Gestational diabetes diet
Making lifestyle changes to follow a good gestational diabetes diet will mean achieving lower blood sugar levels which will ultimately benefit your baby hugely and reduce the risks and complications associated with gestational diabetes. But what is a good gestational diabetes diet?
Our golden rules to eating
The best approach to food we have found is to stick to these 8 golden rules:
- Eat little & often, ideally 3 meals and 3 snacks a day
- 'Pair' foods so that they will be tolerated better, "food pairing" is a term that we use in relation to the GD diet
- Eat high protein
- Eat good, natural fats
- Eat low amounts of unrefined complex starchy carbohydrates at every meal
- Bulk up meals with lots of vegetables & salad
- Drink plenty of water
- Go for a stroll
We explain all these points in more detail below...
#1. Eat little and often
Ideally we want blood sugar levels which look (if we were to draw a picture) like rolling hills, rather than huge spikes and crashes. The best way to achieve good control over levels is to choose sensible foods and to eat little amounts often. We advise aiming for 3 meals and 3 snacks a day.
Avoiding to eat is something that many mothers do when they are first diagnosed with gestational diabetes as they are unsure or too scared over what to eat. This can actually have a detrimental effect on blood sugar levels. If a meal or snack is missed then blood sugar levels can drop low and when this happens the liver dumps glucose into the bloodstream to give us energy and keep us going.
The glucose can raise our levels high and then when eating our next meal, as levels are higher than they should be, they raise even higher. Following a big spike in levels, the body will signal the pancreas to produce insulin, but with gestational diabetes we may not be able to produce enough insulin or hormones block our body from using the insulin we have produced. Sometimes the body will overproduce insulin and cause a big crash in levels, which is the start of roller coaster blood sugar levels.
The other problem with missing meals or snacks, is that when we do eventually eat, we may eat too much in one go and large amounts of food in one go are very hard to tolerate. When a large amount of food is eaten we need to use more insulin to process the sugar in that food. It is much easier to tolerate small amounts regularly where the body is required to produce less insulin at a time.
#2. 'Food pairing'
In the chart below you will see that with carbs, 90 - 100% turn into glucose and this happens rapidly, within 1 - 2 hours. Whereas with proteins and fats, much less turn into glucose and over a much longer period of time.
By eating plenty of protein with any carbohydrates and some natural fats, the absorption of sugar into the bloodstream is slowed down. This is where the term 'food pairing' has evolved from with regards to the gestational diabetes diet. When eating carbs, if you 'pair' them with protein and natural fat you will get lower blood glucose levels.
#3. High protein
50% of protein turns to glucose in 2 - 4 hours and so protein is a 'safe food' on a gestational diabetes diet. Use protein for food pairing to help tolerate carbs better and slow down the absorption of sugar into the bloodstream.
Good sources of protein are: meat, poultry, game, fish, eggs, tofu, Quorn, nuts, yoghurt, hummus, cheese, seeds, quinoa, lentils, chickpeas, beans, soy milk.
Protein should be your first tool in line used for food pairing over fat
Information on eggs. Dippy or runny eggs? Look for the Lion stamp...
There is varied information given regarding eating eggs during pregnancy. Eggs (as long as you have no allergies) will become your best friend whilst having gestational diabetes! They have many vitamins, minerals and heart healthy fats. Most importantly they are high in protein and therefore become a food that will be tolerable for your blood sugars and will actually help keep levels lowered and stabilised. The majority of good gestational diabetes breakfasts include eggs in one form or another and they are a good tool for food pairing.
Egg safety in pregnancy
At the time of the salmonella and eggs scare in 1988, the Department of Health recommended that recipes for uncooked dishes involving raw eggs should be avoided, and that lightly cooked eggs should not be served to vulnerable groups – i.e. infants, pregnant women, elderly and debilitated people.
This advice, however, pre-dated the introduction of the British Lion scheme in 1998. The Food Standards Agency has announced a review of the evidence relating to the safety of eggs in the UK early next year.
The British Egg Industry Council says that the safety record of British Lion eggs means that vulnerable groups should now be allowed to consume them when runny.
