DASH Diet

Diet Reference Archive: dietary pattern

DASH Diet

An eating pattern built on vegetables, fruit, whole grains and low-fat dairy foods, with less saturated fat, fewer sweets and, in its current form, a limit on sodium. It was designed and tested in the 1990s to lower blood pressure, and blood pressure is still where its evidence is strongest.

Family: Guideline-endorsed and evidence-based dietary patterns Promoted by: the National Heart, Lung, and Blood Institute, part of the National Institutes of Health First appeared: 1997, when the first trial was published GRADE certainty of evidence against typical or usual diets: Moderate for lowering systolic blood pressure. Effect on heart attacks, strokes and deaths not established

ON THIS PAGE

1. In brief
2. Overview
3. In practice
4. For the coach
5. The evidence (opens on request)
6. Mechanisms (opens on request)
7. Risks, contraindications and myths (opens on request)
8. Key terms
9. Review questions
10. References
11. Evidence rating and review record

The summary and sections 1 to 3 are the short version and are open when the page loads. Sections 4 to 6 hold the research detail, the biology, and the cautions. Each of those opens when you select its heading, and you can read the page without opening them. Back to the Diet Reference Archive index.

In brief

What is it? A way of eating that fills most of the plate with vegetables, fruit and whole grains, adds fat-free or low-fat milk and yogurt, beans, nuts, fish and poultry, and keeps fatty meat, full-fat dairy, sweets, sugary drinks and salt low. The name stands for Dietary Approaches to Stop Hypertension, and it came out of research funded by the National Heart, Lung, and Blood Institute.

Does it work? For blood pressure, yes. In the original trial, where people were given all of their food for 8 weeks and their weight and salt intake were held steady, the pattern lowered blood pressure by 5.5/3.0 mm Hg more than a typical American diet. Eating less sodium on top of it lowered blood pressure further. When the pattern is taught rather than supplied, trials still find lower blood pressure, by amounts that vary with the program. Compared with typical or usual diets, independent reviewers rated the evidence moderate in certainty for systolic blood pressure, the top number. Whether it prevents heart attacks, strokes or deaths is not known: the few trials that counted those events had too few to tell, and studies that follow large groups of people show an association, not cause and effect. It was not designed as a weight-loss diet.

Is it safe? For most adults, yes. It removes no food group and asks for more of several foods rather than fewer. Two cautions come up most often. It is deliberately high in potassium, which matters for people whose kidneys have trouble clearing it and for people taking certain blood pressure medicines. And because it lowers blood pressure, anyone already taking medicine for blood pressure should keep their prescriber informed.

Who should not do it without talking to a doctor or dietitian first? Anyone with chronic kidney disease, and anyone on dialysis, for whom the National Kidney Foundation advises against it. Anyone taking an ACE inhibitor, an angiotensin receptor blocker or a potassium-sparing diuretic, since these can raise blood potassium. Anyone taking medicine for blood pressure or diabetes, or taking warfarin, because a substantial change in eating can change what those medicines do. Anyone who is pregnant.

Related pages: Mediterranean Diet, MIND Diet and the Low-Sodium Diet. Full list on the archive index.

1. Overview

What you eat

Vegetables, fruit and grains, mostly whole grains, make up most of what is eaten. Fat-free or low-fat milk, yogurt and cheese appear every day. Fish, poultry, beans, nuts and seeds supply most of the protein, and vegetable oils supply most of the fat. The pattern is written as daily and weekly servings rather than as a list of permitted foods, and it asks for foods that are rich in potassium, calcium, magnesium, fiber and protein and low in saturated fat, trans fat and sodium.

At about 2,000 calories a day, the National Heart, Lung, and Blood Institute plan works out to 6 to 8 servings of grains, 4 to 5 servings of vegetables and 4 to 5 of fruit, 2 to 3 servings of fat-free or low-fat dairy, 6 or fewer servings of lean meat, poultry or fish, where a serving is 1 ounce of cooked meat or 1 egg, 2 to 3 servings of fats and oils, 4 to 5 servings a week of nuts, seeds and legumes, and 5 or fewer servings a week of sweets and added sugars. A grain serving is a slice of bread; a fruit serving is a medium piece of fruit; a vegetable serving is a cup of raw leafy greens. The servings scale up and down with calorie needs.

What you avoid or limit

Fatty meats, full-fat dairy products and the tropical oils, coconut, palm and palm kernel, are limited because of their saturated fat. Sugar-sweetened drinks and sweets are limited. Sodium has a daily ceiling: the current plan sets it at 2,300 milligrams, and notes that 1,500 milligrams lowers blood pressure further. None of these is a forbidden food. The limits are targets for a day or a week, and a person following the plan is working toward them rather than obeying a rule.

Where it came from

Unlike most of the diets in this archive, DASH was not observed in a population or promoted by an author. It was designed for a trial. Before the trial, studies across societies had found that people eating mostly vegetarian diets tended to have lower blood pressure, while trials of single nutrients taken as supplements had given inconsistent results. The National Heart, Lung, and Blood Institute funded a multicenter feeding trial to test whole eating patterns instead, in the hope of finding a practical and palatable way to eat that would lower blood pressure across the general population (Vogt et al., 1999).

The investigators built 3 diets. A control diet was low in fruit, vegetables and dairy, with fat typical of the American diet at the time. A second diet added fruit and vegetables. The third, the combination diet, added fruit, vegetables and low-fat dairy and cut saturated fat, total fat and cholesterol (Appel et al., 1997). Aiming at a few nutrients thought to affect blood pressure produced diets that were very different in their food groups: the combination diet had more fruit, vegetables, nuts and low-fat dairy, more magnesium, potassium, fiber and calcium, and less red meat, table fat and sweets than the control diet (Karanja et al., 1999).

The combination diet is the one now called DASH. The trial was published in 1997, and a second feeding trial, DASH-Sodium, added sodium reduction to the pattern in 2001 (Sacks et al., 2001). The National Heart, Lung, and Blood Institute still publishes the plan and describes its later research as part of about 3 decades of funded work on diet and blood pressure (National Heart, Lung, and Blood Institute, 2026c).

What it claims to do

The pattern's main promoter is a federal agency, and its claims are broader than the trial that started it. The National Heart, Lung, and Blood Institute states that "the DASH diet lowers blood pressure, improves the lipid panel, helps people lose weight, and reduces the risk of Type 2 diabetes and heart disease" (National Heart, Lung, and Blood Institute, 2026c). The National Kidney Foundation calls it "a recognized treatment for hypertension, heart disease, and kidney disease" that "can slow the progression of heart and kidney disease" (National Kidney Foundation, n.d.).

Commercial books have been built on the name. One, by a dietitian who markets DASH materials, is subtitled "2 Weeks to Drop Pounds, Boost Metabolism, and Get Healthy," and says the plan can "lower cholesterol and blood pressure without medication" (Heller, n.d.). Section 4 takes these claims one at a time. The blood pressure claim is well supported. The others range from modestly supported to not directly tested in the sources reviewed for this page.

A client may also cite a ranking. In both the 2025 and the 2026 editions of U.S. News and World Report's diet rankings, DASH was ranked the best heart-healthy diet and second-best diet overall, and the 2026 edition also ranked it first for high blood pressure. In each of those 2 editions a panel of 69 experts judged 38 diets across 21 categories. These figures are as reported by Pennington Biomedical Research Center, which says its scientists helped develop the diet (Pennington Biomedical Research Center, 2025, 2026); the U.S. News pages themselves were not opened for this page. A ranking is a summary of expert opinion, not a study.

What it gets right

Nearly all of it lines up with current guidance. The American Heart Association's 2026 statement on heart-healthy eating lists, among its 9 features, plenty of vegetables and fruit, mostly whole grains, healthy sources of protein, unsaturated fats in place of saturated fats, minimal added sugar, and less sodium (Lichtenstein et al., 2026). DASH asks for every one of those. The 2025 American Heart Association and American College of Cardiology blood pressure guideline recommends a heart-healthy eating pattern such as the DASH eating plan for adults with or without high blood pressure, at its strongest class of recommendation and highest level of evidence, and calls DASH the most effective eating pattern for lowering blood pressure (Jones et al., 2025). And unlike most named diets, it was tested as a whole pattern with the food supplied, so its central claim rests on a trial rather than on a book.

How clients describe it, and what it gets confused with

Clients say "my doctor put me on DASH," "I'm on the blood pressure diet," "I'm supposed to cut out salt," or "I'm eating heart-healthy." Any of these can mean the full servings plan, a sodium limit on its own, or a general intention to eat better. Ask before assuming.

It is most often confused with a low-sodium diet, because the current plan includes a sodium limit and because doctors often give both pieces of advice together. The original DASH trial held sodium constant, and the pattern lowered blood pressure without any change in salt. It is also confused with the Mediterranean diet, which shares much of its food list but uses olive oil and nuts as its main fats rather than low-fat dairy; with the MIND diet, which is a deliberate blend of DASH and Mediterranean eating aimed at the brain; and with the older Therapeutic Lifestyle Changes diet, which targeted cholesterol. This archive has pages on the Mediterranean Diet and the MIND Diet; the Low-Sodium Diet and TLC Diet are listed on the archive index.

2. In practice

A typical day of eating

Breakfast is oatmeal made with low-fat milk, topped with a sliced banana and a spoonful of walnuts. Lunch is a turkey and vegetable sandwich on whole-grain bread with a side salad, a piece of fruit and a yogurt. The afternoon snack is a handful of unsalted almonds or raw vegetables with hummus. Dinner is baked fish or chicken seasoned with herbs and lemon rather than salt, brown rice, and 2 vegetables, with fruit afterward. Water, low-fat milk or unsweetened drinks through the day. Nothing here is unusual food. What changes for most people is the number of vegetable, fruit and dairy servings, which is higher than they are used to, and the amount of packaged and restaurant food, which is lower.

Cost, products, and who profits

The plan itself costs nothing. The National Heart, Lung, and Blood Institute publishes it free, with servings charts and sample menus, and there is no program to join or product to buy (National Heart, Lung, and Blood Institute, 2026a, 2026b). What costs money is the food, and the evidence on that is thin.

A survey of grocery stores in lower- and higher-income areas of Boston priced a week of DASH meals at about $30.73 in the lower-income areas and $40.20 in the higher-income areas, and found that stores in the lower- and higher-income areas carried 46.5 percent and 75 percent of the DASH food items surveyed, a difference in availability that did not reach statistical significance (Young et al., 2008).

That is one city and one time, so it describes a local price, not what DASH costs a household in general. Food companies donated some of the food for the original trial, which the paper discloses; the trial itself was funded by the National Heart, Lung, and Blood Institute (Appel et al., 1997). Among 22 Black adults with kidney disease interviewed about the pattern, 11, about half, said that after paying their monthly bills they rarely or never had money left for healthy food (Tyson et al., 2023).

The expensive parts are fresh produce, fish and daily dairy. The cheaper parts are oats, beans, lentils, frozen and canned vegetables without added salt, bananas, apples and store-brand milk and yogurt, and a client with a tight budget can move a long way toward the pattern through those. Time is the other cost: cutting sodium mostly means cooking more and buying fewer packaged and restaurant meals. In the United Kingdom, a study that priced the diets of 24,293 adults found that diets closest to DASH cost 18 percent more than the diets furthest from it (Monsivais et al., 2015). Money also attaches to the name. Books, cookbooks and websites sell DASH plans, some of them repackaged for weight loss, and a client who has met DASH through one of those may be describing the product rather than the pattern.

Environmental footprint

The one study found for this page is a modeling study, not a measurement. Researchers estimated the greenhouse gas emissions of the diets reported by 24,293 adults aged 39 to 79 in Norfolk, England, using food questionnaires and United Kingdom emissions data for each food. Diets in the fifth closest to DASH came out at 5.60 kg of carbon dioxide equivalents a day, against 6.71 kg for the fifth furthest from it.

