by Marion Nestle
Nov 1 2011

Latest US News rankings: healthy diets!

U.S. News has just released its rankings of 20 popular diet plans—the “Best Diets for Healthy Eating.”

The top five:

  • DASH (Dietary Approaches to Stop Hypertension)
  • TLC (Therapeutic Lifestyle Changes)
  • Mediterranean
  • Mayo Clinic
  • Volumetrics

These may be healthy, but from the standpoint of survey respondents, they don’t work very well.  To the question “Did this diet work for you?” the “no’s” hugely outnumber the “yes’s” for a whopping 16 of the 20 diets.

The four exceptions:

  • Weight Watchers (#6)
  • Vegetarian Diet (#9)
  • Eco-Atkins (#15)
  • Vegan (#16)

Diets are about maintaining or losing weight.  This means balancing food energy against the amount of energy used in metabolism and activity.   To lose weight, you have to eat less or move more or do both.  It also helps to eat better and make healthier food choices.

All of the diets on the US News list are based on healthy food choices.  But these are the only four diets on the list that seem to help a majority of people to eat better and eat less.



  • Alex

    Then I suppose we’re only really disagreeing about phrasing. If someone is obese and borderline diabetic, I’ve no doubt that a LC diet would help. I just don’t think that means we should promote it as the healthy diet in the first place, and certainly not for people with normal, working metabolisms. I think of it like reading glasses. We don’t give them to everyone, just those who need them.

  • MargaretRC

    @suzanne, well put. I was going to say the same thing. I’m in no way suggesting that thin, fit people need to change the way they are eating! There are thin, fit people all over the world who eat a variety of cuisines, most of which include grains (and none of which sre even remotely like DASH or Weight Watchers, etc.) Like Suzanne, I am suggesting that a large and growing number of people in the western world are obese and/or have metabolisms that can no longer handle grains and other starchy foods because of the misguided advice to avoid fat, especially saturated fat (and resulted in overconsumption of grains snd sugar.) For them, the answer, perhaps the only snswer) is a program like Paleo or LCHF and for influential media to tell them those aren’t healthy options is wrong. There’s also the fact that modern day wheat, thanks to some nifty genetic engineering) is vastly different from the wheat of even 50 years ago (source: Dr. William Davis’ “Wheat Belly”). Do we really know that basing our diet on that (as the USDA duidelines do) is ok or that eliminating it is a bad thing? I don’t.

  • Michael Bulger

    Replacing grains with saturated fat, which we don’t need to consume in the first place as our body will manufacture it on its own, doesn’t seem like a good pitch. As saturated fat raises LDL and clogs arteries, the emphasis should be on eating veggies. Even if you are emulating the physical activity level of a Paleolithic human, eating a lot of red meat isn’t living as they did. Granting the very real diversity of the humans of that period, anthropological thought is that they could generally be described as having a diet based primarily on gathering and not hunting.

    Taking a real unbiased, anthropological and nutritionally-informed look just leaves me with the impression that the idea of eating more meat came first. After that, the science on saturated fat was jettisoned by the LCHF culture and a myth of Paleolithic homo sapien sapien was constructed to justify the diet. Heavy exercise and shunning refined carbs (soda, cakes, cookies) are probably what saving grace the diet can claim.

    Thought I’d put that out there.

