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Gestational Diabetes and Paleo; You Horny Women, You

Now I must ask you, ladies, when I've ever done a post for the best among you? I'm talking, of course, of you who let the men in your lives have such a good time with you that the consequences last around 9 months + 18-20 years (nowadays, if you're lucky: make those "little fuckers" grow up to be self sufficient ASAP, willya? ...Tired of readin' about 20-somethin' live-at-home children -- it's getting to be epidemic).

Turns out, you maybe face even greater risk than had you let a kid -- in his own right -- have his way with you, only to bolt, and to sack you with the 9m+20y. By by whom might you face such greater risk? Maybe your doctor?

Alright, before we go any further, what in the eff is "gestational diabetes? Here, five minute education, if you're interested. If not, follow along because you'll get the gist of it anyway.

Here's the email I got yesterday.

Hi Richard,

My name is Kelly and my husband, Bryce, and I are expecting our first child at the beginning of February. We have both been following the primal lifestyle for about 1.5 years now (a little longer for my husband), and Bryce is a huge fan of your blog. He's always followed it pretty closely, though being deployed for the last 6 months has kept him from being able to do that. I'm writing to you at the suggestion of Bryce, as he values your dietary/physiology knowledge and general contempt of the mainstream medical institution very highly ;)

I just recently underwent 2 Oral Glucose Tolerance Tests (OGTTs) and received somewhat confusing results that my doctor could not fully explain. For the first test I was required to eat a "protein-rich" breakfast (not a problem for someone who eats bacon, eggs, and butter every morning!), followed by drinking a 50g solution of glucose derived from corn. My blood glucose level was then tested exactly one hour after I began drinking the solution. The reading came back at 197 mg/dl, and "passing" is 140 mg/dl. Imagine my horror and shock at that reading, from a woman who prides herself on her low carb diet and her body's ability to handle glucose like it's nothing. It wasn't until after I failed this test that I learned from some basic internet research that a low-carb diet will, in fact, skew the results of an OGTT, making them higher than they should be.

Well, if you fail the first test, you are then required to take the 3 hour fasting OGTT. For this test, you fast 8-12 hours before the test begins and drink a solution of 100g of corn-derived glucose. Blood glucose levels are checked at the 1, 2, and 3 hour marks. I was required to schedule this no more than a week after my first test. Needless to say, I have spent the last week stuffing myself with carbs (potatoes, rice, wheat, fruit) in an attempt to reach the minimum 150g per day that is recommended for the 3 days prior to this test. Apparently, not eating enough carbs for 3 days before will skew the results for a woman already eating the SAD, and so I figured I needed to spend the whole week eating an irresponsible amount of carbs in an attempt to help my body "catch up." For 6 days, I ate between 150 and 200g of carbs per day.

I had my test this morning, and since I failed 2 of 4 readings I have been labeled with gestational diabetes. My readings were as follows:

  • Fasting: 88 mg/dl
  • 1 hour: 187 mg/dl (limit is 180)
  • 2 hours: 118 mg/dl (limit is 150)
  • 3 hours: 166 mg/dl (limit is 140)

So, as you can see, I failed the 1 and 3 hour marks, the first only by a few points. The doctor could not explain to me why my glucose level would actually increase from 2 to 3 hours past, and, unfortunately, this test is pass/fail. I could have surpassed the limit by 1 point on 2 readings and I still would have been diagnosed with diabetes.

I'm writing to you because Bryce and I are absolutely convinced that this is a misdiagnosis. While I have been primal for 1.5 years, we have indulged in the occasional cheat and I have never had a problem handling a large load of glucose/fructose. Pre-pregnancy, I practiced IF about once/week and would be fine not eating for 18 hours at a time. I had no negative physical reactions to the glucose solutions from my recent testing other than dry mouth.

If this is a mystery that interests you at all, I would LOVE your feedback. The doctor did not want to hear anything I had to say about paleo, and instead handed me a sheet recommending a diet consisting of low-fat dairy, franken oils, no more than 5oz of meat/day, and a limit of "high-fat" foods to 1 per day. Whole grains and fiber, however, were at the top of the list of good foods. I obviously will not submit to this BS, and would like to avoid having to check my blood sugar 4x/day for the rest of this pregnancy as well.

Any thoughts?

OK, upon receiving this my first thought was to put it up. This sort of thing, to my mind, is absolutely the very best reason for this blog -- to deal with real world problems real people face. So I got permission and some added info.

That would be wonderful! Some other bits of information that may be important that I left out in my previous email:

  • I am 24 years old
  • My blood pressure is always at 120-122/60-75 and my monthly prenatal urine dips have all been negative for sugar (with the exception of the most recent one taken after my glucose test)
  • I am 29 weeks along, and have thus far gained 17 lbs (pre-pregnancy weight was 110...at 5'3", obviously not overweight)
  • My average intake of carbohydrates for the past 1.5 years has been <50g daily
  • Though I increased carbohydrate intake for the 6 days prior to the test, I did not decrease fat or protein intake. My last meal, the bedtime snack recommended for the test, consisted of salami, pepperoni, cheddar cheese and some crackers.

I really appreciate you taking an interest in this case, and I look forward to your post!

The other thing I recalled was Robb Wolf, author of the newly published and NYT bestselling The Paleo Solution: The Original Human Diet, mentioning it sometime back. I found the post. He's a buddy of mine, so I emailed to see if he had anything to add. In the meantime, I found a more recent post I'll link later, but Robb also mentioned in reply that he's covered it in some of his podcasts. Unfortunately, I'm like on number 15 and he's up to around 50. So, you'll need to go it alone, there. But, from the first link...

This is bad for both mom and baby from an epigenics perspective as baby is now predisposed to obesity, depression…all the fun that goes with high insulin levels. If you peruse the gestational diabetes link the line will go “we don’t know what causes gestational diabetes…” Well, some people don’t! The placenta directs a huge amount of control over both fetus and mom..it can sieve omega-3′s out of the moms body for the fetal brain development ( this is the cause of post partum depression BTW) and it exerts some powerful hormonal control over the mom’s physiology. One of these controls is a transitory state of insulin resistance. Why would biology want to do this? If the mom is a bit LESS insulin sensitive than the baby, the baby will be insured a steady supply of glucose and other nutrients. If the mom becomes MORE insulin sensitive than the baby it may be difficult for the little-whipper-snapper to receive adequate nutrients. Normally this situation is not a problem but add modern refined foods and this weird notion among many women that “I’m pregnant…I can EAT ANYTHING AND GET AS FAT AS I WANT!!”…well, the combo of a really bad modern diet coupled with an ancient biological mechanism results in diabetic moms and HUGE, over weight babies.

Hmm..., I was a big fat baby, at 9/6oz...

And then Robb points to what my initial curiosity was: what about 1AC?

What the retards in our medical establishment are missing (top of the list the clueless vegans) is the need to look at blood glucose OVER TIME and see what is happening. How we do this is by looking at the Hb1AC. What this test shows is how much glucose is sticking to red blood cells…this tells us our average systemic glycation rate (sugar sticking to protein) and is a great indicator of how well our blood sugar is controlled.

Now I'll give you the second link.