Of the 8 food groups in the DASH score, red and processed meat had the strongest link: diets that most closely met the limit on it had much lower estimated emissions than diets that least met it. Closer accordance with the fruit, whole-grain and sodium targets also went with lower emissions, while eating more vegetables went with somewhat higher ones (Monsivais et al., 2015). The study estimated greenhouse gases only, in one sample in England, so it does not establish the footprint of every version of DASH. It does suggest that choices within the pattern, especially how much red and processed meat a person eats, make a difference.

Cultural fit

The pattern is described in food groups and servings, not cuisines, so it can be cooked in most food traditions. The friction points are dairy and salt. Dairy, at 2 to 3 servings a day, sits at the center of the plan, and a household that does not use dairy has to decide how to replace them, which is a question for a dietitian. Many traditional dishes rely on salt, cured meat or salty sauces, and reducing sodium changes how they taste. When researchers interviewed Black adults with kidney disease about DASH, participants saw it as compatible with their culture: they said they already ate many of the foods, that traditional recipes could be adapted, and that there is no single way Black Americans eat. The authors concluded that support should be built around the person rather than around assumptions about a culture (Tyson et al., 2023).

What makes people stop

Even the original feeding trial, where every meal was supplied, had to work at adherence: most participants ate only the study food, and when they slipped, lack of variety in the menus was the reason they gave most often (Windhauser et al., 1999). Outside a trial, few people eat this way. In national survey data from 1999 to 2004, 19.4 percent of 4,386 adults with high blood pressure met at least half of the researchers' 9 DASH nutrient targets, down from 26.7 percent in the late 1980s and early 1990s (Mellen et al., 2008).

The reasons people give are practical. In interviews with Black adults with kidney disease, the barriers named were not knowing serving sizes, limited cooking skills, household members who did not support the change, and the cost of healthy food; the helps were having healthy food nearby, a supportive household, and personal motivation (Tyson et al., 2023).

In the ENCORE trial, closer adherence went with larger drops in blood pressure regardless of weight change, and African American participants followed the plan less closely than white participants, which the authors took as a sign that the way DASH is taught needs to fit the people learning it (Epstein et al., 2012). The pattern's fiber can also cause bloating. In the DASH-Sodium trial, the high-fiber DASH diet raised the risk of reported bloating by about 41 percent compared with the lower-fiber control diet, and a high-sodium intake raised it too (Peng et al., 2019). That is worth knowing because it is ordinary, usually harmless, and a reason people quietly give up.

What happens when you stop

Few trials have checked what happens afterward, and the answer has varied with the program. In the GoFresh trial in Boston, home-delivered DASH-style groceries with dietitian counseling lowered systolic blood pressure by 3.4 mm Hg more than cash for self-directed grocery shopping after 12 weeks, but the effects were gone 3 months after the deliveries stopped (Juraschek et al., 2026). A companion trial, GoFreshRx, gave the same kind of grocery delivery for 12 weeks to 176 Black adults in Boston whose high blood pressure was already being treated; systolic pressure fell by 5.0 mm Hg more than in a group given cash to shop for themselves, and the benefit was partly maintained 3 months after the deliveries ended (Juraschek et al., 2026). Neither trial is a test of stopping the pattern: they measured what happened after the groceries stopped, whatever people then chose to eat.

In the PREMIER trial, which taught DASH alongside other lifestyle changes, the blood pressure differences between groups that were clear at 6 months were no longer statistically significant at 18 months, although the group taught DASH still had lower odds of having high blood pressure than the advice-only group (Elmer et al., 2006). A review of named-diet trials in adults with overweight or obesity found no statistically significant blood pressure difference between any named diet and a usual diet by 12 months, and its authors grouped DASH with the diets whose blood pressure benefits were seen at 6 months but not at 12 (Ge et al., 2020). That does not show the effect had fallen to zero, and the review compared people still assigned to their diets, so it describes fading over time rather than what happens after stopping.

The original feeding trials ended when the food did, and the reports opened for this page did not follow participants afterward. Blood pressure responds to the pattern within about 2 weeks (Conlin et al., 2000), which suggests it also responds quickly when the pattern is dropped, but that is an inference, not a finding.

Common variations

The lower-sodium DASH plan is the version the National Heart, Lung, and Blood Institute now publishes, with a daily sodium limit of 2,300 or 1,500 milligrams; it comes from the DASH-Sodium trial. The OmniHeart trial tested 2 variations that replace some of the pattern's carbohydrate with protein or with unsaturated fat, and found that both lowered blood pressure a little more than the higher-carbohydrate version, with blood fat changes the authors judged favorable and a lower estimated risk of heart disease (Appel et al., 2005); the institute describes them as variations on DASH (National Heart, Lung, and Blood Institute, 2026c).

Weight-loss versions cut calories within the DASH servings and are often sold under the DASH name. The MIND diet borrows from both DASH and the Mediterranean diet and has its own page, MIND Diet. And a client may describe "eating DASH" when they mean only cutting salt, which is a different and narrower change.

3. For the coach

SCOPE OF PRACTICE

A health and wellness coach does not prescribe, adjust, endorse or discourage this or any diet, and does not diagnose or treat. The coach helps the client understand what they have chosen, notice how it is going, and decide what to do next.

DASH needs a physician or a registered dietitian at 3 specific points: when the client has chronic kidney disease or is on dialysis, because the pattern is high in potassium and what is right for that client depends on their kidney function, lab results and treatment; when the client takes a medicine that reduces how much potassium the body excretes, such as an ACE inhibitor, an angiotensin receptor blocker, a potassium-sparing diuretic or spironolactone, where the blood pressure guideline calls for monitoring blood potassium; and when the client takes medicine for blood pressure or diabetes, or takes warfarin, because a substantial change in eating can change what those medicines do, and whether anything about the medication needs to change is the prescriber's call.

DASH often arrives with a clinician's instruction attached. When it does, the coach supports the plan the client and clinician made and does not adjust it. A client who wants an individualized eating plan built for them is describing the work of a registered dietitian, not a coach.

Who does what

The physician

Diagnoses and treats high blood pressure, decides whether DASH is safe for this person, and adjusts any medication it affects. For this pattern the relevant medicines are blood pressure medicines, especially those that change potassium levels, such as ACE inhibitors, angiotensin receptor blockers and potassium-sparing diuretics, and, when blood pressure or blood sugar falls, the doses of blood pressure and diabetes medicines. The labs that matter are blood potassium and kidney function in anyone with kidney disease or on those medicines, and blood pressure itself, measured over time.

The registered dietitian

Designs and monitors the individual plan, and the blood pressure guideline notes that counseling by a registered dietitian makes DASH more effective (Jones et al., 2025). For DASH that usually means translating servings into meals the person actually eats, setting a sodium target that fits the person's condition, adapting the plan for kidney disease, where potassium may need an individual limit, replacing dairy for someone who does not use it, fitting the plan to a food budget, and adapting it to the client's own food traditions.

The health and wellness coach

Finds out what the client was told, what they understood, and what they want. Tests the plan against the life the client is living: who shops and cooks, what the budget is, how much of the week's food comes from packages or restaurants, and who else eats at the table. Helps the client choose a first change small enough to hold, notices what is working and what is quietly not, and holds the referral line when a question belongs to the physician or the dietitian.

What a client bringing this diet needs

Clients usually bring DASH for one of 3 kinds of reason: a clinician recommended it after a high blood pressure reading, someone in the family has high blood pressure or had a stroke, or they read that it is the best heart-healthy diet. The reason shapes the conversation. A client sent by a doctor often has a handout, a number to bring down and a feeling of being told what to do. They may need help turning a list of servings into meals, or they may need room to say that the list does not fit their life before any plan will hold.

What the coaching conversation offers that the handout cannot is the fit between the plan and this person. The servings chart is everywhere. What is not everywhere is a clear look at whether someone who eats lunch from a vending machine, cooks for 3 children and has never bought plain yogurt can make this their own, and where they would begin.

What to ask

• When your doctor talked about DASH, what did you take away from that conversation?
• What does a usual day of eating look like for you right now, and where does most of it come from?
• Which part of this feels most doable to start with, and which part feels furthest away?

Referral red flags

A client with chronic kidney disease, or on dialysis, who is starting DASH or changing how much fruit, vegetables, beans or dairy they eat should have their kidney care team involved before the change, not after. A client taking an ACE inhibitor, an angiotensin receptor blocker or a potassium-sparing diuretic who is moving to a much higher-potassium way of eating should let the prescriber know. A client on blood pressure medicine who reports feeling dizzy or lightheaded, especially on standing, should tell their prescriber, who can work out the cause; the coach does not guess at it.

A client on insulin or a sulfonylurea who reports shakiness, dizziness or confusion may be having a low blood sugar episode right now, and the first step is the one in their own diabetes plan, with emergency help if the symptoms are severe or they cannot manage the episode themselves (National Institute of Diabetes and Digestive and Kidney Diseases, n.d.); telling the prescriber is the separate step that follows. A client on warfarin who is about to eat a lot more leafy vegetables goes back to the prescriber first. And a client whose attention has moved from meals to exact milligrams of sodium, or who has started turning down food other people cook because nothing fits, is worth asking about it, as described under special populations below.

Special populations

Pregnancy and breastfeeding

Studied, but mostly in pregnancies with a medical problem, and the results point in different directions. A pooled analysis of 6 trials in pregnant women with conditions such as gestational diabetes, obesity or high blood pressure found lower fasting blood sugar, fewer cases of preeclampsia and of very large babies, and a smaller average newborn head circumference with a DASH diet (Li et al., 2020). A 2026 pooled analysis of 5 studies, 4 of them cohort studies comparing women whose eating most and least resembled DASH and 1 a small randomized trial, found no statistically significant association with gestational hypertension and a favorable but inconclusive result for preeclampsia (Alatsis et al., 2026). Because most of that evidence is observational, it describes associations rather than the effect of taking up the diet.

Neither says anything about breastfeeding. With the client's permission a coach can share that DASH is a pattern the obstetric team may recommend and explore how the client feels about it; any plan for a pregnancy, and any sodium or potassium target, belongs to the obstetric clinician or dietitian.

Children and adolescents

One trial of 159 adolescents aged 11 to 18 with elevated blood pressure found that 6 months of DASH-focused counseling lowered systolic blood pressure by 2.7 mm Hg more than routine dietitian counseling, and that diet quality and a measure of blood vessel function were still better at 18 months (Couch et al., 2021). The searches for this page found no trial that followed children long enough to test disease outcomes. A coach works with the adult in front of them, and a child's eating belongs to the family and their pediatrician.

Older adults

The trials enrolled adults across a wide age range. A pooled analysis found that the pattern's effect on blood pressure was larger in trials whose participants averaged under 50 years old than in trials of older people (Filippou et al., 2020), while in the DASH-Sodium trial, among participants without high blood pressure who ate the control diet, lowering sodium had a larger effect in those over 45 than in those 45 or younger (Vollmer et al., 2001). The kidney and medication cautions on this page apply at any age.

Athletes and people with high activity

No trial of DASH in athletes was found for this page. The pattern is high in carbohydrate from grains, fruit and vegetables and supplies protein from dairy, fish, poultry, beans and nuts, and a person training hard mainly needs more of it. Whether their sodium target should differ because of sweat losses is a question for a sports dietitian, not a coach.

People with chronic kidney disease

This is the group where DASH needs the most individual attention, because the pattern is deliberately high in potassium and kidneys that work less well can have trouble clearing it (NIH Office of Dietary Supplements, 2022). The National Kidney Foundation says that anyone who already has chronic kidney disease should speak with their doctor and dietitian before starting any new diet, and advises against DASH for people on dialysis, whose needs are worked out with a registered dietitian (National Kidney Foundation, n.d.).

