The Ketogenic Diet and Vegetarianism: Can They Coexist?
The Ketogenic Diet and Vegetarianism: Can They Coexist?
The interest in the hot, but controversial ketogenic diet has been growing on a daily basis. The diet consists of mostly fat (generally 70% of the diet or more), with generally lesser amounts of protein and a minimal amount of carbohydrates. During this carbohydrate-restricted diet, blood glucose (sugar) levels eventually fall. Glycogen, which is a form of sugar that is stored in muscle (the body stores most of its accessible energy as fat), is used for energy. After a certain period of time, the body begins to burn its fat stores and the liver begins producing ketones to provide energy to our cells.
Ketones are not the dangerous poisons that some tend to describe them as, nor are they magic beings that cure every disease and ailment known to man, something that more and more people seem to be claiming these days. Ketone bodies are nothing more than sources of energy that can feed cells throughout the body and can also cross the blood-brain barrier to keep our neurons firing throughout the day (and throughout the night, where many of us have already experienced ketosis).
These sources of energy kept the human race intact and alive over its lifetime, especially during periods of limited food supplies and in the winter when we relied on a high-fat and low carbohydrate diet. Ketones are normal aspects of human physiology that allow the body to function close to its normal physiologic state, which may help fight diseases like cancer,1–4 and has certainly been shown to fight diabetes and obesity.5,6
However, many controversies exist regarding a ketogenic diet:
Who would benefit most from a ketogenic diet?
What is the correct macronutrient ratio?
How positively (or negatively) does a ketogenic diet affect athletic performance?
Can it enhance the treatment of cancer?
Are some foods better than others to eat while on the diet (i.e. fat sources, glutamine, dairy, etc.)?
While many of these questions may never be answered exactly, as they are likely person-dependent and extremely variable, current ketogenic diets often consist of large amounts of foods from animal sources due to the requirement of excessive amounts of fat. Because of that, one group consistently seems to get the short end of the stick when it comes to the ketogenic diet…
What About the Ketogenic Diet for Vegetarians?
Attaining ketosis requires a large amount of fat, which can often be found in animal sources of food. Therefore, the ketogenic diet and animal foods go hand-in-hand. Yet, there are many non-meat and even non-animal sources of food that contain significant amounts of fat. The irony of the ketogenic diet is that those who eat a diet composed mostly of meat (especially typical lean cuts of meat), often find themselves getting kicked out of ketosis.
Dairy and Eggs
Dairy is controversial, but for those vegetarians that include it or eggs in their diet, several sources stand out as helpful on a ketogenic diet:
Eggs and egg yolks (from chicken that are pastured or roam the pasture eating insects) provide a significant amount of healthy fat and are very nutrient-dense with basically no carbohydrates present.
Raw (unpasteurized) cheese made from the milk of cows that are pastured (they only roam the pasture eating grass) and fed 100% grass provides significant amounts of fat with little to no carbohydrates, along with a plethora of other nutrients as well as bacteria for the bowels.
Heavy cream is a welcome addition to many cups of morning coffee, because it provides a hefty amount of fat with little to no protein or carbohydrates, as well as conjugated linoleic acid (if from cows that eat grass and not grains or corn).
Vegetable and Non-Animal Fat
Getting significant amounts of fat in the diet from vegetables is challenging. Turning towards “pseudo” vegetables, fruits, and nuts makes it easier.
Avocados, which are actually a fruit, provide a healthy amount of monounsaturated fat, a plethora of vitamins and nutrients, and most of the carbohydrate content is fiber, which feeds your bowel bacteria and will not affect ketone levels like non-fiber carbohydrates.
Coconuts, coconut oil, and coconut manna (the pulp of the coconut which contains some fiber) provide significant saturated fat and medium-chain triglycerides, which are easily turned into ketones.
Macadamia nuts provide the best bang for your buck in terms of fat-to-carbohydrate ratios with 21 grams of fat per ounce serving and only four grams of carbs (two grams are fiber).
Almonds are also good sources of fat and vitamins but can often lead to issues, as their fat content per ounce serving drops to 14 grams and the carbohydrates rise to six grams.
The Backup Plan
When all else fails, oils are an easy way to add fat to any meal. Keep in mind these are methods of supplementation and not reliance. A fat-free vegetable dish can quickly be turned into a high fat meal. As is the case with any diet, the oils used should be healthy and stable, and vegetable oils should be avoided.
The best oils:
Olive oil (make sure it is fresh as it spoils quickly and avoid high heat)
Butter (100% grass-fed and raw if possible)
Lard (just kidding)
A Final Word on Carbohydrates:
Vegetables generally contain more carbohydrates than meat sources — especially the fatty cuts of meat that are generally consumed on a ketogenic diet. As vegetarians often rely on increased amounts of vegetables and fruits, extra care must be taken to keep the carbohydrates limited. Leafy greens and cruciferous vegetables are great sources of nutrients, and they can be cooked or garnished in fatty sources or eaten in a salad with olive oil.
This will increase the amount of fat in the diet. Fruits should be watched closely and the best sources seem to be berries, as the skin is consumed and made mostly of fiber. These include blueberries, strawberries, raspberries, and blackberries. Fruits like bananas are difficult to eat on a full ketogenic diet as they can contain large amounts of carbohydrates and sugar.
Whether you are a carnivore or vegetarian, ketosis is a normal state that your body encounters. If you are planning on undergoing a full-blown ketogenic diet or periodic ketosis (my preference), you may be able to do it without meat as part of your diet.
I hope this short guide provides some ideas, but also stimulates discussion on other ways vegetarians can increase their dietary fat. If anyone has any other helpful tips or suggestions, please add them below in the comments.
To Your Health,
Dr. Colin Champ
Dr. Colin Champ is a practicing radiation oncologist and nutritional expert. He is the author of Misguided Medicine: The truth behind ill-advised medical recommendations and how to take health back into your hands” You can hear more from him as the host of the incredibly popular Caveman Doctor podcast.
1. Champ CE, Palmer JD, Volek JS, et al. Targeting metabolism with a ketogenic diet during the treatment of glioblastoma multiforme. J. Neurooncol. 2014;117(1):125-31. doi:10.1007/s11060-014-1362-0.
2. Klement RJ, Champ CE. Calories, carbohydrates, and cancer therapy with radiation: exploiting the five R’s through dietary manipulation. Cancer Metastasis Rev. 2014:1-13. doi:10.1007/s10555-014-9495-3.
3. Champ CE, Baserga R, Mishra M V, et al. Nutrient Restriction and Radiation Therapy for Cancer Treatment: When Less Is More. Oncologist 2013;18(1):97-103. doi:10.1634/theoncologist.2012-0164.
4. Simone BA, Champ CE, Rosenberg AL, et al. Selectively starving cancer cells through dietary manipulation: methods and clinical implications. Futur. Oncol. 2013;9(7):959-976. doi:10.2217/fon.13.31.
5. Forsythe C, Phinney S, Fernandez M, et al. Comparison of Low Fat and Low Carbohydrate Diets on Circulating Fatty Acid Composition and Markers of Inflammation. Lipids 2008;43(1):65-77. doi:10.1007/s11745-007-3132-7.
6. Volek J, Phinney S, Forsythe C, et al. Carbohydrate Restriction has a More Favorable Impact on the Metabolic Syndrome than a Low Fat Diet. Lipids 2009;44(4):297-309. doi:10.1007/s11745-008-3274-2.