Skip to main content

The DASH Diet and Insulin Sensitivity

Abstract

Lifestyle modifications, including adoption of the Dietary Approaches to Stop Hypertension (DASH) dietary pattern, weight loss in individuals who are overweight or obese, and physical activity, are effective in the prevention and treatment of hypertension. A healthy lifestyle may also have beneficial effects on metabolic abnormalities, such as insulin resistance, that are associated with high blood pressure. This review examines the independent and combined effects of the DASH diet and weight loss plus exercise on blood pressure and insulin sensitivity, with a focus on recently published results from the ENCORE study. Our data suggest that the DASH eating plan alone lowers blood pressure in overweight individuals with higher than optimal blood pressure, but significant improvements in insulin sensitivity are observed only when the DASH diet is implemented as part of a more comprehensive lifestyle modification program that includes exercise and weight loss.

This is a preview of subscription content, access via your institution.

Fig. 1

References

Recently published papers of interest have been highlighted as: • Of importance •• Of major importance

  1. 1.

    Lewington S, Clarke R, Qizilbash N, et al.: Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002, 360:1903–1913.

    Article  PubMed  Google Scholar 

  2. 2.

    Vokonas PS, Kannel WB: Epidemiology of coronary heart disease in the elderly. In Cardiovascular Disease in the Elderly, edn 2. Edited by Tresh DD, Aronow WS. New York: Marcel Dekker; 1999:139–164.

    Google Scholar 

  3. 3.

    MacMahon S, Peto R, Cutler J, et al.: Blood pressure, stroke and coronary heart disease. Part 1: prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias. Lancet 1990, 335:765–774.

    CAS  Article  PubMed  Google Scholar 

  4. 4.

    Kannel WB, Neaton JD, Wentworth, et al.: Overall and coronary heart disease mortality rates in relation to major risk factors in 325,348 men screened for the MRFIT. Am Heart J 1986, 112:825–836.

    CAS  Article  PubMed  Google Scholar 

  5. 5.

    Kannel WB, Wilson PWF, Zhang TJ: The epidemiology of impaired glucose tolerance and hypertension. Am Heart J 1991, 121:1268–1273.

    CAS  Article  PubMed  Google Scholar 

  6. 6.

    Julius S, Jamerson K, Mejia A, et al.: The association of borderline hypertension with target organ changes and higher coronary risk: Tecumseh Blood Pressure Study. JAMA 1990, 264:354–358.

    CAS  Article  PubMed  Google Scholar 

  7. 7.

    Nguyen NT, Magno CP, Lane KT, et al.: Association of hypertension, diabetes, dyslipidemia, and metabolic syndrome with obesity: findings from the National Health And Nutrition Examination Survey, 1999–2004. J Am Coll Surg 2008, 207:928–934.

    Article  PubMed  Google Scholar 

  8. 8.

    Almgren T, Wilhelmsen L, Samuelsson O, et al.: Diabetes in treated hypertension is common and carries a high cardiovascular risk: results from a 28-year follow-up. J Hypertens 2007, 25:1311–1317.

    CAS  Article  PubMed  Google Scholar 

  9. 9.

    Stamler J, Vaccaro O, Neaton JD, Wentworth D: Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial. Diabetes Care 1993, 16:434–444.

    CAS  Article  PubMed  Google Scholar 

  10. 10.

    Hypertension in Diabetes Study Group: HDS 2: Increased risk of cardiovascular complications in hypertensive type 2 diabetic patients. J Hypertens 1993, 11:319–325.

    Article  Google Scholar 

  11. 11.

    Dunder K, Lind L, Zethelius B, et al.: Increase in blood glucose concentration during antihypertensive treatment as a predictor of myocardial infarction: population based cohort study. BMJ 2003, 326:681–684.

    Article  PubMed  Google Scholar 

  12. 12.

