Forging and bringing an entirely new life into this world, the very idea of pregnancy can be quite anxiety inducing. Understandably, the desire to do everything right so that the baby has the best of everything is incredibly overwhelming.
Here, I discuss the details surrounding pregnancy on keto/carnivore.
The Placenta
The placenta along with the uterus is the home of the fetus through this 9 month journey. It tethers the life of the baby to the mother, so even before the baby is born, mother and baby share an intimate bond. It only makes sense, that the integrity of the placenta is of vital importance for the health of the baby.
This clip demonstrates how diet and nutrition is fundamental to the development of the child throughout the pregnancy.
The placenta of the vegan mother is anemic and calcified as opposed to the placenta of the animal-based diet mother, which is rich with blood. Though the physiological processes of calcification in the placenta are not well understood at this time, it is clear it is linked with inflammation, infection, and cardiovascular disease. The stark contrast between the two placentas is astounding, especially considering that it is the conduit between the mother and baby providing the lifeforce required for development. Additionally, a phenomenon known as placental abruption, where the placenta detaches from the uterus during the pregnancy, is seen commonly in vegetarians; a full abruption in a raw vegan. As mentioned in the video, midwives and doulas have noted that vegetarian placentas look like that of a smoker’s placenta. As a proportion, 74% of vegans are women; infants put onto a vegan diet can result in permanent brain damage.
How do we ensure the fidelity of the placenta, the tree of life for the baby?
Fixing the metabolism
The crucial aspect of pregnancy that everyone understands is eating healthy. But what does that really mean? For an optimal pregnancy, eating healthy means consuming foods that provide an adequate amount of protein, fats, nutrients, and vitamins in tandem with supporting proper cell energetics. In addition, these factors need to be in forms that are bioavailable and readily utilized by the body. Animal products such as meats, eggs, and fish are the cornerstones with which a healthy diet following those principles is built upon. Importantly, I also need to emphasize eliminating seed oils from the diet, as once an evolutionarily incompatible amount of omega-6, found in high amounts in seed oils, is incorporated into cell membranes, energy production is compromised, higher levels of inflammation is observed, and mobilization and utilization of crucial omega-3’s is negatively impacted.
Unfortunately, over half of the mothers attempting to conceive are metabolically ill. The fraction of Americans that are metabolically healthy stands at 12% and that number is only shrinking. This typically manifests itself in PCOS and difficulty achieving pregnancy. In the medical world, this is defined as having unprotected sex for over one year. Women and men with metabolic syndrome are insulin resistant and cell energetics are compromised. However, with proper diet management, the insulin resistance can be reversed; it has been shown over and over that once couples reverse their insulin resistance and metabolic syndrome, they are able to conceive effortlessly.
I realize that some parents who might be reading this are already well past conception or even birth. The important thing to keep in mind is that what’s done is done, focus on what you can do now to better support the health of your child. While there might have been some deficiencies earlier in their growth, you can still provide proper nutrition starting now to positively impact their continued development.
Ketones
When pregnant, women who were in ketosis before will notice that they get into ketosis more easily even without strictly restricting carbohydrates.
People erroneously believe glucose is the preferred fuel when ketones are a more efficient form of energy for the body(1). Clinicians still get ketosis confused with ketoacidosis.
Nutritional ketosis is the state of ketosis under normal physiological conditions, granted the individual is not consuming beyond a threshold amount of carbs. Starvation ketosis is a similar state, the only difference being that it is while occurring while fasting. Lastly, there is ketoacidosis where a diabetic does not have insulin or functioning insulin signaling that results in extreme levels of ketones in the blood. This is a medical emergency, but it is hardly seen in pregnancy if at all. In late pregnancy, maternal generation of ATP comes almost exclusively from burning fats; ketones are able cross the placenta; the fetus is also in ketosis during the third trimester. Moms that follow a ketogenic diet tend to feel better, gain less weight, and have fewer issues postpartum. Is it safe for the baby? Absolutely. Babies are in and out of ketosis every 2-4 hours, which facilitates the development of the brain, with ketones supplying 25-30% of the brain’s energy needs and 90% of the carbon used to make brain lipids(2) as fats cannot traverse the blood brain barrier while ketones can; babies’ body fat stores serve to extend the period in which they can remain in ketosis.
Preconception
The health of the baby starts from even before conception. Maternal nutrition prior to conception is of utmost importance. In just the first 12 weeks after conception, a significant amount of neurodevelopment has already taken place even before parents are aware and visit the hospital. Additionally, the metabolic state of the parents before and during the pregnancy affect epigenetic changes that influence the baby’s development. If the baby is exposed to elevated levels of blood sugars, it is much more likely develop conditions of obesity, diabetes, and hypertension later in life(3).
