DASH for Diabetes
Illustration by: Antonio Giovanni Pinna
For adults with type 2 diabetes, following a lower-sodium DASH-style diet (Dietary Approaches to Stop Hypertension) could achieve a clinically meaningful reduction in blood pressure, according to the results of a new Johns Hopkins study, which appeared in JAMA Internal Medicine.
“The DASH diet has been around for a long time, and is part of the standard treatment for hypertension. We know that it lowers blood pressure, but there has been little study of this diet and sodium reduction in people with diabetes,” says lead author Scott Pilla, an assistant professor of medicine at Johns Hopkins. “The goal of the study was to develop a new version of the DASH diet and see how effective it was in lowering blood pressure for people with diabetes. We called it DASH4D.”
The DASH diet is rich in fruits, vegetables and low-fat dairy products, and is lower in saturated fat and cholesterol. For the DASH4D study, Johns Hopkins researchers modified the original DASH diet for people with type 2 diabetes by lowering carbohydrates and increasing unsaturated fat. The researchers also reduced the potassium content to ensure the diet was safe for chronic kidney disease, which affects many people with diabetes.
Pilla says that people with diabetes tend to focus on their blood sugar levels, even though high blood pressure commonly affects those with diabetes and is an important cause of stroke and heart disease. The blood pressure goal for people with diabetes is less than 130 mmHg over less than 80 mmHg. When people take blood pressure medication, it typically lowers systolic blood pressure (the top number) by about 10 points. In this study, eating the low-sodium DASH4D diet lowered systolic blood pressure by about 5 additional points. In people with diabetes, a 5-point reduction in blood pressure reduced the risk of stroke by 14%, cardiovascular events by 6% and heart failure by 8%.
“The next steps are to get the knowledge that we gained out to people with diabetes and help them use the diet to make healthy changes. We need to make it easier for people to follow this diet in ways that are affordable and accessible to people of different cultures and with different dietary habits so they can integrate them into their daily life and make them part of their daily routine.”
Scott Pilla, assistant professor of medicine
“A lot of people are interested in controlling diabetes and their blood pressure through diet and other lifestyle changes,” says corresponding author Lawrence Appel, a Johns Hopkins professor of medicine who helped develop the original DASH diet.
“Most people in this study were taking more than one blood pressure medication, but we found that you can lower it further with dietary change,” he says. “Blood pressure is one of the most important numbers to control because the higher the number, the higher the risk of stroke and heart disease.”