The gestational diabetes diet can be confusing when you're first starting out. Learn the "why" and "how" here.
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Table of Contents
- Gestational Diabetes Treatment
- Gestational Diabetes Diet
- Build Your Plate
If you haven't already, it's highly recommended that you read Everything You Need to Know about Gestational Diabetes and Gestational Diabetes Test & Alternatives. These articles will give you a better understanding of the "why" behind the diet.
Gestational Diabetes Treatment
Gestational diabetes (GD), also called gestational diabetes mellitus (GDM), is diabetes that is discovered during pregnancy. It’s treated by diet, exercise, and medicine if necessary. In most cases, diet is the first form of treatment, and if the combination of diet and exercise don’t effectively control blood sugars, medication and/or insulin is the next step.
Treatment is a case-by-case basis. You and your healthcare team will decide what's best for your situation. For more information visit Everything You Need to Know about Gestational Diabetes.
Gestational Diabetes Diet
Gestational diabetes requires a special diet because your pancreas can’t produce enough insulin to maintain safe blood sugars. Since carbohydrates are the nutrient that raise blood sugar, the diet requires that you change the type of carbs you eat, the amount and the frequency of which you eat them.
Finding out what works for you will be a trial-and-error journey; however, there are general guidelines to help.
Number of Carbs
It's likely that you'll need to reduce the number of carbs you eat so that your body's natural insulin remains effective.
For GD, breakfast and snacks are normally limited to 15g - 20g carbs and lunch and dinner are limited to 30g – 45g carbs.
|Breakfast||15g – 20g|
|Snack||15g – 20g|
|Lunch||30g – 45g|
|Snack||15g – 20g|
|Dinner||30g – 45g|
|Snack||15g – 20g|
It’s estimated that pregnant women (without GDM) need about 156g carbs per day. Based on your GDM test results, your dietitian will recommend a maximum number of carbs per day and per meal.Real Food for Pregnancy
If you’ve been diagnosed but haven’t seen a dietitian yet, it’s wise to start with the lower carb allowance for each meal. Take note of how you feel and whether your blood sugars are within range and adjust up or down from there.
Take a look at the chart below. You'll see that foods aren't placed in their normal food groups; instead, they're categorized based on their macro-nutrients and the way they affect blood sugar. Pay particular attention to the Carbohydrates column where you'll see unusually placed foods like fruits and milk.
Notice that some foods are listed in two columns, like beans. That's because beans have significant amounts of both protein and carbs. And you may wonder why yogurt is in the Carb column but Greek yogurt is listed under Proteins. Greek yogurt, like beans, has a considerable amount of protein and should be considered both a protein and a carb.
So, what you can take from the chart above is that the foods listed as proteins and fats will not spike your blood sugar. The foods listed as carbohydrates, however, will raise your blood sugar.
Now that you have a general idea of what foods are considered carbs in this diet, let's break them down.
Types of Carbs
"Glycemic" is common terminology in the diabetic world. Glycemia is a ranking system for carbohydrates and how they affect blood sugar/glucose.
High glycemic = 70+
Moderately glycemic = 56 - 69
Low glycemic = 55 or less
Normally, simple carbs are moderately to high glycemic, but complex carbs can fall anywhere on the scale.
Simple carbs are considered moderate to high glycemic because they're processed quickly by your body. In other words, they rush into your system causing your blood sugar to raise quickly (spike). Simple carbs include:
- juices (even 100% fruit juice)
- corn syrup
- white grains (flour, rice, bread, etc.)
- and more
These are most commonly found in heavily processed foods. They're the type of carbs you want to eat less of, if not avoid.
Tip - If your blood sugar is too low, eat a simple carb to quickly bring it back to a safe level.
Complex carbs have more fiber and are digested more slowly. They will still raise your blood sugar but at a slower pace. This is important because it also allows your natural insulin to be more effective. Complex carbs include:
- whole fruits
- whole grains (quinoa, whole wheat products, etc.)
- vegetables (non-starchy)
- and more
You want to eat more complex carbs than simple carbs because they're more nutritious and better sustain your energy levels.
Take note that starchy vegetables are not included with complex carbs. That's because they're more starchy than fibrous. Starchy vegetables and foods include:
- winter squash
- and more
Starchy vegetables and grains are high glycemic. This doesn't mean you can't eat a baked potato, rice or corn; rather, it means that you have to strictly portion each serving to avoid spiking. Although, some mothers find that they have to avoid one or more of these foods.
To recap, carbs are what raise blood sugar. Eating complex carbs like whole grains, whole fruits, vegetables, beans, etc. is better than eating simple carbs like sugar, white grains, juices, jellies, pastries, etc. Starchy carbs like potatoes, corn, peas, oats, brown grains, etc. are good but should be strictly portioned.
Pairing Carbs with Protein
Regardless of the type of carb you eat, it's best to pair it with another food group. Protein acts as a stabilizer so your blood sugar doesn't spike. And because protein needs are increased during pregnancy, it's double beneficial to pair carbs with protein.
Protein needs change with pregnancy stages. It's recommended that pregnant women eat about 140g of protein daily.Real Food for Pregnancy
No matter how much protein you pair with carbs, you should still stay within your carb limits.
Some examples of protein paired with carbs are:
- cheese with crackers
- nut butter on bread or an apple
- eggs and milk
- chicken stuffed potato
Here's the chart from earlier. Take a look and think of some protein and carb pairings.
Build Your Plate
Balancing each meal is easier than you think. It can be done in 3 simple steps.
How to and what foods to eat with gestational diabetes:
- Fill half of your plate with vegetables
"Half of your plate" is about 2 cups worth. Green veggies are best - the darker the better. A list is provided below.
