In many cases, therapeutic carbohydrate reduction, including keto, can be followed safely without intensive medical supervision. However, if you have diabetes, high blood pressure, kidney disease, epilepsy, or another chronic health condition, your healthcare provider may need to monitor your progress or adjust medications as your health improves.
Even if you don’t have a medical condition, sharing your dietary approach can give your doctor a more complete picture of your lifestyle and can help them interpret changes in laboratory results or other health markers.
Prepare for the Conversation
Before your appointment, spend a few minutes thinking about why you’re following a ketogenic diet and what you hope to accomplish.
For example, your goals might include:
- Losing body fat
- Improving blood glucose control
- Lowering triglycerides
- Overcoming brain fog
- Feeling more energetic
It’s also helpful to bring information that can help guide the discussion, such as:
- Recent blood glucose or ketone readings
- Blood pressure measurements
- Recent weight or waist circumference changes
- A list of any supplements and over-the-counter medications you take
Sharing this information can help your doctor better understand how you’re responding to your ketogenic diet and make the conversation more productive.
If You Have Diabetes
This is one of the most important situations in which your healthcare provider should be involved.
If you have type 2 diabetes, you may experience significant improvements in blood glucose levels after reducing carbohydrate intake. As a result, insulin and certain other medications may need to be reduced or discontinued when starting a ketogenic diet to help prevent hypoglycemia (low blood sugar).
If you take an SGLT2 inhibitor (eg, Jardiance, Farxiga, or Invokana), talk with your healthcare provider about whether it should be discontinued before starting a ketogenic diet. This type of medication increases the risk of euglycemic diabetic ketoacidosis (EDKA), a rare but potentially serious complication, and following keto may further increase your risk.
If you have type 1 diabetes, it’s important to work with an experienced healthcare team when following a ketogenic or very-low-carbohydrate diet.
If You Have High Blood Pressure
Ketogenic and low-carb diets lower insulin levels and promote weight loss, which often lead to improvements in blood pressure. While this is a positive change, you may need an adjustment to your blood pressure medication when eating keto or low-carb. This can help prevent your blood pressure from dropping too low.
Monitoring your blood pressure at home and sharing those readings with your healthcare provider can help determine whether medication changes are needed.
Other Conditions That May Require Medical Guidance
Diabetes and high blood pressure aren’t the only conditions that can benefit from medical supervision while following a ketogenic diet. Depending on your health history, it’s important to work with your healthcare provider if you have:
- Polyendocrine Metabolic Ovarian Syndrome (PMOS), formerly known as Polycystic Ovary Syndrome (PCOS)
- Kidney disease
- Mental health disorders
- Neurological disorders
- Cancer
What If Your Doctor Isn’t Supportive?
Many healthcare professionals have limited training or clinical experience with therapeutic carbohydrate reduction (TCR), including ketogenic diets. Some may have concerns based on older nutrition guidelines or limited experience using these approaches in clinical practice.
If your doctor has questions or concerns, try to keep the conversation focused on your health goals and measurable outcomes rather than debating nutrition philosophy.
You might say something like: “I’ve been following a ketogenic diet for several months and would appreciate your help monitoring my health as we see how my body responds,” or “I’d like to work together to make sure I’m doing this safely and adjust my medications if needed.”
This kind of collaborative approach often leads to a more productive conversation.
It’s OK to Seek Additional Support
If you feel your concerns aren’t being heard or your healthcare provider isn’t willing to work with you, you may want to work with another healthcare professional who is knowledgeable about keto and supportive of your goals. Fortunately, many physicians, nurse practitioners, dietitians, and other healthcare professionals have experience using low-carbohydrate and ketogenic diets as part of medical care.
Here are a few directories to help you find a healthcare professional who can provide guidance and support:
- Society of Metabolic Health Practitioners (SMHP): Find a Practitioner
- Ketogenic Diets for Mental Health Clinician Directory
- Ketogenic: Find a Doctor
- The Charlie Foundation: Private Keto Specialists (registered dietitians with expertise in therapeutic ketogenic diets)
Finding a clinician who understands and supports ketogenic nutrition doesn’t necessarily mean replacing your current provider. In many cases, it simply means adding another member to your healthcare team.
The Bottom Line
Your doctor doesn’t have to be an expert in ketogenic diets to be an important partner in your care.
For the most productive conversations, the two of you should focus on your health goals, objective results, and ongoing monitoring rather than trying to “win” a debate about nutrition.
When you and your healthcare team work together, you’re more likely to develop a plan that supports your ketogenic lifestyle and long-term health.
