Wednesday, June 27, 2012

The Answer to the Big Question

* This article is Part II in a series. To see Part I, click here. To see Part III, click here. 

Okay, folks.... It's time to wrap up my year-and-a-half research mission into the big question....

"Does a very-low-carbohydrate diet work to prevent hyperemesis gravidarum?"

And the answer, the definitive answer, based on eighteen months of research and one practical experiment during our last pregnancy, is....

"Errrr.... I think so."

You can read about how I found out about the very-low-carb diet here. You can read my summary of results from using that diet before and during pregnancy here.

To sum up my pregnancy (more detailed summary at the above link):

I used the VLC (Very Low Carb) diet for 40 days before getting a positive pregnancy test. I started a strong HG slide at 3w6d, which mysteriously began to resolve 36 hours later until I felt almost well again within a couple of days. However, I also started to experience other miscarriage symptoms (cramping and spotting), which led me to believe that I was about to miscarry... and I started cheating on the diet. Three days after I started cheating, the nausea came back and I had to go on medication (Unisom and Zofran).

However, (1) This was the easiest pregnancy I have ever experienced, and (2) Barring the brief HG slide, I was able to stay off of medication for two weeks during a time that I am normally desperately ill.

This experience left two big unanswered questions:

(1) If the diet was working, why did I start going into an HG slide? And why did I recover?

(2) If I had not started cheating on the diet, would I have been able to do a pregnancy without medication?

This past week, I heard back from the doctor with whom I have been communicating, acknowledging his receipt of my results which I typed out for him. We had a brief email conversation, and then signed off for the time being. I did not receive any additional information toward answering the above questions.

The difficulty is that although I have many questions that I would like to ask this doctor, I do not feel justified in doing so when he is a busy doctor and has so graciously communicated with me by email. His phone consultation fee is quite high (as becomes a busy reproductive endocrinologist), and I feel that if I want a more detailed conversation, then I am honor-bound to make use of that rather than demand more detailed email communiques.

So, HG mamas, if any of you are in or near Jacksonville, FL, consider checking in with this fellow for pre-conception nutritional counseling! He did tell me that his practice specializes in dealing with problems that cause other OBs to throw up their hands - such as nausea or metabolic disorders.

With all that in mind....

I believe that this diet works. However, I cannot say for sure because of the following:

(1) I cheated. Thus, my results are tainted.

(2) Every pregnancy is different, and sometimes an easier pregnancy can lull us into thinking that something we used worked, when, in fact, it was just an easier pregnancy.

(3) The HG that I get in an unmedicated pregnancy is "mild" compared to you severe-HG mamas out there. The diet would have to be used by a severe-HG mama for more conclusive results.

* Note - I have given the diet sheets out to about twenty or so women - please make sure to write back to me with results when you have them!

The best evidence that I have for the diet is from the doctor who prescribed the diet, who told me that a woman who had aborted multiple times for HG (and thus, a severe-HG mama) was able to have a normal pregnancy using this diet before and after conception. That's pretty serious positive evidence.

For myself.... The only way to know for sure is to do it again. Without cheating. 

And there you have it.

***

For those of you who wish to try this diet for HG prevention, here are some practical notes:

(1) If you want me to send you the diet sheets, leave your email address in the comments.

(2) The diet phase recommended is Phase II (the hardest one). Please do your research to determine if you believe this to be safe - there are many who do not believe a low-carb diet (resulting in possible ketosis) is safe for a developing baby. I believe that it is perfectly safe, based on the fact that exclusively-meat-eating cultures (Inuit, for example) live their entire lives in ketosis and have perfectly healthy babies. I can also testify that I have produced a healthy, normal-sized, incredibly advanced and intelligent baby doing the entire first trimester in ketosis (assumed). But make your own decisions.

(3) On the diet, the only food choices are meat, eggs, nuts, cream, cheese, and non-starchy/sugary vegetables. For me, I find vegetables unutterably disgusting while nauseated with pregnancy hormones - so my food choices were limited. Two challenges that I faced were, (1) cooking meat, which was horrible due to the smell, and (2) coming up with new choices since the ability to eat something usually only lasted a day or two once the nausea was back. Here are some of the choices I came up with:

- Cheddar cheese
- Swiss cheese
- Fried eggs, with or without cheese (and dill pickles to cover up the taste)
- Tuna salad (plain, on a salad, or served on cucumber or zucchini round "crackers")
- Rotisserie chicken from the store
- Taco salad
- Hamburger patties
- String cheese
- Almonds
- Peanuts (watch out for storebought nuts - they often have spices that contain sugar)
- Wrap using low-carb tortilla, lunchmeat, cheese, mustard, and cream cheese
- Ham lunchmeat
- Turkey lunchmeat
- Protein shakes using no-sugar powder (I used Sprouts brand) and cream/water instead of milk to mix it up with (these did not work as well as solid food for quelling nausea, but they came in handy)
- Celery with no-sugar peanut butter

Things I didn't think of but should have:
- Hardboiled eggs
- Scrambled eggs
- Steak
- Chicken salad from canned chicken
- Egg salad
- Nut butters put on thin slices of cucumber (this is great!)