  • Margeretrc

    @Michael, It’s difficult to know where to begin a response to your comment as there are grains of truth, but also a whole lot of misinformation. Yes, saturated fat raises LDL. But it also raises HDL. And there are two kinds of LDL: large and fluffy (harmless, probably helpful, not involved in plaque formation, more likely involved in protecting from inflammation) and VLDL–small, easily oxidized and involved in the formation of plaque. The kind of LDL that saturated fat raises is the first kind, not the second. The kind of LDL that carries triglycerides produced from carbohydrates (read grains and sugar) is the second, more dangerous kind, the kind that “clogs your arteries.” Yes, the body is capable of making saturated fat, so you are right. We don’t NEED to eat it–maybe. Can the body indeed make all the saturated fat it needs? Every cell in the body needs saturated fat for its membranes–all of them. The brain needs saturated fat. And if we don’t eat fat, including saturated fat, we tend to eat excess carbohydrates to satisfy our hunger, carbohydrates which the body then turns into VLDL , the kink of LDL that is found in plaque. The large, fluffy LDL that is increased when we eat saturated fat is not found in plaque. So, in fact, saturated fat does NOT clog arteries. As a matter of fact saturated fat can’t be found free in the arteries or blood anywhere. Because fats don’t dissolve in water, they have to be carried in lipoprotein carriers–HDL, LDL, and VLDL. And saturated fat in the body is not solid like it is at room temperature, so couldn’t clog the arteries anyway. At body temperature, all fats are free flowing liquids, incapable of clogging anything. Our arteries are not the pipes under your kitchen sink. As to replacing saturated fat by unsaturated fats, as recommended in the article you linked, here is a link to a discussion that does a good job of explaining why that is probably not a good idea: Saturated fats can’t be easily oxidized, while unsaturated fats can and poly unsaturated fats are the most easily oxidized. And it is oxidized LDL that is implicated in the development of plaque and heart disease.
    The science of saturated fat hasn’t been jettisoned by anyone. It is still alive and well and embraced by the LCHF culture, but they are not by any stretch the only ones who embrace it. The only thing that has been jettisoned by the LCHF culture and others is the idea that saturated fat is an unhealthy component of the diet. That’s because it isn’t. None of the studies that have been used to prove it is have stood up to the scrutiny of real, unbiased scientists, most especially the very first–Ancel Keys’ 7 Countries Study, in which he cherry picked 7 countries out of the 21 (22?) for which data was available to create a false association between saturated fat and heart disease. If saturated fat “clogs your arteries”, how is it that some of the populations that have the lowest risk of heart disease eat a diet extremely high in saturated fat?

    I personally don’t care at all what Paleolithic humans ate. I am not trying to emulate them. I care about science. I care that, on the basis of some very flimsy, even fraudulent science, the people of this country have been misled into believing that they should not eat something they are designed by evolution to thrive on and instead base their diet on grains and other starchy carbohydrates and that, as a result, we are facing an epidemic of obesity, diabetes and heart disease. I eat carbohydrates, primarily non starchy vegetables. I eat some fruit and once in a while a very moderate amount of wheat or rice or whatever–because my metabolism isn’t totally broken; because I realized early enough, before the damage was irreparable, that the advice to avoid meat and saturated fat was at best, misguided. I realized it because I read books and articles that exposed the bad science on which the whole anti-saturated fat paradigm is based: Gary Taubes’ “Good Calories, Bad Calories”, “Why we get Fat,” “What if it’s all been a Big Fat Lie?” and “The Soft Science of Dietary Fat;” Uffe Ravnskov’s “The Cholesterol Myth” (now available as “Fat and Cholesterol are Good for You”); Mary Enig’s “Know Your Fats,” and Will Clower’s “The Fat Fallacy.” You might consider checking them out. Or just watch the documentary “Fat Head.” Or check out sites maintained by the doctors and scientists of the growing worldwide LCHF/Paleo/Primal community. A good place to start is Also

  • Margeretrc

    @Michael, P.S., I wonder if the peoples of Thailand, the Philippines and parts of Africa know that the coconut, coconut oil, and palm oils they eat lots of are “bad fats” (according to the article you linked). Perhaps they should stop eating stuff they have been eating for eons so that they don’t clog their arteries.

  • Margeretrc

    More links re sat fat in the diet: “A meta-analysis of prospective epidemiologic studies showed that there is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of CHD or CVD. More data are needed to elucidate whether CVD risks are likely to be influenced by the specific nutrients used to replace saturated fat. ” “A Randomized controlled trial of 48,835 postmenopausal women, aged 50 to 79 years, of diverse backgrounds and ethnicities, who participated in the Women’s Health Initiative Dietary Modification Trial, mean follow-up in this analysis was 8.1 years. The objective of the trial, was to see if a cut back on dietary fat, would improve health, and reduce the risk of cardio vascular disease or stroke, it did not !”

