By Dr. Alisha Ghajar, ND
Spring is near, and many people take advantage of this season to overhaul their diet for weight loss, to have more energy, or to improve cardiovascular health. As a nutritionist and naturopathic doctor (ND), I am frequently asked, “what’s the best diet”? The short answer is: there is no one right way of eating for everyone, no matter what the celebrity blogger says.
Below are three of the hottest diet trends patients ask about most often. I’ll briefly explain what they are, how they may be beneficial, and dispel some myths.
The Mediterranean Diet
Is it really just about olive oil and red wine?
So called because it mimics traditional diets of countries like Greece, Italy and Crete, which border the Mediterranean Sea, this diet is mostly a plant-based, whole-foods way of eating that emphasizes healthy fats, fresh fruits and veggies, legumes and whole grains. Fatty fish and olive oil take center stage in this diet, while eggs, red meat and sugar are limited or discouraged. Red wine is included in the diet in moderation, as it is high in antioxidants, which are heart-protective. 
Benefits: This style of eating has been shown in multiple studies to lower cholesterol levels, and higher consumption of omega-3 fats from fish and olive oil is linked to lower risk of heart disease and stroke, and improved brain function. [2,3,4] Because sugar and processed foods are minimized or eliminated, this diet is useful for those with type II diabetes as well. It has been around for several years, so longer-term studies are available and largely positive.
Challenge level: Easy; most restaurants serve options that can be altered to suit the Mediterranean Diet, and you don’t need to be a chef to prepare some basic meals.
Myth debunked: No, you don’t have to drink red wine to see health benefits from a Mediterranean style diet. While red wine is allowed in moderation, drinking too much of any alcoholic beverage can increase the risk of certain cancers.  And let’s not forget how much more difficult it is to make healthful decisions when we have had a little too much to drink. (Think late-night chips and cookies).
Food for thought: People who live on the Mediterranean Sea and eat the traditional diet also typically exercise more, have stronger family ties and support systems, and take more time to relax and de-stress. The importance of these lifestyle choices and their positive impact on our health cannot be emphasized enough.
Where to learn more: Oldways is a non-profit organization offering detailed information about traditional diets from around the world, including recipes and meal ideas.
The Paleo Diet
A modern take on hunting and gathering
The Paleo diet is based on the way Paleolithic people, our caveman ancestors, ate before the invention of farming. It is grain-free, dairy-free, sugar-free, and avoids processed foods, potatoes and legumes (including peanuts). Strict versions avoid alcohol, coffee and salt. Paleo foods include grass-fed meat and eggs, seafood, vegetables, fruits, nuts and plant-based fats such as avocado oil and olive oil. Grass-fed meats are encouraged because they are leaner than their grain-fed counterparts, making them more similar to the wild game our ancestors would have hunted. The diet is high in fiber and protein, and lower in carbohydrates. 
Benefits: Research has shown a significant reduction in weight, blood pressure, diabetes markers such as A1c and fasting glucose, and LDL cholesterol (the more inflammatory type of cholesterol). This should not be surprising given the diet’s low sugar and high fiber content, when vegetables are eaten abundantly. [7,8]
Challenge level: Moderate; many people find it difficult to avoid dairy, grains and legumes, and grass-fed meat can be expensive and hard to find in some areas.
Myth debunked: While eating the Paleo diet can result in a number of health benefits for those with diabetes and cardiovascular disease, not all “Paleo” foods are created equal. There are many packaged foods on the market labeled “Paleo”, because they don’t contain certain ingredients like dairy or sugar. However, these foods may still cause weight gain and contribute to insulin resistance when eaten to excess, as they usually contain dried fruits in high quantities and are often very caloric.
Food for thought: Arguments criticizing the Paleo diet often cite the differences in food supply today vs. the food supply during the Paleolithic period. For example, animals today are generally raised on feedlots and subjected to hormones and antibiotics, and the diet does allow for pressed oils that would never have been available to our ancestors thousands of years ago. These are all true statements, but they don’t negate the obvious health benefits of eating a more whole-foods approach that limits sugar.
Where to learn more: While he didn’t invent the Paleo diet, Loren Cordain, PhD did popularize it when he wrote The Paleo Diet. His website has helpful information and recipes.
The Ketogenic Diet
Fat makes a comeback
Food policy makers in the 1970’s and 80’s promoted low-fat diets to prevent cardiovascular disease, and manufacturers brought us low-fat packaged foods by the ton. Unfortunately, heart disease rates only increased in the United States, along with diabetes and obesity.  Fast forward to today, and the pendulum shift in response is the ketogenic (keto) diet. When the human body burns fat for fuel, instead of glucose from carbs, it produces ketones which can be used by nearly every cell for energy. This is the foundation of the keto diet: it is a high fat, low carbohydrate diet that generally keeps carbohydrates to about 20-50 grams per day. Foods allowed include meat, seafood, low-glycemic vegetables, high-fat dairy and nuts. Limited low-glycemic fruits are allowed. There is little to no space for sugar or grains, as they would quickly push the body over the low carbohydrate limit.
