The increasing prevalence of diabetes/prediabetes, hypertension, and obesity among American adults is becoming alarming, and the majority of those who suffer from one of these conditions also suffer from two or all three. And while the general consensus among physicians and researchers is that diet and lifestyle changes should be among the frontline treatments for these conditions, opinions differ on the effectiveness of specific regimens.
Since its inception in 1997, the DASH diet (Dietary Approaches to Stop Hypertension) has been the go-to eating plan for people with hypertension. Over the years, it has also shown promise in controlling blood sugar and promoting weight loss, and thus has been recommended to patients dealing with diabetes and obesity, as well.
That may be changing, however, as a new study published in May in The Annals of Family Medicine showed that a ketogenic (very low-carbohydrate) diet demonstrated greater improvements in systolic blood pressure, glycemic control, and weight management than a DASH diet in adults who were overweight or obese and also had hypertension and diabetes.
To test the merits of a ketogenic diet against the DASH diet, a team of researchers from the University of Michigan recruited 94 overweight or obese adults who also had hypertension and prediabetes or type 2 diabetes. Participants were divided into four groups: keto diet with extra support (cooking education, mindful eating, social support, etc.), keto diet without extra support, DASH diet with extra support, and DASH diet without extra support, and followed for a period of four months.
After the trial period ended, the researchers found that the keto diet led to greater improvement in estimated mean systolic blood pressure, greater improvement in glycosylated hemoglobin, and greater improvement in weight, compared to the DASH diet. The addition of extra support did not have a statistically significant effect on outcomes.
While noting the small sample size and other limitations of their study, the Michigan researchers also pointed out its implications for future research.
“In this study,” they wrote in their conclusion, “we found that for adults with overweight or obesity, hypertension, and prediabetes or type 2 diabetes, a [keto] diet showed greater improvements in [systolic blood pressure], glycemic control, and weight over a 4-month period compared with a DASH diet, although both dietary approaches improved outcomes. To our knowledge, this is the first trial to compare these 2 dietary patterns in a population of adults with this high-risk set of metabolic conditions.
“These results provide initial evidence that a [keto] dietary pattern might be more appropriate than the DASH dietary pattern for short-term disease management for these high-risk adults, and thus might have implications for clinical practice guidelines. Future research with larger samples, longer follow-up periods, and long-term outcomes is warranted.”