Everything You Need to Know About a Keto Diet, Plus How to Do It Plant-Based

The keto diet is one of the most popular diets around, but it has received a lot of publicity, most of it bad, due to the fact that keto dieting is tied to adverse side effects. Some of the health risks of keto dieting can be serious, like increased risk of heart disease, kidney stones, and even, occasionally, fatal organ failure. So, is following a keto diet dangerous?  After decades of research into low-carb, high fat, protein-heavy diets, the studies tell us that a keto diet is unhealthy, especially if you do it by eating a high percentage of animal products. Still, people continue to sign up for this method of weight loss, because it works.

Eating a ketogenic diet typically reduces the number of carbs you intake to fewer than 50 grams a day or about 5 to 10 percent of your total calorie intake. Typical keto diets call for eating the rest of your calories from fat and protein, about 70 to 80 percent from fat and 20 percent from protein, which traditionally means loading up animal fat. The goal is to go into "ketosis" which is a state where your body is deprived of its preferred fuel choice, carbohydrates, and is forced to burn fat instead. When fat is mobilized in the absence of carbs your body releases ketones, which are acidic, leading to some of the problems.

We've learned from recent research into the health risks of a keto diet that the side effects include elevated risk of heart disease and other dangerous conditions. It turns out that concentrating the majority of your calories from fat – especially animal fat such as bacon, red meat, full-fat cheese, and dairy – can raise your cholesterol, cause plaque to form in your arteries, and ultimately lead to heart attacks or strokes. Meanwhile, the acidic ketones that are released as fat cells get broken down enter the bloodstream and can cause scarring on the heart, according to one animal study.

Plus by eating fewer carbs, you cut out important sources of vitamins and minerals such as vegetables and fruit, which are also full of gut-healthy fiber and an array of micronutrients that help your body function at its best, including your immune system. Keto, everyone agrees, in the long term is a potential killer.

But keto diets can also be dangerous short term. Back in the fall of 2020, the death of Bollywood Actress Mishti Mukherjee, an up-and-coming 27-year-old from kidney failure was attributed to her keto diet, according to her family, who warned others that her tragic death could have been avoided.

Doctors have warned that while keto works well for obese patients who face dire health consequences unless they lose weight, it can cause more severe issues for thinner patients who stay on it too long, since when the body stores up too many ketones—the acids produced as a byproduct of burning fat—the blood can become too acidic, which can damage the liver, kidneys, and brain. Left untreated, the damage can be lasting, according to medical experts. Keto dieters should drink plenty of water to reduce the stress on their kidneys while on a strict keto diet.

There is a debate over which is worse: Being morbidly overweight, which a keto diet can help solve, or staying in ketosis for long periods of time, which has been linked to compromised heart health and specific symptoms such as irregular heartbeat, and risk factors such as higher blood lipids.

For obese patients with dire health conditions, losing weight quickly (by going on a keto diet) can lower their risk of obesity, heart attack, and bring their blood pressure and other health markers from dangerously high to under control. But for the average dieter looking to lose 5 or 10  or 15 pounds and keep it off, a keto diet comes with health side effects that are not worth the risk. Plus it can be impossible to maintain the weight loss, since the minute you add back in carbs (such as pasta, bread, rice, or any form of added sugar) you are likely to gain the weight back and possibly more. The health risks associated with a keto diet include:

Keto is a very low carbohydrate dietary approach that sends the body into ketosis, a metabolic state in which it has reduced access to glucose and is instead fueled mostly by fat. While the study of the keto diet shows that those who follow it do manage to lose weight initially, it tends not to be sustainable, according to 12-month data. It is also unclear whether the weight loss is caused by achieving ketosis or simply by calorie restriction and less sugar.

Researchers also have concerns about the type and amount of fat consumed by those following a keto diet. While existing studies strictly controlled the type of fat and foods participants consumed, many who try keto consume high amounts of unhealthy saturated fat, which is associated with an increased risk of heart disease and high lipid levels in the blood.

Eating high levels of saturated fat leads to a higher risk for long-term heart disease, according to studies, while short term a low-carb diet  can produce other health conditions and side effects, such as a "keto flu" and headaches, according to the Mayo Clinic

There is also evidence that eating a keto diet for an extended period of time may lead to stiffening of the arteries, and several studies found that those who eat a keto diet have a greater risk of premature death.

