Keto for fertility and pregnancy from a keto dietitian

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The ketogenic diet (keto diet) is becoming so popular and is spilling over to the reproductive world. Many have their opinions on the topic. For me, 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.

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 (unless your eating fish daily – which probably isn’t most of us. Lauren can help with that too.) 

 

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 (Lauren can help you select these) .  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?

 

Ohhh..you 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. 

 

Conclusion

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.

A note to other RDNs, Laura has an extensive store on RD2RD if you want to check out any of her resources. Click here to check it out.