Dear DOCTOR Owen:

I am pregnant and have been diagnosed with gestational diabetes. I was counseled about diet, but it was a blur because I was so upset on hearing the bad news. After they told me about the effects on my pregnancy, I suffered “brain lock.” What is the latest about this condition relative to diet and exercise? Can I diet safely and should I exercise?

Sugar Mama

Dear “Mama”:

This is not normally my area, so I advise listening closely to your obstetrician and dietitian. I will share with you two articles that relate to your questions. Refer these publications to your obstetrician and dietitian for review if they haven’t seen them.

Gestational diabetes is abnormal blood sugar control caused or precipitated by pregnancy. It is, basically, diabetes. The complications in the fetus can be the same as those in a person who has diabetes prior to pregnancy. Often it will resolve after pregnancy, only to return in later life in a majority of cases. You might think of this as “pre-diabetes,” but to your fetus—diabetes is diabetes. This is serious, and you need guidance.

Gestational diabetes has traditionally been treated by a “diabetic” diet of complex carbohydrates, lean protein, and fat—roughly, 50%/25%/25%—in that order, as a percentage of the total diet. This is similar to diets for non-pregnant diabetics.

1. An article on pregnancy in the American Journal of Obstetrics and Gynecology, Vol. 91, 600–604, discussed a “novel” approach to treating diabetes: a high-protein, low-carbohydrate, and low-fat diet, with results compared to those of a traditional diet. The diet plans were not unlike the “trendy,” yet-to-be-proven, Atkins and Sugar Busters!TM diets (a New Orleans version of the Atkins Diet, in my opinion). The results were quite startling. On the high-protein diet, insulin was required 5% vs. 33% on the traditional diet. Cesarean section rates for large baby problems were 3% in the high-protein group vs. 48% in the traditional group. Glucose (sugar) levels were substantially higher among the traditional group after eating. The total number of calories was similar in both groups, which lends credibility to the hypothesis promoted by the high-protein, low-carbohydrate diet plans. More research is anxiously awaited.
2. Another article on pregnancy in the American Journal of Obstetrics and Gynecology, Vol. 178, 280–286, looked at strenuous exercise during pregnancy by conditioned athletes. One group continued with high-intensity exercise while the other group continued with mild-to-moderate exercise. Both groups had excellent outcomes. The cesarean section rate was only 4%, which is incredible by today’s standard of 20% or higher. None of the pregnancies had bad outcomes.

Both articles revealed that we still have a fixed cultural view of “right” and “wrong” when it comes to diet and exercise styles, and that we have a lot to learn. An open mind is essential if progress is to be made. Pregnancy is an area in which novel ideas are taboo, as it is risky to “experiment” in today’s legal environment. A negative outcome will, no doubt, be blamed on “the” diet or “the” exercise program—not the cola, the fried chicken, or the 13 hours of inactivity spent in front of the “boob tube.” And lawyers will not be the ones who are doing the blaming. It will be Mama, Grandma, Great-grandma—even doctors and midwives who are passing on traditions developed out of traditional education, religious, social, economic, legal, and cultural factors.

Studies like those reported on in the articles reinforce the need for good science and research in medicine. Further, the public should know, via the media, how science can improve people’s lives. Additionally, public awareness may change preconceptions and perceptions. People resist change, which is often viewed as “scary.” However, change is necessary for progress.

So, if your “Sugar Buster Baby” or “Atkins’ Meathead” is healthy, successful, and happy, what more could you want?

I tell my patients over and over that “the” diet does not exist. Know that malnutrition is rare and avoidable today because of all the available vitamin and food supplements. “The” diet is the one that works for you, in your particular situation, culture, social environment, physical environment, medical condition, and mood.

It is important to follow the diet plan. If you tire of the regimen, move on to a different program. But do not go back to the “no-plan” that got you into trouble. Weight management requires constant learning, trial and error, planning, and persistence. These—not willpower—are synonymous to success.