Brewer diet

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Re : Brewer diet

Postby fiona » Mon Feb 18, 2008 01:49 pm

quote:
Originally posted by djsnjones

Yes, I am stating that for a test of albumin therapy in PE to be valid and successful, all antihypertensive therapies must be discontinued.

I do believe that any antihypertensive drugs, or low-salt therapies, or low-calorie diets are part of the cause of the PE end result.

I do not believe that the standard of care is always the best or most effective care. [quote]


Joy, I know you believe this to be the case, but do you have any single piece of properly collated research to support this view? To come onto this site claiming that the use of hypertensives in any way causes or increases the degree of preeclampsia requires substantial evidence.

Without it, I am afraid you are insulting our intelligence, not to mention potentially causing deep distress to many women who have buried their child, their mother, their daughter or their sister.

If that sounds harsh, I apologize. But we have pooled an enormous amount of literature in response to your claims on this thread.

You may not think much of standard of care, but it is exactly standard of care guidelines that have been introduced in the UK and are currently under research in a study in Canada and Australia that are showing remarkable improvements in maternal morbidity and mortality.

This is the bottom line we care about.
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Re : Brewer diet

Postby caryn » Mon Feb 18, 2008 01:52 pm

I do not believe that the standard of care is always the best or most effective care.

Without evidence in your favor, this is your belief alone.

But it is also possible that some women have been taught the BD incorrectly and don't realize it, or have not been taught how to augment the Brewer Diet to meet the unique needs of their unique lifestyles--and so they might not be as much on the BD as they believe themselves to be.

My Bradley-trained direct entry midwife also believed me to be on the Brewer diet, what with the completely filled-out checklists and the supplemental calories noted to the sides of the record.

You have not addressed my other questions about shallow placentation, active untreated HIV, and KIR AA genotypes coupled to HLA-C genotypes.
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Re : Brewer diet

Postby djsnjones » Mon Feb 18, 2008 02:08 pm

I just spent about 45 min. typing up the titles of the studies and papers and touched something wrong and lost it all.

I will have to try again later on that.

I do not have answers for your other questions yet.

Some midwives and Bradley teachers do not fully understand the BD.

I do know that one doctor successfully treated PE with diets up to 260 gram protein with no ill effects.

I need to go do other things now.

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Re : Brewer diet

Postby caryn » Mon Feb 18, 2008 02:41 pm

Joy, are the studies you're referring to confirmed by subsequent research? If not, they don't count as an answer, in much the same way that Ptolemaic studies are no longer considered to confirm geocentrism.

ETA: For any who might not know (I've gotten email asking), Ptolemy was a hardworking, thoughtful Greek astronomer who believed, as the result of a lot of learned academic effort, that the Earth was at the center of the universe ("geocentrism".) This view was later overturned by the work of Copernicus, Brahe, and Galileo. Science is dynamic.

For example, Brewer's 40-year-old rebuttal of the ischemia/hypoxia theory of preeclampsia is irrelevant, because we've not only confirmed the theory with uterine artery doppler studies, but we've also isolated the soluble factors produced by the placenta in response to hypoxia, and determined that they cause the downstream symptoms of preeclampsia. (Subsequent work remains to be done, of course -- like all science, this is preliminary confirmation.)

Here are links to the studies I mentioned:

http://tinyurl.com/2jr452
in pre-eclampsia the trophoblastic invasion is sufficient to allow early pregnancy phases of placentation but too shallow for complete transformation of the arterial utero-placental circulation, predisposing to a repetitive ischaemia-reperfusion (I/R) phenomenon. We suggest that pre-eclampsia is a three-stage disorder with the primary pathology being an excessive or atypical maternal immune response. This would impair the placentation process leading to chronic oxidative stress in the placenta and finally to diffuse maternal endothelial cell dysfunction.

http://www.ncbi.nlm.nih.gov/pubmed/16327320?dopt=AbstractPlus
In 1985-2000 (n = 390) to 2001-2003 (n = 82), rates per 1000 deliveries in HIV-infected women rose from 0.0 to 109.8 (P < 0.001) for pre-eclampsia and from 7.7 to 61.0 (P < 0.001) for fetal death. (In other words, with the advent of HAART for HIV-positive women, PE rates rose from 0.0 to 109.8:1000 deliveries.)

