Gestational Diabetes Causes: High Folate Levels?

Written by Dr. Steve Chaney on . Posted in Diabetes, Gestational Diabetes?

What Should You Look For In A Prenatal Supplement?

Author: Dr. Stephen Chaney

 

gestational diabetes causesAccording to the CDC, almost 10% of the women in this country will develop diabetes during pregnancy, something referred to as gestational diabetes. After delivery, their blood sugar levels will usually return to normal.

However, gestational diabetes is not a benign condition. It increases your risk of serious complications during both pregnancy and delivery. It also increases the risk that your baby will suffer complications during birth, and it increases their risk of developing obesity and diabetes later in life.

Obesity and a family history of diabetes both increase the likelihood that you will develop gestational diabetes during pregnancy. Beyond that, what could be gestational diabetes causes are not well known.

There have been numerous suggestions in the literature that high folate levels may increase your risk of gestational diabetes. If that is true, it is concerning.  After all you are being told you should probably be taking a folic acid supplement before and during pregnancy to prevent birth defects. Could the very supplement you are taking to prevent birth defects be harming both you and your unborn child?

Before you throw out your folic acid supplements, I should hasten to add that the science is not definitive. Some studies have reported an association between high folate levels and gestational diabetes. Other studies have seen no association. It has been very confusing. No one has been able to figure out why the study results have been so inconsistent.

In this issue of “Health Tips From The Professor,” I share a study that may clear up the confusion.

How Was The Study Done?

pregnancy diabetesThis study (Lai et al, Clinical Nutrition, doi: 10.1016/j.clnu.2017.03.22 ) was part of a larger study,  “Growing Up in Singapore Towards Healthy Outcomes” (GUSTO). The larger study was designed to assess multiple factors related to the health of pregnant mothers and their offspring. This particular study was designed to assess whether there was an association between high blood folate levels and gestational diabetes in Asian women.

The investigators recruited 923 women of Chinese, Malay, and Indian descent when they were less than 14 weeks pregnant. The women returned to the clinic at 26-28 weeks of pregnancy. Fasting blood samples were obtained for analysis of plasma folate, B12, and B6 levels. Gestational diabetes was diagnosed during the same clinic visit based on a fasting blood glucose level followed by a second blood glucose test 2 hours after ingestion of 75 grams of glucose. The women also completed a diet recall during this office visit.

 

Do High Folate Levels Cause Gestational Diabetes?

 

When the data were analyzed:

  • A high blood level of folate was associated with a 30% increase in gestational diabetes.
  • A high blood level of B12 was associated with a 20% decrease in gestational diabetes.
  • A high blood level of B6 showed no association with gestational diabetes.

vitamin b12When the investigators looked at the association between folate status and gestational diabetes in each of the ethnic groups individually, they discovered that the association between high blood folate levels and gestational diabetes occurred almost entirely in the Indian women.

This offered an important clue. A high proportion of the Indian women were following a vegetarian diet, which could predispose to B12 deficiency. When the investigators looked at both folate and B12 status, they found:

  • A high blood level of folate combined with B12 insufficiency was associated with a 97% increase in gestational diabetes.
  • A blood level of folate in women with normal B12 status showed no association with gestational diabetes.

What Does This Study Tell Us?

This is a single study, and it is based on associations which do not prove cause & effect. Additional studies are clearly needed to prove this hypothesis. However, if these data are confirmed, this study has several interesting ramifications.

#1: It offers a possible explanation for the inconsistencies of previous studies looking at the associations of high folate status with gestational diabetes. Most previous studies simply measured folate status without looking at B12 levels. This study suggests it is important to assess both folate and B12 status. Elevated blood folate levels may only predispose to gestational diabetes in populations that are also B12 deficient.

#2: This study suggests a previously unknown interaction between folate and B12. This is not simply a case of high folate levels masking the symptoms of B12 deficiency. The prevalence of gestational diabetes was much greater when blood folate levels were elevated than it was with B12 deficiency alone. In other words, folate made the symptoms worse. The authors offered a potential mechanism for this interaction, but it was speculative. In short, we simply do not understand the mechanism of this interaction at present.

What Does This Study Mean For You?

folic acid pregnancyIf this study is confirmed, it has several important implications for any woman who is pregnant or is considering becoming pregnant.

#1: Methyl folate offers no advantage over folic acid: These data are based on blood folate levels, not on folic acid intake. Methyl folate and folic acid are equally likely to increase blood folate levels.

#2: B12 supplementation is important if you are vegetarian or are restricting meat intake: This is just a reminder of what you have probably heard before. There are many potential causes of B12 deficiency. However, in the younger age range, vegetarianism is the most common cause of B12 deficiency.

#3: A holistic approach to supplementation is better than taking individual vitamins. In this case, it is clearly preferable to take a supplement containing both folic acid and B12 than one just containing folic acid or methyl folate. That is an important message. You are constantly being reminded that optimal folate status is important for a healthy pregnancy. It is easy to find supplements containing just folic acid or methyl folate. Avoid those supplements! Look for ones that contain both folic acid and B12 (preferably with B6 and the other B vitamins as well). The same holds true for prenatal supplements. Make sure they contain all the B vitamins in balance, not just folic acid.

So, could high folate levels be one of the gestational diabetes causes?  We simply don’t know yet.

