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Gestational Diabetes



If a woman has elevated blood glucose (sugar) levels during pregnancy, it is called gestational diabetes mellitus. Just like type 2 diabetes, this type of diabetes causes a resistance to the signaling of insulin as it reaches the cells, leading to dysfunction of energy storage in the cells and rising glucose levels in the blood stream as a result.

 
  • Overview
  • Action Plan
  • Ask The Doctor
  • Related Info
  • Success Stories

Overview


It is estimated that gestational diabetes may be affecting up to approximately 18% of pregnancies.1 Not only are these women at risk for complications during pregnancy and delivery of their baby (such as low blood sugar of the baby at birth, excessive birth weight, and risk of the baby developing obesity and diabetes), they are also at risk of developing type 2 diabetes after pregnancy and all the problems that come with it. Gestational diabetes usually produces no symptoms, and it is typically discovered during routine screening during pregnancy, however, during pregnancy, some women with gestational diabetes may notice signs typical of type 2 diabetes including:

  • Fatigue
  • Feeling thirsty
  • Urinating often

For those women with gestational diabetes who go on to develop type 2 diabetes later in their lives (up to 60%), it can lead to many health complications such as:

  • Eye disorders, including blindness
  • Kidney failure
  • Neuropathy (damage to nerves)
  • Skin infections, discoloration, itchiness, and/or rashes
  • Limb amputations
  • Heart attacks and strokes

The causes of gestational diabetes are the same causes as Type 2 diabetes. It is primarily a dietary-caused disease related to eating processed foods, highly prevalent in the Standard American Diet (SAD) and across the modern world today. Excess fat on the body increases insulin resistance and diabetes, but other factors that place a biochemical stress on the beta cells in the pancreas that secrete insulin, such as repeated glycemic stress and chemicals, can play a causative role. Implementing lifestyle changes, which include regular vigorous exercise and a Nutritarian diet-style during pregnancy, is a powerful attack against the risk of complications during pregnancy and birth and if continued after pregnancy, will protect against diabetes risk in the future.

 
References
  1. Kendrick JM. Screening and diagnosing gestational diabetes mellitus revisited: implications from HAPO. J Perinat Neonatal Nurs 2011, 25:226-232; quiz 233-224.

Action Plan


Diet

During pregnancy, you may get all sorts of advice on what to eat or not eat (let alone your strange cravings and nausea to deal with). But the same Nutritarian eating strategy prescribed for diabetes should be strived for in order to see quick results on blood sugars and weight in gestational diabetes. Follow a Nutritarian eating style rich in vegetables, seeds and nuts, low glycemic fruits, and legumes and make small adjustments in glycemic loading at meals.

Tips for treating gestational diabetes:

  • One fruit is allowed, per meal, but you may need to limit or avoid dried fruits and very sweet fruits such as tropical fruits.
  • Limit the overall daily intake of fruit to 2-3 servings, making berries (strawberries, blueberries, blackberries, etc.) the primary fruit choice.
  • Reduce all flour and potato intake, and eat more legumes (especially beans), nuts, and seeds in their place. Beans have been shown to provide health advantages over whole grains in diabetes, and nuts provide healthy fats and are very low-glycemic calorie source.1, 2
  • No snacking or overeating at meals.
  • Combine your higher glycemic foods ( fruit, etc.) with raw vegetables (such as a salad) at the same meal.
  • Eat lots of green vegetables wokked, steamed, and raw.
  • Eat sufficient nuts and seeds to reach caloric needs and to supply needed fats.
  • Take a DHA/EPA supplement as part of your nutritional protocol.
  • Meal plan: Diabetes Reversal

Supplements

  • Dr. Fuhrman’s general supplement protocol for adults (see Vitamin Advisor for details) includes:
  • Consider adding:
    • Thiamin and chromium: People with diabetes are at risk of low thiamin (vitamin B1) and chromium levels, and additional supplementation may be appropriate.
    • Cinnamon: Many human trials have suggested that cinnamon powder or supplemental cinnamon extract can support healthy blood glucose levels.3, 4 Discuss taking purified cinnamon extract with your doctor, especially if you are taking medication, as it may require an adjustment medication.5
    • Green tea extract: A meta-analysis of 17 trials using green tea extract as a supplement concluded that green tea extract reduced fasting blood glucose and HbA1c (a long-term indicator of blood glucose levels).6
    • Aloe vera gel: In people with either diabetes or prediabetes, supplementing with aloe vera gel powder resulted in decreases in fasting blood glucose.7
    • White mulberry leaf, banaba leaf, gymnema leaf, and fenugreek seed phytochemicals may also be helpful, according to preliminary studies 8-11

Exercise

Exercise daily, even multiple times a day, as a strategy to lower blood glucose, such as after meals (and remember, unless your doctor says otherwise, it is generally safe to exercise during the entire pregnancy).