    Neal B, MacMahon S, Chapman N: Effects of ACE inhibitors, calcium antagonists, and other blood-pressure-lowering drugs: results of prospectively designed overviews of randomised trials. Blood Pressure Lowering Treatment Trialists’ Collaboration. Lancet 2000, 356:1955–1964.

    CAS  Article  PubMed  Google Scholar 

  13. 13.

    Law MR, Wald NJ, Morris JK, Jordan RE: Value of low dose combination treatment with blood pressure lowering drugs: analysis of 354 randomised trials. BMJ 2003, 326:1427–1431.

    CAS  Article  PubMed  Google Scholar 

  14. 14.

    Elliott WJ, Meyer PM: Incident diabetes in clinical trials of antihypertensive drugs: a network meta-analysis. Lancet 2007, 369:201–207.

    CAS  Article  PubMed  Google Scholar 

  15. 15.

    Chobanian AV, Bakris GL, Black HR, et al.: Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 2003, 42:1206–1252.

    CAS  Article  PubMed  Google Scholar 

  16. 16.

    Knowler WC, Barrett-Connor E, Fowler SE; Diabetes Prevention Program Research Group: Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002, 346:393–403.

    CAS  Article  PubMed  Google Scholar 

  17. 17.

    Tuomilehto J, Lindstrom J, Eriksson JG, et al.: Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001, 344:1343–1350.

    CAS  Article  PubMed  Google Scholar 

  18. 18.

    •• Orozco LJ, Buchleitner AM, Gimenez-Perez G, et al.: Exercise or exercise and diet for preventing type 2 diabetes mellitus [review]. Cochrane Database Syst Rev 2008, (3):CD003054. This review summarizes the published literature describing the effects of exercise and weight loss on insulin sensitivity and the development of diabetes.

    PubMed  Google Scholar 

  19. 19.

    Pan XR, Li GW, Hu YH, et al.: Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study. Diabetes Care 1997, 20:537–544.

    CAS  Article  PubMed  Google Scholar 

  20. 20.

    Torjesen PA, Birkeland KI, Anderssen SA, et al.: Lifestyle changes may reverse development of the insulin resistance syndrome. The Oslo Diet and Exercise Study: a randomized trial. Diabetes Care 1997, 20:26–31.

    CAS  Article  PubMed  Google Scholar 

  21. 21.

    Wing RR, Venditti E, Jakicic JM, et al.: Lifestyle intervention in overweight individuals with a family history of diabetes. Diabetes Care 1998, 21:350–359.

    CAS  Article  PubMed  Google Scholar 

  22. 22.

    Goodpaster BH, Kelley DE, Wing RR, et al.: Effects of weight loss on regional fat distribution and insulin sensitivity in obesity. Diabetes 1999, 48:839–847.

    CAS  Article  PubMed  Google Scholar 

  23. 23.

    Rice B, Janssen I, Hudson R, Ross R: Effects of aerobic or resistance exercise and/or diet on glucose tolerance and plasma insulin levels in obese men. Diabetes Care 1999, 22:684–691.

    CAS  Article  PubMed  Google Scholar 

  24. 24.

    Dengel DR, Pratley RE, Hagberg JM, et al.: Distinct effects of aerobic exercise training and weight loss on glucose homeostasis in obese sedentary men. J Appl Physiol 1996, 81:318–325.

    CAS  PubMed  Google Scholar 

  25. 25.

    Tinker LF, Bonds DE, Margolis KL, et al.: Low-fat dietary pattern and risk of treated diabetes mellitus on postmenopausal women: the Women’s Health Initiative Randomized Controlled Dietary Modification Trial. Arch Intern Med 2008, 168:1500–1511.

    Article  PubMed  Google Scholar 

  26. 26.

    Palmer JR, Boggs DA, Krishnan S, et al.: Sugar-sweetened beverages and incidence of type 2 diabetes mellitus in African American women. Arch Intern Med 2008, 168:1487–1492.

    Article  PubMed  Google Scholar 

  27. 27.

    Feinglos MN, Totten SE: Are you what you eat, or how much you eat? The case of type 2 diabetes mellitus. Arch Intern Med 2008, 168:1485–1486.

