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  #1   ^
Old Mon, Jan-07-19, 16:59
teaser's Avatar
teaser teaser is offline
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Default Balanced diet, exercise may not prevent gestational diabetes

Quote:
Balanced diet, exercise may not prevent gestational diabetes

It may be time to reconsider the conventional wisdom for preventing gestational diabetes: limiting weight gain and increasing physical activity.

"Our data suggest that in pregnancy, energy balance -- the calories consumed versus the calories burned -- may not determine the development of gestational diabetes," said Leanne Redman, PhD, director of LSU Pennington Biomedical Research Center's Reproductive Endocrinology and Women's Health Lab. "We and others now believe that there are different types of gestational diabetes that warrant different approaches to treatment and prevention."

The new Pennington Biomedical study is the latest evidence that the "first-line" strategy for preventing gestational diabetes mellitus isn't working. Over the past five years, more than 5,000 pregnant women took part in clinical trials that focused on limiting weight gain in order to prevent gestational diabetes.

The result? The moms-to-be improved their diet quality, ate less, and increased their physical activity. They also developed gestational diabetes at about the same rates as the women who didn't change their diet or activity levels.

"Preventing gestational diabetes is not as simple as reducing weight gain," said Jasper Most, PhD, co-lead author of the study. "It may require more individualized approaches based on each person's risk factors."

Some women may develop gestational diabetes because their pancreas doesn't adapt adequately to producing additional insulin to match the increased demand of pregnancy, Dr. Most said. Others may develop gestational diabetes because their muscles and livers become more insulin resistant.

Most and Nicholas Broskey, PhD, are co-lead authors of Pennington Biomedical's new study published in Cell Metabolism. Both are postdoctoral researchers in the Reproductive Endocrinology and Women's Health Lab.

The five-year study looked at 62 pregnant women with obesity. Nine developed gestational diabetes.

Researchers found that:

The primary risk factors for gestational diabetes, such as excess fat and insulin resistance, were evident early in pregnancy.
Women that developed gestational diabetes tended to be heavier. They weighed 10 pounds to 35 pounds more. They also had more body fat, from 7 pounds to 25 pounds, and significantly more fat around their waists.
The women also had more relatives with diabetes, significantly higher fasting blood sugar levels and a greater prevalence of prediabetes. Redman said the study's findings do not mean that pregnant women should abandon their efforts to eat a more healthy diet and be physically active.
"But the results do underscore the need to better understand the way that gestational diabetes develops in women with obesity," Dr. Redman said.

New research is needed into other factors that lead to insulin resistance in pregnancy, Dr. Redman said. In their next study, the scientists hope to better classify the different types of gestational diabetes and to study energy balance in addition to insulin secretion.

Gestational diabetes leads to health issues for the mother and child, issues which can extend well beyond pregnancy. Among other things, around 50 percent of the women with gestational diabetes go on to develop type 2 diabetes, according to the federal Centers for Disease Control. Babies exposed to gestational diabetes are more likely to develop type 2 diabetes and have a higher risk of being overweight or developing obesity.



Channelling Dr. Atkins here (though I don't really accept the concept of a 'balanced diet' or hold much to channelling for that matter)--but how about an 'unbalanced' diet? If they can't produce 'enough' insulin for the increased calorie needs of pregnancy, how about eating in a way that can provide those calories with less of an insulin requirement?
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  #2   ^
Old Mon, Jan-07-19, 18:33
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Ms Arielle Ms Arielle is offline
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YES!!

I was given the standard american diet food list, of which I remember the snacks specifically: eat ritz with peanut butter!! OMG!!

I dropped all the literature from the dietitian in the trash and followed Atkins instead. Though he said not to diet for weight loss, as Im sure that was to stay out of trouble. I ate lots of OP foods and gained far too much weight. ANd I was plenty active with a farm to run and 4 dogs.

