLunchtuna salad sandwich:1/2 cup tuna, drained, rinsed1 Tbsp mayonnaise, low-fat1 large leaf romaine lettuce2 slices tomato2 slices whole wheat bread1 medium apple1 cup low-fat milkDinner1/6 recipe zucchini lasagna:*salad:1 cup fresh spinach leaves1 cup tomato wedges2 Tbsp croutons, seasoned1 Tbsp vinaigrette dressing,reduced calorie1 Tbsp sunflower seeds1 small whole wheat roll:1 tsp soft (tub) margarine1 cup grape juiceSnacks1/3 cup almonds, unsalted1/4 cup dry apricots6 whole wheat crackersTotals273110717339101122991107368249621330148458031662,0691 cup regular oatmealsubstitute cottage cheese, low-fat,no salt added in recipe*1 Tbsp low-sodium vinaigrettedressing, from recipe†1 tsp unsalted soft (tub) margarine5165101,421
43AWeekWiththeDASHEatingPlanNuts,Seeds,andLegumesFatsandOilsGrainsVegetablesFruitsMilkProductsMeats,Fish,andPoultrySweetsandAddedSugarsNumber of Servings by DASH Food GroupNutrients Per DayCarbohydrateProteinCalciumMagnesiumPotassiumFiber2,300 mg283 g93 g1,616 mg537 mg4,693 mg32 g1,500 mg285 g97 g1,447 mg553 mg4,695 mg33 gSodium Level1231/41181/41/41/211243/41121511114331/2111/211/2121/2 0
Here are some recipes to help you cook up a week of tasty, hearthealthy meals. If you’re following the DASH eating plan at 1,500milligrams of sodium per day or just want to reduce your sodiumintake, use the suggested recipe changes.45RecipesforHeartHealthRecipes for Heart HealthChicken Salad31/4 cups chicken breast, cooked, cubed, and skinless1/4 cup celery, chopped1 Tbsp lemon juice1/2 tsp onion powder1/8 tsp salt*3 Tbsp mayonnaise, low-fat1. Bake chicken, cut into cubes, and refrigerate.2. In a large bowl combine rest of ingredients, add chilledchicken and mix well.Makes 5 servingsServing Size: 3/4 cupPer Serving:CaloriesTotal FatSaturated FatCholesterolSodiumProtein1766 g2 g77 mg179 mg27 gCarbohydrateCalciumMagnesiumPotassiumFiber2 g16 mg25 mg236 mg0 g* To reduce sodium, omit the 1/8 tsp of added salt.New sodium content for each serving is 120 mg.Day 1
46YourGuidetoLoweringYourBloodPressureWithDASHVegetarian Spaghetti Sauce2 Tbsp olive oil2 small onions, chopped3 cloves garlic, chopped11/4 cups zucchini, sliced1 Tbsp oregano, dried1 Tbsp basil, dried1 8 oz can tomato sauce1 6 oz can tomato paste*2 medium tomatoes, chopped1 cup water1. In a medium skillet, heat oil. Sauté onions, garlic, and zucchiniin oil for 5 minutes on medium heat.2. Add remaining ingredients and simmer covered for 45 minutes.Serve over spaghetti.Makes 6 servingsServing Size: 3/4 cupPer Serving:CaloriesTotal FatSaturated FatCholesterolSodiumProtein1055 g1 g0 mg479 mg3 gCarbohydrateCalciumMagnesiumPotassiumFiber15 g49 mg35 mg686 mg4 g* To reduce sodium, use a 6-oz can of low-sodium tomatopaste. New sodium content for each serving is 253 mg.Day 2
47RecipesforHeartHealthVinaigrette Salad Dressing1 bulb garlic, separated and peeled1/2 cup water1 Tbsp red wine vinegar1/4 tsp honey1 Tbsp virgin olive oil1/4 tsp black pepper1. Place the garlic cloves into a small saucepan and pour enoughwater (about 1/2 cup) to cover them.2. Bring water to a boil, then reduce heat and simmer until garlic istender, about 15 minutes.3. Reduce the liquid to 2 Tbsp and increase the heat for 3 minutes.4. Pour the contents into a small sieve over a bowl, and with awooden spoon, mash the garlic through the sieve into the bowl.5. Whisk the vinegar into the garlic mixture; incorporate the oil andseasoning.Makes 4 servingsServing Size: 2 TbspPer Serving:CaloriesTotal FatSaturated FatCholesterolSodiumProtein333 g1 g0 mg1 mg0 gCarbohydrateCalciumMagnesiumPotassiumFiber1 g3 mg1 mg6 mg0 gDay 2
48YourGuidetoLoweringYourBloodPressureWithDASHNew Potato Salad16 small new potatoes (5 cups)2 Tbsp olive oil1/4 cup green onions, chopped1/4 tsp black pepper1 tsp dill weed, dried1. Thoroughly clean potatoes with vegetable brush and water.2. Boil potatoes for 20 minutes or until tender.3. Drain and cool potatoes for 20 minutes.4. Cut potatoes into quarters and mix with olive oil, onions,and spices.5. Refrigerate until ready to serve.Makes 5 servingsServing Size: 1 cupPer Serving:CaloriesTotal FatSaturated FatCholesterolSodiumProtein1966 g1 g0 mg17 mg4 gCarbohydrateCalciumMagnesiumPotassiumFiber34 g31 mg46 mg861 mg4 gDay 3
