Trendy diets like Whole30 and keto might be top-of-mind for healthy eaters in the new year, but U.S. News and World Report’s annual ranking of the 35 most popular eating plans named the Mediterranean diet the best diet overall, followed by the DASH diet and the Flexitarian diet, which are tied for second place. Meanwhile the aforementioned Whole30 and keto, along with the Dukan diet, were all ranked at the bottom of the list.
This might seem like déjà vu for the wellness crowd. As it does every year, U.S. News & World Report enlisted a panel of 25 experts who specialize in nutrition, obesity, diabetes, and heart disease to rate 35 diets based on how easy they are to follow, their effectiveness for healthy weight management, how nutritionally sound they are, their safety, and their ability to prevent and manage conditions like diabetes and heart disease. And for the third year in a row, the Mediterranean diet—which advocates for lean proteins, whole grains, seafood, and plenty of vegetables, along with the occasional glass of wine—was given top marks by experts.
Here’s the thing: the Mediterranean diet is based on how people in southern Italy and Greece ate in the 1960s, and it’s been part of the nutritional mainstream since the 1990s. Yet despite all we’ve learned about nutrition in the decades since (you know, like how fat isn’t necessarily the devil and calorie counting isn’t the end-all, be-all of health), the eating plan continues to be something that many experts, from cardiologists to registered dietitians, love to recommend. We talked to some of these pros to understand why.
Want to know more about the best diet of 2020? Check out this FAQ with a top dietitian:
While many other buzzy eating plans’ benefits are largely anecdotal (or in the case of the keto diet, based on small studies or mouse studies), the Mediterranean diet’s benefits are backed by decades of robust clinical research. “There have been studies upon studies that have shown that the Mediterranean diet can lower the incidence of heart disease by as much as 70 percent,” says Suzanne Steinbaum, DO, a cardiologist and the director of women’s cardiovascular prevention, health, and wellness at Mount Sinai Hospital in New York City. For example, a 2018 study in JAMA, which surveyed more than 25,000 American women, showed that those who followed the Mediterranean diet reduced their relative heart disease risk by 28 percent compared to those who didn’t.
Its benefits transcend heart health. A 2015 review in BMJ Journals found that the Mediterranean diet showed better blood sugar control and lower cardiovascular risks than lower-fat diets. Another 2014 study in the Annals of Internal Medicine, which followed more than 3,000 men and women, suggests that a Mediterranean diet supplemented with healthy fats like extra-virgin olive oil, could lower diabetes risk in people with heart disease. And a 2019 study found that it’s great for gut health and reducing inflammation.
“People respond to diets that are fast-acting but at the end of the day, they aren’t sustainable and don’t offer as many great nutritional benefits as the Mediterranean diet.” —Suzanne Steinbaum, DO
Other research suggests that following the Mediterranean diet can help reduce your risk of developing cognitive impairment and Alzheimer’s disease, likely thanks to the high amounts of brain-supporting fats from extra-virgin olive oil, fish, and nuts and seeds so integral to the eating plan. These healthy fats have been directly associated with preventing cognitive decline that comes with age.
All of the above-mentioned research confirms or builds upon previous findings on the Mediterranean diet, which has been studied for nearly fifty years. The landmark Seven Countries study of 1970 found that people in certain areas of the Mediterranean and Japan who followed certain dietary patterns (particularly high amounts of what we now know are healthy fats) had lower rates of heart disease and all-cause mortality. This initial research continued through the ’80s and ’90s and consistently found similar results—results that are confirmed in modern research today.
The Mediterranean diet isn’t particularly complicated. You don’t have to count calories or macros, measure ketones, or go overboard reading labels to properly avoid specific ingredients. Instead, it emphasizes eating lots of fruits and vegetables, healthy fats, lean protein, and some carbs while cutting back on processed foods. That simplicity, as proven in all the research above, comes with great rewards for health.
“Following a traditional Mediterranean diet limits your intake of refined breads, processed foods, and red meat—all factors that can help prevent heart disease and stroke,” says Ammon Beniaminovitz, MD, FACC, a board-certified cardiologist at Manhattan Cardiology. “The key to the diet’s success is its emphasis on natural, mostly vegetarian, unprocessed foods,” he says.
It also doesn’t demonize foods like carbohydrates or fats—two macronutrients long shunned by healthy eating circles. “Omega-3 fats are good for increasing HDL levels—good cholesterol—and promote vasodilation for decreasing blood pressure. Our bodies don’t make enough of these good fats, so we need to get them through diet,” Dr. Steinbaum says. As for carbs, the eating plan emphasizes eating whole grains, fruits, and vegetables, all of which are rich in fiber and antioxidants. These complex carbs prevent huge swings in blood sugar and are essential for promoting satiety and lowering cholesterol, Dr. Steinbaum says.
“I always find a way to incorporate carbs into every meal because they make me feel satisfied,” “A meal without carbs makes you feel like you’re missing something.”
Perhaps the biggest reason the Mediterranean diet continues to reign supreme is that it offers versatility without a ton of sacrifice. “The Mediterranean diet has no ‘allowed’ or ‘avoid’ lists, unlike paleo or keto. If you don’t like meat or fish, there’s beans. If you don’t like bread, there are whole grains,” says Bonnie Taub-Dix, MA, RDN, CDN, author of Read It Before You Eat It – Taking You from Label to Table. Yet still is room for red meat, dairy, and dessert in small, mindful quantities—they’re not completely off-limits.
There’s also room for interpretation with the Mediterranean diet. It can accommodate many dietary preferences (such as vegetarianism or veganism) because there isn’t a specific formula for following it. “It’s not a diet that is based on deprivation. It’s more about life than worrying about what you weigh,” Taub-Dix says.
“It’s not a diet that is based on deprivation. It’s more about life than worrying about what you weigh.” —Bonnie Taub-Dix, RDN
Outside of eating nutritionally balanced meals, the Mediterranean lifestyle is also about slowing down and reducing stress. It also highlights the importance of savoring your meals and enjoying the company you have—which can make it easier to stick to. “Many diets can feel isolating because they prevent you from eating with others who eat differently from you,” Taub-Dix says. “But the Mediterranean diet welcomes eating with people and enjoying the process of cooking. It’s less of a diet and more of a culture that encourages you to eat with family,” she adds.
Of course, choosing an eating plan that best suits you comes down to your own health needs, and there is no one right way of eating that works for every single person. But for most experts, Mediterranean-style eating continues to be the gold standard. “People respond to diets that are fast-acting but at the end of the day, they aren’t sustainable and don’t offer as many great nutritional benefits as the Mediterranean diet,” says Dr. Steinbaum. Don’t expect that to change any time soon.