Medicating the Unborn

      45 Comments on Medicating the Unborn

Just when I think the medical profession can’t sink any lower, it digs a trench a climbs in.

My previous post was about a new study claiming that surgery reverses diabetes more effectively than diet and drugs – the only problem, of course, was that the diet was the American Diabetes Association’s high-carbohydrate diet.  The study was set up to produce a better outcome for surgery.  That’s sinking pretty low.

Now here’s the new low:  Researchers are giving a diabetes drug to pregnant women, essentially drugging their unborn babies, in an attempt to prevent the babies from becoming obese.  Here are some quotes from an article in the U.K. Daily Mail:

In a world first, dangerously overweight mothers-to-be in four British cities have started taking a diabetes drug during their pregnancy. The doctors behind the controversial NHS trial say that obesity among pregnant women is reaching epidemic proportions and they need to act now to protect the health of tomorrow’s children.

Yes, they do need to act now.  They could start by telling pregnant women that the Eat Well Plate (the UK’s version of our USDA Food Plate) is a crock of @#$%.  Here’s what the official Eat Well site recommends:

  • Plenty of fruit and vegetables
  • Plenty of potatoes, bread, rice, pasta and other starchy foods
  • Some milk and dairy foods
  • Some meat, fish, eggs, beans and other non-dairy sources of protein
  • Just a small amount of foods and drinks high in fat and/or sugar

So you’re an obese, insulin-resistant British mom-to-be, and you follow the Eat Well guidelines by eating plenty of fruit, plenty of starchy foods, and just a bit of meat and dairy.  Great.  You just sent your blood sugar through the roof.

I swear, every time I see these government goofballs put fat and sugar into the same category, I want to kidnap two of them, stuff a pound of sugar down one’s throat and a pound of lard down the other’s, then have them compare notes on the effects.  They might notice a slight difference.

However, there is likely to be unease about resorting to medication in pregnancy for a problem that can be treated through changes in diet and exercise.

Yes, this problem can be treated through changes in diet.  But not if the diet consists of plenty of fruit and plenty of potatoes, bread, rice, pasta and other starchy foods.

If the strategy is a success, the treatment could be in widespread use in as little as five years, with tens of thousands of overweight but otherwise healthy mothers-to-be drugged each year.

This will be a boon not just for the pharmaceutical industry, but for the paper industry as well.  Doctors will be going through prescription pads like crazy.

The Daily Mail recently revealed the rise of the ‘sumo baby’, with the number of newborns weighing more than 11lb soaring by 50 per cent over the last four years.

Remember the days when a big baby was considered a healthy baby?  Not anymore.  Now more and more babies are big because they’ve already been biochemically programmed to become obese.

The trial involves 400 pregnant women in Liverpool, Coventry, Sheffield and Edinburgh. They have started taking metformin, which has been safely used by diabetics for decades and is cleared for the treatment of diabetes in pregnancy. It costs just pence per tablet.

Okay, maybe not a huge boon to the pharmaceutical industry.  But tens of thousands of prescriptions will still add up to a tidy profit.

The study aims to exploit the ability of metformin to lower levels of the hormone insulin in the bloodstream. Obese women make more insulin than other mothers-to-be and this leads to a greater nutrition supply reaching the baby. It is hoped that lowering levels of insulin will reduce the supply and so cut the odds of babies being born obese.

What, they’re blaming high levels of insulin?  No, no, no .. insulin has nothing to do with becoming obese.  Just ask all those people who are calling Gary Taubes an idiot on their blogs.  The problem here is food reward.  The moms are eating too much palatable food, so their babies are sitting there in the womb thinking, “Dang, that’s good stuff!  Salty, sweet, fatty … delicious!  I’m going to open the spigot on my feeding tube and have another couple of servings!”

Study leader Professor Jane Norman of Edinburgh University said: ‘One of the challenges is that many women feel perfectly healthy but there is very good evidence that women who are obese have an increased risk of pregnancy problems and their babies are at risk, and we’d like to reduce that risk.’

Addressing concerns about unborn babies being medicated for a problem that many would say could be treated by diet and exercise, she said: ‘I absolutely support the improvement of diet and encouraging exercise. ‘But we are increasingly faced with women who start their pregnancy obese. Saying at that stage to eat less and exercise more is not particularly helpful.’

No, we shouldn’t be telling pregnant women to eat less.  We should be telling them to eat differently.  We should be telling them to adopt a diet that doesn’t pump their unborn babies full of insulin.  Giving pregnant women a drug to beat down their glucose and insulin levels when switching to a low-carb, high-fat diet will accomplish the same goal is just nuts.

 

p.s. — I apologize for going all day without checking comments.  I was juggling projects and just now got around to it.

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45 thoughts on “Medicating the Unborn

  1. js290

    Food reward is a specious explanation of the Conservation of Energy, which as a Law of Science must absolutely hold true, but is often confused as a cause rather than correctly as an effect. People who still talk about energy balance as it relates to metabolism obviously do not understand science nor do they offer any useful insights into metabolism.

    Exactly. We don’t explain an overflowing toilet by saying it’s taking in more water than it’s flushing out.