(4) One thing mentioned via email was to make sure that fat makes up at least 50-80% of calories. Use lots of butter and healthy oils (coconut, olive, ghee, etc.). Keep the diet high-fat as well as low-carb.

(5) Being "very low carb" is one component - being "very high protein" is another. Even if you can eat vegetables, pump protein anyway - in any form possible. One midwife told me that she has noticed that in situations (like pregnancy or HG) that stress the body immensely, the body's need for protein skyrockets. This blogger writes:
"Protein, protein, protein. I eat tons of it (or so it seems). I’ve been doing this for several pregnancies with good results. No, I still don’t feel great, but before I implemented a higher protein pregnancy diet, things were much worse. I haven’t had what I would call hyperemesis since I added so much protein to my diet."
Read more of this blogger writing on the protein connection (and low-carb connection) here.

(6) I would highly recommend that this diet be started before conception. This means either (1) planning pregnancies, or (2) for you Quiverfull (or accident-prone) mamas out there, living on this diet once you get your period back or would reasonably expect it.

I do think that the diet might be helpful even if you find you are pregnant before you start. But, (1) since this diet deals with hormone regulation, it would be easier to get your body functioning well on the diet before you have to deal with the onslaught of pregnancy hormones, (2) this is a very difficult diet, and easier to learn when you're not freaking out about oncoming HG, and (3) it's easier to start something like this when you're not nauseated, especially with HG-type nausea which usually precludes eating anyhow.

I had brief issues with nausea on the first day that I started the diet - so initiating it was definitely easier when I was not pregnant and dealing with pregnancy nausea.

(7) As always, eat, eat, eat. All the time. Hourly at least, especially when starting the diet and when pregnant.

(8) Other things I used: I used Vitamin B/Folate/Magnesium shots at our local naturopathic college, zinc and magnesium and vitamin B-complex supplements orally (as well as multi, probiotic, omega-3s, etc.), Morning Sickness Magic, and an herbal detox pre-conception (by accident!), as well as Zofran and Unisom.

Next time, I would add acupuncture to the list. I now have the name of a good acupuncturist, so I would add that to the repertoire.

(9) There are some lines of thought linking high-protein pregnancy diets to bigger babies. Do your research and, again, make your own informed decision about whether or not this is something you can deal with. My experience was that the diet did indeed produce a bigger baby.


  • Baby #1 (no high-protein diet) = 7#12. 
  • Baby #2 (no high-protein diet) = 7#15. 
  • Baby #3 (VLC high-protein diet) = 9#9. 
And you know what? It was just fine. I loved it. Baby #3 went from in to OUT in something like thirty seconds. No tearing, no health problems, my healthiest baby and my best and strongest nurser. So I am all about bigger babies, and in fact would probably do a high-protein diet just to ensure that our baby was nice and big! 

But again, do your own research and make your own decisions


(10) My disclaimer: I have no guarantees that this will work. So PLEASE do not neglect to make other plans (for medication, etc.) if you decide to give this a whirl. Make your usual plans and add this on top of them.

***

Ladies, is there anything else that I need to add to this explanatory document? Do you have any questions that I need to answer? I want this information to be available to all comers, so please let me know if I have left anything out. And please do let me know, if you use the diet, how it goes with you.

Thank you to all who shared this past pregnancy journey with me, and for all of your prayers and encouragement! They have meant so much, and I really appreciate it.

Signing off for now!

***

Later Note: Please note the excellent discussion in the comments! Some alternate viewpoints, and some great additional thoughts.

An Even Later Note: Click over here to see Part III in this series, "Practical Tips for Living Life the Very-Low-Carb Way." (This entry is not the official diet sheets, but rather my collection of tips on following the diet sheets.)

