Is low carb and keto safe during pregnancy?

“I find it ironic that if you tell your doctor that you plan to eat low carb during pregnancy, they’ll say it is unsafe, but if you say you to plan to eat a diet based on fresh vegetables, meat, fish, eggs, dairy, nuts, seeds and a little fruit, they will tell you to stay the course,” she says.

She also notes, however, that some women especially during early days of pregnancy feel better eating slightly more carbs. If that happens “don’t beat yourself up, go for it. You have to get through the first trimester anyway you can.” But try, she says, to always opt for nutrient-dense food. “All pregnant women benefit from the most nutrient dense diet they can manage and that just happens to be naturally lower in carbohydrates.”

Real keto moms

For some moms like Jill Kingsley, who has experienced two high-carb pregnancies and a third ketogenic pregnancy, the advantage of the latter was exceedingly clear. She decided to switch to a ketogenic diet 16 weeks into her third pregnancy this past year after experiencing extreme nausea. Within 24 hours of switching, her nausea resolved.

“It was obvious, my body runs better on fat and protein. I can’t do carbs,” said the 32-year-old Mesa Arizona mom. Her two previous pregnancies had been wrought with issues: swelling and bloating, high blood pressure, extreme nausea, and infections. She had complete bed rest for her entire second pregnancy because her nausea was so bad she couldn’t stand up.

Jill Kingsley

In her keto pregnancy her blood pressure was normal and her weight gain moderate, she experienced no swelling or bloating, and she felt great. She marvels at the fact that during her keto pregnancy she was going for long walks with no difficulty right up until labour, when during her second carb-fueled pregnancy “I couldn’t even get out of bed.”

She gave birth to 6 lb 9 ounce (3 kg) Justin Tyler Kingsley on July 11 after 3 hours and 2 minutes of labour, from the time her water broke to delivery. “He is my perfect keto baby.” Her midwife, who had never attended to a keto mom in more than 300 births, was at first a bit skeptical and then amazed at the results. She told Jill that with her keto eating “You took your pregnancy from high risk to low risk for both you and your baby.”

For Carolina Cartier, it frustrates and even angers her that anyone would suggest, with her health history, that she add carbs back in during pregnancy for her twins and that she must eat a daily carb requirement. She firmly believes it was her mother’s high-carb eating and poorly controlled gestational diabetes, exposing her to high blood sugars and high levels of insulin in utero, that set her up for her metabolic issues. “The ketogenic diet was such a simple fix to all my problems. Had anyone ever said ‘Don’t eat sugar or foods that convert to sugar’ I might have avoided two decades of pain.”

So not only is Carolina firmly staying keto through her pregnancy, she has enrolled to retrain as a nutritionist at a Bastyr University in Washington State for Fall 2018, after her maternity leave. “I want to support and empower other people, particularly pregnant moms, in this diet.” In fact, she is already a frequent commentator helping other would-be moms learn about ketogenic eating on two closed Facebook groups10 devoted to ketogenic pregnancies. Each already has around 5,000 members, and growing.

In some recent advice to other members about what to tell your doctor about how you have chosen to eat for your baby, she counselled: “Don’t say keto. It makes them scared. Say you’re eliminating sugar and processed, starchy foods. No doctor is going to give you a daily sugar requirement.”

Anne Mullens

Halle Berry Revealed She Was On the Keto Diet While Pregnant—But Is That Safe?

Christopher Polk/Getty Images

It’s no secret that 2018 was the year of the keto diet. A year later, the trend shows no signs of slowing down any time soon. Celebs like Kourtney Kardashian, Alicia Vikander, and Vanessa Hudgens continue to spill their high-fat, low-carb eating tips on their IG stories. Recently, fitness queen Halle Berry took to Instagram to drop some of her keto wisdom as part of her infamous #FitnessFriday Instagram series.

For those who might not be familiar with #FitnessFriday, Berry and her trainer Peter Lee Thomas get together every week and share details on IG about their wellness regimen. In the past, they’ve talked about everything from Berry’s favorite workouts to her intense fitness goals for 2019. Last week’s chat was all about keto. (Related: Halle Berry Admits to Doing This Very Questionable Thing When She Works Out)

Yes, Berry is a huge proponent of the keto diet. She’s been on it for years. But she’s not about “pushing the keto lifestyle” on anyone, she said in her latest #FitnessFriday post. “It’s just the lifestyle that we subscribe to that works best for our bodies,” Berry added. (Here’s everything you should know about the keto diet.)

Berry and Lee Thomas shared all sorts of keto tips, including some of their go-to keto snacks: TRUWOMEN Plant Fueled Protein Bars (Buy It, $30) and FBOMB Salted Macadamia Nut Butter (Buy It, $24).

Toward the end of their chat, Berry revealed that she stayed on the keto diet throughout pregnancy as well. “I did eat pretty much keto, mainly because I’m diabetic and that’s why I’ve chosen the keto lifestyle,” she said. (Related: Halle Berry Says She Does Intermittent Fasting on the Keto Diet—Is That Healthy?)

ICYDK, doctors recommend the keto diet for a plethora of medical conditions, including diabetes, polycystic ovary syndrome (PCOS), and epilepsy. But how safe is it really during pregnancy?

“For obvious ethical reasons, we do not have any studies that say it is safe to be on the ketogenic diet during pregnancy, so I can’t really advocate for it,” says Christine Greves, M.D., a board-certified ob-gyn from Orlando Health.

The few studies that are out there specifically highlight the dangers of not having enough folic acid during pregnancy, explains Dr. Greves. She says that carbohydrates found in grains like wheat flour, rice, and pasta (all big no-no’s in the keto diet) are rich in folic acid, which is very important for fetal development, especially during the first trimester.

Women who eat a low-carb diet during pregnancy are at a greater risk of having a baby with neural tube defects, which can cause the child to develop conditions like anencephaly (an underdeveloped brain and an incomplete skull) and spina bifida, according to a 2018 National Birth Defects Prevention study. That’s part of the reason why, in 1998, the FDA required the addition of folic acid to many breads and cereals: to increase the amount of folic acid in people’s general diets. Since then, there has been about a 65 percent reduction in the prevalence of neural tube defects in the general population, according to the Centers for Disease Control and Prevention (CDC).

