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Are Breastfed Infants In Ketosis?

Ketogenic Diet Guidelines For Infants

Ketogenic Diet Guidelines For Infants

History of the Ketogenic Diet in Infants For many decades, the idea of using the ketogenic diet for infants with epilepsy was discouraged. Concerns were raised in chapters and books about the diet that infants were highly likely to become hypoglycemic, have complications, and unlikely to achieve ketosis. Although infants often have seizures, and at times very difficult-to-control seizures, until the 1990s, we also did not have pre-made, commercially-available ketogenic diet infant formulas. Even though most anticonvulsant drugs are not FDA-approved for use in infants, this was the main treatment option for most child neurologists. What’s New Things have changed drastically in the last few years. Published research has shown that not only can infants become ketotic, but they respond very well to dietary therapy. In fact, infantile spasms is one of the established "indications" for ketogenic diet treatment. An article from last year by Dr. Anastasia Dressler from Vienna even stated, "The ketogenic diet is highly effective and well tolerated in infants with epilepsy. Seizure freedom is more often achieved and maintained in infants." Adding to this rising tide of acceptance, the European Journal of Paediatric Neurology published guidelines for the use of ketogenic diets in infancy (defined as less than 2 years of age) this month. This was a group effort from 15 neurologists and dietitians with particular expertise in using ketogenic diet in infancy, convened at a conference in London in April 2015. What does this guideline say? Much of it is information about infants that already has been established and is similar to older children. The authors comment that the ketogenic diet can be helpful for infantile spasms, epilepsy with migrating seizures, and GLUT-1 deficiency (al Continue reading >>

Babies In Ketosis

Babies In Ketosis

This post topic was inspired by the following article: Ketosis - key to human babies’ big brains? It is hosted on Tim Noakes' website and written by one of his associates in nutritional information misdirection, Tamzyn Murphy Campbell, RD. I'm going to address this misdirection and the disturbing parts of this article vis a vis Campbell in a future BabyGate Files, but for now I want to discuss the role of ketones in metabolism. In doing so, I'd also like to explain my somewhat cryptic recent post on heating my kitchen. (I've C&P'd that entire post to the end further down in this one, so if you don't wish to go to another page, you can just scroll down to The Kitchen Heating Analogy). I'm going to structure this post a little differently than most and get to my point, then provide the back up information. Let's see how this goes. The major source (6 of 12 numbered citations, 1 of 6 unique sources) for her article is: Survival of the fattest: fat babies were the key to evolution of the large human brain (2003) Stephen C. Cunnane, Michael A. Crawford (I'll call this C&C) In this paper, they make the following points: Human babies have higher body fat than other mammals and this may be as a source of ketones in early infancy. Infants have slightly elevated ketones (mild ketonemia) regardless of feeding status which differs from adults who only have elevated ketones when food is restricted (no details here). Glucose is the primary fuel for the human brain Ketones are an alternate source of fuel when glucose is less available Ketones "appear to be" an essential fuel for the midterm fetus, and may provide as much as 30% of the developing brain's needs Ketones are both an energy source and carbon source for fat and cholesterol synthesis in the brain. Campbell relates these so Continue reading >>

Lactation

Lactation

(redirected from lactation ketosis) Also found in: Dictionary, Thesaurus, Encyclopedia. Lactation Definition Lactation is the medical term for yielding of milk by the mammary glands which leads to breastfeeding. Human milk contains the ideal amount of nutrients for the infant, and provides important protection from diseases through the mother's natural defenses. Description Early in a woman's pregnancy her milk-producing glands begin to prepare for her baby's arrival, and by the sixth month of pregnancy the breasts are ready to produce milk. Immediately after the baby is born, the placenta is delivered. This causes a hormone in the woman's body (prolactin) to activate the milk-producing glands. By the third to fifth day, the woman's breasts fill with milk. Then, as the baby continues to suck each day, nursing triggers the continuing production of milk. The baby's sucking stimulates nerve endings in the nipple, which signal the mother's pituitary gland to release oxytocin, a hormone that causes the mammary glands to release milk to the nursing baby. This is called the "let-down reflex." While the baby's sucking is the primary stimulus for this reflex, a baby's cry, thoughts of the baby, or the sound of running water also may trigger the response. Frequent nursing will lead to increased milk production. Breast milk cannot be duplicated by commercial baby food formulas, although both contain protein, fat, and carbohydrates. In particular, breast milk changes to meet the specific needs of a baby. The composition of breast milk changes as the baby grows to meet the baby's changing needs. Most important, breast milk contains substances called antibodies from the mother that can protect the child against illness and allergies. Antibodies are part of the body's natural defense Continue reading >>

