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

How to Choose the Right Pillow

Posted April 17, 2018 by Dr. Steve Chaney

Wake Up Each Morning Pain Free

Author: Julie Donnelly, LMT – The Pain Relief Expert

Editor: Dr. Steve Chaney

 

how to choose the right pillow without headachesThe way you sleep is often a key to discovering the cause of headaches and more. If you wake up with neck pain, a headache, or you suffer from ringing in your ears, dizziness, or ear pain, there is a good possibility that it may be caused by the way you are sleeping. Your pillow may be the culprit.  But if you need to know how to choose the right pillow for you, it’s easy.   It just takes a little “investigation.”

 

How to Choose the Right Pillow if You Sleep On Your Side

Your head, neck, and spine need to always stay in a nice straight line, just as it is when you are standing up, but that takes a little thought and understanding of the way you sleep.  So, get comfy in your bed and then notice how your head is resting.

how to choose the right pillow to sleep painfreeIf you sleep on your side, your pillow needs to be just the right size, so your head doesn’t point down toward the mattress (your pillow is too soft) or up to the ceiling (your pillow is too thick). Either of these positions will make the muscles on the side of your neck stay in the contracted position for hours and pull your vertebrae in that direction, especially when you try to turn over to your other side.

Your SCM Muscle May Cause Serious Problems

You also need to notice if you turn your head a bit, especially if you are turning into your pillow or turning your head up toward away from your pillow. In either of these two cases you will be causing your sternocleidomastoid (SCM for short) to be held shortened for hours.

Your SCM originates on your collarbone and inserts into the bone behind your ear.  When it contracts you turn your head to the opposite side. However, if the muscle is tight (for example, when you’ve held your head turned toward one side for an extended period of time) and then you bring your head back so you are facing forward, the tight muscle will pull on the bone behind your ear and cause havoc.

The symptoms for a tight SCM are tinnitus (ringing in the ear), dizziness, loss of equilibrium, ear pain, headaches, pain in the eye and around the skull, pain at the top of the head, and even pain in the throat. Amazing! What’s even more amazing is that it’s rare that this muscle is considered when a medical professional is searching for the cause of your symptoms.

These are the things to know when considering how to choose the right pillow if you sleep on your side.

How To Choose The Right Pillow If You Sleep On Your Back

how to choose the right pillow for sleeping on your backIf you sleep on your back, your head should be on the mattress (not propped up with a pillow) and you should have a tiny support (like a folded washcloth) under your neck.  Or, you can have a wedge pillow that starts at your mid-back and gently raises your entire trunk and head up while still allowing your head and back to be in a straight line.

It’s always a challenge for people who toss and turn during the night, sometimes on their side and sometimes on their back.  The best thing I’ve found for this situation is to have the pillow below shoulder level so when you turn on your side your shoulder will automatically slide to the edge of the pillow while still supporting your head properly, and when you turn onto your back, the pillow will start at shoulder level so your head and neck are supported, but your head is being pushed in a way that causes your chin to move down to your chest.

hip pain causes and treatment pain freeIt’s tricky, but I can personally attest to the fact that it will work.  I can always tell when I’ve had my head tilted (I toss and turn during the night) because I will wake with a headache. When that happens I’m grateful that I know how to self-treat the muscles of my neck and shoulders so the headache is eliminated quickly.  If you already have Treat Yourself to Pain Free Living,  you can self-treat all your neck and shoulder muscles to release the tension.

How To Choose The Right Pillow If You Sleep On Your Stomach

If you sleep on your stomach, this is the one position that is so bad that it behooves you to force yourself to change your position. Your head is turned to the side and held still for hours, putting a severe strain on all your cervical and upper thoracic vertebrae. Not only will this cause headaches, tinnitus, and a list of other pains, but it can cause problems down your entire spine. It can also impinge on the nerves that pass through the vertebrae on their way to your organs.

If you do sleep that way, let me know and I’ll give you some suggestions that work to change your habit of sleeping. It takes time and energy, but the results are worth the effort.

In every case, the way you sleep may cause neck pain that won’t go away until the pillow situation is resolved.

Now you should know how to choose the right pillow for the way you sleep.

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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