Despite the potential dangers of eating low-carb during pregnancy, some exceptions can be made for women who have medical conditions like diabetes and epilepsy. “In medicine, you have to weigh the risk versus benefits,” says Dr. Greves. “So if you have epilepsy or diabetes, some of the medications used to treat those conditions can end up being more harmful to the fetus. In those scenarios, the ketogenic diet might be an acceptable non-pharmacological alternative for controlling symptoms and ensuring a safe pregnancy.”

But since some people go on the keto diet to drop pounds, Dr. Greves notes that weight loss is not recommended during pregnancy, nor is going on a diet you haven’t tried before. “Instead, you should focus on nourishing your body and your growing baby,” she says. “By restricting carb-rich whole grains, beans, fruits, and certain vegetables, you can easily fall short of valuable fiber, vitamins, and antioxidants.”

Bottom line? If you have any questions about your diet while you’re pregnant, it’s always a good idea to talk to your doctor first. They’ll help you make the right decision for your body and your baby.

Ketosis is a safe state of metabolism for most adults and has many health benefits. However, those who are pregnant or looking to get pregnant might be wondering if the ketogenic diet and ketosis can fit into this cycle of life, too.

Whether ketosis is safe and beneficial to pregnant women is a very important thought to ponder. In this article, we’ll cover in more details this important question, so you can make informed decisions when considering ketosis during pregnancy.

Pregnancy and Ketones

When a woman is pregnant, the body goes through a lot of changes. Even when a couple is trying to conceive, they’re likely more aware of the choices they make about food. Let’s look at how ketosis fits into the life of a woman trying to get pregnant and through pregnancy.

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Getting Pregnant in Ketosis

Ketosis may actually be helpful for getting pregnant. For example, it’s been recommended for women with polycystic ovarian syndrome (PCOS) who have struggled with getting pregnant (a common symptom of PCOS). In a pilot study on PCOS, two of the women in the study became pregnant even though they had previously dealt with infertility .

In addition, just as a well-planned ketogenic diet is safe for the average person, it’s also safe for women who are trying to get pregnant, especially if she was eating high-carb or Standard American Diet foods before switching to low-carb ketogenic and improving her health.

So with that, the next question becomes, “is it safe to continue ketosis throughout the pregnancy?” While ketosis can be helpful for getting pregnant, the rules are a little different during pregnancy.

Safety of Ketosis During Pregnancy

Before we get into ketosis during pregnancy, let’s examine some of the common beliefs about ketosis during this time of life—because there’s a lot of misguided information out there.

Misconceptions about Ketosis During Pregnancy

When anyone talks about ketosis being unsafe in pregnancy, they’re likely referencing studies on diabetic ketoacidosis (DKA), which actually is very harmful and entirely different than nutritional ketosis.

Let’s look at the differences:

  • DKA is a very dangerous metabolic state seen in people with diabetes where insulin or diet isn’t properly managed. DKA includes levels of ketones that are unnaturally high and blood sugar levels three or more times higher than the norm. This creates a dangerous acid-base balance in the body. Ketoacidosis should be avoided by all pregnant women (and anyone in general).
  • Nutritional ketosis is a natural metabolic state in which the body is primarily using fat for energy instead of carbohydrates. It includes very low ketone levels and blood sugar that is normal, as well as a healthy acid-base balance in the body.

When there’s confusion about the difference, it can cause professionals to assume nutritional ketosis has the same effect as DKA, especially since studies have suggested DKA is harmful to brain development of the fetus . This has led to a widely accepted belief that ketosis during pregnancy is harmful to the baby; however, this is misinformation.

Let’s look at some of the facts.

Natural Instances of Ketosis in Pregnant Women

Most pregnant women suffer from morning sickness, at least in the beginning of their pregnancy. Between that, nausea, low appetite and food aversions, it’s not uncommon for eating to be sporadic and often in low amounts, at least during the early stages of pregnancy. This will naturally occur taking pregnant women temporarily in and out of ketosis.

We should note here that ketosis is a natural part of being human. For example, between the time we eat dinner and wake up to have our first meal, the body is in a fasting state (think about it: our traditional first meal of the day is literally called breakfast). This is true for everyone including pregnant women.

Additionally, the state of pregnancy may even favor ketosis. That’s because the blood ketone levels in healthy pregnant women after a fast overnight are around three times higher than that of women who aren’t pregnant .

Ketosis in Late Stage Pregnancies

It appears ketosis happens naturally quite often in women who are pregnant, especially in the late stage pregnancies. The fetus uses ketones before and immediately after birth to make essential fats in the brain during growth . In fact, researchers believe fetuses might even make their own ketones. This could be the reason ketosis is more common in pregnant women during the third trimester.

During the late stage of pregnancy, a woman’s metabolism also switches to a catabolic state (the breaking down of molecules). This means ketosis is happening more often . Note the frequent occurrence of food aversions and nausea experienced by many pregnant women. This alone will naturally reduce the frequency and amount of food intake, which more easily puts you into ketosis.

Low-Carb and Pregnancy

As registered dietitian Lily Nichols says in this article, it seems safe for women to eat lower carb during pregnancy as long as they are still eating certain foods for proper nutrition.

Fetuses require both glucose and ketones to grow, so a balance is key. What’s important is to ensure the mother has normal blood sugar levels and is getting enough calories.


Although ketosis is natural and safe if done effectively, big changes happen in a woman’s body and extra precautions must be taken during this cycle of life. Here are some things to keep in mind for those who are pregnant, whether in ketosis or not:

Don’t aim for weight loss. We know the ketogenic diet is effective for weight loss, but for most pregnant women, pregnancy is not the time to pursue it. No matter what way of eating is being followed, getting enough calories and proper nutrition is most important.

Eat whole foods. Speaking of nutrition, it’s especially vital when you’re growing a baby. That being said, there are some foods with carbohydrates that are important for pregnant women to include in their diets: vegetables and fruits, nuts and seeds, legumes, and sometimes dairy.

Avoid refined grains, added sugars, and processed foods. The quality of carbohydrates is important to ensure the diet is nutrient-dense and both mom and baby are getting the good stuff they need to thrive.

Don’t do intermittent fasting. While intermittent fasting has a variety of benefits for the average person, it’s not appropriate during pregnancy when it’s most important to listen to your own hunger cues and ensure mother and baby are getting enough nutrients for growth.

