Carnivore vs Ketogenic vs Vegan

Health

May 15

Written By Kevin H

Which diet reverses plaque best?

Dr. Kevin Ham, MD

“So whether you eat or drink, or whatever you do, do all to the glory of God.”

1 Corinthians 10:31

Since my YouTube channel has had a video hit a million and a handful of 100,000+ views, I’ve had many people wonder about other diets. I wanted to comb through the medical studies to see what diets actually reverse plaque. I used to eat a lot of meat, seafood, dairy, and fruits, but not a lot of salads or beans. Now most of my meals are salads, veggies, beans, sourdough breads and modest fruits.

I would gladly eat meat, seafood, and dairy, but I sincerely wish to reverse my plaque and not die of a heart attack, stroke, or any metabolic disease, which I put diabetes, autoimmune and cancer in that category as well. As I’ve looked at the evidence, knowing that I have major blockages in my heart arteries and that my Bruch’s membrane (the wall between my retinal vessels and my retina) is brittle, I’ve been pretty disciplined for the past year, reading medical studies and implementing what I believe based on evidence to reverse both my eye and heart disease. So far, so great.

Every drink and food I put into my mouth, I consider whether it is making me healthier or sicker. Closer to life or further from death. Of course, I enjoy a great tasting meal. The irony is that I have made my meals very delicious. I absolutely look forward to many of my meals. Some of them I am still working on making delicious. I never imagined myself being on a ‘vegan’ or what we call a 10% low-fat whole food plant-based (WFPB) diet for a year now. May 9 marked my first anniversary. Wow. I committed at least three years of my life to this WFPB diet protocol, fasting protocol and HIIT protocol. I view myself as being the Roger Bannister of plaque reversal. He was the first to run a mile under 4 minutes.

Although my role model is Dr. Joe Crowe, who reversed 100% of his LAD coronary plaque in 32 months, he was only 44 at the time. His plaque was 11 years younger than mine, so it had more fibrous atheroma (Type 3 plaque), and mine is more Type 4 and 5 (calcified and mixed). It’s like the difference between curing Stage 2 cancer vs Stage 3 vs Stage 4 cancer. I view my diet as 80/20, contributing 80% of the results, with exercise and fasting accounting for the remaining 15%-20%. Of course, sleep, stress, and genetics also play a role.

So in this article, I would like to examine the evidence for and against two of the four most touted and often controversial diets. Carnivore vs Ketogenic vs Low-fat Vegan (plant-based) diets. Each has its evangelists. Right now, I am in the low-fat WFPB camp. Ready?

The Carnivore Diet

“Every moving thing that lives shall be food for you.
And as I gave you the green plants, I give you everything.”

Genesis 9:3

After Noah’s flood, God commanded Noah to eat every moving thing. In other words, fish, birds, creeping things, animals, in addition to every green plant, were the diet for ten generations from Adam to Noah.

The carnivore diet was popularized by orthopedic surgeon Shawn Baker, who stipulated that it be based solely on animal foods. Meat, eggs, dairy, but no plants. The lion is its role model. Ribeye for breakfast. Complete opposite of WFPB.

The carnivore literature, as far as I could find, had no randomized controlled trials for plaque reversal. But let’s look at the lipid endpoints, which are different from plaque reversal endpoints.

The first study we examine is a Harvard social media survey of 2,029 self-selected adults, led by Belinda Lennerz and David Ludwig at Boston Children's Hospital. The respondents had eaten carnivore for a median of 14 months. They reported high satisfaction. LDL cholesterol in the subset who provided lab values averaged 172 mg/dL.

My only risk factor for my heart disease was a high LDL of 168 mg/dl. I was eating a high-saturated-fat diet of meats, seafood, dairy, and complex carbs. My hsCRP has been only 0.3 for the past 6 years.

So far, I don’t think I would reverse my plaque on this carnivore diet.

