By Marla Heller
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The DASH diet has been a staple of the dieting world, recommended by doctors, nutritionists, and crowned the US News and World Report’s #1 best diet for 8 years in a row. But popular tastes and medical guidelines have evolved, and The Dash Diet Mediterranean Solution presents a new approach to the time tested diet program that highlights the benefits of whole foods.
Marla Heller, MS RD has overhauled the DASH plan to reflect the latest, cutting-edge research on hypertension, diabetes, depression, and other health issues that impact millions of Americans. Meal planning gets a new focus on unprocessed foods (less sugar free jello, more fresh fruits!), seafood options, and even a whole section examining vegan and vegetarian choices. Filled with four weeks of menus and tons of strategies and research, The Dash Diet Mediterranean Solution offers readers a new approach to their best health the DASH diet way.
The Best of the Best
The DASH diet (based on the research, Dietary Approaches to Stop Hypertension) and the Mediterranean diet have both been acclaimed as the best of the best in the world. Both became famous for their amazing impact on heart health. Both help reduce inflammation and are associated with lower rates of heart attacks, strokes, heart failure, certain types of cancer, and a reduced risk of developing type 2 diabetes. Following these eating patterns has been shown to help preserve brain health. And as you will learn here, together they comprise a plan that is sustainable, so that it will become your life-long healthy eating style while helping you reach and maintain a healthy weight.
There is so much confusion about diets. How can we know if we have a good one, when it seems like every time we turn around, there is a new hot diet in the news? What does it mean to say that one or two diets are the best? Are they really better than any other diet, or might the nutrition gurus say something entirely different next year? And beyond the hype, how can we, ourselves, judge if a diet is really good? We’ve seen this happen over and over. A diet is super popular, and then after a few years you never hear about that miracle diet again.
Would it reassure you to know that there are only two diets that have stood the test of time? And that they are completely compatible, complementary, and even better together? Why not choose the best of the best? This is the moment to change your life.
The DASH diet and the Mediterranean diet are the plans that endure. Year after year. They have stood atop the best diet rankings every year that the panel of experts from U.S. News & World Report has rated all the popular and also-ran diets. The DASH diet is extra rich in fruits and vegetables, low-fat dairy, and nuts, and includes mostly whole grains, lean meats, fish, and poultry, and moderate amounts of heart-healthy fats. The Mediterranean diet is also based on all those foods, along with an emphasis on seafood, olive oil, beans, herbs, and spices, and the optional inclusion of red wine. When you combine DASH with the Mediterranean diet, you truly have the best of the best. Not a fad. The only diets that have stood up under scrutiny. Because they work and have been proven to work in multiple, multiple studies. No diets have been this researched. No other diets have this kind of medical pedigree. Even better together, they help people get healthier and support reaching and maintaining a healthy weight. Easily. Deliciously.
For any diet or eating pattern to be worth your time and effort, it should be something you can live with for the long run, and it should make you healthier. No plan should be so restrictive or difficult that it leads to feeling bad about yourself or induces guilt if you don’t follow it perfectly. No plan should ruin your health. (Even if you only follow it for a short while.) It’s only a worthy plan if it makes you feel great and lets you truly enjoy eating. It should help you set the stage for continued success, not set you up for failure.
The Mediterranean DASH diet—“Med-DASH”—plan is all of that. It is a delicious, enjoyable, beautiful way of eating, and it just happens to make you healthier. There are no other plans in the world with the same proven health benefits or that address each of our epidemic chronic health issues. This plan makes it easy to manage weight and reduces risk for heart disease, hypertension, fatty liver disease,1 and diabetes. If your goal is to reach or sustain a healthy weight, the Med-DASH plan is so satisfying that you will find it’s easy to stay on track with your goals. You will relearn how to eat, how to set the stage for success even in a busy life, how to enjoy restaurant meals, and how to continue to follow this plan because it makes you feel better and you love eating this way. You will discover positive changes in your body and how it operates. This plan has been proven to lower cholesterol and blood sugar. Your waistline will shrink, which is a huge clue that your body is better able to metabolize carbohydrates instead of storing extra glucose in your abdominal (visceral) fat and your liver. Belly fat is the symptom, but diabetes, high blood pressure, clogged arteries, and fatty liver disease are the consequences.
Forget struggling, forget “cheating,” forget counting calories, forget lists of allowed and forbidden foods, forget the battle to follow one more diet that gives guidance that completely conflicts with sound science regarding what your body does and doesn’t need to get healthy. Forget those feelings of failure that you had when you found that the latest fad diet was impossible to stick with. This plan has a positive focus, with negativity banished from dieting.