#4. Natural fats
Fat I hear you cry?! Yes fat! But good, natural, heart healthy unsaturated fats such as monounsaturated fats and polyunsaturated fats which include omega-3 and omega-6 fatty acids.
These fats improve blood cholesterol levels and can decrease your risk of heart disease. They also play an important role in the development of the brain, eyes and nervous system of your growing baby and so are essential for baby's growth
Use the good fats listed below to help with food pairing
| MONOUNSATURATED FATS
|| POLYUNSATURATED FATS
We also find that full fat dairy products which are saturated fats, go a long way to helping a good gestational diabetes diet and this will be controversial to most people as for many years saturated fats have been the bad fat that should be avoided. However, recent research has challenged that saturated fats now may be no worse than other 'healthy' fats.
Here's an extract from the British Heart Foundation's Senior Dietitian's article on the research around saturated fats:
Last week saturated fat came back to the top of the news agenda because research we’d helped to fund suggested there isn't enough evidence to support current guidelines on which types of fat to eat. While the latest study didn't show saturated fat is associated with cardiovascular disease, it also didn't show that eating more of it is better for your heart health.
There will always be a battle between fat v's sugar. We are not suggesting you live on high trans fat takeaways or products containing hydrogenated vegetable oil for the rest of the pregnancy, but introducing 'good' fats into the diet, rather than fat free or diet alternatives which are filled with refined carbs and sugar, will help control blood sugar levels.
#5. Low amounts of unrefined complex starchy carbs at every meal
Carbohydrates are a tricky thing for diabetics to tolerate. Gestational diabetes is defined as carbohydrate intolerance!
This is because a high amount of carbohydrate turns into glucose, raising blood sugar levels. They are however important as they provide the body with energy.
If you are confused about carbs, then don't worry, we have a whole page dedicated to explaining carbs.
Carbohydrates can be found in many different foods. Naturally occurring carbohydrates include fruit, vegetables, milk, honey, nuts, grains, seeds and legumes.
There are two main types of carbohydrates:
- Simple - Sugar or glucose is a simple carbohydrate. Sugar is naturally occurring in many foods, forming fructose in fruit, lactose in milk and sucrose in granulated sugar.
- Complex - Starch is a complex carbohydrate made of sugar units bonded together. Starch occurs naturally in vegetables, grains, and cooked dried beans and peas. When a complex carb is refined, it is processed and much of the fibre and goodness is stripped away. Unrefined carbs are therefore, carbs which are in their natural state and contain much more goodness.
|Refined complex carb||Unrefined complex carb|
|White flour||Wholemeal flour|
|White bread||Granary or wholemeal bread|
|White pasta||Whole wheat pasta|
|White rice||Brown or whole grain rice|
|Breakfast cereals||Steel cut/pinhead porridge oats|
Choose small amounts of unrefined complex starchy carbs to eat at every meal. Carbohydrates are important as they provide the body with energy and also stop the body from going into a ketosis state.
Carb counting and how much carb to eat
Many gestational diabetes diets that are given by hospitals/dietitians involve counting set amounts of carbohydrates for each meal and snack.
We have found that carb counting can help gauge portion sizes of starchy carbs, however it does not work accurately for controlling blood sugar levels with gestational diabetes and can lead to some ladies being put on medication earlier than necessary, or doses increased earlier.
Carb counting works well for other types of diabetes such as type 1 diabetes where carbs are measured to work out insulin doses, however gestational diabetes is different (even when controlled using insulin).
Gestational diabetes is driven by the hormones from the placenta, meaning when baby has a growth spurt and the placenta works harder, more of the insulin blocking hormones are pushed out.
Due to ebs and flows of the hormones, we've found that gestational diabetes can be more erratic with certain foods, making it extremely difficult to predict how well you will tolerate them and subsequently control levels.
Foods that you could tolerate well for a few days, even weeks, all of a sudden can start giving you high readings - this is perfectly normal and to be expected the further into pregnancy you go.
