Monday, December 1, 2014

Avoiding Hyperemesis Gravidarum With a Very Low Carb Diet

Hello, dear readers!

At long last, here is my write-up about what I've learned about hyperemesis gravidarum prevention. I beg your forgiveness for any errors or omissions, and I ask you to remember that I am not a medical professional - just a passionately interested amateur. Please note my disclaimer at the bottom, and do your own research on any method presented that you wish to try.

I have chosen to write this post interview-style for clarity of subject matter and ease of topic location. Please note, I am not *really* being interviewed here (or rather, I am being self-interviewed!). It is only a chosen method of narration.

Please feel free to ask any questions or join - nicely! - in the conversation. I cannot have any arguments or unkind words here, so please do note that any such comments will be quietly deleted.

Enjoy, dear friends!


Basic term definitions:

  • NVP = Nausea and Vomiting of Pregnancy, the technical term for "morning sickness," and used throughout this article preferentially due to clearer meaning
  • HG = Hyperemesis Gravidarum, the most extreme form of NVP


Let's start at the beginning. What is hyperemesis gravidarum (HG)?

Nausea and Vomiting of Pregnancy (NVP) runs a complete spectrum. At one end is the woman who traverses the journey of pregnancy without a bit of nausea; at the other end is the woman whose NVP brings her to near-death (or occasionally, death). Hyperemesis gravidarum is the extreme form of NVP. Though there is no exact dividing line between "bad NVP" and hyperemesis (or rather, dividing lines vary by the person defining them), hyperemesis can be roughly defined as extreme nausea and vomiting of pregnancy. The definition I list on this site is:
"Hyperemesis gravidarum (HG) is a severe form of nausea and vomiting in pregnancy. It is generally described as unrelenting, excessive pregnancy-related nausea and/or vomiting that prevents adequate intake of food and fluids. If severe and/or inadequately treated, it is typically associated with: (1) loss of greater than 5% of pre-pregnancy body weight (usually over 10%), (2) dehydration and production of ketones, (3) nutritional deficiencies, (4) metabolic imbalances, (5) difficulty with daily activities."
Again, there are many different definitions of HG. Various definitions that I've heard include: "You have HG when you've... (1) lost 10% of your pre-conception weight, (2) been hospitalized for dehydration, (3) been hospitalized twice, (4) been hospitalized three times (seriously!), (5) received IV rehydration, (6) required medication for NVP management, (7) are unable to continue with daily activities" - and the list continues. Definition really seems to vary by caregiver.

After experiencing the condition myself and doing years of reading on the subject, I tend to define hyperemesis with a combination of physical and emotional markers. For example, on the physical side:
  1. I can’t keep anything down.
  2. I am no longer using the bathroom (or not very often).
  3. I am losing weight.
  4. I am vomiting multiple times per day.
  5. I am having trouble handling ordinary everyday tasks, such as caring for myself and my children.
And on the emotional side. Some of these are hard to write, or read, but they're very much a part of HG reality:
  1. I am feeling frightened, panicky or desperate. 
  2. My body is out of control and I can't stop it.
  3. Nobody understands what's happening to me and I feel very alone and isolated. 
  4. I am hoping or praying for death or miscarriage.
  5. I have considered, envisioned, planned, or gone through with an abortion.
  6. I have considered, envisioned, or attempted suicide. 

I want to learn more about HG. Where do I go from here?

Start with the link list to the left of my blog! Make sure to visit the HER Foundation website. Buy and read the definitive guide to HG, Beyond Morning Sickness: Battling Hyperemesis Gravidarum by Ashli McCall. (Pregnant mamas, please don't read this book while you're expecting. It's very dark.) Ashli is a severe-HG survivor and knows far more than I about this condition!

How did you learn about hyperemesis?

Like most of us, I had never heard of HG prior to pregnancy. I have no history of extreme NVP in my family. My mom, for example, told me that during her pregnancy she experienced a few days of light nausea that was completely manageable by nibbling a few dry crackers. I expected the same for myself.

When we discovered that we were expecting our first (live-born) son, my nausea stayed "cute" for a few days. Cute as in, "I'm pregnant! I'm nauseated! This is so exciting!" The problem was that it didn't stop there. It simply got worse, and worse, and worse, and worse - until I was lying on the bathroom floor crying and hoping that I would die. It was hideous. And it stayed that way. I ended up being on a liquid diet (hourly sips of Ensure and Slimfast) for about fifteen to twenty weeks, which kept me out of the hospital. After that I was still nauseated and weak for the rest of the pregnancy, but more stable. I then dealt with residual postpartum nausea for somewhere between one and a half and two years.

With subsequent pregnancies, the illness was controlled by drugs and thus never reached the same level of misery. However, I noticed that with those pregnancies the nausea hit harder and much, much faster (before I could get a positive test), leading me to think that the drug-free versions of those pregnancies would have been much worse than my first (in which I had a few non-nauseated days and then a few days of lighter nausea).

What type of hyperemesis (HG) do you get during your pregnancies?

I have a hard time qualifying the type of HG that I get.

On the one hand, HG was the most horrific event of my life. It entailed the most physical suffering I have ever experienced. Afterward, it took me two years to recover physically, and six years to recover my faith in God. I still get horrible flashbacks to that time (I'm getting them as I write this article). The only way that I can describe my experience was that it felt like sliding into the pit of Hell.


I am also aware that compared to many of you ladies out there, my HG experience was a blissful walk in the park - complete with rainbows, flowers, balloons, and dancing unicorns.

The type of HG that I get has been manageable with home medication. In other words, with high doses of Zofran (24 mg/day) and Unisom (don't ask), I have been able to stay out of the hospital and out of the world of extreme HG.

