Women are still dying – completely unnecessarily – of eclampsia nearly a half century after Dr. Tom Brewer told us all how to totally prevent (and if necessary, effectively treat) this often fatal condition found in young mothers. Eclampsia – also called toxemia of pregnancy – is defined as ‘coma and convulsions that develop during or immediately after pregnancy’.
In pre-eclampsia of pregnancy, convulsions haven’t occurred yet, but the major signs are obvious: significant water-weight gain (oedema), high blood pressure and protein in the urine. By the time pre-eclampsia has unnecessarily evolved into the coma and convulsions of eclampsia, most women are beyond treatment.
Even in 2015, the ‘routine’ treatment of more serious pre-eclampsia is nothing more than bed rest. When the situation becomes more serious, magnesium injections are sometimes given, and are sometimes helpful. But as Dr. Tom Brewer taught us, eclampsia is totally preventable.
Who is Dr. Brewer? What did he discover that totally prevents and effectively treats pre-eclampsia and eclampsia and could potentially save a young mother you know? Back in 1998, Nutrition & Healing published the brief biography and interview included here. It will provide you with the answers to those questions. It’s been updated here and there as needed but, unfortunately, the very best update – the news that young mothers are no longer dying of eclampsia – still lies somewhere in our future. Tragically, young mothers are still going into comas and convulsions and dying from this totally preventable and treatable condition.
Iron-clad connection between pre-eclampsia and nutrition revealed – An interview with Dr. Tom Brewer: 1998
Dr. Wright: Figures recently released by the World Health Organization and others state that approximately 75,000 women worldwide die of toxemia of pregnancy every year. For decades you’ve taught that toxemia is an entirely preventable disease, a disease of malnutrition. Following your lead and a few other clues, I’ve helped women eliminate early to moderate cases of toxemia (technically called pre-eclampsia). Why isn’t your work taken more seriously?
Dr. Brewer: The major criticism of my work is that I wouldn’t do ‘controlled studies’. I contend that any such study is unethical: who wants to be assigned to the ‘poor-diet control group’ and risk harming herself or her child?
Dr. Wright: When did you first become interested in the problem of toxemia of pregnancy?
Dr. Brewer: Almost 50 years ago. I was a medical student at Tulane University, on obstetrics in my third year. My instructor was Dr. James Henry Ferguson, who had been to the Mississippi countryside studying maternal deaths, particularly among poor black and white mothers. Ferguson told us students the classic picture of toxemia: high blood pressure, oedema, protein in the urine, progressing to headaches, spots in front of the eyes, dizziness, nausea, vomiting, and in the end a lethal situation of coma or convulsions or both, heart failure, kidney and liver damage and death. Toxemia was more common among the poor, teenagers, black women, unmarried women, older women with many children, women with diabetes, women with high blood pressure prior to pregnancy, lupus, and so on. There were a whole gamut of things associated with toxemia, it had been and still is studied rigorously. Yet then and even now the official line is ‘nobody knows what causes toxemia’.
Ironically, our instructor Ferguson had studied in Chicago with William Dieckmann, the author of a textbook Toxemias of Pregnancy. Dieckmann is the only American author I know who cited the work of Pinnard, a French professor at the Hospital of LaMaternité in Paris who discovered in 1893 that milk could totally prevent seizures in toxemia. The ‘régime latté absolut’, he called it. So there’s been evidence toxemia is a nutritional problem for over 100 years now. But I’m digressing…
Dr. Wright: You were telling us you were a third year medical student…
Dr. Brewer: Yes. I went out to the toxemia wards. In those days, the black and the white were on opposite sides of the hospital. Even the blood banks were segregated into ‘black blood’ and ‘white blood’.
Dr. Wright: Excuse me, you said toxemia wards? There were whole wards with toxemic women?
Dr. Brewer: Yes.
Dr. Wright: How many women in each one?
Dr. Brewer: About 20. As a student, my job was to take and record blood pressures, collect urine specimens, run tests in the lab. I took medical histories – do you remember doing that in school, they ran to 20 or 30 pages? – one of the sections was for diet. Someone would tell me ‘I had fatback and cornbread and clay dirt and sago starch and sorghum’ and so on. I’d ask, ‘Did you drink milk, eat any eggs, what about meat?’ They mostly said no. After taking histories including diet from several hundred women with toxemia and then some who didn’t have toxemia, it occurred to me that toxemia must be a disease of malnutrition.
I then began to tell my fellow students, the interns, occasionally a resident, ‘These women here, they’re malnourished, that’s why they’re sick, they’re seriously malnourished’. They usually told me ‘they can’t be’. When I found out the serum proteins in these women were very low, I thought that confirmed it, but the medical literature from all around the world said it was because protein was being lost in the urine. But I found out that isn’t true: the protein loss into the urine doesn’t start until the toxemia has well-progressed all over the body.
Dr. Wright: Didn’t Professor Maurice Strauss of Harvard publish1 in the 1930s about low serum albumin in women with toxemia?
