The ketogenic diet is gaining momentum among health professionals but also the general public. But is it really suitable for everybody? The answer is a clear no. There are a number of ketogenic diet contraindications that you need to be aware of. Certain health conditions can also be an obstacle in the implementation of the diet.
When I started the ketogenic lifestyle for cancer in 2012, hardly anybody knew what it was and most people confused it with “ketoacidosis“, a dangerous metabolic state that diabetics or alcohol-dependent people can develop. The ketogenic diet is receiving a lot of attention and is becoming more and more- do I dare say?- mainstream. That means that a lot more people have actually heard the word “ketogenic” before and some even know what it is! This dietary approach is certainly not a fad and I get contacted by many people who want to give the diet a go for various health conditions.
To be specific, the contraindications are as follows (Source: Kossoff et al (2009) Optimal clinical management of children receiving the ketogenic diet: recommendations of the International Ketogenic Diet Study Group. Epilepsia. 50(2): 304-17):
That’s when the ketogenic diet is an absolute no-no! Yes, this is quite a long list but there’s no need to be worried- to be honest, I haven’t come across any of these conditions in my clinical practice. And I don’t know anybody among friends and family who suffers from one of them.
Often these conditions are diagnosed early in life with the exception of porphyria, which can also develop at a later stage in life. So, the likelihood of having one of these conditions and not being aware of it is really small.
- Carnitine deficiency (primary)
- Carnitine palmitoyltransferase (CPT) I or II deficiency
- Carnitine translocase deficiency
- b-oxidation defects
- Medium-chain acyl dehydrogenase deficiency (MCAD)
- Long-chain acyl dehydrogenase deficiency (LCAD)
- Short-chain acyl dehydrogenase deficiency (SCAD)
- Long-chain 3-hydroxyacyl-CoA deficiency
- Medium-chain 3-hydroxyacyl-CoA deficiency
- Pyruvate carboxylase deficiency
Health Conditions that need special Attention
But what about other health conditions that could make it difficult or impossible, or even harmful, to go into nutritional ketosis? There are a number of conditions that can put a spanner in the works and it is very important that you’re getting extra support when you suffer from any of these:
- Abnormalities in blood chemistry: My first step is to do a full blood count and other relevant baseline blood tests to exclude any underlying conditions. Impaired liver function, for instance, can be a problem when implementing a ketogenic diet because the liver will be in charge to produce ketone bodies and also larger amounts of bile than usual (due to the high fat intake on the ketogenic diet).
- History of pancreatitis: Case studies show that elevated levels of triglycerides in the blood can lead to acute pancreatitis. Prolonged hypotension and acidosis can eventually lead to cardiac arrest.
- Active gall bladder disease: The gall bladder is responsible for storing and concentrating bile produced by the liver. There are various types of gall bladder diseases and you need professional advice before starting on the ketogenic diet.
- History of kidney failure: Although there are studies suggesting that low carb approaches can be very beneficial in renal failure, caution is advised when there is/have been issues with the kidneys.
- Poor nutritional status: If you already suffer from poor nutritional status, you definitely need individual guidance and special care. Poor nutritional status can be assessed via blood work as suggested earlier but also via physical signs. There is also a functional test called Nutreval that is outstanding when it comes to determining and analysing nutrient deficiencies.
- Gastric bypass surgery: This is obviously a unique situation where the patients needs an individualised nutrition protocol.
- Abdominal tumours and/or impaired gut function: The high fat consumption can pose a problem for patients with abdominal tumours or impaired gut function. Gut healing/an adapted form of ketogenic diets can be an option. I’m currently looking into various other approaches for people with seriously compromised gut function.
- Decreased gastrointestinal motility: This can be caused by conventional cancer treatments and also certain medication. Because one of the first side effects of the ketogenic diet can be constipation, you need to be cautious if you suffer from this condition.
The other thing I often get asked is if people with liver tumours (primary or secondary, i.e. metastatic) can do the ketogenic diet. This very much depends on liver function, which can be tested. I look after a number of clients who have large tumours in their liver but who successfully manage to be in ketosis. As always- it depends on the individual!
As you see- the ketogenic diet is not for everybody and can lead to serious complications. That’s why it is important to do baseline blood tests and have professional support by somebody who understands the ins and outs of the ketogenic diet.