While many people view gestational diabetes (GD) or high blood sugar during pregnancy as a temporary condition, in reality it can have a lasting impact in women's health. Gestational diabetes recurrence is very common, affecting up to 73% of women in subsequent pregnancies. Also, almost half of all women with gestational diabetes that goes away after birth eventually develop permanent diabetes later in life, with much of it occurring within the first 10 years.
Therefore, the postpartum period is a crucial time to address blood sugar imbalances and establish a healthy diet and lifestyle, to avoid complications down the road.
Blood glucose metabolism during pregnancy
To understand why women are more vulnerable to blood sugar increases during pregnancy and postpartum, we need to know that blood glucose metabolism dramatically changes during pregnancy. A woman’s body becomes more insulin resistant and blood glucose rises particularly in the second half of pregnancy because higher levels of glucose are needed for the development of a healthy fetus. For most of human history, sugar was scarce, and as a result, mothers developed insulin resistance so that the little sugar they ate didn’t get consumed only by the mother’s cells, but stayed in the blood and could reach the placenta to feed the fetus. To keep more glucose in the bloodstream, the placenta secretes hormones and enzymes that counteract, reduce or destroy insulin. The mother’s pancreas then creates more and more insulin which results in a 3-fold increase in maternal insulin secretion by the time the mother gives birth.(1)
Flooded with so much insulin, insulin receptors become insulin resistant, and thus keep glucose at higher levels in the blood, so the glucose can reach the baby via the placenta. This is not a pretty picture nowadays- when most women eat plenty of carbohydrates and sugary foods - resulting in even higher levels of insulin and more insulin resistance, ultimately pushing women into gestational diabetes. In other words, pregnancy is not an ideal time to indulge in sweets and carbohydrate-rich foods, given that a woman’s body is already in an insulin resistant state. (1,2)
The consequences of sustained high blood sugar affect both mother and baby during pregnancy, and can continue to affect the mother postpartum.
The good news is, in more than 85% of cases, blood sugar can be controlled by diet and lifestyle changes. The best protection against diabetes is a diet of low refined carbohydrates, adequate animal protein and rich in healthy fats along with moderate exercise, stress reduction and adequate sleep, all of which work together to keep blood sugar stable. (2)
"The three best ways to manage high blood sugar are diet, exercise and stress reduction."
1. Diet. Food is the most important part in controlling blood sugar levels. (3,4)
Eliminate refined carbohydrates and processed foods, such as cereal, cookies, pasta, sodas, fruit juices, jams, jellies, white bread, chocolate, etc
Avoid “fast food”, and packaged, convenience foods such as instant noodles, canned soups, frozen meals and energy bars, most of these are laden with sugar.
Read labels and avoid foods that contain added sugar: high fructose corn syrup, molasses, honey, brown sugar and sugar alcohols like sorbitol and mannitol
Consume more healthy fats, in particular cod liver oil, egg yolks, grass fed butter, lard and seafood like shrimp and fish eggs, which are also high in vitamin D.
Choose foods that are high in fiber as it slows down the release of glucose to the blood. Good sources include flaxseeds, chia seeds, avocados, jicama and nuts.
Include a good source of protein and fat in every meal and snack. Grass fed and free range meats are best.
Follow a regular eating schedule, trying to eat at the same time every meal and keeping meals the same size
KEY NUTRIENTS TO INCLUDE IN YOUR DIET
Nourishing Fats: Fats are of particular importance to balance blood sugar, because they do not mobilize insulin or affect blood sugar levels. When eaten in combination with carbs and proteins, they help to slow down digestion and the release of glucose into the blood stream. Monounsaturated and some saturated fatty acids confer the greatest benefits on glucose stabilization. Excess omega-6 fats from poly-unsaturated oils (vegetable oils) can be very damaging to both glucose and lipid metabolism, due to increased inflammation. Omega-3 fatty acids and docosahexaenoic acid (DHA) in particular provide protection from diabetes and heart disease. In a study of Eskimos, they improved insulin sensitivity in 70% of subjects. Monounsaturated fatty acids (MUFAs) found in olive oil and avocados, are very effective in preventing diabetes as they also improve glycemic control.
