New study: Can a keto diet result in birth defects?

Can a keto low-carb diet result in birth defects? Well, that’s what you may think, reading this article from the Daily Mail today, based on a new observational study:

Daily Mail: Low carb diets like Atkins, Paleo or Keto linked to risk of birth defects including spina bifida, study claims

The argument is that lower carb diets can lead to a lower intake of folic acid, if people eat less bread. White bread normally has close to zero vitamins and minerals, which is why it’s fortified with some added vitamins, like folic acid.

A new observational study found that pregnant women who reported eating few carbs also ate less folic acid (likely for this reason) and their babies had a borderline significant 30% increased risk of some birth defects, like spina bifida, that may be caused by a lack of folic acid:

Birth Defects Research: Low carbohydrate diets may increase risk of neural tube defects

Weaknesses

There are plenty of weaknesses with the study, primarily that it’s observational, meaning it’s just based on statistical correlations (weak ones, in this case). This means that the study simply can’t prove whether the defects were caused by folic acid deficiency, or the diet of the mothers, or something else.

The mothers who reported a lower carb intake were also older, more obese, smoked more and drank more alcohol, all things that may be connected to an increased risk of birth defects, so it’s perhaps not a fair comparison.

However, even if the study is hardly the final word on the topic, it can still be a good idea to make sure to have enough folic acid if you are planning to conceive. Just to be safe.

How to eat plenty of folate on low carb and keto

Fortunately, it’s not necessary to eat wheat flour (clearly not great for anyone’s health) with artificially added vitamins just to get enough folic acid. You could also just eat vitamins as a supplement, negating the need to eat flour+vitamins. Or, you could eat real low-carb foods.

Some of the most folic acid-rich foods in the world happen to be low in carbs, including vegetables (particularly dark green leafy vegetables). Avocado, spinach, liver, asparagus, and Brussels sprouts are among the foods with the highest levels of folic acid, and it’s also found in dairy products, poultry and meat, eggs and seafood.

Sounds like a low-carb diet to me.

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3 comments

  1. Chris Barclsy
    Folic acid and folate are not, as your excellent article suggests, the same. Pills contain folic acid, as do many fortified foods. Folic acid is a manufactured/synthetic chemical. Folate on the other hand is chemically different and is the natural vitamin found in the real food you mentioned. A small but, I think, significant difference. Keep up the fantastic work.
    Dr Chris Barclay
  2. Chris Barclay
    Folic acid and folate are not, as your excellent article suggests, the same. Pills contain folic acid, as do many fortified foods. Folic acid is a manufactured/synthetic chemical. Folate on the other hand is chemically different and is the natural vitamin found in the real food you mentioned. A small but, I think, significant difference. Keep up the fantastic work.
    Dr Chris Barclay
  3. Eloise deLun
    Unfortunately, this article was published too late for our son & daughter -in-law. She had been on a strict Keto diet (testing her urine 2x/day) for almost a year when she got pregnant. Their baby, born in December 2018 was diagnosed within just hours of birth with Tetralogy of Fallot.

    He has all 4 heart defects in various stages of severity (fused Aorta & pulmonary artery, a hole between the ventricles, the R. ventricle is badly thickened & pumps very little blood & the distal end of the pulmonary artery is stenosed, cutting further the flow of blood to the lungs.) He'll be having open heart surgery next week. Meanwhile keeping this little guy (he's so beautiful nobody would suspect he's impaired in any way) quiet to reduce his need for oxygen & constant respiratory monitoring (an attached pulse-ox & special motion -detector monitoring while asleep even next to their bed takes a lot of the fun out of having a baby. Even diaper changes are stressful as they must be done very quickly as to avoid him crying or fussing for even a few minutes. Thankfully, the success rate of the planned surgery needed is very high.

    Neither of our families has a history of birth defects or heart problems. Genetic testing of both sides of the family didn't reveal anything unusual. The Cleveland Clinic geneticist & the neo-natal cardiologist, though they won't officially blame the Keto diet, said this wasn't the first baby by far seen with [heart] problems whose mother had followed it & hadn't started on pre-natal vitamins PRIOR to getting pregnant.

    She went off the Keto diet after finding out she was pregnant & hasn't resumed it post-partum (breast feeding). No more special diets, urine testing or skipping treats. The irony is she's already lost all the weight gained in pregnancy plus more & looks better than she ever has.

    All I can say is if there is even a remote chance of a woman getting pregnant, especially while on the Keto diet she really needs to take not just a daily multivitamin but one specifically designed for pre-natal health. This will help avoid having a baby with any number of birth defects. The thought of any other family having to unnecessarily deal with the huge emotional and financial strain of such problems is truly sad & utterly preventable. What should have been one of the happiest events in their - and our - lives has been overshadowed by all of this.

    All to lose a few pounds of weight to meet someone else's idea of what looks good.

    Eloise deLun RN,C

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