Can gestational diabetes be prevented through diet and probiotics?
Hello friends! After a long hiatus, I am back! A lot has happened since my last article. First and foremost, my husband and I learned that we are expecting! That’s right; another tiny microbe will be joining our family in August. Also, we moved houses. Then there was Christmas. Then we visited my in-laws in South Africa. Then I battled a nasty head and chest cold for 3 weeks. Needless to say, December and January were a whirlwind of change, excitement, family, travel, and challenges. Much of it was pure enjoyment, but as I spent more time out of my routine and normal life, my balanced, microbiome-focused diet slowly slid away from me. I tried many times to reel it back in, but just couldn’t manage.
“It’s Christmas.” “I’m on vacation.” “I’m pregnant.” “I’m sick.” “I don’t want to eat that [mostly referring to vegetables].” “I want to eat this [mostly referring to processed carbs].” “It’s hard!”
These are the many reasons/excuses I fell back on to continue eating poorly. And, not surprisingly, I noticed many effects: lack of energy and sluggishness, sinus congestion issues (which are a common symptom of pregnancy, but also for me a symptom of eating inflammatory foods), more first trimester weight gain than I wanted. But the effects of my poor diet began to extend beyond me. Since I didn’t feel as good, I became less patient and more grumpy (not a good combination), with myself, my husband, and my 2-year old. And as I continued to eat poorly, my fasting blood glucose levels slowly crept up (I still occasionally measure my blood sugar at home).
As I mentioned in My Health Journey, I had gestational diabetes mellitus (GDM; also known simply as gestational diabetes) with my first pregnancy. I took the diagnosis pretty hard. It seemed like a negative reflection of my health. I felt disappointed, embarrassed and even ashamed. But meeting with the dietician and sitting through my support group, I learned that healthy people get it too, including people like me who have none of the obvious risk factors. I say obvious, because genetic factors are rarely obvious, but likely play a role. For example, some of my family members suffered from Type II diabetes and my mom was borderline gestational diabetic with my youngest brother. So it seems that I may have a genetic predisposition to reduced insulin sensitivity under certain conditions.
I continually wondered if maybe I could have prevented GDM, or could prevent it in subsequent pregnancies. The diet and exercise to manage blood sugar weren’t awful; in fact I learned a lot of useful information, eliminated some unhealthy habits and developed many healthy ones. But of course I would rather not have it again. It can strain on the baby and increase the risk for health issues in the baby’s life. It is a pain to measure blood sugar levels 4 times a day. I exercise regularly, but having to fit in 20 min after each meal is tough, especially with a toddler. And if this time my blood sugar couldn’t be controlled with diet and exercise and I required insulin, it would feel much more overwhelming to me.
Because I had GDM, my risk of developing it again is higher. My dietician mentioned that GDM recurs in approximately two-thirds of pregnancies. A large study of 65,132 pregnant women showed that the risk of developing GDM in the 2nd pregnancy was 41% for women who previously had GDM and 4.2% for women who didn’t [1]. Although it’s not completely preventable, there are some steps to reduce the risk of gestational diabetes.
As I’ve read more about the effect of the gut microbiome and inflammation on development of Type II diabetes, I’ve wondered if a balanced gut microbiome could help prevent gestational diabetes.
Last year, I read one study that showed that intensive dietary counseling along with taking probiotics reduced the incidence of gestational diabetes in pregnant women [2]. The study included 191 healthy pregnant Finnish women, who were randomly assigned to 1 of 3 groups at their first prenatal doctor’s visit during the first trimester. One group received dietary counseling and a placebo, one received dietary counseling and a probiotic capsule, and the control group received only the placebo. The incidence of gestational diabetes was 36% in the first group, 13% in the second group and 34% in the control group [2].
These results shows 60% fewer women were diagnosed with GDM in the group that received both dietary counseling and probiotics than in either the group that received only dietary counseling or only placebo. The study also tracked mothers and babies throughout pregnancy and 2 years postpartum and showed that probiotic use during pregnancy is safe for both mother and baby [2]. The take home is that dietary counseling plus probiotics may prevent GDM.
These numbers seem really promising; however, there are a few caveats. First and foremost, it is only one study that assessed only 191 Caucasian women. It would have been interesting to see a “probiotic only” group to better understand the effect of the probiotic. Also, the study may have been slightly skewed--the incidence rate was really high in the control and dietary counseling only groups. The global incidence of gestational diabetes is approximately 15% [3], but was between 13 and 36% in the Finnish study [2]. This study used a lower cutoff for fasting blood glucose levels than is considered standard, so more women would be diagnosed with GDM. The caveats don’t necessarily diminish the significance of the results, but we should consider them when deciding the impact.
The burning question is: can gestational diabetes be prevented by dietary intervention and probiotics?
