The Dash Diet for Weight Loss
1 Why This Book Is Different
YOU BOUGHT this book because you want to lose weight on the DASH Diet for Weight Loss, and you are probably anxious to get started. If you just can’t wait another minute, you will find detailed instructions on how to get started in Part 2
of this book. But please do read these first three chapters, whether now or later. In these initial pages you will find plenty of reasons to believe in this weight-loss program.
The DASH Diet for Weight Loss is different from any other weight-loss program out there. Our eating recommendations are based on the DASH Diet, which is backed by extensive scientific evidence and is endorsed by leading health care organizations.
I’ve incorporated our scientific discoveries into the diet as well as lessons from ten years of using DASH to help thousands of people lose weight and get healthier. Our nutrition advice is highly customized for every calorie level—including yours. Finally, this is a weight-loss diet of satisfying, real foods that you can stick to for the long term.
Let’s answer some key questions you probably have:
• WHAT’S SO SPECIAL ABOUT THE DASH DIET?
• HOW DOES THE DASH DIET WORK?
• WHERE IS THE EVIDENCE THAT THE DASH DIET CAN HELP YOU LOSE WEIGHT?
• HOW IS THE DASH DIET FOR WEIGHT LOSS DIFFERENT FROM OTHER WEIGHT-LOSS PROGRAMS?
The diet and exercise advice we give in this book is based on established and proven medical evidence. But it may not be appropriate for everyone. We encourage you to ask your doctor about any planned changes in your eating or exercise habits. Your doctor knows your medical condition better than anyone and can give you the best advice about whether the DASH Diet and moderate exercise are right for you.
And if you have any known food allergies or reactions, you should avoid those foods even if they are listed among the DASH recommended items.
WHAT’S SO SPECIAL ABOUT THE DASH DIET?
The DASH Diet is rich in fruits, vegetables, low-fat dairy foods, and whole-grain products. It is reduced in red meat, animal fats, and sugar. “What’s so special about that?” you ask. “My parents were telling me to eat that way years ago.” True. But what’s different about DASH is that we have determined through research the combination of servings from each of eight key food groups you should eat each day. And the number of servings differs depending on your size and calorie needs. We will give you the specific number of food servings that are right for you.
Another thing that’s special about the DASH Diet is that it is recommended as an ideal eating pattern for all American adults by the US Department of Agriculture (USDA). The American Heart Association recommends the DASH Diet, too. And in 2011, a team of nutrition experts rated twenty popular diets for U.S. News & World Report and selected the DASH Diet as the number one best overall diet.
But it isn’t high rankings that make the DASH Diet so special. It is special because it is backed by a mass of scientific proof that shows that eating the DASH Diet can provide real and important health benefits.
The DASH Diet was designed by a team of medical and nutrition scientists and funded by the National Institutes of Health. Our goal was to design an eating pattern that would lower blood pressure. (The name “DASH” stands for Dietary Approaches to Stop Hypertension.) We spent a full year designing the diet and then tested it in a study involving 459 people. We found that the DASH Diet lowered blood pressure as well as a typical high blood pressure medication did. We published those results in the New England Journal of Medicine, and the DASH Diet is now part of most standard guidelines for preventing and treating high blood pressure here in the United States and around the world.
As we looked more closely at the data, we found that the DASH Diet did more than just lower blood pressure. It also lowered blood cholesterol levels. And it showed evidence of protecting bone strength. People eating the DASH Diet even reported that they felt better!
Since that original study, our team and others have found additional benefits of the DASH Diet. In fact, there are now more than 100 scientific articles that attest to the benefits of eating the DASH Diet. To mention just a few:
• The DASH Diet combined with a reduced salt intake lowers blood pressure even more than either maneuver alone.
• The DASH Diet prevents the onset of high blood pressure.
• The DASH Diet reduces the occurrence of heart attacks (by 18 percent) and strokes (by 24 percent).