Take Away Message

While extra considerations definitely must be taken regarding diet during pregnancy, don’t let fear mongering convince you that a healthy ketogenic diet is damaging—especially compared to the standard diet most people are eating.


Mavropoulos, John C et al. “The Effects of a Low-Carbohydrate, Ketogenic Diet on the Polycystic Ovary Syndrome: A Pilot Study.” Nutrition & Metabolism (2005): 35. PMC. Web. Rizzo, Thomas A., Sharon L. Dooley, Boyd E. Metzger, Nam H. Cho, Edward S. Ogata, and Bernard L. Silverman. “Prenatal and Perinatal Influences on Long-term Psychomotor Development in Offspring of Diabetic Mothers.” American Journal of Obstetrics and Gynecology 173.6 (1995): 1753-758. Web. Felig, P., and V. Lynch. “Starvation in Human Pregnancy: Hypoglycemia, Hypoinsulinemia, and Hyperketonemia.” Science 170.3961 (1970): 990-92. Web. Herrera, E. “Metabolic Adaptations in Pregnancy and Their Implications for the Availability of Substrates to the Fetus.” European Journal of Clinical Nutrition 54 (2000): n. pag. Web. Coetzee, E. J., W. P. U. Jackson, and P. A. Berman. “Ketonuria in Pregnancy–With Special Reference to Calorie-restricted Food Intake in Obese Diabetics.” Diabetes 29.3 (1980): 177-81. Web.

If it seems like the keto diet is everywhere you turn right now, well, you’re right—everyone and their mother is on the high-fat, low-carb plan.

But should expectant mothers be on keto at all? Or is that just a bad idea—for mom and baby?

First things first: There is definitely an ideal pregnancy diet—and it’s not keto.

Honestly, dieting during pregnancy in any way isn’t recommended—especially when you’re supposed to be consuming an extra 300 calories each day, according to the American Pregnancy Association.

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Above that, a balanced diet during pregnancy is key, says Christine Greves, M.D., a board-certified ob-gyn at the Winnie Palmer Hospital for Women and Babies. That means fruits, vegetables, whole grains, proteins, you name it. “You’ll also want to avoid supplements other than prenatal vitamins, and avoid foods that are high in added sugars and fats.” Sure, you’re probably going to throw a little Ben & Jerry’s in the mix, but focusing on a overall well-rounded diet is the goal.

A lot of that is pretty much the opposite of keto—the low-carb, high-fat diet that actually encourages dieters to limit many fruits (sugar equals carbs, btw) in order to stay in ketosis, the state during which your body uses fat for fuel instead of carbs.

But…is it okay to do keto while you’re pregnant?

Honestly, no one knows for sure—there just isn’t scientific data to say that it’s okay (or not okay) to be on the keto diet while you’re pregnant.

“At this point, there’s very little known about its effects on the developing fetus,” Greves says. Constantly being in ketosis is a concern—since ketosis isn’t a normal body state, and doctors really have no idea how that might affect a fetus.

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Aside from the keto diet in general, pregnancy is usually not a great time to try to lose weight. “I would say wait, and eat what we know is okay during those nine months of gestation,” Greves says—and if you’re compelled to lose weight after having your baby, start then.

That said, not all aspects of the keto diet are potentially at odds with a healthy pregnancy diet. People typically cut down on processed foods while they’re on keto, and that’s never a bad thing, Greves says. You can also work on limiting the amount of sugary foods you eat, while making sure to eat plenty of healthy fruits (and veggies) that can benefit your pregnancy.

“Just try to eat more healthy in general,” Greves says. Then, after you have the baby, there’s no reason why you can’t go keto (just keep in mind that it might not be the best option right away, while you’re solely breastfeeding).

Of course, if you have any questions about your diet while you’re pregnant, talk to your doctor. They should be able to help steer you in the right direction.

Korin Miller Korin Miller is a freelance writer specializing in general wellness, sexual health and relationships, and lifestyle trends, with work appearing in Men’s Health, Women’s Health, Self, Glamour, and more.

TUESDAY, Jan. 30, 2018 (HealthDay News) — Having a baby? Don’t skimp on carbs.

Following a low-carbohydrate diet during pregnancy may increase a woman’s risk of having a baby with serious birth defects, a study by researchers at the University of North Carolina at Chapel Hill suggests.

Compared with pregnant women who didn’t restrict their carbohydrate intake, those on a diet that reduced or eliminated carbs were 30 percent more likely to have babies with neural tube defects. Those include spina bifida (spine and spinal cord malformations) and anencephaly (missing parts of the brain and skull).

These birth defects can cause death or lifelong disability, the study authors said.

“We already know that maternal diet before and during early pregnancy plays a significant role in fetal development. What is new about this study is its suggestion that low carbohydrate intake could increase the risk of having a baby with a neural tube defect by 30 percent,” study leader Tania Desrosiers said in a university news release.

“This is concerning because low-carbohydrate diets are fairly popular,” she explained. Desrosiers is a research assistant professor of epidemiology in UNC’s School of Global Public Health.

“This finding reinforces the importance for women who may become pregnant to talk to their health care provider about any special diets or eating behaviors they routinely practice,” she added.

An essential nutrient called folic acid (vitamin B9) is known to reduce the risk of neural tube defects. This study found that dietary intake of folic acid among pregnant women on low- or no-carb diets was less than half that of women who didn’t limit carbohydrates.

All women who plan to become pregnant should take a daily multivitamin with at least 400 micrograms of folic acid before and during pregnancy, according to the U.S. Centers for Disease Control and Prevention.

Since nearly half of pregnancies in the United States are unplanned, many women may not take the supplements until later in pregnancy, after a neural tube defect might have occurred.

However, the study authors pointed out that, in the United States, folic acid is added to enriched grain products, which can be an important source of the nutrient for women who may become pregnant.

According to the American Pregnancy Association, good dietary sources of folic acid include leafy green vegetables, such as spinach; citrus fruits, such as orange juice; beans; and fortified breads, cereals, rice and pasta.

The study was published Jan. 25 in the journal Birth Defects Research.

