All diets / Ketotarian

Drawing for Ketotarian: the healthen mark with the word KETOTARIAN, tofu, olive oil, zucchini, avocado, seeds, mushroom, walnuts and edamame.
What you eat on ketotarian: tofu, olive oil, zucchini, avocado and seeds.

Ketotarian: keto without the bacon. Harder to do, easier to defend.

Most keto plates are piled with meat and cheese. Ketotarian swaps them for avocado, olive oil, nuts, seeds and tofu. It's a pain to plan, but the evidence for plant-based low-carb is surprisingly good.

The short version

What it is
Keto built on plants: avocado, olive oil, nuts, seeds, tofu, low-carb vegetables. Eggs and fish optional.
Good for
Vegetarians who want low-carb. LDL cholesterol, in a related trial.
Bad at
Being easy. Protein and variety take real planning.
Evidence
Weak for ketotarian itself, moderate for plant-based low-carb.
Our take
A building block. It's how vegetarians get our keto-style first meal.

What ketotarian actually is

"Ketotarian" is a name coined by author Will Cole in a 2018 book.1 It's keto with plants doing the heavy lifting: very low carbs, high fat, moderate protein, but the fat comes from avocado, olive oil, coconut, nuts and seeds rather than bacon and butter. There are three flavours: vegan, vegetarian (with eggs and some dairy), and pescatarian (with fish).

A related idea had already been tested by researchers, under the much better name "Eco-Atkins": a vegan low-carb diet built on plant proteins and plant fats.2 Eco-Atkins wasn't strictly keto, but it's the closest real trial we have.

How it works in your body

The same as keto. Cut carbs very low and your body uses up its sugar stores, drops water, and switches to burning fat and making ketones. Appetite often drops.

The difference is what fills the plate. Plant fats are mostly unsaturated, which tends to be kinder to LDL cholesterol than the saturated fat in butter and fatty meat. That matters, because rising LDL is keto's best-known side effect.4

What you eat, what you don't

Eat

  • Tofu, tempeh, edamame, seitan (if no coeliac disease)
  • Avocado, olives, olive oil
  • Nuts and seeds: walnuts, almonds, pumpkin, hemp, chia, flax
  • Leafy greens, broccoli, cauliflower, courgette, mushrooms, peppers
  • Eggs and oily fish, if you include them
  • Berries, in small amounts

Forget it

  • Sugar, soft drinks, juice
  • Bread, rice, pasta, potatoes
  • Most fruit
  • Most legumes beyond small portions (too many carbs for keto)
  • Processed "vegan keto" snacks and sweets
  • Beer

A day on ketotarian

Notice what's doing the work: tofu, tempeh, eggs or fish for protein, and fat from olives, nuts, seeds and avocado. Take away the soy and the eggs, and the day gets thin fast.

Ketotarian in Singapore and in Austria, Germany and Switzerland

Singapore: you're in luck. Firm tofu, tau kwa, tempeh and edamame are cheap at every wet market and supermarket. At the hawker centre, yong tau foo without noodles (skip the fried, flour-filled pieces) and stir-fried greens from the zi char stall work well. Traps: mock meat, which is often flour-based and sweet-sauced, and vegetarian bee hoon stalls, where the noodles are the meal.

Austria, Germany, Switzerland: look for Räuchertofu (smoked tofu) and tempeh, now in most supermarkets, plus pumpkin seeds and Kürbiskernöl (pumpkin seed oil) from Styria. Mushrooms, sauerkraut and Feldsalat fill the plate. Traps: vegetarian menus built on Käsespätzle, Knödel and Flammkuchen.

Alcohol on ketotarian

OK, now and then

  • Vodka, gin, whisky, tequila: neat, on ice or with soda water and lime
  • One glass of dry red or white wine (check it's vegan if that matters to you)
  • Sparkling wine labelled brut nature or extra brut

Kicks you out of ketosis

  • Beer, cider
  • Cocktails, liqueurs, sweet wine
  • Anything mixed with juice, cola, tonic or energy drinks
  • "Zero" mixers: sweeteners are on our never list

50 Club: one light beer or a small sake.

Zero carbs doesn't mean zero effect: two drinks cut fat burning by about 73% in one study.6 Never drink on an empty stomach. All the details are in our alcohol guide.

What ketotarian is good for, with proof

Lower LDL cholesterol than a high-carb vegetarian diet

In the Eco-Atkins trial, adults with high cholesterol ate either a vegan low-carb diet or a high-carb lacto-ovo vegetarian diet for six months. The low-carb plant group lost a bit more weight (6.9 vs 5.8 kg) and their LDL cholesterol dropped clearly more.2 The catch: 39 started and only 23 finished. Small, but encouraging.

The right kind of low-carb

In a 25-year US study and a meta-analysis of over 400,000 people, low-carb eating that replaced carbs with plant fats and proteins was linked with lower mortality, while replacing them with animal fats and proteins was linked with higher.3 Observational, so not proof. But if you're going low-carb, the evidence leans clearly towards the ketotarian side of the plate.