- Fill one quarter of your plate with protein
This is about 3 - 4 ounces of animal meat or other low carb protein. A list is provided below.
- Fill the last quarter of your plate with complex carbohydrates
This equates to about one-half cup. Complex carbs are whole grains, brown grains, whole fruits, etc. A list is provided below.
Screenshot or download this for reference.
When it comes to veggies and proteins, it's hard to spike your blood sugar. What I mean by that is you can probably eat double portions (and be stuffed) before you reach your max carbs with just veggies and proteins.
Yes; vegetables have carbs, but they're complex carbs that are digested slowly, and most are low glycemic. They're much lower in carbs than any food in the carbohydrate column - foods in the Carbohydrates column have carbs that significantly impact your blood sugar.
Foods to Avoid
- sugary drinks
- dried, canned or packaged fruit*
- large portions of fruit*
- refined sugar
- baked goods
- breakfast cereals
- white flour, bread, rice, pasta, tortillas
- packaged snack foods
- trans fats**
This list is not all inclusive
*Whole fruits are encouraged in this diet because they are nature's food with necessary vitamins and minerals; however, since they are simple carbs that digest quickly, they must be strictly portioned. Small whole fruits are safest. Examples of whole fruits are oranges, apples, pears, peaches, berries, etc. - fruits that still have their peelings or outer shells; are in their natural form. Fruits not considered whole are juices, concentrates, dried, or otherwise transformed.
**Trans fats are found in margarine, peanut butter and other spreads, baked goods and other processed foods. Sometimes the amount of trans fat per serving isn't enough to annotate it on the nutrition label. To know whether a food contains trans fat, check the ingredients for "hydrogenated" or "partially hydrogenated."
Here are acceptable substitutions to the foods to avoid.
Download diabetic food substitutions here
Eating Frequency & Snacks
When you eat, you tell your blood sugar what to do. If you eat simple carbs you tell it to give you a quick pick-me-up, and if you eat complex carbs you tell it to sustain you for a while. But what happens when you don't eat?
When you don't eat your blood sugar decides what it wants to do. It may drop low or spike high. (This is why the fasting glucose is the trickiest.) Either situation is undesired, so you must tell it what to do - meaning you have to eat every few hours.
Eating every 3-4 hours tells your blood sugar to remain steady in a safe range.
Snacks are built into the diet in between meals to ensure sugars don't drop too low or spike too high.
Ideally, snacks are eaten about 3 hours after a meal, and at least 2 hours before the next meal. As always, they should be within carb limits and paired with protein.
Did you know?
Carbs you drink enter your bloodstream more quickly than carbs that are eaten.
When it comes to drinks for diabetics, options are few. Sodas and juices are on the foods to avoid list, and many other drinks use "hidden" sweeteners that affect your blood sugar.
There are some drinks that use low glycemic sweeteners, but they vary by brand. Generally, diet sodas use an alternative sweetener called aspartame that is unlikely to affect your glucose. Other than diet sodas, flavored water, teas, coffee, alternatively sweetened sodas and low sugar-protein added smoothies are all options, but most importantly, water!
Hydration is super important in life, and more so in pregnancy. It's recommended that pregnant women drink 100 ounces of water a day (Real Food for Pregnancy). That's almost a gallon of water (128 ounces)! Suffice to say, if you're drinking the recommended amount of water, and eating 6 times a day, you probably have no room left for any other drink.
BUT you can also eat your water! What does that even mean: right? Water is in fruits and vegetables, so you can eat some of the water you need. This doesn't mean you can measure it the same way, but it does mean that you don't have to drink almost a gallon of water while eating 6 times a day.
Watery foods include but aren't limited to zucchini, cucumber, watermelon, oranges, celery, etc.
You can flavor your water to switch it up a bit, but be careful when using flavoring powders. Check to see which sweetener is used and make sure it's low glycemic.
The Build Your Plate guide above can also be used when eating at a restaurant. The tricky part will be controlling portion sizes so guesstimations will have to do.
To help, measure your food by relating it to normal objects.
1 cup of veggies = baseball
3 ounces of protein = deck of cards
½ cup of carbs = tennis ball
For more visual representations, visit How to Estimate Portion Size.
Tip - You'll likely be served larger portions than you need so ask for another plate. Divide the portions and place the excess food on the other plate to help prevent overeating/exceeding your carbs.
Fast food restaurants are a bit different. You can see menu reviews and and low carb options at your favorite spots in the Fast Food Series.
Even if vegetarian isn't a way of life for you, meat is a common food aversion during pregnancy. Unfortunately, eating low carb on a vegetarian diet is tricky because most of the filling staples like pasta, bread, potatoes, etc. are high glycemic and not appropriate for the gestational diabetes diet.
Thankfully meat substitution is a rapidly growing market and there are new products popping up everywhere. Concurrently, this is the age of low carb substitutions as well, so there are many options for eating a low carb, high protein diet. Just be smart to eat the foods that satisfy your hunger without exceeding carb limits.
- Finding out what works for you is a trial and error journey
- Know your carb limits
- Know which foods significantly affect blood sugars (Carb column)
- Eat more complex carbs than simple carbs
- Pair carbs with protein, always
- Portion carbs
- Build Your Plate (download guide)
- Eat every few hours
- Drinks lots of water
- Avoid simple carbs
- Processed foods, sugars, white flour/rice/bread/tortillas, baked goods, etc.
If you need gestational diabetes recipes or inspiration, check out the Recipe Blog and Fast Food Series! To access all downloads and quick reference guides, create an account here.
“Real Food for Gestational Diabetes: An Effective Alternative to the Conventional Nutrition Approach” is a great, plainly-stated, in-depth resource if you want to learn more.