One thing that many women are not aware of is that OCP’s deplete B vitamins, zinc, selenium, and magnesium through low-level oxidative stress(4). Using prenatal vitamins which are typically in synthetic forms and less bioavailable when compared to organ meats is ineffective. They also lack iodine, choline, or iron. The vitamin A is in the form of beta carotene. Synthetic vitamin A is linked to teratogenecity, while naturally occurring vitamin A is not. As liver is nature’s multivitamin containing vitamin A, D, E, K, B12, and heme iron, the recommendation would be to eat 1-2oz of liver a day or larger amounts a couple times a week.
Experts recommend making appropriate adjustments to metabolism from 4 months to 3 years out prior to conception. As seen in the clip earlier, eating an animal-based keto/carnivore diet provides the most optimal sources of essential vitamins and nutrients. Frankly, what’s best for the baby is best for the parents as well.
In regards to fertility, on a carnivore diet, women report menstrual cycles are more regular and predictable. Increased levels of fatty acids DHA and EPA intake, found only in an animal based diet, improve fertility; Notably, about 40-50% of infertility is male factor. Nowadays, only 7% of sperm have normal physiology, where the ideal is 14%. So, maintaining a keto/carnivore diet goes a long way in preparing your body for the best chance at a successful pregnancy.
First Trimester
During the first trimester, the mother’s body is in an anabolic state and becomes insulin resistant with a 30% increase in production of insulin by the pancreas, glycogen accumulation in the liver, and fat cell hypertrophy. It is also during this time that the woman begins to suffer from nausea and aversions to food. So, during this period, the main focus should be to maintain an adequate consumption of calories regardless of its macro composition.
Second Trimester
In this phase, the mother’s body slowly transitions to a catabolic state. Typically, the nausea and food aversions abate at this point. During this time, rises in leptin and insulin resistance are also observed; these changes serve to maintain the mother’s appetite/cravings and reserve a larger portion of the consumed for the growing fetus. Concurrently, there is increased lipolysis and hepatic gluconeogenesis to ensure that the baby has all the necessary energy substrates available.
Through this period, hyperinsulinemia and gestational diabetes mellitus(GDM) is typically detected. GDM is essentially undiagnosed prediabetes that is too commonly incorrectly treated with metformin. In GDM, the blood glucose travels through the placenta but maternal insulin does not. The fetal pancreas is only functional at 10-12 weeks. Oddly, women are tested much too late for GDM at 24-28 weeks, well past the time period where neural tube defects formations would occur. Continuous glucose monitors(CGM)s are a valuable tool for pregnant women to monitor their blood sugar levels in real time. The devices are also much better tolerated for monitoring blood glucose levels compared to using OGTT. Women with poorly controlled GDM have children with a six-fold increased risk of obesity and diabetes (some studies show up to 19 times the risk), and macrosoma.
To avoid GDM, if the mother was already metabolically ill, diet modifcations needed to be made well in advance. Regardless if that was done or not, similar to preconception, the same applies to throughout the pregnancy. Particularly after the nausea in the first trimester subsides, implementing a/returning to keto/carnivore and monitoring with the CGM is an effective strategy to keep blood sugars in normal ranges and prevent GDM.
Tests to consider checking are A1C, C peptide, fasting insulin, and fat omega-6 composition.
Blood sugar levels should aim for 120 highest one hour post meal and 90 while fasting.
Postpartum
The work does not end after delivery. Sadly, the mother(especially in the US) ends up having to go back to work shortly after delivery. Whereas in other developed countries and traditional societies, mothers are afforded 4-6+ weeks to support her recovery. It is important to establish a support system that is ready to provide the mother the assistance she needs during this critical time.
Mothers who were used to being independent and fending for yourself also need to learn to let go and let your loved ones pamper you. They want to feel like they are able to contribute too!
Have meals prepared and ready to go. There will inevitably be times between waking in the middle of the night and fussing over the baby where the mom is simply not in any capacity to cook a meal. It’s at these times, having prepared meals helps to prevent the family from ordering out and eating nutritionally subpar food.
Nutrients
The best sources of the following nutrients and vitamins are from organ meats(such as liver and heart) and bone marrow. Raw foods can still be consumed, but use caution if it is not sourced from a reliable producer.
