Positive Health Online

I wrote these thoughts on preeclampsia for a South African doctor; this information should be public knowledge.

Preeclampsia is a life threatening syndrome in mothers giving birth and a huge problem in South Africa, a summary of noted deficiencies there being applicable to other women. The rate of preeclampsia in South Africa is around 10% but in that doctor’s hospital he quoted 18%. The rate in Caucasian women is estimated at around 2 to 4%; the increased rates in women from developing countries is largely due to dietary deficiencies.

Preeclampsia is often caused by antibodies to yourself that involve fat or lipids so the immune system gets confused; sometimes immune system markers called HLA antigens[1] on the sperm of a partner become an allergen too. Or your own HLA antigens which are also self recognition cell markers, an area of your body may have too much inflammation. and immune system activity binds to your HLA antigens and starts attacking them.

This is the same type of problem in diabetes where the immune system attacks insulin cells, for rheumatoid arthritis it is the joints, psoriasis the skin; even asthma has these features where allergens or confusion from immune cells squeeze lung airways and prevent breathing.

When pregnant, a hypertensive attack in preeclampsia is like being choked to death and this involves both mother and child.

"Pregnancy in women with systemic lupus erythematosus (SLE) or antiphospholipid antibodies (APL Ab) - autoimmune conditions characterized by complement-mediated injury - is associated with increased risk of preeclampsia and miscarriage."[2]

Homocysteine

Diet is a way to manage the inflammation with these problems. High levels of an amino acid called homocysteine are an indicator of inflammation and a  risk factor for both preeclampsia and heart disease, as well as  autoimmune diseases like lupus and arthritis. The B vitamins folate, B12 and B6 help to lower levels of homocysteine. When a baby is growing it also uses up more of the available folate, B12 and B6, so these nutrients are very important for the child’s growth too.

"Black women had higher plasma total homocysteine and lower plasma folate concentrations than white women, largely because of lifestyle factors, which may contribute to the greater rate of Coronary Artery Disease in premenopausal black than in white women."[3]

"Women who developed severe preeclampsia have higher plasma homocysteine levels than women who remain normotensive throughout pregnancy."[4]

“Plasma homocysteine is increased in preeclampsia. Homocysteine concentrations are affected by nutritional deficiencies, particularly decreased folic acid and B12, leading to increased homocysteine.”[5]

Quoting the study below shows vitamin B6 and folic acid lowered homocysteine and both helped preeclampsia and fetal growth.

"Vitamin B6 and folic acid correct the methionine loading test in patients with hyperhomocysteinemia. Perinatal outcome in patients with a history of preeclampsia or foetal growth restriction and hyperhomocysteinemia appears to be favourable."[6]

So African, Caucasian and all women[7] with preeclampsia may have these deficiencies and quality of the diet is a big factor.

"Dietary data for South Africa showed that Calcium, Iron, Folate, Vitamin B6, and Vitamin D were the most deficient in the diet."

"In South Africa the most commonly consumed foods were sugar, tea, maize porridge, brown bread, coffee, white bread, potatoes, hard (brick) margarine and milk."[8]

When folate, B12 and B6 are low then this also affects iron absorption and unabsorbed iron creates inflammation. Iron gets absorbed with co-factors Folate, B12, B6, Copper and Vitamin C. This translated to foods involves eating green vegetables for folate or eating fish, birds, meat, eggs to obtain B12 and B6.  Copper comes from the same protein foods with nuts like cashews. Lemons and limes and vegetables in general for vitamin C.

Vegetarians may need a B12 supplement while B6 is also needed for protein synthesis, red blood cell formation and muscle enzymes, so anyone at risk of preeclampsia may need vitamin B6 at around 50mg to 100mg a day depending on body size. I use an algae called Chlorella as a source of B12 and iron.

It is advisable to see a health consultant for any supplement use in pregnancy.

These iron absorbing co-factors also help infections like Tuberculosis, Staphylococcus, Candida and Malaria, as all bacteria, fungi and parasites will take your leftover iron if you don't absorb it first; life then literally becomes a tug of war over iron so people can keep breathing. The complications of low folate, B12, B6, copper and vitamin C can be anaemia, infections, inflammation and preeclampsia.

In Caucasian white women many have problems with a folate processing gene called MTFHR and another C677T. This is a factor in autoimmune diseases and coeliac as well as preeclampsia, as the low levels of folate simply cause too much inflammation if untreated or unnoticed. In Europe though because of better diet, even though up to 20% of women may have the folate gene problems, the diet makes up for it and preeclampsia is still much lower than in women from developing countries.

Here they are talking about Turkish women.

"In a another study there was no difference in folic acid and vitamin B12 levels between pooled normal and pre-eclamptic groups, but these levels were significantly lower in patients with the C677 mutation of MTFHR."[9]

African women in general have no problems with folate genes though. Sickle cell traits are more of a problem in that too much iron can cause infections. Sickle cell seems to be a defence against bugs getting iron from your blood.