You are going to love, love, love this plan. The Mediterranean DASH diet is a fresh way of eating that relies on solid nutrition science to propel you to reach your goals. Scientifically proven and translated into fabulous meals, the Med-DASH plan provides all the strategies you need to facilitate your entry into the delicious new world of healthy eating.
What is the promise of the Med-DASH program? Heart health is what garnered all the attention for the DASH diet and the Mediterranean diet. Lower blood pressure. Lower cholesterol. Reduced rates of heart attack, stroke, and heart failure. And there is so much more. Research shows that DASH is associated with improved brain health and reduced systemic inflammation, along with lower risk for type 2 diabetes, some types of cancers, and fatty liver disease. This is the way healthy people have been eating for generations. Before all the processed foods and easy access to junk food. Back when food was slow and delicious.
Does this seem like a miracle? It may be, but it is based on the real-life results observed by studying how the healthiest people have eaten over the years. Do they eat more vegetables? Check! More fruits? Check! Healthy, protein-rich foods? Check! Add to that the fats that are beneficial for your heart, particularly from olive oil, avocados, nuts, and seafood. The Mediterranean people usually complement their meals with red wine—which is completely optional, but you can do that on this program if you’d like. All these habits combine to make a complete program or eating style that you will love and appreciate for your health, your well-being, and your gastronomic pleasure.
I have heard that this eating pattern just seems like common sense. Yes, it is. But unfortunately, common-sense eating is very uncommon. It isn’t our habit. We didn’t get our epidemics of heart disease, diabetes, and obesity by following common-sense principles regarding the majority of our decisions about how to eat. Sadly, too many people have missed out on the best, flexible eating plans because up until now, no one made them into a real-life, practical, and delicious lifestyle program. People have avoided even trying either the DASH diet or the Mediterranean diet, perhaps because they thought the plans might be too difficult, confusing, or not enjoyable enough.
The epidemics of chronic disease are the result of our having destroyed our bodies with low-level inflammation that is mostly the result of unhealthy eating. This inflammation is the root cause of plaque buildup in the arteries. Inflammation causes the body to store excess carbs as belly fat (also called visceral fat) and leads to fatty liver disease, both of which are associated with the development of type 2 diabetes. Inflammation is considered to be a factor in initiating some cancers, including some types of breast cancer and colorectal cancer. Poor diet and unhealthy weight are at the root of this inflammation. We need to reexamine how we eat and find out how to make it easy to follow a realistic, healthy eating plan. We need a sane plan that is time-proven, with self-evident health benefits.
You are going to wipe out your memory of all the bad diet advice from the past. Too many diets encourage eating lots of processed starchy foods, cutting way down on fats, and eating lower amounts of protein-rich foods. This was a recipe for making meals that were less satisfying, leading to overeating and weight struggles at levels never before seen in the U.S. Between 1979 and 2014, the U.S. adult obesity rate increased from 15 percent to nearly 38 percent, with the fastest increase coming after 1988.2 But the weight problem is only a symptom of impending chronic diseases. Following those old high-carb guidelines, for many people, wore out the body’s ability to produce insulin, resulting in type 2 diabetes or prediabetes. And in fact, the number of adult Americans diagnosed with diabetes increased from 5 million to 23 million between 1979 and 2014. And we know that the real number is twice as high, since about half of actual cases are undiagnosed. So forget loading up on carbs or skimping on fats or protein. That advice needs to be erased from your memory banks. Banished!
While we’re at it, let’s wipe our memories of all the fad diets from the last two decades. Why were we so eager to jump on the bandwagon for fad diets that we knew weren’t healthy and that conflicted with the standard USDA recommendations from the food guidelines? Why did we think we could get results that we were happy with on programs that were so clearly unsustainable? To some degree, the issue is that we simply didn’t believe the national food guidelines could be a workable model for how we should eat. People were skeptical because it seemed that the USDA was too much in the pockets of lobbyists for the processed food industry and grain farmers. Yes, the feds were much too slow to warn people about excessive sugar and refined grain products in our diets. They were too slow to strongly embrace vegetarian diets and organic foods. When dietary guidelines were developed, the DASH and Mediterranean diets only showed up buried in the fine print or footnotes of very dense reports. The oversimplified and vague nutrition guidance was unhelpful. Fad diets proliferated in the absence of beneficial national nutrition guidelines.
Neither the DASH diet nor the Mediterranean diet was brought to you by any lobbyist. Nor were they promoted by advertising or highly paid publicity agents. These two plans, DASH and Med, were created by looking at what the healthiest people eat and have eaten over long periods of time. But sadly, these scientific breakthroughs were just languishing, waiting for someone to turn them into real-life solutions, with, perhaps, a little of the glamour of the fad diets.