 

The Bottom Line

 

  • Recent headlines have suggested that high blood folate status is associated with an increased risk of developing gestational diabetes during pregnancy. This raises the question as to whether the supplementation you have been told was essential to prevent birth defects could also put you at risk for another health problem.
  • The study actually showed that high blood folate status only increases the risk of gestational diabetes in women who are also B12 deficient.
  • If you are pregnant or thinking of becoming pregnant, this study has several important implications for you.
    • Methyl folate offers no advantage over folic acid. These data are based on blood folate levels, not on folic acid intake. Methyl folate and folic acid are equally likely to increase blood folate levels.
    • B12 supplementation is important if you are vegetarian or are restricting meat intake. This is just a reminder of what you have probably heard before.
    • A holistic approach to supplementation is better than taking individual vitamins. In this case, it is clearly preferable to take a supplement containing both folic acid and B12 than one just containing folic acid or methyl folate. That is an important message. You are constantly being reminded that optimal folate status is important for a healthy pregnancy. It is easy to find supplements containing just folic acid or methyl folate. Avoid those supplements! Look for ones that contain both folic acid and B12 (preferably with B6 and the other B vitamins as well). The same holds true for prenatal supplements. Make sure they contain all the B vitamins in balance, not just folic acid.
  • For 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.

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Latest Article

One of the Little known Causes of Headaches

Posted August 15, 2017 by Dr. Steve Chaney

Your Sleeping Position May Be Causing Your Headaches!

Author: Julie Donnelly, LMT – The Pain Relief Expert

Editor: Dr. Steve Chaney

 

Can sleeping position be one of the causes of headaches?  

A Sleeping position that has your head tilted puts pressure on your spinal cord and will cause headaches. I’ve seen it happen hundreds of times, and the reasoning is so logical it’s easy to understand.

causes of headachesYour spinal cord runs from your brain, through each of your vertebrae, down your arms and legs. Nerves pass out of the vertebrae and go to every cell in your body, including each of your organs. When you are sleeping it is important to keep your head, neck, and spine in a horizontal plane so you aren’t straining the muscles that insert into your vertebrae.

The graphic above is a close-up of your skull and the cervical (neck) vertebrae. Your nerves are shown in yellow, and your artery is shown in red.  Consider what happens if you hold your head to one side for hours. You can notice that the nerves and artery will likely be press upon. Also, since your spinal cord comes down the inside of the vertebrae, it will also be impinged.

In 2004 the Archives of Internal Medicine published an article stating that 1 out of 13 people have morning headaches. It’s interesting to note that the article never mentions the spinal cord being impinged by the vertebrae. That’s a major oversight!

Muscles merge into tendons, and the tendons insert into the bone.  As you stayed in the tilted position for hours, the muscles actually shortened to the new length.  Then you try to turn over, but the short muscles are holding your cervical vertebrae tightly, and they can’t lengthen.

The weight of your head pulls on the vertebrae, putting even more pressure on your spinal cord and nerves.  Plus, the tight muscles are pulling on the bones, causing pain on the bone.

Your Pillow is Involved in Your Sleeping Position and the Causes of  Headaches

sleep left side

The analogy I always use is; just as pulling your hair hurts your scalp, the muscle pulling on the tendons hurts the bone where it inserts.  In this case it is your neck muscles putting a strain on your cervical bones.  For example, if you sleep on your left side and your pillow is too thick, your head will be tilted up toward the ceiling. This position tightens the muscles on the right side of your neck.

sleeping in car and desk

Dozing off while sitting in a car waiting for someone to arrive, or while working for hours at your desk can also horizontal line sleepcause headaches. The pictures above show a strain on the neck when you fall asleep without any support on your neck. Both of these people will wake up with a headache, and with stiffness in their neck.

The best sleeping position to prevent headaches is to have your pillow adjusted so your head, neck, and spine are in a horizontal line. Play with your pillows, putting two thin pillows into one case if necessary. If your pillow is too thick try to open up a corner and pull out some of the stuffing.

 

sleeping on stomachSleeping on Your Back & Stomach

If you sleep on your back and have your head on the mattress, your spine is straight. All you need is a little neck pillow for support, and a pillow under your knees.

Stomach sleeping is the worst sleeping position for not only headaches, but so many other aches and pains. It’s a tough habit to break, but it can be done. This sleeping position deserves its own blog, which I will do in the future.

 

Treating the Muscles That Cause Headaches

sleeping position causes of headachesAll of the muscles that originate or insert into your cervical vertebrae, and many that insert into your shoulder and upper back, need to be treated.  The treatments are all taught in Treat Yourself to Pain Free Living, in the neck and shoulder chapters.  Here is one treatment that will help you get relief.

Take either a tennis ball or the Perfect Ball (which really is Perfect because it has a solid center and soft outside) and press into your shoulder as shown.  You are treating a muscle called Levator Scapulae which pulls your cervical vertebrae out of alignment when it is tight.

Hold the press for about 30 seconds, release, and then press again.

Your pillow is a key to neck pain and headaches caused by your sleeping position.  It’s worth the time and energy to investigate how you sleep and correct your pillow.  I believe this blog will help you find the solution and will insure you have restful sleep each night.

Wishing you well,

Julie Donnelly

 

About The Author

julie donnelly

Julie Donnelly is a Deep Muscle Massage Therapist with 20 years of experience specializing in the treatment of chronic joint pain and sports injuries. She has worked extensively with elite athletes and patients who have been unsuccessful at finding relief through the more conventional therapies.

She has been widely published, both on – and off – line, in magazines, newsletters, and newspapers around the country. She is also often chosen to speak at national conventions, medical schools, and health facilities nationwide.

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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