Scientists from the US’ National Institutes of Health developed the ‘DASH’ diet to reduce high blood pressure. Low in salt, rich in vegetables, whole grains and legumes, the DASH diet has been easy for people to implement at home and has delivered positive health results. What happened when scientists in China tailored the DASH diet to suit local tastes in a randomized controlled trial across four cities? The success of the diet in lowering hypertension was repeated. This provides useful lessons, not in only dietary modification and public health in China but also for countries in the region.
Chinese researchers created a relatively low salt, low fat and high fibre diet to see the outcome on heart and vascular health. The intervention reduced sodium from 6000mg to 3000mg per day (this is still above the WHO recommendation of 2000mg per day), increased potassium and doubled the daily fibre intake by increasing vegetable, legume and fruit intake. Not surprisingly the results showed great improvements for those in the intervention group. For those on the heart healthy diet, compared to the control group eating normal cuisine) blood pressure lowered by an average 10 mm Hg and diastolic blood pressure fell by an average 3.8 mm Hg. This is the equivalent of taking blood pressure medicine with none of the side effects or costs.
The China Heart Healthy Diet used four regional cuisines - Cantonese, Huaiyang, Shangdong and Sichuan – mirroring the four population centres where the trial was conducted. The China Heart Healthy Diet reflected local tastes and was effective in its focus on local and traditional ingredients only marginally more expensive than food used for the control groups. This provides a useful case study for countries that have undergone or are going through the nutrition transition from traditional food culture to diets higher in processed foods and animal products. Specifically for China we can compare data from 1982 and 2012 showing that consumption of grain foods, tubers and legumes, vegetables and fruits decreased by 34%, 80%, and 15%, respectively. Meanwhile meat, eggs, and edible oil consumption increased by 162%, 233% and 132% respectively.
How does this relate, say, outside of China? Says Felicia, The Whole Health Practice's co-founder and nutritionist, “Cutting back on salt, using low sodium soy sauce or salt substitutes directly addresses the quantity of salt in the diet.” But what about flavour? She recommends that we "Enjoy local foods based on traditional cuisines. These are likely in keeping with flavours than you can relate to and enjoy. For example, Southeast Asia has a vast variety of kampung (village) cuisines that can be enjoyed. Focus on simple daily foods rather than the richer specialities that used to be consumed only on feast days."
We reached out to Singaporean foodie and food technologist Andrew Yip, who spent his early years in the kitchen and more recently in a food laboratory. He advises to “Let salt play its functional role, use enough to bring out the natural flavours of the other ingredients.”
He parallels Felicia’s advice to concentrate on flavour, suggesting “to include black or white pepper 黑/白 - 胡椒 , for enhancing the flavour of dishes use combinations of spices to generate natural sweetness and umaminess of dishes: amomum tsaoko 草果, bay leaf 月桂葉/香葉, chenpi 陳皮, cinnamon 肉桂/ 桂皮, liquorice root 甘草”. For meat dishes Andrew recommends “Sand ginger 沙薑, sichuan pepper 花椒, star anise 八角/ 大料 and cloves 丁香 are great to provide aroma and taste to dishes. Try using ingredients like garlic, onions, radish and carrots and corn for sweetness and balance with dash of mirin and rice vinegar.”
Final Thoughts
Wherever you reside, minimise your consumption of processed or preserved foods (often high in salt and refined carbohydrates), enjoy plant-rich dishes and moderate the consumption of meat. Making these small changes in eating practices can provide massive long-term benefits in terms of your health and quality of life.
For most people, improving diet and health is about finding motivation and prioritising self-care with an ultimate goal of taking action. If you want to take effective and targeted steps that fit into your unique lifestyle, The Whole Health Practice is here to help.
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Stay Healthy,
Alastair
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Related Studies
The study in question: Wang Y, Feng L, Zeng G, Zhu H, Sun J, Gao P, Yuan J, Lan X, Li S, Zhao Y, Chen X, Dong H, Chen S, Li Z, Zhu Y, Li M, Li X, Yang Z, Li H, Fang H, Xie G, Lin PH, Chen J, Wu Y; DECIDE-Diet Study Group. Effects of Cuisine-Based Chinese Heart-Healthy Diet in Lowering Blood Pressure Among Adults in China: Multicenter, Single-Blind, Randomized, Parallel Controlled Feeding Trial. Circulation. 2022 Jul 26;146(4):303-315. doi: 10.1161/CIRCULATIONAHA.122.059045. Epub 2022 Jul 11. PMID: 35861850; PMCID: PMC9311470.
Others...
Cai, J., Sun, X., Li, M. et al. Dietary factors in relation to hypertension: a mendelian randomization study. J Health Popul Nutr 43, 91 (2024). https://doi.org/10.1186/s41043-024-00575-7
Theodoridis X, Chourdakis M, Chrysoula L, Chroni V, Tirodimos I, Dipla K, Gkaliagkousi E, Triantafyllou A. Adherence to the DASH Diet and Risk of Hypertension: A Systematic Review and Meta-Analysis. Nutrients. 2023 Jul 24;15(14):3261. doi: 10.3390/nu15143261. PMID: 37513679; PMCID: PMC10383418.
Yin R, Yin L, Li L, Silva-Nash J, Tan J, Pan Z, Zeng J, Yan LL. Hypertension in China: burdens, guidelines and policy responses: a state-of-the-art review. J Hum Hypertens. 2022 Feb;36(2):126-134. doi: 10.1038/s41371-021-00570-z. Epub 2021 Jul 2. PMID: 34215840; PMCID: PMC8252986.
Aliasgharzadeh S, Tabrizi JS, Nikniaz L, Ebrahimi-Mameghani M, Lotfi Yagin N. Effect of salt reduction interventions in lowering blood pressure: A comprehensive systematic review and meta-analysis of controlled clinical trials. PLoS One. 2022 Dec 7;17(12):e0277929. doi: 10.1371/journal.pone.0277929. PMID: 36477548; PMCID: PMC9728935.
Filippou CD, Tsioufis CP, Thomopoulos CG, Mihas CC, Dimitriadis KS, Sotiropoulou LI, Chrysochoou CA, Nihoyannopoulos PI, Tousoulis DM. Dietary Approaches to Stop Hypertension (DASH) Diet and Blood Pressure Reduction in Adults with and without Hypertension: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Adv Nutr. 2020 Sep 1;11(5):1150-1160. doi: 10.1093/advances/nmaa041. PMID: 32330233; PMCID: PMC7490167.
Bai G, Zhang J, Zhao C, Wang Y, Qi Y, Zhang B. Adherence to a healthy lifestyle and a DASH-style diet and risk of hypertension in Chinese individuals. Hypertens Res. 2017 Feb;40(2):196-202. doi: 10.1038/hr.2016.119. Epub 2016 Sep 8. PMID: 27604345.
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