Thus, I know that I am only partially qualified to talk about this condition, and I want my readers to be aware of this fact. I am not on the same level as you extreme-HG ladies, and my writing will reflect that ignorance. I know more about NVP than 98-odd percent of the world, but those last few percentage points represented by some of you really blow me out of the water.

Okay, let's move on and talk about the VLC diet. What is it, and how did you run across it?

Several years ago, I ran across an internet interview of a physician who uses a VLC (very low carb) diet to treat infertility in clients with PCOS/PCOD (polycystic ovarian syndrome/disorder). In the article, it was mentioned that those same clients also experienced lower NVP levels than typical women.

Being ever-aware of the NVP issue, I immediately located the doctor and contacted him to ask if this same diet was ever used to treat or prevent hyperemesis. He replied in the affirmative, and was so kind as to provide the diet guideline sheets for my use.

Read the whole story here.

How do you know that this diet is safe - for you and for baby? 

The main question seems to revolve around the issue of ketosis, a state induced by a very-low-carb diet. To explain in brief - when we humans have carbohydrates in our diets, we are "carb burners." We burn carbs for fuel. When we don't have carbs available, our bodies make the switch into fat-burning for fuel, inducing a state called ketosis. This is a common human condition - sometimes culturally (some entire cultures live in perpetual ketosis), sometimes situationally (during fasting, for example), and sometimes due to purposeful cultivation - ketosis is used intentionally by athletes in training, and also for treatment of seizure disorders.

Please note that ketosis is very different from diabetic ketoacidosis, which is indeed a dangerous condition. Often there is no differentiation made between the two, and hence the panic.
"Part of the problem lies in the word ketosis itself, which closely resembles ketocacidosis, a medical term that's used to describe a life-threatening condition in type 1 diabetics. Many doctors scoff at the idea of allowing one of their patients to get into a state of ketosis because they immediately think of all the negative side effects associated with ketoacidosis. This confusion may have allowed many patients to remain in a diseased state when they could have seen tremendous improvements in their health with the use of a ketogenic diet." (Jimmy Moore, Keto-Clarity, p. 38)

An additional interesting point is that ketosis is often found in NVP/HG clients as a side-effect of NVP/HG itself. So, rather oddly, if I avoid the VLC diet to stay out of ketosis, I will end up with HG... which may very well put me into ketosis anyway. I'd rather have ketosis and no HG than both at once!

In my never-to-be humble opinion, there is no doubt that a low-carbohydrate diet and ketosis are safe and even advantageous for adult humans. Not only have I had spectacular personal results health-wise from this diet (both during pregnancy and before), but there are entire cultures who have lived for hundreds of years on low-carb or even very-low-carb diets. I have no qualms about this.

The real concern is whether a VLC diet is safe for a developing baby. Again, as there are many cultures who live continually in ketosis (including during pregnancy), I am satisfied with the safety of ketosis for babies in utero.

Most care providers will be more nervous about it.

This is where it's up to you to do your homework and make your own decisions. If you're not comfortable with the safety issue, don't do it.

I should note, however, that for me (as with many of you) this is not a "Hey! I'm in ketosis for the fun of it!" thing. It's an either/or situation. Either I can be in ketosis (and HG-free and drug-free), or I can be in active hyperemesis and therefore be pumping large amounts of synthetic drugs into my body and my baby. I have to pick one or the other.

Most obstetricians, due to their training in western medicine, will be horrified at the thought of ketosis but will be absolutely fine with you pumping massive amounts of drugs into your body and your baby. That's just their bias received in training. I'd prefer it the other way around!

I'm sure there are other issues to consider health-wise, and other arguments to ponder. Do your research and make a decision with which you are comfortable. For more information, join us over at the Facebook group Pregnant Ketosis. Also check out the excellent book Keto-Clarity (and consult the appendices of that book for a list of further resources, including books and websites).

You mentioned positive health effects from doing the VLC diet. Can you elaborate? 

Besides avoiding hyperemesis, pre-conception health benefits that I noticed included:

- Healing my seasonal allergies (I have heard that this can be done by going grain-free or even wheat-free, so the low-carb part may not be necessary for this.)
- Healing my adult acne
- More energy and less fatigue
- Healing my postpartum post-HG nausea

This diet looks really hard. How could I ever do something like this? 

I am notoriously bad at sticking to diets. Many years ago, when my husband asked me to do a low-carb diet with him (a diet which was, incidentally, much easier than this one!), I lasted somewhere between 24-48 hours. It just wasn't worth it to me.

With this diet, however, I had a huge motivating factor on my side - fear. I fear HG more than anything in the world, and this was my chance to avoid it. That is the only thing that made staying on this diet faithfully even a remote possibility - and it worked. Fear is a powerful motivator.

What difficulties or challenges did you experience as you adopted this diet? 

I encountered many challenges with this diet. Here are a couple:

(1) Expense - Any good cook or homemaker knows that high-carb foods (grains, legumes, seasonal fruit, and starchy vegetables) are the saving grace of a grocery budget. Removing these and substituting low-carb, high-fat, high-protein foods (eggs, non-starchy vegetables, meat, cheese) causes significantly higher grocery costs.

(2) Learning to "double-cook" - The method I developed for family cooking was to make a low-carb main dish and vegetable, and then add a high-carb side dish (corn, peas, potatoes, rice, cornbread, etc.) to keep the family happy. This works well, but it adds to the workload - as well as to the planning component of meal times. Additionally...

(3) Keeping kids happy! - There are lots of low-carb meals out there, but many (most) of them are not particularly kid-friendly. This has been a definite (ongoing) challenge.

