STANDARD NUTRITIONAL PREGNANCY ADVICE | EVIDENCE AGAINST KETO | EVIDENCE IN FAVOR OF KETO | BOTTOM LINE
It’s no surprise that most women gain a bit more weight than expected while pregnant. Beyond the obvious—you’re growing a bowling ball-sized human inside your belly— everyone around you suddenly wants to fatten you up. Currently, my baby is the size of a prune, yet everybody wants to remind me that I’m eating for two. At ten weeks— am I really? Does that justify hogging down an entire sleeve (or two) of Double-Stuff Oreos?
Now I’m not trying to fat-shame myself (or any other mothers-to-be) for poor dietary choices made throughout the prenatal experience. Pregnancy is challenging (and I’m just getting started)! When you’re dealing with nausea, food-aversions, aggravated digestion, fatigue, and the general stress that comes along with— oh f*ck we’re about to be responsible for another human life— you’re allowed some emotional eating.
The bit I find particularly interesting is that our society is more than accepting when it comes to prenatal emotional eating (in fact, we encourage it). Yet, if you mention keto in relation to pregnancy most get all bent out of shape and concerned about the welfare of your baby.
So let me get this straight— pizza, donuts, and ice cream are perfectly acceptable for us pregos— but liver, bone marrow, and beef tallow are going to jeopardize the health of my newborn? What am I missing here?
Standard Nutritional Pregnancy Advice
For the record, standard nutritional advice is not exactly encouraging pregnant mothers to eat pizza, donuts, and ice cream. For the most part, standard nutritional pregnancy advice mirrors USDA recommendations of eating a well-balanced diet, selecting complex carbohydrates over simple, and limiting saturated fats as well as processed food products.
For example, WebMD encourages pregnant women to include the following in their daily diet:
- Five servings of fresh fruits and vegetables (including at least one serving of a dark orange vegetable, two servings of dark green leafy vegetables, and one serving of citrus fruit)
- Six servings of enriched, whole-grain breads and cereals. Three servings of nonfat or low-fat milk or milk products
- Two to three servings of extra-lean meats, chicken without the skin, fish, or cooked dried beans and peas
- Eight glasses of water
So what I gather— whether pregnant or not— the USDA is encouraging us to consume roughly 45-65% of our 2000 daily calories from carbohydrates, 10-35% from protein, and 20-35% from fat. That’s not to say there aren’t some additional nutritional requirements for pregnant women such as increased iron, folate, calcium, Vitamin D, DHA, and iodine, but for the most part, macronutrient requirements aren’t much different for expecting mothers.
Which has me asking— if I wasn’t in bed with the USDA’s recommendations prior to pregnancy— why would I suddenly believe they’re in the best interest of my developing baby?
Now before I go any further, I should remind you that I am a Nutritional Consultant, NOT a medical doctor or health professional. Please do your own research and talk with your healthcare provider prior to starting a ketogenic diet while pregnant.
The Evidence Against Keto + Pregnancy
So, you’re pregnant and wondering if you should keep up with your ketogenic diet. Congrats! So am I! Prior to getting knocked up, I had commended pregnant women for sticking to their keto diet throughout their nine-month journey. Assuming, what’s good for you is good for your baby.
However, once I was in their shoes, naturally I felt compelled to do my own research. So I began with the “Holy Grail” of pregnancy resources, What to Expect When You’re Expecting. In a nutshell, What to Expect flat out says, “No, pregnant women shouldn’t go keto.”
The Lack of Research
Well, quite honestly, when it comes to keto and pregnancy there just isn’t a whole lot of research. To date, there hasn’t been one controlled study performed on pregnant women in relation to the ketogenic diet. Much like the topics of caffeine or alcohol consumption while pregnant, controlled studies are rightfully discouraged and all we’re left with is testimonial or circumstantial evidence.
Which means, currently, the only research we have to back the dangers of keto and pregnancy have been performed on mice. A study published in BMC Pregnancy & Childbirth revealed, “Pregnant mice fed a ketogenic diet experienced many problems with their offspring, including slower growth, smaller hearts and brains, and an enlarged spine.”
So there’s that.
Beyond the lack of controlled studies, there are heaps of doctors that adamantly disapprove of the ketogenic diet in relation to pregnancy. As G. Thomas Ruiz, M.D., OB-GYN, Lead of Obstetrics at MemorialCare Orange Coast Medical Center explains, “The keto diet is simply not safe for pregnant women.” Adding that, “Glucose, from carbohydrates, is the primary energy source for baby’s growth and development and not having enough glucose can cause serious problems.”
Christine Greves, M.D., a board-certified ob-gyn from Orlando Health backs up his claims by stating, “For obvious ethical reasons, we do not have any studies that say it is safe to be on the ketogenic diet during pregnancy, so I can’t really advocate for it.” What’s more, “The few studies that are out there specifically highlight the dangers of not having enough folic acid during pregnancy. Carbohydrates found in grains like wheat flour, rice, and pasta (all big no-no’s in the keto diet) are rich in folic acid, which is very important for fetal development, especially during the first trimester.”
The Evidence In Favor of Keto + Pregnancy
Sure, there’s plenty of folks highlighting the dangers of keto— whether you’re pregnant or not. Alternatively, there’s a growing community of cheerleaders (mothers, doctors, and experts) that are advocating on behalf of the ketogenic diet— pregnant or not.