If you consume a large bolus (75-100g) of glucose and fail to clear it in a timely manner, you are insulin resistant and thus have “gestational diabetes” (GD). I’ve written on this topic before and the whole thing makes me want to lobotomize myself with a blunt instrument. It’s a tough and incendiary topic. On the one hand our medical professionals deal with a huge population of women who eat very poorly, never exercise and somehow still manage to get pregnant. Miracle that this situation is, biology makes things worse. During pregnancy the mom becomes even more insulin resistant due to an evolutionary adaption in mammalian-mom’s in which they become slightly insulin resistant to allow a positive flow of nutrients to the developing fetus via the placenta. If the mom was more insulin sensitive than the fetus we could end up in a nutrient scarcity situation due to nutrition flowing to the more ubiquitous tissues of the mom. Biology fixes this problem by making mom a little insulin resistant, effectively “pushing” nutrients to the fetus. Score one for biology! Problems arise however when our modern diet and lifestyle make this otherwise favorable adaptation dangerous. Too many carbs (particularly chronic fructose intake), autoimmune complications with lectins, loss of insulin sensitivity due to sleep deprivation and stress can drive expecting moms into gestational diabetes. [...]

So far so good? Great, now let’s go to Bizzaro world (ours) and see how a lack of evolutionary understanding on the part of our medical professionals can derail an otherwise good situation. In the example above “paleo mom” has been eating great and if we ran an A1c (a measure of blood glucose over time, much more valuable than the OGTT or blood glucose measure) we’d likely find she has low, BUT HEALTHY blood glucose levels. She is fat adapted, not insulin resistant and can thus run many of her tissues on fat. That folks, is good. But what happens when she is given a bolus of raw sugar, much larger than anything she, or her developing fetus have ever seen? Well, she has trouble clearing all that sugar. This may give people a headache, but some of this mom’s tissues are “insulin resistant” but healthy because they run on fat. [...]

Where things are falling down is this mom is not having a blood sugar management issue typical of most people coming through the door of hospitals. Her metabolism is running on a comparatively “infinite” fuel source (fat) and she and her developing baby are doing just fine, thanks. At least until they were exposed to a 100g bolus of raw glucose (which they do not clear quickly, but this is a normal adapation to a lower carb intake) and are then told to increase her carb intake until she becomes….a SUGAR BURNER!!! The recommended diet change would drive average blood glucose up, increasing inflammation and advanced glycation end products typical of elevated blood glucose. Mom can now suffer legitimate blood sugar crashes due to an inability to access body fat for the preponderance of energy needs in her body. Thanks Doc!

Fuck sugar! Hey, just getting a word in edgewise...

So, the medical professional dealing with these folks is both confused and ignorant on a number of topics. Confusion grows from the fact that she is simply not used to seeing a healthy, fat burning mom walk through the door.

OK; you should, of course, read both of those links. It strikes me hunchwise that physiological insulin resistance might play an added role in this, but I only have the most slim awareness of it. I'm wondering if, in a real food, natural diet setting, a higher fat diet with significant palmitic acid might be a double whammy for a pregnant woman. Just a hunch. I'll email Peter, cause he's the expert on this.

So, what we're left with is, to my mind, a rather odd situation: a normal, proper eating individual undergoing a natural phenomena (pregnancy) and failing a sugar burning test

"Miss, could you step up here," asked the seemingly nice and caring doc. "I want to test you. It's for your baby."

"Test me for what," asked the girl rather innocently -- merely curious -- who'd been so horny as to let her man knock her up with no thought of the long-terms consequences.

"Dear, that's really not for you to understand. ...I want to ensure that you're sensitive and fully responsive to bee sting anti-venom."

"...Sensitive...? ...Anti...??? ...But I stay away from bees; I had my experiences when I was a silly girl; and now I keep away...no matter the honey."

"Didn't you read the literature? We told you to get 4-5 bee stings per day," the doc admonished; showing signs of impatience.

"But bee stings hurt! And worse, they make me feel bad for days. They itch; they hurt. It seemed the right thing to do to just avoid them."

"WELL HOW ARE YOU GOING TO HANDLE THEM, THEN!?"

And with that, the doc ushered her into the enclosure to get not the 4-5 stings she's recommended to get in a day, but 4-5 in the space of a few minutes, just to see how sensitive she'd be to the anti-venom; in the space of an hour.

"You didn't do too well," said the doc, conclusively. "I'm afraid we're going to have to re-run the test."

"Re-run the test!!!? ...You mean 4-5 more stings," asked the girl, pleading 'no!' by implication.

"Oh, no," replied the doc. "See, we're wondering if this was just a fluke, so here's what we're gonna do: over the next week, I want you to get stung 1-2 times per day, 2-3, 3-4, 4-5 and so on...for a week. Got it; understood!?"

"Oh no!"

"Yes, and then we'll see if you can handle 10 bee stings in a hour!" (he tried, but could couldn't resist letting off a tinge of excitement, at this point).

"And if I fail?" she whimpered.

"Oh, missy; you do not want to fail."

Update 11/26: Well I'm always so far behind in reading my comrades' posts that I had not see Stephan's most recent, which is very relevant to all this: Glucose Tolerance in Non-industrial Cultures. Enjoy; I did.

Comments

  1. Richard,

    Thanks for taking up our cause here. It’s not easy trying to support your wife through nonsense like this while deployed. When Kelly told me the frustrating results of these seemingly unreliable tests, I figured the FreeTheAnimal community would be the place to turn for a little sanity.

    One more thing to add about Kelly (just so nobody suspects her of being on the frail side and thus potentially an undiagnosed diabetic?): at 5’3″ and 110#, she could strict deadlift about 185# prior to becoming pregnant – no mean feat.

    I might get in trouble for bragging about that over such a large venue, but suffice it to say she’s the picture of primal health, and so we’re very eager to get some closure on this – perhaps in the form of good results on an HbA1C test?

    Thanks again for fighting the fight, and I hope you and all of your readers enjoy a great thanksgiving weekend.

    Best,
    Bryce Lee

    • Hey, Bryce, if I don’t put stuff like this out front & center, then I should just close it up.

      No, thanks, because in potentially getting a bit of help and support yourselves, there’s a record that Google will bring others to. It just goes around.

  2. Dan Linehan says:

    Not to mention that this misdiagnosis could fuck up her insurance rates, especially if it is considered some sort of pre-existing condition.

    I’d get a second opinion from a savvier doctor.

  3. The problem with the ob docs I dealt with was that they confused statistical averages with individual outcomes. For example, if you are over 35 and pregnant, you are considered ‘high risk’ because there are more problems on average. However, in my case, women back to my great-grandmothers on both sides of my family have given birth to healthy children when they around 40 years old and medical care was lot more primitive. I was railroaded into having an amniocentesis done and no one cared that genetic risk for chromosomal abnormalities was minimal for both me and the father. According to the March of Dimes website the risk of Down’s syndrome and other trisomies at age 35 is about 1 in 400, whereas of an amniocentesis is between 1 in 200 to 1 in 400 according to the webmd website. I have nothing against doing an amnio if the benefit outweighs the risk, but I believe that for my situation the risk from the amnio was greater than the risk of a birth defect. Obstetrics has a high rate of malpractice lawsuits and accordingly care is likely to be more tailored to the doctor’s risk profile than the patient’s. So, the ob’s will follow the book with this lady’s glucose test because if anything goes wrong they want to be able to stand up in court and say that they followed standard practice. Unfortunately all this b.s. just adds to the misery of pregnancy, labor and delivery.