(3) Learning to brown-bag - On this diet, it is a constant assumption that I will need to bring my own food wherever I go. Church, potlucks, family reunions, visits with family, dinners with friends, any social gathering - I have to bring my own food. This is time-consuming, somewhat embarrassing, and a bit isolating - but one does get used to it. After all, I'm working for the greater good here - it's not just for the fun of it.

(4) Family/culture issues - One of the hardest parts about adopting any particular diet is the fact that it isolates one from one's family and family history history (goodbye to Grandma's apple pie) and one's culture (farewell to Independence Day fried chicken and potato salad). About 95% (or more) of your recipes will have to be put aside for this dietary lifestyle. This is a purely emotional and psychological phenomenon, but it is not to be underestimated. It's depressing! Again, it's important to remember that I'm working for an important goal.

(5) Reactions from others - Do not expect your extended family to understand or sympathize with what you are doing. Some will, and some will not. You may even receive some hostile reactions (common to anyone trying a new diet). It's just part of life. Depending on your family's reaction, you will have to develop your own emotional coping strategies. Just be prepared for this. Additionally, many people  will be sympathetic but will not understand. For example: "Oh, you can't eat carbs? So... you have to use whole wheat bread instead of white when you make a sandwich?" Or "You can't eat carbs - but you can surely eat honey, RIGHT?" Expect some people to be confused, uncomprehending, or even horrified.

Can I ever "cheat" on this diet?

It's best not to cheat. And indeed, I went (nearly) an entire year absolutely carb-free. But technically, you are allowed one cheat meal per week. The method that I eventually adopted was to allow one or two cheat meals per month, always during my period (when I was at the beginning of my cycle, knew that I wasn't pregnant, and had an entire month to do damage control).

How did your first run-through with this experiment go?

I began this experiment with our last child. When we got a positive test, I had been doing the VLC diet for 40 days. Read the full story here and my discussion of the story here. Unfortunately, it was a very mysterious outcome. The quick summary: I went into a horrible and fast HG slide... but them quickly recovered and felt fine. (Weird.) However, believing that I was going to miscarry, I began to cheat (badly) on the diet, and the NVP came galloping back. I ended up having to take my usual high doses of medication, but going right back on the diet along with the medication helped me to manage. It's really a mystery, but suffice it to say that the diet worked then too - I just messed it up through my own stupidity.

This is one reason why I recommend doing the diet far-far-far in advance of conception, especially for you severe-HG mamas. With my most recent pregnancy, I had been on the diet for almost two years (instead of 40 days), and I did not experience that same horrifying HG slide. It could be coincidental, but my conclusion is that longer is better.

Let's talk about your most recent pregnancy. How did using the VLC diet work this time around?

I will start out (and continue, of course!) by being honest - at first, I was very disappointed with my results. I had worked so long and so hard at this diet (almost two years before conception!) that my hope was for an NVP-free pregnancy - a pregnancy in which I felt fine (or had perhaps only minimal occasional twinges of nausea) and was able to keep up with all daily activities even during the first trimester.

That didn't happen. To the contrary, I spent the first trimester (and the second, to a lesser extent) feeling good and crummy. I spent a lot of it lying down, and my daily routine was completely disrupted. It wasn't the dream-pregnancy I'd envisioned at all. And I stayed nauseated until the day of birth.

But I was soon able to face the facts. I did not throw up. I did not need to take Zofran. I was functional, and clearly non-hyperemetic. The fact that I felt like dirt for a few months was an easy trade-off for those blessings. And had we had the money to add in a few extras like acupuncture, it might have been even easier. I also believe that I could have had better results had I paid more attention to pre-conception supplements, which I neglected due to our financial situation.

How about some specifics? What daily activities were you able to continue?

I was able to continue an almost-full load of activities through the early part of week 5. This is a huge improvement, as I am usually on medication and miserable by the end of week 3. At 5+1 I attended a park day with all of the children, and at 5+3 I was able to handle playing for a two-hour long evening church service (though not feeling so hot for that one!).

Daily activities that I was able to keep up during the first trimester:
  • Self-care (showering, dressing)
  • Feeding the children cold foods (cheese, crackers, etc.)
  • One daily load of laundry
  • Dishes
  • Daily pick-up
  • Minimal housework 

And what activities did you have to discontinue temporarily? 
  • Devotions
  • Exercise and stretching
  • Evening walks 
  • Cooking 
  • Deep house-cleaning, dusting
  • Routines
  • Supervising chores
  • Errands, playdates, park days, church - anything outside of the house was just too much
  • Yard work
  • Reading aloud to the children

How did your pregnancy go in general?

During pregnancy, all of my pregnancy stats stayed absolutely on target per gestational age. For baby, this includes fundal height (FH), fetal heart tones (FHT), fetal positioning, etc. For me, this included pregnancy urinalysis, blood pressure (which stayed rock-solid low the entire time), blood tests, and weight. I stayed in ketosis the entire time, ranging from deep (at the beginning) to mild (at the end).

Nausea was "strong but manageable" from week 5, tapering down to "comfortable" at the end. Again, I never threw up. Unfortunately, it stayed till birth, as it always has.

Check out my pregnancy updates here:

First Trimester
Weeks 12-13
Weeks 14-15
Week 20
Week 24
Week 28
Week 32
Week 36
Week 38

And how about some stats for baby - any health problems? How about labor, Apgars, birth weight, etc.? 

We do not do prenatal ultrasound scans unless indicated by other variables. Thus, I cannot give any ultrasound scan results.

