Guest Blog Post: Is It Safe To Go Low Carb During Pregnancy?
Today my friend and colleague, Lily Nichols, a fellow registered dietitian and certified diabetes educator, shares her insight on carbohydrate-restricted diets during pregnancy. This is a controversial topic that I believe deserves more attention and investigation, which Lily does brilliantly in the following article. Is It Safe to Go Low Carb During Pregnancy? With the wide adoption of low-carbohydrate diets, many people question if they are safe during pregnancy. While quite a few women use a lower carbohydrate diet to conceive (since they are especially useful for women struggling with infertility[1]), most medical professionals discourage women from continuing this diet during pregnancy. I find it ironic that if you tell your doctor that you plan to eat low carb during pregnancy, they’ll say it’s unsafe, but if you say you plan to eat a diet based on fresh vegetables, meat, fish, eggs, dairy, nuts, seeds, and a little fruit, they’ll encourage you to stay the course. The controversy over the safety of low carbohydrate diets in pregnancy stems primarily from misconceptions around ketosis. It’s incorrect, but widely accepted, that ketosis during pregnancy is harmful to a developing baby. When I first dove into the research, I was shocked to find that studies on healthy, non-diabetic pregnant women (eating a “regular” diet) show a marked elevation in ketones after a 12-18 hour fast, which is akin to eating dinner at 8pm and having breakfast at 8am (or skipping breakfast entirely).[2] What’s more interesting is that pregnancy actually seems to favor a state of ketosis. Compared to non-pregnant women, blood ketone concentrations are about 3-fold higher in healthy pregnant women after an overnight fast.[3] And in late pregnancy, metabolism shifts to a state o Continue reading >>
Hyperlipemia And Ketosis In The Pregnant Rat
Pregnant rats fasted on the 18th or 19th day of gestation developed hypoglycemia, severe ketosis, and hyperlipemia. The latter, which consisted primarily of triglycerides, was accompanied by increased plasma free fatty acids and accumulation of fat in the liver and kidneys. The effects of fasting were diminished by starting the fast earlier in pregnancy or by hysterectomy. Both ketosis and hyperlipemia were corrected by administration of insulin, tolbutamide, or glucose. The findings indicate that increased fat mobilization and ketosis in fasting pregnant rats are the result of insulin lack. It is suggested that the high priority of the fetuses for glucose reduced the maternal blood glucose concentration to a level too low to stimulate insulin secretion during fasting. Fasting did not alter the rapid growth of the fetuses. Pregnant rats fed ad libitum also developed hypertriglyceridemia if the diet contained fat. This hyperlipemia, unlike that in the fasted rats, was not due to increased fat mobilization and was unaffected by insulin administration. It is concluded that the fractional clearance of blood triglycerides is greatly reduced during late pregnancy. The comparative effect of anterior and posterior hypothalamic lesions on the development of sexual maturation of prepubertal female rats was investigated. Lesions by electrocoagulation were made in the medial hypothalamus of 45 rats at 25–26 days of age. Thirty-nine animals of the same age constituted the sham-operated and nonoperated controls. A hastened appearance of vaginal opening and first estrus, a significant increase in uterine weight, precocious ovarian luteinization, and premature sexual cycles were observed following both types of lesions. Sham-operated rats and animals with lesions in other parts of th Continue reading >>
The Paleo Guide To Ketosis
Ketosis is a word that gets tossed around a lot within the Paleo community – to some, it’s a magical weight-loss formula, to others, it’s a way of life, and to others it’s just asking for adrenal fatigue. But understanding what ketosis really is (not just what it does), and the physical causes and consequences of a fat-fueled metabolism can help you make an informed decision about the best diet for your particular lifestyle, ketogenic or not. Ketosis is essentially a metabolic state in which the body primarily relies on fat for energy. Biologically, the human body is a very adaptable machine that can run on a variety of different fuels, but on a carb-heavy Western diet, the primary source of energy is glucose. If glucose is available, the body will use it first, since it’s the quickest to metabolize. So on the standard American diet, your metabolism will be primarily geared towards burning carbohydrates (glucose) for fuel. In ketosis, it’s just the opposite: the body primarily relies on ketones, rather than glucose. To understand how this works, it’s important to understand that some organs in the body (especially the brain) require a base amount of glucose to keep functioning. If your brain doesn’t get any glucose, you’ll die. But this doesn’t necessarily mean that you need glucose in the diet – your body is perfectly capable of meeting its glucose needs during an extended fast, a period of famine, or a long stretch of very minimal carbohydrate intake. There are two different ways to make this happen. First, you could break down the protein in your muscles and use that as fuel for your brain and liver. This isn’t ideal from an evolutionary standpoint though – when you’re experiencing a period of food shortage, you need to be strong and fast, Continue reading >>
