Brewer diet

[caryn]

To make that more explicit:

The answers you would provide to the questions above are only relevant if there is some reason to think diet affects hypertensive pregnancy outcomes.

But there is no evidence whatsoever to support this. (ETA: and please, don't say that it's just intuitively obvious that you have to feed the mother enough to grow a baby. Quantum mechanics isn't intuitively obvious, but it's true, and it's confirmed every day in computers and cell phones and particle accelerators. I'd like to see some actual, peer-reviewed evidence.)

We would have no reason to expect the answers to be true. They might be logically consistent with Brewer's argument, but there seems to be no evidence to support Brewer's argument, and a lot of recent and well-supported evidence to reject it.

I don't want to know how Brewer would work, if it did. I want to know why I should think that Brewer would work.

[celticepona]

Hello Joy,

May I ask who you are?

[djsnjones]

1) I do not know if there are any peer-reviewed articles or research regarding the Brewer Diet. That does not mean that they do not exist--only that I am not privy to all of their files.

2) I talked with my husband on the subject of peer-review. My husband has been a college professor for about 27 years, and the chair of the Audio Arts and Acoustics Department for maybe 10 years. He said that the peer-review system has two sides to it. On the one hand it does succeed at eliminating quacks. On the other hand, it also succeeds at suppressing any point of view that happens to be unpopular, because any unpopular view will not get a fair chance for review.

The old story of Dr. Semmelweis would seem to be a classic example of this unfair suppression of an unpopular medical view, a suppression which was unrelated to how valid his view was.


3) I don't have the energy to read all the threads here of all your previous discussions on the Brewer Diet, but so far in this one there have been several items stated or implied as fact which simply are not factual, and people are apparently building on those items as if they are factual, which leads to faulty conclusions. I'm simply offering to clarify those faulty beginning assumptions. It would seem unfortunate to me to allow your membership to continue to believe that the Brewer people claim things that they do not claim. But I do agree that it is the prerogative of the moderators to decide what information is allowed on their board.

4) I was not even considering replying that anything is intuitively obvious. I do believe that the answers are much more scientific than that--and consistent with what I learned about the human physiology in nursing school.

5) I can't begin to explain anything as long as you list reasons why you don't want to hear them.

6) These are some of the questions I see so far in this thread which I could answer factually, not based on intuition.

--What is the difference between chronic hypertension and the hypertension of pregnancy?

--Does Brewer actually claim that pre-eclamptic women aren't eating enough protein to grow a baby?

--Does Brewer actually claim that the deficiency of albumin in the blood causes leaky blood vessels (leading to the downstream symptoms of pre-eclampsia)?

--Can any increase of protein in the pregnant diet claim to be following the Brewer Diet, or is it more specific and precise than that?

--Can any non-Brewer-oriented physician know enough about the Brewer Diet to be able to use it or prescribe it well enough to judge whether it "works" on any of their pre-eclamptic patients?

--Does Brewer actually claim that this diet is good for any non-pregnant person with kidney disease, heart disease, or diseases of the circulatory system?

--Does Brewer actually claim that this diet is good for any pregnant woman with kidney disease, heart disease, or diseases of the circulatory system?

--There's been much confusion about what the Brewer Diet actually is. Even some midwives and childbirth educators sometimes teach the Brewer Diet incorrectly. How can any mother who feels that it didn't work for her know whether she was one of the ones who was taught incorrectly or not?

--There is a specific way to adjust the Brewer Diet for when symptoms of pre-eclampsia appear. Does any one here know what that is? If not, how do the ones whose experience was that it didn't work know whether it was applied for their situation correctly?

--Does Brewer actually say that this diet would be good for someone with kidney transplant failure?

--Is it really scientifically accurate to compare a healthy bodily function like pregnancy which has been serving us well for thousands of years to a disease-ridden, medication-ridden, surgically-altered situation like a kidney transplant failure?

7) Dr. Brewer first wrote up his research and findings and case studies in his thesis, published in 1966. Presumably every thesis gets a peer review as part of the process.

In the first edition, there are 76 articles in the bibliography, many of them from the American Journal of Obstetrics and Gynecology, Journal Obstetric Gynaecology British Commonwealth, and Lancet, among others. Presumably every article published in those journals got a peer review before they were allowed to be published there.

In the revised edition of his thesis, published in 1982, a detailed "New Annotated Bibliography of Scientific Studies" is added, which includes 35 articles in the category of "Clinical Observations and Research", including at least one article published in JAMA in which two other doctors (not Brewer) directly linked toxemia with low serum albumin and inadequate protein intake. This bibliography also includes 41 additional entries in the category of "Books, Reviews, and Academic, Statistical and Epidemiological Studies".

8) I do not believe that this new direction in the research on PE necessarily contradicts the Brewer view on it. It seems to me, from what I have read, that it sounds as though this researcher is just finding another symptom, not a cause. It also seems to me that what he is finding is consistent with what Brewer was saying all along--except the mother-fetus conflict.

