It is vital that your friend NOT cut out salt! In fact, salt restriction
will probably make her blood pressure increase, not decrease. This is an
alarming prescription for disaster: please read on.
Your friend's doctor has prescribed the most common medical treatment for
high blood pressure in pregnancy, also known as "pregnancy induced
hypertension," or PIH. It can be an early symptom of toxemia, but in the
well-nourished woman, it seldom is.
Your friend needs to be sure that her diet is indeed adequate for
pregnancy. If not, she may be on the road to the very problems her doctor
suspects. See Dr. Tom Brewer's "Blue Ribbon Baby Pages" at
HREF="http://www.kalico.net/blueribbonbaby/">
http://www.kalico.net/blueribbonbaby/ for the proper prenatal diet to
prevent toxemia.
As for hypertension and salt restriction, here's the scoop:
[The following is adapted from What Every Pregnant Woman Should Know
by Gail Sforza Brewer and Thomas Brewer, M.D., Chapter 4.]
Salt is a vital nutrient. No woman, expectant or otherwise, can live
without it. Neither can the unborn baby, who receives sodium from his
mother's blood stream, through the placenta. Sodium requirements vary
widely depending on activity level, environmental conditions, personal
health, and many more factors. Pregnancy is one condition where the body
actually requires MORE salt in order to remain healthy.
Each person has many finely tuned mechanisms that work in the body to
preserve the appropriate concentration of sodium in the tissues and in the
bloodstream. In normal pregnancy, the mother's blood volume must expand by
more than 40% to meet the metabolic demands of the placenta. Salt is a
chief element in maintaining this dramatically expanded blood volume. Salt
causes the body to retain fluid, which, under normal conditions, is
retained in the bloodstream for use in placental perfusion.
Salt restriction during pregnancy limits the normal expansion of the blood
volume, with disastrous consequences. Depending on the degree of sodium
restriction and the subsequent blood volume limitation the placenta may:
* grow slowly, or not at all,
* develop areas of dead tissue (infarcts) that cannot function,
* be unable to accomplish the transfer of nutrients to the baby,
* even begin to separate from the wall of the uterus, causing hemorrhage
and cutting off the baby's oxygen supply.
Under these conditions, the baby's growth, development and even life are
imperiled.
Cutting out salt frequently leads to an inadequate diet in other areas as
well. Foods such as eggs, milk, cheese and salty meat products are often on
the list of restricted foods for a low-salt diet. These foods are sources
of essential high-quality protein, necessary for baby's growth, and for
prevention of toxemia. It may also mean reduced food intake overall, as
food is no longer quite as palatable without salt. Inadequate calorie
consumption leads to the body using protein for fuel...protein needed for
the baby's growth and development.
Some women live and/or work in conditions that cause their bodies to lose
more sodium than is healthful (hot climate, "sweaty" work, aerobic
exercise, etc.), and thus boost the body's sodium need. If the mother does
not take in more, her depletion will activate temporary sodium-conserving
mechanisms in the kidneys and adrenal glands. If salt deprivation
continues, these organs can become exhausted, and show signs of
degenerative disease.
The best way for any pregnant woman to be assured of meeting her body's
(and her baby's) need for sodium is to follow the wisdom of her body and
salt her food to taste throughout pregnancy. The body's simplest
salt-regulating mechanism, the taste buds, are the most reliable guides to
salt intake management.
The low-salt diet doesn't work because it overlooks the body's physiologic
self-conserving mechanism and brings about the very conditions it was
designed to prevent:
* High blood pressure--when salt is restricted below body requirements, the
kidney reacts by releasing a hormone, renin, into the bloodstream. Renin
influences other hormones which, in turn, cause the arterioles to
constrict. The effect is to raise the blood pressure since the same amount
of blood is being pumped with the same force through a smaller opening. The
obstetrician worries about high blood pressure since it often accompanies
one of the most dangerous pregnancy diseases, toxemia. By putting the
mother on a low-salt diet he can *cause* hypertension where there was none
before.
