Preventing Gestational Diabetes With Vitamin C

How to Get More Vitamin C During Pregnancy

Author: Dr. Stephen Chaney

 

Does the belief that some mothers are preventing gestational diabetes with vitamin C have any merit?

preventing gestational diabetes with vitamin cEach year about 280,000 women in the United States will develop gestational diabetes in the second or third trimester of pregnancy. Gestational diabetes has increased by 56% between 2000 and 2010 and now represents 7% of all pregnancies in the US.

These are alarming statistics because gestational diabetes can have devastating consequences for both the mom and the unborn baby. For example, gestational diabetes:

  • Can cause excessive birth weight that causes the baby to become stuck in the birth canal, which requires a C-section and/or may cause brain damage to the baby.
  • Can cause early (preterm) birth and/or respiratory distress symptom in the newborn infant.
  • Can lead to preeclampsia (high blood pressure), which causes several other problems.
  • Is associated with an increased risk of obesity and type 2 diabetes later in life for both the mom and her baby.

Because of these risks it is of paramount importance that you get your blood sugar levels under control if you develop gestational diabetes. The first line of defense against gestational diabetes is diet, exercise, and weight management (more about that later). If that fails to get your blood sugar under control, your physician may recommend oral diabetes medications. However, the American Diabetes Association does not recommend their use during pregnancy because their safety has not been established in pregnant women. Instead, they recommend insulin because that does not cross the placenta.

So, what can you do? Gestational diabetes is like type 2 diabetes in that it is caused by insulin resistance. In last week’s issue of “Health Tips From the Professor,”  I discussed two recent publications that suggest vitamin C improves blood sugar control in type 2 diabetics. Could vitamin C do the same thing for gestational diabetes? One recent study, (C. Liu et al, Clinical Nutrition), says the answer may be yes.

How Was The Study Done?

preventing gestational diabetes with vitamin c studyThis study recruited 3,009 pregnant women from the ongoing Tongji Maternal and Child Heart Cohort study in the Wuhan region in China. Their average age was 28 and their average BMI was 20, which is in the healthy range. [Note: This is significantly different than in the United States, where a significant percentage of women enter pregnancy in the overweight or obese category.]

Gestational Diabetes was assessed by an oral glucose tolerance test (the most accurate method) during weeks 24-28 of pregnancy (third trimester). Of the participants, 344 (11.4%) developed gestational diabetes.

Diet and supplement use were assessed during their first prenatal care visit and at the beginning of each trimester. The assessment was conducted by a trained interviewer. The adequacy of vitamin C intake was based on Chinese standards and was divided into inadequate (<115 mg/day (range = 10-110), adequate (115-200 mg/day), and above adequate (greater than 200 mg/day (range = 200-567)).

In terms of supplementation:

  • 44% of the population used supplements containing vitamin C.
  • 6% of the population got their supplemental vitamin C from a multivitamin.
  • Not surprisingly, multivitamin use was much higher in the group with above adequate vitamin C intake.

 

Preventing Gestational Diabetes with Vitamin C

 

preventing gestational diabetes with vitamin c fruits and vegetablesThe major findings of this study were:

  • Dietary intake of vitamin C was inversely proportional to gestational diabetes.
  • Women with above average dietary vitamin C intake had a 26% lower risk of developing gestational diabetes.
  • The primary dietary sources of vitamin C in the Chinese population were, in descending order, green leafy vegetables, cabbage, citrus fruits, chili peppers, and berries. These 5 foods accounted for 80% of the vitamin C in their diet.
  • A multivitamin supplement had no effect on gestational diabetes.

The authors concluded: “Sufficient dietary vitamin C intake (more than 200 mg/day) may protect pregnant women from developing gestational diabetes. Therefore, sufficient vitamin C from fruits and vegetables should be recommended.”  This means preventing gestational diabetes with vitamin C may be possible.

The authors pointed out that their data on multivitamin use was consistent with a recent US study (Y. Song et al, Diabetes Care, 34: 108-114, 201) showing that multivitamin use did not affect the risk of developing type 2 diabetes, but vitamin C supplementation did decrease risk. The authors said: “Whether pure vitamin C supplements have an effect on gestational diabetes risk needs further research.”

What Does This Study Mean For You?

