The Ketogenic Diet is the Worst Diet in 2022

The results are in for the ‘Best Diets of 2022’ from U.S. News. At the beginning of every year, a panel of diet and nutrition “experts” rank 40 of the most popular diets according to a specific set of criteria. Though the keto diet has garnered ever-growing attention over the past decade due to the millions of dieters who have experienced notable metabolic health improvements and increased weight loss, the keto diet (and modified keto diet) came in nearly last at number 37 of the 40 ranked diets. In fact, it was ranked dead last (40/40) for “Best Diets for Healthy Eating.” Was the ketogenic diet accurately ranked using evidence-based nutrition science? Let’s explore.

Criteria

Each diet was examined and given ratings based on a set of seven different factors. Those ratings from experts are converted to scores ranging from five (highest) to one (lowest). In addition, the panelists weighed in with characteristics of each diet they liked or disliked. The panel of 27 experts in nutrition, diabetes, obesity, heart disease, and food psychology judged each diet in the following seven categories:

·        The diet’s capacity to generate short-term weight loss.

·        The diet’s capacity to generate long-term weight loss.

·        The nutritional completeness of the diet.

·        The ease with which the diet can be followed.

·        The diet’s safety.

·        The diet’s ability to avoid and control heart disease.

·        The diet’s ability to avoid and control diabetes.

Keto Rankings Based on the Criteria

The keto diet received an overall score of 2/5. To break it down by each general category, the ratings they gave the ketogenic diet are as follows:

·        Short-term weight loss = 3.7/5

·        Long-term weight loss = 2.2/5

·        East to follow = 1.4/5

·        Healthy = 1.9/5

 Below are the ratings for each subcategory along with the experts’ opinions regarding every category that was assigned to rank each diet. Each explanation is refuted using evidence-based nutrition science to show where the experts missed the mark.

Short-Term Weight Loss: 3.7/5 Stars

The panelists noted that the keto diet is a fast and effective strategy for weight loss. This was followed by one expert’s opinion that short-term effectiveness doesn’t mean it’s a “good idea”.

Counter: While we agree that keto is a fast and effective strategy for weight loss, it should have received an excellent rating (not just average) in this category. Studies show that following a ketogenic diet is superior in inducing weight loss in patients with obesity. The induced weight loss is rapid, intense, and sustained until at least two years. ^[1]. While we’re focusing on short-term weight loss for this category, these findings of sustainment for ‘at least’ two years indicate that keto may also produce long-term results. Further, studies done studies done in obese men found significantly greater weight loss over a four-week period when subjects were allowed to eat “ad libitum” or as much as they wanted when they were eating keto vs a moderate carb diet (-6.34 kg vs 4.35 kg). ^[2] Additionally, a paper published in Nature found that subjects assigned to a “low calorie” (500 – 1000 calorie deficit) still didn’t lose as much weight as subjects on a ketogenic diet. After four months of eating a keto diet, 85% of subjects lost >10% of their body weight while only 17% in the low-calorie group accomplished the same. ^[3]  Not to mention, their HA1C levels dropped by nearly a point in the ketogenic diet group which was significantly better than the low-calorie group, only in the same time period. 

These findings aren’t too surprising as the Standard American Diet (SAD) includes hundreds of high-glycemic, processed carbohydrates per day. When carbohydrates and sugar are drastically reduced, weight loss happens quickly. Also, when one consumes fatty foods such as avocados, the healthy fats and fiber help regulate blood sugar levels, leading to less cravings and naturally less calories consumed.

Long-term Weight Loss: 2.2/5 Stars

One of the biggest criticisms of the keto diet is people claiming, “it’s unsustainable.” In research, long-term is considered greater than one to two years. Experts stated there was lacking evidence that indicates sustained weight loss for long periods of time. The keto diet was given a below-average ranking for this category.  

