BREWER – um notável médico-obstetra que estudou sal na gestação mas que comumente é “esquecido” pela medicina mainstream
Médico, pesquisador norte-americano que livrou gestantes dos males da eclâmpsia através de medidas alimentares, eis o Dr Tom H Brewer
[Dr Thomas H Brewer]
Mais ou menos na mesma época em que a medicina oficial e a indústria começaram a propagar a doutrina de que o sal é nocivo na gestação – e a promoverem restrição de sal e diuréticos na gravidez e na hipertensão – um médico e estudioso norte-americano, obstetra, consolidou e publicou seus estudos mostrando o papel do sal e da boa oferta de proteína alimentar para evitar uma gravidez com eclâmpsia [hipertensão, proteinúria, edema grave]. Portanto, medidas dietéticas para evitar uma doença grave, para a mãe e o feto, além de potencialmente letal.
O médico é o Dr Thomas H Brewer e seu último livro, intitulado Toxemia metabólica da gravidez tardia – uma doença nutricional [Metabolic toxemia of late pregnancy, a disease of malnutrition] foi lançado próximo da época da sua morte, 2005.
Como poucos, ele acompanhou gestantes de risco por longos anos, pesquisou e escreveu sobre isso, a despeito do ostracismo acadêmico a que foi submetido quanto mais aprofundava e divulgava seu trabalho. Ostracismo não por incompetência, como se pode confirmar lendo seus materiais, mas por razões certamente extra-médicas, as quais, em todo caso, não constituem tema desta breve nota [B].
Em seu tempo, Brewer dialogou – sempre argumentando a partir da pesquisa qualificada - com o mantra médico de que sal dá edema, hipertensão e piora eclâmpsia. E que sal seria um problema; ao ponto de se precisar restringir sal para diminuir a pressão arterial, garantir a gestação saudável. Sim, diminuir o sal eventualmente pode baixar alguns poucos pontos da pressão arterial em um primeiro momento – segundo alguns - , mas, na sequência, o organismo reage com mecanismos -e uma hemodinâmica - que converterão a carência de sal em problemas de saúde de vários tipos, inclusive hipertensão [A].
Como obstetra, cuidando de um sem número de casos de pré-natal, ele já sabia que a pressão sanguínea [oncótica] é mantida por proteína+sal, ou seja, por albumina e cloreto de sódio, e que, sem o sal – portanto em regime de carência de sal – a albumina segue a água que extravasa do compartimento vascular, engendrando edema e outras consequências.
Redução do sal no plasma também tem o efeito de acionar a aldosterona, o sistema inflamatório renina-angiotensina-aldosterona e, dessa forma também contribui para aumento da pressão arterial. E inflamação.
Nada disso favorece a boa gestação. Menos proteína e menos sal contribuem para queda no volume do sangue, o que, por outro lado, impacta a oxigenação do feto, diminui a perfusão renal, aciona a renina [do SRAA].
A renina promove uma circulação mais rápida do sangue e aumento da pressão arterial. A diminuição do volume plasmático prepara o terreno para edema e, mais adiante, choque. Todos esses processos ocorrendo na esfera do sal, isto é, da falta de sal. E que, em seu tempo, foram foco dos estudos de Brewer.
Sua perspectiva clínica era a de enfatizar proteína e sal na alimentação da gestante. Ele defendia 100 g de proteína por dia. E, segundo R. Peat, foi Brewer quem mostrou que uma deficiência proteica era a maior causa histórica de eclâmpsia ou toxemia na gestação. Brewer argumentava que restrição de sal na dieta [ou mesmo dar um diurético para fazer o corpo perder sal] atrasavam o próprio desenvolvimento cerebral do feto.
Foi estudioso e pesquisador de toxemia gravídica [eclâmpsia] e, em entrevista aqui citada, ele argumentou que “tive um parceiro, o Dr Jim Hill, com quem fez residência medica em Lallie Kemp. Jim e eu estudamos toxemia gravídica. Na nossa conduta clínica não restringíamos sal, nem vários alimentos ou mesmo o ganho de peso, tampouco utilizávamos diuréticos e encorajávamos nossos pacientes a consumir proteína e, ao final, tivemos gestações saudáveis com as mães dando origem a bebês saudáveis” [C]. Os trabalhos de Brewer e o livro d Shanklin e Hoden chamam a atenção para estudos onde se abordava a hipertensão com várias gramas extra de sal por dia.
