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Balancing low carb diet and ketones

Hi, I am 27 weeks with my 7th baby... I have had 4 babies where I needed insulin, however it wasn't until last year when I developed type 2 that I looked into low carbs and have been implementing that diet.

So far so good any way. Not on meds and no glucose in my urine, or protein etc and really well controlled Bgl... this being a huge difference from when I was on insulin.
Ketones in pregnancy... diabetic, gestational diabetes or nothing is normal...

Ketones are released by fat cells when they break down and then come out as waste product in urine, this happens tenfold during pregnancy anyway and you need to drink plenty of fluids to wash them away... if it comes with glucose in the urine then it is a sign of gd... which you know you already have.

We are using a lot of energy to support our growing bumps and think about the calories burnt just getting around this huge weight!!! Yes it is an effort... the stretch marks testify to that. This means though our bodies are working hard to store fat ready for birth and breastfeeding etc, we are also burning and using more energy than normal just going about our daily lives... thus excess Ketones.

I wouldn't worry too much, just follow the Dr advice about drinking plenty of fluids, if you feel like you do need to add some carbs then I would while testing to make sure you don't upset the balance of Bgl.

Not long to go now so stay calm, relax, have a warm bath, face mask etc and have a whole lone of tea ready (possibly water too)...
 
I have had '++' and '++++' Ketones in previous pregnancies while on insulin... the midwives didn't bat an eye lid and seemed more concerned with the glucose and protein in my urine... they did take a blood test to check that my liver wasn't shutting down but they didn't seem that concerned after the blood results came back.

None of my kids have been adversely affected by Ketones in the way you describe and I think telling a pregnant woman this, when her Dr hasn't is likely to bring undue stress to her!
If the Dr was worried that her Ketones were too high I am sure she would not have been allowed home and put on an iv.
My husband is a phlebotomist and a lab technician, all of them will tell you the same thing... Ketones in pregnancy is normal. Yes too high is bad for you but then too high glucose is just as bad and can cause even more trouble.

(Not being said nastily just experience and knowledge learnt)
 
http://americanpregnancy.org/prenatal-testing/urine-test/

https://realmealrevolution.com/real-thinking/ketosis-key-to-human-babies-big-brains

I tried to post these last night but couldn't seem to sign back on until morning, yes there is one VERY old "test" on Ketones affects on mice... but we humans control our food... plus our diet is not similar to mice, it would be like putting a lion on a vegan diet and comparing the outcome with vegan diet on humans.
There is a difference between ketoacidosis and Ketones... the fact that 30% of babies energy comes from Ketones especially in brain development... thus I need to ask the question if a third of their energy for brain development comes from Ketones, how can Ketones be bad and negative for brain development?
 
Rather a biased interpretation of that study on the Real Meal Revolution site. Glucose/carbohydrate is the primary source of nutrition for babies. Babies are only n ketosis between feeds due to their high growth demands, so ketones are a back up not a preferred source of nutrition.

http://carbsanity.blogspot.co.uk/2015/06/babies-in-ketosis.html

The study in mice showing later cognitive deficits in youth will, of course, never be replicated in human foetuses because it wouldn't be ethical.

The bottom lne for me during pregnancy is that I'd rather err n the side of caution and avoid ketones as much as possible.
 
Problem with that is that up until this year the nhs only accept hclf as the ONLY way to treat diabetes and have only just accepted that this isn't the right way to do it for ALL people until recently.
We also know that certain drugs were given to women and we're KNOWN to be safe until it was discovered that those medications caused terrible side effects in those babies, not just dwarfism but also certain medication given for depression which cause brain damage in the baby.
We also KNEW that formula was best for baby until we didn't...