Counter: There are several short-term (less than two years) studies showing weight loss in those who follow the keto diet. In research, it’s extremely difficult to do any long term, diet-controlled studies due to lack of compliance. Irrespective of the diet, you can imagine controlling subjects for several years is a difficult task for any researcher to do. That being said, there are several long-term studies showing a positive benefit for the ketogenic diet. One study found that 66 obese individuals with high cholesterol were able to lower their weight and cholesterol levels with a ketogenic diet over 56 weeks. ^[4] A meta analysis (which is an analysis of several published papers) found that “Individuals assigned to a ketogenic diet achieve a greater weight loss than those assigned to a low fat diet in the long term; hence, a ketogenic diet may be an alternative tool against obesity.” ^[5] All of the studies analyzed were greater than 12 months in duration. Lastly, even reducing your carbohydrate intake to less than 20% has shown to have sustainable weight loss even 44 months later! ^[6]

For individuals starting a keto diet in the 1990’s, adherence to the diet was likely a lot harder as options were a bit more limited. Today, you can “ketofy” nearly anything from pizza to desserts so it’s much more sustainable and the research shows the weight loss is maintained. 

Nutritional Completeness: 1.6/5 Stars

 Rated as “extremely incomplete” in the nutrition category, panelists had concerns about the saturated fat content. One expert explained that ‘any diet that recommends snacking on bacon can’t be taken seriously as a health-promoting way to eat’ and another added that the keto diet is ‘nutritionally unbalanced and likely difficult for most people to stick with long-term, which means that any weight loss will likely be regained.’

Counter: The experts continue to parrot the same talking point of too much saturated fat. Like with any diet, the way in which one chooses to approach the diet will cause significant variation of outcomes. For example, one can say she is vegan by living off soda, French fries, and egg-free baked goods. The same goes for keto—while keto can technically be achieved through copious amounts of bacon, and Big Macs without the bun, it’s not commonplace. Most keto dieters enjoy a variety of nutrient dense foods that don’t purely fall into the pork or red meat category such as wild fish, green vegetables, avocado, berries, and nuts. And by the way, aren’t we WAY past the whole saturated fat is bad for your health nonsense or is Ancel Keys still lurking around, making us all look silly?

From a scientific standpoint, if there were any nutritional inadequacies, it would show when implementing a well formulated ketogenic diet in safety parameters, etc.–which studies show is not the case.  ^[7]

Ease of Following: 1.4/5 Stars

The keto diet got a low ranking in this category as experts alluded to the misconception that your grocery list will be limited on the keto diet. One expert commented, “People become very bored just eating fatty foods, fat, and meat.”

Counter: The keto diet employs a variety of whole foods, and the best part is most are naturally occurring since cutting out most carbohydrates means leaving processed foods on the shelves where they belong. While opponents repeat the talking point of being limited to red meat and bacon, the keto diet encompasses a wide variety of foods.  

The staples of the keto foods list include lettuces, leafy greens, green vegetables, cruciferous vegetables, berries, avocado, bell pepper, olives, fish, shellfish, poultry, beef, wild game, cheese, plain yogurt, butter, ghee, nuts, seeds, nut and seed butters, and healthy oils such olive, walnut, coconut, and avocado.  Oh and when you do want to switch it up you can make keto waffles, keto pancakes, or even keto cookies.

Lastly, scientific research shows that 80+% of subjects in a study were able to adhere to the diet over a six month period which is quite high in research. ^[8]

Safety: 2/5 Stars

The keto diet was rated poorly in the category of safety, due to the high fat content. One panelist stated the diet could be dangerous for some while another cautioned those with heart disease, kidney disease, and severe diabetes against adoption of the diet.

Counter: It’s interesting to note that a group of experts who rightfully admitted that a ketogenic diet can help with weight loss also ranked it low on safety. Further, a recent meta analysis examined 12 studies utilizing a ketogenic diet and saw no adverse effects. ^[9] Well, if sustained weight loss for two years following the study is an adverse effect, then I think it’s one that most people would be willing to risk it for. Lastly, it’s even been published and shown to be safe in children with intractable epilepsy. ^[10]

Moreover, the primary criticism (from the experts) regarding safety lies in the high-fat content. We must keep in mind that the ketogenic diet relies heavily on healthy monounsaturated fats and omega-3 fatty acids. Those fats have been shown, time and again, to improve cholesterol and decrease mortality risk from cardiovascular disease. ^[11]

The majority of fat sources found in the ketogenic diet stem from salmon, other fatty fish, nuts, seeds, olives, olive oil, and avocado.

