With a plethora of dieting options available, it can be challenging to determine the best approach to weight loss and overall health. Many Americans are trying to lose weight and improve their health, and diet plays a major role in cardiovascular health. Each person’s goals and starting place are different, and the aim is to find a diet that is sustainable and right for you, whether you are trying to trim your waistline or control your blood pressure. This article provides a detailed comparison of the ketogenic (keto) and Dietary Approaches to Stop Hypertension (DASH) diets, examining their philosophies, typical foods, benefits, and potential downsides.
Understanding the DASH Diet
The DASH diet has been recommended for many patients with underlying hypertension or cardiovascular disease. The diet was initially developed to test the effects of dietary patterns on lowering blood pressure. Patients were randomly assigned to eat the typical American diet, the American diet plus more fruits and vegetables, or the DASH diet.
Philosophy
The DASH diet was initially developed to test the effects of dietary patterns on lowering blood pressure. Compared with the typical American diet, the DASH diet is lower in sodium and richer in nutrients such as potassium, magnesium, calcium, and fiber, which are associated with lower blood pressure.
Typical Foods
The diet is rich in fruits, vegetables, low-fat milk, whole grains, fish, poultry, beans, and nuts. It emphasizes reducing intake of sodium, beverages with added sugar, saturated fat, and red meat.
Benefits
The DASH diet is designed to lower blood pressure and improve cardiovascular health. A meta-analysis of DASH diet trials demonstrated that DASH diet interventions significantly reduced serum uric acid.
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Downsides
The list of foods that are part of the DASH diet is not comprehensive and may be misleading. For example, breakfast cereal is listed as a grain, but many cereals are high in sugar and have little nutritional benefit.
Exploring the Ketogenic Diet
The ketogenic diet has become very popular in the US. While it is a restrictive dietary plan, many people have seen significant weight loss results. However, the effect of the diet on overall health is unknown, and there are concerns about the impact of a high-fat, high-protein diet on cardiovascular disease risk.
Philosophy
As with intermittent fasting, the goal of the keto diet is to force the body into ketosis, in which it begins to use fatty acids instead of glucose as its major source of energy. The ketogenic diet is an ultra-low-carb, very high-fat diet that involves a drastic reduction in carbohydrate intake.
Typical Foods
It is a diet rich in proteins and fats.
Benefits
The keto diet has been associated with faster weight loss than some of the low-fat diets; however, this difference disappears over time.
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Downsides
It is a very restrictive diet and difficult to sustain. It can lead to fatigue, nausea, constipation, and insomnia. Because of the high fat intake, there is concern about the effects of the diet on cholesterol levels and overall cardiovascular health; however, more studies are needed to determine the cardiovascular impact of this diet plan. The ketogenic diet prohibits legumes, fruits, and whole grains.
Comparative Analysis: Keto vs. DASH
A new study in the Annals of Family Medicine pitted a very-low-carbohydrate diet against the DASH diet for adults with hypertension, type 2 diabetes or pre-diabetes, and overweight or obesity. For the very-low-carb (VLC) diet, subjects were advised to limit carbohydrate intake to 20 - 35 grams of non-fiber carbohydrates per day with the goal of being in ketosis when measured via urine test strips at least once weekly. The DASH diet called for limiting sodium intake to less than 2,300 mg daily and fat intake to 20% - 30% of calories per day.
Impact on Blood Pressure and Weight Loss
Both diets improved blood glucose control, as indicated by similar drops in HbA1c levels (9% on keto and 7% on Mediterranean). Each diet had one other statistically significant benefit: LDL cholesterol increased on the keto diet and decreased on the Mediterranean diet - a point for Mediterranean.
A study published in April 2024 reported that following the Mediterranean diet was linked to a lower risk for high blood pressure. Another study published in July 2019 showed that following a low carbohydrate diet like the keto diet helped lower blood pressure readings in people with type 2 diabetes.
At the study’s conclusion, researchers found that participants in both diet groups experienced a decrease in blood pressure and weight loss after three months. Scientists also found that participants in both diet groups experienced an increase in their fat-free mass - the total mass of the body excluding fat - and a decrease in their body fat, blood lipid levels, and insulin concentrations.
