every year US News publishes a ranking of the best diets. there are winners, there are losers and of
course there are online fights. it's kind of like the Oscars but for food nerds. the 2021 edition
recently came out so let's see who got the glory and who got snubbed. and there were some vicious
snubs. now, we might say "it's a magazine ranking, who cares" but this is not decided by editors and
journalists, they have a panel of scientists vote. harvard and stanford professors, some of these
people are internationally respected nutrition scientists. of course that doesn't mean we have
to agree with them but this is not the diet advice on your typical checkout aisle magazine
it does have scientific substance. now, just like the Oscars they have different categories but
unlike the Oscars we're not gonna milk this for three hours, we're gonna go straight for the juice
the main category: best diets overall. and here are the top three. numbers two and three were basically
a tie between DASH and flexitarian. DASH stands for dietary approaches to stop hypertension and
as the name indicates it's focused on improving blood pressure so it's low in sodium and high
in potassium. it emphasizes fruits, vegetables, whole grains, lean meats and low-fat dairy and conversely
it's low in fatty meats, full fat dairy and added sugar. and flaxitarian means flexible vegetarian
it's basically a diet moderate in meat, the idea is to be plant-centered but then be able to eat
a burger once in a while if that craving hits. and the number one pick for best diet overall was the
mediterranean diet. there are many variants of mediterranean diets but the common themes
are produce, nuts, olive oil and some dairy and lean meats and low in red meat and added sugar
the mediterranean diet was also number one in the categories best heart-healthy diets,
best diabetes diets, best plant-based diets, best healthy eating and easiest diets to
follow. alright, we get it, scientists love the mediterranean diet. why do they rank it so high?
three main reasons. the first one is that there's a lot of research on it, both observational and large
clinical trials. the lyon heart study had over 400 subjects and lasted around four years and PREDIMED
had over 7 000 people and lasted almost five years. these are massive randomized trials. there's some
controversy surrounding PREDIMED but both of those studies showed pretty impressive results
lowering cardiovascular risk. another diet that's often brought up when it comes to cardiovascular
benefits is the Ornish diet, and in fact they ranked it at the top for heart health tied with
mediterranean, although we have to remember the Ornish trials included other lifestyle changes
so we can't attribute the results to the diet alone and they did note that in the rankings
the second reason the mediterranean diet is popular with scientists is population data
for general dietary recommendations you want to know that a diet is sustainable long term,
for a lifetime, even generations. of course that's a very high bar. historically, an entire geographical
region ate variations of the mediterranean diet and population data show good health outcomes in
general. this is very different from running a rigorous randomized controlled trial but
it gives us some added confidence. and the third criterion they value is practicality
how easy is the diet for the average person to start and maintain. is there a social structure
supporting it? these things matter for populations. if a diet is really good health-wise when done
perfectly but people have a hard time sticking with it, that's not a good default for a large
population. other diets that also made the top 10 include the MIND diet which focuses
on preventing cognitive decline and alzheimer's, the nordic diet which is kind of a pescetarian-ish
diet, the Ornish diet and vegetarian. so now that we know what they put on top let's look at the
only thing people want to know: how did vegan and keto rank? first let me prepare you a little bit
because the news ain't good. yep, they got snubbed. bad! vegan was number 17 in the overall category
and keto was number 37. the only diet that ranked below keto was the dukan diet. whatever that is. so
how is this possible? how can arguably the two most popular diets online be ranked so low? it
might be tempting to just brush it all aside. "ah the panel's just biased" or "they're all clueless"
but i don't think that's a productive mindset. this isn't one random guy, it's 24 people from different
universities, different organizations, several are top scientists that have worked in nutrition
at the highest level their entire careers. in fact, the USDA recommendations, which we looked
at recently, are pretty similar to this so this is representative of expert opinion in nutrition. but
this raises a crucial question: why is there such a massive disconnect between nutrition professionals
and the public? online people are fighting over keto and vegan, experts recommend mediterranean and
most of the population are doing none of the above. most people in our society are on the so-called
seefood diet, they see food and they eat it. clearly we got a problem. the whole point of this channel
is to bridge science and the real world of people just going about their lives trying to be healthy
most people are rarely exposed to science, they see headlines written by journalists, they hear
advice from health gurus but they don't hear from the scientists directly and those messages
they get through intermediaries are often very warped so the result is confusion and distrust
there's a general sentiment that expert advice doesn't work so just ignore the out of touch
nerds and let's do what works for us. but of course we all have the same goals. most doctors, nutrition
scientists, you and me, we all just want to be healthy. so let's see if we can make sense of
the different approaches and opinions. they did rank keto in the top five for fast weight loss
and they ranked vegan in the top five for weight loss, for diabetes and for heart health so it's
not like they're anti-keto or anti-vegan, period. the main reason they downscored those two diets
is the ease factor. they consider them restrictive and hard to follow. of course ease is relative,
some of you are jumping out of your seats saying vegan or keto are super easy for you to follow, and
i also find it pretty doable to make changes and stick with them, but a lot of people are not like
that, they have enormous difficulty changing habits and the farther away from what they're used to, the
harder, so the panel is trying to bear that in mind. now, maybe scientists should just tell us the data.