Read

  • The End of Diabetes contains the scientific information and full program to most effectively enable you to reverse your gestational diabetes. The book contains a section dedicated to addressing women with gestational diabetes with specific dietary guidelines.
  • Transformation 20 – Diabetes Edition.
    • Reduce or eliminate type 2 diabetes medication and lose weight in 20 days. 
    • This e-book supplies the menu plans, shopping list and recipes for 20 days, to resolve type 2 diabetes.
    • A majority of overweight type 2 diabetic people will not need diabetic medication after this initial period.  This program is safe and effective as a therapy for gestational diabetes avoiding the need for medications.
  • Study: Glycemic and cardiovascular parameters improved in Type 2 Diabetes with the high nutrient density (HND) diet
    • In this study on type 2 diabetics following a Nutritarian diet, 90 percent of participants were able to come off all diabetic medications, and the mean HbA1c after one year dropped from 8.4 to 5.8%, which is in the non-diabetic (normal) range.12

Other Considerations

  • Weight loss is key to improving gestational diabetes. Even when expecting to gain a certain amount of weight from the pregnancy itself, a net loss of fat weight should still be the goal, and a Nutritarian diet (carefully followed so as to not overeat) will produce weight loss when needed without overly restricting calories.
  • One secondary goal of making these lifestyle changes is to resolve the abnormal glucose readings so medication is not required. For those women who are taking medications already, it is important to work closely with your doctor to reduce medications to prevent blood glucose levels from going down too low.

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References
  1. Jenkins DJ, Kendall CW, Augustin LS, et al. Effect of legumes as part of a low glycemic index diet on glycemic control and cardiovascular risk factors in type 2 diabetes mellitus: a randomized controlled trial. Arch Intern Med 2012, 172:1653-1660.
  2. Jenkins DJ, Kendall CW, Banach MS, et al. Nuts as a replacement for carbohydrates in the diabetic diet. Diabetes Care 2011, 34:1706-1711.
  3. Davis PA, Yokoyama W. Cinnamon intake lowers fasting blood glucose: meta-analysis. J Med Food 2011, 14:884-889.
  4. Akilen R, Tsiami A, Devendra D, Robinson N. Cinnamon in glycaemic control: Systematic review and meta analysis. Clin Nutr 2012, 31:609-615.
  5. Ziegenfuss TN, Hofheins JE, Mendel RW, et al. Effects of a water-soluble cinnamon extract on body composition and features of the metabolic syndrome in pre-diabetic men and women. J Int Soc Sports Nutr 2006, 3:45-53.
  6. Liu K, Zhou R, Wang B, et al. Effect of green tea on glucose control and insulin sensitivity: a meta-analysis of 17 randomized controlled trials. Am J Clin Nutr 2013, 98:340-348.
  7. Suksomboon N, Poolsup N, Punthanitisarn S. Effect of Aloe vera on glycaemic control in prediabetes and type 2 diabetes: a systematic review and meta-analysis. J Clin Pharm Ther 2016, 41:180-188.
  8. Mudra M, Ercan-Fang N, Zhong L, et al. Influence of mulberry leaf extract on the blood glucose and breath hydrogen response to ingestion of 75 g sucrose by type 2 diabetic and control subjects. Diabetes Care 2007, 30:1272-1274.
  9. Stohs SJ, Miller H, Kaats GR. A review of the efficacy and safety of banaba (Lagerstroemia speciosa L.) and corosolic acid. Phytother Res 2012, 26:317-324.
  10. Leach MJ. Gymnema sylvestre for diabetes mellitus: a systematic review. J Altern Complement Med 2007, 13:977-983.
  11. Lu FR, Shen L, Qin Y, et al. Clinical observation on trigonella foenum-graecum L. total saponins in combination with sulfonylureas in the treatment of type 2 diabetes mellitus. Chin J Integr Med 2008, 14:56-60.
  12. Dunaief DM, Fuhrman J, Dunaief JL, Ying G. Glycemic and cardiovascular parameters improved in type 2 diabetes with the high nutrient density (HND) diet. Open Journal of Preventive Medicine 2012, 2.

