Low-carbohydrate Diet For The Treatment Of Gestational Diabetes Mellitus
OBJECTIVE Medical nutrition therapy based on the control of the amount and distribution of carbohydrates (CHO) is the initial treatment for gestational diabetes mellitus (GDM), but there is a need for randomized controlled trials comparing different dietary strategies. The purpose of this study was to test the hypothesis that a low-CHO diet for the treatment of GDM would lead to a lower rate of insulin treatment with similar pregnancy outcomes compared with a control diet. RESEARCH DESIGN AND METHODS A total of 152 women with GDM were included in this open, randomized controlled trial and assigned to follow either a diet with low-CHO content (40% of the total diet energy content as CHO) or a control diet (55% of the total diet energy content as CHO). CHO intake was assessed by 3-day food records. The main pregnancy outcomes were also assessed. RESULTS The rate of women requiring insulin was not significantly different between the treatment groups (low CHO 54.7% vs. control 54.7%; P = 1). Daily food records confirmed a difference in the amount of CHO consumed between the groups (P = 0.0001). No differences were found in the obstetric and perinatal outcomes between the treatment groups. CONCLUSIONS Treatment of women with GDM using a low-CHO diet did not reduce the number of women needing insulin and produced similar pregnancy outcomes. In GDM, CHO amount (40 vs. 55% of calories) did not influence insulin need or pregnancy outcomes. Gestational diabetes mellitus (GDM) is defined as glucose intolerance with its onset or first recognition during pregnancy. The prevalence of GDM is ∼7% (from 1 to 14%), depending on the population and the diagnostic criteria used (1). In Spain, GDM has an estimated prevalence of 8.8% (2). GDM is associated with an increase in maternal and n Continue reading >>
A Tale Of Low Carb Diets And Gestational Diabetes
With the rising popularity of low carb/paleo type diets has come a curious unintended consequence: expecting mothers receiving a false positive on their Gestational Diabetes Mellitus (GDM) test. Gestational Diabetes Mellitus (GDM) GDM is diabetes (“Type 4 Diabetes”) diagnosed in the second or third trimester of pregnancy that is not obviously type 1 or 2 . Women with diabetes in the first trimester would be classified as having type 2 diabetes . The essential contributing factor to GDM is pancreatic insufficiency . Basically, your pancreas is not making enough insulin for your body to overcome the increased insulin resistance due to the placental hormones of pregnancy and increased maternal adipose tissue, which could potentially cause your blood glucose levels to remain high. GDM = weak pancreas. Not making enough insulin for you and the baby. Testing There are two test for GDM: the one step and two step strategy. The One-Step test is the first test for diagnosing GDM. The diagnosis of GDM is made when any of the following plasma glucose values are met or exceeded : Fasting: 92 mg/dL (5.1 mmol/L) 1 hour into the test: 180 mg/dL (10.0 mmol/L) 2 hours into the test: 153 mg/dL (8.5 mmol/L) If for whatever reason you do not pass the One-Step Oral Glucose Tolerance Test (OGTT), ask for the Two-Step test or ask them to check your HbA1C, as it shows blood sugar levels over time as opposed to the brief snapshot these one and two step tests provide. HbA1C can be measured with a simple blood test. The Two-Step test involves the following : Step 1: Perform a 50-g Glucose Loading Test (GLT) (non-fasting), with plasma glucose measurement at 1 h. If the plasma glucose level measured 1 h after the load is ≥140 mg/dL (7.8 mmol/L), proceed to a 100-g OGTT. Step 2: Continue reading >>
Low-carb Diet Linked To Insulin Resistance In Gestational Diabetes
