Many people think that eating a low carb or ketogenic diet necessitates eating meat — in the same way that many assume that one needs to eat lots of added fat, but neither are true. In a previous article, I addressed the misconception that eating a low carb or keto diet is all about eating lots of extra fat and in this article, I will address the false belief that one has to be a meat-eater to follow a low-carb or ketogenic diet.
Before launching into the article, it’s important to define some terms.
Vegetarian versus Vegan
There is a significant difference between vegetarians and vegans and these two terms seem to get mixed up frequently. Vegans eat no animal products, while vegetarians don’t eat the meat of animals but will eat products that come from animals, such as dairy and eggs.
There are different categories of vegetarians, including ovo-lacto (those who eat eggs and milk-based products), as well as those that only eat one or the other (ovo or lacto). Some classify pescatarians who eat wild fish and seafood as a form of vegetarianism because they don’t eat farmed animals for food but for the purpose of this article I will use the term “vegetarian” to mean ovo-lacto vegetarian, as this is the most common form.
Different Motivations, Same Needs
Religious or cultural vegetarians
People are vegetarian for different reasons; some for religious reasons, including some Hindus, Buddhists, Jains, Sikhs and Seventh Day Adventists. Some people don’t eat meat for cultural reasons. For example, some people from India may not be religious themselves but don’t eat meat because they were not raised eating it or because others in their social circle don’t eat meat. I refer to these type as being culturally vegetarian. Finally, some don’t eat meat for ethical reasons — believing it is morally wrong to kill an animal to eat it.
From my perspective as a Dietitian, it is important that people who want to eat a low carb or ketogenic diet for health reasons are able to do even if they are vegetarian.
While type 2 diabetes is on the rise in those of various ethnic backgrounds, people of South Asian descent (those who have their roots in India, Pakistan, Sri Lanka, Bangladesh and Nepal) are thought to be at higher risk, and many people from these regions eat a vegetarian diet for religious or cultural reasons. Given what we now know about the association between a diet high in carbohydrate and both hyperinsulemia and type 2 diabetes (documented in many previous posts), offering people the option of eating a low carb or ketogenic vegetarian diet, enables them to obtain the same health benefit as those that choose to eat meat. And why not?
While many omnivores consider vegetarianism an ‘inferior diet’ it need not be so. A well-designed vegetarian or omnivore diet enables people to access all the essential macronutrients (essential fats and amino acids) from real, whole foods. This article will explains ‘how’, below.
Oftentimes I find that people that choose vegetarianism for ethical reasons don’t realize that one can purchase ethically-raised meat and poultry. There are butchers in my area that raise their animals out back, where they are humanely treated their entire lives and killed humanely. These are a far cry from the industrial feed-lots that often motivate ethical vegetarians, and for understandable reasons. One place that I shop at has the motto “know your farmer, know your meat“. As well, some of the most ethical meat-eaters I know are hunters that train at the range to make sure that the animal they harvest doesn’t suffer, and they use the whole animal for food; from snout to tail. In fact, one local hunting group I’ve heard of is run in association with a local First Nations band that teach hunters that already have their Federal hunting licence to select animals in accordance with centuries-old First Nations principals for animal stewardship. One does not have to become a vegetarian for ethical reasons, as there are other options.
Defining a Low Carb or Keto Diet
Whether one is a vegetarian or a meat-eater, defining what “low carb” or “keto” is necessary in order to determine how one can eat this way.
As mentioned in a prior article, what makes a diet “low carb” or “ketogenic” is how much carbohydrate it has, not how much fat it contains. In the same way, what makes a diet low carb or ketogenic has nothing to do with how much meat one eats, or whether one eats meat at all.
Feinman et al  defined three categories of reduced-carbohydrate diets as follows;
(a) very low carbohydrate ketogenic*: carbs limited to 20–50 g per day or < 10% of total energy intake.
(b) low carbohydrate: carbs limited to < 130 g per day or < 26% of total energy intake.
(c) moderate carbohydrate: carbs limited to 130–225 g per day or 26–45% of total energy intake.
In my clinical practice and in other articles on this web page, I define “low carb” and “ketogenic” in the same way — with a low carb diet being one that is < 130 g carbohydrate per day, and a ketogenic diet as one that is 20–50 g of carbohydrate per day. What makes a keto diet ketogenic is that carbohydrate intake is low enough to put an individual into a state of ketosis, which is a normal physiological state that people go into after an overnight fast when they have used up their glycogen stores. When the body is in ketosis, it is burning stored fat for energy and releasing ketones which can be used by the brain and other tissues. In general, men can achieve ketosis eating ⩽ 50 g of carbs per day, but women often need to eat ⩽ 35 g of carbohydrate per day.
As covered in detail in this previous article, from a dietary perspective only protein and fat are essential in the diet. For a nutrient to be “essential”, it is required to be eaten because the body can’t manufacture it.
There are 2 essential fats; linoleic acid, an omega 6 fat and alpha-linolenic acid, an omega 3 fat, and there are 9 essential amino acids. Amino acids are are the building blocks from which proteins are made.
For omnivores, getting all the essential nutrients is fairly straight forward and simply requires eating a wide range of meat and animal products, along with nuts and seeds, but for those who are ovo-lacto vegetarians, one needs to be more intentional to ensure getting all the essential nutrients.
The 2 essential fatty acids (linoleic and alpha-linolenic acid) can be easily obtained from eggs, nuts and seeds, but ensuring adequate intake of all 9 of the essential amino acids (histidine, isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan, and valine from low carb, vegetarian sources can be achieves as follows ;
- Vegetarians following a low carb or ketogenic diet can obtain histidine from dairy foods such as milk and cheese, as well as from nuts, seeds and eggs.