Whether you just started following my blog or have been at it for years, you know I have a special interest in prenatal nutrition. That means I inevitably get a lot of questions about what I personally ate during pregnancy.

Well, I’m spilling the beans today.

Remember last year when I spoke at Paleo f(x)? My talk, The Carbohydrate & Pregnancy Controversy drew a bigger audience than I expected. And little did I know, Leanne of Healthful Pursuit and her assistant were in the audience taking notes.

Leanne first reached out to me to set up an interview about ketogenic diets and pregnancy this summer, but alas, with a small baby, no childcare, and life being crazy pants, we got delayed. Like… 6 months delayed.

But, you know what? Babies eventually get a little less clingy, eat things other than the milk your body produces (even if they’re still milk monsters), and lo and behold, childcare gets arranged and BAM, things-other-than-babying get done… sometimes. Imagine that?!

It’s with great pleasure that I share with you my interview for The Keto Diet Podcast where we cover a whole host of questions about carbs and pregnancy, like whether a low carb or ketogenic diet are safe in pregnancy, how metabolism shifts during pregnancy (and what that means about carbohydrate needs), Qs and As about ketosis, and some important considerations about going low carb while breastfeeding.

Listen here or on iTunes (The Keto Diet Podcast, Episode 21)

Here are a few highlights from our interview:

  • Is low carb right for everyone? How does low carb affect women with infertility or amenorrhea? Should women eat low carb if they’re having trouble getting pregnant?
  • How do blood sugar levels affect infertility and rates of miscarriage?
  • Are carbs required for pregnancy? Is it safe to stay low carb while pregnant?
  • What happens during the first trimester that makes it tough to stick to low carb? Is it ok to cheat more? (psst – I share my personal experience with morning sickness from my pregnancy and the not-super-healthy food that got me through the tough days)
  • How does insulin & insulin resistance differ in the first half vs second half of pregnancy and what does that mean when it comes to your diet?
  • What to do when: “I just crave carbs every day? I love being ketogenic, and I love being low-carb, but I can’t seem to stick to it while pregnant?!”
  • The importance of mindful eating and staying open-minded about food during pregnancy.
  • Real talk about why eating healthy before getting pregnant is so, so helpful (beyond just getting enough nutrients to your baby).
  • How low-carb can you go in a pregnancy? Is it safe, is it not safe? Do I need carbohydrates to make my baby grow?
  • Possible reasons pregnant women often go into ketosis (whether a mom eats low carb or not).
  • Why you shouldn’t freak out if you feel “puffy” or “pudgy” in the first trimester. (HINT: there’s a metabolic reason for it!)
  • My thoughts on intermittent fasting and pregnancy. “I just heard that ketones are really good for the baby, so should I fast to create even more ketones?”
  • Why breastfeeding moms should quit worrying about macronutrients and what to do instead.
  • Foods to emphasize while breastfeeding to make sure you’re making enough milk (and nutrient-rich milk).
  • What I ate postpartum (with a little more specifics beyond ALL. THE. FOOD.)

As I say in the interview, when I wrote Real Food for Gestational Diabetes (which for those of you who don’t know, is the first book that scientifically defends a lower carbohydrate diet during pregnancy), I was coming at the topic from the stance that whoever was reading was a) diagnosed with gestational diabetes and b) most likely in the second half of their pregnancy. That means the nutrition recommendations, while totally safe and healthy, aren’t always practical when you’re battling first trimester nausea and food aversions. Leanne and I chat about what’s going on in your body in the first half of pregnancy vs. the second half and what that means about how many carbohydrates you need.

HINT: you’re not “weak” or “hurting your baby” if you can’t maintain eating low carb in your first trimester.

WARNING: I share a LOT of #truthbombs in this interview.

If you don’t mind me quoting myself…

I think at the end of the day, we have to do a lot more mindful eating in pregnancy than prescriptive eating.

And this one:

“I feel like pregnancy is such a chance to surrender. It’s a good preparation for motherhood… You have to get less serious about yourself. There’s going to be so much that’s out of your control. All you can do is do the best that you can at the time.”

Aaaaaand this one about why eating healthy BEFORE getting pregnant is SO key:

“You’re probably not going to magically switch to being a vegetable lover while you’re pregnant, nor is there any chance you’re going to want to, or be able to, continue that postpartum when you have zero time to yourself, and zero time to cook. The time to eat healthy is now. Get it in your bones. Learn to make vegetables taste good. Learn to cook, learn to enjoy healthy foods, and then you’ll figure out how to make it work during and after pregnancy.”

Have you listened to our interview yet? Get on it, sistah!

Until next week,

PS – If you enjoyed our interview, tell me about your favorite “aha moments” in the comments. I certainly hope you can intelligently answer the Q: “Are carbs required for pregnancy?” after tuning in.

PPS – Wanna learn the science behind low-carb and ketogenic diets during pregnancy. Check out my training over on Vimeo, based on my uber popular presentation at Paleo f(x) 2016, The Carbohydrate & Pregnancy Controversy: How Conventional Recommendations Stack Up Against the Evidence.

Can You Do Keto While Pregnant? You Might Not Want To Ditch The Bread Just Yet

I used to spend a lot of time working in the fitness and health blogging industry, and many of my friends are still working in this arena. In our circles, there is one diet that has swept the industry more than any other — the keto diet. I know many people who’ve had tremendous success losing and maintaining their ideal weight with this diet. I also know moms who’ve used ketosis to help get pregnant, and kept a keto diet during their pregnancy, but is it safe? Can you do keto while pregnant?

The science surrounding the keto diet is still in its nascent stage, given that the diet’s popularity is so recent. However, there have been studies completed that highlight its effectiveness as a treatment for mothers who suffer from epilepsy or diabetes. Unfortunately, another study showed that it’s possible that women who follow a strict ketogenic diet while pregnant could give birth to babies with larger hearts and smaller brains, although it’s important to note, this study was only looking at the effect of a ketogenic diet on mice, and not humans. But it’s also important to remember that almost all studies begin the same way and have a measure of translatable consequences for the human population.


The diet is more controversial than you might think given its popularity. Last week, in US News and World Report’s yearly rankings of the best diets overall and the best diets for weight loss, keto came in dead last. The explanation given for such a low rank included the difficulty to maintain the diet, the lack of support and community for people on the diet, the lack of nutrition counseling, and the overall healthfulness of a diet stacked with fats and meats which have long shown to impact health negatively.

