Gestational Diabetes: What constitutes low blood sugar?

67 Comments

I received a great question about the problematic diagnosis of gestational diabetes due to a failed oral glucose tolerance test. Give this a read so we can dismantle pregnancy related nutrition.

Hey Robb,

My wife and I have been Paleo ever since I was “certified” in Portland last year:)
My wife is 8 months pregnant and has been dx with gestational diabetes (I truly believe its total bs and that the OGTT is inaccurate in so many ways that it is ridiculous, but I digress) We are using a birthing center with a midwife so it was a sad requirement that we consult with an “expert” in nutrition, which had to be the most frustrating 2 hour visit of my life (the RN who we visited with was diabetic herself and came in drinking a large diet coke…I threw an apple core in her waste basket and found multiple fast food containers…Im not judging…she then began to tell us how we were eating to “low carb” and how bad it was).
ANYWAY, my wife left with a glucometer (awesome) and she was  told to check her sugars 4x a day for 2 weeks 1 hour after every meal and then send the results back in (BTW my wife does CFmoms and is 5?10 170…138 with out the baby, very lean and athletic).
So for 2 weeks we BOTH checked sugars, to compete, and all of our sugars were great, below 88 after 1 hour and fasting in the am high 60′s low 70’s, she faxed her sugars in and was immediately called by above referenced nutritionist and told that her sugars were “to low” and asked to eat MORE carbs (complex of course) and check for another week, so we made up sugars that were slightly higher and faxed them in and have not received a call since. We eat fairly strict, always unlimited quantity and to satiety, we have never felt better. I’m a Fire/Medic and will occasionally check my sugars at work for random reasons and several times have found my sugars in the low 60’s (no symptoms, feeling great)….and I’m aware this flies in the face of western medicine (we practice under our protocols that we cant leave a diabetic at home with bgc less then 80).
SO, my question is, based on your genius….what is to low (not according to current medical standards which seem to be on the high side)?

 

Thanks, Silky

If you are unfamiliar, the oral glucose tolerance test (OGTT) is a diagnostic test used to establish gestational diabetes. The thinking goes like this:

If you consume a large bolus (75-100g) of glucose and fail to clear it in a timely manner, you are insulin resistant and thus have “gestational diabetes” (GD). I’ve written on this topic before and the whole thing makes me want to lobotomize myself with a blunt instrument. It’s a tough and incendiary topic. On the one hand our medical professionals deal with a huge population of women who eat very poorly, never exercise and somehow still manage to get pregnant. Miracle that this situation is, biology makes things worse. During pregnancy the mom becomes even more insulin resistant due to an evolutionary adaption in mammalian-mom’s in which they become slightly insulin resistant to allow a positive flow of nutrients to the developing fetus via the placenta. If the mom was more insulin sensitive than the fetus we could end up in a nutrient scarcity situation due to nutrition flowing to the more ubiquitous tissues of the mom. Biology fixes this problem by making mom a little insulin resistant, effectively “pushing” nutrients to the fetus. Score one for biology! Problems arise however when our modern diet and lifestyle make this otherwise favorable adaptation dangerous. Too many carbs (particularly chronic fructose intake), autoimmune complications with lectins, loss of insulin sensitivity due to sleep deprivation and stress can drive expecting moms into gestational diabetes. From the paper linked above we have an interesting observation that severity of GD is likely determined in part by estrogen and progesterone levels. One of the key features of hyperinsulinism is a decrease in sex hormone binding protein (SHBP) which then makes estrogen more available to the tissues. Interestingly, this problem with estrogen is actually at the heart of most female infertility, but that is a topic for another day (or a book…)

Now’s My Chance to Party!

As if the above was not bad enough, many moms-to-be decide “this is my chance to eat anything…I’m going to get fat anyway!” We now have a really terrible situation for the moms, unborn kids and the medical professionals who deal with this everyday. These mom’s are laying down the genetics for their kids in such a way that kiddo will be prone to poor insulin control, diabetes and a host of related problems throughout life. In geek-speak our phenotype (the physical manifestation of our genetics) begins in uttero and that sets the tone for the rest of our lives.

So far so good? Great, now let’s go to Bizzaro world (ours) and see how a lack of evolutionary understanding on the part of our medical professionals can derail an otherwise good situation. In the example above “paleo mom” has been eating great and if we ran an A1c (a measure of blood glucose over time, much more valuable than the OGTT or blood glucose measure) we’d likely find she has low, BUT HEALTHY blood glucose levels. She is fat adapted, not insulin resistant and can thus run many of her tissues on fat. That folks, is good. But what happens when she is given a bolus of raw sugar, much larger than anything she, or her developing fetus have ever seen? Well, she has trouble clearing all that sugar. This may give people a headache, but some of this mom’s tissues are “insulin resistant” but healthy because they run on fat.

Smoke’em if You’ve Got’em

A “sugar burner” will see decreased physical and cognitive performance quite quickly compared to a fat burner. Why? Because that fuel (glucose) is comparatively limited and if most of the tissues are running on glucose one must rely on constant feedings or face a blood sugar crash. Folks with this problem must re-feed every 2-3 hrs to avoid “hypoglycemia”. In extreme situations this hypoglycemia could result in coma or death and this is part of what the medical folks are worried about in this gestational diabetes situation. But just like standard insulin resistant type 2 diabetes, they botch the solution. What they are missing in this situation is this paleo-mom is buffered against the vagaries of blood sugar changes because her main fuel source is fat. In chemistry a buffer is the salt of a weak acid or base that prevents changes (up to a point) in the pH of a system. This is pretty handy in biological systems that operate within very tight acid/base ranges. In economics and statistics a similar phenomena is called an attractor. Biological systems, economies and other dynamic processes function well with “buffers” as it prevents high’s and low’s that could destroy that system.