just tell us what the healthiest diet is and let us make the choice, let us worry about whether we
find it easy or hard. i'm sympathetic to that view, that's what we try to do here. the panel
was also concerned about nutrient completeness. not that keto or vegan necessarily make you
nutrient deficient, they don't, but they require attention to specifics. for example if you're
vegan you obviously need to know about b12 but most people have never heard of it so it's not
an absolute obstacle but it requires education and attention to avoid problems. the other key factor
explaining differences of opinion is speed. people love things that work fast. try to sell a diet that
guarantees health in 20 years. good luck. scientists like short-term results but they also want to see
long-term outcomes. there is some long-term data on vegan diets, for example the seven-day adventists
in california show good outcomes, although it's a pretty healthy population overall, they don't
drink much, they don't smoke, so we have to take all of that into consideration. coincidentally, a study
just came out pitting a vegan and mediterranean diet against each other. people on the vegan diet
ate less calories, lost more weight and had some metabolic improvements. of course there's been some
controversy, we were discussing this last night on twitter, i might make a separate video on that
study, but it's an example of how tricky these head-to-head comparisons can be. it all hinges
on how each diet is designed. lastly, the choice of vegan diet is often linked with environment
and animal welfare but this ranking only looked at health. now, as for keto the main claim to fame
is fast weight loss and the panel recognized that, keto ranked very well in that category. and weight
loss is a good thing especially in our society. what scientists are a bit more wary about is
what happens after five or ten years on keto. we don't really know, we don't really have those data
i'm sure we'll have them eventually and i'm very curious to see. now, to me it felt a bit unfair to
put keto at the bottom like they did. i think we tend to associate keto with the extreme version
bacon and lard and butter in your coffee. and yeah, most nutrition scientists are not going to get
behind that. in fact, they ranked keto number 34 for heart health, close to the bottom, so i think it's
that high saturated fat, low fiber version they have in mind. but keto just means ketogenic, it's
very low carbohydrate so we go into ketosis. high saturated fat is not a requirement. we even have
published examples of low-carb diets designed to be low in saturated fat and they actually improved
cardiovascular markers. so if we're going to rank keto based on an unhealthy version just because
it's common, then we got to rank the junk vegan version because that's what a lot of vegans do
and we gotta rank mediterranean with a bunch of junk foods because that's how most
mediterranean people eat nowadays. we have to decide if we're ranking ideal versions of the
diets or popular versions, we can't compare the perfect mediterranean diet to the version of keto
that happens to be viral, that doesn't seem fair. so although we don't really know what happens long
term with keto, i suspect it can be done in a safer way than that extreme version we tend to associate
it with. i also wonder if the low rankings for keto are a reaction of the scientific community
to the online hype and the predatorial gurus. maybe it's the scientists trying to communicate to the
public to be cautious, although in my opinion there's a better way to do that: explain the risks
and the uncertainties and talk about how to do it safer. all of that said, i suspect the keto camp
is not too worried that the academics are not on board. as i was going through the rankings, they
put keto at the bottom but all the ads throughout are for keto companies. maybe keto isn't getting
the critical claim but it's crushing it at the box office! man, i'm really stretching that Oscar
analogy. the other thing that's a bit confusing: this ranking structure suggests the diets were all
compared side by side and we do have some studies like that, we just looked at an example of vegan
and mediterranean diet compared, but most data isn't structured like that. what happens to a
population after 10 years of mediterranean versus vegan versus keto? we don't really know. it's very
difficult to do that. we can kind of piece together the different shreds of information but it's not
like we did this massive trial for decades and we got this perfect black and white answer at the end
that everybody agrees with. so what these rankings and expert recommendations reflect is not so
much that the mediterranean diet is better than everything else but that it's a pretty good bet
based on the different types of evidence behind it, including long-term, and that it's pretty doable
at a population scale. it's an educated guesstimate. but of course there's plenty of room for
personalization. even if the mediterranean diet is the safest bet for population-wide recommendations
that doesn't necessarily mean it's the best diet for every single human. more on that in a second
now, if at this point you're thinking "ah these rankings are a bit silly", i don't disagree with you
in fact, the funniest thing to me is that when we step back, these diets on the ranking, they all look
the same. here's the mediterranean diet. here's DASH. do you see a huge difference? DASH is basically
mediterranean without salt. and the MIND diet is a mix of mediterranean and dash. in fact the M in
MIND stands for "mediterranean dash". separated by a dash just to make it extra confusing and annoying
and if you go to dashdiet.org they have a dash mediterranean version and a dash vegetarian. are
you confused yet? call me crazy but instead of all these labels we can barely tell apart
i find it easier to just know which foods to focus on and which foods to eat more sparingly
i don't have a name for my diet, i don't call it anything, it's just food. so when we brush aside
the bells and whistles and the branding, the key here are the commonalities. all top diets are rich
in plant foods. plant rich diets dominate these rankings. all top diets avoid ultra processed foods
all top diets avoid an excess of saturated fat and added sugar. which diet is the best?
any diet that's rich in unprocessed plant foods. if you have high blood pressure issues, go easy
on the salt. if you like olive oil, have some. if you prefer no oil, don't eat it. if a lower carb
or lower fat pattern works better for you, do that. if you prefer no animal products, leave them out
if you want to have a little bit of fish or some dairy, have some. and if having a hot dog
once in a while helps you maintain a healthy dietary pattern for years, then maybe that's
the way to go for you. all of those tweaks can fit into a health promoting dietary pattern
call it mediterranean, middle earth, dine and dash, whatever floats your boat. or come up with a new
name for your diet. maybe it'll make the rankings next year. alright, here's a look at the new USDA
guidelines that just came out, and this video looks at the evidence behind a lot of this. how
do we know vegetables are good for us? click here to find out