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  2. Davida

    I am type 2 diabetic and take metformin sometimes (right now I’m taking the herbal version, because it is a known galactogogue.) I have elevated blood sugar often even when I eat very low carb….not NEARLY as high as when I eat “normal”, but still elevated. Metformin seems to act in two ways: to make the cells more sensitive to insulin and to slow the creation of glucagon. It also reduces fatty liver. It normalized my hormones enough so that I got pregnant after 15 years without pregnancy due to PCOS. It did not work like that when I was eating a “diabetic’s” diet, but only when going low carb (low carb by itself did not work either…it wasn’t til the two were put together that things started straightening out.) If there are some diabetic/obese women who just cannot seem to change their diet at first metformin may be able to help til they are able to. It isn’t without risks… B12 deficiency is common, and if a person’s digestive system doesn’t do well on it, it can lead to other deficiencies. It can be a tool if there are multiple issues going on, etc. It should not, however, be pushed to every overweight pregnant woman out there, like statins are to….well, everyone. I’m not sure exactly how strong the link to superhuge babies is with obesity either. Is it a “slight increase”, “moderate increase”, or “major increase” in the numbers of huge babies born to overweight mothers? I would be considered obese, as would my sister. My one-year-old was 6 lbs 10 oz, and that was included the extra weight from iv fluids used in the c-section. My sister’s 4 month old was 7 1/2 lbs. Anectdotal, i know, but I know of many more overweight women with low and normal weight babies. Pushing drugs may just stress the women out….

    Some people need the drugs, no matter what diet they’re on. But drugs should always be the last resort.

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  3. Katy

    I was overweight when I discovered I was pregnant in 1975, and decided to eliminate starchy foods, bread, etc., and just eat protein, vegetables, milk, and some fruit. At the hospital prior to delivery, I weighed what I did when 9 months earlier. Three days later at home, I had lost 25 lbs., and had a healthy baby girl. I understand the mandate to not “diet” when pregnant, but as you said, overweight women can eat differently and have healthful outcomes. Also, chronic low blood sugar can damage the baby’s brain.

    Pregnant women shouldn’t have to go hungry. They just need the right diet — and so does the baby.

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  4. gollum

    A German poster at

    http://www.dasgelbeforum.de.org/forum_entry.php?id=252463

    claims pregnant women are being aggressively checked for gestational diabetes and if they fail the OGTT, put on near-starvation diet [That’s my term, not his – the usual whole bread, veggies, tiny amounts of meat etc., rationed, not ad lib!] and failing that, insulin. Goal to keep birth weight down [literally]. Poster is not sure how to see good motive behind this. Poster mentions doctors being evasive/defensive to critical questions (literally, “blocking”).

    Well, it is certainly nice that they are actually checking for gestation diabetes – I mean, I was literally born fat (by sight and documented weight), and no one seemed to care (though I do not know whether g.d. was tested for), though there were certainly lots of “fattie” and “exercise more” comments; gee thank you.

    However, strict dieting while pregnant – I mean, you certainly can imagine my comment; and with the insulin, I am not sure whether that fixes more than it damages; would have to look up fetal metabolism but the insulin is acting on the fetus too, right?

    That’s nuts. With the right diet, there’s no need for pregnant women to go hungry.

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  5. Joey

    Oh man, that’s just sick. Now the pharmaceutical industry is trying to get people on a lifetime of meds before they’re even born!

    By the way, Tom, I get the feeling that you’re pretty adverse to fruit. What gives? I eat a lot of fruit, especially during spring and summertime but I never have a problem with it. From time to time I live only on fruit and it just gives me a lot of energy without getting cravings or energy dips.

    Some fruit in the diet is good. But if you’re insulin resistant and filling up your plate with fruit (which the government goofs put in the same category as vegetables) and starches, it’s just too much glucose-producing food.

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  6. Sahanya

    You are so right. I am pregnant, I got pregnancy diabetes and I changed my diet to a low-carb diet AGAINST the recommondations of the doctors.

    Every time I have an apointment with the doctors, which is every 3 weeks, I have to fight/argue with them. On the one hand they have to admit that my blood values are excellent, but on the other hand they critizize my diet and constantly tell me to eat more carbohydrates!

    They are telling me that I will get fat, although fact is that I lost a total of 2 kg during my pregnancy so far and Im now in my 32 week!

    I feel excellent and will stick to a low-carb diet also after the pregnancy. I´m not obese but overweight, so I hope to loose those remaining extrakilos.

    It´s a shame that a lot of doctors are so ignorant and I´m glad I´m in the situation to inform myself.

    How’s that for logic? Your results are great, but we want you to stop doing what’s producing those results.

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  7. Tammy

    Tom – I commend you for all your work. I see articles like this pretty much everyday too and all I can do is shake my head. Sometimes it seems pretty overwhelming. Thanks Again !!

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  8. Auntie M

    Sigh. I’m one of the people who needs to take metformin at the beginning of a pregnancy because of my PCOS. I took it in the first trimester, while eating my low carb menu and doing insulin shots, because my body goes nuts when I’m pregnant. With PCOS, the miscarriage rate is about 70% for women who don’t take metformin. At least that’s according to my endocrinologist. They didn’t seem to want me on it after the first trimester, though. One of the docs said it was “probably” fine, but I was under good sugar control, so I didn’t need it.

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  9. Auntie M

    Also, I’m sick of being maligned by the medical community for my weight as though I’m fat on purpose. I’m overweight BECAUSE of my insulin resistance, not the other way around. I was in my late 20s before I discovered that the high-carb, low-fat way was making me sick. I’m still fighting to fix those problems at age 37.

    I swear the word “obese” was written on my medical discharge papers after my baby was born at least three times, but “diabetes”, “high blood pressure”, and “preeclampsia” were mentioned once each, and PCOS wasn’t even on there. Cart before the horse, anyone?

    They definitely get the cause-and-effect backwards.

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  10. Mike P.

