Thursday, March 14, 2013

Paleo Pregnancy - Refusing the Oral Glucose Tolerance Test for Gestational Diabetes

Let me start off by saying that gestational diabetes is a condition that should be taken seriously. If there had not been a viable alternative, I would have sucked it up and drank that nasty, orange glucose drink for the sake of my health and my baby's. But the good news is there are alternatives and if you wouldn't usually willingly gulp down a large, sugary beverage and are worried about the effects a clean-eating diet could have on the test results, talk with your healthcare provider about your options (Read: I am not a doctor and only your healthcare provider can advise you on your risk and your options).

  • What is gestational diabetes? 
According to babycenter.com, gestational diabetes is a form of diabetes that between 2 and 10 percent of expectant mothers develop during pregnancy. Because of the hormonal changes to your digestive system during pregnancy, it is possible for your cells to become less responsive to insulin. If your pancreas can't produce enough insulin to keep up with your body's demand, you can have too much glucose in your bloodstream and develop gestational diabetes.

There are certain factors that may put you at a higher risk for developing gestational diabetes, such as body mass index, a diagnosis of gestational diabetes in previous pregnancies, the presence of sugar in your urine or a family history of diabetes. Excessive first trimester weight gain has also been linked with a higher occurrence of gestational diabetes.

It is possible to develop gestational diabetes without the presence of any of these risk factors, which is why most practitioners screen all of their patients between 24 and 28 weeks of pregnancy. With so many unknowns, I felt it was important to address the issue of gestational diabetes with my midwife, even if I wasn't on board with the traditional testing methods.

  • How does it affect your baby?
If you have gestational diabetes and your blood sugar levels are too high, your baby's blood sugar levels will be too high, as well, which will cause the baby's pancreas to produce more insulin. The additional glucose and insulin can cause your baby to gain too much weight in utero, to the point that the baby may be too large to fit through your birth canal or to become injured during delivery. On top of that, babies who are born with a higher than normal birthweight because of gestational diabetes often go on to be overweight in childhood and adulthood.

  • How can you manage gestational diabetes?
In most cases, gestational diabetes can be easily managed through diet and exercise. Eating a balanced, whole foods diet and avoiding processed foods like candy, cake, fast food and pretty much anything in a box, and getting some form of exercise most days of the week should keep gestational diabetes under control and decrease any potential risks to you or your baby. Medication may be prescribed if diet and exercise alone don't help to lower your glucose levels, but this is rare.

Sorry. No more donuts...

Let's see.......plenty of exercise, lots of fruits, vegetables and healthy protein and little or no processed foods. Sounds a lot like what I was already doing! Another reason I felt confident I was not at risk, but I still didn't want to leave my baby's health to chance.

I've got the exercise part down cold!

  • How do practitioners test for gestational diabetes?
Gestational diabetes is typically tested using the oral glucose tolerance test (OGTT). When you arrive at your practitioner's office, you will be given a drink that contains 50 grams of glucose and told to consume it in five minutes. This is usually a standard beverage provided by a drug manufacturer, but some practitioners will allow you to drink a regular soda or even eat jelly beans.

It would have been hard to resist the test if I could have eaten these yummy jelly beans :)

What else is in this drink? I had a hard time finding an ingredient list, but a kind reader who had a bottle of the orange flavor (because she also refused the test and never drank it) shared the ingredients of this  artificially sweetened, artificially flavored drink with me:

Ingredients: purified water, 50g Dextrose (D-glucose derived from corn), Citric Acid, Natural and Artificial Flavors, Sodium Benzoate, 0.1%, FD&C Yellow #6. It also labeled as "Gluten Free & Dairy Free".

An hour after consuming 50 grams of glucose, your blood will be drawn. Typically, a blood glucose level of 140 mg/dl or above means further testing to more accurately diagnose gestational diabetes in the form of a three hour OGTT. You get to consume the fake, sugary beverage again and this time you get to sit around and have your blood drawn once an hour for three hours and you aren't allowed to eat or drink anything for the duration of the exam.

I had a couple of concerns as I learned more about the OGTT. 

First, how would my body react to ingesting such a high dose of sugar in one sitting? Would I get dizzy, throw up or maybe even pass out? It has been a long time since I have had that much sugar and on the few occasions where I have had too much sugar in the past year, it affected how I felt for the whole day.  