Simply put, it’s hard to stay on the diet, expensive to eat that way, and really easy to eat nothing but bacon and steak. Also, there are little to no grains allowed on the ketogenic diet, and decades of research has shown that whole grains are linked to a healthy life and lower risk of premature mortality, according to Harvard University. Not only that, but studies suggest that the resistant starches found in some whole grains, like barley, brown rice, and in other carbs like bananas and potatoes, can combat the fatigue and nausea associated with pregnancy, as well as aiding in digestion.


I asked a friend and nutritionist Kristan Albany, MPN, RD, about trying the keto diet during pregnancy. She tells Romper that it’s not the best idea, but that you can keep certain aspects of the keto diet while you’re pregnant. “It’s always a good idea to load up on veggies, and the keto diet really stresses the need for a lot of greens and a ton of veg, which is excellent.” She says that where keto becomes problematic is in the amount of fat consumed and the lack of carbohydrates. “If you’re pregnant, you need carbs. Unless your doctor has you on an extremely restrictive diet for a reason, carbohydrates are your first line of defense against lagging energy and nausea.” That’s not to say that you should eat them in an unlimited supply — quite the contrary. Albany notes you should be picky about the carbohydrates you eat, and choose the ones that are healthiest and that you can stomach.

Albany also explains that the fat intake that accompanies a ketogenic diet is often from saturated sources like bacon fat and beef fat. While there is some research that grass-fed beef and pork fat isn’t as troublesome as grain fed, many dieters aren’t making this distinction, and even then, the difference is negligible. “Calories add up, and you want them to be as nutritious as possible,” Albany implores. You might not want to give up your morning bowl of Cheerios while you’re pregnant, but instead do the bacon and avocado switch postpartum.

Check out Romper’s new video series, Romper’s Doula Diaries:

Watch full episodes of Romper’s Doula Diaries on Facebook Watch.

Keto for fertility and pregnancy from a keto dietitian

The ketogenic diet (keto diet) is becoming so popular and is spilling over to the reproductive world. Many have their opinions on the topic. I generally recommend a Mediterranean-style diet for those TTC AND pregnant. However, people will do what they want to do, and one of my role responsibilities as a dietitian is to “do no harm”. Because of this, I can not ignore those following this diet because they are not playing by my rules. If someone is going to follow the keto diet, I want to make sure they are being as safe as they can.

Since I am not an expert in keto, I enlisted the help of a friend and colleague. Laura Dority is a registered and licensed dietitian. She has been working with patients who require guidance to follow the ketogenic diet for medical purposes (like epilepsy in the pediatric world). She presently basically runs the nutrition show at the Medical University of South Carolina, and before that worked in the keto world at Riley Children’s Hospital in Indiana.

She and I also combined forces and created an ebook called Keto For Fertility. It is available if you need more information, studies, meal plans, recipes, and details than what is provided in this post.

I asked her some questions about this diet, and she was gracious enough to give her expert opinion. Hope you enjoy!

1. Can you briefly explain what the ketogenic (keto) diet is, and why it has become so popular?

Simply put, a ketogenic diet is a very low carb and high fat approach to eating. When done correctly, a ketogenic diet changes the body’s metabolism from using glucose (sugar) as the primary fuel source to ketones (fat). The diet consists of eating large amounts of healthy fats such as olive oil, avocados, flaxseed, nuts, seeds and very very small amounts of carbohydrates – typically from fruits and low carbohydrate vegetables. Dairy products such as heavy cream, butter and cheese are allowed (of course unless you are following a vegan ketogenic diet) as well. Protein is also included on the plan but shouldn’t be consumed excessively because then the body will process it similar to glucose.

A typical breakfast may be bacon, eggs and avocado. Lunch a salad with chicken, cheese, avocado, bacon, and an olive oil based dressing. Dinner may be a steak with butter and asparagus.

It has primarily been used for the treatment of medication resistant epilepsy for over 100 years but has recently become a popular weight loss diet as well. Every day on social media there is a link to a new celebrity or influencer losing loads of weights and quickly on a ketogenic diet. While the diet can be very effective for weight loss as it eliminates about 60% of foods we typically consume thus creating a calorie deficit…the bigger question is…is it sustainable? And what happens if you stop eating the ketogenic diet way and go back to eating carbs? Weight gain??? Probably!

Weight loss isn’t the only reason it has become so popular in the last few years though as claims have been made that ketogenic diets can help a variety of disease states including but not limited to diabetes, migraines, traumatic brain injury, autism, acne, chronic pain, cancer and autism. Some of these diseases do have good evidence/studies for ketogenic diets helping while others are purely speculation and need a lot more research.

2. What do you like about this diet?

I like that the ketogenic diet takes us back to real foods. If you think about most of the carbohydrates in our diets, it tends to be breads and pastas and cereals and all of those products are really heavily processed. This diet takes all that away. It makes you focus on real foods – vegetables, berries, meats (ideally organic), cheeses, eggs and fats. When done correctly it can be very a clean diet free of most additives and preservatives. Although you do have to be careful because as the diet has gained popularity so the “keto junk” food has hit the market such as keto cookies and keto brownies. No one needs that stuff and I would never encourage eating “keto junk food” often just like I would never encourage someone on a regular diet to be eating cookies and brownies.

The other thing I like about the diet is that it is also very satiating so you stay full!

Oh yay and I should mention that for my particular specialty of pediatric epilepsy…it works! About 50% of the kiddos we put on a ketogenic diet get seizure improvement and some of them even get off all their seizure medications. That’s pretty amazing and super rewarding as a dietitian.

3. What are your thoughts on following the keto diet to enhance fertility?

Honestly I think it depends on the reason for fertility issues if it will help or not but I am fully supportive of women using this therapy for preconception. If someone is having trouble with fertility due to weight issues or PCOS (definitely for PCOS), this diet can help you lose a large amount of weight in a short period of time which could certainly help with fertility but you just have to be careful that once you resume a less restrictive approach to eating you do not gain all the weight back.