http://tinyurl.com/2l6nlz
Mothers lacking most or all activating KIR (AA genotype) when the fetus possessed HLA-C belonging to the HLA-C2 group were at a greatly increased risk of preeclampsia. This was true even if the mother herself also had HLA-C2, indicating that neither nonself nor missing-self discrimination was operative. Thus, this interaction between maternal KIR and trophoblast appears not to have an immune function, but instead plays a physiological role related to placental development.
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Re : Brewer diet

Postby missgamecock » Mon Feb 18, 2008 04:36 pm

YIKES what would have been my bp WITHOUT the 2000mg of Aldomet and 60mg of procardia last time??? Geez that is the only thing that kept it down to a "reasonable" 160/120. Oh wait, stroke/seizure that would have been the cure. Without antihypertensives, I would not have a live baby now. Oh and I tried the Brewer Diet last time. Ummm it obviously didn't work for me. As Caryn says, this is your opinion alone. None of my docs would go for it.

quote:
Originally posted by djsnjones

Yes, I am stating that for a test of albumin therapy in PE to be valid and successful, all antihypertensive therapies must be discontinued.

I do believe that any antihypertensive drugs, or low-salt therapies, or low-calorie diets are part of the cause of the PE end result.

I do not believe that the standard of care is always the best or most effective care.

I would not do a randomized study with any group on the ACOG diet, because I believe that that diet is part of the cause of PE. Doing a randomized study in this way, believing as I do that such a diet would cause disease and death, would be an unethical act for me. This standard would also be true for any researcher who supported the B philosophy.

I will look up the studies that support this and post them.

As far as your question regarding why well-nourished women get PE, the answer is much longer than I can give here. I can post the pages for the answers on my website here, or I can PM them to you privately, whichever you prefer.

But it is also possible that some women have been taught the BD incorrectly and don't realize it, or have not been taught how to augment the Brewer Diet to meet the unique needs of their unique lifestyles--and so they might not be as much on the BD as they believe themselves to be.

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Re : Brewer diet

Postby djsnjones » Mon Feb 18, 2008 04:39 pm

I did not copy them all--only the ones which seem the most relevant to today's discussion. I don't know which ones would fit into your criteria, but they are all significant to me and others who support the BD.

I will PM you with the links to the other info on my website.

Ahokas, R.A., et al. "Maternal dietary restriction and repletion: effects on cardiac output and placental blood flow in the rat." Paper presented to Society of Perinatal Obstetricians, annual meeting, San Antonio, Tex., Feb. 1982.

Beerers, D.G., et al. "Salt and blood pressure in Scotland." Brit. Med. J. 281 (Sept. 6, 1980): 641.

Bletka, M., et al. "Volume of whole blood and absolute amount of serum proteins in the early stages of late toxemia of pregnancy." Am. J. Obstet. Gynecol. 106 (1970):10.

Brewer, T.H. "Role of malnutrition, hepatic dysfunction and gastrointestinal bacteria in the pathogenesis of acute toxemia of pregnancy." Am. J. Obstet. Gynecol. 84 (1962):1253.

________. "Toxemia of pregnancy." Am. J. Obstet. Gynecol. 89 (1964):838.

________. "Serum albumin and pregnancy toxemia." Lancet 2 (Nov. 21, 1964): 1125.

________. "Good prenatal nutrition prevents toxemia of late pregnancy." Postgrad. Med. 39 (Feb. 1966): A 119 (Jean Mayer, ed.).

________. "Human pregnancy nutrition: a clinical view." Obstet. Gynecol. 30 (1967):605.

________. "Nutrition and pre-eclampsia." Obstet. Gynecol. 33 (1969):448

________. "Metabolic toxemia of late pregnancy:a disease entity." Gynaecologia 167 (1969):1 (Basel)

________. "Human pregnancy nutrition: an examination of traditional assumptions." Aust. N.Z. J. Obstet. Gynaecol. 10 (1970): 87.

________. "Human maternal-fetal nutrition." Obstet. Gynecol. 40 (1972): 868

________. "Metabolic toxemia: the mysterious affliction." J. Applied Nutrition 24 (1972): 56.

________. "Metabolic toxemia of late pregnancy in a county prenatal nutrition education project: a preliminary report." J. Reproduct. Med. 13 (1974):175.