The 2025 blood pressure guideline makes the same exception: it recommends more dietary potassium for adults with high blood pressure, except in chronic kidney disease, where blood potassium should be monitored (Jones et al., 2025). That is not a statement that everyone with kidney disease must avoid these foods. Whether potassium needs a limit depends on the person's lab results, and some people with kidney disease are advised to eat more of it rather than less (National Kidney Foundation, 2023).

The trial evidence is thin: both founding DASH feeding trials excluded people with kidney insufficiency (Appel et al., 1997; Sacks et al., 2001). In a feeding study of 11 adults with moderate kidney disease who took blood pressure medicine, 2 weeks of a reduced-sodium DASH diet raised blood potassium slightly after the first week, no one developed high potassium, and the authors called for longer studies (Tyson et al., 2016).

With the client's permission, a coach can share the foundation's general guidance and explore what the client wants to do with it. The eating plan itself belongs to the kidney care team and a renal dietitian.

People taking medication for diabetes, blood pressure, or blood thinning

A pattern designed to lower blood pressure, eaten by someone already taking medicine to lower it, is the case this entry exists for. No one in the 2 founding feeding trials was taking blood pressure medicine during the trial (Appel et al., 1997; Sacks et al., 2001), but later trials that enrolled people taking it found that DASH lowered blood pressure in them too (Chiavaroli et al., 2019), as did the 2026 GoFreshRx grocery-delivery trial in 176 adults whose high blood pressure was already being treated (Juraschek et al., 2026), which is why the prescriber needs to know about the change. Some common blood pressure medicines also change how the body handles potassium: ACE inhibitors, angiotensin receptor blockers and potassium-sparing diuretics reduce how much potassium the kidneys clear, and loop and thiazide diuretics increase it (NIH Office of Dietary Supplements, 2022).

The 2025 blood pressure guideline recommends more potassium, ideally from food, for adults with high blood pressure, except that people with chronic kidney disease or taking drugs that reduce potassium excretion need their blood potassium monitored; its list of those drugs includes potassium-sparing diuretics, mineralocorticoid receptor antagonists such as spironolactone, ACE inhibitors, angiotensin receptor blockers and some immunosuppressants (Jones et al., 2025). Warfarin depends on a steady intake of vitamin K, which leafy vegetables supply (NIH Office of Dietary Supplements, 2021).

The standing rule is that a client on blood pressure medicine, on insulin or a sulfonylurea, or on warfarin lets the prescriber know before a substantial change in eating, not after a problem appears. That is the client keeping the prescriber informed, not asking permission for every food choice, and whether anything about the medication needs to change is the prescriber's call. When a client says "my doctor put me on DASH," the plan is already a medical one, and the coach's role is to support the plan the client and clinician made, not to adjust it.

People with a history of disordered eating

DASH removes no food group, but it is written as servings to count and a sodium number to stay under, and any plan built from numbers can be turned into a set of rules. Tallying servings, reading every sodium label or turning down food someone else cooked can come from a medical plan, a religious practice or a preference, so on its own that behavior tells a coach little. The questions are what the behavior is for, whether it causes distress, whether it is narrowing what the person eats, and whether it is getting in the way of daily life. For someone with a history of disordered eating, the pattern is taken up within their existing care plan, and a concern goes to their clinician.

Client misconceptions

Three come up most. That DASH is a low-salt diet, when the original trial lowered blood pressure with salt held constant, and sodium reduction is a second, separate change that adds to it. That DASH is a weight-loss diet, when the original trials held weight steady on purpose and the weight results from later trials are modest and short-lived. And that DASH is proven to prevent heart attacks and strokes, when the proof is for blood pressure: the trials that counted heart attacks and strokes had too few to tell, and the observational evidence is rated low or very low in certainty. Each is taken up in section 6.

🤝 COACHING CONNECTION

Marcus, 52, comes to a session holding a printed handout. His doctor told him his blood pressure is high, started him on a pill and said to "follow DASH." He has circled the line about 4 to 5 servings of vegetables and says he does not know where he would put that many. The coach asks what his doctor said about the handout, and then what Marcus makes of it. He eats lunch at his desk from whatever is in the break room and cooks dinner for himself most nights. The coach asks what a first change might look like that he could actually keep. Marcus says he could take leftovers from dinner for lunch if he made more of it. The coach asks what follow-up he and his doctor arranged, and what support he wants in carrying out the plan. Marcus says he has a blood pressure check in a month and would like help planning the bigger dinners.

4. The evidence

(select the heading to open or close this section)

The evidence that DASH lowers blood pressure is strong and comes from randomized trials, including trials in which every meal was supplied. The evidence that it lowers LDL cholesterol is moderate, as it is for small average differences in body weight and fasting insulin; most other outcomes rated with GRADE are low or very low.

Trials have recorded too few heart attacks, strokes or deaths to show whether DASH prevents them, so most of what is known about those outcomes comes from observational studies that score how closely people already eat this way. Reviewers using GRADE rated the observational links with cardiovascular disease, coronary heart disease and stroke low or very low in certainty. The links with death were appraised separately, on a different scale called NutriGrade, as described under mortality below, and a score on that scale does not show cause and effect. The pattern was designed to be tested for weeks, not years, and most of its trials are short.

Evidence from randomized controlled trials

A trial assigns people to an eating pattern by chance and compares them with people assigned to something else, which is the strongest way to test whether the eating itself causes a result. DASH has 2 kinds of trial behind it, and they answer different questions. Feeding trials supplied all of the food, held body weight and often sodium steady, and asked whether the pattern itself changes blood pressure. Advice trials taught people the pattern and sent them home to shop and cook, and asked whether it works when people carry it out themselves. Every number below says which kind of trial it comes from. Blinding participants to whole-food dietary assignments is difficult; some trials instead kept the staff who measured blood pressure unaware of each person's diet (Appel et al., 1997).

Cardiometabolic outcomes

Blood pressure in feeding trials. The original trial screened 8,813 people and randomized 459 adults whose systolic blood pressure was below 160 mm Hg and whose diastolic pressure was 80 to 95 mm Hg. The trial counted a starting pressure of 140/90 or higher as high blood pressure, the threshold in use at the time; the 2025 guideline now calls 130 to 139 systolic or 80 to 89 diastolic stage 1 high blood pressure, and 140/90 or higher stage 2 (Jones et al., 2025). None was taking blood pressure medicine, and people with kidney insufficiency, poorly controlled diabetes or a body mass index over 35 were excluded. 49 percent were women and 60 percent were Black.

Average blood pressure at the start was 131.3/84.7. Everyone ate the control diet for 3 weeks and was then assigned to the control diet, the fruit-and-vegetable diet or the combination diet for 8 weeks, with all food provided, sodium held at about 3 grams a day, and weight kept steady; average weight changed by less than half a kilogram in every group. More than 95 percent of each group finished, and the staff who measured blood pressure did not know who was on which diet. The combination diet lowered systolic and diastolic pressure by 5.5 and 3.0 mm Hg more than the control diet, with intervals of 3.7 to 7.4 and 1.6 to 4.3.

The fruit-and-vegetable diet lowered systolic pressure by 2.8 mm Hg more, and its diastolic difference of 1.1 mm Hg did not reach statistical significance. Among the 133 participants with high blood pressure by that 140/90 threshold, the combination diet lowered pressure by 11.4/5.5 mm Hg more than control, with intervals of 6.9 to 15.9 and 2.7 to 8.2; among the 326 without it, by 3.5/2.1 (Appel et al., 1997). The trial reported 97.5 percent intervals rather than the usual 95 percent, to allow for its several comparisons. The authors stressed that this was an 11-week feeding study, not designed to test what happens when people choose their own food, what happens over the long term, or which parts of the diet did the work (Appel et al., 1997).

Several later analyses of the same trial fill in the picture. The combination diet lowered systolic pressure significantly in every subgroup examined, and more in African American participants than in white participants, 6.8 against 3.0 mm Hg (Svetkey et al., 1999). Measured with a 24-hour monitor rather than in the clinic, it lowered pressure by day and by night (Moore et al., 1999). Among participants with high blood pressure, the drop was visible within 2 weeks, and after 8 weeks 70 percent of those on the combination diet had a blood pressure below 140/90, against 45 percent on the fruit-and-vegetable diet and 23 percent on the control diet (Conlin et al., 2000).

Where the pattern ends and sodium begins. The DASH-Sodium trial answered the question the first trial left open. It assigned 412 adults with systolic pressure of 120 to 159 mm Hg to the DASH diet or a control diet typical of American eating, and within each diet participants ate high, intermediate and low levels of sodium for 30 days each, in random order. Again all food was provided, weight stayed stable, and people taking blood pressure medicine or with kidney insufficiency or heart disease were excluded. The target levels were 150, 100 and 50 millimoles of sodium a day at 2,100 calories. Urine measurements showed participants actually took in about 3.3, 2.5 and 1.5 grams of sodium a day at the 3 levels. About 95 percent of each group finished (Sacks et al., 2001). Lowering sodium lowered blood pressure on both diets.

Going from high to intermediate sodium lowered systolic pressure by 2.1 mm Hg on the control diet and 1.3 on DASH; going on from intermediate to low lowered it by a further 4.6 on the control diet and 1.7 on DASH. DASH lowered systolic pressure at every sodium level, and its advantage was larger at high sodium than at low. Compared with the high-sodium control diet, the low-sodium DASH diet lowered systolic pressure by 8.9 mm Hg overall, from 6.7 to 11.1, by 7.1 in participants without high blood pressure and by 11.5 in those with it, again using the 140/90 threshold. Sodium reduction had about twice as large an effect on the control diet as on DASH. The low-sodium DASH diet was well tolerated, with no increase in symptoms or dropouts, and the authors noted that long-term benefits remained to be shown (Sacks et al., 2001).

So the 2 changes are separate and they add up, but not completely: each does less when the other is already in place. That is the boundary between this page and the Low-Sodium Diet page. The pattern of foods lowered blood pressure in the first trial with sodium held constant, and sodium reduction lowered it further in the second.

A later analysis of DASH-Sodium by starting blood pressure found that the combination of low sodium and DASH lowered systolic pressure by 5.3, 7.5, 9.7 and 20.8 mm Hg against the high-sodium control diet in people starting below 130, at 130 to 139, at 140 to 149, and at 150 or higher, while DASH alone at high sodium lowered it by 4.5, 4.3, 4.7 and 10.6 (Juraschek et al., 2017). The largest effects were in the people with the highest pressures, and the founding feeding trials enrolled people with systolic pressure below about 160, so they cannot show the effect above that.

Blood pressure when the pattern is taught rather than supplied. The PREMIER trial assigned 810 adults with above-optimal blood pressure, none taking blood pressure medicine, to advice only, to a behavioral program built on the lifestyle changes already recommended for blood pressure, including weight loss, less sodium and more physical activity, or to the same program with DASH added. At 6 months, after subtracting the change in the advice-only group, systolic pressure had fallen by 3.7 mm Hg in the established-recommendations group and 4.3 in the group that also got DASH, from 2.8 to 5.9. The difference between the 2 programs was 0.6 mm Hg, from 2.2 lower to 0.9 higher, which is not statistically significant. The share of participants with high blood pressure fell from 38 percent at the start to 26, 17 and 12 percent in the 3 groups (Appel et al., 2003).

At 18 months, the blood pressure differences between groups were no longer statistically significant, and the odds of having high blood pressure were 0.77 in the DASH group compared with advice only, from 0.62 to 0.97 (Elmer et al., 2006). The authors offered reasons the DASH effect was smaller than in the feeding trials.

