Spilling ketones - Mothering Forums

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#1 of 22 Old 08-30-2012, 07:01 PM - Thread Starter
 
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Hey ladies. Maybe somebody can help me out! I am 15+5 and cut grains out of my diet a few weeks ago. I lost around 5 lbs, which my m/w said not to be concerned about. I started this pregnancy 20lbs over my normal weight anyway. Over the last several days I've been spilling small-moderate ketones and I've been having lots of headaches. I upped my food and carb (beans, fruit) intake and I've gained a bit of weight but I'm still spilling. I talked to my m/w tonight and she said I should eat rice daily if I'm consuming no other grains. I'd prefer not to, but if it is best for the baby I'll do it. Any advice?


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#2 of 22 Old 08-30-2012, 07:21 PM
 
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Have you considered the possibility of gestational diabetes?

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#3 of 22 Old 08-30-2012, 09:02 PM
 
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If OP is 15+5 and it's diabetes, it's pre-existing type 2, not gestational. Are you drinking lots of water, josie423? Ketones + h/a can be dehydration.


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#4 of 22 Old 08-30-2012, 09:14 PM
 
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It's not unheard of to detect gestational diabetes in early pregnancy...http://care.diabetesjournals.org/content/14/4/288

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#5 of 22 Old 08-30-2012, 11:29 PM
 
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This article http://care.diabetesjournals.org/content/33/3/676.long is quite a bit more recent. There's a relevant section toward the end titled "detection and diagnosis of overt diabetes during pregnancy". If diabetes is diagnosed for the first time during early pregnancy, by definition it's "gestational diabetes", but is likely (depending on mom's risk factors) to be pre-existing Type 2 DM that hadn't been diagnosed. 


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#6 of 22 Old 08-31-2012, 12:03 AM
 
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Whether you have diabetes or not, ketosis is pregnancy is a very bad idea. I would definitely suggest reintroducing enough grains to prevent yourself from remaining ketotic. My personal view is that any low GI grains are fine as long as you don't have any other reason not to eat them ( coeliacs etc) but as long as you're getting the nutrients from somewhere then, from a carb point of view, just rice should be ok. Try brown rice or basmati and spread your servings over the day. A single serving of cooked rice is 1/2 a cup. I would suggest that your goal is to eliminate the ketosis ASAP and then consider reducing your carbs to the minimum you need to stay there. Bear in mind that that amount may increase as your pregnancy progresses and your and the baby's nutritional requirements change. So I would continue too monitor the situation and tweak things as needed.

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#7 of 22 Old 08-31-2012, 04:22 AM - Thread Starter
 
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Thanks for the suggestions everyone! I don't think the issue is GD, and there is no pre-existing diabetes either (I'm 150 lbs and have no other risk factors). I thought over my food intake yesterday and realized I had very few carbs, so I'm sure that's it and a possibility of not drinking enough. Some days I do very well on water, some days not so well. Yesterday was so-so. I'm going to have some rice at lunch and eat more fruit as well. Hopefully that takes care of it! Oh, and is there any significance to the time of day I spill ketones? I am usually fine early on, but in the evening they are there. 

 

This type of eating demands much more vigilance than I am used to, but I don't think that's a bad thing. 


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#8 of 22 Old 08-31-2012, 04:35 AM
 
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How much fluid are you getting in?  I spill ketones in the afternoon if I have not drunk enough fluids during the day.  The two big things I suggest are 1) add a complex carb to each meal and 2) up your fluid intake. 
 

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#9 of 22 Old 08-31-2012, 05:58 AM - Thread Starter
 
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I try to get minimum of about half an ounce of water per pound of body weight, most days I get min. 70-80 ounces usually more. The first day I found I was spilling was after drinking close to 200 oz throughout the day. I'd had an awful headache since that morning and the water wasn't helping at all like it normally did, that's why I dipped a stick in the evening. 

 

I checked this morning before eating breakfast and it was just trace (small-moderate last night)? I find that odd, I would think it would be even more than last night after not eating for a whole night.


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#10 of 22 Old 08-31-2012, 02:57 PM
 
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Your basal metabolic rate is at its lowest overnight so you require less energy for basic functioning. During the day it is higher so you require more glucose. You're not providing that to your body with carbs so it needs to seek energy elsewhere. Your liver starts breaking down fats for energy and ketones are the byproduct of that.

