preeclampsia

Thiamine, Pregnancy, and the Energy Connection

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There is an old saying “for any workman who has only a hammer for a tool, everything is a nail”. Thus, I am in danger of writing article after article about one vitamin, B1, or thiamin/thiamine, but write I must. Thiamine is critical for energy production and the energetic demands of pregnancy are substantial. Insufficient thiamine during pregnancy can and does have negative impacts on both maternal and fetal health. Both Dr. Marrs and I have written about this previously, but it bears exploring further. Before we begin, however, let us review a few concepts.

Energy to Respond

In order to understand its therapeutic use in the treatment of many different conditions, you have to understand its function and how it differs from “taking medicine”. Let me first remind you that we live in a hostile environment to which we have to adapt in order to survive. Infection, trauma, weather, work assignments and a variety of changes in life’s journey (stress) have to be met as they occur. Assuming that our genetically determined “blueprint” is intact, all we require is energy. To meet the pressure of stress, an automatically increased supply of energy is necessary. Food provides us with fuel that must be burned (oxidized) in supplying that energy and thiamine is essential in igniting the fuel.

When we are attacked by a microorganism, the brain organizes a comprehensive defensive mechanism that we refer to as an illness or a disease. With trauma, healing requires increased energy so that the healing process can proceed. Let it be clearly understood once again that our food provides both the fuel and the vitamins that enable oxidation to supply the required energy. I have come to the conclusion that illness is either a genetically determined error in the DNA code, a failure to synthesize the energy requirement to meet stress, or a combination of the three. If we are attacked by a microorganism, a healthy organism defeats the foe. This is by no means a new idea. It just has not been put into practice, so we are still stuck with the antiquated concept that each disease is represented by a collection of symptoms and physical signs with a unique cause in each case that must be researched to find the magic cure. In order to understand why a thiamine supplement is so protective in pregnancy, I must try to show that any form of stress requires a genetically determined resistance and energy. It is illustrated by a case in my own clinical experience.

When Genetics, Trauma and Diet Collide: Cataracts and Galactosemia

Some years ago, a 6-year old boy was referred to me by an ophthalmologist, because he had been found to have cataracts in both eyes. The ophthalmologist knew that this could be a manifestation of a rare genetically determined disease known as galactosemia and had asked me to research it. There is a sugar in milk called lactose. When milk is consumed, the lactose is converted to galactose that is then broken down by a recessive gene inherited from each of the parents. In order to bear a child that has the potential to have the disease, the child must have obtained a gene from each parent. With two genes, the galactose accumulates in the blood and affects the eye, causing the density known as cataract.

The level of galactose can be determined in the laboratory and in the case of this child, it was in the normal range, at the time of the study. In the meantime, however, the laboratory had been asked to check the presence of the abnormal gene. It was reported that he had only one copy of the gene. With only one copy, the child was classified as a carrier and on general principles, he could not have the disease. So I sat down with the child’s mother to ask her about the diet that she had been giving and I found that she had a tremendous faith in the health manifestations of milk. Therefore she had insisted on multiple glasses of milk for the child. In addition the child had experienced a head injury with a fractured skull. When he returned to school, the school nurse had insisted that he have eye testing every two weeks because, she said “people go blind after an injury like this”. Whether this was an accurate statement or not, the child’s vision was perfectly normal immediately after his discharge from hospital. Three months later there was a dramatic change, causing her to refer the child to the ophthalmologist who had discovered the cataracts. I had to conclude that the combination of trauma, genetic risk and unknown dietary indiscretion combined to cause the disease. The “stress” of the head injury, or the genetic carrier state, or the excessive intake of milk, would not be damaging on their own. It was their coincidental relationship that precipitated the cataracts.

The Energetic Demands of Pregnancy

In 2013, I received a letter from Dr. John Irwin an OB/GYN specialist in Connecticut and his remarkable book: The Natural Way to a Trouble-Free Pregnancy: The Toxemia-Thiamine Connection. The letter said:

Dear Dr. Lonsdale,

I am writing to you, because I have found another mortal being who is particularly interested in the biological activities of thiamine. I had previously thought that I was nearly the loan believer in the benevolent effects of thiamine, particularly for the treatment and prophylaxis of the toxemias of pregnancy and its many associated problems. I had even written to the chief of the Cleveland Clinic OB-GYN about the “miracles” I was performing and offered to work with him in further development of the concepts, but my information seems to have experienced obstacles.

After Dr. Irwin had retired, he spent 25 years in the Commonwealth of the Northern Mariana Islands where he had been concentrating on the use of what he called “megathiamin, 100 mg daily” in the prevention of toxemia and many other complications of pregnancy. His first patient was introduced to him by an introductory meeting with a group of island doctors who were all American board-certified in their specialties. The patient had severe preeclampsia, had been sick for six weeks and was essentially moribund at 36 weeks of gestation. She also had severe heart disease and he recognized the compound symptoms of thiamine deficiency disease. In the face of the open skepticism of the other physicians, he started her on a 100 mg pill of thiamine daily. He reported that she was cured in six days. She had some fetal distress on the seventh day and was delivered of a 3 lbs. 12 oz. baby by cesarean section. The infant’s Apgar was 10-10, an extraordinary result in a situation where death of both mother and infant would be the expected outcome.

He then started all his patients on “prophylactic megathiamin” at the third trimester and he reported that it prevented the development of every type of toxemia completely, including eclampsia, preeclampsia, intrauterine growth retardation of the fetus, premature delivery, fetal death, premature rupture of membranes and in fact virtually any pregnancy complication. To anyone that contemplates pregnancy and can overcome her expected skepticism, this book is an absolute essential.

Thiamine, Energy, and Pregnancy

I believe that we can offer a rational explanation of what superficially appears to be “miraculous”. In many posts on this website I have commented on the energy relationship between stress and maintenance of well-being. There must always be a complete balance between energy synthesis and its utilization. In good health, the rate of synthesis automatically accelerates to meet any increased demand, although there must be a normal limit to that capacity. The stress in pregnancy is enormous. The mother is feeding her fast-growing baby as well as herself, giving rise to a marked increase in energy demand. Thiamine is the key to energy synthesis from the oxidation (burning) of glucose. Her physiology must meet this ever increasing demand to full-term. The failure of this equation obviously imperils both mother and fetus and it also explains many of the complications observed in the neonate’s immediate and future development. The dysregulation of body organs by the energy deficient brain explains the multiplicity of the complications because all of them have a common cause.