I followed their advice and diet and ended up with a baby in neonatal care because of it... yes rds is real and does happen... Ketones were produced because I was following their diet and the insulin I HAD to take because of their diet wasn't enough.
I disagree because of experience that "erring" as you call it is a good idea... as that could cause even worse problems including having a severely disabled child depending on which parts of your baby's brain is starved of oxygen and how good the hospital is! It took almost a year for my son to get over this damage and we are more than lucky to have escaped him being left with disability...which according to doctors in the John Radcliffe hospital (which he had to be transferred to) say was miraculous.
Following that advice could put you into ketoacidosis which is dangerous rather than just having the normal level of Ketones!?!

https://www.ncbi.nlm.nih.gov/pubmed/3884390

This is from the same body who tested on mice and show there is a different effect of ketogenic diet on human mothers and babies which is beneficial... thus we need to question the validity of carrying on using an outdated test on mice while other test results show no adverse affect and actually in opposition to that.

http://www.lowcarbdietitian.com/blog/guest-blog-post-is-it-safe-to-go-low-carb-during-pregnancy

You also have this site to look at... it also shows that medical professionals have and are changing their stance on low carb in pregnancy... I repeat ketoacidosis is bad but it is not the same as nutritional Ketones found in the urine and this one should explain it better.

I am convinced that lchf (healthy fat) is OK in pregnancy otherwise I would be back on the carbs...
 
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I remember you talking about your baby before - hugely upsetting. I can understand why you still think about that because I would. I had a bad hospital experience with my 2nd baby. It haunts you. I sympathise totally.

The key is BS cntrol and adequate carbs, in my opinion. Obviously, eating carbs without paying attention to BS is madness. I'd also add that women with GD who need meds are not failures in any way. Some women simply need med support to eat a good diet. That avoids persistent ketones.
 
But we need to ask which returns us to the op question... what is a safe amount of Ketones?
We know that there will always be Ketones in the urine especially in the morning, but this may not be in the blood!
Yes taking meds is not your fault with gd, and if you find you need it you should take it, I would always tell a mum to follow their body and what the body is telling them... the low carb diet I follow is extremely healthy and means I am getting more nutrients than I would have, my dietitian agrees which is lovely. It is lovely to see controlled Bgl without being hungry... though I do see them creeping up, they are still within range.

I know rds doesn't happen all the time with high uncontrolled Bgl.

It may be I was lucky with Ketones not harming any of my babies, I certainly wouldn't want to go through it...

Just a note of interest I was researching about the drugs that have been discovered to be harmful (such as the anti depressants and thalidomide) they have started tests and are now discovering that paracetamol has an adverse affect on male fetus when taken for a week! This test also done on mice but has been rejected by most medical professionals because the effect on mice doesn't always convert to humans!

I do believe that more testing needs to be done, maybe taking a case study of woman on here who are low carbing voluntarily and the effect on the baby...

This is always the problem when companies pick and choose which tests results to accept even when taken under the same condition (in this case one accept using mice the other rejected because they used mice!).
Also the link you shared with the kitchen analogy is flawed because it doesn't take diabetes into account! This turning up the heating would cause a huge gas/electric bill which may have repercussions later on... also I don't think trying to get a higher amount of Ketones with the theory of a more intelligent baby is a good idea at all as that could put you into ketoacidosis... they didn't really share any scientific evidence just argued the point, yet again though the point was lost due to not taking into account that (using their kitchen analogy) not everyone has enough money (insulin) to pay the bill...

A balance needs to be found and more research needs to be done... however due to the fact that we are all unique means that there is just no 1 size fits all.
 
I agree the kitchen link didn't take into account diabetes, but the points about the misrepresentation of that study still remain. It's equally true for people with diabetes and the facts it contain are, again, relevant to all women.

Diabetes isn't a reason to eat a diet that purposely causes ketosis during pregnancy.

Excuse the brief reply - children calling!
 
I didn't see a misrepresentation though!