Many women find that with the gestational diabetes diet, there are certain unrefined, starchy, complex carbs which are better tolerated than others. Therefore you may be able to tolerate 40g basmati rice, yet 40g of whole wheat pasta sends your levels into the teens!
Trial and error with starchy carbs is the best approach at the start, so try different ones and keep a food diary alongside your readings. Start with small amounts (ie. 3 egg sized new potatoes, 4 tbl sp of cooked rice or pasta, one slice of 800g bread) and depending on your readings increase the carbs so that you are comfortably within your test target for blood sugar levels.
Food labels, checking for carbs and sugar
Read food labels carefully to make choices which have lower amounts of carbohydrates.
The 'total carbohydrate' on the label includes all types of carbohydrate, the sugar, complex carbohydrate and fibre. Because all types of carbohydrate can affect blood glucose, it's important to use the 'total carbohydrate' grams, rather than just the grams 'of which are sugar'.
A label which states less than 5g sugar per 100g is classed as a low sugar product.
It is important to look at the serving size you plan on consuming in relation to the amount of carbohydrates shown in the nutritional information so as not to be caught out!
Different types of carbohydrates are digested at different rates in the body and this has an effect on your blood glucose levels. The Glycaemic Index (GI), is a system of ranking used to understand how quickly these foods make your blood glucose levels rise after eating them (or spike).
Low GI foods should be used to help make better choices when selecting which carbohydrates to eat, so we advise swapping high GI foods for low GI instead for a better gestational diabetes diet.
A list of better options and quick swaps for a gestational diabetes diet
|Carbohydrate food||Better options for GD|
|Breads||Burgen soya & linseed, multigrain, rye, pumpernickel bread, Hi-Lo, wholemeal sandwich thins, Lidl high protein rolls or low GI bread, 400g slices of wholemeal/granary breads
see our post on best breads here
|Crackers||Oatcakes, Ryvita, whole wheat crackers & wholegrain crispbreads|
|Potatoes||new potatoes, sweet potatoes
small or half a jacket potato and mash may be tolerable but they must be paired with protein & natural fats - add cheese, butter and cream
|Pasta and noodles||wholewheat pasta & noodles cooked until al dente|
|Rice||Basmati or brown wholegrain rice|
|Grains||Quinoa, wholegrain couscous|
|Breakfast cereals||Pinhead porridge oats (not rolled oats - these are still not tolerable to many)|
|Fruit||Tart/sharp berries, Granny Smith apple, kiwi, small sharp citrus fruit|
|Fruit juices & carbonated drinks||Water, no added sugar squash, diet/zero drinks. See our drinks information|
|Sugars, syrups, honey||Sweeteners, agave nectar|
|Cakes, biscuits & pastries||Nairns oat biscuits, hobnobs, digestives, rich tea|
|Jams & preserves (avoid even diabetic jams)||Peanut butter (<6g total carb per 100g), marmite, cheese spread|
|Desserts||Sugar free or no added sugar jelly, no added sugar angel delight/shops own brand no added sugar 'delight'|
|Sweets & chocolate||Dark chocolate, ½ Kinder Bueno, Cadbury's Freddo, treat size chocolate buttons|
|Milk||Whole (full fat) milk, soy milk, almond milk, coconut milk, lactofree milk|
|Yoghurts||Coconut milk yoghurt, full fat Greek yoghurt, soya yoghurt
See our posts on the best brands of yoghurt here
Carb free meals and ketones
It is common for women with gestational diabetes to develop ketones due to limiting too many carbs from the diet, by not eating enough in general and/or being dehydrated. Once on a gestational diabetes diet many ladies worry about what foods to eat and may avoid eating altogether. Or, knowing that carbs cause rises in blood glucose levels, they cut them out of the diet or limit them too severely as a way of controlling and lowering blood glucose levels.
When too many carbs are cut from your diet, you may produce ketones which can lead to a condition called Ketosis which is dangerous for your baby and you.
We advise eating a small amount of starchy carbs at every meal to avoid this and keeping well hydrated. If you have a carb free breakfast (as many do, due to carbs being very hard to tolerate in the morning because of increased insulin resistance), then it is important to incorporate carbs into your other meals and next snack.
