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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What Is The Planetary Diet?

Posted May 21, 2019 by Dr. Steve Chaney

Is Your Diet Destroying The Planet?

Author: Dr. Stephen Chaney

 

Earth Day has come and gone, but you are still committed to saving the planet. You save energy. You recycle. You drive an electric car. But is your diet destroying the planet?

This is not a new question, but a recent commission of international scientists has conducted a comprehensive study into our diet and its effect on our health and our environment. Their report (W. Willet et al, The Lancet, 393, issue 10170, 447-492, 2019 ) serves as a dire warning of what will happen if we don’t change our ways. I touched on this report briefly in a previous issue of “Health Tips From The Professor,” What Is The Flexitarian Diet , but this topic is important enough that it deserves an issue all its own.

The commission carefully evaluated diet and food production methods and asked three questions:

  • Are they good for us?
  • Are they good for the planet?
  • Are they sustainable? Will they be able to meet the needs of the projected population of 10 billion people in 2050 without degrading our environment.

The commission described the typical American diet as a “lose-lose diet.” It is bad for our health. It is bad for the planet. And it is not sustainable.

In its place they carefully designed their version of a primarily plant-based diet they called a “win-win diet.”  It is good for our health. It is good for the planet. And, it is sustainable.

In their publication they refer to their diet as the “universal healthy reference diet” (What else would you expect from a committee?). However, it has become popularly known as the “Planetary Diet.”

I have spoken before about the importance of a primarily plant-based diet for our health. In that context it is a personal choice. It is optional.

However, this report is a wake-up call. It puts a primarily plant-based diet in an entirely different context. It is essential for the survival of our planet. It is no longer optional.

If you care about global warming…If you care about saving our planet, there is no other choice.

How Was The Study Done?

The study (W. Willet et al, The Lancet, 393, issue 10170, 447-492, 2019 ) was the report of the EAT-Lancet Commission on Healthy Diets from Sustainable Food Systems. This Commission convened 30 of the top experts from across the globe to prepare a science-based evaluation of the effect of diet on both health and sustainable food production through the year 2050. The Commission included world class experts on healthy diets, agricultural methods, climate change, and earth sciences. The Commission reviewed 356 published studies in preparing their report.

 

Is Your Diet Destroying The Planet?

When they looked at the effect of food production on the environment, the Commission concluded:

  • “Strong evidence indicates that food production is among the largest drivers of global environmental change.” Specifically, the commission reported:
  • Agriculture occupies 40% of global land (58% of that is for pasture use).
  • Food production is responsible for 30% of global greenhouse gas emissions and 70% of freshwater use.
  • Conversion of natural ecosystems to croplands and pastures is the largest factor causing species to be threatened with extinction. Specifically, 80% of extinction threats to mammals and bird species are due to agricultural practices.
  • Overuse and misuse of nitrogen and phosphorous in fertilizers causes eutrophication. In case you are wondering, eutrophication is defined as the process by which a body of water becomes enriched in dissolved nutrients (such as phosphates from commercial fertilizer) that stimulate the growth of algae and other aquatic plant life, usually resulting in the depletion of dissolved oxygen. This creates dead zones in lakes and coastal regions where fish and other marine organisms cannot survive.
  • About 60% of world fish stocks are fully fished and more than 30% are overfished. Because of this, catch by global marine fisheries has been declining since 1996.
  • “Reaching the Paris Agreement of limiting global warming…is not possible by only decarbonizing the global energy systems. Transformation to healthy diets from sustainable food systems is essential to achieving the Paris Agreement.”
  • The world’s population is expected to increase to 10 billion by 2050. The current system of food production is unsustainable.

When they looked at the effect of the foods we eat on the environment, the Commission concluded:

  • Beef and lamb are the biggest contributors to greenhouse gas emissions and land use.
  • The concern about land use is obvious because of the large amount of pasture land required to raise cattle and sheep.
  • The concern about greenhouse gas emissions is because cattle and sheep are ruminants. They not only breathe out CO2, but they also release methane into the atmosphere from fermentation in their rumens of the food they eat. Methane is a potent greenhouse gas, and it persists in the atmosphere 25 times longer than CO2. The single most important thing we can do as individuals to reduce greenhouse gas emissions is to eat less beef and lamb. [Note: grass fed cattle produce more greenhouse gas emissions than cattle raised on corn because they require 3 years to bring to market rather than 2 years.]
  • In terms of energy use beef, lamb, pork, chicken, dairy and eggs all require much more energy to produce than any of the plant foods.
  • In terms of eutrophication, beef, lamb, and pork, all cause much more eutrophication than any plant food. Dairy and eggs cause more eutrophication than any plant food except fruits.
  • In contrast, plant crops reduce greenhouse gas emissions by removing CO2 from the atmosphere.

 

What Is The Planetary Diet?

In the words of the Commission: “[The Planetary Diet] largely consists of vegetables, fruits, whole grains, legumes, nuts, and unsaturated oils. It includes a low to moderate amount of seafood, poultry, and eggs. It includes no or a very low amount of red meat, processed meat, sugar, refined grains, and starchy vegetables.”

