DASH Eating Plan: An Eating Pattern for Diabetes Management

Abstract

IN BRIEF The DASH ( Dietary Approaches to Stop Hypertension ) feed plan is an acceptable consume practice for people who have diabetes. In accession to promoting lineage pressure master, this eat blueprint has been shown to improve insulin resistance, lipemia, and even overweight/obesity. This poise approach promotes pulmonary tuberculosis of a kind of foods ( unharmed grains, nonfat or low-fat dairy products, fruits, vegetables, domestic fowl, pisces, and nuts ) and is appropriate for the entire kin .

The U.S. Department of Agri-culture ( USDA ) has described several food patterns designed to help people follow the recommendations set away in its Dietary Guidelines. specifically, three food patterns have been developed : the Healthy U.S.-Style Pattern, the Healthy Vegetarian Pattern, and the Healthy Mediterranean-Style Pattern. The American Diabetes Association, in its 2013 position statement “ Nutrition Therapy Recommendations for the Management of Adults With Diabetes, ” besides promotes the use of a variety of eating patterns to help with the management of diabetes ( 1 ). One of the feed patterns promoted in these recommendations is the DASH ( Dietary Approaches to Stop Hypertension ) plan. This eat plan is one of several eating patterns that is appropriate for diabetes educators to recommend to their patients with diabetes. This dietary approach is a alimentary, balanced, and sustainable eat design that can improve a number of health parameters, including high blood pressure, insulin resistance, lipemia, and overweight/obesity. People with diabetes have a higher risk of developing high blood pressure than people without diabetes ; in addition, the share of adults with diabetes ≥18 years of age who have high blood pressure was 57.1 % in 2009 compared to 46.2 % in 1995 ( 2 ). Clearly, efforts to help prevent and do high blood pressure must be increased, specially in the diabetes population.

The appeal of the DASH eating form for patients is that it is besides virtual ; it does not require limited foods or supplements, and it is an set about that is appropriate for patients ’ integral family to follow. This article introduces diabetes educators to the DASH consume model in more detail, providing the attest behind the plan and suggesting practical tips for introducing the DASH feed plan to patients .

Overview of the DASH Trial

The DASH eat plan was developed as an overture to help lower blood pressure without the habit of medicine. A multicenter trial, funded by the National Heart, Lung, and Blood Institute ( NHLBI ) and published in 1997, was conducted to study the effects of dietary patterns on blood blackmail in 459 adults with a systolic blood imperativeness of < 160 mmHg and a diastolic blood imperativeness of 80–95 mmHg. Subjects in the discipline initially followed a control diet first gear in fruits, vegetables, and dairy products, along with a fat consumption of 37 % of calories ( representative of the typical American diet ). After 3 weeks of this quarrel diet, subjects were randomized to one of the trace diets for 8 weeks : the master diet, a diet rich in fruits and vegetables, or a diet that combined fruits, vegetables, and low-fat dairy foods. Body weight, forcible activeness, and sodium inhalation were held constant during the trial. The combination diet reduced systolic blood imperativeness by 5.5 mmHg and diastolic rake coerce by 3.0 mmHg, whereas the fruits and vegetables diet reduced systolic blood press by 2.8 mmHg and diastolic blood blackmail by 1.1 mmHg. Subgroup analyses showed that african Americans and individuals with high blood pressure showed the greatest reductions in blood atmospheric pressure ( 3 ) .

DASH Diet: What Is It?

The NHLBI, share of the National Institutes of Health ( NIH ), promotes the DASH diet, or eating practice, as a mean of preventing and controlling blood pressure without the function of medication. The DASH eating blueprint is besides promoted as a healthful option for the general population ( 4 – 6 ). The DASH eat radiation pattern promotes blood pressure decrease by encouraging the pulmonary tuberculosis of foods that are low in saturated fatness, entire fatten, cholesterol, and sodium and high in potassium, calcium, magnesium, fiber, and protein. In terms of actual food choices, the DASH feed convention encourages solid grains, nonfat or low-fat dairy products, fruits, vegetables, poultry, fish, and nuts. Foods that are circumscribed include fatso meats, full-fat dairy products, tropical oils ( for example, coconut, palm, and palm kernel oils ), and sweets and sugar-sweetened beverages. The number of servings of foods is based on a person ’ randomness estimated calorie needs. Based on the above recommendations, provides examples of daily and hebdomadally servings that meet DASH targets for a 2,000-calorie corrode plan ( 7, 8 ) .

TABLE 1.