Participants raised their fruit and vegetables from 4.8 to 7.8 servings a day, short of the 9.6 servings the feeding trials supplied; combining several lifestyle changes produces less than the sum of each alone; and the advice-only group made changes of its own, losing 1.1 kg and lowering its systolic pressure by 6.6 mm Hg within the group, which narrowed both program groups' differences from the advice-only group. Only 71 and 78 percent of the 2 program groups attended at least 15 of the 18 sessions (Appel et al., 2003). So PREMIER shows that adding DASH advice to an already intensive program added little to blood pressure over 6 months; it does not show that the pattern itself does little.

Other advice trials measured the pattern more directly. In the ENCORE trial, 144 adults with overweight or obesity and high blood pressure who were not taking medicine were assigned for 4 months to their usual diet, to DASH, or to DASH with a weight-management program of exercise and calorie reduction. Clinic blood pressure fell by 3.4/3.8 mm Hg on the usual diet, 11.2/7.5 on DASH, and 16.1/9.9 on DASH with weight management (Blumenthal et al., 2010). Those are changes within each group, not differences between groups, and even the differences between groups are larger than the pooled averages below.

In the GoFresh trial, 180 Black adults in Boston neighborhoods with few grocery stores, with systolic pressure from 120 to under 150 and no blood pressure treatment, were assigned to 12 weeks of home-delivered, lower-sodium DASH-style groceries with dietitian counseling, or to 3 payments of $500 for their own grocery shopping. Systolic pressure fell by 5.7 mm Hg in the grocery group and 2.3 in the cash group, a difference of 3.4, from 0.8 to 5.9 (Juraschek et al., 2026). And in a trial of a digital program that coached 301 adults with high blood pressure toward DASH, the program improved DASH scores modestly by 12 months but did not lower blood pressure more than the comparison program (Miller et al., 2025).

Blood pressure across all the trials. Pooled analyses combine these trials. An umbrella review carried out for European diabetes guidelines took its blood pressure estimate from an earlier meta-analysis, which the umbrella review counts as 19 trials in 1,918 people, most of them taught the diet rather than fed it, lasting 2 to 24 weeks. Compared with control diets, DASH lowered systolic pressure by 5.2 mm Hg, from 3.4 to 7.0, and diastolic pressure by 2.6 mm Hg, from 1.7 to 3.5. The reviewers rated the systolic result moderate in certainty, lowered one level because the trials disagreed with one another more than chance would explain, and the diastolic result low (Chiavaroli et al., 2019; Siervo et al., 2015).

A larger and later meta-analysis of 30 trials in 5,545 adults found smaller average reductions, 3.2 mm Hg systolic, from 2.3 to 4.2, and 2.5 diastolic, from 1.5 to 3.5, rated both moderate in certainty, and found that the effect did not depend on whether participants had high blood pressure. The systolic effect was larger in trials where sodium intake was above 2,400 milligrams a day, and both effects were larger in trials whose participants averaged under 50 years of age (Filippou et al., 2020). Both estimates favor DASH and both describe a change of a few mm Hg on average. They are not directly comparable: the reviews included different trials, and the later one calculated its average from the blood pressures each group reached during follow-up (Filippou et al., 2020), so the 2 may differ in method as well as in trials.

Blood lipids. In the original feeding trial, the combination diet lowered total cholesterol by 13.7 mg/dL, LDL cholesterol by 10.7 mg/dL and HDL cholesterol by 3.7 mg/dL compared with the control diet, with no significant effect on triglycerides, in 436 participants whose weight stayed stable. The fall in LDL was larger in men than in women. The authors judged that the diet was likely to lower coronary risk and noted that the fall in HDL, the cholesterol usually considered protective, needed further study (Obarzanek et al., 2001). Across trials, the umbrella review found LDL cholesterol 0.10 mmol/L lower, about 3.9 mg/dL, from 0.01 to 0.20 mmol/L, rated moderate in certainty and lowered one level for imprecision, and no significant effect on HDL or triglycerides (Chiavaroli et al., 2019).

In the OmniHeart feeding trial, 164 adults ate 3 diets in turn for 6 weeks each, all low in saturated fat: one rich in carbohydrate, one with some carbohydrate replaced by protein, and one with some replaced by unsaturated fat. Compared with the carbohydrate diet, the protein diet lowered LDL by a further 3.3 mg/dL and triglycerides by 15.7 mg/dL but also lowered HDL by 1.3; the unsaturated-fat diet raised HDL by 1.1 and lowered triglycerides by 9.6 with no significant change in LDL (Appel et al., 2005).

Blood sugar and uric acid. The umbrella review found HbA1c, a measure of average blood sugar, 0.53 percentage points lower on DASH, but from only 2 small trials in 65 people, one in type 2 diabetes and one in gestational diabetes, and rated it low in certainty. It found fasting insulin slightly lower, rated moderate using GRADE, and no significant effect on fasting blood glucose (Chiavaroli et al., 2019). In a feeding study of 103 adults within the DASH-Sodium trial, DASH lowered serum uric acid, the substance that causes gout when it builds up, by 0.35 mg/dL, and by more in the 8 participants whose uric acid started high (Juraschek et al., 2016).

Heart attacks, strokes and deaths. The trials reviewed have not established whether DASH prevents heart attacks, strokes or deaths; they recorded too few events for a reliable answer. A 2025 Cochrane review pooled the events that trials recorded: 5 randomized trials of 1,397 generally healthy adults, with the diet taught for 16 weeks to 12 months and follow-up of up to 18 months.

Against no intervention or usual care, 1 trial of 144 people had no heart attacks or strokes in either group over a year. In the review's "minimal intervention" comparison, 2 trials with 629 people in the groups compared recorded 1 heart attack, in a DASH group, and no strokes. For PREMIER, one of those 2 trials, this compared established lifestyle counseling plus DASH with the same lifestyle program without DASH; the advice-only arm was excluded. The review rated the certainty of these results low for heart attacks and strokes and very low for death from any cause (Bensaaud et al., 2025).

In PREMIER's own report, 1 stroke, 1 transient ischemic attack and 1 heart attack occurred in the advice-only group, the group the Cochrane comparison left out, and 1 heart attack in the group taught DASH (Appel et al., 2003). Blood pressure is a risk marker, not an event. A lower blood pressure is expected to mean fewer strokes and heart attacks over time, and that expectation is reasonable, but the trials reviewed here have not been large or long enough to estimate an effect on these events reliably.

Cancer

No randomized trial of DASH with a cancer outcome was found for this page. The cancer evidence is observational and is described below.

Body weight, as measured

This archive reports body weight as something a study measured, in that study's own numbers, and not as a goal or as a measure of whether an eating pattern worked. See the standing rule in the review record at the foot of this page.

In the original feeding trials, weight was held steady by design, so their blood pressure results do not depend on weight change. In trials where weight was allowed to change, a meta-analysis of 10 articles found people assigned to DASH weighed 1.42 kg less than controls after 8 to 24 weeks, from 0.82 to 2.03 kg. Some of those trials cut calories within the DASH servings, and the difference was larger when DASH was compared with a usual Western diet and in participants with overweight or obesity (Soltani et al., 2016). The umbrella review, counting the same estimate, reports it as 11 trial comparisons in 1,211 people.

The umbrella review rated that result moderate in certainty, lowered one level because the trials disagreed with one another (Chiavaroli et al., 2019). A network analysis of trials in adults with overweight or obesity found DASH programs 3.6 kg lower than a usual diet at 6 months, rated moderate in certainty, and found that weight differences generally shrank by 12 months among the named diets with 12-month data (Ge et al., 2020). In the GoFresh grocery trial, body mass index did not change (Juraschek et al., 2026). Read together, these describe a modest average difference, mostly in trials that also reduced calories, that shrinks with time.

Mortality

The trials that recorded deaths had too few to tell anything (Bensaaud et al., 2025). What is known comes from cohort studies, below.

Evidence from long-term prospective cohort studies

A cohort study follows people who already eat a certain way and records what happens to them. It can show that a pattern goes with an outcome; it cannot by itself show that the pattern caused it, because people who eat this way also tend to differ in income, education, smoking, exercise and much else. In this literature, how closely a person eats like DASH is scored from a food questionnaire. Several different DASH scores exist, and they do not all measure the same things, which is one reason results vary.

Cardiometabolic outcomes

The umbrella review pooled cohort studies covering about 942,000 people. Comparing the people whose eating most resembled DASH with those whose eating least resembled it, cardiovascular disease was 20 percent lower, a relative risk of 0.80, from 0.76 to 0.85, across 11 cohorts of 783,732 people followed for 7.9 to 24 years; coronary heart disease 21 percent lower, 0.79, from 0.71 to 0.88; stroke 19 percent lower, 0.81, from 0.72 to 0.92; and diabetes 18 percent lower, 0.82, from 0.74 to 0.92. The reviewers rated cardiovascular disease and stroke low in certainty, which is where observational evidence starts. They rated coronary heart disease very low, lowered for indirectness because the reviewers judged the 3 cohorts behind it too narrow in who they included to generalize from, and diabetes very low, because its studies disagreed with one another (Chiavaroli et al., 2019).

Individual cohorts show what those numbers are built from. In the Nurses' Health Study, 88,517 women aged 34 to 59 at the start were followed for 24 years; those in the top fifth of a DASH score had a relative risk of coronary heart disease of 0.76, from 0.67 to 0.85, and a relative risk of stroke of 0.82, compared with the bottom fifth, after adjustment for age, smoking and other risk factors (Fung et al., 2008). Later meta-analyses point the same way.

Higher DASH scores went with a lower risk of developing high blood pressure, a hazard ratio of 0.81, from 0.73 to 0.90, in cohort studies, though the results varied widely enough that a new study could plausibly find anything from 0.61 to 1.08 (Theodoridis et al., 2023). For diabetes, a 2024 meta-analysis of 15 studies found a relative risk of 0.82, from 0.76 to 0.90, and 0.83 in the cohort studies alone, but no clear dose-response relationship (Quan et al., 2024). In men followed for 26 years, the highest DASH scores went with a 32 percent lower risk of gout, 0.68, from 0.57 to 0.80 (Rai et al., 2017).

Cancer

A meta-analysis of cohort studies found that people with the highest DASH scores had 16 percent lower cancer mortality, a relative risk of 0.84, from 0.81 to 0.86, and 21 percent lower risk of colorectal cancer, 0.79, from 0.75 to 0.83 (Ali Mohsenpour et al., 2019). For breast cancer, a 2022 meta-analysis reported 21 percent lower risk overall, but that figure mixes cohort studies with case-control studies, which ask people to recall how they ate after they are already ill. In the cohort studies alone the association was much smaller, 0.92, from 0.86 to 0.98 (Shu et al., 2022). Neither review offered a certainty rating in the parts opened for this page. These are associations, and confounding is the limit that matters most.

Body weight, as measured

No cohort synthesis of body weight was retrieved and read for this page, so none is reported here. The trials above are the better source for this question in any case, because they compare people assigned to a pattern rather than people who already differ from one another in many ways.

Mortality

A dose-response meta-analysis of 17 cohort studies converted every DASH score to a common scale running from 8 to 40 points. Each 5-point rise went with 5 percent lower death from any cause, a hazard ratio of 0.95, from 0.94 to 0.96; 3 percent lower cardiovascular death, 0.97, from 0.95 to 0.98, the figure in the paper's results and its figure, where the abstract gives 0.96; and 3 percent lower cancer death, 0.97, from 0.95 to 0.98.

The all-cause result came from studies that disagreed with one another a great deal, and the association looked stronger above 20 points (Soltani et al., 2020). The reviewers rated this body of evidence high on NutriGrade, a scoring system for nutrition research that is not the same as GRADE; a high score on it does not turn an association into cause and effect, and the studies still disagreed with one another (Soltani et al., 2020).

