February 14 2017

A Primal Look at Gestational Diabetes

By Mark Sisson
23 Comments

6e47810c-637e-41e1-8858-bb0cb20b1fa5Every pregnant woman I’ve ever known has hated the oral glucose tolerance test. Yet, they still do it. Drinking a tall glass of sickly sweet orange-flavored glucose water on an empty stomach is thoroughly disgusting, but it, apparently, offers a rare and valuable glimpse into the state of a woman’s perinatal health.

What they’re testing for is gestational diabetes mellitus—a variant of diabetes characterized by pancreatic insufficiency during pregnancy.

Sometimes it’s a misdiagnosis. Low-carb, high-fat diets transiently increase insulin resistance. This isn’t a flaw, it’s a feature to ensure you keep burning fat in the tissues that can and preserve precious glucose for the sections of the brain that must burn glucose. But this also means that taking a gestational diabetes test while low-carb can give a false diagnosis.

Moreover, pregnancy in general throws glucose tolerance out of whack. Just like a low-carb diet can induce insulin resistance to temporarily preserve glucose for the brain, pregnancy induces insulin resistance to preserve glucose for the fetus. This made sense when glucose was rarer, when you had to shimmy up a tree for honey or dig for roots and tubers. In that metabolic milieu, a little insulin resistance during pregnancy was adaptive. In today’s environment, where at any given moment you’ve got a million inexpensive glucose calories within a 5-minute drive, it can cause problems.

In babies:

  • Excessive birth weight.
  • Injuries from a rough birth.
  • Low nutrient levels upon entry.
  • Pre-term delivery.

In moms:

  • Increased type 2 diabetes risk.
  • Increased C-section risk.
  • Increased risk of hypertension and pre-eclampsia.
  • increased risk of miscarriage.

You have two options to test for it. Well, three technically: you could just skip the test, but I don’t recommend that because GD is quite serious.

  1. Eat 150-250 grams of carbs per day in the week leading up to the test. This will give you a chance to shift back into sugar-burning mode.
  2. Ask for a “whole food” GD test. A friend of mine’s wife opted for a mixed meal containing carbs, fat, and protein instead of drinking the disgusting glucose solution, as a meal is a far more realistic test of one’s ability to tolerate glucose. The most common GD test meal involves pancakes, but those can always be gluten-free.

Okay, say you’ve got gestational diabetes, or you’re worried about getting it. What now?

Prevention

Stopping it before it happens is always the ideal course of action. How can women reduce the risk of gestational diabetes?

Let’s look at risk factors. Beyond “being pregnant,” what else seems to predispose a woman to developing gestational diabetes?

  • Prior diabetes. Being diabetic makes you more likely to stay diabetic. Same goes for family history of diabetes.
  • Excess weight. This is another reason pregnancy sets the stage for diabetes: the unavoidable weight gain.
  • Twins. Carrying twins increases the risk.
  • Age. Older moms are at a higher risk of GD.

Those are difficult—maybe impossible—risk factors to change, but at least you know your risk profile. Now what can you actually do to reduce the risk?

Be Primal.

You knew it was coming, but this really does work. Eat well, sleep lots, reduce unnecessary stress, get your veggies, eat seafood, and lead a generally healthy lifestyle.

Exercise.

One study found that moderate intensity cycling for 30 minutes 3 times a week in the first trimester drastically reduced the incidence of GD in overweight and obese women.

Although we don’t have data on the relationship between gestational diabetes risk and lifting heavy things, sprinting, burpees, CrossFit, bodyweight training, gymnastics, MovNat, or high-intensity gardening, all those activities improve insulin sensitivity and glucose tolerance.

Eat well and exercise.

A recent study found that healthy eating and exercising are more protective against GD than either alone. No word on what “healthy eating” actually meant. It was probably better than McDonald’s and Doritos, worse than grass-fed meat and sweet potatoes.

Take probiotics, eat fermented food.

One study found that taking probiotics early on in pregnancy reduced the risk of gestational diabetes and slightly reduced birthweight without increasing preterm labor, though it had no effect on miscarriage or fetal death risk.

If you want a food source of some of these strains, most kefirs I’ve encountered in the market have L. rhamnosus GG. 