Here are some basic labor/birth stats for baby:

Gestational age at birth: 39+3
Laboring times: Hard to say, but approximately 2:00 p.m. on 11/11/14 to 10:06 on 11/12/14
Total labor time: 20:06 total, 15 minutes hard labor
First stage complications: None
Second stage complications: None
Third stage complications: None

Apgar, 1 minute: 10
Apgar, 5 minute: 10

Baby's length: 21 inches
Baby's weight:  8#8 (Our other babies were 7#12, 7#15, and 9#9.)
Baby's head circumference:

Read our birth story here.

I think we need to take a break and talk about confounding variables. 

YES. Absolutely. Confounding variables are a huge factor that merits discussion here.

In any truly scientific experiment, it is permissible to vary only one variable at a time. Otherwise, accurate conclusions cannot be drawn from said experiment.

"Confounding variables (aka third variables) are variables that the researcher failed to control, or eliminate, damaging the internal validity of an experiment.
"A confounding variable, also known as a third variable or a mediator variable, can adversely affect the relation between the independent variable and dependent variable. This may cause the researcher to analyze the results incorrectly. The results may show a false correlation between the dependent and independent variables, leading to an incorrect rejectionof the null hypothesis." (source)

Let me illustrate this point. In my researches to find the cause and help for severe NVP, I have run across many ideas to try. The include using the following to prevent HG: pre-conception liver-cleansing, magnesium levels, fermented foods (H. pylori theory), and the VLC diet.

If I wanted to conduct a truly scientific experiment, I would have to utilize only one of those items per experiment (i.e. per pregnancy). In other words, with one pregnancy I would work only on my pre-conception magnesium levels. For the next pregnancy I would work only on using the fermented foods/H. pylori protocol. For the next pregnancy I would work only on using the VLC diet.

This is the only way that results can be considered conclusive.

However, I am neither so brave nor so foolish. I am not willing to leave any possible avenues untapped while waiting to see if HG is going to rear its ugly head.

Rather, like most women, I am completely willing to pile together every method of HG prevention to see if I can achieve my goal - that is, pregnancy without hyperemesis.

But this means that there are confounding variables - that it isn't possible to know without the shadow of a doubt which factor contributed to HG prevention - or if it was a combination of two or more factors together. While I am confident that the VLC diet worked to prevent HG, it must be admitted that I did plenty of other things to work on HG prevention.

In that case, can you elaborate a bit? What confounding variables did you have in this experiment? 

Ah, that will take a while! Let's look at the other things I did before and during this pregnancy.

(1) Magnesium supplementation - Read more about magnesium and NVP here. I started using magnesium at least half a year before conception. Primarily we use Natural Calm. I also used small amounts of topical Magnesium Oil and Epsom salts baths, but those were minor contributors.

(2) Fermented cod liver oil - Great product. Unfortunately we haven't continued it due to the cost, but it has a great reputation. I'm still supplementing with DHA/EPA (just not the fermented variety).

(3) H. pylori protocol - One of the most exciting events of last year for me was the news that a friend of mine (and repeat-HG mama) had figured out the cure to her hyperemesis - a fact that was confirmed by the fact that her pregnancy turned out to be twins (with still no more than moderate NVP!). I immediately added her ideas to my pre-conception diet, starting 6-8 months before our own baby was conceived. These steps included:
  • Adding raw fermented foods to my diet (raw sauerkraut, raw dill pickles, kefir, raw kombucha)
  • Using colloidal silver 
  • Doing a pre-conception turmeric/colloidal silver protocol: 1 tsp of colloidal silver plus one tab turmeric 3 times per day on an empty stomach for 9-14 days. (I plan to make this an annual routine.) 
I should note that the VLC-diet method and the H. pylori theory fit together rather well, theoretically, as H. pylori thrives in a high-carb environment and would thus be minimized by a VLC diet.

(4) Supplements in general - We have been fairly good about trying to take good supplements. However, this is not really a serious contender for HG prevention. I mention it only because it is "something I did." See my full list of supplements here.

And, as a side note, are there any methods out there that you didn't use?

I no longer use any herbs (including ginger) for pre- or post-conception HG prevention. I worked with herbs during an earlier pregnancy, and they simply did not help - rather, they made me sicker due to the horrible taste/smell. While some women do use herbs for HG management, my guess is that herbs are primarily helpful for women with mild to moderate NVP rather than active HG.

Additionally, I did not use any homeopathic remedies. I have heard of great success for some women using these methods, but I simply have never had any luck using them. I'll leave that for better women than I.

Let's say that I want to try the VLC diet for myself. What steps should I take?

That's a complicated question. Let's break it down into some basic steps.

(1) Leave me your email so that I can send you the diet sheets.

(2) Do your own research to determine if you are comfortable using this diet during pre-conception and/or pregnancy. If you're not, trash it. If you are, head to stage 2 on the diet sheets - the longer the better before conception, at least two cycles but preferably longer.

Again, dear readers, please realize that you assume all risks here. If you are not completely assured of the safety of this diet, do not do it. It's that simple.

(3) Realize that in both life and HG, there are no guarantees. I cannot say that this is guaranteed to work. Thus, make all of your usual preparations for an HG pregnancy. This means:
  • Ensure that you have a supportive care provider who is willing to be aggressive with HG treatment. 
  • Ensure that you have access to needed medications (i.e. Zofran, etc.). 
  • Do all that you can to ensure the best of pre-conception health: Healing nutritional deficiencies from past HG, addressing current health problems, healthy diet, supplements (like magnesium, fish oil, multi, etc.), sunlight, exercise, etc. 
(4) Add in all of the extras - magnesium, fermented foods, pre-conception acupuncture, etc. If you can think of it, add it to your protocol!

Do I have to do this pre-conception? Why can't I just start it when I get a positive pregnancy test? 

This diet is specifically for healing hormonal issues and retraining the body into a different type of metabolism. There are several problems with waiting till a positive test to get started:

(1) This is a very difficult diet to do. Waiting until "panic time" is not a wise idea, as it's difficult enough to learn during normal times!