An Even Later Note: See my final summary post from November 2014, Avoiding Hyperemesis Gravidarum With a Very Low Carb (VLC) Diet

***

Material on this blog is provided for informational purposes only. It is not a substitute for medical care or advice. Please consult your healthcare provider before undertaking any dietary changes. Under no circumstances, shall the author be liable under any theory of recovery for any damages arising out of or in any manner connected with the use of information or documents from the site.

38 comments:

  1. Would love info on this! Sarahnazarian@gmail.com

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  2. Info sent, Sarah! Let me know if you didn't receive it! :)
    Diana

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  3. I've been following your blog for quite some time and really enjoy it, thank you. I've been researching gestational diabetes and insulin resistance and believe these may be the underlying cause of some cases of severe pregnancy sickness, along with inflammation. This can be fixed before pregnancy and does not require a very low carb diet. Avoiding omega 6 fats is a very important part of treating insulin resistance. I also don't necessarily think low-carb during pregnancy is safe, after reading a few journal articles that say it causes epigenetic changes and obesity in offspring. Perhaps getting insulin resistance under control before pregnancy could be done instead of the ultra-low carb diet. I would prefer to do this and stay out of ketosis, while still taking advantage of a higher fat/higher protein diet.

    After reading the book "Pregnancy Sickness", I do not feel vegetables and herbs are safe during the first trimester. Berries are a low-carb fruit that could be subbed for veggies. Boiling meat is the best way to avoid both toxic charring and bad smells. Coconut milk/oil/flour is high in fats and/or fiber and doesn't have the bad omega 6 oils. Nuts have toxins and omega 6. Milk and especially cheese spikes insulin so probably not a good idea.

    I'm planning to start trying in a few months and I have a blog so I will keep you posted on my diet and if it works. I want to be low-carb but just above ketosis. I have strips to test this. I am trying to merge low-carb, paleo, "pregnancy Sickenss protocol" and manage insulin/inflammation all at the same time.

    Some supplements that help manage insulin are magnesium, alpha-lipoic acid, and DHA/EPA. B vitamins seem to be of great benefit for pregnancy and health problems, especially "non-folic acid" forms of folate such as: folinic acid and methyl-folate. (Excess B vitamins are lost in the urine). My body does not process folic acid so my doctor has me on methyl-folate instead (Deplin). Of course B6 is a must for pregnancy sicknesses.

    I read an article that said alpha lipoic acid helped infertile women concieve but am not sure if it is safe during pregnancy. Magnesium and DHA are safe and recommended, along with vitamin D which boosts the immune system, reduce inflammation, seems to prevent developmental disorders, and also prevents severe flu complications. I also think there should be a greater focus on vaginal health (ie vaginosis and candida) and anemia, especially getting these under control before pregnancy for better outcomes.

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  4. Unknown - I am so blown away by the thoroughness of your research! WOW!!! I love it! Thank you so much for sharing. If you'd like to share your blog address, I'd love to follow it and see how your adventure goes. Good luck, and thank you again for sharing!! Your research is waayyyy over my head in terms of complexity - I am in awe. :)

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  5. Well my thought is the same as Dr. Fox: that insulin resistance leads to infertility and NVP/HG. He used to treat with metfomin, now uses a low carb diet, but there are other ways to lower insulin resistance:

    -weight lifting (the more muscle that can store glycogen, the less insulin resistance)
    -avoiding omega 6's
    -supplements: magnesium, alpha lipoic acid, vitamin D, DHA, probably B vitamins
    -lowering overall inflammation with a gluten-free paleo/GAPS/SCD diet.

    No fancy ideas here, just a compilation of ways other than low-carb diet to control insulin:)

    Metabolic problems in moms such as insulin resistance, diabetes, obesity have been linked to autism in the children (recent research). One more reason to get insulin under control way before TTC.

    Power of 10 and Body by Science are excellent books to teach high intensity weight lifting. This type of workout is done one a week and build the most amount of muscle in the fastest amount of time. They also noted that when pregnant women did the workouts before and during pregnancy, they had low incidence of diabetes, and much easier labor. The mechanics of the workout (slow controlled movements while avoiding holding the breath) are very similar to what women do in natural labor. Having high muscle mass in pregnancy leads to a much quicker recovery.

    It's just amazing how all this stuff ties together. I think a huge problem is our modern lifestyle, if my theory is right, it makes NVP/HG way worse.

    I just had my HemoglobinA1C and insulin retested, going to see if the weight lifting and diet and supplements have lowered the A1C.

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  6. Unknown - I'm sorry I've taken so long to respond to your second post! I have been digesting the amazing amount of info you sent over - you continue to blow me away with the depth of your research!