Food sources: Fats from pastured meats or rendered fat (lard, schmalz, tallow, etc) dairy fats (butter, cream, yogurt) egg yolks, ghee, coconut and olive oil.
Omega 3 sources: fatty fish such as sardines, mackerel, herring, salmon, trout and eel. Avoid foods rich in inflammatory omega-6 fatty like corn, soy, canola, safflower, peanut, and sunflower oil.
Supplementation: A balanced ratio of omega 6 to omega 3 is 3:1. In addition to recommending several helpings of omega 3 rich foods weekly (see above), you can take a daily concentrated fish oil supplement, with at least 1,000 milligrams of omega 3's including EPA and DHA. Mother Nutrient's Omega 3 DHA + EPA includes 1,200 mg.
Vitamin D. This vitamin is vital for insulin production. Requirements for vitamin D are increased during pregnancy and lactation, as vitamin D plays an important role in the development of the baby's brain and skeletal structure. Therefore, if the mother’s intake is inadequate, pancreatic function (insulin production) may be sacrificed to the needs of the growing baby. A study showed that the majority of mothers with gestational diabetes had a vitamin D deficiency when tested following pregnancy.(5) Another study showed that vitamin D deficiency correlates with gestational diabetes and heightened the risk for the future development of diabetes. (6)
Food Sources: Vitamin D rich foods include oily fish like eel, sardines, herring, and salmon. Cod liver oil, pastured beef, chicken liver, egg yolks, and butter are good sources as well. Animal forms are the best sources since these animals have already gone through the vitamin D creation process themselves. Plants are low in vitamin D, but the best plant sources are dark leafy greens like kale, chard, spinach, beet greens, turnip greens, and collard greens.
Supplementation. The ideal way to optimize vitamin D levels is by getting regular sun exposure. It is estimated, however, that up to 75% of adults are vitamin D deficient, therefore supplementation is recommended to achieve a level of 40-60 ng/mL. Vitamin D3 is found as a supplement in capsules, tablet and liquid form. Make sure you choose a vitamin D3 supplement as opposed to D2. D2 is a controversial form of vitamin D that is added to commercial milk, processed foods, and most multi-vitamins. D2 is not as active as D3 and some say it even causes adverse effects. Mother Nutrient's Vitamin D3 comes in liquid form and contains MCT oil (derived from coconut oil) since Vitamin D is a fat-soluble vitamin and is better absorbed when you consume it with fat. (6,7,8)
Fiber. Soluble fiber helps to slow the body's breakdown of carbohydrates and the absorption of sugar, helping with blood sugar control. In a recent study conducted by researchers at the Imperial College London, those who had the highest intake of fiber (more than 26 grams a day) had an 18 percent lower risk of developing type 2 diabetes than those with the lowest intake (less than 19 grams a day). Another way in which fiber helps blood sugar regulation is through prebiotics, which help nourish beneficial bacteria in the gut. Inulin, a prebiotic fiber found in onions, leeks, and garlic (among many other foods), has also shown particular promise for type 2 diabetes. Women with type 2 diabetes who consumed 10 grams of inulin a day for two months had improvements in glycemic control and antioxidant levels. It's thought that inulin may work to improve diabetes by improving gut microflora or due to a direct antioxidant effect. It is recommended to consume 20-50 grams of fiber per day.
Food Sources: Highest sources of soluble and insoluble fiber: Chia seeds, berries, brassica vegetables (broccoli, Brussel sprouts, cabbage), cauliflower, flax seeds, root vegetables and tubers (sweet potato, onions, beets, etc), avocados.
