Chris Kresser: Next question from Simone. It’s about gestational diabetes and what the best approach there is. She had a patient who came to her for gestational diabetes advice, initial consult from her doctor is to monitor blood sugar as closely pre- and one hour post meals and adjust carbs based on that threshold, or I guess this was Simone’s initial advice. “She was very sensitive to even my suggestion of 40 grams lower carbs per meal and was refusing any medication from our clinic. She recently returned to me seven months later and is 34 weeks pregnant. Feels good. Baby growing to size but she’s only one kilogram above her original booking weight and you can see she’s lost a good 10 kilograms. Her starting BMI was 24. Throughout pregnancy she has chosen to keep carbs to 80 grams a day and has remained ketone-free. Would you be concerned?”
That’s a good question because of course during pregnancy we want a normal healthy amount of weight gain, and that’s a sign that the baby is growing and developing in a healthy way. At the same time, this is a tricky situation because we also want the mother to be able to control her blood sugar and blood pressure. It’s not good for the baby if mom develops preeclampsia or something like that. And so that has to be weighed against the other things here. Eighty grams a day of carbohydrate is a little on the low end of what I would typically be comfortable with. But it’s certainly not going to be ketogenic for most people or even close to that. It is true that women will gain different amounts of weight, and that’s not necessarily a clear indicator of the health of the pregnancy. I mean, I know that I’ve had patients who have gained even different amounts of weight with different babies, so the same woman gaining different amounts of weight with different kids that she had, and that wasn’t necessarily an indicator of the health of the baby.
I think if she with her OB/GYN, midwife, or whoever is supervising her, and all of the signals looked good there and her blood sugars are under control, you might consider seeing if she can get up to 100 grams of carbs a day, at least without losing control of blood sugar. That would probably be a little bit better. But if that’s not possible, I think it is acceptable if everything else is as well.