Unfortunately, many people have concluded that taking sugar will increase energy production by “throwing fuel on the fire”, a fact that has led to a great deal of energy deficiency illness. There has to be a normal glucose/thiamine ratio for healthy oxidation. Just as an excess of gasoline introduced into the cylinders of a car produces inefficient engine performance, an excess of glucose induces illness. If we insist on ingesting empty calories, we must optimize the glucose/thiamine ratio by supplementing thiamine, thus explaining Dr. Irwin’s success in eliminating many of the common complications associated with pregnancy.

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More people than ever are reading Hormones Matter, a testament to the need for independent voices in health and medicine. We are not funded and accept limited advertising. Unlike many health sites, we don’t force you to purchase a subscription. We believe health information should be open to all. If you read Hormones Matter, like it, please help support it. Contribute now.

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This article was published originally on February 11, 2019. 

Heart Problems, Pregnancy, and Nutrient Deficiency

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In the Wall Street Journal, August 14, 2018, Your Health, written by Sumathi Reddy, recorded the case of a 34-year-old pregnant woman who went to the hospital with shortness of breath and dizziness. Doctors decided that they were “pregnancy-related symptoms and nothing to be overly concerned about”. The column goes on to say that eight weeks after her daughter was born she experienced terrible stomach pains, orthopnea (severe breathing difficulty when lying down) and chest pains. At the emergency room, she was diagnosed with peripartum cardiomyopathy, noted  as “a type of heart failure related to pregnancy”. Reddy continues: “the rates of heart-related problems in women before and after childbirth have increased in the US., a problem that some experts think may be contributing to a rise in the country’s maternal mortality rate. It has been reported that the number of women having heart attacks before, during and after deliveries increased by 25% from 2002 through 2013. Around 4.5% of women who had heart attacks died”.

This is truly an appalling statistic, begging for an explanation as soon as possible. I believe that such an explanation is possible. With the necessary clinical knowledge, thiamine deficient beriberi would certainly enter into the potential diagnosis. The combination of “shortness of  breath and dizziness”  as an initial guide to its consideration, together with the later onset of “terrible stomach and chest pain” associated with heart failure 8 weeks after parturition in the case of that 34-year old pregnant woman, should have given  rise to its consideration. The trouble with this description is that it is not pathognomonic (uniquely indicative) of beriberi, a diagnosis that the medical profession refuses to recognize as a possibility in America.

What needs to be understood is that pregnancy is an enormous metabolic stress. The mother has to feed herself and her offspring, requiring a vast amount of cellular energy, not only to meet her own maintenance, but to support the rapid growth of her fetus. The enormous variety of complications in pregnancy can only be explained by a failure to produce sufficient energy to meet the metabolic demand. The diet in America, together with possible and undiagnosed genetic risk, does not always meet that goal. A common problem is known as hyperemesis gravidarum (severe pregnancy vomiting), a thiamine deficiency complication that can result in the much more serious thiamine deficiency brain disease known as Wernicke encephalopathy. So let us look at the evidence to support thiamine deficiency as a cause of pregnancy complications..

Thiamine Treatment of Severe Pregnancy Toxemia

In 2013 I received a letter from a retired American specialist in OB/GYN, John B. Irwin M.D., together with a book that he had written with the intriguing title “The Natural Way to a Trouble-Free Pregnancy” with subtitle “The Toxemia/Thiamine Connection“. He was desperate in trying to locate a physician who could subject his work to further research. His many attempts had fallen on deaf ears. He hoped that I could promulgate his work. In retirement he had hired himself out to the government of the Commonwealth of the Northern Mariana Islands to try to improve upon their system of obstetrical care.  He had attended an introductory meeting with a group of island doctors who were all American board-certified in their specialties. They introduced him to a woman who, at 36 weeks of gestation was essentially moribund with severe preeclampsia (advanced pregnancy toxemia), severe gestational cardiomyopathy (pregnancy heart failure), and with some premature separation of the placenta. Recognizing that the patient had the thiamine deficiency disease beriberi and in spite of the massive skepticism of the assembled doctors, he told them that he was going to make her well with mega-thiamine. He treated her with 100 mg of thiamine daily, reporting that she was physiologically well in six days. She delivered a 3 lbs. 12 oz. infant with a normal Apgar score

Yes, I know how many will react to this. They will say that “this patient was on a tropical island where beriberi was much more likely. This could not happen in America where the science of nutrition is so well known and where all the foods are enriched with vitamins”.

Thiamine Deficiency and Pregnancy Complications

Because of this case, Dr. Irwin started the clinic patients on prophylactic thiamine, beginning in the second trimester. Over a period of 25 years, during his retirement, he had found that it prevented the development of every type of toxemia completely, including eclampsia, preeclampsia, intra-uterine growth retardation, premature delivery, fetal death, premature rupture of membranes, placenta previa and gestational diabetes. In short, he had found that this simple non-toxic administration of megadose thiamine had virtually abolished all the common complications of pregnancy. It is important to recognize that he had spent his professional lifetime before retirement in Connecticut, attempting to bring healthy babies into the world. He was conversant with all the complications of pregnancy, for which he had previously known the absence of adequate treatment. He wondered whether the island doctors had failed to recognize beriberi, or whether toxemias of pregnancy were merely a manifestation of thiamine deficiency.

In his book, Dr. Irwin reports that

“the daily 100 mg thiamine tablet has been given to over 1000 unselected prenatals so far, starting in the second and third trimesters. More than 450 cases were conducted in Saipan of the Mariana Islands, over 600 in Waterbury Connecticut after his return from Saipan and 15 selected high risk cases with a collaborator in Adelaide, Australia. There have been no adverse reactions to thiamine. The expected and predictable number of toxemia patients in this group would be well over 150, but the actual occurrence was zero. This was an almost unbelievably favorable response. Modern science has not been able to do what thiamine has done for my patients. I have treated pregnancy-induced heart failure patients who were very close to heart failure death. They returned to normal, and continued their pregnancies to a normal conclusion at term. Treated patients did not deliver prematurely”.

Why Megadose Thiamine?