Many of the fad diets have been focused on the “don’t eat” principle. Don’t eat gluten. Don’t eat meat. Don’t eat foods that ever had a face. Don’t eat animal foods at all. Don’t eat white foods. Don’t eat nightshade foods. Surprise! We are not going there. We will focus on the “let’s eat” principle—what you should include. A positive focus that prioritizes delicious, vibrant, beautiful eating.
When I decided to become a dietitian, my motivation was to show people how to eat in a healthy way and make it enjoyable. I was struck by how many of my coworkers were having heart attacks at relatively young ages, but still would not change anything in their eating or activity habits to avoid future events. They felt they would rather continue to eat the foods they loved than change to a “boring, unappealing” healthy diet. They chose not to lose weight or protect their hearts. Unfortunately, they died of massive heart attacks, much too young. That is why I believe it is imperative that we change our perceptions about the false choice between being healthy and enjoying food. My mission is to show you that healthy eating can be fabulous! Because if you don’t enjoy it, you won’t follow the plan, and that does no one any good.
And lest you think heart disease is something only men have to worry about, heart disease is the number one killer of women, too. And over two-thirds of women who have a heart attack will never fully recover.3,4 Heart disease kills more people than all types of cancer combined. (More on this later.)
Let’s move on to a plan that will promote heart health and be a pleasure to follow. It must deliver on this seemingly impossible promise, or why bother? This has been the mission of my career and my mission in writing this book. And I am thrilled to be able to share this secret with you.
It’s Not a Secret Anymore!
The DASH diet and the Mediterranean diet are the two most researched diets in history. They weren’t discovered as a result of some happy accident in a science lab. Rather, their discoveries were based on observations of how regular people live and eat in various parts of the world, and how that affects their health. It has been well-known that people in certain regions live longer and are healthy for their entire lives. What has been discovered about the secrets for a healthy life?
In the Mediterranean region, especially Sardinia in Italy and Crete and Corfu in Greece, people continue to follow a traditional eating pattern, one that is rich in plant foods, along with cheese and yogurts, seafood, and limited amounts of meat. Their diets also include lots of salad greens, herbs, and spices. And of course, wine and coffee are also stalwarts of the daily lives of people in the Mediterranean region. People in these regions are also usually physically active and very socially connected. Many of them live to be over ninety or even one hundred, and are still in good health.
Another Mediterranean country with lower rates of heart problems is France. They eat lots of cheese, meat, and white bread, yet they do not suffer from high rates of heart disease. This is described as the French Paradox. Of course, they eat moderate portions and are famous for their green salads (salades vertes) with every meal. They are also likely to have fruit for dessert and snacks. They include vegetables with their meals, have regular consumption of coffee and wine, and walk everywhere. When you are on the streets of Paris, you are struck by all the flat bellies. So different from the plump bellies we see on most Americans, which are not just a size issue, but are indicators of metabolic illness.
Of course, not all Americans have these problems. We can find clusters of super-healthy people who live among us, but with a few different lifestyle choices. In the United States, it was observed that there was a population that seemed to be blessed with longevity and health. In the region of Loma Linda, California, there were many people living to be over one hundred years old in good physical health. This area is home to many Seventh-Day Adventists, who are primarily vegetarian. Like traditional Italians and Greeks, they are physically active and socially connected. What is so special about these people’s habits that seems to protect them from the ailments that befall most Americans? What has allowed them to have lower blood pressure and lower rates of heart disease? They don’t live in a bubble. They get their foods from the same food supply as the rest of Americans and are subject to the same stresses of everyday life. But, as noted, they are primarily vegetarian. They are physically active throughout their day, not just through exercise, but with their chores around the house, walking places, hiking, enjoying nature.
The DASH diet is a specific eating pattern, rich in plant-based foods, which was originally designed to lower blood pressure without medication. It was, additionally, designed to be the healthiest possible diet that would be acceptable to the eating style of the average American. It well-known that traditional vegetarians living in the United States live longer and have fewer chronic diseases than the average American. A vegetarian diet formed the basis of the DASH diet. However, researchers knew that most Americans wouldn’t want to follow such a strict plan, so DASH also incorporates meats, poultry, and fish. It is extra rich in fruits and vegetables, and includes dairy, beans, nuts and seeds, mostly whole grains, and heart-healthy fats.
The DASH diet delivers the vegetarian benefits, but without making you give up some favorite foods (although it fully supports a wholly vegetarian eating plan, if that’s what you want).