  • preventing gestational diabetes with vitamin c meaningA recent study conducted in China reported that >200 mg/day of dietary vitamin C reduced the risk of developing gestational diabetes during pregnancy by 26%.
  • The study found that multivitamin use did not affect the risk of developing gestational diabetes but did not assess the effect of vitamin C supplementation on the risk of developing gestational diabetes.
  • The Chinese consume a primarily plant-based diet. Fruit and vegetable consumption is much less in the US. Consequently, dietary vitamin C intake in the US is much less. For example:
  • The average dietary vitamin C intake in the Chinese study was 163 mg/day. In contrast, the average intake for women of childbearing age in the US is 91 mg/day.
  • In the US 12% of women of childbearing age are deficient in vitamin C and an additional 20% are getting less than the RDA of vitamin C from their diet.

This is a small study and needs to be confirmed by larger studies. However, the idea that vitamin C may help reduce the risk of developing gestational diabetes is consistent with recent studies suggesting vitamin C helps with blood sugar control in type 2 diabetes (see my recent issue of “Health Tips From The Professor:” Vitamin C and Diabetes).

So, what should you do to reduce the risk of gestational diabetes if you are pregnant or treat it if it develops when you are pregnant?

#1: Diet: Here is what the American Diabetes Association recommends:

  • Eliminate sodas, sweets, and highly processed foods from your diet. Also avoid alcohol and cigarette smoking.
  • Consume a variety of whole foods from all 5 food groups. This includes fruits, vegetables, whole grains, beans, low-fat dairy, and low-fat meats.
  • Practice portion control. You are not really eating for two. Frequent small meals are better than 2 or 3 large meals.
  • You may want to consider a moderately low carb diet, but this is not the time to be cutting out nutrient-rich food groups. If you wish to go this route, I would suggest the low-carb version of the Mediterranean diet (minus the red wine, of course).

#2: Exercise: Exercise is a key component for controlling blood sugar levels. Consult with your physician about the best exercise program for you.

#3: Weight Management: The current recommendation for weight gain during pregnancy is between 25 to 35 pounds if you are at normal weight and 15-25 pounds if you are overweight. If you are gaining more than that, ask your physician for referral to a dietitian who can help you limit your weight gain. This is not the time to go on any extreme weight-loss diet.

  • For example, contrary to what you hear from keto advocates, this is not the time to go on the keto diet. Recent studies suggest that ketosis adversely affects brain development in the fetus. Until we know more, there is no reason to risk harm to your unborn baby.

#4: Diabetes Medications: The American Diabetes Association does not recommend diabetes medications if you develop gestational diabetes during pregnancy. They recommend insulin instead. However, some physicians still prescribe diabetes medications for women with gestational diabetes.

preventing gestational diabetes with vitamin c pills#5: Vitamin C: If you wish to avoid insulin or diabetes medications, you may want to try increasing your vitamin C intake first. Based on the current study and other recent studies, here are my recommendations:

  • Start with adding more vitamin C-rich fruits and vegetables to your diet. If your diet is like that of most US women of childbearing age, you will want to more than double your dietary vitamin C intake.
  • Consider adding a vitamin C supplement. In my previous “Health Tips From The Professor” I discussed a study showing that 1,000 mg/day improved blood sugar control in people with type 2 diabetes.
  • Don’t think of vitamin C as a “magic bullet.” It will not control gestational diabetes by itself. It should be thought of as part of a holistic program that includes diet, exercise, and weight management.
  • The only caution I am aware of for vitamin C supplementation during pregnancy is that the newborn baby may metabolize vitamin C more rapidly. You will want to continue vitamin C supplementation while you are breastfeeding as a precaution.

 

The Bottom Line

 

  • A recent study conducted in China reported that >200 mg/day of dietary vitamin C reduced the risk of developing gestational diabetes during pregnancy by 26%.
  • The study found that multivitamin use did not affect the risk of developing gestational diabetes but did not assess the effect of vitamin C supplementation on the risk of developing gestational diabetes.
  • The idea that vitamin C may help reduce the risk of developing gestational diabetes is consistent with recent studies suggesting vitamin C helps with blood sugar control in type 2 diabetes.
  • The Chinese consume a primarily plant-based diet. Fruit and vegetable consumption is much less in the US. Consequently, dietary vitamin C intake in the US is much less.

