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Warning against Ketogenic diets during pregnancy

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  • #46
    Originally posted by Forgotmylastusername View Post
    There's no hard evidence whole cultures have been in ketosis for generations and spent their pregnancies in ketosis. Just a lot of guesswork and theorizing. Even the Inuit are said to have adaptations that make them more efficient at gluconeogenesis, thus keeping them out of ketosis a lot of the time. Add to that their diet sometimes consisted of berries, roots and glycogen in fresh meat. And the reasons there is no big studies is because no logical mother is going to enroll in a diet study experiment that could have lifelong consequences on their unborn child. Every low-carb book I have read has strongly warned against ketosis in pregnancy. Strangely enough, the only one that I can think of that doesn't mention pregnancy is "The art and science of low-carbohydrate living" by Volek and Phinney, which I think is kind of telling. I'll guess because if they mentioned it at all they would have probably have to put in a disclaimer, which would kind of be counter productive considering the whole book is basically all about how natural and great ketosis is.


    Furthermore, even Michael Eades who is possibly one of the biggest proponents of ketogenic diets you will find online is against the idea.

    Eades:
    "The medical literature (at least with animal studies; no one could ethically do such studies with humans) is pretty clear that ketogenic diets are NOT good for the developing fetus.

    I’m not an expert on this issue as it applies to developing fetuses, so I check with my friend Larry McCleary who is a pediatric neurosurgeon, low-carb advocate, and well read in the nutritional fetal development literature. He says that in the fetal brain most of the lipid synthesis is from glucose and to a smaller degree, lactate. Beta hydroxybutyrate (a ketone) is not a major contributor. In addition, the enzymes in the pathway from BHB to acetyl CoA in the fetal brain are poorly developed. Post natally they activate. Hence, BHB is not a major provider for ATP generation in the fetal brain.

    For these reasons he feels that a ketogenic diet might not be the best diet during pregnancy. But having said that, I (and he) don’t think a high-carb diet is the diet of choice either. A moderate carbohydrate diet with plenty of colorful fruits and vegetables along with healthy servings of meat would be ideal in my opinion."

    Anyone that takes the risk is truly insane. People need to be a bit more responsible about some of the ideas they promote online. Just because conventional wisdom is wrong some of the time it doesn't mean you should automatically reject all of it.
    Pregnant women should eat whatever they want, when they want it, depending on availability & finances. Ice cream & salted whatever. Let the body's wisdom &/or whacked out hormones rule the day... I've been there & done that, having to live with in close quarters, while working f/t & trying to feed, clothe & please a pregnant pizza eating, veggie hating gf, the mother of my child...

    "Hell hath no fury like a pregnant woman scorned!"
    "Science is not belief but the will to find out." ~ Anonymous
    "Culture of the mind must be subservient to the heart." ~ Gandhi
    "The flogging will continue until morale improves." ~ Unknown

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    • #47
      Originally posted by Betorq View Post
      Pregnant women should eat whatever they want, when they want it, depending on availability & finances. Ice cream & salted whatever. Let the body's wisdom &/or whacked out hormones rule the day... I've been there & done that, having to live with in close quarters, while working f/t & trying to feed, clothe & please a pregnant pizza eating, veggie hating gf, the mother of my child...

      "Hell hath no fury like a pregnant woman scorned!"
      This. This times 1,000,000.

      I mean really... If a woman is listening to her body and decides that she still feels best on a ketogenic diet, then let her do it. Remember, if the woman feels great, it's one way to judge a healthy developing fetus. On the other hand, if she feels lousy, that can have an adverse effect on the fetus.

      Let the woman make her own dietary decisions. I think womanly intuition and instinct will naturally drive a woman towards the foods that are best for her AND her developing fetus. It's in their genetic and hormonal codes after all.
      "The cling and a clang is the metal in my head when I walk. I hear a sort of, this tinging noise - cling clang. The cling clang. So many things happen while walking. The metal in my head clangs and clings as I walk - freaks my balance out. So the natural thought is just clogged up. Totally clogged up. So we need to unplug these dams, and make the the natural flow... It sort of freaks me out. We need to unplug the dams. You cannot stop the natural flow of thought with a cling and a clang..."

