How To Prevent And Treat Gestational Diabetes With Functional Medicine - Transcript

Dr. Elizabeth Boham: When you're in the second and third trimester and you're needing that 300 to 400, 500 extra calories a day, make it a comprehensive meal where it has good, healthy, fat, good, healthy protein, and healthy fiber in each meal to help keep that blood sugar more stable. Dr. Mark Hyman: Welcome to The Doctor's Farmacy. I'm Dr. Mark Hyman and that's farmacy with an F, F-A-R-M-A-C-Y, a place for conversations that matter. And today we have a special episode of Doctor's Farmacy called House Call, with one of our leading physicians here at the UltraWellness Center, the medical director, Dr. Elizabeth Boham. We've been working together for decades. She's awesome. And I would see her and do see her as my personal doctor. So you better listen up. Dr. Mark Hyman: She's going to be talking today and we're going to be talking about a condition, it's pretty common. That's a hundred percent preventable, a hundred percent reversible, that is managed often in very weird ways by traditional medicine. And it's something that's called gestational diabetes, which is essentially diabetes of pregnancy. So Liz tell us how common is this problem and why should we even care or be worried about it? Dr. Elizabeth Boham: Yeah. Well, thanks Mark. Thanks for having me. It's great to be on with you again. And it's really common, actually. They say up to 10% of women have gestational diabetes, which means their blood sugar is too high during pregnancy. And as a result, what happens when their blood sugar is too high during pregnancy is the babies grow too big. So they will get overweight when they're born, so they can grow too big. Those offspring often have increased risk of insulin resistance and diabetes and weight gain when they're adults. So when women have gestational diabetes during their pregnancy, it makes it harder for that baby to maintain a healthy weight when they're an adult. So it's transgenerational. Dr. Mark Hyman: It's dangerous for the baby. Dr. Elizabeth Boham: Absolutely. Not only is it dangerous for the baby during that pregnancy, they have a higher rate of problems with birth. They have an increased rate of C-section, but their metabolism is damaged. So they have a harder time with maintaining a normal weight. As an adult, they have an increased risk of obesity. They have an increased risk of insulin resistance. Dr. Elizabeth Boham: And for that mother too, if they had gestational diabetes, they have a much higher rate of diabetes post-pregnancy, both type 1 and type 2, which is interesting. So they also have a higher rate of cardiovascular disease. They say that a third will develop metabolic syndrome within the next five years. So it is definitely a risk. So if you were told during your pregnancy that you had gestational diabetes, or you were at risk for gestational diabetes, it's important that you are paying attention to your blood sugar, to your insulin level, to that waist to hip ratio, postpartum, because you want to be picking this up early, because it's much easier to reverse if you pick it up early. Dr. Mark Hyman: Well, it's really important, you say 10% of women who have pregnancies have this problem, which is a lot. But when you think about the fact that one in two Americans has prediabetes or type 2 diabetes, that's pretty significant. And the question I have is, if 10% have actual gestational diabetes, which means your blood sugar is over 140 after a glucose tolerance test, or 126 fasting, how many have prediabetes who are pregnant? Because it might be the same ratio as with regular diabetes. It might be 10% and another 40% of the population might have prediabetes who's pregnant. And that also comes with risks. So even though you don't technically have gestational diabetes, what are the risks of having prediabetes when you're pregnant? Which may be up to half of all pregnancies. Dr. Elizabeth Boham: It's really fascinating just to recognize how much what you're eating during pregnancy is impacting your offspring. We know that it's important to avoid the high mercury fishes when we're pregnant and under cooked food, when you're pregnant because of infection. We also know it's really important to watch the amount of simple sugars and refined carbohydrates for the impact that it can have on your growing fetus and their life afterwards. So, it has a big impact on everybody's life. Dr. Mark Hyman: And what's concerning to me is that most obstetrician gynecologists probably are not addressing the prediabetes issue. In fact, 90% of people with prediabetes are never diagnosed by their doctor. Dr. Elizabeth Boham: That's very true. Dr. Mark Hyman: And I would say, from a functional medicine perspective, that by conventional criteria, half of Americans have prediabetes or type 2 diabetes. That's a blood sugar over 100 fasting, that's a blood pressure over, let's say 140 over 90, it's a waist to hip ratio that's larger than a certain amount. It's triglycerides over 150, it's your HDL under 50 if you're a woman, 40 if you're a guy. Those are the sort of technical definitions of pre-diabetes. But from my perspective, it's a