This is a small study and needs to be confirmed by larger studies. However, the idea that vitamin C may help reduce the risk of developing gestational diabetes is consistent with recent studies suggesting vitamin C helps with blood sugar control in type 2 diabetes.

So, what should you do to reduce the risk of gestational diabetes if you are pregnant or treat it if it develops when you are pregnant?

#1: Diet: Here is what the American Diabetes Association recommends:

  • Eliminate sodas, sweets, and highly processed foods from your diet. Also avoid alcohol and cigarette smoking.
  • Consume a variety of whole foods from all 5 food groups. This includes fruits, vegetables, whole grains, beans, low-fat dairy, and low-fat meats.
  • You may want to consider a moderate low carb diet, but this is not the time to be cutting out nutrient-rich food groups. If you wish to go this route, I would suggest the low-carb version of the Mediterranean diet (minus the red wine, of course).

#2: Exercise: Exercise is a key component for controlling blood sugar levels. Consult with your physician about the best exercise program for you.

#3: Weight Management: The current recommendation for weight gain during pregnancy is between 25 to 35 pounds if you are at normal weight and 15-25 pounds if you are overweight. If you are gaining more than that, ask your physician for referral to a dietitian who can help you limit your weight gain. This is not the time to go on any extreme weight-loss diet.

  • For example, contrary to what you hear from keto advocates, this is not the time to go on the keto diet. Recent studies suggest that ketosis adversely affects brain development in the fetus. Until we know more, there is no reason to risk harm to your unborn baby.

#4: Diabetes Medications: The American Diabetes Association does not recommend diabetes medications if you develop gestational diabetes during pregnancy. They recommend insulin instead. However, some physicians still prescribe diabetes medications for women with gestational diabetes.

#5: Vitamin C: If you wish to avoid insulin or diabetes medications, you may want to try increasing your vitamin C intake first. Based on the current study and other recent studies, here are my recommendations:

  • Start with adding more vitamin C-rich fruits and vegetables to your diet. If your diet is like that of most US women of childbearing age, you will want to more than double your dietary vitamin C intake.
  • Consider adding a vitamin C supplement. Don’t think of vitamin C as a “magic bullet.” It will not control gestational diabetes by itself. Instead, it should be thought of as part of a holistic program that includes diet, exercise, and weight management.

For more details read the article above.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

 

Vitamin C and Diabetes

Author: Dr. Stephen Chaney

 

vitamin c and blood sugar glucose testType 2 diabetes is increasing at an alarming rate. Between 1990 and 2010, the number of people in the US living with diabetes has more than tripled. In 2017 the CDC reported that 30.3 million Americans (9.4% of the population) had diabetes. Another 84.1 million had pre-diabetes, a condition which, if left untreated, will develop into diabetes within 5 years.

That is concerning, because type 2 diabetes can have devastating health consequences. It increases inflammation and oxidative damage. It significantly increases your risk of heart disease, Alzheimer’s Disease and some cancers. Then there is kidney disease, nerve pain, and loss of limbs.

It is the hyperglycemia (high blood sugar levels) associated with diabetes that plays a major role in many of these poor health outcomes. That is why so much effort is focused on helping people with type 2 diabetes gain better control of their blood sugar. Management of blood sugar levels in people with diabetes involves both medications and a healthy lifestyle (weight control, a healthy diet, and exercise). Unfortunately, despite their best efforts and the best efforts of their doctors, millions of Americans with diabetes struggle to control their blood sugar levels.

Is there a positive relationship between vitamin C and diabetes?

What if there were a simple, inexpensive intervention that could help diabetics control their blood sugar levels? Recent research suggests that vitamin C might be that intervention. Nobody is claiming that vitamin C is THE solution to blood sugar control. However, the recent research suggests it may be a useful addition to diabetes drugs and a healthy lifestyle.

 

Does Vitamin C Improve Blood Sugar Control?

 

vitamin c and blood sugar pillsThe idea that vitamin C may improve blood sugar control has been around for decades based on studies showing that vitamin C helps clear glucose from the circulation. Now, however, we are starting to understand how vitamin C does that.

But before I discuss how vitamin C may improve blood sugar control, the professor in me feels a need to explain what I call Diabetes 101. In type 1 diabetes the pancreas has become unable to produce insulin. In type 2 diabetes tissues have become resistant to the effects of insulin. I will focus on type 2 diabetes.