    • coming in late on this: I don’t buy the lawsuits argument. I go for the simplest explanation in a situation like this. The simplest explanation is that with or without lawsuits these doctors and labs and hospitals make more money if they come up with more bullshit reasons for interventions. Even a C-section nets a doc more money than a natural birth does. As long as someone’s paycheck is tied up in medically monitoring a pregnant woman I’m never going to believe it’s the lawsuits. It’s not like a lot of those lawsuits aren’t *justified.* I read once about a doctor who used a vacuum extractor and YANKED the baby’s head up and down on its way out and killed the baby. That kind of bullshit is why malpractice suits happen. If they really believed the tests were about avoiding lawsuits they’d require you to take them if you wanted to continue seeing that doctor.

      I get so angry with that shit. I’ve given birth to two kids and OB/GYNs treat you like an idiot even with no evidence indicating that you are. You’re just a thing they have to manipulate in all the right ways to produce another thing. Maybe it’s a fault in the system. If I had to treat that many patients every day I guess I couldn’t afford to see them as human either.

  4. I am a Labor and Delivery RN and a Graduate Midwifery Student. I have 2 children both of whom were not delivered by OB’s but at a birth center and at home by midwives. In the “natural birth” community, the glucose screen is managed much differently. Usually a midwife will have her client eat a normal breakfast and test based on what her normal diet is. The OB glucose screen IMO causes excessive false positives because it is geared towards women who routinely eat sugar/ carbs which most people who eat cleanly (primal or otherwise) do NOT.

    My advice is to fire your OB, hire a midwife (Nurse Midwife-CNM or Certified Professional Midwife-CPM) and experience that same trust in birth that you have in your diet. Your body isn’t broken, it knows how to grow the right sized baby for your size.

    A great article by Henci Goer (author of A Thinking Woman’s Guide to Childbirth):
    http://www.gentlebirth.org/archives/gdhgoer.html

    • Unfortunately for the Lady in Question, it may be hard to find a midwife now that she is “diagnosed” as a gestational diabetic. In many states, midwives are highly regulated and can only take the most low-risk of pregnancies to avoid even further government interference. I ran into this situation with my third and fourth children. I was young, and healthy, and had zero gestational problems. However, because my first two births had been complicated by routine-yet-unnecessary medical interference, I was a “high risk delivery” and not a candidate for midwifery.

      Let me rephrase that: Because I had complications caused by the overreaching Modern Medical Establishment, I could only legally be treated by the Modern Medical Establishment. Makes perfect sense!

      God forbid I get pregnant with a fifth, I’ll be immediately labelled as a required c-section because the action of the Modern Medical Establishment during my fourth delivery caused a partial uterine prolapse. A midwife wouldn’t touch me with a 10-foot pole.

      If she lives in a state that regulates midwives into obscurity, the only solution now is to seek out a doctor who understands and supports the real-food mindset, will accurately interpret the tests, do an A1C and make biological sense of the results. With the power of the almighty MD’s seal of approval, she could continue on [safely] to a midwife.

  5. John Shelley says:

    Richard, you’re the man. Bringing all the info together and slapping down fools in the process.

  6. Yup, everything that Robb said. My wife also failed her oral glucose tolerance test (fucking huge cup o sugar). She’s a petite Asian who doesn’t eat sugar except in its natural state (i.e., sugar bags called fruit). She thought it was all a bunch of hooey.

  7. I am lucky because I have a doc that will allow me to refuse the glucose tests. I know that that much syrupy glucose is horrible for me and will make me sick, so I have refused this test the last two pregnancies. She trusts me, and my diet is good. I’d hope that all pregnant paleo eaters would just refuse to take that glucose. The “post-prandial test” would be OK, where they test your fasting blood and then your after-breakfast blood, right?

    • What happens if you refuse to take the test ?
      I have two coworkers here in France (talk about coïncidence, we just talked about this glucose test thing this morning), one has had a baby less than a year ago and the other one just went through a miscarriage and is dying to get pregnant again. They both told me this glucose test is absolutely mandatory. Both are not at all paleo.
      I don’t expect an specific answer about what happens in France if you refuse the test (although I’ll be glad if there are french readers who can answer me…) but I’m curious about what happens if you refuse that test in the USA, as it’s a pretty good indication (I don’t know why but french politiciens are obsessed with USA and always end up implementing in France what exists in the USA).
      I’m actually planning to have a good time and get pregnant as a consequence in the near future, so I’d like to have a little idea of what I’ll be up against when I refuse that test (BTW, my GO has been trying to put me on a statin for 2 years now, I’ve always refused. Last time I saw her she told me that next time “there was gonna be no arguing”. Brrrrr, I’m only 31 (and weigh no more than 50kgs).

      • The only test that was done to my wife during her pregnancy (in 2004 in the Moselle departement) was a fasting blood test. They never did a OGTT test. They also checked the blood glucose level of my wife and the baby at birth, noticing that they had both elevated values, but appart from an advice to keep an eye on it (vous devriez surveiller ça, qu’ils dirent) nothing happened.

      • Thanks !
        I think this blood glucose test is fairly recent in France.
        I have been working as a temp worker these last 10 years, mainly replacing mums to be. I’ve only heard those mums to be speek about this test since the year 2006…

      • Doctors just want a reasonable alternative (and something to document for liability sake.) An agreement to be johnny on the spot with a HbA1C or several fasting blood sugar doesn’t seem like the worst idea.

      • If you refuse the test in the US, your OB may refuse to give you prenatal care. You would have 30 days to continue seeing your OB for possible emergency care and at the end of that time, you would be kicked out of the practice. If you birth in a hospital and you had an OB or CNM who let you refuse the GD screening, the peds in charge of your baby would freak because your GD status would be unknown. They may take your baby away for monitoring, sugar water, formula, IVs and lots of blood sugar checks.

        I refused the screening with 2 pregnancies with midwives. It was no big deal. They understood that I didn’t eat 100 grams of glucose in the a day (not to mention at one time). My first midwife let me check my blood sugar after a normal breakfast. She put in my chart that I passed the screening so that in case of a transfer to a hospital the peds wouldn’t freak out. My second midwife thought that we might at well skip the whole thing.

  8. No mystery at all.

    Everyone on VLC has physiologic (peripheral) insulin resistance, otherwise they would not have enough glucose in the brain.

    A VLC female who is pregnant will have the completely normal additional physiologic insulin resistance that Robb is describing – gestational IR – on top of the Physiologic insulin resistance due to high fat low carb diet. The placenta and fetus are like having two extra brains metabolically, so the differential between maternal liver and muscle insulin resistance must increase to allow the conceptus the metabolic right of first refusal. The mechanism and metabolic rationale are the same as in the non-pregnant state.

    My belief is that GD as currently diagnosed merely represents women with pre-existing metabolic syndrome whose abnormal physiology is simply unmasked by the additional peripheral IR that always accompanies pregnancy. GD Is not caused by pregnancy, it is merely made clinically evident by it.

    To anyone, physician or otherwise, who is actually thinking about the purpose of the OGTT in pregnancy, it is intended to uncover the risk of elevated BG by SIMULATING THE MEAL NORMALLY EATEN BY THE PATIENT. The OGTT is only ever relevant because most people get 50% or more of their calories from carbohydrate.

    As Lea so sensibly notes: “Usually a midwife will have her client eat a normal breakfast and test based on what her normal diet is. ”

    The baby and mother are at risk from elevated BG only if the BG elevates. If there is no BG elevation at 30 minutes, 1 hr and 2 hrs after a meal THAT IS NORMALLY EATEN BY THE PREGNANT SUBJECT, there is no diabetes, period.

    Test yourself with your usual meals thusly, and if you are normal (ex 0=90 30min = 115 1hr=120 and 2hr =100 …something like that) then there is nothing to worry about.