Highlighted studies

These 4 sources carry the most weight for this pattern. Each is described so that a reader can judge it without opening the paper. The limitation column gives the one weakness that most affects how far the finding can be trusted.

On a narrow screen, scroll the table sideways to see every column.

Highlighted studies for the DASH Diet

Study	Design	Sample size	Duration	Finding	The limitation that matters
Appel et al., 1997, the original DASH trial	Randomized controlled feeding trial; all food provided; sodium and weight held constant; blood pressure measured by staff unaware of diet assignment	459 adults with systolic pressure under 160 and diastolic 80 to 95 mm Hg, none on blood pressure medicine	3-week run-in, then 8 weeks	The combination diet lowered blood pressure by 5.5/3.0 mm Hg more than a typical American control diet, and by 11.4/5.5 in the 133 participants with high blood pressure, defined then as 140/90 or higher	By the authors' own account, an 11-week feeding study that could not test adherence when people choose their own food, long-term effects, or which parts of the diet worked. It also excluded people with kidney insufficiency, and no participant was taking blood pressure medicine: the 2 groups this page most cautions about
Sacks et al., 2001, the DASH-Sodium trial	Randomized controlled feeding trial; diet assigned in parallel, sodium level varied in random order within each diet; outcome staff unaware of diet assignment	412 adults with systolic pressure of 120 to 159 mm Hg, not on medication	2-week run-in, then 3 periods of 30 days	Lower sodium lowered blood pressure on both diets. Low-sodium DASH lowered systolic pressure by 8.9 mm Hg overall, 7.1 in people without high blood pressure and 11.5 in people with it, by the 140/90 threshold, compared with the high-sodium control diet	Each sodium level lasted only 30 days with all food provided. The authors wrote that long-term benefits remained to be shown and would depend on people making lasting changes and on lower-sodium foods being available
Appel et al., 2003, the PREMIER trial	Randomized controlled trial of behavioral programs; DASH taught as advice, no food provided	810 adults with above-optimal blood pressure, not on medication	6 months, with 18-month follow-up	Adding DASH to a program of established lifestyle changes lowered systolic pressure by 0.6 mm Hg more than the program alone, a difference that was not statistically significant	DASH was taught as one part of a package, and by the authors' account participants ate less of it than the feeding trials supplied, while the advice-only comparison group also changed. The trial cannot isolate what the pattern did on its own, and its blood pressure differences were no longer statistically significant at 18 months
Chiavaroli et al., 2019, umbrella review	Umbrella review of meta-analyses of controlled trials and cohort studies, with GRADE ratings	31 trials with 4,414 people; 15 cohorts with 942,140 people	Trials of 2 to 52 weeks; cohorts followed for up to 24 years	Systolic pressure 5.2 mm Hg lower in trials, rated moderate; cardiovascular disease 20 percent lower in cohorts, rated low	The ratings rest on earlier meta-analyses whose searches ended between 2012 and 2018, most of the trials lasted weeks rather than years, and the event outcomes come only from observational studies

Head to head

DASH has been tested directly against other diets less often than against a typical diet. The one direct trial against the Mediterranean diet found in the searches for this page assigned 240 adults with high-normal blood pressure or the first grade of high blood pressure, none on medication, to 3 months of either diet with salt restriction, salt restriction alone, or no or minimal intervention. The Mediterranean group's office systolic pressure fell by 3.2 mm Hg more than the DASH group's. The 2 diets did not differ on office diastolic pressure or on 24-hour blood pressure, and both did better than salt restriction alone (Filippou et al., 2023). One trial in one country is not enough to rank the 2 patterns.

Pooled comparisons point in different directions depending on what they compare. A network meta-analysis of 67 trials comparing 13 dietary approaches in people with high or high-normal blood pressure ranked DASH first for lowering both systolic and diastolic pressure; it rated the credibility of most comparisons very low to moderate, but the comparison of DASH with a low-fat diet high (Schwingshackl et al., 2019); the abstract, the part read for this page, does not name the rating method.

A network analysis of named diets in adults with overweight or obesity found DASH among the diets with the most consistent effects on weight and blood pressure at 6 months, alongside Atkins and Zone, with differences between diets generally small at 6 months and smaller and uncertain by 12 months (Ge et al., 2020). A 2026 meta-analysis of 10 trials that compared DASH with other dietary interventions or with usual care found no significant advantage for DASH on systolic or diastolic pressure, with certainty rated low overall using GRADE (Valenzuela-Fuenzalida et al., 2026); only its abstract was read for this page. The Mediterranean Diet page in this archive carries the comparison from its side.

Where the evidence is absent

The trials reviewed have not established whether DASH prevents heart attacks, strokes or deaths; they recorded too few events for a reliable answer (Bensaaud et al., 2025). The feeding trials lasted 8 weeks or 30-day periods, and the trials that taught the diet mostly ran for weeks to a year. The longest follow-up found was of a trial of 1 year of dietitian-led DASH counseling in adults with nonobstructive coronary artery disease: about 6 years after it ended, 84 of its participants were re-examined, and 1 major cardiovascular event had occurred in the DASH group against 4 in the control group, a difference that was not statistically significant; adherence had declined somewhat but stayed higher in the DASH group (Makarewicz-Wujec et al., 2025). The founding feeding trials excluded people with systolic pressure of 160 or more, so they cannot show the effect at the highest pressures.

Both founding feeding trials excluded people with kidney insufficiency, and no one in them was taking blood pressure medicine. The feeding study in chronic kidney disease retrieved for this page was a 2-week study in 11 people, and evidence in people already on blood pressure medicine comes from a few smaller trials, among them the 2026 GoFreshRx trial of 176 treated adults (Juraschek et al., 2026). Evidence in pregnancy comes from small trials, mostly in pregnancies with a medical complication, and from cohort studies, with inconsistent results. Evidence in adolescents comes from a small number of trials, including the one described in section 3, and the searches for this page found no trial in athletes. The cancer-outcome evidence reviewed here is observational. And the whole-pattern trials described on this page do not isolate every component's contribution or identify a single biological pathway.

5. Mechanisms

(optional reading; select the heading to open or close this section)

This section explains how the diet is thought to work in the body. You can skip it. Nothing in the coaching sections depends on it.

Established mechanisms

What the trials established is an effect rather than a biological pathway: a change in the mix of foods, with sodium intake and body weight held constant, lowers blood pressure. The original trial was designed to show exactly that, and it did (Appel et al., 1997). The effect appears quickly, within about 2 weeks in people with high blood pressure (Conlin et al., 2000), and it holds through the day and night (Moore et al., 1999). So the pattern does not work only by causing weight loss or only by cutting salt, though either can add to it.

Sodium is a second, separate lever. In the DASH-Sodium trial, eating less sodium lowered blood pressure on both the DASH diet and the typical American diet, and DASH lowered blood pressure at every sodium level, with each change doing somewhat less when the other was already in place (Sacks et al., 2001). The current plan combines the 2.

The cholesterol effect is consistent with what the diet changes. The combination diet was lower in saturated fat, total fat and cholesterol than the control diet (Karanja et al., 1999), and in the feeding trial it lowered total and LDL cholesterol, along with HDL (Obarzanek et al., 2001). Choosing unsaturated fats in place of saturated fats is one of the 9 features of a heart-healthy pattern named by the American Heart Association (Lichtenstein et al., 2026).

Proposed mechanisms

Several explanations for why this particular mix lowers blood pressure are plausible and widely repeated, and none of them supports a claim in section 4. The pattern was built to be richer in potassium, magnesium, calcium and fiber than the typical diet (Karanja et al., 1999), and the proposal is that these nutrients act together: potassium helps the kidneys excrete sodium, and potassium and calcium interact with the hormone system that regulates blood pressure. Another proposal is that nitrate from vegetables, especially leafy ones, is converted in the body to nitric oxide, which relaxes blood vessels (Chiavaroli et al., 2019).

Others involve fiber, the gut, and inflammation. These are the authors' proposals, discussed but not tested in the trials reported here. The early trials of single nutrients taken as supplements gave inconsistent results, which is why DASH was tested as a whole pattern in the first place (Vogt et al., 1999), and the trials reported here do not show which part of the pattern does the work.

6. Risks, contraindications and myths

(select the heading to open or close this section)

Warnings from professional or regulatory bodies

The National Kidney Foundation, which otherwise describes DASH favorably, states: "The DASH diet should not be used by people on dialysis." It adds that people on dialysis have special dietary needs that should be discussed with a registered dietitian, and that anyone who already has chronic kidney disease should speak with their doctor and dietitian before starting any new diet (National Kidney Foundation, n.d.). No other warning from a professional or regulatory body was found for this page.

Nutrient gaps

DASH is more likely to raise nutrient intake than to leave gaps. The combination diet in the original trial was higher in magnesium, potassium, fiber and calcium than the control diet, and differed substantially in several vitamins and minerals (Karanja et al., 1999). The concern with DASH is more often the opposite: too much potassium for someone whose kidneys or medicines limit how much of it the body can clear (NIH Office of Dietary Supplements, 2022). A version without dairy has to replace 2 to 3 daily servings that supply much of the pattern's calcium, and a person who drops meat without replacing its protein can fall short on protein. Both are planning questions for a dietitian rather than properties of the pattern.

Who should not follow it without medical supervision

People on dialysis, for whom the National Kidney Foundation advises against it, and people with chronic kidney disease, who should involve their doctor and dietitian before starting (National Kidney Foundation, n.d.). In people whose kidneys clear potassium poorly, even a potassium intake below the usual recommendation can cause high blood potassium (NIH Office of Dietary Supplements, 2022). That does not mean every person with kidney disease must avoid these foods; whether potassium needs a limit depends on the person's lab results, and some are advised to eat more (National Kidney Foundation, 2023). People taking medicines that raise blood potassium, described below. People taking medicine for blood pressure or diabetes, or taking warfarin, because a substantial change in eating can change what those medicines do. And anyone who is pregnant, whose eating plan belongs to the obstetric team.

Medication interactions

A coach never adjusts medication. The point of knowing these is to know when to send a client back to the prescriber. ACE inhibitors and angiotensin receptor blockers, both used to treat high blood pressure, reduce how much potassium the kidneys excrete and can lead to high blood potassium; potassium-sparing diuretics do the same. Loop and thiazide diuretics work the other way and can lead to low blood potassium (NIH Office of Dietary Supplements, 2022). The 2025 blood pressure guideline adds mineralocorticoid receptor antagonists such as spironolactone and some immunosuppressants to the list of drugs that reduce potassium excretion, and calls for blood potassium to be monitored when people taking them increase their potassium (Jones et al., 2025).

A diet built to be high in potassium matters to both groups, which is why the prescriber should know about the change. Blood pressure medicine raises a second question as blood pressure falls. If a client on it reports feeling dizzy or lightheaded, the coach's job is to encourage them to tell the prescriber, not to guess the cause. Warfarin depends on a steady intake of vitamin K, and a sudden increase in leafy vegetables can change how it works (NIH Office of Dietary Supplements, 2021).

Signs it is going wrong

Physical signs a coach or a family member might notice are dizziness or lightheadedness, especially on standing, in someone on blood pressure medicine; shakiness, dizziness or confusion in someone on insulin or a sulfonylurea; and, in someone with kidney disease or on potassium-raising medicines, any symptom their care team has told them to watch for. Shakiness, dizziness or confusion in someone on insulin or a sulfonylurea may be a low blood sugar episode happening now: the first step is the one in the client's own diabetes plan, with emergency help if the symptoms are severe or the client cannot manage the episode, and telling the prescriber follows (National Institute of Diabetes and Digestive and Kidney Diseases, n.d.). Bloating is a common effect of the higher-fiber pattern (Peng et al., 2019), and it is worth asking about because it is a reason people quietly give up.

