How to follow a healthy vegetarian keto diet

Name: How to follow a healthy vegetarian keto diet
Creator: Franziska Spritzler, RD
Published: 2018-06-03T17:04:46+02:00

By , medical review by ,

Introduction
5-step action plan
Avoiding deficiencies
Recipes

Are you a vegetarian interested in experiencing the many benefits of a keto diet? Or perhaps you’re already eating keto but have been thinking about giving up meat.

There’s good news: a vegetarian keto lifestyle is definitely doable. However, there are some potential health consequences of which you should be aware.

Read on to learn how to follow a vegetarian keto diet in a healthy, sustainable way.

Introduction

Are there any health concerns for keto vegetarians?

Although some people avoid eating meat due to environmental or animal welfare concerns, others may choose vegetarianism because they believe it is healthier.¹ Yet, vegetarian diets are typically high in grains and legumes, which may not be the best choice for those who want to control diabetes with diet rather than medications.²

Additionally, people often find that they feel hungry and struggle to lose weight when they follow a low-fat, high-carb vegetarian way of eating.³

Therefore, the idea of a keto vegetarian diet may be appealing to many who want to avoid meat but still get the benefits of ketogenic living.

Be aware, though, that on a vegetarian keto diet, it’s possible to become deficient in protein, certain essential fats, and some vitamins and minerals.⁴

However, your risk for nutrient deficiencies depends on what type of vegetarian diet you follow and the variety of foods you eat. The more restrictive your diet, the more likely you are to become deficient.

What are the different types of vegetarians?

These are the different vegetarian categories, in order of strictest to most liberal:

Vegans avoid dairy, eggs, seafood, poultry, meat, and other animal products, including honey in most cases.
Lacto vegetarians eat dairy but avoid eggs, seafood, poultry and meat. People in India who are vegetarians mainly follow this way of eating.
Lacto-ovo vegetarians eat dairy and eggs but avoid seafood, poultry and meat. This is the most common form of vegetarianism in the US, Europe, and other western countries.
Pescatarians eat seafood, dairy, and eggs but avoid poultry and red meat. This way of eating is considered semi-vegetarian and doesn’t pose any greater risk for nutrient deficiencies than diets that include meat.⁵

Which vegetarian diets work best with keto?

Keto can be incorporated into most vegetarian lifestyles. Of course, the more liberal forms of vegetarianism allow a wider range of food choices, which can make mealtimes more enjoyable.

Even a vegan-keto approach is possible, but it’s much more challenging. As humans, we need to consume complete protein containing all nine essential amino acids.⁶ While animal protein provides all the essential amino acids in the amounts we need, most plants lack one or more of them.⁷

By excluding all animal products, vegans typically rely on a combination of grains, legumes, and seeds to meet their essential amino acid needs. These foods are usually not a good fit for a keto diet, which is usually restricted to 20 grams of net carbs (total carbs minus fiber) per day.

The “Eco-Atkins” is one option for those who want to avoid all animal products.⁸ Eco-Atkins is entirely plant based and contains fewer carbs than most vegan plans. However, it isn’t considered keto because it includes grains and provides over 50 grams of net carbs per day.

To learn more about combining carb restriction with a vegan lifestyle, see our evidence-based guide, How to eat low-carb as a vegan.

5-step action plan for eating a vegetarian keto diet

Here is our 5-step action plan for eating a well-formulated vegetarian-keto diet. Scroll down to read everything, or click on a specific step to jump ahead.

Reduce carbohydrates
Include protein
Eat 1 to 3 servings of vegetables at least twice a day
Use healthy oils for cooking and when making salad dressings
Season your food with different herbs and spices

1. Reduce carbohydrates

In order to get into ketosis and remain there, it’s best to limit your net carb intake to 20 grams per day.⁹ This means you’ll need to avoid many popular vegetarian protein sources, such as quinoa, buckwheat, legumes, and pulses. These foods are too high in carbs to be part of a ketogenic lifestyle for most people.

Also be sure to steer clear of milk, starchy vegetables, and fruits, other than perhaps a small amount of berries.

2. Include a high-quality protein source at every meal

As discussed earlier, with few exceptions, only the protein in animal products contains all nine essential amino acids in the amounts your body needs.¹⁰

Combining keto-friendly, low-carb plant proteins, such as nuts and seeds, with animal protein sources like dairy and eggs can improve the protein quality of a vegetarian diet.