There is a lot more to this and I can only suggest that anybody wishing to be pregnant should obtain this book. It is, of course, mandatory for you to undertake this with the permission and care of your OB/GYN physician. However, do not expect that the physician will automatically accept the idea. You may have to show him/her the book. As I have said many times in posts on this website, the emerging truth concerning the application of vitamins in the treatment of disease and the preservation of health has not yet reached the collective psyche of the medical profession. It has been hard won by the few pioneers that have begun to practice what is now called Alternative Integrative Medicine.

It is quite obvious that you might ask the question, why, if this is so important in the lives and well-being of millions, it is not an acceptable practice in modern medicine by the majority of physicians? We all have known for many years that thiamine is acquired from the diet.  The recommended daily allowance (RDA) is only 1 to 1.5 mg. This minute dose acts as what is called a cofactor to many enzymes essential to energy production. Without sufficient cofactor, the enzymes do not function properly and their action gradually deteriorates. Thus, vitamin deficiency has long been regarded as a situation that only requires simple replacement of the RDA dose.

Unfortunately, what has not sufficiently been realized is that a megadose of the cofactor is required to resuscitate the enzymes that have been damaged by prolonged use of an overload of empty calories (high calorie malnutrition). Pregnancy requires energy for the development of the fetus as well as the health of the mother so the demand is greatly increased. Cells will use what is needed of the megadose for the resuscitation to take place and will discard the excess in urine. The beauty of this new way of thinking about treatment of disease is that it is non-toxic and harmless. We even know now that some of the diseases, previously thought to be entirely genetic in origin, respond to megadoses of vitamins. This has opened up a brand-new science called epigenetics that studies the effect of lifestyle and nutrition on genes. Genes are no longer considered to be solely in charge of our health destiny. We each have a responsibility towards the preservation of the blueprint (inheritance) by what we eat and our lifestyles.

Heart Problems and Insufficient Maternal Thiamine

In our book entitled “Thiamine Deficiency Disease, Dysautonomia and High Calorie Malnutrition” Dr. Marrs and I demonstrated that thiamine deficiency is widespread in America, causing diverse symptomology responsible for a host of puzzling diseases. We provided evidence that different forms of physical and mental stress result in an increased energy demand in the part of the brain that deals with environmental adaptation. It is suggested here that the stress of pregnancy, superimposed on marginal high calorie malnutrition, is responsible for the increase in heart failure. It is well known that the heart and brain have the highest metabolic rate, making these organs more susceptible to the effects of limited energy synthesis.

We Need Your Help

More people than ever are reading Hormones Matter, a testament to the need for independent voices in health and medicine. We are not funded and accept limited advertising. Unlike many health sites, we don’t force you to purchase a subscription. We believe health information should be open to all. If you read Hormones Matter, like it, please help support it. Contribute now.

Yes, I would like to support Hormones Matter. 

Image by Manuel Alejandro Leon from Pixabay.

This article was published originally on August 21, 2018

Pregnancy Toes – What Sugar Does to Feet

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Pregnancy toes are really swollen feet and swollen toes. The name stuck in my mind because one of my daughter-in-laws is pregnant and I was sent a photo from her winter vacation in her flip flops in the snow and winter coat—she was not able to put her boots on because of her swollen feet (swollen even in the cold!).

I did not think much about it until she came to visit me yesterday and I noticed the flip flops and her chubby toes. She had “pregnancy toes” again she said. It then suddenly all became clear. I asked her: did you by any chance have any sugar today? And she said “as a matter of fact, yes!”

I reached for my salt pills that I use for my migraines as do all members in my migraine group on Facebook and handed her one. I really should have photographed what happened but I did not think the effect was going to be so fast and so big. Less than 15 minutes after she took the salt pill and a glass of water, her toes went back to normal. We ended up laughing it away. Had she known this, she could have worn her boots in the snow after all!

So what did her pregnancy toes have to do with sugar and salt you may ask? Previously, I quoted from the Harrison’s Manual of Medicine an important paragraph that I repeat here:

…serum Na+ falls by 1.4 mM for every 100-mg/dL increase in glucose, due to glucose-induced H2O efflux from cells. (page 4)

The above means glucose (part of sugar) and sodium (part of salt) are in inverse relationship. As you increase sugar, salt drops and water is sucked out of your cells by sugar like a giant Slurpee machine. The water then collects on the outside of your cells rather than the inside, thereby dehydrating your cells and at the same time make your body swell. Edema is often associated with too much salt, but in fact, it is too much sugar. Being always thirsty is associated with Type 2 Diabetes but it is also associated with not having enough salt in the body since without salt the cells cannot get hydrated.

In light of this fragile balance between sodium and glucose in the blood, are we treating pregnancy edema, gestational diabetes, and other maternity complications, the way we should? Consider that with pre-eclampsia (gestational hypertension), women are told not to eat salt. You can see what happens when we reduce sodium: glucose increases and we also induce an ionic imbalance. This ionic level imbalance is visible (like the swollen toes) and may lead to further complications. There are two problems that we are facing here: first if she does not eat salt, her sodium-potassium pumps cannot work–this may cause migraines and headaches as I often see in my migraine group. Secondly, as you saw the fragile balance between the see-saw action of glucose and sodium, if she stops eating sodium her glucose may increase, causing swelling. This is an interesting theory to ponder – one that merits research.

Sodium and Glucose Work Together

Salt breaks up in the body into sodium and chloride. Sodium attracts water and holds onto it inside the cells. It keeps chloride outside of the cells to ensure proper voltage and electrolyte balance with the aid of potassium. When you eat sugar, the glucose part of it removes the water from the cells via osmotic channels that are too narrow for the sodium ions to exit. Thus, one ends up with a ton of water outside the cells with sodium inside hugging a tiny amount of water. Swelling occurs as the water leaves the cells but remains between cells.

Given the inverse nature of glucose and sodium in the blood, if one is swollen as a result of too much sugar, eating salt will take the water back from sugar and move it back into the cells–as it did for my daughter-in-law’s pregnancy toes. What is important in this information is this:

  1. If you feel swollen after eating sweets, you need to eat salt and drink a bit of water to reduce your swelling.
  2. If you have Type 2 Diabetes or are hypoglycemic, eating a salty meal can give you a major sugar crash and land you in the hospital!
  3. Eating sugar of any quantity will dehydrate your cells and you and make you run to the toilet every 30 minutes.