Os trabalhos de Tom Brewer em toxemia na gravidez tardia, não foram os únicos, mas foram bem consolidados e amparados cientificamente.
Na abordagem da gestação, Tom Brewer, previsivelmente, estava na linha oposta à da Big Pharma. As empresas de drogas fomentaram entre os doutores a doutrina de que sódio traz uma perigosa retenção de água e que é preciso restringir sódio na dieta e até usar diurético. Os doutores também acreditam que a mulher deve tomar determinadas medidas, controversas, para controlar o ganho de peso na gestação. Alegando, ideologicamente, que retenção de água e ganho de peso são nocivos à gestação porque criaria uma situação similar à diabetes. Esse é o tamanho da doutrina que ele afrontou.
Falecido em 2005, aos 80 anos, o eminente Dr Brewer foi autor também de livro com Krebs What every pregnant woman should know [O que toda mulher gestante deveria saber] e de mais de 40 artigos publicados.
Mas ainda está por ser redescoberto, em grande escala, pela medicina dominante.
GM Fontes, Brasília, 31-12-23
As informações aqui presentes não pretendem servir para uso diagnóstico, prescrição médica, tratamento, prevenção ou mitigação de qualquer doença humana. Não pretendem substituir a consulta ao profissional médico ou servir como recomendação para qualquer plano de tratamento. Trata-se de informações com fins estritamente educativos.
[Nosso trabalho neste nota foi o de apenas resumir ideias divulgadas frequentemente pelo PhD em Biologia e pesquisador de hormônios e estresse, o Dr R. Peat, em artigos dados a público no seu site e em entrevistas nas últimas décadas. Faço sua divulgação aqui em benefício daquelas pessoas – médicos/pacientes que, fazendo uso adequado, possam se beneficiar de tais informações e que possam estudá-las a fundo].
Referências _______________
[A] ADLER A J TAYLOR F, 2014. Reduced dietary salt for the prevention of cardiovascular disease. Cochrane Database Syst Rev. 2014 Dec 18;2014(12):CD009217. doi: 10.1002/14651858.CD009217.pub3. PMID: 25519688 PMCID: PMC6483405
DOI: 10.1002/14651858.CD009217.pub3 “Background: This is an update of a Cochrane review that was first published in 2011 of the effects of reducing dietary salt intake, through advice to reduce salt intake or low-sodium salt substitution, on mortality and cardiovascular events. Objectives: 1. To assess the long-term effects of advice and salt substitution, aimed at reducing dietary salt, on mortality and cardiovascular morbidity.2. To investigate whether a reduction in blood pressure is an explanatory factor in the effect of such dietary interventions on mortality and cardiovascular outcomes. Search methods: We updated the searches of CENTRAL (2013, Issue 4), MEDLINE (OVID, 1946 to April week 3 2013), EMBASE (OVID, 1947 to 30 April 2013) and CINAHL (EBSCO, inception to 1 April 2013) and last ran these on 1 May 2013. We also checked the references of included studies and reviews. We applied no language restrictions. Selection criteria: Trials fulfilled the following criteria: (1) randomised, with follow-up of at least six months, (2) the intervention was reduced dietary salt (through advice to reduce salt intake or low-sodium salt substitution), (3) participants were adults and (4) mortality or cardiovascular morbidity data were available. Two review authors independently assessed whether studies met these criteria. Data collection and analysis: A single author extracted data and assessed study validity, and a second author checked this. We contacted trial authors where possible to obtain missing information. We extracted events and calculated risk ratios (RRs) and 95% confidence intervals (CIs). Main results: Eight studies met the inclusion criteria: three in normotensives (n = 3518) and five in hypertensives or mixed populations of normo- and hypertensives (n = 3766). End of trial follow-up ranged from six to 36 months and the longest observational follow-up (after trial end) was 12.7 years.The risk ratios (RR) for all-cause mortality in normotensives were imprecise and showed no evidence of reduction (end of trial RR 0.67, 