Second, would the results be accurate? Most days, my sugar consumption is limited to fresh fruit, dried fruit and maybe some natural sweeteners such as honey or molasses. I was concerned that this could affect my results and I would end up with a false positive. 


  • What's a pregnant mama to do?
At my twenty week appointment, my midwife brought up the topic of gestational diabetes and let me know that my test would be given at my next appointment at 24 weeks. I have been open with my her about my diet since the beginning of my pregnancy and let her in on my concerns. She did say it was possible that my diet could produce inaccurate results, which backed up the research I had done online of other pregnant women following a Paleo diet who failed the OGTT. I asked if there were any alternatives and, luckily, there was.

She told me that they could call in a prescription for diabetes testing supplies and I could keep a food diary and test my blood sugar after each meal for a two week period. This didn't exactly sound like my idea of a good time, but it did sound manageable. The results would be much more accurate and I could learn more about how my body processes certain foods.

This went everywhere with me for two weeks. Maybe they should make a cute purse to hold it.

I thought it over for a few days, but what finally clenched it was when I learned that my health insurance covers diabetic testing supplies and I would pay almost nothing ($10 to be exact) for the glucose monitor, lancets and test strips. I was in! My midwife called in the prescription and I proceeded to test my blood sugar four times a day for two weeks. I bought a little notebook to record my meals and glucose levels and named it "The Blood Sugar Diaries".  My first finger prick of the day came right after waking up, while my body was still in a state of fasting. I then tested my blood sugar level two hours after the start of each meal. I actually had to get Kevin to prick my finger the first time because I was too scared. Once I realized that it barely hurt at all, I took over for the rest of the two weeks. 

I was shocked, but it really didn't hurt. 
At first, it was kind of fun. I liked seeing that my levels were normal and my body seemed to be processing everything as it should. After the first week, when I was fairly well convinced that I did not have gestational diabetes, it got to be a little less fun and became more of a chore. But I kept at it because I knew it was the only way I could avoid that nasty drink. 

My next appointment was only a few days after I completed my testing so I prettied up my food diary and blood sugar results into a word document (my midwife was very impressed). She looked it over for a few minutes and said that my numbers looked great and no further testing was required. My fasting blood sugar was usually in the 80's or 90's and my average after meals was about 110 mg/dl. If you are super nerdy and into that sort of thing, you can see my full two week diary at the end of this post. Note: I only recorded my meals, not the many snacks that I eat in between meals.

In the end, I was relieved to learn that both myself and my baby were healthy and I was glad that I didn't just accept the standard test without further questioning. But, really, if I had failed the OGTT, the diet that would have been prescribed would be eerily similar to the diet that I already follow. That is the funny thing about it. The very diet that could cause my results to be inaccurate is the one that I would be told to follow if I had failed the test.  Things that make you go hmmmm....


This post is linked to Party Wave Wednesday at HolisticSquid.com!


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2/16/13
7:40am Fasting 83 mg/dl
10:50am Breakfast Eggs, sausage, pepper, onion
Smoothie with banana, coffee, cocoa, coconut milk
12:50pm 99 mg/dl
3:15pm Lunch Romaine, apples, dried cherries, carrots, oil and vinegar, pepitas
5:15pm 107 mg/dl
7:05pm Dinner Burger patty, mustard, pickle
9:05pm 89 mg/dl


2/17/13
7:45am Fasting 112 mg/dl
8:30am Breakfast Eggs, salsa, onion, cabbage, bacon, avocado
10:30am 94 mg/dl
1:30pm Lunch Grapes, nuts, raisins, turkey
3:30pm 83 mg/dl
7:00pm Dinner Chicken, spaghetti squash, olives, basil, onion, coconut milk
9:00pm 90 mg/dl


2/18/13
6:45am Fasting 82 mg/dl
7:15am Breakfast Sausage, brussels sprouts, onion, dried cherry, avocado, egg
Smoothie with banana, cocoa, coconut milk
9:15am 113 mg/dl
11:30am Lunch Chicken, spaghetti squash, olives, basil, onion, coconut milk
Dried apricots
1:30pm 115 mg/dl
7:30pm Dinner Tilapia, broccoli, cherries, walnuts, dark chocolate soufflé w/ raspberries
9:30pm 106 mg/dl