    Article  PubMed  Google Scholar 

  28. 28.

    Yamanouchi K, Shinozaki T, Chikada K, et al.: Daily walking combined with diet therapy is a useful means for obese NIDDM patients not only to reduce body weight but also to improve insulin sensitivity. Diabetes Care 1995, 18:775–778.

    CAS  Article  PubMed  Google Scholar 

  29. 29.

    Schneider SH, Khachadurian AK, Amorosa LF, et al.: Ten-year experience with an exercise-based outpatient life-style modification program in the treatment of diabetes mellitus. Diabetes Care 1992, 15:1800–1810.

    CAS  Article  PubMed  Google Scholar 

  30. 30.

    Vanninen E, Uusitupa M, Siitonen O, et al.: Habitual physical activity, aerobic capacity and metabolic control in patients with newly-diagnosed type 2 (non-insulin-dependent) diabetes mellitus: effect of 1-year diet and exercise intervention. Diabetologia 1992, 35:340–346.

    CAS  Article  PubMed  Google Scholar 

  31. 31.

    Trovati M, Carta Q, Cavalot F, et al.: Influence of physical training on blood glucose control, glucose tolerance, insulin secretion, and insulin action in non-insulin-dependent diabetic patients. Diabetes Care 1984, 7:416–420.

    CAS  Article  PubMed  Google Scholar 

  32. 32.

    Poirier P, Tremblay A, Broderick T, et al.: Impact of moderate aerobic exercise training on insulin sensitivity in type 2 diabetic men treated with oral hypoglycemic agents: Is insulin sensitivity enhanced only in nonobese subjects? Med Sci Monit 2002, 8:CR59–CR65.

    PubMed  Google Scholar 

  33. 33.

    Cuff DJ, Meneilly GS, Martin A, et al.: Effective exercise modality to reduce insulin resistance in women with type 2 diabetes. Diabetes Care 2003, 26:2977–2982.

    Article  PubMed  Google Scholar 

  34. 34.

    Blumenthal JA, Sherwood A, Gullette ECD, et al.: Exercise and weight loss reduce blood pressure in men and women with mild hypertension. Arch Intern Med 2000, 160:1942–1958.

    Article  Google Scholar 

  35. 35.

    Mikines KJ, Sonne B, Tronier B, Galbo H: Effects of training and detraining on dose-response relationship between glucose and insulin secretion. Am J Physiol 1989, 256(5 Pt 1):E588–E596.

    CAS  PubMed  Google Scholar 

  36. 36.

    Devlin JT, Hirshman M, Horton ED, Horton ES: Enhanced peripheral and splanchnic insulin sensitivity in NIDDM men after single bout of exercise. Diabetes 1987, 36:434–439.

    CAS  Article  PubMed  Google Scholar 

  37. 37.

    Burstein R, Polychronakos C, Toews CJ, et al.: Acute reversal of the enhanced insulin action in trained athletes. Association with insulin receptor changes. Diabetes 1985, 34:756–760.

    CAS  Article  PubMed  Google Scholar 

  38. 38.

    Giacca A, Groenewoud Y, Tsui E, et al.: Glucose production, utilization, and cycling in response to moderate exercise in obese subjects with type 2 diabetes and mild hyperglycemia. Diabetes 1998, 47:1763–1770.

    CAS  Article  PubMed  Google Scholar 

  39. 39.

    Appel LJ, Moore TJ, Obarzanek E, et al.: A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group. N Engl J Med 1997, 336:1117–1124.

    CAS  Article  PubMed  Google Scholar 

  40. 40.

    Svetkey LP, Simons-Morton D, Vollmer WM, et al.: Effects of dietary patterns on blood pressure: subgroup analysis of the dietary approaches to stop hypertension (DASH) randomized clinical trial. Arch Intern Med 1999, 159:285–293.

    CAS  Article  PubMed  Google Scholar 

  41. 41.