Food GroupDaily Servings (except as noted)Serving SizesGrains and grain products7–81 slice bread1 cup ready-to-eat cereal*1/2 cup cooked rice, pasta, or cerealLean meats, poultry, and fish≤23 oz cooked lean meat,skinless poultry, or fishVegetables4–51 cup raw leafy vegetable1/2 cup cooked vegetable6 oz vegetable juiceFruit4–51 medium piece of fruit1/4 cup dried fruit1/2 cup fresh, frozen, or canned fruit6 oz fruit juiceLow-fat or fat-free dairy foods2–38 oz milk1 cup yogurt1 1/2 oz cheeseNuts, seeds, and dry beans4–5 per week1/3 cup or 1 1/2 oz nuts1 Tbsp. or 1/2 oz seeds1/2 cup cooked dry beansFats and oils†2–31 tsp. soft margarine1 tsp. low-fat mayonnaise2 Tbsp. light salad dressing1 tsp. vegetable oilSweets≤5 per week1 Tbsp. sugar1 Tbsp. jelly or jam1/2 oz jelly beans8 oz lemonadeSodium††<2,300 mgTotal from prepared/packaged foods and added during cooking or at the tableOpen in a separate window In terms of macronutrient writing, the alimentary goals of the DASH eating blueprint are as follows :

• • Total fat : 27 % of calories
• • Saturated fat : 6 % of calories
• • Protein : 18 % of calories
• • Carbohydrates : 55 % of calories
• • Cholesterol : 150 milligram
• • sodium : 2,300 magnesium ( A lower goal of 1,500 mg sodium was tested and found to be even better for lowering blood imperativeness, particularly for middle-aged and older individuals, african Americans, and those who already had high blood blackmail [ 9 ]. )
• • potassium : 4,700 magnesium
• • calcium : 1,250 milligram
• • magnesium : 500 milligram
• • Fiber : 30 gram

The DASH eating pattern is closely aligned with the USDA ’ s dietary recommendations, as outlined in the 2015–2020 Dietary Guidelines for Americans. As described in chapter 1 of the USDA guidelines, the “ Key Recommendations ” for goodly feed patterns are as follows :

• • Consume a healthy eating traffic pattern that accounts for all foods and beverages within an allow calorie level .
• • A goodly eat pattern includes :
  • ◦ A diverseness of vegetables from all of the subgroups—dark greens, red and orange, legumes ( beans and peas ), starchy, and early
  • ◦ Fruits, specially hale fruits
  • ◦ Grains, at least half of which are whole grains
  • ◦ Fat-free or low-fat dairy, including milk, yogurt, cheese, and/or fortified soy sauce beverages
  • ◦ A assortment of protein foods, including seafood, list meats and domestic fowl, eggs, legumes ( beans and peas ), balmy, seeds, and soy sauce products
  • ◦ Oils
• • A healthy corrode convention limits :
  • ◦ Saturated fats and trans fats, added sugars, and sodium

key Recommendations that are quantitative are provided for respective components of the diet that should be limited. These components are of finical public health concern in the United States, and the specified limits can help individuals achieve goodly eat patterns within calorie limits :

• • Consume < 10 % of calories per day from added sugars
• • Consume < 10 % of calories per day from saturated fats
• • Consume < 2,300 magnesium per day of sodium
• • If alcohol is consumed, it should be consumed in moderation—≤1 drink per day for women and ≤2 drinks per day for men—and only by adults of legal drink age
• • Both the USDA dietary guidelines and the DASH feed form powerfully encourage the inhalation of vegetables, fruits, whole grains, and lower-fat dairy products, while limiting the consumption of sugars, saturated fat, and sodium ( 5 ) .

DASH–Sodium Trial

interestingly, although the DASH diet was not low in sodium ( providing 2,400 magnesium of sodium per day ), blood pressure was placid reduced. To understand the impression of sodium limitation, the DASH–Sodium trial was conducted. This test included 412 subjects who were randomized to a control diet or the DASH diet for 90 days. Within each group, subjects were then assigned to three diets : a high-sodium diet ( 3.5 g/day ), a moderate-sodium diet ( 2.3 g/day ), or a low-sodium diet ( 1.2 g/day ), each for 30 days. For those on the DASH diet, the greater the decrease in sodium, the greater was the decrease in blood coerce, although there was no significant difference on diastolic blood pressure between the high- and moderate-sodium intake levels. furthermore, lowering sodium consumption to 1.2 g/day would be challenging, given the amount of sodium used by the food diligence in food work ( 4, 10 ) .

