DASH &
Mediterranean diet
• At the end of the lesson, you
should be able to;
• Describe the DASH and
Mediterranean diet
Learning • Provide dietary advice based
on the DASH and
Objectives Mediterranean Diet
• Plan a day's menu based on
the DASH/ Mediterranean Diet
DASH
DIET
WHAT IS IT?
DASH and Med Diet
• DASH and Mediterranean diets are two of the most proven dietary
approaches for preventing hypertension and improving one’s dietary
health.
• Both diets promote healthy lifestyles, which includes both physical
and nutritional health
What is DASH Diet?
• The Dietary Approaches to Stop Hypertension (DASH) diet is
recognized as an effective dietary intervention to reduce blood
pressure (BP).
• DASH diet is rich in several nutrients known to play important roles
in regulating blood pressure, including fibre, potassium,
magnesium, and calcium, and is lower in sodium and saturated
fat.
DASH CLINICAL TRIAL
• Started in 1993
• A controlled feeding trial funded by the National heart ,Lung and
Blood Institute (NHLBI) in the US.
• Tested the effects of 3 different diets on BP levels.
1. Typical American Diet
2. A typical American Diet plus fruit and vegetables
3. The “combination” diet, which was rich in fruits, vegetables, and
low-fat dairy products, currently named the “DASH” diet
DASH CLINICAL TRIAL
• All 3 groups consumed about 3000 mg of salt daily which was
slightly lower than the average US daily intake of 3600 – 4000
mg.
• Caloric intake was similar in 3 groups
• Alcohol was limited in all the groups ( 1-2 drinks a wk.)
RESULTS OF DASH CLINICAL TRIAL
BP in participants who added more fruits and
vegetables
BP in those who followed the DASH diet
especially those who were hypertensive
Reducing sodium intake lowered BP in both the
typical American diet and the DASH diet groups
RESULTS OF DASH CLINICAL TRIAL
Different clinical trials : DASH diet alone or in
combination with other lifestyle changes, such as
sodium restriction, weight loss, or physical exercise,
is effective for BP reduction across a wide range of BP
levels
A systematic review and meta-analysis of
observational prospective studies found that a
DASH-style diet decreases the risk of heart
failure by 29%, coronary heart disease by 21%,
and stroke by 19% (Salehi-Abargouei et al,
2013)
AND Evidence Analysis
Library
• The DASH diet with a sodium range of 1,500mg to 2,400mg, reduced
SBP by 2.0mmHg to 11mmHg and DBP by 0.0mmHg to 9.0mmHg in
overweight or obese adults with HTN regardless of anti-hypertensive
medications.
• DASH diet plus weight loss resulted in reductions in SBP of 11mmHg
to 16mmHg and DBP of 6.0mmHg to 10mmHg.
Grade I (means there is Good/Strong evidence supporting the
statement)
NOTE
• Original DASH diet did not require stringent sodium restriction
or weight loss.
• However, combining the original DASH diet with sodium
restriction appears to be more effective in controlling HTN
than just dietary manipulation.
Additional Benefits of DASH Diet
Effective in reducing inflammation markers.
Lower risk of developing kidney disease
Decrease levels of LDL
Reduce risk of some cancers
2000 kcal diet
• Vegetables:4 –5 servings
• Fruits: 4 –5 servings
• Whole grains: 6-8 servings
• Fat free/low fat : 2 –3
• Fish, Lean meat, Poultry: 6 or fewer
• Nuts , seeds and legumes: 4 –6 sv.
• Fats/Vegetable oils: 2-3 servings
• Sweets/added sugar: 5 or fewer/wk.
American Institute of Preventive Medicine, 2009
Dietary advice: fruits and vegetables
• Fruits and vegetables – Fill half of the plate with vegetables and include a lean protein-
rich food
• Frozen vegetables can also be consumed
• Include fresh vegetables, preferably with a healthy oil-based dressing
• Fruit, raw vegetables, yogurt, cheese, nuts, or hard-boiled eggs can also be consumed as
snacks.
• Choose a whole grain or cereal that is low in added sugars for breakfast.
• Snacks and meals should be balanced with foods that are protein-rich (eg, cheese, eggs,
nuts, yogurt) bulky and filling (eg, fruits or vegetables).
Dietary Advice: Nuts
Unsalted nuts are an excellent source of unsaturated fats and shown to help
lower “bad” (LDL) cholesterol when substituted in place of saturated fats.
Also rich in antioxidants and contain compounds which may reduce
damage to blood vessels, keep blood vessels healthy for unrestricted blood
flow.
Dietary Advice: Dairy
• Low-Fat or Fat-Free Dairy
• Calcium is not only important for bones, but also for blood vessels. Low-
fat or fat-free milk and dairy products in place of full-fat options or
calcium-fortified soymilk should be recommended.