If you're going to use fruit as a source of carbs may I suggest the lower GI ones or you're likely to experience blood sugar spikes and troughs which won't make you feel great either.

Also, the absence of diabetes risk factors doesnt exclude it completely so keep it in the back of your mind in case increasing your carbs doesn't improve things.

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#11 of 22 Old 08-31-2012, 03:45 PM - Thread Starter
 
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Thank you! That makes a lot of sense. I had a big lunch and had some rice with it, and also a carb-y breakfast and no ketones this evening. It seems like a pretty simple fix (I hope!).


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#12 of 22 Old 09-01-2012, 06:35 AM
 
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Ketones happen when your body is using fat for fuel. If you are on a low-carb diet, you will get ketones because your body is burning the fat you eat for energy rather than carbs. If you are diabetic, you can also get ketones, because your body is unable to effectively use glucose for energy and will begin to burn your body fat. I am unaware of any evidence that ketosis that is unrelated to diabetes is damaging to an adult or a developing fetus. I would be very interested in any research that addresses that, however. In the midwifery practice I work with, we are not concerned about ketones if they are due to a mama being on a low-carb diet.

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#13 of 22 Old 09-01-2012, 10:38 AM
 
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Hi, I had gestational diabetes and they made me test daily for ketones--apparently they can be really harmful to your kidlet (at least that's what they told me, I must admit that I never researched it).  You may want to look into it.

 

I can tell you that I only ever once got ketones when I really, REALLY skimped the carbs I ate (like 70 g carbs on one particular day).  With something like 90g carbs/day, all stuff like fruit, brown rice, sweet potatoes, steel-cut oats, etc., I didn't spill ketones.
 


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#14 of 22 Old 09-01-2012, 03:19 PM
 
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Ketones happen when your body is using fat for fuel. If you are on a low-carb diet, you will get ketones because your body is burning the fat you eat for energy rather than carbs. If you are diabetic, you can also get ketones, because your body is unable to effectively use glucose for energy and will begin to burn your body fat. I am unaware of any evidence that ketosis that is unrelated to diabetes is damaging to an adult or a developing fetus. I would be very interested in any research that addresses that, however. In the midwifery practice I work with, we are not concerned about ketones if they are due to a mama being on a low-carb diet.

I'm not aware of any research either but I'm not sure why a diabetes-related ketosis is different to a low carb diet ketosis. Why would one be harmful and one not?

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#15 of 22 Old 09-02-2012, 11:36 AM
 
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I'm not aware of any research either but I'm not sure why a diabetes-related ketosis is different to a low carb diet ketosis. Why would one be harmful and one not?

Because the ketones that are spilled in a diabetic are due to ketoacidosis, which is a disease process caused by diabetes which can lead to death. The ketones are a symptom, not a cause, of disease in the case of ketoacidosis. Ketones being spilled because of a low-carbohydrate diet don't cause the same health effects as ketoacidosis. In fact, ketogenic (ketone-causing) diets are prescribed to control epilepsy and neurodegenerative disorders. These patients do not suffer the same risks as someone who is diabetic being in ketoacidosis. Ketones don't, in and of themselves, cause a problem. A disease process that leads to ketones can, however.

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#16 of 22 Old 09-02-2012, 12:48 PM
 
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Hi all,

I just wanted to chime in on the ketosis vs ketoacidosis explanations. I actually have type 1 diabetes, so I've heard about the dangers of ketoACIDOSIS all of my adult life - and yes, it can kill you. That said ... nutritional ketosis is a very different beast, and many researchers now actually seem to believe that it is a very healthy state to be in. As other posters have mentioned, ketones are formed by your body when you are using fat for energy instead of carbohydrates - so most people who don't eat very many carbohydrates will automatically produce ketones. That state of nutritional ketosis is characterized by a lack of hunger and stable energy and a clear mind. What happens in type 1 diabetics is very different: they will, like anyone else, also make ketones if they eat a low-carb diet (actually the optimal diet for diabetics). There are two other necessary conditions that make this safe and healthy nutritional ketosis turn into diabetic ketoacidosis (and these conditions CANNOT BOTH OCCUR in a non-diabetic): the diabetic is dehydrated for some reason (perhaps he or she has been sick with a stomach flu and vomiting, can't hold food down, for example), and he/she has very high blood sugar (meaning, conversely, that he/she has not injected enough insulin). A non-diabetic will always produce the requisite insulin and so his/her blood ketone level will never go above something like 4 or 5 (if I remember right - I can't quite remember the exact numbers or units, but it is something like that, if someone else knows the exact figures please correct me) - whereas the blood ketone level in a diabetic in a ketoacidic state will reach 30, 40, something like that. What happens is that when the ketone levels are so astronomically high in the diabetic, his/her body actually becomes acidic, leading to diabetic coma and potential death. This is IMPOSSIBLE in a non-diabetic.