continuum, and not my perspective, but if you just look at the risk with increase in blood sugar, over 85, which is considered great, right? Dr. Elizabeth Boham: Yep. Dr. Mark Hyman: There's increasing risk as you go up and up and up. And even if your blood sugar is perfectly normal, you can still have pre-diabetes because your insulin levels are high. So even if your blood sugar is normal, your insulin can be high and your body's compensating for the extra carbohydrates you're eating by pumping up more insulin that keeps your blood sugar normal, but the insulin itself causes problems. The insulin itself causes weight gain, causes inflammation, causes more belly fat, makes you hungrier, causes craving. Just all these horrible stuff. And yet, I don't think there's probably many practices that are delivering babies, that actually even check insulin levels. Dr. Elizabeth Boham: Yeah. And what's interesting with pregnancy, is our insulin naturally goes up when we are pregnant and our pancreas produces more insulin. It's one of the natural, normal mechanisms of pregnancy to help us hold on to weight, but there's a limit to what is normal. We're learning so much about what is optimal during pregnancy. Dr. Elizabeth Boham: In the Dutch famine in the 1940s, when there was not enough food around, pregnant women were consuming around 800 calories a day during the pregnancy. And they realized that those babies were born, they did a bunch of research on the offspring of babies born during the Dutch famine and they found that those babies were born small for gestational age. So they were underweight, but they had a much higher rate of obesity later in life. So we know that you don't want- Dr. Mark Hyman: I think that's true. Dr. Elizabeth Boham: You know you don't want to under eat, that's important. We also know we don't want to overeat. And we also really know, we don't want to overeat the wrong foods that are causing spikes in blood sugar. Dr. Mark Hyman: Yeah. My cat was a runt in a litter, came out super, super small. And now we call him fatty patatty catty because he just eats all the time and he actually overcompensated and got fat. Dr. Elizabeth Boham: Yep. And probably through epigenetics, the whole metabolism has shifted for some of these offsprings. So, officially the diagnosis of gestational diabetes gets made at around 24 to 28 weeks of pregnancy. There's a one hour glucose challenge test with 50 grams of dextrose. And if the one hour blood sugar is greater than 130, then they go on to do a more careful two hour glucose tolerance test. All done with blood sugar looking. So if your fasting blood sugar is greater than 95 or at two hours greater than 155, you're considered having gestational diabetes. And as we talked about, the big concerns are having a baby that's too big, which is called macrosomia. And that is if a baby is born greater than eight pounds, 13 ounces, and that's considered too big. And we know that that increases their risk of diabetes and insulin resistance and cardiovascular disease later in life. Dr. Mark Hyman: Yeah. It's all true. And Elizabeth, I would say is, these criteria are a standard of criteria and I don't buy it because if half of all of us have prediabetes or diabetes and 90%'s undiagnosed, the prediabetes is also causing problems. And I think for women who have extra belly fat, who may have diabetes in their family, who are eating a lot of refined carbohydrates, even if their blood sugar is normal on this test, I'm not convinced. I want to see the insulin levels. I'm going to look at other biomarkers. I want to look at their lipids. Because my guess is if we optimize a woman's nutrition during pregnancy to keep them in ideal sugar balance, that the baby is going to be healthier, they're going to be healthier. And that the risks are all going to go down. And I think we're not aggressive enough in how we put our parameters in of what's normal and not normal, right? Dr. Elizabeth Boham: Yeah. I agree with you. Dr. Mark Hyman: Like if your blood sugar is 99 it's okay. But if it's a hundred it's not. Dr. Elizabeth Boham: Very true. Dr. Mark Hyman: Does that make sense? Dr. Elizabeth Boham: No. And one in every two women, so half of all women of childbearing age are either overweight or obese. And we know that women who are overweight or obese have a higher rate of gestational diabetes. So it is an area that we have to pay attention to. It's not the only thing that causes gestational diabetes though. We know that there are some ethnicities that are at higher rates of gestational diabetes, Asian population at higher rates of gestational diabetes, even within normal weight levels. We also know of course, that having low lean muscle mass, not doing enough exercise. We also know that there's such a connection, we've talked about this time and time again, between the microbiome and our toxic exposure and our genetic makeup, that all influence how we manage our blood sugar and our insulin response to a meal, that are really critical for us to be paying attention to. Dr. Mark Hyman: Yeah. And we really are highly experienced here at the UltraWellness Center in dealing with people with insulin resistance