Dr. Brewer: Exactly. He influenced my thinking. And a fellow Harvard faculty member, Bertha S. Burke2 worked it out very clearly that women who ate over 60g of protein a day simply didn’t get toxemia. That was in the 1930s and 40s. But one of the most important influences on my thinking were my experiences in the war in the Pacific, where I observed directly that people could get malnourished enough to get sick from it.
But nobody wanted to listen to me, I was just a student and besides at that time I was making a racial issue of it, as there were many more malnourished blacks than whites. It didn’t help at all that I was a lower middle-class white anti-segregationist Texan in Louisiana in the late 1940s and early 50s. But I’m digressing again…
They were using a potent diuretic made with mercury, Mercuhydrin…
Dr. Wright: Which works by actually damaging the kidneys…
Dr. Brewer: Yes, we were actually ordered to give mercury diuretics to these pregnant women. Later on I worked in the outpatient clinics – we would have as many as 300 women, occasionally 350 a day…
Dr. Wright: All with pre-eclampsia?
Dr. Brewer: Every one. And all that we did in those clinics was check the blood pressure, give the mercurial diuretic, weigh them, and give drastic warnings about not gaining weight or eating salt or they might swell up with water and have seizures and die. That’s where I first encountered what I called iatrogenic starvation. They were putting women I knew to be malnourished onto starvation diets. I complained and said ‘these women simply need more and better food and not starvation and all these drugs’. That didn’t make me any more popular with the professors in charge; Remember, I was still a medical student.
After I graduated from medical school I started an internship at Charity Hospital, but it was all the same, and I couldn’t do anything about it. I got discouraged and dropped out, worked as a carpenter’s helper and delivered milk for a couple of years. I went back to another internship in Houston in 1953.
Dr. Wright: We’re happy you didn’t quit medicine entirely.
Dr. Brewer: I thought about it. After I finished the internship, I was a general practice resident for a year. This was in Independence, Louisiana, which was a very, very poor rural area About 25 per cent of the women delivered there had one stage or another of toxemia; at Charity Hospital in New Orleans it had been 19 per cent. Again I took dietary histories and got the same stories: fatback, cornbread, sorghum, grits, soda pop, maybe an apple a week or so. No good quality sources of protein. None of this was formal research, though.
But after the residency, a partner and I took over a practice in Fulton, Missouri, and we saw only one woman of the first 100 we delivered with toxemia. Only 1 per cent! It was easy to predict: she was very poor, lived in a shack on an easement by the Missouri River, and was malnourished.
While I was in Fulton, drug company ‘detail men’ were calling me all the time. They were promoting the latest diuretics for toxemia, it drove me crazy. By early 1958 I just had to do research on toxemia, so I went to Miami where my former instructor James Henry Ferguson was now professor. He was the only one who would listen to me. He couldn’t get me any money for research, so I became an Ob/Gyn resident in his department because he would let me do research on the side. I didn’t really want to be an Ob/Gyn specialist, but it was the only way. I finally got a paper published in the American Journal of Obstetrics and Gynecology about the limitations of diuretics and the meaning of low serum albumin in toxemia.
Dr. Wright: That was in 1962?
Dr. Brewer: Yes. By 1963, I had done another study where I gave intravenous human albumin to a few toxemic women with massive oedema. These were women with already-low serum albumin, the lowest was 1.2g per 100g blood. It was just dramatic. Women who were in shock came right out of it, their oedemas lessened, their blood pressures lowered, they felt much better. It seemed almost miraculous, but it was just simple physiology. Every gram of albumin given intravenously could draw 50 ccs of oedema fluid back out of the tissues into the bloodstream where it belongs.
Dr. Wright: Starling’s Law.
Dr. Brewer: You’re onto this, aren’t you? Starling, Journal of Physiology, 1895, Volume 19, pages 312-336. His paper on ‘Absorption by Blood Vessels’. That was Maurice Strauss’ take-off point.
Dr. Wright: How many women did you give intravenous human albumin?
Dr. Brewer: I personally gave it to 13, and all 13 had marked diuresis, loss of oedema fluid.
Dr. Wright: That would support your theory. What happened?
Dr. Brewer: No one would accept the results.
Dr. Wright: So you kept working on it?
Dr. Brewer: During my entire residency in Ob/Gyn, from 1958 through 1962. Then I went to the University of California, San Francisco, as an NIH Fellow Instructor in the Ob/Gyn department. But when I started a programme of trying to teach the women at the Outpatient Clinic to eat right, to gain any weight they wanted as long as it came from a good diet, the other Ob/Gyn instructors and professors wouldn’t support me. You’d have thought I was the worst food faddist in the world. I got so frustrated all over again.
Somebody else would see one of my patients and lecture her about not gaining weight and put her on a low-salt low-calorie diet and give her amphetamines to promote weight loss. Honest to God, they were giving amphetamines to pregnant mothers. I nearly went mad and told myself ‘I can’t stay here another year, I have to go somewhere and do this on my own!’
