There is a lot of agreeance among the health and nutrition fields that point to a ketogenic diet as an aid to fertility. While ketosis can be helpful in helping one get pregnant, the question is: is it safe to maintain a keto diet while pregnant?

Ketosis vs. Ketoacidosis

There is a bit of controversy whether the answer to this question is yes or no, and most doctors are still trying to “get with the curve” and understand/ grasp what a ketogenic diet is. Such doctors in the latter half of the controversy, are hesitant to recommend or even steer patients away from “low-carb” dieting while pregnant based on their concerns not on ketosis, but something called ketoacidosis.

Ketoacidosis is a state in which the body has an extremely high number of ketones and blood sugar levels. The result is a dangerous acid-base (pH) imbalance. Such a state is unhealthy for any individual, pregnant or not.
Ketosis, on the other hand, is a metabolic state in which the body uses fats (ketones) as fuel versus carbohydrates. In ketosis blood sugar is normal, there is a healthy pH (acid-base) balance, and ketone levels are relatively low. This is considered a “healthy” state of the body.

Maintaining a healthy keto diet leads to a state of ketosis, not ketoacidosis. Ketosis can be healthy for both mom and child when it comes to pregnancy.

Natural Pregnancy and Ketosis Connection

Keto and pregnancy are naturally connected. Nausea and curved appetite during pregnancy cause many women to go in and out of ketosis naturally. In addition, pregnant women naturally become insulin resistant to provide the developing child with proper nutrients, making them more sensitive to carbohydrate intake. Thus, maintaining a ketogenic diet during pregnancy may help aid these natural processes.

In addition, ketosis can be a healthy and natural adaptation for the baby. Keto-adapted babies have an easier time converting ketones to acetyl-coA and myelin. Such conversions aid in brain and neural development of the child.

Eat Whole Foods and Listen to Your Body

While a keto diet, and ketosis, can be good for both the mother and child throughout pregnancy, there are a few fundamental concepts to consider.

Do not focus on weight loss. Many who start the keto diet do so for the weight loss benefits. This should not be the goal of pregnant women on keto. It is important that both the mother and child get the proper nutrients and calories and weight gain is a natural and healthy component of pregnancy.

Do not be strict keto. It is not uncommon to go in and out of ketosis just based on fluctuations in appetite and nausea throughout pregnancy. Listen to your body and the baby and do not fret or put your body through additional stress to try and maintain a constant state of ketosis. If your craving a piece of whole grain sourdough toast, feed the baby what it wants.

Whole food, nutrient-dense, and calorie sufficient should be the focus. This may be redundant, but when pregnant, making sure the baby and mother get proper nutrients and caloric intake is the primary concern when it comes to diet. The best way to achieve these things is to eat whole foods like vegetables, fruits, nuts, legumes, and grass-fed meats. One should avoid processed and packaged foods.

Breast Feeding and Ketosis

It is recommended that one breastfeeds, on or off keto. Breast milk is better than formula. Breast milk is high in natural fats, whereas most formulas are high in carbohydrates and sugar. If one has the ability, breast milk is a better option to make sure the baby is getting proper nutrients and not getting addicted to a high carbohydrates and sugar diet at a young age.

Additionally, coconut oil, a common component of the keto diet, can assist in lactation and allows breast milk to contain lauric acid that helps support a babies’ healthy metabolism.

Clinical Guidance

It is highly suggested that you start the diet before getting pregnant. Switching from burning primarily carbohydrates as fuel to fats as fuel can be a stressful transition on your body. Avoid extra stress on the baby and mom by navigating this transition before conception.

Also, it is best to have some clinical guidance while maintaining a ketogenic diet during pregnancy. A doctor can make sure that both the mother and the baby are getting enough nutrients and calories and monitor healthy levels for both mom and child. Because some health professionals are still trying to “catch-up” to the ketogenic diet, it may be helpful to explain your dietary choice as one in which you are avoiding sugar and focusing on healthy vegetables, fruits, and proteins versus telling them you are on a keto diet. Or better yet, seek a health professional that does understand the keto diet.

Take-Away Message

It is safe and arguably healthier for both mom and child to maintain a ketogenic diet during pregnancy. It is vital that the mother listens to her body, gets enough calories, and focuses on whole food consumption during this process. It is recommended that a mother seek clinical guidance to help navigate and monitor.

- Dr Jerry Hizon