Because glucose takes water out of the cells, the edema that follows increases extra-cellular water and causes swelling in the body. This extra-cellular water needs to be reabsorbed into the circulation for the kidneys to be eliminated. To be reabsorbed, sodium is necessary since without sodium, the cells cannot operate their voltage gated sodium pumps and so the gates cannot open to grab glucose to take it into the cells and to get the water back into the cells. I think you can already see the contradictions in the logic of reduced salt: the mom-to-be is told to not eat salt, this causes extra-cellular water and swelling, which needs salt to be reabsorbed into her cells for clearance by the kidneys but which she is not allowed to eat. This way ionic level balance is not possible and chain reactions may occur with negative consequences. She may have protein leaching into her urine, extra hard kidney work, and a whole other long chain of complex events may kick in to make pregnancy a rather unpleasant experience risking the health of the fetus.

The amount of extra-cellular water is very hard for the body to get back into circulation without salt and may take days, taxing the kidneys with the volume of water leaving and increasing pressure on the blood vessels from the outside, causing high BP. However, as the volume of water is leaving the body finally, this reduces blood pressure. When a pregnant woman’s blood pressure drops as a result of all that water leaving, the dehydrated blood cells carry less oxygen. This indicates reduced oxygen for both her and the baby.

By telling mothers to reduce salt intake, glucose increases, which increases blood pressure (BP) rather than reduces it. The similar phenomenon happens in gestational diabetes. In gestational diabetes (and gestational hypoglycemia as well) the sugar level is unstable and is either too high or too low, respectively. Should the mother-to-be eat a salty pickle (as cravings always dictate pickles), she may end up in a major sugar crash and in the hospital for immediate treatment.

The balance between sodium and glucose is very fragile and extremely quick changing as you could see on my daughter-in-law’s foot. Interestingly we now also know that salt does not increase blood pressure but sugar does and so a reduced salt diet automatically increases blood pressure because of the glucose and sodium inverse connection and sugar’s dehydrating properties. Reduced salt also increases triglycerides (Graudal, 2011), causing a lot of problems for people with preexisting heart conditions. So by reducing the salt intake of the mothers to be, are we creating diabetic mothers and/or babies? Babies have been born with diabetes 2!

Is it possible that we are giving the wrong advise to pregnant women about salt and sugar? It’s an interesting question to pose and further research is badly needed. Knowing that salt and sugar are in inverse proportion in the blood, one may suggest eating them together. In fact, eating them together is a much better idea than eating sugar alone. It is best to not eat sugar at all but if you must eat sugar, consider eating salt too.

Sources:

Effects of low sodium diet versus high sodium diet on blood pressure, renin, aldosterone, catecholamines, cholesterol, and triglyceride. Graudal et al., Cochrane Database Syst Rev. 2011 Nov 9; (11).

This article was published originally on Hormones Matter on February 15, 2015. 

We Need Your Help

More people than ever are reading Hormones Matter, a testament to the need for independent voices in health and medicine. We are not funded and accept limited advertising. Unlike many health sites, we don’t force you to purchase a subscription. We believe health information should be open to all. If you read Hormones Matter, like it, please help support it. Contribute now.

Yes, I would like to support Hormones Matter. 

How to Have a Healthy Pregnancy: Avoiding Preeclampsia and Toxemia

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A few months ago, I received a book from a doctor who had retired from his specialty in obstetrics and gynecology. It was accompanied by a letter that began as follows, “I am writing to you, because I have found another mortal being who is particularly interested in the biological activities of thiamine. I had previously thought that I was nearly the lone believer in the benevolent effects of thiamine, particularly for the treatment and prophylaxis of the toxemias of pregnancy and its many associated problems”. In this letter, he went on to tell me that he had hired himself out, in his retirement, to the government of the Commonwealth of the Northern Mariana Islands “to improve upon their system of obstetrical care”.

Severe Preeclampsia

On his first day he attended an introductory meeting with a group of island doctors who were all American Board Certified in their specialties. Their purpose was to introduce him to a patient who was 36 weeks pregnant. He described her as “essentially moribund” with severe preeclampsia, gestational cardiomyopathy, and some separation of the placenta (preeclampsia is the term used for severe pregnancy toxemia and cardiomyopathy is the term used for a sick heart. Separation of the placenta would mean that there would be bleeding into the uterus). She  was so sick that she had orthopnea (breathlessness while lying flat on her back. She could only breathe when sitting up in bed, a characteristic of heart failure). Spontaneous labor and delivery, he said, most likely would cause maternal and fetal death and that she would fail to come through a cesarean section. All in all, this was considered by all of the island doctors concerned to be a hopeless case. He suggested that she had beriberi, the vitamin B1 deficiency disease. The letter went on to say “in a private huddle the doctors decided that if the patient died while they were holding me up, they would be found solely guilty, so with anger, sneers and audible comments they told me to go ahead!” He gave the woman 100 mg of thiamine daily in a pill and she was physiologically cured in six days, sleeping flat and hiking the long halls for exercise to shake off her prolonged immobilization. On the seventh day, because of fetal distress, she was subjected to cesarean section, with the delivery of a 3 lbs. 12 oz. baby with a normal Apgar score.

Yes, I know how many will react to this. They will say that this patient was on a tropical island where beriberi was much more likely. This could not happen in America where the science of nutrition is so well known and where all the foods are enriched with vitamins. Also, they might think that the doctor was deluded into thinking that all forms of toxemia were really beriberi and that he had treated this disease rather than toxemia. So the doctor started the clinic patients on prophylactic mega-thiamine for the second and third trimesters, preventing development of every type of toxemia completely, including eclampsia, preeclampsia intra-uterine growth retardation, premature delivery, fetal death, premature rupture of membranes, placenta previa and gestational diabetes, among other possible complications. Again, the reader might well say that these were all patients on a tropical island. Consider however that this doctor had spent his professional lifetime in his attempt to bring healthy babies into the world. He was conversant with all the complications of pregnancy. Did the island doctors fail to recognize beriberi or is toxemia of pregnancy merely a manifestation of thiamine deficiency? Our preconceived idea that each disease is a separate entity with a separate cause and an individualized treatment may very well be completely wrong. If energy metabolism is compromised, the dysfunctional effects will be related to the cells most affected. The symptoms and physical or mental deterioration will be as variable as the distribution of the energy deficit.