* Low protein intake--the low-salt provision sharply reduces the mother's
range of food choices, and makes the permitted foods less palatable. Her
appetite wanes, so she will probably eat less than she should. She will
then be even more severely malnourished than a first look at the low-salt
diet indicates. As her intake of protein falls, her liver becomes less able
to manufacture circulating serum proteins, such as albumin, and albumin
levels start to fall. As a result, water is lost from her bloodstream in
the the area surrounding the cells (interstitial space) and it appears that
other substances in the blood, such as iron, are present in adequate levels
(true anemia resulting from the diet is masked). Fluid lost from the
bloodstream shows up as generalized swelling of tissues (edema). Edema
caused by this fall in albumin levels is abnormal, a sign of the disease of
metabolic toxemia.
* "Excess" weight gain--the edema will increase as long as the woman's body
is malnourished. Her kidneys excrete less water in the urine as they
scramble to keep salt and water in the body within normal limits; the
reabsorbed water cannot be held in the bloodstream since albumin levels are
too low, so it leaks out into the tissues. Result: added swelling and added
pounds. [end excerpt]
It is not unusual for obstetricians to make a reflex diagnosis of toxemia
whenever one or more of the "classic" symptoms are present: swelling of the
hands and face, excess weight gain, protein in the urine or elevated blood
pressure. Your friend is fortunate to have been only diagnosed as
"borderline hypertensive," but her treatment may still CAUSE her to develop
toxemia, because she is being treated for a problem she may not actually
have. Her blood pressure should be rechecked several times before making a
diagnosis, and her diet must not be ignored. Her BP may be high because
she's not eating well--not having enough salt, fluids or protein to expand
her blood volume as needed for pregnancy. Again, see the Blue Ribbon Baby
web site for more on this.
[Quoting again from Brewer, p. 82]
Elevated blood pressure (hypertension) may result from many different
causes. "Anxiety" hypertension is engendered by emotional stress of any
sort. Many women become anxious during physical examinations or during
laboratory testing. Women whose blood pressure has been normal throughout
pregnancy may develop hypertension at the time of admission to the hospital
for labor and birth. These mothers do not have MTLP; the liver is
functioning normally and the blood volume is expanded.
"Essential," chronic, or benign hypertension is most common in women over
thirty years of age. However, many black teenagers have already developed
the condition and will continue to have it the rest of their lives. These
mothers require exactly the same diet as mothers with normal blood
pressures--including the use of salt to taste--since their blood volumes
must expand, too, as pregnancy advances.
Sodium deficiency can trigger hypertension, as mentioned previously.
Obese women are often incorrectly diagnosed as hypertensive when a
standard-size blood pressure cuff is used to take a reading. When the cuff
is too small, additional pressure on the mother's arm reads on the meter as
elevated blood pressure. Using a larger cuff prevents this error.
Pheochromocytoma, an exceedingly rare tumor of the adrenal gland, also
causes hypertension.
Kidney diseases also result in high blood pressure. [end quote]
There is so much more I could share with you. Please check out Dr. Brewer's
web site,
http://www.kalico.net/blueribbonbaby/ for more information. Also, I
have been working with Gail (Brewer) Krebs (excerpted above) on publishing
both of her books on prenatal nutrition online. She is working on updated
versions of them, but it is taking longer than expected. Visitors to the
web site can click a button to be notified when the books are available. I
hope it will be soon!
To reach Dr. Brewer personally:
tombrewer@mailbug.com
phone number (hotline number): (802) 388-0276
He LOVES to hear from expectant moms and from midwives and other
professionals. He needs to know that his work is influencing lives, because
the medical profession has completely ignored, even disdained, him!
(Note: I'm not getting personal benefit from promoting Dr. Brewer's web
site. It's truly a labor of love because I believe in his work, and have
seen too many benefits from it to let it be ignored. If you have
suggestions for the site, please let me know. I will be putting the above
information on the site, so you may refer other clients to it as well.)
-Marci O'Daffer, CCE
Reply to: marci@i4f.net
Reprinted from Midwifery Today E-News (Vol 2 Issue 16 April 21, 2000)
To subscribe to the E-News write: enews@midwiferytoday.com
For all other matters contact Midwifery Today:
PO Box 2672-940, Eugene OR 97402
541-344-7438, midwifery@aol.com, Midwifery Today
|
|