49RecipesforHeartHealthChicken and Spanish Rice1 cup onions, chopped3/4 cup green peppers2 tsp vegetable oil1 8 oz can tomato sauce*1 tsp parsley, chopped1/2 tsp black pepper11/4 tsp garlic, minced5 cups cooked brown rice (cooked in unsalted water)31/2 cups chicken breasts, cooked, skin and bone removed,and diced1. In a large skillet, sauté onions and green peppers in oil for5 minutes on medium heat.2. Add tomato sauce and spices. Heat through.3. Add cooked rice and chicken. Heat through.Makes 5 servingsServing Size: 11/2 cupPer Serving:CaloriesTotal FatSaturated FatCholesterolSodiumProtein4288 g2 g80 mg341 mg35 gCarbohydrateCalciumMagnesiumPotassiumFiber52 g50 mg122 mg545 mg8 g* To reduce sodium, use one 4-oz can of low-sodiumtomato sauce and one 4-oz can of regular tomatosauce. New sodium content for each serving is 215 mg.Day 4
50YourGuidetoLoweringYourBloodPressureWithDASHTuna Salad2 6 oz cans tuna, water pack1/2 cup raw celery, chopped1/3 cup green onions, chopped61/2 Tbsp mayonnaise, low-fat1. Rinse and drain tuna for 5 minutes. Break apart with a fork.2. Add celery, onion, and mayonnaise and mix well.Makes 5 servingsServing Size: 1/2 cupPer Serving:CaloriesTotal FatSaturated FatCholesterolSodiumProtein1387 g1 g25 mg171 mg16 gCarbohydrateCalciumMagnesiumPotassiumFiber2 g17 mg19 mg198 mg0 gCaloriesTotal FatSaturated FatCholesterolSodiumProtein1917 g2 g103 mg205 mg23 gCarbohydrateCalciumMagnesiumPotassiumFiber9 g24 mg33 mg268 mg1 gTurkey Meatloaf1 pound lean ground turkey1/2 cup regular oats, dry1 large egg, whole1 Tbsp onion, dehydrated flakes1/4 cup ketchup*1. Combine all ingredients and mix well.2. Bake in a loaf pan at 350 ˚F for 25 minutes or to an internaltemperature of 165 ˚F.3. Cut into five slices and serve.Makes 5 servingsServing Size: 1 slice (3 oz)Per Serving:* To reduce sodium, use low-sodium ketchup.New sodium content for each serving is 74 mg.Day 5Day 5
51RecipesforHeartHealthYogurt Salad Dressing8 oz plain yogurt, fat-free1/4 cup mayonnaise, low-fat2 Tbsp chives, dried2 Tbsp dill, dried2 Tbsp lemon juiceMix all ingredients in bowl and refrigerate.Makes 5 servingsServing Size: 2 TbspPer Serving:CaloriesTotal FatSaturated FatCholesterolSodiumProtein392 g0 g3 mg66 mg2 gCarbohydrateCalciumMagnesiumPotassiumFiber4 g76 mg10 mg110 mg0 gDay 5
52YourGuidetoLoweringYourBloodPressureWithDASHSpicy Baked Fish1 pound salmon (or other fish) fillet1 Tbsp olive oil1 tsp spicy seasoning, salt-free1. Preheat oven to 350 ˚F. Spray a casserole dish with cooking oilspray.2. Wash and dry fish. Place in dish. Mix oil and seasoning anddrizzle over fish.3. Bake uncovered for 15 minutes or until fish flakes with fork.Cut into 4 pieces. Serve with rice.Makes 4 servingsServing Size: 1 piece (3 oz)Per Serving:CaloriesTotal FatSaturated FatCholesterolSodiumProtein19211 g2 g63 mg50 mg23 gCarbohydrateCalciumMagnesiumPotassiumFiber<1 g18 mg34 mg560 mg0 gDay 6
53RecipesforHeartHealthScallion Rice41/2 cups cooked brown rice (cooked in unsaltedwater)11/2 tsp bouillon granules, low sodium1/4 cup scallions (green onions), chopped1. Cook rice according to directions on the package.2. Combine the cooked rice, scallions, and bouillon granules andmix well.3. Measure 1-cup portions and serve.Makes 5 servingsServing Size: 1 cupPer Serving:CaloriesTotal FatSaturated FatCholesterolSodiumProtein2002 g0 g0 mg18 mg5 gCarbohydrateCalciumMagnesiumPotassiumFiber41 g23 mg77 mg92 mg6 gDay 6