Take myo-inositol. 

Pregnant women with a family history of GD who took 2 grams of myo-inositol and 200 mg folic acid each day starting from the end of the first trimester went on to develop less gestational diabetes than the control group who took only folic acid (6% versus 15.3%).

Managing GD

Say you’ve got it. What can you do?

Keep eating well.

Studies on low-carb diets in women with gestational diabetes have had fairly disappointing results. Heck, pretty much all studies of dietary interventions for gestational diabetes have been underwhelming. What might work is a focus on less refined carbs rather than a big reduction in overall carbs. I’ve said before that pregnant women need more carbs than their non-pregnant counterparts. Just make sure they’re unrefined, rather than refined. Anywhere in the range of 120-200g per day is probably best.

Check out this account from a woman who conquered her GD by following the Primal Blueprint. Simple changes like ditching wheat, eating sweet potatoes instead of rice, and eating more veggies—alongside regular checkups with her doctor—did the trick.

But don’t “diet.”

You can change how you eat. In fact, you probably should.

You can eat healthier. Again, you’re better off doing this.

But you shouldn’t diet to lose weight. You shouldn’t cut calories, adopt any extreme eating strategies, adhere to a compressed eating window, or obsess over your weight gain while pregnant.

Focus on improving insulin sensitivity.

Unchecked insulin resistance lies at the heart of gestational diabetes. Pregnancy itself increases IR, so you’re starting from behind. The best thing you can do is review the list of 25 ways to improve insulin sensitivity and make sure you’re doing some of them.

Not all are suitable, though. Pregnant women do have some limitations:

  • Don’t go too hard or too heavy. Lift weights, safely and moderately. Don’t try to keep up with everyone at CrossFit. Don’t go for any powerlifting PRs, either. Keep things moderately intense across moderate levels of volume. Somewhere in the 5-8 rep range if weighted. Consider just doing bodyweight training, too.
  • Don’t sprint. While it’s a great way to increase insulin sensitivity, carrying an entire human in your womb makes sprinting unwise.
  • Keep intensity moderate. Moderate intensity aerobic exercise (30 min/day, 3x/week) really does reduce adverse GD-related outcomes.
  • Don’t fast. Now is not the time.

Snack on exercise.

If it’s at all possible, weave movement and exercise into your day. Go for walks after meals. Do a few sets of squats before you eat. This will keep your glucose tolerance primed.

Supplements and specific foods may help.

A number of studies show that certain supplements can be useful.

  • Myo-inositol reduces insulin resistance in women with gestational diabetes.
  • When given to pregnant women with GD, magnesium improves insulin resistance, glucose tolerance, and other metabolic markers while reducing infant hospitalization and newborn jaundice.
  • Vitamin D improves insulin sensitivity, blood glucose, and blood lipids in women with GD.
  • Selenium also improves glucose metabolism while reducing oxidative stress and inflammation in women with GD.
  • Zinc doesn’t affect birth outcomes in GD, but it does improve inflammatory markers.
  • Other supplements or supplemental foods that help with insulin sensitivity (haven’t been studied in gestational diabetes), but probably don’t hurt include vitamin K2, cinnamon, ginger, garlic, turmeric (don’t forget the black pepper).

Definitely check with your doctor before beginning any supplementation during pregnancy.

Probiotics and/or fermented food can help.

A recent RCT out of Tehran found that women with GD who took probiotics (strains: Lactobacillus acidophilus LA-5, Bifidobacterium BB-12, Streptococcus thermophilus STY-31 and Lactobacillus delbrueckii bulgaricus LBY-27) once a day for 8 weeks improved fasting glucose, reduced insulin resistance, and gained less weight than the control group.

All of these strains can be commonly found in commercial yogurt and kefir. Check the label for a list of strains.

What about pharmaceuticals?

For many years, the primary pharmaceutical treatment for women with gestational diabetes who weren’t responding to diet and exercise was an insulin injection. More recently, some doctors are giving metformin, whose potential life extension applications I’ve discussed before, to GD patients. Neither seem to be any worse for the mom or baby than the other. Another anti-diabetic drug sometimes given to women with GD called glyburide seems to increase the risk of complications.

