3

votes

Gestational diabetes question

Answered on August 19, 2014
Created June 06, 2012 at 6:00 AM

My wife has recently been diagnosed with GD (she barely failed the 1 and 2 hours of her test, by 1 or 2 points) and the doctor's dietician has put her on a very restrictive diet. A diet low in fat, low/moderate in protein, and high in carbs. While I am big enough to concede that a licensed RN may know more than I do, the macro nutrient counting is soooo frustrating and difficult. I see why people fail on this type of diet.

I believe in the paleo diet. I think, even with its restrictions, it would be easier for her to follow. But is it safe for a 30 weeks prrgnant, mother of (soon to be) twins, who has preeclampsia and GD to switch to a paleo model?

The dietician is old and still teaches the dangers of fat--especially saturated fat--so I doubt she'll agree such a plan is wise. But I doubt the wisdom of telling a person, who is on bed rest, that eating starchy veggies and snack crackers for every meal is good.

Thoughts?

6120c989fd5b69f42a0834b69b87955b

(24553)

on October 09, 2012
at 06:35 PM

That Michel Odent article is amazing. Just got a GD diagnosis myself, but I think it might have been a false positive after plugging my food into fitday for a half week and realizing that my idea of "high carb" in preparation for the test never went above 175g, and mostly complex carbs so the slam of straight glucose was probably a foreign experience for my body.

6120c989fd5b69f42a0834b69b87955b

(24553)

on October 09, 2012
at 06:34 PM

That Michel Odent article is amazing. Just got a GD diagnosis myself, but I think it might have been a false positive after plugging my food into fitday for a half week and realizing that my idea of "high carb" in preparation for the test never went about 175g, and mostly complex carbs so the slam of straight glucose was probably a foreign experience for my body.

193f00d53ebcb13940c7a55afc78ad17

(1260)

on June 08, 2012
at 05:36 AM

Thanks kk, I'll take her to the pool this weekend for some soak/stand time. To be fair, the diabetes journal article is talking about a study conducted outside the USA, and its effects on blood sugar/insulin levels, but stops short of really advocating a move to similar models.

38dc9448a52fef25672c8ef6e17e8efc

(70)

on June 07, 2012
at 04:46 PM

Also, I don't know where you live, but if you have access to a pool, standing in deep water is a great way to get fluid out of the legs. The water pressure pushes it out of the tissues and back into the veins. It also takes the pressure of the belly off the back.

38dc9448a52fef25672c8ef6e17e8efc

(70)

on June 07, 2012
at 04:45 PM

I'm shocked you found a diabetes website that advocated those ratios. I wonder how long it will take for mainstream nutritionists/docs to get it. I think they're great, especially since in pregnancy your carb needs do seem to go up a little (just basing that on my own experience). I really wouldn't discuss her diet with the doctor. Just take the glucose monitor with you to each visit.

Ce41c230e8c2a4295db31aec3ef4b2ab

(32564)

on June 07, 2012
at 12:32 AM

Amen to this!!!

193f00d53ebcb13940c7a55afc78ad17

(1260)

on June 06, 2012
at 06:48 PM

Awesome, thanks!

Fd70d71f4f8195c3a098eda4fc817d4f

(8014)

on June 06, 2012
at 05:57 PM

@Kelly: "I'm sorry, the minute the dietician recommended Lean Cuisine, I would have walked out." THANK YOU! As I was reading the original post, I was like, "Am I the only one who wants to kill this dietician?" A "Certified diabetes specialist." Yeah, she's certifiable, all right...

F0e558010a2ecb31fa37b7c491596b8e

(3850)

on June 06, 2012
at 05:08 PM

Even the ultra-SAD NIH says with gestational diabetes not to get more than 50% of your calories from carbs and not to severly limit fat because it's necessary for fetal development. That alone would be evidence that this RD's recommendations are not acceptable.

