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What to know about a Ketogenic Diet during Pregnancy

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

How To Measure Your Ketone Levels

When you start a ketogenic diet, one of the most common questions is how to measure your ketone levels. Most people on a keto diet do this because they want to see if there are in ketosis.

To get started measuring your ketone levels, there are three types of ketone bodies to know about:

Acetone
Acetoacetate
Beta-Hydroxybutyrate (BHB)

Unlike protein intake, where the daily amount is determined by your lean mass weight, the number of carbs to enter ketosis can be estimated using three methods.

1) Blood Ketone testing

The level of BHB in your bloodstream will tell you how much you have in your fuel tank but it will not measure the metabolic usage of ketones. Blood ketone testing is the most accurate way to measure ketone bodies.

Blood ketone testing can precisely determine the level of ketones in your blood. But the drawback is that they are more expensive. The testing meter costs $40 and the test strips cost $5 each. If you are testing your ketone levels daily, it could cost you $150 per month.

2) Ketone Breath testing

A non-invasive and cheap alternative is to measure ketones is to use breath acetone concentration. Acetone is one of the ketone bodies that results from a break down of acetoacetate. The level of acetone will reflect the metabolic usage of ketones.

The Ketonix Acetone Breathalyzer is available and offers an easy and inexpensive way to test your breath ketones (acetone). Keep in mind that breath ketones do not always exactly correlate with blood ketones and are affected by several factors (alcohol consumption and water intake).

3) Ketone Urine strips

Ketostix, Uriscan, and other urine detection strips are not as accurate as the blood and breath test. This because they only measure the level of acetoacetate. These are the excess ketone bodies that are not utilized by the body and are excreted via urine.

Urine ketone strips can still be useful during the initial phase of the ketogenic diet when you simply want to test the level of carbohydrates in order to enter ketosis.

Some people use them to test if they are sensitive to certain foods that may be keto-friendly but still have a negative effect on their progress.

The good news is they are easy to use and fairly cheap to buy. You’ll only pay about $10 for 50 strips, which adds up to about $6 a month if you test yourself daily. If urine detection strips don’t work for you, use one of the other two methods.

4) Your own observation

Listening to your body’s signals is another way of finding out whether you are in ketosis. When your body is in ketosis, you may smell of acetone. This could be sensed in your breath, sweat or urine. Some people refer to this as ketogenic “fruity” smelling breath. If you detect any of these signs, you are more than likely in ketosis.

Don’t Focus Just on Ketones

Recently, I’ve noticed a growing obsession when it comes to measuring ketones precisely. Although urine detection strips may not be accurate for keto-adapted people, they work for most of those that have just started the ketogenic diet.

By the time most people become keto-adapted (which takes 3-4 weeks) most of them understand what to eat and what to avoid without any real need to measure the precise level of ketone bodies.

In the end, what really matters is not ketones but the effects of low-carb diets: weight loss and improved health.

Dr. Jerry Hizon

Mike’s Daily Blog Post: Day 3 & 4

Days Three and Four: Wednesday, 11/29/2017 and Thursday, 11/30/2017

stripThe past few days were a bit hectic because of interview season and the website we are working on, so I was unable to post. The good thing about being busy is we get caught up in our task and forget about food. It makes intermittent fasting much easier. I’m glad to say that in the same time frame, I have successfully entered ketosis.

That means my body has switched over from burning sugar/glucose for energy to burning fat for energy. Fat can be used by the brain and muscles in the form of ketone bodies. There are 3 types of ketone bodies that may be measured in different ways: acetone (breath), beta-hydroxybutyrate (blood) and acetoacetate (urine). The cheapest way to measure this is by urinating on ketone strips. Yes…I pee on a strip every morning.

The fastest way to get into ketosis is by fasting. From Sunday to Thursday evening, I almost completely abstained from food. My intake was in the form of fat from bulletproof coffee and bone broth (had some nuts here and there). I felt amazing during that time. Physical hunger was virtually non-existent. Social hunger, however, the type where you see others eating or think it’s time to eat because you “should eat something”, were plentiful. I can proudly say that I resisted eating at my residency interview. They were serving bread, pasta and soda (I honestly had no desire for that anyway). Peeing on the strip helps keep me motivated throughout the day; I want that thing to be able to change color every morning. That’s my external motivation.

Mike’s Daily Post Day 2:

Day Two: Tuesday, 11/28/2017

bulletproof coffeeMorning: Day two is underway. Woke up this morning and chugged 32 ounces of water. Something I learned from intermittent fasting and the ketogenic diet is to always stay hydrated. Because these two techniques deplete the body of glucose (sugar from carbs) and glycogen (storage form of glucose in skeletal muscles and the liver), the body loses one of the mechanisms by which it can hold onto water. So…we urinate it out. We urinate a lot, making it necessary to replace that water throughout the day.

For breakfast, I crafted some bulletproof coffee. This stuff can stop anything. Kidding. It is a combination of coffee (I use Keurig Starbucks Pike Roast) with two tablespoons coconut oil, 2 tablespoons butter and 2 tablespoons heavy cream. If you’re counting calories, it equates to approximately 500 Calories. But I don’t count Calories because it is defined as, “the amount of energy required to raise the temperature of 1L pure water by 1 degree Celsius at sea level.” What does that even mean? More importantly, I am concerned with the fat and carbohydrate content of my food rather than Calories. Bulletproof coffee provides the energy I need in the form of caffeine, adds delicious flavor from the heavy cream and gives me the fat content I need from the butter and coconut oil to feel satiated and full.

bone brothAfternoon: Because I am intermittent fasting and want to give my body time to heal and process all the damage I did to it over the Thanksgiving weekend, I need something to make sure I can get through the day and avoid the “Keto Flu”.