Effects Of A Ketogenic Diet During Pregnancy On Embryonic Growth In The Mouse
Go to: The increasing use of the ketogenic diet (KD), particularly by women of child-bearing age, raises a question about its suitability during gestation. To date, no studies have thoroughly investigated the direct implications of a gestational ketogenic diet on embryonic development. To fill this knowledge gap we imaged CD-1 mouse embryos whose mothers were fed either a Standard Diet (SD) or a KD 30 days prior to, as well as during gestation. Images were collected at embryonic days (E) 13.5 using Optical Projection Tomography (OPT) and at E17.5 using Magnetic Resonance Imaging (MRI). An anatomical comparison of the SD and KD embryos revealed that at E13.5 the average KD embryo was volumetrically larger, possessed a relatively larger heart but smaller brain, and had a smaller pharynx, cervical spinal cord, hypothalamus, midbrain, and pons, compared with the average SD embryo. At E17.5 the KD embryo was found to be volumetrically smaller with a relatively smaller heart and thymus, but with enlarged cervical spine, thalamus, midbrain and pons. A ketogenic diet during gestation results in alterations in embryonic organ growth. Such alterations may be associated with organ dysfunction and potentially behavioral changes in postnatal life. Keywords: Ketogenic diet, Low-carbohydrate diet, Embryonic development, CD-1 mouse, Mouse imaging, Optical projection tomography, Magnetic resonance imaging An illustration of the animal-to-animal variation within the SD group at E13.5. The coloured traces are outlines of all linearly-aligned individual SD images, and the white region is a mask of the final average image. Click on the image to see a larger version. Embryonic size difference at E17.5. (A) A consensus average of all E17.5 embryos constructed using the SD and KD MRI embryo im Continue reading >>
Ketosis During Pregnancy
So I did a urine dip stick test and my ketones were really high (the second highest) and I also had elevated protein and bilirubin. I'm only 7 weeks pregnant and I've been very nauseous but no vomiting. I really can't stomach eating very much at all and I've lost 10 lbs in the last 3 weeks! With my daughter, I also had morning sickness but lost about 12 lbs over 3 months. The only difference between this pregnancy and the last is that I'm paleo now, and I wasn't with my daughter. I'm wondering if anyone else has had this? Should I be eating the most sugary foods I can manage? I'm not sure what to do. I haven't gone to the doctor about it yet, but I'm planning on making an appointment if things don't get better in a couple of days. Continue reading >>
My Low Carb Twin Pregnancy Journey
I realize this is much different than my regular food based posts, but none the less one that has raised many an inbox question. I just reached the halfway mark of my pregnancy with what we now believe to be two baby girls. We are so thrilled! We are expecting fraternal twins which means they are not identical. Basically two babies sharing the same birthday, but unique in every other way. We can’t wait to meet them! It was really funny and ever so slightly ironic that I had to test oodles of recipes for my recipe book in my first few weeks of pregnancy. YES! Nausea and new recipes… fun! But as they say, all is well that ends well. 1. WHY DID I CHOOSE TO CONTINUE WITH A LOW CARB LIFESTYLE DURING MY PREGNANCY? My family has been on a fully integrated low carb lifestyle for just over 18 months now. It is our new normal. It is our lifestyle. We cannot imagine feeling tired, emotional and hungry all the time anymore, so for me it made perfect sense to keep doing what is obviously working for my body. BUT the fact that I am also making decisions for someone else’s body… it made me ponder if I’m doing the right thing for them? I found confirmation after confirmation once I stopped reading pregnancy sites and shifted my research to what babies need for healthy growth. I devoted an entire chapter in my book to this. Basically, I looked at my entire nutritional regime and could not think of a time in my life that I actually ate a better amount of nutrients and less junk. I figured… our girls do not need junk like preservatives, colorants, enhancers, modified starches, hormone filled GMO Soy or GMO wheat. Sugar is void of any nutrients and really is the weakest form of energy so… not needed! I was shocked to see that most recommended pregnancy diets actually promoted Continue reading >>
Pregnancy Ketosis