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      • #48
        Originally posted by Forgotmylastusername View Post
        Anyone that takes the risk is truly insane. People need to be a bit more responsible about some of the ideas they promote online. Just because conventional wisdom is wrong some of the time it doesn't mean you should automatically reject all of it.
        I did not see any evidence in what you posted, only opinion based on opinion.
        Do you have any data to support the hypothesis that inuit have a special glucogenesis adaptation?
        I have looked around and couldn't find anything on that, I'm pretty sure it is well established that their traditional diet was ultra low carb, you were cherry picking that opinion, you quoted Phinney/Volek not saying anything about pregnancy and Ketosis, you should also have quoted them as being 100% definitive on the Inuit diet being ketogenic as well.

        I'm not advocating it, but if there is any actual evidence I'd like to see it.

        I think it's a little bit rich suggesting anyone that comes to a different conclusion than you must be Insane.
        "There are no short cuts to enlightenment, the journey is the destination, you have to walk this path alone"

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        • #49
          I have an anecdotal experience to add. I had a gastric bypass 2 years before becoming pregnant with my daughter. Due to that surgery, I ate a relatively low-carb, high protein, moderate fat diet simply because my short gut made sugar/carbs hit my bloodstream too quickly (resulting in dumping syndrome and later reactive hypoglycemia). I didn't eat a lot of grains/carbs, and only in small portions with plenty of protein and veg.

          When I became pregnant, a weird thing happened. All of a sudden I could tolerate carbs again, almost as if I had never had the surgery. I didn't go overboard on them, but having had them taken out of my diet for over 2 years, I ate more than I probably should have. When I asked one of my OB/GYN's about it, she said something about the placenta aiding in glucose tolerance? I passed the glucose test with normal numbers. I also ate butter, cream in coffee, etc. because I had been diagnosed a year before with blind loop syndrome (a SIBO), which damages the intestines and causes fat malabsorption, so I didn't want to limit my fat intake. I lost weight in the first trimester due to severe nausea, and then gained only baby weight during the rest of the pregnancy. My daughter was born on-time, healthy, and now at 4 years old she's normal weight (if not a little on the skinny side, she worried us during the terrible twos) and healthy--in fact, she's never needed antibiotics, and has never had a sick visit to the doctor.

          What I wonder is why did my body suddenly start tolerating carbs/sugar during pregnancy? I never did find any solid info on the placenta bit that my doctor told me, so this has always boggled me to a degree.

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          • #50
            Cos we humans have amazingly bloody adaptive bodies. YOU are amazing! And it's a mystery we may or may not ever figger out, lol
            "Science is not belief but the will to find out." ~ Anonymous
            "Culture of the mind must be subservient to the heart." ~ Gandhi
            "The flogging will continue until morale improves." ~ Unknown

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            • #51
              It was a grand statement by the OP with no scientific backing. That's all I was pointing out. I mean you can ignore that 20% of hunter gatherer societies out of 229 known that got more than 85% of their calories from the hunt if you wish AND that small animals and bugs counted as gathered. I think it takes a helluva leap in logic to think that none of them existed in ketosis even during pregnancy, but hey that's just me. In today's environment I don't see why a woman would "have" to be in ketosis during pregnancy, but also see no harm as long as nutritional needs and calories are met. In a scientific sort of inquisition its quite dubious to label it "insane" or "dangerous" just because it doesn't mesh with your particular values.
              Last edited by Neckhammer; 09-28-2012, 02:17 PM.

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              • #52
                "Cos we humans have amazingly bloody adaptive bodies."

                I would like to add something to the poster's note about being suddenly able to handle carbs during pregnancy. My experience isn't as dramatic, but interesting example of how our bodies can 'tell' us what we need.