Where things are falling down is this mom is not having a blood sugar management issue typical of most people coming through the door of hospitals. Her metabolism is running on a comparatively “infinite” fuel source (fat) and she and her developing baby are doing just fine, thanks. At least until they were exposed to a 100g bolus of raw glucose (which they do not clear quickly, but this is a normal adapation to a lower carb intake) and are then told to increase her carb intake until she becomes….a SUGAR BURNER!!! The recommended diet change would drive average blood glucose up, increasing inflammation and advanced glycation end products typical of elevated blood glucose. Mom can now suffer legitimate blood sugar crashes due to an inability to access body fat for the preponderance of energy needs in her body. Thanks Doc!

Take a look at this study for some specific numbers. You will notice that glucose utilization for fuel went from .71g/kg/min in the baseline period to .50g/kg/min in the 4th week of adaptation to a ketogenic diet. Folks were burning 30% less glucose for their energy by the 4th week and this is just getting going. Those numbers improve with time and drop glucose consumption by upwards of 50% vs baseline. This means it actually gets damn hard to face a hypoglycemic event. Here is a nice closing paragraph from that paper:

 

“These findings indicate that the ketotic state induced by the EKD (EKD is a ketogenic diet with a maintenance level of calories) was well tolerated in lean subjects; nitrogen balance was regained after brief adaptation, serum lipids were not pathologically elevated, and blood glucose oxidation at rest was measurably reduced while the subjects remained euglycemic.”

 

This is a great paragraph. The ketogenic diet was not muscle wasting, did not unfavorably alter blood lipids, and stable blood sugar was maintained while decreasing total glucose consumption. If ketosis also fought cancer and reversed neurological disease ranging from Parkinson’s to Huntington’s it would be just amazing. Oh, wait…that’s exactly what ketosis does. HMMM.

May I have a slice of confusion, with a side of Ignorance?

So, the medical professional dealing with these folks is both confused and ignorant on a number of topics. Confusion grows from the fact that she is simply not used to seeing a healthy, fat burning mom walk through the door. Confusion and ignorance surround the use of the OGTT. And hopefully it’s obvious that the preferred management strategies for diabetes, be it gestational or otherwise, are ridiculous when we really think through the metabolic mechanisms. The two blood values that get doctors and dieticians in a fizz in situations like this are blood glucose and ketones. If they see ketones they assume a state of ketoacidosis but the two states cannot be any more different other than they both have ketone bodies in circulation. Ketoacidosis is not just ketone bodies but also decreased blood pH and typically very high blood glucose. This is a nasty situation but simply seeing ketones on blood work should not be all that is involved in making a determination of “ketoacidosiss.” The other piece, blood glucose levels finally brings us back to the original question: “How low is too low?” Well, we see numbers in hunter gatherers in the 60-70 range. In certain clinical situations of advanced ketosis individuals have functioned as low as 40ng/dl. From anthropological data and research on ketogenic diets I’d put a safe operating low end at 55-60ng/dl. Possibly lower, but the real take home here is simply how do you feel and perform? If you are having a blood sugar crash, it’s too low! But compared to what our medical establishment would like to see the fat adapted paleo-mom is likely fine at levels lower than commonly accepted so long as mom shows good A1C’s and simply feels good.

I’ll likely get a bunch of hate mail on this but there was a time when childbirth did not require OGTT’s and a host of other management schemes. Can childbirth be dangerous? Absolutely, but it would be nice if medicine adopted the position of using our best understanding of biology combined with the amazing advances in emergency care to offer the healthiest, safest experience imaginable for our moms and next generation of kids.

It’s time for the medical community to recognize the difference between health and pathology…and to actually advocate for health. We need a physician network that understands evolutionary biology and how a deviation away from our ancestral diet and life-way can create havoc for our health before we are even born. We, or at least our kids, deserve better than this.

Below is a photo of my nephew, Kayden. He is the cutest kid who ever lived. Or perhaps I’m biased as his uncle. He was conceived while his mom was eating paleo, and mom has mainly stuck with that both for him and her. All the way through pregnancy, breast feeding  etc. Kayden is “off the charts” in every developmental category and although his parents are exceptional people, this is simply a phenotypic expression: Kayden is being compared against kids and moms who do not eat as well as they do. He will have a remarkable advantage throughout his whole life.

 

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  1. Ben Wheeler
    September 6, 2010 at 3:42 pm

    Robb-I guess I was right when I posted on your facebook comment regarding the insulin resistance in mothers to partition nutrients to the baby. I can’t remember if I read that is some of T.S Wiley’s work…Sex,Lies and Menopause maybe??

    Is Kayden the little guy who became sugar addicted after his first sitting of gluten-free pancakes!!??

    • Robb Wolf
      September 7, 2010 at 6:04 am

      Ben-
      Yep. It was quite an eye opening experiment for the parents. He is seldom fussy and very good natured. One shot of GF pancakes and that was ALL he could talk about for a day and he refused to eat, dinner, breakfast the following day and finally caved and had chicken and blueberries for lunch.

