US News and World Report’s panel of experts ranked 41 diets for 2019 (as they have done for many many years in a row) based on several factors:

  • ease of compliance
  • safety
  • nutritional completeness
  • effectiveness for weight loss (both short and long-term)
  • prevention of diabetes and heart disease –  two leading causes of death in the US

According to this report, the top three best overall diets are:

  1. Mediterranean – a plant-heavy diet low in sugar, red meat, and saturated fat with an emphasis on an active lifestyle. This diet is followed in the Mediterranean region of the world and is associated with improved lifespan and longevity.
  2. DASH – Dietary Approaches to Stop Hypertension – a plant-heavy diet that encourages vegetables, fruits, whole grains, legumes, lean protein and dairy.
  3. Flexitarian – a plant-heavy vegetarian diet mixed with occasional non-vegetarian foods.

According to this report, the top three best weight loss diets are:

  1. Weight Watchers (WW) – the WW Freestyle program is a point system with values assigned to over 200 foods based on nutrition. In-person and virtual follow-up is a foundation of WW
  2. Volumetrics – an eating plan tied to 4 levels of calorie density of foods that emphasizes produce and low calorie foods.
  3. Flexitarian – a plant-heavy vegetarian diet mixed with occasional non-vegetarian foods.

Two very popular diets, Paleo and Ketogenic, both ranked low, #33 and #38 for the overall category, and #31 and #12 for the weight loss categories. Why did they rank so low? Sustainability and food restriction are major factors. Does this mean a ketogenic diet, for instance, is not beneficial? Not necessarily. Other experts and many studies have found the ketogenic diet resulted in more weight loss, more fat loss, and better health outcomes when compared to low fat diets, reduced calorie diets and calorie counting.

In addition, a ketogenic diet has shown benefit for conditions like obesity, diabetes, metabolic and brain diseases, seizures and more. However, to obtain and maintain the benefits of any healthy lifestyle changes, planning, consistency and sustainability are key. Though most research finds weight loss is easier to sustain after lifestyle changes have been maintained for at least a year, there is some variability based on individual factors. Some research shows weight loss hits its peak after 6 months of intervention and without a long-term health maintenance lifestyle or program, weight regain occurs in about 50% of people at the 5-year mark. If you have done your research, and feel you can maintain a ketogenic diet for 3 months up to 3 years followed by a healthy diet to obtain and maintain the therapeutic benefits, read the tips below to follow a well-planned, nutritious ketogenic diet.

1. Aim for a Mediterranean-style ketogenic diet. Instead of eating a meat-heavy, dairy-heavy ketogenic diet which runs the risk of worsening health over the long-term, focus on more plant fats. Sub sardines for bacon, nuts like almonds for pork rinds, avocado for cheese, and MCT, olive, avocado or coconut oil for margarine/butter. Some people have genetic variations or SNPs on genes that code for saturated fat metabolism and may see worsened cholesterol levels and other markers of heart health when saturated fat is increased.

Those without these genetic variations may have improvements in heart health parameters when following the same diet. To minimize these risks if you are not sure of your genetics, focus on a Mediterranean-style ketogenic diet that limits saturated fats and emphasizes monounsaturated and polyunsaturated fats and medium-chain fatty acids which can benefit all.

2.  Make it plant-heavy for adequate fiber and nutrition. Ample research has shown the value of fiber and plant material for cancer reduction, microbiome health, diabetes prevention and treatment and longevity. While it may be easy and convenient to snack on beef jerky sticks and cheese slices, these foods provide little nutrition in regard to micronutrients, antioxidants, and fiber. Include colorful foods at each meal and snack throughout your day.

A small serving of blackberries and half an avocado with breakfast, a loaded salad of spinach, kale and cabbage at lunch topped with macadamia nuts and 2 cups of broccoli with dinner will go a long way in helping you maintain optimal nutrition.

3. Include gut-healthy foods. Your gut bacteria depends on fiber and plant material for fuel so your digestive and immune health may be at risk without a well-planned ketogenic diet. Eat probiotic-rich foods daily like kimchi, sauerkraut, and others for a daily dose of healthy bacteria.

Prebiotics are foods rich in soluble fiber that are broken down and fermented by bacteria in the colon. This fermentation results in the production of short-chain fatty acids like butyrate, propionate, and acetate that have powerful benefits to the human body. Prebiotic rich foods to include on a ketogenic diet include dandelion greens, chicory root, garlic, onions, berries, flaxseed and leeks.

4. Supplement with electrolytes, MCT, fiber and a multivitamin. During ketosis, the kidneys eliminate more sodium and electrolytes which can contribute to the symptoms of the “keto flu.” To prevent this, supplement with sodium, potassium, magnesium and eat more foods rich in these electrolytes like bone broth and salted vegetables and nuts. MCT stands for medium-chain triglycerides, or medium-chain fatty acids. MCTs have been shown to reduce weight, body fat and food intake, improve metabolism and gut health, enhance insulin sensitivity, reduce lactic acid build up after intense exercise, improve brain function in those with Alzheimer’s disease, reduce CRP, an inflammatory marker, improve heart health and more! It’s an excellent staple fat in the ketogenic diet.

A prebiotic, gluten-free fiber supplement like Benefiber, derived from wheat dextrin, is a great choice when following the ketogenic because it selectively feeds the gut bacteria that normally thrives on grains in the diet. A chicory root fiber supplement is an additional beneficial fiber supplement that can protect gut bacteria when carbohydrates and other fibrous foods are restricted. A complete multivitamin will help to cover any nutritional gaps and meet basic needs for vitamins and minerals.

5. Plan your transition. The ketogenic diet is often used as a short-term medical nutrition therapy for treatment of a variety of diseases. One study reported weight loss, fat loss, and improved cholesterol and blood sugar with a 12-month program that only involved two 20-day periods of a ketogenic diet. The program design was: 20 days of a Mediterranean-style ketogenic diet, followed by 20 days of a low-carb non-ketogenic diet, followed by 4 months of a regular Mediterranean diet, followed by a second 20-day Mediterranean ketogenic diet, followed by a 6-month regular Mediterranean diet. Weight regain was minimal and compliance was high among the 89 subjects.

This study reveals that in order to maintain the benefits like weight loss lifelong, a healthy diet and lifestyle must be followed post-keto. Once you have reached your health goals or find the ketogenic unsustainable, plan to transition to a Mediterranean-style diet that is more inclusive of high fiber, low glycemic carbohydrates to protect gut bacteria and long-term health. This way of eating still excludes or significantly limits refined carbohydrates, added sugars, red meats and encourages fruits, vegetables, legumes, seafood and plant-based fats like avocado, nuts, seeds and olive oil. Extensive research supports the Mediterranean-diet for longevity, cancer prevention, brain health, diabetes, cardiovascular health and more.

Bottom Line

As a dietitian nutritionist, I view the ketogenic diet as a powerful tool in my toolbox, but it’s not the only tool or the only path to health. Those with kidney and liver disease should not attempt a ketogenic diet unless specifically prescribed by your physician. Find the way of eating that works for you – one that helps you feel your best and eat more plants, improves your labs, helps you manage any diseases you have and feels sustainable.

AUTHOR BIO – Natalie Butler, RDN, LD

Owner of Nutrition by Natalie and Staff Dietitian for SuperFat