Danielle Belardo: What Is Plant Based Keto

[Plumster]

Danielle Belardo, MD, is a plant-based doctor. She wrote the following on her Instagram and I thought it might be of interest here. She did a two-week trial of a plant-based keto. This is not specific to AD prevention. Here is her account: https://www.instagram.com/theveggiemd/

Why I am doing a 14 day Plant Based Keto Experiment:
First… the “what”:
I wanted to do a 14 day experiment where I follow a plant based keto diet – monitor myself in plant based ketosis – and then track my advanced lipid panel and other biomarkers PRE and POST. Additionally, I am tracking my satiety levels, energy, sleep, and more.
(Swipe to see my baseline lipids on a standard low fat whole food plant based diet, drawn 10 days before the experiment began)⠀⠀
I am on Day 4 of a 2 week plant based keto experiment – and I’ve received an overwhelming number of messages, tweets, emails, DMs, asking me: What? How? Why? So – here we go. And for the record, I have NO plans on extending this experiment longer than 14 days, but I sure am learning a LOT.

How:
To get into ketosis, you need to reach 20 g NET carbohydrates, this means total carbs minus fiber. I have been averaging 80-85 g fiber per day on plant based keto, eating tons of leafy greens, veggies, avo, etc and this is really not much different than my baseline fiber intake. So my GI system has not changed. At all.
Fat – the primary fuel source in ketosis: avocados, nuts, tofu, lupini beands, olives, etc. It took me less than 48 hrs to go into ketosis and I have been in since.
And in full transparency and total honesty… I feel totally fine. No brain fog. No headaches. My 5 mile runs have been great. I feel…..normal. But remember, this experiement is N=1.

And now the important part – the WHY:
Ketosis is ALL the rage. And all of the research showing the danger of the keto diet is focused on animal based ketosis: they are high in saturated fat from animals, turn on IGF-1, mTOR, elevate TMAO, etc.
⠀⠀
On the other hand, plant based ketosis is very different. Instead of saturated fat, the entire diet is rich with MUFA and PUFAs which have been shown in cardiovascular research to be beneficial. But guess what – plant based keto has NOT been studied long term (no keto diet has). And long term data showing mortality benefit of a high fat diet is especially important in patients with CAD and diabetes. That being said - many of the variables concerning for an animal based keto diet are absent in a plant based keto diet.
⠀⠀
So…. Low fat plant based? Moderate fat plant based? Plant based keto? What is best? The answer: they have never been compared in a research study.
⠀⠀
There is NO cardiovascular or diabetes research showing plant based keto, is helpful OR harmful for cardiovascular disease or diabetes, simply because it has not been studied long term.
But we DO have data showing that a low fat whole food plant based diet improves individuals with cardiovascular disease, improves insulin resistance, and even reverses type II diabetes.
⠀⠀
Well, then what data DO we have about Plant Based Keto? Only short term data.
⠀⠀
David Jenkins MD did a study on “ECO-Atkins” & evaluated a low carb high fat diet composed of whole food plants. His research was a short term study (4wks) that showed improvement in weight, cholesterol and blood glucose.
⠀⠀
How about SHORT term calorie restricted plant based keto?
Dr. Valter Longo’s 5 day calorie restricted plant based keto FMD seems to help individuals who are most metabolically challenged, with elevated IGF-1, cholesterol, triglycerides, fasting glucose, systemic inflammation, and systolic+diastolic blood pressure, to help them return to normal levels. In regards to biomarkers, 60% of the positive effects were still present after 3 months.
And what do the blue zones tell us?
Interestingly enough - you can see the same longevity in different areas with different macronutrient profiles. Okinawa Japan: 10% fat. Ikaria Greece, with 40% fat. In Ikaria, they found that for middle-aged people, about 6 tbs of olive oil daily seemed to cut their risk of dying in half. So what is the common thread across ALL of the blue zones? They all eat 95-100% plant based with VERY little animal products & no processed foods.
⠀⠀
So, would I recommend my patients follow plant based keto diet LONG TERM? No. And my reasoning is 2 fold:
⠀⠀
1. It simply has NOT been studied long term and we have no information re safety in diabetes or CAD. There is an inspiring physician named @carriediulusmd who has been really pioneering plant based keto in diabetes, and hopefully she will fascilitate some longitudinal studies and shed light on this question.
⠀⠀
2. But still - there are SO MANY, I mean ENDLESS, health benefits for eating fruits, lentils, and whole grains, which are restricted/eliminated on any keto diet, whether plant based or not. Beans reign supreme in blue zones – regions of the world where populations have the most longevity and lowest mortality/chronic disease. They’re the cornerstone of every longevity diet in the world: black beans in Nicoya; lentils, garbanzo, in the Mediterranean; & soybeans in Okinawa. People in the blue zones eat at least 4x as many beans as Americans do on average. And we have so much data to show us the benefit of whole grains and fruit consumption in every disease process.
⠀⠀
That being said: I am only 4 days into my two week experiment: what have I learned so far?
1. Satiety:
When it comes to satiety, it is well known that FIBER is king. My fiber is somewhat lower on plant based keto (80 g per day) than my normal low fat WFPB diet (90-100 g per day). BUT – my fat intake is significantly higher on plant based keto (again, MUFA and PUFA, NOT SATURATED FAT). And what have I noticed about satiety? My appetite has dropped, drastically with high fat + fiber combo. Is it the ketones? Maybe. Is it the fat content? Maybe. Either way – there is a difference.

