Katie Kish


High or Low Carb Diet?

When I found out I have gestational diabetes my first instinct was to eliminate most carbohydrates from my diet. When I finally saw the dietitian and doctor, two weeks later, I was scolded for that choice and told that it would produce high levels of ketones in my urine, which are ‘toxic’ for the baby.

Toxic? Really? Is that a word health care professionals use now?

I was in a state of distress and all the information coming at me was overwhelming so I didn’t question her. I went from 60 net carbs a day up to 140 net carbs and my glucose numbers went through the roof. My ketones went down from large to small and my insulin was going up-up-up everyday. It didn’t seem right to me. Maybe I hadn’t made the right choice to cut carbs as low as I had, but it also didn’t seem right to be eating SO MANY CARBS that I was finding it hard to eat my bedtime snack because I was so full from all the food I had eaten that day. Why couldn’t I increase to just 90 or 100 net carbs a day? 

So, I hopped on PubMed and started researching. 

There appears to be some evidence that ketones in urine during pregnancy can lead to learning disabilities, but the results are inconclusive and could be related to many other factors going on during the pregnancy and woman’s life. One study from 2009 suggests that ketones could have consequences for the neurocognitive development of the infant citing a chapter that doesn’t seem to address this directly and instead  recommends further research is needed on the impacts of ketones with no initial indication on the impacts, simply that pregnant women develop ketones faster than non-pregnant women. More recently, in 2013, some concerned developed regarding ketones and sufficient growth of organs, based on a study of mice.

However, in 1991 a study was published that questions the severity of these later published studies. Knopp et al. write:

In conclusion, 50% caloric restriction improves glycemic status in obese women with gestational diabetes but is associated with an increase in ketonuria, which is of uncertain significance. An intermediate 33% level of caloric restriction (to 1600-1800 kcal daily) may be more appropriate in dietary management of obese woman with gestational diabetes mellitus and more effective than prophylactic insulin. Further studies are required to confirm these findings.https://www.ncbi.nlm.nih.gov/pubmed/1770194

It might be, especially in overweight/obese women such as myself, that a slightly restricted caloric diet that still contains carbohydrates but will most certainly lead to ketones in the urine could be appropriate. But, the impact of weight loss is uncertain and therefore also not generally not recommended.

This is why it’s confusing. After a week of obsessive research my conclusions are:

“Yes cut calories by 33% (so you will see ketones and use less insulin because you’ll be burning fat) but don’t lose weight (so don’t cut your calories) and watch for ketones (likely by eating more carbs and needing to take more insulin) but we don’t have proof as to why – except that we want to definitely avoid ketoacidosis, but maybe not nutritional ketones … but we can’t tell the difference on the pee stick. Oh, and that high positive you get on your ketones might just be from dehydration and, Dr. Jovanovic argues that ketones in urine actually mean nothing (but I would take anything posted on Diet Doctor with a grain of salt because they don’t quite seem to understand what we can learn from mice and apply to humans).”


Oy. Vey.

AllinaHealth (and others I’ve read) suggest there is a problem only when both ketones and blood glucose are high. So, if I can keep my glucose low and ketones in moderation, maybe that’s the sweet spot. Hopefully, because that’s what I’ve decided to do and so far it’s working. My blood levels are nice and low and my ketones range from trade to moderate – usually depending on my hydration level. 

This has once again highlighted the importance of having a health care team that you trust. I am going to take this conversation to my team next week and see what they have to say – but I’m pretty sure they’re just going to stay to up my carbs and up my insulin to lower the ketones because that’s the standard route. I don’t believe they see people as indiviudalized agents with preferences who have done research themselves. I’m certainly not saying that I know more than a medical doctor, I just hope they’ll be open to having the conversation with me. And when they tell me to increase the carbs again, I hope they’re ready to explain why. 

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