Using his kitchen reference it could be used another way... being English it is hard to imagine certain things so changing it to our "language would make better sense...
I have a radiator in my kitchen which is designed to heat the room, however if I use this not only does it heat the kitchen but all the other rooms of the house that are empty and not in use. This is very inefficient, a waste of energy and expensive to run... some people may be able to afford to run the central heating constantly and without thought for the environment by using the central heating... then you have me who can't afford to do this and makes me very sick (yes having the heating on makes me feel ill!)
I have an electric oven in my kitchen which I am going to use anyway (which if used with heating makes it intolerably hot and in need of opening doors and windows) it still costs money to run, but not as much as using central heating. I can also use it to cook my food in.
Thus it makes more sense to use the oven, being more economic and better value money wise...
Central heating is carbs
Oven is low carb food
Money is insulin
Opening doors and windows would be the medicine

Now the better option would actually be to wear a cardigan... however until we work out what that is I will carry on using the metaphorical oven... both have side effects and cost to run, but we must look at what is less damaging both economically and financially.

Thus the kitchen analogy can be used to incorporate diabetes and comes out as lower carbs being better. We need the low carb foods and are already eating them (using the oven) we also know it produces energy (heats the kitchen)...

Again I need to ask the question if the scientists are happy to accept this result even though it used mice and yet reject another test result showing a medicine to be harmful and in wide use BECAUSE it used mice citing that the results from mice do not convert to humans... how can we accept either test as being definitive?
I use again the asimille of the lion, if we put a lion on a vegan diet and then used the conclusion that it was bad for humans as absolute... should we accept this?
The same can and should be said about the mice... the diet given to them is not the normal diet for a mouse! However the food in the low carb diet are normal foods for us which even high carbers consume... so how can the results be converted over to humans? This being a similar argument to the scientists rejecting paracetamol as being harmful in pregnancy!
I have seen several experts argue against the test of Ketones on mice and it seems the only people arguing against them are using that test as "evidence".
Knowing that pregnant woman are usually in a state of ketosis knowingly or not, diabetic or not is not a cause for concern... the Ketones in the urine are not in the blood and there is NO evidence to show Ketones in urine as being harmful to mother or baby... it is when the Ketones are in the blood that causes danger however that does not come from diet, that comes from insufficient insulin supply.
 
The misrepresentation is how the study is portrayed and also the comments about breastmilk, among other things. The fat content of breastmilk varies but one element of breastmilk remains constant because it's so important. That element is the carbohydrate content.

Pregnant women are not usually in a state of ketosis. Trace ketones occasionally appear but most of the time there are no ketones in the urine. The reason pregnant women are advised not to skip meals or leave too long between meals is to help avoid ketones because they are not advisable in pregnancy.

No, we're not mice, but genetically altered mice give us the best chance to mimic humans and suggest areas about which we should be concerned. With regard to the paracetamol, I was told that it was wise to limit its use as much as possible during pregnancy.

Fats are not the body's preferred fuel. They're a back up fuel. Carbs/glucose are our main fuel and even more so in pregnancy. Think about it. We can use that back up energy source (fat/ketones) when we have to eg in times of famine. That's how we were designed. However, 'starvation ketones' as they're often called signal to the body that it's in a time of famine. A 'time of famine' isn't the body's preferred time to grow another human being.
 
I very much disagree...

https://www.ncbi.nlm.nih.gov/pubmed/3808512

There is a difference between Ketones made because of starvation, dehydration, lack of insulin and diet!!!
You seem to be putting all Ketones into the same box as ketoacidosis!

Ketoacidosis is in the blood and not the same as Ketones in urine!

Ketones in the urine are PROVEN to be normal in EVERYBODY including pregnant woman regardless of gestation!

https://www.ncbi.nlm.nih.gov/pubmed/392766

This link shows the composition of breastmilk properly... yes carbs are Max 7% however fat is 5% and protein just say 1%... also some of those carbs feed the digestive flora and so do not get absorbed by baby... thus we still don't know if the 7% is total for baby and what is for flora! It also says that colostrum has a much higher amount of fats while a huge reduction in carbs.
I also think more work needs to be done in researching breastmilk as this result is probably from high carb mothers, I wonder whether there is a different composition for low carb mothers?
I also wonder why the colostrum which they say is the most important milk for baby has a much higher protein value and much lower carb value?

