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Diet PK: The Mediterranean diet wins the championship, but the ketogenic diet is at the bottom

May 31, 2023

Whether you're trying to lose weight or you're living with a chronic medical condition like diabetes or heart disease, healthy meal choices are crucial.

In January 2018, "U.S. News & World Report" determined the annual best diet ranking by analyzing and selecting 40 different diets, aiming to help people in different health states choose a suitable diet according to their needs.

By referring to government reports, research papers published in major medical journals and other documents, the journal supplemented and perfected the list of candidates, and comprehensively analyzed the health outcomes of each diet.

25 experts with international influence were invited to rate different diets. They come from research fields such as nutrition, food psychology, obesity, diabetes and heart disease, and they rank eating styles according to the following criteria:

1. Is it easy to follow

2. Whether the nutrition is comprehensive

3. Is it safe and effective to lose weight

4. Whether it can prevent and control diabetes or heart disease

In order to ensure objectivity and impartiality, the invited experts made independent evaluations without interference from each other, and avoided dietary patterns with interests. The final ranking results are based on the evaluation opinions of all experts.

The rankings identify the best diets for diabetes, the best diets for heart health, the best diets for vegetarians, the best diets for fast or slow weight loss, and more. By combining the above scores, the best comprehensive diet of the year was determined: the Mediterranean diet and the Deshu diet (or diet to control high blood pressure).

It is worth mentioning that the "ketogenic diet", which is highly respected by some people in the weight loss industry, is at the bottom of the comprehensive ranking.

03) Mediterranean diet (Mediterranean diet)

On January 4, U.S. News & World Report released its list of the best diets for 2022. The top spot is still the "Mediterranean Diet", which is the fifth consecutive year that the Mediterranean Diet has topped the list of the best diets in the world.

The Mediterranean diet reflects the traditional way of eating in the countries surrounding the Mediterranean Sea. Greeks, Italians, French and Spanish eat differently, but share many common preferences.

►Mediterranean Diet Pattern Chart. Image source: (mijian360.com)

As can be seen from the figure above, the core foods of the Mediterranean diet are whole grains, vegetables, fruits, beans, herbs, spices, nuts, and healthy fats (such as olive oil), and it is recommended to eat fish and seafood at least twice a week, and consume a moderate amount of milk. Products (especially fermented milks such as yogurt and traditional cheese), eggs and poultry, and less red meat and sweets. Common drinks are water and red wine.

In addition, the Mediterranean diet also attaches great importance to moderate exercise and active social activities, and advocates sharing food with relatives and friends. This part of the content is located at the bottom of the diet pagoda and is an important part of a healthy lifestyle.

The Mediterranean diet was also rated as the easiest diet to follow because it has no restrictions on specific foods. In addition, it was the best plant-based diet, the best diabetes diet, and the second best heart-healthy diet, behind the DASH diet. More and more studies have shown that the Mediterranean diet is beneficial for the prevention and control of cardiovascular and cerebrovascular health, cancer and diabetes. Some people worry that the fat in olive oil, avocado and cheese in the Mediterranean diet is not conducive to weight loss. The Mediterranean dietary pattern has been shown to be beneficial for weight management.

In a five-year trial project published in The Lancet Diabetes and Endocrinology in 2016, 7,447 adults with type 2 diabetes or at risk of cardiovascular disease were divided into three groups, using a Mediterranean diet plus Olive oil (approximately 1 liter per week), a Mediterranean diet plus nuts (30 grams per day), and a control group on a low-fat diet. The results showed that the Mediterranean diet group had the least increase in waist circumference, and the Mediterranean diet plus olive oil group had the best weight loss effect.

02) DASH Diet

►Deshu eating pattern. Image source: http://ohiohealth.com

The DASH diet has been rated as the best comprehensive diet for 8 consecutive years before the Mediterranean diet. It was developed as part of a large hypertension program at the National Institutes of Health to maintain healthy blood pressure. The focus of this diet is to control sodium intake, not exceeding 2300 mg per day, preferably around 1500 mg (about half a teaspoon). Control or lower blood pressure effectively by consuming whole grains and vegetables rich in dietary fiber, calcium, protein and potassium. This diet advocates eating less high-fat, high-calorie desserts and red meat, and is also beneficial to the prevention and treatment of cardiovascular and cerebrovascular diseases and diabetes.