The Lack of Research
Let’s be honest, the lack of research works in favor of keto as well. Consider for a moment that it doesn’t always take a controlled study to gather substantial evidence. Take for example alcohol. To date, there are no controlled studies regarding the harmful effects alcohol can have on a growing fetus. Why? Because it would be entirely unethical to expose a growing human fetus to any questionable substance. However, we have heaps of circumstantial and testimonial evidence, right?! We know Fetal Alcohol Syndrome is a real thing— and it didn’t take a controlled study to prove it to us.
Likewise, there are mountains of testimonials from real women that committed to the ketogenic diet while pregnant and gave birth to perfectly healthy, happy babies. In fact, ketogenic expert, author and Diet Doctor contributor Maria Emmerich, has counseled 100’s of women on ketogenic eating during pregnancy, with great success! “As if this diet of real food would be harmful to the fetus?” she asks rhetorically. Maria points to evidence that the fetus is naturally in a frequent state of ketosis— one that is essential for laying down fatty structures like brains and nerve cells.
What’s more, often articles on the web will discredit keto and pregnancy by pointing to the unfavorable studies with mice or rats. However, they seldom mention the favorable studies that have been performed on pregnant pigs consuming a ketogenic diet. And regardless, studies involving animals do not constitute conclusive evidence.
What I find far more compelling is our innate metabolic disposition. Studies suggest that soon after birth, human babies are naturally in a state of ketosis, and remain so while breastfeeding. This happens regardless of whether the mother was following a ketogenic diet or not. Babies use ketones and fats for energy and for brain growth.
Which proposes the question, how could a ketogenic diet be detrimental for the fetus but ideal for the baby?
Sure, there are plenty of doctors that will talk you right out of your prenatal plans for keto. However, there are also a number of doctors advocating in its defense.
Take for example Dr. Robert Kiltz, a fertility specialist at CNY Fertility. Dr. Kiltz has been recommending the ketogenic diet for improved fertility and pregnancy for the last five years stating, “‘Ketogenic’ means ‘the key to genius’!,” Dr. Kiltz reminds us, “We have zero need for carbohydrates as humans.”
Unfortunately, regardless of Dr. Kiltz’ success, he is still in the minority of fertility doctors recommending this approach.
The Argument in Favor of Carbohydrates
“Zero need for carbohydrates.” Try telling that to just about anyone and see what kind of response you get. Most doctors will insist glucose is our preferred energy source (and glucose we’re told is obtained from carbohydrates). As you may recall, according to Dr. Ruiz, “Glucose, from carbohydrates, is the primary energy source for baby’s growth and development and not having enough glucose can cause serious problems.” I see his point, and largely agree considering glucose is the principal energy substrate for the placenta. However, what Ruiz fails to mention is that the body doesn’t rely on carbohydrates for glucose. In fact, the body can produce all the glucose it needs (with the help of protein and fat) through a process known as gluconeogenesis.
The other argument in favor of consuming carbohydrates (specifically whole grains) while pregnant has to do with folic acid intake. It’s widely accepted that folic acid is a crucial component of a healthy prenatal diet. In fact, there’s plenty of research to back that folic acid fortification significantly reduced the prevalence of neural tube defects (NTDs) in the United States. However, folic acid is not found in natural food sources. Folic acid is the synthetic B vitamin form that is used in vitamin supplements and added to fortified foods (such as whole grains). Folate is the B vitamin form found naturally in foods. And folate can be found in plenty of keto-approved foods such as: asparagus, avocados, broccoli, collard greens, okra, peanut butter, and spinach. Beyond that, you won’t find a prenatal vitamin on the market that doesn’t contain folic acid/folate.
Clean Keto vs. Dirty Keto
To the credit of all the doctors against keto and pregnancy, I would NEVER recommend that a pregnant woman follow a “dirty” or “lazy keto” approach. Both forms of keto will result in nutritional deficiencies and could contribute to developmental issues within the womb.
If you’re interested in following a ketogenic diet while pregnant (or as a fertility method) you’d be wise to do your research and be sure to follow a clean ketogenic diet. If you have no idea where/how to begin, I would suggest reading up on Clean Keto vs. Dirty Keto.
The Bottom Line
I find it ironic that all the supplements we’re told are necessary for proper development (prenatal vitamins) can be fulfilled by eating consciously-sourced meat, nuts, and nutrient-dense veggies (all clean keto-approved). Yet most OB-GYN’s will frown on the ketogenic diet.
Regardless, diet is personal (and even more so when you’re building a baby). My husband and I have concluded that following a ketogenic diet during pregnancy and while breastfeeding will set baby up with optimal nutrition and ultimate success.
But your situation, your needs, and your body are all different from my own. And you need to do what’s best for you and your baby.
Good luck to you Mama, and please don’t hesitate to comment below about your experience with the ketogenic diet and pregnancy. 🙂
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This content is for informational and educational purposes only. It is not intended to provide medical advice or to take the place of such advice or treatment from a personal physician. All readers/viewers of this content are advised to consult their doctors or qualified health professionals regarding specific health questions. Neither Katie Rodriguez nor the publisher of this content takes responsibility for possible health consequences of any person or persons reading or following the information in this educational content. All viewers of this content, especially those taking prescription or over-the-counter medications, should consult their physicians before beginning any nutrition, supplement or lifestyle program.