    My wife, who is completely normal in terms of health and fitness, got gestational diabetes during the pregnancy of our second son. She met with the nutritionist to learn how to test her blood sugar, how to eat an ADA diet, etc. She goes home, eats the diet, tracks her food, her blood sugar skyrockets, and she can’t maintain the blood sugar levels recommended by the nutritionist. We were not Paleo/Primal/LC at the time, but I was in the middle of reading the Primal Blueprint and GCBC. A week or two of uncontrollable blood sugar is enough to order up insulin shots for a pregnant mother. My wife was über-determined to not take insulin shots. So she started looking at her food log and figuring out what foods raised her blood sugar and which ones didn’t. By this time, I’m all on board for a Primal lifestyle. Having gone through that personal experience, she was on board too. The sad thing is that when she showed the nutritionist the diet log and the resulting good blood sugar numbers, the nutritionist was upset she wasn’t following the diet. So my wife continued to eat what she knew would work and just lied to the nutritionist for the remainder of the pregnancy. Subsequently, our son has a metabolism off the charts. He is only 2, but he eats almost as much as our 5 yr old, has endless energy, and is lean. He is programmed for a lean body because of how my wife ate during the pregnancy.

    Sorry for the long comment but this story hit home for me. It’s scary what new “treatments” doctors are coming up with. What ever happened to preventative medicine?

    Keep up the great work Tom!

    Mike

    No apologies necessary for the long comment. It’s a compelling story.

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  11. Anne

    “I swear, every time I see these government goofballs put fat and sugar into the same category, I want to kidnap two of them, stuff a pound of sugar down one’s throat and a pound of lard down the other’s, then have them compare notes on the effects. They might notice a slight difference.”

    Note to all govt bureaucrats – If two of your “friends” mysteriously disappear after the release of some stupid nutritional study, you know where to look. 😉

    ((It made me laugh as I’ve thought the exact same thing many times!))

    I hope a couple of USDA bureaucrats don’t disappear anytime soon. I’d be a suspect.

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  12. Isabel

    I do have to say, that metformin’s impact on insulin resistance allows many women with Poly Cystic Ovarian Syndrome to become pregnant. I had been taking Metformin for years (for the PCOS, not diabetes) when I became pregnant with my second child. I continued to take it during my pregnancy because I acquired gestational diabetes and was able to manage the GD with the metformin and a low carb diet of about 100 carbs per day. I lost 20 lbs during my pregnancy and never had to take any insulin. My daughter weighed the same as my older son did at birth, but I can definitely see a difference in her physical structure. While my son has been ‘chunky’ all his life (I suspect that I had GD during his development, which was uncontrolled by either medication or diet), my daugher is much slimmer.

    I agree that a mother’s insulin and glucose levels during pregnancy can impact their child’s predisposition for insulin resistance and obesity, but I disagree with giving metformin to healthy mothers. Rather, I think that women should lose the mindset that they can gain 40, 50 or 100 lbs during pregnancy. They are not only setting them selves up to never lose the additional weight, but they are impacting their child’s health. Also, huge weight gain during pregnancy will almost certainly guarantee undiagnosed and untreated GD in the last few months of pregnancy. What I would like to see is a study showing weight gain during pregnancy compared to the childs weight at birth, 2yrs old, 10 yrs old, etc…

    I was lucky to have a great gestational endocrinologist who did not endorse the “eat carbs, take insulin” strategy that the ADA seems to recommend. I followed a strict diet, ate according to my meter (glucose levels 7 times a day!), and learned exactly what a low carb diet can do for my body.
    Yes, my weight goes up and down, but I have managed to lose 100 lbs and can keep it off as long as I stay on a low carb diet. I am now off the metformin (A1c of 5.3), but I already know that I will resume it when I want to get pregnant again.

    Some people need metformin, even if they’re on a low-carb diet. But the drugs-first mentality drives me nuts. It should be a low-carb diet first, then drugs if and only if eliminating the foods that spike glucose levels isn’t enough.

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  13. NM

    I enjoyed your swipe at those who attack Taubes and think that “palatability” and “food reward” explain everything. Those who think that it explains anything need to look up the logical meaning of “begging the question”: another word for “hyper-palatable” is “insatiaitng”, if you think about it. And what is it about sweet, simple carbs in particular that makes them just so constantly palatable without ever *satisfying* said palate? In the end, the proponents of food reward simply say that palatable food is rewarding because it is palatable. Gee. Thanks.

    Even if Taubes’s thesis has gaps and needs refining, at least it is a thesis that doesn’t simply chase its own tail!

    I don’t doubt that certain combinations of flavors encourage us to eat more — that’s what food-industry scientists are paid to figure out — but some people are assuming that if palatability explains some cases of over-eating, it must be the whole ball of wax when it comes to obesity. As Dr. Lustig pointed out when I interviewed him, gluttony can’t explain the rise in the number of obese babies.

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  14. Beowulf

    It’s amazing how entrenched the LF dogma is, as is the “Healthy Whole Grains” mantra. They are valued by the medical system to the point that adhering to that regimen is more important that actual health.

    They just can’t shake the belief that fat is bad for us, so therefore our diets should be mostly carbohydrates.

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  15. bigmyc

    But ah…’taking’ drugs when a proper (natural) diet will do even better IS nuts.
    ‘Prescribing’ drugs when a proper diet will do even better is profitable.

    The idiot circus has no shortage of clowns in the medical/health field but those ringleaders know exactly what is up. You could go ahead and group them with the “conscientious non-cognizants” of Wall Street, Pesticide manufacturers, Military Contractors, Grain and Soy Agro and the like, et al.

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  16. Joe Lindley

    Great article Tom! While agreeing with what you say, my question is for the obese mother-to-be that either refuses to diet/exercise or who is forced into the high carb diet mentioned here that won’t work. Is it better for her to take the Metformin? We are focused on the overarching diet issue, but what about those pregnant women who are going to go to term with gestational diabetes?

    In that case, they probably need the drug. But if pregnant women were told to avoid sugars and starches, a lot fewer would develop diabetes.

