As with many issues related to pregnancy and parenting, there are many myths and misconceptions about gestational diabetes.
Gestational diabetes has been a controversial topic for some time, with even world famous obesterician, Michel Odent, weighing in on the matter.
Some medical and health professionals believe gestational diabetes (not to be confused with type 1 diabetes) is a “diagnosis looking for a disease”, because the steps to manage it is exactly the same as the advice to prevent it – with diet.
Women diagnosed with gestational diabetes are given a label, without any evidence to show that the label improves outcomes.
Low carb eating (which includes an adequate intake of protein and healthy fats), quitting smoking, getting enough sleep, and doing some exercise is how you can best help prevent and treat insulin resistance.
Recently, a study found that pregnant women who were having less than 6.25 hours of sleep per night were significantly more likely to be diagnosed with GD. How could that be?
While we sleep, our bodies generate hormones involved in appetite control and metabolism.
If we don’t get enough sleep, our body will secrete less leptin, a hormone that signals to us that we are satiated after eating. In addition, levels of ghrelin (known as the hunger hormone) will increase with less sleep, making us crave foods which provide a quick hit of energy.
Is Education The Problem?
A diagnosis of gestational diabetes results in the very same advice which should already be given to all pregnant women, long before their glucose tolerance tests. They should eat a low GI diet, eliminate sugar and processed grains, eat enough protein and healthy fats (both help with feeling satiated and stable blood sugar levels) as well as get some daily exercise.
Very wise advice for all of us, regardless if we’re pregnant or not.
A recent study concluded, “A low GI diet was associated with less frequent insulin use and lower birth weight than control diets, suggesting that it is the most appropriate dietary intervention to be prescribed to patients with GDM [gestational diabetes mellitus].”
However, the vast majority of doctors and midwives are not trained nutritionists, dieticians or researchers – it’s not their job.
This means quality dietary advice often slips between the cracks, or the wrong information is given. For example, it may be suggested to use low fat milk instead of full fat. However, low fat products usually have added sugar to compensate, so everyone ends up wondering why blood sugar levels don’t improve.
Simarly to type 2 diabetes, gestational diabetes is primarily a lifestyle condition. Yes, there can be genetic inheritance, but just like some people are intolerant to gluten, those with diabetes are intolerant to sugars. So it’s important to control this with lifestyle factors, just like those with gluten sensitivity cut out gluten.
As Doctor Chatterjee says, “Our genes load the gun, but it’s our environment that pulls the trigger”.
In order to have the lowest risk of gestational diabetes, a woman should have a healthy lifestyle before conception.
Recent research discovered women who ate a healthy diet, didn’t smoke, and exercised before they conceived, had a reduced risk of gestational diabetes by 83%. This is a highly significant finding — out of ten women, eight to nine cases of gestational diabetes could be preventable.
You can still reduce your risk if you adopt a healthy lifestyle during pregnancy, but the reduction is not as high, at around 50%.
But Isn’t Gestational Diabetes Due To Hormones Or The Placenta?
The biggest myth people believe about gestational diabetes is that it occurs due to being unlucky with hormones or it was the placenta. But if this were true, wouldn’t all pregnant women get it? Or is it because some women have insulin resistance already? Insulin resistance takes time to tip over the edge and has no to little symptoms.
Despite the pile of research showing significant percentages of women being diagnosed with gestational diabetes are due to dietary and lifestyle issues, this hormone belief is preventing women from knowing the truth.
Lifestyle factors impact and mess with our hormones. Here are nine things that mess with your hormones – and what’s number one? Sugars.
Reproductive and Women’s Health Specialist, Doctor Andrew Orr says, “Yes, hormones do come into play with gestational diabetes. But insulin also affects hormones, and diet affects insulin. So diet is a big driving factor that every pregnant woman, or any woman trying to fall pregnant, needs to be aware of.”
But Can’t Gestational Diabetes Have Genetic Or Hereditary Factors Too?
Yes, it can. Factors that can increase the risks for gestational diabetes are PCOS (poly cystic ovarian syndrome, which also has significant dietary factors), being overweight, having fat in the abdominal area (apple shape), a sedentary lifestyle, consuming a high sugar and high processed food diet, genetic factors and hereditary factors.
It’s well known that a child inherits genes from the mother and father, and the way those genes are expressed (turned on) or not, are due to modifications to DNA. Research has begun to uncover the extent at which diet impacts the health of our unborn children. Researchers have found the health of the parents at conception (and even before then) can impact on what the child will be genetically predisposed to.
A recent study found a mother’s diet before she conceives can affect her unborn child’s genetic make-up and immune system. A similar study has just come out about fathers too.
Doctor Orr says, “There have been numerous studies showing the link between what happens in utero, to childhood conditions, as well as conditions that may be expressed in adulthood.”
It’s all the more reason to ensure you eat well if you’re already genetically predisposed to gestational or type 2 diabetes. It can help to break the cycle, rather than continuing to trigger the gene expression.
In Which Ways Is Gestational Diabetes NOT Diet Driven?
Is it possible to have gestational diabetes even though you have a healthy diet?
According to Doctor Orr, those who use assisted reproduction have an increased risk of gestational diabetes.
How could this be?
In study findings from the European Association for the Study of Diabetes (EASD) in 2015, they found women undergoing assisted reproductive technology were 30% more likely to be diagnosed with gestational diabetes.
