The ketogenic (keto) diet, characterized by high fat, moderate protein, and minimal carbohydrate intake, has surged in popularity due to its perceived efficacy in rapid weight loss. Nevertheless, accumulating evidence highlights significant health risks, particularly exacerbating cardiovascular morbidity in patients with Coronary Artery Disease (CAD), mediated primarily through increased Low-Density Lipoprotein (LDL) cholesterol, systemic inflammation, oxidative stress, and endothelial dysfunction. Conversely, Bethsaida Hospital, under the leadership of Prof. Dasaad Mulijono (DM), has adopted an evidence-based Whole-Food Plant-Based Diet (WFPBD) that is deeply embedded within compassionate, holistic patient care, achieving remarkable clinical outcomes. These successes include reversal of hypertension, diabetes control without reliance on insulin, substantial reductions in LDL cholesterol, sustained normalization of body weight, renal function stabilization, notable recovery in heart failure patients, mitigation of chronic inflammation, and remarkably low restenosis rates (~2%) following Drug-Coated Balloon (DCB) angioplasty. This review critically examines the pathophysiological mechanisms underlying keto-induced cardiovascular harm, explores the socio-psychological drivers of its widespread acceptance despite inherent risks, outlines the acute and chronic adverse effects, and robustly contrasts these findings with the proven efficacy and sustainability of plant-based dietary interventions.