If you are not able to keep your blood sugar levels within target levels when eating small amounts of carbs at meals, then you should be given medication and/or insulin to help you increase the amount of carbs being eaten to tolerate them better.
For more information on ketones and ketosis, please read more here
#6. Bulk up meals with lots of vegetables and salad
Eating plenty of vegetables and salad does two things. It fills you up so that you don't feel hungry and it also provides you with important fibre, nutrients, vitamins and minerals.
Vegetables are actually a third type of carbohydrate known as fibrous carbohydrates. These play an important role in the gestational diabetes diet as they keep the digestive system running well, but it's important to make informed choices when selecting salad and vegetables as some starchy or sweet ones may still raise blood sugar levels too high.
All varieties of potatoes should be considered the carbohydrate of your meal, rather than the vegetable counterpart due to them raising blood sugar levels.
Vegetables which may prove trickier to tolerate for some are: tomatoes (technically a fruit), carrots, swede, parsnips, sweetcorn, squashes, beetroot, peppers and canned vegetables such as peas where sugars may have been added in the canning process.
It's also worth noting that vegetables in there raw form or cooked al dente will provide your body with more nutrients and will have a lower glycaemic index than those that have been cooked which will be more easily digested.
#7. Drink plenty
Staying well hydrated is very important during pregnancy and even more so if you have diabetes whilst pregnant. Drinking water doesn't directly lower blood sugar levels, but it does flush excess sugar out of your system. Staying hydrated will help control and stabilise blood sugar levels and so is a major part of a good gestational diabetes diet.
Ideally you should be drinking around 3 litres (10 -12 glasses) at least, a day. You will need to drink even more during warmer weather or if you are exercising.
We recommend drinking a glass of water with AND in between every meal and snack during the day.
Tea, coffee and fizzy drinks containing caffeine should not be included as part of your recommended daily fluid intake as they are diuretics. Diuretics make you urinate more frequently, causing you to lose water. If you don't like the taste of water then you could try carbonated water with lemon and lime added to it, or some sugar free squash. Be careful when choosing drinking squash which has 'no added sugar', it means exactly that, no ADDED sugar, but will still contain natural sugars. Check labels for the lowest total carbs for the best choices. For more information on drinks please read more here.
#8. Walking does wonders
Where possible, going for a walk for around 30 minutes after eating can help lower blood sugar levels. This does not have to be a brisk walk, even a comfortable stroll will be beneficial. Exercising has an insulin-like effect on your cells and so will assist in lowering blood sugar levels.
The sugar come down
After following the gestational diabetes diet for a few days you may feel a bit rotten. The gestational diabetes diet is similar to a detox as you are severely cutting the sugar your body is used to.
Many ladies experience symptoms such as headaches, fatigue, drowsiness, low energy levels and generally a bit rubbish! These symptoms WILL pass and many say they feel so much better with so much more energy than before after they have gotten over this stage. If you find your levels drop very low then you may experience what is known as a false hypo. For more information on false hypos please read more here.
Breakfast cereals AKA 'GD kryptonite'!
The majority of dietitians and hospital dietary info. will suggest a suitable gestational diabetes breakfast as Weetabix, Bran flakes, All Bran, Shreddies, Shredded Wheat, Granola, No added sugar Muesli, or porridge oats.
We have learnt through experience that it is very rare for ladies to be able to tolerate these cereals throughout a pregnancy when diagnosed with gestational diabetes. Many will be able to tolerate them earlier in pregnancy, when insulin resistance has not yet peaked. Then as the pregnancy progresses and insulin resistance increases, overnight, a cereal which was once tolerated often raises levels very high (spikes), usually into double figures, hence we named breakfast cereal 'GD kryptonite'! Sometimes ladies are able to move onto things like porridge oats which are low GI, but for many all cereals become an intolerable food which has to be forgotten until baby is born. For this reason, cereal becomes a craving food for many ladies with gestational diabetes.
We see many ladies being told that they should be able to tolerate cereal and that they should continue to try and ultimately this results in them being medicated, or doses of medication or insulin being increased in order to control the sugar hit from the cereals.