2/19/13
8:00am Fasting 93 mg/dl
7:30am Breakfast Sausage, pepper, onion, cabbage, egg
9:30am 86 mg/dl
12:30pm Lunch Sausage, pepper, onion, cabbage, egg, grapes
2:30pm 134 mg/dl
8:00pm Dinner Ground beef, onion, lettuce, apple, coconut
10:00pm 107 mg/dl

2/20/13
7:50am Fasting 92 mg/dl
8:15am Breakfast Eggs, salsa, onion, cabbage, bacon, avocado
10:15am 96 mg/dl
12:15pm Lunch Salad w/ blueberries, avocado, romaine, turkey, oil and vinegar, pepitas
2:15pm 88 mg/dl
6:15pm Dinner Roast beef, salad
8:15pm 82 mg/dl

2/21/13
7:30am Fasting 90 mg/dl
7:30am Breakfast Egg, pepper, bacon, avocado, onion, sweet potato
Smoothie with banana, coconut milk, cocoa, almond butter
9:30am 102 mg/dl
12:15pm Lunch Egg, pepper, bacon, avocado, onion, sweet potato
Apple, dried apricots
2:15pm 110 mg/dl
6:00pm Dinner Roast beef, salad
8:00pm 98 mg/dl

2/22/13
5:30am Fasting 86 mg/dl
7:45 am Breakfast Pepper, onion, egg, avocado, spinach, bacon
10:00am 93 mg/dl
1:00pm Lunch Qdoba salad and soup, dried apricots, dark chocolate
3:00pm 114 mg/dl
8:00pm Dinner Turkey, mushrooms, tomatoes, broccoli, mustard, fruit
10:00pm 103 mg/dl

2/23/13
7:35am Fasting 88 mg/dl
10:30am Breakfast Sweet potato, onion, pork, eggs, salsa, avocado
Smoothie with banana, coconut milk, cocoa, strawberries
12:30am 85 mg/dl
8:30pm Dinner Turkey, bok choy, carrots, grain free muffin, banana
10:30pm 119 mg/dl

2/24/13
7:30am Fasting 82 mg/dl
8:00am Breakfast Sweet potato, onion, pork, eggs, salsa, avocado 
Smoothie
10:00am 99 mg/dl
12:45pm Lunch Grain free muffin, turkey burger
2:45pm 119 mg/dl
6:15pm Dinner Salad, pumpkin chili
8:15pm 90 mg/dl

2/25/13
7:15am Fasting 83 mg/dl
7:30am Breakfast Eggs, salsa, onion, cabbage, bacon, avocado
Smoothie with banana, pumpkin, coconut milk
9:30am 103 mg/dl
1:45pm Lunch Pumpkin chili, apple, dried apricots
3:45pm 109 mg/dl
8:00pm Dinner Tilapia, asparagus, grain free brownie, almond butter, blueberries
10:00pm 102 mg/dl

2/26/13
6:00am Fasting 90 mg/dl
7:30am Breakfast Brussels sprouts, onion, eggs, avocado, sausage 
Smoothie
9:30am 106 mg/dl
12:45pm Lunch Grain free muffin, turkey burger
2:45pm 119 mg/dl
6:15pm Dinner Salad, pumpkin chili
8:15pm 90 mg/dl

2/27/13
7:15am Fasting 83 mg/dl
7:30am Breakfast Eggs, salsa, onion, cabbage, bacon, avocado
Smoothie with banana, pumpkin, coconut milk
9:30am 103 mg/dl
1:45pm Lunch Pumpkin chili, apple, dried apricots
3:45pm 109 mg/dl
8:00pm Dinner Tilapia, asparagus, grain free brownie, almond butter, blueberries
10:00pm 102 mg/dl



25 comments:

  1. Yeah! I did that, too! Well, after I already did an early OGTT when we found out our baby is big. I eat a (ahem, mostly) plaeo diet and knew there was no problem - I just have a big, healthy baby! I drank that junk and felt dizzy, nauseous, and couldn't eat for 8 hours afterward because I felt so awful. I was right - no GD.

    The second time they wanted to test me I instead bought a testing kit and checked my blood glucose at the hour, two hour, and three hour mark for four days along with a food journal. My numbers were great, except that one time when I felt sick and ate a gluten free, dairy free (not grain free) muffin. For lunch. :( My glucose went pretty high. So, no more muffins for me, which I basically knew anyway - this muffin was a rare event and I was curious about what my blood glucose might do after eating one. My midwife said what I already knew: no more [grain based] muffins.

