Paleo and Gestational Diabetes

Pretty much every pregnant woman in the U.S. is tested for gestational diabetes between 24-28 weeks.  I was curious about what this would entail, so I did some research. Standard practice (including at my OB's office) is to take a glucose test at the 28 week appointment. The glucose test consists of drinking an artificially colored, artificially flavored drink containing 50g of raw glucose. You aren't supposed to eat within 2 hours of drinking it and are told to finish the drink within 5 minutes. An hour after having the drink, your blood sugar is tested. A blood glucose level of 140mg/dL is "failing," and you would then be told to take the 3 hour oral glucose tolerance test.

Women are often told to eat a high carb diet (150-200g) for at least 3 days prior to the 3 hour test.  For the 3 hour test, you are given a drink with 100g of raw glucose. Blood sugar is tested prior to consuming the drink (fasting blood sugar as you not to eat within 12 hours of the test) and every hour for 3 hours after taking the test.  If you fail the 3 hour test, you are considered to have gestational diabetes.

Treatment? Most pregnant women with gestational diabetes are able to keep their blood sugar levels in check with a low carb diet and moderate exercise. Sigh, facepalm.

So, we're going to pump me (and the baby) full of sugar to see how my body responds to something I never consume; if my body sucks at processing 50g, we'll see how I do with 100g; and if I fail that test, I'll be told to avoid carbs and sugar and go for walks. Sounds like modern medicine at its finest. 

I probably would have just assumed "well, I'm healthy and eat right, so I'll just suck it up and pass the 1 hour test no problem." But I started reading several accounts of paleo-eating, crossfitting moms-to-be failing the glucose tests and being told they have gestational diabetes.  Why?  Robb Wolf says:

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.

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

So rather than suck it up, I decided to talk to my doctor about it at my 24 week appointment this week. I was expecting to be told the test is mandatory and maybe be lectured on how I need to be eating whole grains. I was very pleasantly surprised by my doctor's response. She basically agreed that consuming the glucose drink would make me feel like crap, and (based on my diet and lack of other risk factors) she's comfortable with me not taking the glucose test. She has to run it by the other (5) doctors in the practice, but she sounded confident that they could offer an alternative, such as testing my blood sugar a couple hours after a normal meal. Whew!

[Update:  I'll be going in Monday (2/13) morning for a fasting glucose test and HbA1c.]

Considering the typical pregnant American's diet and that as many as 10% of pregnant women develop gestational diabetes, I can see why this method of testing makes some sense. However, in my common sense view, it is extremely stupid when applied to someone that eats paleo. I found this analogy funny:

"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.

"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."

http://freetheanimal.com/2010/11/gestational-diabetes-and-paleo-you-horny-women-you.html

Some other helpful links on the issue:

http://www.robbwolf.com/2008/06/25/gestational-diabetes/
http://www.carbohydratescankill.com/1835/44-dr-mary-vernon-on-gestational-diabetes-its-causes-prevention-treatments

107 days to go!