The other big concern with breakfast cereals is that they spike blood sugar levels very quickly and so those that only test pre-meal levels or 2 hours after eating may miss the big rise in blood sugar levels.
Our advice is to keep breakfast cereals locked in the cupboard and step away from them. Add them to the list of post gestational diabetes diet treats to have once your baby has been born and follow the 8 golden rules to choose a better breakfast.
This is from a survey held in our Gestational Diabetes UK Mums and Life After GD UK Facebook support groups.
251 women answered:
- 74% could not tolerate any breakfast cereals, including porridge
- 12 % could tolerate only porridge, but no other breakfast cereals
- 10% could tolerate cereal
- 4% could tolerate cereal but were under 32 weeks gestation (between 32 36 weeks insulin resistance worsens)
This survey shows 86% of women with gestational diabetes in this survey could not tolerate breakfast cereals suggested by their diabetic team or dietitian such as Bran flakes, Weetabix, Shredded Wheat, Shreddies, low sugar museli or granola.
What about fruit?
Fruit is packed with vitamins and minerals but due to the high fructose content (natural sugars from fruit), fruit is a type of carbohydrate and may be very difficult to tolerate.
Some cannot tolerate any fruit at all. Fruit is a type of carbohydrate and so you need to bear this in mind when deciding what to eat and what to pair it with.
Certain fruits are better than others and all fruit should be 'paired' to slow down the release of fructose into the bloodstream e.g. a granny smith apple dunked in peanut butter, or a few berries with a good yoghurt and seeds.
FAQs around our dietary advice...
Why is the diet I've been advised at my hospital different?
The gestational diabetes diet we advocate is what we have learnt works best since setting up and running the support group, alongside extensive research and my own personal experience with my own GD pregnancies.
Unfortunately one of the biggest things that varies is dietary advice and one of the biggest concerns and complaints in the support group is dietitians and poor advice or lack of dietary advice. Much of the dietary advice given in hospital is based on a diabetic diet for type 2 diabetes, which is currently a low fat diet due to type 2 diabetes being associated with obesity. Many have tried and failed at following this type of 'diabetic' diet (myself included) which includes advocating eating breakfast cereals, lots of fruit and drinking fruit juices, following a fat free or low fat diet. Gestational diabetes is different to type 1 & 2 diabetes due to the fact that it is driven by hormones from the placenta which can fluctuate dramatically and even previously diagnosed diabetics may struggle due to the hormonal fluctuations during pregnancy.
Opinions in the diabetic community are currently changing and so whilst the NHS still advocates a low fat balanced diet (in most areas), many type 2 diabetics are starting to change opinions and are also following low carb, high fat, high protein diets too although we believe it will be some time before the NHS change their opinion on dietary advice.
Gestational diabetes is a progressive condition which worsens (insulin resistance increases) as the pregnancy goes on and so our bodies can struggle to tolerate many things that would be deemed suitable for a type 2 diabetic diet. For many ladies in the group who've had gestational diabetes in previous pregnancies, they've said that the dietary advice we've offered has made huge differences in their subsequent GD pregnancy and they wished they'd had the support and knowledge before now. For a look at some of these ladies testimonials, please read more here.
What do I look for when reading food labels?
List of ingredients: When you're looking at food labels, look at the list of ingredients. Ingredients are listed in descending order by amount. The main ingredient is listed first, followed by other ingredients in decreasing amounts. If the first or second ingredient is sugar then beware! The other problem is that many labels will not state that the item is 'sugar', they may use any number of different names for sugar. Anything ending in "ose" can usually be assumed to be sugar, as is anything that is a type of syrup or nectar.
Nutritional info labels: Look at total carbohydrates grams, not just 'of which are sugar', remember that 90 - 100 % of carbs turn into glucose in the bloodstream and that an item may be 'sugar free' but it doesn't mean that it is carbohydrate free!
No added sugar, not sugar free! This means that no additional sugars have been added to the product BUT any naturally occurring sugars will be present and so once again, compare total carbohydrate grams to check for the lowest before choosing which product to purchase and consume.
