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Experts say the Mediterranean diet has a healthy nutritional foundation and is among the easiest to follow. Linda Raymond/Getty Images
  • The Mediterranean diet is once again at the top of an annual list of best diets, followed closely by the DASH and flexitarian diets.
  • Nutritionists say that’s because these diets have the best foundations and are among the easiest to follow.
  • They advise people trying to eat healthier to be flexible with their favorite diet and try not to change too many things at once.

The Mediterranean diet has been ranked first in a best overall diet list for the sixth year in a row.

The DASH diet and the flexitarian diet were closed behind, ending up in a tie for second place.

The rankings were released this week in U.S. News & World Report’s annual diet list.

All three of these diets reduce or eliminate processed foods. They also stress filling your plate with fruits, vegetables, beans, lentils, whole grains, nuts, and seeds.

“The take-home message here is the recognition that the Mediterranean diet is really not just about the foods around the Mediterranean,” Gretel Schueller, managing editor of health for U.S. News & World Report, told CNN. “You can take the lessons and the approach of the Mediterranean eating pattern and apply it to any cuisine in any country.”

In the new survey, a panel of experts analyzed 24 diets and ranked them based on several categories, including how easy they are to follow and how well they promote weight loss, both in the short term and in the long term.

The number of diets examined was reduced from the 40 studied in the 2022 rankings. Some diets were integrated into existing categories, including five into the Mediterranean diet. Two new diets — Keyto and Pritikin — were added to the list.

The Mediterranean diet had the highest overall score with a 4.6 out of a possible 5.0. Both the DASH and the flexitarian diets were given scores of 4.4.

The DASH diet actually scored higher than the Mediterranean diet on weight loss, but the Mediterranean diet received a higher healthiness score.

The Mediterranean diet scored high in the category of lowering cholesterol. The flexitarian diet was listed as the most family-friendly while the DASH diet was tops for best bone and joint health.

In addition, a December 2022 study reported that adherence to a Mediterranean diet was associated with a lower risk of adverse pregnancy outcomes,

The annual diet type listing has been no surprise to nutrition experts over the years.

“These diets are ranked so high because they not only have the most data behind them, but the data is strong,” Kristin Kirkpatrick, MS, RDN, the author of “Skinny Liver,” told Healthline after the 2021 rankings were released.

“They are both well researched and have been proven to improve health outcomes in select populations,” added Caroline West Passerrello, MS, RDN, LDN, CLT, a spokesperson for the Academy of Nutrition and Dietetics.

“They are certainly among the most researched and scientifically well-supported styles of eating, which plays a big role,” Andy De Santis, RD, a weight-loss specialist, told Healthline in January 2021.

“There are endless studies at this point demonstrating the health benefits of both the DASH and Med diet in terms of reducing the risk of all sorts of negative health outcomes like certain types of cancer, heart disease, and diabetes,” he added.

In a 2020 study, researchers analyzed 121 trials that enrolled nearly 22,000 adults who were overweight or obese.

The participants followed one of 14 popular diets, including the DASH and the Mediterranean diets, for an average of 6 months with a follow-up at the 1-year mark.

While overall health improvements in blood pressure and cholesterol levels weren’t found to be sustainable in the long term, there was one notable exception: Reduced LDL (“bad”) cholesterol levels while on the Mediterranean diet persisted at 1 year.

Nutrition experts suggest that the Mediterranean and DASH diets see greater success long term because they’re easier to follow.

“Both diets (as well as their combination, the MIND diet) are found to be easy to sustain long term and associated with reduction of chronic disease,” said Kirkpatrick. “The MIND diet has so much strong data and tends to be easier to follow for so many of my patients.

“It’s a combination of Med and DASH with a high attention on plants, lean poultry, olive oil, etc. [Ten healthy foods] and five unhealthy foods to nix, which are sweets and pastries, fried foods, butter, cheese, and meat,” Kirkpatrick added.

Adding certain foods such as fresh fruits, whole grains, and fatty fish to your diet is a more sustainable strategy than eliminating and restricting items, say experts.

“The DASH and Mediterranean diets both involve changes to eating patterns and are flexible to meet the needs of many individuals,” said Passerrello.

“They also align with an assets-based approach, what foods and habits can we focus on to improve health, which makes them easier to follow and more appealing than a deficit approach, or foods to avoid.”

De Santis agrees.

“They are among the least convoluted, least restrictive, and most sustainable ‘diets’ just simply because they are based on logical foundations and incorporate, rather than restrict, a wide array of food groups,” he said.

“The Med diet is essentially the halfway point between the ‘average American’ diet and veganism,” explained De Santis.

“No one says you have to be vegan, vegetarian, or even pescatarian, but if you eat more like one [like the Med diet prescribes], it will be to your benefit,” said De Santis.

Long-term changes don’t happen overnight, though.

“Take it slow,” advised Kirkpatrick. “Making too many changes all at once can be hard to sustain.”

She recommends sticking with a whole foods diet and identifying the one thing you should change the most.

“Then, focus on that for the next 6 weeks before moving on to another behavior change,” she said.

When it comes to the DASH diet and reducing alcohol consumption in particular, Kirkpatrick has her clients limit the days of consumption (for example, only drink on weekends) and to try nonalcoholic and lower-alcohol options such as seltzer water mixed with white wine instead of an entire glass of white wine.

You can also find support by following the slogan for National Nutrition Month 2021 and “Personalize Your Plate,” says Passerrello.

“Everyone’s plate is going to look different from each other, and our own plates will look different day-to-day and meal-to-meal, which is expected,” she said.

“Check out the newly revamped MyPlate website where you can access a plan that provides recommendations for food groups to include, and you can choose what foods meet those recommendations,” she added.

Still not sure how to make lasting changes?

“Meet with a registered dietitian or nutritionist that aligns with your philosophy of eating if you aren’t sure how to personalize your plate,” said Passerrello.

Beyond specific dietary patterns, nutrition experts are seeing emerging health trends toward less meat, less alcohol, and less sugar consumption.

Experts say people are taking positive actions in these areas despite the lack of backing from dietary guidelines.

In December 2020, federal officials released the 2020–2025 Dietary Guidelines for Americans. They didn’t include a reduction in the recommended intake of alcohol and sugar, a move criticized by some organizations.

“The scientific report from the Dietary Guidelines Advisory Committee found that the current evidence justifies tightening the alcohol guideline for men to no more than one drink per day, to match the recommended limit for women,“ a statement from the American Institute for Cancer Research says. “AICR recommends that, for cancer prevention, it is best not to drink alcohol.”

While these changes were not implemented, and industry pressures are cited as an explanation, experts are nonetheless noticing gaining interest in plant-based, lower-sugar, and alcohol-free lifestyles.

“I’m seeing a trend with my patients to drink less,” said Kirkpatrick. “Intermittent fasting, and specifically, time-restricted eating, has also been trending.”

“Trends focus on foods and patterns of eating to support our immune function and improve both our mental health and gut health,” explained Passerrello.

“Consumers are still interested in eating less sugar and red meat, but they are approaching it differently. Focusing on more unsweetened beverages (like sparkling water) and a flexitarian approach that has them eating more meatless meals,” she said. “I also see a welcome trend toward rebuking diet culture.

“My clients, and consumers alike, are focusing on their overall health and well-being more than a specific weight,” Passerrello added. “Unless there is a life-threatening reason to avoid a food, like a food allergy, all foods can fit.”