Be savvy in your interpretation of the “Best Diets Rankings for 2018” to avoid some serious pitfalls. Read on to find out how.
What are the Best Diets Rankings for 2018?
At the start of 2018, US News released their widely-publicized Best Diets Rankings for 2018. Put together by a prestigious panel, the results nevertheless leave us concerned about this guidance that will likely be followed by unsuspecting readers.
The rankings categorize Best Overall Diets, as well as their top diets in different categories including Best Weight-Loss, Best Diets for Healthy Eating, Best Diets for Diabetes, Best Heart-Healthy Diets and others. One important thing the US News editorial is getting right, is that there is “no single diet (that) is the best for all of us.” We absolutely agree with this idea.
In our quest to help others be more informed and savvy consumers of health information, here are our two most important reasons for caution in interpreting the Best Diet Rankings at face value.
#1 Missing Component: Food Quality
Food quality is foundationally important for any diet. And that doesn’t just mean organic, which we do recommend, even knowing that not all sections of the population can either afford or have access to organic foods (hopefully that will continue to improve!). It also means limiting or avoiding processed food additives, and choosing non-GMO foods (since GMO foods can have higher levels of carcinogenic pesticides, or built-in pesticides).
These factors aren’t considered in the Best Diets methodology; healthy eating criteria are limited to nutritional completeness and safety.
Concerning examples of how this appears in the results include the number one ranked diet for “Fast Weight-Loss”, the Health Management Resources (HMR) Diet, owned by a subsidiary of Merck. Never mind that fast weight loss isn’t typically recommended, and should be implemented very cautiously (excess toxin release from fat cells and thyroid strain are some of the potential issues there). The HMR pre-made shakes are described as ‘the cornerstone’ of the program, yet a quick scan of their ingredients raises some flags: fructose (a type of sugar linked with fatty liver in excess), sugar, maltodextrin (more sugar), aspartame, corn syrup solids (more sugar), and artificial flavors, to name a few. One serving contains 14 grams of sugar (that’s 3.5 teaspoons, close to the content of some candy bars!). Read/listen to why simple carbohydrates and sugars are the principle driver of metabolic disorders here. Aspartame has been linked in humans to headache, kidney damage, arterial plaque formation and systemic inflammation – not factors on the radar of the expert panel.
Yet we DO want our experts to be considering all the potential benefits and side effects of any particular diet.
Ingredients in HMR 120 Vanilla Shake
#2 Missing Component: Therapeutic vs Maintenance Phase Diets
The second major factor that isn’t acknowledged in these rankings is therapeutic versus maintenance dietary needs, especially when working to address a chronic condition. This is really an important distinction, and sets a different scene when using dietary interventions clinically. Oftentimes, we’re using a more intensive, course-corrective intervention at the early stage of our work with patients, keeping in mind a timeframe for transition onto a more relaxed, still individualized, maintenance plan.
Take Type 2 diabetes, for instance. In our experience, truly turning around Type 2 diabetes often requires more than the Mediterranean, DASH or vegan diet that top the lists for this condition in the US News rankings. Carbohydrate intolerance, characteristic of the disease, means that the carbohydrate ‘lever’ is a far more powerful tool, especially as an early-stage intervention. Adopting a low carbohydrate diet, such as Paleo, is much more effective in our experience. If clinical need dictates, dialing that up further, into a (closely supervised) ketogenic diet, is also a short-to-medium-term intervention we consider. Other benefits seen by dialing down carbohydrates are reduced fasting insulin and triglyceride levels, and improved HDL levels.
Speaking of ketogenic diets, they get a particularly bad rap in these rankings, coming in #39 out of the 40 diets assessed. Nutrient insufficiency, excess fat intake and too little carbohydrate are noted as reasons for concern. Do we still consider ketogenic diets to be useful in our practice? Unequivocally yes.
In fact, the expert panel seems to agree, despite the ranking, when you look more closely at their write-up. It acknowledges that:
- “Low-carb diets were associated with significantly greater weight reduction and significantly lower predicted risk of heart disease tied to hardening of the arteries, compared with low-fat diets, according to the study published October 2015 in the journal PLoS One” and
- “The Public Health Collaboration report includes findings from a British researcher, who used a LCHF (low carbohydrate, high fat) diet with patients who have Type 2 diabetes, showing “dramatic” health improvements and cost savings on diabetes drugs that were no longer needed.”*
*We do not recommend discontinuing any medication unless approved and closely monitored by your prescribing physician.
That said, we consider a ketogenic diet a medical intervention, requiring assessment for suitability, close monitoring (including with labwork), and knowing when to end the diet. Supplementation is usually needed because it isn’t easy to make up all nutrient requirements under the restrictions of the diet.
Food quality also plays a big role in successful implementation of a ketogenic diet. Take these two daily food logs below, for example. Both meet the requirements for a low carbohydrate, high fat diet, but the second is significantly more dense in micronutrients, phytonutrients, and healthy fats. It also avoids poor quality foods and food additives. Choosing appropriate fat types on a ketogenic diet makes a significant difference in the impact of the diet on total and LDL cholesterol. Working with a nutritionist can help tremendously here.
Two different versions of a ketogenic diet, one healthier than the other:
Source: data entered into Cronometer
To find out more about the history of ketogenic diets, and potential benefits, we recommend these articles:
- A little bit of a history and a few thoughts on the ketogenic diet
- Alzheimer’s disease:
- Metabolic disease:
Let us know what you think below? Have you had success with any of these diets? What do you think about the US News’ Best Diets Rankings – helpful or harmful?