Beware of fat free and diet products: Fat free and diet products can very often contain higher amounts of carbohydrates than a full fat or standard versions. Compare products to see which contain less carbs.
What is classed as low in sugar? Products with less than 5g of sugar per 100g
Serving sizes: The serving sizes listed on food labels may be different from the serving sizes you are planning to consume. Play close attention and bear this in mind when looking at total carb amounts.
GD 'naughty' foods, treats and falling off the wagon
We all have foods we crave or want to eat (even more so in pregnancy) and especially once we are told to restrict certain things, however please think about your baby when you reach for these things. This condition is not forever and it is for the benefit of the baby growing inside you.
With gestational diabetes, high sugar foods may need to be thought as foods your baby has an intolerance or allergy to. Just like not feeding nuts to someone who suffers with nut allergy, feeding sugar to your growing baby is going to be harmful to them.
Many think that gestational diabetes just causes a big baby, there's no other concerns or that it is not a serious condition. Unfortunately gestational diabetes is an extremely serious condition, which can cause many complications. Large babies are uncommon if blood glucose levels are controlled well, but there are also many other complications related to gestational diabetes and the condition itself makes us higher risk of developing other problems. For more information on the complications linked to gestational diabetes, please read more here.
There are some things (treats) that are more GD friendly and we will help you find things that are generally better suited or tolerated in a gestational diabetes diet. Please don't push the limits though. A common question is "I have eaten x,y and z, why is my reading below target?" Bearing in mind how the body processes food and how fast the food turn into glucose in the bloodstream, this will determine if you catch the peak in levels or not when you test.
Some foods will spike blood sugar levels (raise levels to the highest point) extremely quickly, within 15 mins and so testing at one hour or two hours after will miss the spike, however your baby has still received the sugar and will start to overproduce their own insulin. It is also common for blood glucose levels to crash low after a high, which results in your blood sugar levels yoyo'ing like a rollercoaster. This is something that should be avoided, as ideally we are looking to stabilise levels so that your baby can also stabilise their insulin production. For more information on our thoughts on testing blood sugar levels in order to catch spikes in blood sugar levels, please read more here.
Still stuck with what to eat?
If you have read this information but still feel overwhelmed as to what to eat for a good gestational diabetes diet, then you may want the convenience of food and meal suggestions, further hints and tips and shopping lists.
You may feel that even with that information, a set meal plan with recipes would be beneficial whilst you learn more about how to use the 8 golden rules and apply them every day.
If this is the case, you may wish to look at our membership options which can be found here and gain access to the following membership pages depending on the level of membership:
- Main meals
- Desserts & treats
- Takeaway & eating out
- 7 day meal plan
- 7 day vegetarian meal plan
- 7 day gluten free meal plan
We also offer a free one day gestational diabetes diet plan. Click here to see the free example plan
For more meal idea inspiration you could also check out our posts on Instagram
The charts below show results from question and answer polls conducted in our Facebook support group around the gestational diabetes diet, but make for interesting reading.
153 members answered;
- 64.7% said following the hospital dietary advice did not help them
- 17.6% said the advice helped
- 17.6% were not offered to see a dietitian
145 members answered;
- 89% had switched to following the our gestational diabetes diet
- 6.2% were sticking with following hospital dietary advice which didn't include carb counting
- 4.8% were using hospital dietary advice that included carb counting
160 members answered;
- 72.5% had lost weight as a result of following a gestational diabetes diet
- 22.5% hadn't lost or gained weight since falling pregnant
- 5% said they had gained weight.
It should be noted that we saw a strong correlation between mothers gaining weight when following hospital dietary advice
196 members answered this poll in our Life After GD UK Facebook group.
It should be noted that only two babies born in our group since it has been running (over 2,000 women have passed through the group) have been reported a birth weight of 10lb or just over, the majority have been significantly smaller
For more stats on methods of birth and gestation at time of birth, please read more here
There is limited research on the best diets suitable for gestational diabetes and so some Type 2 diabetes research was included, bearing in mind that gestational diabetes can have the same characteristics as type 2 diabetes