Glucose is the primary sugar in the bloodstream. Whenever blood sugar (glucose) increases, our pancreas responds by producing insulin. Insulin binds to receptors on our tissues and signals them to take up glucose and rapidly metabolize it. As a result, glucose is rapidly cleared from the circulation and blood sugar levels return to normal.

Type 2 diabetes is caused by insulin resistance. Simply put, our pancreas is still producing insulin, but our tissues have become less efficient at responding to it. Initially, the pancreas responds by overproducing insulin. A new homeostasis is achieved. Blood insulin levels are abnormally high, but glucose is still cleared from the circulation reasonably well. We call this pre-diabetes.

Eventually the pancreas loses the ability to overproduce insulin. Because our tissues are still insulin resistant, glucose is cleared from the circulation slowly. We now have trouble keeping blood sugar levels under control. We call this type 2 diabetes.

There are two major theories at present for why vitamin C may help diabetics control their blood sugar levels:

  • One theory holds that oxidative stress reduces the ability of the pancreas to release insulin. This theory suggests vitamin C improves insulin release from the pancreas, and the extra insulin overcomes insulin resistance and improves the ability of our tissues to clear glucose from the circulation.
  • The other theory holds that oxidative stress plays an important role in causing insulin resistance. This theory suggests vitamin C reduces insulin resistance and improves the clearance of glucose from the circulation by this mechanism.

There is some experimental evidence for both mechanisms. It may be that both play a role in vitamin C’s ability to improve blood sugar control.

How Were The Studies Done?

vitamin c and blood sugar studyIn terms of the effect of vitamin C on blood sugar control, there are two recent studies that have provided intriguing results.

The first study (Y. Song et al, Diabetes Care, 34: 108-114, 2011) was designed to see if supplementation with multivitamins or individual vitamin and mineral supplements affected the risk of developing diabetes among older US adults. It utilized data from the National Institutes of Health – American Association of Retired Persons Diet and Health Study.

The study enrolled 566,402 AARP members ages 50-71 in 1995-1996. Upon entry into the program, participants filled out a dietary survey that included supplement usage. In 2004-2006 a follow-up survey was mailed out to surviving participants that asked about occurrences of major chronic diseases.

Because the onset of a major disease is known to affect supplement usage, all participants with pre-existing diabetes or who developed diabetes prior to 2,000 were excluded from this analysis. Of the remaining 232,007 participants, 217,877 did not have diabetes and 14,130 had developed diabetes between 2000 and the end of the study.

The second study (SA Mason et al, Diabetes, Obesity and Metabolism, 21: 674-682, 2019 ) was a double blind, placebo controlled study design to determine whether supplemental vitamin C improved blood sugar control in people who already had type 2 diabetes.

In this study 31 adults (average age 62 years) were enrolled in the study. All the subjects were borderline obese and had type 2 diabetes. Five of the patients were being managed with lifestyle changes only. The other 26 patients were on one or more diabetes medications to help control their blood sugar levels.

The subjects were advised to avoid supplementation prior to the study. They were then given either 1,000 mg of vitamin C (two 500 mg capsules) or a placebo to take for 4 months. After the first 4-month period they were put on a “washout” protocol with no supplementation. Then they were put on a second 4-month regimen in which they received the opposite tablets (Those who received vitamin C during the first 4 months received a placebo during the second 4 months and vice versa.) Compliance with the protocol was determined by measuring blood levels of vitamin C.

The subjects were outfitted with a continuous blood glucose monitor for a 48-hour period at the beginning and end of each 4-month regimen. They were given standardized meals during those 48-hour test intervals and their blood sugar response to the meals was continuously monitored over the next 48 hours.

Vitamin C and Diabetes

 

vitamin c and blood sugar glucose meterThe results of the first study were:

  • Multivitamins and most of the individual supplements tested had no effect on the risk of developing diabetes over the next 10 years. The only supplements that reduced the risk of developing diabetes were vitamin C and calcium.
  • Vitamin C reduced the risk of developing diabetes by 9%.
  • The benefits of vitamin C appeared to be limited to individuals who did not use multivitamins and who had low dietary intake of vitamin C (No surprises there. Supplementation is usually most effective when it is filling in nutritional gaps).