As an example Maasai don't eat that much meat as people would think and a lot of the diet uses milk. Apparently the lactoferrin in milk takes some iron out of the body but just enough not to get anaemia. When they tried iron supplements on the Maasai in the early 80s they ended up with malaria infections because the malaria got the iron before it got to the blood and this fed the malaria parasite instead.[10] So African women have no folate gene problems, but lack the dietary things like Folate, B12, B6 to lower Homocysteine and Copper or Vitamin C as well to absorb Iron.

Magnesium

Magnesium reduces hypertension [11] and also preeclampsia. A B6 supplement may be the first choice to stop morning sickness along with magnesium. Magnesium sulphate has been used as a relief for hypertension in preeclampsia since 1810, so magnesium is important. Magnesium sulphate does not taste great and moves the bowels, though a clinician can inject it; dietary sources may be best throughout pregnancy as magnesium is a mineral and can release toxins which the kidneys then need to deal with. In this study on 10,000 women in 33 countries they had the remarkable results with injected magnesium sulphate, showing that it works.

“Magnesium sulphate halves the risk of eclampsia, and probably reduces the risk of maternal death” and ‘ There do not appear to be substantive harmful effects to mother or baby in the short term.”[12]

Oxidized Fats

Oxidized low-density lipoprotein or Oxidized LDL fats appear in autoimmune lupus and  in people with  antiphospholipid antibodies,[13] thus giving clues to the sort of inflammatory antibodies seen with preeclampsia.[14] Beta-Oxidation is the way the body breaks up fat to be reused in the Mitochondria which are our energy cells, and an increase in the wrong lipids or oxidised fats is a feature of preeclampsia with a reduction in the necessary beta-oxidation.

An amino acid called Carnitine often floats around in the blood of women with preeclampsia indicating that it is there but not getting used properly.[15] Carnitine absorption also affects the level of beta-oxidation; basically it means you get tired, and weight problems could get worse while fats are not being used properly. Carnitine is made in the kidneys and liver from the amino acids methionine and lysine, and as the name suggests can be found in fish and meats but methionine and lysine are plentiful in nuts and beans. So carnitine is needed by the mitochondria to enable beta-oxidation to occur along with vitamin C to absorb the carnitine. I would say a lemon a day before a protein meal.

"Vitamin C is a cofactor in the biosynthesis of carnitine, a molecule required for the oxidation of fatty acids."

“These preliminary results show that low vitamin C status is associated with reduced fat oxidation during submaximal exercise. Low vitamin C status may partially explain the inverse relationship between vitamin C status and adiposity and why some individuals are unsuccessful in their weight loss attempts.”[16]

Most women are likely to eat enough meat after hearing the 'eat meat' campaigns for iron. Though women with preeclampsia should know we are partly allergic to all mammals and the Neu5Gc sialic acid from mammals gets incorporated into our nervous system and can cause inflammation. Humans have a sialic Acid called Neu5Ac and that is also in fish, birds, eggs and reptiles. We are the only apes with the Neu5Ac sialic acid and even chimps have the different Neu5Gc sialic acid. Our immune system may react to this and it may also be better to stick to breast milk[17] and the animal foods without Neu5Gc for growing children. Long term inflammation from this other mammal Neu5Gc sialic acid is blamed as a possible cause of cancer.[18]

But the carnitine in fish, birds, eggs and reptiles is still needed and the simple co-factor is vitamin C to absorb carnitine. Vegetarians will get Lysine and Methionine to make Carnitine from beans, sprouts and nuts; I see no advantage in either being vegetarian or eating meat and fish as long as there is enough protein and vitamin C and co-factors like B6 to absorb it.

Vitamin D and Sunlight

The diet study on African women showed they were low in vitamin D in Africa where sun should not be a problem. In places like London, low vitamin D is a concern in all the Indian and African communities. Low vitamin D is a big factor in Multiple Sclerosis in people with dark skin who live in the Northern Hemisphere along with impaired immunity with Tuberculosis,[19] Cancer, Arthritis [20] and vitamin D also inhibits Herpes infections [21].

It is mainly due to a lack of sun and no different in South Africa or for Caucasians. Without Vitamin D the immune system can get overactive; this is how your own immune system reacts to the lipids or the HLA antigens on the edges of your cells. Vitamin D is like the hand brake on the immune system and reduces inflammation in all autoimmune diseases and asthma.

"The prevalence was highest in winter (13.6% pre-eclampsia patients from all admissions). Women admitted in winter had a higher risk of developing pre-eclampsia compared to those admitted in summer"[22] Vitamin D from bathing in sunlight can fix seasonal deficiencies.

“The previously documented seasonal variation in serum 25-hydroxyvitamin D recorded in patients in Johannesburg is probably a consequence of the increased clothing worn and the decreased time spent out of doors during winter, rather than decreased ultraviolet radiation reaching the earth. The limited in vitro formation of vitamin D3 during winter in Cape Town may have clinical implications insofar as the management of metabolic bone diseases like rickets and osteoporosis is concerned. Breast-fed infants resident in the area are likely to suffer from vitamin D deficiency rickets unless vitamin D supplements are provided, or the mothers are encouraged to take their children out of doors."[23]

To sum up: The basic points are.

