Wednesday, August 15, 2012

The Difference 15 Pounds Makes

During my most recent pregnancy, I worked very hard to gain less weight than I had with my first two. During my first two pregnancies, my weight gain was in the neighborhood of 45-50 pounds, and with this one, my weight gain was 35 pounds.

I had several hopes for lower weight gain. First, I hoped it would keep my blood pressure more firmly within the safe zone towards the end of the pregnancy, as my blood pressure had gone up considerably (even though not out of a normal range) with the first two. Second, I hoped I might have a smaller baby. Third, I didn't want to barely be able to squeeze into size Large maternity clothes and possibly be forced to go out and buy more. And lastly, I had a pipe dream that maybe, just maybe, the baby would decide that I was too skinny to maintain him much longer and evict himself earlier so that I could avoid induction.

In order to accomplish my goal, I tried to avoid eating when I felt bad. As a diabetic AND as a pregnant woman, this was very, very difficult. During the first trimester, I chose to lie down instead of eat when things got rough. During the second and third trimesters, I chose to eat just enough to bring my blood sugar up when it was low, but no more. Snacks were small, and I often considered anything I used to bring my blood sugar up a "snack," even if it was just a bottle of Gatorade. I also tried to manage my mealtimes so that they coincided with lows. For example, if I found my blood sugar low at 11:00a, I'd eat lunch a little early. I drank a lot more water. I would avoid going for seconds at dinner, and avoiding eating after 8:30p, so that my blood sugar could stabilize before bed. No "second breakfast" like I had during my first pregnancy, when I remember eating a piece of lasagna at 10:00 in the morning sitting at my desk at work. That was, of course, in addition to a full lunch!

Another circumstance that coincided with my efforts to keep my weight gain down was my father's adoption of the Paleo Diet. It was recommended to him for a variety of ailments he suffered, and ever since we moved in with my parents, as an expression of gratitude, I try to make meals we can all enjoy together. So when my dad adopted the new diet, I got a crash course in a new way of eating.

In short, it's a no starch (including rice, corn, and potatoes), no dairy diet that pretty much restricts your food intake to meat, vegetables and fruit, and it turns out to be a good diet for a pregnant diabetic, too. I've mentioned a few times that I try to keep my carb intake to 60g or less for each meal, and making Paleo-friendly meals was a great way to do that. I made lots of vegetable side dishes instead of starches, and plainer, leaner meats prepared simply. I think eating lots of veggies helped me fill up at each meal, but not take in too many calories. I also got plenty of protein. My postprandials were pretty great, because a low carbohydrate intake at each meal meant I was less likely to under- or over-estimate my carbohydrates so badly that I was really high or really low two hours later.

All in all, my experiment was somewhat inconclusive. For one thing, my blood pressure still peaked a little closer to 140/90 than I would have liked. As before, however, it never got so high that anyone worried about it. I did fit into my maternity clothes better, but I'm not sure I'd say that alone was really worth the effort. My baby wasn't that small, but he was about a pound smaller than the last one. Who knows? Maybe he would have been a lot larger if I had gained an extra 10 pounds. And he did evict himself *slightly* early, but I was, after all, at my due date.

There were some other things I noticed that I didn't expect. My insulin resistance was lower, so I was giving less insulin at each meal and my total daily insulin was about 65-70 units compared to 100 or more with the first two. My bolus insulin : basal insulin ratio was about 50:50, where during the first two pregnancies it was more like 65:35. Finally, my placenta was quite a bit smaller, and came out quite a bit faster (but healthy, as far as I know).

It's hard to say whether this experiment was worth it. It was hard, a real squeeze to keep my calorie consumption down. I was uncomfortable and weak sometimes. My blood sugar hung out just above low for long hours during the day. There were times that I woke up in the middle of the night absolutely famished, and I would snag a spoonful or two of peanut butter or a glass of milk. Discipline was hard. I usually stopped eating well short of full, and knew that I might be hungry again a little longer than I'd like to be before my next meal. I would distract myself from hunger by playing with the kids, and sip on Gatorade just enough to keep me mentally focused. There were some weeks when I got used to it, and didn't mind, but there were other times when impromptu dessert after dinner was a serious temptation. Sometimes when I was tempted to have an after-dinner snack, I'd just go to bed so I didn't have to feel hungry anymore.

But lest you think I was starving myself or my child, please note that I *did* gain 35 pounds, and my child *was* 8 pounds, 5 ounces at birth. It was more a matter of adjusting expectations, finding other ways to comfort myself when I felt bad, and being disciplined about eating, rather than grabbing food every time I walked through the kitchen. Indulgence was not out of the question, but I tried to limit it to special occasions, rather than just, "I had a bad day today, so I deserve a cookie." Sunday, for example, the great solemnity of the resurrection, was a special day every week.

So I think that, in the end, it was an exercise in temperance and sacrifice for me, rather than a real deprivation. I adopted a greater level of self-discipline over my eating habits than I exhibited with the last two, and they seem to be good habits that I will use for the rest of my life. I had a healthy, normal-sized baby (although I still maintain that there's no reason to freak out over babies that are larger), and he did come out right on time. I do anticipate losing the baby weight a little faster. It is nice to fit back into non-maternity clothes.

Perhaps most importantly, however, now I know what healthy hunger feels like. It was like fasting without the crazy blood sugars, and therefore an excellent way to unite my sacrifice to the penitential practices of the Church. My physical discomfort was not so great as to feel like a punishment, and the physical benefits were real, especially as a help to managing my blood sugars. I know that I can be content and healthy with less. I don't need to be afraid of a little bit of hunger, and food is not the only thing I have to comfort myself when things get difficult. Above all, the longing for food points to the heavenly bread that will never leave me hungry, and I think that's a lesson worth repeating every day for the rest of my life.


  1. Wow, didn't know you were doing this. Good job!!

    PS I think it's cool that you were able to notice how your insulin resistance was lower. I knew that this was supposed to happen, but you actually got to observe it. Isn't that a pretty good benefit in itself?

    1. I didn't really want to advertise it to the friends that actually see me, lest they track my progress and make me more aware of my successes and failures :). I didn't really want to advertise it at all, actually, in case I failed or it ended up being pure vanity that didn't help my pregnancy at all and only made my clothes fit better.

      But after the experiment worked out, I thought it was worth sharing my observations. I think it's a worthwhile effort.

    2. And I don't know about the insulin resistance thing being worth it. Since it only lasts a couple of months at the end of your pregnancy, I don't know how much different a slightly elevated insulin resistance makes for yours or your baby's long-term health. Perhaps some, though.