Pregnancy Nutrition Preventing Eclampsia with High Protein Diet

by Jeffrey Dach MD

About 30 years ago, a friend’s wife tragically passed away as a complication of pregnancy.   We may never know the cause, however we were told it was ruptured placenta.  Years later, I sometimes wonder if the underlying disorder was eclampsia or pre-eclampsia, (also called toxemia of pregnancy) with elevated blood pressure, edema (swelling of the extremities) and urinary protein.  This condition is sometimes mistakenly treated with diuretics which only makes things worse.  Above header image courtesy of Debug Lies News.

Eclampsia is a Nutritional Disorder

From reading Jonathan Wright’s newsletter, I learned that eclampsia is a nutritional disorder.(7)   Abundant research in the 1930’s and 1940’s showed low serum protein concentrations in this condition.(1-6) Dr Tom Brewer devised a high protein diet which completely prevents the condition.(8-12) The observations of Dr Maurice Strauss from 1935 are to the point (1):

A low protein diet aggravated the symptoms. It is suggested that the toxaemic condition is related to water retention associated with low plasma protein osmotic pressure and increased venous pressure, and that beneficial results may arise from an increase in the protein intake and administration of accessory nutritional factors.”(1)

A recent article in the New York Times describes a study which found that 4 mg a day of folic acid was useless in preventing pre-eclampsia.(15)

Folate fortification of flour for prevention of neural tube defects (anencephaly, microcephaly, spina bifida etc.) is mandated in 53 countries.  Fortification of flour with folic acid was mandated in the US in 1998, the most successful public health measure in history, with reduction of neural tube defects by 36%.(18-20)   In 2009, Dr Oakley declared this success story a “modern miracle of epidemiology”.(20)

Conclusion : The use of folate in pregnancy prevents neural tube birth defects, and was hailed as one of the greatest public health measures. (20)  However, if eclampsia is a protein malnutrition problem, folate or similar measures that ignore the low serum protein levels cannot be expected to help. Link to this article.

Jeffrey Dach MD
7450 Griffin Road Suite 180/190
Davie, Florida 33314
954-792-4663

Links and References for Eclampsia

1) Strauss, Maurice B. “Observations on the etiology of the toxemias of pregnancy. The relationship of nutritional deficiency, hypoproteinuria, and elevated venous pressure to water retention in pregnancy.” American Journal of Medical Sciences 190 (1935): 811-824.

Abstract : The average plasma protein osmotic pressure in 20 cases of non convulsive toxaemia of pregnancy was 215 mm. ; in 10 cases of eclampsia 175 mm. ; and in 20 normal pregnant women 258 mm. of water: in 15 normal pregnant women on a low protein diet the value was 232 mm. of water. The average venous pressure in normal and non convulsive toxaemic pregnant women was double that of non pregnant subjects. Twenty toxaemic women were found to have had a low protein diet over a number of years. A diet consisting of 260 g. protein, 150 g. carbohydrate and 70 g. fat, with vitamin B1 concentrate and liver extract, produced a diminution in oedema and a gradual disappearance of symptoms in pregnancy toxaemia; in cases so treated there was no fetal mortality. A low protein diet aggravated the symptoms. It is suggested that the toxaemic condition is related to water retention associated with low plasma protein osmotic pressure and increased venous pressure, and that beneficial results may arise from an increase in the protein intake and administration of accessory nutritional factors.-W. J, Griffiths.

2) Dodge, Eva F., and Thomas T. Frost. “RELATION BETWEEN BLOOD PLASMA PROTEINS AND TOXEMIAS OF PREGNANCY: A PRELIMINARY REPORT.” Journal of the American Medical Association 111.21 (1938): 1898-1902.

3) Freis, Edward D., and James F. Kenny. “Plasma volume, total circulating protein, and “available fluid” abnormalities in preeclampsia and eclampsia.” The Journal of clinical investigation 27.2 (1948): 283-289.

4)  Mack, Harold C. “Plasma proteins in toxemias of pregnancy.” The Journal of clinical investigation 30.6 (1951): 609-615.

5) Browne, Francis J. “The aetiology of the toxaemias of late pregnancy.” BJOG: An International Journal of Obstetrics & Gynaecology 51.5 (1944): 438-471.

6) Poon, L. C., et al. “First-trimester maternal serum pregnancy-associated plasma protein-A and pre-eclampsia.” Ultrasound in obstetrics & gynecology: the official journal of the International Society of Ultrasound in Obstetrics and Gynecology 33.1 (2009): 23.