(2) It takes your body time to heal, normalize, and get used to this diet. I honestly do not know if doing the diet after a positive test would even be effective in HG-prevention. It's always worth a try, and raising dietary protein levels while dropping sugar levels will always be beneficial for NVP sufferers - but it probably won't be enough to circumvent hyperemesis.

(3) Remember that your body is manufacturing pregnancy hormones long before you can get a positive pregnancy test. To do its job properly, the diet must already be well in place at conception, not one to two weeks later at test-time.

(4) Many HG women, myself included, get sick very fast and very early (for me, it's during week 3). This is before a positive test can be obtained. Trying to implement a very difficult diet while already nauseated is not a pleasant proposition - or often times, even a possible one.

Any special notes on how to use this diet?

A couple of notes:

- Do not mistake this diet for a run-of-the-mill low-carb diet. This is not a low-carb diet. This is a VERY-low-carb high-fat diet, and the two cannot be compared. Low-carb may improve NVP levels, but it will not cut it for preventing hyperemesis.

- Make sure that your diet is high fat as well as being very-low-carb. High fat is essential - if you attempt a low-fat low-carb diet, you will have problems with nausea even while not pregnant! The usual guidelines are to have 75-80% of your calories come from healthy fats and less than 5% from carbs.

- I also did my best to avoid industrial seed oils (soybean, cottonseed, etc.) and fake fats (margarine, shortening, etc.) and to focus on healthy fats like saturated animal fats, nuts, avocados, coconut oil, etc.

What if I'm not comfortable using this diet? Is there anything else I can try?

Yes! There are several other options! Check these out:

(1) Check out the fermented foods (H. pylori) method that a friend used to cure her repeat hyperemesis. Give it a try! (And, as I mentioned previously, adding fermented foods to your diet is an excellent thing to do alongside the VLC diet, but it can also be done by itself).

(2) One woman told me (and I've heard from others) that she discovered that sugar triggered her NVP. Cutting all sugars and high-glycemic foods, even if you don't go super-low-carb, is a great option for moderating NVP.

(3) One woman prevented HG-recurrence using the Paleo diet and supplements: Read about it here and here.

(4) Make sure your magnesium levels are good and high pre-conception! Ditto for vitamin D and DHA.

(5) Read this mama's experience and give her ideas a try!

(6) Check out HyperG Pregnancy for more ideas - especially try her free e-book (on the right sidebar) for a lot of excellent information.

(7) Check out Pink Stork Solutions (read her story here) for proven all-natural pre- and post-conception remedies for severe NVP and hyperemesis.

So, how did your use of the VLC diet proceed throughout the pregnancy?

As the nausea lessened over the course of the second trimester, I loosened up a bit more into traditional "low carb" foods that aren't allowed on the VLC diet - like whole milk yogurt, berries, and cottage cheese. From about 30 weeks and onward, I utilized more and more off-plan foods, such as beans and fruit. (It was a matter of realizing that these foods did have a bad effect on my energy and nausea levels, but enjoying them anyway since they were no longer dangerous.)

In the immediate postpartum, I plan to give myself a break between birth and New Year's, or thereabouts - which will be approximately six weeks. May I note that I am immensely grateful that this baby was born just before Thanksgiving and Christmas?? Yum! (Though I know that eating grains will bring back my seasonal allergies - not so fun.) I hope to transition back to the VLC at that point.

There's still so much research to do. While this pregnancy has been amazing (no Zofran!), there is still so much room for improvement. I also need to get back into things that have been neglected over the second half of pregnancy. I want to get back into a good regiment of supplements, and hopefully this time we'll be able to afford them! I also need to restart all of my lacto-fermentation cultures and get back into eating raw fermented foods. I'd also like to start pre-conception acupuncture, continuing after conception.

There is so much room for improvement, and I want to be ever-vigilant in searching for ways to make pregnancy better.

Any final notes?

Yes! HG mamas, I know that many of you out there are doing some awesome research and experimentation in finding what helps YOU to avoid repeat hyperemesis gravidarum. I would LOVE-LOVE-LOVE to hear from you! Please send me your stories, and the information you find, and I will gladly link to it. The answers are out there, and most likely it will be the amateurs - the HG mothers passionate about finding answers - who discover them. I would love to hear from you.

Please also consider joining us in the Facebook group Preventing Hyperemesis Gravidarum. This is an awesome group filled with super-knowledgeable women who are all doing their own research and discussing it. Come on over and join us!

Anything else?

Yes. I'd like to address one common misconception that I've seen. One is, "How can you tell a woman in active hyperemesis to adopt an incredibly difficult diet? Don't you know that hyperemetic women can't eat?"


This diet is emphatically NOT about taking a critically ill woman and telling her to start eating handfuls of walnuts. That is not possible. By the time a woman is in active HG, she is usually unable to eat anything - or at best, only easy-to-eat things that are usually some form of simple carbs. Additionally, strong food aversions usually make eating at will impossible, even if a woman is stable enough to eat solids.

The entire point of this diet is to prepare for pregnancy before conception - preferably as far in advance as possible. If a woman chooses to wait until HG has kicked in to try this... my guess is that it's not going to work. Anything is possible, I suppose, but I don't think there will be a good success rate.

Most of the other methods for NVP prevention are similar - magnesium supplementation, the fermented foods method, etc. They all need to be started pre-conception for best results.

And.... anything else?

One other thing that I have heard is some variation of the following: "You shouldn't tell people about this because someone might try it and it might not work for that woman. You shouldn't give people false hope."

I have considered that.