                In my mid-40s, I woke up one morning, first day of TOM, with a massive migraine. I rarely get headaches, and this was a really powerful one. I didn't think I'd be able to function for the rest of the day, much less go to work.

                At the same time, I had a strong craving for coffee. At that time, I rarely drank more than a single cup with my breakfast, but I had an overwhelming urge for my coffee (which I normally drink black). I brewed a full pot--and drank the entire thing, one cup after another. It was almost a compulsion. By the time I finished the pot, my headache was gone--and I felt great.

                This happened each month for the next 3 months (possibly perimenopause issue), and each time the headache was accompanied by a strong craving for coffee--and each time the coffee 'cured' th headache.

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                • #53
                  Interesting,
                  So was it the adrenal response, fatty acid release or some other factor present in the coffee??
                  "There are no short cuts to enlightenment, the journey is the destination, you have to walk this path alone"

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                  • #54
                    Originally posted by Neckhammer View Post
                    Emily Deans also wrote something relevant and telling recently

                    Let me put it this way. Breastmilk is high in fat. Newborns (should) spend a lot of time in ketosis, and are therefore ketoadapted.
                    This seems strange, because when I think of milk, the first thing I think of is lactose, sugar. So I looked up on wikipedia to see what the composition of breastmilk is, and it turns out:

                    Foremilk, the milk released at the beginning of a feed, is watery, Low in fat, and high in carbohydrates relative to the creamier hindmilk, which is released as the feed progresses.

                    Human milk contains 0.8% to 0.9% protein, 4.5% fat, 7.1% carbohydrates, and 0.2% ash (minerals).

                    So the amount of carbs are ALMOST DOUBLE the amount of fat.

                    This seems like pretty damn good evidence that carbs are essentially in the growth process.

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                    • #55
                      Originally posted by BestBetter View Post
                      This seems strange, because when I think of milk, the first thing I think of is lactose, sugar. So I looked up on wikipedia to see what the composition of breastmilk is, and it turns out:

                      Foremilk, the milk released at the beginning of a feed, is watery, Low in fat, and high in carbohydrates relative to the creamier hindmilk, which is released as the feed progresses.

                      Human milk contains 0.8% to 0.9% protein, 4.5% fat, 7.1% carbohydrates, and 0.2% ash (minerals).

                      So the amount of carbs are ALMOST DOUBLE the amount of fat.

                      This seems like pretty damn good evidence that carbs are essentially in the growth process.
                      That early milk is rich in colostrum too. Of prime significance is the ratio of fats/proteins/carbs as well as the immune building effects of that colostrum that will last a lifetime for the infant consuming such mother's milk. We too can get healthier consuming colostrum, even as adults. Back home in Marin, once or twice a year for a brief week or two window, I can get goat colostrum by the gallon when the kids are born & nursing, from my buddy who owns a goat farm & has a goat cheese company. I miss California...
                      "Science is not belief but the will to find out." ~ Anonymous
                      "Culture of the mind must be subservient to the heart." ~ Gandhi
                      "The flogging will continue until morale improves." ~ Unknown

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                      • #56
                        Originally posted by BestBetter View Post
                        Human milk contains 0.8% to 0.9% protein, 4.5% fat, 7.1% carbohydrates, and 0.2% ash (minerals).

                        So the amount of carbs are ALMOST DOUBLE the amount of fat.

                        This seems like pretty damn good evidence that carbs are essentially in the growth process.
                        No, that's an observational relationship which is enough to create a suspicion and from that propose a Hypothesis.
                        Then the hypothesis needs to be tested in a variety of ways depending on how the hypothesis is structured, if it holds true in all tested circumstances and can be repeated independantly then this then becomes supporting evidence and can reasonably treated as fact until a situation is found where the hypothesis does not apply, then it needs to be reviewed.

                        The primary question being ketosis, so the questions to answer are:
                        Does umbilical fluid differ in composition in ketogenic mothers?
                        Does breast milk differ in composition in ketogenic mothers?
                        If so does this variation have any negative impacts on the foetus or nursing child?