  2. julianne
    September 6, 2010 at 4:23 pm

    Just wondered if you might, for us non-Americans, do a tiny favour? (no this is not a spelling mistake, it’s correct kiwi spelling!)
    As myself and a bunch of other readers don’t live in USA and our blood tests do not come back in ng/dl, would you please give the alternative measurements that the rest of the world understands? That would be much appreciated!

    And thanks for a great article.

  3. Primal_in_Pittsburgh
    September 6, 2010 at 5:11 pm

    Great post, Robb. It basically answers the questions I had a couple of weeks ago, but it raises a few others. I’ll ask the questions first, then give some background info.

    1. What do you consider to be normal daily bloodsugar levels for a non-diabetic?
    2. How long does it take to establish normal levels coming off a SAD diet, assuming fairly strict compliance with paleo (95%-ish)?
    3. Is there a good insulin sensitizing regimen you’d recommend for someone who suspects they have some stubborn insulin issues?

    Background info: Since my wife has been testing herself regularly (her numbers have been good, and the doctors decided she was a false positive from the oral glucose tests) I’ve also done a few tests on myself.

    My fasting levels so far have been 85 and 93, and my one post-meal test was 114. I’ve been eating pretty well for the last seven weeks, but these numbers seem high based on the question in the post above.

    I have been trying to lean out a bit (5’9″ and 156 lbs with an estimated 15-17% body fat, mostly around the middle). I’d like to get down to around 10% body fat. Since going primal I haven’t seen much appreciable fat loss, which has been frustrating. I don’t expect it to come off in a week, but some slow progress seems achievable.

    My glucose numbers make me think I might have some insulin resistance issues, despite my dietary changes.

    Two things I still need to incorporate are fish oil and better sleep. I have always had trouble sleeping, and used to average 4-5 hours per night. I’m doing better now with 6-7 hours. I got some Natural Calm to see if that would help.

    Aside from that stuff, do you have a general protocol for enhancing insulin sensitivity for people looking to lean out?

    Thanks for all the great info you share.

  4. gilliebean
    September 6, 2010 at 5:57 pm

    Awesome! I’m planning on getting started on a family with my husband very soon and I love anything that gives me good information about being paleo and pregnant! Thanks Robb! :D

  5. Jacob Egbert
    September 6, 2010 at 6:07 pm

    Robb,
    I appreciate this post very much as a physician. I am an avid crossfitter and Paleo dieter. I try to pass on the wisdom I have learned to my fellow docs and I will say it is tough. Either they cannot see passed the “whole grain” dogma, don’t care at all, or see the benefit but can’t put forth the effort themselves let alone try to convince their patients during a 15 minute visit. As I’m sure you know convincing others of obvious truths is a real challenge. I try to implement Paleo diet and vigorous exercise prescription to all who come to me ailing. I am committed to delivering true health but no one is buying it. They want a quick fix in a pill or a needle (both of which we didn’t evolve relying upon). I look forward to reading your book (need to find one, Amazon?) and will be attempting to create a treatment plan around many of the principle you outline. Unfortunately, insurance programs don’t pay for preventative health care like educational programs, good books, or gym memberships.
    Have you successfully worked with any physicians who are using Paleo to treat patients? I’d be interested to learn all I can about programming for a clinical setting.

    Thank you for your time,
    Jacob Egbert D.O.
    Physical Medicine and Rehabilitation

    • Robb Wolf
      September 7, 2010 at 6:00 am

      Dr. Egbert-
      We’ve worked with a few doc’s but they are diffuse and we lack organization as of yet. The plan is to have a physician network steeped in these ideas. Sounds like you are another one! Shoot me an email via the contact page and I’ll get you in touch with Prof. Cordain and the other docs we have worked with.

  6. Jesse
    September 6, 2010 at 6:10 pm

    Awesome Post Robb! Great info and good job laying the smackdown on cookie cutter responses!

  7. Whitney
    September 6, 2010 at 11:45 pm

    Hey Robb,
    I went to your Paleo seminar at Crossfit South Brooklyn. Definitely learned a lot of eye-opening information. And thanks again for the book!

    Anyway, I just “tinfoil-ed” by door (I have no windows in my room but I door with a big chunk of glass in the middle of it. Go figure.). My roommate looked at me like I was crazy but I took one of the best naps of my life! And then slept a blissful 8 hours straight. Thanks so much for that advice.

  8. Andrew
    September 6, 2010 at 11:54 pm

    Hasn’t Cordain written that pregnant women should increase carb load?

    • Robb Wolf
      September 7, 2010 at 5:56 am

      Andrew-
      The point of this post was to make folks aware that some mom’s may be presenting with “low” blood glucose levels and that is in fact healthy and fine. The point that Prof Cordain has made is a potential of protein aversion in pregnant women:
      http://thepaleodiet.blogspot.com/2010/07/protein-intake-for-pregnant-women.html
      and a subsequent recommendation to “increase carbs and fat”. I tend to recommend more fat as a baseline then Loren, so I’ve not seen the pregnant mom’s we work with present much if any kind of aversion to protein. Keep in mind that the basic Rx ala The Paleo diet is over 200g of protein for an average size female:
      http://www.thepaleodiet.com/articles/JANA%20final.pdf

      So this is a completely different issue. One of liver metabolic changes limiting protein processing during pregnancy.