Ce41c230e8c2a4295db31aec3ef4b2ab

(32564)

on June 06, 2012
at 04:47 PM

tdgor- Preeclampsia seems to be associated with poor nutrition, but there is no conclusive evidence yet in the literature. Sufficient protein, magnesium & Vitamin D are all helpful in preventing it. Once it has been diagnosed, it can be harder to remedy, especially at this stage of pregnancy. That said, a nutrient-dense Paleo/Primal diet may still help.

870fdea50f2a9f1cd2890c8e22549300

(2056)

on June 06, 2012
at 04:37 PM

The preeclampsia is a much bigger deal than the GD. Why is no one focusing on that? I'm not qualified to give you an answer, but I'm disturbed that no one is paying any attention to that. That having been said, I don't know that the dietary advice from the RD is correct for preeclampsia either.

F0e558010a2ecb31fa37b7c491596b8e

(3850)

on June 06, 2012
at 04:05 PM

Seriously, though, start slowly. Feed her zero grains, and get carbs from starcy vegetables, tubers, fruit, and dairy. You have to give her more than 15 grams of fat a day - she's growing twins for god's sake (ok, stopping ranting). Add a little more saturated fat and protein every day and see how her sugars do. I bet they will be fine. That should make her feel better about the diet and the doctor as well.

F0e558010a2ecb31fa37b7c491596b8e

(3850)

on June 06, 2012
at 04:01 PM

I'm sorry, the minute the dietician recommended Lean Cuisine, I would have walked out.

Ce41c230e8c2a4295db31aec3ef4b2ab

(32564)

on June 06, 2012
at 03:23 PM

I'm really sorry your wife has had to go through this!

Ce41c230e8c2a4295db31aec3ef4b2ab

(32564)

on June 06, 2012
at 03:23 PM

And pregnant women are no different from anyone else. They should eat whole, nutrient-dense foods to hunger. She also could benefit from supplemental D (after testing her level) if she is on bed rest & not getting sun and Magnesium will help with the bloating.

Ce41c230e8c2a4295db31aec3ef4b2ab

(32564)

on June 06, 2012
at 03:19 PM

Agree that trying to work with the dietitian is a failing proposition. If you want to chat about pregnancy diet (my specialty is pregnancy & nutrition coaching) you can contact me through my website on my profile page.

E12ead3bf63c94b5b619b03722ef554f

on June 06, 2012
at 03:03 PM

I agree, I am afraid you won't be able to change that dietitian's view... not in time anyway! Other than that, I would say that 350 g of carbs is a lot of carbs! If you try to go lower, make sure she stays properly hydrated, monitor her blood sugar and blood pressure closely. Please try to find a qualified health professional familiar with Paleo/low-carb to supervise everything.

5ccb98f6ae42ce87e206cf3f6a86039f

(11581)

on June 06, 2012
at 02:51 PM

Find a different dietitian. One who isn't a carb pusher, that understands that human fetuses need fats and protein and that is experienced in GD.

Ce41c230e8c2a4295db31aec3ef4b2ab

(32564)

on June 06, 2012
at 02:32 PM

Often the docs will be OK in forgoing the dietician if you agree to monitor her blood sugar yourself.

193f00d53ebcb13940c7a55afc78ad17

(1260)

on June 06, 2012
at 12:23 PM

Monitoring isn't a big issue, she sees a doctor twice a week now, we have an at-home BP monitor, and now a bloos sugar monitor as well. I'll check out those links and see if I can find a dietician who I better agree with. Thanks!

E35e3d76547b18096a59c90029e7e107

(15613)

on June 06, 2012
at 08:18 AM

Why would it be helpful for her GD?

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7 Answers

best answer

8
Ce41c230e8c2a4295db31aec3ef4b2ab

(32564)

on June 06, 2012
at 08:40 AM

Of course Paleo would be helpful. Lacto-Paleo even more so.

That is a ridiculous diet from the dietician--and not even standard of care for GD! Your babies need fat for brain development.