________. "Prenatal complications." In Pomeroy, Leon, ed., New Dynamics of Preventive Medicine, vol. 2. Miami, Symposia Specialists, 1974.

________. "Iatrogenic starvation in human pregnancy." Medikon 4 (1974): 14 (Ghent).

________. "Consequences of malnutrition in human pregnancy." CIBA Review: Perinatal Medicine. Basel: Ciba-Geigy, 1975, p.5.

________. "Role of malnutrition in pre-eclampsia and eclampsia." Am. J. Obstet. Gynecol. 125 (1976):281.

________. "Etiology of eclampsia." Am. J. Obstet. Gynecol. 127 (1977):448.

________. "Maternal Malnutrition." Journ. Nutri. Educ. 14-5, 1982 (Jan.-Mar.).

Briend, A. and Carles, C. "Protein deficiency and pregnancy toxemia in Africa." Lancet, Jan. 21, 1978, p. 146.

Burke, Bertha S., et al. "Nutrition studies during pregnancy." Am. J. Ostet. Gynecol. 46 (1943):38.

Cameron, C.S., & Graham, S. "Antenatal diet and its influence on stillbirths and prematurity." Glasgow Med. J. 24 (1944):1.

Dodge, Eva, & Frost, T. "Relation between blood plasma proteins and toxemias of pregnancy." JAMA 111 (1938): 1898.

Ebbs, John, et al. "The influence of prenatal diet on the mother and child." J. Nutr. 22 (1941) 515.

Ferguson, James Henry. "Maternal death in the rural South: a study of forty-seven consecutive cases." JAMA. 146 (1951): 1388.

Foote, R.G., et al. "The use of liberal salt diet in pre-eclamptic toxemia and essential hypertension with pregnancy." New Zealand Med. J. 77 (1973):242.

Fort, A.T. "Adequate prenatal nutrition." Obstet. Gynecol. 37 (1971):286.

Gray, Mary Jane et al. "Regulation of sodium and total body water metabolism in pregnancy." Am. J. Obstet. Gynecol. 89 (1964): 760.

Green, G.H. "Maternal mortality in the toxaemias of pregnancy." Aust. N.Z. J. Obstet. Gynaecol. 2 (1962)"145.

Grieve, J.F.K. "Prevention of gestational failure by high protein diet." J. Reprod. Med. 13 (1974): 170.

Hamlin, Reginald H.J. "The prevention of eclampsia and pre-eclampsia." Lancet 1 (1952):64.

________. "Prophylaxis against toxemia." Clin. Obstet. Gynecol. 1 (1958):369.

Higgard, Lester. "Maternal mortality due to acute toxemia." Obstet. Gynecol. 42 (1973):263.

Higgins, Agnes C. "Nutritional status and the outcomes of pregnancy." J. Canadian Dietet. Assoc. 37 (1976):17.

________. "The Higgins Intervention Method for Nutritional Rehabilitation During Pregnancy: procedure for estimation of caloric and protein requirements" (reprint). Montreal Diet Dispensary, 2182 Lincoln Avenue, Montreal H3h 1J3, Quebec, Canada.

Iyengar, Leela. "Urinary estrogen excretion in undernourished pregnant Indian women: effect of dietary supplementation on urinary estrogens and birth weights of infants." Am. J. Obstet. Gynecol. 102 (1968):834.

Jeans, P.C., et al. "Incidence of prematurity in relation to maternal nutrition." J. Am. Deit. Assn. 31 (1955):576.

Kelman, L., et al. "Effects of dietary protein restriction on albumin synthesis, albumin catabolism, and the plasma aminogram." Am. J. Clin. Nutr. 25 (1972):1174.

Lechtig, A., et al. "Effect of moderate maternal malnutrition on the placenta." Am. J. Ostet. Gynecol. 123 (1975):191.

Liley, A.W. "Clinical and laboratory significance of variation in maternal plasma volume in pregnancy." Int. J. Gynaec. Obstet. 8 (1970):358.

Lindberg, Bo. "Salt, diuretics and pregnancy." Gynecol. Obstet. Invest. 10 (1979): 145-156.

Maqueo, Manuel, et al. "Nutritional status and liver function in toxemia of pregnancy." Obstet. Gyne. 23 (1964):222.

Mellanby, Edward. "Nutrition and childbearing." Lancet 2 (1933):1131.

