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Marlene Ellmer, BSc Diet, M Nutr, RD (SA,UK)
Aside from the factors already discussed above, it is imperative that pregnant and breastfeeding mothers maintain a healthy diet throughout pregnancy and breastfeeding. Although they should not “eat for two”, they need to provide “nutrients for two” and be very selective about the type of food eaten.
One “advantage” of the LCHF diet is the effect it has on appetite, namely that it can reduce it. This is known as a state of ketosis where the body’s glucose stores are depleted and as a result fat stores are broken down which produces ketones for energy. Typically, this happens when dietary intake of carbohydrate is ≤60g/day, although it does vary between individuals. No human studies have been done in this area to date, but animal studies show a strong association between ketosis and reduced milk production.13 It is argued that this may as a direct result of the lack of glucose in the mother’s diet which leads to poor lactose production. Furthermore, elevated levels of ketones may also affect the taste and smell of the breast milk, potentially altering the infant’s intake13.
One study carried out in 3601 pregnant mothers14 showed that high levels of urinary ketones led to a >2-fold occurrence of oligohydramnios (amniotic fluid insufficiency) and a significant increase in foetal heart rate decelerations.
It is widely acknowledged from nutrition studies that with LCHF diets, protein intake increases and high protein intakes are associated with bone mineral loss and calcium excretion13. A pregnant and breastfeeding mother’s calcium requirements are higher than most adults, putting her at a risk for poor bone health.
Excluding fruit and whole-grain from your diet may lead to inadequate intake of anti-oxidants and other nutrients and evidence has shown an association linking inadequate antioxidant status in utero and early childhood to an increase in the risk of allergic disease, amongst other concerns.15
Given the potential risks and the lack of evidence in this vulnerable population it is not suitable to recommend the LCHF diet to this group. The Institute of Medicine currently recommends a minimum intake of 175 – 210g carbohydrates per day for pregnant and lactating mothers.9
If you suffer from gestational diabetes, your dietary requirements will be highly individualised and it is strongly recommended you consult a registered Dietitian with particular focus in this area of nutritional management.
The Health Professions Council of South Africa (HPCSA) protects both the public and patients by making it compulsory for all Dietitians to be registered. We are required by law to keep up to date with the most scientific evidence available and we specialise in supplying the public with this evidence in a manner that is effortlessly accessible and easily understood. Ultimately, our patient’s well-being and state of health is of utmost concern.
I would like to thank Dr. Rosan Meyer, (Principle Paediatric Research Dietitian Research and Education Manager of the Food Allergy and Intolerance Specialist Group, Great Ormond Street Hospital for Sick Children London) and Dr. Carina Venter (Senior Research Fellow at the University of Portsmouth, Senior Allergy Dietitian, The David Hide Asthma and Allergy Research Centre, Isle of Wight, UK) for their comments and contributions to this article.
References:
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