The ketogenic diet, commonly known as the keto diet, has gained tremendous popularity in recent years. This low-carb, high-fat eating plan promises rapid weight loss, improved energy, and better mental clarity. While many people thrive on keto, it’s not the right choice for everyone.
In this article, we’ll explore who should not follow a ketogenic diet and why. Understanding the risks, medical conditions, and contraindications associated with keto is essential for making informed decisions about your health.
What Is the Ketogenic Diet?
Before we dive into the reasons why keto might not be suitable for some people, let’s understand what the ketogenic diet is.
The keto diet focuses on reducing your carbohydrate intake to less than 50 grams per day. By doing so, the body enters a metabolic state called ketosis, where it burns fat instead of glucose for energy. This process produces ketones, an alternative energy source that fuels the brain and body.
While ketosis can lead to weight loss, improved insulin sensitivity, and enhanced focus, it may not be safe or effective for everyone.
Who Should Not Follow a Ketogenic Diet?
1. People with Type 1 Diabetes
If you have type 1 diabetes, following a ketogenic diet can be dangerous without strict medical supervision.
Type 1 diabetics depend on insulin and have a higher risk of developing diabetic ketoacidosis (DKA) — a life-threatening condition caused by dangerously high levels of ketones in the blood. While ketoacidosis is not the same as nutritional ketosis, the line between the two can blur without careful monitoring.
Recommendation: Consult an endocrinologist before starting keto if you have type 1 diabetes.
2. Individuals with Kidney Disease
People with chronic kidney disease (CKD) or reduced kidney function should avoid high-protein or high-fat diets like keto.
Why? The kidneys play a critical role in processing protein waste and managing electrolyte balance. The keto diet, especially if poorly managed, can put extra strain on the kidneys, potentially worsening kidney function.
Recommendation: Stick to a balanced, renal-friendly diet if you suffer from kidney disease.
3. Pregnant or Breastfeeding Women
During pregnancy and breastfeeding, the body’s nutritional demands increase significantly. Carbohydrates are a vital source of energy for both the mother and the growing baby.
Following a keto diet during this period may lead to:
- Nutrient deficiencies (folate, calcium, iron)
- Decreased milk production
- Increased fatigue
Recommendation: Pregnant or nursing women should prioritize a well-balanced, whole-food diet unless medically advised otherwise.
4. People with Gallbladder Issues
If you’ve had your gallbladder removed or suffer from gallstones, the high-fat nature of the keto diet could cause discomfort and digestive issues.
The gallbladder helps digest fats by releasing bile. Without it, your body may struggle to process the increased fat intake required on keto, leading to:
- Bloating
- Diarrhea
- Nausea
Recommendation: Consult your doctor and consider a modified low-fat version of the diet if you have gallbladder issues.]
5. People with Eating Disorders or a History of Disordered Eating
The strict nature of keto — especially the need to track macros and restrict entire food groups — can trigger or worsen eating disorders such as:
- Anorexia
- Bulimia
- Orthorexia
- Binge eating disorder
Mental health is just as important as physical health, and obsessing over food rules can be harmful to emotional well-being.
Recommendation: Seek guidance from a mental health professional or registered dietitian before starting any restrictive diet if you have a history of disordered eating.
6. People Taking Certain Medications
Some medications can interact negatively with the ketogenic diet. For instance:
- SGLT2 inhibitors for diabetes may increase the risk of ketoacidosis
- Diuretics may lead to electrolyte imbalances
- Anti-hypertensives may cause dangerously low blood pressure when combined with keto-induced weight loss
Recommendation: If you’re on prescription medications, especially for blood sugar or blood pressure, speak to your doctor before starting keto.
7. Athletes Requiring High-Intensity Performance
While the keto diet can improve endurance in low-intensity activities, it may not be ideal for high-intensity athletes, such as sprinters, weightlifters, or CrossFit enthusiasts.
These athletes rely heavily on glycogen (stored carbohydrates) for quick bursts of energy. Keto, being low in carbs, may lead to:
- Decreased performance
- Muscle fatigue
- Slower recovery
Recommendation: Consider targeted or cyclical keto approaches or a moderate-carb plan for optimal performance.
8. Children and Adolescents Without Medical Supervision
Keto has been used therapeutically in children with epilepsy, but only under medical supervision. For healthy children and teenagers, however, a ketogenic diet may restrict essential nutrients during key growth years.
Children need a balanced diet rich in:
- Whole grains
- Fruits
- Vegetables
- Healthy fats and proteins
Recommendation: Avoid restrictive diets for children unless prescribed for a specific medical condition.
Risks of Following Keto When It’s Not Right for You
Starting the ketogenic diet without proper guidance can lead to a range of short- and long-term health risks, including:
- Nutritional deficiencies (due to restricted food variety)
- Constipation (from lack of fiber)
- Electrolyte imbalances
- Mood swings or irritability
- Muscle loss if protein intake is too low
Always assess whether keto aligns with your unique medical history, lifestyle, and goals before making the switch.
Alternatives to the Ketogenic Diet
If you fall into any of the above categories, consider safer and more balanced dietary approaches that still support weight loss and health, such as:
- Mediterranean diet – rich in whole foods, healthy fats, and moderate carbs
- Low-carb, high-protein diets – suitable for blood sugar control
- Plant-based diets – ideal for heart and kidney health
- Intermittent fasting – can be combined with any diet for metabolic benefits
Final Thoughts: Is the Keto Diet Right for You?
The ketogenic diet offers many benefits, but it’s not suitable for everyone. If you belong to a group at risk — such as those with kidney disease, gallbladder issues, or specific medical conditions — pursuing keto could do more harm than good.
Always consult a qualified healthcare provider or registered dietitian before starting any restrictive diet plan. Remember, there’s no one-size-fits-all solution in nutrition. The best diet is one that’s safe, sustainable, and tailored to your individual needs.
