Tag: lactation

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Iodine recommendations for pregnancy and lactation may be too low for mom and baby.

Iodine during the prenatal period is necessary for the mother and infant’s health. Prenatal and lactation needs for iodine are increased and current recommendations and screening may not be sufficient to provide both the baby and mom what they need for optimal health.

Many women may not get the iodine that they need for their own body and the growing fetus or may become depleted during lactation. (1) Each additional pregnancy can leave the woman even lower in iodine. Woman with many pregnancies may have more of a risk for having a child with congenital hypothyroidism at birth. Low iodine prenatally may also add to risk for autism or schizophrenia later in the child’s life. 

Current recommendations for iodine by international agencies may be too low for pregnancy, lactation and for newborns. (1) A review team has recommendations for an increase in iodine supplementation – 250-300 micrograms of iodine daily for pregnancy and lactation and 90 micrograms for newborns. The team also recommends increasing the screening range for urinary iodine considered optimal to 150-230 micrograms of iodine. (1) Less iodine is excreted in the urine when the body is depleted.

A study based in Hong Kong also suggests that urinary iodine levels may not be an accurate test for assessing adequacy of iodine intake by lactating women as an indicator suggesting their breast milk would supply recommended iodine levels for their infants. (3)

“The most recent guidelines issued by the American Thyroid Association (73) suggested that all pregnant women should ingest ~250 μg iodine daily, and women who are planning pregnancy or are currently pregnant, should add to their diet a daily oral supplement that contains 150 μg of iodine.” May 21, 2020 (7)

*This was an unfinished older post, so I wanted to check if the recommendations have been updated.

Pregnancy and the neonatal period are higher risk stages for iodine deficiency t occur because the thyroid stimulating hormone (TSH) and thyroxine levels are modulated more than in other stages of the lifespan. TSH tends to be elevated more than normal and thyroxine decreased. Checking newborns for elevated TSH would be a biomarker for iodine deficiency. (1) When adequate iodine is provided promptly, the mental retardation associated with congenital hypothyroidism may be preventable. Treating with Synthroid alone would not help enough. All the glands of the body need iodine, not just the thyroid gland. If it is low, it means everything else in the body is even more depleted as the thyroid gets preferential use.

Re pregnant women and neonates: “…their serum thyroid-stimulating hormone (TSH) and thyroxine are increased and decreased, respectively, for degrees of ID that do not seem to affect thyroid function in the general population. Systematic neonatal thyroid screening using primary TSH could be the most sensitive indicator to monitor the process of ID control.” (1) *ID = iodine deficiency.

Conclusions from a study based in Thailand included the finding that heel prick blood at three days old was not as accurate as a sample from the umbilical cord sera for screening TSH levels in the newborn. (4)

Women become more depleted in iodine with each pregnancy and lactation stage of their lives. Infants seem to also get preferential use of iodine from the mother’s body stores. A study based in China found lower iodine levels in urban and rural prenatal and lactating women compared to the iodine levels of infants and school aged children living in the regions. The presence of goiter was low in all women (2.0%) but was more common in prenatal women (2.7%) than in lactating women or for all women combined. (2) Mammary glands also can use more iodine from maternal stores for breast milk production due to an increased activity of the iodine symporter/mineral channel. Low intake of iodine will lead to lower levels of iodine in the breast milk. (5)

“In areas of iodine sufficiency breast milk iodine concentration should be in the range of 100-150 microg/dl. Studies from France, Germany, Belgium, Sweden, Spain, Italy, Denmark, Thailand and Zaire have shown breast milk concentrations of < 100 microg/l. Adequate levels of iodine in breast milk have been reported from Iran, China, USA and some parts of Europe.” (5)

This information about maternal and neonatal preferential uptake of iodine suggests that iodine is VERY IMPORTANT for infant development. ←Noteworthy.