95% confidence interval (CI) 0.40 to 1.12, 60 deaths; longest follow-up RR 0.90, 95% CI 0.58 to 1.40, 79 deaths n=3518) or in hypertensives (end of trial RR 1.00, 95% CI 0.86 to 1.15, 565 deaths; longest follow-up RR 0.99, 95% CI 0.87 to 1.14, 674 deaths n=3085). There was weak evidence of benefit for cardiovascular mortality (hypertensives: end of trial RR 0.67, 95% CI 0.45 to 1.01, 106 events n=2656) and for cardiovascular events (hypertensives: end of trial RR 0.76, 95% CI 0.57 to 1.01, 194 events, four studies, n = 3397; normotensives: at longest follow-up RR 0.71, 95% CI 0.42 to 1.20, 200 events; hypertensives: RR 0.77, 95% CI 0.57 to 1.02, 192 events; pooled analysis of six trials RR 0.77, 95% CI 0.63 to 0.95, n = 5912). These findings were driven by one trial among retirement home residents that reduced salt intake in the kitchens of the homes, thereby not requiring individual behaviour change.Advice to reduce salt showed small reductions in systolic blood pressure (mean difference (MD) -1.15 mmHg, 95% CI -2.32 to 0.02 n=2079) and diastolic blood pressure (MD -0.80 mmHg, 95% CI -1.37 to -0.23 n=2079) in normotensives and greater reductions in systolic blood pressure in hypertensives (MD -4.14 mmHg, 95% CI -5.84 to -2.43 n=675), but no difference in diastolic blood pressure (MD -3.74 mmHg, 95% CI -8.41 to 0.93 n=675).Overall many of the trials failed to report sufficient detail to assess their potential risk of bias. Health-related quality of life was assessed in one trial in normotensives, which reported significant improvements in well-being but no data were presented. Authors' conclusions: Despite collating more event data than previous systematic reviews of randomised controlled trials, there is insufficient power to confirm clinically important effects of dietary advice and salt substitution on cardiovascular mortality in normotensive or hypertensive populations. Our estimates of the clinical benefits from advice to reduce dietary salt are imprecise, but are larger than would be predicted from the small blood pressure reductions achieved. Further well-powered studies would be needed to obtain more precise estimates. Our findings do not support individual dietary advice as a means of restricting salt intake. It is possible that alternative strategies that do not require individual behaviour change may be effective and merit further trials”.
[B] Dificílimo encontrar artigos de Brewer, inclusive menções na wikipedia, e claramente há forças com interesses fortes de que as descobertas daquele autor saiam de cena ao máximo. Eventualmente se ouve falar na propaganda de uma dieta que leva seu nome [Brewer] mas se trata de uma dieta inadequada, de conjunto, inspirada nele, que leva seu nome, muito divulgada por sua ex-mulher Gail, mas seguramente o Dr Brewer entendia muito mais de gestação-proteìna-sal do que de uma alimentação integralmente pró-metabólica.
[C] PUOTINEN C J, 2004. Preventing eclampsia (metabolic toxemia of late pregnancy): an interview with Tom Brewer, MD. Townsend Letter for Doctors and Patients, no. 256, Nov. 2004, pp. 69+. Gale Academic OneFile, link.gale.com/apps/doc/A123709104/AONE?u=anon~f38f023&sid=googleScholar&xid=ce768298. Accessed 28 Dec. 2023.
[D] A seguir, bibliografia, ainda que bem parcial, sobre o tema citada pelo próprio Dr Brewer]
MITCHELL J et. al.1949. Dietary habits of a group of severe preeclamptics in Alabama. J. Natl. Med. Assn, 41:122, 1949. Toxemia was found to be closely associated with inadequate nutrition. When placed on a sound diet providing, on the average, 124 grams of protein per day, all of the toxemic women improved.
CAMERON, C S GRAHAM S, 1944. Antenatal diet and its influence on stillbirths and prematurity. Glasgow Med. J. 24:1, 1944. In both prospective and retrospective studies, maternal malnutrition was found to cause low birth weights, stillbirth and infant mortality.
HAMLIN R, 1952. The prevention of eclampsia and preeclampsia. Lancet 1:64, 1952. Eradicated eclampsia by an aggressive nutrition education program in a prenatal clinic, Women’s Hospital, Sydney, Australia.