New producers of small ruminants often learn about pregnancy ketosis first time the hard way—with a dead dam, fetuses or both. This article explains the causes of pregnancy ketosis (a.k.a. toxemia) and more importantly—how to prevent it. Sheep and goat fetuses add 70% of their final birth weight in the last six to eight weeks of gestation. A singleton increases a dam’s nutritional requirements by 1.5 to 2 times maintenance in the last trimester. Multiple fetuses greatly increase energy demands on their mother: twins require 1.75 to 2.5 times maintenance requirements and triplets demand up to 3 times maintenance. Twins and triplets are common in some breeds of sheep and goats; quadruplets and even more are not uncommon in Boer goats, Finnsheep and Romanov sheep. Concurrent with a pregnant dam’s increasing nutritional needs, her physical capacity for feed intake is reduced by the rapid abdominal expansion of her pregnant uterus. Without managerial changes, the dam will be unable to ingest the calories needed to support herself and her fetuses, sending her into negative energy balance. Detecting a drop in blood glucose levels, her body’s regulatory systems will liberate energy from reserves stored as body fat. The release of stored energy will address her low blood glucose issues (remember the Krebs cycle?), but not without side effects: by-products of fat mobilization called ketone bodies can accumulate to toxic levels and suppress appetite. Without intervention and sometimes despite it, affected does or ewes may spiral downward in a fatal negative energy balance, taking their unborn fetuses with them. Besides multiple fetuses, health and management factors can predispose a pregnant ewe or doe to ketosis during pregnancy. For example, if there isn’t enough fee Continue reading >>
7 Lingering Myths Everyone Should Know About Low-carb Ketogenic Diets
The public’s interest in learning more about the low-carb, moderate protein, high-fat, ketogenic diet is gaining momentum and is stronger than ever as evidenced by it being the #5 most Googled diet search term in 2013. Because this nutritional approach has scientific evidence showing it to be a powerful modality against most of the chronic diseases of our time, the curiosity about it comes from a variety of perspectives. From strong evidence for conditions such as diabetes mellitus (Type 2 diabetes) to cardiovascular disease, good evidence for issues like Alzheimer’s Disease to narcolepsy, and emerging evidence for a wide variety of other issues of great research interest including cancer, fibromyalgia, traumatic brain injury and so much more, there are compelling reasons to at the very least give this way of eating a try for yourself just to see how you do in your pursuit of optimizing your health. With the overwhelming flood of support for the new book on this subject written by me and my coauthor Duke internist Dr. Eric Westman called Keto Clarity: Your Definitive Guide to the Benefits of a Low-Carb, High-Fat Diet (we are already in our fourth printing after just four weeks!), it seems many have already decided to do their own n=1 test of nutritional ketosis doing it in a methodical way making appropriate tweaks and changes along the way. But I’ve become increasingly concerned by the perpetuation of certain myths that continue to pervade the discussion about very low-carb, high-fat diets that is unfortunately turning some people away from even attempting to get into ketosis because of fear about what they have heard about it on the Internet. A number of these objections to very low-carb, high-fat ketogenic diets have been out there for many years without any sc Continue reading >>
Is Keto Safe For Pregnant Women?
Ketosis during pregnancy is a controversial topic. Health authorities and bloggers often praise low-carb diets for their ability to reverse infertility. But when it comes to low-carb during pregnancy, many of these same “experts” warn against the “dangers” of burning fat for fuel while pregnant. Most conventional medicine doctors would likely condemn this dietary choice as well. But is there any evidence to back up all of the fear mongering? The Evidence There are a few studies which on the surface seem to suggest possible complications with ketosis during pregnancy. Upon further investigation, however, they fall short of rational scrutiny. There aren’t many studies on pregnant women in ketosis. This likely due to the ethics and liability concerns involved with experimenting on vulnerable populations. It is important to note though that mountains of anecdotal evidence suggest that an intelligently formulated ketogenic is not only safe but may actually be beneficial to both mom and baby. Despite this, however, most mainstream doctors and media outlets have conflated ketosis with a dangerous condition called ketoacidosis and thus trumpet the dangers of keto during pregnancy. Ketosis vs. Ketoacidosis Much of the worry surrounding ketosis and pregnancy stems from a conflation of dietary ketosis with a dangerous metabolic state called ketoacidosis. Ketoacidosis happens to diabetics and involves extremely high levels of glucose and ketones in the blood. Ketoacidosis is very different from ketosis and should not be a concern for non-diabetic pregnant women. So is ketosis safe during pregnancy? The Keto Pregnancy Connection Far from being harmful, ketosis is actually a natural part of every pregnancy. In fact, pregnant women are able to enter ketosis 3 times more quic Continue reading >>
Ketosis: Why Women Need To Drink Their Way Through Labour