• It reduces the risk of developing heart failure by 37 percent.
• It reduces the development of kidney stones by 45 percent.
• It reduces the risk of developing colon cancer by 20 percent.
• It reduces the risk of developing diabetes (a very important benefit at this time, when the frequency of diabetes in America is skyrocketing).
• It even helps people think more clearly!
There is more scientific evidence to support the DASH Diet than any other eating pattern. And that’s why it is recommended by the USDA, the American Heart Association, U.S. News & World Report, and others. But I always tell my patients, don’t be impressed that the DASH Diet is so highly rated—be impressed with the evidence that inspired those ratings. The DASH Diet truly is the eating pattern that will protect your health for life.
HOW DOES THE DASH DIET WORK?
In brief: We don’t know.
The cholesterol-lowering effect may be due to the reduced amount of animal fat in the DASH Diet (from less meat, whole milk, full-fat cheeses, and so on). But the cause of the other benefits is really unknown. If we could identify the “magic bullet” in the DASH Diet, we could synthesize it, put in a pill, and just give that to people. Certainly that would be easier than convincing people to change their eating habits! Unfortunately, that “magic bullet” has not been found.
Take blood pressure as an example. We originally designed the DASH Diet to lower blood pressure. So in our design, we tried to incorporate all of the nutrients that earlier studies had suggested might lower blood pressure—elements such as a high potassium content, calcium content, and magnesium content. But then we did a separate study where we gave those minerals as individual supplements and in combination to a group of 300 women. We found that even combining all three of these “magic bullets” lowered blood pressure by only about 2 points. That’s much less than the effect of the DASH Diet.
Foods are very complex combinations of minerals, vitamins, anti-oxidants, fiber, protein, and some other substances we don’t even know
about yet. It is likely that this combination of nutrients leads to the benefits of the DASH Diet. Or maybe, once we adopt the DASH Diet, we are no longer eating a lot of unhealthy stuff. We really don’t know.
As a scientist, I would of course very much like to know how the DASH Diet achieves its benefits. But as a physician, I can be satisfied just knowing that it does provide these benefits and keeps people healthy.
WHERE IS THE EVIDENCE THAT THE DASH DIET CAN HELP YOU LOSE WEIGHT?
Every day, dietitians all over the country are teaching people the DASH Diet to help them lose weight. In part they do this because the DASH Diet is such a healthy eating pattern, as I’ve just described. But there’s also proof that the DASH Diet is an effective diet for weight loss.
A group of my DASH colleagues conducted a study to see if people could lose weight on the DASH Diet. They recruited subjects and divided them into two groups. One group of research subjects was given advice about weight loss but no further instruction. The other group was taught the DASH Diet and was encouraged to exercise regularly. Over a period of eighteen months, the DASH Diet group had regular meetings with dietitians to reinforce the weight-loss advice. Both groups were shooting for a goal of fifteen pounds of weight loss. At the end of eighteen months, the DASH group had lost an average of nine and a half pounds, significantly more weight loss than the “advice only” group. And 25 percent of the DASH group hit their target goal of losing fifteen pounds or more. These results, published in the Annals of Internal Medicine, clearly demonstrate that the DASH Diet can be an effective part of a weight-loss plan.
I took a different approach to studying whether people can lose weight on the DASH Diet. Rather than test this in a traditional controlled scientific study (which typically involves only a small number of subjects), I wanted to test it on a much larger number of subjects in a real-life setting. So I developed an online program to teach the DASH Diet and began offering it in 2002. (We will discuss this program, called DASH for Health, in Appendix B
at the end of this book.) Since it began, over 18,000 people have enrolled in the program. Many of these people have successfully lost weight and have kept it off. And what we have learned from these 18,000 people—what does and what does not work for weight loss—forms the basis of much of the advice in this book.
DASH Frequently Asked Question
Almost every week in the newspaper I read about a new study about how to lose weight. Often these studies contradict one another. What should I believe?