Dietary Advice: Sodium & Saturated Fat
• Limit Sodium and Saturated Fat
• Limits sodium to 2,300 mg per day. Additional benefits may be seen in
BP reduction for those who limit sodium to 1,500 mg.
• Studies have shown that a diet low in saturated fats can decrease risk of
heart disease and hypertension.
• Introduction of plant foods such as beans, lentils and tofu will
introduce variety of nutrients, including protein and limit saturated fat.
Sodium restriction
• Teach client to
• Limit the intake of highly processed foods
• Avoid foods that are cured using salt
• Limit salt during cooking and preparation of food
• Limit sodium to 2300mg/day
• Provide information on sodium content of food
Additives and preservatives
• Look for the word sodium on food labels
• Disodium phosphate (stabilizes and buffers quick-cooking cereals and
processed cheese)
• Monosodium glutamate (MSG) (enhances flavours in meats and vegetables
• Sodium alginate (gels, chocolate milk, ice cream and jams)
• Sodium benzoate (preserves condiments, salad dressings and sauces, fruit
juices and soft drinks)
• Sodium caseinate (emulsifies coffee creamers, ice-cream, milk shakes,
processed meats)
Additives and preservatives
• Sodium citrate: (buffers, emulsifies, gelatin desserts, ice-cream, jams,
yoghurts)
• Sodium hydroxide (softens and loosens fruit and vegetable skins e.g
olives)
• Sodium nitrate (cures meat and sausages)
• Sodium propionate (inhibits mold in bread, cakes, pasteurized cheese)
• Sodium saccharin (sweetens beverages and candies)
• Sodium sulfite (bleaches fruits prior to colouring, preserves dried fruits, )
Sodium terminology
• Sodium free :less than 5 mg per serving
• Very low sodium :35 mg or less per serving
• Low sodium:140 mg or less per serving
• Light in sodium/ Lightly salted : at least 50% less of sodium
per serving than an average amount of the same food that does
not have sodium restriction
Sodium terminology
• Reduced or less sodium: at least 25% less of sodium per serving than an
average amount of the same food that does not have sodium restriction
• Unsalted, without added salt, no salt added: no salt added during
processing
Alcohol
• Abstinence from alcohol results in decrease in systolic BP
• AND Evidence Analysis for Hypertension: if an adult with HTN is
a heavy drinker, RD should recommend abstinence from alcohol
• Men two drinks or less per day ; women no more than one drink
per day.
DASH Diet and Cost
• Previous research has found that dietary costs are strongly
associated with diet quality.
• A UK study reported that closer adherence to the DASH dietary
pattern is associated with greater dietary costs.
• Those with the highest DASH scores had 18% greater food costs
than those with the lowest DASH scores.
Physical Activity
• Be Physically Active and Limit Alcohol
• Aerobic and muscle-strengthening exercises are recommended
• Regular physical activity may help to increase levels HDL cholesterol
• <150 to 300 minutes of moderate-intensity physical activity each week, along with
muscle-strengthening activities 2 or more days per week is recommended.
References
• Savica V, Bellinghieri G, Kopple JD. The effect of nutrition on blood
pressure. Annu Rev Nutr. 2010;30:365–401.
• Filippou CD, Tsioufis CP, Thomopoulos CG, Mihas CC, Dimitriadis KS,
Sotiropoulou LI, Chrysochoou CA, Nihoyannopoulos PI, Tousoulis DM.
Dietary Approaches to Stop Hypertension (DASH) Diet and Blood
Pressure Reduction in Adults with and without Hypertension: A
Systematic Review and Meta-Analysis of Randomized Controlled Trials.
Adv Nutr. 2020 Sep 1;11(5):1150-1160. doi: 10.1093/advances/nmaa041.
PMID: 32330233; PMCID: PMC7490167.
References
• Salehi-Abargouei A, Maghsoudi Z, Shirani F, Azadbakht L. Effects of Dietary
Approaches to Stop Hypertension (DASH)-style diet on fatal or nonfatal
cardiovascular diseases — incidence: a systematic review and meta-analysis on
observational prospective studies. Nutrition. 2013;29(4):611-618.
• DASH_Table.pdf (todaysdietitian.com)
• American Institute of Preventive health (2009). DASH Eating Plan for 2000 and
1000 calories https://healthylife.com/hier/DASH.html
• Marcus J.(2012)
DASH Eating Plan: Reducing Blood Pressure through Diet and Lifestyle Culinary
Nutrition, Academic Press, USA: Chapter 9.org
Mediterranean
Diets
What Is the Mediterranean Diet
(MedDiet)?
• Refers to the dietary patterns of people living in
countries surrounding the Mediterranean Sea,
predominantly Greece, Crete (a Greek island), and
southern Italy.