Researchers were unsure as to the link between assisted reproduction and gestational diabetes, but found those in the study who were diagnosed with gestational diabetes were more likely to be overweight, have a history of gestational diabetes, have a history of miscarriage and more likely to have a family history of diabetes. Therefore, diet (and the diet of our parents) remains a dominant, underlying factor.
Doctor Orr says, “Other possible causes may be the drugs involved with reproductive medicine, which could also be messing with the pancreas [which is responsible for releasing insulin], plus many of those women have PCOS, both diagnosed and undiagnosed cases.”
Diet is critical to treating PCOS, particularly cutting out sugar and grains.
The root cause of our health problems must be investigated and addressed, or we have nothing more than a bandaid fix… and bandaids always fall off.
“But I Know Someone With Gestational Diabetes Who Is Skinny And Healthier Than Me…”
Isn’t it frustrating when you have a friend who seems to get away with everything they eat?
No matter what food or drink they consume, they don’t put on any weight. However, skinny doesn’t always mean healthy. You don’t have to be overweight to have gestational diabetes or other fertility problems, like PCOS.
Doctor Orr says, “What people need to realise is skinny people can have gestational diabetes too. It isn’t about the weight necessarily, and what some people think is healthy, may not be healthy at all. In addition, some skinny people also have PCOS, which puts them at higher risk of gestational diabetes too. Some people are simply lucky not to get gestational diabetes – it really does come down to pure luck sometimes.”
The Problem With Diet During Pregnancy
The erroneous saying “eating for two” doesn’t help the fact that many mothers-to-be think pregnancy is a free for all, as far as food and drink is concerned.
Doctor Orr says, “They don’t even consider the dangers of gestational diabetes. High GI [glycemic index] foods spike the blood sugars, which elevates the insulin — and this is where the problem lies. Remember, savoury foods and flour-based foods like bread, cereals and pasta are still sugar. It’s how they convert in the body.”
Something many people don’t realise is a bowl of pasta will spike blood sugars more than a chocolate bar, many times.
“But then, the resulting inflammation causes damage to organs and the body through oxidation. There is actually cell damage. Plus the body stores the fats, which we are now calling “obestrogens.” The resulting oestrogen dominance also causes more issues in the body — and more inflammation,” says Doctor Orr.
He continues, “Plus, the high levels of sugars and inflammation interfere with DNA and the DNA helix. It allows gene expression of conditions such as gestational diabetes. Once you express the gene, then it is damn hard to reverse that. But, we do know with genuinely low GI diets, type 2 diabetes can be reversed.”
So while the news may sound grim at first glance, there is a positive side to the story. It starts with a decision — yours — to help prevent the cycle of lifestyle conditions like gestational diabetes and type 2 diabetes… for starters.
Pregnant Women Do Need To Be Careful With Their Diets
Doctor Orr warns pregnant women to be careful with their diets during pregnancy. Even if they decide to take the OGTT (oral glucose tolerance test) during pregnancy and receive a negative result – the test isn’t known for it’s high accuracy rate.
“Pregnant women need to be very careful, because their body is already going through a great deal of change. There’s a lot of stress internally and systemically. Add in the bad sugars and the bad refined foods (which convert to sugars in the body), and the risk of gestational diabetes is increased. This then leads to an impact on the baby. The baby can have a higher risk of diabetes and cardiovascular complications later in life too. And let’s not forget, once a pregnant woman has gestational diabetes, she is also at risk of cardiovascular problems and pre-eclampsia, which are very dangerous and life threatening.”
If you also have PCOS, you are already at increased risk.
“Women with PCOS have a higher risk of type 2 diabetes through insulin resistance, and therefore when they fall pregnant, they are at increased risk of gestational diabetes. So they need to be really careful and adopt a Low GI diet long before falling pregnant, and maintain it into pregnancy,” says Doctor Orr
A recent study in China found consuming more vegetables were associated with a decreased risk of gestational diabetes, and sugar was associated with an increased risk.
Buyer Beware: Even Health Professionals Can Get Diet Advice Wrong
“When I was studying medicine, I had a total of eight hours on dietetics. At the end of eight hours, I realised I knew nothing about dietetics. I now understand why people spend four years studying to become a dietitian.” — Dr Karl Kruszelnicki
At the end of the day, simple nutrition education before and during pregnancy is key.
Doctor Orr often sees patients who have recieved incorrect advice with regards to what they can and can’t eat, in order to avoid and treat gestational (and type 2) diabetes. As a medical professional and nutritionist of 21 years who presents seminars on insulin resistance, Doctor Orr recommends the following dietary tips for those who are trying to conceive or are pregnant:
- Avoid low fat products, including dairy (sugar is added to compensate)
- Avoid pasta, bread, cereals, cake, biscuit – any processed grain based foods
- Avoid high carbohydrate fruits (see our video, Is Fruit Good For You?)
- Avoid low sugar products (artificial sweetener is added and may cause sugar cravings)
- Start the day with a healthy breakfast
- Avoid sweet drinks, including flavoured milks, sports drinks, juices, lattes
- Have protein with every meal or snack
- At least 8 glasses of water per day
- Exercise helps with insulin resistance – try and get out for a walk each day
For more great information, follow Dr Andrew Orr on Facebook.