OmniHeart Study

The OmniHeart ( Optimal Macro-nutrient Intake Trial for Heart Health ) cogitation compared three heart-healthy diets that were known to lower blood atmospheric pressure and improve blood lipids. These three diets were based on the DASH diet but differed in the sum of carbohydrate, protein, and unsaturated adipose tissue, while being equivalent in calories. The higher protein ( 25 vs. 15 % of calories ) and higher unsaturated fat ( 10 vs. 8 % of calories ) diets showed the most benefit on blood pressure and blood lipids and reduced the estimated 10-year hazard of heart disease compared to the higher-carbohydrate diet. Of note, the higher-protein diet emphasized plant sources of protein, which have been associated with dilute blood coerce ( 11 ). Although the OmniHeart report was not specifically geared toward diabetes or glycemic management, the fact that affection disease is the leading cause of death among people with diabetes makes its results applicable to this population .

DASH Eating Pattern for Diabetes

The DASH corrode model has proven to be beneficial for those who are aiming to control or prevent high blood pressure. about two out of three individuals with diabetes have high blood pressure ( 12 ), so it is fair to expect that the DASH eat plan would be of benefit for people who have both high blood pressure and diabetes. In a study by Paula et aluminum. ( 13 ), 40 patients with type 2 diabetes and uncontrolled blood imperativeness were randomized to either the DASH diet and increase physical natural process or a control diet and instructions to maintain their common level of physical natural process. Reductions in blood pressure were greater in the intervention group compared to the control group. Is the DASH eat form beneficial for people who have diabetes ? As previously mentioned, the DASH feed traffic pattern can provide upwards of 55 % of calories from carbohydrate, which may be excessively high a carbohydrate inhalation for some people with type 2 diabetes. furthermore, there is little inquiry demonstrating the glycemic benefits of the DASH eating plan for people who have diabetes. Yet, in one sketch of 31 subjects with type 2 diabetes ( 14 ), the DASH feed design did improve blood lipids and lineage press while besides decreasing A1C ( by 1.7 share points ) and fasting blood glucose levels ( by 29 % ). Of note, De Paula et aluminum. ( 15 ) found that fruits and vegetables were the two food groups of the DASH consume design that helped to lower lineage blackmail in a group of 225 subjects with type 2 diabetes. however, the benefits of the DASH corrode plan may be applicable to people who have type 2 diabetes in other ways. For exemplar, the diets of women in the Nurses ’ Health Study and the Nurses ’ Health Study II, and of men in the Health Professionals Follow-Up Study were measured every 4 years. attachment scores were computed for the Alternate Mediterranean Diet, the Alternate Health Eating Index–2010, and the DASH diet. improvement in all three of these scores was associated with less weight amplification, specially in younger women or fleshy individuals ( 16 ). Weight control is linked with better glycemic control in people with type 2 diabetes ( 17 ). interestingly, the DASH diet is ranked by U.S. News & World Report as being “ # 1 in effective diets overall ” for helping to manage not entirely blood pressure but besides weight ( 18 ). Although the DASH eat pattern is not specifically aimed at weight passing, its emphasis on fruits and vegetables, lower-fat dairy foods, and reduce consumption of red kernel and sweets can be beneficial for patients who are aiming to lose weight or maintain their weight at a healthy horizontal surface .

DASH Eating Pattern in Gestational Diabetes

A healthy feed design is a key factor in the management of gestational diabetes mellitus ( GDM ) ; specifically, the finish is to prevent or reduce adverse maternal and newborn outcomes without instigating any short-run harmful effects. respective dietary approaches have been studied, including a low–glycemic index ( GI ) diet, a low-carbohydrate diet, and a calorie-restricted diet. In a systematic review and meta-analysis of randomized clinical trials of dietary interventions in GDM, Viana et alabama. ( 19 ) concluded that, although the low-GI corrode plan was associated with less frequent insulin habit and lower parturition weight than the early diets, the DASH diet besides holds promise for patients with GDM. In a belittled test ( 20 ), women with GDM followed the DASH diet for 4 weeks. The DASH diet during pregnancy lowered insulin use, deoxidize cesarean rates, and lowered parturition weights. Although the DASH approach looks promising for the management of GDM, further research is warranted, as, in this study, the diet was not followed throughout the pregnancies and deliveries .

