From rightasrain.uwmedicine.org
Quick ReadIs keto or a plant-based diet healthier?
- Social media often tries to sell either keto or plant-based diets as the only way to be healthy, causing confusion if you’re trying to find your best fit.
- Plant-based diets, including the vegan diet, can be a great way to get fibre and can help with weight management, but may also lack certain essential nutrients and can be difficult to stick with.
- The ketogenic diet can help treat conditions like epilepsy and diabetes, and can help with weight loss, but is restrictive and could lead to high cholesterol levels.
- The best diet is the one you can actually stick with, one that includes all the nutrients you need and doesn’t harm your mental or physical health.
If you’ve recently been searching for information on various diets on TikTok then you’re probably used to encountering a growing number of videos about the benefits of plant-based and vegan diets. And then videos about how a keto diet is the best. And then videos passionately bashing each of those diets. Confusing and contradictory? For sure. Which is why we’ve consulted the experts to understand what exactly the benefits (and the drawbacks) of these trendy diets are, and why so many people are talking about them.
Plant-based, keto and social media
Though plant-based diets, especially vegan diets, have been around forever, thanks to social media, their popularity continues to rise. The ketogenic, or keto diet, is a low-carbohydrate, high-fat diet that aims to make your body burn fat for energy (instead of carbs). It hasn’t been trendy for quite as long, but it’s rapidly picked up steam, especially in the last five to 10 years.
So, why are there so many conflicting ideas about which diet is the healthiest? Most of that confusion can be blamed on social media, well-intended friends and family, and maybe even the healthcare industry itself.
“I’ve heard reports from patients saying they get conflicting information from what their doctors are saying versus what they read online versus what their families and friends tell them,” says Shari Brown, RDN, a dietitian at UW Medicine Primary Care. “They may even see multiple providers who end up recommending different things — so I think patients are coming in feeling really confused about the best option.”
Plant-based pluses
So, what are the benefits of a plant-based diet? Well, a plant-based diet is good for your body for plenty of reasons, but there are also ethical and environmental reasons to adopt it, including minimizing harm to animals and reducing your carbon footprint.
Also, to be clear, a plant-based diet can mean a lot of things. It can rely heavily on fruits, vegetables and plant-based protein, but still include eating some animal products — for example, the Mediterranean diet, where you limit red meat but eat whole grains, fruits, veggies, lean proteins (like fish) and healthy fats. The benefits of eating this way? It’s plant-forward, since you’re still making plants the main characters. It’s also anti-inflammatory because of all the antioxidants, and it’s good for your heart because it focuses on healthy fats and proteins that give you nutrients, without all those saturated fats.
Some might colloquially use the term “plant-based” to mean a vegan diet, which is different — it requires eliminating all animals and animal by-products from your diet. Since you’re not eating meat and dairy, you need to rely more heavily on foods like whole grains, fruits, veggies, beans, nuts and seeds — which all offer lots of nutritional benefits. Plus, vegan diets tend to have a lot of fibre and antioxidants, and they’re rich in potassium, magnesium, folate, and vitamins A, C, and E. You can also get iron from a vegan diet, but the form of iron that plants provide isn’t absorbed as well as the kind found in animal foods.
Overall, a plant-based diet, whether or not it’s fully vegan, can help reduce your risk of heart disease, type 2 diabetes and even cancer. It can also help manage weight, improve digestive health and potentially reduce inflammation in your body.
The downside of plant-based diets
As with most things ... there are some downsides to avoiding meat and dairy:
Sticking with it
Keeping up with a plant-based diet isn’t too hard if you’re not being super strict about including healthy animal products, but it can be challenging to go fully vegan, especially if you’re only doing it for weight loss, and not for ethical or environmental reasons. It can be hard to avoid certain foods consistently (I mean, can a person really give up cheese forever?), and you can get into a recipe rut unless you’re careful.
Nutrient deficiencies
You can usually get most of your nutrients from a plant-based diet if it includes some animal products, however, if you’re following a vegan diet, it can be difficult, though not impossible, to get all of the nutrients you need.
“B12, in the form of cyanocobalamin or sublingual methylocobalamin, is usually the supplement that I recommend all my vegan patients take,” says Brown. “Some other nutrients of concern that I will pay attention to are iron, zinc, calcium, Vitamin D and omega-3 fatty acids.”
In respect to omega-3’s, Brown says that while vegans can get some of these essential fatty acids from foods like flax, chia and walnuts, it is in the ALA (alpha-linolenic acid) form, where the conversion rate to the forms you actually need (DHA and EPA) is quite low. That usually means that some kind of DHA supplement will be necessary (algae-based sources can be used for vegans).
Pregnancy and lactation
Again, if you’re following a plant-based diet that includes some animal products, you should be getting sufficient nutrients. But if you’re vegan, you may choose to incorporate some animal products into your diet just while you’re pregnant and breastfeeding since it can be hard to get all the protein and nutrients you need otherwise. This is something you can talk to your doctor about and see what might be healthiest for you (and your baby).
Healthy? Not always
Another thing: Just because a food is plant-based doesn’t always mean it’s healthy. The key is to ensure that your food is still nutrient-packed.