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  17. Jen

    In general it is a bad idea to hand out drugs indiscriminately, but metformin is quite possibly one of the most beneficial and least dangerous drugs in existence. At least it will partially mitigate the effects of the unhealthy diet prescribed along with it.

    Sure, some people need metformin. But if we dumped the high-carb diets first, far fewer people would need a drug.

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  18. Cor Aquilonis

    Yeah, right; hyper-palatability is crap. Compare my last night’s dinner of homemade-from-scratch cocktail shrimp and cocktail sauce (less than 1T, from homemade low-sugar ketchup), plus wedge salad with Roquefort dressing and strawberries and cream with what I used to eat before low carb: veggie pizza, vegetables, chips and sweets.

    I assure you, last night’s dinner was far more palatable than the high carb meal, yet I was able to be far more satisfied on fewer calories, and felt better after eating it. I think your term of “insatiating” is far more useful and descriptive than “hyper-palatable.”

    PS – I got “Nourishing Traditions” by Sally Fallon after you mentioned it on your blog, and thank you for the tip! It’s where I got the ketchup recipe – I will never have store ketchup again. Homemade is so, so tastier.

    I believe the food reward idea makes sense in that some foods — sugar and wheat, for example — produce a cocaine-like effect in the brain. But I don’t believe mere palatability causes over-eating. Like you, I enjoy delicious meals without feeling any desire to stuff myself.

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  19. Joe Dokes

    Finally ordered Fat Head and your other DVDs and watched Fat Head with my wife. My wife was / is a constant yo-yo dieter (of course she was following traditional low fat high carb diets).

    At the end of the movie my wife exclaimed, “This is the exact opposite of everything I’ve ever heard.” I responded, “Yeah and that’s why you haven’t been able to lose weight and keep it off.”

    By the way, I liked the movie, not much new information to me as I’m a frequent reader of your blog and have read Taube’s GCBC. The absolute best part was when you went back to your doctor and had your weight and cholesterol checked. The incredulous look on his face when your cholesterol and weight numbers were lower.

    I think the look on his face, and the fact that he couldn’t believe the results showed how much education needs to take place. The above post also shows the level of education that needs to take place. Recommending a high carbohydrate diet to a diabetic is criminal.

    Keep up the good work.

    Regards,

    Joe Dokes

    The doctor’s reaction was priceless. So glad we caught that on camera.

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  20. Dave, RN

    Wow. Lots of PCOS here. Google “PCOS and iodine”. You probably don’t have enough iodine in your body. All those halides (flouride and bromine) in our water and bread displace iodine. Used to be that each slice of bread had 100 mcg of iodine, until they substituted bromine (basically a poison) for the iodine. Lots of bromine in hair coloring as well.
    It’s a big subject. I think the book “Iodine, Why You Need it and Can’t Live Without It” is as important as “Good Calories, Bad Calories”, or “The Primal BluePrint”. Or “FateHead” even. 🙂
    Look at it enough and you’ll get as disgusted at the iodine issue as you do with other Conventional Wisdom issues. Maybe more so.

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  21. Brad C. Hodson

    Really? Shooting pregnant women full of drugs is preferable to having them eat less suagr? Wow. And I thought we had already seen the bottom level of idiocy. It seems like the “experts” are armed with shovels and continuously dig deeper to find a new low.

    My wife is pregnant and is taking her glucose screening test today. She’s been nervous about how someone who never eats sugar or bread will react to a sudden shot of 50 grams of sugar on an empty stomach. How does that actually reflect the way her body normally processes insulin? (She’s written about it on her blog at http://theprimalsophisticate.com/2012/04/05/glucose/).

    I’m prepared for them to falsely tell her she has gestational diabetes and then for us to smugly to ignore the dietary guidelines she’s given over a plate of bacon.

    Do whatever you have to do.

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  22. Jana

    This news article was so annoying. I couldn’t believe how stupid their ideas are. All I could think of was that back at the turn of the 20th century, Lou Gehrig was born at 14 lbs. if you look at pictures of him he is thin. Having a heavy baby at birth does not condemn them to a life of obesity. What people eat after they are born is a greater determining factor. Are they trying to kill the human race with their idiotic ideas?

    It depends on why they’re born big. If babies are born big because they were exposed to high levels of insulin in the womb, that is a problem. They’re being programmed to be fat.

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  23. JFlaminio

    So, is this implication that large babies will become obese children? My last one was a whopping 9 1/2 pounds (at least, it felt whopping to me), and eleven years later is tall, slim and wants to run cross-country in the fall. Is a large baby now considered a bad thing?

    Insulin acts as a growth hormone, among other functions. If babies are being born at 10+ pounds because they’ve been exposed to high levels of insulin in the womb, they can be born with insulin resistance already developing.

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  24. Rachel

    I also applaud your mentioning this whole anti-Taubes thing online. It’s been quite depressing to see. Why has the carbs/insulin hypothesis been declared dead so summarily, by so many? I missed the memo, clearly.

    There’s no doubt in my mind that some foods are addictive; they create the desire to eat more of such foods, in some people. Seems to me a huge leap from that to “…and that’s what makes us fat!”. Show me your working!

    As for obese pregnant women, I’ve no idea how to get the Department of Health or the NHS to change dietary advice, but I can tell you this- the NHS webpages allow comments, and last time I checked every single comment on the diet advice page took issue with the EatWell Plate, the lipid hypothesis and the energy balance theory of obesity. The truth will out! 🙂

    That’s why I believe the Wisdom of Crowds effect will turn things around. Supposed experts post the same old advice and they get slammed in comments.

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  25. Bex

    This is horrific but I’m having difficulty working out who’s making money out of this. The drugs cost pennies and pregnant women get free prescriptions so the NHS will spend a fortune it can ill afford. It’s still scary though…..

    The makers of metformin will certainly make money, if not a fortune.

