Why Aren’t You Following the DASH Diet?

“The DASH diet is proven to work. Why hasn’t it caught on?”

This was the title of a recent article from the Washington Post by Christy Brissette that has gotten a lot of shares this past week, offering thoughts as to why the diet hasn’t been adopted (despite being ranked #1 by US News and World Report for several years).

Brissette reports that while the original research studies for the diet were directed toward managing and preventing high blood pressure, the diet also has additional appeal.

“…the model eating plan for all Americans is the DASH diet, because it outlines a generally healthy diet from which anyone can benefit. Following the DASH diet’s principles will mean you’re eating a nutrient-rich yet not calorie-dense diet that has been shown to be helpful for promoting weight loss and maintenance. A growing body of evidence suggests DASH is also helpful for managing diabetes, preventing cancer and improving kidney health.”

The Post article offered opinions as to what the barriers may be in not adopting an evidence based plan for health. Let’s take a look.

People Don’t Have Access to the Foods and It’s Expensive

This is an easy excuse. Dori Steinberg, a research scholar at Duke University, suggests that people don’t adopt the diet because they may not have access to the foods included. This may be the case in some geographic areas, but there are many people who do have access to markets, have transportation, and could indeed follow the diet plan if they wanted to. Or, if they knew about it.

While “food deserts” exist, there are many who have plenty of access to supermarkets that aren’t following the diet. The notion that it’s too expensive doesn’t fly with me. You don’t have to eat avocados everyday. You don’t have to eat the most expensive cuts of meat. You don’t have to buy designer food. You can buy the vegetables that are on sale or in season, you can look for BOGO fruits (buy one, get one half off or free), you can rinse canned beans (which are very inexpensive), you can purchase store brand barley or brown rice, or store-brand yogurt. You can buy frozen vegetables or canned fruits, that are on sale, or try store brands, which are generally less expensive. There are lots of options.

Patients also need to begin to view some of the more expensive food items as an “investment” in their health. For instance, nuts are expensive; but you are only supposed to eating about 1/4 cup serving, so they can last a while. In the long run, fruits and vegetables are not more expensive than junk food or convenience food (the foods you’ll need to cut back on). Meats are to be consumed in smaller portions (3-6 ounces), so you can spend less, and stretch the portion out for four people.

Do People Who Could be Following the DASH Diet Actually Know What they are Supposed to Eat?

This is my thought – despite the news reports that tout the benefit of the DASH Diet lifestyle, and despite my own efforts to market the diet plan – people, in general, still don’t know what the diet plan includes, or how to follow it, or why they should.

I couldn’t agree more with Ms Brissette:

“The key to helping people eat better is giving them the tools they need to put nutrition information into action.”

For the most part, this education should begin in the doctor’s office. We need more primary care physicians to promote the DASH Diet as an option for “how to eat well”. And then, give the patient some resources. It’s great to say “Well, you should try the DASH Diet or the Mediterranean Diet”, but if your patient has no idea what that means, then the “advice” is useless. Whether the direction to “follow the DASH Diet” comes with a simple flyer, one-pager, a book referral, or a referral to a registered dietitian for counseling, there must be a “next step”.

Next Step: Proper Health Education and Follow-Up

You’d think we’d have this figured out by now. This has been one of my pet peeves for thirty years: Physicians telling their patients to “go on a diet”, “lose weight” or “try the DASH Diet” without any further instruction or support. When I worked in a health center, one of my favorite things to do was clean out the “nutrition education” file drawer that the doctors and their nurses kept…the handouts filed in there were generally outdated, and unappealing. Nobody will take a faded, poorly printed or unprofessional-looking document seriously.

Most patients need the extra step of seeing a registered dietitian to guide them in the first steps of adopting the eating plan. It may only take a few visits.

My goal is to continue to help people understand what the DASH Diet is, and how to set goals to adopt it. As always, my advice is to set small goals, and build on them to create healthy, long-term habits. Nobody can be perfect every day. The goal is to adopt a lifestyle. This means continuously setting goals each week to eat well and exercise. It’s never an all-or-nothing deal, and you don’t have to be an overnight-success.

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Why Aren’t You Following the DASH Diet? — 2 Comments

  1. DASH Diet does include low fat dairy, but some high fat dairy can be incorporated. There is no reason to use only whole wheat pasta – if you don’t like it, don’t use it. I personally prefer regular pasta and choose whole wheat versions of breads and cereals, and other grains (like barley or farro) instead. The protein content of the diet is adequate, and it’s not a “laboratory experiment” but evidence based to lower blood pressure. The most important components are increased fruits and vegetables and lower sodium intake.

  2. People don’t follow the DASH diet because the meal plans put out by NIH (https://www.nhlbi.nih.gov/health-topics/dash-eating-plan) are unrealistic and often ridiculous. There are a lot of recommendation for things like low fat cheese and low fat cottage cheese. These are things that do not taste like their high fat counterparts. Furthermore they actively taste bad. Similarly Whole wheat pasta which is heavily recommended, is difficult to cook and doesn’t taste “right”. That and the hilariously minuscule amounts of protein in the plans makes them laughable. Also the massive amount of fiber in the diet can lead to gastro -intestinal distress in people not used to whole grains. In short the DASH diet is a laboratory experiment that does not consider how real human beings live.

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