In addition since a ketogenic diet when done correctly can be anti-inflammatory, it can help improve chronic body inflammation and potentially enhance fertility in that manner. On this point though, you have to be extra careful to eat a very clean approach to the diet. Focus on healthy oils such as avocados, olive oil and flaxseeds or other nuts over bacon, butter and heavy cream. Make sure to purchase organic meats, eggs, fruits and vegetables. You do not want to trade regular bread for a “keto bread” that can be full of artificial sweeteners and chemicals and such…that won’t help your bottom line. But I do think that a well-planned, clean ketogenic diet certainly could help with enhancing fertility. As with most diets though, it’s not a one-size fits all so if embarking on this endeavor you should always be followed by a Registered Dietitian familiar with ketogenic diet therapies or a dietitian who specializes in fertility.

Finally the ketogenic diet can help reduce levels of insulin (remember you need insulin to break down carbohydrates) which can be linked to improved fertility. Some very preliminary studies have also shown that improvement in reproductive hormones has also occurred for those on a ketogenic diet. We do know that the ketogenic diet has a link to hormones and metabolism in a beneficial manner but we haven’t quite figured out all the specific details of this effect.

4. What about keto during pregnancy?

Great question and one that is difficult to study because it is difficult to conduct research on pregnant women for the obvious reasons.

Unfortunately we do not know exactly what happens with a women is pregnant and in ketosis (again the body/brain functioning off of fat). What does that give the baby in terms of energy – glucose/sugar or fat/ketones? Will the baby grow normally? Will the baby develop normally? Those are the research questions we just don’t have answer to at this point in time. So I cannot recommend ketogenic diets for pregnant women at this time. Of course my answer may be different in 5 years as research in this area continues to evolve.

Now what I do think can be done during pregnancy without detriment to the baby is a lower carb diet. So not a very low carb/high fat diet that induces ketosis (again remember that is when your body is functioning off of fat instead of sugar) but a lower carb diet than most Americans eat is not a bad idea. I think using some of the “rules” of the ketogenic diet while pregnant would be fine. Such as cut out bread, pasta, sweets, treats and all of those really heavy carbs and junk food. Focus on eating more berries and low carb vegetables – never hurt anyone!! Getting a good intake of organic protein sources such as meats, eggs, nuts and seeds are all great foods. Eating an avocado a day (something I often recommend to my clients) is super low carb/keto friendly and crazy healthy. So In general I think a modified version of a ketogenic diet can be healthy for pregnancy with the caveat of your body should not be in ketosis but you can still eat very clean and low carb.

For anyone on a ketogenic diet (both preconception and during pregnancy) just make sure you are supplementing with the following and gaining appropriate weight:

· A great prenatal vitamin (I’m sure my friend Lauren can help you choose a good one.)

· A calcium supplement if you don’t drink cow or nut milk fortified with calcium

· Fish oil supplement with a nice 50/50 blend of EPA and DHA

General recommendations are as follows (to be used for educational purposes-these are not personalized recommendations and should not be treated as such):

· A high-quality prenatal with at least 600 mcg folate, 150 mcg iodine, and provides some biotin and Vitamin E (minimally)

– A range of 1,000-2,000 IU Vitamin D per day (in the D3 form, not D2 form)

– A blend of calcium and magnesium (to be taken in the evening)

– An omega-3 supplement with an approximate 50:50 ratio of DHA and EPA

– A multi-strain probiotic supplement that contains a variety of lactobacillus strains. Ensure you are consuming prebiotic-rich foods (like garlic, onion, and asparagus) to “feed” your probiotics.

– Carnitine (to aid with your increased fat digestion)

Additional antioxidants may be considered.

5. If a women chooses to follow the keto diet, what suggestions do you have for her to help keep her bowel movements regular? Some women complain that they have trouble with this when following this diet

Oh yes good old constipation. The #1 side effect to the ketogenic diet. Well first ladies you aren’t alone! Here are some tips:

1.) Eat an avocado daily. They are natural laxatives.

2.) Use coconut oil. Coconut oil is 66% medium chain triglycerides which is a special type of fat that can have a laxative effect as well.

3.) If coconut oil doesn’t help, then use pure MCT oil. You can add this to your decaf tea or coffee or add to a smoothie. Just don’t cook with it.

4.) Make sure you are drinking enough fluids.

5.) Spend your carbohydrates on leafy green vegetables. Most ketogenic diets allow 20-40 grams of carbohydrates. Personally for me I educate people to count net carbs so total carbohydrates minus fiber (not everyone in the keto community agrees on whether we should be counting total carbohydrate or net carbohydrates) but either way you get a certain amount of carbohydrates a day (you have to eat some!) so spend those carbohydrates on vegetables so you get lots and lots of fiber to help you stool.

6.) Start a good probiotic with at least 5 different strains of bacteria for overall gut health.

6. Do you think that the keto diet has any effect on egg quality? Knowing that antioxidants are key for enhancing egg quality, what role does following the keto diet have on egg quality? know I really don’t know. It’s a great question. When considering antioxidants though, the diet (when done correctly – starting to sound like a broken record) is anti-inflammatory so in theory your antioxidants would be put to better use than clearing the body from inflammation and “pro-oxidants.” In other words they would be freed up to do other bodily functions. In addition the foods people should be eating on a ketogenic diet such as berries, vegetables, dark chocolate (this can fit into a well planned ketogenic diet in small quantities…so good),nuts and seeds all contain large amounts of antioxidants. So it’s possible that the supply of antioxidants would be higher than the body’s demand which isn’t a bad thing and certainly could improve egg quality.

Let’s remember though that it’s not just about the egg…it could be the sperm quality. A typical diet full of those junk carbohydrates (think bread, chips, etc – not talking fruits and vegetables here) can impact sperm health. So for men who go on a ketogenic diet full of healthy fats sperm health can improve.


So there you have it straight from the expert. I think it is important to gain many different interpretations of diets and nutrition practices, as each clinician practices a little differently. You will encounter many dietitians who are 100% against the keto diet, and they have valid reasons for concern. But if you are going to be following this diet regardless of their opinion and advice, I hope this helps.

Learn more about keto for fertility, including specific studies, specific supplement recommendations, meal plans, recipes, and more by clicking here and checking out our ebook!

Pregnancy Chronicles: 1st Trimester

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If you haven’t heard by now…I’m pregnant! Surprise!!! We’ll be welcoming our third baby to the family in May! We couldn’t be more excited to complete our family (a.k.a. this is our last baby)!