This study has several obvious limitations:

  • It is an association study, so it does not prove cause and effect.
  • It does not tell us whether vitamin C prevents diabetes or simply improves blood sugar control in people who are borderline diabetic.
  • It did not measure how much supplemental vitamin C people were taking. However, based on what is available in the marketplace, it is probably safe to assume it was between 500 and 1,000 mg/day.

However, this study did lay the groundwork for the second study.

The results of the second study were that 4 months of vitamin C supplementation reduced:

  • The blood sugar response to standardized meals by 36%.
  • The duration of high blood sugar following a standardized meal by 1.7 hours.
  • The amount of time during the day with high blood sugar levels by 2.8 hours.

These are all important improvements for anyone with type 2 diabetes. In the words of the authors: “The improvement in total daily time spent with hyperglycemia [high blood sugar] is of potential clinical importance as the risk of complications in type 2 diabetes is strongly associated with previous hyperglycemia.”

The authors went on to say: “Compliance in the present study was high [people did not find it difficult to take 2 tablets a day] and the number of reported adverse effects was low, suggesting that vitamin C may be safely and consistently used in addition to [emphasis mine] primary diabetes treatment. Given the potential side effects with common anti-diabetic medications…, the idea that a relatively benign and inexpensive vitamin supplement might play a role in managing diabetes has particular appeal.”

Note: This was a very well-designed study. Its weakness is its small size. While it is consistent with other recent studies, larger clinical trials are needed to confirm this effect. 

What Do These Studies Mean For You?

vitamin c and blood sugar meaningThe idea that vitamin C may help with blood sugar control has been around for decades. These studies provide experimental support for that idea. While both studies have limitations, they are consistent with other recent studies. Much more research is needed, but it is good to finally see the hypothesis being rigorously tested.

So, what do these studies mean for you? Here is the take home message:

  • Although more studies are needed, vitamin C appears to help with blood sugar control.
  • We don’t know how much vitamin C is needed, but the most recent study was done with 1,000 mg/day. That is more than can be obtained from diet alone.
  • The improvement in blood sugar control was significant, but it was not huge. Vitamin C will not replace a healthier weight, a healthy lifestyle, and exercise.
  • You should think of vitamin C as something you add to the treatment plan your doctor recommends for type 2 diabetes. At best it may allow your doctor to reduce the amount of medication they prescribe.

If you have type diabetes, here are my recommendations:

  • If you are overweight, try to attain and maintain a healthier weight.
  • Eat a whole food, primarily plant-based diet. Avoid sodas, sweets, and highly processed foods. Eat a variety of fruits, vegetables, whole grains, and beans in their natural, unprocessed state. Include small amounts of meat, eggs, and dairy. Think of them as the garnish, not the main course.
  • Add a daily vitamin C supplement.
  • If that is not enough, ask your doctor what medications he or she recommends.

Other nutrients that may help are chromium, taurine and alpha lipoic acid. Herbs that may help are bitter melon and gymnema.

 

The Bottom Line

 

What is the association between vitamin C and diabetes? The idea that vitamin C may help with blood sugar control has been around for decades. Two recent studies provide experimental support for this idea. The second study showed that 4 months of 1,000 mg/day vitamin C supplementation reduced:

  • The blood sugar response to standardized meals by 36%.
  • The duration of high blood sugar following a standardized meal by 1.7 hours.
  • The duration of the day with high blood sugar levels by 2.8 hours.

These are all important improvements for anyone with type 2 diabetes. In the words of the authors: “The improvement in total daily time spent with hyperglycemia [high blood sugar] is of potential clinical importance as the risk of complications in type 2 diabetes is strongly associated with previous hyperglycemia.”

While this study has limitations, it is consistent with other recent studies. Much more research is needed, but it is good to finally see the hypothesis that vitamin C improves blood sugar control being rigorously tested.

So, what do these studies mean for you? Here is the take home message:

  • Although more studies are needed, vitamin C appears to help with blood sugar control.
  • We don’t know how much vitamin C is needed, but the most recent study was done with 1,000 mg/day. That is more than can be obtained from diet alone.
  • The improvement in blood sugar control was significant, but it was not huge. Vitamin C will not replace a healthier weight, a healthy lifestyle, and exercise.
  • You should think of vitamin C as something you add to the treatment plan your doctor recommends for type 2 diabetes. At best it may allow your doctor to reduce the amount of medication they prescribe.

For more details and my recommendations read the article above.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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