The Better Diet to Reduce High Blood Pressure

If you are diagnosed with hypertension don’t be too quick to accept the DASH diet as a nutritional model to lower your blood pressure. This diet is not necessarily the most effective.

While the DASH diet would be a marked improvement for most Americans because it includes more vegetables and fruits, fewer sweets, more whole grains and a smaller amount of oil than the typical Western diet, if you want to normalize your blood pressure, reverse heart disease, and prevent heart attacks and strokes, you need more than a better diet. You need a superior diet, like the nutrient-dense, plant rich, Nutritarian diet.

Let me explain why. The U.S. National Heart, Lung, and Blood Institute developed the DASH diet to specifically lower blood pressure. But while there is evidence from randomized controlled dietary intervention trials that this diet helps to reduce blood pressure and LDL cholesterol, it is not enough to offer significant protection against cardiovascular death.

Results Without Medication

I recently published a study in the American Journal of Lifestyle Medicine that illustrates the effectiveness of the Nutritarian diet on reducing blood pressure, losing weight and lowering cholesterol. The study showed that those who started out with hypertension were able to achieve an average reduction in systolic blood pressure of 26 mmHg (the top number) and a decrease of 14.7 mmHg in diastolic blood pressure (the lower number). Due to these improvements, there was a 60 percent reduction in the use of blood pressure-lowering medication. The study also showed dramatic reductions in weight, cholesterol and triglyceride levels.¹

In comparison, a meta-analysis of 17 randomized controlled trials concluded that the standard DASH diet reduced systolic blood pressure by 6.82 mmHg and diastolic pressure by 3.59 mmHg in those with hypertension. ² A lower sodium version of the DASH diet (1500 mg/d sodium) reduced systolic blood pressure by 11.5 mm Hg in those with hypertension.³

The DASH diet doesn’t emphasize nuts, seeds and beans, all of which have profound and extensively researched cardio-protective benefits. In addition, it encourages too much consumption of animal products, including up to three servings a day of dairy. While the DASH diet emphasizes eating lots of vegetables and fruits, it does not specifically encourage the consumption of leafy green and cruciferous vegetables, which are powerfully associated with a lower risk of death from cardiovascular disease and all other causes.

Green leafy vegetables are foods with the highest nutrient density. They contain phytochemicals that are thought to protect blood vessels from inflammation and a greater consumption of them is associated with a reduced risk of death from cardiovascular disease .^{4, 5} In addition to also being anti-cancer powerhouses, these vegetables (like kale, cabbage, and bok choy) also are low in calories, and high in protein, calcium, and fiber. Cruciferous vegetables like broccoli, cauliflower and cabbage are also potent anti-cancer foods.⁶

Lower Blood Pressure and Weight

In terms of weight loss, the DASH diet resulted in less than one pound of weight loss. When combined with calorie restriction and exercise, the weight loss was an average of 19 pounds over four months. ⁷ Although it is unclear if the DASH dieters would maintain this weight loss over a longer period of time, this result could be a step up from the 6 to 13 pound sustained weight loss after two years that is typical of weight loss intervention studies. ⁸  Still, the DASH diet does not come close to  a Nutritarian diet; respondents to a survey who started out obese experienced an average sustained weight loss of more than 50 pounds at both the one year and the two year mark after switching to a Nutritarian diet. ¹ 

In my book, The End of Heart Disease, I devote an entire chapter to comparing my Nutritarian diet to a number of different diet plans— including the DASH diet -- that are typically recommended to patients who have been diagnosed with heart disease or have risk factors for heart disease.

The DASH diet has only a modest effect on blood pressure compared to the Nutritarian diet. With an emphasis on green vegetables, beans, nuts, seeds and other foods with documented cardiovascular protective effects, the Nutritarian diet is the healthiest way to eat.  It is the safest and most effective strategy for lowering blood pressure and preventing future heart attacks and strokes.

1. Fuhrman J, Singer M: Improved Cardiovascular Parameter With a Nutrient-Dense, Plant-Rich Diet-Style: A Patient Survey With Illustrative Cases. Am J Lifestyle Med 2015.
2. Saneei P, Salehi-Abargouei A, Esmaillzadeh A, et al: Influence of Dietary Approaches to Stop Hypertension (DASH) diet on blood pressure: a systematic review and meta-analysis on randomized controlled trials. Nutr Metab Cardiovasc Dis 2014;24:1253-1261.
3. Sacks FM, Svetkey LP, Vollmer WM, et al: Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N Engl J Med 2001;344:3-10.
4. Zakkar M, Van der Heiden K, Luong le A, et al: Activation of Nrf2 in endothelial cells protects arteries from exhibiting a proinflammatory state. Arterioscler Thromb Vasc Biol 2009;29:1851-1857.
5. Zhang X, Shu XO, Xiang YB, et al: Cruciferous vegetable consumption is associated with a reduced risk of total and cardiovascular disease mortality. Am J Clin Nutr 2011;94:240-246.
6. Higdon J, Drake VJ: Cruciferous Vegetables. In An Evidence-based Approach to Phytochemicals and Other Dietary Factors 2nd edition: Thieme; 2013
7. Blumenthal JA, Babyak MA, Hinderliter A, et al: Effects of the DASH diet alone and in combination with exercise and weight loss on blood pressure and cardiovascular biomarkers in men and women with high blood pressure: the ENCORE study. Arch Intern Med 2010;170:126-135.
8. Franz MJ, VanWormer JJ, Crain AL, et al: Weight-loss outcomes: a systematic review and meta-analysis of weight-loss clinical trials with a minimum 1-year follow-up. J Am Diet Assoc 2007;107:1755-1767.