9) It also seems to me from what I have read that the findings of this research so far are not consistent. It seems that sometimes the tests confirm the theory and sometimes not.

10) The mother-baby conflict is a belief system that one must buy into to move further with the theories based on that belief system. It is not a belief system that is universally accepted in the community of health professionals--doctors, midwives, nurses, etc. Robbie Davis-Floyd, an anthropologist, has written some very thought-provoking articles on this subject, the links for which I can provide to anyone who would email me for them, unless you prefer that I post them here. You can also find them by clicking on her name, on my list of authors.

If you decide to hear the answers to the questions that I have listed above, I will be glad to post them as soon as you give me the go-ahead.

Joy

[djsnjones]

Sorry, Amy. I did not see your question before I posted my last post.

My history and CV are listed on my "About" page of my website, which is listed in my profile.

If you cannot get there, I will copy it here, if that's ok with the moderators.

Most briefly, I am a Registered Nurse who has been working with midwives for the past 30 years.

Joy

[onesock]

My concern here is that the thesis revision was done in 1982...which was a very long time ago. Even since I have had my son in 1999, there have been huge discoveries and strides towards the control (notice I did not say cure) of PE. Is there ongoing studies of the Brewer's Diet to date and is the research still ongoing or evolving?
When you say "Is it really scientifically accurate to compare a healthy bodily function like pregnancy which has been serving us well for thousands of years to a disease-ridden, medication-ridden, surgically-altered situation like a kidney transplant failure?" What you may not understand, possibly because you have not directly experienced PE, is that PE IS a disease and in most of us here, it is NOT a "healthy bodily function," which is often medication ridden, and does include kidney and/or liver failure. So, my answer to that would be YES! it is accurate to compare them. I am not sure that you fully understand the disease, which is not uncommon. We are just a community of ladies that have become very educated on this disease, because it is often our own advocacy that has saved our lives.

[fiona]

Joy,

if you are ready to produce evidence, then bring it on. Thus far you have answered our questions with more questions, admitted you 'don't know' if there is any peer-reviewed data on a theory now almost 50 years old (BTW: there isn't)and have questioned the validity of the new research on preeclmapsia and its mechanics because of how it 'seems' to you.

We don't talk down to our members here. We don't deal in whats, ifs and maybes. We offer solid advice based on the best current research we can find.

We also call this disease by its proper name: preeclampsia.

You want to debate this here properly? Go ahead. But no, we will not tolerate you attempting to lure members to your site so you can promote Brewer without being forced to back up what you say with evidence. Not anecdotes. Evidence.

[djsnjones]

I have noticed a tone in some of your responses to me that seem rather condescending. I hope that I have responded to you with nothing less than respect, with no sarcasm or put-downs. I ask that you would do the same for me.

1) I don't know what research is still ongoing regarding the Brewer viewpoint. That does not mean that it isn't there--only that I'm not privy to all that goes on in their camp.

2) 1982 may be a long time ago, and hopefully there will be a more recent bibliography available sometime soon. Dr. Brewer and Gail Brewer Krebs were working on such a bibliography in the months before his death, I have heard. But it seems to me that there are some basic things that don't need proving over and over and over again.

3) I do understand that PE is a disease. I have been learning about and working with this disease for 30 years. But what you were saying was that the disease was TRIGGERED by an immune process similar to the immune process in a patient with kidney transplant failure. So actually your scenario would include comparing a pre-disease situation with a disease situation.

Joy

[caryn]

I'll take these point by point.

1) If you do not know if Brewer's argument for the mechanism underlying preeclampsia has been confirmed in peer review, why are you claiming that it is true?

Surely good evidence for it would appear in a literature search.

2) If, for some reason or other, this evidence hasn't been peer-reviewed, why not? Surely in the intervening 40 years, a decent clinical trial could be conducted and the evidence could be submitted to a medical journal. Why has this not happened?

Alternatively, do you have any evidence you could provide -- and I don't mean anecdotes -- in support of Brewer's claims? The normal standard for quality evidence is peer-reviewed research. If you have some quality evidence that isn't peer-reviewed, what is it?

3) I've linked to evidence supporting my claims. I would like to see evidence supporting yours.

4) Good. I see the claim that nutrition is just intuitively obvious far too often. I would like to see evidence.

5) I am listing reasons why I would like to see empirical evidence for Brewer's claims.

6) Frankly, I don't want to get into the minutia of Brewer's worldview without some actual data supporting his diet. As I said, it's talking about the specifics of how it would work, if it did. But we have no evidence that it works at all.

I did not say that Brewer would recommend his diet to people with kidney transplant failure. I used a kidney transplant as an analogy.

