Brewer diet

[mada]

Cheryl, well said and I am wishing you a beautiful holiday.

[annegarrett]

Thank you Cheryl.

The truth of the matter for me is my best friend had all four of her babies at home, in a bathtub and I absolutely envy her. We tried--I even had hypnobirthing classes--but I'm afraid the childbirth is natural line doesn't work for me. (If I'd tried to have babies in the in-room jacuzzi I would have died of electric shock--I was hooked up to so much equipment keeping both of us alive!)

Of course childbirth is natural. Illness is natural, death is natural. We need only look at the incidence of women dying in childbirth in Africa (1 in 7), or even our mother's generation in the USA, to understand how very natural death in childbirth is/was. I'm not saying we ignore a good diet--but I've been quite familiar (personally, professionally and anecdotally) with preeclampsia for 23 years and I can tell you every single theory I've read about has been disputed, refuted, revived, killed, revived, etc. I sit in medical conferences hearing the debate on how to take your BP, how to test for proteinuria, whether to give you magnesium sulfate, rage on and on and it infuriates me that no one can agree.

I just know I ate the diet. I was religious about the diet because I did not want to try to die--AGAIN--and I did. So for me, I can't believe it.

One thing I did want to also mention is that the incidence of this disease/syndrome internationally is ubiquitous--you find it happening at the same rate in populations like Japan with protein-rich diets, and in India where meat protein in particular is hard to come by. The Farm, in our own country, promotes a meat-free diet which is in part based on the work of Dr. B. They claim a low-incidence.

I just know for me--the "B" diet failed me. And it wasn't about my not doing it right, I was working with a midwife and the hypnobirther and they were shocked when I went into kidney failure because I had been a model patient. It shook them to their core and the midwife now no longer recommends that diet as a "cure all". I do have a good friend who swears by this diet--so I know women who share your passion--but I don't. I'm afraid my experience was just too **** frightening and frankly horrific for me to be "cool" with recommending it to other women.

My world for the past eleven years has been all about preeclampsia--even as I worked "real" jobs, this has been my dinner conversation, I go to conferences, I talk to doctors, I get invited to seminars. My crowd (per se) is not just this group of amazing women--it includes a lot of researchers and midwives and nurses and of all of these literally thousands of folks--I only know the ONE (a mom who had a healthy 2nd pregnancy) who thinks this diet works.

I can't argue research as well as Caryn--and frankly, like I said, I've seen it all come and go and then come back again, but I can say that the people who study nothing but preeclampsia (not folks like you and me who occasionally meet someone with it) want NOTHING MORE than to be able to say they cured this disease. There is probably a Nobel Prize waiting and in fact at the University of Chicago, in their Nobel Prize hallway, they have a blank award hanging that says: "for the person who discovers the cure to preeclampsia". These guys (and women) are competetive as * and if they thought they could secure that place in history--they would be jumping on top of one another to get to it.

I believe in taking extra Vitamin C when I have a cold, in not drinking alcohol or caffeine when I feel under the weather, in juicing, in organic and whole foods, I'm even a recovered vegan. Trust me--I'm about as open-minded as you are going to find (just back from a couple days in Sedona,AZ) and so I really really want to believe, but I can't. But you know, I believe in angels and I know a lot of people who love me to death who think that's nuts. So there you go...

I'd love to see you all publish a book of amazing recoveries, on women who turned it all around...I think that's of interest but the truth is, you're never going to convince me that it works--because for me, it didn't and at the end of the day, that is all that really matters to me. Sorry to sound so harsh, but I can't recommend it to my friends when I can't even recommend it for myself.

[blythe]

I feel like I should start out by apologizing for resurrecting this thread [;)]. One of Joy's suggestions, albumin infusion, made me secretly hopeful. Then a friend found this study for me:

http://www.ncbi.nlm.nih.gov/pubmed/1752073
Clin Nephrol. 1991 Nov;36(5):234-9
Repeated albumin infusions do not lower blood pressure in preeclampsia.
"We report the results observed in an open pilot study in ten preeclamptic patients treated with daily albumin infusions (0.4 to 1 g/kg) from 7 to 36 days. No acute effects were shown on blood pressure, and the need for antihypertensive therapies did not decrease in the following days. Serial evaluation after at least five or ten days of repeated albumin infusions did not show stable changes in electrolytes excretion, renal clearances, serum protein concentration and hematocrit value, nor in aldosterone, renin and atrial natriuretic peptide basal levels, while proteinuria tended to increase. Uteroplacental and fetoplacental blood flow acutely ameliorated in 3 cases only after albumin 1 g/Kg, but reached basal values again on the next day. The clinical implications are that daily albumin infusions with this schedule dosage do not lower blood pressure and that they are unable to induce stable changes in renal function, uteroplacental and fetoplacental resistance. No maternal complications were observed during the conservative management, but fetal mortality was high (6/10)."