Heart Healthy: 1.9/5 Stars

The keto diet was ranked near the bottom of the heart-healthy category and one of the primary reasons was an outright piece of misinformation. The expert stated that one who follows the keto diet gives up non-starchy vegetables. In addition, he or she said that giving up fruits, whole grains, and starchy vegetables ‘and this “is the opposite of what we want for diabetes and heart disease prevention.”

Counter: As previously stated, the ketogenic diet urges that most of its carbohydrates come from low-carbohydrate, fibrous green vegetables, as well as nutrient-dense, low-sugar fruits such as berries, bell peppers, avocado, and olives.

The keto diet is certainly lacking in grains and starchy but are they necessary to maintain heart health? May they possibly even harm heart health? Refined grain-based foods such as bread, cereal, and pasta are highly processed and strip nutrients and fiber, resulting in a pale version of what the intact whole grains resembled before processing. A diet high in added sugars for just a few weeks has been found to produce numerous abnormalities found in patients with coronary heart disease including elevated insulin levels and insulin resistance. More importantly, a diet low in added sugars and refined carbohydrates has been found to reverse all these metabolic defects. ^[12]

Fortunately, the science still confirms what many people to be true–which is the opposite of what these experts are claiming. Within just six weeks of being on a ketogenic diet, researchers found that the  “ketogenic diet does not have a deleterious effect on cardiovascular disease risk profile and may improve the lipid disorders characteristic of atherogenic dyslipidemia.” ^[13] Not only may it not have negative effects on your heart, but it might significantly help. As mentioned in this review article, “At low concentration, endogenously produced ketone bodies upon uptake of a ketogenic diet or supplemented ketone bodies (or their precursors) may prove beneficial to ameliorate endothelial function and, consequently, pathologies in which endothelial damage occurs.” ^[14]

We are going to have an MD speak on this exact topic at our upcoming Global Virtual Keto Summit. Make sure you don’t miss it!

Managing or Preventing Diabetes 2.6/5 Stars

The panel of experts stated that preventing or controlling diabetes with the keto diet was minimally effective. One expert went as far to say that the ketogenic diet isn’t safe for those with diabetes. Ironically, the explanation in the article did include the disclaimer that research has proven that decreasing carbohydrates can help with the disease.

Counter: Of all the areas for these experts to lend support to a low carb, ketogenic diet, this should be the one. The data is OVERWHELMINGLY clear that a ketogenic diet can not only help prevent diabetes but actually has been shown to reverse it. Despite the fact that the CDC still recommends that those with type II diabetes consume 225 grams of carbohydrates per day,  doctors are speaking out against this recommendation as it keeps patients on the vicious cycle of diabetes medication requiring carbohydrates to prevent hypoglycemia, followed by needing the medication for insulin that is released after the consumed carbs.

A recent meta-analysis which included 20 years of published research studying the effects of a ketogenic diet on patients with type 2 diabetes. The review concluded that ketogenic diet is ‘superior’ in terms of glycemic control—the results were significant enough to recommend the keto diet as a treatment for type 2 diabetes. ^[15]

Another recent study concludes that in addition to reduction in body weight and improving lipid profile, there was a significant improvement in HbA1c and reduction in the intake of insulin and oral antidiabetic drugs in patients with type 2 diabetes. ^[16] Not only does this research show how the keto diet can lead to weight loss and improved metabolic health, it’s also monetarily cost effective as it reduces the need for insulin and oral antidiabetic drugs.

Lastly, our friends at Virta Health are doing incredible work reversing type 2 diabetes with their low carb protocols. One of their studies shows that this dietary monitoring protocol lowered glycemic control medication from 55.7 to 26.8% including insulin (-62%) and sulfonylureas (-100%). There was also resolution of diabetes (reversal, 53.5%; remission, 17.6%) in the intervention group but not in usual care group. ^[17]

Overall Ranking: 2/5 Stars

The experts placed the keto diet in the bottom half in all but the short-term weight loss category primarily because of the diet’s emphasis on fat-rich foods. One expert noted, “This diet is excessively high in saturated fat.” In addition, the diet was falsely stated to be low in fiber and calcium.