  • Michael Bulger

    How relevant do you think that coconut oil is to the discussion of American consumption of saturated fat?

    As to your studies, I don’t intend to engage in a running debate when the subject has been so vetted in more formal settings. I will point out that the second study you link contains this quote:

    “Trends toward greater reductions in CHD risk were observed in those with lower intakes of saturated fat or trans fat or higher intakes of vegetables/fruits.”

    The lower rate of actual CVD outcomes was not statistically significant (but was lower). However, the study was for under a decade. Heart disease endpoints aren’t caused overnight, are they?

    There are many factors that result in CHD. The researchers stated that, “…more focused diet and lifestyle interventions may be needed to improve risk factors and reduce CVD risk.” They did not suggest SFA were not associated with elevated risk of heart disease. In fact, they established it elevated risk.

    As for the oft-misinterpreted study by Dr. Hu, perhaps you’d be interested in his real viewpoint. Too often his position on the error of replacing SFA with refined carbs in an overweight population is mistaken as a dismissal of the damage done by SFA. Here’s a link to an article that better illuminates his research, along with the following quote from Hu himself.

    “Clearly, diets high in either saturated fat or refined carbohydrates are not suitable for heart-disease prevention,” Dr. Hu concludes.

    Like I said, I don’t desire to go back and forth with studies, and clarify all the misinterpretations floating in cyberspace. Suffice to say, the research is not represented accurately.

    It might be of interest that Dr. Hu works at Harvard School Of Public Health (HSPH). That link I posted in my previous comment is from HSPH. If you didn’t read it, here are some quotes:

    “Our bodies can make all the saturated fat we need, so we don’t need to eat any of it. That’s why saturated fat can be in the bad category—because we don’t need to eat any of it, and it has undesirable effects in cardiovascular disease.”

    “Red meat and dairy fats are the main sources of saturated fat in our diets, so keeping these low is the primary way to reduce intake of saturated fat.”

    But don’t replace them with soda or refined grains…

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  • Margeretrc

    I did actually read the study you linked from Harvard and I agree with most of it, just not the part about saturated fat being bad fat and that replacing it with polyunsaturated fats is good. And calling coconut and palm oils bad fat despite the fact that cultures in various parts of the world thrive on it without heart disease IS relevant to this country because manufacturers used to use it in baked products here, but replaced it with trans fats–infinitely worse–when it was suddenly decided that coconut oil was bad because it is a mostly saturated fat–and because, when hydrogenated, it gave rabbits (herbivores not designed to eat sat fat) plaques like we see in humans with heart disease. One of the links I posted above addresses this. Some manufacturers are just now starting to return to using palm oil and palm fruit oil because they know that people won’t buy their products if they are made with partially hydrogenated oils.
    You don’t wish to trade studies and think much of the information on the internet is misrepresented. That is fine. My primary sources aren’t from the internet, but whatever. Just think for yourself and ask yourself some critical thinking questions: If saturated fat is, indeed, bad,
    -why is it that many cultures with low rates of CVD eat a large percentage of their diet as saturated fat? (French, Inuit, Masai, etc. There are others, but in science one doesn’t need multiple contradictions to throw out a hypothesis)?
    -why has the rate of CVD in this country continued to climb–and climb precipitously–over the last few decades despite the decrease in sat fat consumption and increase in poly-unsaturated fat consumption?
    -If saturated fat is bad, why is human mother’s milk loaded with it? Does our need for sat fat in the diet end in infancy or at some young age, when we are weaned from it, and suddenly become disease causing?
    See, these are questions that the whole “sat fat is bad and causes heart disease meme” can’t answer–and needs to answer to be taken seriously by anyone who can think for themselves.
    And I’ll leave it at that.

  • Michael Bulger

    I was simply illustrating your references were being misrepresented, and actually tied SFA to elevated risk.

