Over three years ago, I was diagnosed with a condition called Polycystic Ovarian Syndrome, or PCOS, the leading cause of female infertility. Since I have a family history of fertility issues, I was seriously concerned about my ability to conceive. Unfortunately, everything I read says there is no cure for PCOS. My research led me to several sources and online forums that recommended a very specific way of eating called the "Ketogenic Diet." You might have heard of it before, under its more common name "Keto."
Here are the basics: Every macronutrient in food provides energy. Carbs provide fast-acting energy that is easy for the body to break down and burns quickly. Proteins provide a moderate energy - they don’t break down or burn up as quickly as carbs. Fats are the slowest to burn - it's harder for the body to break fats down into fuel, making it the most stable and long-lasting source of energy in our food.
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When I found out I was pregnant, I wanted to make sure my hormone levels would support a pregnancy. Like every first-time mom, I became acutely aware of what I was putting into my body. All of a sudden, it wasn't just about me anymore - it was about my baby. While the Keto diet had helped heal my PCOS and amenorrhea - and it helped me lose some extra weight - I wasn't sure it was safe for my unborn child. I dug deeper. It turns out, pregnancy naturally puts the mother's body into a slight state of insulin resistance. The simple explanation of this is that it's an evolutionary tool designed to more effectively push nutrients to the fetus. In fact, pregnant women generally have significantly higher fasting glucose levels than women who aren't expecting. In this case, keto diets may help regulate those levels and bring them back into a normal range.
I am not a medical professional, so none of what I say here can or should be taken as qualified medical advice. No, I'm just a woman with a family history of Type 2 diabetes and insulin resistant PCOS, and a love of scientifically verifiable research. Once I heard that PCOS could cost me my fertility, I immediately dove headfirst into finding a way to treat it. Many women with PCOS suggested Metformin, a drug used to treat insulin resistance and diabetes with some common intense gastric side effects. While Metformin might be fine for women who aren’t pregnant, it’s got some side effects that your doctor ought to share. Specifically, Metformin can pass through the placental barrier, which means it can affect your baby. My endocrinologist won’t even prescribe it to pregnant women anymore, though many other doctors still do.
Beyond anecdotal evidence or animal studies, there isn't much research on pregnancy and the ketogenic diet. That's because there are obvious ethical concerns with studying or testing pregnant women and their unborn children. Unfortunately, that means that evidence-based care for the duration of pregnancy is an uphill battle. We just don't have a way to gather the evidence without pushing the bounds of reasonable liability.
Gestational Diabetes vs Keto
Most doctors err on the side of caution when giving advice to pregnant mothers. As an inexperienced mother myself, I didn't know any better - so I listened to my doctor. I stopped eating a ketogenic diet, and resumed a more carb-centric way of eating. I guzzled insane amounts of sugar water to subject myself and my baby to the glucose tolerance test. When my results came back, I was diagnosed with gestational diabetes. This wasn't too much of a surprise - my mother had gestational diabetes when pregnant with me, which means I have an 80% chance of developing it myself when pregnant.
[caption id="" align="alignnone" width="620"] Via CTV News[/caption]
After my diagnosis, my doctor referred me to an endocrinologist. Part of the endocrinology consult included a meeting with a dietitian - who immediately told me that I should be eating around 175 net grams of carbs per day. That's over SIX TIMES as many carbs as the Keto diet dictates! The endocrinologist told me that I'd be giving my baby schizophrenia (no, I'm *not* kidding) if I ate Keto while pregnant. She cited a study of rats on a "keto diet" - but at a closer look, these rats were literally starved in order to get them to produce ketones in their urine. That's probably closer to a state of ketoacidosis instead of nutritional ketosis, and nothing like a keto diet actually works in practice.
During my more recent pregnancy with my daughter, I made several changes. I ate a moderate-carb daily diet of 50 net grams of carbs or fewer. The nutritionist explained that I should be eating more carbs and I just nodded and smiled at her. I gained just half the weight I had gained when I was pregnant with Shep, which made this pregnancy somewhat easier on my body. Instead of drinking a huge dose of sugar water for the glucose tolerance test, I offered a compromise. I'd monitor my glucose by finger pricks so that my endocrinologist could get more data with which to make an evidence-based decision on my care and treatment. I staved off gestational diabetes for a whole month longer than I did with my son - but it got me again, that darn fetus beetus! But even this was different - I only needed insulin once per day (long-acting at night) and I needed less than half of what I required the first time around. My glucose levels were much more stable and mostly controlled by diet an exercise, with a boost of insulin for my fasting levels.
[caption id="" align="alignnone" width="889"] Via CAPITOL ZERO[/caption]
Now, I DO NOT advise you to ignore your doctors. AT ALL. Untreated gestational diabetes can be deadly to both mother and child, and it's incredibly dangerous to avoid diagnosis or treatment altogether. Notice that I was under monitoring by three different specialists throughout my pregnancy, and only one of them was upset that I wouldn't comply with the high-carb diet recommended. The rest were very happy with my health and the data I was providing for them, and saw no reason to think I was being unhealthy or threatening my child's health.
More Steak For Me
Honestly, the hardest part of the keto diet is denying yourself foods that you crave. When you're pregnant, it's tempting to "eat for two", even though that's not really how it works. In my opinion, the trade-off is totally worth it! Yes, keto improved my health overall. It helped me conceive - three times - and carry two healthy babies to full-term. But beyond all that, I GOT TO EAT STEAK WITH NO GUILT. What more could a pregnant mama with cravings for red meat ask for?