Introduction

High blood pressure hypertension is a chronic medical condition in which normal force of the

blood additionally pressures walls of the arteries. Additional force of blood occurs as a

consequence either of the higher blood volume or reduced arterial lumen. Both factors may be

affected by hormonal or kidney disorders, as well as numerous lifestyle factors such as stress,

obesity, lack of exercise, alcohol, smoking and diet. Considering the abovementioned, I chose to

follow Dietary Approach to Stop Hypertension DASH diet in order to structure a diet plan to

prevent hypertension, mainly because of the mechanisms behind chosen food, promoted by

DASH diet.

Sodium Intake

Two DASH Diets are available, one which limits consumption of sodium to less than 2300 mg a

day and another that limits sodium intake to 1500mg. I was indecisive which type to follow as

the research papers are controversial. Study done by Stolarz - Szkrzyp et al (2012), mentioned

that in the case of optimal kidney function, sodium is not a threat for hypertension. Despite that,

evidence in research done by Feng et al (2012) contribute to the claim that dietary sodium intake

directly increases blood pressure, regardless of the kidney function. Their study suggests the

additional reduction of sodium to 1200 mg -1600 mg (Feng et al 2012). With respect to another

study done by Frizoli et al (2011), which explains that the reason for increased blood pressure,

when considering lifestyle factors, is not necessarily sodium intake only, I decided to go for the

standard DASH diet that includes 2300 mg of sodium per day. The standard DASH diet allowed

me to have a greater choice of groceries, and helped me structure more acceptable menu.

However, none of the studies is neglecting the chemical relation which links sodium and water

retention. Positively charged sodium attracts polar water molecules, which causes water

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retention. Furthermore, retained water causes higher blood volume and thus raises the blood

pressure. According to Stolarz- Szkrzyp et al (2012), in the case of the optimal kidney function

the blood pressure is increased just temporarily. In spite of the fact that I chose the standard

DASH diet, I tried to keep the sodium intake as low as possible. On the other hand, I made an

effort to structure a tasteful menu. Therefore, I added spices like parsley, garlic and olive oil in

order to replace table salt. A mayor limitation that I found following the DASH diet is that it

does not specify the use of spices. People are most likely to use high sodium spices and if this is

left to the patient, I would stress this as a huge limitation of the diet.

Garlic itself has the ability to decrease the blood pressure over couple of well established

mechanisms. One mechanism includes anti-inflammatory abilities of garlic by modulating

cytokines in human blood. Another mechanism involves derivates of organic polysulfides which

are converted by erythrocytes into hydrogen sulfide - a powerful vasodilator (Ginter & Simko

2010). Finally, garlic has the ability to stimulate the nitric oxide generation in the endothelial

cells.

Nitric Oxide

Nitric oxide improves blood flow reducing the blood pressure by widening the blood vessels.

Lean et al (2012) recently showed that the DASH diet contributes to the bioavailability of nitric

oxide. Increased nitric oxide production may be a consequence of increased antioxidants. In the

case of high concentration of antioxidants, more nitric oxide produced would be oxidized to

nitrite rather than peroxynitrite and nitrate; this mechanism was established in study of Kojsova

et al (2006), and lately showed by Lean et al (2012). DASH diet boosts antioxidant intake as it

recommends 4-5 portions of fruits, and the same amount of vegetables a day. I included the

required amount of fresh fruits and vegetables in the diet plan, but my biggest problem

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structuring a menu plan was how to add all required fruits and vegetables in the menu and avoid

a large number of snacks. Considering the fact that my patient is not an obese person, I had a fear

that the number of meals would scare him, adding too many obligations to his diet. In addition to

that, I added fresh apple and banana in yoghurt as a part of homemade muesli. I am aware that

some people may experience bloating feeling after mixing fructose with other food (Friedman

1989). However, fruits could be eaten separately either before or at least two hours after a meal

that contains nutrients with longer digestion time.

Apart from whole grains, I added almonds to breakfast, because of the high L-arginine content.

L-arginine is a precursor of nitric oxide and therefore another contributor in lowering blood

pressure (Gokce 2004). In addition to that, I added more rich sources of L-arginine: chicken,

sunflower seeds and pumpkin seeds.

