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Who Should Not Do A Ketogenic Diet?

Who should not do a ketogenic diet? This is the question we will discuss in this article. The way I think about this question is to break it into four different sets of possible health problems.  People with problems in these four areas may not want to do the ketogenic diet for reasons we will discuss below.  At a minimum, people with problems in these areas should watch more closely if they are doing or considering doing a ketogenic diet.  There are a few labs and health parameters to follow and ensure these health issues are not occurring.  


If you are interested in this, keep reading we are going to discuss the details. 

Four Groups Who Should Not Do A Ketogenic Diet

So who should not do the ketogenic diet or who should be more cautious when they are starting a ketogenic diet? The four kind of health issues or categories that should cause a little caution with this diet are:

  • high cholesterol
  • digestive issues
  • adrenal issues
  • hypothyroid or thyroid issues

We will dive into each of these in a little more detail so you have some context and understanding of what to look for if you decide to do the ketogenic diet.

Learn How To Calculate Your Macro's For Ketogenic Diet


Those With Digestive Issues Should Not Do Ketogenic Diet

If you have problems with your digestive tract, in particular constipation and low amounts of the good bacteria, the ketogenic diet may make things worse.  This does not always happen but is common if you are not paying attention.  Now, I say this but it can also make things better too.  So let me give you some further details.

When you have low amounts of good bacteria, a high fiber diet is going to promote the growth of these microbes.  Fiber is main source of food for these bacteria.  When we talk about good bacteria and the microbiome we are referring to the bacteria in the large intestine. This is where most of the bacteria should be.  They feed off of the leftover fiber material that is not absorbed in the small intestine.  Lower carb and ketogenic diets generally are going to have less fiber in them.  To ensure this does not happen to you focus on eating a lot of vegetables like Brussels sprouts, cauliflower, broccoli and the like. These vegetables are low in net carbs but also high in fiber, so they work well for ketogenic and low carb diets. 

It is not necessary for people eating a ketogenic diet to eat a low fiber diet. So my first recommendation if you are going to do ketogenic diet and you have constipation or low good bacteria be sure you have plenty of the good fiber sources or high vegetable sources in your diet. 

I also mentioned that a ketogenic diet could actually make your digestion better.  This often occurs when you have bacterial overgrowth.   Sometimes people have too much bacteria in their small intestine which is higher up or before your large intestine.  This is known as SIBO or small intestinal bacterial overgrowth. You can read more about SIBO here

Even if you have an excess of bacteria or pathogenic microbes in your large intestine, limiting the amount of carbohydrates, could make your symptoms better.  You just want to pay attention and not be doing this long term.  Mainly because the good bacteria in your large intestine need a wide variety of fiber sources to thrive and do well over time. 


Those With Adrenal Issues Should Not Do Ketogenic Diet

The second category of people that should not do the ketogenic diet are those with adrenal and cortisol problems. When you are doing ketogenic diet, at least initially, your body is going through low blood sugar states off and on.  When you initially start doing the ketogenic diet you will have lower blood sugar at times.  This is partially what is responsible for the "keto-flu."  When this lower blood sugar state occurs, cortisol will be released from your adrenal glands to increase your blood sugar.  One of the jobs of cortisol is to mobilize the stored glucose in your cells known as glycogen.  When you have low blood sugar the glycogen gets mobilized to keep your blood sugar at a normal rate.  If you drop too low, it could cause a major issue for your brain, your kidneys, and other parts of your body.  Our body always need to keep a certain amount of glucose in the blood or it can be detrimental to these organs. 

If you are someone dealing with an ongoing stressful situation or chronic anxiety, the high cortisol from the ketogenic diet can make this worse . Over time the diet could actually improve your cortisol because your blood sugar will not be bouncing back and forth all the time (as it does on moderate to high carb diets).  Keep this in mind if you have a more fragile cortisol or adrenal issues.  Instead you should ease into the diet slowly.


Those With High Cholesterol Should Not do Ketogenic Diet

The third group who should not do the ketogenic diet are those with high cholesterol.  There are some cases or subsets of the population that really do not do well with high saturated fat.  This probably doesn't come as a surprise to most of us who have been following the best diets to lower cholesterol. Typically these diets focus on lowering saturated fats. However not everyone will lower their cholesterol by lowering their saturated fats. 

Most of the macronutrients seen in diets today are higher carbohydrates and sugar. These diets cause high insulin, high liver enzymes, high triglycerides, and high LDL cholesterol.  This kind of pattern is the pattern that the ketogenic diet will actually help.  Most of the time when these people consume a more ketogenic diet, they will see an improvement in their LDL cholesterol.

More on Cholesterol Testing

If you have a normal blood sugar and you have high cholesterol, there is less chance that your cholesterol will improve on the ketogenic diet.  To know for sure you should always test your levels.  Make sure you are not assuming that it is ok because you never had a cholesterol problem and you think you are "eating healthy." 

If you are just assuming it's gonna be better just because you are eating less carbohydrates it's not always the case.  Even for people that do you have the high triglycerides and high blood sugar, there is still a chance that things will get worse.  Keep that in mind and make sure you are checking your numbers when you are three months to six months into it.  If  your cholesterol goes up when start the ketogenic diet and it stays up, it probably will not go down.  There are some tweaks you can do to kower it while maintaining this diet.  Primarily you have to decrease the saturated fat in your diet.  In my experience that's the only way to get the numbers down or back into a normal range.

High LDL cholesterol (or LDL particle number) is the one cause that we know of that progresses cardiovascular disease (this and inflammation). Cardiovascular disease is the number one cause of death in the United States.  With that being said, high cholesterol is something that is very controllable through diet and other things. So don't overlook this if you are doing ketogenic diet. 


Those With Hypothyroidism Should Not do Ketogenic Diet

The last group that should not do ketogenic diet is those that have thyroid issues,  specifically hypothyroid.  I did post a separate video on this topic,  "Can You Do Ketogenic Diet If You Have Hypothyroid" (coming soon).  This article goes into more detail. The main point is if you have hypothyroid you should use a little more caution. The reason is the conversion rate between your T4 to T3 thyroid hormone can be slowed. Your T3 thyroid hormone is the more metabolically and energetically stimulating part of the thyroid hormone.  If you have lower conversion rate into this hormone, then you might have more hypothyroid symptoms.  It will not be a problem for everyone but it is something to watch out for.  You can follow both through thyroid lab testing and monitoring any low thyroid symptoms. 

This should give you a better idea of who should not do the ketogenic diet and who should be a little more cautious when they're thinking about doing the ketogenic diet.  If you have questions about anything in the article leave a comment below.  For a customized diet or health plan, click on the link below to get started. 


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