At Diet Doctor, we recommend that most people aim for 1.2 to 2.0 grams of protein per kilo of reference body weight.¹¹ That usually comes out to at least 70 grams of protein on a keto diet per day, depending on health conditions, body composition, activity level, and age.

How much do you need? Use the simple chart below to find out what your minimum daily protein target should be, based on your height.¹²

The indicated goal represents the middle of the recommended protein intake range. For a more detailed discussion of protein requirements, see our evidence-based guide, How much protein should you eat?

Minimum daily protein target

Height	Women	Men
Under 5’4″ ( < 163 cm)	90 grams	105 grams
5’4″ to 5’7″ (163 to 170 cm)	100 grams	110 grams
5’8″ to 5’10” (171 to 178 cm)	110 grams	120 grams
5’11” to 6’2″ (179 to 188 cm)	120 grams	130 grams
Over 6’2″ (188 cm +)	130 grams	140 grams

Our top 3 vegetarian proteins

Egg: Contains high-quality, easily digestible protein; provides choline which has been associated with better brain function¹³; extremely versatile and economical. 14 grams of protein and 1 gram of carb per two large eggs
Greek yogurt: Rich in protein; excellent source of calcium, potassium, and magnesium; provides probiotics that are potentially beneficial for gut health and immunity.¹⁴ 15 to 20 grams of protein and 4 to 7 grams of carbs per 6 ounces (170 grams)
Hemp seeds: High in protein; rich in soluble fiber; great source of magnesium, potassium and omega-3 fatty acids. 9 grams of protein and 1 gram of net carb per ounce (28 grams)

Other great keto vegetarian protein sources

Cottage cheese: 20 grams of protein and 6 grams of carbs per 6 ounces (170 grams)
Parmesan and Romano cheese: 9 to 10 grams of protein and 1 gram of carb per ounce (28 grams)
Hard and semi-hard cheese (cheddar, gouda, provolone, Swiss, etc.): 7 to 8 grams of protein and 0.5 to 1.5 gram of carbs per ounce (28 grams)
Soft cheese (Brie, Camembert, feta, blue cheese, queso blanco, etc.): 4 to 6 grams of protein and 0 to 1 gram of carb per ounce (28 grams)
Peanut or almond butter: 7 to 8 grams of protein and 4 grams of net carbs per 2 tablespoons (32 grams)

Keep in mind that you’ll get small amounts of protein from vegetables as well. Most vegetables provide about 2 grams of protein per cup.

We recommend getting most of your protein through minimally processed food rather than through protein powders, bars, or shakes. Whole foods are more likely to have needed micronutrients and less likely to contain fillers you don’t need.

What about soy?

Soy products, such as tofu, are an excellent source of plant-based protein. In the past, concerns were raised about possible detrimental effects of soy isoflavones, based mainly on animal and test-tube studies.¹⁵ However, the research on soy when consumed by humans is mainly positive regarding safety and disease risk.¹⁶

When it comes to the thyroid gland, soy doesn’t seem to cause problems for people with normal thyroid function. But there is conflicting evidence regarding whether people with subclinical (borderline) hypothyroidism are likely to progress to more overt hypothyroidism if they consume a lot of soy.¹⁷ The risk appears to be low, and getting adequate dietary iodine should reduce this already low risk even further.¹⁸ The best low-carb vegetarian sources of iodine include iodized salt, seaweed, and yogurt.

Larger amounts of soy may interfere with thyroid hormone absorption, so people with hypothyroidism should take their thyroid medication separately from a soy-heavy meal. Given that levothyroxine (the most commonly prescribed form of thyroid hormone) is usually taken 30-60 minutes prior to a meal, most people with hypothyroidism will find this advice easy to follow. However, because some of the absorbed levothyroxine circulates back and forth between the intestines and liver, the constant presence of soy in the gut in people who consume it multiple times per day could bind to levothyroxine and interfere with its overall absorption more significantly.¹⁹

Studies have also examined whether soy has any effect on sex hormones in both men and women. Although initial animal and test-tube studies suggested cause for concern, most human studies have shown either very small or no effects on sex hormones and reproductive health. This includes conflicting data regarding decreased male and female fertility, as well as early female puberty.²⁰

If you want to avoid animal products on a keto or low-carb diet, the benefits of soy seem to outweigh the risks.²¹

Soy protein options

Tofu (extra firm): 24 grams of protein and 3 grams of net carbs per 8 ounces (240 grams)
Edamame (green soybeans): 19 grams of protein and 6 grams of net carbs per 5.5 ounces (155 grams)
Tempeh: 18 to 20 grams of protein and 7 grams of net carbs per 3.5 ounces (100 grams)
Natto: 18 to 20 grams of protein and 7 grams of net carbs per 3.5 ounces (100 grams)

3. Have one to three servings of very low-carb vegetables at least twice a day

There are plenty of keto-friendly vegetables that taste delicious, provide a nice dose of fiber, and help you to meet your daily micronutrient needs.