Also if "famine" as you call it (which actually is low carb) is bad then why do women who follow low carb diet become 5 times more fertile as well, evidence is from a previous link shared, both mother and baby are more equipped to survive... it seems to me you don't understand what low carb is... I am not in "famine" mode, nor am I starving myself... I get plenty of nutrients, I eat loads of cheese and so get plenty of calcium, loads of veg so get plenty of iron, potassium, folic acid etc... someone on famine would not be getting.
I have an extremely healthy diet, I am not losing weight or anything and knowing that it is professionals who have answered in the links shared gives me a big amount of confidence, unfortunately your links are hearsay, and old fashioned beliefs which are now being proven wrong. I don't mean to be disrespectful in this at all, I would just like you to understand that low carb does not equal starvation, instead of reaching for the biscuits I am reaching for nuts or cheese or yoghurt, which are not empty calories... how is that bad? I am in hospital on Thursday for a scan (28wk) I will let you know then how baby is growing... I have been low carbing all through this pregnancy and so far everything is normal and baby is growing nicely (not to big or too small) his organs are all good too. By 28wks with previous pregnancies baby's ac usually was starting to rise above his centile and I needed to be induced early before they got too big!
So seeing what happens next week will be huge.
 
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I'm Type 1. I am not putting all ketones in the same box.

I'm talking about ketones in relation to ketosis NOT DKA.

The mouse study I refer to is NOT talking about DKA either. It is concerning the possible risks of a low carb diet during pregnancy. The study suggests too few carbs can cause cognitive deficiencies in the foetus.

I thought I'd made that clear above but apologies as I clearly didnt. Whenever I've said or say "ketones" here, I mean ketones not ketoacidosis.

My OB said ketones were undesirable in pregnancy. She did not mean ketoacidosis. She meant ketones such as any pregnant lady could get. I'm sure most pregnant ladies with or without diabetes get occasional ketones, but the concern is persistent higher ketones (ie not just a trace).

The increases fertility you mentioned was related to women with PCOS/IR or who were overweight. I beLieve this is the study you mentioned:

http://www.mdpi.com/2072-6643/9/3/204/pdf

That talks about a high carb diet. Nowhere have I suggested that a high carb diet is crucial/good. As with most things, the answer lies in moderation - that is enough carbs (to avoid ketones) but not too many to the detriment of other nutrients. Also, of course, all foods should be good quality rather than processed ****.

I didn't say you were eating in a famine. I said that ketosis is the body's copying mechanism for dealing with famine. It's not necessary to eat low carb to have a healthy diet. I'm sure your diet is very nutritious - as is mine

For me, the issue is the possible problem of ketones in relation to the foetus. For that reason, I would never purposely aim for ketosis when pregnant, or ignore ketones. That is, I would - and did - eat enough carbs to stay out of ketosis. This level of carbs was not high nor did it consist of rubbishy foods. My BS was tightly controlled (lowest HbA1C in pregnancy was 27).

We all make our choices about what we consider best to do. Mine was to avoid ketones in pregnancy as much as possible. (As an aside, if you're wondering what I'd have done if I was Type 2, then I'd have eaten a moderate level of carbs and taken insulin if it was necessary to keep my BS in range).

Any ladies reading this can see our individual points and preferences, and then make their own decisions as to what's best, in discussion with their medical team
 

The mouse test on Ketones was about dka, the problem between the tests is that the Dr only accept a result that they "like" and deny the results of those they don't... I gave the example of the mouse fetus studies... one tested for Ketones the other about safety of paracetamol... Ketones is accepted and paracetamol rejected, it was rejected on the basis that even though human skin grafts and cells were used the subject was a mouse and THEY said that the outcome could not convert to humans!

https://www.sciencedaily.com/releases/2004/11/041123111459.htm

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3111740/
These tests showed benefits to the lchf diet!

