Keto vs. DASH: Which Diet Really Works Best for High Blood Pressure and Diabetes?

You've got high blood pressure, prediabetes or diabetes, and extra weight. Your doctor hands you a pamphlet about the DASH diet: lots of fruits, veggies, whole grains, not much meat and low-fat foods. It's the standard advice. But what if there's a better option sitting right under our noses?

A head-to-head trial just put two popular diets to the test, and the results should make doctors take notice. For people juggling the triple threat of hypertension, blood sugar issues, and excess weight, one approach clearly came out ahead.

The Diet Debate Doctors Are Having

Here's the dilemma: When you're dealing with high blood pressure, diabetes risk, and weight issues all at once, which diet gives you the best shot at improvement?

For years, the DASH diet has been the gold standard recommendation from major medical organizations. It emphasizes produce, whole grains, and lean proteins while limiting fat and sodium. And it works—studies consistently show it helps lower blood pressure.

But there's another contender: the very low-carbohydrate (VLC) or "keto" diet. This approach flips the script: very few carbs (20-35 grams daily), moderate protein, and higher fat. Research shows it can drop blood pressure and improve blood sugar control, and diabetes organizations now list it as an option for managing the disease.

The problem? Until now, no one had directly compared these two diets in people who actually have all three conditions at once. That just changed.

What This Head-to-Head Study Found

Researchers in Michigan recruited 94 adults with hypertension, prediabetes or type 2 diabetes, and overweight or obesity. They randomly assigned participants to follow either a very low-carb diet or the DASH diet for 4 months, providing online support, coaching, recipes, and guidance. The results were striking:

Blood pressure improvements were substantially better on keto. Systolic blood pressure (the top number) dropped by an average of 10 points on the very low-carb diet versus 5 points on DASH, a significant difference that could meaningfully reduce heart disease and stroke risk.

Blood sugar control improved more with keto. Hemoglobin A1c or just commonly called HBA1c (a 3-month average of blood sugar levels) decreased by 0.35% on the low-carb diet compared to just 0.14% on DASH. That might sound small, but in diabetes management, every tenth of a percent matters.

Weight loss was nearly double on keto. Participants following the very low-carb approach lost an average of 19 pounds versus 10 pounds on DASH over the same 4-month period.

Medication reductions were more common with keto. Among those on blood pressure medications at the start, 31-44% of the low-carb groups reduced or stopped their meds, compared to just 5-13% in the DASH groups. For diabetes medications, 40-75% of low-carb participants reduced or stopped their meds, while none of the DASH participants did.

Both diets led to improvements, this isn't about one being "bad." But the very low-carb approach produced meaningfully better results across the board for this high-risk group.

What This Means for You (and Your Doctor)

If you're managing this triple combination of health issues, these findings suggest it's time for an honest conversation with your doctor about whether a very low-carb approach might work better for you than the standard recommendations.

Talk to your doctor before making changes. This is especially critical if you're on blood pressure or diabetes medications. As this study showed, your medication needs may decrease quickly on a low-carb diet, and you'll need medical supervision to adjust doses safely and avoid dangerous drops in blood pressure or blood sugar. Give yourself a chance and have that conversation with you doctor, show him this study if they still hesitate.

Consider whether you can realistically follow a very low-carb diet. In this study, 64-79% of participants stuck to their assigned diet, which is actually quite good. But keto requires significant changes: cutting out bread (yeah I know, this one is the hardest!), pasta, rice, potatoes, most fruits, and sugar. Ask yourself: Can I do this long-term? The best diet is one you'll actually follow.

Start with whole foods either way. Whether you choose low-carb or DASH, both emphasize whole, minimally processed foods. That foundation—cooking at home, eating vegetables, choosing quality proteins—matters more than getting caught up in which approach is theoretically "best."

Monitor your response. Track your blood pressure at home, watch your blood sugar if you're diabetic, and pay attention to how you feel. Some people thrive on low-carb; others struggle with energy or find it too restrictive. Your individual response matters more than group averages.

Give it time but not forever. This study lasted 4 months. That's enough time to see real changes but not so long that you're locked into something that's not working. Commit fully for 3-4 months, then reassess with your doctor.

A Note to Healthcare Providers

The medical community needs to catch up with the evidence. While some physicians have embraced low-carbohydrate approaches for diabetes and metabolic health, many remain skeptical or unaware of the research.

This study joins a growing body of evidence showing that very low-carb diets can be safe and effective, potentially more effective than current standard-of-care recommendations for patients with this specific cluster of conditions. The results suggest we should be offering low-carb approaches as a first-line option alongside DASH, not as an alternative therapy or last resort.

Your Action Plan

• Schedule a medication review if you're considering going low-carb. Your doctor needs to know upfront so they can monitor and adjust your prescriptions as needed. Dont' wait, you deserve to feel better.

• Choose the approach that fits your life. Low-carb can produce faster, more dramatic results, but DASH is easier for some people to maintain long-term and still produces real benefits.

• Get support. Both approaches work better with guidance. Whether that's a dietitian, a diabetes educator, an online program, or a supportive community, don't go it alone.

• Track your progress. Measure your blood pressure at home regularly, monitor your weight weekly, and get your A1c checked every 3 months if you have diabetes.

The science is clear: for people dealing with the dangerous combination of high blood pressure, diabetes, and excess weight, a very low-carbohydrate diet may offer advantages over the current standard recommendation. It's time for both patients and doctors to take this option seriously.

Managing multiple metabolic conditions can feel overwhelming. Let's create a personalised nutrition plan that actually works for your health goals and lifestyle—whether that's low-carb, DASH, or something in between.

Schedule your consultation today.