OBJECTIVES: To examine the relationship between low maternal serum pregnancy-associated plasma protein-A (PAPP-A) and uterine artery pulsatility index (UtA-PI) at 11+0 to 13+6 weeks with subsequent development of pre-eclampsia (PE).
METHODS: UtA-PI and serum PAPP-A were measured in women attending for routine care at 11+0 to 13+6 weeks of gestation. In the population, 156 (1.9%) women developed PE, including 32 (0.4%) in whom delivery was before 34 weeks (early PE) and 124 (1.5%) with delivery at 34 weeks or more (late PE); 7895 (98.1%) women had no PE. Regression analysis was used to examine which of the factors amongst maternal characteristics, log PAPP-A multiples of the median (MoM) and log UtA-PI MoM contributed to the prediction of PE.
RESULTS: The median PAPP-A MoM was 1.002 (interquartile range (IQR), 0.685-1.411) in the unaffected group, 0.555 (IQR, 0.463-0.922) in early PE and 0.911 (IQR, 0.580-1.247) in late PE. Serum PAPP-A was below the 5th centile in 21.9% of early PE and 6.5% of late PE cases. The PAPP-A-related patient-specific risk for PE was strongly influenced by maternal characteristics. There was a significant association between log UtA-PI MoM and log PAPP-A MoM (P=0.001), and the detection rate of screening for PE by maternal variables and UtA-PI was not improved by inclusion of PAPP-A. Regression analysis was used to establish tables that allow modification of the maternal history and PAPP-A-related patient-specific risk for PE by the measurement of UtA-PI.
CONCLUSIONS: Low PAPP-A is a marker for subsequent development of PE. The PAPP-A-related patient-specific risk for PE can be modified by the measurement of UtA-PI.

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7) Nine Ways to Prevent or Treat Specific Illnesses
Sep 30, 2015 | Dr. Jonathan V. Wright’s Articles, Hot Articles, Prevention |

Prevent and Eliminate Toxemia of Pregnancy, (also called “pre-eclampsia” and ‘eclampsia) 100%

Thomas Brewer, MD, Physician, Richmond Health Center, Richmond, California. Research Fellow, Howard Hughes Medical Center, Miami, Florida.  Book: Metabolic Toxemia of Late Pregnancy; A Disease of Malnutrition. Charles C. Thomas, Publisher

Brewer reduced incidence of eclampsia and pre-eclampsia to near-zero in every hospital and clinic where he was in charge with one simple measure: high protein diet.

Strauss MB. Observations on the etiology of toxemias of Pregnancy. Amer J Med Sci 1935 (190):811.   Toxemia subsided in women put on a 260 gram protein diet with injections of Vitamin B-complex.

Burke BS. Nutrition studies during pregnancy. Am J Obstet Gyn 1943(46):38   Confirmed nutritional cause of pre-eclampsia, demonstrated protective effects of adequate nutrition on mother, fetus/neonate, and infant.

Puotinen, CJ. “Preventing eclampsia (metabolic toxemia of late pregnancy): an interview with Tom Brewer, MD.” Townsend Letter for Doctors and Patients, Nov. 2004, p. 69+. Academic OneFile, Accessed 23 Sept. 2018.

8) Preventing eclampsia : an interview with Tom Brewer, MD by CJ Puotinen.  Healthy Childbirth Classes, Rochester, NY Empowering Women & Families Through Childbirth Education

An estimated 50,000 women die every year from eclampsia.
Hypertension, severe edema, and protein in the urine are the signature symptoms of eclampsia, which adversely affects the brain, kidneys, liver, and lungs.  eclampsia is an easily prevented nutritional disease.

9)  Preventing Complications with Nutrition  by Amy V. Haas September 1, 2003 Editor’s note: This article first appeared in Midwifery Today, Issue 67, Autumn 2003.

10) The Dr. Brewer Pregnancy Diet Pre-eclampsia
Hamlin, Strauss, Burke, and Ferguson live on through Brewer’s work
Joy Jones, RN

Books
11) Metabolic Toxemia of Late Pregnancy by Brewer, Thomas H. (2004)

12) What Every Pregnant Woman Should Know: The Truth about Diets and Drugs in Pregnancy Paperback – July 26, 1979 by Gail Brewer Sforza (Author)

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conventional medicine

13) Lopes, Laudelino Marques, Padma Murthi, and Fabricio da Silva Costa. “Prevention of Preeclampsia.” Journal of Pregnancy 2012 (2012).

14) Khanum, Sabiha, Najma Naz, and Maria de Lourdes de Souza. “Prevention of Pre-Eclampsia and Eclampsia. A Systematic Review.” Open Journal of Nursing 8.01 (2018): 26.