Researchers in China found that a keto diet can lead to dangerous scarring of the heart.

Keto diets put your body into a state of ketosis, or burning fat for fuel, which releases acids called ketones into the bloodstream that are believed to be damaging to the heart muscle. In one study conducted on lab animals in China, scientists looked at the cellular impact of ketones on the heart and found that when ketones are formed, they can have a detrimental impact on heart tissue, causing permanent scar tissue to form, which itself hinders the heart's ability to pump blood properly.

The researchers at  Fudan University in Shanghai, and Sichuan University in Chengdu, were seeking to find out of going keto might benefit the immune system. Instead, they found disturbing evidence that it could lead to atrial fibrillation or irregular heartbeat due to the scarring that occurs when the body is in ketosis. Their research "has suggested that elevated [ketone levels] is linked with poorer cardiac health, alongside various other concerning correlations between ketosis and mortality," according to an article in the online medical journal IFL Science. 

Kidney stones are a well-known side effect of a ketogenic diet. In a study of children on a keto diet for the treatment of epilepsy, 13 out of 195 subjects developed kidney stones, according to a study published in the Journal of Child Neurology. One way to mitigate this risk is to supplement with potassium citrate and limit the number of processed meats and sodium you take in, according to experts. Animal protein increases the acidic value in the kidneys and can lead to stones as well as gout, a painful arthritic condition in the joints.

A ketogenic diet can exacerbate kidney disease since people with kidney disease are often advised to follow a low-protein diet, which is the opposite of a keto approach.

As if the real flu season and the threat of having a COVID-19 breakthrough case aren't enough to worry about, when you go on a keto diet, your body is often shocked by the lack of carbs and you suffer from low energy, aches, and the general need to lie down. As the body switches over from burning glucose as fuel to ketones from the fat you are burning, it can feel as if you have been sidelined with the flu.

For many keto dieters, this keto flu, with accompanying fatigue, aches, and general lack of energy is anathema to the goal: A desire to lose weight and feel energized by the food you eat. So when the "keto flu" strikes, it can bench you for days or weeks and it may be a sign that the keto diet is not the right approach for you. If you are trying to power through, one way is to add back in light exercise such as strength training, which can help activate the muscles and help you snap out of it.

So why is keto dieting still so popular? The problem with these arguments is that people keep signing on for a keto style of weight loss because it works. At least in the short term.

The question is:  Is it possible to eat keto and be healthy? Can you have your carrot cake and eat it too? Here's how to do a healthy keto diet. Or at least do keto a healthier way!

What if you could do a keto-friendly diet, and use healthy keto foods, such as plant-based fats that are from avocado, nuts, seeds, olive oil, and considered heart healthier? And what if instead of cutting back on carbs to an extreme, you calculated "net carbs," or the difference between total carbs and fiber content, since fiber is hard to break down in the body and is essentially like shopping at discount: You can take a percentage of the carbs in, say, broccoli, out of the total equation because it happens to also be full of healthy fiber. Net carbs mean you can eat more carbs, as long as they are high in fiber, and still stay on a keto diet.

That's the idea behind a vegan keto diet: You can still lose weight by cutting out simple carbs such as those from bread, pasta, cereal, crackers, cookies, and all packaged foods. And you can eat healthy fats from plant-based sources, such as avocado, olive oil, nuts, and seeds.

By choosing your carbs wisely and seeking high-fiber vegetables, leafy greens, whole grains, and legumes, it is possible to go keto and avoid the dangerous side effects. On a vegan keto diet, you allow yourself to eat healthy carbs in the form of vegetables and to a lesser extent fruit. That way you don't lose out on all the healthy antioxidants, nutrients, vitamins, and minerals in whole food, plant-based diet.

Keto diets are not unhealthy themselves, but it's the way people do them that is, according to Dr. Andrew Freeman, a cardiologist at National Jewish in Denver. Dr. Freeman, known as the vegan cardiologist, released a study that keto dieting can lead to heart disease because of the foods people eat while on the traditional keto diet.