TOMPKINS W WIEHL D, 1954. Nutrition and nutritional deficiencies as related to the premature. Pediatric Clin. No. Am. 1:687, 1954. Weight at birth was highly associated with prenatal nutrition, weight gain during pregnancy, and pre-pregnancy weight. The low-birth-weight incidence among women who received protein and vitamin supplementation, gained substantial weight during pregnancy, and were not underweight at conception was less than 2 percent. In contrast, 24% of the babies born to women most likely to be malnourished were underweight at birth.
BREWER TH 1962. Limitations of diuretics therapy in the management of severe toxemia: The significance of hypoalbuminemia. Am. J. Obstet. Gynecol. 83:1352, 1962. First published account of the threat diuretics pose to the health of mothers and their unborn by attacking maternal and fetal plasma volumes. This warning went unheeded, as the use of sodium diuretics became a routine practice in prenatal care among most obstetricians in the US.
PIKE R L GURSKEY D S, 1970. Further evidence of deleterious effects produced by sodium restriction during pregnancy. Am. J. Clin. Nutr. 23:883, 1970. The consequences of sodium deficiency, such as hypovolemia and stress on the renin-angiotensin-aldosterone homeostasis, are well documented.
BREWER, T H, 1970. Human pregnancy nutrition: An examination of traditional assumptions. Aus. N.Z. J. Obstet. Gynaecol. 10:87, 1970. Exposes the incorrect ideology and dangers of the routine obstetrical practices of weight control, salt restriction and the use of sodium diuretics.
DUFFUS G M et. al 1971. The relationship between baby weight and changes in maternal weight, total body water, plasma volumes, electrolyte and proteins and urinary oestriol excretion. J. Obstet. Gynaecol. Br. Cwlth. 78:97, 1971. Total circulating protein mass correlated most significantly with infant birth weight.
PLATT B S STEWART R J C, 1971. Reversible and irreversible effects of protein-calorie deficiency on the central nervous system of animals and man. World Rev. Nutr. Diet. 13:43, 1971. Neurological dysfunction is extensively linked to malnutrition in both animal and human studies in this review of 177 works.
SCHEWITZ L, 1971. Hypertension and renal disease in pregnancy. Med. Clin. No. Am. 55:47, 1971. This erudite review of 100 studies demonstrated the absence of scientific validity driving a low-salt diet and/or sodium diuretics to edematous or hypertensive expectant mothers. Severely hypertensive pregnant women received 14 grams of salt daily without demonstrable harmful effects or increased blood pressures.
KELMAN, L et. al, 1972. Effects of dietary protein restriction on albumin synthesis, albumin catabolism, and the plasma aminogram. Am. J. Clin. Nutr. 25:1174, 1972. A valuable study done on men in South Africa which demonstrates the critical role of dietary protein intake in maintaining hepatic synthesis of serum albumin. Such studies, in which daily protein intakes were reduced to 10 grams, cannot be done ethically on human pregnancies, yet they demonstrate the pernicious effects of both low-protein and low-calorie diets.
LOWE C U, 1972. Research in infant nutrition: The untapped well. Am. J. Clin. Nutr. 25:245, 1972. Emphasizes that the abandonment of weight control, low-salt diets, and diuretics is necessary to significantly reduce the rates of prematurity and low birth weight.
PIKE Ruth L, 1972. A reappraisal of sodium restriction during pregnancy. Intl. J. Gynaecol. Obstet. 10:1, 1972. Demonstrates that salt is an essential, protective nutrient for human pregnancy and not a “poison,” as is still thought by many OB/GYN physicians in the US.
BURKE, Bertha S et. al, 1943. Nutrition studies during pregnancy. Am. J. Obstet. Gynecol. 46:83, 1943. Confirmed nutritional thesis of the etiology of eclampsia and demonstrated the protective effect of adequate nutrition on the mother, fetus/neonate and infant.
FOOTE R G et. al, 1973. The use of liberal salt diet in pre-eclamptic toxemia and essential hypertension with pregnancy. New Zealand Med. J. 77:242, 1973. More clinical observations which destroyed the “salt is a killer” myth in human pregnancy.