Actually, I have considered this issue in depth. I do not want to give anyone false hope. And, being an overly sensitive introvert, I strongly shy away from any type of publicity, especially negative publicity - even if it's within a tiny community like the HG community. I have actually considered keeping all of the above information to myself and not mentioning it publicly on my blog - I don't like the attention, and I don't want to lead anyone down the garden path with a method that might not work.


The alternative is ugly. The alternative is that, finding something that worked for me, I keep it to myself out of fear and a dislike of publicity - regardless of how many women could benefit from this knowledge.

I can't do that. And thus, I am publishing this information. And my prayer is that it will benefit many - or even one mama.

But again...


You might try this and still come down with active HG. I cannot tell you that you will not. I cannot even guarantee that I myself will not experience hyperemesis in a subsequent pregnancy. Please be prepared. Make all of your usual preparations for an HG pregnancy. Find other methods (magnesium, etc.) and add them in too. Do everything you can to avoid HG, but be prepared for recurrence.

(2) Again, if you're not comfortable doing a low-carb pregnancy, DON'T DO IT.
If you're not comfortable being in ketosis, DON'T DO IT.

This article is not a command. It is not a guarantee. It is a simple statement of, "I tried it. It worked for me. Here is the information in hopes that it can be a blessing to someone else."

Does that make sense, everyone? I know I'm repeating myself here, but I think it bears repeating.

Closing remarks?

Thanks, everyone, for your help, support, and patience! It's been an amazing journey, and it's not over yet. I hope that this information is of help to some of you.

You can check out the podcast where Rachel of HyperG Pregnancy and I discuss VLC diet and hyperemesis here.

You can hear the podcast with Dr. Fox discussing the VLC diet and hyperemesis here.




Polite discussion and honest questions are always welcome! I'll answer any that I can! Please know that I cannot have this blog turned into a war zone, so I will have to quietly delete any comments that are rude, insensitive, hurtful, or combative in nature. Structure your conversations kindly, ladies!

Lots of love, dear friends,

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 changes to your pregnancy healthcare. 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.


  1. I have PCOS, married late in life and now to old to ever become pregnant but I read what you read and man, you have done alot of research and work! I'm sure this information will be very useful to people! I always wonder what would happen if I changed my diet for my PCOS although I truly hope to go into menopause SOON! I enjoy reading your blog and congrats on your new little girl, Greta! Love her name!

    1. MtnGirl - Thank you so much for your kind words, and for visiting! I really appreciate it!! :)

  2. I have not finished reading the entire article yet, but I wanted to let you know I was finding it very interesting. I am 18 weeks pregnant with my first and I am grateful that I have not suffered from HG.

    1. Sister in the Mid-west - Thank you so much for visiting, and for your kind words! Congratulations on your newest little one!!


  3. Hi,

    Thanks for this post... I will def.consider doing this since we might have more children and I cannot go through another tough pregnancy again. I did blog abotu my 4th pregnancy, did you get the link? Can you email me the diet plan, so I can start now, just in case God blesses us with more. Grace and Peace and my homeschool/motherhood blog

    1. Hi, Cathy Rose! I am going to email you right now! I did read your birth story and look through your blog - thank you for the link! I wondered if you had done a write-up summary post of your experience, i.e. comparing your HG v. non-HG pregnancy? I couldn't find that on your blog (so far!).

  4. I had an HG pregnancy two years ago this month with my first and only ds. Ptyalism was one of the worst symptoms outside of the nausea and vomiting. The NVP abated around 25 weeks thankfully. But here I am on the eve of his second birthday thinking (before my first conception)that I'd be on my third pregnancy by now. Yet every time my fertile period comes around I double up on protection out of anxiety for fear I will conceive. :( I'm pretty sure HG contributed to my getting ppd as well. My motherhood experience from the start left me feeling utterly out of control and hopeless. Its only been recently that ive been able to come out of it. I have done research over the past year for HG prevention /protocols and upped my mag levels, taken milk thistle, food based prenatals with probiotics but nothing truly consistent. I think in my heart of hearts I just want to get lucky and have a fluffy pregnancy but I know that's foolish.... Could you email me the diet sheets please? Thank you so much for all the research you've done and for sharing it with the HG community!!

    1. Hi, Crystal!

      Thanks so much for visiting, and for sharing your experience!!

      I would be glad to send you the diet sheets - just leave your email address and I'll send them right over!!

      After my active-HG pregnancy, I too found myself unable to try to conceive - I was too scared. It's a hard journey to travel to try again after an HG experience.

      I do believe that many HG mums go into a post-HG pregnancy with nothing more than hopeful thinking, and that usually doesn't work. Recurrence is very high. I'm thrilled to see that you're starting to do research to help yourself do as well as possible with your next little one!

      I've recently found some awesome resources that I'm really excited about. Here are just a few of them:

      - The Preventing Hyperemesis Facebook group - lots of wonderful women talking about what they're doing to avoid HG.

      - Pink Stork Solutions - Supplements specifically for HG prevention.

      - HyperG Pregnancy website - Podcasts specifically addressing HG prevention.

      Best of luck to you!!

  5. Hi,

    I have a 5 year old daughter and just found out I'm pregnant again! I had HG the first pregnancy, and thought I would never have another child. The reason I started a LCHF diet was in order to achieve pregnancy, since we tried for 3 years to get pregnant with no success.

    I began seeing Dr.Fox, who gave an interview on and he put me on LCHF to manage my PCOS in order to get pregnant. I plan to stay on the diet now that I am pregnant.

    Your story gives me so much hope! Even though I know Dr.Fox advises staying on LCHF diet during pregnancy, there is so much negativity about it out there. I was definitely on ketosis when I had HG, I remember the bad breath! As you said, I would rather be in ketosis and eating real food than be in ketosis and pumped full of drugs.