Being iodine deficient can equate to a drop in Intelligence Quotient (IQ) of up to 15 points. Supplementation can improve cognitive ability if started early for neonates or if the low iodine didn’t begin in infancy. (6)

“The intelligence damage of children exposed to severe ID [iodine deficiency] was profound, demonstrated by 12.45 IQ points loss and they recovered 8.7 IQ points with iodine supplementation or IS [iodine sufficiency] before and during pregnancy. Iodine supplementation before and during pregnancy to women living in severe ID areas could prevent their children from intelligence deficit. This effect becomes evident in children born 3.5 years after the iodine supplementation program was introduced.” (6)

Infants who are born low in iodine tend to grow very slowly, in proportion, but tiny. Shorter, narrower, lighter, less muscle mass, than if they had been sufficient in iodine. The appearance has been described as elfin and can be very cute as a child, however what might their full potential have been if mom had had enough iodine? More to point – why are low iodine thyroid conditions only treated with Synthroid and rarely with extra iodine? That is standard for anyone with hypotthyroidism – totally ignore the need for iodine by every other gland in the body.

Buyer be very wary of “health care professionals” – they may just be following standard protocols and seeking more information may be life improving.

Food sources of iodine: Eating adequate seaweed and seafood is the traditional source of iodine in many areas of the world. Seaweed species vary in iodine content, and it can vary within species. Supplements of seaweed for iodine use should be tested batch by batch for iodine content of the seaweed if the company is reputable. Other crops grown near the ocean tend to have higher levels of iodine than crops grown inland, which makes coconut a fairly good iodine source.

Some plants uptake iodine preferentially such as rhubarb, making it a vegetable high in iodine. It also has other medicinal benefits. This person really loved Siberian rhubarb for perimenopause, so I will let her tell you about it: (indigonaturals.net) There may be a product for sale, I am not affiliated. It is a thorough article on the intricacies of estrogen receptors.

green-leafed plant
Young rhubarb stalks. The leaves and stalks can get quite large. Generally the leaves are not eaten, only the colorful stalks. Rhubarb is a tangy celergy like vegetable that can be used in place of celery in soup or is typically sweetened and thickened in the US to serve as a tangy “fruit” pie, possibly prepared with strawberries too. Photo by kaori nohara on Unsplash

The recommendations for iodine intake across the lifespan, may also be too low for everyone, when the competition of halides in the water and food supply is considered. Iodine can be replaced by bromide or fluoride or chloride in thyroid hormone, but the resulting hormone is then dysfunctional. Lab tests would show “normal” levels. Symptoms of hypothyroidism may be present while lab tests show the presence of a normal amount of T3 and T4 that may not have three atoms of iodine or four atoms of iodine. Instead, it might have some atoms of fluoride, bromide or chloride if the body was low in iodine and had plenty of the other halides present.

More information about iodine and selenium food sources, and the issue of halides in hypothyroidism is on page G9. Iodine & Thyroid. (effectivecare.info)

Selenium is also needed for the enzyme that breaks down excess thyroid hormone. Two Brazil nuts per day provides the typical goal used in alternative treatment – 200 micrograms of selenium per day. Selenium is not readily available in many foods and checking your one-a-day or Trace Mineral supplement mix for it would be a good idea as Brazil nuts can be expensive or hard to find.

**Addition, off-topic from iodine – I went back to the perimenopause article, (indigonaturals.net), and have found a biological difference between males and females – females may have – drumroll – more bliss – more of the THC equivalent endocannabinoid: anandamide.

“Despite these differences, FAAH inhibitors retain anxiolytic- and antidepressant-like effects in ovariectomized female rats [112]. Interestingly, however, anxiolytic- and antidepressant-like effects produced by estradiol administration are attenuated by CB1R blockade [112], whereas estradiol administration increases AEA levels [113] or AEA signaling [114], possibly via downregulation of FAAH* driven by an estrogen response element on the FAAH gene that suppresses FAAH transcription when bound by estrogen.”

https://pdfs.semanticscholar.org/a188/3e071695213724c1f9df258910481d6c2ae7.pdf

Goodness, let’s decipher that.

Basically, estradiol exerts its antidepressant and anti-anxiety effects by boosting anandamide. [*FAAH is an enzyme that breaks down cannabinoids.] In fact, they were able to block estradiol’s effect on depression and anxiety by blocking CB (endocannabinoid) receptors!