Sadly, as of this year, we still don’t have any good research comparing oral diabetic meds to non-pharmaceutical treatment or placebo in women with GD. Exercise caution and discuss all this with your practitioner before deciding on a course forward.

That’s my (outsider’s) take on gestational diabetes. It can often be managed using Primal principles, it’s not a death sentence, but it shouldn’t be ignored either.

What do you think, everyone? To the women readers—have you ever dealt with GD? Men—have you (in a loved one)? What worked? What didn’t?

Thanks for reading. Take care!

Olive_Oil_640x80

If you'd like to add an avatar to all of your comments click here!

23 thoughts on “A Primal Look at Gestational Diabetes”

Leave a Reply

Your email address will not be published. Required fields are marked *

  1. My OB/GYN was using the “whole food” test at least 20 years ago. IIRC, breakfast was a choice between measured amounts of cornflakes and 2% milk with half a banana, or a specific McDonald’s breakfast, something like an Egg McMuffin with orange juice. They also allowed two choices–one homemade, one McDonald’s–for the after-lunch appointments.

  2. Wow, love the idea of the whole foods GD test. I drank the crappy orange sugar water when I was pregnant (20 years ago). I was fortunate not to have GD. Was definitely not primal back then. I was pretty much vegetarian/pescatarian, but way too heavy on the carbs. I was trying to be so good…reading those “What to Expect Books” which really stressed the whole grains. Thankfully I didn’t eat much actual junk food, and I definitely walked quite a bit. Interesting post! Would love to hear from woman who are having a primal pregnancy and hear how it is going

  3. I had twins 2 years ago and tested negative for GD on the one hour test. I definitely gravitated toward a higher carb diet when pregnant just based on my food cravings. I was worried I would fail because I was thirsty all the time and obviously carrying multiples is a big risk factor. Per the advice of my midwife, I ate a big egg fritatta with no carbs that morning and passed with flying colors!

  4. They will often also let you drink a juice – I think I did grapefruit juice with both of my pregnancies because I love grapefruit juice! You just have to measure out the right amount so that you consume the same number of carbs as you would have with the orange goo.

  5. In my experience I don’t think there’s a lot you can do to actually prevent it. The only thing you can really do is manage it well. I’ve scored high on my 1 hr glucose challenge with all my full term pregnancies. I am predisposed to diabetes and IR (found that out later unfortunately). I was shocked when I scored a 135 with my first pregnancy at age 24. They made me take the 3 hr test then. I wasn’t obese or even overweight… I exercised and although my diet wasn’t stellar, it wasn’t horrid either (compared to the average SAD). With each pregnancy, my number went up a bit…139 at age 27; 159 at age 30 and 151 at age 33. I declined any more 3 hr tests and basically monitored carbs and checked my sugars with the glucometer (SO FUN! ha!). I knew I had a problem though when I would slip up and eat a high carby meal …my numbers went over 140 at the 2 hr mark…a sure sign that something was amiss. With my last pregnancy I stumbled across a website called blood sugar 101…it was so eye opening and I’m glad I read it. (truly normal blood sugar would have been back close to fasting level 1-2 hrs later…not barely hovering under 140) It was the first step on the way to primal! I’m 36 now and know I have issues with blood sugar and insulin resistance, I’m so grateful I found the primal blueprint. I’ve lost 30 lbs over the past 9 mths including a 10% drop in body fat. I wish I would have known about it back then. I managed my gestational diabetes with diet and exercise but still included wheat and soy based “low carb” options. I know better now lol!

  6. I told my OB that I would be refusing the Oral glucose test (it would have made me throw up, I know I can’t have that much sugar, regardless of my current diet.) I was able to keep a food log for a week, and took my own blood sugar levels at fasting, and after meals. I had lower fasting numbers that I had before pregnancy, and while my after meal numbers were higher, none reached any concerning levels.

    1. I also refused the glucose test in favor of blood sugar testing (fasting and after my largest meal). I feel that the test is an antiquated procedure that doctors just continue doing because it’s quicker/easier than the other options. A whole foods test would be better and give a more realistic view, but my obgyn office does not allow it.