                        It is highly likely that a significant number of HG groups would have eaten a diet at times that theoretically was Ketogenic and this would have included pregnant and nursing women.
                        As far as I am aware there has been no indication in any of these cultures of specific cultural and dietary behaviours to address this carbohydrate defecit, so from that one must conclude either Ketosis is not an issue in pregnancy and nursing or these HG groups had specific adaptations to address this.

                        It may well be that the foetus gets what it needs irrespectiv of what the mother eats, there is a lot of information that during pregnancy the foetus is calling the shots and has first dibs on all nutrients and the mothers cravings are the result of her nutritional defecits as the foetus is a bit of a hog, like it or lump it the relationship shows patterns of being parasitic, so maybe the foetus will do quite fine if the mother is on a low carb diet.
                        "There are no short cuts to enlightenment, the journey is the destination, you have to walk this path alone"

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                        • #57
                          Originally posted by BestBetter View Post
                          This seems strange, because when I think of milk, the first thing I think of is lactose, sugar. So I looked up on wikipedia to see what the composition of breastmilk is, and it turns out......
                          Well it is what she says it is..."high in fat" being over 50% of the calories, but that is largely beside the point. When I posted that I really saw no need to discuss mother milk honestly. That portion was obviously the least compelling evidence wise (which is likely why three different people have remarked on it while disregarding the rest). Ah, well...confirmation bias I suppose.

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                          • #58
                            I did think about the ancient Mongol empire.
                            Their traditional diet was meat and fermented dairy and the other northern peoples like Inuit were probably related to them as Mongolia was on the likely migration path to the America's.

                            As far as I could determine dairy formed a significant part of their diet in summer, but in winter they were nearly carnivore's, they did use a little bit of wild onion, garlic and some other herbs, but there were no real fruits, starchy tubers etc.
                            They ruled the biggest empire in history, basically the story goes that the Khan decreed they should concour all the lands to the west until they got to the sea and when they were conquering they only stopped at Poland because word got through that the Khan had died and they had to get new orders, they then retreated to Russia and held that for nearly 300 years I think, this is the only recorded time that a caucasian population had an Asian aristocracy, but I digress.

                            There are records in history about their meat eating and europeans were disgusted by them, bit of "Penis Envy" I think, they referred to the Chinese as "Grass Eaters" because vegetables were so foreign to them. So here is a population that was in Ketosis more often than not and I don't think they would have been able to achieve what they did if all their offspring were weak and sickly because women were in Ketosis.
                            Last edited by Omni; 09-28-2012, 10:13 PM.
                            "There are no short cuts to enlightenment, the journey is the destination, you have to walk this path alone"

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                            • #59
                              Omni-
                              In response to you question about my migraine/coffee experience, I have no idea what element in the coffee (or in me) cured the headache. I just thought it was interesting how what I was craving was the cure. Since that time, I have a friend who has been plagued my migraines for many years. She told me that many people get relief from caffeine (she's not one of them), and doctors will often suggest that to chronic migraine sufferers before resorting to Rx or OTC meds.

                              THIS is what I've always read:

                              "It may well be that the foetus gets what it needs irrespectiv of what the mother eats, there is a lot of information that during pregnancy the foetus is calling the shots and has first dibs on all nutrients and the mothers cravings are the result of her nutritional defecits as the foetus is a bit of a hog, like it or lump it the relationship shows patterns of being parasitic, so maybe the foetus will do quite fine if the mother is on a low carb diet."

                              The real 'danger' to the foetus is any drugs, alcohol, or other chemicals (smoking, e.g.,) that the mother may consume. What makes this particularly dangerous is that the first three months are the most formative stages of foetal development, and many women are unaware that they are pregnant that early.

