Health
Eating for heart health
What the evidence supports for cholesterol and blood pressure: the DASH and Portfolio patterns, less salt and saturated fat, and more fibre. General principles alongside any treatment.
Two patterns with trial evidence
DASH (Dietary Approaches to Stop Hypertension) is built on vegetables, fruit and wholegrains, with low-fat dairy, fish, poultry, beans, nuts and vegetable oils, and limits on fatty meat, full-fat dairy, tropical oils, sweets and sugary drinks. Across 30 randomised trials it lowered blood pressure by about 3.2/2.5 mmHg compared with a control diet.
The Portfolio pattern combines four cholesterol-lowering foods: nuts, plant protein such as soya and beans, viscous fibre of the kind found in oats and barley, and plant sterols. In a meta-analysis of seven trial comparisons in people with raised cholesterol, adding it to a standard cholesterol-lowering diet reduced LDL cholesterol by about 17%.
Fats and salt
A Cochrane review of 15 randomised trials found that cutting saturated fat for at least two years reduced combined cardiovascular events by about 21%, with little or no effect on overall mortality. Replacing it with polyunsaturated fat or carbohydrate appeared useful. In practice that means oils, nuts and fish in place of butter, fatty meat and pastries.
Sodium matters for blood pressure. The DASH plan sets it at 2,300 mg a day and notes that 1,500 mg lowers blood pressure further. Recipes here show sodium per serving, so you can see what a day adds up to. Season with herbs, spices, citrus and vinegar in place of some of the salt.
Putting it on the plate
The two patterns overlap, so you do not have to choose. Base meals on vegetables, pulses and wholegrains, have unsalted nuts most days, use oats or barley often, cook with vegetable oils, and keep fatty and processed meat, pastries and salty snacks for now and then.
DASH for a 2,000 kcal day works out at 4–5 servings each of vegetables and fruit, 6–8 of grains and 2–3 of low-fat dairy a day, plus 4–5 servings of nuts, seeds and pulses a week. Use it as a sketch to check your week against, not a rule book.
Worth knowing
- This is general information, not individual medical or dietetic advice, and food is not a substitute for prescribed treatment. Do not stop or change statins or blood pressure medicines because of a change in diet.
- If you take medication for blood pressure, cholesterol or diabetes, or have kidney disease, speak to your clinician before making major changes to how you eat.
- The Portfolio trials involved 439 people with raised cholesterol following the full pattern. Partial changes at home are likely to have smaller effects.
Common questions
Is DASH or Portfolio better?
They aim at different things: DASH was designed for blood pressure, Portfolio for LDL cholesterol. They share most of their foods, and you can combine them.
Do I have to give up salt completely?
No. The DASH plan allows 2,300 mg of sodium a day. Tasting before you salt and comparing the sodium on recipes and labels goes a long way.
Can diet replace my statin?
No. Diet changes work alongside medication, not in place of it. Any decision about your medicines is one to make with your doctor.
Sources
- National Heart, Lung, and Blood Institute (NIH): DASH Eating Plan
- DASH diet and blood pressure reduction in adults with and without hypertension: systematic review and meta-analysis, Adv Nutr (2020)
- Portfolio dietary pattern and cardiovascular disease: systematic review and meta-analysis of controlled trials, Prog Cardiovasc Dis (2018)
- Cochrane review: Reduction in saturated fat intake for cardiovascular disease (2020)
General information, not medical or dietary advice. Speak to a doctor or registered dietitian about your own situation.