    Based on your entry, I went and got "Power of 10" from the library (they didn't have the other) and also got some alpha lipoic acid. I'm also taking magnesium in a number of different ways, vitamin D, B vitamins, multi, omega 3s, and a couple of others. Supplement overkill, LOL!

    I have been learning so much through this research - the books and interacting with other mothers such as yourself. I completely agree with you that something in our modern lifestyle is causing increasing rates of NVP/HG. It's just not normal for women to have debilitating or life-threatening NVP, and I don't really see any evidences of that historically. You just don't see historical records of "she died from morning sickness." (I know there's some thought that Charlotte Bronte died from that, but it's inconclusive - and even if that was the case, it's still an isolated incident rather than widespread, as it would be today without HG treatments/drugs).

    I'm going to write out my protocol when I get some time (no guesses when!), but keep me updated as to how things go for you!!

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  7. I just found out I am pregnant, 5 weeks along! Feeling good! Thanks Again for you blog ^_^ The protocol is working! Thanks for the reminder about magnesium.

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  8. Anti-Inflammatory Momma -
    Congratulations!!!!!!! :)

    Now, I received "I am 5 weeks pregnant" notes on two blog entries from seemingly different mamas - were they both you? I wasn't sure if I had one or two women to congratulate! But either way, good job and congrats!! Making it to five weeks feeling great is an accomplishment, and I hope it goes all the way! If you ever write out what you did, please let me know so I can link to it!!!

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  9. Please can I have the diet sheets if it's not too much trouble? I suffered from hg the first half of my first pregnancy and then the same for my second which sadly ended in miscarriage at 21 weeks :( I am ttc again and very worried about hg so would love to try the diet.
    Thanks in advance,
    Jo
    jobywater at hotmail dot co dot uk

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  10. Jo - Diet Sheets sent! Good luck!!! :)

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  11. Would love to get diet sheets. Suffer from HG!! And wanna another baby

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  12. This comment has been removed by the author.

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  13. Hi, Rachel! I'd love to send them, just leave your email address and I'll pop them on over! :) In the meantime, I have updated this entry with the link to my list of tips for the diet, so you can glance at those as well:

    http://whiningpuker.blogspot.com/2012/11/practical-tips-to-living-life-very-low.html

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  14. This comment has been removed by a blog administrator.

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  15. I am in need of a healthy, safe pregnancy after suffering from a very traumatic HG pregnancy. We are looking to TTC #2 after we lost our #1 angel baby last Summer. Please email me as soon as you find time so we can try to possibly prevent this terrible disease that everyone seems to think is in my head :'(

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  16. Hi, Kara! I would be glad to email you - just leave your email and I'll shoot you a message! :)

    Diana

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  17. Hi Diana! My wife is suffering from a severe case of HG. I would be grateful to recieve info about the diet to my email mnx05eer at gmail dot com.

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  18. Ed - Diet sheets sent! Let me know if you don't receive them!
    Diana

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  19. I would love to get the diet sheets. Currently almost 5 weeks pregnant and following a no flour no sugar high protein diet. Hyperemesis in 3 previous pregnancies, trying to avoid it this time! My email is cschrem@yahoo.com. Thanks so much!

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  20. Chris - Diet sheets sent! Let me know if you don't get them - best of luck, and congratulations! :) Thanks for stopping by!

    Diana

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  21. i would like the info also - misspbc@gmail.com
    although i don't know if i could do that!

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  22. Sarah Grace - Diet sheets sent! Let me know if they don't make it to you!! :)

    Diana

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  23. Hi, I am the one who left the long comments above. I had a healthy pregnancy (despite placenta previa and borderline glucose numbers) and healthy baby, 8 lbs 1oz. He is now one and I expecting again, 6 weeks and feeling great. I used the supplements I mentioned. If I had been able to exercise I might have had better glucose but it wasn't full blown GD. I needed a lot of mag, 800 mg a day. Didn't throw up once, no HG or nausea. :)

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  24. Hi, Sa Pa! Congratulations on both of the new little ones! And CONGRATS on no HG - how wonderful! Now, let me get this straight - are your comments these two? -

    "I've been following your..."
    and
    "Well my thought is...."

    Wanting to make sure I have the right comments! :)

    Thanks so much for getting back with me and letting me know!!!
    Diana

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  25. Sa Pa - One more note! I would LOVE to see dosages for the supplements you recommended in your comments. If you'd like to share, please do!