Our top 5 keto vegetables

Spinach: rich in iron, potassium, and magnesium, with 1 gram of net carb per serving
Zucchini: a good source of vitamin B6, vitamin C, and potassium, as well as a fantastic noodle substitute, with 3 grams of net carbs per serving
Avocado: (technically a fruit) excellent source of potassium, magnesium, and fiber, with 2 grams of net carbs per serving
Brussels sprouts: rich in vitamin C, potassium, and folate, with 5 grams of net carbs per serving
Cauliflower: a great source of vitamin C and fiber and the perfect keto-friendly sub for mashed potatoes and rice, with 4 grams of net carbs per serving

For more tips on what low-carb vegetables to eat, check out our low-carb vegetable guide.

4. Use healthy oils for cooking and when making salad dressings

Natural fats improve food’s texture and can help you stay full and satisfied for hours. In addition, they’re necessary for proper absorption of the fat-soluble vitamins A, D, E, and K.

Since fats contribute most of your calories on a keto diet, it’s important to choose healthy, natural keto fats and condiments, such as butter, ghee, coconut oil, olive oil, and avocado oil for meal preparation and at the table.²²

Although the data regarding vegetable and seed oils and their health effects are inconclusive, as a general policy we recommend focusing on less processed foods closer to their natural source.²³

5. Season your food with different herbs and spices

Cooking with herbs and spices can help increase variety on a vegetarian diet. What’s more, they’re an additional source of micronutrients and provide very few net carbs. Besides the more common ones like basil, rosemary and cinnamon, experiment with some you haven’t tried as well. You may find a few new favorites!

How to avoid nutrient deficiencies on a vegetarian keto diet

Vegetarians often rely on grains and legumes to meet their daily micronutrient needs. On a vegetarian keto diet, where these foods are restricted, make sure to consume adequate amounts of omega-3 fats, iron, calcium, vitamin B12, vitamin D, zinc, potassium, and magnesium. Or, make sure to take the appropriate supplements if you can’t get an adequate intake from your food sources.

If you follow our 5-step plan, which involves eating high-quality vegetarian protein sources and plenty of very-low-carb vegetables, you should be able to meet these needs. If you want to be extra sure, include the foods below on a regular basis to provide your body with the micronutrients keto vegetarians sometimes don’t get enough of:

Nuts & seeds

Almonds
Chia seeds
Flax seeds
Hemp seeds
Pumpkin seeds
Walnuts
100% dark chocolate
Unsweetened cocoa

Vegetables

Artichokes
Broccoli
Brussels sprouts
Kale
Mushrooms
Spinach
Swiss chard

Dairy

Plain greek yogurt
Cheese

Fruits

Avocado
Olives

If you follow these steps, but still don’t feel your best, you may benefit from paying attention to which nutrients you could be deficient in. You can also preempt any possible deficiencies by routinely checking certain blood tests, such as B12 levels. Consult with your healthcare provider to determine the most appropriate tests for you.

Click on the button below to see the appendix on specific nutrients that can be an issue for keto vegetarians.

Appendix

Delicious vegetarian keto recipes

At Diet Doctor, you can find many delicious keto vegetarian options, from classics like Caprese salad to more unusual dishes like Keto goat cheese and mushroom frittata.

Here are a few other keto vegetarian recipes you’ll love:

Vegetarian-keto breakfasts

Vegetarian-keto meals

More vegetarian keto recipes

Staying keto vegetarian long term

It’s clearly possible to be both keto and vegetarian. The biggest issues may be lack of variety and meeting your nutrition needs on a regular basis without eating meat or seafood.

However, choosing foods rich in key nutrients, experimenting with different vegetable and protein combinations, using a wide range of herbs and spices, and taking supplements if needed can help you create a keto vegetarian lifestyle that is healthy, sustainable, and pleasurable.

