Further support for the linkages posited by Jenny Brand Miller between insulin resistance and fecundity comes from this study by my colleagues here at Univ of Cal, Irvine. In this case the evidence is of the effects of a surfeit of CHO, rather than a deficit. In two groups of women with gestational diabetes, large gestational age infants tend to be borne by women who are on higher CHO diets. Large gestational age infants are difficult children to birth, risky both to the mother and the child. Consistent with the "carnivore-connection" hypothesis, insulin resistant females would be poor procreators in a CHO abundant environment and would have a selective advantage were CHO scarce. (Abstract from PubMed follows.) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Arthur De Vany Professor Institute for Mathematical Behavioral Sciences 3151 Social Science Plaza Irvine, CA 92697-5100 949-824-5269 [log in to unmask] http://www.socsci.uci.edu/mbs/personnel/devany/devany.html ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Obstet Gynecol 1998 Apr;91(4):600-604 The effects of carbohydrate restriction in patients with diet-controlled gestational diabetes. Major CA, Henry MJ, De Veciana M, Morgan MA University of California, Irvine Medical Center, Department of Obstetrics and Gynecology, Orange 92686, USA. OBJECTIVE: To determine the effect of carbohydrate restriction on perinatal outcome in patients with diet-controlled gestational diabetes mellitus (GDM). METHODS: Women with diet-controlled GDM were divided non-randomly into two groups based on their dietary carbohydrate content: those with low dietary carbohydrate content (below 42%) and those with high dietary carbohydrate content (exceeding 45%). Subjects kept dietary accounts and were followed with daily fasting and postprandial glucose assessments. Subjects also were tested daily for urinary ketones. Glycosylated hemoglobin, mean fasting and postprandial glucose values, incidence of macrosomia and large for gestational age (LGA) infants, cesarean deliveries for cephalopelvic disproportion and macrosomia, and need for insulin therapy were compared between the groups. RESULTS: The two groups were identical in terms of demographic characteristics. Significant reductions in the postprandial glucose values were seen among subjects in the low-carbohydrate group (P < .04). Fewer subjects in the low-carbohydrate group required the addition of insulin for glucose control (P < .047; relative risk [RR] 0.14; 95% confidence interval [CI] 0.02, 1.00). The incidence of LGA infants was significantly lower in the low-carbohydrate group (P < .035; RR 0.22; 95% CI 0.05, 0.91). Subjects in the low carbohydrate group also had a lower rate of cesarean deliveries for cephalopelvic disproportion and macrosomia (P < .037; RR 0.15; 95% CI 0.04, 0.94). CONCLUSION: Carbohydrate restriction in patients with diet-controlled GDM results in improved glycemic control, less need for insulin therapy, a decrease in the incidence LGA infants, and a decrease in cesarean deliveries for cephalopelvic disproportion and macrosomia.