Please see the answer to FAQ 1 in Section V
, Frequently Asked Questions.
HOW IS THE DASH DIET FOR WEIGHT LOSS APPROACH DIFFERENT FROM OTHER WEIGHT-LOSS PROGRAMS?
The most important difference between this program and others—the DASH Diet is backed by scientific evidence. You can be confident you are getting healthier. Your blood pressure will be lower and your cholesterol levels will be healthier. You will be eating foods that have been linked to a lower incidence of heart disease, cancer, osteoporosis, and diabetes. If you follow the DASH eating plan, you will get healthier if you lose a lot of weight, a little bit of weight, and even if you lose no weight at all.
And second, the DASH Diet for Weight Loss uses proven techniques to help you change your eating habits and follow the DASH Diet. These are tricks and tools that we have learned from the more
than 18,000 people who enrolled in the DASH for Health program—people just like you. The tips, tricks, and techniques they have shared with me over the years provide the “skillpower” you need to start on and stick to the DASH Diet for Weight Loss. I’m very pleased that some of the participants in the program volunteered to share their specific advice and experiences in this book. Most diet books offer generic advice about eating fewer calories and exercising more. Our advice is very specifically tailored to helping you follow the DASH Diet.
The DASH Diet for Weight Loss offers in-depth meal plans carefully tailored to the number of calories you should be eating to lose weight. These meal plans have been created by a team of qualified health professionals under my direction. There is a meal plan for you if you are a 140-pound-woman who works a desk job or if you are an ex–football player who works on a construction site all day—and there’s a program for you, too.
Then there is the food itself. The DASH Diet for Weight Loss focuses on “high volume–low calorie” foods, which nutritionists understand are essential to any weight-loss program. These foods have fewer calories relative to their size. As an example, a wedge of watermelon has far fewer calories than an equivalent-sized piece of chocolate. The greater sense of fullness you get from large volumes of low-calorie foods is the reason nutritionists recommend focusing on these foods if you are trying to lose weight.
We have taken this established concept and developed it by focusing also on how hard you have to work to eat a particular food. Foods that need more chewing and take longer to eat are beneficial if you are trying to lose weight. That’s because if the foods take longer to eat (and if you also focus on eating more slowly), then it is more likely your “fullness signal” will be triggered and you won’t eat as much as you would if you were eating small amounts of very-high-calorie foods that can be eaten very quickly.
We’ve combined these food characteristics into an easy-to-remember slogan, Hi-Lo-Slo: HIgh volume, LOw calorie, SLOw to eat. We will refer to this slogan throughout this book.
INTRODUCING HI-LO-SLO FOODS
High Volume: Take up a lot of space on your plate and in your stomach so you feel satisfied
Low Calorie: Low in calories relative to how bulky they are
Slow Ingestion: Require a relatively long time to eat, therefore allowing your fullness signal to be activated
I will recommend that you avoid eating large amounts of high-density foods such as most red meat, full-fat cheese, and sweets like chocolate and pastries. However, in the DASH Diet for Weight Loss, no foods are out of bounds and you can include small amounts of high-density foods in Hi-Lo-Slo food combinations and recipes.
One of the distinguishing characteristics of Hi-Lo-Slo foods is that most of them are high in fiber. Fiber stays in your digestive system longer and provides a feeling of fullness on fewer calories.
Finally, our emphasis is on the long term—losing excess weight and keeping it off. A person can lose weight for a few weeks on almost any diet. All you have to do is eat fewer calories than you burn each day and you’ll lose weight. That’s the easy part. The hard part is keeping that weight off. That’s where most diet programs fail. To have a meaningful effect on health, a diet has to be healthy and allow you to lose the excess weight and keep it off. And that long-term emphasis—keeping it off—is an important part of what this book is about.
To better understand how this diet will help you achieve your goals, the next chapter will take a closer look at the metabolic process we call “weight loss.”