The second study: a German exploratory study by Rainer Klement and Johanna Matzat, published in Cureus in April 2025. 23 adults submitted paired blood panels before and after at least one month on the diet. Total cholesterol rose from a median of 224 to 305 mg/dL. LDL rose from 157 to 256. Both shifts were statistically significant. The authors wrote:

The significant elevation of total and LDL cholesterol concentration is striking and warrants further investigation into potential adverse effects.

Klement RJ, Matzat JS. Cureus. 2025;17(4):e82521

The third was a scoping review published in Nutrients in January 2026 by Lietz and colleagues. They searched the entire global literature on the carnivore diet. Nine human studies met the inclusion criteria. Zero were randomized. Zero were long-term. Zero captured hard cardiovascular endpoints. Their conclusion was the gentlest possible no:

The Carnivore diet (CD) may offer short-term health benefits but carries substantial risks of nutrient deficiencies, reduced intake of health-promoting phytochemicals, and the development of cardiovascular disease. At this time, long-term adherence to a CD cannot be recommended.

Lietz A, Dapprich J, Fischer T. Nutrients. 2026;18(2):348

We should also consider George Mann’s studies on the Masai, an African tribe that is said to eat meat, dairy, and blood and to have no cardiovascular disease. Mann found in 1964 that they were lean, fit, and their ECG and blood pressure were normal. They consumed 3000 calories but were so active and fit from hunting and roaming that they were metabolically fit. Guess who this reminds me of? Yes, my friend Rob Thompson, who climbed the Matterhorn mountain three times. He died of a sudden heart attack at age 58.

They also had periods of fasting between meals. It also reminds me of me. HR 42 bpm. BP 105/65. Able to ride 100 km on my bike at fast speeds, up mountains every week with relative ease. Coronary arteries clogged 77%, 55%, 45% in every vessel!

In early 1972, Mann did an autopsy study on 50 Masai. Most of the population did not reach past 60, so they were still relatively young. What was found was astounding! Major atherosclerosis in their arteries. But their arteries were larger. Let’s see what Mann reported.

A field survey of 400 Masai men and additional women and children in Tanganyika indicates little or no clinical or chemical evidence for atherosclerosis. Despite a long continued diet of exclusively meat and milk the men have low levels of serum cholesterol and no evidence for arteriosclerotic heart disease.

he average total cholesterol is about 130 mg/dL in men aged 25 to 55. Lean. Active. No clinical signs of CVD on physical exam or EKG. This is the paper the carnivore community cites. Mann himself became a public critic of Ancel Keys on the strength of it.

Mann's 1972 paper, American Journal of Epidemiology, 95(1):26-37

This was the autopsy study. Fifty Maasai men. Hearts and aortae were examined under the microscope. Verified verbatim abstract:

The hearts and aortae of 50 Masai men were collected at autopsy. These pastoral people are exceptionally active and fit and they consume diets of milk and meat. The intake of animal fat exceeds that of American men. Measurements of the aorta showed extensive atherosclerosis with lipid infiltration and fibrous changes but very few complicated lesions. The coronary arteries showed intimal thickening by atherosclerosis which equaled that of old U.S. men. The Masai vessels enlarge with age to more than compensate for this disease. It is speculated that the Masai are protected from their atherosclerosis by physical fitness which causes their coronary vessels to be capacious.

Read those two sentences together.

Coronary intimal thickening that equalled that of old U.S. men. Extensive atherosclerosis in the aorta. The Maasai had the disease. They just weren't dying from it.

The protection was not the diet. The protection was three things the diet did not provide.

One. Compensatory arterial enlargement. Their coronary vessels dilated as plaque grew, preserving the lumen. We now call this positive remodelling, the Glagov phenomenon, first formally described by Seymour Glagov in 1987 in the New England Journal of Medicine. The Maasai were the original case series.

This arterial enlargement, and I believe also the collateral vessels, which are natural bypasses the body makes, allow more blood flow past the severe obstructions.