• Folate, B12 and B6 lower Homocysteine and lower inflammation;
• Folate, B12, B6, Copper and Vitamin C absorb Iron and lower inflammation;
• Magnesium can be used safely to lower blood pressure. Chocolate is a source of magnesium;[24]
• Vitamin D lowers the antibody response when it gets out of control;
• Sunlight is still a good source

References

1. de Luca Brunori I et al. HLA-DR in couples associated with preeclampsia: background and updating by DNA sequencing. Journal Reproductive Immunology. 59(2):235-43. August 2003.

2. Salmon JE et al. Mutations in Complement Regulatory Proteins Predispose to Preeclampsia: A Genetic Analysis of the PROMISSE Cohort. PloS Medicine. March 2011.

3. Gerhard GT et al. Higher total homocysteine concentrations and lower folate concentrations in premenopausal black women than in premenopausal white women. American Society for Clinical Nutrition. 70 (2) 252-260 August 1999.

4. Hasanzadeh M et al. Elevated plasma total homocysteine in preeclampsia. Saudi Medical Journal. 29(6):875-8. June 2008.

5. Patrick TE et al. Homocysteine and folic acid are inversely related in black women with preeclampsia. Hypertension. 43(6):1279-82. June 2004.

6. Leeda M et al. Effects of folic acid and vitamin B6 supplementation on women with hyperhomocysteinemia and a history of preeclampsia or fetal growth restriction. American Journal of Obstetrics and Gynecology. 179(1):135-9. July 1998

7. Bergen NE et al. Homocysteine and folate concentrations in early pregnancy and the risk of adverse pregnancy outcomes: the Generation R Study. An International Journal of Obstetrics and Gynecology. 119(6):739-751. May 2012.

8  Steyn NP & Nel JH. Dietary intake of adult women in South Africa and Nigeria with a focus on the use of spreads. Chronic Diseases of Lifestyle Unit, Medical Research Council, Tygerberg. February 2006.

9. Acilmis YG et al. Homocysteine, folic acid and vitamin B12 levels in maternal and umbilical cord plasma and homocysteine levels in placenta in pregnant women with pre-eclampsia. Journal of Obstetric Gynecology Research. 37(1):45-50. January 2011.

10. Murray MJ et al. The salutary effect of milk on amoebiasis and its reversal by iron. British Medical Journal. 7 June 1980.

11. Houston M. The role of magnesium in hypertension and cardiovascular disease. Journal of Clinical Hypertension (Greenwich). 13(11):843-7. November 2011.

12. Altman D et al. Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: a randomised placebo-controlled trial. Lancet. 1;359(9321):1877-90. June 2002.

13. Amengual O et al. Autoantibodies against oxidised low-density protein in antiphospholipid syndrome. British Journal of Rheumatology. 36:964-968. 1997. 

14. Qiu C et al. Oxidized low-density lipoprotein (Oxidized LDL) and the risk of preeclampsia. Physiology Research. 55(5):491-500. 2006.

15. Thiele IG at al. Increased plasma carnitine concentrations in preeclampsia. Obstetrics and Gynecology. 103(5 Pt 1):876-80. May 2004.

16  Johnston CS et al. Marginal vitamin C status is associated with reduced fat oxidation during submaximal exercise in young adults. Nutrition & Metabolism. 3:35. 2006.

17. Wang B et al. Concentration and distribution of sialic acid in human milk and infant formulas. American Society for Clinical Nutrition. vol. 74 no. 4 510-515. October 2001.

18. Inoue S et al. Extensive enrichment of N-glycolylneuraminic acid in extracellular sialoglycoproteins abundantly synthesized and secreted by human cancer cells. Oxford Journals, Glycobiology. 20 (6): 752-762. March 2010.

19. Nnoaham  KE & Clarke A. Low serum vitamin D levels and tuberculosis: a systematic review and meta-analysis. International Journal of Epidemiology. 37 (1): 113-119. 2008.

20. Cutolo M. Vitamin D and autoimmune rheumatic diseases. Rheumatology. 48 (3): 210-212. 2009.

21. Zwart SR et al. Response to Vitamin D Supplementation during Antarctic Winter Is Related to BMI, and Supplementation Can Mitigate Epstein-Barr Virus Reactivation. American Society for Nutrition. vol. 141 no. 4 692-697. April 1, 2011.

22. Immink A et al. Seasonal influence on the admittance of pre-eclampsia patients in Tygerberg Hospital. Acta Obstetricia et Gynecologica Scandinavica. 87(1):36-42. 2008.

23. Pettifor JM et al. The effect of season and latitude on in vitro vitamin D formation by sunlight in South Africa. South African Medical Journal. 86(10):1270-2. October 1996.

24. Triche EW. Chocolate Consumption in Pregnancy and Reduced Likelihood of Preeclampsia. Epidemiology. 19(3):459-464. May 2008.