For the other signs, a coach encourages the client to tell their clinician; working out the cause is the clinician's job. Behavior has to be read with care. Counting servings, reading sodium labels or turning down food someone else cooked is what the plan asks for, and the same behavior can also come from a medical plan, a religious practice or a preference, so on its own it tells a coach little.

Talking about foods as clean and dirty, or treating a restaurant meal as a failure, carries more meaning and is worth asking about directly. In every case the questions are the same: what the behavior is for, whether it causes distress, whether it is narrowing what the person eats, and whether it is getting in the way of daily life. None of this is a diagnosis. Where the answers raise a real concern about disordered eating, the coach follows their own referral process.

Myths and where they came from

Myth: DASH is a low-salt diet

Where it came from: the current plan sets a sodium limit, doctors often give "follow DASH" and "cut the salt" as a single instruction, and the second trial combined the 2. What is true: the original trial held sodium constant and still lowered blood pressure by 5.5/3.0 mm Hg compared with a typical American diet (Appel et al., 1997). Sodium reduction is a second change that lowers blood pressure further, on DASH or on a typical diet (Sacks et al., 2001). A client who has only cut salt has made one of 2 changes.

Myth: DASH is a weight-loss diet

Where it came from: books and websites sell DASH plans for weight loss, one of them promising results within 2 weeks (Heller, n.d.), and the National Heart, Lung, and Blood Institute lists weight loss among the pattern's benefits (National Heart, Lung, and Blood Institute, 2026c). What is true: the original trials held weight steady on purpose, so their blood pressure results have nothing to do with weight. Later trials that allowed weight to change found modest average differences, often in versions that also cut calories (Soltani et al., 2016), and in a network analysis those differences generally shrank by 12 months (Ge et al., 2020).

Myth: DASH is proven to prevent heart attacks and strokes

Where it came from: the strength of the blood pressure evidence, and large observational studies in which people eating most like DASH had fewer heart attacks and strokes. What is true: the few trials that recorded heart attacks or strokes had too few to tell (Bensaaud et al., 2025). The observational evidence is consistent but rated low or very low in certainty, because people who eat this way differ from others in many ways (Chiavaroli et al., 2019). Lower blood pressure is expected to mean fewer strokes and heart attacks over time; that is a reasonable expectation, not a trial result.

7. Key terms

Systolic and diastolic blood pressure

The 2 numbers in a blood pressure reading. Systolic, the top number, is the pressure while the heart beats; diastolic, the bottom number, is the pressure between beats. Both are measured in millimeters of mercury, written mm Hg.

Controlled feeding trial

A trial in which researchers provide all of the participants' food, so that what people eat is known and fixed. It shows what a diet can do when it is followed exactly, which is different from what it does when people follow it on their own.

Crossover trial

A trial in which each participant eats every diet being tested, one after another in random order, so each person is compared with themselves.

Sodium and salt

Sodium is the part of table salt that affects blood pressure. Food labels and eating plans give sodium in milligrams, and in the United States most of the sodium people eat is added during food processing or in restaurant cooking rather than at the table (Jones et al., 2025).

Potassium

A mineral found in fruit, vegetables, beans and dairy that the kidneys regulate. DASH is deliberately high in it. Healthy kidneys clear excess potassium; kidneys that work less well, and some medicines, can let it build up.

DASH score

A number calculated from a food questionnaire that shows how closely a person's eating resembles DASH. Several versions exist, and cohort studies use them to compare people who eat more and less like DASH.

Mean difference

In a trial, the average difference in an outcome, such as blood pressure, between the group on the diet and the comparison group. A mean difference of 5 mm Hg is a group average and does not mean every person's blood pressure fell by 5.

Relative risk and hazard ratio

Ways of comparing how often an outcome happens in 2 groups. A value of 0.80 means the outcome happened at about 80 percent of the rate in the comparison group, a 20 percent relative difference. On its own it says nothing about how common the outcome was.

GRADE

The 4-level scale used in clinical guidelines to say how certain the evidence for a conclusion is: high, moderate, low or very low. It rates the evidence, not the diet, and it rates each outcome separately.

8. Review questions

1. Describe the DASH pattern to someone who has never heard of it, in 4 sentences, without using the word healthy. Then name the 2 changes most people find hardest, and why.
2. The original DASH trial held sodium and body weight constant. Explain why the investigators designed it that way, what it allowed them to conclude, and what question the DASH-Sodium trial then answered. This question draws on section 4.
3. A client says his doctor put him on DASH and started him on lisinopril, an ACE inhibitor, at the same visit. Write what you would say and what you would ask. Then say where the referral line is, and why his medicine matters for this particular diet. This question draws on sections 3 and 6.
4. Independent reviewers rated the evidence on DASH and systolic blood pressure moderate in certainty and the evidence on DASH and cardiovascular disease low. Explain to a classmate why the same diet can earn 2 different ratings. This question draws on section 4 and the review record.
5. Where did the belief that DASH is a weight-loss diet come from, and what do the trials show? Write the 2 sentences you would use with a client who raises it.

9. References and Resources

Alatsis, A., Xixi, N. A., Sokou, R., Volaki, P., Paliatsiou, S., Iliodromiti, Z., Iacovidou, N., & Boutsikou, T. (2026). The effect of the DASH diet on the development of gestational hypertension in pregnant women: A systematic review and meta-analysis. Nutrients, 18(2), 268. https://doi.org/10.3390/nu18020268

Ali Mohsenpour, M., Fallah-Moshkani, R., Ghiasvand, R., Khosravi-Boroujeni, H., Mehdi Ahmadi, S., Brauer, P., & Salehi-Abargouei, A. (2019). Adherence to Dietary Approaches to Stop Hypertension (DASH)-style diet and the risk of cancer: A systematic review and meta-analysis of cohort studies. Journal of the American College of Nutrition, 38(6), 513-525. https://doi.org/10.1080/07315724.2018.1554460

Appel, L. J., Champagne, C. M., Harsha, D. W., Cooper, L. S., Obarzanek, E., Elmer, P. J., Stevens, V. J., Vollmer, W. M., Lin, P. H., Svetkey, L. P., Stedman, S. W., Young, D. R., & Writing Group of the PREMIER Collaborative Research Group. (2003). Effects of comprehensive lifestyle modification on blood pressure control: Main results of the PREMIER clinical trial. JAMA, 289(16), 2083-2093. https://doi.org/10.1001/jama.289.16.2083

Appel, L. J., Moore, T. J., Obarzanek, E., Vollmer, W. M., Svetkey, L. P., Sacks, F. M., Bray, G. A., Vogt, T. M., Cutler, J. A., Windhauser, M. M., Lin, P. H., & Karanja, N. (1997). A clinical trial of the effects of dietary patterns on blood pressure. New England Journal of Medicine, 336(16), 1117-1124. https://doi.org/10.1056/NEJM199704173361601

Appel, L. J., Sacks, F. M., Carey, V. J., Obarzanek, E., Swain, J. F., Miller, E. R., Conlin, P. R., Erlinger, T. P., Rosner, B. A., Laranjo, N. M., Charleston, J., McCarron, P., Bishop, L. M., & OmniHeart Collaborative Research Group. (2005). Effects of protein, monounsaturated fat, and carbohydrate intake on blood pressure and serum lipids: Results of the OmniHeart randomized trial. JAMA, 294(19), 2455-2464. https://doi.org/10.1001/jama.294.19.2455

Bensaaud, A., Seery, S., Gibson, I., Jones, J., Flaherty, G., McEvoy, J. W., Jordan, F., Tawfick, W., & Sultan, S. A. (2025). Dietary Approaches to Stop Hypertension (DASH) for the primary and secondary prevention of cardiovascular diseases. Cochrane Database of Systematic Reviews, 2025(5), Article CD013729. https://doi.org/10.1002/14651858.CD013729.pub2

Blumenthal, J. A., Babyak, M. A., Hinderliter, A., Watkins, L. L., Craighead, L., Lin, P. H., Caccia, C., Johnson, J., Waugh, R., & Sherwood, A. (2010). 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. Archives of Internal Medicine, 170(2), 126-135. https://doi.org/10.1001/archinternmed.2009.470

Chiavaroli, L., Viguiliouk, E., Nishi, S. K., Blanco Mejia, S., Rahelić, D., Kahleová, H., Salas-Salvadó, J., Kendall, C. W., & Sievenpiper, J. L. (2019). DASH dietary pattern and cardiometabolic outcomes: An umbrella review of systematic reviews and meta-analyses. Nutrients, 11(2), 338. https://doi.org/10.3390/nu11020338

Conlin, P. R., Chow, D., Miller, E. R., Svetkey, L. P., Lin, P. H., Harsha, D. W., Moore, T. J., Sacks, F. M., & Appel, L. J. (2000). The effect of dietary patterns on blood pressure control in hypertensive patients: Results from the Dietary Approaches to Stop Hypertension (DASH) trial. American Journal of Hypertension, 13(9), 949-955. https://doi.org/10.1016/S0895-7061(99)00284-8

Couch, S. C., Saelens, B. E., Khoury, P. R., Dart, K. B., Hinn, K., Mitsnefes, M. M., Daniels, S. R., & Urbina, E. M. (2021). Dietary Approaches to Stop Hypertension dietary intervention improves blood pressure and vascular health in youth with elevated blood pressure. Hypertension, 77(1), 241-251. https://doi.org/10.1161/HYPERTENSIONAHA.120.16156

Elmer, P. J., Obarzanek, E., Vollmer, W. M., Simons-Morton, D., Stevens, V. J., Young, D. R., Lin, P. H., Champagne, C., Harsha, D. W., Svetkey, L. P., Ard, J., Brantley, P. J., Proschan, M. A., Erlinger, T. P., Appel, L. J., & PREMIER Collaborative Research Group. (2006). Effects of comprehensive lifestyle modification on diet, weight, physical fitness, and blood pressure control: 18-month results of a randomized trial. Annals of Internal Medicine, 144(7), 485-495. https://doi.org/10.7326/0003-4819-144-7-200604040-00007

Epstein, D. E., Sherwood, A., Smith, P. J., Craighead, L., Caccia, C., Lin, P. H., Babyak, M. A., Johnson, J. J., Hinderliter, A., & Blumenthal, J. A. (2012). Determinants and consequences of adherence to the Dietary Approaches to Stop Hypertension diet in African-American and white adults with high blood pressure: Results from the ENCORE trial. Journal of the Academy of Nutrition and Dietetics, 112(11), 1763-1773. https://doi.org/10.1016/j.jand.2012.07.007

Filippou, C. D., Tsioufis, C. P., Thomopoulos, C. G., Mihas, C. C., Dimitriadis, K. S., Sotiropoulou, L. I., Chrysochoou, C. A., Nihoyannopoulos, P. I., & Tousoulis, D. M. (2020). Dietary Approaches to Stop Hypertension (DASH) diet and blood pressure reduction in adults with and without hypertension: A systematic review and meta-analysis of randomized controlled trials. Advances in Nutrition, 11(5), 1150-1160. https://doi.org/10.1093/advances/nmaa041

Filippou, C., Thomopoulos, C., Konstantinidis, D., Siafi, E., Tatakis, F., Manta, E., Drogkaris, S., Polyzos, D., Kyriazopoulos, K., Grigoriou, K., Tousoulis, D., & Tsioufis, K. (2023). DASH vs. Mediterranean diet on a salt restriction background in adults with high normal blood pressure or grade 1 hypertension: A randomized controlled trial. Clinical Nutrition, 42(10), 1807-1816. https://doi.org/10.1016/j.clnu.2023.08.011

