What is Preeclampsia?
Preeclampsia is a prenatal and postpartum condition that is hallmarked by gestational hypertension and the presence of protein in the urine. It occurs in approximately 5-8% of pregnant women, and can be life threatening. Woman who have had preeclampsia with a previous pregnancy are at a higher risk of developing it again.
Symptoms can include:
It is a very serious condition, but there are ways to lessen the incident. There is research that supports nutritional deficiencies to play a role in the onset of the disease.
Like I mentioned, there have been several studies linking different nutritional deficiencies with an increased risk of developing gestational hypertension and preeclampsia. In this article I will address the individual nutrients linked in these studies, as well as nutritional principles to get you started.
Nutrients associated with the increase risk of preeclampsia and hypertension
Vitamin A: There are really two dietary forms of Vitamin A. Carotenoids found in plants and Retinol found in animal products. Both forms are fat soluble, meaning they need to be bound to a fat to absorb. Carotenoids, which include Beta Carotene, are strong antioxidants, is converted to retinol in small amounts. Retinol is essential for proper fetal development, and is also important in the functions of many other essential nutrients during pregnancy; Zinc, B Vitamins, and Vitamin D. Without Retinol, these other nutrients cannot function properly. For example: Vitamin A is necessary to unlock the Vitamin D receptor sites. Vitamin D, you will read about below.
Vitamin B1 Thiamine: It was theorized decades ago that preeclampsia was a B complex deficiency. The B Vitamins work together and if one is deficiency, than most likely others are as well. B1 Thiamine is necessary for proper heart function, and has been found to be deficient in preeclampsia women. Your body needs B1 Thiamine to form ATP, the energy molecule of all cells. It is also necessary for the metabolism of carbohydrates...one reason why preeclamptic women gain weight quickly is due to a poor metabolism of carbohydrates.
Vitamin B2 Riboflavin: B2 Riboflavin is a coenzyme, meaning it is catalyst for chemical reactions in the body. Specifically many of those necessary to grow your baby's brain, nerves, and muscles. Like B1 Thiamine, deficiencies in B2 Riboflavin have been associated with preeclampsia. Symptoms of B2 deficiency can mimic other nutrient deficiencies, and so it can be hard to diagnose - anemia, dry/cracked lips/nose/mouth, magenta red tongue, skin rash. B2 Riboflavin is necessary for iron metabolism, and without enough you can become iron deficient. B2 Riboflavin supplementation has been used, successfully, to prevent and lessen preeclamptic symptoms.
Vitamin B5 Pantothenic Acid: B5 Pantothenic Acid is essential in the formation of red blood cells, sex hormones, and the regulation of stress hormones. It is also necessary for the absorption of B2 Riboflavin, so if you are deficient in B5 Pantothenic Acid, you will become deficient in B2 Riboflavin.
Vitamin B6 Pyridoxine: B6 is a cofactor for enzymatic reactions that effect the metabolism of proteins, fats, glycogen and Nucleic Acid (DNA/RNA), as well as in the integrity of blood vessel walls. B6, B12, and B9 (folate) are necessary for blood health and formation, and deficiencies in any can attribute to anemia. Not only do they make up red blood cells, but they work on the fluidity of the blood. Thinning the blood and increasing circulation without increasing the risk of bleeding, making blood easier to pump and reducing elevated blood pressure
Vitamin B9 Folate: Folic Acid and Folate are different (Don't get me started on the detriment of synthetic vitamins.) Folic Acid is a synthetic form of naturally occurring Folate. It is difficult to utilize in the body and can overwork the liver enzymes. Like I mentioned above, Folate plays a role in blood formation. High sugar and glucose diets deplete Folate and diminish carbohydrate metabolism, leading to a strain on the pancreas, insulin, and increases body weight gain. Folate has been pushed quite a bit as a pregnancy vitamin, for good reason, just make sure you are getting the real vitamin. Folate is used in methylation, and supplementing with Folate and increasing dietary Folate have been shown to decrease preeclampsia in patients.
Vitamin B12 Cobalamin: B12 is kind of like the glue that hold iron onto red blood cells. Without enough B12 we can get anemia. There is a link with high blood levels of folate and B12 and an increased risk of autism…I personally believe that it is linked the MTHFR gene mutation, and these woman’s inability to process B9 and B12, vs. consuming too much, since B12 is required for the proper development of the Myelin Sheath that covers all nerves (and hence why I dislike synthetic Folic Acid supplementation, which cannot be properly used in the body). Another indication of preeclampsia is elevated homocysteine levels. B12 and Folate work together to remove excess homocysteine, as long as the MTHFR gene mutation is not present. Those with a history of preeclampsia should be tested for the MTHFR gene mutation. Special supplements should then be given if positive.