54YourGuidetoLoweringYourBloodPressureWithDASHZucchini Lasagna1/2 pound cooked lasagna noodles, cooked in unsaltedwater3/4 cup part-skim mozzarella cheese, grated11/2 cups cottage cheese,* fat-free1/4 cup Parmesan cheese, grated11/2 cups raw zucchini, sliced21/2 cups low-sodium tomato sauce2 tsp basil, dried2 tsp oregano, dried1/4 cup onion, chopped1 clove garlic1/8 tsp black pepper1. Preheat oven to 350 °F. Lightly spray a 9- by 13-inch baking dishwith vegetable oil spray.2. In a small bowl, combine 1/8 cup mozzarella and 1 TbspParmesan cheese. Set aside.3. In a medium bowl, combine remaining mozzarella and Parmesancheese with all the cottage cheese. Mix well and set aside.4. Combine tomato sauce with remaining ingredients. Spread a thinlayer of tomato sauce in the bottom of the baking dish. Add athird of the noodles in a single layer. Spread half of the cottagecheese mixture on top. Add a layer of zucchini.5. Repeat layering. Add a thin coating of sauce. Top with noodles,sauce, and reserved cheese mixture. Cover with aluminum foil.6. Bake 30 to 40 minutes. Cool for 10 to 15 minutes. Cut into 6portions.Makes 6 servingsServing Size: 1 piecePer Serving:CaloriesTotal FatSaturated FatCholesterolSodiumProtein2005 g3 g12 mg368 mg15 gCarbohydrateCalciumMagnesiumPotassiumFiber24 g310 mg46 mg593 mg3 g* To reduce sodium, use low-sodium cottage cheese.New sodium content for each serving is 165 mg.Day 7
55ToLearnMoreTo Learn MoreNHLBI Health Information Center NHLBI Heart HealthP.O. Box 30105 Information LineBethesda, MD 20824–0105 1–800–575–WELLPhone: 301–592–8573TTY: 240–629–3255 Provides toll-free recorded messages.Fax: 301–592–8563Provides information on theprevention and treatment of heartdisease and offers publicationson heart health and heart disease.Also, check out these online resources:General Health InformationNHLBI Web site: www.nhlbi.nih.govDHHS Web site: www.healthfinder.govDiseases and Conditions A–Z Index:www.nhlbi.nih.gov/health/dci/index/htmlYour Guide To Better Health SeriesYour Guide Homepage: http://hp2010.nhlbihin.net/yourguide featuring:Your Guide to Lowering High Blood Pressure With DASHYour Guide to Lowering Your Cholesterol With TLCYour Guide to Physical ActivityNutritionDietary Guidelines for Americans 2005 and A Healthier You:www.healthierus.gov/dietaryguidelines/How to Understand and Use the Nutrition Facts Label:www.cfsan.fda.gov/~dms/foodlab.htmlMyPyramid and other nutrition information:www.mypyramid.gov and www.nutrition.govPhysical ActivityThe President’s Council on Physical Fitness and Sports: www.fitness.govExercise: A Guide from NIA:http://www.niapublications.org/exercisebook/exerciseguidecomplete.pdf
56YourGuidetoLoweringYourBloodPressureWithDASHWeightAim for a Healthy Weight: http://healthyweight.nhlbi.nih.gov.Menus and recipes were analyzed using the Minnesota NutritionData System software—Food Data Base version NDS-R 2005—developed by the Nutrition Coordinating Center, University ofMinnesota, Minneapolis, MN.
Discrimination Prohibited: Under provisions ofapplicable public laws enacted by Congresssince 1964, no person in the United States shall,on the grounds of race, color, national origin,handicap, or age, be excluded from participationin, be denied the benefits of, or be subjected todiscrimination under any program or activity (or,on the basis of sex, with respect to any educa-tion program or activity) receiving Federal finan-cial assistance. In addition, Executive Order11141 prohibits discrimination on the basis ofage by contractors and subcontractors in theperformance of Federal contracts, and ExecutiveOrder 11246 states that no federally funded con-tractor may discriminate against any employee orapplicant for employment because of race, color,religion, sex, or national origin. Therefore, theNational Heart, Lung, and Blood Institute must beoperated in compliance with these laws andExecutive Orders.
ISBN 1-933236-09-4U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICESNational Institutes of HealthNational Heart, Lung, and Blood InstituteNIH Publication No. 06-4082Originally Printed 1998Revised April 2006