  7. They didn’t do this test when I was pregnant years ago, or if they did, it was done selectively. I did notice, however, that some women used pregnancy cravings as an excuse to pig out on anything and everything, hence incurring a huge weight gain that’s difficult to get rid of post-delivery. Judging from the number of obese new mothers I see, things haven’t changed much since then. The only thing I ever craved when I was pregnant was spinach, which I ate a ton of. Fortunately it isn’t fattening. I did find it a bit odd since I’ve always eaten a lot of vegetables.

  8. My scary and wonderful GD story.

    It was my wife’s gestational diabetes that led me to The Primal Blueprint. Late in her pregnancy she was diagnosed with GD, scans suggest totally normal growth so despite the late diagnosis she was advised first on diet (wholegrain & “balanced”). That didn’t work (obviously) so she was given an epi-pen with insulin. Incidentally, my boy didn’t like the sound of that because he busted out that evening, 5 weeks early and before she’d taken he first dose of insulin.

    6 months later I stumbled on the blood meter she’d been given for the GD and tested myself for “a laugh”. Horrified at my result I found ultimately found MDA and dietdoctor.com. Read a tonne of books, dropped 30kg without exercise in 6 months and felt at least 15 years younger. My boy and my wife both got on board, my wife dropped about 10kg and my boy is almost never sick… Everything was great!

    18 months later, and shockingly easily relative to round 1, she got pregnant again. This time the midwives were immediately all over the previous GD diagnosis explaining that it was unimaginable that she would not succumb to GD again. We were given the blood glucose meter and told to monitor, but to everyone’s surprise results were totally normal (if not a little abnormal, apparently it’s not expected that pregnant women have flat serum glucose levels day and night).

    The GD specialists were surprised at the blood results to say the least and extremely pleased. When the conversation turned to diet they were somewhat horrified that we were not eating grains and really put my wife and I on the spot for where we got B vitamins, fibre, etc, etc. Having been primal for nearly 2 years I pacified them without blinking (maybe the GD specialist even went on to lose 50kg herself, ironically and undoubtably possible).

    Fast forward to the birth, all involved did unbelievably well, I’m not sure whether it was the primal mentality but my wife refused all pain relief, not even having the gas that she’d had first time around. Before I knew it I had a beautiful daughter too.

    My wife really suffered for at least the next week. She had routine blood work taken immediately after giving birth. A rather concerned doctor came in saying that they wanted to conduct a complete cholesterol panel. I enquired why they took a sudden interest in her cholesterol and was told that it was actually due to unusually high visual signs of fat in her blood after her bloods were spun in the centrifuge for other tests.

    I wasn’t that concerned despite her having some pain in the liver/pancreas area, thinking of course her HDL would be through the roof and those pesky triglycerides would be low.

    The result came back that her triglycerides her highest this young doctor had EVER seen, 63mmol/L (that’s 1134mg/dL. Yes, one thousand, one hundred and thirty four milligrams per decilitre!!!!!). Needless to say I began to think I’d been killing her with the high fat “GD diet” that I’d created (and lets not forget, kept her off insulin with).

    Long story short, they kept her in for about a week with daily cholesterol tests each and every test came back significantly improved, indicating it was an acute rise until eventually they discharged her. Another 3 weeks later (a little over a month after birth) she had a final test at the GPs office and scored a very boring 1.8mmol/L trigs with high HDL and low LDL.

    No doctor could ever explain to me how this occurred in or out of the context of a pretty low carb (probably very low carb for pregnancy probably, 50-90g slow carbs daily), moderate protein, high fat diet. Given how well everything turned out I’ve come to believe that actually this could be quite normal, even sugar burners are expected to have widely high cholesterol during the third trimester.

    As you all know, taking snacks everywhere you go is an unnecessary habit that is quickly and easily broken when you’ve been primal for a couple of years so my wife pretty much went through labour in a fasted state (and she doesn’t exercise beyond playing with the kids.) My guess is that her body dumped a tonne of triglycerides to fuel the production of ketones for her and baby.

    My daughter is now 15 months and she’s remarkable in so many ways, I know every parent says that!! Whatever was going on metabolically, the midwife of more than 35 years was utterly floored when on the day of her birth, 4 weeks premature, she turned herself from her stomach to her back. It made me think that maybe it’s possible that in days gone by human babies did indeed crawl to the breast unaided immediately after birth.