When described in that fashion it sounds very much like other healthy diets such as semi-vegetarian, Mediterranean, DASH, and Flexitarian. However, what truly distinguishes it from the other diets is the restrictions placed on the non-plant portion of the diet to make it both environmentally friendly and sustainable. Here is a more detailed description of the diet:

  • It starts with a vegetarian diet. Vegetables, fruits, beans, nuts, soy foods, and whole grains are the foundation of the diet.
  • It allows the option of adding one serving of dairy a day (It turns out that cows produce much less greenhouse emissions per serving of dairy than per serving of beef. That’s because cows take several years to mature before they can be converted to meat, and they are emitting greenhouse gases the entire time).
  • It allows the option of adding one 3 oz serving of fish or poultry or one egg per day.
  • It allows the option of swapping seafood, poultry, or egg for a 3 oz serving of red meat no more than once a week. If you want a 12 oz steak, that would be no more than once a month.

This is obviously very different from the way most Americans currently eat. According to the Commission:

  • “This would require greater than 50% reduction in consumption of unhealthy foods, such as red meat and sugar, and greater than 100% increase in the consumption of healthy foods, such as nuts, fruits, vegetables, and legumes.”
  • “In addition to the benefits for the environment, “dietary changes from current diets to healthy diets are likely to substantially benefit human health, averting about 10.8-11.6 million deaths per year globally.”

What Else Did The Commission Recommend?

In addition to changes in our diets, the Commission also recommended several changes in the way food is produced. Here are a few of them.

  • Reduce greenhouse gas emissions from the fuel used to transport food to market.
  • Reduce food losses and waste by at least 50%.
  • Make radical improvements in the efficiency of fertilizer and water use. In terms of fertilizer, the change would be two-fold:
    • In developed countries, reduce fertilizer use and put in place systems to capture runoff and recycle the phosphorous.
    • In third world countries, make fertilizer more available so that crop yields can be increased, something the Commission refer to as eliminating the “yield gap” between third world and developed countries.
  • Stop the expansion of new agricultural land use into natural ecosystems and put in place policies aimed at restoring and re-foresting degraded land.
  • Manage the world’s oceans effectively to ensure that fish stocks are used responsibly and global aquaculture (fish farm) production is expanded sustainability.

What we can do: While most of these are government level policies, we can contribute to the first three by reducing personal food waste and purchasing organic produce locally whenever possible.

What Does This Mean For You?

If you are a vegan, you are probably asking why the Commission did not recommend a completely plant-based diet. The answer is that a vegan diet is perfect for the health of our planet. However, the Commission wanted to make a diet that was as consumer-friendly as possible and still meet their goals of a healthy, environmentally friendly, and sustainable diet.

If you are eating a typical American diet or one of the fad diets that encourage meat consumption, you are probably wondering how you can ever make such drastic changes to your diet. The answer is “one step at a time.”  If you have read my books “Slaying The Food Myths” or “Slaying the Supplement Myths,”  you know that my wife and I did not change our diet overnight. Our diet evolved to something very close to the Planetary Diet over a period of years.

The Commission also purposely designed the Planetary Diet so that you “never have to say never” to your favorite foods. Three ounces of red meat a week does not sound like much, but it allows you a juicy steak once a month.

Sometimes you just need to develop a new mindset. As I shared in my books, my father prided himself on grilling the perfect steak. I love steaks, but I decided to set a few parameters. I don’t waste my red meat calories on anything besides filet mignon at a fine restaurant. It must be a special occasion, and someone else must be buying. That limits it to 2-3 times a year. I still get to enjoy good steak, and I stay well within the parameters of the Planetary diet.

Develop your strategy for enjoying some of your favorite foods within the parameters of the Planetary Diet and have fun with it.

The Bottom Line

 

Is your diet destroying the planet? This is not a new question, but a recent commission of international scientists has conducted a comprehensive study into our diet and its effect on our health and our environment. Their report serves as a dire warning of what will happen to us and our planet if we don’t change our ways.

The Commission carefully evaluated diet and food production methods and asked three questions:

  • Are they good for us?
  • Are they good for the planet?
  • Are they sustainable? Will they be able to meet the needs of the projected population of 10 billion people in 2050 without degrading our environment.

The Commission described the typical American diet as a “lose-lose diet.”  It is bad for our health. It is bad for the planet. And it is not sustainable.

In its place they carefully designed their version of a primarily plant-based diet they called a “win-win diet.”  It is good for our health. It is good for the planet. And, it is sustainable.

In their publication they refer to their diet as the “universal healthy reference diet” (What else would you expect from a committee?). However, it has become popularly known as the “Planetary Diet.”

The Planetary Diet is similar to other healthy diets such as semi-vegetarian, Mediterranean, DASH, and Flexitarian. However, what truly distinguishes it from the other diets is the restrictions placed on the non-plant portion of the diet to make it both environmentally friendly and sustainable (for details, read the article above).

I have spoken before about the importance of a primarily plant-based diet for our health. In that context it is a personal choice. It is optional.

However, this report is a wake-up call. It puts a primarily plant-based diet in an entirely different context. It is essential for the survival of our planet. It is no longer optional.

If you care about global warming…If you care about saving our planet, there is no other choice.

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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