Counter: The keto diet is higher in fat-rich foods as the metabolic state of ketosis uses fat for fuel instead of carbohydrates which will help your body turn into a fat burning machine. While it could be higher in saturated fat based on how one employs the keto diet, it may not necessarily be the case. Even if one’s keto nutrition plan is higher in saturated fat, recent research shows that mortality from cardiovascular disease does not decrease with the reduction of dietary saturated fat. ^[18] In fact, studies show that replacing saturated fat with carbohydrates is associated with an increase in cardiovascular disease risk. ^[19]

The American Heart Association suggests that total dietary fiber intake should be 25 to 30 grams per day, while the average American consumes only 15 grams per day. While the keto diet typically allows for no more than 50 grams of total carbohydrates per day, most of the allotted carbohydrates come from fibrous carbohydrates.

For example, one can consume a cup of cooked spinach, two cups of chopped romaine lettuce, two cups of cooked broccoli, and ½ cup of raspberries in one day to achieve a total of 46 grams of carbohydrates, and whopping 24 grams of fiber. More fiber is likely to be added by way of other keto-friendly foods such as nuts, seeds, avocado, and dark chocolate. 

Keto is certainly not limited in the calcium department either—this myopic statement was likely made only because milk is not allowed on the keto diet due to its sugar content. Other high-calcium foods such as sesame seeds, Chia seeds, cheese, plain yogurt, sardines, canned salmon, almonds, and leafy greens are part of the ketogenic diet.

Discrepancies in Top Ranked Diets of 2022

We’re not here to belittle or degrade other dietary protocols, however if this analysis from the experts was predicated on scientific evidence, they significantly missed the mark. Let’s take Weight Watchers for example—this diet came in at number five for best diets overall. This is fascinating considering the University of British Columbia recently conducted a randomized trial which explored the results of those following a ketogenic diet versus the Weight Watchers diet.

At the 12-week checkpoint, the group following the ketogenic diet achieved two times more weight loss than the Weight Watchers group. More significantly, the keto group lost three times the amount of weight than the Weight Watchers group after 24 weeks and had substantial improvements in metabolic health. Cholesterol and other lipids showed no changes of concern. ^[20]

To read more about the trial, click on the article here.

Coming in at number 20 was the infamous Biggest Loser diet. It ranked .8 points higher on “Easy to Follow” and 1.6 points higher in the “Heart Healthy” categories. These rankings come, despite the research showing persistent metabolic adaptations after the Biggest Loser competition–six years later! ^[21] This study showed that the majority of the weight lost on the show was regained, yet their metabolisms were still suppressed/slowed. Further, while I agree that exercise is extremely important, on the Biggest Loser diet, it’s a “key part” of the success. So, in essence, this diet requires putting people on an unsustainable caloric restriction protocol combined with exercise to induce fast weight loss that is likely to be regained long term while also suppressing your appetite–and it really only works if you exercise enough to overcome your metabolism slowing down from the caloric restriction (aka Jillian Michaels screaming in your face). According to these experts, this diet/protocol ranks higher than the keto diet.  

Closing Thoughts

We’re not certain why the keto diet doesn’t seem to get a fair shake when it comes accurately assessing and comparing the diet with others. Though often purported to only be beneficial for “quick weight loss,” a well-formulated ketogenic diet is so much more. Unfortunately, these experts missed the mark and the science when properly evaluating the ketogenic diet as well as several other diets involved in this analysis. Lastly, one interesting thing to note is the owner of U.S. News is Mortimer B. Zuckerman. He’s made several contributions to highly regarded research institutes like Columbia University, even having the Zuckerman Institute created. At the Zuckerman Institute, they have a great mission to decipher the brain–including effective treatments for disorders like Alzheimer’s and autism. Mr. Zuckerman, one area you might want to suggest your scientists start looking at is utilizing alternative fuels (i.e. ketones) to overcome neurological deficits/starvation seen in neurodegenerative diseases. The data is pretty exciting in terms of how a ketogenic diet can be a useful strategy in combination with other therapeutics. Maybe that should be an additional category added in next year’s criteria?!