Agree with Aglaee that monitoring is important when making dietary changes, especially given her situation.

Here are a few articles for you:

http://primaltoad.com/primal-pregnancy/

http://rixarixa.blogspot.com/2008/01/michel-odent-on-gd.html

http://robbwolf.com/2010/09/06/gestational-diabetes-what-constitutes-low-blood-sugar/

Ce41c230e8c2a4295db31aec3ef4b2ab

(32564)

on June 06, 2012
at 02:32 PM

Often the docs will be OK in forgoing the dietician if you agree to monitor her blood sugar yourself.

193f00d53ebcb13940c7a55afc78ad17

(1260)

on June 06, 2012
at 12:23 PM

Monitoring isn't a big issue, she sees a doctor twice a week now, we have an at-home BP monitor, and now a bloos sugar monitor as well. I'll check out those links and see if I can find a dietician who I better agree with. Thanks!

6120c989fd5b69f42a0834b69b87955b

(24553)

on October 09, 2012
at 06:34 PM

That Michel Odent article is amazing. Just got a GD diagnosis myself, but I think it might have been a false positive after plugging my food into fitday for a half week and realizing that my idea of "high carb" in preparation for the test never went about 175g, and mostly complex carbs so the slam of straight glucose was probably a foreign experience for my body.

6120c989fd5b69f42a0834b69b87955b

(24553)

on October 09, 2012
at 06:35 PM

That Michel Odent article is amazing. Just got a GD diagnosis myself, but I think it might have been a false positive after plugging my food into fitday for a half week and realizing that my idea of "high carb" in preparation for the test never went above 175g, and mostly complex carbs so the slam of straight glucose was probably a foreign experience for my body.

5
38dc9448a52fef25672c8ef6e17e8efc

(70)

on June 06, 2012
at 06:34 PM

As a woman who has had GD myself in 3 pregnancies, that diet would have landed me on medication in an instant. I don't even speak to dieticians for specifically that reason.
I don't tell the doctor what I eat, I just show him my sugar levels.
Higher protein helps prevent preeclampsia. A low protein diet increases the risk. Babies need fat and protein. It's what they're made of. Check out http://www.blueribbonbaby.org/ifyouarepregnant/daily-pregnancy-nutrition-checklist/. With the exception of the grains, it's pretty paleo. My typical pregnancy diet is eggs and sausage for breakfast, chef salad for lunch, nuts for snacks, (nut butter on pork rinds is good too), meat and veggies for dinner. I try to stick to sweet potatoes and fruit for my 'sugar'. Rice or regular potatoes will raise my sugar. You can try switching her over, and watch her sugars to see what she reacts to. I can usually tolerate steel cut oats with no sugar if I feel like I can't handle meat and beggies due to morning sickness.

193f00d53ebcb13940c7a55afc78ad17

(1260)

on June 06, 2012
at 06:48 PM

Awesome, thanks!

4
E12ead3bf63c94b5b619b03722ef554f

on June 06, 2012
at 08:05 AM

I think it can be safe and very helpful for her GD, but I also believe that you should work with a qualified health professional familiar with the Paleo diet. You will need a very close follow-up because the Paleo diet can quickly change her blood pressure and blood sugar levels.

Have a look on the Paleo Physician Network or Primal Docs to find someone that can help you and your wife. :) Good luck!

E35e3d76547b18096a59c90029e7e107

(15613)

on June 06, 2012
at 08:18 AM

Why would it be helpful for her GD?

2
193f00d53ebcb13940c7a55afc78ad17

on June 07, 2012
at 02:00 PM

UPDATE


Before I start, I'd like to thank everyone for the support, advice, and general love that you've thrown our way. I really appreciate it and it's helped me feel confident that I'm not as crazy as the dietitian thinks I am.