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Nutrient Levels
In nutrient levels, the ketogenic diet provided less fiber; thiamin; vitamins B6, C, D and E; and phosphorus.
Adherence and Sustainability
When food was delivered, participants stuck to both diets relatively well, scoring an average of 7.5 on a 10-point adherence scale. "The one thing everybody did pretty well was limiting added sugar and refined grains. "The keto diet was more polarizing," he said.
When the research team checked in with the participants three months after the trial, on average, they had maintained lower blood glucose levels and weight loss. Notably, they were eating closer to a Mediterranean diet than to a keto diet.
Specific Benefits for Certain Conditions
For adults with hypertension, prediabetes or type 2 diabetes, and overweight or obesity, the VLC diet resulted in greater improvements in systolic blood pressure, glycemic control, and weight over a 4-month period compared with the DASH diet. In the VLC + support arm, almost 44 percent of subjects (7 out of 16) were able to decrease or discontinue medication for hypertension, compared to just 5 percent (1 out of 19) in the DASH + support group.
Expert Opinions
Chen commented that while the Mediterranean and keto diets are somewhat different in their food restrictions, the study results suggest that there may be different dietary techniques that can achieve the same beneficial outcome, depending on the food preferences of an individual. Because this was a smaller study, Ali suggested expanding it to a larger patient base or population to refine it further. “What is it about these two types of diets that are helpful?,” he asked. “Is it reducing processed foods or is it more reducing the carbohydrates and sugars? So there are some differences between the diets, and trying to define further what is optimal between these two diets.”
Dietary Recommendations
Richard suggested honing in on increasing foods rich in nutrients with many health benefits, such as:
- Healthy fats like olives, extra-virgin olive oil, avocados, nuts, and seeds.
- Non-starchy vegetables such as leafy greens, beets, peppers, onions, garlic, scallions, tomatoes, cabbage, and Brussels sprouts.
- Herbs such as chives, basil, mint, rosemary, thyme, and sage.
- Proteins from plants and animals, such as goat cheese, yogurt, beans and lentils, fish, hummus, and tzatziki.
- High fiber foods from whole grains like oats, whole wheat, and rye, and fresh fruits in season such as peaches, plums, apples, grapes, berries, pears, oranges, figs, dates, and cherries.
- Incorporation of green, black, white, or herbal teas.
PCOS and Dietary Choices
Polycystic ovary syndrome (PCOS) is one of the most common hormone-related conditions affecting women of reproductive age. It’s linked to irregular or missed periods, fertility problems, and metabolic issues like insulin resistance. Keto can bring fast results, especially for insulin resistance, but it’s not for everyone. The Mediterranean and DASH diets are more flexible and easier to maintain long term. They still help with inflammation, hormone balance, and blood sugar control.
Ketogenic Diet and PCOS
A study published in Frontiers in Nutrition and specifically focused on women with PCOS, involved 30 women diagnosed with PCOS who followed a ketogenic diet for at least three months. The study found that all participants regained regular menstrual cycles, and among those desiring pregnancy, 55.6% conceived naturally.
Mediterranean Diet and PCOS
A 2019 study compared 112 women with PCOS to healthy women of similar age and BMI. The results showed that women with PCOS had lower-quality diets. They ate fewer anti-inflammatory foods like olive oil, fish, legumes, and nuts, and consumed more sugar, saturated fat, and low-fiber carbs.
DASH Diet and PCOS
The DASH diet (Dietary Approaches to Stop Hypertension) wasn’t created for PCOS, but its benefits for hormone health, blood pressure, and inflammation make it worth including.
The Importance of a Balanced Approach
There is no debate that successful weight loss is mainly driven by dietary measures; however, exercise is key to a healthy lifestyle. Exercise has been linked to numerous health benefits, including decreasing the risk of cardiovascular disease, preventing neurocognitive decline, improving mental health, and lowering the risk of certain types of cancer (colon, breast, lung). It is also a key aspect of helping a person lose weight and keep it off. Choose a diet that is sustainable for you. If it is too restrictive or requires you to cut out too many food options you enjoy, it will be difficult if not impossible to maintain. Remember that a few cheats here and there are okay, and sometimes you just need that piece of cake or bowl of ice cream.
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