Preventing Gestational Diabetes With Vitamin C

Written by Dr. Steve Chaney on . Posted in Gestational Diabetes, Vitiman-C and Blood Sugar

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.

 

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Can Plant-based Diets Be Unhealthy?

Posted September 10, 2019 by Dr. Steve Chaney

Do Plant-Based Diets Reduce Heart Disease Deaths?

Author: Dr. Stephen Chaney

 

plant-based diets vegetablesPlant-based diets have become the “Golden Boys” of the diet world. They are the diets most often recommended by knowledgeable health and nutrition professionals. I’m not talking about all the “Dr. Strangeloves” who pitch weird diets in books and the internet. I am talking legitimate experts who have spent their life studying the impact of nutrition on our health.

Certainly, there is an overwhelming body of evidence supporting the claim that plant-based diets are healthy. Going on a plant-based diet can help you lower blood pressure, inflammation, cholesterol and triglycerides. People who consume a plant-based diet for a lifetime weigh less and have decreased risk of heart disease, diabetes, and cancer.

But, can a plant-based diet be unhealthy? Some people consider a plant-based diet to simply be the absence of meat and other animal foods. Is just replacing animal foods with plant-based foods enough to make a diet healthy?

Maybe not. After all, sugar and white flour are plant-based food ingredients. Fake meats of all kinds abound in our grocery stores. Some are very wholesome, but others are little more than vegetarian junk food. If you replace animal foods with plant-based sweets, desserts, and junk food, is your diet really healthier?

While the answer to that question seems obvious, very few studies have asked that question. Most studies on the benefits of plant-based diets have compared population groups that eat a strictly plant-based diet (Seventh-Day Adventists, vegans, or vegetarians) with the general public. They have not looked at variations in plant food consumption within the general public. Nor have they compared people who consume healthy and unhealthy plant foods.

This study (H Kim et al, Journal of the American Heart Association, 8:e012865, 2019) was designed to fill that void.

 

How Was The Study Done?

plant-based diets studyThis study used data collected from 12,168 middle aged adults in the ARIC (Atherosclerosis Risk in Communities) study between 1987 and 2016.

The participant’s usual intake of foods and beverages was assessed by trained interviewers using a food frequency questionnaire at the time of entry into the study and again 6 years later.

Participants were asked to indicate the frequency with which they consumed 66 foods and beverages of a defined serving size in the previous year. Visual guides were provided to help participants estimate portion sizes.

The participant’s adherence to a plant-based diet was assessed using four different well-established plant-based diet scores. For the sake of simplicity, I will include 3 of them in this review.

  • The PDI (Plant-Based Diet Index) categorizes foods as either plant foods or animal foods. A high PDI score means that the participant’s diet contains more plant foods than animal foods. A low PDI score means the participant’s diet contains more animal foods than plant foods.
  • The hPDI (healthy plant-based diet index) is based on the PDI but emphasizes “healthy” plant foods. A high hPDI score means that the participant’s diet is high in healthy plant foods (whole grains, fruits, vegetables, nuts, legumes, coffee and tea) and low in animal foods.
  • The uPDI (unhealthy plant-based diet index) is based on the PDI but emphasizes “unhealthy” plant foods. A high uPDI score means that the participant’s diet is high in unhealthy plant foods (refined grains, fruit juices, French fries and chips, sugar sweetened and artificially sweetened beverages, sweets and desserts) and low in animal foods.

For statistical analysis the scores from the various plant-based diet indices were divided into 5 equal groups. In each case, the group with the highest score consumed the most plant foods and least animal foods. The group with the lowest score consumed the least plant foods and the most animal foods.

The health outcomes measured in this study were heart disease events, heart disease deaths, and all-cause deaths. Again, for the sake of simplicity, I will only include 2 of these outcomes (heart disease deaths and all-cause deaths) in this review. The data on deaths were obtained from state death records and the National Death Index. (Yes, your personal information is available on the web even after you die.)

 

Do Plant-Based Diets Reduce Heart Disease Deaths?

plant-based diets reduce heart deathsThe participants in this study were followed for an average of 25 years.

The investigators looked at heart disease deaths over the 25 years and compared people with the highest intake of plant foods to people with the highest intake of red meat and other animal foods. The results were:

  • People with the highest intake of plant foods and the highest intake of healthy plant foods (whole grains, fruits, vegetables, nuts, legumes, coffee and tea) had a 19-32% lower risk of dying from heart disease than people with the highest intake of red meat and other animal foods.
  • People with the highest intake of unhealthy plant foods (refined grains, fruit juices, French fries and chips, sugar sweetened and artificially sweetened beverages, sweets and desserts) had the same risk of dying from heart disease as people with the highest intake of red meat and other animal foods.