Case Study: Low Carb Diets And Breastfeeding Mothers

Case Study: Low Carb Diets And Breastfeeding Mothers

I recently had an interesting experience helping a mother with a breastfeeding situation. I received her permission to share her story here as a case study to help other mothers/breastfeeding counselors. Helping situation: The mother contacted me because her baby was experiencing poor weight gain. Baby was three months old and after having gained steadily during the first two months had not gained weight in a month and was still at nine and half pounds. In addition to talking about signs of dehydration, we explored a ton of possibilities during the hour-long call, including the fact that baby started daycare and then weight gain stopped. Towards the end of the call, I asked a couple of questions about the mother’s diet, mentioning that sometimes certain proteins in foods can cause sensitivities in the baby. Mother paused and then said, “so protein might possibly be related to this?” She then shared that she has been on a high protein/low-carb diet that she started last month. My brain tickled with a memory and sure enough in the conference notes from Diana West’s presentation at the 2011 LLL of Missouri conference, I found the note that, “Low carb diets have been observed to significantly decrease milk production.” I suggested mama go back to eating the way she used to do. Follow-up results: At the beginning of this month, the mother emailed me to let me know that she’d discontinued the low-carb diet and baby gained a pound in a week. A second follow-up email reported another pound of weight gain and a third email showed pictures of a happy, chubby breastfeeding baby. I was fascinated at the potent results from this seemingly small/possibly unrelated change. LLLI has additional information about low-carb diets and breastfeeding women here, but it does not Continue reading >>

Is Keto Safe For Kids?

Is Keto Safe For Kids?

In short, yes. Thanks. Have a nice day. I have to be honest with you, I’m not sure why all the fuss about making sure kids are shielded from a ketogenic diet. If it’s healthy, why wouldn’t it be healthy for kids? Some points to consider: New born babies who are breastfed are ketogenic. They are getting the majority of their calories from the fat in their mother’s milk. And I don’t know a single person is actively advocates AGAINST breastfeeding. Historical documentation, provided by Anthropologists and Sociologists, have shown that cultures like the Masai and the Inuit, both of which were, essentially, ketogenic, had healthy, robust babies. And those babies grew up to be healthy, strong, tall, children and adults. It wasn’t until the refined, processed, sugar and flour heavy foods of the Western diet infiltrated their culture that their children started developing widespread health problems. So it is, somewhat, baffling to me when people warn or caution against kids eating keto. Keto is about whole foods, lots of good fats (which is essential for brain development), good protein (which is essential for growing bodies), and limited non-starchy vegetables. I don’t see what about that would be problematic for kids. It’s not like the physiology of children is so terribly different than that of adults. However, the most common refrain opposing keto for kids has to do with a study that was concluded in 2008. The study, apparently, showed that keto resulted in bone loss in children. Here’s the study. (And here’s a longer version). But what does the study actually show? First, it was a two part selection process. The first part was to find kids with epilepsy, who had not responded well to medication. The second part was to see how they responded to keto. If Continue reading >>

Babies Thrive Under A Ketogenic Metabolism

Babies Thrive Under A Ketogenic Metabolism

Some people, even some scientists who study ketogenic metabolism, have the idea that ketogenesis is somehow abnormal, or exceptional; an adaptation for emergencies only. We disagree. One reason we think a ketogenic metabolism is normal and desirable, is that human newborns are in ketosis. Despite the moderate sugar content of human breast milk, breastfeeding is particularly ketogenic. This period of development is crucial, and there is extensive brain growth during it. Although the composition of breast milk can be affected by diet [1], it is reasonable to assume that breast milk has always been ketogenic, and this is not an effect of modernisation. When the brain is in its period of highest growth, and when the source of food is likely to be close to what it evolved to be for that period, ketones are used to fuel that growth. If nothing else, this suggests that learning is well supported by a ketogenic metabolism. It is also consistent with the ability of ketogenic diets to treat a variety of seemingly unrelated brain disorders and brain trauma. Newborn infants are in ketosis. This is their normal state. Breastfeeding is particularly ketogenic (compared to formula feeding). Breastfeeding longer (up to a point) is associated with better health outcomes. This suggests the hypothesis that weaning onto a ketogenic diet would be healthier than weaning onto a high-carb diet. (Mark-up ours) Human babies are in ketosis Soon after birth, human babies are in ketosis, and remain so while breastfeeding [2]. They use ketones and fats for energy and for brain growth. When this has been studied, in the first couple of hours after birth, babies aren't immediately in ketosis. There is a short delay [3]. During that brief period before ketogenesis starts, lactate (confusingly not to do Continue reading >>