There is a lot more to this and I can only suggest that anybody wishing to be pregnant should obtain this book by John B Irwin M.D. “The Natural Way to a Trouble-Free Pregnancy” with the subtitle “The Toxemia-Thiamine Connection”.

It is, of course, mandatory for you to undertake this with the permission and care of your OB/GYN physician if you are pregnant. However, do not expect that the physician will automatically accept the idea. You may have to show him/her the book. As I have said many times in posts on this website, the emerging truth concerning the application of vitamins in the treatment of disease and the preservation of health has not yet reached the collective psyche of the medical profession. It has been hard won by the few pioneers that have begun to practice what is now called Alternative Complementary Medicine. They use few drugs and the results that they get are real.

Of RDAs and Mega-doses

It is quite obvious that you might ask the question, why, if this is so important in the lives and well-being of millions, it is not an acceptable practice in modern medicine by the majority of physicians? The answer is because of the teaching of biochemistry in medical schools. We all have known for many years that thiamine is acquired from the diet.  The recommended daily allowance (RDA) is 1 to 1.5 mg. This minute dose acts as what is called a cofactor to many enzymes. Without sufficient cofactor, the enzymes do not function properly. Thus, vitamin deficiency has long been regarded as a situation that requires simple replacement of the cofactor. Therefore, the only dose required is that recommended as the RDA and mega-doses are regarded as being completely useless.

Unfortunately, what has not sufficiently been considered is that an overload of simple carbohydrate empty calories overwhelms the ability of thiamine to process  glucose derived from the food. Glucose is used by body cells as fuel and the energy supply that results from it must meet physical and mental demands for maintaining healthy life. The modern diet is grotesquely unnatural and, because of the overload of empty calories the enzymes that are starved of their cofactors, begin to deteriorate. In order to resuscitate them, the cofactors must be used in a pharmacological way to stimulate the respective enzymes back into a healthy state.

Pregnancy Energy Demands are Significant

Pregnancy requires energy for the development of the baby as well as the health of the mother so the demand is greater. Cells will use what is needed of the mega-dose for the resuscitation to take place and will discard the excess in urine. The beauty of this new way of thinking about treatment of disease is that it is non-toxic and harmless. We even know now that some of the diseases, previously thought to be entirely genetic in origin, respond to mega-doses of vitamins. This has opened up a brand-new science called epigenetics that studies the effect of lifestyle and nutrition on genes. Genes are no longer considered to be solely in charge of our health destiny. We each have a responsibility towards the preservation of the blueprint (inheritance) by what we eat and our lifestyles.

Maternal Vitamin D: Pregnancy and Beyond

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Researching the role of vitamin D in pregnancy for this article, I unexpectedly blew inches of virtual dust from a page of medical correspondence published almost seven decades ago. With keen interest I read “Vitamin-D Requirements in Pregnancy,” published in a 1947 edition of the British Medical Journal. The author Edgar Obermer, MD asserted the necessity for English pregnant women to supplement with robust daily doses of vitamin D.

Perhaps Dr. Obermer was ahead of his time, or today we are behind in understanding the power of vitamin D. I think both are true. Nonetheless, his assertion about relatively high maternal vitamin D doses accentuates vitamin D’s importance during pregnancy. Today pregnant women typically supplement with prenatal vitamins, most of which only contain enough vitamin D to prevent rickets.

Unfortunately, taking prenatal vitamins without supplementing with extra vitamin D provides expectant mothers with a false sense of health for their babies and themselves. In this article, I address vitamin D’s role in pregnancy, recent evidence supporting the positive effect of vitamin D on expectant moms and their babies, and vitamin D supplementation guidelines for pregnant and lactating women and their infants.

A Healthy Pregnancy

Many people may not realize that vitamin D is actually a steroid hormone produced in our body. We manufacture vitamin D when we take a quality vitamin D3 supplement, expose our skin to optimal sunlight, or consume lots of wild-caught fatty fish or vitamin D3-fortified foods.

The female reproductive system comprises billions of cells. Every cell in the female reproductive system contains genetic codes as well as a receptor to receive vitamin D. Cells in the female reproductive system (including the ovaries, fallopian tubes, uterus, placenta, decidua, vagina, and breasts) are replete with vitamin D receptors.

When we have ample amounts of activated vitamin D in our cells, the vitamin D binds with its receptor to regulate genes in our reproductive system. For example, the vitamin D pathway genes affect in utero fetal development. Conversely, when the female reproductive system lacks activated vitamin D, genes essential to a smooth pregnancy and sound fetal health are not expressed.

Mom Needs Nutrients for her Health

Vitamin D is vital to a pregnant women’s health. An expectant mom with adequate vitamin D levels may enjoy a reduced risk of pregnancy complications including preeclampsia, gestational diabetes mellitus, Caesarian section, and preterm birth. However, low vitamin D blood serum levels are common in pregnant women.

The recent findings of a Canadian study published in the December 2014 edition of the journal Current Opinion in Obstetrics and Gynecology once again accentuate the importance of vitamin D to maternal health. Lead researcher Shu-Qin Wei, MD, PhD examined scientific evidence of the role of maternal vitamin D on pregnancy outcomes. Focusing on studies published between January 1, 2013 and July 1, 2014, she concluded: “Recent evidence supports that low maternal vitamin D status is associated with an increased risk of adverse pregnancy outcomes. Interventional studies demonstrate that vitamin D supplementation during pregnancy optimizes maternal and neonatal vitamin D status.”

A Seed for Healthier Babies

Vitamin D is vital to fetal bone and cell development. Medical research suggests some seeds for disease are sown before birth. Low vitamin D during pregnancy may be one of those seeds. Babies born to mothers with a vitamin D deficiency are more likely to develop a number of medical conditions including asthma; autism; soft bones (rickets, craniotabes); brain disorders; cardiovascular malformation; and type 1 diabetes mellitus.

A new study highlights the benefit of vitamin D to fetal skeletal development. Dutch researchers explored the effect of vitamin D supplementation during pregnancy and early infancy on skull formations. The scientists recommended that women in their last trimester and early infants take a daily vitamin D dose of 400 international units ((IU) albeit a small amount). The research team found that non-adherence to their recommendations for vitamin D supplementation by pregnant mums and infants is linked to an increased risk of skull deformities in babies at 2 to 4 months of age. This study was published in a November 2014 issue of the journal Maternal & Child Nutrition.