When the investigators looked at all-cause deaths over the 25 years:

  • People with the highest intake of plant foods and the highest intake of healthy plant foods had an 11-25% lower risk of dying from any cause than people with the highest intake of red meat and other animal foods.
  • People with the highest intake of unhealthy plant foods had the same risk of dying from heart disease as people with the highest intake of red meat and other animal foods.

What Else Did The Study Show?

The investigators made a couple of other interesting observations:

  • The association of the overall diet with heart disease and all-cause deaths was stronger than the association of individual food components. This underscores the importance of looking at the effect of the whole diet on health outcomes rather than the “magic” foods you hear about on Dr. Strangelove’s Health Blog.
  • Diets with the highest amount of healthy plant foods were associated with higher intake of carbohydrates, plant protein, fiber, and micronutrients, including potassium, magnesium, iron, vitamin A, vitamin C, folate, and lower intake of saturated fat and cholesterol.
  • Diets with the highest amount of unhealthy plant foods were associated with higher intake of calories and carbohydrates and lower intake of fiber and micronutrients.

The last two observations may help explain some of the health benefits of plant-based diets.

 

Can Plant-Based Diets Be Unhealthy?

plant-based diets unhealthy cookiesNow, let’s return to the question I asked at the beginning of this article: “Can plant-based diets be unhealthy?” Although some previous studies have suggested that unhealthy plant-based diets might increase the risk of heart disease, this study did not show that.

What this study did show was that an unhealthy plant-based diet was no better for you than a diet containing lots of red meat and other animal foods.

If this were the only conclusion from this study, it might be considered a neutral result. However, this result clearly contrasts with the data from this study and many others showing that both plant-based diets in general and healthy plant-based diets reduce the risk of heart disease deaths and all-cause deaths compared to animal-based diets.

The main message from this study is clear.

  • Replacing red meat and other animal foods with plant foods can be a healthier choice, but only if they are whole, minimally processed plant foods like whole grains, fruits, vegetables, nuts, legumes, coffee and tea.
  • If the plant foods are refined grains, fruit juices, French fries and chips, sugar sweetened and artificially sweetened beverages, sweets and desserts, all bets are off. You may be just as unhealthy as if you kept eating a diet high in red meat and other animal foods.

There is one other subtle message from this study. This study did not compare vegans with the general public. Everyone in the study was the general public. Nobody in the study was consuming a 100% plant-based diet.

For example:

  • The group with the highest intake of plant foods consumed 9 servings per day of plant foods and 3.6 servings per day of animal foods.
  • The group with the lowest intake of plant foods consumed 5.4 servings per day of plant foods and 5.6 servings per day of animal foods.

In other words, you don’t need to be a vegan purist to experience health benefits from adding more whole, minimally processed plant foods to your diet.

 

The Bottom Line

A recent study analyzed the effect of consuming plant foods on heart disease deaths and all-cause deaths over a 25-year period.

When the investigators looked at heart disease deaths over the 25 years:

  • People with the highest intake of plant foods and the highest intake of healthy plant foods had a 19-32% lower risk of dying from heart disease than people with the highest intake of red meat and other animal foods.
  • People with the highest intake of unhealthy plant foods had the same risk of dying from heart disease as people with the highest intake of red meat and other animal foods.

When the investigators looked at all-cause deaths over the 25 years:

  • People with the highest intake of plant foods and the highest intake of healthy plant foods had an 11-25% lower risk of dying from any cause than people with the highest intake of red meat and other animal foods.
  • People with the highest intake of unhealthy plant foods had the same risk of dying from heart disease as people with the highest intake of red meat and other animal foods.

The main message from this study is clear.

  • Replacing red meat and other animal foods with plant foods can be a healthier choice, but only if they are whole, minimally processed plant foods like whole grains, fruits, vegetables, nuts, legumes, coffee and tea.
  • If the plant foods are refined grains, fruit juices, French fries and chips, sugar sweetened and artificially sweetened beverages, sweets and desserts, all bets are off. You may be just as unhealthy as if you kept eating a diet high in red meat and other animal foods.

A more subtle message from the study is that you don’t need to be a vegan purist to experience health benefits from adding more whole, minimally processed plant foods to your diet. The people in this study were not following some special diet. The only difference was that some of the people in this study ate more plant foods and others more animal foods.

For more details on the study, 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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