  9. Jules Marsh
    September 7, 2010 at 6:49 am

    Fantastic write up Robb. People seem to forget sometimes that low heart rate, low blood pressure, and low blood sugar require numbers AND symptoms in order to diagnose a problem. If you feel good and those numbers are low, then awesome! You only have a problem if the low numbers are making you feel lousy. Last time my fasting blood sugar was checked it was 65. I felt great at the time and was thrilled with the result.

    Dr Egbert: There are a few of us around. I’m still trying to figure out how to get into a practice setting where I can really put this stuff to work. IMHO paleo is far stronger medicine than most of the pills on the market. Plus it’s cheaper and has basically no unpleasant side effects.

    Jules Marsh, MD

    • Robb Wolf
      September 7, 2010 at 8:28 am

      Jules-
      We will do it!

      We chat more when Nicki and I are there for a gig in Woodenville.

      Everyone-Jules is an MD who trains with Dave Werner in Seattle. Another great doc who fully grasps the power of paleo.

  10. Ben Wheeler
    September 7, 2010 at 7:27 am

    Robb- Just was thinking. If you were a fat burning machine and couldn’t handle a large dose of sugar, would the pwo carb up be a bad idea?? Or does the non-insulin mediated glucose transport take care of this somehow? Obviously an easy way to find out would be to try it! But was just curious to hear your take on that. Also, I know is OPT’s nutrition 301 dvd he talks about the older your “training” age is, the less able you are to handle a large carb load pwo. Any reasoning for this that you would see?

    THanks amigo…book is almost here!!!!!

    • Robb Wolf
      September 7, 2010 at 8:26 am

      Ben-
      Yea, this is part of what makes that PWO feeding both smart and doable.

  11. hans keer
    September 7, 2010 at 7:33 am

    Hi Rob, you are totally right also touching the autoimmune complications of lectins in your post. This factor is much underestimated. Pregnant women oftentimes consume too much of the lectin containing foods (i.e. grains, legumes and nightshades). Furthermore diary and eggs can play an important role in the autoimmune problem. I wrote an (I hope) easy to read post on the subject http://bit.ly/a9Gvjk. VBR Hans

  12. Bryan
    September 7, 2010 at 7:59 am

    Thanks for posting this, Rob. I asked a question about pregnancy on podcast 43 and this is REALLY helpful information. It’s nice to know that all of the effort of eating paleo during pregnancy and post-pregnancy (while breast feeding) is completely worth it and will help my kid develop correct.

  13. Aimee Lyons
    September 7, 2010 at 8:42 am

    Thank you for this post Rob, I honestly found it while I was sitting in the office waiting for my OGTT test today…50g of sugar in the plus. I’m eagerly anticipating my results. I did a light met-con, ate a handful of almonds and some turkey prior to downing my 50g sugar ladened OJ…so I hope it offset the results a bit. I don’t want to have to sit through the 4 hour test. It’s so hard to find info out there on Pregnancy and proper nutrition I just wanted to say thank you for the posts and info!

    Aimee Lyons/26 weeks pregnant

  14. Yet Another Jeff
    September 7, 2010 at 11:40 am

    Great post Robb, I was especially interested to see the ‘how low is too low’ for non-diabetics. I’m a type 1 diabetic and I can say that switching to a ketogenic diet was the smartest thing I’ve ever done! While I’ve never put it to the test intentionally.. I have driven home from the gym many times to find blood glucose in the 20-30 mg/dl range, even as low as 18 once. This would mean certain death on the ADA-suicide diet, but I feel perfectly normal with these low numbers, so I’m not sure where the low limit is on blood glucose in the ketogenic dieter, could it be there isn’t one?

    • Robb Wolf
      September 7, 2010 at 3:05 pm

      Yet another jeff-
      That is remarkable. I really do not know the absolute low limit. I suspect this reflects the total conversion of tissues to ketosis. It would be great to get some numbers from you and do a write up on this.

  15. Victoria Goldstein
    September 7, 2010 at 2:00 pm

    Thank you soooo much for posting this! I went for my first appointment today with the OB-GYN and when they told me that I would eventually be getting this test, I knew then that there was no way I would pass. I’m pretty strict paleo and have cut out cheating entirely since discovering I was pregnant. I’m determined to give my baby the best chance for a great life while in the womb. When the nurse said I would have to drink a bunch of glucose later on, I told her then that there’s no way I’d pass. My body isn’t used to getting sugar. And frankly, I don’t want to take this test solely on the fact that I don’t want to feed a huge amount of glucose to my unborn baby. I will be urging the doctor to get the Hba1c to test for this which I know I won’t have. I put my full faith in the Paleo Diet, CrossFit, and Chiropractic care for wellness. I have great faith that our child is destined for health and success.

    • Robb Wolf
      September 7, 2010 at 2:43 pm

      Victoria-
      This is awesome and we don’t need to have “faith” in it. We have proof.

      Congrats on the pending motherhood and keep me posted on your progress.

    • Jessica Griffith
      March 4, 2011 at 11:28 pm

      Just wanted to mention that you have the legal right to refuse any tests and/or procedures you don’t want or feel are necessary. It is your right. I have found that educating yourself on pregnancy and all the tests, procedures, and interventions is the best way to know what you as the mother feel is necessary. I highly recommend “The Thinking Woman’s Guide to a Better Birth” by Henci Goer to any pregnant mom I know. A little known fact, our maternity care system in the US is in crisis, just like the rest of our healthcare system. The US has one of the worst maternal and infant mortality rates of industrilized nations. So many pregnancy issues can be prevented with proper nutrition. Mothers and Fathers-to-be need to ask questions and educate themselves, just like the couple that wrote Robb, they didn’t want TP accept what modern medicine was telling them. Ok, off my soapbox now! Childbirth and pregnancy are one of those things I am passionate about, especially educating others!