The DASH diet does not require cutting or extreme control of other foods, and it is simple and easy to follow. In the DASH diet guide, there are detailed calorie intake guidance for people of different ages and different levels of exercise. For example, a 2,000-calorie diet includes 6 to 8 servings of grains (1 serving equals 1 ounce, about 28 grams), 4 to 5 servings of fruits and vegetables, and 2 to 3 servings of fat-free or low-fat dairy products per day. Fewer than 6 servings of lean meat, poultry and fish, 2 to 3 servings of fat; 4 to 5 servings of nuts, seeds and legumes, and less than 5 servings of sugar per week.

Although the purpose of the DASH diet is not to lose weight, it also has excellent performance in weight control.

In a 2006 study published in the Annals of Internal Medicine, 810 adults with borderline or mild hypertension were randomized into three groups. The first group changed their lifestyle according to the recommendations of conventional blood pressure control. The second group controlled the daily sodium intake below 2300 mg, while losing weight, exercising and limiting alcohol. Follow the DASH Diet Guidelines. After 18 months, the second group lost an average of 8 pounds, the third group lost 9.5 pounds, and the first group lost the least amount of weight.

It is worth mentioning that the survey shows that the salt intake of Chinese residents has declined in recent years, but it is still generally high, with an average of about twice the amount recommended by the guidelines. Today, office workers tend to eat fast food outside, making salt intake even more uncontrollable. For children, if they often eat fast food or processed snacks, their salt intake will seriously exceed the standard and increase the metabolic burden.

03) Ketogenic diet

►Ketogenic diet pattern. Image source: What is the ketogenic diet and what to eat on a ketogenic diet? - Zhihu (zhihu.com)

The ketogenic diet, which has been quite popular in recent years, has not been recognized. The ketogenic diet ranked last in the overall ranking this year and was rated as the most unhealthy diet.

The ketogenic diet is characterized by a very low intake of carbohydrates (starches, sugars, etc.) and a very high (70% of total calories) fat, thereby forcing the body to burn fat. As can be seen from the diet pattern diagram, staple foods such as pasta, rice, corn, and beans are all banned. Since there is almost no carbohydrate intake, fat becomes the main energy source for the body, and its metabolism breaks down to generate a large amount of ketone bodies. This is how the ketogenic diet got its name.

In 2016, the report "Healthy Diet Guidance and Weight Loss Recommendations" released by the British non-profit organization Public Health Collaboration pointed out that a high-fat and low-carbohydrate diet is very effective for weight loss and blood sugar control. In 2017, a small study published in Nutrition and Metabolism showed that a six-week ketogenic diet did not affect fitness performance in 42 healthy adults participating in fitness training. Lost 4.4 lbs. For similar reasons, the ketogenic diet has become popular in recent years and has been favored by people who lose weight.

The ketogenic diet may be able to quickly lose weight in a short period of time, but it is not suitable for long-term adherence, and the weight is easy to rebound. Unlike the Mediterranean and DAZO diets, the ketogenic diet has fewer health studies and insufficient evidence to support the long-term health benefits of this diet.

What is certain is that many nutritionists believe that the extreme dietary pattern of high fat and low carbon (or no carbon) does more harm than good. It is not conducive to the prevention and control of heart disease, and it is also very dangerous for people with liver and kidney diseases. For diabetic patients, blood sugar is only a criterion for evaluating the condition, and how to reduce the incidence of long-term complications and mortality is the most important thing.


1. Best Diets. Usnews.

2. 'Best diets' ranking puts keto last, DASH first. By Sandee LaMotte. CNN.

3. From Vegan To 'Keto' And Mediterranean: Experts Rank 2018's Best Diets. By Allison Aubrey. NPR.

4.Best Diets of 2018: Déjà vu All Over Again? By David L. Katz

5. Ketosis in Perspective: Thinking Twice About the Keto Diet Fad. http://Citizenjournal.net

6. http://www.sciencemag.org/news/201

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