    Since I happen to have a bottle of the stuff right here (because I refused the test) I have the ingredients. Here are the gory details verbatim from the bottle (Orange flavor): Ingredients: purified water, 50g Dextrose (D-glucose derived from corn), Citric Acid, Natural and Artificial Flavors, Sodium Benzoate, 0.1%, FD&C Yellow #6. It also says "Gluten Free & Dairy Free" on the bottle which made me chuckle a bit.

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    1. Thank you so much for sharing - I'll update my post to make sure everyone sees the ingredients. At least it is "safe" since it is gluten and dairy free :)

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  2. it's strange (and i'm incredibly jealous) that you were able to do this and be declared non-gestational diabetes... especially as your fasting levels would be considered relatively high in my country (Australia- we have the toughest testing levels in the world i think!)... they are determined in my country that that you cannot tell if you are GD unless you see how your body actually responds to carbs...
    so just monitoring your normal low carb eating habits is not considered enough to tell if you are GD...

    any fasting levels over 90 where i am is considered a fail and makes you qualify as gestational diabetes.... and to have 3 fasting levels in a week go over 90 they would be talking insulin!! yes, sadly i'm serious!! it totally sucks for me as i was JUST over 90 for fasting levels on my GTT and they said i had GD and i've had to do the crappy finger prick testing every day for over a month now... my levels (eating what i normally eat) are similar to yours... in fact i've only had one fasting level go over 90 in 1 month of finger prick testing and all my daytime levels have been low... but they STILL say i'm gestational diabetes... to be honest i'm NOT convinced... the whole thing experience has been horrible and stress causing and my levels weren't that different with my last child and she was born completely normal birthweight- no complications at all :(

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    1. I am so sorry to hear that. :( Sounds like they are being way too cautious!

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  3. Thanks for sharing. I'm 26 weeks pregnant now and I'm having a hard time refusing the test. My OB is putting so much pressure on me to take it. I eat a pretty strict paleo diet and I'd rather not purposely increase carbs for several days just to pass a test. I decided to monitor my blood sugar at home for several days and see how I'm reacting to my normal food intake. So far, I am not at all worried about GD.

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    1. I definitely think it is important to make sure you don't have GD, but I just think there are better ways to do it than the traditional testing. I am so glad you are sticking to your guns. :)

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  4. Tarah, I drank the Glucola Drink. and failed the 1 hr. screening test. Can you please guide me on what to purchase, meaning the kit that is required. I am from Paraguay and I don't know anyone that can guide me trough this process, my midwife here wants me to go again for the 3 hour test, and I will not drink 100 mg of the poison again. I would like to present to her this option and see her approach. Thank You. Judith.

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    1. I bought this glucose meter - https://www.accu-chek.com/us/glucose-meters/aviva.html and the accompanying test strips. I took my fasting blood sugar each morning and then took my blood sugar two hours after each meal and kept a food journal that included my blood sugar numbers. My insurance covered the glucose meter, too.

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  5. Hi Tarah,

    I just met with my midwife today (I am 20 weeks) and she gave me the orange drink to take home for our next visit. I didn't realize there were other options. How can I ask my midwife for this test pack? Can you order it yourself or do you have to go through a doctor? We have an HSA so it will not likely be cover, but neither is our midwife fee, so oh well.

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    1. I had to have them write me a prescription for the testing supplies, but you can buy them over the counter. At my pharmacy they are right in front of the pick-up counter. The price actually isn't too bad, but it was a little less through insurance.

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  6. Thanks for this post. I don't do any special diet but I failed my 1 hr test in the 170's, after fasting through the night. When the docs recommended the 3 hour test I cringed. After going home and thinking about it I thought to myself I'd rather get myself a glucometer, go ahead and cut out the sodas and junk foods, and test my sugars daily. My parents both have type 2 so I'm familiar with this stuff. I'm going to call my provider tomorrow to see if she will give me a script for the supplies and work with me on this. I already went to Walgreens to look at their testing supplies but they are expensive so if I have a script, that will be covered. Wish me luck!

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    1. Good luck! Let me know how it goes. It gives you such a much more accurate picture of how your body handles certain foods anyway!