Low Carb Diets And Breastfeeding

Low Carb Diets And Breastfeeding

High protein, low carbohydrate diets like the Atkins diet and the South Beach diet are very popular. These diets can be helpful for diabetics and people with gluten intolerance. In these diets, protein and high fat foods are not restricted; vegetables are limited. The main difference between Atkins and South Beach seems to be that the South Beach diet is less structured and emphasizes eating healthier, mostly unsaturated fats. The primary objections I’ve seen to these and similar diets — and this applies to everyone, not just nursing mothers — is simply the fact that they are not balanced and thus have the potential to make you feel unwell. These diets tend to be low in phytochemicals, antioxidants and folic acid. They also tend to be low in fiber and minerals (including calcium, magnesium, phosphorus & potassium), and the Atkins diet may be high in saturated fats. Because of this, long-term adherence to these diets may increase your risk for various health problems. Since some of the weight loss from these diets is simply due to water loss, dehydration is a risk if the dieter is not careful to drink plenty of water. Some moms have found that very low carb diets decrease milk supply. Going off the diet generally brings milk volume right back up again. This decrease in milk supply may be due to several factors: Dehydration. The sudden decrease in calories when mom goes on the diet. If a woman is used to a certain level of calories, an abrupt drop due to dieting (or illness) may reduce her milk supply. This sudden decrease in calories can tell mom’s body that she is in “starvation mode” and to conserve on all fronts (thus less of her body’s resources go into making milk). Insufficient caloric intake. With a low carb diet, many people are not nearly as hungry Continue reading >>

Stop Being Confused About Health

Stop Being Confused About Health

I’ve heard several times now about this idea that babies are in ketosis, and in other words are “keto-adapted.” This idea is then used to support the ketogenic diet in human adults. Let’s break this idea down here and examine its veracity. It’s important to define our terms. I’ve heard the saying “babies are in ketosis” rather than “infants are in ketosis” or “infants less than 6 months old are in ketosis.” What age group are we talking about? Infants are rapidly growing little people. Thus it become problematic already to assume that just because we have been in ketosis for a period of time during our breastfeeding careers we may be able to continue it as our bodies grow in every way and direction. So we’re really talking about infants, and more specifically, the typical age that breastfeeding occurs. Since this is pretty variable I can’t specify an exact age, but I’m guessing 12 months or less. It would also be interesting to discuss how the energy needs of infants may change as they develop physically. I would expect that as they learn to crawl, walk, and run, their bodies might start to prefer glucose. Adults who go on ketogenic diets typically go through an adaptation phase for the first two weeks of the diet. This adaptation period usually brings some discomfort, GI symptoms like constipation, and fatigue (which is often corrected with additional electrolytes). After this period, many people feel better and it is believed they have “adapted” to ketosis. Infants however are in a state of mild-ketosis. Their brains use ketones more so than the adult brain. From this paper (which has a very strong point of view and suggests that brains “prefer” ketones, which is up for debate): “Postnatally, the brain’s dependence on ketones Continue reading >>

Initiating And Maintaining The Ketogenic Diet In Breastfed Infants

Initiating And Maintaining The Ketogenic Diet In Breastfed Infants

Abstract The ketogenic diet has been used as an effective treatment for intractable epilepsy since 1921. Its efficacy in the treatment of epilepsy in infants has been reported to be similar to that in older children. However, there have been no reports in the literature addressing the possibility of continuing breastfeeding during treatment with the ketogenic diet. The authors performed a retrospective chart review of the patients initiated on the ketogenic diet and identified 5 infants who continued to receive breast milk while on the ketogenic diet treatment. All 5 experienced a >90% reduction of seizures during the first month on the ketogenic diet treatment with continued breastfeeding. Four of the 5 were able to maintain >90% reduction of seizures for the duration of their time receiving breast milk while on the ketogenic diet treatment. Traditionally, infants have discontinued breastfeeding prior to diet initiation because of the concern that the carbohydrates in the breast milk will prevent attaining adequate levels of ketosis. It is the authors’ experience with these 5 patients that infants can continue to breastfeed while successfully using the ketogenic diet for seizure treatment. Continue reading >>