and prediabetes and diabetes, and it's a hundred percent fixable and a hundred percent preventable. And I think that the approach is really a food first approach. And let's talk a little bit about the diet because I think a lot of women who get pregnant, eat a lot and feed the baby and eat whatever you want, have ice cream. And I love the question that I get often. Is it safe to eat the pegan diet or to eat this way when I'm pregnant? I'm like, is it safe to drink soda and have French fries when you're pregnant? No. Is it safe to eat fruits and vegetables and nuts and seeds and good fats and clean protein and beans and grains? Yeah. Dr. Elizabeth Boham: A hundred percent. Dr. Mark Hyman: I'm like, you don't need to change your diet. If you're eating a healthy diet, just eat that healthy diet. And it's even more important to double down on very nutrient dense food and the idea that you have to gain all this weight or anything, it's just nonsense. And I think there is this kind of meme out there and I don't know how it ever started, but just like that it's okay to gain a ton of weight during pregnancy. It's really not. Dr. Elizabeth Boham: It's really important not to, because that really is impacting your outcome, your risk of prediabetes, diabetes and cardiovascular disease, postpartum. Really what's recommended, at first trimester really, there's no extra calories that are recommended. About 350 extra calories a day for a woman in their second trimester and around 400 to 450 extra calories a day in their third trimester. And so it's not a ton of extra calories and it's really important that we're making those extra calories from really good nutrient dense foods so we can feed that baby and that baby's brain properly. Some of the things that we know impact risk too. There's definitely a genetic component here. And one of the things that I think is interesting to pay attention to is L-carnitine. L-carnitine or carnitine is a really important nutrient that helps the body with using food and especially your fat, for energy. Dr. Elizabeth Boham: And it's really an important nutrient for metabolic flexibility, which means the ability to shift from using your fat as energy and using carbohydrates as energy. And when people have diabetes, insulin resistance, prediabetes, gestational diabetes, they're not as metabolically flexible. And sometimes when we look and check, we also find that they're low in this nutrient carnitine. Dr. Mark Hyman: Yeah. And where does that come from? Dr. Elizabeth Boham: So it comes from a lot of our animal protein and some people, probably based on either their diet, of course, if they're low in animal protein or based on genetics and just having an increased genetic need- Dr. Mark Hyman: The word carnus, which is meat in Italian and Spanish, that comes from carnitine and the highest source of carnitine in animal foods is lamb. Which is my favorite. Dr. Elizabeth Boham: I'd like lamb too. So I think that sometimes we have to be a little more careful with patients who are on a lower animal protein diet, or we'll just look at things like carnitine levels in the blood, or you can do functional carnitine levels with an organic acid test that we look at. We look to see where somebody's at in carnitine. Dr. Elizabeth Boham: A lot of really good prenatal vitamins out there. When a woman is looking for prenatal, I always say a couple of things, you want to make sure there's methylfolate in it, that it's not folic acid. That's a good sign that it's a good prenatal vitamin. And a lot of the good prenatal vitamins also have L-carnitine in it. And L-carnitine just helps the body's metabolism. It helps it do what it needs to do and use those nutrients for energy and fuel. Dr. Mark Hyman: Exactly. It helps you burn the calories, right? Dr. Elizabeth Boham: Mm-hmm (affirmative). Dr. Mark Hyman: Hey everybody, it's Dr. Hyman, thanks for tuning in to The Doctor's Farmacy. I hope you're loving this podcast. It's one of my favorite things to do and introducing you to all the experts that I know and I love, and that I've learned so much from, and I want to tell you about something else I'm doing, which is called Mark's Picks. It's my weekly newsletter. And in it I share my favorite stuff, from foods to supplements, to gadgets, to tools to enhance your health. It's all the cool stuff that I use and that my team uses to optimize and enhance our health. And I'd love you to sign up for the weekly newsletter. I'll only send it to you once a week on Fridays. Nothing else, I promise. And all you have to do is go to to sign up. That's, P-I-C-K-S and sign up for the newsletter. And I'll share with you my favorite stuff that I use to enhance my health and get healthier and better and live younger longer. Dr. Mark Hyman: Now, back to this week's episode. What are the specific things you would say to women that they should focus on when they're pregnant or if they're maybe a little overweight or maybe they've diabetes in their family and they're a little concerned about gestational diabetes, what are the most important things to focus on in terms of your diet? Dr. Elizabeth Boham: Yeah. You were spot on with the pegan diet. It's