    • Great post, Rich! And always good to read your comments, Dr. Harris! Good to see you on these boards. As you’re well aware, theres a lot of people out there who eagerly await your return to blogging or move to writing books? Anyway, cheers. Eat turkey.

    • Missed you, Dr. Harris. Your comments are a privilege to read, and your posts are missed.

    • Dr. Harris – I LOVE your posts and opinions… and I too miss your posts.

      Great Post Richard! … it and the comments as always are very enlightening.

      On this Turkey Day… just want to say thanks to YOU BOTH.

    • Having been through GD (twice), I second the call to self test. The first time I failed the GTT I had to take the 3 hour and it was horrible. Fortunately I had the good sense to do my own research, ignore the nutritional “advice” from the special diabetes nurses they send you to, and recklessly pursue low carb eating throughout the remainder of the pregnancy, carefully monitoring post-prandial blood sugars.

      So when the next baby came along, I told the doc I didn’t want to do any BG testing. So we made a deal that I would self monitor my blood sugars, with post prandials and fasting readings a few times a week. I did, ate low carb, no problems. As long as the 1 hour and 2 hour post prandials are fine, the baby is not at any risk.

      As footnotes, my first GD baby was 7.4 pounds, second GD baby was 6.4 pounds. My first 3 hour test was very strange too, first reading was high, second reading way low, third high and fourth dropped off again. No, the special diabetes doctors couldn’t explain it either.

      Personally speaking Richard, I always planned to do as you suggest. Raise the kids to be self sufficient and independent by no later than 16. All well and good for the girls, but when the boy came along my inclination was to lock him in the basement until he’s thirty. What can I tell ya’, emotions with kids are funny things and when you have kids you experience a lot of emotions you never thought possible. By far the single worst thing about having kids is losing your sense of humor. When I was in college I was a huge fan of Edwin Gorey. I laughed until I cried at “The Beastly Baby”. Now I read it, and I still cry, but the laughter has faded. Poor little unwanted baby, sigh.

      • “All well and good for the girls, but when the boy came along my inclination was to lock him in the basement until he’s thirty.”

        Hmmm, I’d always assumed that raising boys would be far easier than girls since, with the former, you’ve got only one penis to worry about whereas with the latter, you’ve gotta worry about ALL of them. :)

    • Even if you are diabetic it’s not a sure thing you’ll have a huge baby or other GD-related complications. Just handle it like you would non-gestational diabetes: don’t eat the fucking sugar in the first place. Everybody panics about this. There is nothing to panic about. The disease is in how you handle the sugar; lacking the sugar, everything else is fine. As this is a primal mama we’re talking about, I’m preachin’ to the choir here.

  9. Hey Kelly and Bryce,

    Congratulations! I so wish I knew about paleo prior to my 2 pregnancies. Your primal baby will have one of the most optimal conceptions, pregnancy and lactation EVER :) Bryce, love your blog!

    Robb’s information is the BEST!

    I’d only add that by being somewhat lower carb, mild insulin resistance does occur and you passed the fasting glucose test by consuming more carbs prior to the test. I’ve been low carb and if I consume a carb load (esp if simple carbs — potatoes, rice, candy, sugar, CANDY CIGARETTES!!, etc) I see the one-hour glucoses exceed 180 mg/dl too unless I’m training cardio. The 1-hour OGTT result is reasonable IMHO… actually within 10-15% lab error.

    The 3-hour fail may be secondary to reactive hypoglycemia, I suspect. The liver and gluconeogenesis is making up for an adrenaline response subsequent to the rapidly lowered glucose at 2-hours. You mentioned being lower carb, primal for the past 1+ yrs so this may explain adaptations and some mild insulin resistance (don’t worry) at the liver level but other peripheral tissues are fine and insulin sensitive.

    Kelly, strict press 185 lbs!!! You ROCK! You are little BUT STRONG and BAD*SS.

    I suspect as many of the aware and knowledgable commenters have already voiced, the glycation will be fine (though the 150 to 200 g carb loading experiment may spike it a bit), the Hgba1c test (excellent is < 4.5%).

    Consider with the MD, to try fructosamine as a lab test — it is short term measuring the glycation for the past 2 wks, not 2 mos like A1c.

    My suggestion, for this MD, consider a moderate carb diet (and no wheat or gluten or other inflammatory carb) like 50 g/day plus re-feeds of carbs or 80 g/day consistently and repeat the OGTT, if that is what you want to pass. By avoiding the super high carbs (150-200g/day), I believe, you'll avoid the super reactive highs and lows from the original test…

    There is this neat article — we become overt diabetics on standard lab tests when (1) eat tons of carbs or (2) starve ourselves. Eating low carb primally actually produces the 2nd scenario to a certain extent (but healthy considering our primal HIT/xfit exercises and low level/high volume movement and optimal paleo nutrition coz we're not constantly starving).
    J Diabetes Complications. 1996 Mar-Apr;10(2):109-12. Starvation diet and very-low-calorie diets may induce insulin resistance and overt diabetes mellitus. http://www.ncbi.nlm.nih.gov/pubmed/8777329

    CONGRATS AGAIN!!!

    grace

  10. Standard up to date treatment for gestational diabetes is to minimize carbs anyway (though they would never tell you to eat paleo sat fat). Follow the blood glucose, then if it is out of range still metformin or insulin. If it isn’t out of range, then you’re golden. I sincerely doubt the bg would be out of range in this case.

    I was eating a no processed foods no HCFS no vegetable oil diet for my two pregnancies. But plenty of whole grains (this was prior to learning about paleo). Both OGTTs made me sick as a dog, and my BG was in the 80s at 1hr and probably the 60s at 2hr as I had huge sugar crashes. I was unable to go for more than 3-4 hours without eating and would often get up at 2 am very ill and have to eat (usually it was cereal and milk). Needless to say I gained 70-75 pounds with each pregnancy, despite prolonged morning sickness and lots of vomiting. And I wasnt pounding down doritos and ice cream either – not regularly anyway. I know now my issue was reactive hypoglycemia and what Robb describes as the babies possibly less insulin sensitive than I was naturally so in order to get fed the babies/hormones were jacking up the hunger and doing the best they could to make me insulin resistant. I would never eat that way during pregnancy again considering the glucose regulation problems. Most of the weight fell off very quickly each time with attempt to diet and no change in eating habits speaking to the different hormonal environment of pregnancy (further proof that a calorie is not a calorie) but it took a few months of low carb paleo to get the last of it off after number two.

    If there were to be a third kid, I would eat as I do now (mod carb paleo) and if the morning sickness came again experiment with low carbing it. I would likely refuse an OGTT as they make me sick anyway (and i wouldnt want to risk failing it due to ikung style physiologic IR) and maybe offer to do regular glucose monitoring if it made my OB feel better. She’s pretty cool and since I’m a doctor, my doctors have the unfortunate habit of just doing what I tell them more or less.

  11. Just wanted to add – when breastfeeding I was hungry. HUNGRY as in if there were no food in the house, I could have killed the neighbor’s cats and eaten them. (that’s a metaphor. No pets were harmed in the raising of my babies). When I was pregnant I was never hungry. Just sick. Sweaty nauseated weak horrible I felt like I needed to go to the hospital because I was about to die sick. Every 3 hours. The only thing that helped was eating, but looking at food or thinking about food made me sick. I couldn’t go to a grocery store without throwing up for the first 4-5 months, and it was touch and go thereafter. It was horrible, but could be managed with carrying food around and eating bodybuilder style. But when I hear how pregnant women just “eat whatever” and stuff their faces and if only they could control themselves I just want to throttle that person. (I’m not typically violent). It’s the same damn thing as telling a diabetic he can have half a banana and a few grapes and some fibery cardboard and maybe some olive oil and then being surprised when he’s hungry and keeps packing on the pounds despite all your wonderful advice for him to control his appetite.