Two. Extreme physical activity. The Maasai warriors walked 15 to 20 kilometres per day, herding cattle, in semi-fasting states between feedings. The Mbalilaki 2010 study in the British Journal of Sports Medicine found that Maasai daily energy expenditure was roughly twice that of urban Bantu Tanzanians.

Three. Extreme leanness. Mean BMI around 20. Frequent caloric restriction between feedings. Genetic adaptations to a milk-heavy diet (the Maasai are among the most lactase-persistent populations on earth).

If you have seen any studies that show plaque reversal with the carnivore diet, I would love to read them.

I can see how a carnivore diet could eliminate some of the processed, sugar-laden food that many people eat and have a great metabolic effect, as well as cover some of the nutritional deficiencies from the “Western diet”.

But long term, I believe a carnivore diet will increase the risk of disease and death from heart attacks, strokes and cancer. After all, red meat is classified as a Class 2 carcinogen. I await studies showing plaque reversal with a carnivore diet.

The Ketogenic Diet

“And after fasting forty days and forty nights, he was hungry.”

Matthew 4:2

The ketogenic diet was born to treat epileptic seizures. When fasted, childhood seizures would drastically reduce or disappear on day 4 or 5. But the kids needed to eat, and they discovered that removing carbs (glucose) from their diet mimicked a fast. This was popularized by Robert Atkins (the Atkins diet). Eat fat and protein and remove carbs. The body then converts fats and carbs in the liver to ketones. The body can run on ketones. Glucose falls. Insulin falls. Hunger dissolves. Weight loss ensures. It is great for diabetes and weight loss.

I’ve developed a protocol for diabetics, high blood pressure, and weight loss that has quite remarkable results based on this and other dietary protocols. Reversing diabetes is much easier than reversing plaque. Of course, diabetes is also a very high risk factor for heart attacks and strokes, so although I have excellent glucose control and insulin sensitivity.

The ketogenic data is more interesting than the carnivore data because it is recent and contradictory.

In August 2024, Matthew Budoff and Nicholas Norwitz published the KETO Trial in JACC Advances. Eighty lean ketogenic dieters, averaging 4.7 years on the diet, with LDL cholesterol above 190, were matched one-to-one with Miami Heart cohort controls whose LDL was 149 milligrams per deciliter lower. Cross-sectional coronary CT angiography asked a simple question: Does the lean mass hyper-responder phenotype carry more plaque?

The answer, in the authors' own words:

Coronary plaque in metabolically healthy individuals with carbohydrate restriction induced LDL-C ≥190 mg/dL on KETO for a mean of 4.7 years is not greater than a matched cohort with 149 mg/dL lower average LDL-C. There is no association between LDL-C and plaque burden in either cohort.

Budoff M, Manubolu VS, Kinninger A, Norwitz NG, et al. JACC Advances. 2024;3(8):101109

The comparison here is against a matched cohort where there is no cited plaque reversal. The endpoint I would like to model is any protocol or diet that reverses plaque, and what kind of plaque and the degree of plaque reversal.

The keto community received the paper as justification. The cardiology community received it with caution. A cross-section is a single photograph. It tells you where you are. It does not tell you where you are going.

In April 2025, the same research group published the longitudinal answer. Adrian Soto-Mota and Nicholas Norwitz followed 100 ketogenic dieters in the lean mass hyper responder phenotype for one year with serial coronary CT angiography. The endpoint was a change in noncalcified plaque volume. The paper, titled "Plaque Predicts Plaque, ApoB Does Not," reported a median plaque progression of 18.9 cubic millimetres in one year. A 42.8 percent relative increase. The authors wrote:

In lean metabolically healthy people on KD, neither total exposure nor changes in baseline levels of ApoB and LDL-C were associated with changes in plaque. Conversely, baseline plaque was associated with plaque progression.