So the next year I went across the Bay to the Contra Costa County Health Services, and I started my programme in Richmond. I talked to every woman who came in there about good nutrition on her first visit. I told them this was the most important part of pre-natal care. Just as importantly, I eliminated all the stuff about low calories, low salt, diuretics, and so on. I just stopped all that.
Dr. Wright: What were the results?
Dr. Brewer: After I had been there a few years, the NIH agreed to come in with a sophisticated team and go over the records. They compared records from patients in my programme at Richmond to records from Richmond patients prior to my programme. They found a ten-fold reduction in what they called ‘pregnancy-induced hypertension’ in first pregnancies.
Dr. Wright: Did they publish that anywhere?
Dr. Brewer: No.
Dr. Wright: Why not?
Dr. Brewer: I don’t know, it’s political, I guess.
Dr. Wright: How long were you with Contra Costa County Health Services?
Dr. Brewer: Twelve and a half years.
Dr. Wright: Were any other statistics collected during that time?
Dr. Brewer: NIH actually carried out an extensive study. They hired seven clerks. They brought a big trailer office, set it up on the hospital grounds, and supposedly abstracted every record of every woman delivering a baby there for a five-year period. They coded them as to whether they were from the Richmond Clinic with Brewer or not Brewer, the Martinez Clinic with Brewer or not Brewer, and the Pittsburgh Clinic with or without Brewer. I thought, ‘What wonderful statistics we’re going to have!’ They checked every serum protein, every urinalysis was recorded, every blood pressure was coded on cards and tape… and they came out with nothing at all.
Dr. Wright: Where is all this data?
Dr. Brewer: Supposedly the NIH still has it. They gave me a copy of the computer tape, I sent it to five different computer experts, [and] they couldn’t decipher it. I finally gave up. I’m not a computer person.
Dr. Wright: They studied five years’ worth of records?
Dr. Brewer: Yes. Several women clerks were working five days a week, eight hours a day from 1971 through sometime in 1974. I kept asking, when is something going to show? I know personally there were no cases of toxemia in my patients. I had people visit to see if I was doing anything wrong from the University of California-Davis, University of California-Berkeley, Planned Parenthood, March of Dimes, and so on. No one could find anything the matter, but none of them publicly acknowledged my work. By the way, have you heard of the 1958 Vanderbilt Study?
Dr. Wright: No.
Dr. Brewer: It was done by Darby, one of the so-called leading nutritionists at Vanderbilt, and someone from the Ob/Gyn department. They concluded from a study of reasonably well-fed middle class white women that nutrition had nothing to do with toxemia – or for that matter with low birth weight or infant mortality. It was believed by all the academics. I was up against that, and to some degree we still are.
Dr. Wright: It would seem so. Since you left the Contra Costa County Health Services, what have you been doing?
Dr. Brewer: I’ve been involved with SPUN (the Society for the Protection of the Unborn through Nutrition), writing, lecturing, doing telephone consultations, and promoting my book Metabolic Toxemia of Late Pregnancy: A Disease of Malnutrition.
No more deaths from eclampsia!
Those of us familiar with the history of medicine will not be surprised to learn that in 2015 young mothers are still getting ill and in some cases dying from an entirely preventable problem. Eclampsia has been known to be a disease of malnutrition since the work of Strauss1 and Burke2 at Harvard (yes, that Harvard) in the 1930s and 40s.
As Dr. Brewer reported, from 1971 through 1974, a team from the National Institutes of Health exhaustively studied the remarkable records of Dr. Tom Brewer at public health clinics in Contra Costa County, California, comparing with them with records of women from the same clinics but not under Dr. Brewer’s care. Using standard medical care of the time with the added dimension of nutrition education, Dr. Brewer virtually eliminated toxemia among his patients, and drastically cut the incidence of low birth weight infants. Yet the team from NIH departed and has not to this day published its findings!
Where are the NIH findings? Why haven’t we heard about this from the Centers for Disease Control and Prevention? Is the malnutrition explanation just too simple? If NIH or CDCP don’t believe it, it should only take them a few months to prove or disprove it. Aren’t poor mother’s lives important enough to at least study this question?
In 42 years of practice – including seven when helping with home births for couples who preferred them – I have personally observed that pre-eclampsia is always reversible. For example, one woman was told she must be hospitalized because her pre-eclampsia was becoming eclampsia, but she decided instead to take treatment based on Dr. Brewer’s work. In just two days, using intravenous amino acids, magnesium, and vitamin B6, her blood pressure completely normalised. Incredibly she shed 22 pounds of oedema fluid, and all other signs of ‘almost eclampsia’ and even pre-eclampsia disappeared in those two days!
But why wait to treat pre-eclampsia and eclampsia when prevention is 100 per cent effective? Consuming high-quality protein and supplements (especially vitamin B6 and magnesium) completely prevents the problem! There’s just no excuse for allowing eclampsia to claim the life of even one more pregnant mother!
Wishing you the best of health,
Dr. Jonathan V. Wright
Nutrition & Healing
Vol. 9, Issue 2 • February 2015
Full references and citations for this article are available in the downloadable PDF version of the monthly Nutrition and Healing issue in which this article appears.