  12. Emily, you had a hard time of it. I didn’t have any morning sickness and felt good throughout pregnancy except the last trimester when I could hardly breathe because baby so high and had heartburn. Whenever I got hungry it was so weird I had this urge for food and had to have the food immediately. Its like I couldn’t wait a second otherwise I would start feeling kind of anxious.

  13. I’ve had reactive hypoglycemia for 20 years Pregnancy was just the big league version of it. Likely saved me from going on some sort of more foolish uber low fat diet over the years. Dropping fat below 30% always made me feel rotten. Getting rid of grains and increasing the fat is perfect. I can go without snacking and skip dinner if I like. Liberating. Too bad I wasn’t smart enough to figure this out between 1 and 2 – but you know you just kind of survive and don’t have a whole lot of time to think with little kids.

    I just wish doctors in general who have the knowledge and the responsibility to think about these things would figure it out.

  14. Kelly Lee says:

    Thanks, Richard…great post! The doctor’s office called yesterday morning to set up my 3-hr nutritional counseling for diabetics class. I politely told the nurse that I respectfully refused to go to this class or undergo any other sort of GD special treatment, as I was not convinced that the OGTT results were accurate. I requested an HbA1c test and a meeting with the doctor who diagnosed me…still haven’t heard back yet.

    Lea: Great article! Unfortunately, I already am working with midwives at a birthing center. The problem, however, is that this particular birthing center is physically located in a hospital. Great if there are labor/delivery complications that require immediate intervention beyond a natural birth, but not so great in that the midwives are forced to follow hospital guidelines for certain procedures (the OGTT, of course, being one of them). Of the 4 midwives working at the center, only one has ever heard of paleo, and I didn’t get to take my initial 50g OGTT with her. And if you fail the first OGTT, you are then required to do the 2nd under the supervision of one of the OBs in the practice. I would love to “fire” her (after giving her a fair chance to change her diagnosis, of course), but the unfortunate truth is that short of a home birth (not covered by my insurance), this birthing center is the closest thing I’m going to get to a natural birth in my locale.

    So, my current course of action is to persist in asking for the HbA1c test and to try to get a meeting with this doctor during which I can present all of this information to her. I’m also hoping that the midwife who knows about and approves of paleo (though does not practice herself) will back me up on this.

    • a fructosamine test may be a better choice unless the A1c is done at least 30 days after the OGTT. I mean, your A1c may be a bit higher than you’d expect.

  15. Oh Kelly and Bryce ( and thank you RIchard for posting this), while nobody, even the MD’s in these comments can safely diagnose you over the web (and I’m just a very well read biochemist and a mom- so don’t take what I say as advice or gospel- but please do consider what I have to say) and lots of moms here know what’s going on too….. when I read the description of you drinking a poisonous amount of glucose, I wanted to vomit for you. I have docs in my family and one very good friend who’s an OB-Gyn (more about her in a moment) and from them I totally understand the litigious nature of practicing medicine today and combine that with the completely incorrect dietary information out there (high-carb, low-fat travesty) and unfortunately you and your cherub are at the mercy of corn oil, fructose, and cereal grains…..those three are deadly (and slow death so it’s insidious) in my humble, well-educated, thoughtful opinion.
    In 1986 I was pregnant with my first child and I developed toxemia of pregnancy- pre-eclampsia. During her delivery (luckily she was full-term) I had a grand-mal seizure with respiratory arrest- eclampsia. My daughter is fine (just graduated Magna from Northeastern U.) and I didn’t know anything about metabolic syndrome or paleo or GD back then, but all I can say is that it had to have been my SAD diet that caused this. And here’s my reasoning and why I’m so convinced. My older, physician, sister did the same darn thing 7 years earlier when delivering her first son!!!!!!!!!
    We are of Northern European ancestry and what I’ve read and learned in the past 2 years since discovering Gary Taubes leads me to believe I was at high risk of being damaged by the SAD.
    Anyway, my good friend the OB gave us some great advice for the second pregnancy and birth and that went off with no fireworks. OB friend was ‘forced’ by me to read Taubes and thankfully she is now a physician who gets it. She only does Gyn work anymore, but she delicately counsels most of her patients about the wonders of low-carb, high-fat when she has their undivided attention as she’s giving them pelvic exams!

  16. Reminds me of this WAP article

    http://www.westonaprice.org/traditional-diets/625-nasty-brutish-short.html

    Give the mothers and kids fish, organ meats and butter.

  17. Kelly, you’re doing great. Take a couple of deep breaths and relax.

    I, also, failed the OGTT 1- and 3-hour versions both times I was pregnant, and was diagnosed both times with gestational diabetes. I was sent to a dietitian who gave me a diet, and an endocrinologist who gave me a blood sugar meter and instructions to test my blood 4 times a day. My doctor, the dietitian, and endocrinologist all felt it necessary to threaten me with dire consequences (huge baby, elevated risk (euphemism for dead certainty) to develop Type 2 Diabetes later in life, spending the remainder of my pregnancy in the hospital receiving insulin injections, etc. if I was not compliant. I was compliant and never had blood sugar over 120 for the rest of either pregnancy (remarkable since the diet I was given was identical to the old Food Pyramid, complete with 6-11 servings per day of grains/bread/crackers). I gained only 20 lbs. with each pregnancy. At birth, my older son weighed 9 lbs. 5 oz., my younger son weighed 9 lbs. 11 oz. Both are bright, healthy, delightful young men (ages 24 and 20 years old) now.

    This is in spite of the following: at the time of the conception of my first child, I was 32 years old, 20+ lbs. overweight, and ate the SAD; at the time of the conception of my second child I was 36 years old, 40+ lbs. overweight, and still ate the SAD. I have been overweight since age 5, and have diabetes on both sides of my family (maternal and paternal aunts, and a sister with T2DM, one maternal aunt died from diabetic complications).

    I discovered Atkins in the late 1990′s and have been doing one version or another of low-carb ever since, with varying degrees of success depending on the version (Atkins Induction is great for me, South Beach is not). Because of (apparent) residual damage from years and years and years of grain and sugar addiction and abuse I do have to keep my carbohydrates at Atkins Induction levels. I am not diabetic, my HbA1c and fasting and post-prandial blood sugar levels are all normal (yes, I do test regularly although not every day). I have lost 48 lbs. since January 2009 when I re-started Atkins after a disastrous affair with South Beach and “healthy whole grains”. I eliminated sweets in January 2009 and grains/nightshades in June 2009, and have felt immensely better ever since. I did a dairy elimination this summer but it made no difference, so I went back to cream in my coffee. I am still 30-40 lbs. overweight.

    My point is that I, overweight and with metabolic and genetic tendencies toward diabetes, was able even with bad dietary advice, to have healthy (although large, but I am 5’8″ and large-boned) babies. You will be fine, and so will your baby. The human race did not make it this far by having doctors deliver every baby, but we did make it by helping each other. Listen to other women but in the end, use your common sense (it appears you have it). Listen to your body and to your baby. And although this has been over-long already, please indulge me a couple more sentences as I must tell you two things I would like to have been able to tell myself as a new mother:

    Breastfeed exclusively–do not give your baby formula under any circumstances. The nurses in the hospital may not be too helpful, so get a coach, contact the La Leche League, do whatever you have to do, but your baby’s future really depends on it (and it is a miraculous experience for both of you). Do it for as long as you can–2-3 years is fine and good for you both.