  16. malac
    September 7, 2010 at 4:38 pm

    Hey Robb,
    Thanks for taking the time to answer my question. It was one of the most frustrating experiences of our lives. We legitimately felt that western medicine had set us up to fail. Even after my wife got her a1c (4.9) tested (at our expense and request, in a vain attempt to refute the Ogtt..) we still had to comply with the special gestation diabetes guidelines in order to deliver at our birthing inn.
    On the plus side…my wife has been in labor for 36 hours (hes being a stubborn bastard) and I mentioned that you referred to her as “paleo mom” on your website and she cracked her first smile in a couple hours.
    Thanks again for all that you do. Looking forward to the book.

    Silkey

    • Robb Wolf
      September 7, 2010 at 6:08 pm

      You guys hang in there. Much love to you guys. Shot us a picture of mom and kid when you get one.

  17. julianne
    September 7, 2010 at 4:51 pm

    RE pregnancy:
    2 supplements I stress that women take are Vitamin D and Omega 3, (which most women following following paleo are be aware of):
    Vitamin D is so important for gene transcription, as well as insulin sensitivity, and Omega 3 for brain and nerve cell development, and decreasing risk of pre-eclampsia. Both also decrease the risk of miscarriage and early delivery.

    http://www.cbc.ca/health/story/2010/05/03/vitamin-d-pregnancy.html

    http://www.vitamindcouncil.org/newsletter/pregnancy-and-gestational-vitamin-d-deficiency.shtml
    http://www.ncbi.nlm.nih.gov/pubmed/19781131

    http://www.pregnancy-info.net/omega3.html

    And even add probiotics to the mix
    http://www.webmd.com/diet/news/20090507/probiotics-cut-belly-fat-after-pregnancy

  18. Ronald Pottol
    September 7, 2010 at 9:38 pm

    My wife is a type 2 diabetic, who has had three kids, according to her reading, the only reason they do the OGT is because they think women cannot be trusted to take a fasting glucose reading for a week. That would be easier, cheaper, and more reliable.

    Oh, and if you are diabetic, the OGT can be dangerous for the baby.

    • Siriwan
      May 25, 2011 at 3:12 pm

      A bit late in “responding”, but I’m 10 week pregnant and 3 weeks ago, on my first visit to the doctor, she tried to force me to have the glucose test AFTER I told her I was diabetic, type 2. AND told her I took care of myself eating a zero-carb diet. I refused the test, and she basically became hysterical, shouting how she’d been to school for so long (yeah, same as me, and???) and I was not to teach her anything and what I was doing was dangerous for my baby, blah blah blah. She refused to listen to my reasons for refusing the test… Yes, I’m changing doctor :-) And printing this article to show the new ones and the specialist I’m seeing next week.. hoping they’ll understand English :-))

      • Robb Wolf
        May 25, 2011 at 7:39 pm

        Keep me posted on that. As an FYI- folks eating low carb CAN show elevated A1c’s because the red blood cells live longer than in high carb folks, so this can skew things and make it look like blood sugar has been too high. Fructoseamine is a good indicator and might be better for you.

  19. Ronald Pottol
    September 7, 2010 at 9:46 pm

    One question, my wife wondered why the doc ordered the test, usually it is only ordered if there is a reason (such as a high hemoglobin A1c). Though in the madness of the American way of birth, anything could be true).

    • Robb Wolf
      September 8, 2010 at 7:07 am

      Ron-
      It’s a standard screening method that i’ve argued is unnecessary compared to using the A1c.

  20. Mark R.
    September 8, 2010 at 7:17 am

    Hey Robb,
    Great post but just playing devils advocate here, non-Paleo people would look at this inability to handle a large bolus of carbs as a negative of being low-carb. I know you’ve said before that Paleo is largely carb-agnostic as long as you aren’t eating carbs that are from grains or other refined stuff. Personally I know that I tend to look, feel, and perform better when eating more carbs (some more fruit and more yams/peeled potatoes) than doing just veggies and a very little fruit. Maybe I haven’t given it enough time to adapt in the past but the drop in performance is so severe that it is hard to stay on that path. If it matters, I’m fine not eating for long periods of time (a whole day if need be), so I don’t think I’m a pure sugar burner. Anyways, I just wanted to see if you still hold the position that Paleo is carb-agnostic as long as you stick to no dairy, grains or legumes?
    On other sites, some non-Paleo, I always position and defend Paleo as a way of eating that avoids bad foods and not certain macro-nutrient categories. Sometimes my association with Paleo draws attacks but when I say that I’m just trying to avoid autoimmune diseases by eating real food, most have little ground to stand on.
    Thanks,
    Mark

  21. Mark R.
    September 8, 2010 at 7:39 am

    Cool, thanks Robb.

  22. Megan
    September 13, 2010 at 9:52 am

    Robb,

    Thanks so much for the post. I discovered Paleo eating during my pregnancy and stuck with it fairly well. When I went in to have my OGTT I felt light headed afterward and my results came in right on the borderline of having Gestational Diabetes. I was a bit nervous, but I suspected something about it wasn’t right and I stuck with a mostly paleo lifestyle. My daughter was born naturally and neither of us needed any meds. She is now a beautiful thriving 6 month old. I’m so glad I stuck with it.