    I will indulge you further with my thoughts on your three questions:

    – The Inuit ate primarily seal meat, which is more akin to fish. The Masai were extremely physically active. Extreme might even be an understatement. Both had short life expectancies, making it difficult for CVD to cause mortality. SFA take time to elevate risk enough, and an active lifestyle can mediate some of the risk. The French are traditionally more active as well. They traditionally eat smaller portions. There have been several explanations offered for the “French Paradox”. Here’s one that attributes it to underreporting of CVD and a time lag in diet changes: .

    – USDA data shows total SFA consumption increasing over the past 15 years. Americans are eating more in general, and SFA remains above the recommended percentage of our that intake. See Table D.3.8:

    – Growing babies do have different nutritional needs than adults. The body does need saturated fat for our entire lives. However… it can make its own. It’s impossible to avoid altogether, but we don’t need to consume it as our body will make its own saturated fat. As we age over time, if we consume too much saturated fat it can accumulate and lead to heart disease.

    I will leave it at that.

  • Alex

    – A calorie deficit is a powerful thing. If you don’t eat “too much”, the composition of your diet matters a lot less. Take the “Twinkie Diet” professor’s self-test as an example. All of his blood markers improved, and he lost weight, because he could do basic math. All of those cultures consume less calories than Americans typically do, are thus less fat, and less prone to CVD.

    – Because we consume more calories, and burn less. There is no single macronutrient to blame for this.

    – Every mammal drinks milk when weaning, then shifts to an “adult” diet. In the case of herbivorous mammals (and some omnivores, like humans), the ability to synthesize saturated fat is developed, thus negating an absolute need for consumption.

    Now, I think saturated fat is far from the biggest problem with the American diet. I think natural foods are best for optimal health, and that eating satisfying food ultimately helps in eating less. And a lot of real food happens to contain saturated fat. I eat such foods, and think others should too. All of which is to say, this isn’t really that complicated. Don’t eat crap; don’t gorge; work out.

  • Margeretrc

    @Alex, “Now, I think saturated fat is far from the biggest problem with the American diet. I think natural foods are best for optimal health, and that eating satisfying food ultimately helps in eating less. And a lot of real food happens to contain saturated fat. I eat such foods, and think others should too. All of which is to say, this isn’t really that complicated. Don’t eat crap; don’t gorge; work out.” Very sane approach and I agree. If we as a population had stuck with those principals, we wouldn’t be in the mess we are in! However, we didn’t.
    “Because we consume more calories, and burn less.” Why? Why us? Why is this a problem mostly of our culture (with some spill over into other western cultures?) Like all animals, we have the innate ability to self regulate the calories we take in to match the calories we expend–assuming we eat a balanced diet of foods we were designed to eat–including fat. But we don’t. Well, actually, I do and you do, but many don’t. And, twinkie diet notwithstanding, it is not just about calories. The calories in/calories out/you’re fat because you eat too much and move too little paradigm ignores the fact that we are animals and not cars. Yes, Professor Twinkie was able to do the math and externally control the calories he was eating. But why should anyone have to exert external control when we naturally have exquisite internal controls?
    “There is no single macronutrient to blame for this.” Actually, there is a good deal of scientific evidence that says otherwise. A diet that is high in refined carbohydrates, sugar in particular–foods that jack up insulin–can totally mess with that internal control and take it away. And for the last few decades we have been encouraged (and continue to be encouraged) to eat less fat and replace the fat we aren’t eating with carbohydrates–the same time period during which the incidence of obesity, type 2 diabetes, and metabolic syndrome epidemic has risen astronomically–and continues to rise. Do you really think that is a coincidence?

  • Alex

    Do I think it’s a coincidence? Kind of, actually. I think we ought not overestimate the amount of people who actually take the government’s (admittedly poor) dietary advice. Fewer still make any effort to impliment it. And while the percentage of our diet that’s composed of carbs has risen, total fat calories have risen as well. Again, we’re simply eating more in general. Does sugar spur that? Yes; but no more so than fatty snack foods. A diet reasonably high in carbs can be perfectly healthy, as can one that’s high in fat. Regardless, you do have to have some idea of how much you’re consuming. Any athlete, those who require good body composition to perform, knows their general macronutrient breakdown. Now, not everyone needs to go to that extreme. But some amount of intake awareness is not too much to ask. We may not be cars, but the law of thermodynamics still applies.