    When you have decided to begin feeding solid food to your baby, DO NOT FEED YOUR CHILD CEREAL. Go for the meat.

    Ok, I’m getting down off my soap box.

    I wish you a smooth and speedy and painless delivery, a long and happy marriage, and a very healthy, happy baby.

  18. Ah! As a future MD and a scientist, diabetes, particularly GD is such a thorn in my side. Unlike what someone said above, my experience with GD and current practice is that you tell them to follow the ADA diet AKA- tell them to eat low fat and count their carbs. When I told my old roommate that she’d be much better off skipping all the carbs and just eating meats and veggies she told me her doctor said it would be ‘Bad for the baby’, so she kept eating ice cream and pasta. AHH!!

    Screw the OGT test- If you’re concerned, check your Hemoglobin A1C and monitor your blood glucose after meals (your NORMAL meals, not some giant dose of a macronutrient you usually eat sparingly).

    As a med student, I look around and fear that the people happily regurgitating conventional wisdom with absolutely no understanding of the actual science will shortly be practicing medicine. Terrifying…

  19. Get a homebirth midwife, get out of the system, and dont let those fuckers put one finger on you or your baby. Seriously.

  20. Hi all. Here’s what “Peter the Great” at Hyperlipid sent back via email. Enjoy. I’ll be hitting the road soon for a 7hr drive.

    Here in the UK routine pregnancy monitoring for diabetes does not involve a glucose tolerance test, so we have not been plagued by this very simple response to a low carbohydrate diet in Melanie’s current pregnancy. The big problem we have had is that she is in chronic ketosis and this twitches the medics like mad. They think it signifies dehydration, go figure… There is plenty of anecdote that pregnant women make ketones very easily and even after three days of carb loading (which she hates) she still comes through at trace positive ketones. Without the carb loading the urinary ketone level is high which really makes them uncomfortable unless you get a medic who has some understanding of metabolism. The good news is that these folks do exist, although they are rare, but the chances of seeing the same GP twice in a row are vanishingly small in the NHS. Post prandial ketosis with a blood glucose of 5.6mmol/l is not something the average GP or midwife ever comes across or understands.

    I think the most telling paper I’ve seen on the OGTT in pregnancy is the one by Takizawa et al,

    http://www.ncbi.nlm.nih.gov/pubmed/14616250

    which looks like a bit of a follow on to Wang’s paper in non pregnant people from 1999,

    http://www.ncbi.nlm.nih.gov/pubmed/10622209

    In amongst the related links section is this cringe-making twaddle, from Germany of all places, in 2004

    http://www.ncbi.nlm.nih.gov/pubmed/15003736

    which highlights the ignorance of basic metabolism and of the previous literature which is so rampant in the medical profession.

    The best line overall is from Takizawa:

    “there is a risk of misdiagnosis of impaired glucose tolerance with only one intake of this extremely low-carbohydrate meal on the evening before testing”

    with MISDIAGNOSIS as the most important word.

  21. The idea that an insulin resistant state serves positive purposes is fascinating.

    I have also read that another positive purpose of insulin resistance is to help prepare the body for the winter season — to increase fat stores, and sugary cells are more freeze resistant. Could there be something to this? Did insulin resistance protect Ice Age people from low temps? I work with a few guys that are over 350 lb (at 6 feet tall) and both find outside temps in the 50s very pleasant, and sweat just sitting still at room temp. Is there a purposeful biological connection between temp tolerance and insulin resistance or am I connecting dots that shouldn’t be connected?

    • T. S. Wiley, who is a quack about huge amounts of bio-identical hormones for the treatment of menopause, nevertheless brought up this point in her first book about sleep and how it impacts metabolic syndrome. She specifically mentions excess sugar in the blood as a means of lowering freezing point. Apparently there are some animals whose bodies do it on purpose, in a cyclical pattern, as winter nears and they risk freezing to death. The carbiest foods do seem to be available in the autumn.

  22. Thanks for this post! Great information to have on hand. I’m 12 weeks pregnant with my first and a little terrified of getting an OGTT. I’m working with a midwife, so hopefully she’ll be open to giving the test after a normal breakfast (I think that a gestational diabetes diagnosis might automatically disqualify me from CPM care in that state). I doubt I’ll be allowed to skip it altogether since I thought I’d be honest and admit that my mom and her 9 siblings all have some combination of diabetes/prediabetes/visceral obesity/morbid obesity/high blood pressure/heart problems/thydoid problems/breast lumps. Every cousin in that family over the age of 25 also has one of more of those issues. I’m nearly 24….and that’s why I do paleo :)

  23. Hi there I am reading extensively about hormones and their influence on insulin resistance. Being menopausal I have had an epiphany when I read recently that hormones being out of balance during pre and post menopause can cause insulin resistance. I remember that when I was pregnant (I was 56 kg) and I put on weight until full term at 70kg. The symptoms I have experienced over the last few years feel similar to pregnancy issues, ie overweight, hormonal, etc. I breastfed my daughter and by 6 months I was 53kg. I have also read that the body adapts to a slightly insulin resistant state during pregnancy. My weight currently fluctuates between 67 – 70 kg. I haved studied the hormone issues (menopause and symptoms) and blood sugar and insulin (as two seperate fields). I never made the connection that hormones being too high or low (can influence insulin and leptin sensitivity). This stuff is fascinating to me and worth pursuing for any one with weight and possibly hormone issues. That a slightly insulin/leptin resistant state is part of pregnancy as it gives the body the ability to store fat. Anyone’s input and experience in these areas would be of interest to me.

  24. Managing a pregnancy with such CW testing/nutrition advice these past few generations, and assembling each successive generation from substandard foods, is a crime against humanity. Thumbing through Weston A Price’s “Nutrition and Physical Degeneration” just now after reading this post and comments brings me down. Is the human race’s epi-genetic profile forever sent down a damaged course?

    Our 7 month old baby boy is benefiting from this awareness, but easily 3 or 4 generations’ past eating industrial foods likely has us all starting from below “scratch”.

  25. I’m just laughing to myself at the idiocy of the thinking behind the test! I mean, what they are really trying to do is see how someone reacts to FOOD, and yet they have them ingest what is essentially a REAGENT.

    • As a standardized population screening test for mothers on SAD the initial 50 gram dextrose test isn’t the worst thing in the world. It is meant to give false positives so that no one is missed. It’s the follow up OGTT that is silly.

  26. Oddly enough, it was because I was diagnosed with GD 23 years ago, that I realized 20 years later what food was good for me. Even though I failed both tests, I was “marginal” so they sent me to a dietician instead of prescribing insulin. At that time, the ADA was recommending a basically lower carb/whole foods diet, which I followed to a T. The result was feeling better than I had ever felt in my life. My daughter was born on the day before Easter and I was told by the doctor to enjoy the candy on Easter after all those months of restriction. I went from feeling great to feeling tired and bloated in a matter of days, but of course, it took me about 20 more years to put 2+2 together. I kept following SAD trying to get it right. Forty lbs and 20 years later, I discovered the link between gluten and migraines and that has led to primal/paleo land and once again, I feel great and some lbs lighter. It’s amazing how we survive despite medical “science.”