      1. Thank you, and you’re very welcome. One day I hope to write my full success story containing the other 200 reasons I’m never going back to my old ways. I just thought I’d put the chunk detailing our experience with GD here.

        1. A woman’s cholesterol levels will increase by as much as 50% during pregnancy and up to 6 weeks postpartum as she needs the extra to create sex hormones, develop baby, and prepare for breastfeeding. This is why doctors never test cholesterol when a mom is pregnant. Looks like yours did because of the unusual situation. Glad it all worked out and her numbers reduced.

          I had a similar experience about 4 weeks postpartum when I applied for life insurance. My total cholesterol came back at 291, which is 100 points higher than usual! That’s when I started researching and learned more. I still passed the test for the insurance since I was technically under 300 🙂

  9. So, I’m currently pregnant, and have been low carb paleo roughly 90% of the time for the last 4 years, and I just failed the three hour glucose test. (The test made me feel like crap for 36 hours, which confirm the reasons I cut carbs in the first place, but I digress.) I think it’s a false positive for GD in my case, because I ate a meal that included half a cup of white rice, and an hour later tested my blood sugar, and it was 113. I would expect that number to be higher if I were truly diabetic, yes?

    I do have risk factors, in that I’m over 35 years old, was overweight pre-pregnancy, and have family members that are type 2 or prediabetic. I’ve been referred to a Perinatal office for “diabetes management” but the only direction given by my OB nurse was to not drink soda, which I don’t do, and to cut back on simple carbs, which I don’t eat that often.

    Does anyone have any insight into what to expect from this diabetes management appointment as someone who does low carb, and what exactly I need to do to appropriately advocate for myself? I feel like I’m going into this blind.

    1. The nutrionist is likely going to recommend 150 g of carbs a day and whole grains. My issue was my fasting numbers were between 90-100. They wanted them less than 90. I convinced them with research to allow 95. I walked after meal and snack. Kept carbs between 60-80g a day. Ate primal. I also took a chromium supplement. Primal/paleo is not going to be suggested or approved by most diabetes management clinics. They will probably suggest fasting under 90 and after meals under 120 might be different for 1 hour than 2 though. Be prepared to listen but don’t expect them to give much advice consistent with primal.

    2. It’s probably a diabetic dietician who will go over all of the stuff you probably already know and then will give you a diabetic meal plan as a guideline to follow. As Karen said, it will probably be around a 150g of carbs a day one. That’s what mine was and I did not follow it. If I had, my sugar levels definitely would’ve been over the limits all the time.
      Trust the test though. The 1 hour one can be wrong (which is why they do the 3hr), but never heard of the 3hour one giving a false result.
      Just keep doing what you’re doing and keep an eye on your carb intake. It’s trial and error at first. You may be able to eat what you normally do since you’re already low carb and still be fine or you may come to find out that eating bread or potatoes will spike it like crazy while fruit and rice doesn’t.

  10. I had GD 2 out of 3 of my pregnancies, but I was already high risk to begin with bc I’m already insulin resistant, have pcos, and I’m chubby. It really wasn’t too difficult to control through diet. I couldn’t control my fasting level in the morning so had I take glyburide. It’s trial and error at first, but once you know how much carbs you can eat, you just stick with it until the end. I had to go low low carb though. Well under 100g a day.
    Also, I would just recommend women to drink the drink. It really isn’t that bad. The one I had tasted like too sweet orange koolaid. It’s not that much and you have 5mins to drink it. I think people exaggerate how bad it is.

    1. I refused the drink. There are high instances of false positives if you are low carb and then go for the test. I also don’t eat any food dyes and the ingredient list is horrible. I also have a corn allergy and it’s corn based. I tested at home for two weeks 4 times a day. It was worth it to me to avoid that drink.