Vitamin C & E: Vitamin C is a water soluble vitamin that helps the body absorb Iron, among it's other functions. Vitamin E is a fat soluble vitamin, and must be combined with a fat to be absorbed. There is controversial research on Vitamin E and preeclampsia. Some studies suggest an increased risk of preeclampsia with Vitamin E supplementation because blood levels of Vitamin E and C are higher in those with preeclampsia. Defendants say that the reason levels are so high is that the body is reacting to the inflammation in the blood vessels by increasing Vitamin E and C levels to counteract the oxidation. Both Vitamin C and E work together in the amniotic fluid to reduce inflammation, infection and prevent premature labor. Vitamin C is in the makeup of the amniotic sac and deficiencies can lead to premature rupture of membranes. Vitamin E also regulates the production of progesterone by the uterus and placenta to sustain pregnancy. Making sure that your dietary intake is adequate is essential to a healthy pregnancy, although it does not reduce or treat existing preeclampsia and hypertensive symptoms.
Vitamin D: Vitamin D is a hormone. It is formed from cholesterol in the diet which interacts with the UVB rays to create Vitamin D. It is a fat soluble vitamin in the diet, and there MUST be a fat present for absorption. We do know that Vitamin D plays a significant role in the regulation of the hormones of our body. The role of Vitamin D in hypertension is still not fully understood, but we know there is a connection between low Vitamin D preeclampsia. There is an interesting correlation between winter pregnancies (lack of sunlight) and preeclampsia rates. Vitamin D is necessary in the formation of several enzymes produced by the placenta, which are missing in preeclampsia. Vitamin D is necessary for Calcium and Phosphorus to form developing bone and teeth buds.
Vitamin K: Vitamin D and K work together, and in combination with Calcium, Magnesium and Potassium. Vitamin K2 is a fat soluble vitamin that is produced through bacterial fermentation (either in the form of cultured food products, or by our digestive bacteria in our guts), or in cultured dairy products and bone marrow (bone broth). Its role in the body is only just starting to be understood, but its main known function is that of blood clotting (actually done by K1, not K2). K2 on the other hand works throughout the body. K2 and D3 work together to regulate Calcium deposits and transportation…some studies suggest that taking a Calcium and D supplement without a Vitamin K and Magnesium is actually a CAUSE of calcification in arteries. Vitamin K deficiencies were also associated with an increased risk of preeclampsia. Vitamin K deficiency is so common and big in pregnancy that newborns are given the vitamin K shot to prevent hemorrhaging from lack of vitamin K1. We are also seeing an increase in postpartum hemorrhaging in vaginal birthing mothers, which could have a connection with low Vitamin K levels.
Calcium: Calcium interplays with a number of different nutrients (Vitamin D/K/Magnesium). During pregnancy Calcium is very important in the growth of your baby’s bones, teeth buds, and more. Calcium is another nutrient deficiency associated with an increased risk of gestational hypertension. Calcium regulates the hormones that function on the arteries (tightening and relaxing), and thus regulates blood pressure. In order to work properly, there must be enough Magnesium.
Magnesium: Magnesium is addressed quite a bit in pregnancy. Not only is it necessary for many of the other nutrients, like Calcium, Sodium and Potassium, to function properly, it is also necessary for the hormone receptors to accept certain hormones. Without proper levels of Magnesium, sodium and calcium build up in the blood causing increased blood pressure, and increasing the risk of preeclampsia. Magnesium is a natural muscle relaxant, and deficiency can cause tightening of the blood vessels. Magnesium deficiency is also associated with increased anxiety and stress management symptoms. The majority of women I come across are magnesium deficient. In hospital care, Magnesium Sulfate is used to prevent seizures in preeclamptic woman, and reduce hypertension.
Potassium: The balance between potassium and sodium is crucial to regulating blood pressure. Magnesium is the balancing mechanism that makes sure there is the right ratio of sodium and potassium inside and outside of the cells. Too much sodium in the blood = hypertension. Potassium supplements have been used to treat hypertension for years…often with mixed results because potassium needs magnesium to work properly. Potassium is an electrolyte and you are going through a lot of these during pregnancy in the making and filtering of amniotic fluids, as well as the doubling of your blood volume.
Zinc: Zinc is an important mineral for hormone development and immune support. It is one of the most essential mineral for pregnancy. Deficiencies are associated with an increased risk of miscarriage, birth defects, and stillbirths. Too much copper or iron can deplete zinc (there is a tricky balance), it is also necessary for proper B6 absorption. Zinc is the catalyst for the millions of enzymatic reactions that are occurring as your baby develops. It is also necessary in protein synthesis (protein is what your oxytocin is going to be made from). Zinc plays a role in the formation of red blood cells, and deficiency can lead to anemia.
CoEnzyme Q10: Another Fat Soluble nutrient, CoQ10 is often not mentioned when talking about prenatal nutrition, and is most likely not in your prenatal. Nevertheless, it is found in high amounts in the Heart, Nerves, Liver and Kidneys, and has been shown in some studies to reduce the risk of preeclampsia in high risk women. It does have an effect on blood clotting and is essential for blood clotting at delivery.
How To Prevent Preeclampsia With Diet
Bear in mind that the development of the blood vessels between the placenta and the uterus begin early on in gestation. In prevention, it is important to begin proper nutrition prior to conception. This doesn't mean that it cannot develop later, or that severity in symptoms cannot be prevented during gestation. The placenta is growing for several months, as your baby develops, and at any point proper nutrition can be used to grow these blood vessels properly, create healthy blood flow, and relax tense blood vessels all to lower hypertension.