Fung, T. T., Chiuve, S. E., McCullough, M. L., Rexrode, K. M., Logroscino, G., & Hu, F. B. (2008). Adherence to a DASH-style diet and risk of coronary heart disease and stroke in women. Archives of Internal Medicine, 168(7), 713-720. https://doi.org/10.1001/archinte.168.7.713

Ge, L., Sadeghirad, B., Ball, G. D. C., da Costa, B. R., Hitchcock, C. L., Svendrovski, A., Kiflen, R., Quadri, K., Kwon, H. Y., Karamouzian, M., Adams-Webber, T., Ahmed, W., Damanhoury, S., Zeraatkar, D., Nikolakopoulou, A., Tsuyuki, R. T., Tian, J., Yang, K., Guyatt, G. H., & Johnston, B. C. (2020). Comparison of dietary macronutrient patterns of 14 popular named dietary programmes for weight and cardiovascular risk factor reduction in adults: Systematic review and network meta-analysis of randomised trials. BMJ, 369, m696. https://doi.org/10.1136/bmj.m696

Heller, M. (n.d.). The DASH diet weight loss solution. DASH Diet. dashdiet.org/dash-diet-weight-loss-solution.html

Jones, D. W., Ferdinand, K. C., Taler, S. J., Johnson, H. M., Shimbo, D., Abdalla, M., Altieri, M. M., Bansal, N., Bello, N. A., Bress, A. P., Carter, J., Cohen, J. B., Collins, K. J., Commodore-Mensah, Y., Davis, L. L., Egan, B., Khan, S. S., Lloyd-Jones, D. M., Mazurek Melnyk, B., ... Williamson, J. D. (2025). 2025 AHA/​ACC/​AANP/​AAPA/​ABC/​ACCP/​ACPM/​AGS/​AMA/​ASPC/​NMA/​PCNA/​SGIM guideline for the prevention, detection, evaluation and management of high blood pressure in adults: A report of the American College of Cardiology/​American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 152(11), e114-e218. https://doi.org/10.1161/CIR.0000000000001356

Juraschek, S. P., Col, H., Ferro, K., Turkson-Ocran, R.-A. N., Cluett, J. L., Davis, R. B., Kraemer, K. M., McManus, K., Mukamal, K. J., Aidoo, E. L., Larbi Kwapong, F., Budu, M., Patil, D., Nartey, S., Michetti, J., Allison, S., Mate-Kole, M., Cao, J., Grobman, B., ... Fitzpatrick, S. L. (2026). DASH-patterned groceries and effects on blood pressure in adults treated for hypertension: The GoFreshRx randomized trial. Nature Medicine, 32(6), 2128-2136. https://doi.org/10.1038/s41591-026-04319-4

Juraschek, S. P., Col, H., Ferro, K., Turkson-Ocran, R.-A. N., Cluett, J. L., Davis, R. B., Kraemer, K. M., McManus, K., Mukamal, K. J., Aidoo, E. L., Larbi Kwapong, F., Budu, M., Patil, D., Nartey, S., Michetti, J., Allison, S., Mate-Kole, M., Cao, J., Grobman, B., ... GoFresh Collaborative Research Group. (2026). DASH-patterned groceries and effects on blood pressure: The GoFresh randomized clinical trial. JAMA, 335(1), 36-48. https://doi.org/10.1001/jama.2025.21112

Juraschek, S. P., Gelber, A. C., Choi, H. K., Appel, L. J., & Miller, E. R. (2016). Effects of the Dietary Approaches to Stop Hypertension (DASH) diet and sodium intake on serum uric acid. Arthritis & Rheumatology, 68(12), 3002-3009. https://doi.org/10.1002/art.39813

Juraschek, S. P., Miller, E. R., Weaver, C. M., & Appel, L. J. (2017). Effects of sodium reduction and the DASH diet in relation to baseline blood pressure. Journal of the American College of Cardiology, 70(23), 2841-2848. https://doi.org/10.1016/j.jacc.2017.10.011

Karanja, N. M., Obarzanek, E., Lin, P. H., McCullough, M. L., Phillips, K. M., Swain, J. F., Champagne, C. M., & Hoben, K. P. (1999). Descriptive characteristics of the dietary patterns used in the Dietary Approaches to Stop Hypertension trial. Journal of the American Dietetic Association, 99(8 Suppl), S19-27. https://doi.org/10.1016/S0002-8223(99)00412-5

Li, S., Gan, Y., Chen, M., Wang, M., Wang, X., O Santos, H., Okunade, K., & Kathirgamathamby, V. (2020). Effects of the Dietary Approaches to Stop Hypertension (DASH) on pregnancy/neonatal outcomes and maternal glycemic control: A systematic review and meta-analysis of randomized clinical trials. Complementary Therapies in Medicine, 54, 102551. https://doi.org/10.1016/j.ctim.2020.102551

Lichtenstein, A. H., Khera, A., Anderson, C. A. M., Appel, L. J., DeSilva, D. M., Gardner, C., Hu, F. B., Jones, D. W., Petersen, K. S., & American Heart Association. (2026). 2026 dietary guidance to improve cardiovascular health: A scientific statement from the American Heart Association. Circulation, 153(18), e1285-e1295. https://doi.org/10.1161/CIR.0000000000001435

Makarewicz-Wujec, M., Henzel, J., Kępka, C., Kruk, M., Jakubczak, B., Wróbel, A., Dąbrowski, R., Dzielińska, Z., Demkow, M., Czepielewska, E., & Filipek, A. (2025). Long-term outcomes of the Dietary Approaches to Stop Hypertension (DASH) intervention in nonobstructive coronary artery disease: Follow-up of the DISCO-CT study. Nutrients, 17(15), Article 2565. https://doi.org/10.3390/nu17152565

Mellen, P. B., Gao, S. K., Vitolins, M. Z., & Goff, D. C. (2008). Deteriorating dietary habits among adults with hypertension: DASH dietary accordance, NHANES 1988-1994 and 1999-2004. Archives of Internal Medicine, 168(3), 308-314. https://doi.org/10.1001/archinternmed.2007.119

Miller, H. N., Askew, S., Berger, M. B., Kay, M. C., Palipana, A., Trefney, E., Blackman Carr, L. T., Barnes, C., Tyson, C. C., Svetkey, L. P., Shaw, R., Steinberg, D. M., Yang, Q., & Bennett, G. G. (2025). Effects of a digital intervention to improve DASH and blood pressure among US adults. Hypertension, 82(2), 370-381. https://doi.org/10.1161/HYPERTENSIONAHA.124.23887

Monsivais, P., Scarborough, P., Lloyd, T., Mizdrak, A., Luben, R., Mulligan, A. A., Wareham, N. J., & Woodcock, J. (2015). Greater accordance with the Dietary Approaches to Stop Hypertension dietary pattern is associated with lower diet-related greenhouse gas production but higher dietary costs in the United Kingdom. American Journal of Clinical Nutrition, 102(1), 138-145. https://doi.org/10.3945/ajcn.114.090639

Moore, T. J., Vollmer, W. M., Appel, L. J., Sacks, F. M., Svetkey, L. P., Vogt, T. M., Conlin, P. R., Simons-Morton, D. G., Carter-Edwards, L., & Harsha, D. W. (1999). Effect of dietary patterns on ambulatory blood pressure: Results from the Dietary Approaches to Stop Hypertension (DASH) trial. Hypertension, 34(3), 472-477. https://doi.org/10.1161/01.HYP.34.3.472

National Heart, Lung, and Blood Institute. (2026a, February 25). DASH eating plan. National Institutes of Health. nhlbi.nih.gov/education/dash-eating-plan

National Heart, Lung, and Blood Institute. (2026b, February 25). Following DASH. National Institutes of Health. nhlbi.nih.gov/health/dash/following-dash

National Heart, Lung, and Blood Institute. (2026c, February 25). Health benefits of DASH. National Institutes of Health. nhlbi.nih.gov/health/dash/health-benefits

National Institute of Diabetes and Digestive and Kidney Diseases. (n.d.). Low blood glucose (hypoglycemia). National Institutes of Health. niddk.nih.gov/health-information/diabetes/overview/​preventing-problems/low-blood-glucose-hypoglycemia

National Kidney Foundation. (2023, May 5). Potassium in your CKD diet. kidney.org/kidney-topics/potassium-your-ckd-diet

National Kidney Foundation. (n.d.). The DASH diet for kidney disease treatment. kidney.org/kidney-topics/dash-diet

NIH Office of Dietary Supplements. (2021, March 29). Vitamin K: Fact sheet for health professionals. ods.od.nih.gov/factsheets/VitaminK-HealthProfessional

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Obarzanek, E., Sacks, F. M., Vollmer, W. M., Bray, G. A., Miller, E. R., Lin, P. H., Karanja, N. M., Most-Windhauser, M. M., Moore, T. J., Swain, J. F., Bales, C. W., Proschan, M. A., & DASH Research Group. (2001). Effects on blood lipids of a blood pressure-lowering diet: The Dietary Approaches to Stop Hypertension (DASH) trial. American Journal of Clinical Nutrition, 74(1), 80-89. https://doi.org/10.1093/ajcn/74.1.80

Peng, A. W., Juraschek, S. P., Appel, L. J., Miller, E. R., & Mueller, N. T. (2019). Effects of the DASH diet and sodium intake on bloating: Results from the DASH-Sodium trial. American Journal of Gastroenterology, 114(7), 1109-1115. https://doi.org/10.14309/ajg.0000000000000283

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Rai, S. K., Fung, T. T., Lu, N., Keller, S. F., Curhan, G. C., & Choi, H. K. (2017). The Dietary Approaches to Stop Hypertension (DASH) diet, Western diet, and risk of gout in men: Prospective cohort study. BMJ, 357, j1794. https://doi.org/10.1136/bmj.j1794

Sacks, F. M., Svetkey, L. P., Vollmer, W. M., Appel, L. J., Bray, G. A., Harsha, D., Obarzanek, E., Conlin, P. R., Miller, E. R., Simons-Morton, D. G., Karanja, N., Lin, P. H., & DASH-Sodium Collaborative Research Group. (2001). Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. New England Journal of Medicine, 344(1), 3-10. https://doi.org/10.1056/NEJM200101043440101

Schwingshackl, L., Chaimani, A., Schwedhelm, C., Toledo, E., Pünsch, M., Hoffmann, G., & Boeing, H. (2019). Comparative effects of different dietary approaches on blood pressure in hypertensive and pre-hypertensive patients: A systematic review and network meta-analysis. Critical Reviews in Food Science and Nutrition, 59(16), 2674-2687. https://doi.org/10.1080/10408398.2018.1463967

Shu, L., Huang, Y. Q., Zhang, X. Y., Zheng, P. F., Zhu, Q., & Zhou, J. Y. (2022). Adherence to the Dietary Approaches to Stop Hypertension diet reduces the risk of breast cancer: A systematic review and meta-analysis. Frontiers in Nutrition, 9, 1032654. https://doi.org/10.3389/fnut.2022.1032654

Siervo, M., Lara, J., Chowdhury, S., Ashor, A., Oggioni, C., & Mathers, J. C. (2015). Effects of the Dietary Approach to Stop Hypertension (DASH) diet on cardiovascular risk factors: A systematic review and meta-analysis. British Journal of Nutrition, 113(1), 1-15. https://doi.org/10.1017/s0007114514003341

Soltani, S., Arablou, T., Jayedi, A., & Salehi-Abargouei, A. (2020). Adherence to the dietary approaches to stop hypertension (DASH) diet in relation to all-cause and cause-specific mortality: A systematic review and dose-response meta-analysis of prospective cohort studies. Nutrition Journal, 19(1), 37. https://doi.org/10.1186/s12937-020-00554-8