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    2. I am 27 weeks pregnant and I refuse this test. I am supposed to take it next week. I was on antibiotics two weeks ago plus I was never able to drink or eat any sugar. Even when I was little, it would upset my stomach pretty bad. I have done a lot of research on the subject and it seems that women with horrible diets and do not workout pass it with flying colors. I am a personal trainer and a health coach, I eat really healthy and I would like to avoid this test. I will offer my OB what you did instead, thank you for the idea!

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    3. I am in the same situation as you. I did not pass the 1 hour test and the drink made me feel horrible (I am very strict sticking to the Autoimmune Paleo diet (AIP)). I think I will try the same procedure of getting a glucometer (both my parents have type 2 as well). I will call my provider and see if she will also work with me on this. Thanks so much for writing about your experience, it makes me feel that the thought of doing it again has me really worried, and having a possible alternative is more comforting.

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  7. I failed the one hour and had to go take the 3 hour. I bombed the 3 hour test too. So far I spent over an hour with a diabetic counselor and over an hour with a nutritionist. I go to see an endocrinologist in a couple of days. For the last 3 days I have been testing my levels with a meter and altered my carb intake according to diabetic rules ie. only one piece of whole wheat bread with peanut butter not 2 like a normal person. Well I am totally within the "right" numbers and have at times been starving and had zero energy which does not seem ok for a pregnant mama. I have already asked why on earth I failed the sugar tests but my numbers are totally healthy and fine. No answer to that question from the specialist. Is it possible I just couldn't handle that kind of sugar test? Maybe my body just works a little differently than everyone else's? If my numbers over the last few days have been considered HIGH then I wouldn't be so annoyed. But to take all these tests with these low numbers yet still have to limit my intake of foods (ie. scared to eat an orange, or more than half an apple or banana) just doesn't seem healthy to me. So I will be bombarding the endocrinologist with questions about this in a couple of days because this has been a lot of worry/stress, a lot of time, and a l feel a lot more drained than I did before. Frankly if they just said don't eat any chocolate or desserts until you deliver and make sure you eat 6 small meals a day I would be better off. I now regret not pushing back on these tests but I had no idea it was an option and I had no idea I could've just done the same testing I am doing now for a couple of weeks as a replacement. Ugh!

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    1. I am so sorry you are going through this. Honestly, a paleo diet is quite similar to the diet recommended for gestational diabetes. Probably with less fruit and starchy vegetables, though. I would definitely talk with them further and see what foods you could add in so you aren't feeling run down. Especially if you are testing your blood sugar regularly to be sure your levels aren't going too high.

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  8. I wish I found this post sooner. I originally refused the test as well, but just this past week, my midwife was concerned, as I am measuring 40 weeks, even though I am only 33. She sent me for an u/s and begged me to take the test. I did the 2 hr one and my middle level (after one hr) was abnormal, so I was immediately diagnosed w/ GD. I believe my levels were high because I usually eat healthy and my body is not used to consuming that much sugar. (How any woman's levels are normal after drinking this sugary poison is beyond me.) Anyway, though I am almost certain I do not have GD, I am getting a monitor and doing what you did to be sure, as I feel like it's the only way I'll have piece of mind. For the record, the u/s doctor was not at all concerned about my baby's weight. Said he was definitely measuring on the big side, but not abnormally so- 70th percentile.

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    1. Devon, I think you are doing the right thing by continuing to monitor. A GD diet is similar to a Paleo diet anyway so as long as you are monitoring and your levels are normal then I would think your assumptions are correct and you didn't have GD in the first place.

      Good luck with a healthy remainder of your pregnancy and a happy, healthy baby!!

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  9. Hey Tarah,
    I'm so happy my husband found this post. I was skeptical of the suggested SUGAR DRINK. Not only for my body (and the possible false positive?) but what it would do to my very tiny unborn baby in my belly. I quickly imagined her going into a hyperactive fit in there not knowing what kind of junk hit her system. I wasn't for it so my first instinct was to decline especially because of all the other unnecessary tests Hospitals like to put expectant mothers through.

    I've been going to a "Natural Child Birth" wing of a hospital working with a MIdwife and I've still had all the over the top testing pushed at me. I keep on declining and the Drs act as though I'm being unaware or not being a caring enough mother to be. What I don't want to be is a guinea pig. My husband and I asked if any of these tests would allow us to help our unborn child if there was a real problem? The answer was always no except for the GD test which I knew I didn't have. We switched Hospitals and the Midwife we're working with now is amazing.