Ask The Doctor


The following are sample questions from the Ask the Doctor Community Platinum and higher members can post their health questions directly to Dr. Fuhrman. (All members can browse questions and answers.)

Q.

Do the diabetes menu plans apply to gestational diabetes?

She read ETL a few years ago - and her diet is mostly vegetarian with some dairy and fish. I don’t know if she will be open to deviate from the recommended menu from the dieticians who were referred by her doctor, but I will share with her.

She is taking direction from the OBGyn - their next step is to get a closer look at the size of the baby. They have not been concerned about her weight gain as they said she started underweight before pregnancy. My hunch is the weight gain accelerated under the dietician plan.

A.

Yes, but 2 ounces of seeds and nuts a day are recommended. I have a program specifically designed for gestational diabetes in my book, The End of Diabetes.

You can’t have it both ways. If she has gestational diabetes it means she gained too much weight with the pregnancy. The activity of insulin is blocked by fat cells, not by baby cells, and this is being made worse by the dietician’s advice and all the frequent feedings.

 
Q.

My wife is 32 weeks pregnant. No family history of diabetes. Age: 41. Height: 5’4". Weight before pregnancy: 105 lbs. She has gained 35-40 pounds total since getting pregnant. She failed the gestational diabetes test with borderline numbers, and her doctor put her on a program with a dietician to treat with diet.

The nutritionist program has her eating 6 meals a day: 3 meals and 3 snacks. They want her to have 70 grams of protein daily.

Breakfast - small 30-40 grams carbs, a serving of protein, a fat
Snack - 30-40 grams carbs, protein, no fat
Lunch - 45-60 grams carbs, protein, vegetable
Snack - 30-40 grams carbs, protein, no fat
Supper - 45-60 grams carbs, protein, vegetable
Snack before bed - 30-40 grams carbs, protein, no fat

She feels like she is eating too much and eating when not hungry on this diet. The bedtime snack is her least favorite but the dietician strongly recommends it. Her blood glucose levels have been nearly perfect since she started testing last week. Ketones have been normal.

We are a little concerned about her weight gain and size of the baby since starting this nutritionist recommended diet. Before getting on this diet, her weigh-ins and measurements were exactly on target. Last Friday the dietician showed she gained 4 pounds after 1 week of being on their diet. Her doctor also showed the baby measuring big and scheduled a sonogram for next week to get a closer look.

What are your thoughts on this recommended diet plan for her condition, and would you recommend a different approach to keep her blood glucose stable and mitigate the risk of the baby getting too big?

A.

I think advice from conventional nutritionists/dieticians is dangerous and in the dark ages. I can’t understand why anyone reading my books and newsletters would attempt to follow such advice.

I have detailed dietary advice and menu plans for diabetes, which she should follow.

Your wife has obviously gained too much weight with pregnancy and has not been following my dietary advice. The starting place is for her to read The End of Diabetes and follow the plan for gestational diabetes in the book precisely.

 
Q.

I am 16 weeks pregnant now and my OBGYN wants to do a routine glucose testing. Is this test really necessary? I am looking for a good argument if not. A major argument of mine is that I wouldn’t normally ingest such refined sugar and thus would not want to just for a "routine test."

A.

It really isn’t necessary for someone without diabetes in their family or a history of borderline or high blood sugars in the past or any symptoms of diabetes. Also, if you are not overweight, then the risk is even lower.

If the test were positive, meaning that you had gestational diabetes, then your doctor would just recommend that you eat better and not gain as much weight or even lose weight. We want you to do this regardless of these test results, which makes the test not that useful in your situation, if you successfully are eating properly as we recommend for pregnant women.

 
Q.

I have been mostly following your diet (about 90% I think). I haven’t lost weight, which from your other responses means that I must be overeating, though I don’t eat a lot.

