Preeclampsia – the uterine reinnervation view

A full account of this new view of preeclampsia is published on the front page of and also in Medical Hypotheses.  It will take two further studies to be persuasive.

This view simply says that injured uterine vasomotor nerves release cytokines that result in (i) regeneration of abnormal nerves (ii) hyperplasia of now-denervated, blood vessel walls, and, (iii) expression of purinergic  stretch receptors in the vessel walls.  Increased blood flow through uteorplacental blood vessels (up to 34 weeks, early-onset preeclampsia) “stretches” these receptors leading to changes in renal cortical good flow, hypertension and proteinuria. Stretching the uterus as a whole (beyond 34 weeks, “late-onset preeclampsia) leads to similar changes.

Uterorenal nerves were first demonstrated in the 1950’s by John Sophian and Keith Franklin in Oxford.

See full argument here.

Preeclampsia – the uterine reinnervation view, AJOG 2014

Preeclampsia is high blood pressure (hypertension) and protein in the urine (proteinuria) occurring after 20 weeks gestation. It kills many women and babies. It gets better (quickly) when you deliver the baby. We have not understood the process despite investigating it for 400 years or so ! It occurs with some pregnancy-associated conditions e.g. twins, excess fluid, hydatidiform mole, type 1 diabetes mellitus, preexisting high blood pressure – but not others. It is called the “disease of theories” (Zweifel, 1903) – and the “uterine reinnervation” view is yet another theory – however it accounts for most of the clinical associations of the condition, and importantly, it explains why the condition improves with delivery of the baby and placenta.

In the “uterine reinnervation” view published in AJOG this month, injuries to uterine nerves (straining during defaecation, surgery, difficult first labour) cause “new” nerves to regenerate that have “new” properties. These new, abnormal nerves respond to “stretch”, send nerve signals to the kidney that result in hypertension and proteinuria. Increasing, maternal blood volume before 34 weeks gestation results in increased blood flow through some injured blood vessels whereas after 34 weeks it is more likely to result from excessive stretch to the uterus e.g. twins, excessive fluid, etc. Delivering the baby and placenta removes the “stretch” and the hypertension and proteinuria resolve quickly.

Simple really – but it has to be proved – and that is not so easy !

Autonomic denervation and Western diseases, Am J Med 2014

A brief commentary in the American Journal of Medicine sets out the etiological basis of many Western diseases. Injuries to autonomic nerves include straining during defaecation, surgery, difficult first labours and miscellaneous traumatic injuries. Consequences of injuries to autonomic nerves are diverse and varied; they include changes in form, changes in function, susceptibility to infection, susceptibility to alcohol, tobacco, drugs, and, pain ! Then you layer on the consequences of obesity to add many different hernia, varicose veins, type 2 diabetes and the rest of the metabolic syndromes, and, you result in a wide-ranging series of conditions that we call “Western diseases”.

Medicine labels them as appendicitis, Crohn’s disease, diverticulosis, type 1 diabetes, asthma, “autoimmune” diseases, inguinal hernia, hiatus hernia, endometriosis, preeclampsia, preterm labour, etc. – but all appear to be different manifestations of the same processes. Diagnosis is elevated to a specialist art-form, though may be achieved by some simple questions. And, aside from replacement therapy for non-functioning organs e.g. insulin for T1DM, thyroxine for hypothyroidism, etc., there is very little useful treatment. However, prevention is relatively straightforward; eat a “healthy” diet (fruit/vegetable/some meat in limited quantity), cultivate a “normal” bowel habit (once a day, increased stool weight, no straining), avoid surgery where possible, avoid prolonged and difficult first labours, etc.

A new squat toilet – 2013

Peter Codling has designed a new squat toilet that is suitable for contemporary use.

In this innovative piece of porcelain, the bowl enables the user to get their knees above their hips in a comfortable sitting position. Leaning forward will improve the angle. Evacution can then take place WITHOUT physical straining efforts. Autonomic nerves remain intact. Physical health is maintained.

Is the flush sufficient to remove the waste ? Africans have a mean daily stool weight of over 450 g whereas Europeans are in the range of 100-120g. So it should be sufficient for those eating European diets.

This design deserves widespread adoption as an important contribution to public health.

NGF and Autoimmune diseases

Typically autoimmune diseases are common in women over 50 years of age, and, some are x10 more common in women than in men. they include diseases like systmic lupus erythematosus (SLE), rheumatoid arthritis (RA), myasthenia gravis (MG), hypothyroidism, thyrotoxicosis, Sjogren’s syndrome etc. They are alleged to result from the effects of “autoantibodies” though there has been very little progress in our understanding over recent decades. Much research has focussed on the origins and effects of autoantibodies though it is possible that these are secondary to a primary injury to the nerve supply to these endocrine (hormone) glands.

Nerve growth factor (NGF) is a cytokine released by injured nerves. It is found in increased levels in “autoimmune” diseases (Levi-Montalcini, 2002). The question arises as to “where does it come from ?”. We know that one source of NGF is injuries to nerves associated with persistent straining during defaecation. Recurrent, varying and inco-ordinate straining may cause injuries at different sites in the body. Other sources include childbirth, surgery and direct trauma; these are less likely in postmenopausal women.

Are “autoimmune” diseases misnamed ?

Integrative medicine conference – New York 2012

Dr Dean Ornish gave a keynote lecture at this meeting. He explained the relationship between diet and lifestyle, and, coronary artery disease, prostate cancer and type 2 diabetes mellitus. Specifically, he demonstrated that changes in diet and lifestyle not only prevent these Western diseases but reverse established disease.

What was particularly interesting was that his prostate cancer study showed 500 genes being turned on and off as a direct result of changes in diet and lifestyle. It begs the question as to whether all the billions spent on genome sequencing simply reflect variations in lifestyle ?

The bugs will win !

An urgent call to action from Dan Rather at Huff Post Health owing to the “rise and rise” of antibiotic-resistant antibiotics this week (16th Jan 2011).
In the autonomic denervation view, insufficie­nt attention is being paid to “host factors” i.e. self-infli­cted injuries by ourselves against ourselves