Is the Ketogenic Diet Safe for Pregnant and Breastfeeding Women?

Is Keto Safe During Pregnancy and Breastfeeding?

I can't emphasize this enough; the goal of eating a healthy ketogenic diet during pregnancy is not — and should not be — to lose weight. So eat a variety of foods to supply adequate nutrients for both you and your child for each trimester during pregnancy.

As long as you are eating enough calories to support a healthy growing baby, you can eat keto.

What Is the Difference Between Ketosis and Ketoacidosis?

All pregnant women (healthy, those with or without gestational diabetes, and women with type 2 diabetes) should know that, in general, urine ketones (reflected as pink to purple color on urine strips) or blood ketones in the range between 0.5 - 3 mmol/L indicates you are in nutritional ketosis, i.e. you are using fat, not carbohydrates, as your main energy source. This isn't dangerous.

However, when urine ketones are coupled with uncontrolled high blood sugar it can lead to ketoacidosis. If you are at risk for ketoacidosis and you have the symptoms below, go to the emergency room immediately, as ketoacidosis can be deadly (1).

Ketosis (safe, elevated ketone levels as a result of carbohydrate reduction) and ketoacidosis (dangerously high ketones levels occur when insulin is deficient) are two very different things. Common symptoms of ketoacidosis are excessive thirst, frequent urination, nausea and vomiting, abdominal pain, shortness of breath, confusion).

Hormones during pregnancy typically trend towards higher insulin levels (not deficient insulin levels, as seen in ketoacidosis). Therefore, dangerous ketoacidosis should not be a concern while following a ketogenic diet. If you are unsure, speak with your doctor.

Ketosis vs Ketoacidosis: Know the Difference
Nutritional ketosis is a natural and safe state in which ketones are present in the blood stream, and at the same time blood sugar levels are stable and controlled. Unlike nutritional ketosis, ketoacidosis is very dangerous and is characterised by high levels of ketones with extremely high uncontrolled blood sugar levels.

Ketogenic Diet Rationale For Pregnancy

You will hear that the ketogenic diet is unsafe to follow when pregnant ( 2,  3). This is misinformation that just might stem from research that is not specifically related to women, adequate calorie intake and ketosis. I have been unable to find current research studies on this topic.

However, we do know three key facts that lend themselves to the understanding of how eating a ketogenic diet helps support fertility and a healthy pregnancy for both mom and fetal growth.

Advantages For Women Who are Considering Pregnancy

For women who are considering pregnancy, the advantages of using a ketogenic diet are that:

1. It may help restore menstruation in women with polycystic ovarian syndrome and be used to support hormonal imbalance;
2. There is no better natural tool to control blood sugar for gestational diabetes and pregnant women who have a long-standing history of diabetes; ( 4)
3. Consuming essential fats will support healthy fetal eye, nerve and brain development ( 5) and contribute to building healthy baby body fat stores.

Beyond Science, There Are Women Who Eat Keto During Pregnancy

While there may be no scientific evidence that supports the use of a ketogenic diet during pregnancy, there is evidence that suggests the fetus is naturally and often in ketosis ( 6).

If you chose to eat keto while pregnant, know that you are not alone. Physicians and pregnant women can attest to the safety and efficacy of the ketogenic diet during pregnancy.

Dr. Michael Fox, fertility specialist at the Jacksonville Center for Reproductive Medicine, and Dr. Robert Kiltz recommend a ketogenic diet to all of their patients, not just those with blood sugar or infertility issues.

There are hundreds of women “who have been completely ketotic throughout pregnancy without any untoward effects. It is completely safe for women to be eating a ketogenic diet in pregnancy. Women in ancient times were certainly ketotic during pregnancy,” says Dr. Fox.

According to Dr. Fox, a ketogenic diet is safe to follow when pregnant. And it can also help alleviate morning sickness and pregnancy-associated medical conditions such as reducing the rates of miscarriage and lowering risk for preeclampsia and  gestational diabetes.

Dr. Fox uses the ketogenic diet for his patients because the diet helps to maintain stable blood sugar. He believes women suffer from nausea/morning sickness as a result of hormone shifts that cause high insulin levels and low blood sugar.

How Many Calories Should Pregnant Women Eat?

What Are Your Nutritional Needs During Pregnancy?

A general guide for adequate calorie intake during pregnancy is between 2,200 and 2,900 calories a day. However, the nutritional needs of women during pregnancy vary from woman to woman, and some may need slightly less calories than this in the first trimester.

If you are eating healthy and within ideal body weight range, there is no need to eat more calories in the first trimester of pregnancy. Once you move into the second trimester add 340 calories a day and then another 110 calories to total 450 calories by the third trimester (7). Recommended weight gain is based on pre-pregnancy weight.

Because the additional calorie need during pregnancy is minimal, it is important to eat foods that are high in the nutrients that are critical for the baby. These nutrients are: docosahexaenoic acid (DHA), iron, iodine, calcium, folic acid, and vitamin D ( 8). All of these nutrients are easily found in the protein and vegetable foods that are consumed on a ketogenic diet.

Specific Ketogenic Foods Provide Necessary Nutrients For Your Baby

With so few extra calories to consume during your pregnancy, it seems prudent to add the necessary nutrients the baby needs. Selecting foods that provide these nutrients is important.

• DHA: fish (salmon, trout, sardines), seaweed and other sea vegetables. Walnuts, chia, flax and pumpkin seeds contain omega-3, but their alpha-linolenic acid (ALA) must be converted to DHA. These veggies are fair sources of ALA: Brussels sprouts, kale, spinach, broccoli, and cauliflower.
• Iron: red meat, spirulina, liver, pistachios, spinach, sardines, dark chocolate
• Iodine: seafood, seaweed, cottage cheese, Greek yogurt, egg yolk Calcium: sardines, dairy (cheese, yogurt or kefir), kale, okra, bok choy, almonds, broccoli
• Folic acid: spinach, collard greens, nuts/seeds, avocado, asparagus
• Vitamin D: egg yolk, cod liver oil, sardines, beef liver, wild-caught salmon

So if you are not eating these foods just replace the foods that are not as important for the baby (starches and processed or high-glycemic carbs) with these foods to help fetal growth and development.