There is no evidence to show Ketones as being bad, there are several ways Ketones come into the system, the most common is that of dehydration... especially morning sickness... this will also come with starvation because she can't keep anything down.
The second common will be stress.
The other is insulin.

As I am not losing weight I don't think I am in ketosis... you can eat a low carb diet and NOT be in ketosis. This is because there are a certain amount of carbs in most foods.
When I say low carb I talk about avoiding the high carb content foods.

Unfortunately just upping your carbs and going on insulin doesn't mean your Bgl will be under control. It also doesn't guarantee you won't get Ketones... like I said before I was on insulin and was getting way more than trace Ketones regularly, they tested my blood and the Ketones were not a concern, either because it was low in the blood or not at a level to worry about.
My your medical team were worried about dka with you being type 1? I guess we will never know.

Certainly though there is a huge risk by having high Bgl, being on medication does not guarantee that these will be kept under control or that the adverse effects on baby will not occur!

Being low carb doesn't mean being in ketosis, I have put on 9kg so far... (depressing) no Ketones found yet, but I am still on a very low carb diet... though I am eating more than I was before pregnancy. I know it I eat 1 slice of wholemeal bread I will be in double figures... which is damaging to my baby, to the lungs and organs as well as risk rds at birth and or them going hypo.

There are so many risks to calculate for... and while I worry that a lot of hospitals are behind (check qpr rating) my current hospital is really good. Though the targeted carb level is still above what my body can accept it is less than my old hospitals targets!
Each hospital gives different advice, I also think it will have different outcomes... I was only ever high carb so this will be my first comparison to those.

We know our bodies and what works and what doesn't, the problem is that diabetes in pregnancy is different and reacts differently. Yes listen to the medical bodies, but when going in, go in armed with as much material as possible... I would not tell another person to eat my diet, I am unique, what works for me may not work for someone else. I wouldn't however put them off it either.

We must all find our own paths... challenge the "professionals" who just tell you to do something as if you are just a number and they are just following a script. No one truly has the answer yet as to what is best, hc, lc... and that is probably because there just isn't a 1 size fits all... hc works for some and lc works for other...

Anyway sorry it took so long in answering, I was typing and finding the links at the same time... as well as dealing with kids!!!
 
Sorry I didn't report yesterday, was tired after the appointment...

I had a 1+ for Ketones which diabetes consultant didn't even mention. She looked at my Bgl and was really happy with them.
I did have raised liquid... however they have ruled out blood sugars as being the cause and are looking for an infection instead. (Got sucked dry by the vampires!)

The Ketones were there probably because my appointment was at 1:30 and had to leave the house by 12 to reach hospital on time... thus no lunch until I got home after 5! So I doubt the diet was the cause. I was too tired to cook, so my husband prepared food... I had a slice of pizza (really bad but smelt and looked too good to resist) and salad... Bgl 1 hr after was 7.6 so didn't suffer for it too much and won't repeat just in case.

Baby is growing well, moving well, blood pressure is excellent, no glucose or protein in urine...

I did ask to be moved to the morning session (so hopefully I won't miss a meal) and will see next appointment (32 weeks) how he is growing.
 
I had an appointment today. Baby is growing really well! Has a big head (at 31.1 his head already reads 305mm!!!)
Sugars under control, I had a 2+ for Ketones today so I did ask if it would be a problem... she said it is normal and she isn't surprised that Ketones were there, I did ask about damage to the baby, the response was ketoacidosis was the only thing to damage baby and that is with mums who are on insulin rather than in general. Consultant didn't even blink an eye at it TBH. So I would say if the consultant, midwives etc are not worried then it shouldn't be something for you to worry about either.
Hope everyone is well I won't keep boring you all with updates but thought that info may be found useful.
 
You have answered a question I was wondering about - many thanks
 
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