BREWER T H 1974. Iatrogenic starvation in human pregnancy. Medikon 4:14, 1974. A call for major changes in current US. OB/GYN nutrition and drug practices and antenatal care. Advocates that constructive actions be taken immediately to improve human maternal/fetal and neonatal health in the U.S. and to protect all pregnant women and their unborn from the ravages of prenatal malnutrition and harmful drugs.
BREWER T H 1974. Metabolic toxemia of late pregnancy in a county prenatal nutrition education project: A preliminary report. J. Reprod. Med. 13:175, 1974. Data from National Institutes of Health retrospective study of 5,615 pregnancies delivered in Contra Costa County, CA, 1965-70, a 5-1/2 year period. No cases of eclampsia were found, nor were there any maternal deaths in the nutrition project pregnancies. Not one woman had a cesarean for “severe pre-eclampsia” or “hypertension.”
BREWER T H 1974. Pancreatitis in pregnancy. J. Reprod. Med. 12:204, 1974. Another painful, often fatal complication of pregnancy linked to the use of sodium diuretics and low-sodium, low-calorie diets.
BTEWER T H, 1974. Toxemia- a disease of prejudice? World Med. J. 21:70, 1974. Includes a review of Pathology of Toxemia of Pregnancy by H. L. Sheehan and J. B. Lynch (Edinburgh and London: Churchill Livingston, 1973). A great deal of emphasis is placed on the specific liver pathology associated with eclampsia.
HABICHT J P et. al 1974. Relation of maternal supplementary eating during pregnancy to birth weight and other sociobiological factors, in Nutrition and Fetal Development. M. Winick, ed. New York: John Wiley & Sons, 1974. Caloric supplementation among low-income women resulted in eradication of stillbirth and a reduction of the incidence of low birth weight from 13.4% to 3.5 percent. Demonstrates the protein-sparing effects of calories from carbohydrates and fat among women on low-protein diet.
SHNEOUR E 1974. The Malnourished Mind. New York: Doubleday, 1974. Discusses, in a conversational manner, the unequivocal causal relationship between impaired development and malnutrition during pregnancy, infancy and childhood. Refutes the myth that mental deficiency is largely caused by genetic factors.
PEGGY H, 1974. Albumin concentrate can be used for preeclampsia. OB/GYN News, October 1, 1974. All of the toxemic women given 50 grams of serum albumin daily gave birth to babies in good health. Infusion of serum albumin improved renal function, increased estriol excretion, prevented eclamptic convulsions, and resulted in a reduction in perinatal mortality to 1/4 the rate of the “controls” and eradication of abruptio placentae.
BREWER T H, 1975. Consequences of malnutrition in human pregnancy. CIBA Review: Perinatal Medicine, pp. 5-6. Basel, Switzerland: CIBA-Geigy, Ltd. 1975. Discusses the role of malnutrition, including iatrogenic malnutrition, via physician-prescribed low-calorie, low-sodium diets and sodium diuretics in the etiology of metabolic toxemia of late pregnancy, abruptio placentae, low birth weight, prematurity, severe infections and brain damage in children. Another call for applied science in this field on the clinical level in human prenatal care.
LECHTIG A et. al, 1975. Effect of moderate maternal malnutrition on the placenta. Am. J. Obstet. Gynecol. 123:191, 1975. Placental weight, associated with birth weight, increased with caloric supplementation, providing more evidence of the protein-sparing effect of calories.
HIGGINGS A C, 1976. Nutritional status and the outcome of pregnancy. J. Can. Diet. Assn. 37:17, 1976. Documents the value of nutrition education and food supplementation in the increasing birth weight, lowering infant mortality, and eradicating eclampsia.
BREWER T H 1977. Etiology of eclampsia. Am. J. Obstet. Gynecol. 127:448, 1977. Refutes the age-old myth that eclampsia is a disease limited to the first pregnancy and another myth that it is caused by an occult “uteroplacental ischemia.” The well nourished primigravida, protected from hypovolemia (the real cause of “uteroplacental ischemia”) all through gestation, never develops eclampsia.