  27. Paul C. I have heard of a possible connection between anti freeze and higher blood sugar. Sugar is plant anti-freeze
    - I read ‘The Queen of Fats’ by Susan Allport (several years before I discovered Taubes and long before I’d heard of paleo) and she spent a lot of the book on the remarkable good health of the Inuit- the ones who still ate their traditional diet. I also read, somewhere, that probably Inuit and Northern Europeans naturally tend to higher blood sugar because it acts as anti-freeze in the cold environment. Add in western foods and VOila! DOCs appear. Fructose overload.
    Also, the chubby faces the Inuit sport are most likely from ……wait for it….. the need for insulation on that part of their exposed bodies in the cold. If I hear one more neolith, fructose, healthy whole grains swiller tell me an all meat-fat ‘Eskimo’ diet is unhealthy because they are all fat looking and all have diabetes I might have to tell them to start thinking and that maybe there’s something else going on NOW because of their newly adopted western ‘diet’.

  28. “The placenta directs a huge amount of control over both fetus and mom..it can sieve omega-3′s out of the moms body for the fetal brain development ( this is the cause of post partum depression BTW) and it exerts some powerful hormonal control over the mom’s physiology.”

    That also deserves highlighting. With our first son, who is now almost 7, my wife suffered horrible post-partum depression for almost two years. We tried a variety of treatments stopping short of prescription drugs, because we didn’t want it in her breast milk. Trooper that she was, endured it all. Long story short, within a month or two of our son naturally weaning, she was back to her old self and we were considering a second child.

    That night & day difference always stuck out in my mind and I pretty much decided that something was going on with the breast feeding that was depleting her of some nutrient and making her depressed. I did some internet searching on breast feeding and post-partum depression, but wasn’t able to turn anything up. With the second we were always on edge about the possibility of a depression recurrence. Thankfully none happened.

    With our third (who was born last week in fact! :-) I noticed in the third trimester she started getting occasions of moodiness. She had been taking a 1g O3 pill once a week. Without telling her why, I started having her take them 3x a week. Then one week I “forgot” to give her the O3 pills. Almost immediately the boughts of moodiness returned. I started her back on the O3 and things were fine, except if we ever forgot an O3 she would regress. It finally dawned on me we were supplementing just enough to keep her at a sane baseline, and that was a stupid goal. I shared with her my “experiment” and said she should start taking 1 of the 1g O3 pills every day. Since then, there’s been no more moodiness and only a mild case of the “baby blues” when her milk came in.

    One last thing, I had her stop supplementing the O3 about 2 weeks before her due date as it thins the blood and can interfere with clotting. She’ll probably restart the O3 supplementing in a couple weeks and continue the daily dosing as long as she is breast feeding.

    Finally, best of luck to all the other expectant Moms.

  29. “The baby and mother are at risk from elevated BG only if the BG elevates. If there is no BG elevation at 30 minutes, 1 hr and 2 hrs after a meal THAT IS NORMALLY EATEN BY THE PREGNANT SUBJECT, there is no diabetes, period.

    Another point that needs highlighting. People seem to be oblivious to the fact that it’s not the diabetes it’s the sugar. Like the old joke about falling off a cliff, it’s not the falling that kills you, it’s the sudden stop at the bottom. Or for Kurt, guns don’t kill people, people kill people. ;-) Type 2 diabetes doesn’t kill people, dietary sugar kills people.

    As for our experience, my wife had mid-wives and home-birthed all three of our children. I didn’t know about low-carb and paleo eating until this last pregnancy, but with all three pregnancies the midwives suggested against the OGTT and instead did a urine test after a normal, albeit heavy breakfast.

    I will say, with this last pregnancy the midwives were always nervous about her elevated ketones, and talked us into staying moderately carb-ed after the first trimester just to be safe. As she became pregnant only about two months after I’d discovered paleo we went along with their suggestion. For us that meant about 100-120g of carbs a day.

  30. I had GD during my pregnancies – one undiagnosed (resulting in very big baby by c-section) and the other diagnosed, managed well first with a very low carb diet then with insulin when my fasting levels got too high. With the second baby, I had a very supportive doctor who told me how to eat. And I ignored the hospital dietitian’s recommendation to eat bagels.

    I had the support of midwives with both pregnancies. Unfortunately, I passed the post-prandial (eat your normal breakfast) test by a hair’s breadth and my midwife (being anti-establishment), missed my diabetes, which was not helped by my then-vegetarian diet. My first son was 12 lbs 9 oz. My second 8 lbs 6 oz.

    My suggestion is to “act as if” and check. The OGTT is a only diagnostic tool, and as the comments suggest, the interpretation of the results against people with “typcial diets” might not match your blood chemistry.

    Keep a food diary for a week while eating your normal diet, and check your blood sugar with a finger-stick when you get up in the morning, and after each meal, and before & after exercise. The real question is not what the OGTT says, but rather what’s your blood sugar doing while you’re eating normally and going about your daily life. It is possible that you have GD despite eating really well. And the key point at the moment is to care for yourself and your baby.

    Wishing you a healthy and safe delivery!
    Chris

  31. Just to add something to what has already been said above, it seems that the degree to which a person display physiological insulin resistance is positively associated with the person’s concentration of ketones in the blood.

    Given that, the deeper a person is in ketosis, the more likely it is that blood glucose will spike (above “normal”) in an OGTT.

    The table below shows blood ketone concentrations under various circumstances:

    http://healthcorrelator.blogspot.com/2010/04/ketones-and-ketosis-physiological-and.html

    As you can see, pregnancy significantly increases blood ketone concentrations. So does being on a high-fat diet (way more than fasting for 24 h, by the way).

  32. Kelly Lee says:

    Thanks everyone for the advice, information, and support! :)

  33. I had not read Stephan’s post until now. Very relevant.

    http://wholehealthsource.blogspot.com/2010/11/glucose-tolerance-in-non-industrial.html

  34. You people are a bit weird. Vegetarianism may not be for everyone, but it is perfectly healthy, probably more so than “normal” diets. It also reduces harm to animals (which is totally undeniable) and massively reduces CO2 emittance.

    So why do you people bother defending something that is considered normal, and unlikely to change in your lifetimes?

    • Hey toby:

      Do yourself a favor and use the search function on this blog for keywords like vegetarian and read up before you come here in comments spouting your ignorant drivel, as though we haven’t all heard it before, and it’s Big News.

      “Vegetarianism may not be for everyone, but it is perfectly healthy…”

      A vegetarian diet is sub-optimal for ALL members of the human species, simply because we evolved on animal products, it’s our natural diet, and thus the optimal diet.

      And if you dispute that our evolution was driven by the nutritional density of animal products than you’re abjectly ignorant on the topic and should be dismissed out of hand. (See: Kleiber’s Law and the Expensive Tissue Hypothessis – the search function here and/or Google should work just fine).

      http://www.npr.org/2010/08/02/128849908/food-for-thought-meat-based-diet-made-us-smarter?sc=emaf

      A vegetarian diet can be minimally adequate, provided it employs significant eggs & dairy. A vegan diet, on the other hand can in no way be made minimally adequate.

      “It also reduces harm to animals (which is totally undeniable) and massively reduces CO2 emittance.”

      This right here tells me that you’re just a KoolAid drinker.

      So was vegan activist George Monboit, who recently came to his senses and admitted he was wrong about it.

      http://www.theguardian.com/commentisfree/2010/sep/06/meat-production-veganism-deforestation

  35. Thanks for posting this. I had the same problem myself and couldn’t find any info about it online, even searched Robb’s site, but didn’t unearth that gem. I know I’m late to the conversation, but even if she can’t get more definitive testing from her doc, if she tests her blood sugar throughout the day eating her normal diet and it’s always normal, they will leave her alone. I suspect that would be the case. Let us know what happens!