The Mediterranean and the DASH diet plans are so similar that it seems perfect to put them together. Who wouldn’t want the promise of longer, healthier life? Who wouldn’t want the promise of being able to reduce or eliminate dependency on medications? But of course, we want the plan to be something we can actually follow in a real life, with all of its time challenges, and it should accommodate our own personal tastes and food preferences. We want a plant-based diet, with some flexibility, and we are completely willing to incorporate olive oil to make our meals more satisfying.
Our two mash-up plans:
1. The DASH diet—Developed in research, to provide benefits that were observed from plant-focused and vegetarian diets and designed to be America’s healthiest diet.
2. The Mediterranean diet—Discovered via observation of the habits of some of the world’s healthiest and longest-lived people.
Each is plant-focused and includes beans, nuts, and seeds; dairy; olive oil and other heart-healthy fats; as well as seafood and moderate amounts of meats for those who choose to include them. Both are associated with lower risks for cardiovascular disease and type 2 diabetes.
The first publication of DASH research was in 1997. It was immediately seen as a breakthrough program for an epidemic health problem. DASH was even incorporated into the U.S. treatment guidelines for hypertension, mandated for all physicians.5 Now it is over twenty years later, and the Journal of the American Medical Association recently published an editorial bemoaning the fact that DASH has never received widespread use. Many physicians, in spite of knowing the DASH diet’s strong health benefits, do not often prescribe it because they think it is too hard to follow. Based on the strong research evidence, DASH has been a consistent part of U.S. national treatment guidelines and U.S. dietary recommendations since the original publication of the diet’s supporting research.6 I first heard about the DASH diet from my advisor for my master’s degree thesis, Shiriki Kumanyika, PhD, MPH, RD. As one of the foremost researchers on the relationship between diet and blood pressure, she was involved in the creation of the DASH eating pattern. But even before the first research about the DASH diet was published, it had been my mission to make it easy to follow and practical for real lives; a plan that can become a life-long eating style. Although over six hundred thousand of my books have been sold, DASH is still an unexplored topic for too many people. It is my belief that DASH could and should be the foundation for how we eat in this country—not as a weight-loss tool or a program to regulate chronic illnesses we already have, but as the foundation for sensible eating for every man, woman, and child. This is a philosophy about food that can optimize health for everyone—why wait until you have a problem that needs to be solved?
The health benefits seem almost miraculous. DASH controls high blood pressure as well as the first-line medications. Let that sink in. As well as the first-line medications! The 2017 blood pressure treatment guidelines for stage 1 hypertension recommend the DASH diet, along with the Mediterranean diet, as part of the lifestyle strategies for controlling the “silent killer.” DASH also helps lower cholesterol and is associated with reduced risk of strokes, heart attacks, heart failure, some kinds of cancer, type 2 diabetes, and kidney stones. And though not originally designed as a weight-loss plan, DASH easily adapts, and helps people reach and maintain a healthy weight. It provides more satisfying meals and snacks, which make it easy to manage hunger and avoid overeating. Who would not want all these benefits in one package?
The Mediterranean diet has also been shown to be directly associated with many health benefits. Heart health and longevity were the first observed benefits. New studies have suggested that the Mediterranean diet may help stave off the deterioration of cognitive function on aging, and perhaps even Alzheimer’s disease. It may help relieve depression and reduce the risk for colon cancer.
Let’s learn a little more…
The DASH Diet
In the mid-1990s, the DASH diet (Dietary Approaches to Stop Hypertension)7 was conceived as a way to help lower blood pressure through a healthy diet rather than with medication. The researchers had been investigating the effect of diet on blood pressure for some time. Now it was time to put this knowledge into action.
The researchers had also noted that diets rich in calcium and potassium and to a lesser extent, magnesium, were beneficial for lowering blood pressure. It seemed logical to evaluate whether taking supplements of these nutrients would lower blood pressure. Several studies were conducted, but unfortunately, most showed little or no benefit from calcium, potassium, or magnesium supplementation, so the focus returned to diet.
As we have noted, it was observed that, in general, vegetarians living in the United States had lower blood pressure and lower rates of heart disease mortality than people eating a more traditional Western diet. But few Americans would be willing to give up meat even if it meant reducing the risk of a heart attack. Being frustrated with the failure of supplements to provide an easy solution for high blood pressure, the researchers decided to create a diet that was rich in the foods containing those nutrients. The diet was replete with plant foods, including fruits, vegetables, beans, nuts, seeds, mostly whole grains, and heart-healthy oils. Reduced-fat dairy was an essential part of the diet, along with limited amounts of lean meats and poultry, and fish. It was based on the knowledge learned about vegetarian diets.