Breastfeeding & No Carb Diets

Breastfeeding & No Carb Diets

Video of the Day Cutting carbs or calories suddenly can cause your milk supply to dwindle, leaving you struggling to make enough breast milk for your baby's needs. Some moderately low-carb diets have multiple phases, so you might be able to skip the ultra-restrictive early phases and try a diet that gives you some healthy carbs and enough calories to maintain milk production. Aim for slow weight loss of 1 to 2 pounds a week and avoid dieting at all until around eight weeks after your baby's birth. At this point, your milk supply is fully established, so dieting won't derail that process. When you embark on a drastic diet, your body's fat stores may release stored toxins that could get into your breast milk. If your diet restricts carbs, you could also be missing out on vital nutrients that your body needs to support your own and your baby's health. Women on an extremely carb-restricted diet often begin to produce types of chemicals called ketones, and it is unknown whether ketones can get into breast milk or whether they are a danger to a nursing baby. Continue reading >>

Is Keto Dangerous While Pregnant, Breastfeeding, Or For Children?

Is Keto Dangerous While Pregnant, Breastfeeding, Or For Children?

A question I’ve come across seemingly increasingly in the past few months, is a variation of, is it safe for kids to eat keto, including women during pregnancy and breastfeeding? This is where a simple disambiguation between a well and poorly formulated diet should end the discussion but let’s dig a little bit deeper into the concerns themselves, studies on children, the validity thereof, what a good diet is and context. One of the applications of a well formulated ketogenic diet has been in treatment of PCOS with much success, though more research is needed. You can search for yourself to find more info on this and the specifics with lots of other blogs and anecdotes covering it out there, but between weight loss and improved hormone regulation from better food choices it’s a way to manage symptoms and issues associated with the disorder. Many women who see improvements have noted they end up with a surprise pregnancy after starting low carb. Though usually planned or at least semi-planned, you can find near endless anecdotes of despite several years of trying, a sudden ketobaby happened after a few weeks or months of low carb. Just search through //www.reddit.com/r/xxketo and /r/ketobabies for personal accounts thereof. If you’ve done prior research into keto, you should already know that improvements in endocrine function are one of the benefits with plenty of evidence to support it. So if you’ve found yourself with a surprise baby thanks to keto the next question is, can you, should you, or is it dangerous to continue while pregnant? Ketosis and Pregnancy: Thanks to Japan and low carb as a treatment for diabetes we do have some research done regarding the application of a low carb diet in pregnant mothers on ketone levels and their role. Aside from this, c Continue reading >>

Atkins For Breastfeeding Mothers

Atkins For Breastfeeding Mothers

For new mothers, losing weight is probably the furthest thing from their minds and in my opinion, this is exactly as it should be. I think that in our culture mothers are sometimes expected to bounce back to ‘normal’ as though nothing has changed! In reality, everything has changed and you have a lot more important things to think about in those first few weeks or months. As well as getting to know your baby, establishing breastfeeding, adjusting your sleeping patterns and often your expectations you need to try to give yourself time to rest and recover. However, at some point when you feel ready to begin losing the baby weight and you have consulted with your doctor, the Atkins Nutritional Approach is an excellent choice. This is true no matter how you feed your baby but when breastfeeding there are some extra considerations so I’ll focus on these for this article. Won’t breastfeeding make me lose the baby weight? While breastfeeding certainly helps with losing the baby weight more quickly, it’s not a magic fix. Just as you cannot ‘out-train a bad diet’ you can’t ‘out-breastfeed a bad diet’ either! There are many many regular gym goers and marathon runners that are overweight proving that exercise alone will not make you lose weight. In the same way, it stands to reason that if your diet is not good, the extra calories needed for breastfeeding will not make you lose the baby weight either. Should I wait until the baby is weaned? Sometimes you may see the advice to wait until the baby is weaned before starting a diet. However the World Health Organisation say: “Exclusive breastfeeding is recommended up to 6 months of age, with continued breastfeeding along with appropriate complementary foods up to two years of age or beyond.” Obviously, the deci Continue reading >>