Anyway, I am 2 months pregnant. I’m 30 years old, 5’5’, and 195 lbs. I took the glucose tolerance test (50g of glucose, not fasting) and got tested an hour later, and the result was 142. They recommended that since my value was over 135 I should take the three hour test where I have to consume twice as much glucose. I’m hesitant to do this partly because consuming 100g of glucose sounds bad for me and my baby and partly because I follow a very healthy diet without added sugar or almost any bread anyway. I did take the three hour test three years ago and had a normal result, though I wasn’t pregnant. I am interested in hearing what you recommend. Thanks.

A.

If you weigh that much and are not losing, and your glucose tolerance test is high, then you are not following the proper diet for you. Ninety percent or whatever you really are doing is not sufficient. Since this is serious, I think you should post everything you eat here and follow your routine fasting glucose and a 2-hour post prandial. I think the 100 gram test is irrelevant because your body weight and the 50 gram glucose test already determines that you are at high risk and need intervention with your diet and exercise.

Here is a sample Phase One Diabetic Reversal Diet for newly diagnosed Gestational Diabetes, however, I suggest you purchase and read my book, The End of Diabetes, immediately.

This menu includes options, do not attempt to consume all the food or dishes suggested, choose only one or two options at each meal. You can eat the same dish for more than one meal and even use as leftovers for a few days. Breakfast is only listed for those who are doing lots of exercise and hungry in the morning. If not hungry eat two meals a day. You do NOT have to eat all the food listed.

Please note that carbohydrates (even beans) are not fed with breakfast because insulin resistance is highest in mornings.

The most important advice here is to stop, do not make choices and decisions about what to eat and what not to eat. Let me make all these decisions for you.

Remember, you developed this condition based on the choices you made. In order to give this method a chance to see what it can do, you must do it exactly as prescribed, without modifications.

Just follow this plan until your blood sugars are relatively favorable. Then, once your condition is in the safe, non-diabetic range, we can advance the diet to the next phase and we can discuss.

Breakfast – (use one or both of below suggestions):

  1. A green salad with lettuce, thin sliced red onion, tomatoes, and roasted red peppers with a creamy hemp seed herbal dressing made from hemp milk, seeds, and a fruit flavored vinegar, or use a roasted tomato basil dressing made from tomato paste, soaked sundried tomatoes, raw and roasted garlic, vinegar, roasted red pepper, chopped scallions, basal, cumin, and cinnamon.
  2. A roasted eggplant casserole made with sliced zucchini, mushrooms, onions, tomato, garlic, and spices such as cinnamon and cumin, sprinkled with lightly toasted and chopped pumpkin seeds.

Lunch – (use two of the following):

  1. A vegetable-bean soup or stew, served over or with a bowl of shredded lettuce and shredded raw spinach. The soup should be made with a low salt tomato and/or celery juice base and lots of leafy greens, leaks, zucchini, and onion.
  2. Roasted tofu slices or one ounce sliced turkey with avocado, dill, and roasted garlic wrapped in raw collard green leaves.
  3. Zucchini-cauliflower casserole baked with chopped onion and mung bean or other sprouts and sprinkled with nutritional yeast.
  4. Or, the roasted eggplant/mushroom dish can be eaten here instead of at breakfast.
  5. Spicy beans or lentils (one cup) served hot over a bed of finely shredded lettuce and cabbage.

Dinner – (include all three options below):

  1. A steamed green vegetable dish made with steamed or water sautéed mushroom and onions. Steamed green vegetables (string beans, artichokes or asparagus), crushed raw walnuts and lightly toasted almonds slivers.
  2. Raw vegetables, such as raw broccoli, snow peas, cauliflower, kohlrabi, cucumber, radish, peppers, tomatoes, and celery served with a humus dip or salsa dip. A half ounce of sunflower seeds mixed with a half-ounce of your nut of choice or a sunflower-mushroom burger served with lettuce, tomato, raw onion and tomato sauce, (without bread). One fruit such as kiwi or berries. 
  3. One fresh fruit for dessert, or two kiwis or box of berries.
 
Q.

Do you consider gestational diabetes reversible on a Nutritarian diet?

A.

Yes, a Nutritarian diet designed for this issue is described in my book, The End of Diabetes. Not only can you reverse the diabetes, but you improve other nutritional and health parameters that protect you and your baby. Medications can also have risky side effects.