After talking to my wife yesterday evening, I was livid. The nutritionist (a different one that the one we initially saw, I think it was her assistant?) came in and lectured my wife for OVER AN HOUR about how she was harming the babies if she deviated even a single point from their macronutrient profile. She also contradicted herself numerous times, told her that moderate salt intake was fine "our guidelines do not limit sodium intake, so don't worry about it", and continually hounded her even after she left the exam room (and she did all of this while my wife was getting an ultrasound, so she didn't get to pay attention or ask any questions about that).

The lady told my wife to not research diet, 'because you can find evidence to support anything on the internet', and to instead just trust the experts. She used an her mother's cancer diagnosis as an example citing that she just trusted the doctors and now her mom is cancer free. Well my wife's mother had cancer, and if my wife hadn't done her own research and been so damn stubborn/insistent about things her mom would be dead now (because the doctor failed to even test/biopsy the ever growing lump in 3 consecutive visits.)

My wife left in tears, with badly swollen legs (she sat on the exam table for over an hour), and last night at 9:30 pm (6 hours after getting home) her blood pressure was 145/90, which is about the highest its been since leaving the hospital (I'm afraid to guess what it was while in the office).

I am scheduling an appointment to meet with the doctor who operates the practice later today. In person, not by phone, so I can express my concerns and make him aware of what happened.

That aside, I've decided that we are off the 'diet' and I've put my wife back onto whole--real-- foods, plenty of fats, and low/moderate carbs (from healthy sources). After dinner last night her blood sugar was 97. Every time she has broken with their advice her blood sugar has been below 100. In fact, the only readings she has that are over 100 (a 140 and a 115) are after strictly following the 'recommended' breakfast model. (Insert my shockedface.jpd)

I am going to clear with the doctor to move her to a different diet. We will continue to monitor her glucose levels and blood pressure, knowing that her blood/urine are checked at least once a week and that the babies' sizes will be checked every other week, and should things got out of hand we'll consult a different nutritionist.

The diet will be built around a macro profile of 20:30:50 (C:P:F), per http://diabetes.diabetesjournals.org/content/53/9/2375.full, and food selection will be a combination of paleo and the guidelines found at http://www.blueribbonbaby.org/ifyouarepregnant/daily-pregnancy-nutrition-checklist/ and http://www.blueribbonbaby.org/ifyouarepregnant/what-is-a-good-nutritious-balanced-diet/

(She has no celiac, lactose, or casein issues, so I'm OKing cheerios/oatmeal in the morning, because she likes them and her glucose levels don't get all crazy). The above will, of course, serve only as a guide line. If she is full she doesn't have to eat everything, if she hungry she can eat more. Fruit (limited) and fatty (whole food) snacks will be available to her (versus packaged processed garbage). We will, however, continue with the meal spacing (3 meals, 3 snacks, 2-3 hours apart) as my wife felt it would make glucose monitoring easier.

Does this meal plan look fine?

38dc9448a52fef25672c8ef6e17e8efc

(70)

on June 07, 2012
at 04:45 PM

I'm shocked you found a diabetes website that advocated those ratios. I wonder how long it will take for mainstream nutritionists/docs to get it. I think they're great, especially since in pregnancy your carb needs do seem to go up a little (just basing that on my own experience). I really wouldn't discuss her diet with the doctor. Just take the glucose monitor with you to each visit.

38dc9448a52fef25672c8ef6e17e8efc

(70)

on June 07, 2012
at 04:46 PM

Also, I don't know where you live, but if you have access to a pool, standing in deep water is a great way to get fluid out of the legs. The water pressure pushes it out of the tissues and back into the veins. It also takes the pressure of the belly off the back.

193f00d53ebcb13940c7a55afc78ad17

(1260)

on June 08, 2012
at 05:36 AM

Thanks kk, I'll take her to the pool this weekend for some soak/stand time. To be fair, the diabetes journal article is talking about a study conducted outside the USA, and its effects on blood sugar/insulin levels, but stops short of really advocating a move to similar models.