There are some foods that are better than other for providing the nutrition needed in the prevention of preeclampsia. As you noticed when reading the above section, there are some food group that are listed as food sources in most all of the nutrients. My top foods for preventing hypertension and preeclampsia would be:
To help you put it all together, I have a couple of tips for you.
What is Hypertension (High Blood Pressure)
Hypertension (aka High Blood Pressure) is described as an increased force of blood against the blood vessel walls. The harder the force, the harder the heart has to work to push the blood through the vessels, the higher the blood pressure.
As many as 70% of adults and over 2 millions teens have hypertension. According to the CDC 50% of those with hypertension do not have it controlled.
Normal Blood Pressure is under 120/80
Prehypertension is between 120/80 and 139/89
Hypertension is above 140/90
The top number is called the systolic measurement, and the bottom number is called the diastolic measurement. The systolic number represents the pressure in the arteries when the heart beats. The diastolic number represents the pressure in the arteries between heart beats. Blood pressure can be effected by stress and activity, so one high reading is not a diagnosis of hypertension. If you have consistently high readings of above 140/90 then hypertension is diagnosed and treatment regimes are prescribed.
What Causes Hypertension
There are two diagnostic forms of hypertension; Essential and Secondary. Essential hypertension is hypertension with an unknown cause, 95% of all cases. Secondary hypertension is hypertension that has an underlying cause.
Though most causes of hypertension are unknown, there are several factors that increase the risk of developing hypertension.
There are also some genetic factors that predispose certain people to developing hypertension. Men age 45 or women age 65, African American heritage, and or having a family member with hypertension can increase your risk of developing hypertension.
Diagnosis Hypertension in TCM
Hypertension is not a Traditional Chinese Medicine diagnosis, nor was the condition mentioned as such in the classical texts. The symptoms of Hypertension, though usually silent; severe headache, fatigue, confusion, vision changes, palpitations, chest pain; all point to several different diagnosis in TCM theory.
To create a treatment plan with TCM, we must first differential the pattern. This pattern is different for different people. The symptoms experienced by an individual varies, and may change based on other imbalances present within the body. By taking the individual and differentiating their unique pattern, we have the best chance of treating, reversing, and managing their presentation.
In TCM we describe hypertension as "Dizziness and Headache, due to Internal Injury." From here, we further differential the symptoms. You may hear your acupuncturist mention terms like;
To aid in diagnosis, the acupuncturist will consult tongue and pulse readings. The condition of the tongue and pulse can give us a glimpse of internal imbalances, as well as the severity of the condition.
Treating Hypertension with TCM
Acupuncture Treatment for Lowering Blood Pressure
Using Exercise to Manage High Blood Pressure
Each of these patterns listed above, constitutes a different treatment protocol, a different combination of acupuncture points. During treatments, blood pressure readings will be taken before and after. Treatments are typically done twice weekly for 4 weeks, once weekly for 4 weeks, and slowly spaced out to twice monthly, once monthly and so on, until we can set up the optimal period between treatments for management.
Many of the points needles will be located on the hands, feet and ears. Often we will send a patient home with ear seeds or tacks taped to the ears. These auricular acupuncture points help to extend the treatment once the patient has left the office.
We almost always see an immediate drop in blood pressure after the first treatment. Often by as much as 10 points! Patients will be asked to take daily blood pressure readings outside of the office and to bring those readings with them to their appointments for analysis.
Always check with your doctor and start SLOW! If you push yourself too hard, you may actually increase your blood pressure. By including easy activity into your daily routine, you can strengthen your heart and blood vessel. Your heart is a muscle, just like those in your legs and arms, and just like all other muscles it needs to be exercised to maintain its health. If you have been extra sedentary, set a reasonable goal. Take short walks everyday, take the stairs up to your office, part at the furthest parking spot at the store, start a garden, take yoga or pilates, go swimming, take baby steps and slowly build up what you are able to do.
If you are dealing with stress induced hypertension, these activities will also help to calm your mind, and increase the production of neurotransmitters that can make dealing with stress more manageable.
Using Diet to Manage High Blood Pressure
Considering that most cases of hypertension are directly affected by what a client is or is not consuming in their diet, this is of upmost importance in treatment. We will look very closely at the diet, often asking patients to keep a food journal. As mentioned above, being overweight or obese, struggling with diabetes, and consuming excess sodium and alcohol can contribute to uncontrollable hypertension. By simply working to control diet, we can have a significant effect on hypertension symptoms.
Nutritional Supplements for High Blood Pressure
In our treatments plans, after taking a good hard look at the diet, we may find some nutritional gaps that need to be filled while we make nutritional changes. Often times supplements are added.
Herbal Formulas for High Blood Pressure
Occasionally, but not always, we will add in Chinese Herbal Formulas to help us in treating hypertension. This will vary between individuals, dependent on the underlying diagnosis, current medications, allergies, sensitivities, and progression of treatment. Most of our formulas are made to order specifically for an individual clients needs.
When taking an herbal formula, you should not stop taking your prescription medication to control high blood pressure. Any changes in prescription medication should be done by your primary care provider.
Resources and References