    Thanks for backing up my gut instinct with the real science.

    Megan

  23. Hannah
    August 22, 2011 at 5:29 am

    Hi Robb,
    Thank you for the post. It gave me some strength to carry on with my quest to continue the rest of my pregnancy on a LC diet. I’m eating according to LCHF so not too far from paleo. I’m about 28 weeks pregnant and run into some issues because of the OGTT test.

    Before my pregnancy I was eating LC. Then found out I was pregnant and wanted to follow all the instructions and started eating more carbs. This resulted in a quick and large weight gain within just weeks. Not to mention the swollen feet etc. During these weeks I was reading more about paleo and got acquainted with LCHF and decided that the carb-rich food wasn’t doing it for me and started eating LCHF. After that my weight gain has been much much more subtle and even my doc was happy with the new pace. Also my feet don’t get that swollen anymore.

    Then came the OGTT. Phh… if only I’d known..

    I asked my doctor and the nurse who did the test if there was a chance that my very low carb diet could influence the results. I got a hesitant “no, I don’t think it should..” as an answer. I then took the test. My fasting value was good, so was the value after 2 hrs BUT the value after 1 hr was higher than the reference value. Thus, I am now labeled gestational diabetic. Before the test I also gave a urine sample in which they’d found a high level of ketones. When I heard about the ketones, I just said that it’s ok, it’s probably because of my diet.

    Then it started. I had to take a second urine test and a blood test. They wanted to check if my blood pH was normal, which it was. But I still had a lot of ketones in my urine. Now my doc has been convincing me to at least switch the fatty foods to light-products, butter to margarine etc. I’m not doing it. She then wanted me to read a study she’d found that said that children whose mother had had high levels of ketones in her blood during pregnancy had lower IQ. The study has been published 1991 in the New England Journal of Medicine: http://www.nejm.org/doi/full/10.1056/NEJM199109263251303#t=articleTop

    Any thoughts on this?

    From all I’ve gathered, except for this study, is that paleo babies are born healthy and strong with good intellectual skills, not the other way around.

    Sorry for the extra long comment :) Would really appreciate if you had time to give your thoughts on the article…

  24. how soon can i take a pregnancy test
    December 21, 2011 at 1:12 pm

    I just could not depart your site prior to suggesting that I actually enjoyed the usual info a person provide on your guests? Is going to be back frequently to inspect new posts

  25. Lauren
    March 20, 2012 at 4:05 pm

    Actually,no, in that picture kayden doesn’t look that healthy, at least by current standards. Perhaps it is nothing, or maybe it’s a more natural paleo development, but his head and eye shape are unusual.

  26. Michelle L.
    April 4, 2012 at 3:31 pm

    Thanks Robb so much for this post and your other post! http://robbwolf.com/2008/06/25/gestational-diabetes/

    I am pregnant and just knowing from other pregnant friends that this was a standard test, I took it without thinking about what exactly what was involved in taking the test.

    I took the 2-hour Glucose Tolerance Test, thinking I would pass fine because I eat Paleo – a healthy diet of course! Well, I FAILED – terribly. It was a shocker and i couldnt believe it. This post has brought me a lot of relief in knowing what I am doing is great and that the Glucose Test is flawed.

    Now all i need to do is prove to them through bloodwork, that my diet is fine and that my blood glucose is healthy. It’s still so frustrating to get that kind of result from a test when i know i am eating a healthy diet!!

  27. Madeleine Ripa
    June 14, 2012 at 9:45 am

    Hi there!
    Thanks for an awesome post!
    I found it today after slightly failing my OGTT (since I live in Sweden I’m not 100% certain that the procedure is the same) at 28 weeks.
    The thing is I’m thin, healthy, has never had any health issues what so ever. There is no diabetes is my family on either side, and I have none of the symptoms that puts a person in the risk of getting GD. So therefore I was crushed when I got the results. I thought eating paleo for the last year would make all tests a piece of cake (and all others have been). After crying about it to my husband he researched and sent me this link. Now I’m relaxed and trust our beliefs again. So, thank you!
    I got an appointment to retake the test in two weeks, and we’re considering whether to load up on carbs the days before or trying to get our midwife on board, which feels like climbing Mount Everest.

    Thanks again, and keep enlightening!
    BR
    Madeleine

  28. Angela Crum
    June 22, 2012 at 10:00 am

    I was just diagnosed with gestational diabetes after a 3 hour glucose tolerance test. I am pregnant with TWINS at 27 weeks gestation. I have heard this is fairly common in twin pregnancies. I am very concerned about the health of my babies. I was eating paleo before I got pregnant but just ate crackers and toast due to morning sickness. I plan to get back to paleo noow of course. I wish that I had kept up the paleo diet. We shall see how it goes.

  29. Emmaleigh
    July 16, 2012 at 5:38 pm

    I “failed” my 1-hour (50g) glucose test by 10 points and did the 3-hour (100g). I failed the hour test:
    fasting level: Normal
    1 hour: “failed” by 10 points cut off 180, I was 190)
    2 hour: “failed” by 4 points (cut off 155, I was 159)
    3 hour: Normal

    Here’s the problem: I found out 4 years ago that I was born with 1 kidney. My last “true” GFR read at 96. I had a rapid GFR done at the ER (fever of 103 at 18 weeks pregnant) which read 133 out of potential 140, which is 2 kidney max function), my nephrologist says it is impossible to be 133 on 1 kidney.