Labor, Lactation, and Early Infant Life

Vitamin D also plays a beneficial role regarding labor pain, breastfeeding, and early infant health.

Labor. The benefits of maternal vitamin D have recently been extended to decreased labor pain. In October 2014, Andrew W. Geller, MD, a physician anesthesiologist at Cedars-Sinai Medical Center in Los Angeles, presented a study about vitamin D‘s effect on labor pain to the American Society of Anesthesiologists’ annual meeting. Dr. Geller and colleagues measured the vitamin D levels of 93 pregnant women prior to delivery. All of the patients requested an epidural for pain during labor. The research team then measured the doses of pain medication required by each woman during labor. They compared the quantity of pain medicine consumed by women with higher vitamin D levels with those with lower vitamin D status. The patients with lower vitamin D levels used more pain drugs than those women who enjoyed higher vitamin D status. Dr. Geller concluded that “prevention and treatment of low vitamin D levels in pregnant women may have a significant impact on decreasing labor pain in millions of women every year.”

Lactation. Nature intended for newborns to obtain their nutrients, including vitamin D, from breast milk. Breastfeeding provides babies with the vitamins and minerals required for healthy development. That’s why it is imperative that lactating mums supplement daily with adequate vitamin D. Vitamin D supplementation guidelines are discussed in the next section of this article.

Early Life. Vitamin D is important to all stages of life including neonatal. The growth and development of an infant is associated with the vitamin D intake during pregnancy.

Recent research from the University of Southampton in the United Kingdom suggests that young children are likely to develop stronger muscles when their mums enjoyed a higher level of vitamin D during pregnancy.

The connection between vitamin D levels and muscle strength has been well-established by the scientific community. However, the Southampton study, published in the January 2014 issue of the Journal of Clinical Endocrinology and Metabolism, marks the first time that the relationship between maternal vitamin D status during pregnancy and the muscle development and strength in offspring was examined.

Led by Nicholas Harvey, PhD, the researchers measured the vitamin D levels in 678 mothers from the Southampton Women’s Survey in their later stages of pregnancy. Four years after the babies were born, the Southampton team measured their hand-grip strength and muscle mass. The researchers found that the higher the levels of vitamin D in the mother, the higher the grip strength of her child. A secondary finding addressed a lesser connection between maternal vitamin D and the child’s muscle mass. The Southampton study’s outcome suggests more far-reaching health benefits. Dr. Harvey commented,

“These associations between maternal vitamin D and offspring muscle strength may well have consequences for later health; muscle strength peaks in young adulthood before declining in older age and low grip strength in adulthood has been associated with poor health outcomes including diabetes, falls, and fractures. It is likely that the greater muscle strength observed at four years of age in children born to mothers with higher vitamin D levels will track into adulthood, and so potentially help to reduce the burden of illness associated with loss of muscle mass in old age.”

Supplementation Guidelines for Mum and her Newborn

The importance of vitamin D supplementation cannot be overstated for the health of mothers and their infants.

British nutrition expert Sara Patience, author of the new book Easy Weaning, stated, “It’s important for mums to understand that their baby will be born with the same vitamin D status as themselves, therefore, if mum is vitamin D deficient during pregnancy, baby will be too. Women, who are pregnant, or planning to become pregnant, should ensure they are vitamin D sufficient, not only to protect their own health, but also to protect the health of their baby.”

The most effective source of vitamin D3 (cholecalciferol) is an oil-based soft gel or liquid supplement. Vitamin D3 supplements (usually measured in international units) are available over-the-counter in retail and online stores. Beware of vitamin D prescriptions as most contain vitamin D2 (ergocalciferol) that is much less effective than vitamin D3.

How much vitamin D a pregnant woman (or anyone, for that matter) needs continues to be a topic of debate.

First, let’s consider Dr. Obermer’s surprising recommendation in 1947. Remarking that the subject of vitamin D supplementation in pregnancy “is a difficult and complex one,” he concludes, “In a climate like that of England every pregnant woman should be given a supplement of vitamin D in doses of not less than 10,000 i.u. per day in the first 7 months, and 20,000 i.u. during the 8th and 9th months.” (Note: England’s distance from the equator denies its residents from enjoying optimal sun light exposure during the majority of the year.)

Second, a few noted organizations recommend daily intake of vitamin D for pregnant women as follows:

  • Vitamin D Council: 4,000-6,000 IU (Upper limit: 10,000 IU)
  • Endocrine Society: 1,500-2,000 IU (Upper limit: 10,000 IU)
  • Institute of Medicine (IOM): 600 IU (Upper limit: 4,000 IU)

It is interesting (and refreshing) to note that the Vitamin D Council and the Endocrine Society’s “upper limit” recommendations almost mirror those of Dr. Obermer’s. Please note that the IOM’s Food and Nutrition Board’s controversial recommendations, announced four years ago, were largely based on nutritional requirements for bone health. Most vitamin D experts agree that the IOM’s guidelines are woefully low with regard to vitamin D and way too high concerning calcium. Moreover, the intake of magnesium and vitamin K2 (vitamin D co-factors) was not addressed by this IOM panel.

According to the Vitamin D Council, if you are lactating and taking 6,000 IU of vitamin D daily, your breast milk should have enough vitamin D for your baby. If you are taking less than 5,000 IU of vitamin D a day, you should give your baby a daily vitamin D supplement (quality vitamin D3 drops are widely available).

Daily supplementation guidelines for babies include:

  • Vitamin D Council: 1,000 IU (Upper limit: 2,000 IU)
  • Endocrine Society: 400-1,000 IU (Upper limit: 2,000 IU)
  • Institute of Medicine: 400 IU (Upper limit: 1,000-1,500 IU)

Why risk pregnancy and neonatal complications? Vitamin D supplementation is a safe, inexpensive, and effective approach to a smooth pregnancy and birth of a healthy baby.

**This article is a companion post to “Improving Male and Female Fertility with Vitamin D”.

Editor’s Note: Susan Rex Ryan is an award-winning author who is dedicated to vitamin D awareness. Her extensive collection of health articles can be found on Hormones Matter as well as on her blog at smilinsuepubs.com Follow Sue on FB “Susan Rex Ryan” and Twitter @vitD3sue.

