More than 37 million Americans are living with chronic kidney disease (CKD), and many more are at risk. Proactive lifestyle changes, including dietary adjustments, are crucial in managing kidney health. The Dietary Approaches to Stop Hypertension (DASH) Diet, originally designed to lower blood pressure, is increasingly recommended for improving kidney health, especially in its early stages.
Understanding the DASH Diet
The DASH Diet focuses on creating heart-healthy, nutrient-rich, and well-balanced meals. It doesn't require special or restrictive foods, making it a sustainable approach to healthier eating. The DASH diet is rich in fruits, vegetables, low-fat dairy products, whole grains, fish, poultry, beans, seeds, and nuts. It is low in salt and sodium, added sugars and sweets, fat and red meats.
The Kidneys and Blood Pressure
Your kidneys filter toxins, balance electrolytes, and regulate blood pressure. High blood pressure can strain these organs, accelerating the progression of CKD. The DASH Diet helps alleviate this strain through several mechanisms.
How the DASH Diet Benefits Kidney Health
Reduced Sodium Intake: The DASH Diet emphasizes potassium-rich foods while reducing sodium intake. This approach relaxes blood vessels and lessens the workload on your kidneys. Opt for fresh or frozen produce over canned goods, which often contain excess sodium.
Electrolyte Balance and Reduced Inflammation: Eating a diet low in saturated fats and high in whole foods can help maintain electrolyte balance, reduce inflammation, and protect kidney function over time.
Read also: Delicious DASH Diet Treats
Proven to Lower Blood Pressure: The DASH (Dietary Approaches to Stop Hypertension) Diet has been recommended by the National Kidney Foundation and approved by The National Heart, Lung and Blood Institute, The American Heart Association, the Dietary Guidelines for Americans, and also forms the basis for the USDA MyPyramid.
DASH Diet and Risk of ESRD
A study examined whether a DASH diet is associated with lower risk of ESRD among 1,110 adults aged ≥ 20 years with hypertension and CKD (estimated glomerular filtration rate, eGFR 30-59 ml/min/1.73 m2) enrolled in the National Health and Nutrition Examination Survey (1988-1994). Over a median follow-up of 7.8 years, 18.4% of subjects developed ESRD. Compared to the highest quintile of DASH diet accordance, there was a greater risk of ESRD among subjects in quintiles 1 and 2. Significant interactions were observed with diabetes status and race/ethnicity, with the strongest association between DASH diet adherence and ESRD risk observed in individuals with diabetes and in non-Hispanic blacks.
Components of the DASH Diet
The individual components of the DASH accordance score may also have a considerable impact on the association of the DASH accordance score with risk of ESRD. Exploratory analysis supports dietary K and Mg as strong mediators of the association between DASH accordance score and risk of ESRD. The increased level of dietary magnesium in the DASH accordance score may lead to lower production of inflammatory and proatherogenic cytokines in endothelial cells, a possible pathway to restore kidney function.
DASH Diet and Diabetes
In the stratified model we found higher levels of DASH diet accordance may lower the risk of CKD progression to ESRD among adults with diabetes. Because the DASH diet is rich in fruits and vegetables, it is likely to be high in dietary K and Mg and low in in Na, which is reflective of lower DAL than a typical Western diet and hence the lower risk of ESRD that was noted in study participants.
Implementing the DASH Diet: Practical Tips
Making dietary changes may sound overwhelming, but small, consistent steps can make a big difference.
Read also: Which Diet is Right for You?
If switching your entire dietary routine feels daunting, start small. Replace one processed snack with fresh fruit. Swap sugary beverages for water infused with cucumber or lemon.