Current dietary practice for women who have gestational diabetes is to focus on a low-carbohydrate diet, which often coincides with increased fat consumption. But low-carbohydrate, high-fat diets may increase maternal insulin resistance and infant adiposity, according to preliminary findings of a study presented by Teri L. Hernandez, PhD, RN, assistant professor of medicine and nursing at the University of Colorado. In the small trial, 11 pregnant women with gestational diabetes were randomized to either a low-carbohydrate, high-fat diet (LC/HF) or a high-carbohydrate, low-fat diet (HC/LF). The LC/HF was comprised of 40% carbohydrate, 45% fat, and 15% fat, while the HC/LF diet was comprised of 60% carbohydrate, 25% fat, and 15% protein. In both diets, 82% of the carbohydrates were complex. All meals were provided by the researchers. The researchers took blood samples at 30-32, and 37 weeks into the women’s pregnancies and biopsied the women’s adipose tissue at 37 weeks. At 37 weeks the women in the LC/HF group had higher fasting blood glucose (P = 0.007), insulin (P = 0.06), maternal insulin resistance (P = 0.02), and post-prandial free fatty acids (P = 0.037) than those in the HC/HF group. Mean adiposity was greater in infants born to mothers in the LC/HF group, at 14% compared to 11% in infants born to mothers in the HC/LF group. Overall, the higher fasting insulin and insulin resistance among women in the LC/HF group was associated with greater infant adiposity. In an interview with EndocrineWeb, Dr. Hernandez said that until now, most research involving women with gestational diabetes focused on maternal blood glucose. “That has been the only clinical metric we have, but our data implies that we can have an impact on these patients’ insulin resistance even i Continue reading >>
Low-carbohydrate Diet For The Treatment Of Gestational Diabetes Mellitus
Low-Carbohydrate Diet for the Treatment of Gestational Diabetes Mellitus 1Department of Endocrinology and Nutrition, Hospital Universitari Arnau de Vilanova, Lleida, Spain 2Department of Medicine, University of Lleida, Lleida, Spain Find articles by Cristina Moreno-Castilla 1Department of Endocrinology and Nutrition, Hospital Universitari Arnau de Vilanova, Lleida, Spain 2Department of Medicine, University of Lleida, Lleida, Spain 3Institut de Recerca Biomedica de Lleida, Lleida, Spain 1Department of Endocrinology and Nutrition, Hospital Universitari Arnau de Vilanova, Lleida, Spain 2Department of Medicine, University of Lleida, Lleida, Spain 1Department of Endocrinology and Nutrition, Hospital Universitari Arnau de Vilanova, Lleida, Spain 3Institut de Recerca Biomedica de Lleida, Lleida, Spain 3Institut de Recerca Biomedica de Lleida, Lleida, Spain 4Department of Basic Medical Sciences, University of Lleida, Lleida, Spain Find articles by Montserrat Martinez-Alonso 1Department of Endocrinology and Nutrition, Hospital Universitari Arnau de Vilanova, Lleida, Spain 2Department of Medicine, University of Lleida, Lleida, Spain 3Institut de Recerca Biomedica de Lleida, Lleida, Spain 1Department of Endocrinology and Nutrition, Hospital Universitari Arnau de Vilanova, Lleida, Spain 3Institut de Recerca Biomedica de Lleida, Lleida, Spain 5Unitat de Salut Publica i Nutricio, Universitat Rovira i Virgili, Institut dInvestigaci Sanitria Pere Virgili, Reus, Spain 1Department of Endocrinology and Nutrition, Hospital Universitari Arnau de Vilanova, Lleida, Spain 2Department of Medicine, University of Lleida, Lleida, Spain 3Institut de Recerca Biomedica de Lleida, Lleida, Spain 1Department of Endocrinology and Nutrition, Hospital Universitari Arnau de Vilanova, Lleida, Spain 2Departm Continue reading >>
Can Low Carb Help With Gestational Diabetes In Pregnancy?