1
6120c989fd5b69f42a0834b69b87955b

(24553)

on June 06, 2012
at 09:50 PM

First, ask for a redo, she was close enough to normal that she might pass if she eats a large enough breakfast before the test. It isn't paleo per se, but my midwives say unless someone really has GD they generally pass if they eat a big salad with beans and meat before the test.

If they don't allow a redo, I think getting a blood glucose meter and ignoring the prescribed diet would be advised in this situation. She can find out for herself what foods are spiking her blood sugar.

If you are having twins and she has preeclampsia, they are going to be pushing for delivery within the next few weeks so she could probably eat whatever the heck she wants and doesn't make her feel dizzy (a sign the blood sugar has been spiked), and it wouldn't matter. Seriously ignore the Lean Cuisine ideas, those make me feel like crap even when I'm not pregnant, she needs food that is alive.

And get that woman in an Epsom salt or Magnesium chloride bath stat. It is so much more pleasant the the magnesium drip at the hospital. If there are any day spas near you, floating in water can lower blood pressure in meaningful ways for days near the end of a pregnancy, and is more fun and relaxing than lying in bed cursing the situation. Beyond being in the water, being around other women who are actively relaxing can help, and being very pregnant she will get lots of reassuring smiles and support, which is really nice when all of your interaction with the outer world is about how your pregnancy is going sideways.

Ce41c230e8c2a4295db31aec3ef4b2ab

(32564)

on June 07, 2012
at 12:32 AM

Amen to this!!!

0
Ef6b49e40857e1db680d2069ebbc10b1

on October 09, 2012
at 01:04 PM

Here is something id consider watching quite an eye opener id say. at about 30 minutes or so it tells how nutrition advisers have it all wrong for dietetics. yet the advise before americans started exploding with diabetics was high fat while starch, sugar and carbs were considered strictly forbidden.

http://m.youtube.com/#/watch?v=FSeSTq-N4U4&desktop_uri=%2Fwatch%3Fv%3DFSeSTq-N4U4

Send me an email if you thought it was helpful, i am a paleo dieter as well :)

Ganamaha2@y7mail.com

0
193f00d53ebcb13940c7a55afc78ad17

on June 06, 2012
at 02:47 PM

Some additional information on the situation (I posted from my phone last night, so I was a little on the brief side):

-My Wife-
*30 years old
*Pregnant with twins (first pregnancy)
*30 weeks pregnant
*Diagnosed preeclampsia (as a result, she's now on bed rest)
*Diagnosed Gestational Diabetes Her fasting number was 78 (if I remember correctly) , 1 hour was 180, 2 hour was 157, 3 hour was 130 something. So she failed the test, but only barely. (Diagnostic criteria are 2 or more values at or above 95/180/155/140) *Current weight is around 175lbs (but very swollen/lots of retained fluids)
*Pre-pregnancy she was not overweight, but not particularly active either.
*She is not currently, nor has she ever eaten according to the paleo plan.

-The Dietitian-
*Registered RN
*Certified Diabetic Specialist
*Many years of experience
*Advocate of the OLD school, low fat diet model

-The meal plan-
Standard diabetic model. Calorie limited at 2600/day
Macro profile looks like (in grams):
Carbs
60 (fruit)
255 (bread/starchy vegetables)
36 (milk/dairy)
Protein
70 (meat/animal sources)
24 (milk/dairy)
Fat
15

For a daily total of
(C) 351
(P) 94
(F) 15
Split across 3 meals and 3 snacks.

Here are my concerns/questions: The current diet plan has my wife very stressed because of the marco-nutrient counting requirement. Since she is on bed-rest cooking falls to me, and trying to hit those macros is super frustrating, plus it requires me to basically cook 2 meals at a time (hers and then my paleo meal). The dietitian advised us to use microwave dinners (lean cuisine and healthy choice) and canned goods to make things easier, but these are all high in sodium, which has caused my wife to swell like a balloon (preecalmpsia). While 'salad veggies' are 'free and unlimited' she gets too full eating all the damn carbs, so she's actually stopped eating them now.