IMO "they" have missed the mark entirely on managing gestational diabetes so far. Including using Insulin injections.
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  #3   ^
Old Mon, Jan-07-19, 20:55
jschwab jschwab is offline
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I don't really understand this study. Thin women get GD, too.
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  #4   ^
Old Tue, Jan-08-19, 05:10
M Levac M Levac is offline
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Quote:
because their pancreas doesn't adapt adequately to producing additional insulin to match the increased demand of pregnancy

That's all kinds of wrong. Here, diabetes means type 2 diabetes, where there's both hyperglycemia (BG too high) and hyperinsulinemia (insuln too high). How could anybody then conclude that there ain't enough insulin?!? They have no clue what insulin does. They have no clue what insulin resistance is. What they believe it is, is a resistance to insulin signaling, exclusively in the context of "pushing" glucose into those resistant cells, cuz that's exactly the absolute total full complete extent of their knowledge about insulin. What in fact happens, insulin is very well received and responded to by the liver, to wit there's zero ketones in the blood and the only way for that to happen is if ketogenesis in the liver is shut down by excess insulin. Furthermore, fat tissue responds exquisitely well to all that surplus insulin - it grows bigger, doh. Indeed, if it did not, BG would go even higher, since fat tissue grows bigger by taking in excess glucose, converting it into glycerol, forming triglycerides. In spite of this "protective" mechanism, BG remains higher than otherwise. I'm not a genuises, but Ima say, ya know, just for kicks, that maybe, just maybe, it's got something to do with that Holy Balanced Diet, Full Of Wholesome Good-For-You Grains And Other Refined Carbs, cuz ya gotta eat yar carbs, or we won't sell any.
Quote:
Researchers found that:

The primary risk factors for gestational diabetes, such as excess fat and insulin resistance, were evident early in pregnancy.
Women that developed gestational diabetes tended to be heavier. They weighed 10 pounds to 35 pounds more. They also had more body fat, from 7 pounds to 25 pounds, and significantly more fat around their waists.
The women also had more relatives with diabetes, significantly higher fasting blood sugar levels and a greater prevalence of prediabetes. Redman said the study's findings do not mean that pregnant women should abandon their efforts to eat a more healthy diet and be physically active.

Redman is a Big Giant Idjit.

I'm so pissed. Somebody please pretty please point me to a genuinely smart article about gestational diabetes.
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  #5   ^
Old Tue, Jan-08-19, 15:08
Dodger's Avatar
Dodger Dodger is offline
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Perhaps they should do a study where the women eat fewer carbs.
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  #6   ^
Old Tue, Jan-08-19, 16:26
Zei Zei is offline
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Insulin resistance causes fat gain, not the other way around. Therefore insulin resistant pregnant women are more likely to be fat. Pre- and full-blown T2 diabetes are insulin resistance. So I think is GD. Back in the day for GD we were given carb-reduced (but in no way low) diets, generally low-fat due to the era. I was on Atkins and told to get off to avoid harming the baby because that's what well-intending doctors thought. But even a diet that left me hungry and losing weight third trimester, normal looking blood sugars etc., didn't prevent a huge birth weight. Now that more is known about safety issues with low-carb during pregnancy, I'd advise that cutting carbs with GD is the way to go because insulin resistance (trouble processing carbohydrate) is happening.
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  #7   ^
Old Wed, Jan-09-19, 11:03
Bonnie OFS Bonnie OFS is offline
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Quote:
Originally Posted by jschwab
I don't really understand this study. Thin women get GD, too.


That was me. Quite thin, but still got GD with 2nd pregnancy. But I had gone thru a couple of overweight/thin cycles before that. I did eventually get fat along with full-blown t2.
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  #8   ^
Old Wed, Jan-09-19, 12:05
teaser's Avatar
teaser teaser is offline
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Quote:
Originally Posted by Zei
Insulin resistance causes fat gain, not the other way around.


I don't really agree here. Overfilled subcutaneous fat cells leading to fat being deposited in liver and other vital organs, leading to insulin resistance is a pretty plausible chain of causation. After that, increased peripheral exposure to insulin due to central (liver, pancreas, brain) insulin resistance might drive fat gain further.

A thinner person might get type II diabetes, and there are situations where some difference in individual genetics etc. may cause this. But a lot of people who aren't all that fat, but who develop type II, may still be "fat" in the sense that their personal subcutaneous fat limit before fat trapping is compromised and fattening of the liver and pancreas becomes more likely to has been met--some Asian groups becoming diabetic at a lower bodyweight than people from a background more prone to fat gain is an example here.


