The DASH diet vs. The Nutritarian Diet


With your heart at stake and your life on the line, it is imperative to know what diet program is the best. U.S. News & World Report evaluated 38 popular diet plans and ranked them. They chose the DASH (Dietary Approaches to Stop Hypertension) diet as their number one choice, and recently Nutrition Action agreed. They called the OmniHeart diet (a slight variation on the DASH diet) the “healthiest diet to follow if you’re not a vegetarian.”

DASH diet background

The U.S. National Heart, Lung, and Blood Institute developed the DASH diet to specifically lower blood pressure. It emphasizes vegetables, fruits, and whole grains; to be low in saturated and trans fats; to be low in sodium; and to be rich in potassium, calcium, magnesium, fiber, and protein.

DASH diet guidelines:

  • 4-5 servings/day of vegetables
  • 4-5 servings/day of fruit
  • Up to 6 ounces/day of meat, fish or poultry
  • 2-3 servings/day of low-fat dairy
  • 2-3 tablespoons/day of oil
  • 4-5 servings/week of nuts, seeds and beans
  • Up to 5 servings/week of sweets

There is evidence from randomized controlled dietary intervention trials that the DASH diet helps to reduce blood pressure and LDL cholesterol. But are these reductions enough to offer significant protection against cardiovascular death?

Why the Nutritarian diet wins over the DASH diet

In my book The End of Heart Disease, I devote one entire chapter to comparing my Nutritarian dietary guidelines to a number of diet plans, including the DASH diet, that are typically recommended to patients with heart disease or have risk factors for heart disease.

The DASH diet is an improvement compared to the Standard American diet, but it’s far too permissive to be called “the healthiest.” The DASH diet does not emphasize nuts, seeds, and beans, which have profound and extensively researched cardio-protective qualities. In addition, it encourages too much consumption of animal products, including up to 3 servings of dairy daily. On the positive side, the DASH diet emphasizes vegetables and fruits. However, no distinction is made to specifically encourage eating leafy green and cruciferous vegetables.

It’s clear that the DASH diet is not the healthiest, when we compare the effects of the DASH diet (and OmniHeart diet) on blood pressure, cholesterol levels, and body weight to those of the Nutritarian diet reported in my recent study in the American Journal of Lifestyle Medicine. This study used survey data and case histories to demonstrate the dramatic weight loss and cardiovascular benefits possible with a Nutritarian diet.

Blood pressure:

A meta-analysis of seventeen randomized controlled trials concluded that the DASH diet reduced systolic blood pressure (top number) by 6.82 mmHg and diastolic blood pressure (bottom number) by 3.59 mmHg in participants with hypertension.1 The lower sodium version of the DASH diet (1500 mg/d sodium) resulted in a greater blood pressure reduction, 11.5 mm Hg (systolic) in those with hypertension.2

The OmniHeart trial tested three different modified versions of the DASH diet: one was rich in carbohydrate, one in protein (half plant protein), and the third high in unsaturated fat (primarily monounsaturated). Similarly, in the OmniHeart trial, systolic blood pressure was reduced on average 9 mm Hg and diastolic 4-5 mm Hg.3 These improvements are on par with those that are typically observed with blood pressure-lowering drugs.4-8

Although this may seem impressive, the improvements reported by respondents following a Nutritarian diet were almost two and a half to three times greater. Among the 443 survey respondents with hypertension who had made the change to a Nutritarian diet, there was a 26.4 mm Hg average reduction in systolic blood pressure, and 14.7 mm Hg in diastolic blood pressure. Due to these improvements, there was a 60 percent reduction in the use of blood pressure-lowering medication.9

LDL cholesterol:

The DASH diet has been reported to reduce total cholesterol by 13.6 mg/dl and LDL cholesterol by 10.7 mg/dl. A decrease in HDL of 3.7 mg/dl was also observed, and no effect on triglycerides.10 In the OmniHeart trial, all three plans reduced cholesterol by 11-14 mg/dl.3

A dietary intervention study on a Nutritarian diet-style published in 2001 found that LDL cholesterol was reduced by 33%. 11 More recently, my study in the American Journal of Lifestyle Medicine found an average 42 mg/dl decrease in LDL cholesterol in respondents who were not taking cholesterol-lowering medication and switched to a Nutritarian diet; in addition there was an average decrease in triglycerides of 79.5 mg/dl.9

Weight loss:

When tested side-by-side, the DASH diet combined with calorie restriction and exercise induced weight loss of an average of 19 pounds over 4 months, whereas the DASH diet alone resulted in less than one pound of weight lost.12 The OmniHeart trial lasted 41 days, and the average weight loss was about 2 pounds. With such a short duration, it is unclear how effective the OmniHeart diets would be for weight loss.3

Typically, long-term (two-year) weight loss diet interventions achieve only a 6-13 pound sustained weight loss.13 On a Nutritarian diet, respondents to the survey who started out obese experienced an average sustained weight loss of over 50 pounds at both the one year and the two year mark.9

Summary

DASH

OmniHeart

Nutritarian

Systolic blood pressure reduction (mm Hg)

6.82-11.5

9

26.4

Diastolic blood pressure reduction (mm Hg)

3.59

4-5

14.7

LDL cholesterol reduction (mg/dl)

10.7

11-14

42

Weight loss (lbs.)

19 (at 4 months)

2 (at 41 days)

50 (at 2 years)

 

The DASH and OmniHeart diets would be a notable improvement for most Americans: more vegetables and fruits, fewer sweets, more whole grains, and a smaller amount of oil. However, just because a diet plan is better than the disease-causing Standard American Diet doesn’t mean that it will be effective for reversing heart disease or preventing heart attacks and strokes. We can do better.

Despite its name and purpose, the Dietary Approaches to Stop Hypertension diet has only a modest effect on blood pressure compared to a Nutritarian diet. The emphasis on green vegetables, beans, nuts, and other foods with documented protective effects makes the Nutritarian diet the most effective, safest and healthiest way to eat.

 
References
  1. 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.
  2. 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.
  3. Appel LJ, Sacks FM, Carey VJ, et al: Effects of protein, monounsaturated fat, and carbohydrate intake on blood pressure and serum lipids: results of the OmniHeart randomized trial. JAMA 2005;294:2455-2464.
  4. Heran BS, Wong MM, Heran IK, et al: Blood pressure lowering efficacy of angiotensin converting enzyme (ACE) inhibitors for primary hypertension. Cochrane Database Syst Rev 2008:CD003823.
  5. Wong GW, Wright JM: Blood pressure lowering efficacy of nonselective beta-blockers for primary hypertension. Cochrane Database Syst Rev 2014;2:CD007452.
  6. Musini VM, Rezapour P, Wright JM, et al: Blood pressure-lowering efficacy of loop diuretics for primary hypertension. Cochrane Database Syst Rev 2015;5:CD003825.