Mitchell, J., et al. "Dietary habits of a group of severe pre-eclamptics in Alabama." J. Natl. Med. Assn. 41 (1949):122.

Pike, R.L., & Smicklas, H.A. "A reappraisal of sodium restriction during pregnancy." Internatl. J. Gynaecol. Obstet. 10 (1972):1.

________, & Gursky, D.S. "Further evidence of deleterious effects produced by sodium restriction during pregnancy." Am. J. Clin. Nutr. 23 (1970):883.

Platt, B.S., & Stewart, R.J. "Reversible and irreversible effects of protein-calorie deficiency on the central nervous system of animals and man." World Rev. Nutr. Deitet. 13 (1971):43.

Porapakkham, Saroj. "An epidemiological study of eclampsia." Obstet. Gynecol. 54 (1979):26.

Robinson, M. "Salt in pregnancy." Lancet 1 (1958): 178.

Rosso, Pedro. "Nutrition and maternal-fetal exchange." Am. J. Clin. Nutr. 34 (Apr. 1981):744-755.

________, & Streeter,M.R. "Effect of food or protein restriction on plasma volume expansion in pregnant rats." J. Nutr. 11 (1979):1887.

________., et al. "Effects of maternal undernutrition on placental metabolism and function." In Young, D.S., and Hicks, J.M., eds., The Neonate. New York: John Wiley & Sons, 1976.

Schewitz, Lionel. "Hypertension and renal disease in pregnancy." Med. Clin. N. Amer. 55 (1971):47.

Shank, R.E. "A chink in our armor." Nutrition Today 5, no.2 (1970):2.

Shearer, Madeleine H. "Malnutrition in middle-class pregnant women." Birth and the Family Journal 7 (Spring 1980):1.

Sibai, Baha M., et al. "Plasma volume determination in pregnancies complicated by chronic hypertension." Paper presented to Society of Perinatal Obstetricians, annual meeting, San Antonio, Tex., Feb. 1982. Obstet. Gynecol. 60 (1982):174.

Strauss, M.B. "Observations on the etiology of the toxemias of pregnancy: the relation of nutritional deficiency, hypoproteinemia, and elevated venous pressure to water retention during pregnancy." Am. J. Med. Sci. 190 (1935):811.

Theobald, G.W. "Discussion on diet in pregnancy." Proc. R. Soc. Med. 28 (1935): 1388.

Tompkins, W.T., et al. "The underweight patient as an increased obstetrical hazard." Am. J. Obstet. Gynecol. 69 (1955):114.

________, & Wiehl, D. "Nutrition and nutritional deficiencies as related to the premature." Pediatric Clin. No. Amer. 1 (1954):687.

Walker, Elizabeth Cabell. "Sodium and calorie restriction during pregnancy: the knowledge and practices of New York State obstetricians." Master's thesis, Cornell University Graduate School, Dept. of Nutrition, Ithaca, N.Y., 1980.
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Re : Brewer diet

Postby cindergretta » Mon Feb 18, 2008 04:49 pm

quote:
Originally posted by djsnjones
Some midwives and Bradley teachers do not fully understand the BD.



I don't understand this-- if it so difficult that Bradledy teachers and m/ws don't really understand how to teach it, what good is it??? It seems like if it were such a "miracle" cure, every OB, peri, m/w, & CCE would know all about it and be having everyone on it.

All the studies you list are at the *very least* 25 years old. Most much older than that. Not too compelling for me, personally. Seems like a diet that would prevent the leading cause of maternal/fetal death would warrant a LOT of studies, on-going and constant and *current.*
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Re : Brewer diet

Postby aundapenner » Mon Feb 18, 2008 04:49 pm

Joy - I'm overwhelmed with the information you've provided.

Seeing as we're now into year 8 of the 21st century, I'm appalled that you would cite resources ranging from 1933 to 1982 (and only 2 of those sources were from 1982).

Do you have any information with research done in the 21st century?
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Re : Brewer diet

Postby djsnjones » Mon Feb 18, 2008 04:52 pm

quote:
"ETA: For any who might not know (I've gotten email asking), Ptolemy was a hardworking, thoughtful Greek astronomer who believed, as the result of a lot of learned academic effort, that the Earth was at the center of the universe ("geocentrism".) This view was later overturned by the work of Copernicus, Brahe, and Galileo. Science is dynamic.