This means, the key to estradiol’s control of mood is…the endocannabinoid system and anandamide in particular!

By the way, this was a sex dependent effect…only women used this pathway in other experiments: Remarkably, this effect of E2 [estradiol] is sex specific, occurring in females but not in males.  

https://www.sciencedirect.com/science/article/pii/S0896627312003753

Can we all agree that irritability is the opposite of bliss? (indigonaturals.net)

Yes, I can agree that irritability is the opposite of bliss – PMS history and genetic inability to make anandamide has left me familiar with irritability, also those around me – sorry. I would try to go to my office during PMS week and warn staff that I was having a cranky day – paperwork catch up day.

*In the modern era of trans gender hormone use, it is also interesting because the DNA male body might not be as blissful/peaceful even with estradiol use as someone with a DNA female body because the estrogen receptors would likely still respond as a male. If you paint a barn red, it doesn’t become a fire engine. Self-acceptance is a goal of maturing – we all have flaws and aging adds changes to those old familiar flaws.

Chocolate and Pregnancy – moderation/common sense – it is a nutrient rich food, hold the sugar and bad fats.

Chocolate is the richest commonly used food with some cannabinoid content – but not much for the calorie ratio. Bliss but not in a dose large enough for someone with a gene difference in ability to make endocannabinoids.

Cannabinoids are needed in pregnancy and lactation and chocolate is not that high in caffeine or theobromine that chocolate needs to be avoided (a frequent recommendation for pregnancy that I don’t agree with). Moderation on the calories, use of dark cocoa powder in a low sugar product would provide a variety of phytonutrients with anti-inflammatory benefits.

Disclaimer: Opinions are my own and the information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes.

Reference List

  1. Delange F., Iodine requirements during pregnancy, lactation and the neonatal period and indicators of optimal iodine nutrition. Public Health Nutr. 2007 Dec;10(12A):1571-80; discussion 1581-3. doi: 10.1017/S1368980007360941. http://www.ncbi.nlm.nih.gov/pubmed/18053281
  2. Yan YQ, et al., Attention to the hiding iodine deficiency in pregnant and lactating women and lactating women after universal salt iodization: A multi-community study in China. J Endocrinol Invest. 2005 Jun;28(6):547-53. http://www.ncbi.nlm.nih.gov/pubmed/16117197
  3. Kung AW., Iodine nutrition of pregnant and lactating women in Hong Kong, where intake is of borderline sufficiency. Public Health Nutr. 2007 Dec;10(12A):1600-1. doi: 10.1017/S1368980007360989. http://www.ncbi.nlm.nih.gov/pubmed/18053285
  4. Rajatanavin R., Iodine deficiency in pregnant women and neonates in Thailand., Public Health Nutr. 2007 Dec;10(12A):1602-5. doi: 10.1017/S1368980007360990. http://www.ncbi.nlm.nih.gov/pubmed/18053286
  5. Azizi F1, Smyth P., Breastfeeding and maternal and infant iodine nutrition. Clin Endocrinol (Oxf). 2009 May;70(5):803-9. doi: 10.1111/j.1365-2265.2008.03442.x. Epub 2008 Oct 6. http://www.ncbi.nlm.nih.gov/pubmed/19178515
  6. The effects of iodine on intelligence in children: a meta-analysis of studies conducted in China. Asia Pac J Clin Nutr. 2005;14(1):32-42.   http://www.ncbi.nlm.nih.gov/pubmed/15734706
  7. Toloza FJK, Motahari H, Maraka S, Consequences of Severe Iodine Deficiency in Pregnancy: Evidence in Humans, MINI REVIEW article, Front. Endocrinol., 19 June 2020, Sec. Thyroid Endocrinology, https://doi.org/10.3389/fendo.2020.00409, https://www.frontiersin.org/articles/10.3389/fendo.2020.00409/full
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Links on heart disease, calcium and iodine