— Soto-Mota A, Norwitz NG, Manubolu VS, et al. JACC Advances. 2025;4(7):101686

The story, so far, is that elevated LDL in this phenotype does not translate cross-sectionally to greater plaque than matched controls, but the same phenotype shows measurable plaque progression over one year of longitudinal imaging. Progression. Not reversal.

The ketogenic diet has one other claim, and it is real. In 2019, Shaminie Athinarayanan and the Virta Health group, including Sarah Hallberg, Jeff Volek, and Stephen Phinney, published a two-year open-label trial of 262 type 2 diabetic adults on a well-formulated ketogenic protocol with continuous remote care. HbA1c fell from 7.6 to 6.3 percent. Patients lost about 12 percent of body weight. Many came off insulin. The five-year extension published in 2024 reported 20 percent sustained diabetes remission and 32.5 percent reversal to HbA1c below 6.5 percent on no medication or only metformin. Type 2 diabetes is real. Ketosis reverses it. That is the legitimate ketogenic claim.

It is, however, not a coronary endpoint. No ketogenic trial has ever documented coronary plaque regression on imaging.

The Plant Based Diet

“Test your servants for ten days; let us be given vegetables to eat and water to drink. Then let our appearance and the appearance of the youths who eat the king's food be observed by you, and deal with your servants according to what you see. At the end of ten days it was seen that they were better in appearance and fatter in flesh than all the youths who ate the king's food.”

Daniel 1:1,12-15

The low-fat, plant-based diet, advanced by Dean Ornish and Caldwell Esselstyn since the 1980s, asks the opposite. No oil. No animal products. Whole foods with less than 10 percent fat. The Tarahumara as model. A bowl of beans and greens for breakfast.

Next week, we will look at plaque reversal studies for a whole-food, plant-based diet, and then also examine the Mediterranean diet for plaque reversal. This is a much more interesting comparison, in my opinion.

Plaque reversal on imaging has been documented only by Ornish and Esselstyn. No carnivore study has ever imaged the arteries. No ketogenic study has ever reported plaque regression. The ketogenic phenotype showed measurable plaque progression at one year in KETO-CTA.

LDL and ApoB: Plant based drives both sharply down. My LDL decreased from 168 to 61 mg/dL. My ApoB 45. Carnivore drives both consistently up, sometimes doubling within months. Keto raises both modestly on average and dramatically in the lean responder phenotype.

If you have established coronary plaque on a CT angiogram or calcium score, the imaging trials are the endpoints of which dietary protocols shrink it.

A Request

Each Friday, I upload a new YouTube video. Please like, comment and subscribe so I can help many others in your network and beyond. It’s my mission to help people avoid the same fate as Rob, the same fate as I could have had. Heart attack, stroke or sudden death.

https://www.youtube.com/@DrKevinHam

My latest video is going vi ral :) My #1 meal to unclog arterial plaque. Thank you.

What to Start Now

If you are reading this with a calcium score above zero, or a family history that worries you, or a friend who suffered what Rob did

Get the numbers. ApoB, Lp(a), CIMT, CT calcium. You cannot manage what you do not measure. If your doctor will not order them, find one who will.
Eat real food. Whole, plant-based, low in added fat. The Esselstyn protocol is the most effective in all the studies I have seen for plaque reversal and arrest.
Walk, cycle, run, or move. Every day before meals and especially after meals. Move your body the way your great grandparents moved theirs for 30 minutes to an hour each day. Take the stairs.
Sleep. Eight hours. Without an alarm if you can manage it.
Then repeat.

This is how plaque reverses. This is how compounding pays out on the side of life.

Your Question

Questions worth exercising with
For yourself. For someone you love. Answer them in the quietness of your day.

What diet shrinks plaque and why aren’t you on it?

For Someone You Love

There is someone in your life running and falling. You thought of them. Send this to them. Your loved ones just need the information to act and a guide to help them.

Keep going. The race is long, the road is beautiful, and the body was built to heal.

Grace, strength and love to you.

