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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High Protein Diets and Weight Loss

Posted October 16, 2018 by Dr. Steve Chaney

Do High Protein Diets Reduce Fat And Preserve Muscle?

Author: Dr. Stephen Chaney

Healthy Diet food group, proteins, include meat (chicken or turkAre high protein diets your secret to healthy weight loss? There are lots of diets out there – high fat, low fat, Paleolithic, blood type, exotic juices, magic pills and potions. But recently, high protein diets are getting a lot of press. The word is that they preserve muscle mass and preferentially decrease fat mass.

If high protein diets actually did that, it would be huge because:

  • It’s the fat – not the pounds – that causes most of the health problems.
  • Muscle burns more calories than fat, so preserving muscle mass helps keep your metabolic rate high without dangerous herbs or stimulants – and keeping your metabolic rate high helps prevent both the plateau and yo-yo (weight regain) characteristic of so many diets.
  • When you lose fat and retain muscle you are reshaping your body – and that’s why most people are dieting to begin with.

So let’s look more carefully at the recent study that has been generating all the headlines (Pasiakos et al, The FASEB Journal, 27: 3837-3847, 2013).

The Study Design:

This was a randomized control study with 39 young (21), healthy and fit men and women who were only borderline overweight (BMI = 25). These volunteers were put on a 21 day weight loss program in which calories were reduced by 30% and exercise was increased by 10%. They were divided into 3 groups:

  • One group was assigned a diet containing the RDA for protein (about 14% of calories in this study design).
  • The second group’s diet contained 2X the RDA for protein (28% of calories)
  • The third group’s diet contained 3X the RDA for protein (42% of calories)

In the RDA protein group carbohydrate was 56% of calories, and fat was 30% of calories. In the other two groups the carbohydrate and fat content of the diets was decreased proportionally.

Feet_On_ScaleWhat Did The Study Show?

  • Weight loss (7 pounds in 21 days) was the same on all 3 diets.
  • The high protein (28% and 42%) diets caused almost 2X more fat loss (5 pounds versus 2.8 pounds) than the diet supplying the RDA amount of protein.
  • The high protein (28% and 42%) diets caused 2X less muscle loss (2.1 pounds versus 4.2 pounds) than the diet supplying the RDA amount of protein.
  • In case you didn’t notice, there was no difference in overall results between the 28% (2X the RDA) and 42% (3X the RDA) diets.

Pros And Cons Of The Study:

  • The con is fairly obvious. The participants in this study were all young, healthy and were not seriously overweight. If this were the only study of this type one might seriously question whether the results were applicable to middle aged, overweight coach potatoes. However, there have been several other studies with older, more overweight volunteers that have come to the same conclusion – namely that high protein diets preserve muscle mass and enhance fat loss.
  • The value of this study is that it defines for the first time the upper limit for how much protein is required to preserve muscle mass in a weight loss regimen. 28% of calories is sufficient, and there appear to be no benefit from increasing protein further. I would add the caveat that there are studies suggesting that protein requirements for preserving muscle mass may be greater in adults 50 and older.

The Bottom Line:

1)    Forget the high fat diets, low fat diets, pills and potions. High protein diets (~2X the RDA or 28% of calories) do appear to be the safest, most effective way to preserve muscle mass and enhance fat loss in a weight loss regimen.

2)     That’s not a lot of protein, by the way. The average American consumes almost 2X the RDA for protein on a daily basis. However, it is significantly more protein than the average American consumes when they are trying to lose weight. Salads and carrot sticks are great diet foods, but they don’t contain much protein.

3)     Higher protein intake does not appear to offer any additional benefit – at least in young adults.

4)     Not all high protein diets are created equal. What some people call high protein diets are laden with saturated fats or devoid of carbohydrate. The diet in this study, which is what I recommend, had 43% healthy carbohydrates and 30% healthy fats.

5)    These diets were designed to give 7 pounds of weight loss in 21 days – which is what the experts recommend. There are diets out there promising faster weight loss but they severely restrict calories and/or rely heavily on stimulants, they do not preserve muscle mass, and they often are not safe. In addition they are usually temporary.  I do not recommend them.

6)    This level of protein intake is safe for almost everyone. The major exception would be people with kidney disease, who should always check with their doctor before increasing protein intake. The only other caveat is that protein metabolism creates a lot of nitrogenous waste, so you should drink plenty of water to flush that waste out of your system. But, water is always a good idea.

7)     The high protein diets minimized, but did not completely prevent, muscle loss. Other studies suggest that adding the amino acid leucine to a high protein diet can give 100% retention of muscle mass in a weight loss regimen – but that’s another story for another day.

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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