When Natalie Thompson Cooper was diagnosed with gestational diabetes in her first pregnancy, at age 28, she was very concerned. The condition, which affects at least one in seven pregnancies to as many as one in five, causes blood sugars to rise abnormally high, called hyperglycemia. 1 Natalie knew hyperglycemia bathed her unborn daughter in glucose, putting the fetus at risk for a wide range of potential complications, including miscarriage, birth defects, macrosomia (very large size), high blood pressure, birth trauma, and higher rates of C-section and even stillbirth. 2 Moreover, gestational diabetes (GD) — also called ‘carbohydrate intolerance of pregnancy’ — greatly increases the risk that the mother and her offspring will both face future health problems, such as much higher rates of eventual type 2 diabetes, metabolic conditions, and cardiovascular disease. 3 GD is one of the most common and significant complications of pregnancy. Prenatal guidelines the world over recommend the routine screening of all pregnant women and then, if positive, strict management, starting with dietary therapy, then if that does not work, insulin injections. 4 However, to this day, what constitutes the best “dietary therapy” is hotly debated, with some researchers proposing a diet high in complex carbohydrates (60% carbs) and others lower carbohydrates (40% carbs). 5 However, the recommended “lower carb” GD diet is still far higher than the under 20 g per day of the strict low-carb high-fat or ketogenic diet. In fact, many guidelines for GD recommend women, on an ostensibly “lower-carb” diet, eat a minimum 175 g of carbohydrate daily, a level at which many women see their blood sugar rise out of control. “Honestly, 175 g of carbohydrate is stupid! Women should be Continue reading >>
Gestational Diabetes: Can I Lower My Risk?
As many as 9 out of every 100 pregnant women will develop a condition known as gestational diabetes mellitus (GDM). It can put you at risk for problems during pregnancy and delivery. When you're pregnant, your cells become slightly more resistant to insulin. This causes the amount of glucose or sugar in your blood to rise. The extra sugar helps make more nutrients available to your baby. But if your cells become too resistant and the glucose can't into them, your blood sugar level becomes too high. It can cause problems for you and your growing baby. Although some things mean you're more likely to get it, you can steps to lower your risk. Who Gets It? No one can say for sure who will have gestational diabetes, but your chances go up if you: Are Hispanic, African-American, Native American, Asian American, or Pacific Islander Were overweight before your pregnancy Have a family member with diabetes Are age 25 or older Had gestational diabetes in an earlier pregnancy Had a very large baby (9 pounds or more) or a stillbirth Have had abnormal blood sugar tests before Talk to your doctor about how likely you are to get it and what symptoms to watch for. Diet Your doctor or a nutritionist can help you choose foods that may keep your blood glucose within a healthy range. They can also teach you about ideal portions and meal timing. In general, limit sweets and track how many carbohydrate-rich foods you eat. Include fiber in your meals. This can come from vegetables, fruits, whole-grain breads, whole-grain crackers, and cereals. One large study looked at diets of women before they got pregnant. Each daily increase in fiber by 10 grams reduced their risk of gestational diabetes by 26%. In addition to what you eat, taking fiber supplements may be helpful in helping you reach your f Continue reading >>
The Gestational Diabetes Diet: Taking Carbs From A Pregnant Lady
When I decided, at age 40, that I wanted to try to have a child, I knew I faced a few elevated risks over younger women: first and foremost, I might not be able to conceive at all. I mentally prepared myself—as much as I could, anyway—for that and other possibilities, including the higher risk of the baby having a genetic defect. So far I’ve been fortunate. The one risk I hadn’t given much thought to—the higher chance of developing gestational diabetes—is the only one that has been a factor in my pregnancy. I’m fairly healthy, I have no history of diabetes in my family, and I try to eat well—lots of fresh fruits and vegetables and few highly processed junk foods. But older pregnant women—and that means even women as young as in their late 20s, believe it or not—can have a harder time regulating insulin, leading to increased blood sugar levels. Gestational diabetes, if not controlled through diet and