Appendix

The summary of the referred exercise studies:

1. Lennerz BS, Mey JT, Henn OH, Ludwig DS. Behavioral Characteristics and Self-Reported Health Status among 2029 Adults Consuming a "Carnivore Diet." Curr Dev Nutr. 2021;5(12):nzab133.

Online survey of 2,029 self-selected carnivore dieters at median 14 months. High subjective satisfaction. Average LDL 172 mg/dL in subset with labs. No imaging. No cardiovascular endpoints. (28 words)

2. Klement RJ, Matzat JS. Subjective Experiences and Blood Parameter Changes in Individuals From Germany Following a Self-Conceived "Carnivore Diet." Cureus. 2025;17(4):e82521.

Twenty four German adults with paired pre and post panels. Total cholesterol rose 224 to 305 mg/dL. LDL rose 157 to 256 mg/dL. Both statistically significant. (26 words)

3. Lietz A, Dapprich J, Fischer T. Carnivore Diet: A Scoping Review of the Current Evidence, Potential Benefits and Risks. Nutrients. 2026;18(2):348.

Scoping review of nine human studies, 2021 to 2025. Zero randomized. Zero captured cardiovascular endpoints. Long term adherence to a carnivore diet cannot be recommended. (25 words)

4. Budoff M, Manubolu VS, Kinninger A, Norwitz NG, et al. Carbohydrate Restriction-Induced Elevations in LDL-Cholesterol and Atherosclerosis: The KETO Trial. JACC Adv. 2024;3(8):101109.

Eighty lean keto dieters, mean 4.7 years on diet, LDL above 190, matched against Miami Heart controls with 149 mg/dL lower LDL. Cross sectional plaque burden equal. (28 words)

5. Soto-Mota A, Norwitz NG, Manubolu VS, et al. Plaque Predicts Plaque, ApoB Does Not: Longitudinal Data From the KETO-CTA Study. JACC Adv. 2025;4(7):101686.

One hundred lean keto dieters, serial CT angiography at one year. Median plaque progression 18.9 cubic millimeters, a 42.8 percent increase. ApoB not associated with progression. (27 words)

6. Athinarayanan SJ, Adams RN, Hallberg SJ, et al. Long-Term Effects of a Novel Continuous Remote Care Intervention Including Nutritional Ketosis for the Management of Type 2 Diabetes. Front Endocrinol. 2019;10:348.

Two year open label trial in 262 type 2 diabetic adults on Virta ketogenic protocol. HbA1c fell 7.6 to 6.3. Twelve percent body weight loss. Insulin reduced. (27 words)

7. Ornish D, Brown SE, Scherwitz LW, et al. Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial. Lancet. 1990;336(8708):129.

Forty eight patients randomized to whole food vegetarian intervention or usual care. Eighty two percent of intervention patients regressed coronary stenosis at one year on quantitative angiography. (27 words)

8. Ornish D, Scherwitz LW, Billings JH, et al. Intensive lifestyle changes for reversal of coronary heart disease. JAMA. 1998;280(23):2001.

Five year follow up of Lifestyle Heart Trial. Intervention group regressed 7.9 percent. Control group progressed 27.7 percent. Control group experienced 2.47 times more cardiac events. (26 words)

9. Esselstyn CB Jr, Ellis SG, Medendorp SV, Crowe TD. A strategy to arrest and reverse coronary artery disease. J Fam Pract. 1995;41(6):560.

Twenty two severe coronary patients on plant based protocol with cholesterol below 150 mg/dL. Eleven completers imaged at 5.5 years. All eleven showed disease arrest. Eleven lesions regressed. (28 words)

10. Esselstyn CB Jr, Gendy G, Doyle J, Golubic M, Roizen MF. A way to reverse CAD? J Fam Pract. 2014;63(7):356.

One hundred ninety eight cardiovascular patients counseled in plant based nutrition. Mean follow up 3.7 years. Of 177 adherent patients, 99.4 percent free of recurrent cardiac events. (27 words)

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