  • Michael

    @Ellen: Thanks very much for posting this. I can see why an overzealous low-carb (or any other) critic of the Dietary Guidelines would mash such comments up as “the USDA dietary guidelines… are not based on science”, but clearly that’s not what she’s saying: rather, she’s rightly admitting to the modest quality of the evidence on which they rely. The problem, of course, is that advocates of alternative dietary regimens largely rely on even poorer-grade evidence. “More research necessary” ≠ “Not based on science”: the best science available *is* the science.

    MargaretRC: You said that “ “I see my earlier post is now up, so repost is not necessary.” Actually, several posts of yours appear, but none with any further info on the original claim. I take it you’re indicating that the comments from Dr. Joanne Slavin dug up by Ellen are those to which you /ultimately/ refer, although I’m not clear whether you had heard this claim at second hand and were simply repeating this other source’s distorting oversimplification, or if “she admitted that they are not based on science” your own summary; IAC, Dr. Slavin was clearly not saying that the Guidelines are “not based on science” — just that they are based on limited science, because only limited science is available.

    I will say that I think the Harvard/Willett guidelines are a *better* synthesis of the available science than the USDA Guidelines, and am aware that the *presentation* of the USDA Guidelines is badly marred by industry pressures, as Marion has documented so depressingly in her books.

  • Suzanne

    Here is the link to the Harvard/Willet guidelines, their version of “My Plate”

    @Michael: I hope you are advocating this version for healthy, non-Diabetic, metabolically normal people. This plate recommends nearly half of daily consumption as fruits and grains/starches. You do realize there is a Diabetics epidemic going on, don’t you? An explosion of Celiac Disease? Encouraging a diet of this sort will facilitate diabetic complications down the road for the eater with metabolic vulnerability. Type I Diabetics are at risk for hypoglycemic episodes, trying to match insulin to their consumption of carbohydrates, starches and fructose. Type II Diabetics eventually lose appropriate function of their Pancreatic beta cells eating a high carbohydrate diet. Increasing one’s medications eventually becomes ineffective without decreasing carbohydrate intake.

    Call me overzealous if you like, but I’d prefer to avoid an amputation, stroke, heart attack and blindness, thank you very much. Had I known there was a way to forestall developing Syndrome X and Diabetes, I would have eaten quite differently as a young adult. You sure don’t get this information from most doctors and Registered Dietitians! It’s the same calories in, calories out, eat less move more eat your healthywholegrains mantra that is incomplete as a message, and not at all useful in slamming the brakes on the diabesity epidemic.

  • Margeretrc

    @Alex, Fair enough. But I did not say the law of thermodynamics doesn’t apply–I just said it applies differently to us than to cars, because we are animals with hormonal and other mechanisms which, if not interfered with, naturally regulate our intake to match our expenditure. That does require an awareness, but not so much of intake, rather of signals the body is sending. However, I’m not an athlete of the kind you speak of, so I’ll grant you that special circumstances probably do require special awareness not required of the average person.

    @Michael, If the science is “inadequate”, why have guidelines at all? People left to their own devices have managed just fine in most places around the world and continue to do so. No guidelines, no industry pressure to mar its presentation! No matter how much we can agree to disagree about the “soft science of dietary fat”, I think we would all be better off if there were no government influence over what we put in our mouths and bodies. Because, @ Alex, people do pay attention to guidelines. When the media, such as US News and World Report, are constantly hammering them home and touting their (dubious) health benefits, people do sit up and take notice. Not everyone, for sure, but the majority. I did. For 16 years I did. It did not improve my health or my weight–the opposite, in fact. Likewise my husband and my children. I suspect we are not alone or even unusual.