- Isoleucine can be obtained from eggs and cheese, as well as from seaweed and soy protein, if people wish.
- Rich sources of leucine include milk, cheese and egg, as well as from pumpkin or squash seeds. It can also be obtained from tofu and legumes eaten in daily maximum 1/2 cup quantities (as they are a significant source of carbohydrates).
- Lysine can be found in some cheeses such as Parmesan, eggs and spirulina as well as from tofu, and if needed can be supplemented with whey protein isolate and isolated soy protein.
- Foods high in methionine include dairy of different types, cheese, eggs, and nuts, as well as soy and legumes.
- High phenylalanine foods include cheese, nuts and seeds, eggs and dairy, as well as from soybeans and legumes.
- Foods rich in threonine include cheese, nuts and seeds, and if desired, in soy, and in legumes and lentils (in maximum daily 1/2 cup servings as they are significant sources of carbs)
- Good sources of tryptophan include egg, milk products such as yogurt, nuts and seeds and soy products, if eaten.
- High valine foods include nuts and seeds, mushrooms, and soybeans if eaten, as well as legumes.
Note (Nov 8, 2019 @ 10 am): shortly after publishing this article, the topic of whether vegetarians can obtain sufficient vitamin B12 and the long chain fatty acids, DHA and EPA was raised on social media. While this article is about a vegetarian diet providing all the essential macronutrients, I will add the following information for those who are interested:
Re: vitamin B12: 2 cups of yogurt per day provides 100% DV of B12 and so do 4 eggs (which many low carb omnivores eat in a day). Add to that 3 oz of Swiss cheese which provides 100% DV, or a cup of tofu (which provides more than 100%), getting enough vitamin B12 is not an issue, provided vegetarians are not restrained by a “low fat” paradigm.
Re: the long chain fatty acids DHA and EPA: There is no Dietary Reference Intake (DRI) for EPA or DHA, only for alpha-linolenic acid. In healthy young men, approximately 8% of dietary alpha linolenic acid is converted to EPA and ≤4% alpha-linolenic acid is converted to docosahexaenoic acid (DHA). [Burdge GC, Jones AE, Wootton SA. Eicosapentaenoic and docosapentaenoic acids are the principal products of α-linolenic acid metabolism in young men. Br J Nutr. 2002;88(4):355-364].
In healthy young women, approximately 21% of dietary alpha-linolenic acid is converted to EPA and 9% is converted to DHA. [Burdge GC, Wootton SA. Conversion of α-linolenic acid to eicosapentaenoic, docosapentaenoic and docosahexaenoic acids in young women. Br J Nutr. 2002;88(4):411-420. ].
The better elongation in young women is related to the effects of estrogen. [Burdge G. α-Linolenic acid metabolism in men and women: nutritional and biological implications. Curr Opin Clin Nutr Metab Care. 2004;7(2):137-144, Giltay EJ, Gooren LJ, Toorians AW, Katan MB, Zock PL. Docosahexaenoic acid concentrations are higher in women than in men because of estrogenic effects. Am J Clin Nutr. 2004;80(5):1167-1174.]
For vegetarians, eating seaweed including nori, spirulina and other types of edible seaweed provides a good source of pre-formed DHA & EPA in the diet. These also form the basis for vegetarian-sourced DHA and EPA supplements that can be purchased.
Low Carb and Ketogenic Diets are Truly Not “One-Sized-Fits-All”
There really isn’t a “one-sized-fits-all” low carb or ketogenic diet!
There are the high fat / moderate protein varieties popularized by Dr. Jason Fung and that are often associated with high consumption of bacon, heavy whipping cream, and fatty meat, and offset by periods of intermittent fasting.
There is the higher protein lower fat approach during weight loss, followed by a moderate protein higher fat diet during weight maintenance of Dr. Stephen Phinney MD, PhD and Dr. Jeff Volek RD, PhD.
You can read more about the above two approaches in this article.
There are the higher lean protein type, with more grams of protein than grams of fat (popularized most recently by Dr. Ted Naiman in his P:E Diet and referred to in the previous article). More than likely, there are different macronutrient combinations than the ones listed here that are popular with others.
I don’t believe that any of the above can serve as a “one-sized-fits-all” approach because everybody’s nutritional needs and health conditions are different.
Those who are omnivore can choose a meal pattern that includes meat, and for those that are vegetarian (for whatever reason) can still reap the health benefits from eating a well-designed low carbohydrate diet that does not include meat.
It is my observation that many people who follow a low carb or ketogenic lifestyle tend to be overly loyal to their particular dietary style, which inadvertently makes people who need to or choose to eat differently feel that the health and metabolic benefits of following a low carb diet is not available to them.
People that don’t eat meat for religious, cultural or ethical reasons need to know there are options available for them to have a well-designed meal plan that includes the animal derived products they do eat, rather than to be told how ‘inadequate’ their diet is compared to those who eat meat.
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- Gujral UP, Pradeepa R, Weber MB, Narayan KM, Mohan V. Type 2 diabetes in South Asians: similarities and differences with white Caucasian and other populations. Ann N Y Acad Sci. 2013;1281(1):51–63. doi:10.1111/j.1749-6632.2012.06838.x
- Feinman RD, Pogozelski WK, Astrup A, Bernstein RK, Fine EJ,Westman EC, et al. Dietary Carbohydrate Restriction as the First Approach in Diabetes Management: critical review and evidence base. Nutrition. 2015;31(1):1–13.
- USDA Food Composition Databases, https://fdc.nal.usda.gov/