From the side of weight loss--I do think insulin resistance (as long as it's not of the fat cells themselves) can certainly interfere with weight loss itself, since by definition the insulin levels will be much higher than they needed to be to stimulate most of the fat gain in the first place.
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  #9   ^
Old Wed, Jan-09-19, 12:16
Meme#1's Avatar
Meme#1 Meme#1 is offline
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One Vietnamese lady who I have known for 15 years is very very thin and diabetic. She eats a ton of rice and very little meat. She asked me about not being diabetic and why am I healthy. I told her to cut way back on the rice and eat more meat. She doesn't like meat but maybe she listened and is replacing some of the rice for meat.
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  #10   ^
Old Wed, Jan-09-19, 12:26
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WereBear WereBear is offline
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Quote:
Originally Posted by Meme#1
One Vietnamese lady who I have known for 15 years is very very thin and diabetic. She eats a ton of rice and very little meat. She asked me about not being diabetic and why am I healthy. I told her to cut way back on the rice and eat more meat. She doesn't like meat but maybe she listened and is replacing some of the rice for meat.


There was that weird Rice Diet which some people found helped their diabetes. Though that can't be working for her.
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  #11   ^
Old Wed, Jan-09-19, 12:29
teaser's Avatar
teaser teaser is offline
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Even here, very very thin--there are mouse models of very very thin that result in fattening of the liver and insulin resistance. It's not the getting fat, there are models where increasing ability to trap fat subcutaneously decreases central insulin resistance. Central visceral obesity is something that can be measured with a tape measure, but fattening of the liver itself cannot--and in the case of the pancreas itself, levels of pancreatic fat supposed to cause insulin resistance and beta and alpha cell dysfunction is measure in grams, single digits.
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  #12   ^
Old Mon, Jan-14-19, 00:57
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nawchem nawchem is offline
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teaser is it something like when Dr. Fung brings up gastric bypass curing diabetes. Is it the weight loss or the change in diet that cured their diabetes?

On the question of thin Asian diabetics, many, Asians I know eat tons of fruit. Filipinos eat 11 different types of round fruits for New Year's luck.
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  #13   ^
Old Wed, Jan-16-19, 08:45
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WereBear WereBear is offline
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Good research is pointing to the flood of progesterone during pregnancy (important for the entire nervous system of the developing fetus) which can trigger gestational diabetes for those on high carb diets.

And we all know the solution to that.
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  #14   ^
Old Wed, Jan-16-19, 09:26
teaser's Avatar
teaser teaser is offline
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Quote:
Originally Posted by nawchem
teaser is it something like when Dr. Fung brings up gastric bypass curing diabetes. Is it the weight loss or the change in diet that cured their diabetes?


The Newcastle people suggest that it's the reversal of fatty pancreas and liver that's most important. We do know that the diet they use there, that's similar to the early phase of a gastric bypass diet, where there is a very low calorie diet, reduces fatty liver and pancreas fairly rapidly. Of course, with gastric bypass, early on, most of the overall body fat hasn't been reduced all that much, and people reverse diabetes without becoming what you would necessarily call lean. But even on a standard macronutrient ratio, these people will be eating less carbohydrate, so into the mix goes the fact that it just takes less insulin to handle a smaller amount of food, and walking around with lower glycogen levels, tissues may be more insulin sensitive.

The fat in/fat out conundrum for organs--strategies for defattening the liver include increased export of triglycerides--this actually does happen for a lot of type II diabetics when they first go on insulin, that nastly VLDL that our liver puts out is also doing a good thing, transporting fat out of the liver. Another good strategy that occurs more in starvation or semi-starvation or on a low carb diet is increased oxidation of free fatty acids in the liver. Increase this and fatty liver could be reversed. It's not just because those fats are oxidized--also, the pathways for triglyceride synthesis tend to be reduced when fat oxidative pathways are upregulated and glucose pathways are downregulated. So, you can increase export of triglyceride, or decrease synthesis. Fattening occurs when synthesis outstrips export.

For synthesis--that's where subcutaneous fat and the personal fat threshold comes in. "Overstuffed" fat cells-->increased availability of free fatty acids from spillover for synthesis of triglycerides in the liver and pancreas. In starvation or very low carb, elevated free fatty acids is the physiologic norm. It's a pathological state when accompanied by a high availability of glucose. If the liver is glucose replete, and free fatty acids are elevated, that's a good recipe for fat accumulation in the liver. If free fatty acids are elevated, but glucose is scarce, it's not.

What I'm trying to say here is--I think yes, it's the diet, and yes it's the fat loss. In rodent models, just getting the animals very fat can get them diabetic--but concentrating on a high sugar diet is a more direct path to insulin resistance and diabetes, even though it might not get them as fat as some other diets.
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  #15   ^
Old Wed, Jan-16-19, 12:46
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nawchem nawchem is offline
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Thanks, teaser.

I was stealing the thread, I will post my question on a new thread.
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