exercise, can cause high-birth-weight babies and potentially lead to delivery complications, as well as increasing the risk that the child will develop obesity and type 2 diabetes later in life. For the mother, there’s also the risk of high blood pressure and a higher likelihood of developing type 2 diabetes in the future. I haven’t been diagnosed with gestational diabetes so far. But because my blood sugar was a little high during my early glucose tolerance test (this is given to all pregnant women around 28 weeks, but women of my age are also sometimes tested earlier), I was advised to exercise more frequently and follow a low-carbohydrate diet, the same advice given to those with the diagnosis. The last thing a pasta-loving pregnant lady with a sweet tooth wants to hear is that she should cut out carbs. I have always been skeptical of the low-carb Continue reading >>
Gestational Diabetes Diet
Gestational diabetes, which causes higher-than-normal blood sugar levels to be present, occurs during pregnancy. Gestational diabetes testing usually occurs between 24 and 28 weeks of pregnancy. If you have risk factors for diabetes, your doctor may recommend testing earlier in the pregnancy. If you receive a gestational diabetes diagnosis, you’ll need testing 6 to 12 weeks after giving birth to see whether the diabetes is still present. Gestational diabetes usually resolves after you deliver, although you’re at higher risk for developing type 2 diabetes later in life. According to Johns Hopkins Medicine, gestational diabetes affects 3 to 8 percent of pregnant women in the United States. Gestational diabetes increases the risk of having a large baby, which may cause problems with delivery. It also increases the risk of having a baby born with hypoglycemia (low blood sugar). Respiratory distress, jaundice, and low calcium and magnesium levels are also more common in babies whose mothers have gestational diabetes. There’s a higher risk of your baby developing diabetes later in life as well. Changing your diet is generally the first method of treatment for gestational diabetes. The amount of calories you should consume each day depends on a number of factors, such as your weight and activity level. Pregnant women should generally increase their calorie consumption by 300 calories per day from their prepregnancy diet. Doctors recommend three meals and two to three snacks per day. Eating smaller meals more frequently can help you keep your blood sugar levels stable. Your doctor will likely recommend that you monitor your blood sugar levels to help manage gestational diabetes. Testing your blood sugar after meals tells you how that meal affected your blood sugar. Your d Continue reading >>
What Can I Eat If I Have Gestational Diabetes? Food List And More
Gestational diabetes is diabetes that only occurs in pregnant women. That means you can't get gestational diabetes unless you’re pregnant. You may develop gestational diabetes for the first time during pregnancy or you might have a mild undiagnosed case of diabetes that gets worse when you’re pregnant. During pregnancy, the way your body uses insulin changes. Insulin is a hormone that breaks the foods you eat down into glucose, or sugar. You then use that glucose for energy. You’ll naturally become more resistant to insulin when you’re pregnant to help provide your baby with more glucose. In some women, the process goes wrong and your body either stops responding to insulin or doesn't make enough insulin to give you the glucose you need. When that happens, you’ll have too much sugar in your blood. That causes gestational diabetes. If you have recently been diagnosed with gestational diabetes, or are curious about what will happen if you are diagnosed with it, keep reading to learn more about maintaining a healthy pregnancy. Eat protein with every meal. Include daily fruits and vegetables in your diet. Thirty percent or less of your diet should be made up of fat. Limit or avoid processed foods. Pay attention to portion sizes to avoid overeating. If you have gestational diabetes, maintaining a healthy, balanced diet may help you manage your symptoms without needing medication. In general, your diet should include protein plus the right mix of carbohydrates and fats. Once you are diagnosed with gestational diabetes, ask your doctor about working with a registered dietitian or nutritionist. They can help you plan your meals and come up with an eating plan that will keep you and your baby healthy. Aim to base your meals around protein. Include lots of fresh foods a Continue reading >>
What Do We Know About Diet And Gestational Diabetes?