For example, Brewer's 40-year-old rebuttal of the ischemia/hypoxia theory of preeclampsia is irrelevant, because we've not only confirmed the theory with uterine artery doppler studies, but we've also isolated the soluble factors produced by the placenta in response to hypoxia, and determined that they cause the downstream symptoms of preeclampsia. (Subsequent work remains to be done, of course -- like all science, this is preliminary confirmation.)"


Not all research that was done in antiquity is automatically irrelevent just because it is old.

Dr. Ignaz Semmelweis was ridiculed for his assertion that hand-washing would save the lives of women in the postpartum wards of the hospitals of his day. His evidence was suppressed and defamed until years after his death, when the invention of the microscope proved the existence of microorganisms that could contribute to illness and disease. It is one of my deepest desires that some day soon there will be some new kind of technology that will finally reveal incontrovertibly, once and for all, the validity of this research done by Brewer as he walked in the footprints of Hamlin, Strauss, Burke, and Ferguson, researchers who went before him on the same path.

And Brewer's rebuttal was not that there is no ischemia of the placenta, I don't think. Rather, his rebuttal probably was that that ischemia was not the primary cause of PE, but an end result of the PE process. Indeed, one of his basic premises was that hypovolemia and lack of blood to the placenta was one of the main problems/causes of many of the symptoms of the "toxemia syndrome". So the proof that there is hypoxia to the uterus and placenta does not disprove Brewer's assertions.

Also, the fear that without antihypertensives the situation would go out of control is influenced by the process of mistaken information that was started in the late 1950's, primarily by manufacturers of prescription drugs. It will be very difficult to find mainstream research that is not influenced and tainted by that history.

And I am getting tempted once again to engage in this debate, even though my intention was to just make one statement and move on. So now I must move on.

Thank you for engaging in this discussion with respect.

(edited by Laura to include quote tags, for easier understanding [:)])

Thanks for the helpful edit, Caryn. [:)]
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Re : Brewer diet

Postby caryn » Mon Feb 18, 2008 04:56 pm

Joy, those are *old* studies -- 1935? 1971?. Scientists have followed up closely on these older studies, with bigger cohorts and more careful selection of populations and more precise measurement, and they've gotten different results. You may have a preference for the conclusions of these older studies, but that is like having a preference for geocentrism, and is not a reason to adopt them as a better description of reality than higher-powered modern studies.

Here's a link to a recent study of nutritional factors in preeclampsia, from 2001: http://www.ncbi.nlm.nih.gov/pubmed/11262466?dopt=Abstract
After adjustment for baseline risks, none of the 28 nutritional factors analyzed were significantly related to either preeclampsia or pregnancy-associated hypertension.

Here's a link to the most recent Cochrane review of protein and protein-calorie supplementation in pregnancy, from 2003: http://www.ncbi.nlm.nih.gov/pubmed/14583907?dopt=Abstract
In five trials involving 1134 women, nutritional advice to increase energy and protein intakes was successful in achieving those goals, but no consistent benefit was observed on pregnancy outcomes.In 13 trials involving 4665 women, balanced energy/protein supplementation was associated with modest increases in maternal weight gain and in mean birth weight, and a substantial reduction in risk of small-for-gestational-age (SGA) birth. These effects did not appear greater in undernourished women. No significant effects were detected on preterm birth, but significantly reduced risks were observed for stillbirth and neonatal death.In two trials involving 1076 women, high-protein supplementation was associated with a small, nonsignificant increase in maternal weight gain but a nonsignificant reduction in mean birthweight, a significantly increased risk of SGA birth, and a nonsignificantly increased risk of neonatal death. In 3 trials involving 966 women, isocaloric protein supplementation was also associated with an increased risk of SGA birth.In three trials involving 384 women, energy/protein restriction of pregnant women who were overweight or exhibited high weight gain significantly reduced weekly maternal weight gain and mean birth weight but had no effect on pregnancy-induced hypertension or pre-eclampsia.

Notice that *restricting* protein intake did not increase rate of preeclampsia in that population. On Brewer's argument, it should.

Here's a link to the most recent recommendations about salt intake in pregnancy, from 2005: http://tinyurl.com/2mnfef
In the absence of evidence that advice to alter salt intake during pregnancy has any beneficial effect for prevention of pre-eclampsia or any other outcome, salt consumption during pregnancy should remain a matter of personal preference.
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