    Diana

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  26. Hi. Can you please send me your diet sheets. Trying to avoid HG at all cost for the next time. Thank you!! Stokesd@hotmail.com

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    1. Hi, Dawn! Diet sheets sent! Thank you for visiting!
      Diana

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  27. no4nojdozor @ googlemail.com

    thank you so much for you work!

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    1. Hi, Arabella! Diet sheets sent!! :)
      Diana

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  28. I stumbled on this Blog during a search on Hyperemesis and diet. I have 4 children , Thanks be to God and each pregnancy was worse than the last. Between the second and third, I did intense body cleanses, Blessed Herbs total herbal cleanses, was running, working out and eating clean..If it is in a box or a can it isn't from God is our family rule. Third pregnancy was awful....I develop AVERSION to water! This spirals me into dehydration and a bad cycle of HG. Vomiting once it starts, doesn't stop. The B6/unisom combo was insufficient and I needed zofran...taken in smallest does possible and using fluid Ivs every 3 days..I survived to the 20 week mark when it suddenly disappears! Healthy baby boy born at home at 9#7 ...I should mention Before my first baby I took Bradley classes which stress importance of protein and so 100 g. a day was my goal during all these...xcept the HG periods where toast with butter was all I could tolerate. My fourth I started out overweight. My husband's business was going under, I was homeschooling and working and not sleeping and gained 25 pounds...so I started out the pregnancy (which was a shock) overweight...not ideal! This time I saw a specialist in HG before I even saw the O.B. and they had prescriptions for zofran and everything else lined up and ready for me. I thought id I was ahead of the curve perhaps i could beat it...but at 5 weeks it started and I resisted until 10th week when I collapsed, my heart was beating out of chest my urine was brown and I was placed on midline/i.v in home for quick re hydration . (I consciously pushed to 10 weeks hoping that this way the organs would be formed before taking the meds) What is interesting in all of this is that I didn't lose any weight which is typical in HG. even surviving on 6 pieces of toast with butter a day! I am convinced that I was insulin resistant and that those pieces of toast were enough to keep me fat LOL. At any rate at 20 weeks...the horribleness of HG lifted Thank you GOD! I was able to drink water without gagging and eat clean as I had prior ...first meak I had was baked eggplant parmesan...i got so dizzy, seating and then I nearly passed out. I knew my sugar must be to blame! It was...I was told to eat "diabetic diet" I didn't beacuse the standard diabetic diet they give is horrible for diabetes, it has things like grapes!! I designed my own no grain diet with my 100grams of protein and made sure to include protein at every snack/meal. Blood sugar still very high upon waking...rest of day perfect! So I had to take glyburide before bed so that the morning numbers were better, it was placenta induced diabetes. I gained 10 pounds total in pregnancy and had a baby at 7#7 smallest of the 4 WHICH NO ONE believed was born of a Gestational diabetic mother! I had a tubal ligation before leaving the hospital because it was a psychological and physical nightmare the time sick in bed, with my children being cared for whichever friend had duty of my care that day (a sign up form was in place). My husband's business suffered further...I am sad that had to be my choice..my husband is 12th of 12 children and had wanted a big family but God had another plan...during my own research and particpation in a HG genetic research study out of California, I talked to my grandmothers about this ..and it turned out MY great great Aunt almost died because she was so ill in her pregnancies. My grandmother said she remembers her aunt wasting away. And her own sister was bed ridden her whole pregnancy because she vomiting in continuation. She herself said she had nausea all 9 months but never vomited. I DO believe there exists a genetic component in all of this!

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    1. Thank you so much for visiting and sharing your story! You are truly a warrior mama - I am so impressed by what you've survived!!

      Diana :)

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  29. Thank you for all the helpful information. I would love the diet sheets as well. Surfgal545 at yahoo.com

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    1. Chelsea, thank you for visiting! I have emailed you the diet sheets - let me know if you don't get them, or if you have any questions!

      Diana

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  30. Hi Diana. very severe HG sufferer here. I would like to have a look at your diet sheets please. mail2nellie@gmail.com. Thanks so much.

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    1. Good morning! I sent the diet sheets - let me know if they don't arrive, or if you have any questions - thanks for visiting!

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  31. Hi there! Stumbled upon your blog. Can I get the diet sheets? Maysaaf@gmail.com

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  32. Hi there! Stumbled upon your blog. Can I get the diet sheets? Maysaaf@gmail.com

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    1. Diet sheets sent! Let me know if you don't receive them! Thanks for stopping by!

      Delete

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