BREWER T H HODIN J, 1977. Why Women Must Meet the Nutritional Stress of Pregnancy in 21st Century Obstetrics Now! Stewart and Stewart, ed. Marble Hill, Mo.: NAPSAC Press, 1977. Cites 143 references linking maternal malnutrition to a continuum of perinatal complications.
WILLIAMS, S R, 1977. Nutrition during Pregnancy and Lactation in Nutrition and Diet Therapy, 3d ed. St. Louis: C. V. Mosby Co., 1977. An excellent text book providing a wealth of information about basic nutrition science and its application on the clinical level. The first nutrition textbook to break with the traditional “nothing is known” position regarding the role of prenatal malnutrition in causing human reproductive metabolic toxemia of late pregnancy.
MATTHEWS D D et. al, 1978. Modern trends in the management of non-albuminuric hypertension in late pregnancy Br. Med. J. 2:623, 1978. Challenges the traditional therapies of hypertension in pregnancy: bedrest, sedation, low-sodium diets and sodium diuretics and pre-term induction. These are shown to be of no value of harmful. The authors still exhibit no conception of the role of malnutrition in causing hypovolemia.
BREWER, T H 1978. The ‘No-Risk’ Pregnancy Diet in The Pregnancy after 30 Workbook. Gail Sforza Brewer, ed. Emmaus, Pa.: Rodale Press, 1978. Provides the expectant mother with the guidance she needs to maintain good health and give birth to a healthy, fully developed child. Valuable for women of any age.
BREWER Gail Sforza, 1979. What Every Pregnant Woman Should Know: the Truth about Diets and Drugs in Pregnancy. New York: Penguin, 1979. Available from www.pregnancybooksonline.com. The physiological adjustment of pregnancy and how to meet its nutritional stresses to help the expectant mother maintain proper nutritional status and problems caused by conventional care. Spanish translation: Lo Que Toda Mujer Embarazada Debe Saber: La Verdad Acerca de las Dietas y las Medicinas Durante el Embarazo. Mexico, D. F.: Editorial Diana, S.A., 1980.
SHANKLIN D HODIN J, 1979. Maternal Nutrition and Child Health Springfield, IL: C. C. Thomas, 1979. Extensive review of prospective and retrospective scientific studies, physiological and neurological evidence, and epidemiological reviews linking prenatal malnutrition to a wide spectrum of perinatal complications.
LINDBERB B S, 1979. Salt, Diuretics, and Pregnancy. Gynecol. Obstet. Invest. 10:145, 1979. Examine’s Swedish policy of treating over 10,000 pregnancies per year with diuretic drugs without any scientific basis.
LAURENCE K M et. al 1980. Increased risk of recurrent of pregnancies complicated by fetal neural tube defects in mothers receiving poor diets, and possible benefit of dietary counseling. Br. Med. J. 281:1592, 1980. Prospective and retrospective studies indicated that the second most common birth defect in the US is preventable by sound nutrition. The incidence of neural tube defects was 18% in a control group of poorly nourished mothers.
GORMICAN A et. al, 1980. Relationships of maternal weight gain, prepregnancy weight and infant birth weight. J. Amer. Diet. Assn. 77:662, 1980. A retrospective controlled study documented that weight control and salt restrictions significantly reduced birth weight and resulted in other deleterious consequences.
BREWER Gail and Greene, J 1981. Right from the Start Emmaus, Pa.: Rodale Press, 1981. Incorporates the nutritional perspective on all aspects of fetal development, labor and delivery, breastfeeding, and first month after birth for mother and baby.
KENEFICK M, 1981. Positively Pregnant. Los Angeles. Pinnacle Books, 1981. Outlines the specific role of nutrition in contributing to maternal health and fetal development, maintains an emphatic position against the use of physician-imposed restrictive diets and drugs, and discusses effective, common sense approaches in treating pregnancy-related complications.
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Você provavelmente não conhece DHEG e seus riscos gravíssimos para o binômio Materno Fetal...
Sal em excesso é prejudicial em toda e, qualquer gestação. Bem como para todo e , qualquer ser humano
Reduzir sal para controle da HAS não é uma estratégia da INDÚSTRIA FARMACÊUTICA como você sempre justifica...aliás para ela...quanto mais sal melhor!