Soltani, S., Shirani, F., Chitsazi, M. J., & Salehi-Abargouei, A. (2016). The effect of dietary approaches to stop hypertension (DASH) diet on weight and body composition in adults: A systematic review and meta-analysis of randomized controlled clinical trials. Obesity Reviews, 17(5), 442-454. https://doi.org/10.1111/obr.12391

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Theodoridis, X., Chourdakis, M., Chrysoula, L., Chroni, V., Tirodimos, I., Dipla, K., Gkaliagkousi, E., & Triantafyllou, A. (2023). Adherence to the DASH diet and risk of hypertension: A systematic review and meta-analysis. Nutrients, 15(14), 3261. https://doi.org/10.3390/nu15143261

Tyson, C. C., Lin, P. H., Corsino, L., Batch, B. C., Allen, J., Sapp, S., Barnhart, H., Nwankwo, C., Burroughs, J., & Svetkey, L. P. (2016). Short-term effects of the DASH diet in adults with moderate chronic kidney disease: A pilot feeding study. Clinical Kidney Journal, 9(4), 592-598. https://doi.org/10.1093/ckj/sfw046

Tyson, C. C., Svetkey, L. P., Lin, P. H., Granados, I., Kennedy, D., Dunbar, K. T., Redd, C., Bennett, G., Boulware, L. E., & Fish, L. J. (2023). Self-perceived barriers and facilitators to Dietary Approaches to Stop Hypertension diet adherence among Black Americans with chronic kidney disease: A qualitative study. Journal of Renal Nutrition, 33(1), 59-68. https://doi.org/10.1053/j.jrn.2022.05.002

Valenzuela-Fuenzalida, J. J., Trujillo-Riveros, M., Schwmber-Vega, J., Avalos-Diaz, C., Utreras, A. D., Hernandez-Nilo, J., Orellana-Donoso, M., Bruna-Mejias, A., Cifuentes-Suazo, G., Moya, M. P., Piagkou, M., Valenti, V. E., Sanchis-Gimeno, J., Konschake, M., & Loaiza-Giraldo, J. P. (2026). Effectiveness of the DASH diet versus alternative dietary interventions for hypertension management: A systematic review and meta-analysis. Current Problems in Cardiology, 51(11), 103397. https://doi.org/10.1016/j.cpcardiol.2026.103397

Vogt, T. M., Appel, L. J., Obarzanek, E., Moore, T. J., Vollmer, W. M., Svetkey, L. P., Sacks, F. M., Bray, G. A., Cutler, J. A., Windhauser, M. M., Lin, P. H., & Karanja, N. M. (1999). Dietary Approaches to Stop Hypertension: Rationale, design, and methods. Journal of the American Dietetic Association, 99(8 Suppl), S12-S18. https://doi.org/10.1016/S0002-8223(99)00411-3

Vollmer, W. M., Sacks, F. M., Ard, J., Appel, L. J., Bray, G. A., Simons-Morton, D. G., Conlin, P. R., Svetkey, L. P., Erlinger, T. P., Moore, T. J., Karanja, N., & DASH-Sodium Trial Collaborative Research Group. (2001). Effects of diet and sodium intake on blood pressure: Subgroup analysis of the DASH-Sodium trial. Annals of Internal Medicine, 135(12), 1019-1028. https://doi.org/10.7326/0003-4819-135-12-200112180-00005

Windhauser, M. M., Evans, M. A., McCullough, M. L., Swain, J. F., Lin, P. H., Hoben, K. P., Plaisted, C. S., Karanja, N. M., & Vollmer, W. M. (1999). Dietary adherence in the Dietary Approaches to Stop Hypertension trial. Journal of the American Dietetic Association, 99(8 Suppl), S76-83. https://doi.org/10.1016/S0002-8223(99)00420-4

Young, C. M., Batch, B. C., & Svetkey, L. P. (2008). Effect of socioeconomic status on food availability and cost of the Dietary Approaches to Stop Hypertension (DASH) dietary pattern. Journal of Clinical Hypertension, 10(8), 603-611. https://doi.org/10.1111/j.1751-7176.2008.08199.x

Evidence rating and review record

Every page in this archive rates its evidence outcome by outcome, using GRADE wherever a published GRADE rating exists. GRADE is the same 4-level scale used in the clinical guidelines you will meet in practice. High means further research is very unlikely to change the conclusion. Moderate means further research may change it. Low means further research is likely to change it. Very low means the conclusion is uncertain.

GRADE rates each outcome separately, so a diet can be moderate for one outcome and very low for another. Each row below says who rated the outcome and exactly which comparison the rating belongs to. Every rating on this page comes from a published review; none is this page's own judgment. Where a review used a different scale, the row names it.

The rating in the banner is for systolic blood pressure, because that is what DASH was designed to change and where its evidence is strongest. A high or moderate rating means the research is solid; it does not mean the diet is right for everyone, and it does not mean a coach should recommend it.

On a narrow screen, scroll the table sideways to see every column.

Certainty of evidence by outcome and by comparison, with the source of each rating and the reasons for it

Outcome	Certainty	Who rated it, and for which comparison	Why it is rated this way
Systolic blood pressure, the main outcome and the rating in the banner	Moderate	Chiavaroli et al., 2019, using GRADE. DASH compared with control diets in 19 controlled trials of 1,918 adults with and without high blood pressure, lasting 2 to 24 weeks, most of them taught the diet rather than fed it. A second review, Filippou et al., 2020, also using GRADE, rated its own estimate from 30 trials and 5,545 adults moderate as well	Randomized trials start at high certainty. Lowered one level for inconsistency, because the trials disagreed with one another more than chance would explain. Not lowered for imprecision: the estimate is 5.2 mm Hg lower, from 3.4 to 7.0. The larger review found a smaller average, 3.2 mm Hg, from 2.3 to 4.2. Moderate certainty here is a statement about how reliable a group-average change of a few mm Hg is, not about how much any one person's blood pressure will change
Diastolic blood pressure	Low	Chiavaroli et al., 2019, using GRADE. Same trials and comparison as the systolic row. Filippou et al., 2020 rated its own diastolic estimate moderate	Lowered one level for inconsistency and one for imprecision, the reviewers' term for an interval that is wide or crosses the smallest difference they counted as important. The estimate is 2.6 mm Hg lower, from 1.7 to 3.5. The 2 reviews rated this outcome differently, and this row reports the umbrella review's rating because its reasons were read in full
LDL cholesterol	Moderate	Chiavaroli et al., 2019, using GRADE. DASH compared with control diets in 13 controlled trials of 1,673 adults	Lowered one level for imprecision, the reviewers' term for an interval that is wide or crosses the smallest difference they counted as important. The estimate is 0.10 mmol/L lower, about 3.9 mg/dL, from 0.01 to 0.20 mmol/L
HbA1c, a measure of average blood sugar	Low	Chiavaroli et al., 2019, using GRADE, from the reviewers' own meta-analysis. DASH compared with usual diets in 2 trials of 65 adults, one with type 2 diabetes and one with gestational diabetes	Lowered for inconsistency, because the 2 trials disagreed sharply, and for indirectness, because 2 small trials in 2 different conditions cannot stand for people in general. The estimate is 0.53 percentage points lower
Body weight, in trials lasting 8 to 52 weeks	Moderate	Chiavaroli et al., 2019, using GRADE, from a meta-analysis counted as 11 trial comparisons in 1,211 adults. Some of the DASH arms also cut calories, and the comparisons included usual diets and other weight-loss diets	Lowered one level for inconsistency. The estimate is 1.42 kg lower, from 0.82 to 2.03. This rates an average difference in measured weight across a mix of programs, not a claim that DASH is a weight-loss diet; see the standing rule below
Cardiovascular disease, in cohort studies	Low	Chiavaroli et al., 2019, using GRADE. The people whose eating most resembled DASH compared with those whose eating least resembled it, in 11 cohorts of 783,732 people followed for 7.9 to 24 years	Observational studies start at low certainty and this was neither lowered nor raised. The relative risk is 0.80, from 0.76 to 0.85. Trials have recorded too few events to test this outcome, so the blood pressure rating does not carry over to it
Coronary heart disease, in cohort studies	Very low	Chiavaroli et al., 2019, using GRADE. Same comparison, in 3 cohorts of 144,337 people	Starts low and lowered one level for indirectness, because all 3 cohorts were of middle-aged or older women, so the reviewers judged the result not generalizable. The relative risk is 0.79, from 0.71 to 0.88
Stroke, in cohort studies	Low	Chiavaroli et al., 2019, using GRADE. Same comparison, in 3 cohorts of 150,191 people	Starts low; neither lowered nor raised. The relative risk is 0.81, from 0.72 to 0.92
New cases of diabetes, in cohort studies	Very low	Chiavaroli et al., 2019, using GRADE. Same comparison, in 5 cohorts of 158,408 people	Starts low and lowered one level for inconsistency, because the studies disagreed with one another. The relative risk is 0.82, from 0.74 to 0.92
Heart attacks and strokes, in randomized trials	Low	Bensaaud et al., 2025, a Cochrane review using GRADE. DASH compared with no intervention or usual care, in 1 trial of 144 adults, and in the review's "minimal intervention" comparison, in 2 trials with 629 adults in the groups compared, over up to a year. For PREMIER, that comparison set a lifestyle counseling program with DASH against the same program without it	Lowered for risk of bias, because participants knew which diet they were on, and for imprecision, because there were no strokes in any group and too few heart attacks to show a difference. Low certainty here means these trials cannot say whether DASH prevents heart attacks or strokes; it is not evidence that it does not
Death from any cause, in randomized trials	Very low	Bensaaud et al., 2025, using GRADE. DASH compared with no intervention, in 1 trial of 90 adults over 6 months, and with another dietary intervention, in 1 trial of 261 adults over a year	Lowered for risk of bias and for imprecision: there were no deaths in the first trial and too few in the second to show a difference
Death from any cause, cardiovascular death and cancer death, in cohort studies	High on NutriGrade, a different scale from GRADE	Soltani et al., 2020, using NutriGrade. Each 5-point rise in a DASH score, in up to 17 cohort studies; for death from any cause, 5 percent lower risk	NutriGrade is a scoring system for nutrition research that weighs features such as study design, effect size and dose-response. A high score on it is not a high GRADE rating and does not show cause and effect. The studies disagreed with one another a great deal for death from any cause, and every result is an association

How this archive talks about weight. This page reports what studies measured, including body weight, and does not treat weight change as a goal or as a measure of a diet's success. Weight a person loses without meaning to can be a sign of a health problem, and where it is, the page names it as a reason to see a clinician. People are described the way the study described them.

Status: reviewed and approved by James Peth, MS, MPH, PhD, on October 3, 2026, after its 2 planned reviews and a combined final review. What changed: revised September 27, 2026, after the first review: trial evidence on heart attacks, strokes and deaths added with its ratings, several findings restated more precisely, and the summary shortened. Revised September 28, 2026, after the final verification review: the Cochrane review's "minimal intervention" comparison now says what it compared in PREMIER, statements about what the trials have not shown are limited to the trials and sources reviewed, the section 4 overview keeps the GRADE ratings for heart disease and stroke apart from the separate NutriGrade appraisal of death, 5 reference details were corrected, and both tables gained row headers and a note for narrow screens. Prepared by James Peth, MS, MPH, PhD.

Updated October 21, 2026: The American Heart Association is now named as an author of its 2026 dietary guidance statement (Lichtenstein et al., 2026), as the publisher's citation credits it. No content changed.

Next scheduled review: August 2027. Pages built on annual guidance are rechecked each year. The sodium limits and the blood pressure guideline on this page are in that category and should be rechecked first.

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Diet Reference Archive | One James

Prepared by James Peth, MS, MPH, PhD

© 2026–2027 One James. All rights reserved.

This page is for education and coaching practice. It is not medical or dietary advice.