She commented to me last night that she feels like she's eating worse now than she did before. Her blood-glucose levels are also on the rise now (only post meal, fasting numbers remain solid).

While I do not believe in calorie/macro counting, I'll need something to pitch to the dietitian, I was thinking a 2600 calorie plan composed of (187g carbs/ 150g fat/ 125g protein). Is this fine/safe/advisable?

Is it safe for me to move her to a low/moderate carb, moderate/high fat, moderate protein diet at this point? (following paleo guidelines).

Are there any recommended changes from the standard paleo model for her specific needs?

What should I expect to see, blood-glucose wise, when making the change (will it be erratic for a while, as she adjusts, or should things just settle down?)

And most importantly, what are some good reputable sources I can refer the dietitian to, in support of my decision to break from her advice? (The above mentioned ones are great, but I don't know if blogs will sway the dietitian)

E12ead3bf63c94b5b619b03722ef554f

on June 06, 2012
at 03:03 PM

I agree, I am afraid you won't be able to change that dietitian's view... not in time anyway! Other than that, I would say that 350 g of carbs is a lot of carbs! If you try to go lower, make sure she stays properly hydrated, monitor her blood sugar and blood pressure closely. Please try to find a qualified health professional familiar with Paleo/low-carb to supervise everything.

5ccb98f6ae42ce87e206cf3f6a86039f

(11581)

on June 06, 2012
at 02:51 PM

Find a different dietitian. One who isn't a carb pusher, that understands that human fetuses need fats and protein and that is experienced in GD.

F0e558010a2ecb31fa37b7c491596b8e

(3850)

on June 06, 2012
at 04:01 PM

I'm sorry, the minute the dietician recommended Lean Cuisine, I would have walked out.

F0e558010a2ecb31fa37b7c491596b8e

(3850)

on June 06, 2012
at 04:05 PM

Seriously, though, start slowly. Feed her zero grains, and get carbs from starcy vegetables, tubers, fruit, and dairy. You have to give her more than 15 grams of fat a day - she's growing twins for god's sake (ok, stopping ranting). Add a little more saturated fat and protein every day and see how her sugars do. I bet they will be fine. That should make her feel better about the diet and the doctor as well.

Ce41c230e8c2a4295db31aec3ef4b2ab

(32564)

on June 06, 2012
at 03:23 PM

And pregnant women are no different from anyone else. They should eat whole, nutrient-dense foods to hunger. She also could benefit from supplemental D (after testing her level) if she is on bed rest & not getting sun and Magnesium will help with the bloating.

F0e558010a2ecb31fa37b7c491596b8e

(3850)

on June 06, 2012
at 05:08 PM

Even the ultra-SAD NIH says with gestational diabetes not to get more than 50% of your calories from carbs and not to severly limit fat because it's necessary for fetal development. That alone would be evidence that this RD's recommendations are not acceptable.

Ce41c230e8c2a4295db31aec3ef4b2ab

(32564)

on June 06, 2012
at 03:23 PM

I'm really sorry your wife has had to go through this!

Fd70d71f4f8195c3a098eda4fc817d4f

(8014)

on June 06, 2012
at 05:57 PM

@Kelly: "I'm sorry, the minute the dietician recommended Lean Cuisine, I would have walked out." THANK YOU! As I was reading the original post, I was like, "Am I the only one who wants to kill this dietician?" A "Certified diabetes specialist." Yeah, she's certifiable, all right...

Ce41c230e8c2a4295db31aec3ef4b2ab

(32564)

on June 06, 2012
at 03:19 PM

Agree that trying to work with the dietitian is a failing proposition. If you want to chat about pregnancy diet (my specialty is pregnancy & nutrition coaching) you can contact me through my website on my profile page.

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