    Sacks FM, Svetkey LP, Vollmer WM, et al.: Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N Engl J Med 2001, 344:3–10.

    CAS  Article  PubMed  Google Scholar 

  42. 42.

    Appel LJ, Champagne CM, Harsha DW, et al.: Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER clinical trial. JAMA 2003, 289:2083–2093.

    Article  PubMed  Google Scholar 

  43. 43.

    • Blumenthal JA, Babyak MA, Hinderliter A, et al.: Effects of the DASH diet alone and in combination with exercise and weight loss on blood pressure and cardiovascular biomarkers in men and women with high blood pressure: the ENCORE study. Arch Intern Med 2010, 170:126–135. This paper describes the main results of the ENCORE study. In overweight and obese persons with above-normal blood pressure, the DASH diet lowered blood pressure, but the addition of exercise and weight loss resulted in even larger blood pressure reductions, greater improvements in vascular and autonomic function, and reduced left ventricular mass.

    Article  PubMed  Google Scholar 

  44. 44.

    Liese AD, Nichols M, Sun X, et al.: Adherence to the DASH diet is inversely associated with incidence of type 2 diabetes: the Insulin Resistance Atherosclerosis Study. Diabetes Care 2009, 32:1434–1436.

    Article  PubMed  Google Scholar 

  45. 45.

    Ard JD, Grambow SC, Liu D, et al.: The effect of the PREMIER interventions on insulin sensitivity. Diabetes Care 2004, 27:340–347.

    Article  PubMed  Google Scholar 

  46. 46.

    Lien LF, Brown AJ, Ard JD, et al.: Effects of PREMIER lifestyle modifications on participants with and without the metabolic syndrome. Hypertension 2007, 50:609–616.

    CAS  Article  PubMed  Google Scholar 

  47. 47.

    • Blumenthal JA, Babyak MA, Sherwood A, et al.: Effects of the Dietary Approaches to Stop Hypertension diet alone and in combination with exercise and caloric restriction on insulin sensitivity and lipids. Hypertension 2010, 55:1199–1205. In this secondary analysis of the ENCORE study, the DASH diet alone reduced blood pressure, but improvements in insulin sensitivity and lipid levels were noted only when the DASH diet was combined with caloric restriction and exercise.

    CAS  Article  PubMed  Google Scholar 

  48. 48.

    Katz A, Nambi SS, Mather K, et al.: Quantitative insulin sensitivity check index: a simple, accurate method for assessing insulin sensitivity in humans. J Clin Endocrinol Metab 2000, 85:2402–2410.

    CAS  Article  PubMed  Google Scholar 

  49. 49.

    Gutt M, Davis CL, Spitzer SB, et al.: Validation of the insulin sensitivity index (ISI(0,120)): comparison with other measures. Diabetes Res Clin Pract 2000, 47:177–184.

    CAS  Article  PubMed  Google Scholar 

  50. 50.

    Muniyappa R, Lee S, Chen H, Quon MJ: Current approaches for assessing insulin sensitivity and resistance in vivo: advantages, limitations, and appropriate usage. Am J Physiol Endocrinol Metab 2008, 294:E15–E26.

    CAS  Article  PubMed  Google Scholar 

Download references

Acknowledgment

Supported by grants from the National Heart, Lung, and Blood Institute (HL074103) and the General Clinical Research Center, National Institutes of Health (M01-RR-30).

Disclosure

No potential conflicts of interest relevant to this article were reported.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Alan L. Hinderliter.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Hinderliter, A.L., Babyak, M.A., Sherwood, A. et al. The DASH Diet and Insulin Sensitivity. Curr Hypertens Rep 13, 67–73 (2011). https://doi.org/10.1007/s11906-010-0168-5

Download citation

Keywords

  • Hypertension
  • Blood pressure
  • Diabetes
  • Insulin sensitivity
  • DASH diet
  • Exercise
  • Physical activity
  • Weight loss
  • Lifestyle modification