Mamas on Bedrest: Pregnancy, Carbs and Gallstones-Oh My!

May 12th, 2011

Pregnancy and Gall Bladder Disease

“Pregnancy is a high-risk time for the development of gallstones.  In fact, it’s one of the most common nonobstetrical causes for hospitalization of women both during and after pregnancy.”                                           ~Alan C. Wong, MD

Pregnancy has long been established as a risk factor for gallstones in women. The current thinking on this is the fluctuation in hormones causes a change in cholesterol metabolism leading to increasing biliary sludge (debris) and stone formation. Recently however, researchers at the University of Washington found that pregnant women who consume lots of carbohydrates are at an even greater risk of developing gall bladder disease.  Alan C. Wong, MD and Cynthia W. Ko, MD, of the University of Washington in Seattle presented their findings at the 2011 Digestive Disease Week conference as an abstract and their work was recently summarized on Medpage Today

Previous studies had suggested that a diet high in carbohydrates put pregnant women at increased risk of later gallbladder surgery. But wanting to know that direct association, Wong and Ko followed 3070 pregnant women through their pregnancies to see if they would develop gallbladder disease. The women had baseline ultrasounds of their gall bladders and During the third trimester, each woman filled out a detailed dietary questionnaire from which Wong and Ko were able to determine carbohydrate consumption. The women were followed throughout their pregnancies and for 4-6 weeks post partum.

The study yielded very interesting findings.  Women who consumed the most carbohydrates were at greatest risk for developing gall bladder disease. Those with the highest Fructose and starch intakes were at an even greater risk. An interesting finding was that women who had high galactose levels had a lower risk of developing gallbladder disease. In fact, Galactose appears to be protective against developing gall bladder disease! Wong and Ko did not expect the Galactose finding and admit that they are stumped as to why Galactose is protective against gallbladder disease. They recommend further research on Galactose and gallbladder disease to be able to provide definitive answers.

Not all sugars are created (or metabolized) equal

Galactose is derived from lactose, the sugar found in milk and dairy products. As lactose is broken down, it produces glucose and Galactose. Galactose is also found in many fruits and vegetables such as tomatoes, persimmon and watermelon.*

While fructose is found in many fruits, the bulk of the fructose in our diets today comes from High Fructose Corn Syrup, a processed form of sugar found in some 80% of all processed foods. Pregnant women who consumed diets high in processed foods take in too much fructose and hence put themselves at increased risk of developing gallbladder disease.

It all comes down to metabolism

So how does fructose increase gallbladder disease risk in pregnant women? It all comes down to metabolism. Glucose, the sugar the body needs for energy, needs insulin to help it to be taken from our blood stream into cells for use. High sugar diets increase insulin production because more insulin is needed to accommodate the additional sugar (glucose). People who are insulin resistant or have impaired glucose metabolism aren’t able to get needed sugar into their cells for energy. In some people, they don’t make enough insulin. In others, the insulin isn’t functioning properly. The body tries to compensate by increasing insulin levels. This goes on for awhile until finally the body cannot compensate and glucose remains in the blood stream causing elevated blood sugar levels or diabetes.

Fructose on the other hand does not need insulin to enter into cells. It stimulates less insulin release, yet promotes hepatic lipogenesis (i.e. causes the liver to produce fat, in particular, triglycerides), increases serum (blood) triglycerides, and promotes both hepatic (liver) insulin resistance and leptin (the hormone responsible for telling us when we are full) resistance — all factors associated with gallbladder disease (and excessive weight gain leading to diabetes and heart disease!).

The Hormone Connection

The normal hormonal changes of pregnancy are associated with hyperinsulinemia and insulin resistance. In plain language, pregnancy makes it harder for insulin to take glucose into cells (insulin resistance). The body responds by making more insulin (hyperinsulinemia). Women whose bodies are unable to cope, develop gestational diabetes.

What Wong and Ko found that is so striking is that in pregnant all women, postprandial (after eating) insulin levels increase threefold, basal insulin increases twofold, and insulin sensitivity decreases by 50% to 70%. In turn, the hyperinsulinemia and insulin resistance increase bile cholesterol secretion, decrease bile acid synthesis, and increase bile cholesterol saturation, producing a state of bile cholesterol supersaturation that can lead to stone formation. While Wong and Ko admit that there needs to be much more research done to more pointedly identify the specifics of sugar metabolism during pregnancy, they do suggest that pregnant women at least consider modifying their carbohydrate intake during pregnancy and discuss their diets with their doctors.

The “Take Home” message

The take home message is that pregnancy is not a time to over indulge, especially when it comes to sweets and processed foods. Due to the increased hormones present during pregnancy, a woman’s body is already having difficulty metabolizing and processing sugar. Consuming a diet high in sugar, especially processed sugars such as high fructose corn syrup, only adds insult to injury. As this research and many nutritionists and obstetricians suggest, pregnant women should consume diets composed of lean protein, complex carbohydrates such as raw fruits and vegetables and healthy fats such as Omega 3 and Omega 6 fatty acids found in olive oil and fish.

If you would like to learn more about a healthy pregnancy diet or to discuss your own diet, sign up for a Complimentary 30 minute Bedrest Breakthrough Session.

References

Wong A, Ko C “Carbohydrate intake: a risk factor for biliary sludge and stones during pregnancy” DDW 2011; Abstract 322.

*K. C. Gross  and P. B. Acosta “Fruits and Vegetables are a Source of Galactose: Implications in Planning the Diets of Patients with Galactosaemia” J. Inher. Metab. Dis. 14 (1991) 253-258. (the third page of this article lists the Galactose content of many common fruits and vegetables)

One response to “Mamas on Bedrest: Pregnancy, Carbs and Gallstones-Oh My!”

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