7) No followup research seems to have supported his thesis. Lots of new research has confirmed a completely different mechanism by which the preeclampsia syndrome develops. There've been 40 years of subsequent research which have failed to support his initial claim.

8) The subsequent research confirms hypoxia and likely confirms an immune system response to the foreign placenta. It does not confirm insufficient dietary protein. Upregulated sFlt-1 is not thought to be a symptom, but a cause of the downstream symptoms.

9) Please post links to the research which doesn't support the current view of the disease.

10) Maternal-fetal conflict is a well-confirmed biological theory. Do you have any evidence suggesting that another theory is a more accurate model of preeclampsia?

You may be noticing a theme here. [:)] I have heard exactly these claims from a good number of midwives, doulas, and homebirth advocates, but no one seems to have any evidence to support them, apart from vague mentions of political conspiracies against Brewer's claims and a willingness to debate the fine details of exactly how it would work, *if* it worked. But there is no evidence *that it works*.

I would like very much to see some evidence for Brewer's diet.

[fiona]

quote:

---

Originally posted by djsnjones

But it seems to me that there are some basic things that don't need proving over and over and over again.

---

Would you care to elaborate on what has been proven?

[caryn]

quote:

---

Originally posted by djsnjones

But what you were saying was that the disease was TRIGGERED by an immune process similar to the immune process in a patient with kidney transplant failure.

---

Yes, and this is so well-established that it is now the focus of literature reviews, whereas there is still no support for dietary manipulation. See the following:

http://tinyurl.com/265jfm
Maternal-fetal (paternal) immune maladaptation is implicated in the insufficient trophoblast invasion, which leads to an imbalance of angiogenic and antiangiogenic factors at the maternal-fetal interface. This review summarizes the actual knowledge of important pathophysiological basic principles of preeclampsia.

http://tinyurl.com/yt3mnn
(1) Patients with preeclampsia and those who deliver an SGA neonate had a significantly lower serum concentration of sCD30 than normal pregnant women. (2) This finding is consistent with the view that preeclampsia and SGA are associated with a polarized Th1 immune response and, perhaps, a reduced Th2 response.

http://tinyurl.com/26v3wr
Pre-eclampsia seems to be related to the disturbance of immune tolerance regulation during pregnancy. Receptor-binding cancer antigen expressed on SiSo cells (RCAS1) decidual level alterations were concomitant with changes in immune cell number and activity in decidua. As decidual immunomodulating activity participates in the development of immune tolerance during pregnancy, we aimed to evaluate the immunoreactivity level of decidual RCAS1 with respect to the presence and activity of immune cells... RCAS1 immunoreactivity was statistically significantly higher in decidual tissue samples derived from patients with sPE tissue than in those derived from healthy patients in whom elective cesarean section at term was performed.

http://tinyurl.com/2c8bu6
The present study supports the hypothesis of altered immune response in preeclampsia and suggests that dysregulation of cytokine expression occurs in preeclampsia with increased levels of IFN gamma, IL-12p70, IL-15, IL-18 and IL-4.

http://tinyurl.com/ytzeqd
The sera from preeclamptic women significantly inhibited the immortalized trophoblastic cell proliferation in comparison with those from normal pregnancy. Among the lymphocyte fractions, monocytes significantly inhibited the immortalized trophoblastic cell proliferation. The monocytes from preeclamptic women were found to produce higher levels of tumor necrosis factor-alpha (TNF-alpha) in the culture supernatant than those from normal pregnant women. The coculture with the monocytes from preeclamptic women increased the frequency of TUNEL-positive TCL cells. TNF-alpha inhibited immortalized trophoblastic cell proliferation in a dose-dependent manner and induced apoptosis. CONCLUSION: The present results suggest that monocytes are activated and that cytokines, such as TNF-alpha, which is produced by monocytes, induce apoptosis and inhibit proliferation of trophoblast cells in pre-eclampsia.

http://tinyurl.com/2ap4yr
During blastocyst implantation, the maternal endometrial response to the invading semi-allograft has characteristics of an acute, aseptic inflammatory response. However, once implanted, the embryo suppresses this response and prevents rejection. Simultaneously, the mother's immune system prevents a graft VS. host reaction deriving from the fetal immune system. We have shown that embryonic trophoblast and maternal decidua cells, i.e., cells located in the interface between the fetal placenta and the maternal endometrium, produce corticotropin-releasing hormone (CRH) and express Fas ligand. CRH may play a crucial role in the implantation and the anti-rejection process that protects the fetus from the maternal immune system, primarily by killing activated T cells through the Fas-FasL interaction.

This is just from the first page of hits on PubMed if you type in "preeclampsia immune". Since your husband is a professor, you'll be able to pull the full-text of these papers and read them; I do. You'll notice that they come from the USA, Greece (oops, I mean Poland -- I must have skipped posting the one from Greece), Japan, Iran, Canada... and that they're from just the past few months of research into this disease.