Chris Kresser: Great questions. Yeah, I think the ADA diet, which is basically a high-carbohydrate, low-fat diet, is a nightmare for patients who are at risk for gestational diabetes. In theory, the ADA is not recommending that people eat more bread and bagels and cereal and things like that. They’re suggesting something different. But in practice, that’s what it often ends up being, particularly in populations that live in food deserts and don’t have access to higher-quality food or for whom access is more difficult. So I think if I had a patient that was at risk for gestational diabetes and they were overweight and they had the genetic background and risk factors, I would probably put them on a lower-carb version of a Paleo diet.
That’s, in my experience, been very effective for averting gestational diabetes or even for treating it if it’s present. And one of the things you need to know about that, though, is that if the patient has been on a lower-carb Paleo approach and then they do the oral glucose tolerance test early on, prior to pregnancy or early on in pregnancy, as a way of screening for gestational diabetes, they very well may fail it even if their blood sugars are in a normal range because they become fat adapted rather than carbohydrate adapted. And the big bolus of glucose that they get as part of that test is not something that they’re physiologically accustomed to and thus they’ll generate a false positive.
So in those cases, this is kind of the other side of the coin, someone that’s been on a low-carb diet for a while, we typically, and they have to get that test, we’ll advise them to eat a higher-carbohydrate diet for a week or 10 days prior to getting that test. So gradually start increasing their carbohydrate intake, but obviously from good carbohydrates, like, say, starches and fruits and things like that. So that when they have that bolus of glucose, they’re, it’s not such a shock to the system and they are less likely to fail the test for that reason. In terms of Metabolic Synergy and GlucoSupreme during pregnancy, I personally don’t use them, and the problem here is that none of these these botanicals or some of the nutrients in these products have been tested and shown to be safe in pregnancy, and they never will be because of the problem with doing those kinds of studies during pregnancy. Nobody in their right mind is going to volunteer, they’re unethical, they’re never going to be done. So we’re left kind of wondering, are they safe or are they not safe?
Certainly some of the vitamins in Metabolic Synergy are believed to be safe during pregnancy, but the botanicals are more of a question mark, and given that, I feel reluctant to suggest them. Of course, we always have to weigh the potential downsides of one intervention versus another. So if someone is, is it safer to take metformin or some other kind of drug during pregnancy then it is take Metabolic Synergy or GlucoSupreme? We don’t really know. No one has done those studies and again, they’re not going to be done. Given the imperative to first do no harm, and also just the regulatory and legal environment, I think I would err on the side of caution there.