DASH Eating Pattern for Diabetes Prevention

The DASH eat plan or DASH-like eat plans have besides led to improvements in insulin sensitivity, far demonstrating that this type of eating plan may be helpful for individuals with prediabetes or who are at hazard for type 2 diabetes ( 21, 22 ). A meta-analysis ( 23 ) of prospective cohort studies looked at the differences among assorted diets ’ effects in preventing type 2 diabetes. The authors concluded that several diets, including the DASH diet and the Mediterranean diet, were associated with a 20 % decrease in the risk of future type 2 diabetes. The ADA ’ s nutrition recommendations for adults with diabetes state that “ there is no ‘ ideal ’ conclusive corrode blueprint that is expected to benefit all individuals with diabetes ” ( 1 ). different types of corrode patterns and macronutrient distributions have been shown to lead to improvements in glycemic control condition ( 24 ). Given the testify health benefits of the DASH corrode plan, along with its recommendation to consume a variety of sanitary foods, one could infer that the DASH eat design is appropriate for those who have diabetes .

Practical Considerations

How can you help your patients get started with the DASH consume plan ? Although this eat design is healthful for anyone, it is particularly aimed at helping those with prehypertension or high blood pressure. A first footfall is to refer your patients to a record dietician ( RD ), preferably one who has experience working with people who have diabetes. Dietitians are particularly skilled at determining the right “ match ” of an consume plan for a specific patient, taking into history factors such as level of glycemic dominance, other health issues, life style factors, cultural factors, and personal preference. Once it has been determined that the DASH eat design is indeed a good fit for a affected role, the keep up tips can help ensure success :

• • Determine the appropriate calorie level for the affected role, based on overall health and nutrition goals. The DASH feed plan can be geared to individuals for whom weight loss is a finish. The NIH offers a link on its web site that helps patients and health care professionals calculate a person ’ randomness calorie needs ( hypertext transfer protocol : //www.supertracker.usda.gov/bwp/index.html ). In addition, the publication Your Guide to Lowering Blood coerce with DASH, which can be printed release of cathexis from hypertext transfer protocol : //www.nhlbi.nih.gov/health/resources/heart/hbp-dash-index, provides serving sizes and food choices for diverse calorie levels .
• • If weight loss is a finish, encourage patients to :
  • ◦ Reduce parcel sizes
  • ◦ Consider eating smaller meals more frequently during the day
  • ◦ Limit consumption of fatso meats, high-fat dairy, and added fats
  • ◦ Drink water or soda water body of water alternatively of sweetened beverages
  • ◦ Aim for at least 150 min/week of forcible activeness, or about 30 min day by day on most days of the workweek
• • To help meet blood glucose and A1C targets, serve patients set appropriate meal and bite carbohydrate goals. Adjust goals, as needed, based on accomplishment of pre- and postmeal targets. When patients begin this corrode plan, suggest that they check their blood glucose levels more frequently than common to learn how this design affects their glycemic operate .
• • Discuss the benefits of planning meals ahead of clock to help meet DASH design and system of weights goals. Using a denounce list can help with meal plan and besides help to ensure that sanitary foods are purchased .
• • If patients are unfamiliar with sanitary cooking methods or cooking in general, suggest that they watch healthy cook videos ( available on-line on YouTube ) or even sign up for a cook class .
• • Help patients set humble goals on a weekly basis to include a yield and/or vegetable at each meal and bite .
• • encourage patients to aim for eating at least one meatless meal each workweek. Meatless meals emphasize plant-based protein sources, including legumes, bean curd, tempeh, and kernel substitutes such as soy-based vegetable burgers. Examples of tasty vegetarian meals are bean chili, beans and rice, bean curd and vegetable stir-fry, and lentil soup .
• • Provide sanitary recipes or mention patients to the recipe section of Your Guide to Lowering Blood pressure with DASH, the rid on-line publication mentioned previously .
• • Discuss tips for dining out because typical restaurant meals tend to be high in sodium and saturated fatten, and portions are frequently large. helpful hints include requesting that foods be prepared without add salt, asking for sauces and salad dressings on the side, substituting a vegetable for a polished carbohydrate food, limiting boodle, drinking body of water or seltzer, and eating half of the meal and taking the rest home for another meal.

  Read more: How Unearth A Weight Reduction Program That Works

The DASH eat plan is easily adaptable to other styles of eat and dietary preferences, including vegetarian, vegan, gluten-free, and kosher. Again, a referral to an RD may be warranted for more particular steering on adapting different styles of feed .

Duality of Interest

No electric potential conflicts of interest relevant to this article were reported .