Copyright © 2014 by Smilin Sue Publishing, LLC
All rights reserved.

This post was published previously in December 2014.

Pregnancy Hypertension

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Every now and again I have the great pleasure of stumbling upon a brilliant piece of research; research that shakes the very core of medical science. Sadly, this is not one of those times. No, with the research I write about here, I cannot help but wonder why? Why was this study conducted? Why was it funded? Why was it published in such a prominent journal? And perhaps most importantly, why are there 15, well-credentialed, and likely, very highly accomplished individuals, lending their names to such a weak piece of research? Did they not read the study?

Just last month, published in the esteemed The New England Journal of Medicine, whose impact factor (54) far exceeds most journals in the space by a factor of 10, published a purportedly seminal piece on pregnancy hypertension: Less-Tight versus Tight Control of Hypertension in Pregnancy. The study was a huge, presumably well-funded (through a grant from the Canadian government), multi-center, international, randomized controlled trial set to investigate the important topic how best to treat pregnancy hypertension.

Pregnancy Hypertension

Hypertension during pregnancy is a growing problem that brings with it substantial risk to maternal and fetal health. How to treat pregnancy hypertension is of critical importance but not a single anti-hypertensive medication on the market currently has been tested for safety on pregnant women. Few data exist to evaluate the risks of taking such medications on short-term maternal or fetal health and no data exist to identify long term consequences. Not even the most basic of studies, those that evaluate drug pharmacokinetics and delineate appropriate dosing have been conducted for pregnancy (or any other complex hormonal environment).

Drug disposition and metabolism are altered significantly by pregnancy when hormone concentrations, plasma volume, enzymes, binding proteins, liver and kidney function change radically. These changes impact drug dosing and safety. Without proper consideration for these variables during pregnancy, the potential for overdosing and mis-dosing is significant, increasing the possibility of evoking serious maternal and/or fetal ill-effects. Setting aside the question of whether medications should be given at all during pregnancy (I don’t think they should be), I think we can all agree that when medications are necessary, safety and efficacy data must exist prior to administration.

It is from this perspective, that I approached the current study; a long overdue investigation about the safety and efficacy of anti-hypertensive drugs during pregnancy. Boy was I disappointed. In fact, the authors state: “We did not collect information on common adverse effects of anti-hypertensive medications…”  In fairness, however, other important outcome data were collected, but the design of the study was so arbitrary that any potential insight these outcomes might have contributed, was lost.

Study Details

The current study asked whether controlling maternal blood pressure strictly within a pre-defined range of parameters provided better or worse maternal or fetal outcomes compared to a more flexible approach with a broader range of accepted blood pressure metrics. For the tight control group, the goal was to maintain diastolic blood pressure at or below 85 mm Hg. For the less tight group, diastolic pressure was to be maintained at or below 100 mm Hg. The study accepted medicated and non-medicated hypertensive women (n = 987, 56-58% were medicated from each group prior to entering the study), who were anywhere from 14 weeks of pregnancy through 33 weeks pregnancy (mean = ~23 weeks).

Once participants were enrolled into the study, decisions regarding whether to medicate (if not previously medicated), which medication to use, and at what dosages, were left to the providing obstetrician’s discretion. The study excluded women who, at the time of admission into the study, showed signs of pre-eclampsia, demonstrated high systolic blood pressure (>160 mm Hg), had pre-gestational diabetes, renal disease or were utilizing ACE inhibitors (angiotensin-enzyme-converting enzyme inhibitors). If these conditions developed subsequently, patients remained in the study.

The primary outcome variables included: pregnancy loss (miscarriage, ectopic pregnancy, elective termination, perinatal death), high level of neonatal care for greater than 48 hours, gestational age and weight at delivery and a range of neonatal complications. Secondary outcome variables, measured at a much more rigorous statistical significance level (p>.001) compared to the primary variables (p>.05) included: serious maternal complications (uncontrolled hypertension, transient ischemic attack or stroke, pulmonary edema, renal failure and transfusion), placental abruption, severe hypertension (>160 mm Hg systolic or >110 mm Hg diastolic blood pressure), pre-eclampsia or abnormal labs indicative of incipient pre-eclampsia.

Results

The reported results of this study were as follows:

  1. There were no between group differences in either maternal or fetal complications.
  2. Women in the less tightly controlled group had higher blood pressure.

So for all of the money and time spent, we learned that anti-hypertensives do, in fact, reduce blood pressure, and that how intensely one uses these medications has no statistical bearing on this particular set of outcomes. This is not to say that there were not negative outcomes. There were plenty in both groups of participants; from severe maternal hypertension, pulmonary embolism and pre-eclampsia, to serious neonatal complications and fetal death. There were simply no statistically identifiable differences in the rates of these complicatiosn between the two groups. In other words, both groups had similar rates of negative outcomes.

Flaws in Study Design

Why weren’t there any statistically relevant differences between the two groups?  The answer to this question involves study design and herein we have a number of problems. First, the participant pool was largely hypertensive and medicated before entry into the study, providing no real control group from which the assess differences between blood pressure and outcomes in unmedicated versus medicated women. Elevated blood pressure is a significant risk factor for a number of maternal complications but so too are medications. What is the risk/benefit calculus that determines when the inherent risks of medications during pregnancy are outweighed by the risks of maternal blood pressure? In other words, when should we medicate to control hypertension?  Delineating between the dangers of the blood pressure versus those of the medication would have been more telling. Admittedly, such a study would present ethical considerations and quite possibly could have only been done retrospectively. Nevertheless, without these types of data, it is impossible to discern either the safety or efficacy of any therapeutic intervention; effectively nullifying the results from the onset.

A second methodological problem is the failure to address statistically pre-existing health conditions and environmental variables that confound results. That is, we don’t know what portion of the overall negative outcomes might be attributable to pre-existing or even extraneous maternal health issues versus medication use or blood pressure control. For example, a good percentage of the women in both groups were not only medicated prior to entry into the study but were significantly overweight pre-pregnancy, smoked and/or had additional health considerations. These variables would independently impact maternal and fetal outcomes, but also, could additively or synergistically influence blood pressure and other maternal risk factors. Although the mean data for both groups were presented, no analyses that might provide a richer understanding of the relationship between blood pressure and perinatal outcomes was given.