    Thanks again for your account, it really helps to read success stories!

    1. Hi, Caitlin!

      Congratulations on your newest little one! How exciting! I hope very much that the LCHF diet works beautifully for you. Please let me know how it goes!!

      I recommend the "Preventing Hyperemesis" and "Pregnant Ketosis" Facebook groups if you are looking for any community support - both have excellent resources and wonderful and supportive women.

      A lot of the women on the Preventing Hyperemesis group use supportive supplements as well as diet, so if you are looking in that direction too, it's a great place to ask questions.

      I am planning to start back on the LCHF diet after New Year's, so that will be another adventure. Are you in Phase 2? I generally just stay in Phase 2 and add one or two cheat meals per month (though not during early pregnancy - I found that any carbs really made me feel horrid during the first half).

      Please do let me know how it goes! Congrats again!!

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  7. I've been reading your info about HG for a few years now and I'm so excited to see this most recent update!
    Would you email me the diet sheets? I'm already pregnant but as my HG is less severe, doesn't hit until 6 weeks, and I've been low carb for awhile, I'm hoping I'll see at least some improvement this time. Anything would be appreciated!
    Also, I'm not sure if you're aware, but there is a blood test for H.Pylori. My doctor ran the test for me pre-conception a few years ago and it came back negative. So at least I know that H.Pylori is not a cause for my HG.
    Thank you for all your information.
    saidarspyder at gmail

    1. Diet sheets sent! Many congratulations, and best wishes!!!

  8. Hi Diana! I heard about you through HyperG Pregnancy, while researching prevention of HG in a third pregnancy. I'd love your VLC diet sheets please! I'm also blogging about everything I've been learning.
    Michelle (dot) Cohoon at gmail

    1. Hi, Michelle! My apologies for the delayed response! I have emailed you, with diet sheets attached. Please let me know if you don't receive the message! :)

  9. Thanks for all work you have done. HG is hell. If you could please email me a copy of your diet sheets so we can prepare before the next.

    1. Katie, thank you for visiting! I have emailed you the diet sheets. Let me know if you have any questions!!

  10. This comment has been removed by the author.

    1. Diet sheets sent! Let me know if you have any questions! :)

  11. Could you send me the diet pages as well? Thanks!

    1. Amy - thanks for visiting! I have sent the diet sheets along - let me know if you have any questions! :)


    2. Hi, Amy! My email returned as undeliverable, saying that the account does not exist. If you want to try again with another address, just let me know. Blessings!

  12. I have had 4 HG pregnancies. My 3rd pregnancy I wore a Zofran pump for 15 weeks (an IV type administration 24/7). Got pregnant with #4 assuming I could use the pump again to just survive but once they finally got me set up at 7 weeks with it I had become allergic to the medication. I have been doing the South Beach diet to try to get my hypoglycemia under control for the last 3 months and it has done wonders for my blood sugar issues. I can't help but wonder if I would do a low glycemic diet if it wouldn't help me during pregnancy. I am curious how this diet compares to what I have been eating. I am basically doing very low carb and no sugar. I'm sorry your experiences were so difficult. Although mine were extremely hard (hospitalized dehydrated at 5 wks pregnant etc.), the Lord hasn't taken my desire for another child away...a friend of mine and I always joke that we are crazy because we don't know if we could ever say we are "done" having kids. It doesn't make sense from the outside because everyone I meet says some variation of how "horrible" i look and must feel but like I said the Lord hasn't removed that desire. Anyways, I do appreciate your honesty and sharing for those of us who GET IT! I would love to see the diet sheets and see if it's something I think I could do. Thank you

    1. Thanks so much for stopping by, Kelly! I'm going to email you right now, so let me know if you don't get it! :)

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  14. I just found this blog from Like Mother Like Daughter and would really appreciate the diet facts. My email is I only have HG in the first and beginning of the second trimesters (so far) but it is really difficult and worth working hard to avoid. Thank you.

    1. Anamaria, thanks for stopping by! Always glad to meet another LMLD fan! :) I have emailed you the diet sheets - let me know if they don't come through. Sorry for the delay!!

  15. Hi can you please email me the diet sheets please. My email is thanks so much.

    1. Rebekah, diet sheets sent! Let me know if you don't receive them! Thanks so much for stopping by. :)

  16. I've had severe hyperemesis 3 times now. I've recently started the keto diet which is very low carb, no sugar and high fat. I want another baby so badly but don't think I could go through it all again. We want to start trying in October. Its awesome to hear that this could help! Could you please send me your diet sheets. My email is

    1. Jessica, thank you for stopping by! I have emailed you the diet sheets. Let me know if they don't arrive!! :)

  17. Great article and very informative! I would like to start trying to get pregnant with baby #2 within the next 6-12 months. I would love a copy of the diet my email is

    Btw I had hypermesis exactly like how u ha fit - I threw up 10-14 times a day, and needed zofran until the day I gave birth :(

    1. Diet sheets sent! Thanks for stopping by, Nataly! :)

  18. Hi! I've been researching HG prevention as my husband and I are discussing the possibility of trying for baby #2 at the end of the year. I came across your blog, it's very informative! I'm a carb-aholic but like you, the fear of HG can help me stick to a regimen. I can't imagine the ER visits, Reglan pump, enemas, fainting, IVs, constant nausea and lack of energy with a toddler in tow. I'd love to check out your diet plan and see if it seems doable for me. My email is

    Thank you so much! :)

    1. Diet sheets sent! Let me know if you have any questions! :)

  19. Hello!!! Having had HG for the last 4 pregnancies, I am ready to try ANYTHING before I get pregnant with my 5th (and final). I love carbs. I love sugar. But I hate being pregnant with HG, so I'm ready to take the plunge. I am about 7 days in of doing a VLC diet and just feel like I'm swimming around trying to figure it out. I figured I'd just jump in and give it a go and find my resources rather than wait until I'm "ready" or have it "figured out." That would be months! I'd love your diet sheets. Thank you so much for sharing your experience.

