Who Should NOT Try the Ketogenic Diet? (Important Safety Guide)

Mar 4, 2026

Clear rules for who should avoid ketogenic therapy and why are explained. The difference between absolute and relative contraindications is unpacked. Rare inborn metabolic disorders and acute illnesses that truly forbid keto are highlighted. Special situations like pregnancy, diabetes, heart disease, psychiatric conditions, cholesterol concerns, and medication interactions are discussed with emphasis on careful clinical supervision.

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INSIGHT

Rare Absolute Contraindications To Keto

Absolute contraindications to ketogenic therapy are very rare and include inborn errors of fat metabolism like carnitine and VLCAD deficiencies and porphyria.
These conditions present early in life and are typically obvious, so they're unlikely to appear de novo in adults.

ADVICE

Use Caution With Pregnancy And SGLT2s

Pregnancy, breastfeeding, and SGLT2 inhibitor use raise ketoacidosis risk and are often handled with extra caution rather than blanket bans.
Work with an experienced clinician who can assess risk and manage therapy in these situations.

ADVICE

Supervise Keto When On Diabetes Or Heart Meds

If you have type 1 or type 2 diabetes or heart disease, pursue ketogenic therapy only under clinical supervision because it can sharply lower glucose and blood pressure.
Medication doses often need adjustment as ketosis changes metabolic parameters.

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Are there real contraindications to a ketogenic diet? Yes, but they’re far rarer than many people think. So who shouldn’t do keto?

In this video, Dr. Bret Scher breaks down the difference between absolute and relative contraindications to ketogenic therapy. While rare inborn metabolic disorders and certain acute illnesses are true absolute contraindications, most commonly cited concerns, including type 1 or type 2 diabetes, heart disease, serious mental illness, high cholesterol, and even pregnancy are listed as relative contraindications, which really means, “use caution and work with an experienced clinician.”

Watch to learn who should avoid ketogenic therapy, who may benefit, and why clinical guidance makes all the difference.

👉To learn more about the safety and efficacy of ketogenic therapy, check out our “Is Keto Safe?” topic page: https://www.metabolicmind.org/resources/topics/is-keto-safe/

🔎 Have questions about how to apply metabolic therapies effectively? Submit them at metabolicmind.org/questions to be featured in a future Metabolic Mailbag episode.

#MetabolicMind #KetogenicTherapy #FoodAsMedicine

Expert Featured:

Dr. Bret Scher

Baszucki Group Medical Director
https://x.com/bschermd

Resources Mentioned:

Clinician Directories

https://www.metabolicmind.org/peers-families/get-help/

Can a Keto Diet Cause Hypomania, and How Can It Be Avoided?https://www.youtube.com/watch?v=F11ZBvCjVNk

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Our courses have been made FREE by grants from Baszucki Group, so we can spread these powerful therapies as widely as possible. Earn CME/CNE credits: https://www.metabolicmind.org/for-clinicians/trainings-courses/?utm_medium=organic-social&utm_source=youtube&utm_campaign=cme-yt

Follow our channel for more information and education from Bret Scher, MD, FACC, including interviews with leading experts in Metabolic Psychiatry.

Learn more about metabolic psychiatry and find helpful resources at https://metabolicmind.org/

About us:

Metabolic Mind is a non-profit initiative of Baszucki Group working to transform the study and treatment of mental disorders by exploring the connection between metabolism and brain health. We leverage the science of metabolic psychiatry and personal stories to offer education, community, and hope to people struggling with mental health challenges and those who care for them.

Our channel is for informational purposes only. We are not providing individual or group medical or healthcare advice nor establishing a provider-patient relationship. Many of the interventions we discuss can have dramatic or potentially dangerous effects if done without proper supervision. Consult your healthcare provider before changing your lifestyle or medications.