Pregnant, Avoid the Potato

New research shows that eating potatoes during pregnancy may increase a woman’s risk of acquiring diabetes. The researchers conclude future intervention studies and randomized clinical trials are needed to further investigate these findings. To me this indicates a lack of confidence in their findings and that the research has faults.

Gestational diabetes, diabetes that presents in pregnant women who have high blood glucose levels, can affect the baby. Though patients with gestational diabetes do not typically present with birth defects, going untreated or having poor control may ultimately hurt the baby long term. It is imperative to identify modifiable risk factors that could potentially lead a woman to develop diabetes.

Currently, the development of gestational diabetes in women is unclear; however, a new study suggests that intake of potatoes by women during pregnancy could possibly increase their risk of acquiring the condition. After rice and wheat, potatoes are known to be the third most common food crop worldwide; the health effects of the vegetable are still inconclusive. Despite being rich in vitamin C, potassium, phytochemicals, and dietary fibers, potatoes are commonly associated with negative consequences on glucose metabolism due to containing large amounts of absorbable starch. Studies have long shown incidences of increased fasting plasma glucose and insulin resistance in patients who consume potatoes, ultimately increasing risks of developing type 2 diabetes.

The 10-year cohort study examined 15,632 women from the Nurse’s Health study who had no previous gestational diabetes or other chronic diseases prior to pregnancy. The researchers examined the patients’ consumption of potatoes along with other foods and relied on self-reports and physician diagnosis of gestational diabetes. The basis for the study is the amount of starch in potatoes, which is rapidly absorbed in the body leading to an increase in blood glucose levels. The research found that patients during their pre-pregnancy stage who consumed potatoes (especially in the form of french fries) showed a significant correlation with incidences of gestational diabetes. Correlation is the key word.

The proposed mechanism behind this spike is related to the high glycemic index of potatoes; starch in such large amounts is absorbed rapidly once it’s taken into the body, and that results in a significant post-prandial increase in blood glucose and prompt stress to pancreatic b-cells, leading to dysfunction or b-cell exhaustion.

In this study, they observed women for risks of gestational diabetes who consumed baked, boiled or mashed potatoes; they found that there was a greater likelihood that these patients would eat french fries, leading to increased incidences of diabetes. The misconception of french fries holding any nutritional value is a driving force for many women who develop gestational diabetes; it indicates an overall poor diet and less likelihood of getting enough exercise. Other vegetables such as whole grains and legumes have a much lower glycemic index and still contain the essential minerals, fibers and vitamins that are essential for every individual. Research indicated that substituting such vegetables in place of potatoes would essentially decrease women’s chances of acquiring diabetes.

There are several limitations to the study, including the observational nature of the trial, which precludes conclusions about whether potatoes actually cause gestational diabetes.

Today's Doctors Are Without a Moral Code

Normally I do not write about women's health or gestational diabetes. This is one time I feel I must as the doctors are showing their true colors and arguing against making changes to the guidelines for gestational diabetes. If they were supporting changes, then I would not be writing this. However, this time I think they have abandoned the Hippocratic Oath in favor of profits and this does not seem the proper thing for doctors to come out in favor of doing.

At issue is some in obstetrics and gynecology and maternal-fetal medicine have advocated for change to the diagnostic criteria for gestational diabetes for some time now, while others, including the American College of Obstetricians and Gynecologists, say it is not clear that change is needed. Some information is needed here. Under the Affordable Care Act (ACA), money will be available for doctors to reduce medical costs at all levels of medical care. This is what doctors are afraid of losing if new guidelines are put in place tightening the diagnosis and treatment of gestational diabetes.

The upcoming Consensus Development Conference in early 2013 is to assess available scientific evidence for gestational diabetes. In advance of this conference, the opposition is writing articles in opposition to possible changes. The authors advised that "such a change would dramatically increase the number of women identified as having this disease and place a significantly greater burden on an already overburdened primary health care system. We have concluded that before change is made, there needs to be careful analysis of the possible risk, cost and benefit involved in any revisions. If the data aren't available to answer these questions, it would seem prudent and advisable to delay change at this time."

Follow the dollar signs is all I can derive from the discussion. Normally doctors look to the health of the patients (mother and unborn child in this case) and forget about the cost-benefit analysis in favor of health. This time the medical community is placing the emphasis on the cost-benefit analysis instead to the health issues. “Gestational diabetes is a condition that can be potentially devastating to pregnancies. Even mild forms of hyperglycemia could potentially pose significant adverse health consequences for pregnant women and their children. Advocates for changing diagnostic criteria - increasing the number of women diagnosed with and thus treated for the condition - could reduce morbidity and health care costs. Those cost reductions, however, could be offset by an increase in patients diagnosed and treated.”

Each side is bringing in the big guns to bolster their arguments and they are quoting study after study on both sides of the issue. For those on the “do not change” side, I feel they have lost their moral compass and are only interested in the dollars they can divert to their pockets. I can only suggest that you read the article and decide for yourself, which side of the issue you favor. The second article is here.

This just came to my attention - Tom Ross has an excellent blog on the same topic.  Read it here.