  11. My experience with a false GD diagnoses, being covered in a traditional coeliac rash from head to toe for almost 4 weeks and ending up delivering a normal sized baby boy with great glucose numbers serves as a reminder that a 3hr test can be wrong as well. I have been gluten intolerant for 21 years. Have always been able to tolerate some rice, corn and potato. This 3rd pregnancy had me really watch the starches incl rice, corn and potato. I just felt bad after eating them so simply stopped eating them, sweet potato was fine though, same went for peanuts. Felt fine on other nuts just not peanuts. So anyway I passed the 1hr with flying colors for kid #1 12 yrs ago, failed the 1hr but passed the 3hr for kid #2 10 yrs ago, FAILED the 1hr AND the 3hr with kid #3 just past October. 3hr had a great fasting 87, wicked spike 1hr and 2 hr back to normal at the 3hr. Poor baby went literally comatose 1hr in and didn’t move at all, very unusual he was extremely active, for 12 hours. Very next day a rash is appearing on several parts on my body, increasing and spreading like systemic poison ivy would. It was everywhere in huge hive like blisters and bumps. All I got was that I had GD, so i carb tested myself. Half a cup of rice and my sugars went bananas. So next day ate 3 apples by themselves, had tea with honey and ate some squash and carrots. Didn’t do a thing to my sugar levels. They rose moderately but were back to fasting within an hour. OB and midwives didn’t have an answer. Ended up at an endocrinologist who thought my rash was PUPS and wanted me on insulin for having 2 slightly elevated fasting readings after having been up all night scratching since I was soooooo itchy. Made a deal with the doc since my research and gut said this was an allergic reaction and it was a coeliac rash. I asked for an antihistamine was told to take 1 of 2 brands which both ended up having corn in them a known trigger at this point. So found out myself that Benadryl clear liquid gels were the only thing I could take. After the first dose my body stopped itching, the baby started dancing and my blood sugars dropped by 30points. 3 days later of taking Benadryl the rash was gone and fasting was back to under 90. I called the endocrinologist who swore that Benadryl alone couldn’t have done that but I must had something right about it being an allergic reaction to the glucola drink.

    Long story short, I didn’t have GD, honey, maple syrup, fruit, veggies with sugar were fine. I couldn’t tolerate corn syrup, chocolate (been sensitive to it for 2q yrs also), peanuts, rice, corn and white potato. Once baby was born and I ate some no no foods, checked my sugars which remained fine this time but baby got a rash, colicky, gassy, within 6 hours after eating it. Moral here, listen to your body! I’m still eating primal with dairy like I did in pregnancy since it made me feel the best and so is baby. It would have send us to the hospital having to have gotten my carbs from grains back then or even now. I shudder to think what would have happened to my overloaded body if I had agreed to insulin and not figured out the real reasons….

  12. It’s good for women to know there are alternatives to the GD test – another option is for her to actually track her glucose readings over a week or so (just as anyone concerned about diabetes or with diabetes might). That way she’s eating her normal diet. Pregnancy is a time when you want to make sure you’re getting plenty of nutrients and getting enough calories for both mom and baby – realizing the blood supply needs to expand about 60% and that takes some effort 🙂 I think a woman CAN eat well if she’s concerned about GD – being smart about choosing lower-carb veggies and fruits, avoiding grains, and eating plenty of high-quality fats. I really appreciated how you pulled together research on helpful supplements Mark – I hadn’t read the research on probiotics and GD yet, so I’m off to look into that!

  13. I had GD with my last pregnancy so this time around I decided to try myo inositol to see if I could prevent getting it again. I also read that certain strains of probiotics can also help so I tried that too. I wasn’t always consistent with remembering to take my doses, maybe 2/3 of the time I remembered. Had my 2 hr glucose test last week ( at 27 weeks) and found out today my results came back normal. My weight gain has been about the same as last time, and is more than I’d like it to be, but I’m happy to not have GD to worry about again. So just from my experience, it’s worth a try!

  14. I have just been diagnosed with GD, it’s a hell of a shock to be honest and it feels like a personal insult given that I have been primal for about seven years am of average weight and very fit (was training for an Ironman before I found out I was pregnant). I now do light Egoscue Method exercises daily and walking. The one big caveat I suppose is that I just turned 42 and on my third pregnancy. So, if my body is not use to processing glucose can this be a false negative? I’m really not looking forward to going to the perinatal clinic and I’ll probably throw something at the dietician if she says cut back on soda (I don’t think I’ve had soda for about ten years!). Anyway I’m looking for guidance if you are already primal and have GD, just keep monitoring? Thanks!