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Eating for Two? Risks of Too Much - or Too Little - Weight Gain In Pregnancy

>> Monday, August 14, 2017

Many studies have suggested that too much, or too little, weight gain in pregnancy can be harmful to both baby and mother.  A recent review brings together data from over 1.3 million women, to help us understands what the health risk are of inappropriate weight gain in pregnancy.

First, let's review the recommendations for weight gain in pregnancy.  The recommended amount is based on Body Mass Index pre pregnancy, which is calculated by your weight in kg, divided by your height in metres squared (kg/m2). Note that these numbers apply to single pregnancies only (recommendations are higher for twin, triplets etc).

  • BMI less than18.5:  28-40 lbs (about 13-18 kg)
  • BMI 18.5-24.9:       25-35 lbs (about 11-16 kg)
  • BMI 25-29.9:          15-25 lbs (about 7-11 kg)
  • BMI 30 or more:     11-20 lbs (about 5-9 kg)

The review, published in the Journal of the American Medical Association, found that gestational weight gain fell below these guidelines in 23% of pregnancies, and above these guidelines in 47% of the pregnancies studied.

For women not gaining enough weight in pregnancy, there was a 53% higher risk of having a small for gestational age baby, and a 70% increase in the risk of preterm birth.

For women gaining excessive weight in pregnancy, there was an 85% higher risk of having a large for gestational age baby, and a 30% increased risk of needing a C section.

Not only do we know that it is important to manage weight during pregnancy, but optimizing weight prior to pregnancy is important too, as underweight or overweight pre-pregnancy is also associated with adverse outcomes.

If you are pregnant or thinking about becoming pregnant, be sure to speak with your doctor about optimizing weight both before and during pregnancy.

Follow me on twitter! @drsuepedersen © 2017


Could Antacid Medications Affect Blood Sugar Control in Diabetes?

>> Tuesday, August 8, 2017

Proton pump inhibitors (PPIs) are medications commonly prescribed to treat heartburn and peptic ulcer disease [eg omeprazole (Losec), pantoprazole (Pantoloc), esomeprazole (Nexium), lansoprazole (Prevacid), rabeprazole (Pariet)].    Since PPIs work by blocking acid secretion in the stomach, and since a higher acid content of food lowers its glycemic index, I was asked whether PPIs could increase the effective glycemic index of a meal and thus have a negative impact on diabetes control.

It turns out that PPIs have a very interesting relationship with pancreatic function and blood sugars.

Firstly, as PPIs work by blocking acid secretion in the stomach,  PPIs do increase the pH in the stomach and very high up in the small intestine (proximal duodenum).  However, there is little to no effect on pH in the majority of the small intestine, where carbohydrates are absorbed.

PPIs raise serum levels of a hormone called gastrin, which is responsible for stimulating acid secretion in the stomach.  This is because the gastrin secreting cells in the stomach sense that acid production is low, so more gastrin gets cranked out in an attempt to increase acid secretion.

Interestingly, gastrin stimulates glucose-induced insulin secretion from the beta cells of the pancreas.  There is also some experimental evidence that gastrin may stimulate the production of new beta cells.   Further, PPIs slow emptying of the stomach, because less acid in the stomach means that it takes longer for solid food to be broken down and be ready to pass into the small intestine.

So, based on these mechanisms, it seems that PPIs could possibly have a benefit to blood sugar levels.  While the studies on this are still quite limited, the available evidence suggests that PPIs could lower A1C (a marker of diabetes control) by 0.5% to as much as 1% - possibly as much as a diabetes medication!

PPIs are medications that have benefits but also potential risks, including increased risk of gastrointestinal infections, malabsorption of important micronutrients like calcium, magnesium, vitamin B12, and iron, increased risk of fracture, changes in gut bacteria, and others (note this list is not exhaustive), and they should not be prescribed for the purpose of blood sugar control.

That being said, I will be watching blood sugar control with extra interest the next time one of my patients with diabetes is started on a PPI for their gastrointestinal issues.

Follow me on twitter! @drsuepedersen © 2017



I am excited that you have arrived at my site, and I hope you are too - consider this the first step towards a Healthier New You!! As a medical doctor, Endocrinologist, and obesity specialist, I am absolutely passionate about helping people with weight management. Though there is certainly no magic cure for obesity, there IS a successful treatment plan out there for you - it is all about understanding the elements that contribute to your personal weight struggle, and then finding the treatment plan that suits your needs and your lifestyle. The way to finding your personal solution is to learn as much as you can about obesity: how our toxic environment has shaped us into an overweight society; the diversity of contributors to obesity; and what the treatment options out there are really all about. Knowledge Is Power!!

Are you ready to change your life? Let's begin our journey together, towards a healthier, happier you!!

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