    The big suggestion I have to give to expectant mothers is to go with your gut and trust your (newly installed Motherly) instincts. I'm the most healthy person I know, I'm never sick and I eat all organic not quite Paleo but close to.

    I said I would do the drink test at first but when I got home I felt like I could indeed fail as the only sugars I eat are fruit, organic raw honey and sometime a little maple syrup. My husband thought because I was so very healthy the test would be fine (and maybe that would have been true) but after we read your post I was determined to do the (one touch ultra) Glucose Monitoring instead. The equipment was mostly covered by insurance. I of course don't love the prick even though it isn't to horrible but what I do love is the fact that I can accurately chart my blood sugar levels. It gives me such piece of mind knowing that I'm totally fine and my baby is indeed healthy.

    I'm so happy I DID NOT drink that crap drink. I think anyone who eats like you or me could possibly fail and go through all the stress of doing all of those other tests. I get what the false positive can do to someones stress levels. Not a great state to be in while pregnant. So thank you again for posting. Its so important to read about others who have a similar holistic vision:)

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    1. I am so happy to help! I think you hit the nail on the head - as mamas, we have to trust our gut and do what we think is best for our babies. Best of luck with everything!

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  10. My blood sugar testing levels were vey similar to yours even testing only 1 hour after meals and they were very concerned about me. I'm not pure paleo, more WAPF but have basically gone paleo to control blood sugar. The 1 hour test was awful. It was bad during my first pregnancy too but much worse this time. Took me the rest of the day to recover. Always had blood sugar problems- reactive hypoglycemia -and have always naturally avoided anything that would spike my blood sugar. Also we only get more insulin resistant as the weeks go by. My endocrinologist says 32-34 weeks is the worst. Plus it just seems like the lower carb I eat the more my body tris to keep my blood sugar high for the baby. I'm probably pretty ketone adapted at this point so what do I need the blood sugar for?

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  11. I'm a nurse practitioner and also the partner of an expectant mom. Our midwives recommended a "food" oral glucose tolerance test -- a big, carbo-loaded breakfast with blood sugar checks before (fasting), 1 hour, and 2 hours after. This is what we did.

    Reading this post and the comments above, I have a couple thoughts:
    Tarah's fasting blood sugars would actually meet the American Diabetes Association's criteria for gestational diabetes (>92 mg/dl), so it's interesting that her midwife said this looked great. Perhaps this is because her lifestyle already fulfilled recommendations for "medical nutritional therapy" and exercise.

    I'm also seeing someone mention being "ketone-adapted." The concern about ketones is a concern for baby's health/development. Older studies found intellectual delays associated with ketosis during pregnancy.

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    1. I think you are referring only to fasting glucose of 92 mg/dl, which I was well within on most days. The levels are higher for two hours after eating, according to the sources I researched during my pregnancy. Although, I've also seen that many practitioners have their own levels they prefer to see so your midwife may have a different recommendation than mine. My midwife was perfectly happy with my levels, though.

      I love that your midwife is open to a food-based glucose tolerance test!

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  12. Tarah - Thank you for the blog entry. Because of this I doing what intuitively feels right and skipping the 1 hour GTT. I took the 5 hour test in my teens and the practitioner came out and said it was the lowest bs number she'd ever seen! I nearly passed out. I was diagnosed with Hypoglycemia. Anyway, I'm wondering if you have thoughts on what the normal range is. So far, I'm testing similar to you. Just curious! Keep up the great blog. ~ Grateful Reader

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  13. I'm doing this right now. I actually thought of it myself and then googled to see if it was a legitimate option. (Kind of hilarious because my first fasting glucose was 48...I liked that because I felt like I had wiggle room, haha.) So I emailed my midwife and by the end of the day I had a Rx for test trips (since I already had a meter). My brother is diabetic so I know I'm at an increased risk and wanted to be screened somehow, but the amount of sugar grossed me out AND I feel like it's unrealistic. When do I ever slam 50g of sugar in five minutes in my normal life? Never. So why does my body have to be able to do that?

    I feel like it's saying "OKAY and today we're gonna test your fitness...you need to outrun this pack of pitbulls or you're going to be labeled 'obese' for life. READY?" Like, ummm...what if I just live a life free of the need to outrun pitbulls, yeah? Call me crazy.

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