    I’m a 22 year old who is otherwise perfectly healthy. Pre-pregnancy weight was 100lbs. Even at 29 weeks pregnant, my weight is 125. I have NEVER had sugar in my urine and I have NO family history or other risk factors for diabetes. I take walks throughout the day totaling 1.5 to 2 hours a day and I watch what I eat. I do NOT have high blood pressure (never have) and the only times I have protein in my urine is when I have a UTI, which is 1 or 2 times a year. My pregnancy has been super easy; no morning sickness at all, I forget I’m pregnant until I see my just-showing belly or feel the baby move (baby is also “smaller than normal” but perfectly healthy/normal (he has 2 kidneys thank god!).

    I’m wondering if having 1 kidney affects this test, especially considering the kidney diet I’m on (low protein and salt, watch carbs/sugar).

  30. Rachel
    July 21, 2012 at 8:57 am

    I recently “failed” my one-hour OGTT and was really upset afterward. I eat very clean (paleo plus some high quality cheese), am at a healthy weight, and workout 5 times/week. I’m glad that I found this article! I’m hoping that my body just wasn’t used to ingesting that large of an amount of pure sugar in one sitting. I have an appointment at a diabetes education center next week and they’re going to give me an at-home kit so that I can test my blood sugar levels on my own with my typical diet, so fingers crossed that the numbers turn out well!

  31. Amanda
    November 8, 2012 at 1:30 pm

    This is my second GD diagnosis. I am an avid crossfitter, eat low carb (not paleo – but close) and have a healthy BMI – but a family history of diabetes. My fasting is always in the 60s. My dietician prescribed me a meal plan that included 75 carbs for dinner/45 for breakfast and lunch/ 30-45 for snacks. I was shocked. Last time I was prescribed 30-45 g per meal and 15-30 per snack. I don’t think I could eat that many carbs if I tried. I’ve NEVER had a high reading. I think I’m just sensitive to carb loading since my body is not accustomed to it, and I was searching for articles that supported this. I’m just really frustrated by all these extra steps that are unnecessary. My daughter was 6lbs 0oz. My average 2 hour post meal sugar reading is in the 80s (with carbs of around 30-40g). Every time I see that dietitian, I can hardly stand to be around her because I feel she lacks any credibility. I eat how I want – which is close to the way I was eating before (plus a few more carbs) and she keeps giving me a hard time about not eating the recommended carb allowance. I’m just so frustrated.

  32. Shannon
    January 28, 2013 at 8:03 am

    Just another perspective on the OGTT: I was dx’d with type 1 diabetes thanks to the GD screening. My 1 hr BG after a 50g load was 234, and I had a 4-hr postprandial over 200. I had NO idea that I was sick — healthy diet and weight, etc. I’m very glad that I was screened, for my own sake and that of my son. You never know.

  33. Rebecca
    February 7, 2013 at 10:51 am

    Robb,

    I cannot thank you enough for posting this! I have been a “low-carb” eater pretty much my whole like, and an avid fitness buff! I never eat foods with added sugar or hardly anything with natural sugars in it due to the way I was raised, my grandfather has suffered with diabetes all of his adult life and I was taught that if I didn’t want to have to suffer the 4 pricks a day, and multiple heart conditions I would need to eat healthy and exercise… so I do!

    I found out I was pregnant 8 months ago and continued to eat the way I normally do, around 30 net carbs a day. I was diagnosed with GD in Dec the week before Christmas, yay! It almost put me in a depressive state because I couldn’t believe it… I eat so healthy and am active. Of course I will do whatever is best for my baby but taking that sugar solution really made me think, how is this right? It’s almost like some cruel experiment or something; I firmly believe more research needs to be done on this! I asked if I could have my blood sugars taken after eating, fasting etc instead of swallowing the sugar drink but they said no. For the last month and a half I have been following the diabetes dietitian recommendations and taking my sugar readings 4 times a day. They also told me my fasting sugars were too low and to eat more carbs before going to bed, which I can’t believe to be healthy for anyone! The recommended carbs are 30-breakfast (non fruit), 30 snack, 45 lunch, 30 snack, and 50-60 for dinner, with another 40g snack. Even with the increased carb intake the readings were still well below normal. My fasting readings are always in the 60′s and low 70′s and my after meal readings are all lower than normal as well.

    I feel like this is a bunch of bull and my husband and I are really upset that the medical community is doing this to so many people. Your post really shines light on this condition and helps me to understand what has been going on with my body and digestion. I knew that the sugar rush was not normal for me and that this didn’t seem like the logical way to diagnose but I’m no Doctor. I think the moral of the story is that I can eat how I want (to avoid unnecessary weight gain), and to avoid any ill harm to my baby stay away from high quantities of sugar (which I do anyway)!
    Thanks again for the post!

  34. Lindsay
    March 1, 2013 at 11:32 am

    I realize this is an older post, but I just wanted to mention something that hasn’t been, and that is my midwives, in still requiring a screening, always give the option of testing with a meal versus the glucose drink. I can’t recall how it works, it may be that you take a three hour test in this scenario rather than the single, but it is something the local labs allow for. This would definitely be a better alternative for someone who has reason to think their diet/lifestyle is the reason for a poor reaction to the gross sugary drink that is conventionally used. You can eat a healthy meal of your choosing! I hope this is helpful for those looking for alternatives while working within the standard of care, however silly, that many practicioners are required to follow.