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  26. FrankG

    Good nutrition during pregnancy seems to be a major key to long term health for that child. Applying the “eat less, move more” logic to the issue of overweight babies is only going to make the problem worse.

    When I read this Tom, it reminded me of a recent story in the health news here in Canada:

    CBC News ~ Preschoolers urged to reach and move for health…

    “Children under age four should move at least 180 minutes a day, according to the first Canadian physical activity guidelines for that age group …

    Adults may assume that young children are naturally busy and active, but measurements indicate they are sedentary — just sitting or reclining — up to 84 per cent of their waking hours.

    By age five, kids should work toward at least 60 minutes of “energetic play,” such as hopping, skipping or riding a bike with a helmet.”

    Once again the “eat less, move more” thinking, leads to the blaming of our infants for their “behaviour” in leading to excess fat mass. This despite the evidence you recently reminded us: showing that in school children the obesity predates the lack of motivation to be physically active… rather that the other way around.

    I certainly don’t have to encourage my girls to move around.

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  27. Helen

    Hi Tom, here in Australia I was one of many Mums with Gestational Diabetes who took metformin as part of a study. I was happy to do it after receiving the terrible diet info from the dieticians in my previous GD pregnancies and having to take massive doses of insulin instead. It makes me sad to think of the effects of all that insulin and the hypos I had the last time I was on it were quite scary. I happily signed up for the metformin to be able to reduce the amount of insulin dosage they were pushing on me. (multiple injections per day – why did I listen to them?)
    My last pregnancy, I was able to take Metformin alone with no insulin at all. Why? because I ignored the dieticians advice and ate more good fats and avoided many high GI carbs. That was before I discovered LC and Paleo. I figured this out for myself.
    I was assured that Metformin doesn’t cross the placental barrier. The effects were on my side, and decreased the high blood sugar affecting the babies growth.
    With my first few GD pregnancies, I was controlled by diet alone. I never understood why they pushed eating low fat when it was clear by my self monitoring that my blood sugar levels were much better eating fatty things. I remember being scolded by the dietician for eating a whole punnet of strawberries one day (though I was really craving a chocolate bar). I’m not stupid, I looked up the carbs and compared them to how many were in an apple and made a decision that as a special treat I”d rather eat a pile of strawberries instead of an apple. I was made to feel like a greedy pig. It was probably at that point I stopped listening to what they had to say.
    Having had GD so many times, becoming progressively worse each time (7 pregnancies), there was an extremely high risk of developing type 2 diabetes, and so it was, just over a year ago, I was on the cusp of doing so, with some debilitating symptoms, when I took action. I ignored the standard medical advice and started low carb with great results.

    You were lectured for eating strawberries? By some nutritionist who probably thinks whole grains are fabulous? Sheesh!

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  28. Janknitz

    I am another woman with PCOS who took Metformin, in this case AGAINST my OB’s recommendation. First, let me say I had PCOS from the beginning of puberty when I was very thin, and I grew up where the water was NOT flouridated. I grew up on a tropical island, ate a lot of seafood and seaweed, so I highly doubt iodine deficiency was my problem. I believe there is a genetic connection here, as my mother had all the symptoms as well, though never diagnosed. Obesity does not cause the majority of PCOS either, though many women with PCOS will eventually become obese.

    I had to go through multiple In Vitro procedures to conceive my first child. This was 20 years ago, before the metabolic causes of PCOS were known. 8 years later I began following a low carb diet and taking Metformin to treat my PCOS. I was 40 at the time and laughed when the endocrinologist suggested I could get pregnant–I had been infertile all my life. The big laugh came 6 months later, when I found myself pregnant (unplanned, but very much wanted!).

    I did a lot of research. What I learned is that there was an enormous risk of miscarriage in the SECOND trimester for women with PCOS because of the insulin resistance issues. Placental blood clots were common, leading to fetal demise. Some doctors were studying whether or not continuing Metformin during pregnancy would prevent that. I joined an observational study against my OB’s recommendation and I took Metformin throughout the pregnancy while still eating a fairly low carb diet (I was advised to stay out of ketosis). The result was a normal, healthy pregnancy and baby.

    Would I have had a normal, healthy pregnancy and baby without the Metformin? We’ll never know. But I felt in my heart this was the right decision for me and my baby. My first IVF pregnancy was supported with all sorts of monitoring and treatment–I was left on my own for the second pregnancy and had to make this decision myself (my husband really didn’t understand all this, but trusted me to make the right decision). I knew there were risks involved (at that time, Metformin was still classified as a Class C teratogen), but for me, the benefits outweighed the risks.

    I agree that pregnant women should be counseled to follow an appropriate fairly low carb, high fat diet for optimal fetal health, and not simply put on Metformin as a first line of intervention. But I don’t agree that a blanket condemnation of the use of Metformin in pregnancy is appropriate. There are some instances when it may make a lot of sense for a pregnant woman to take it.

    I’m not against people who need metformin taking it. I’m against drugs being used as the treatment of choice when a change in diet would do the job for many women.

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  29. Peggy Holloway

    If you don’t follow Jay Wortman’s blog, I highly recommend reading about his wife’s low-carb pregnancy and their low-carb baby, who is now a healthy, active toddler. The video of her skiing is priceless.

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  30. grace (Dr.BG)

    I was communicating with the author of the below article which compared exercise to exercise+metformin. They found just like the Diabetes Prevention trial that metformin is not only is not as effective as exercise alone but also hampers the benefits of exercise (no lean mass increase) though like exercise alone it does improve insulin sensitivity. Exercise trumps the drug yet the politics of drug pushing continue to herald pill popping. I concur with your stance; diet, exercise FIRST. This is massively evident in the medical literature as well as our anecdotal experiences. I like the stories above!!