Every pregnant woman needs continuous, timely and supportive care throughout during pregnancy for safe motherhood. The objective of this study was to analyze and evaluate the available medications and techniques for the prevention and treatment of pre-eclampsia and eclampsia. The standard methodology of systematic review without meta-analysis was followed and only RCTs and systematic reviews were included in the review. Three electronic data sources (PubMed/Medline, CINAHL, and Cochrane) were searched for studies, published between 1986 and 2016 on the prevention and control of pre-eclampsia and eclampsia. 47 studies were finally included in the review, of which 18 were systematic reviews and 29 were RCTs. Technologies and techniques used in the included studies for the prevention and control of pre-eclampsia and eclampsia are Magnesium Sulphate, Aspirin, Antioxidant (Vitamin C, E and Lycopene), Calcium supplementation, Chinese Herbal Medicine, physical activities, Nitric Oxide, Marine Food Oils, Low Salt Diet, Garlic, Plasma Volume Expansion, Low-dose Dopamine, Progesterone, Smoking, and Diuretics. Magnesium sulfate appears to be the most effective treatment which reduces the risk of eclampsia by more than 50%. However, its best dose and route are still controversial and need further research. The knowledge and experience of nurses in properly using the protocols and evidence-based interventions are necessary for the wellbeing of pregnant women.

15) Wen, Shi Wu, et al. “Effect of high dose folic acid supplementation in pregnancy on pre-eclampsia (FACT): double blind, phase III, randomised controlled, international, multicentre trial.” BMJ 362 (2018): k3478.
Conclusion Supplementation with 4.0 mg/day folic acid beyond the first trimester does not prevent pre-eclampsia in women at high risk for this condition.

16)  High-Dose Folic Acid Does Not Prevent High Blood Pressure of Pregnancy Some studies suggest that taking high doses of folic acid can prevent pre-eclampsia, but a randomized trial found it did not.
Nicholas Bakalar New York Times

17) Crider, Krista S., Lynn B. Bailey, and Robert J. Berry. “Folic acid food fortification—its history, effect, concerns, and future directions.” Nutrients 3.3 (2011): 370-384.
In the United States, mandatory fortification of enriched cereal grain products with folic acid was authorized in 1996 and fully implemented in 1998

18) Centers for Disease Control and Prevention (CDC. “CDC Grand Rounds: additional opportunities to prevent neural tube defects with folic acid fortification.” MMWR. Morbidity and mortality weekly report 59.31 (2010): 980.
Neural tube defects (NTDs) are serious birth defects that result from the failure of the neural tube to close in the cranial region (anencephaly) or more caudally along the spine (spina bifida) by the 28th day of gestation. Infants born with anencephaly usually die within a few days of birth, and those with spina bifida have life-long disabilities with varying degrees of paralysis. Currently, identified risk factors for NTDs include a mother who previously had an NTD-affected pregnancy, maternal diabetes, obesity, hyperthermia, certain antiseizure medications, genetic variants, race/ethnicity, and nutrition (particularly folic acid insufficiency). In the United States, during 1995-1996, approximately 4,000 pregnancies were affected by an NTD. This number declined to 3,000 pregnancies in 1999-2000 after fortification of enriched cereal grain products with folic acid was mandated. Worldwide, in 1998, approximately 300,000 births were affected by an NTD.
U.S. NTD and blood folate trends. The mandatory fortification of standardized enriched cereal grain products in the United States resulted in a substantial increase in blood folate concentrations and a concomitant decrease in NTD prevalence. The percentage of the population with low serum folate (<3 ng/mL) declined from 21% in the period before fortification (1988–1994) to <1% of the total population in the period immediately following fortification (1999–2000) (5). NTD prevalence decreased by 36% after fortification, from 10.8 per 10,000 population during 1995–1996 to 6.9 at the end of 2006 (6).
Cost. Published economic evaluations have shown that folic acid food fortification is cost saving in the United States and other countries. A 2008 study estimated that current folic acid fortification produces an annual savings of about $300 million, or $100 for each $1 invested in fortification (9). Fortification also has resulted in substantial cost savings globally. Chile has demonstrated a savings of $11 (in international dollars) for each $1 invested in fortification (10).

19) Folic acid flour fortification Impact on congenital anomaly South American AmJMedGenet Lopez Cameloz 2010
Lopez-Camelo JS, Castilla EE, Orioli IM. 2010. Folic acid flour fortification: Impact on the frequencies of 52 congenital anomaly types in three South American countries. Am J Med Genet Part A 152A:2444–2458.

20) Oakley Jr, G. P. “The scientific basis for eliminating folic acid-preventable spina bifida: a modern miracle from epidemiology.” Annals of epidemiology 19.4 (2009): 226.

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