• First identified in the early 1960s. (Ancel Keys)
• At that time, the life expectancy of adults in those areas
was among the longest in the world, and the incidence
of heart disease, diabetes, certain cancers, and other
diseases was among the lowest.
Research on
Med Diet
• Significant reduction in ;
• Overall mortality (9%)
• CVD (9%)
• Cancer (6%)
• Parkinson's and Alzheimer's Disease (13%)
• First in series of food guide
• illustrated healthy traditional
food and dietary patterns
• Others like the Asian, Latin
American and Native American
pyramids followed later
Mediterranean Triad
• 3 foods in MedDiet
• Grapes (wine)
• Olives (olive oil)
• Wheat (wheat products)
• Mediterranean inhabitants have consumed these foods since biblical
times
Mediterranean Foods
• Dairy products : usually used in recipes: yoghurt and cheese
• Fruits and vegetables: apricots, figs, grapes, lemons, melons, oranges and plum.
Fruit is often the sign of the end of the meal. Dessert is often simply an
assortment of seasonal fruits.
• Garlic and onions predominant in recipes eg. garlic sauces. Parsley added to Med.
dishes to freshen the strong taste and odour of garlic.
• Legumes: daily serving of legumes. Most famous legumes are chickpeas, fava
beans and lentils.
• Meats : beef, kid (young goat) lamb, pork, poultry and veal
Mediterranean Foods
• Nuts and Seeds: almonds (high in protein, fibre, low in fat. Good source of Vit. E,
copper, manganese and phosphorous. Pine nuts and sesame seeds.
• Olives & olive oil: good source of MUFA
• Wheat and other Grains: bulgur (partially, coarse or cracked wheat )
(Turkey) couscous (crushed selmolina )wheat, corn, millet (North Africa) )
cornmeal (Northern Italy) Rice: short –grain rice, medium-grain rice, long-grain
rice (Spain, Greece and Turkey). These provide the backbone of the
Mediterranean Diet
Mediterranean
Foods
• Wine : moderate consumption of wine with meals is
an integral feature of the MedDiet. (Men: 1-2 (4 ounce
) glasses ; Women: 1 (4 ounce) glass of wine per day
• Grape juice may have the same beneficial effects as
drinking wine.
• Wine vinegar ( red or white wine) is a common
ingredient in some Mediterranean cuisine. Has low
acidity than cider or white vinegars. Eg. French
champagne vinegar, Spanish sherry vinegar and Italian
balsamic vinegar.
• Balsamic vinegar is excellent in salads and fruit dessert
The Mediterranean diet and health: a comprehensive overview
Journal of Internal Medicine, Volume: 290, Issue: 3, Pages: 549-566, First published: 23 August 2021, DOI: (10.1111/joim.13333)
Dietary Advice
• Ghanaian diet can benefit from a Mediterranean-type diet
makeover
• Eat lots of vegetables. Enjoy tossed / sautéed vegetables in salads,
soups, and sides.
• Meat. Use leaner cuts, eat smaller portions, and add plenty of
vegetables to fill half of the plate.
• Include some dairy products.
• Eat seafood at least twice a week. Tuna, herring, salmon, tilapia etc.
Dietary Advice
• Cook a vegetarian meal at least once per week.
• Use fats and oils in moderation e.g. nuts, agushie, seeds,
soybean oil, olive oil, avocados, palm oil, coconut oil.
• Switch to whole grains .e.g. brown rice, wheat, maize,millet, fonio
• Eat fruit for dessert. Dried fruits are also healthy
DASH vs Mediterranean
• DASH Mediterranean
• Encourages eating more whole foods
• Reduces sodium consumption, packed with nutrients and less of
and promotes an increased intake heavily processed and refined foods.
of fruits and vegetables, whole
grains, fish, poultry and nuts. • differs greatly in amount of fish, lean
meat, and sweets consumed.
• These foods provide an abundant
source of nutrients such as • two or more servings of fish, the use
potassium, calcium, and of olive oil in food preparation at
magnesium, which have each meal, and a daily serving of
nuts. Moderate intake of wine
lowering effects on blood are encouraged on a Mediterranean
pressure.po diet plan.
References
• Davis, C., Bryan, J., Hodgson, J., & Murphy, K. (2015). Definition of the
Mediterranean diet: a literature review. Nutrients, 7(11), 9139-9153.
• Guasch-Ferré, M., & Willett, W. C. (2021). The Mediterranean diet and
health: a comprehensive overview. Journal of internal medicine, 290(3), 549–
566. https://doi.org/10.1111/joim.13333
• Joan Salge Blake, The Med Diet Made Easy Today’s Dietitian Vol. 23, No. 5,
P. 18. Available online: todaysdietitian.com. Accessed 28/09/2022
• Marcus J.(2012) Culinary Nutrition, Academic Press, USA: Chapter 9