If you labour for a long time, you could be in danger of dehydration and developing complications such as ketosis. Here’s how to keep yourself safe and healthy during birth. There's so much going on during labour that the last thing that either you, or your birth partner, may think of is getting you to drink enough. Not that sort of drink obviously. There's no ordering a cheeky mojito with your epidural but you do need to keep your intake of water up when you're giving birth if you want to stay healthy, hydrated and keep any chance of developing a nasty case of ketosis at bay. What is ketosis? Ketosis is a complication of dehydration, and a lack of carbohydrates (or glucose) for energy in the body. It is the result of the abnormal accumulation of ketone bodies in the blood stream, body tissues and urine. When does ketosis occur? Ketosis happens when the muscles have little, or no, glucose for energy to be able to function efficiently. Once the glucose supply in the blood stream is depleted, the body starts to break down its fat stores for energy instead. This produces ketones, often causing a fever, body weakness and the muscles to function inefficiently, including the uterus. In cases where the ketosis is prolonged, the condition can develop into ketoacidosis. Ketoacidosis makes the person feel unwell and can damage their body organs. This is something that can occur for people who have uncontrolled diabetes. Ketosis and labour Ketosis is a common outcome for women who experience a prolonged labour (or pre-labour), becoming dehydrated and often causing their contractions to weaken, slow or stop. This can start to happen if glycogen (or glucose) is not being replenished through eating and drinking during labour. During labour, a woman has high-energy needs and her sto Continue reading >>
Wheat Belly For A Marathoner And Pregnant Mother
Chris shared her unique story of being ketotic while following a Wheat Belly wheat/grain-free lifestyle during endurance training/competition and pregnancy. “I did Wheat Belly/ketogenic diet for Boston [Marathon] last year and it was so effective in increasing endurance. There was never a reason to fuel, except for hydration. “Now 6 months pregnant with my 4th and this is the first time I’ve been wheat-free and on a ketogenic diet for pregnancy. The results so far are amazing: no crazy emotional mood swings, no out of control hunger, no crazy weight gain and the baby is growing beautifully. My midwife is basically dumbfounded. “I think the biggest change in this pregnancy over my last 3 is that my husband tells people he can’t believe how nice his wife is this time. I’ve struggled with anxiety my whole life, so having that under control with food is profound. Who knew after growing up a carb-loving vegetarian that I’d feel better removing grains/carbs, eating healthy fats and, of course, meat. “The result: rarely hungry, no crazy anxiety, weight is always stable, lots of energy and a little less money as nutritious dense food is more expensive.” I have previously discussed how endurance athletes are increasingly recognizing that the process of fat burning is a far better method of sustaining energy during endurance exercise than carb loading (not to mention that carb loading is intrinsically detrimental to health and accelerates conditions such as cataracts, deterioration of joint cartilage, and dementia). But I’ve not discussed the effects experienced during pregnancy. Chris’ experience is consistent with what my friend and fertility specialist, Dr. Michael Fox describes: fertility restored in many infertile women, dramatic reduction in morning si Continue reading >>
Pregnancy Toxemia (ketosis) In Ewes And Does – 1.630
by S. LeValley1 (8/2010) Quick Facts… Pregnancy toxemia in sheep and goats is also known as pregnancy disease, lambing sickness and twin-lamb/kid disease. The principal cause of pregnancy toxemia is low blood sugar (glucose). Onset of the disease is often triggered by one of several types of stress including nutritional or inclement weather. The disease is most prevalent in ewes and does carrying two or more lambs or kids. The disease also affects ewes and does that are extremely fat or excessively thin. The best preventive measure is increased feeding of high energy concentrates and grains during the last month of pregnancy. Occurrence and Causes Pregnancy toxemia in sheep and goats has also been called ketosis, lambing/kidding sickness, pregnancy disease and twin-lamb/kid disease. It occurs in all parts of the world and is an often fatal disease occurring only during the last month of pregnancy. Death occurs in two to 10 days in about 80 percent of the cases. It most often affects ewes/does pregnant with twins or triplets and is characterized by low blood sugar (glucose). Economic losses because of the disease have been considerable and it is the most commonly occurring metabolic disease of sheep and goats. It is generally accepted that the basic cause of pregnancy toxemia is a disturbance of carbohydrate or sugar metabolism. In earlier phases of the disease, blood glucose concentrations are less than 30 and may be as low as 10 mg/100 ml (normal 40-60). Blood ketone bodies, on the other hand, are usually greater than 15 and occasionally may be as high as 80 mg/100 ml (normal 1-4). The free fatty acid content of the blood plasma also is increased, meaning that body fat is being broken down and used for energy. Since glucose is essential for proper functioning of the Continue reading >>
What Is Ketosis?