    ‘Independent and Combined Effects of Exercise Training and Metformin on Insulin Sensitivity in Individuals With Prediabetes’
    Braun, Malin
    http://care.diabetesjournals.org/content/early/2011/10/27/dc11-0925.short?rss=1

    For the PCOS I believe the main defect is insulin receptors and subsequent insulin resistance at the muscle level. Our muscles dispose of 80% of our glucose and when the insulin resistance is so high in the muscles, muscles do not grow and preferentially burn protein for a sugar source. Muscle IR is high due to high refined carb diets and high cortisol and lack of weight bearing exercise.

    What works for PCOS???
    — lowish carb diet (50-100 grams daily avoiding ketosis which will increase muscle insulin resistance; or ketosis should be cycled with higher carb days to maintain insulin sensitivity)
    — heavy resistance interval training (brief, episodic spurts of intensity to the point of mild hypoxia but avoiding spikes of excessive cortisol)
    — adequate recovery from exercise and cortisol control via relaxation techniques (excessively wonky cortisol breaks down our muscles and prevents lean mass gains)
    — magnesium, zinc and omega-3 high quality fish oil (which all sensitize insulin and lower excessive cortisol; and everyone is depleted and deficient)

    Good advice.

    Reply
  31. Jonathan

    The shot on food reward was priceless!! Sadly, Dr. Harris and Richard Nickoley are now believers of Reward and that in the end, Calories are all that matter. Those darn fat babies just took in more Calories than they needed. Guess we’ll have to make their food less rewarding so they stop over eating.

    I don’t believe the insulin hypothesis and the food-reward hypothesis are mutually exclusive, but food reward doesn’t explain the rise in obese babies as far as I can see. That’s a point Dr. Lustig made when I interviewed him awhile back: babies didn’t become more gluttonous.

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  32. tasteslikeburnt

    I started eating a low carb diet after watching Fat Head in December, at around 20 weeks pregnant. So far I have lost 18 lbs (from 226 lbs prepregnancy,) currently weighing 208lbs at 37 weeks pregnant. I thought my dr would have a freak out about the quick weight loss (10lbs in one month), but she just asked me what I was eating. I basically told her what I WASNT eating, without mentioning the words “low carb”, and she thought it was great, thankfully. So far I have had absolutely NO swelling, NO cravings and my blood pressure has gone down to a normal level from being prehypertensive before becoming pregnant. My glucose screening test even came back normal; I had been eating a low carb diet for about 4 weeks at the time of the test. Thank you Tom, I credit watching Fat Head to my having a (mostly) awesome pregnancy! PS my husband has lost about 30 lbs since changing his diet as well!

    Outstanding. Here’s to a healthy, bouncing baby. Congratulations to you both.

    Reply
  33. gollum

    Some fruit are high in fructose which has all sorts of evil effects (NA fatty liver, purine upregulation, laxative). Juices, being effectively pre-digested, are even more effective (130 g of sugars on the litre)
    Personally, I mostly eat fruit only when obtained very cheap.

    I found pictures of babies with Mehlnährschaden [“flour diet damage”] and Milchnährschaden [“milk diet damage”] in a 1960s book. First looks a bit like little Michelin man, second a bit like Gollum. I suppose that was cows’ milk – human milk is sweeter.

    Can muscles burn protein? I was under the impression that the liver did that and provided glucose.

    I was thinking about that OGTT. If you are LCing and having been carb-starved for weeks, shouldn’t you suck these up like a sponge since all the stores are empty?
    The experiment seems to indicate this does not happen.
    Then I remembered that the amount of glucose circulating in the blood is about a small spoon only. The insuline/glucagone system is designed to balance fractions of that amount.
    And then I started to wonder whether the OGTT actually measures carb problems:
    – If you are on a carb diet and snacking every 2.7 hours, shouldn’t you have baseline elevated insuline levels from the start, helping to buffer? This is a weak argument since the test in the paper ran over hours and baseline effects should diminish after like 10 minutes.
    – If you are on a carb/fiber diet, your small intestine is probably filled with.. something, mechanically inhibiting uptake. OTOH, if LC-carb-starved, the glucose uptake channels are probably up-regulated to the max. (Glucose, unlike fructose, is being actively taken in, not osmotically only, I remember I read that). So maybe the OGTT is measuring some combination of how good your bowel (uptake) and liver/muscles (storage) are and your max insuline levels. Some of that is certainly related to carb clearance (fatty liver full of glycogen and no muscles, I’d call that relevant), but the bowel, I wouldn’t say. It may also produce false negatives with damaged intestines (bariatric, Crohn, celiac?)
    You can see that the uptake rate is relevant by the fact that 100 g glucose in that 2-person paper produced elevated BG for hours. If it went all in at once they’d have a peak of like 800 and then a steady decline.
    These are just speculative thoughts, not facts; I welcome comments and pointers.
    OTOH explanation is the one given in the paper: pancreas adapts and makes more insulin. This is of course entirely possible, although the empty stores with carb-starving should make any insulin very effective?

    I think what we’re seeing is the body down-regulating its ability to handle foods that are rarely consumed … or you could look at it as up-regulating its ability to handle foods that are often consumed. Same process.

    I was a heavy drinker many years ago, and trust me, my body had up-regulated my ability to process alcohol. On the morning after my last binge (before giving up alcohol completely for three years), I counted 17 empty beer bottles as I threw them away. If I drank half that much beer now, I’d pass out and never make it to the fridge for that eighth or ninth bottle. However, I never tell myself I should start drinking heavily again so my body doesn’t lose its ability to process alcohol.