/ Franziska Spritzler, RD

How to follow a healthy vegetarian keto diet - the evidence

This guide is written by Franziska Spritzler, RD and was last updated on June 17, 2022. It was medically reviewed by Dr. Bret Scher, MD on December 23, 2021 and Dr. Michael Tamber, MD on December 23, 2021.

The guide contains scientific references. You can find these in the notes throughout the text, and click the links to read the peer-reviewed scientific papers. When appropriate we include a grading of the strength of the evidence, with a link to our policy on this. Our evidence-based guides are updated at least once per year to reflect and reference the latest science on the topic.

All our evidence-based health guides are written or reviewed by medical doctors who are experts on the topic. To stay unbiased we show no ads, sell no physical products, and take no money from the industry. We're fully funded by the people, via an optional membership. Most information at Diet Doctor is free forever.

Read more about our policies and work with evidence-based guides, nutritional controversies, our editorial team, and our medical review board.

Should you find any inaccuracy in this guide, please email andreas@dietdoctor.com.

Nutrients 2010: Beliefs and attitudes toward vegetarian lifestyle across generations [observational study; very weak evidence] ↩
Note that a high-carb, low-fat vegan diet can be equivalent or superior to a standard American Diabetes Association diet for diabetes control:

American Journal of Clinical Nutrition 2009: A low-fat vegan diet and a conventional diabetes diet in the treatment of type 2 diabetes: a randomized, controlled, 74-wk clinical trial [randomized trial; moderate evidence]

Diabetes Care 2006: A low-fat vegan diet improves glycemic control and cardiovascular risk factors in a randomized clinical trial in individuals with type 2 diabetes [randomized trial; moderate evidence]

But when ketogenic diets are compared to high-carb, low-fat diets, keto diets consistently result in better diabetes control. While these studies are generally not looking specifically at vegetarians or vegans, we believe that the results are most likely applicable to them as well.

Nutrients 2020: Impact of a Ketogenic Diet on Metabolic Parameters in Patients with Obesity or Overweight and with or without Type 2 Diabetes: A Meta-Analysis of Randomized Controlled Trials [strong evidence] ↩
In a study of overweight people assigned to follow either a low-carb or low-fat diet, those in the low-fat group reported feeling hungrier than those in the low-carb group:

Obesity 2011: Change in food cravings, food preferences, and appetite during a low-carbohydrate and low-fat diet [randomized trial; moderate evidence] ↩
European Journal of Clinical Nutrition 2014: The prevalence of cobalamin deficiency among vegetarians assessed by serum vitamin B12: a review of literature [overview article; ungraded]

Nutrition, Metabolism and Cardiovascular Diseases 2017: Position paper on vegetarian diets from the working group of the Italian Society of Human Nutrition [overview article; ungraded] ↩
Nutrients 2014: Comparison of nutritional quality of the vegan, vegetarian, semi-vegetarian, pesco-vegetarian and omnivorous diet [overview article; ungraded] ↩
An “essential” nutrient can’t be made by the body and must instead be obtained through the diet. ↩
For example, legumes and seeds are high in the amino acid lysine but very low in methionine. By contrast, grains are high in methionine but contain almost no lysine:

Amino Acids 2018: Protein content and amino acid composition of commercially available plant-based protein isolates [laboratory study; ungraded] ↩
Archives of Internal Medicine 2009: The effect of a plant-based low-carbohydrate (“Eco-Atkins”) diet on body weight and blood lipid concentrations in hyperlipidemic subjects [randomized trial; moderate evidence] ↩
Although eating 20 or fewer grams of net carbs virtually guarantees ketosis, some people may be able to eat slightly more than this, and healthy individuals may be able to achieve and maintain ketosis while eating 50 grams of net carbs daily:

Nutrition X 2019: Effects of differing levels of carbohydrate reduction on the achievement of nutritional ketosis, mood, and symptoms of carbohydrate withdrawal in healthy adults: A randomized clinical trial [moderate evidence] ↩
Soy is one of these exceptions, as it provides all essential amino acids. It is discussed in its own section, further below.