Keto's usual benefits

Keto in general led to slightly more weight loss than low-fat diets over a year or more, under a kilo, in a meta-analysis of 13 trials.4 There's no reason to think the plant-based version does worse, but nobody has tested strict ketotarian eating directly.

The uncomfortable truth

"Vegan keto is impossible." It's not, but it is hard. Most plant proteins, beans, lentils, chickpeas, come with plenty of carbs. That leaves tofu, tempeh, seitan, nuts and seeds doing nearly all the work. Without eggs or fish, getting enough protein on strict keto takes real planning. That's why we prefer the looser, legume-friendly version for most people.

Also: plant-based doesn't mean healthy by default. "Vegan keto" cookies made of coconut oil and sweeteners are still cookies.

Ketotarian or standard keto?

Both get you into ketosis in the same way. The difference is the fat. Standard keto, as most people actually eat it, leans on butter, cheese, bacon and red meat. Ketotarian swaps those for olive oil, nuts, seeds and avocado. That's exactly the trade the big mortality analysis favoured: plant fats and proteins in, animal ones out.3 What you lose is convenience. Standard keto is easier to cook, easier to order in a restaurant and easier to hit your protein on. If you eat eggs and fish, the pescatarian version is the sweet spot between the two.

The risks

Allergies: watch the staples

Ketotarian leans on some of the most common plant allergens. If you're allergic, the plan swaps them.

Ketotarian stapleAllergen (EU list of 14)7Swap
Tofu, tempeh, edamameSoyEggs, seitan, hemp seeds
SeitanCereals containing glutenTofu, tempeh, eggs
Almonds, walnuts, cashewsTree nutsPumpkin, sunflower and hemp seeds
Peanut butterPeanutsSunflower seed butter
Tahini, sesame seedsSesamePumpkin seed butter
Eggs (vegetarian version)EggsTofu scramble
Fish (pescatarian version)FishFlax, chia and walnuts for omega-3

Don't do ketotarian if you…

  • are pregnant or breastfeeding
  • have type 1 diabetes, or take insulin or SGLT2 drugs
  • have kidney, liver or pancreas disease
  • have ever had an eating disorder
  • are under 18
  • are allergic to both soy and tree nuts (it gets very hard to eat enough)

Healthen me asks about all of these and gives you a different plan if any apply.

How we use ketotarian in your plan

This is a building block. Every plan breaks the fast with a keto-style meal. If you tell Healthen me you're vegetarian or vegan, that first meal comes from the ketotarian playbook: tofu scramble, avocado, greens, seeds, olive oil, and eggs if you eat them.

After that, your meals are plant-based low-carb, which means lentils, beans and chickpeas are back on the menu. That's where most of your plant protein comes from.

This article is general information, not medical advice. If you have a medical condition or take medication, talk to your doctor before changing how you eat.

Sources

  1. Cole W. Ketotarian: The (Mostly) Plant-Based Plan to Burn Fat, Boost Your Energy, Crush Your Cravings, and Calm Inflammation. New York: Avery, 2018.
  2. Jenkins DJ et al. Effect of a 6-month vegan low-carbohydrate ("Eco-Atkins") diet on cardiovascular risk factors and body weight in hyperlipidaemic adults: a randomised controlled trial. BMJ Open 2014;4(2):e003505. doi.org/10.1136/bmjopen-2013-003505
  3. Seidelmann SB et al. Dietary carbohydrate intake and mortality: a prospective cohort study and meta-analysis. Lancet Public Health 2018;3(9):e419–e428. doi.org/10.1016/S2468-2667(18)30135-X
  4. Bueno NB et al. Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: a meta-analysis of randomised controlled trials. British Journal of Nutrition 2013;110(7):1178–1187. pubmed.ncbi.nlm.nih.gov/23651522
  5. US Food and Drug Administration. Drug Safety Communication: FDA warns that SGLT2 inhibitors for diabetes may result in a serious condition of too much acid in the blood, 15 May 2015 (archived copy). web.archive.org: fda.gov/Drugs/DrugSafety/ucm446845.htm Published case series: Mistry S, Cocks Eschler D. Euglycemic diabetic ketoacidosis caused by SGLT2 inhibitors and a ketogenic diet: a case series and review of literature. AACE Clinical Case Reports 2021;7(1):17–19. doi.org/10.1016/j.aace.2020.11.009 (PMC7924151)
  6. Siler SQ, Neese RA, Hellerstein MK. De novo lipogenesis, lipid kinetics, and whole-body lipid balances in humans after acute alcohol consumption. American Journal of Clinical Nutrition 1999;70(5):928–936. pubmed.ncbi.nlm.nih.gov/10539756
  7. Regulation (EU) No 1169/2011 on food information to consumers, Annex II (the 14 allergens). eur-lex.europa.eu/eli/reg/2011/1169/oj