    Reply
  34. mezzo

    I believe in palatability – but not in the way those geeks do. The more palatable my food is the more satisfying I find it and that the LESS I need to eat. It’s when I am forced to eat plain, tasteless, bland, non-palatable stuff that I am NOT satisfied. As long as you stay away from the fattening combination of sugars plus fat there is absolutely no problem with palatability. I really think those guys have got it absolutely wrong.

    My meals are very palatable. However, if I eat chips or other high-carb junk, I can eat and eat without feeling satisfied until I’ve stuffed myself. I believe aspects of the food-reward hypothesis make sense — something in my brain is telling me to keep eating those chips way beyond the point of needing more fuel in my system — but I don’t see anything in the food-reward hypothesis that negates the insulin hypothesis. The chips trigger some kind of brain reward, I keep eating them, and drive up my blood sugar and insulin levels as a result.

    Reply
  35. James

    The main problem I have with the insulin theory are black swans. The black swan in this case are the Kitavans who eat a diet that is high carb & low protein/fat (70/10/20) yet they have no modern diseases. No obesity, heart disease or diabetes. The only fat Kitavan is one who moved to the main island and ate a modern diet. (this is key)

    I’m no longer a believer in the insulin theory. I believe modern food is toxic, toxic enough to screw up your metabolism. Especially your metabolism of carbohydrates aka type 2 diabetes/insulin resistance. I do not think for a second that carbohydrates can cause this, a toxic diet did. A diet full of excessive omega-6 fatty acids, grains and sugar/hfcs.

    This is an interesting thread on the MDA forums, it caused quite a stir and I happen to agree with him, once you lose the weight and fix your metabolism you should try reintroducing carbs, slowly. Also, by eating natural starches & fruits it’s almost impossible to eat near SAD levels of carbs.
    http://www.marksdailyapple.com/forum/thread48119.html

    I should mention this, a VLC diet makes you insulin resistant. This is not the same insulin resistance that happens due to bad eating habits but rather your bodys way of sparing glucose for parts of the brain & other tissues that don’t run on ketones/fatty acids (red blood cells etc). It’s completely temporary, treat it as ‘moderate carb flu’. After all, there’s low carb flu…

    TL;DR I guess what I’m getting at here is to eat real food.

    I don’t consider the Kitavans a black swan for several reasons.

    1. Their diet is high in carbohydrates, but most of those carbohydrates come from sweet potatoes and other unprocessed foods, which don’t jack up blood sugar like refined carbohydrates do. Their high-carbohydrate diet doesn’t necessarily mean they have high fasting insulin levels. In fact, I’d wager they don’t.

    2. I read early on in my Fat Head research that about 25% of all people are, for lack of a better term, resistant to becoming insulin resistant. The Kitavans, as a people who evolved on a diet largely consisting of sweet potatoes, may fall disproportionately into that category. Those of who trace our ancestry back to cold regions of the world may have less tolerance for high-carbohydrate foods that were consumed primarily in warm parts of the world.

    3. As I’ve said many times, lots of people who never damaged their metabolisms with Captain Crunch and Coca-Cola can probably eat sweet potatoes and rice without becoming fat or insulin resistant. Unfortunately, most of the obese people in the western world are insulin resistant, so a high proportion of those same foods will produce very different effects in them.

    I agree with eating real food, and also agree that it’s not necessary or desirable to aim for zero carbs and stay there forever. Dr. Atkins himself prescribed a two-week induction period, followed by gradually raising the carb intake and finding your individual tolerance level. I lost weight consuming around 100 grams per day, so it’s clearly not necessary for me to go to zero.

    Reply
  36. Nowhereman

    “That’s why I believe the Wisdom of Crowds effect will turn things around. Supposed experts post the same old advice and they get slammed in comments.”

    Tom, you bring up something I’ve noticed about Yahoo Health; lately many of their articles have been coming up with no commentary section. Perhaps it has something to do with every time one of them espoused the same old low-fat, high-carb diet that doesn’t work, people would point this out and bring up Paleo or other diet alternatives.

    If they can’t answer to critics and critical questions, then censor them and only post the “like” button for the article recommendation.

    Someone recently sent me a link to an online article promoting the same old anti-fat nonsense and told me, “Look at the comments! They’re getting blasted!” So I went to check out the article — there were no comments. I can only conclude that the publisher was tired of getting slammed and removed them all.

    Reply
  37. Liz

    Gaaah! This issue makes me want to scream.

    People don’t know that fructose and alcohol is metabolized in the same way. They don’t know because doctors don’t tell them. I guess doctors probably don’t know, either.

    A study you can look up in Google Scholar called Maternal Diet and Offspring Development talks about how an increasing number of babies are born with symptoms similar to fetal alcohol syndrome. This researcher calls it “fetal sugar spectrum disorder”. My daughter will be two in June, and no one mentioned anything about cutting sugar out of my diet. Not that this is surprising, but still.

    That’s why so many of us are trying to spread the word. I’m an optimist, but I’m nonetheless concerned that we may be seeing huge numbers of seriously unhealthy kids growing up to be seriously unhealthy adults.

    Reply
  38. AllisonK

    Here is another interesting connection. At least I think it is a connection. I wonder if a high carb diet can also cause autism in your child instead of obesity with the insulin issues affecting each child in a different way. Some children are having obesity issues and others are having mental brain/gut issues. Incidences of autism are also rising at exponential rates.
    Pregnancy 1: Extremely high carb diet. Instead of GD, I had horrendous morning(all day) sickness the whole pregnancy and lost a lot of weight. Son has been diagnosed with autism, he also cannot seem to handle the slightest amount of starches or added sugar without going nuts! All children react to sugar, but it seems he reacts tenfold as bad. He seems to be able to handle about two pieces of fruit per day, but fruit juice…forget it. Makes me wonder if he was programmed in the womb in regards to sugar and starches.
    Pregnancy 2: Had half started LCHF diet…but had trouble dealing with the wheat addiction. Any time I strayed, had severe morning sickness. Back to LCHF, felt fine. Ridiculous part is they recommend crackers and toast to help with morning sickness. Daughter is only 1.5yrs old right now but shows none of the same behavior patterns as my son.
    (yes, every pregnancy and child is different, but I am sure there is a food connection)
    Have you heard comments and opinions from other parents on this subject?

