The Dietary Approaches to Stop Hypertension (DASH) diet, developed over 30 years ago with the support of NIH research teams, was initially designed to reduce high blood pressure. Emphasizing fruits, vegetables, whole grains, and low-fat dairy products, it also favors lean protein sources like beans and lean meats, while limiting saturated fats and sugar-sweetened foods and drinks. Due to its emphasis on foods and nutrients that can also help control blood sugar, the DASH diet is often recommended for people with diabetes. This article explores the benefits of the DASH diet for individuals with diabetes, including a modified version known as DASH4D, and provides practical tips for incorporating this eating plan into daily life.
Understanding the DASH Diet
The DASH eating pattern promotes blood pressure reduction by encouraging the consumption of foods that are low in saturated fat, total fat, cholesterol, and sodium and high in potassium, calcium, magnesium, fiber, and protein. In terms of actual food choices, the DASH eating pattern encourages whole grains, fat-free or low-fat dairy products, fruits, vegetables, poultry, fish, and nuts. The number of servings of foods is based on a person’s estimated calorie needs. The DASH eating plan is closely aligned with the USDA’s dietary recommendations, as outlined in the 2015-2020 Dietary Guidelines for Americans.
Key Components of the DASH Diet
The DASH diet recommends specific food groups and serving sizes based on individual calorie needs. Key components include:
- Fruits and Vegetables: Rich in vitamins, minerals, and fiber.
- Whole Grains: Provide sustained energy and fiber.
- Low-Fat Dairy: Important sources of calcium and vitamin D.
- Lean Protein: Includes poultry, fish, beans, and lean meats.
- Nuts and Seeds: Offer healthy fats, fiber, and protein.
- Limited Intake: Sodium, saturated fats, added sugars, and alcohol.
The Link Between Hypertension and Diabetes
People with diabetes have a higher risk of developing hypertension than people without diabetes; in addition, the percentage of adults with diabetes ≥18 years of age who have hypertension was 57.1% in 2009 compared to 46.2% in 1995 (2). Nearly two out of three individuals with diabetes have hypertension (12), so it is reasonable to expect that the DASH eating plan would be of benefit for people who have both hypertension and diabetes.
DASH4D: A Modified Approach for Diabetes Management
A research team led in part by Dr. Elizabeth Selvin at Johns Hopkins Bloomberg School of Public Health aimed to take a closer look. They tweaked the DASH diet in ways designed to help people with type 2 diabetes. The modified diet, called DASH for Diabetes (DASH4D), suggests that carbohydrates be only about 45% of total calorie intake, compared to 55% in the original DASH diet. The DASH4D diet is similar to the DASH diet but lower in carbohydrates and higher in unsaturated fats.
Read also: Delicious DASH Diet Treats
Clinical Trial Results: DASH4D for Glycemic Control
The clinical trial included 89 people with type 2 diabetes. Their mean age was 67 years, and 67% were female. The study used a crossover design, in which participants were fed one of four different diets, in random order, for five weeks. With at least one-week breaks in between, they were fed all four diets. Two of the diets were DASH4D, with either higher or lower salt intake (to evaluate blood pressure). The other two diets were typical of what’s eaten by many American adults, with either higher or lower salt. All meals were carefully measured and prepared in a clinical research kitchen. The researchers used a continuous glucose monitor to measure each participant’s blood glucose levels during each diet period. The monitor, attached to the upper arm, measured blood glucose levels every 15 minutes for up to two weeks.
Overall, the DASH4D eating plans led to more time with blood glucose in the recommended range (between 70 and 180 mg/dl) and less time with glucose above 180 mg/dl compared to the typical American diets. DASH4D also led to significantly reduced mean glucose levels. Because the study compared participants with themselves under different diet conditions, it eliminated variability between people, enhancing the statistical power of the study.
Participants eating the DASH4D diet had blood sugar levels that were on average 11 mg/dL lower than when eating the standard diet and stayed in the optimal blood glucose range for an extra 75 minutes a day. Both effects are considered clinically meaningful for people with diabetes, as they may lower risks of heart disease, kidney disease, and other long-term adverse consequences of diabetes.
Impact on Blood Pressure
For people with diabetes, a modified version of the Dietary Approaches to Stop Hypertension (DASH) diet can lower their blood pressure, according to a study published online June 9, 2025, by JAMA Internal Medicine. The study tested two versions of the DASH4D (one with lower sodium and one with higher sodium) and two versions of a typical American diet (one with lower and one with higher sodium). Each of the 85 people who completed the study followed all four diets in a random sequence for five weeks each. Most were taking at least two blood pressure medications. Compared to the typical American diet with higher sodium, the DASH4D diet with lower sodium reduced systolic blood pressure (the first number in a reading) by 4.6 points and diastolic blood pressure (the second number) by 2.3 points.
Additional Benefits of the DASH Diet for People with Diabetes
In addition to promoting blood pressure control, this eating pattern has been shown to improve insulin resistance, hyperlipidemia, and even overweight/obesity.
Read also: Which Diet is Right for You?
