An estimated 38.1 million adults in the U.S. were diagnosed with diabetes in 2021, with the majority—90% to 95%—having type 2 diabetes, according to the Centers for Disease Control and Prevention. A new study from Johns Hopkins Medicine reveals that a modified, lower-sodium version of the DASH (Dietary Approaches to Stop Hypertension) diet can significantly reduce blood pressure in adults with type 2 diabetes, many of whom are already taking multiple antihypertensive medications.
The DASH diet, known for its focus on fruits, vegetables, and low-fat dairy, has long been used to manage hypertension. For this study, researchers adapted the diet for individuals with type 2 diabetes, lowering carbohydrate intake, increasing unsaturated fats, and reducing potassium levels to ensure safety for those with chronic kidney disease, which is common in diabetic patients.
The goal of the study, called DASH4D, was to examine the effects of sodium reduction in diabetes patients. While the DASH diet is well-established in treating hypertension, its effects on those with diabetes had been underexplored. “People with diabetes often focus on blood sugar management, but high blood pressure also affects many and is a key risk factor for heart disease and stroke,” said Dr. Scott Pilla, the study’s lead author and assistant professor at Johns Hopkins University.
Published in JAMA Internal Medicine on June 9, the study found that participants who followed the low-sodium DASH4D diet experienced a reduction in systolic blood pressure by an additional 5 points compared to those on standard blood pressure medication. This small reduction in blood pressure had a significant impact, reducing the risk of stroke by 14%, cardiovascular events by 6%, and heart failure by 8%.
The study included 102 participants, with an average age of 66, 66% of whom were women, and 87% identifying as Black. At the start of the study, the average blood pressure was 135/75 mmHg, and most participants were already using two or more blood pressure medications. Over the course of five weeks, participants were randomly assigned four different diets: the modified DASH4D diet with lower sodium, the same diet with higher sodium, a typical American diet with lower sodium, and the same American diet with higher sodium.
The results showed that the low-sodium DASH4D diet led to a reduction of 4.6 mmHg in systolic blood pressure and 2.3 mmHg in diastolic blood pressure. Most of the reduction occurred within the first three weeks of the diet.
“We want to ensure that the findings of this study reach those with diabetes, helping them make diet changes that can improve their health,” Dr. Pilla noted. “The next step is to make this diet more accessible and affordable for people with different cultural and dietary backgrounds.”
This research was funded by the Sheikh Khalifa Stroke Institute at Johns Hopkins, with additional support from the National Institutes of Health. Researchers involved in the study include Hsin-Chieh Yeh, Christine M. Mitchell, Edgar R. Miller, and others. Dr. Lawrence Appel, who helped develop the original DASH diet, emphasized the importance of controlling blood pressure for reducing the risks of stroke and heart disease.
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