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.
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.
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!?"
"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.