6 out of the 10 babies *died*.

Much worse than false hope.

[kelly w]

Wow Heather - that's hideous.

BTW, count me among the crunchy mamas who believed Dr. B and followed his diet religiously in my second pregnancy. It definitely did not work for me and left me very frustrated [and a bit bitter I'll admit][:)].

Kelly

[heather100]

6 out of 10? OMG. And it was BECAUSE of the albumin addition? Or were these extremely premature babies anyhow?? I'm confused. Those poor mothers. They must be devasted.

[caryn]

My guess would be (not having read the full study) that the babies died because expectant management in preeclamptics is very tricky and requires that you be ready to move to delivery on very, very short notice. And this study was 17 years ago, so perhaps less EFM, or less awareness that a couple of decels in a PE baby can mean that the placenta's about to abrupt, so less quick to section.

Since the albumin didn't affect any of the known markers of the disease state (that they measured, anyway), that most likely means that the disease continued to progress, which means the blood flow to the placenta was being compromised by the inevitable course of the disease. So... failing placentas, dead babies.

With that study on the books, I'd expect all IRBs would be very, very unwilling to try it again. A mortality rate that high probably means they stopped the study early, at an enrollment that low. Because no one thinks it is ethical to engage in research that will harm women, or their babies.

[heather100]

That makes a lot of sense, Caryn. Thank you as always!!! I didn't realize it was 17 years ago. Guess we have come along way since then!

[djsnjones]

I am so very sorry to hear of the grief and loss that you all have experienced recently. May you all be comforted by the love that you have for each other.

I'm not entering this debate again yet, but I've decided to give one response to this specific issue--the issue of the use of albumin for reversing the effects of PE and other related complications.

Here is the quote of the conclusion of this study, which was quoted earlier....

"We report the results observed in an open pilot study in ten preeclamptic patients treated with daily albumin infusions (0.4 to 1 g/kg) from 7 to 36 days. No acute effects were shown on blood pressure, and the need for antihypertensive therapies did not decrease in the following days. Serial evaluation after at least five or ten days of repeated albumin infusions did not show stable changes in electrolytes excretion, renal clearances, serum protein concentration and hematocrit value, nor in aldosterone, renin and atrial natriuretic peptide basal levels, while proteinuria tended to increase. Uteroplacental and fetoplacental blood flow acutely ameliorated in 3 cases only after albumin 1 g/Kg, but reached basal values again on the next day. The clinical implications are that daily albumin infusions with this schedule dosage do not lower blood pressure and that they are unable to induce stable changes in renal function, uteroplacental and fetoplacental resistance. No maternal complications were observed during the conservative management, but fetal mortality was high (6/10)."

Please note the phrase "and the need for antihypertensive therapies did not decrease". Without having read the study, that phrase tells me that this study was not conducted properly, and my conclusions are that the results of this study are therefore invalid. As long as "antihypertensive therapies" were still being used concurrently with the albumin, then any benefits that the albumin could have had were being countermanded by whatever "antihypertensive therapies" were being used at the same time, especially if those therapies included antihypertensive drugs, or low-salt diets, or low-calorie diets.

Dr. B used this therapy successfully, without the concurrent use of any antihypertensive therapies, and his clinical trials were later confirmed by Dr. Peggy Howard of Chattanooga and Dr. Stella Cloeren of Basel, Switzrland, who were both working independently and administered serum albumin to more than 175 mothers with PE, with reports of excellent results.

Cloeren, Stella et al. "Effect of plasma expanders in toxemia of pregnancy." New Eng. J. Med. 287 (1972):1356

Cloeren, S.E. et al. "Hypovolemia in toxemia of pregnancy: plasma expander therapy with surveillance of central venous pressure." Arch. Gynak. 215 (1973):123

Howard, Peggy. "Albumin concentrate can be used for pre-eclampsia." OB/GYN News, Oct. 1, 1974.