The first research on the DASH diet was published in 1997. The goal of that study was to evaluate the effect of the diet pattern on blood pressure, and it did so very effectively. The DASH diet lowered blood pressure as well as the first-line blood pressure medications, and in only fourteen days. Amazingly, the blood pressure breakthrough occurred even though the researchers did not allow the participants to lose weight. It incorporated lots of carbs, specifically to avoid weight loss, because if the participants had also lost weight, the researchers would not have known whether the weight loss or the eating pattern was the beneficial aspect. According to New England Journal of Medicine: “DASH was particularly effective for those with hypertension (SBP and DBP change: −10.7 and −4.7 mm Hg, respectively).”8
In the late 1980s and 1990s most heart specialists were recommending replacing saturated fats (SFA) with what were then called complex carbohydrates. Later research (Omni-Heart) was conducted to evaluate if DASH diet blood pressure results would be better if, instead of replacing SFA with carbs (particularly refined carbs), SFA were replaced with monounsaturated fats (MUFA) or protein. And indeed, they did see better results.9,10 Both approaches lowered total cholesterol, but MUFA did not increase triglycerides (TG) or lower “good” cholesterol (HDL). Keeping HDL higher and TG lower is very beneficial for heart health and is an important sign that you are successfully managing or lowering your risk for metabolic syndrome. A special benefit was that appetite seemed to be much easier to control.
Instead of needing medication that had some very undesirable side effects, the participants could have very positive “side benefits.” Wouldn’t you like to keep your blood pressure under control with food rather than with medication? Had you ever heard about the DASH diet before you picked up this book? Most people have not.
So why hasn’t DASH adoption been more widespread? Why hasn’t it broken out? Most of the educational materials, including those from the National Heart, Lung, and Blood Institute (NHLBI), made DASH seem difficult to follow. (When I first used the NHLBI literature, I found my patients’ eyes glazed over.) Based on the complicated information provided in that literature, many doctors felt that it would be too difficult for patients to follow, so they don’t even bother to recommend it. What a shame! I thought. This eating pattern is too important to just be a research curiosity. I wrote my first book on DASH to show people how easy it could be to adopt as a life-long pattern. And it worked. People found that they could stick with it and that their health improved dramatically. So let’s continue to follow up on the newest improvements on DASH and incorporate the key Mediterranean diet foods to make this the best plan ever! And the best-tasting!
The Mediterranean Diet
It has been long known that people who live in the Mediterranean region have lower rates of heart disease than people eating a typical Western diet. Since it is a totally delicious way of eating, it can be a great model of how to eat. It would be helpful to learn what the key health factors are and how it works. You can probably guess that it isn’t the pasta and white bread that make it effective. After World War II, one of the foremost nutrition scientists in the world, Ancel Keys, organized a consortium of researchers in several countries to investigate how diet impacted health. During World War II, Dr. Keys had become especially famous for designing military K-rations, and for determining how to nutritionally restore the starving people who would soon be liberated from concentration camps. Under the bleachers at the football stadium of the University of Minnesota, Dr. Keys designed a program to begin successfully refeeding starving people, using volunteers from the ranks of conscientious objectors as his subjects. After the war, Dr. Keys was ready to spearhead pursuing foundational nutrition research to learn how the eating patterns in various countries affected heart health. Thus began the Seven Countries Study.
Some of the key findings of the study were learning more details about the types of foods included in a traditional Mediterranean diet, the foods that influenced the risk for heart attacks and other types of heart disease. Important features were that people ate lots of fruits and vegetables, including lots of different types of salad greens, and consumed lots of olive oil. They ate small amounts of meat but enjoyed seafood more frequently. Dr. Keys noticed that the only negative feature about the Mediterranean eating style was that Italy had the highest rate of obesity in Europe, even in postwar Europe when most people did not have enough to eat. Unlike with a more traditional eating style, the Italians tended to have excessive consumption of refined grain foods, such as bread and pasta, which were plentiful and inexpensive. Throughout the region, people complained that they did not get enough meat or poultry and would have loved to have it be more available and more affordable.
Now we know that we can take the best of the Mediterranean plan (without the excessive refined foods that are not traditional and with a little more of the protein-rich foods) to get all the heart-health benefits without weight gain. A recent study showed that the heart-health benefits of the Mediterranean diet are equally good with the inclusion of more lean meats.11
Reaping the Benefits
- On Sale
- Dec 22, 2020
- Page Count
- 272 pages
- Grand Central Publishing