Can the Ketogenic Diet Help with Gestational Diabetes?
Gestational diabetes mellitus (GDM) is a form of diabetes that specifically affects pregnant women. GDM is the most common pregnancy complication with over 200,000 cases diagnosed every year and accounting for two to 10 percent of all pregnancies. Luckily, this condition can be treated with small dietary changes.
What is Diabetes?
When you think of diabetes, you probably think of insulin injections or eating too much sugar, but it’s much more complicated than that. There are many different types of diabetes including type 1 diabetes mellitus, type 2 diabetes mellitus, diabetes insipidus, and gestational diabetes. Diabetes as a whole describes abnormal blood glucose regulation and hyperglycemia (high blood glucose levels)
How Are Blood Glucose Levels Regulated?
Glucose is a simple sugar (monosaccharide) that all carbohydrates are eventually broken down into. For example, lactose in the milk you drink is a disaccharide made of glucose and galactose (monosaccharide). Lactose is broken down into these two sugars and then galactose is further broken down into glucose (or glycogen). [1]
Once carbohydrates are broken down into glucose, they are in the blood (extracellular–outside of the cells); however, cells need that glucose in order to carry out certain processes so it has to be brought inside (intracellular).
Through the process of glycolysis, glucose is broken down to produce ATP. ATP is the currency system of the cell (like dollar bills). It fuels the work that cells need to do. While glucose is a simple sugar, it is still a relatively large molecule, therefore it needs certain transporters in order to allow it to enter a cell. These are known as GLUTs (glucose transporters). [2]
Contrary to popular belief, not all cells require insulin in order to transport glucose inside of a cell. Some organs and tissues are insulin-independent, meaning insulin is not required, whereas others are insulin-dependent, meaning they require insulin. [3]
GLUT 4 transporters are located on skeletal muscle, adipose tissue, and the heart and do require insulin. In order for glucose to be transported into these cells, insulin must bind to insulin receptors and signal for this process to occur. Insulin is produced by beta cells in the pancreas in response to high blood glucose levels. Once it is released, it binds to insulin receptors and triggers a response to allow glucose to be transported into the cell. [4]
GLUT 1
Insulin independent
- Blood
- Blood-brain-barrier
- Heart (partially)
GLUT 2
Insulin-independent
- Liver
- Pancreas
- Small Intestine
GLUT 3
Insulin-independent
- Brain
- Neurons
- Sperm
GLUT 4
Insulin-dependent
- Skeletal Muscle
- Adipose tissue (fat)
- Heart
Dysfunctions in Glucose Regulation
Glucose regulation can become dysfunctional at many different steps. If insulin is not produced sufficiently, glucose is unable to enter insulin-dependent cells and these cells can starve. This is known as type 1 diabetes mellitus. If insulin is produced sufficiently, but receptors are damaged or are insulin resistant, they can not signal to allow glucose transport, and again cells become starved for energy. This is known as type 2 diabetes. [5]
What is Gestational Diabetes?
Gestational diabetes is dysfunction in blood glucose regulation specifically in pregnant women. Women who have gestational diabetes do not have to have a history of diabetes; however, it does put them at higher risk for developing diabetes later in life. [6]
It is not well known why some women develop gestational diabetes, however, various hormones do play a role including insulin. Risk factors include being overweight or obese, limited physical activity, PCOS, familial history of diabetes, previously having gestational diabetes, or previously giving birth to a child over 9 lbs. [7]
What are the Symptoms?
There are very few signs and symptoms of gestational diabetes; however, they tend to mimic traditional diabetes mellitus. This includes increased thirst (polydipsia) and increased urination (polyuria). [7]
Most women do not know that they have gestational diabetes until diagnosed after an oral glucose tolerance test. An oral glucose tolerance test is performed in order to determine how well your body responds to high levels of glucose consumption over a two-hour period.
How Is Gestational Diabetes Treated?
For some, gestational diabetes can go away on its own and have no complications for the baby. However, for some, if left untreated, gestational diabetes can lead to premature birth and other health complications. Luckily, gestational diabetes is easily treatable with changes in diet and activity level. The key focus is to improve blood glucose levels by limiting the consumption of high-carbohydrate foods.
Keto and Gestational Diabetes: Can a Ketogenic Diet Help?
One key way to improve blood glucose regulation is to reduce carbohydrates consumed. By reducing carbohydrates consumed, insulin sensitivity is improved, and blood glucose regulation is improved. One clinical study found that reducing carbohydrate consumption may improve blood glucose regulation, without increasing the risk of ketonemia (abnormal blood ketone levels). [8]
Research has shown that the ketogenic diet can be tremendously helpful in improving type 2 diabetes, as well as improving insulin sensitivity. Because of this, it might prove beneficial for individuals suffering from gestational diabetes. [9] [10]
Final Thoughts
If you have been diagnosed with gestational diabetes, consider talking to your doctor about following a low-carbohydrate or ketogenic diet. Reducing carb intake may help regulate blood glucose levels and improve symptoms of GDM.
References
Dashty M. A quick look at biochemistry: carbohydrate metabolism. Clin Biochem. 2013 Oct;46(15):1339-52. doi: 10.1016/j.clinbiochem.2013.04.027. Epub 2013 May 14. PMID: 23680095.
Chaudhry R, Varacallo M. Biochemistry, Glycolysis. 2021 Aug 17. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 29493928.
Deng, D., & Yan, N. (2016). GLUT, SGLT, and SWEET: Structural and mechanistic investigations of the glucose transporters. Protein science: a publication of the Protein Society, 25(3), 546–558. https://doi.org/10.1002/pro.2858
Huang S, Czech MP. The GLUT4 glucose transporter. Cell Metab. 2007 Apr;5(4):237-52. doi: 10.1016/j.cmet.2007.03.006. PMID: 17403369.
Salsali A, Nathan M. A review of types 1 and 2 diabetes mellitus and their treatment with insulin. Am J Ther. 2006 Jul-Aug;13(4):349-61. doi: 10.1097/00045391-200607000-00012. PMID: 16858171.
Alfadhli E. M. (2015). Gestational diabetes mellitus. Saudi medical journal, 36(4), 399–406. https://doi.org/10.15537/smj.2015.4.10307
Mijatovic J, Louie JCY, Buso MEC, Atkinson FS, Ross GP, Markovic TP, Brand-Miller JC. Effects of a modestly lower carbohydrate diet in gestational diabetes: a randomized controlled trial. Am J Clin Nutr. 2020 Aug 1;112(2):284-292. doi: 10.1093/ajcn/nqaa137. PMID: 32537643.
Westman EC, Tondt J, Maguire E, Yancy WS Jr. Implementing a low-carbohydrate, ketogenic diet to manage type 2 diabetes mellitus. Expert Rev Endocrinol Metab. 2018 Sep;13(5):263-272. doi: 10.1080/17446651.2018.1523713. PMID: 30289048.
Alarim, R. A., Alasmre, F. A., Alotaibi, H. A., Alshehri, M. A., & Hussain, S. A. (2020). Effects of the Ketogenic Diet on Glycemic Control in Diabetic Patients: Meta-Analysis of Clinical Trials. Cureus, 12(10), e10796. https://doi.org/10.7759/cureus.10796