DHA and EPA – found in seafood and fat from animal products. Plants contain neither DHA or EPA. DHA is critical for brain development in the fetus during pregnancy and the first two years of life and several months leading up to pregnancy. DHA is 20% of the brain, the predominant structural fatty acid, and particularly important in brain development. The amount of omega-3s in the body is also inversely related to the amounts of omega-6 polyunsaturated fatty acid intake.
Protein – best sourced from animal products. Recommended 1.2 g per kilogram and 1.6 g per kilogram of protein in first and second trimester respectively. Even higher amounts are needed in postpartum period. Protein also helps to stabilize blood sugars.
Folate – found in egg yolks and liver, folic acid vs folate is important to distinguish. Folic acid is a synthetic form of folate that does not exist in nature; folic acid could block folate in the body. MTHFR is a gene polymorphism that impacts folate metabolism.
Riboflavin – found in liver and heart, in unresponsive iron deficiency it could be possibly due to riboflavin deficiency.
Choline – found in eggs and liver is important the transport of DHA, in optimizing brain development, prevents neural tube defects, and supports placental function.
Glycine – found in bone broth, for collagen needs of the baby, expansion of the uterus, and preventing stretch marks.
Iron – found in meat products, it boosts mental development, verbal learning, and memory. It is involved in the production of dopamine and serotonin. The heme form is the most bioavailable and found only in animal products; plant sources of non-heme iron are poorly utilized in the body.
Iodine – from seafood and seaweed, to improve the intelligence of the baby and prevent postpartum hypothyroidism. An element crucial to thyroid function and the production of hormones in the body. Across the board, effectively everyone is iodine deficient. So it is imperative that everyone supplements iodine, specifically moms-to-be. Thyroid function, which governs the body’s metabolism, plays a fundamental role in pregnancy. It dictates which genes are transcribed and influences the development of the fetus. Iodine supplementation can make a difference of 10-15 IQ points in the child. Do not eat broccoli as it inhibits the absorption of iodine.
Vitamin A – found in liver, for immune function of the baby for first half year of life. 1/3 of women are borderline deficient in vitamin A and conversion from plant versions are variable and generally poor.
Salt – Blood volume increases gradually up to 5 weeks, and nausea comes on 5 to 8 weeks which develops from brain edema -> nausea parallel with keto flu
Complications
Parents that are obese or diabetic have twice the risk of having children with autism and ADHD. If the mother has both obesity AND diabetes, then the child has four times the risk for autism.
Hyperglycemia during pregnancy is known to increase risk of neurodevelopment problems; ultraprocessed food similarly impacts cognitive development negatively. The elements of refined carbohydrates, seed oils that make up ultraprocessed food should be excluded from the diet for this reason.
TL;DR
When it comes to the important life milestone of pregnancy and raising a child, we want to provide the very best for them in terms of nutrition to support proper development and reduce risks for complications. The best way to do so is to adopt a keto/carnivore diet to eliminate metabolic syndrome and facilitate appropriate brain growth. The most bioavailable and utilizable forms of vitamins and nutrients are sourced only from animal products. Together, eating nutrient dense animal products with eliminating ultraprocessed foods and high carb intake from the diet provides the optimal conditions for a successful pregnancy and a healthy child.
Book recommendations
Real food for pregnancy by Lily Nichols, RDN
Real food for gestational diabetes by Lily Nichols, RDN
Media:
Papers:
- Inverse relationship between brain glucose and ketone metabolism in adults during short-term moderate dietary ketosis: A dual tracer quantitative positron emission tomography study
- Energetic and nutritional constraints on infant brain development: Implications for brain expansion during human evolution
- Exposure to sugar rationing in the first 1000 days of life protected against chronic disease
- Oral contraceptives and changes in nutritional requirements
- Effect of dietary macronutrient composition under moderate hypocaloric intake on maternal adaptation during lactation
Associations between lactation, maternal carbohydrate metabolism, and cardiovascular health
Extremely limited synthesis of long chain polyunsaturates in adults: implications for their dietary essentiality and use as supplements
Exploration of the perceived and actual benefits of omega-3 fatty acids and the impact of FADS1 and FADS2 genetic information on dietary intake and blood levels of EPA and DHA
Effects of early maternal docosahexaenoic acid intake on neuropsychological status and visual acuity at five years of age of breast-fed term infants
Iron deficiency anemia and iron therapy effects on infant developmental test performance
Iron deficiency anemia and iron therapy effects on infant developmental test performance
Effect of iron therapy on behavior performance in nonanemic, iron-deficient infants
Iron treatment normalizes cognitive functioning in young women
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