Benefits: Keto diets have been used for years to effectively treat epilepsy. They are also very useful for weight loss, high triglycerides and type II diabetes, though long-term studies are still needed. Emerging research is promising for adjunctive cancer treatment and polycystic ovarian syndrome.  As an added bonus, those who eat a ketogenic diet often report increased mental clarity and energy.
Challenge level: Difficult; many people find the transition from eating carbs to cutting them out to be uncomfortable or inconvenient. The ketogenic diet also usually requires measuring urine or blood ketones, at least at the beginning, in order to confirm that the body has begun burning fat for fuel. This can be expensive, and most people don’t like pricking a finger to test their blood. People also often need to record the quantities of fat, protein and carbohydrates they consume to make sure they are on target, which requires weighing food and tracking it on paper or with an app. Eating out can be difficult, to say the least.
Myth debunked: A keto diet does not require eating a lot of meat, which is very high in protein. A well-formulated keto diet has only moderate amounts of protein, and many vegetarian or vegan keto plans are available online. The body can convert protein to glucose, so eating too much protein can actually prevent ketosis.
Food for thought: Many people misunderstand the keto diet as simply a “high fat” diet, which it is, but it must also be low in carbohydrates and contain low to moderate amounts of protein in order to be healthful. Simply adding butter to your carb-rich breakfast is akin to making frosting in your arteries, which is inflammatory and dangerous for the cardiovascular system.
Where to learn more: Dr. Andreas Eenfeldt founded Diet Doctor, which is a user-friendly site devoted to educating those who are curious about the ketogenic diet. Scientific articles, recipes and meal plans are all available for download.
Diets can be confusing…all have pros and cons, and there is no shortage of misinformation and dogma online. If you have specific goals in mind, and want a rational approach that is safe and tailored to your lifestyle, I recommend making an appointment with a licensed ND who is skilled at helping you choose a lifestyle plan that is right for you.
There are many more diets than can be explored in one article! Leave a comment below if you are interested in learning more about other nutrition topics in the future.
- Diet Review: Mediterranean Diet. (2018, December 12). Retrieved from https://www.hsph.harvard.edu/nutritionsource/healthy-weight/diet-reviews/mediterranean-diet/
- Rimm, E. B., Rodriguez-Artalejo, F., Hu, F. B., Li, S., Fung, T. T., Li, T. Y., … Lopez-Garcia, E. (2013). The Mediterranean-style dietary pattern and mortality among men and women with cardiovascular disease. The American Journal of Clinical Nutrition, 99(1), 172–180. http://doi.org/10.3945/ajcn.113.068106
- Fung, T. T., Rexrode, K. M., Mantzoros, C. S., Manson, J. E., Willett, W. C., & Hu, F. B. (2009). Mediterranean diet and incidence of and mortality from coronary heart disease and stroke in women. Circulation, 119(8), 1093–1100. http://doi.org/10.1161/CIRCULATIONAHA.108.816736
- Aridi, Y. S., Walker, J. L., & Wright, O. R. L. (2017). The association between the mediterranean dietary pattern and cognitive health: A systematic review. Nutrients, 9(7). http://doi.org/10.3390/nu9070674
- Boffetta, P., & Hashibe, M. (2006). Alcohol and cancer. The Lancet Oncology, 7(2), 149–156.
- The Paleo Diet Premise. (2019). Retrieved from https://thepaleodiet.com/the-paleo-diet-premise/
- Tarantino, G., Citro, V., & Finelli, C. (2015). Hype or reality: Should patients with metabolic syndrome related nafld be on the hunter-gatherer (paleo) diet to decrease morbidity? Journal of Gastrointestinal and Liver Diseases, 24(3), 359–368. http://doi.org/10.15403/jgld.2014.1121.243.gta
- Masharani, U., Sherchan, P., Schloetter, M., Stratford, S., Xiao, A., Sebastian, A., … Frassetto, L. (2015). Metabolic and physiologic effects from consuming a hunter-gatherer (Paleolithic)-type diet in type 2 diabetes. European Journal Of Clinical Nutrition, 69, 944. Retrieved from https://doi.org/10.1038/ejcn.2015.39
- Temple, N. J. (2018). Fat, sugar, whole grains and heart disease: 50 years of confusion. Nutrients, 10(1), 1–9. http://doi.org/10.3390/nu10010039
- Paoli, A., Rubini, A., Volek, J. S., & Grimaldi, K. A. (2013). Beyond weight loss: A review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets. European Journal of Clinical Nutrition, 67(8), 789–796. http://doi.org/10.1038/ejcn.2013.116