Perhaps the most problematic aspect of this study was the failure to analyze data regarding the types and dosages of medications relative to the negative outcomes. Though the researchers collected medication data and reported some of those data in the supplementary appendices (number of women per group who took a particular type of medication absent dosages was reported), there were no analyses presented. This made it impossible to identify whether certain medications were more dangerous than others and would account for the observed negative outcomes in either group. Neither did this report tell us about the dose-response relationship relative to effective blood pressure management versus adverse reactions – a very basic calculation – nor did they tell us about the role of medication interactions in the observed negative outcomes.

What Value is This?

From the standpoint of a practicing physician, a researcher or a patient, what use is a study on medication safety and efficacy during pregnancy, if there are no analytics delineating dose-response relationships by medication(s) and risk factor?  Is one medication safer than the others? Does a particular medication work better or worse for a specific group of women? Are there anti-hypertensive medications that are more or less effective during pregnancy at managing blood pressure? Or even more basically, are the dosages we currently use correct? With such a large study group, we could have learned which medications could be used safely during pregnancy, at what dosages, and with which groups of women. It is likely that some women should absolutely not be given medications due to confounding health conditions.

To answer any of these questions would have been highly useful and added significantly to the body of scientific research on pregnancy hypertension. In its current form, however, this study adds little, if anything, to our understanding of the pregnancy hypertension, the use of medications to control hypertension during pregnancy or their potential negative side effects. All this study tells us is that blood pressure medications tend to lower blood pressure and evoke complications in some women. Well, of course they do. That is not novel. We knew that already.

There are so many missed opportunities here. Not parsing the medication, dosage data was an egregious omission; one that makes me wonder why it was funded and why it was published in such an esteemed journal. And with 15 authors attributed to this study, why did no one on the masthead push to expand the analytics beyond what was presented? Pregnancy hypertension can be deadly and there is a striking lack of research in this area. Why are we not asking the big questions?

Fetal Hormone Protects Mom Against Preeclampsia

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Preeclampsia is a serious pregnancy complication that affects 2-6% of all pregnancies in the US and 5-14% worldwide. It is marked by maternal hypertension and protein in the urine, usually presenting after 20 weeks of pregnancy. Despite years of research to identify early maternal markers of preclampsia, no reliable early diagnostics have been developed. Perhaps we are looking in the wrong place.

Preeclampsia research has almost always focused solely on maternal health as the core component of the disease. While it is true that maternal health should be a consideration, as it is severely compromised with preeclampsia, it takes two to make a baby. What about the dad’s contribution to maternal, placental and fetal health during pregnancy? The absence of paternal contributions is curious, especially considering research shows that women with history of preeclampsia who change partners for subsequent pregnancies have a 30% reduction in the risk for preeclampsia. Conversely, women with no history of preeclampsia who change partners for subsequent pregnancies, increase their risk for preeclampsia by 30% – placing the dad’s contribution squarely in focus. Why is dad’s health not considered?

Truth be told, there is a line of research that suggests that a dysregulated maternal immune response to paternal semen causes preeclampsia.  A convenient remedy, greater exposure to one’s partner’s semen prior to pregnancy is postulated. Aside from the obvious chuckles with this line of reasoning e.g. that more sex prevents prevents preeclampsia, the deeper problem lay in the fact that this theory is still squarely focused on the mom’s health, or rather, her response to the semen. It takes no consideration of the healthiness of the semen itself.

What if paternal health contributes not only to fetal health (this should be obvious), but also, placental functioning?  What if the developing fetus, aided by paternal genetics, controls or contributes to placental health at least as much as the mom does?

In an interesting series of experiments conducted using rodents (here, here), researchers have identified a fetal hormone that reduces, maybe even prevents, the development of preelampsia. Although this doesn’t quite point to paternal health as contributing factor, it is a step in the right direction. That is, we’re finally moving beyond the mom as the sole contributor to a healthy pregnancy.

The hormone thought to protect mom from developing preeclampsia is called adrenomedullin or ADM for short. ADM is peptide hormone synthesized in a myriad of tissues including the heart, lungs, kidneys, the ovaries and testis, uterus and placenta. ADM is a vasodilator, meaning it dilates vasculature so that more blood and nutrients can flow to the tissue or organ. It’s also angiogenic, meaning it ‘grows’ new blood vessels. In normal healthy pregnancies ADM is elevated significantly. In preeclamptic pregnancies, it is not.  And this where it becomes interesting.

One of the tell-tale signs of preeclampsia is abnormal vascularization of the placenta. The maternal uterine spiral arteries must remodel and increase capacitance to support the nutrient and oxygen needs of the placenta and growing fetus. When they don’t remodel appropriately or are constricted in some way, placental, fetal and ultimately maternal health are compromised. The theory is, that as the primary recipient of the increased placental blood flow, in normal pregnancies the fetus signals its needs and in some way controls or contributes to uterine and placental artery remodeling and angiogenesis by releasing ADM. Fetal ADM then increases blood flow. This doesn’t appear to happen in preeclamptic pregnancies where ADM levels are diminished and uterine spiral arteries do not remodel appropriately. It is believed that if the fetus does not release sufficient ADM then maternal systems must hyper-compensate resulting in the preeclamptic pregnancy that places great physiological strain on the mom.  An interesting caveat though, ADM is increased in non-pregnant, usually male, patients with hypertension so the relationship may not be linear.

ADM interacts with other hormones as well. It enhances progesterone production, suppresses FSH induced estradiol production, and is thought to be involved with inhibiting uterine contractility during pregnancy. In the heart, ADM interacts with testosterone, estradiol and angiotensin-II to modulate heart vessel contractility.  Interestingly, it is testosterone that increases ADM in these cells, while estradiol has no direct effect on ADM. Through a complex interplay between estradiol and angiotensin II, however, estradiol can increase ADM (see here for details).

This is cool research and likely to open additional possibilities for preeclampsia treatment. It represents somewhat of a paradigm shift in recognizing the role of fetus, and indirectly the role of the dad in the development of preeclampsia. If taken just bit further, perhaps even more diagnostic and therapeutic opportunities would arise.

This article was published previously on Hormones Matter.