DASHING Off High Blood Pressure

Summarized by Irene Berman-Levine, PhD, RD
June 14, 2007

This is the 16th article we've published by Dr Irene Berman-Levine. It's taken from her newsletter, "Dr Irene's Nutrition Tidbits", which discusses the influence of television on US eating habits. You can subscribe to this newsletter by clicking here. Robert Griffith, Editor.

May was National High Blood Pressure Education Month. "Adherence to Treatment" is the theme for this year's campaign. The theme includes lifestyle (diet and physical activity) and medications. Are you great at starting a healthy diet but have trouble with adherence? This newsletter should help, even if you don't have high blood pressure.

Only about 37% of all patients with hypertension have their blood pressure under control. Apparently from 30 to 60% of people do not adhere to their medication regime. Integrating lifestyle changes, especially diet and exercise, are also critical to permanent blood pressure control.

The DASH diet is the primary nutrition therapy for high blood pressure. I've already written many newsletters on the DASH diet, but if you need a refresher, go to: http://www.nhlbi.nih.gov/hbp/prevent/h_eating/h_eating.htm. This article will review the basics diet but will primarily focus on how to keep you on the DASH diet. It's a healthy diet regardless of whether you have high blood pressure or not.

DASH stands for "Dietary Approaches to Stop Hypertension". The DASH diet is rich in fruits, vegetables and low-fat dairy foods, and it reduces intake of saturated fat from foods like red meat and cheese. Because of the emphasis on fruits, vegetables and low-fat dairy products, the DASH diet is rich in potassium, calcium, magnesium, fiber and protein.

Following the DASH diet, while simultaneously keeping sodium intake to less than 1,500 mg/day, lowers the blood pressure of many individuals. The DASH diet is not hard to follow but it's much easier if you can cook your own meals and minimize use of heavily processed foods. Most people can integrate the principles within a healthy lifestyle. The key is maintaining motivation to follow this healthful diet for life, not just the first four weeks.

Most people cannot tell when their blood pressure is high. When first told they have high blood pressure, people are diligent in starting their treatment. Because they cannot usually feel a difference when their blood pressure goes down, motivation to adhere to treatment regimes, including diets, can drop.

According to the National Heart Lung and Blood Institute (NHLBI), people will start to adopt healthier diets and exercise, but beyond the first year or two, their behaviors tend to slip. The same is true for other health behaviors, such as taking medications.

As part of the theme for National High Blood Pressure Month, NHLBI is encouraging health professionals to understand factors influencing adherence. They have a good article for health professionals on their website, although many of the examples are related to medications. If you are interested, read it at http://hp2010.nhlbihin.net/nhbpep_kit/adhere_back.htm. If you don't want to read the article or it is too long and complex, I will summarize it in a few sentences. Basically, it says patients have a variety of reasons why they cannot adhere to health behaviors. Sometimes they follow instructions for awhile and intentionally give up. Other times they think they are following the instructions but are really making mistakes.

The chances of following instructions (whether medication or diet) are increased if instructions are simple, easy to follow, of short duration, do not involve disruptions in lifestyle and are clearly linked to reductions in symptoms or pain. Unfortunately life is not that easy. If you have high blood pressure (or many of the factors leading to high blood pressure like excess weight), the changes you need to make may seem simple but they are for life and may require some disruption of lifestyle. You will not see immediate reductions in symptoms or pain for most dietary changes; benefits are seen/felt over weeks and, in some cases, months.

Yes, it does take effort. Breaking down the dietary changes into small steps can make it easier, but "easy" cannot be promised in a society that wants to eat on demand. When you have a weight problem or high blood pressure, you cannot eat anything you want in every restaurant. If you want to eat out, you have to seek out those restaurants that care about the sodium and fat content of the food they serve. It also might take more effort in the kitchen.

The end results are worth it. Talk to those people that have changed their lifestyle. Imagine what it is like to lose just five pounds. You can put down a phone book and walk around without having to carry it!

Here are 10 delicious ways to DASH down high blood pressure:

1. Be spicy instead of salty. In cooking and at the table, flavor foods with herbs, spices, lemon, lime, vinegar, or salt-free seasoning blends

2. Use fresh poultry, fish, and lean meat, rather than canned, smoked, or processed types.

3. Eat moderate portions, and when snacking, eat fruit, vegetable sticks, unbuttered and unsalted popcorn, or bread sticks.

4. If you use convenience foods, choose those that are lower in sodium. Cut back on frozen dinners, pizza, packaged mixes, canned soups or broths, and salad dressings. These often have a lot of sodium.

5. Start your day with breakfast cereals that are lower in salt and sodium.

6. Cook rice, pasta, and hot cereals without salt; cut back on instant or flavored rice, pasta, and cereal mixes, which usually have added salt.

7. Buy fresh, plain frozen, or canned with no-salt-added vegetables.

8. Drink water or club soda instead of soft drinks high in sugar.

9. When eating out, move the saltshaker away and limit condiments, such as catsup, pickles, and sauces with high salt-containing ingredients.

10. Cut back on processed and fast foods that are high in salt and sodium.

(The source for these tips is: http://hin.nhlbi.nih.gov/mission/partner/healthy_eating.pdf)

Source

• I Berman-Levine PhD, RD. "Dr Irene's Nutrition Tidbits" Newsletter published by HealthandAge.com. Volume VIII, Issue No 9, May 2007.

Related Links
Dr Irene's Nutritional Tidbits
NHLBI: Your Guide to Lowering High Blood Pressure
DASH Diet eating Plan

Please take a moment to give us your comments. For questions about Health matters you may check our "Questions & Answers" Portal and Service.