General Health

Basics of D.A.S.H or Dietary Approach to Stop Hypertension

The body’s normal functioning is governed by its delicate harmony. Mutual understanding between internal organs is the core of this equilibrium. The heart pushes blood through blood vessels, allowing it to flow throughout the body. Blood level and its flow speed decide how much nutrients and oxygen are delivered to each organ. Blood vessels adjust themselves and become either narrower or wider to maintain healthy blood pressure. Inability to continue this normal blood pressure balance brings an enormous number of health complications.

As per WHO, out of 63% of non-communicable disease deaths in India, 27% are due to cardiovascular disease (CVD) affecting 45% of the population between the 40-69 age group. Raised blood pressure is among the most important risk factors for CVDs. It remains poorly controlled due to low awareness about hypertension, lack of appropriate primary care and poor follow up.

A 2021 Lancet report states that around 60%-70% of men and women in India are unaware of their heart condition. The report suggests that India has ranked 193rd for women and 170th for men in the rate of hypertension diagnosis among 200 countries. Many are not aware of being hypertensive and those who get diagnosed are often inadequately treated. This lack of diagnosis further drops down to extremely low rates of hypertension treatment, leaving people at the risk of life-threatening conditions like heart attacks and strokes.

How is blood pressure measured?

Measuring blood pressure is quick and painless. Written as two numbers, the first (systolic) number represents the pressure in blood vessels when the heart contracts or beats and the second (diastolic) number represents the pressure in the blood vessels when the heart rests between beats. It is usually measured with the help of a sphygmomanometer.

What is Hypertension?

Hypertension is diagnosed if, when measured twice on different days, systolic blood pressure on both readings is ≥140 mmHg and/or diastolic blood pressure on both readings is ≥90 mmHg.

Which are the symptoms of high blood pressure?

The WHO calls Hypertension a “silent killer”. Most people with hypertension are unaware of the problem because it may have no warning signs or symptoms.

Silent symptoms include

  1. Early morning headaches,
  2. Nosebleeds
  3. Irregular heart rhythms
  4. Vision changes
  5. Buzzing in the ears

Severe hypertension can cause fatigue, nausea, vomiting, confusion, anxiety, chest pain and muscle tremors

What are the predisposing factors of hypertension?

  1. Intake of an unhealthy diet including high intake of sugar, saturated fat and trans fats
  2. Excessive consumption of table salt and packed foods with hidden high salt content
  3. Low intake of fruits and vegetables
  4. Lack of physical activity and sedentary lifestyle
  5. Obesity
  6. Family history of hypertension
  7. Existing comorbidities like diabetes and kidney diseases
  8. The habit of smoking and alcohol intake

What are the features of D.A.S.H?

A healthy eating plan and physical activity lower the risk of developing high blood pressure and lower blood pressure which is already too high. It also improves the overall quality of life by retaining healthy body weight, improving bone health, maintaining normal blood lipid levels, lowering high uric acid levels, eases diabetes and cancer complications.

D.A.S.H. states that one should consume 2000 calories a day and should include any of the following:

  • 7-8 servings of grains and grain products. Serving size: 1 slice of brown bread, ½ cup of rice, 2 medium size Rotis
  • 4-5 servings of vegetables. Serving size: 1 cup raw green leafy vegetable, ½ cup cooked vegetable and 6 ounces or 170 ml of vegetable juice
  • 4-5 servings of fruits. Serving size: 1 medium fruit, ¼ cup dry fruits, ½ cup fresh fruit, 6 ounces or 170 ml of fresh fruit juice
  • 2-3 servings of low fat or fat-free dairy products. Serving size: 8 ounces or 1 cup of milk, 1 cup curd or yoghurt, 30 gm cheese
  • 2 or fewer servings of lean meat, poultry and fish. Serving size: 80 gm
  • 4-5 servings of nuts, seeds and dried beans per week. Serving size: ⅓ cup of nuts, 1 tablespoon of seeds and ½ cup of cooked dried beans
  • 2-3 settings of fats and oils. Serving size: 1 teaspoon soft margarine, 1 tablespoon low-fat mayonnaise, 2 tablespoons of light salad dressing, 1 teaspoon vegetable oil
  • 5 servings of sweets per week. Serving size: 1 tablespoon sugar, 1 tablespoon jam and 8 ounces or 230 mo of lemonade

D.A.S.H.’s Eating plan recommends eating more fibre-rich grains, fruits and vegetables. Initially, this can cause bloating or diarrhoea. To get used to this eating plan, add food groups gradually. Some other things to keep in mind about while undergoing the D.A.S.H eating plan:

  • In case of trouble digesting dairy products, try lactose-free dairy products
  • Eat small frequent meals instead of a few big meals
  • Limit intake of processed foods like chips, cookies, candies, salted nuts, sodas, energy drinks, overloaded cheese products etc
  • Stop tobacco usage and alcohol consumption totally
  • Drink an adequate amount of water and healthy fluids throughout the day
  • Stick to easy following a daily routine and handle stress sensibly

Ways to reduce salt or sodium intake from diet

  1. Eat fresh vegetables and fruits
  2. Use fresh poultry and fish products instead of canned or processed products
  3. Use herbs, spices and salt-free low-fat seasonings for garnishing
  4. Avoid instant ready to eat and flavoured products
  5. Restrict using added salt while cooking rice and roti
  6. Limit usage of frozen food products
  7. Always check food labels and choose products low in sodium or salt

Conclusion

Taking care of health should be of utmost priority. This can be done by going for a full-body check-up regularly, especially post 30’s. It is good to prevent or treat a disease condition instead of ignoring or avoiding and waiting till the situation goes out of control. It is important to adopt a healthy lifestyle and stay on prescribed treatment to reduce hypertension and its complications.

Before initiating any diet plan including D.A.S.H, qualified experts should be consulted. Self-experimenting, visiting authorised ignorant pretenders and following social media viral fad health advice should be strictly prohibited.

Reference

  1. https://www.hindustantimes.com/india-news/6070-indians-with-hypertension-unaware-of-their-condition-study-101629971301949.html
  2. https://www.who.int/india/health-topics/hypertension
  3. NIH publication no-035232
  4. Lancet, 2021;398:957-80

Author

Aparna Das Parmar

Aparna Parmar has over 8.5 years of rich experience in the field of nutrition and healthcare and is currently a corporate nutritionist.

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