Saturated and Trans Fats

Using only lean meat, poultry and fish, the DASH diet significantly reduces saturated and trans

fats. Lower saturated and trans fats contribute to reduction in blood pressure indirectly by

reducing obesity and Low Density Lipoprotein (LDL) level. Obesity results in increased cardiac

output and blood volume which further consequently increases the blood pressure (Lavie et al

2009). Saturated and trans fats directly increase serum LDL level, which is a main contributor of

fatty plugs. Fatty plugs narrow arterial walls contributing to hypertension. On the other hand,

omega 3 fatty acids reduce blood viscosity, enhancing vasodilatation and reducing agglomeration

of thrombocites ( Iso et al 2006). I added seabass and flex seeds as rich sources of omega 3 fatty

acids and strictly avoided any sources of red or processed meat. Next to the beneficial omega 3

fatty acids seabass is also high in magnesium. Study done by Swaminanthan (2003) showed that

magnesium deficiency increases aggregation of thrombocites contributing to blood viscosity.

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Blood viscosity increases with respect to the increased amount of fibrinogen in the blood.

Fibrinogen is a strong indicator of blood coagulation. Viscous or thicker blood is more resistant

to flow and directly contributes to higher pressure of the blood against the walls of arteries (

Coban et al 2004). Study done by Azadbakth et al (2011) states that there was a reduction in

plasma fibrinogen level after implementing the DASH diet for 8 weeks. Mechanism by which

the DASH diet reduces fibrinogen is probably behind lower saturated, trans fat intake on one side

and higher Omega 3 Fatty acids and magnesium intake on the other side.

Minerals and Blood Pressure

Apart from antioxidants, fresh fruits and vegetables bring one more strong contributor in

lowering blood pressure - potassium. The abovementioned study by Lean et al (2012) observed

but did not spot the clear evidence of potassium benefits. However, a study done by Tayo et al

(2012) which has done investigation on 2704 individuals, showed a positive effect of potassium

regulating hypertension. Their study shows that potassium promotes natriuresis, excessive

excretion of sodium in the urine. Taking into account the small investigated group that was

observed in the first study, while structuring one-day menu plan I decided to go for potassium-

rich food. Taking into consideration the fact that potassium/sodium balance is important in

regulating blood pressure, another reason for adding more of potassium-rich food was a

consequence of my first decision to go for the standard DASH diet, with a higher amount of

sodium. In addition to that, I chose parsley, banana, spinach, pumpkin seeds and yoghurt.

Diary Intake

Yoghurt has multiple benefits in lowering blood pressure. Apart from mentioned potassium

content, Lactobacillus helveticus found in fermented milk has positive effect in regulating fluid

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balance (Yamamoto et al 1994). Lactobacillus helveticus inhibits Angiotensin Converting

Enzyme (ACE). ACE has a pivotal role in Renin- Angiotensin system (RAS), hormonal system

that regulates fluid balance and therefore blood pressure. Angiotensin I is able to be converted to

Angiotensin II; this conversion occurs in the liver only in the presence of ACE. Angiotensin II is

a strong vasoconstrictor and it affects the release of Aldosterone. Aldosterone further increases

absorption of sodium and water, which leads to increased blood volume and thus blood pressure.

Not just yoghurt but other diary proteins are also beneficial in lowering blood pressure, due to

the opioid-like effect on the arteries. The DASH diet recommends 2-3 portions of low fat or non

fat diary daily. Considering all, I decided to go for three servings of diary per day.

Conclusion

Dietary Approach to Stop Hypertension is a powerful method in regulating the blood pressure.

gruba dijeta je sasvim ok I bez ikakve specifikacije svakako ce na osnovu navedenog smanjiti
pritisak, ali detalje dalja precoznost u smislu zacina tipa voca I povrca mislim da bi jos uvecala
efikasnost,.

Considering the fact that lifestyle has a great impact on reduction of blood pressure, the number

of recent researches urges medical professionals to promote lifestyle change rather than

medications when preventing or curing hypertension in its early stages.