That’s where homemade bone broth comes into play. It provides the salt and mineral content needed for my body. By adding apple cider vinegar, I am able to leech out those minerals and extract the bone marrow from within. The marrow contains natural fats. In the crock pot, I added carrots, celery and onion (for flavoring only, I did not eat them). I spiced things up with cayenne pepper, sea salt and black pepper.

As the body is forced to use the glucose (sugars) in the blood and glycogen (in the liver and muscles), we also lose the ability to hold onto water (sugar acts as an osmotic agent, pulling water in with it). Now that the sugar tank is empty, how do we hold onto water? The good old fashioned way…with salt. Salt acts like glucose to create a similar osmotic effect. We know this already, “salt retains water”. We use this property to our advantage.

Drinking homemade bone broth is an excellent way to avoid the Keto Flu, a collection of symptoms such as fatigue, dizziness, brain fog, sugar cravings and stomach irritability. Everyone experiences the Keto Flu differently, but the best way around it is to have high fat in your diet, high salt content coupled with lots of water and to stay busy throughout the day. I have continued exercising as usual. The goal is to get “keto-adapted”, the process of training your body to switch from sugar-burning to fat-burning for fuel (more on this in another post).

Evening: Hit a little speed bump today as I experienced some stomach upset. My theory is that the acidity in my coffee combined with the high fat content in the coffee and broth created some indigestion. Unfortunately, I succumbed and reached for some over the counter antacids. They worked really well, but they have sugar (about 6g). But it still allowed me to continue fasting, so I guess it was worth it.

Exercise: Ab workout, 1 hour spin class
Relaxation: Stretching, Steam room

Motivational word for the day: FOCUS

Set a goal, aim for it, go after it. There should not be any excuses in your mind. Don’t doubt yourself, let others do that for you. Then use that to fuel your fire. Stay focused on your goal and stop at nothing to attain it. Focus on all the pain and the hurt in your past and on all the goals you had and never followed through on; now FOCUS and promise yourself that this current attempt at success will not end the same as times before.

Mike’s Daily Blog: Day 1

Day One: Monday, 11/27/2017

*Disclaimer: I’ve been doing keto for 1 year on and off and consider myself at an advanced level. It is advisable that you consult with your doctor(s) before making major lifestyle changes

Here we are, day one. I’ve said that to myself plenty of times. “Diets ALWAYS have to start on a Monday or they don’t count”, “Get all your cravings out the day before”, been there and done that throughout the years.

If you read my intro, you’ll know I’ve been at this a long time. At my worst in July 2013, I weighed in at a meaty 315 lbs. (photos to come shortly). Over the four subsequent years, I have finagled my way down to 240 lbs. This started off with low-calorie diets, low-fat diets, running over 4 miles per day, cutting sodas and fast food and incorporating some weight training in there. That got me from 315 lbs. down to 265 lbs. At that point, I hit the proverbial great wall. Nothing I did from August 2014 through November 2016 worked for weight loss. While working at Dr. Hizon’s office starting in November 2016, I was introduced to the ketogenic diet and intermittent fasting. I lost 25 lbs. in one month and have been at the new weight of 240 lbs. since then. One year later from the day I discovered the Keto diet, I am embarking on my journey to break through this current wall.

So, here we go. Anyone that knows me knows I don’t like taking off my shirt. Why? Sheer embarrassment. When you’re so big for so long, you get used to certain things like not wanting to take off your shirt in public.

Then why am I posting a collage of myself from all angles? Because I’m all in. This will help hold me accountable. I want to share my ups and downs with everyone. Weight loss is not easy; I know that firsthand. More importantly, I want to show that average individuals, such as myself, can achieve their physical goals.

How I feel: Genuinely excited. There was an internal debate over whether I would post to this blog as I went along or later in time. I knew that if I waited to post, I had a safety net. If it worked, I would post it. If it didn’t, I could always start on another Monday. That said, I’m sharing from the start.

What I expect: Ebbs and flows. Definitely feeling motivated to start. It helps that my family (mother, brother, sister) are all on board. Everyone is as excited as I am. I know that with Christmas coming, I will be tempted by food everywhere. I expect to have cravings when I hang around friends or go into work.

Alright, down to brass tacks, some measurements:
Weight: 241.8 lbs.
Body Fat: 24.1% (correlates to 58 lbs.)
Biceps: 35 cm (13 3/4 inch)
Bust: 114 cm (44 7/8 inch)
Chest: 108.5 cm (42 3/4 inch)
Waist: 98.5 cm (38 3/4 inch)
Hips: 101.5 cm (39 15/16 inch)
Thigh: 66 cm (26 inch)

Meals:
Breakfast: coffee + coconut oil + butter + heavy cream
Lunch: bone broth + coffee
Dinner: fasting

Breakdown: approximately 900 calories (95% fat, 2% protein, 3% carbs)
Water intake: over 128 ounces
Exercise: Ab workout, 1 hour spin class

Relaxation: Stretching, Steam room

Motivational word for the day: ENOUGH
You have to be fed up with your current situation to make real change. I am fed up with mine. Enough is enough. Enough hiding myself behind loose fitting clothing. Enough making excuses for myself. Enough starting diets and never continuing them. Enough not being happy. It’s time for a change…