“You could, in theory, have a diet consisting of mainly Oreos, Tater Tots, vegan pizza and vegan burgers,” says Brown. “And yes, that would fall under a vegan diet, but it would be heavily processed and would be lacking in fibre and many important nutrients.”
Ketogenic diet or bust?
The ketogenic or keto diet is another diet you’ll hear loads about on social media. Unlike plant-based diets, it doesn’t eliminate meat or dairy, but instead restricts carbohydrates and is high in fat. One big misconception about the keto diet is that it’s high in protein. It’s actually moderate or even low protein, because protein in excess can be converted into glucose and can kick you out of ketosis.
And what is nutritional ketosis? Basically, when you cut way down on carbohydrates, your system has to have some form of energy for the brain. So, in the absence carbohydrates, it will break down fatty acids, and in the process of breaking down fat, you produce ketones, which are an alternate fuel source for the brain.
“Nutritional ketosis is a process in which, in the absence of sufficient carbohydrate intake, the body resorts to breaking down fat, producing ketones as one of the metabolic by-products,” says Brown. “If you have enough of those ketones, then you’re in ketosis.”
Not only does “ketosis” sound like a magical state, but it’s also shown to be a beneficial therapeutic treatment for patients with epilepsy. In addition, because it can help regulate blood sugar and insulin levels, it can also be a helpful tool for people managing their blood sugars with type 2 diabetes or for those hoping to lose weight.
What does a keto diet look like exactly?
- It typically includes a moderate amount of protein.
- It usually includes a high amount of fats — usually full-fat dairy, cheese, oils, fatty meats and fish, avocado, nuts and seeds.
- It includes a good amount of non-starchy vegetables and low glycaemic foods.
- While macronutrient distribution ratios vary, it is typically around 75% to 90% calories from fat, 12% to 15% calories from protein, and 5% to 10% calories from carbohydrate.
“There’s no set standard when it comes to the keto diet, because ultimately, it depends on what level of carbohydrates you need to be in a state of ketosis,” says Brown. “So, person A might be able to achieve ketosis eating 70 grams of carbs a day, and then person B might need 50 grams or less to achieve ketosis — but the standard is usually around 50 grams or less a day.”
Maybe keto isn't for everyone
After hearing that, maybe you’re now wondering if the influencers are right and a keto diet really is the one for you? Well, before you make any decisions, it’s important to know that it does come with some risks:
High cholesterol
“When it comes to drawbacks, cholesterol seems to be the biggest biomarker that I’ve noticed,” says Brown. “It doesn’t happen always, and there are even some individuals I’ve seen who go on a keto diet and come back with improved lipid panels, probably because they’re eating less processed food.”
Brown says that most of the time, if someone is coming to her because they’re having issues on a keto diet, it’s typically because their cholesterol and triglycerides levels have skyrocketed — which is likely due to the high intake of saturated fat.
“That can especially happen if someone is doing the keto diet in an unhealthy way, meaning they have no vegetables, and they’re just eating mostly bacon, cheese and cream,” says Brown.
The “antisocial diet”
Brown sometimes calls the keto diet the antisocial diet because it may be hard to go out and be social with friends if you are so restricted in what you’re eating (though the same could also be said for people following a strict vegan diet). Nowadays it is a bit easier to find keto (and vegan) options out there, but ultimately, it may not be very sustainable to stick to long term.
The weight comes back
Another disadvantage? As soon as you stop the diet, most of the time, the weight just comes right back (which to be fair, happens with many diets). And not only do you regain the weight, but now you could be in a worse position because you might now have high cholesterol, as well.
Constipation
The keto diet can also cause some people to experience constipation if they’re not getting enough fibre in their diet. Not only is this uncomfortable, but it can also increase the risk of colon cancer.
“We know that colon cancer risk goes down when fibre intake goes up, and since it might be challenging to get enough fibre on keto diet with fewer whole grains and fruits, this is another one of my concerns,” says Brown.
Missing nutrients
You might also be missing out on some important nutrients if you’re following a keto diet, like whole grains and fruits with B vitamins and magnesium.
So, do they work?
Since people approach these diets so differently, it’s hard to know how successful they actually are. What experts can glean is that after a year or so, the changes in weight loss aren’t statistically significant.
“But of course there’s always the anomaly, right? And usually those are the ones that get famous on TikTok or Instagram, where an influencer tries to convince you that it’s the only diet that will work,” says Brown.
If you’re looking for something less restrictive, Brown suggests the plate method, which is adaptable to all kinds of diets. Essentially, half your plate should be veggies, a quarter should be protein, and a quarter should be carbohydrates, starches, and grains.
Whatever you choose to do, always check with your doctor before you start any diet, especially if you have cardiovascular disease, hypertension, diabetes, chronic kidney disease or any other health conditions. And even if you’re healthy, Brown still suggests that prior to making any major changes to your diet it’s generally a good idea to work with your provider to get some baseline labs drawn, and then make sure to recheck everything after a certain period of time to observe any changes.
“I ultimately just end up telling my patients that the best diet out there is the one you’ll actually stick to and follow,” says Brown. “I don’t shoo anyone away though, so if they really want to do keto, or if they want to go plant-based or vegan, I’ll welcome anyone in and can help them adapt it or make modifications as necessary.”
https://rightasrain.uwmedicine.org/body/food/keto-or-plant-based-diet
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