Disclosure: the following post is solely a document of my personal experience of pregnancy on my keto journey. All thoughts and opinions are my own. I am not a medical professional and cannot answer medical questions. Please consult a doctor before becoming pregnant or if you have questions about eating keto while pregnant.

In complete transparency, we were 100% surprised to find out I was pregnant! We were not trying, nor had we even discussed when we would have another baby. However, God had other plans for us and our little pea pod and for that, we are so thankful!

We are calling this our “keto baby” because we are VERY confident this pregnancy was the result of our ketogenic lifestyle. Having lost a combined 100 lbs, my husband and I were very healthy. We both worked out 3-5x per week, kept our diet 99% keto, and never felt better. Lo and behold the first month we weren’t careful “around that time” and BOOM, we’re pregnant!


My goal from day 1 was to stay keto, continue my workout regimen, and essentially keep my lifestyle the same. Ha! How naive of me! You’ll hear women say every pregnancy is different and that is SO true! This pregnancy has been my hardest yet! I was so sick the first 9 weeks! I could not eat anything more than plain bread and crackers. Forget eating anything keto! I was in survival mode and eating whatever didn’t make me sick or miserable feeling.

When you’re pregnant, your body produces the hormone progesterone. This hormone slows down your digestive tract and causes (in most women) constipation, gas, heart burn, etc. Trying to eat high fat meals has been extremely difficult for me because they make me feel so miserable afterwards (because of the aforementioned).

I have had to eliminate almost all dairy from my diet because of the constipation it causes. Now that I’m heading into my 2nd trimester, that has eased up a bit, and I’ve slowly started reintroducing it. I also ate bacon for the first time in 3 months this week! I know, I know…how ghastly!

I wouldn’t be a transparent blogger if I pretended that I haven’t indulged and satisfied my weird pregnancy cravings either. I have. OFTEN. Taco Bell, y’all. I don’t know what it is about this baby but it wants ALL THE TACOS! What is wrong with me?!? Haha! Aside from my bizarre Taco Hell cravings, I’ve tried to eat low carb (not keto) as much as possible. Since my husband still wants to eat keto, I am fixing suppers as I would have before which helps me eat balanced meals. However, I might add a small baked potato or some extra veggies to my dinner that he wouldn’t eat.

Overall, I have not followed a strict ketogenic or low carb diet these past 12ish weeks. I do have goals/plans for future trimesters but we’ll get to that in a second.


Obviously, pregnancy has some pretty noticeable and exaggerated side effects. I already mentioned the digestive issues. Another one can be dizziness. I stopped going to the gym around 7 or 8 weeks because I was getting so dizzy and nauseous during my workouts that I didn’t feel safe. I was also too sick to get off the couch most days which didn’t help either.

I’ve gained 8 lbs in my first trimester which is a little bit more than recommended (3-5 lbs is “normal”). I think a big reason for that is not going to the gym. I feel flabby and have noticed my legs/arms aren’t as lean as they were before. I suppose that’s to be expected when you don’t work out but it has created mental hurdles (I’ll get to that next).


The weight gain and shift in diet has had a profound impact on me mentally. This is something I haven’t addressed with anyone, even my husband.

Switching from a weight-loss state of mind to a pregnant state of mind overnight wasn’t easy. Having lost 40 lbs this year, I was/am terrified of undoing all my progress. I see pictures from when I was pregnant with my son (who is now 2) and I cringe at the thought of ballooning up like that again. Obviously, I’m not going to try and lose weight right now, but I also don’t want to gain more than I have to.

With pregnancy comes unavoidable bloating. My face is very puffy and will continue to be that way until after the baby is born. That has been hard to see in pictures when I was so lean before.

One thing that helped me jump one of those hurdles was pulling out my old maternity clothes. They were all WAY too big for me, even if I was full term. I was much larger before getting pregnant with my last child. So the reminder of how far I’ve come reassured me that I’m not filling out as much as I feel.

For those of you who want to become pregnant soon or are pregnant now, remind yourself that pregnancy is temporary and you’re growing a HUMAN BEING! Try not to fixate on your body image and just embrace all that pregnancy brings to the table. I’m going to do the same!


As I enter my second trimester, the glorious unicorn trimester, I have goallllllls girlfriend!

I really want to get back to the gym at least 3x a week. Not only will I feel better, it will help make my delivery and recovery easier. Since this will be my 3rd c-section, I want to have the strongest tummy possible. I’m also hoping it will help slow down my weight gain this round.

I plan to eat healthier than I have been. I’m going to go back to my bunless burgers and omit sugar as much as possible (I have eaten sweets). I don’t plan to eat strict keto but I will watch the carbs and stay away from processed foods. It would be naive of me to say I won’t give in to cravings or ignore food aversions, but I’m going to try and be as good to my body (and baby!) as possible! I’ll get my husband to hold me accountable (though he’s probably scared of me right now, ha!).

You can follow my pregnancy journey on Instagram (@keto_in_pearls and #ketoinpearlspregnancy). Are you pregnant and keto? I’d love to hear how you’ve managed it!

Happy Thanksgiving y’all!



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Is the Keto Diet Safe for Pregnant Women?

Forget Paleo or Whole30—when it comes to popular diet plans, the ultra high-fat, low-carb keto diet is king these days. But what is the keto diet, and why does it have people shunning bread, pasta and fruits for cheeses, meats and avocados? And is the keto diet safe while you’re pregnant?

The short answer: no, pregnant women shouldn’t go keto. Read on to find out why experts recommend moms-to-be steer clear of this trendy eating plan.

What is the keto diet?

The keto diet (short for ketogenic diet) generally requires consuming 75 percent of your daily calories from fat, 20 percent from protein and just 5 percent from carbohydrates. Unlike some low-carb diets that recommend nixing sugar and processed grains (like white bread and pasta), going on the keto diet also means eliminating nearly all carbs from your diet, including fruits, whole grains and some vegetables. Why? Carbs are the body’s preferred energy source; when the body runs out of carbs to burn, it turns to fat and protein, a state called ketosis. This can lead to rapid weight loss.