Prebiotic fiber: Jerusalem artichokes, jicama, chicory root, dandelion greens, garlic, leeks, onions
Supplementation: Fiber is more effective when consumed from foods, as opposed to supplement powders. If you need to take a supplement, supplements from foods are best: glucomannan (from konjac root), psyllium, guar gum, defatted fenugreek seed powder, seaweed fibers (alginate and carrageenan), ground flaxseed and pectin. Glucomannan lowers postprandial glucose by 20%, insulin secretion by 40% and produces whole-body insulin sensitivity index improvement of 50%, which is unequaled by any drug or natural product. (8,9)
Exercise helps cells become more sensitive to insulin, helping them overcome insulin resistance.
This is why exercise is key in treating diabetes; it helps to control blood sugar by burning glucose. Check with your doctor if you are ready to start an exercise program. When you are ready start with gentle forms of exercise like walking, yoga or low-intensity swimming. Exercising a few times a week, even if only for 30 minutes can be benefial. It is better to exercise a little every day than to have longer sessions once a week.
3. Sleep and stress reduction. Stress hormones induce blood sugar production.
There are only two instances when insulin springs into action. The first is when we eat carbohydrates and the second is when our body senses stress. The stress hormone adrenaline helps the body produce more blood sugar to fuel action, which insulin can then move into the cells. Another stress hormone, cortisol, then blocks the effects of insulin, leaving blood sugar high. When the stress response is chronic, this will lead to chronically elevated blood sugar.
Therefore, reducing stress is an important part of blood sugar regulation.
Yoga, meditation and Qui Gong and very good ways to reduce stress and are gentle enough for postpartum women to participate in. Sleeping is another way to reduce stress and therefore insulin. The stress hormone cortisol is elevated during the day; it peaks in the morning and steadily goes down during the day and tapers off at night when we go to sleep. This is why sleep is key! The longer we stay awake, the longer cortisol is elevated and the longer insulin is produced. Good sleep is recommended to be at least 8 hours. Managing stress and sleeping adequately will help keep your blood sugar under control.(9,10)
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1. Kresser, 2015. Nutrition for fertility, pregnancy and breastfeeding. www.chriskresser.com
2. Evans, Aronson, 2005. The Whole Pregnancy Handbook: An obstetrician's guide to integrating conventional and alternative medicine before, during and after pregnancy. Gotham Books, Penguin Group New York 2005
3. Jovanovic-Peterson, 1994. Alternative to insulin therapy: diet and physical exercise. Journ Annu Diabetol Dieu. 1997:95-124.
4. Fallon Morell & Cowan, 2005 . The Nourishing Traditions book of Baby & Child care. New Trends Publishing, Inc Washington DC 2013
5. Nichols, Lily, 2018. Real Food for Pregnancy. The science and wisdom of optimal prenatal nutrition.
6. Shin, Choi, Longtine & Nelson, 2010. Vitamin D effects on pregnancy and the placenta.
Placenta. 2010 Dec; 31 (12): 1027-34. Epub 2010 Sep 22. PMID 20863562
Department of Obstetrics and Gynecology, CHA University School of Medicine, Seul, Republic of Korea
7. Yeow, Lim, Hor, Khir, Mohamud & Pacini, 2015. Impact of Vitamin D Replacement on Markers of Glucose Metabolism and Cardio-Metabolic Risk in Women with Former Gestational Diabetes – A Double-Blind, Randomized Controlled Trial. PLoS One. 2015; 10(6): e0129017. Epub 2015 Jun 9. PMID: 26057782
8. Mercola, 2015. More Evidence That a High-Fiber Diet Can Curb Type 2 Diabetes June 2015 http://articles.mercola.com/sites/articles/archive/2015/06/08/fiber-may-lower-diabetes-risk.aspx
9. Pizzorno, Murray and Joiner-Bey, 2008. The Clinician’s Handbook of Natural Medicine. Churchill Livingstone Elsevier, St. Louis Missouri
10. Wiley, Formby, 2001. Lights Out: Sleep, Sugar and Survival. Atria Books.