Weight Management
The diets of women in the Nurses’ Health Study and the Nurses’ Health Study II, and of men in the Health Professionals Follow-Up Study were measured every 4 years. Adherence scores were computed for the Alternate Mediterranean Diet, the Alternate Health Eating Index-2010, and the DASH diet. Improvement in all three of these scores was associated with less weight gain, especially in younger women or overweight individuals (16). Weight control is linked with improved glycemic control in people with type 2 diabetes (17). The DASH diet is recognized by U.S. News & World Report as being “#1 in best diets overall” for helping to manage not only blood pressure but also weight (18).
Gestational Diabetes Mellitus (GDM)
A healthy eating plan is a key factor in the management of gestational diabetes mellitus (GDM); specifically, the goal is to prevent or reduce adverse maternal and newborn outcomes without instigating any short-term harmful effects. In a systematic review and meta-analysis of randomized clinical trials of dietary interventions in GDM, Viana et al. (19) concluded that, although the low-GI eating plan was associated with less frequent insulin use and lower birth weight than the other diets, the DASH diet also holds promise for patients with GDM. In a small trial (20), women with GDM followed the DASH diet for 4 weeks. The DASH diet during pregnancy lowered insulin use, reduced cesarean rates, and lowered birth weights.
Insulin Sensitivity
The DASH eating plan or DASH-like eating plans have also led to improvements in insulin sensitivity, further demonstrating that this type of eating plan may be helpful for individuals with prediabetes or who are at risk for type 2 diabetes (21,22).
Prevention of Type 2 Diabetes
A meta-analysis (23) of prospective cohort studies looked at the differences among various diets’ effects in preventing type 2 diabetes. While there is not one diet, in particular, that is specifically recommended for the prevention of type 2 diabetes, the DASH diet has been associated with a 20 percent reduced risk for being diagnosed with type 2 in the future.
Practical Tips for Starting the DASH Diet
The ADA’s nutrition recommendations for adults with diabetes state that “there is no ‘ideal’ conclusive eating pattern that is expected to benefit all individuals with diabetes” (1). Different types of eating patterns and macronutrient distributions have been shown to lead to improvements in glycemic control (24). Although this eating plan is healthful for anyone, it is particularly aimed at helping those with prehypertension or hypertension.
Read also: The Hoxsey Diet
- Consult a Registered Dietitian (RD): A first step is to refer your patients to a registered dietitian (RD), preferably one who has experience working with people who have diabetes. Dietitians are especially skilled at determining the right “fit” of an eating plan for a specific patient, taking into account factors such as level of glycemic control, other health issues, lifestyle factors, cultural factors, and personal preference.
- Determine Calorie Needs: Determine the appropriate calorie level for the patient, based on overall health and nutrition goals. The DASH eating plan can be geared to individuals for whom weight loss is a goal.
- Set Carbohydrate Goals: To help meet blood glucose and A1C targets, help patients set appropriate meal and snack carbohydrate goals. Adjust goals, as needed, based on achievement of pre- and postmeal targets.
- Meal Planning: Discuss the benefits of planning meals ahead of time to help meet DASH plan and weight goals.
- Incorporate Meatless Meals: Encourage patients to aim for eating at least one meatless meal each week. Meatless meals emphasize plant-based protein sources, including legumes, tofu, tempeh, and meat substitutes such as soy-based veggie burgers.
- Dining Out Strategies: Discuss tips for dining out because typical restaurant meals tend to be high in sodium and saturated fat, and portions are often large.
Adapting the DASH Diet to Different Preferences
The DASH eating plan is easily adaptable to other styles of eating and dietary preferences, including vegetarian, vegan, gluten-free, and kosher.
Easing Into the DASH Diet
DASH isn't an eating plan you follow for a short time. Because of this, you can ease into it. Start by cutting out sodas or adding in fruits and vegetables to every meal. Bring spices to the table and leave the saltshaker in the cabinet - or throw it out! You can love what you eat while still managing your diabetes and protecting your heart.
Potential Benefits and Considerations
Benefits
- Healthy and Nutritious: This diet promotes the consumption of nutrient-dense foods filled with an array of the vitamins, minerals and macronutrients we need for optimal health. It doesn’t call for the restriction of whole grains, fruits or legumes.
- Clinically-Supported: Supporting research shows this diet has can prevent Type 2 diabetes, help manage it better, and reduce the risks of high blood pressure. These factors reduce the chances of having a heart attack or a stroke.
- Convenience: The appeal of the DASH eating pattern for patients is that it is also practical; it does not require special foods or supplements, and it is an approach that is appropriate for patients’ entire family to follow. This isn’t a commercialize diet, meaning, you can’t find a meal service specifically for this diet.
- Family-Friendly: Overall, there are no true negatives to this diet health-wise, it is a diet that promotes choosing the healthiest food when presented with options, it is also a diet that is absolutely fit for the whole family, not just those with diabetes.
Considerations
- Carbohydrate Intake: As previously mentioned, the DASH eating pattern can provide upwards of 55% of calories from carbohydrate, which may be too high a carbohydrate intake for some people with type 2 diabetes.
- Support Groups: Unlike national centralized support groups like Weight Watchers, there isn’t an equivalent for the DASH diet.