[Preview] Being pregnant and in ketosis — Lily Nichols

Interestingly, as you dip into what’s actually
happening during pregnancy physiologically, you see there’s a tendency
to develop ketosis, sometimes ketones go up
two to three fold from baseline, for anybody who has been low-carb or keto
and has monitored ketones pre pregnancy, and then gets pregnant, they notice
that they slip into ketosis much easier, even at lower levels of less carbohydrate
restriction, I should say. So if ketosis happens naturally in pregnancy,
or our body is dumb. Like how would we have survived
the species in times of inadequate food or living at high latitudes where you naturally
don’t have as much carb availability because it just does not grow… How would we have survived? How would
we not all have brain damaged children? Like there has to be
something going on here. So, it’s important to think
about the different types of ketosis and for a lot of you
this will be review. For clinicians who are new in this area, this might be
completely new information because even in my training as a dietician
and a certified diabetes educator, like you know the gold standard
of educators in diabetes care, they don’t talk about this. They just assume ketosis
means diabetic ketoacidosis, and it’s a medical emergency
and the sky is falling. So, nutritional ketosis is when your body
burns primarily fat for fuel, because the diet is limited in carbohydrates
but not energy, so you’re eating enough food
in the form of fat and protein, you’re just not eating
a ton of carbohydrates. At this stage your blood sugar
remains normal, this is a natural state that pregnant women
will go in and out of throughout pregnancy, it’s benign, it’s nothing to worry about,
you’re eating enough calories, you’re getting enough micronutrients,
you’re just not binging on carbohydrates. Starvation ketosis on the other hand, and by the way al a lot of studies trying
to prove that ketosis is harmful are either looking at starvation ketosis
in pregnancy or diabetic ketoacidosis. We don’t have good data
on nutritional ketosis and pregnancy. In this state your body is burning
primarily body fat for fuel because you’re not eating enough,
you are starving and this is a bad idea in pregnancy because you’re also not getting enough
essential nutrients, macro and micro nutrients. We’ve known since at least the 70s,
that this is a problem, it alters the amount of amino acids
in the amniotic fluid. If we look at the data
from the Dutch Famine study, we know that limiting the amount of food
and thus nutrients that a woman is eating, can have long term metabolic
consequences for their children. So, not a good idea,
don’t starve yourself in pregnancy. And then DKA is a very special situation
in type 1 diabetics or insulin dependent type 2 diabetes, when you’re not taking enough insulin,
exogenous insulin, meaning not what your body produces but what
you take in the form of like an insulin shot. Keep in my mind, pregnancy is a naturally
hyperinsulinemic state. So by the end of pregnancy, a woman will produce two to three times
the amount of insulin, maybe more depending on how many
carbohydrates she is eating, but DKA doesn’t make sense
in normal pregnancy in that context, because you’re not
in a state of insulin deprivation. In DKA you see high levels of blood sugar,
you see acidic blood PH, you see very, very high blood ketone levels that you’re just not going to see in somebody
who’s limiting their carbs intake. This is known to be
extremely unsafe in pregnancy, we have seen study after study,
many of them dating from the 80s and 90s, showing that it can harm fetal brain
development, essentially. The problem is when people assume
that ketosis, or a woman having ketones in her urine, automatically means that she is in DKA,
which is not true. The only way to prove somebody is in DKA
is to measure their blood ketones, which they seem to never want to do,
by the way, but a lot of practitioners
get really concerned when they see urine ketones
in pregnant women, and you’re going to see that all the time
and it’s nothing to worry about. The only way to get rid of them is to eat
massive quantities of carbohydrates and as I’ll show later,
that’s not a good idea.

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