Why do some women develop diabetes during pregnancy? And if gestational diabetes is “just” a disease of pregnancy and goes away after birth, why do so many of those women go on to get Type 2 diabetes later in life? As it turns out, diabetes of pregnancy might be a red flag for pre-existing, long-term metabolic problems. It’s not an issue that suddenly appears out of the blue during pregnancy for no reason. And it’s one more reason for everyone to take care of their diet, even if they’re healthy right now. Gestational diabetes can affect the health of the woman long after her pregnancy is over, and it also affects the health of the baby (this is where men come in – if your mother had gestational diabetes, you’ll probably want to know about it). Here’s a look at where it comes from, and why a long-term game plan is so important. What Is Gestational Diabetes? Gestational diabetes is a type of diabetes triggered by pregnancy. Women with gestational diabetes didn’t have diabetes before they were pregnant (in that case it would just be regular old type 1 or type 2 diabetes). Typically, gestational diabetes also goes away after birth…at least temporarily. Like all other kinds of diabetes, gestational diabetes has been getting more and more common: the rate of gestational diabetes increased 122% between 1989 and 2004. Gestational diabetes is more common in older mothers, nonwhite women, women with a family history of diabetes, and women who were overweight before their pregnancy (although it also shows up in thin women, so just being thin is no guarantee of safety). If a woman has gestational diabetes during one pregnancy, she’s more likely to have it in future pregnancies. Women with gestational diabetes usually don’t get any symptoms, but they can some Continue reading >>
Dietary Recommendations For Gestational Diabetes
Diabetes diagnosed during pregnancy is called gestational diabetes. Gestational diabetes occurs in about 7 percent of all pregnancies. It usually arises in the second half of pregnancy and goes away as soon as the baby is born. However, if gestational diabetes is not treated, you may experience complications. The first step in treating gestational diabetes is to modify your diet to help keep your blood sugar level in the normal range, while still eating a healthy diet. Most women with well-controlled blood sugar deliver healthy babies without any complications. One way of keeping your blood sugar levels in normal range is by monitoring the amount of carbohydrates in your diet. Carbohydrate foods digest and turn into blood glucose (a type of sugar). Glucose in the blood is necessary because it is the fuel for your body and nourishment your baby receives from you. However, it's important that glucose levels stay within target. Carbohydrates in Food Carbohydrates are found in the following foods: Milk and yogurt Fruits and juices Rice, grains, cereals and pasta Breads, tortillas, crackers, bagels and rolls Dried beans, split peas and lentils Potatoes, corn, yams, peas and winter squash Sweets and desserts, such as sugar, honey, syrups, pastries, cookies, soda and candy also typically have large amounts of carbohydrate. Carbohydrates in foods are measured in units called grams. You can count how many carbohydrates are in foods by reading food labels and learning the exchange lists. The two most important pieces of information on food labels for a carbohydrate-controlled diet is the serving size and grams of total carbohydrate in each serving. Dietary Recommendations It is important to be meet with a registered dietitian to have your diet assessed. The dietitian will calcula Continue reading >>
What Is The Best Diet For Gestational Diabetes?
Gestational diabetes can cause a range of complications during pregnancy. Fortunately, a woman can help reduce complications by following a healthful diet. What foods should women eat and what foods should they avoid if they have gestational diabetes? Gestational diabetes occurs if a woman's body cannot produce enough insulin, during her pregnancy. This deficiency leads to high blood sugar. High blood sugar levels may cause problems for the woman and her baby if not managed properly. This article explains what type of diet a woman should follow during pregnancy if she has gestational diabetes. It also considers other treatment options for gestational diabetes and what complications may occur if the condition is not properly managed. Contents of this article: Understanding gestational diabetes Gestational diabetes is a type of diabetes that can develop during pregnancy. According to the Centers for Disease Control and Prevention (CDC), between 2 and 10 percent of pregnancies are affected by gestational diabetes each year in the United States. This type of diabetes occurs when a woman's body cannot make enough of the hormone insulin. Insulin is made by the pancreas and helps the body's cells to use sugar from the blood as energy. When a woman is pregnant, her body will produce more hormones, and she may put on weight. Both of these changes may mean that her body's cells may not use insulin as well as they used to. This is called insulin resistance. Becoming resistant to insulin means that the body needs more of it in order to use up the sugar in the blood. Sometimes a woman's body cannot produce enough insulin to keep up. This leads to a sugar buildup in the blood, resulting in high blood sugar levels. Symptoms of gestational diabetes may include: being unusually thirsty Continue reading >>
9 Gestational Diabetes Myths