Initiating And Maintaining The Ketogenic Diet In Breastfed Infants

Initiating And Maintaining The Ketogenic Diet In Breastfed Infants

The ketogenic diet has been used as an effective treatment for intractable epilepsy since 1921. Its efficacy in the treatment of epilepsy in infants has been reported to be similar to that in older children. However, there have been no reports in the literature addressing the possibility of continuing breastfeeding during treatment with the ketogenic diet. The authors performed a retrospective chart review of the patients initiated on the ketogenic diet and identified 5 infants who continued to receive breast milk while on the ketogenic diet treatment. All 5 experienced a >90% reduction of seizures during the first month on the ketogenic diet treatment with continued breastfeeding. Four of the 5 were able to maintain >90% reduction of seizures for the duration of their time receiving breast milk while on the ketogenic diet treatment. Traditionally, infants have discontinued breastfeeding prior to diet initiation because of the concern that the carbohydrates in the breast milk will prevent attaining adequate levels of ketosis. It is the authors’ experience with these 5 patients that infants can continue to breastfeed while successfully using the ketogenic diet for seizure treatment. Nordli DR, Kuroda MM, Carroll J., et al. Experience with the ketogenic diet in infants. Pediatrics. 2001;108:129-133. Google Scholar, Medline Kossoff EH, Pyzik PL, McGrogan JR, Vinig EPG, Freeman JM Efficacy of the ketogenic diet for infantile spasms. Pediatrics . 2002;109:780-783. Google Scholar, Medline Jambaqúe I., Chiron C., Dumas C., Mumford J., Dulac O. Mental and behavioural outcome of infantile epilepsy treated by vigabatrin in tuberous sclerosis patients. Epilepsy Res. 2000;38:151-160. Google Scholar, Medline Freeman JM, Kossoff EH, Freeman JB, et al. The Ketogenic Diet: A Treatme Continue reading >>

Low Carbohydrate Diets And Breastfeeding

Low Carbohydrate Diets And Breastfeeding

Article written by Dr Susan Tawia, Manager, Breastfeeding Information and Research team, for the January 2017 health professional member eNewsletter. Low carbohydrate (carb), high fat diets continue to be popular and women of reproductive age are following them. They will often change their diet to a more ‘conventional’ one during pregnancy, but are often keen to return to a weight-loss diet, that they have had success with, after the pregnancy. So, what do we know about the effect of low carb, high fat diets on breastmilk composition and on the metabolism of the breastfeeding woman? The lack of research on this type of diet, and the possible effect on breastmilk composition, breastfeeding women and their infants, was highlighted by both breastfeeding experts and dietitians in 2004 (Heinig & Doberne, 2004; Wood & Hilldebrandt, 2004) at the height of the popularity of the low carb, weight loss diet advocated by Dr RC Atkins — the Atkins diet. Research on low carb, high fat diets has been undertaken, but surprisingly, only one study has been done. Mohammad, Sunehag, & Haymond (2009) looked at maternal breastmilk production, infant intake and maternal glucose metabolism and broadly looked at the macronutrients in breastmilk. Two moderate hypocaloric diets (1785 ± 22 kcal/day) were assessed in a cross-over design: seven, healthy lactating mothers and their infants were studied on 2 occasions in random order for 8 days separated by 1 to 2 weeks. On one occasion, the subjects received the low carb, high fat (LCHF, 30% of energy as carbohydrate and 55% as fat) and on the other occasion received the high carb, low fat diet (HCLF, 60% of energy as carbohydrate and 25% as fat). It is important to note that the amount of carbohydrates consumed during the LCHF was around 150 Continue reading >>

Ketosis – Key To Human Babies’ Big Brains?

Ketosis – Key To Human Babies’ Big Brains?

Prof Noakes is on trial for ‘advising’ a mom to wean her baby onto low carb, high fat foods. Could babies’ innate ketosis – a state more often associated with low-carb, high-fat diets – be an arrow in Prof Noakes’ defence’s quiver? By Tamzyn Murphy Campbell BSc, BSc Med(Hons) Human Nutrition and Dietetics, RD Did you know that human newborns and exclusively breastfed babies are in ketosis? 1 I am a dietitian, with two years of intensive postgraduate training in nutrition, and I didn’t realise this until just over a month ago. The fact that human babies are naturally in ketosis is an inconvenient truth because it implies that ketosis (which also occurs when fasting or eating a low-carbohydrate, high-fat diet) is not only a natural metabolic state for human infants, but that it’s probably beneficial too. Nature seldom does something without a reason, so it’s likely that ketosis may confer some kind of evolutionary advantage to human infants. Research suggests that it may be one of the main factors behind the development of the large human brain. 2 “Nature seldom does something without a reason, so it’s likely that ketosis may confer some kind of evolutionary advantage to human infants. Research suggests that it may be one of the main factors behind the development of the large human brain. ” A word on ketones and ketosis Ketosis is a metabolic state where your body uses fat as fuel in preference to carbohydrates – as occurs when fasting or eating a low-carbohydrate, high-fat diet. The body makes ketones from fat, when dietary glucose (from carbohydrates and sugar) is low. Ketones can be used as fuel to produce the energy your body and brain needs to function. The human brain only has two options for fuel: glucose or ketones. The other body orga Continue reading >>

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