Brewer, Thomas H. "Administration of human serum albumin in severe acute toxemia of pregnancy." J. Obstet. Gynaecol. Brit. Cwlth. 70 (1963): 1001

Brewer, T.H. "Serum albumin and pregnancy toxemia."--response to a question. Abstract #1093, Excerpta Med. Obstet. Gynaecol. (X) 18 (1965):232

Best wishes,
Joy

[caryn]

Joy, surely you're not suggesting that the standard of care -- antihypertensives to lower blood pressure -- be withheld from women who need it?

The NIH Working Group Report says the following:

Antihypertensive therapy is indicated when blood pressure is dangerously high or rises suddenly in women with preeclampsia, especially intrapartum. Antihypertensive agents can be withheld as long as maternal pressure is only mildly elevated. Some experts would treat persistent diastolic levels of 105 mm Hg or higher. Others would withhold treatment until diastolic blood pressure levels reach 110 mm Hg. In adolescents whose diastolic pressures were recently below 75 mm Hg, treating persistent levels of 100 mm Hg or higher may be considered. When treatment is required, the ideal drug that reduces pressures to a safe level should act quickly, reduce pressure in a controlled manner, not lower cardiac output, reverse uteroplacental vascular constriction, and result in no adverse maternal or fetal effects. The medications used to treat hypertensive crises in pregnancy, and their route of administration, are summarized in Table 4. Details of their pharmacology and safety are discussed elsewhere.

They seem quite certain that these medications are not harmful to mother or baby, and provide citations establishing this. You are speculating that they *are* harmful. Could you provide evidence of this?

As I understand it they often expand plasma volume in preeclamptics in hospital because that reduces the possibility of a profound drop in bp when they administer the antihypertensives, which would compromise uteroplacental bloodflow. (ETA: and not all preeclamptics -- this requires close observation in OB intensive care units.) The antihypertensives used on preeclamptics are not generally diuretics -- they work via a completely different mechanism, ex. beta blockers. Albumin doesn't seem to work any better than any of the other standard plasma volume expanders and the thinking seems to be that whatever mild benefits you might see to uteroplacental flow (and it doesn't seem to provide benefits wrt any of the other symptoms) after volume expansion aren't lasting, since the disease is still progressing in the background and the maternal immune system is still trying to cut the placenta off. (ETA: And at any rate, as the Cochrane study below shows, there are insufficient data and if a therapy has not been shown to be effective it shouldn't be initiated in an uncontrolled experimental way.)

So here's how you'd do a study: you'd randomize half the women to the ACOG's diet and half to Brewer's diet, and then see if fewer of the Brewer group got preeclampsia. Once they developed symptoms that would be where you'd move to standard management. You have to provide standard of care to the whole populations and the experimental protocol to the study group, and then any benefit can be attributed to the experimental protocol if one appears. If the experimental protocol significantly worsens matters -- more preeclampsia in that group, more deaths in that group, whatever -- we shut down that arm of the study. You cannot deprive people of standard of care. (Yes, I checked this against a member of the local university's IRB.)

I also note that the Cochrane database looked at this issue a while back:
http://mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD001805/frame.html

There is insufficient evidence for any reliable estimates of the effects of plasma volume expansion for women with pre-eclampsia. For every outcome reported, the confidence intervals are very wide and cross the no effect line.

Could you explain how it is that eating Brewer's diet would reverse the shallow placentation known to be present in preeclamptics?

Could you explain how it is that women with active untreated HIV infections don't need Brewer's diet to avoid getting preeclampsia, even if they live in parts of the world where diets are generally poor?

Could you explain why it is that, if Brewer's diet is a cure-all and if only women knew about it they wouldn't get preeclampsia, many of the women on this forum followed the final Brewer version of the diet meticulously and still developed preeclampsia?

Could you explain why women with the KIR AA genotype are at greatly increased risk of preeclampsia if they are carrying a baby with HLA-C, and how the Brewer diet would eliminate this risk?

Editor's note: we ran this past an Expert member of our Medical Board, who said:

High protein diets: There are few if any acceptable trials in this area, but in Villar et al. Strategies to prevent and treat preeclampsia, evidence from randomized controlled triasl Semin Nephrol 24:607-15, 04.the authors note, 3-4 randomized trials, with no discernable effect. Of note is a single large trial (782 women,) evaluating isocaloric balanced protein supplements to underweight pregnant women, no effect.

Albumin infusions: To my knowledge there has never been a decent trial. Claims that infusions of amino acids temporarily lowered blood pressure, perhaps due to vasodialtory actions of some of the proteins in the mixture have not been confirmed, and infusion of albumin alone has resulted in equivocal observations. Finally, there are anecdotal reports in the old literature where such infusions aggravated the clinical picture.

[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.