right on, you're saying, avoid the refined carbohydrates and simple sugars. There's no need for them, it is important to pay attention to that when you're pregnant, sometimes, I know for myself, I would get so hungry, so fast. And so if there wasn't good healthy food around, like you said, you can sometimes just eat anything because I was like, I would have driven through KFC to pick up some chicken and potatoes because I was so hungry so fast. So it's really important to plan ahead and have good, healthy food around. So when you do get hungry, you've got what your body needs. Dr. Elizabeth Boham: So really watch the refined and processed carbohydrates, get those carbohydrates from your vegetables, your root vegetables, make sure you're getting good, healthy fat at every meal, good protein source at every meal. And when you're in the second and third trimester and you're needing that 300 to 400, 500 extra calories a day, really make it a comprehensive meal where it has good, healthy, fat, good, healthy protein, and healthy fiber in each meal to help keep that blood sugar more stable. Dr. Mark Hyman: So you really don't need bread. You really don't need rice. You don't need potatoes. You don't need sugar. Dr. Elizabeth Boham: No, there's no problem if you want to have a little bit of healthy rice, small serving as part of a meal, I think it's fine in moderation, but you don't need extra amounts of it. You don't need a lot of extra amounts of potato. You want to be thinking about nutrient density and we're talking about a lot of extra calories, 300 to 500 calories is not a lot- Dr. Mark Hyman: What would that be in terms of food? Dr. Elizabeth Boham: It's a great question. It depends on what kind of meal we're talking about. It would be maybe a half, a sweet potato, three ounces of salmon and a glut of vegetables on the side with a little olive oil, that would be that amount of food, or from an unhealthy food perspective, it might even be just one muffin. Some of those muffins out there are just jam packed with- Dr. Mark Hyman: One extra soda. Dr. Elizabeth Boham: Yap, one extra soda. So those are some examples of the 300 to 500 calories, or a handful of nuts on some good, healthy seed crackers. Great source of fiber, protein and healthy fats. Dr. Mark Hyman: So tell us about this patient you had that had gestational diabetes, who you kind of might not have thought would be someone who would have it. Dr. Elizabeth Boham: She came to see me at the age of 30 and she was told she had gestational diabetes. She was Asian and she was of normal weight. She wasn't overweight and she hadn't gained excessive weight. So she was really frustrated with this diagnosis. And so we did talk about the fact that there is some increased risk for Asian patients. So we do see that. And we did talk to her about really paying attention to those extra carbohydrates, that she needed to be more careful. So we had to pull out all that extra white rice. We had to really work to lower the glycemic impact of that diet and really focus on getting again, her carbohydrates from her vegetables and making sure she's having good healthy fats. Dr. Elizabeth Boham: We also gave her a good prenatal vitamin that was rich in that methylfolate, had extra L-carnitine to help support her body's utilization of her food for energy. We made sure she was getting enough of those omega-3 fats. And I actually gave her some myo-inositol. Dr. Elizabeth Boham: Myo-inositol is a supplement that helps support insulin sensitivity. And you can use it pre-pregnancy to decrease risk of diabetes. And sometimes we can use it with pregnancy. What's really important there is that you work with your own personal physician and make sure that they know that you're taking it or they approve then they think it's okay that you take it. Dr. Mark Hyman: I think this case is very interesting for a reason, is that, is this patient at a normal weight? Dr. Elizabeth Boham: Yes. Dr. Mark Hyman: And she was also Asian, and we know that certain populations are much more likely to get diabetes, whether the Pacific Islanders, Native Americans, African-Americans, Africans, but also Asians and East Indians from India. And they get it in much lower weights. So they don't even have to be considered overweight at all, like a BMI under 25 or obese. This woman was like that. What is going on with these patients? Dr. Elizabeth Boham: Right. It's a great question. And I think it's probably multifactorial, the question of is it because they're just getting too many carbohydrates in their diet, so they have a healthy diet maybe, but it's just too much. Maybe she was just getting too much white rice. There's probably epigenetic shifts that have occurred probably because of toxins in the environment, maybe shifts in her microbiome. I don't think we've got it all figured out, but it's interesting. Dr. Mark Hyman: They tend to deposit visceral fat, this belly fat, much easier and they might look okay, but they have this little pudge in the middle. And that little pudge, even if it's not considered overweight, is still extremely risky. And in this woman, she clearly had prediabetes and gestational diabetes that