Vegan Keto Diets: Difficult, But Not Impossible

By Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T.

Two of the most popular health “trends” these days are vegan and ketogenic (keto) diets. Individually, they each offer their own unique set of benefits, and each also have specific drawbacks.

And they could not be more opposite from one another.

Even so, more and more people are attempting to follow a “vegan keto” lifestyle. Knowing what each diet entails and eschews, going vegan keto is rather difficult…not impossible, but definitely not easy. Moreover, there are a few concerns with this approach, as well as some benefits. Here’s what you need to know.

Keto Diet Explained

The keto diet is a very high-fat, low-carbohydrate plan, where roughly 75% of calories come from fats, 20% from proteins, and the remaining 5% or less from carbohydrates. Foods allowed include all sorts of meat, seafood, eggs, and full-fat dairy. Leafy green and other non-starchy veggies are also staples, as are coconuts, avocados, nuts, seeds, healthy oils (olive, avocado, coconut, flaxseed, macadamia, etc.), and full-fat, unsweetened dairy substitutes (almond, cashew, coconut milk).

The foods avoided on the keto diet include all sugars, all grains and legumes, and most fruit (though berries and tomatoes are OK since they are low glycemic and lower in sugar).

Studies show that keto diets can facilitate weight loss and treat some types of seizures. You’ll find a lot of differing thoughts and opinions from dieticians and doctors on whether keto is safe or sustainable. While many people have been able to sustain ketogenic eating for years with few major problems, such drastic dietary restriction definitely isn’t for everyone. But keto enthusiasts swear by it, and most have noted many benefits and few side effects.

Vegan Diet Explained

In great contrast, vegans eat plenty of keto no-no’s such as grains, legumes, and all fruits and veggies (starchy or not).

But most notably, this diet is entirely plant based. Vegans avoid all animal products and foods that include or are derived from animals (such as collagen, gelatin, honey, whey protein, and baked goods that contain eggs, for instance).

Plant-rich diets are great for many reasons. For one, I think that most Americans eat too much meat. That’s not to say that I’m a vegan or vegetarian because I do enjoy meat, but in moderation. I prefer to add a little meat to my plate full of veggies, instead of the other way around. Going full vegetarian or vegan isn’t necessary, but focusing more on plant foods and less on animal products can be very beneficial for your health. I like the 80/20 rule here…20% animal products and 80% plant foods.

As a cardiologist, I appreciate how plant foods are high in inflammation-fighting antioxidants, fiber, and healthy fats, all of which promote cardiovascular health. Research has shown diets that are abundant in fruits, vegetables, legumes, and grains can significantly reduce risk of heart disease and high blood pressure, along with certain cancers and diabetes. Many people have experienced weight loss by going vegan, too.

With that said, though, the main drawback of a vegan diet is that it simply does not provide all the nutrients that your body needs to function properly. Vegans often don’t consume enough protein, since animal products are the main source of it. Lack of animal products can also lead to deficiencies in CoQ10, L-carnitine, iron, and alpha lipoic acid—all crucial for heart health. Vegans are notoriously low in vitamin B12, too, which is naturally found in fish, meat, eggs, dairy, and poultry. Supplementation is an absolute necessity if you choose to go vegan.

How to Eat Vegan and Avoid Heart-Damaging Nutrient Deficiencies

Vegan Keto Foods List

Between the restrictions of keto and vegan, what’s left as far as “acceptable” foods for vegan keto dieters? A pretty short list of choices:

  • Soy and fermented soy products like tofu and tempeh
  • Seeds and nuts, nut butters, nut flours, nut oils, and nut-based cheeses
  • Olives and olive oil
  • Avocados and avocado oil
  • Coconut and select coconut-derived products (unsweetened milk/cream/yogurt, oil, butter, flour, aminos, vinegar)
  • Non-starchy vegetables – green beans, asparagus, zucchini, cauliflower, broccoli, cabbage, leafy greens like lettuce, spinach, chard and kale, and more (see The Best Low Carb Vegetables for Keto for a more extensive list)
  • Small amounts of berries
  • Seaweed and seaweed products
  • Sweeteners like stevia, erythritol, and monk fruit
  • Water, unsweetened coffee and tea, and other beverages sweetened with only the above sweeteners