The jury still seems to be out on whether ketones are dangerous to the fetus... some doctors seem to worry about it a lot, and others don't seem to care at all. My personal take is that anyone who has had bad morning sickness and can't eat much at all will automatically go into nutritional ketosis. I don't think it is any kind of emergency. Also, I have read that the studies that made everyone get so worried about ketones in pregnant women were actually done on UNCONTROLLED diabetics - not healthy women in nutritional ketosis - so there is a high possibility that the actual danger to the fetus was in fact high blood sugars rather than the ketones, or perhaps a combination of the high sugars and the ketones, but the studies didn't show that ketones would be dangerous in the absence of high sugars. At least that is my laywoman's understanding of the studies!

Hope that helps!!
 

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#17 of 22 Old 09-02-2012, 02:54 PM
 
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I'm not aware of any research either but I'm not sure why a diabetes-related ketosis is different to a low carb diet ketosis. Why would one be harmful and one not?

Because the ketones that are spilled in a diabetic are due to ketoacidosis, which is a disease process caused by diabetes which can lead to death. The ketones are a symptom, not a cause, of disease in the case of ketoacidosis. Ketones being spilled because of a low-carbohydrate diet don't cause the same health effects as ketoacidosis. In fact, ketogenic (ketone-causing) diets are prescribed to control epilepsy and neurodegenerative disorders. These patients do not suffer the same risks as someone who is diabetic being in ketoacidosis. Ketones don't, in and of themselves, cause a problem. A disease process that leads to ketones can, however.

Well, no ketoacidocis is caused by the production of ketones. Ketones are acidic and alter the pH of the blood. The acid/base buffer system can compensate for a period of time but when it fails ketoacidocis is the result.

I agree that ketoacidocis is an extremely unlikely scenario in the case of dietary ketosis. I think what we don't know is how the foetus responds to elevated ketones, with or without maternal acidosis. Ketones readily cross the placenta and there is no research I am aware of to suggest what a safe level may be.

As the PP mentioned, some people believe that ketosis is a healthy state for adults but I am hesitant to extrapolate that to foetal wellbeing as well, especially as it is still only conjecture at this stage. And yes, I'm also aware a ketotic diet is recommended for some neurological diseases but then so is phenytoin ;-)

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#18 of 22 Old 09-03-2012, 12:39 PM - Thread Starter
 
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Thanks for all the info everyone! I have fruit at breakfast and have been having rice at lunch, but still spill ketones in the evening some days, so I've been working on upping my carbs even more. 

 

Some people think ketosis is healthy, and some are very against it.. So I guess I will be on the safe side and try to stay out of it. I feel like I am eating well, so if I spill them sometimes I'm not going to get crazy with worry.


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#19 of 22 Old 09-03-2012, 12:43 PM
 
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sounds like a great plan, josie! best of luck and keep us posted!
 

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#20 of 22 Old 09-03-2012, 02:44 PM
 
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Great. All the best. I hope you continue to feel well and have an enjoyable pregnancy :-)

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#21 of 22 Old 09-03-2012, 03:19 PM - Thread Starter
 
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Just a quick question I forgot to ask, could the ketosis be causing my headaches? When I don't have a headache I feel wonderful, but I get one almost every day now, starting mid-day. greensad.gif I do remember having a lot at this point in my last pregnancy though, and I wasn't in ketosis with him. I just don't know..?


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#22 of 22 Old 09-04-2012, 02:53 PM
 
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It could be but it could also be a pregnancy thIng. I got headaches every couple of days in the first trimester but they stopped in the second and third.

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