Keto diet proponents say that eating this way increases energy, lowers diabetes risk and helps you lose weight quickly without any hunger. But the science behind keto is very limited, with very few clinical studies in humans. Researchers have cautioned that there’s still a lot we don’t know about how high-fat, low-carb eating impacts long-term health.

Is the keto diet safe during pregnancy?

When it comes to the keto diet and pregnancy, research is even scarcer. There haven’t been any controlled studies done in pregnant human women as testing on this group is, understandably, discouraged. However, pregnant mice fed a ketogenic diet experienced many problems with their offspring, including slower growth, smaller hearts and brains and an enlarged spine. “A ketogenic diet during gestation is associated with organ dysfunction and potentially behavioral changes in postnatal life,” according to the study, published in BMC Pregnancy & Childbirth.

“The keto diet is simply not safe for pregnant women,” says G. Thomas Ruiz, M.D., OB-GYN, Lead of Obstetrics at MemorialCare Orange Coast Medical Center in Fountain Valley, California, adding that the basic premise of the keto diet—teaching the body to use ketones instead of glucose—doesn’t work for growing babies. “Glucose, from carbohydrates, is the primary energy source for baby’s growth and development and not having enough glucose can cause serious problems,” he explains.

Not only can the keto diet lead to developmental delays in your baby but it can also cause nutritional deficiencies if done incorrectly, which can lead to serious problems for both pregnant women and their babies, says Lily Nichols, RDN, CDE, author of Real Food for Pregnancy. Many people who follow the keto diet strictly don’t eat foods like fruits, nuts, beans, and many vegetables—sources of essential micronutrients necessary for the healthy development of your baby, she says.

This doesn’t mean you should eat all the carbs all the time and if you’ve learned in the past that your body responds well to a lower-carb diet, it’s fine to continue with that, Nichols says. “I am one of the few dietitians who speaks out in support of lower-carb diets during pregnancy, but it doesn’t have to be an all or nothing situation; you can get the positive effects from reducing your carbs without having to go full keto,” Nichols says.

The key is to remember that not all carbohydrates are created equally. Both experts recommend cutting out simple carbs from junk foods like cookies, sugary cereals, candy, chips, soda and ice cream but keeping healthy carbs like berries, apples, beans, sweet potatoes and squash.

Is the keto diet good for gestational diabetes?

Gestational diabetes rates have doubled in the past decade, with up to 8 percent of all pregnant women getting it, according to the Centers For Disease Control and Prevention. Since the condition can lead to serious complications for both the mother and baby, it’s important to keep your blood sugar in check during pregnancy, Dr. Ruiz says. But while the keto diet has shown to reduce diabetes in non-pregnant people, there is no evidence that the diet helps with gestational diabetes, he says.

“If you have gestational diabetes, we recommend lowering your daily carbs while increasing your protein and vegetables,” Dr. Ruiz explains. “I also tell my patients to eat smaller, more frequent meals throughout the day to keep blood sugar stable. You can definitely maintain a stable blood sugar without going into ketosis.”

Nichols advises her clients to focus on cutting out processed carbs, like candy and junk food, while increasing their intake of veggies, nuts, seeds, and healthy fats and protein. “Just making those changes will help your blood sugar significantly without having to cut out all carbohydrates,” she says.

What if I’m pregnant and overweight?

Unless your doctor specifically advises you otherwise, you should not try to lose weight during pregnancy. While the weight gain recommendations vary based on your starting weight, your body’s first priority is growing a healthy baby so that should be your main focus during your pregnancy, not dieting, Dr. Ruiz says.

However, two-thirds of women start their pregnancies already overweight or obese so losing weight while pregnant is a question Dr. Ruiz says he hears often. While he discourages actively trying to lose weight, he also points out the importance of not gaining too much weight during those nine months either. Nearly half of pregnant women gain more than the recommended amount which can increase their risk of preeclampsia, heart disease, diabetes and macrosomia (having a very large baby). So how do you find that sweet spot of enough but not too much?

If you are in the normal BMI range (18.5-24), then you should aim to gain 25 to 40 pounds during your pregnancy, he says. Underweight women (BMI <18.5) should gain at least 40 pounds, overweight women (BMI 25-30) should gain 10 to 20 pounds, and obese women (BMI >30) should maintain their weight or gain less than 15 pounds, he says. (For a more specific number, use our pregnancy weight gain calculator.)

If you are obese, your doctor may want to do more regular ultrasounds to monitor the baby, making sure that he or she isn’t growing too big (as can happen with gestational diabetes) or too slowly (as can happen if you’re cutting too many calories to lose weight), Dr. Ruiz adds.

Rather than relying solely on your weight as an indicator of your health, Nichols says pregnancy is the perfect time to shift your attention to increasing the quality of your diet.

“I don’t think overweight or obese pregnant women should to be looking at it as ‘I need to lose weight’ but if you focus on eating a nutrient-dense, real-food diet that’s not excessive in refined sugars automatically your weight gain will settle into the correct range for your body,” Nichols explains. “I counsel patients to choose better quality foods and be mindful of their hunger and fullness cues.”

What is the ideal pregnancy diet?

Now that you know the keto diet might be off the table, what diet should you follow? First off, you need to make sure you’re eating enough calories. Calorie needs vary quite a bit depending on your starting weight, height, age, and activity level, but in the second and third trimesters it’s generally recommend you eat 2,200 to 2,600 calories a day, Nichols says. (Wondering about your first trimester? Because your baby is so small, your calorie needs don’t go up and doctors recommend gaining just two to four pounds during this time.) If you are having multiples, your calorie needs will be even higher, she adds.

When it comes to the form those calories come in, Dr. Ruiz recommends the Mediterranean diet as a balanced way to get in all your necessary nutrients. Lots of fish, beans, olive oil, and greens will keep you full and your baby healthy.

“If you eat an omnivorous, real-food diet, you won’t need to stress about your weight or your nutrient intake,” Nichols says. Here are her favorite pregnancy foods:

  • Eggs: the choline is good for baby’s brain development and your placenta

  • Fatty seafood: low-mercury fish like salmon and sardines are particularly good choices

  • Red meat for iron

  • Non-starchy veggies: spinach, kale, green beans, and zucchini are all good options, as the folate will help your baby’s nervous system and the fiber will keep you regular

Keto diet and pregnancy

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