Happy New Year! 2022 is off to an auspicious start: (1) The more contagious but less severe omicron COVID-19 variant runs wild: (2) Governments take draconian measures to enforce vaccine compliance; (3) New Year’s Resolutions around health & wellness take center stage, as people begin the new year with a renewed sense of adherence to an improved dietary lifestyle. Right on cue, U.S. News released its 2022 Best Diets ranking.

U.S. News Best Diets Methodology

Before looking at the diet ranking, it is first very important to review the criteria and methodology U.S. News (USN) uses to offer this ranking. If you would like to read the methodology yourself, click here.

As USN states, they rank diets (40 in total) against a range of factors from heart healthiness to the likelihood of a diet to help you lose weight. They claim to engage a panel of 27 “experts” in diet, nutrition, obesity, diabetes, food psychology & heart disease, who reviewed our (USN) profiles, added their own texture, then rated each diet on seven factors, including:

• How Easy to Follow
• Ability to Produce Short Term Weight Loss
• Ability to Produce Long Term Weight Loss
• Nutritional Completeness*
• Safety
• Potential for Preventing & Managing Diabetes
• Potential for Preventing & Managing Heart Disease

One of the metrics above is Nutritional Completeness, but what exactly does that mean? Well, in their own words, USN states: “Based on conformance with the federal government’s 2020 Dietary Guidelines for Americans, a widely accepted nutritional benchmark (5 = extremely complete, 4 = very complete, 3 = moderately complete, 2 = somewhat complete, 1 = extremely incomplete).”

So, it is fair to say that if a diet does not confirm with the U.S. Dietary Guidelines, it will be ranked much lower than diets that do conform.

Ranking Lower Carb Variants

Given the U.S. Dietary Guidelines recommends, and has continued to recommend for over 40 years, that approximately 55% of your caloric intake comes from carbohydrates, you can imagine how well low carb dietary lifestyles scored in this ranking:

• Intermittent fasting: #27
• Paleo diet: #30
• Atkins: #34
• Whole 30: #35
• Ketogenic & Modified Ketogenic: #37

Notice the language used by USN when describing these diets:

Paleo: too high levels of protein; too restrictive (because it eliminates grains, legumes, refined sugar & dairy); pricey; difficult to follow

Whole 30: don’t like the reduction in carbs; too restrictive & requires higher level of organization & discipline to remove food groups; pricey

Ketogenic: strict carbohydrate limits (much lower than U.S. Dietary Guidelines); can seem “extreme”; pricey; concerns about saturated fat & heart disease

Challenging the Narrative

There are two major assumptions this USN ranking makes:

1. The U.S. Dietary Guidelines are correct & based on sound science. A diet built on 55%+ of carbohydrates, with copious amount of fruit, and low in fat will improve health biomarkers, reduce obesity, and reduce the likelihood and/or severity of chronic metabolic disease.
2. All macronutrients are equal; that they have a similar affect on the body’s mechanisms and are of similar importance.

As I’ve covered in my blog, we know, first off, that the U.S. Dietary Guidelines are not based on sound science, but on questionable (at best) research that has proven to be a disaster when it comes to metabolic health, chronic disease and obesity. Since the late 1970’s we have reduced our fat consumption, increased our carbohydrate intake (including whole grains), shifted away from quality saturated fats to a cocktail of inflammatory poly-unsaturated fats (mostly in the form of vegetable oils), and have been snacking more often. The result: Obesity, Type 2 Diabetes, NAFLD, CVD and other chronic conditions have exploded.

Secondly, it is absolutely clear that the 3 primary macronutrients are not created equal, and they have very different impacts on inflammation, body function, hormone activity and metabolic health. It is the fundamental flaw in the Calories-in / Calories-Out (CI-CO) narrative, as simply counting calories to “hit a number” without embracing the specific macronutrient impact on fat storage, hormone response, organ function & inflammatory triggers has proven to be a failed weight management strategy. I covered this in great detail if you would like to review.

Thirdly, it is becoming more and more clear that LDL, in and of itself, is not the best biomarker for heart disease risk. When assessing metabolic syndrome, the best practice today is to assess HDL, Triglycerides and LDL to try and assess which type of LDL is most prevalent, as LDL size matters. Over the last two decades more research has shown small, dense versions of LDL have a much easier time penetrating arterial walls & causing atherosclerosis, whereas larger, buoyant LDL molecules pose very little risk. What this means is LDL size correlates with HDL and Triglycerides in very apparent ways, and the relationship among those three metabolic measures is a MUCH better indicator of your risk of CVD. In short:

• Small, dense LDL is usually correlated with lower HDL and higher Triglyceride levels = high CVD risk
• Large, buoyant LDL is usually correlated with higher HDL and lower Triglyceride levels = low CVD risk

So, based on this, it would appear making dietary and lifestyle choices to ensure LDL’s are large & buoyant would be important in the pursuit of health & wellness, especially reducing the risk of CVD. The natural next question is what causes LDL to become small & dense, and create that dangerous inverse relationship with HDL & Triglycerides that we want to avoid?

As correctly highlighted in this article, high risk lifestyle factors that contribute to small, dense LDL include:

• Individuals who consume a high amount of carbohydrates in their diet, especially refined sugars
• Those that consume trans fats in their diet
• Anyone who has uncontrolled diabetes (90%+ is Type 2, a disease of insulin resistance)
• Individuals who have been diagnosed with metabolic syndrome

So, if high carbohydrate intake is associated with risky LDL levels that contribute to CVD, and we know high carbohydrate intake is THE major influencer of insulin resistance and Type 2 Diabetes, then why are we being instructed to eat a high carbohydrate diet in pursuit of health and weight management when it is exactly this type of diet that has been exacerbating chronic disease, including obesity, for the last 40+ years?

Educational Resources

Choosing which dietary lifestyle to follow is one of the biggest personal decisions you can make, and requires an abundance of research & consideration of your personal health situation, genetic dispositions, family requirements, life-stage factors, and so on. I encourage you to consult with a recognized medical professional who can speak openly and accurately about the pro’s/con’s of different dietary methodologies, using sound data vs. relying on a long-standing and flawed narrative. I have a reference page on my website that offers scientific literature and research on the benefits of a low-carb diet, but I also encourage you to check with medical thought leaders like dietdoctor.com; virtahealth.com & torontometabolicclinic.com. Wishing you health and wellness in 2022!