COMMENTARY

The Best Antihypertensive Nutritional Advice

Henry R. Black, MD; Lawrence J. Appel, MD, MPH

Disclosures

July 24, 2013

In This Article

Does the DASH Diet Require Supplements?

Dr. Black: Do you need to supplement this diet at all?

Dr. Appel: No. I could speak about that for about an hour. Our culture is very pill-oriented. People think that they need to take pills for nutrients and they have built on the premise that more is better when it comes to supplements, but the data on supplements are actually very weak. An interesting thing about the DASH diet, which happened by accident, is that it meets all the nutrient requirements that have been set across the whole spectrum. People who follow the DASH diet would have a complete diet and not have to worry about a single nutrient. For those who fall short, there are certain nutrients that might appear to be a shortfall. Certain nutrients like potassium would be better consumed in higher amounts, but then there are other nutrients, like vitamin E, for which we didn't find any obvious deficiencies in our hypertensive patients or the general population.

Dr. Black: So, when those supplements have been put to the test in a clinical trial, they tended to fail. They don't help and they don't prevent anything, which is disappointing, but it's very important that whatever people recommend ought to go through that process before we accept it.

Dr. Appel: What is interesting about studies on diet and health is that it's pretty easy to do supplement-type trials. They are very inexpensive to do. We have large numbers of trials of vitamin E, and you're right on target. They have not shown any benefit, and I think in high doses there is a signal of harm. That surprised people. It's not just vitamin E but also beta carotene, which in high doses seemed to be harmful. You could make a case that we evolved while not taking mega doses of almost any nutrient, and to take 400 IU or more of vitamin E is something that our bodies have never encountered before.

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