resulted from this, probably a little extra belly fat and this visceral fat. And it was probably from eating a lot of refined carbohydrates, and it might not have caused her total weight to go up, but actually it was giving her this risk. Dr. Elizabeth Boham: My dad always likes to say, life is unfair and he used to drive me crazy, but it's really true. That for some people they have to be even more careful with the amount of carbohydrates they take in, and that there's a wide range and we definitely all want to be careful of the amount of refined and processed carbohydrates, but some people need to be even more careful. So the visceral adiposity is really important to pay attention to, is how much weight you're putting around your mid section. And if your waist to hip ratio is greater than 0.8 for a woman, then you're putting too much weight around your belly. And that is a sign that your metabolism is not working properly. And the way that you're turning your food into energy, isn't working optimally. Dr. Mark Hyman: The truth is, the time to think about all this stuff is before you get pregnant, right? Dr. Elizabeth Boham: Yeah, optimally. Dr. Mark Hyman: People are taking a prenatal after they get pregnant. You want your nutrient levels tanked up. You want your metabolism optimized. You want your insulin levels low. You want your nutrient dense diet to be dialed in before you get pregnant. Dr. Elizabeth Boham: Optimally. Yes. Dr. Mark Hyman: And I think this is really important because we are not only dealing with the immediate issues and risks of pregnancy and complications from pregnancy that happened with gestational diabetes, but we're dealing with how we program through epigenetics, the future generations that are coming. And that is something that is a very weighty task. And we should take it seriously as a population. And what I'm terrified is, we're creating a whole new generation of people that has never happened like this before. Dr. Mark Hyman: So we're seeing obesity and chronic disease now, but like I said with COVID, the effects of the problems we're seeing in our children and with pregnancies and obesity, we're going to be in trouble in 10, 20, 30 years. The generational effects of this on our children, on their health risks, on the cost to society, on the disability and disease is going to come as a result of it is, is no joke. And we need to take this seriously. And this is really why we really focus here at the UltraWellness Center on food first approach, on food as medicine. Dr. Mark Hyman: That's why I wrote the book Food Fix, to really detail why we need to fix our food system, because it's not always an individual issue here. We are growing food that's making us sick, were producing food that's making us sick and fat, we're marketing the food that's making us sick and fat. We're giving the food to our population through our government programs, that's making us sick and fat and through schools. It's such a pervasive problem. And unless we have a coherent approach that understands the connections between all these things, I'm terrified for what's going to happen in the next 50 years in this country. Dr. Elizabeth Boham: Yeah. And I think COVID-19 really highlighted that and how important it is. We've gotten a little lazy, in this country thinking we can fix everything and that we've got such a high percentage of our population has this underlying inflammatory condition that just puts them at increased risk for getting serious outcomes from this illness and infection. And so it's really highlighted the importance that we have to be dealing more with the prevention of these chronic diseases. And like you mentioned, the importance of that food fix and dealing on it on every level, from a government food policy all the way down. Dr. Mark Hyman: Yeah. So I think we have a long way to go in helping our society just deal with this. And I think the burden right now, honestly, it has to be on individuals and particularly mothers who are thinking of having babies, who want to get pregnant or are pregnant, to really double down on their health. This is not a time to just say, well, "I'm pregnant. I get to eat whatever I want. The doctor said I can gain weight. It's not a big deal, don't be hungry. I got morning sickness, just eat a lot of junk." Do not do that. You will not be happy, your baby will not be happy. And the future of you and your baby's health is really at risk. So I think this is such an important topic and we just sort of scratched the surface, but it's really not only about gestational diabetes, but it's about how do we create a healthy human from the start, because we programmed that baby's health in the womb. And we also have so much impact when we do it right. Dr. Elizabeth Boham: Yeah. I agree, Mark. So it was a great topic to delve into. Dr. Mark Hyman: Well, thank you so much for being on The Doctor's Farmacy again, Liz. If you listening, have loved this podcast, please share with your friends and family, leave a comment, we'd love to hear from you and subscribe wherever you get your podcasts. And we'll see you next time on The Doctor's Farmacy. Dr. Elizabeth Boham: Thank you, Mark.