Damned if I do, damned if I don’t

I’ll be 24 weeks tomorrow, and I’m still feeling sick if I eat too much.  As long as I continue to feel this way, I’ve given up on being Paleo.  It’s amazing how strong the urge is to eat carbs.  And sugar tastes SOO good.  My husband and I went to visit his co-worker who recently had her first baby, and she said she’s never had a sweet tooth before her pregnancy, and doesn’t have one now that the baby was born.  But during the pregnancy, she loved sweets.  Thankfully she didn’t get gestational diabetes and she had a normal vaginal delivery (and she’s a super tiny gal).

That is definitely my fear, though.  While I’ve learned to try not to feel too guilty about giving into my urges for carbs and sweets, I still want to be careful, particularly with the sugar.

On the other hand, I still haven’t been gaining enough weight.  I started my prenatal care with a doctor whose office is near where I live, which was convenient to start, and also I didn’t want my pregnancy to be public at my office early on.  With my next visit and for the rest of the pregnancy, I’ll switch to one of my colleagues in the office where I work, and I plan to deliver at the hospital I work at.

With the first doctor, since I don’t work with her and didn’t know her before my first prenatal appointment with her, I have more of a patient-doctor relationship with her.  So when she pointed out that I haven’t gained much weight, it did make me try to change my eating habits.  Well, at least for a couple days.  I thought maybe I could try to snack more or something.  But when it came down to it, I have been wanting so bad to be able to eat more, but with large meals I feel sick, and then I don’t feel like eating again for a while.  I try to snack at work between meals, but on busy days when I’m seeing patient after patient, it’s tough to sneak much in, just a few bites.  Even on weekends, I still find it hard to eat smaller amounts more frequently because food is just so tasty as I’m eating it, and it’s hard to stop short of feeling full.  Ultimately, since I’m eating fairly normal amounts, so I figure Little Willie is doing just fine in there, and I’m not going to make myself sick just so I can meet the numbers goals.

At 23 weeks, I’ve gained 7 lbs from my baseline before pregnancy.  I feel like I’m constantly fighting the battle of knowing I’m not gaining enough, and feeling guilty for wanting to eat so many carbs.  So that’s why I feel like I’m damned if I do, damned if I don’t.  No matter what I do, I can’t win so long as I’m limited by feeling gross if I eat too much.  So for now, I’m trying to keep a balance- allowing myself not to be Paleo, but trying not to go totally crazy with the sugar and carbs.

I’m keeping my fingers crossed that my upcoming glucola test for gestational diabetes will be negative.  Next week, I’ll be in Iceland (!) so based on my schedule, I’ll have to do the test after I get back.

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4 thoughts on “Damned if I do, damned if I don’t

  1. PracticeBalance May 17, 2015 / 6:51 pm

    What do you think about the OGTT? I would like to refuse it but of course don’t want to miss an important dx. But on the other hand, I have read in some Paleo lit that people who are used to eating low-carb sometimes fail it. I saw one study that said that 1st trimester A1C > 5.9% accurately predicted a positive OGTT and was hoping I could just get that test. I’m 10 weeks along.

    Sorry that food has been hard for you. I assume even smaller meals with fat sources are too hard? I have been eating lots of avocado and home-made fruit jello. They both help a lot. But I have also had my share of chocolate-covered almonds!

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    • Paleo OB May 17, 2015 / 9:15 pm

      Congrats! I’m not sure how often women doing Paleo fail it, but I wouldn’t recommend refusing it. No test is perfect, and if you’re staying pretty Paleo it’s unlikely you’d have gestational diabetes, but it would be really bad to miss the diagnosis. The hemoglobin A1c does tell us how one’s sugars have been for the past 3 months, so it’s a helpful adjunct in general in diabetes diagnosis that I use with non-pregnant patients. But currently the best test as far as I’m aware is the glucola (OGTT). So unless the recommendations change, I would just go ahead and do the standard screening.
      Yeah I thought I’d be able to stay Paleo in pregnancy, but day after day of feeling this way (not to mention the added fatigue) does wear on me. I’ve accepted that for me, the best balance is to just go ahead and have some carbs. Everyone’s different- I have way more patients that gain too much weight and need to reduce carbs than those that have my problem with not being able to gain enough weight. And lucky for most women, they’re not usually still feeling sick at 24 weeks!

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  2. Meg May 19, 2015 / 2:39 am

    Hey POB,

    My lack of interest in food has improved a bit now at nearly 25 weeks, but still not back to baseline. I’ve given up worrying about it – feel like I don’t need the added stress now. I am eating more carbs (particularly bread) than I have in years but I’m more concerned about micronutrients than total calories at the moment and am trying to stay on top of that. I’ve gained 4 kgs (just under 9 pounds) so far and imagine that the rate of gain will go up in the coming 3rd trim. Baby’s growth seems ok from ultrasound (and my rapidly protruding belly!).

    Re OGTT – I’m currently living in a developing country (for my husband’s work) where I don’t really have access to western style monitoring in pregnancy eg. OGTT. I am going to Australia to have the baby, but will not be there till around 34 weeks so will miss out on the routine OGTT. So I am self monitoring my blood glucose with an at home glucometer. I just started routine monitoring at 24 weeks with morning fasting and a pre- and 2 h post-prandial at different times of day. So far my numbers have been all below the new guidelines (fasting < 5 mmol/l or < 90 mg/dl; 2 h post p < 6.7 mmol/l or < 120 mg/dl). In fact my 2 h post pran hasn't gone above 108 mg/dl with my routine diet, so this gives me some confidence. My plan is to do this kind of 3-times a day intensive monitoring every 3rd week (so at 24 weeks, 27 weeks, 30 weeks, etc) assuming the numbers stay good, else will up the frequency.

    My total carb consumption in a day is around 100-120g so drinking 75-100g of glucose in one go does seem mildly scary to me and in my mind, I'm not sure what that's telling me – I don't routinely consume (I can probably say I never consume) that much glucose in one go, so if my body can't clear it in 2 h, what does that mean to me?

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    • Paleo OB May 24, 2015 / 10:52 pm

      Sorry for the delayed response- I’m on vacation in Iceland and Internet connection is inconsistent.
      Sounds like your weight gain and inclination towards carbs are similar to mine. That’s tough that you have to go through the extra effort of checking your blood sugars. Since we normally do the OGTT at 24-28 weeks, if they remain normal at the 30 week mark, you should be fine. For women who can’t do the OGTT, typically those who have had gastric bypass or similar procedures, they do the blood sugar checks like you’re doing.
      I agree that it seems scary to take such a high glucose load in one go. I’ve heard that women who keep a low carb diet can fail the OGTT, probably because our bodies aren’t used to handling that kind of load. But I haven’t looked into the actual data behind that. Also, the follow-up test that we do is a 3 hr fasting glucose load. Not sure if low carb women who failed the initial OGTT would pass that.
      In any case, sounds like you’re doing a great job keeping the carbs reasonable and that your blood sugars are fine so far.

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