03 Nov 2023 — Practicing mindfulness focused on healthy eating helped study participants with elevated blood pressure adhere better to the Dietary Approaches to Stop Hypertension (DASH) diet. Though this diet is known to lower blood pressure, adherence is typically low. 

During an eight-week program, 201 participants were divided into a “usual care” control group and a test group, where people followed a mindfulness-based blood pressure reduction program. This program included personalized feedback and education on hypertension risk factors, mindfulness training related to hypertension risk factors such as mindful eating and behavior change support. 

The control group received educational brochures on controlling high blood pressure. Moreover, both groups received training on using a home blood-pressure monitoring device provided during the study and options for referral to primary care physicians. 

“Participants in the program showed significant improvement in adherence to a heart-healthy diet, which is one of the biggest drivers of blood pressure, as well as significant improvements in self-awareness, which appears to influence healthy eating habits,” says lead study author Eric B. Loucks, an associate professor of epidemiology, behavioral and social sciences and director of the Mindfulness Center at Brown University, US.

“Improvements in our self-awareness, of how different foods make us feel, of how our body feels in general, as well as our thoughts, emotions and physical sensations around eating healthy as well as unhealthy food, can influence people’s dietary choices.” 

Heart-healthy diet 
The program focused on adherence to the DASH diet — rich in fruits, vegetables, whole grains and low-fat dairy. 

For the study, published in JAMA Network Open, the researchers followed both groups for six months after completing the mindfulness and control programs. The mindfulness group showed a 0.34-point improvement in adhering to the DASH diet. 

The DASH diet is rich in fruits, vegetables, whole grains and low-fat dairy.Loucks explains that this change can be interpreted as participants increasing their vegetable intake to recommended levels — from two to three servings to at least four per day — or making similar shifts across another component of the score. 

Meanwhile, the control group showed a -0.04-point change after the study period. 

“The program gives participants the tools to make heart-healthy diet changes that can lower their blood pressure and decrease their risk of cardiovascular disease,” he adds. 

Mindful eating 
Loucks underscores ample research supporting effective strategies to control and prevent hypertension. Scientific studies increasingly consider “food as medicine” to treat or prevent diet-related diseases. At the same time, recent research identified fruits, vegetables, legumes, nuts, fish and whole-fat dairy products as “protective foods.” 

“Almost everyone has the power to control blood pressure through changes in diet and physical activity, adherence to antihypertensive medications, minimizing alcohol intake and monitoring stress reactivity,” asserts Loucks.

While the control group also showed an improvement in the average interoceptive awareness — the process of sensing and interpreting signals from one’s own body — this improved more strongly among participants of the mindfulness group. 

Self-awareness levels and adherence to the DASH diet were assessed in different questionnaires. Moreover, focus groups and in-depth interviews with participants in the mindfulness program suggest that self-awareness was the most important mechanism of action. 

In the mindfulness program developed by Loucks, participants received training in meditation, yoga, self-awareness, attention control and emotion regulation. Moreover, the participants learned how to direct those skills toward behaviors known to lower blood pressure. 

The program consisted of a group orientation session, eight 2.5-hour weekly group sessions and a one-day-long retreat, as well as recommended mindfulness home practice for 45 minutes, six days a week. 

The researchers suggest mindfulness training improves self-awareness, attention control and emotion regulation.Reducing blood pressure 
The authors emphasize that the trial results indicate that an adapted mindfulness training program for participants with high blood pressure targeting diet and self-awareness significantly improves both.

They propose a theoretical framework for how mindfulness training could influence dietary patterns based on self-awareness, attention control and emotion regulation. 

Self-awareness is essential in dietary behaviors through “noticing hunger and satiety, noticing how different food types make one feel and being aware of eating behaviors, including habits and reward-based learning.”

Moreover, the authors explain that attention control can be applied by attending to the sensory properties of food, making conscious choices for healthy eating patterns and shopping for specific, health-promoting foods. 

They add that emotion regulation can help to decrease reactivity to cravings, improve self-kindness and compassion for body and mind and lower psychological distress, which can undermine treatment adherence. 

Further studies are critical to widen the base of participants, increase follow-up time to determine how long the effects last and evaluate which program components were most important to improve diet and self-awareness. 

The research team is studying different versions of the program, such as shorter lengths and fewer sessions, and factors influencing the program’s implementation — for example, eligibility for health insurance coverage, accessibility for different patient groups and flexibility for physicians. 

By Jolanda van Hal

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