Despite a century of research, American medicine offers as little today for the prevention and treatment of eclampsia (traditionally called toxemia) as it did a hundred years ago. This progressive and potentially fatal condition remains a leading cause of miscarriage, premature birth, and infant mortality in the United States and around the world. An estimated 50,000 women die every year from eclampsia.
The condition's name is derived from the Greek word eklampsia, which means a sudden flashing or onslaught, an appropriate term for the rapidly developing system failures that characterize this medical emergency. Hypertension, severe edema, and protein in the urine are the signature symptoms of eclampsia, which adversely affects the brain, kidneys, liver, and lungs. Other common symptoms include headaches, nausea and vomiting, decreased urine output, changes in mental status, agitation and confusion, pain in the upper right abdomen, shortness of breath, sudden weight gain, and visual impairment. If the condition progresses to its final stage, the mother-to-be develops seizures or goes into a coma.
Extensive research notwithstanding, the cause of eclampsia remains a medical mystery. The preferred treatments are bed rest, dietary restrictions, prescription diuretics, and medication for hypertension. The preferred cure is delivery of the infant, usually months premature, by induced labor or Caesarian section.
To Tom Brewer, MD, these methods are worse than useless; they're dangerous. The cause of eclampsia and its simple cure, he says, have been known for decades. Beginning in the 1920s and '30s, medical journals have published dozens of scientific studies based on clinical observation as well as statistical and epidemiological studies showing that eclampsia is an easily prevented nutritional disease. (1-75)
Now retired, Dr. Brewer enjoys a career as a lecturer and nutritional counselor for pregnant women. Thanks to electronic publishing, the books What Every Pregnant Woman Should Know and The Brewer Medical Diet, both of which describe his discoveries and recommendations, are available as ebooks at www.pregnancybooks online.com. The Blue Ribbon Baby Pages website (www.blueribbonbaby.org) details his dietary guidelines, along with case studies, scientific references, and other information for pregnant women. In addition, Dr. Brewer maintains a free information hotline at 802-388-0276.
Interview with Tom Brewer, MD
Q: How did you become interested in the importance of nutrition for a healthy pregnancy?
Dr. Brewer: I learned about the problem of eclampsia, or what I call the metabolic toxemia of late pregnancy, before I went to medical school. I was married and had a new baby, and we had a neighbor from Russia who often described conditions in that country and the toll they took on pregnant women. (7) Times were very hard, food was scarce, and many women died of hemorrhage or convulsions. The Russian people at that time believed such events were the will of God and that women were meant to suffer in childbirth, but my neighbor believed the problem was simply a lack of food.
So in 1947, when I got into medical school at Tulane University, which was at that time in the middle of a New Orleans slum, I saw the problems he described first-hand.
In my first year, I went to a lecture given by James Henry Ferguson, (16) an instructor who came from Chicago, where he had worked with W.J. Dieckmann, a professor from Germany. Professor Dieckmann believed that protein deficiencies and malnutrition were the cause of most of the problems he saw in Chicago. He was then chair of the Chicago Lying-In Hospital.
When Ferguson came to work at Charity Hospital, where Tulane then had an obstetrics ward, he gave several lectures on OB/GYN topics, and one was about toxemia pregnancy, as it was called in those days. He said we were faced with a disease that's common in poor people, common in people who don't have prenatal care, common in diabetics, and common in women who have twins.
As he listed the risk factors, I had a gestalt, a moment of insight. I already had in mind the observations of my Russian neighbor. Now I was hearing an expert talk about the risk factors of toxemia. I realized that this problem could only be due to one thing, and that's poor nutrition.
Q: Did any of your professors make this connection?
Dr. Brewer: None of them did. They were surrounded by poverty and malnutrition but, as far as I know, none of them ever considered that these conditions might have anything to do with the problems we saw every day, like worms in children, miscarriages, and various diseases. My professors definitely did not share Ferguson's views. They were primarily surgeons. They were interested in performing C-sections, removing fibroids and ovarian cysts, performing hysterectomies, and so on.
So there, in my first year of medical school, I developed an antagonistic view.
When I started working with patients, I was on a ward where there were 20 beds with women who had this disease, toxemia pregnancy. Their blood pressure was up, their bodies were swollen, and they had a history of not having a decent diet. I learned this by talking with them. That's considered anecdotal, not verifiable, not from a clinical trial, not statistically significant, and so on. I've never been big on the statistical approach because each individual mother is important. Each one faces her own troubles.
Anyway, I got onto this nutrition connection, and I became obsessed with it. It became a central area of thought for me.
For my internship, I went over to Baylor College of Medicine in Houston. There was a lot of toxemia there, too.
Q: Were you able to help your patients?
Dr. Brewer: Yes. As an intern, I studied them. I did blood tests and liver function tests, and I asked them questions. As a result, I made several observations. For example, the blood gets thicker in toxemia because the woman gets dehydrated. (22-24,35,37,49,52,57) That's why diuretics are so dangerous in pregnancy. Also, toxemia is directly related not only to a lack of fluid in the body but a lack of protein, (5,6,14,18,38,45,54,56) salt, (13,21,36,42,44,46,47,49,59,69) vitamins, (4,18) minerals, (28,56) and other things. (7-9,14,30,56,62,63,65-68) Keep in mind that during my internship, there were only about 50 known nutrients. Now more are being discovered all the time. There may be a thousand nutrients. So I didn't know exactly how nutrition prevented toxemia, I just knew that it worked.
After my internship, I went to Lallie Kemp Charity Hospital, which was a rural hospital north of New Orleans. After a year there, I went into general practice in Fulton, Missouri. I had a partner, Dr. Jim Hill, who went with me from our General Practice residency at Lallie Kemp. Jim Hill and I were both studying toxemia. We did not restrict salt, we did not restrict food or weight gain, we did not use diuretics, we encouraged our patients to eat protein, and we had very healthy women giving birth to healthy babies. Prior to our arrival at Lallie Kemp Charity Hospital, 25% of the pregnant women there had toxemia. To go from a situation where one out of four women has hypertension, edema, and protein in the urine to where there's none at all was what I call a learning experience. It's not something I read in a book. We used the same approach in our General Practice in Fulton, where we worked for three years. Out of 100 births, we had only one toxemic patient. She was a poor woman who came to us from a shack on the Missouri River easement. She was severely toxemic because of her deficient diet, and she had received no prenatal care at all.
Then I went back to take a residency in obstetrics and gynecology, primarily to study this disease further and to try to prove the methods by which it occurred. The only professor who would support me in this effort was the same Jim Ferguson who had lectured at Tulane in 1947. By this time, he had become a professor and chairman at the University of Miami's Jackson Memorial Hospital in Miami, Florida.
I asked him to give me a research fellowship. He said there was no money for research on nutrition and pregnancy but to come anyway. In some ways that was a mistake because it's difficult to be a full-time resident and do research on the side, but I did it. I …