Amino Acids 2018: Protein content and amino acid composition of commercially available plant-based protein isolates [laboratory study; ungraded] ↩
“Reference body weight” is a rough approximation of your lean body mass – the part that needs protein. You can look up your reference body weight here or use the simple chart below to estimate your protein needs. ↩
In this case, height is a proxy for reference body weight. Reference body weight is a way of estimating how much lean body mass a person of a specific height would have and thus how much protein they need on a daily basis. ↩
Nutrition Review 2009: Choline: An essential nutrient for public health[overview article; ungraded] ↩
Nutrition Reviews 2018: Yogurt and other fermented foods as sources of health-promoting bacteria
[overview article; ungraded] ↩
Isoflavones are a type of phytoestrogen (plant compounds that have a structure similar to estrogen) found in soy and other legumes. Older research in animals and on cell lines suggested that these isoflavones might potentially be harmful to health:

Menopause 2005: Dietary soy protein and isoflavones have no significant effect on bone and a potentially negative effect on the uterus of sexually mature intact Sprague-Dawley female rats[rat study; very weak evidence]

Biochemical Pharmacology 1997: Anti-thyroid isoflavones from soybean: isolation, characterization, and mechanisms of action[in vitro study; very weak evidence] ↩
This is true for observational studies spanning many years, as well as for shorter but higher-quality clinical trials:

Advances in Nutrition 2018: Associations between phytoestrogens, glucose homeostasis, and risk of diabetes in women: a systematic review and meta-analysis [meta-analysis of randomized trials and observational studies; moderate evidence]

PloS One 2013: Soy, red clover, and isoflavones and breast cancer: a systematic review [meta-analysis of randomized trials and observational studies; moderate evidence]

Gynecological Endocrinology 2013: Endometrial, breast and liver safety of soy isoflavones plus Lactobacillus sporogenes in post-menopausal women [randomized trial; moderate evidence]

Nutrients 2018: Soy, soy foods, and their role in vegetarian diets [overview article; ungraded]
↩
Scientific Reports 2019: Systematic review and meta-analysis on the effect of soy on thyroid function [strong evidence]

EFSA Journal 2015: Risk assessment for peri- and post-menopausal women taking food supplements containing isolated isoflavones [review of RCTs, observational and animal studies; weak evidence]

The Journal of Clinical Endocrinology & Metabolism 2011: The effect of soy phytoestrogen supplementation on thyroid status and cardiovascular risk markers in patients with subclinical hypothyroidism: a randomized, double-blind, crossover study [moderate evidence]

Journal of the Endocrine Society 2017: Soy protein improves cardiovascular risk in subclinical hypothyroidism: a randomized double-blinded crossover study [moderate evidence]

Frontiers in Endocrinology 2017: The effect of phytoestrogen on thyroid in subclinical hypothyroidism: randomized, double blind, crossover study [moderate evidence] ↩
Thyroid 2006: Effects of soy protein and soybean isoflavones on thyroid function in healthy adults and hypothyroid patients: a review of the relevant literature [overview article; ungraded] ↩
Thyroid 2006: Effects of soy protein and soybean isoflavones on thyroid function in healthy adults and hypothyroid patients: a review of the relevant literature [overview article; ungraded] ↩
Nutrients 2018: Soy, soy foods, and their role in vegetarian diets [overview article; ungraded] ↩
Studies show that soy likely has anticancer properties, and it may also improve cardiovascular health.

Nutrients 2018: Soy, soy foods, and their role in vegetarian diets [overview article; ungraded] ↩
Although still controversial among medical and nutrition experts, several large systematic reviews of clinical trials have found no evidence that eating foods high in saturated fat — like butter, cream, and coconut oil — raises the risk of heart disease, early death, or other health problems:

British Medical Journal 2016: Re-evaluation of the traditional diet-heart hypothesis: analysis of recovered data from Minnesota Coronary Experiment (1968-73) [systematic review of randomized trials; strong evidence]

Nutrition Journal 2017: The effect of replacing saturated fat with mostly n-6 polyunsaturated fat on coronary heart disease; a meta-analysis of randomized controlled trials [strong evidence]

Learn more: A user guide to saturated fat ↩
In addition to being highly processed, vegetable oils are high in omega-6 fatty acids. This has led to an unprecedented level of omega-6 intake in the human diet. The health consequences of this shift remain unknown:

Biomedicine & Pharmacotherapy 2006: Evolutionary aspects of diet, the omega-6/omega-3 ratio and genetic variation: nutritional implications for chronic diseases [overview article; ungraded] ↩