    1. Hi, Michelle! Sure thing! If you can leave me your email address here, I will get those diet sheets out to you pronto. Congratulations on your upcoming fifth little one! We're pregnant with our fifth too at the moment. :)

  20. I would love your diet sheets as well! Thanks for all of your great information. You can send them to me at edennoel (at) hotmail (dot) com

    1. Hi, Eden! I have sent the diet sheets your way - let me know if they don't make it to you. Thanks for stopping by!!

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

    1. Hi, Francesca! I need to remove this comment simply because this post is not about PCOS, but about hyperemesis gravidarum. I am so glad you found a cure for your PCOS, and I know lots of women would love to hear about it on PCOS sites! Have a great day!

  22. Hi Diana! Thank you for the great article! Its very informative. I had HG with my first baby where I was not only on Zofran but PICC line for 5 months and a few hospital stays. I definitely want to have more kids but want to make sure I try everything possible to keep HG at bay if possible. I'd love to check out your diet plan. My email is sara dot jawaid zero nine @ gmail dot com. Thank you!!!

    1. Sara, thanks for visiting! I have sent the diet sheets your way - let me know if they don't get to you, and also if you have any questions! :)

  23. Very interesting. My HG was absolutely HORRIBLE & terrifying with my son (6). I was hospitalized for the first six months. Not in and out of the ER, but literally hospitalized for six months being transferred to different hospitals twice. Even after being released I still vomited several times daily until my son was 2 months old. I would love the diet sheets. Would you be willing to send them my way??? Hiesurvivormom (at) gmail (dot) com

    1. HG Survivor - Thanks for stopping by! I have sent the diet sheets your way. I wasn't sure if your email was supposed to be "Hiesurvivormom" or "HGsurvivormom", so I used both addresses. Let me know if you don't receive the attachment, or if you have any questions. Blessings!!

  24. Hi Diana,

    Thank you for documenting all this great info! I would too love the diet sheets, please. I wish I found your blog earlier. I suffered from HG in my first pregnancy (my son is now 3.5 years old), I was in bed until month 5 with him and was taking several antinausea meds, lost 12% of my body weight and had some good and some bad days. After changing my diet to Paleo and leading a healthier lifestyle I got pregnant last year and my HG kicked in in high gear. I saw a specialist that put me on 3 anti-nausea meds -highest dosage of each plus steroids, highest dosage as well. Nothing worked, I lost 10 pounds on the first week and I'm petitte at 105 lbs, I couldn't even stand up to go use the restroom, because my blood pressure was so low. We ended up losing this baby and my husband and I decided we would never go through this again, it was a traumatic event for both of us (much worse than the first time), and I'm sure for my son as well. We looked into surrogacy and were going through this process when I got a positive H.Pylori test from my gastroenterologist. I've been doing lots of research and now I'm thinking killing the bacteria and changing my diet, as well as addressing nutritional deficiencies might help. I also have heard that liver detox might be beneficial. After my first pregnancy I went to a naturopath that ran all kinds of tests and told me my liver had detox issues.
    My email is Mirelle (dot) Leguia (at) gmail (dot) com

    1. Diet sheets sent, Mirelle! Thanks for stopping by, and feel free to email me with any questions! :)

  25. Diana,thanks for your hard work. May I get the diet sheets?

    1. Laina, thanks for visiting! I have sent you the diet sheets - let me know if you don't receive them! :)


  26. Please send diet sheets to me. I'm suffering greatly.

    1. Diet sheets sent! Let me know if they don't show up! :)

  27. Thanks for all of the information! I'm trying to decide if I want to have another baby and of course one of the biggest concerns is having HG again while having a toddler. Will you please send me your diet sheets as well? Thank you!<3

    1. Tara, I have sent the diet sheets your way - let me know if you don't get them. Thanks for stopping by!

  28. Thank you for your advice. I had hyperemsis with my last baby. He died when we were half way there at 20 weeks, they don't know why. I'm preparing to have another one, but I'm terrified of getting so sick it's a weighed 90 pounds. Will you please email me the diet sheets.
    Thank you

    1. Hi, Danielle! I have emailed you the diet sheets - let me know if they don't make it to you. Thanks for visiting!

  29. Hi Diana! I read the article and I appreciate all the great information. Could you email the diet sheets to me. Thanks!!! -Meena

    1. Hi, Meena! I am SO sorry that I am just getting to this now - I only just now saw your comment. I have sent the diet sheets over - let me know if you don't get them! Happy New Year's!!


  30. Hi, My Wife is hospitalized more than 5 times. Can you please share the diet to be followed.

    1. Hi! Diet sheets sent - thanks for visiting, and hoping that your wife feels better soon!

  31. Hi! I'm not sure if you're still sending the diet sheets but I'd love to see them if you are --

    1. Thanks for stopping by! I have sent the diet sheets - let me know if they don't show up. Have a lovely night!

  32. Thanks for all work you have done. HG is hell, I have suffered from it myself twice. I am planning to get pregnant soon and have been taking magnesium tablets from last 4 months. I have also turned vegetarian 7 months ago and mainly been eating lentils, beans and chickpeas. If you could please email me a copy of your diet sheets so we can prepare before the next.

    1. Hi, Mishi! I have emailed you the diet sheets - please let me know if you don't receive them, and I apologize for taking so long!! Have a wonderful day! Diana


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