  36. Hey Kelly

    You mentioned your insurance doesn’t cover a homebirth. It seems that the insurance companies try and fob people off with a no and hope they go away. For the birth of my second child (first one c-section in a hospital that I would never return to) my insurance company said they would only pay my midwife a measly amount – about $1500 of the $8000 she would bill them. The rest would have to be paid by us out of pocket – my midwife was ok to take $6000 – we’re in NYC so prices are probably higher then in other parts of the country. I called and called and called the insurance company and eventually gave up and figured we’d be paying about $4,500. When she billed them they paid her $6,000 so we ended up paying nothing at all.

    My point is – if a homebirth is something that would like (and I realize it’s not for everybody) then don’t let the insurance company stand in your way.

    Good Luck.
    Anne

  37. I had GD with my first pregnancy and I heard a lot of negative, and more importantly, conflicting information about the tests. Some women were told to eat a high protein diet before the first test. I was not. Some women were told to carbo load before the second test. I was not. I was borderline on the first test and failed the second.

    I went to the diet class and although they were smart enough not to recommend bagels, they didn’t distinguish between high glycemic and low glycemic foods, which I thought was a bit silly. So, in the first week I quickly discovered what would send my blood sugar into the ‘fail’ zone. Six grapes and my blood sugar would still be 200+ after two hours. So, I avoided fruit. But, I could have dairy, including small amounts of ice cream, and my blood sugar was fine. As I discovered, that was just how my body reacted. At the time, I was a member of a forum where women discussed their experience with GD and found that it was completely different for everyone. Some women couldn’t even look at milk, but could eat all the fruit they wanted. It seemed completely random!

    I figured out what worked for me. I played the numbers game. I kept my sugar below 200 two hours after every meal and my fasting sugar was never high. I was able to control it completely with diet and delivered a healthy 8lb, 6oz. baby at 42 weeks naturally (even though I was told I would have to be induced – pfft).

    While I wouldn’t completely trust the results of the GD testing, I would highly suggest testing your own blood sugar and finding out what diet works for you. A lot of people seem to want to throw the whole idea of GD as a real problem out just because the method of testing is stupid (and it is stupid). Based on my own experience, that is unwise. Indeed, some cases of GD can’t be controlled with diet, no matter how strict. It is just bad luck, but at least if you know what you are eating and you have the immediate feedback of a finger prick blood sugar level, you can decide for yourself whether or not you need to have more medical attention/intervention for the issue.

  38. Kelly Lee says:

    Just an update for anyone who is interested:

    When I requested a meeting to discuss my results and offered to take a fructosamine or HbA1c (or a week of blood sugar readings on my normal diet), I was cut off and straight up told “no.” The midwife told me that this so-called natural birthing center has a reputation to uphold, and making an exception for one person (even if I could prove 100% beyond a shadow of a doubt that I was right) would ruin their stats. This in turn might ruin the chance of other low-risk mothers and babies to birth there. It didn’t matter why I failed the OGTT or by how much, only that I had failed it. It took me a half hour on the phone with this woman, calling her out on her ignorance and seeming disinterest in her clients to get her to agree to at least meet with me to hear me out on the relationship between low-carb and the OGTT (not that it would change anything about my case, she made that very clear). This is supposed to be a woman who puts the health and care of mothers and babies first, and she was not even willing to listen to me. I pretty much felt like I was talking to a brick wall, and her attitude the whole time was obviously “you’re a denialist diabetic who doesn’t care enough about her baby’s health to take our recommendations.” She even went so far as to tell me that their procedures and dietary recommendations were evidenced-based. HA!

    So, our choice came down to accepting misdiagnosis and treatment as a GD, or going elsewhere to birth. After being laughed at, patronized, made to feel like a number instead of a person, and treated with hostility by my caregivers, the choice seemed pretty easy to Bryce and I. So we’re giving a big middle finger to this place and taking a hit to our budget to go with a homebirth. It’s more paleo that way anyway, right? :) I’ve already been in touch with the homebirth midwife and she is in complete agreement that the OGTT with glucola is bullshit, and is ready and willing to take on our birth! I am definitely going to file a formal complaint against this facility, though, because other women deserve to know what they’re getting themselves into! The midwives seem friendly and caring enough, until you actually disagree with them, apparently.

    Thanks again to everyone for the support and information. This pregnancy and obstacle, in particular, has been such a learning experience!

    • Congratulations and good luck! I think you’ll be much happier with a home birth anyway.

  39. Hi Kelly – Thanks for the update. I think I missed out on the choice the birthing center was putting to you. I had hired a lay midwife to help with a planned home birth when I lived in Florida (I posted a comment about her missed diagnosis and my very large boy). Ultimately, after 30 hours on exceptionally difficult labor that ultimately failed to progress, my son was delivered by c-section, which I believe saved both our lives given his birth-weight and posterior presentation.

    When you’re navigating through all the decisions about you and your baby, I would offer these two suggestions. First, if you plan a home birth, be sure to have a capable and prepared OB/GYN whom you trust. And second, keep in mind the point is to have a healthy baby and a healthy mama, not necessarily a home birth. I understand your frustrations with wanting accurate information and support from your health professionals. I would suggest periodically testing yourself postprandial (as many comments have recommended) to make sure your sugar is good – throughout the rest of your pregnancy. GD progresses with the pregnancy. So just because you have normal tests this week doesn’t mean you won’t have an abnormal test next month. As the saying goes, “don’t throw the baby out with the bath water.” Get good information to make good decisions.

    warm regards,

    Chris

    • Kelly Lee says:

      Thanks, Chris. I have no problem checking my blood sugars and probably will, though everything (aside from the flawed OGTT) points to a completely normal and healthy pregnancy at this point. The thing that really got to me was the dismissive and belittling attitude I got from my “caregivers.” If I can’t trust them to do something so basic as listen to me and take my concerns into consideration, even if no policies were changed, how can I trust them to deliver my baby safely? If they treat me like this when I suggest an alternate hypothesis regarding a routine prenatal test, how will they treat me when I’m in labor and they insist I need an episiotomy or a C-section when I really don’t? I understand there are circumstances in which these interventions are necessary, but what if it’s not in my case and I try to raise an objection? I need to be 100% confident in my labor assistants, and by treating me with disdain and hostility over an issue that could easily be resolved, the midwives and doctors at the birthing center have lost my confidence in them.

  40. Sorry Kelly – I read my comment, and it doesn’t quite make sense. The reference to the OB/GYN was for someone who would serve as your back-up should you need assistance that a mid-wife can’t offer.
    Chris

  41. Dan Linehan says:

    Kelly,

    Thanks you the update, and so sorry things went down that way. I hope your experience is better from here on out. There is a really great documentary on home birthing on Netflix actually, let me see if I can find it and send it your way!

  42. Dan Linehan says:

    Here we go: The business of being born.

    http://movies.netflix.com/WiMovie/The-Business-of-Being-Born/70075502#height1322

    Well worth watching for anyone, not just pregnant folks. Pretty gripping and disturbing at times.

  43. Everyone,

    Thanks so much for all of your support and advice. For your information, our son was born 4 weeks ago, on January 31st. He was a healthy 7lbs 9 oz, and required no pitocin, and no c-section. He and Kelly are both doing very well. They continue to not have any form of compromised glucose metabolism or insulin resistance ;-).

    Best,

    Bryce and Kelly

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