Thread by @bigfatsurprise

.@usnews "Best Diet" issue is once again completely disconnected to the science.
Monster 🧵
health.usnews.com/best-diet/best…

To start:
Med diet is #1
Yet the single major clinical trial on this diet showed only a .02% absolute reduction in heart-disease risk--see⬇️

This figure is from that largest, longest Med-diet trial PREDIMED: diabetesjournals.org/care/article/3…
Analysis is by @DrFeinman

Also, PREDIMED was simultaneously retracted/republished on the same day (very unusual), with many questions about it still lingering:
bmj.com/content/364/bm…

DASH has long been #1 or 2 for USNews. I looked at total data in 2017 and found major limitations: DASH had only been tested on middle-aged people w/ hypertension ('cept 1 trial in Iran)--thus not generalizable. Short term trials only.
And since then? ⬇️
ninateicholz.com/the-deal-on-da…

This 2020 highly rigorous meta-analysis/systematic review of 14 diets concluded DASH:
-mediocre for weight loss
-mediocre for ⬇️blood pressure
-"among the least effective" for lowering LDL-C and also lowered HDL-C (not good)

So, overall, not great.
ncbi.nlm.nih.gov/pmc/articles/P…

This meta-analysis of 14 diets also says:
Mediterranean diet is mediocre for weight loss and hypertension reduction. So again, why is it #1?

(Yes, it can reduce LDL-C, but remember, the long-term data on heart attacks, stroke, etc, show only that .02% absolute risk reduction)

Meanwhile, USNews gives lower rankings to diets w/ better results:

Paleo, #30 ➡️ 3 trials on pubmed

Atkins, #34 ➡️693 trial results.

Meta-analysis above concluded paleo was one of 2 best diets for reducing blood pressure, and Atkins was one of 2 best for weight loss at 6 mo.

And hey, what happened to the low-carb diet? A pubmed search for clinical trials shows nearly 600 results. A 2021 sys. review/meta-analysis shows "Large clinically important improvements.. in weight loss, triglycerides, and insulin sensitivity at 6 mo."
pubmed.ncbi.nlm.nih.gov/33441384/

To anticipate a criticism: yes, results tend to start reversing after 6 mo.--on all diets.
Yet in "Virta" trial, >50% of the subjects on LC/keto maintained T2 diabetes diagnosis reversal at 2-year mark.
It is possible. frontiersin.org/articles/10.33…

And MDs tell me a top reason people go off low-carb is that they're scared to death by so much negative news --from experts like USNews!
Probably keto/low-carb would see even better results if they got the same kind of love/endorsement as Med/DASH. You think?

Re: keto/ketogenic diets, US News again dumps them at the bottom (#37 out of 39)

Yet search keto/ketogenic trials on pubmed
➡️ 1079 results

Only "glycemic index" diet (#20) gets more: 1,104

VASTLY more evidence for these mid/low-ranking diets than others of higher ranking

Unlike Med/DASH diets, Keto has been shown in multiple trials to reverse a T2 diabetes diagnosis--and dubbed "best" for controlling blood sugar, by Amer. Diabetes Assn.
Fears of side-effects and inc'd mortality risk on keto are unfounded. See our review:
mdpi.com/2072-6643/13/1…

While keto, with >1,000 "clinical trial" hits on pubmed, ranks at the bottom of USNews list, the following diets rank higher.
Each has only 1 clinical trial (pubmed)

"Flexitarian diet" #3
"MIND diet" #4
"Weight Watchers" #5
"Jenny Craig" #12
"Biggest Loser" #20

0 clinical trials could be found via pubmed search for:

"Mayo Clinic Diet" #5
"Volumetrics" #5
"Dr. Weil" #13
"Fertility Diet" #13
"Nutritarian" #17
"Engine 2" #19
"Optavia" #27
"Alkaline diet" #30
"Raw Food" diet #32
"Sirtfood" #32
"Autoimmune Protocol" (AIP) #35
"Whole30" #35

Notes:
--pubmed is a gov't database with nearly all US studies, but not everything. Possible I missed some
--diets w/ many hits may reflect multiple papers on same trial, e.g., 1079 hits for keto is unlikely to mean that there are 1079 different trials. Just a rough indicator

In sum,

#1/2 Med/DASH diets are deemed mediocre for weight loss, and lowering heart-disease risk. No ability to reverse T2 diabetes (T2D).

35 diets ranked higher than keto have less trial evidence showing benefit

Bottom-ranked keto diet has been amply studied, can reverse T2D

It's not as if USNews has not been alerted to the fact that its rankings are unhinged from the science. In 2018, @garytaubes and I wrote this op-ed for the @latimes
latimes.com/opinion/op-ed/…

Also in 2020, the Nutrition Coalition (group I direct) issued a press release calling attention to lack of evidence base for US News diet rankings: agview.net/opinion/us-new…

In 2021, Dr. Mark Cucuzzella, W. Virginia U. Jefferson Medical Center,, wrote this letter
lowcarbaction.org/keto-diet-snub…
300+ MDs signed an addt'l letter (linked in post) asking why USNews continues to ignore data on keto/low-carb and perpetuates scary myths that have been discredited

How does USNews rank its diets? There are no objective criteria. health.usnews.com/wellness/food/…
It simply asks the opinion of an expert panel--criteria that are non-transparent, un-systematic. Clearly open to bias.
That panel?
30% are members of a vegan/vegetarian activist group.

Group is the True Health Initiative, described by editor-in-chief of respected Annals of Internal Medicine as being more "vitriolic" than the National Rifle Assn. tamus.edu/wp-content/upl…

On the USNews panel are the group's leader, David Katz, and 7 others: Rimm, Manson, Dansinger, Cheskin, Gardner, Greger, Young.
Some major heavy-hitters here. Clearly influential on the panel, too, as >1/3 of best diets, ranked #1-12, are "plant-based"
health.usnews.com/best-diet/best…

Why are advocates of Vegetarian/vegan (V/V) diets so anti-keto/low-carb?
Maybe bc these diets are diametric opposites
May be opposed to consumption of animal foods
May also not want competition from a diet that clearly performs so well and backed by more positive outcome data

Others on USNews panel include:
--a nutrition communications consultant for the California Prune Board
--a consultant to “many US Commodity Boards including Potatoes USA”
--a researcher who declares multiple “significant” financial conflicts of interest
acc.org/membership/per…

So, in conclusion: USNews rankings are completely disconnected from high-quality, rigorous trial evidence.

In a country closing in on
50% with obesity (not just overweight but obese!)
>50% with pre-diabetes/diabetes
The public needs rankings it can trust. 👍

CORRECTION:
This figure should be .02 absolute risk reduction. Not .02%.

Correcting this: although obscure and not mentioned in the text of the paper, @whsource believes this is a test of the Volumetrics Diet: ncbi.nlm.nih.gov/labs/pmc/artic…
So that would be 1 clinical trial for the Volumetrics diet.