When they go keto, people often load up on red meat, processed meat like bacon, and stay away from healthy plant-based foods like fruits, vegetables, and whole grains–which are all nutrient-rich and full of antioxidants–because they happen to contain carbs. Someone on a keto diet will likely drop pounds in the short term, he explained, but this weight loss is usually temporary since it's difficult to sustain by eating a diet high in meat, butter, and animal fat, which has been scientifically shown to increase your lifetime risk of heart disease, cancer, diabetes, and premature death from all causes. Meanwhile, a plant-based diet lowers your risk of death from all causes, recent studies have found.

A healthier way to go keto and avoid the risky side effects is to do it on a plant-based diet. While you may not technically enter ketosis, you will lose weight when you cut out carbs from added sugars, processed foods such as chips and crackers, and replace them with vegetables, greens, and other high-fiber sources. These are also filled with antioxidants and nutrients to help keep you healthy as you lose weight in a more sustainable way.

The safest way to try to achieve weight loss is on a plant-based diet, and there is a small Venn diagram of overlap between keto foods and plant-based foods. For how to achieve this, you have to look at the fat, protein, carb ratio of legumes, fruits, and vegetables, such as avocados and beans, nuts, and plant-based oils, explains vegan chef Suzie Gerber, who lost 50 pounds on a plant-based diet and now helps others to be healthy and learn to eat a plant-based diet too.

"You are prioritizing plant-based fats from nuts, plant oils, and whole foods like avocados. It may take a few days of eating this way to get into ketosis, explains Gerber, since there is a "fat adaptive" period in all keto diets, where you train the body to burn fat for fuel, but you can speed this up by practicing intermittent fasting, which is not eating for up to 14 or 16 hours and then eating keto-friendly plant-based foods during the 8 to 10 on-hours, focusing on eating a plant-based diet.

She suggests that you have to leave off bread, alcohol, and other carbs that will put you over the limit of 5 percent of your calories a day from carbs. Dr. Jason Fung, author of Life in the Fasting Lane, told The Beet that his patients often combine Intermittent Fasting and keto diet choices for the fastest weight loss results.

The Vegan Keto Diet plan from The Beet includes tips for every day of the 21-day program, written with vegan nutritionist Lisa Danielson, who is also a keto expert. You can find Lisa Danielson (@veggie_lisa) or read Keto for Vegetarians: Lose Weight and Improve Health on a Plant-Based Ketogenic Diet.

In order for the vegan keto diet to be successful, Danielson advises, you need to reach a state of ketosis, where your primary fuel source is fat. The easiest way to do this is to start with a brief fast, leaving 14 to 16 hours between your last meal and the start of your diet, which will help jumpstart your ketosis and make it easier for your body to begin burning fat. The standard kick-off is actually a 24 hour fast, but if that's too extreme for you, choose a shorter interval. Note: Before you try fasting or any other significant dietary changes, we urge you to check with your doctor and make sure this is safe for you.

For many people, if you have a lot of stored glucose then the longer fast makes it more likely you will get into ketosis faster. During the "fasting" period you will need to hydrate with water, electrolytes, and clear liquids (such as black tea, vegetable broth, or add powdered greens to your water bottle. Most of the time a noon-to-noon fast works well to jumpstart your keto diet, or you can start your fast after an early dinner and go through noon the next day. Then after your brief fast, you can jump into the 21-day meal plan.

Chips, cookies, and bread. It's much easier to go keto if you only have keto-friendly snacks to reach for. Some things to get rid of: All processed foods (cereals, chips, crackers) and all sugary foods (dried fruits, sodas, honey, and of course candy). You may want to ditch the carb-heavy fruits (such as mangos, bananas, pineapples), and even the most starchy vegetables (corn and potatoes). Foods to stock up on for your vegan ketogenic diet: Nuts, green veggies, olives, avocado, coconut oil, berries, and zucchini, plus spinach, kale, and broccoli, to name a few.

Making substitutions for keto-approved foods might take some figuring out at first, but once you get used to thinking about "carbs vs. net-carbs" it will be easy! For example, Regular pasta should be given up for zucchini spirals. Mashed potatoes are off the plate, but mashed cauliflower is on the menu. White rice is out but cauliflower rice is in. Bananas are out but berries are in. The restaurant-style pizza crust is out, but psyllium husk is in (or cauliflower crust.) There are now so many keto-friendly plant-based products on the market you can search for chickpea pasta (which is in) or bean pasta, all of which are low in carbs and high in protein.