"Ketosis" is a word you'll probably see when you're looking for information on diabetes or weight loss. Is it a good thing or a bad thing? That depends. Ketosis is a normal metabolic process, something your body does to keep working. When it doesn't have enough carbohydrates from food for your cells to burn for energy, it burns fat instead. As part of this process, it makes ketones. If you're healthy and eating a balanced diet, your body controls how much fat it burns, and you don't normally make or use ketones. But when you cut way back on your calories or carbs, your body will switch to ketosis for energy. It can also happen after exercising for a long time and during pregnancy. For people with uncontrolled diabetes, ketosis is a sign of not using enough insulin. Ketosis can become dangerous when ketones build up. High levels lead to dehydration and change the chemical balance of your blood. Ketosis is a popular weight loss strategy. Low-carb eating plans include the first part of the Atkins diet and the Paleo diet, which stress proteins for fueling your body. In addition to helping you burn fat, ketosis can make you feel less hungry. It also helps you maintain muscle. For healthy people who don't have diabetes and aren't pregnant, ketosis usually kicks in after 3 or 4 days of eating less than 50 grams of carbohydrates per day. That's about 3 slices of bread, a cup of low-fat fruit yogurt, or two small bananas. You can start ketosis by fasting, too. Doctors may put children who have epilepsy on a ketogenic diet, a special high-fat, very low-carb and protein plan, because it might help prevent seizures. Adults with epilepsy sometimes eat modified Atkins diets. Some research suggests that ketogenic diets might help lower your risk of heart disease. Other studies show sp Continue reading >>
Video: What You Need To Know About Keto And Pregnancy
Is eating ketogenic safe for a pregnant woman? Whether I would continue to eat high-fat, low-carb, ketogenic if I got pregnant tomorrow. There’s a lot of misinformation on the interwebs about whether a high-fat eating style is safe for pregnancy. Today, I’m sharing whether I would continue to eat high-fat, low-carb, ketogenic if I got pregnant tomorrow. I bust through some keto pregnancy myths, breakdown the ketogenic eating style that may respond best for pregnant ladies and share how to reduce water retention and all around puffiness throughout your pregnancy. A must-watch if you’re eating high-fat, or interested in eating high-fat, and plan to be pregnant at some point in your life. For video transcription, scroll down. Highlights… Why it’s widely accepted that ketosis is dangerous for pregnant women How many ketones a fetus needs to flourish 5 ways to slightly adjust a ketogenic eating style to work for your pregnancy Resources… Are you pregnant or planning to be? How will you approach your eating style while pregnant? Let’s chat about it in the comments… Hey, ladies. I’m assuming that the individuals watching this show today are going to be primarily women because today we’re talking about pregnancy and whether or not eating high fat is okay when you’re pregnant or eating more ketogenic. Congratulations if you are trying to get pregnant or you’re already pregnant. That is awesome. I am super happy for you. Maybe you are eating ketogenic or more fat fueled like what I outlined in my program or you’re eating more high fat and you’re wondering like, “Is this safe for the growing baby inside me?” First off, I can’t tell you what to do specifically but what I can do is share what I would do if I were in your position. Preparing for this Continue reading >>
Pregnancy Toxemia
Before kidding it is called Pregnancy Toxemia. After kidding it is called Ketosis. Pregnancy Toxemia/Ketosis is caused by a build up of excess ketones in the blood (urine & milk), due to the incomplete metabolic breakdown of body fat. It occurs in a doe (before or after kidding) because of an inability to consume enough feed to meet her needs. Ketosis can be caused by either too much, or too little grain, or the wrong type of grain and also poor quality hay/forage. Before kidding, internal body fat plus large fetuses prevent the goat from taking in enough calories to support both the doe and fetuses. Because there is an urgent need for calories, the doe's body starts breaking down her body's fat reserves. But this method of metabolism is incomplete, and thus leaves ketones behind. Pregnancy Toxemia usually occurs within the last six weeks of the doe's pregnancy and is usually attributable either to underfeeding (starvation toxemia) or overfeeding grain. We also believe that increased outside stress during the final weeks of pregnancy, in conjunction with large, multiple kids can contribute to the occurrence of Pregnancy Toxemia. After kidding Ketosis results from the doe producing higher milk yields than her body can keep up with. Usually she is not being fed enough to keep up with her milk production. Signs: The doe eats less or stops eating completely. Depression Seperation from the herd The doe may be slow to get up or may lie off in a corner. Her eyes are dull. Somestimes blindness Muscle tremors & seizures Staggering Head pressing She may have swollen ankles She may grind her teeth. The doe may breathe more rapidly. The doe's breath and urine may have a fruity sweet odor. This is due to the excess ketones, which have a sweet smell. Prevention: Prevent excess body f Continue reading >>