Limit salt when cooking. Instead, add flavor without adding salt. Try:
- Aromatic vegetables (examples: onions, peppers, garlic)
- Flavor with fruit (examples: citrus juice and fruit zest)
- Herbs (examples: rosemary, parsley, cilantro)
- Spices (examples: black pepper, cinnamon, cumin, ginger, nutmeg)
Read food labels. The Nutrition Facts label is your guide to what is inside all processed or packaged foods. Low sodium foods have ≤ less than 140 mg of sodium per serving, and Very low sodium products have ≤ less than 35 milligrams sodium per serving.
Snack smart and make low sodium snack swaps. Look for products that are unsalted, have no added salt, or are lower sodium substitutes for your favorite snacks to make healthy, lower sodium choices.
Make your plate colorful. Add fruits or vegetables to every meal. Fill half of your plate with fruits and vegetables. And, try to eat 5 servings of fruits and vegetables per day. This limits your sodium intake, and fruits and vegetables are naturally low in fat and also have fiber! If your healthcare team has told you to limit potassium, then speak to a dietitian about which fruits and vegetables are okay. You may also need to limit portion sizes of certain fruits and vegetables.
Read also: The DASH Diet and Blood Sugar
Choose low fat dairy products. Low fat dairy products include 1% or skim (nonfat) milk, light yogurt, and 2% cheese. If you are currently eating or drinking high fat dairy products, try the next step down. For example, if you drink whole milk, try 2% milk. If you drink 2% milk, try 1% milk. Order your favorite coffee beverage with non-fat or skim milk. This one small change can have a positive impact on your diet and health. Choosing low fat dairy products helps to decrease the saturated fat ("bad fat") in your diet and increases important nutrients like calcium, magnesium, and potassium. Dairy products are naturally low in sodium too! But if your healthcare team has told you to limit potassium and phosphorus in your diet, then dairy products will need to be limited.
Important Considerations for Advanced CKD
Patients with Advanced CKD: Since some DASH-friendly foods are high in potassium (e.g., bananas, sweet potatoes), they may not be suitable for individuals undergoing dialysis or with severe CKD. The DASH diet should not be used by people on dialysis. Individuals on dialysis have special dietary needs that should be discussed with a registered dietitian.
Potassium and Phosphorus
Current CKD guidelines do not recommend routine adoption of the DASH diet by patients with moderate kidney disease, likely because the nutritional profile provides higher quantities of potassium, calcium, phosphorus, and protein than is recommended for patients with CKD stages 3 to 4.
Sample DASH Diet (2,000 Calories)
Here's an example of a DASH diet for a 2,000 calorie intake:
| Food Group | Daily Servings | Serving Size |
|---|---|---|
| Grains | 6-8 | 1 Slice bread, 1 oz dry cereal, ½ cup cooked rice, pasta, or cereal |
| Vegetables | 4-5 | 1 cup raw leafy vegetable, ½ cup cut-up raw or cooked vegetable, ½ cup vegetable juice |
| Fruits | 4-5 | 1 medium fruit, ¼ cup dried fruit, ½ cup fresh, frozen, or canned fruit, ½ cup fruit juice |
| Fat-free or low-fat milk | 2-3 | 1 oz milk or yogurt, 1 ½ oz cheese |
| Lean meats, poultry, and fish | 6 or less | 1 oz cooked meats, poultry, or fish, 1 egg |
| Nuts, seeds, and legumes | 4-5 per week | 1/3 cup or 1 ½ oz nuts, 2 Tbsp peanut butter, 2 Tbsp or ½ oz seeds, ½ cup cooked legumes (dry beans and peas) |
| Fats and oils | 2-3 | 1 tsp soft margarine, 1 tsp vegetable oil, 1 Tbsp mayonnaise, 2 Tbsp salad dressing |
| Sweets and added sugars | 5 or less/week | 1 Tbsp sugar, 1 Tbsp jelly or jam, ½ cup sorbet, gelatin, 1 cup lemonade |
Notes:
- Whole grains are recommended for most grain servings as a good source of fiber and nutrients.
- Serving sizes vary between ½ cup and 1 ¼ cups, depending on cereal type. Check the product's Nutrition Facts label.