As a specialist in gestational diabetes nutrition, I get a lot of questions about blood sugar and pregnancy. Gestational diabetes is controversial. Its complicated. And theres a lot of misinformation out there. I do my best to address the controversies in interviews and with participants in my online gestational diabetes course, but since Ive been receiving more and more inquiries in my inbox from fellow healthcare professionals, I wanted to dispel some gestational diabetes myths head-on right here on the blog. Ill also be attending some midwifery conferences this year (including one this weekend), and I figured this resource would be a helpful place to refer practitioners if they have questions. Given the medical interventions that are commonly pushed on women with gestational diabetes (believe me, Im also disheartened by the over-medicalization of pregnancy and birth), its important to understand the science behind high blood sugar and pregnancy. My goal is to help moms and practitioners make better decisions based on fact, not fear so they can have the healthiest pregnancy possible. Myth #1: Blood Sugar Levels are Naturally Higher In Pregnancy Theres a lot of misinformation floating around about blood sugar levels in pregnancy. Some think that gestational diabetes is a diagnosis looking for a disease. In other words, they believe that blood sugar levels naturally go up during pregnancy, so theres nothing to worry about. Some practitioners dont even test for gestational diabetes and just tell their patients to eat healthy under the assumption that any rise in blood sugar is just a normal phenomenon of pregnancy. Unfortunately, thats not true. Research has looked at blood sugar levels in normal, healthy pregnant women and found that blood sugar levels consistently tre Continue reading >>
Real Food For Gestational Diabetes: What You Need To Know
Note From Mommypotamus: When I wrote about natural alternatives to the glucola test, many of you asked what to do if gestational diabetes is diagnosed and confirmed. Today I am so excited to welcome Lily Nichols, RDN, CDE, CLT, a registered nutritionist and gestational diabetes educator, who will be filling us in on how to take a real food approach to GD. Lily is the author of Real Food for Gestational Diabetes, a thoroughly researched guide filled with practical guidance and easy-to-follow instructions. It is, hands down, the best resource on the subject that I have found so far. If you or someone you know is looking for information on managing GD with real food, I highly recommend it! Gestational diabetes is never part of any mom’s plan . . . But it is the most common complication of pregnancy, affecting up to 18% of pregnant women. Yet there are many misconceptions about this diagnosis, both in conventional health care and the integrative medicine world. As a registered dietician/nutritionist and certified diabetes educator who specializes in gestational diabetes, I’m going to clear up some of the confusion for you today. Whether or not you have gestational diabetes, this post will help you understand how it develops and why it’s important to maintain normal blood sugar (for all pregnant women, really). I’ll also be sharing why the typical gestational diabetes diet fails and why a real food, nutrient-dense, lower carbohydrate approach is ideal for managing gestational diabetes. What is Gestational Diabetes? Gestational diabetes is usually defined as diabetes that develops or is first diagnosed during pregnancy. However, it can also be defined as “insulin resistance” or “carbohydrate intolerance” during pregnancy. I prefer to rely on the latter descrip Continue reading >>
Can A Ketogenic Diet Cure Gestational Diabetes? Here's What The Science Says
Higher risk of the child suffering other health conditions later in life (including obesity, heart disease, and yes, diabetes) Bigger babies, and tougher deliveries (e.g., shoulder dystocia) Plus, the test is cheap and doesnt harm anyone--the benefits greatly outweigh the costs. Should you get a glucose tolerance test if you already manage your diet well? Maybe not, but its good to play it safe. In an abundance of caution, its nice to know your status when it comes to blood sugar in the event you need to manage it better. (I know it helped me.) Most people in the general population can easily get caught up in the stress, dietary decisions, and lifestyle influences that can cause elevated blood glucose. Even healthy people are prone to higher blood sugar because they consume the excess carbs recommended in the Standard American Diet. So for the average pregnant woman, testing for GDM is a safe and reasonable idea--and even if you have a low-risk pregnancy, one morning of drinking sugar syrup isnt that terrible if theres even the slightest chance it would improve outcomes for your baby. When I got my GDM diagnosis, I had to schedule an appointment with a nutritionist to discuss the recommended dietary guidelines for the remainder of my pregnancy. Before I even met the nutritionist, I was furious. I feared they would force me to eat tons of carbs and try to shove a low-fat agenda down my throat. I mentally prepared to argue for a higher-fat, lower-carb diet, confess to my past dietary sins (forgive us our cheese puffs), and basically tell them no if they wanted me to do anything I wasnt comfortable with. I didnt want to follow the guidelines, mainly because theres heavy debate over their efficacy. Some reviews say that none of the existing guidelines help one way or the o Continue reading >>