If you’re still interested after seeing this vegan keto food list, consider this:

To get into a state of ketosis (the main goal of the ketogenic diet, where your body burns fat instead of glucose for energy), you would still need to get the majority of your calories from fat on a vegan keto diet. So, for a 2,000-calorie diet, roughly 1,400-1,500 would come from fat—avocados, coconuts, nuts, olive or coconut oil, peanut butter, etc. Only about 200 calories would come from carbs—leafy greens and other non-starchy veggies, along with small amounts of berries. The remaining calories would fulfill your protein requirement—foods such as tempeh, tofu, almonds, or peanut butter.

Is It Worth It?

Any diet that emphasizes plant-based eating has some excellent health benefits. Likewise, there are some good reasons to follow a keto diet. It’s not the most sustainable diet out there, but it’s worth a try if you’re curious about its effects on your body, weight, and health—and if your fats come mainly from healthy sources and not strictly from bacon and cheese.

But folks, these two diets are so diametrically opposed, that combining them creates a plan that is so restrictive, I’m afraid it would have hard to stick with for more an a few days or weeks.

I’ve said it before, and I’ll say it again: The most important characteristic of any diet or eating plan is sustainability. Any diet can make you lose weight, but is that diet something you can easily—and enjoyably—follow for the long term? Does it offer you a multitude of health benefits, particularly when it comes to heart health?

This is why I’m such a fan of the Pan-Asian Modified Mediterranean Diet (PAMM), which is a blend of  traditional Asian and Mediterranean dietary approaches. The PAMM diet consists of a healthy, balanced ratio of fats, low-glycemic carbohydrates, and lean proteins. You never feel deprived, and for that reason alone, PAMM is extremely easy to follow indefinitely.

If you’re truly interested in trying a vegan keto diet, I suggest you do it gradually. Start by following the basic principles of each diet and modifying a bit to get your feet wet. For instance, go heavy on veggies and very light on meat. Avoid or limit full-fat dairy and processed meats (bacon, sausage, hot dogs, etc.) and stick to coconuts, avocados, olives, olive oil and nut butters for the majority of your fat. Get your protein for two out of your three daily meals from vegetable sources like fermented soy. Or, decide on how many meals per week will include meat (say, 5 meals per week), and cook the rest with vegetable-based protein sources. It’s ok to not be so strict about your food choices; it allows for greater variety and less boredom and frustration when planning meals.

After a period of weaning off animal products, if you feel you’re ready for a true vegan keto diet, then try strictly plant-based eating for a while. Just be sure to take supplements like Coenzyme Q10, L-carnitine, alpha lipoic acid and Vitamin B-12 to prevent heart-damaging nutritional deficiencies associated with veganism.

There are plenty of vegan keto recipes online if you search for them. Here are a couple to get you started.

Vegan Keto Recipes

Coconut Chocolate Smoothie


  • 3/4 cup full-fat coconut milk (canned)
  • 1 Tbsp almond or cashew butter
  • 1/2 tsp raw cacao powder
  • ½ avocado
  • Stevia or monkfruit extract to taste (or leave out if you don’t like sweeter smoothies)

Blend all ingredients with a handful of ice (adjust amount of ice for desired consistency).

Tomato, Avocado & Walnut Salad

Salad ingredients:

  • 1/2 pint grape tomatoes, cut in half
  • 1 cup baby arugula, kale, or baby spinach, roughly chopped
  • 1 avocado, cut into chunks
  • 2 Tbsp red onion, chopped
  • Handful of raw walnuts

Dressing ingredients:

Place all salad ingredients in a large bowl. Whisk together dressing ingredients, then pour over salad and evenly distribute.

For additional salad-building ideas:

Delicious Salads Featuring Extra Virgin Olive Oil

Be well!

© Stephen Sinatra, MD. All rights reserved.

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