  35. Meg
    March 8, 2013 at 8:40 am

    Hi, I’m 3 months pregnant and know of Paleo from a dear friend but myself have not done it. I was just diagnosed with GD and was wondering if I can turn Paleo now and if it’s safe? Thanks for all the great info!

  36. Gestational diabetes
    March 15, 2013 at 11:12 pm

    Gestational diabetes may increase the level of blood sugar and can be more damaging if you detect it too late.

  37. Jen Z
    March 21, 2013 at 12:41 pm

    Robb,
    This is so much like my own experience with GD. Going back to an all paleo lifestyle kicked GD’s butt- and you bet I will never do the sugar test again.

  38. Jen Z
    March 21, 2013 at 12:43 pm

    By the way- my GD was detected in my last six weeks of pregnancy and my baby is perfectly healthy. For Meg, do it- you’ll feel amazing and will be doing a great thing for your baby!

  39. Melanie
    April 20, 2013 at 7:46 am

    Great article! I failed my glucose screening yesterday and my doc said I have GD and need to go to a dietician. I was shocked I failed it! But, like Silky’s wife, I’m extremely healthy, and wonder if it’s because the pure glucose drink was too foreign for my body to know how to handle properly. I am 5’10″ and before pregnancy was 135lbs and avoided all processed foods – just raw, homegrown veggies and pasture-roaming meats/dairy. I’ve put on a healthy 15 lbs at 27 weeks and feel great! My blood pressure and heart rate are usually low (100/60ish, 55-70bpm) and, in the past before I was pregnant, my blood sugars were also on the low end (65-75) (my younger sister has type 1 diabetes and I occasionally check mine with her meter). I’m anxious to see what my sugars are when I start checking regularly and am curious as to what the dietician will recommend! The only other possibility I can think of is the stress of hormone changes has caused me to develop latent type 1, which is am autoimmune disease and not related to my diet (since my sister has it I’m at a higher risk for that, though no one else in our family history has ever had it!).

  40. MK07
    July 21, 2013 at 3:09 pm

    I have reactive hypoglycemia. I took an OGTT and after one hour my blood sugar dropped. I’ve had 35 in the glucometer and scary episodes like blood sugar crashes after eating an apple. In this scenario what can you suggest to overcome this? If it is enterely possible? I’m 20 years old, female. I already given up wheat and gluten, and it’s been really hard fighting my family and friend’s beliefs. months ago I seek help from a well known doctor in my country and she recommended eating carbs every 2 hours. It almost killed me. Since then I’ve been reading many blogs and papers, and I have to say yours is one of my favourites. Thank you for everything.

  41. Anton K
    March 2, 2014 at 8:06 am

    Hi Rob, I was wondering what some of the inaccuracies associated with glucose tolerance testing is? Is it possible for one to have inconsistencies such as high glucose tolerance at 3.5 followed by an extreme hypoglycemic episode during a retest producing 2.0 one week later?

    It should be noted that when recovering from a TBI the body can also mimic hypoglycemia due to an energy crisis. Additionally some correlations are implicated linking certain nutrient deficiencies with diabetes and hypolgycemia, specifically vitamin D as well as omega three fatty acids and magnesium. Some physicians preach the benefits of high protein diets despite causing significant ammonia spikes reaching dangerous levels or avoid mentioning temporary increased kidney strain associated.

  42. Megan G
    April 4, 2014 at 7:14 pm

    I was also diagnosed with gestational diabetes at 29 weeks of pregnancy with my third daughter. I did not have this with my other two and had very easy pregnancies (Babies were 6 lbs 15 oz and 6 lbs 5 oz). I failed the first 1 hour glucose tolerance test with a 175 which surprised me and so I asked if I could take the test again to see if it was a mistake and fasted before the test and it was even higher the 2nd time (195). They automatically diagnosed me with gestational diabetes and referred me to the diabetes center. I am 100 lbs pre-pregnancy weight and have only gained 15 lbs so far in the pregnancy. My baby is measuring right where she needs to be at this stage of pregnancy and two weeks before the OGTT, I had my blood sugar tested at work for a wellness screening and it was perfectly normal. I began checking my blood sugar four times a day and barely modified my diet (it is a most-healthy diet I follow anyway) and my numbers were well below what they wanted – everything was perfectly normal. I go see the diabetes doctor and she tells me that I don’t meet any of the criteria for gestational diabetes except that I am now 30 years old. She said my numbers were great. I said, “Do I really have this?” She said I should take the 2 hour test to find out for sure. I said “Aren’t my numbers enough to show that I don’t have it?” I even had Ghiradellhi ice cream on vacation and my blood sugar was 93 afterward. She said “The test will tell us.” I ate a very small lo-carb dinner the night before and fasted for 14 hours hoping that this would help my numbers and I failed the 2 hour test miserably today (233 at 2 hours). I kept checking my sugar on my own at home and within an hour (3 hours) it had dropped to 180. The doctor called me and said I for sure have gestational diabetes and need to fax them my numbers every two weeks. I said, so you are basing this all on a TEST and not the evidence of my numbers over the past week? Even after the test my numbers went back to normal after meals, etc. I am back on track. The only time my sugar is off the charts is when I drink the toxic orange glucose drink. I truly believe this test is flawed and some people who are not used to consuming that amount of sugar cannot process it as quickly as others who are used to it. I never drink coke or fruit juices. Just water mainly. I am very confused and frustrated by this label given by my doctors that I feel is not looking at the big picture and instead a faulty test.

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