    My personal suspicion is that the rise in autism is related to the changes in wheat. As Dr. Davis explained in Wheat Belly, this ain’t your grandma’s wheat. Mutant wheat has more gluten and the protein sequence of that gluten has been altered.

    Reply
  39. Zoe Harcombe

    Have the guinea pigs looked at the official patient leaflet for metformin? You can download it from this site: http://www.medicines.org.uk/EMC/medicine/23787/PIL/Metformin/

    In section 2, there is a passage saying:
    “Do not take metformin if”…
    There are ten circumstances listed. The tenth is “…you are pregnant, planning to get pregnant or are breast-feeding.”

    You are advised to look at the section “See Pregnancy and Breast-feeding”. This section states: “Pregnancy and breast-feeding: Do not take this medicine and talk to your doctor if you are pregnant, planning to get pregnant or are breast-feeding.”

    That seems pretty categorical to me.

    Come on, Zoe, you know it’s okay if researchers are doing it. They never screw up.

    Reply
  40. Saultite

    @ mike p., I started LC/ paleo about 2 yrs before getting pregnant, and i had the best pregnancy ever! I’m 6’1″ and was about 200 lbs st the start of pregnancy. I gained about 35 lbs, and lost 25 in the first week after birth, 10 lbs 6 oz being my healthy, lean 22 inch baby boy. He wasn’t fat, and never has been. He’s just dense, like he’s made of lead! We have kept him grain free and he loves all food. Egg yolk, meat and avocado were his first foods, with plenty of fat and natural sea salt. He’s 18 months now, loves veg (drenched in butter!) and eats almost as much as I do. He gets sweet potato and isn’t particularly LC but is grain and sugar free. And everyone always comments on how happy, smart and attentive/ well behaved he is for a baby! Oh and he gets fresh milk straight from the cow, pastured chicken eggs and grass fed beef. No factory food here!

    Tom, I would never have to convince my little guy to exercise either, I can barely get him to slow down!

    We have the same problem (?) with our girls. Sara in particular is so bouncy, she wears me out just watching her sometimes.

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  41. Dana

    How in the world are they going to know whether this protocol is successful in just five years? There are kids who don’t get fat til late childhood. But they’ll push this drug anyway. ARGH.

    I know metformin is supposed to be safe in older kids and adults, but there’s a little problem: metformin is known to interfere with B12 absorption and possibly that of folate as well. Women are already not eating enough red meat and cheese to get all their B12, and too many of us try to get by on cyanocobalamin, the cheap non-methyl-donor form of B12 often found in supplements. So there’s potential for brain damage right there. If on top of that this drug also suppresses folate absorption, we’ll see an uptick in cases of spina bifida if not also anencephaly. That’s being born with most of your brain missing, and is always deadly.

    Yes, I’m deliberately trying to scare people. This is supposed to be scary. Google around and see what you find on metformin, B12, and folate. That’s what they want to give to YOUR baby just because you weren’t a size two when you got knocked up.

    And what’s all this hysteria over 11-pound babies? I thought nine pounds was the risky weight threshold. They should have been concerned about this twenty years ago but oh no, now it’s suddenly an emergency when babies are going off the scale.

    And this is dangerous to the mothers too. The bigger the baby, the more the complications–here’s one big reason there are so many more c-sections done in the U.S. than in other countries, and without the concurrent decrease in infant mortality that “they” all tell us c-sections will bring.

    I was fat when I had my daughter and she was just over nine pounds. She’s seven now and still normal weight. I could be feeding her better than I do but I’m feeding her a lot better than lots of kids eat at her age. We go to homeschooling gym and art classes once a week at the rec center near me, here in town, and every other kid there is eating crackers and chips with their moms between classes. Then they think they’ll make up the difference with whole grains and veggies. And no, not all of them are slender–and they think that one day a week at gym is going to cure them of childhood obesity. I like the coach a lot and appreciate what he does, but once a week ain’t cutting it, and even seven days a week wouldn’t hold a candle to better diet.

    Reply
  42. Dani

    I wish I could give some advice to my sister and sister-in-law, who are both pregnant. My sister is at least gluten-free because her boyfriend has Celiac. Disease. But they still bake and pretty much just substitute other gluten-free flours to eat all the same things that someone without Celiac Disease would eat.

    My sister-in-law, on the other hand, switched from Dr. Pepper to ginger ale when she found out she was pregnant, because, you know, Dr. Pepper is bad for you. Nevermind the 34g of sugar per can of ginger ale. She hates vegetables so she doesn’t really eat them. She’s not low-calorie, which is good, but the calories she’s getting aren’t the best ones.

    It just makes me sad because they’ve both had a lot of difficulties. But they don’t really like listening to me talk about nutrition anymore. I suppose that’s my bad; I should have done a better job of it. I’m hoping I can get them to watch Fat Head, at least. At some point. It’s not going to make much of an impact during the pregnancy, I don’t think, but maybe there’s hope for post-pregnancy.

    I feel you. It’s frustrating when people you love are busy filling up on sugar and flour. All you can do is try to tell them what you know — once — and let them go.

    Reply
  43. Walter B

    I have a great title for a movie.

    “Revenge of the Mutant Ninja Wheat”

    Perhaps you and Dr. William Davis could collaborate?

    If I dress up like a turtle, I’m in.

    Reply

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