                              When my sister was pregnant 20 years ago, she developed gestational diabetes, and her OB put her on a low-carb diet to control her blood sugar to insure a healthy pregnancy. He warned that if she was not complaint, she would need insulin, and that was more precarious for the foetus. She complied and told me that she felt better than she'd ever felt eating low carb--and she had a very healthy baby.

                              Also keep in mind that many women suffer from severe morning sickness--which often results in a very poor diet, as some of them live on ginger ale and crackers for a while. Doctors are rarely concerned with their limited eating because, as noted above, the foetus can get sufficient nourishment from the mother's body, as nature has designed.

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                              • #60
                                Originally posted by Neckhammer View Post
                                It was a grand statement by the OP with no scientific backing. That's all I was pointing out. I mean you can ignore that 20% of hunter gatherer societies out of 229 known that got more than 85% of their calories from the hunt if you wish AND that small animals and bugs counted as gathered. I think it takes a helluva leap in logic to think that none of them existed in ketosis even during pregnancy, but hey that's just me. In today's environment I don't see why a woman would "have" to be in ketosis during pregnancy, but also see no harm as long as nutritional needs and calories are met. In a scientific sort of inquisition its quite dubious to label it "insane" or "dangerous" just because it doesn't mesh with your particular values.
                                I didn't conclude that none of them were in ketosis during pregnancy, my conclusion was that we DON'T KNOW if whole cultures spent pregnancies in ketosis or not. So assumptions that they were, and that therefore ketosis during pregnancy is without risks is the leap in logic being taken. In fact I'm positive that there's been many pregnancies spent in ketosis, but is certainly doesn't prove that it is without potential risks. And the fact that some cultures ate up to 85% of calories from animal foods doesn't tell us what the pregnant woman in the tribe were eating. Some hunter gather tribes have different diets catered for the women during pregnancy. It's possible diets provided for the pregnant women were a lot different in macro make-up compared to what the rest of the tribe were eating.
                                In fact there's also evidence that some hunter gatherer societies increased carbs and even placed restrictions on protein and fat for women during pregnancy.
                                A review: dietary restrictions on hunter-gatherer w... [Hum Ecol. 1989] - PubMed - NCBI




                                Originally posted by Omni View Post
                                I did not see any evidence in what you posted, only opinion based on opinion.
                                Do you have any data to support the hypothesis that inuit have a special glucogenesis adaptation?
                                I have looked around and couldn't find anything on that, I'm pretty sure it is well established that their traditional diet was ultra low carb, you were cherry picking that opinion, you quoted Phinney/Volek not saying anything about pregnancy and Ketosis, you should also have quoted them as being 100% definitive on the Inuit diet being ketogenic as well.

                                I'm not advocating it, but if there is any actual evidence I'd like to see it.

                                I think it's a little bit rich suggesting anyone that comes to a different conclusion than you must be Insane.

                                Where's the evidence that pregnant Inuits are in ketosis? A study done on them found they had a greater degree of resistance to ketosis. Not only did they consume glycogen from fresh meat but they were found to be extremely efficient at gluconeogensis and were even more resistant to ketosis than normal people, even during total starvation.
                                www.jbc.org/content/80/2/461.full.pdf

                                So basically we have no evidence that ketogenic diets during pregnancy are without risk, we also have:

                                - no proof that pregnant women in cultures are in ketosis during pregnancy
                                - Hunter gather societies that actually make sure pregnant women eat more carbs during pregnancy
                                - Micheal Eades, one of the biggest "ketosis is natural and beneficial" advocates, saying that ketosis during pregnancy can be harmful to babies
                                - The vast majority of keto and low carb advocates saying that ketosis is not safe during pregnancy
                                - Another low carb advocate and pediatrician who has actually read the literature and concluded that it's not safe
                                - A biological breakdown of why it can be dangerous
                                - Animal studies showing that ketosis can be harmful to fetal development.

                                ..Yet we still have people believing that it's worth the risk with their unborn child. I find that just bizarre that people would choose to take unnecessary risks.
                                Last edited by Forgotmylastusername; 09-29-2012, 03:49 AM.

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