The answer is we don’t know. Relatively few studies have sought to answer this question. The results of the Finnish study would suggest that diet and probiotics had an effect, but many more studies and more women are required to provide an association between probiotic use, gut microbiome, and prevention of gestational diabetes. Furthermore, assessing changes in the gut bacteria before and after taking the probiotics will help establish a connection between gut microbiome and GDM here.
All this aside, I still want to do everything possible in my control to prevent gestational diabetes this time around. When I think of a time of optimal health, I picture myself on the Microbiome Diet (read: eating plan) last summer. A week or two into the diet, I had sustained energy from 5:30 am to 11:30 pm, no cravings, no sinus congestion, I was trim and fit and my moods were generally upbeat and stable. This suggests to me that my inflammation was reduced and my gut bacteria were balanced.
The Microbiome Diet eliminates many inflammatory, high-carbohydrate foods that might contribute to imbalanced gut bacteria and an irritated gut; including sugar, highly processed foods, grains, dairy, starchy vegetables, eggs and most legumes (see full list in Microbiome Diet: The Naughty and Nice). But moreover it encourages consumption of high fiber vegetables and fruits, fermented foods, healthy fats, high quality meats, and bone broth that support the growth of a diverse, healthy microbiome and nourish your body. In Phase 2 of the diet, eggs, legumes, starchy vegetables, some dairy, and the healthiest grains are added back in to provide an optimal, well-rounded, whole-food diet. Plus, during Phase 2 the diet allows for 90% compliance, and only 70% compliance is required for the rest of your life. This seems like a pretty manageable plan.
I will be checking in here each week to share my progress through the Microbiome Diet, including what I’m eating, how I’m feeling, and victories and challenges. I will closely follow the menu and recipes provided by the author of the Microbiome Diet book (the reference guide contains menu plan for 5 weeks and 71 recipes for breakfast, lunch, dinner and snacks; download the free reference guide here.
Based on my current preferences, I will make a few modifications:
Although I don’t have gestational diabetes, my previous GDM diet recommended avoiding fruit in the morning. So I will replace some of the fruit-centric breakfasts of the Microbiome Diet with veggie and meat scrambles, chia seed “pudding” (chia seeds soaked in homemade almond milk), and an oatmeal-free version of The Microbiome Diet granola. I will have a serving of fruit with each of these.
Because I ate some of the Microbiome Diet recipes while I had morning sickness (see, I really did try to get back on the wagon!) and they no longer sound appealing, I will replace those with other compliant meals. Stay tuned for some additional microbiome diet-friendly meal ideas!
Because I feel like I have a lot of inflammation to overcome due to my poor diet for the past 2 months, I am going to omit lentils and chickpeas, which are normally allowed in the first 3 weeks. The Microbiome Diet omits all other legumes due to their lectin content, which can contribute to inflammation, and because of their high starch content can support the growth of unwanted gut microbes. However, Dr. Kellman keeps lentils and chickpeas because they supply a lot of fiber, which in general supports the growth of healthy gut bacteria. I would probably be fine to include them but I decided to take a hard line approach since I feel that I’m up against a lot. However, I am being mindful of my needs during pregnancy, and may add them back in if I feel that I’m not getting enough carbohydrates or fiber.
What are my expectations during the next few months? Number one, I want to improve my health and well-being. I see it as a period of healing from the inside out, and hopefully MicrobeBaby will reap the most benefits! Part of the healing will include improving my relationship with food—I tend to be all or nothing and once I slide from “all” it’s a pretty slippery slope to “nothing.” Practicing mindfulness, especially regarding food choices, is exactly that—a practice. It takes time, patience, commitment, honesty, understanding and reflection. And some slips and victories along the way.
Naturally, the glucose tolerance test to check for gestational diabetes will loom over me for the next 11-ish weeks. Will I be upset if I “fail” it? Of course! But at least I will know that I gave myself a fighting chance to avoid GDM while drastically improving my health. No losing there, right? And will I ever know if anything I do now will actually impact my result? Of course not! Because I am only one person, and I can’t clone myself to run the no-intervention control. So I will never know if these dietary changes and supplementing with probiotics will play any role in preventing or developing GDM. But, I’m MicrobeMom, and it’s fun to run little experiments, even if they’re not perfect.
References
Getahun, D., M.J. Fassett, and S.J. Jacobsen, Gestational diabetes: risk of recurrence in subsequent pregnancies. Am J Obstet Gynecol, 2010. 203(5): p. 467 e1-6.
Luoto, R., et al., Impact of maternal probiotic-supplemented dietary counselling on pregnancy outcome and prenatal and postnatal growth: a double-blind, placebo-controlled study. Br J Nutr, 2010. 103(12): p. 1792-9.
Melchior, H., D. Kurch-Bek, and M. Mund, The Prevalence of Gestational Diabetes. Dtsch Arztebl Int, 2017. 114(24): p. 412-418.
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