What have I learned so far... continued.
⠀⠀
2. If you really, really, really want to do keto – you can DO IT VEGAN: you DO NOT have to harm animals/the environment to do so! Even though we do not have data showing its safety long term, it is sure as hell is safer than doing an animal based keto.
⠀⠀
3. Ok so now I am confusing you guys… so where does a plant based keto diet fit into the world?
Given Dr. Longo’s data, short term calorie restricted FMD has shown benefits, short term, and is now being studied with cancer patients.
Outside of this – maybe a short term plant based keto diet may help those without CAD/DM who struggle with satiety on a low fat whole food plant based diet? Maybe not. It needs to be studied. @drgarthdavis
Maybe research will show us that long term plant based ketosis is perfectly safe? @carriediulusmd ⠀⠀
Do we truly know what macronutrient profile is best for everyone? I don’t think so. For my patients without CAD or weight loss goals, why should I be restricting healthy plant based fats like MUFA’s and PUFA’s in the form of tree nuts, avocado, olives, etc to very low levels? And for even those patients who struggle with weight loss – how are we sure that a LOW fat plant based diet is the best for their satiety and reduction of appetite, instead of a whole food plant based diet with a moderate amount of healthy fats? Maybe they will lose more weight with high fiber + moderate healthy plant fats?
⠀⠀
4. Asking questions is good. Being open minded is even better. We should all stop doing things just because we have been doing them. Read the primary research and literature yourself. And remember, everyone is an individual. Nutrition and macronutrient profiles are NOT a one size fits all. But what is clear amongst researchers– that a whole food plant based diet, regardless of macronutrient composition, is most healthful for cardiovascular disease prevention and all cause mortality.

[Julie G]

Thanks for sharing, Plumster. Good stuff. I love that she averaged 80-85g of fiber per day. That's super high and very easy when you're eating lots of veg. We also know that fiber in the gut gets transformed into short chain fatty acids and may also help to supply butyrate. I wanted to clarify that Dr. Longo's FMD is not keto. He's decidedly high carb, not low carb with his approach. Yes, ketones are produced but only because the diet is HYPOcaloric, not because of added fats. I respect Belardo's conclusion that she wouldn't recommend this without more long term safety data, but question why she would withhold it for patients with CAD and DM. Those might be the groups who could benefit most. And, she completely ignores us —25% of the population— with a reduction in cerebral glucose utilization who could use the ketones for brain fuel.

[slacker]

I'm one of the Luddites without an instagram account. I would love to know more about the details of her 2 week plant based keto diet. I'm impressed with only 48 hours of reaching ketosis. Wonder what level of ketones she uses?

[Plumster]

I believe there is more info on her experiment on her Twitter account than her Instagram: https://twitter.com/TheVeggieMD

[thjj]

From Dr. Belardo's twitter:
Aug 6
Vegan Keto update: lipid panel is back after 14 days >130 g PUFA/MUFA, 85+g fiber w/ 20g net carbs daily, & it didn’t change[ ]guess I’m gonna get an IRB started![ ]

• Tc 132137
  HDL 79 82
  TG 40 38
  LDL 4547
  hsCRP unchanged <0.01
  Lp(a) unchanged <50
  ApoB 52 50