Whether nutrient deficiencies or other metabolic imbalance is the cause is not clear or it may be a response to oxidative stress, however levels of the trace nutrients magnesium, selenium, zinc, and vitamin D3 were found to be low and the level of calcium elevated in myocardium, a type of muscle tissue in the heart. (1)

The short story – adequate nutrition is needed to support pregnancy and lactation (breast feeding) – longer duration breast feeding (6-12 months or more) is associated with less heart disease (2) and breast cancer (3) risk. Increased amounts of iodine is needed for pregnancy and lactation (4) and low iodine and low selenium may be involved in breast cancer risk. (5)

A high protein diet, especially one high in dairy products is associated with more heart disease risk. (6) Background information – a high protein diet creates more work for the kidneys in order to excrete the extra nitrogen from protein that was converted into energy (ketones) (7) (29) instead of being used to build muscle or other proteins.

Magnesium may help protect against calcification in heart disease in two important ways. It is needed for the kidneys to be able to excrete excess calcium. It also acts as a calcium channel blocker by providing electrical power from inside of cells or organ tissue in order to help keep excess calcium from entering the soft tissue and blood vessels through the membrane calcium channels. Medications used for hypertension include several calcium channel blockers.

Potassium is also important to protect against calcification of blood vessels by preventing increased calcium entry into the cell. The mineral is also important for preventing high blood pressure/hypertension – in addition to excess sodium/salt, too little potassium can be a problem. See excerpt with the link. (29)

Five to nine servings of vegetables or fruits per day is the recommendation for a healthy balanced diet (five) or potentially cancer preventing diet (nine). They are a good source of potassium and magnesium in addition to other trace nutrients.

Cholesterol plaque formation (atherosclerotic plaques) along vessel membrane walls may be simply acting as a coating to prevent the electrically active calcium ions from entering cells or doing other damage by plastering it in place, like plaster or spackle on dry wall. Calcium and magnesium levels in normal health are very carefully controlled by the kidneys. Lack of potassium and excess sodium may also affect the kidneys ability to excrete excess calcium.

The current understanding of atherosclerosis does not describe the role of magnesium in this way – current description: (8) and (9).

The role of potassium, magnesium and calcium in hypertension is available here: (10) and (29).

Magnesium has been found to help reduce vascular calcification (atherosclerotic plaques in blood vessels) in animal based research, (11) {and I believe in a few human research studies too but I have to find the links again. See Table 7 for a list of symptoms common to magnesium deficiency, hypertension and myocardial infarction are included: (14)} Magnesium may also help reduce prostate cancer risk or progression, (15), and low magnesium levels may be an underlying factor in the formation of cancer tumors, (18); and depression (16) can be a symptom of magnesium deficiency (14) and frequently co-occurs with other diagnoses. (17)

The short story – excess calcium may increase heart disease risk while adequate iodine, selenium, magnesium, potassium and vitamin D are all important for a healthy pregnancy, ability to lactate for a longer duration and reduce the risk of heart disease and breast cancer.

Addition, miscarriage history and history of having more than four pregnancies/four children has been associated with increased risk of heart disease for the mothers. (12) Increased losses of iodine and magnesium stores from the bones may be an underlying factor.  Premature infants born to multiparous women (women who had previous pregnancies) are more likely to have low Thyroid Stimulating Factor – which is associated with hypothyroidism which can simply be due to low iodine levels during the pregnancy. (13)

The long story is in the links below;

except for references about magnesium, potassium and vitamin D for pregnancy and breast feeding but they are also important for pregnancy and lactation. The baby may not thrive or may be fussier if the breast milk is low in essential nutrients or it may be difficult to maintain an adequate supply if the woman is malnourished.

Disclaimer: Opinions are my own and the information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes. Thanks.

  1. Karl T. Weber, William B. Weglicki, Robert U. Simpson, Macro- and micronutrient dyshomeostasis in the adverse structural remodelling of myocardium, Cardiovasc Res. 2009 Feb 15; 81(3): 500–508. https://www.ncbi.nlm.nih.gov/pubmed/18835843 (1)
  2. Katherine Lindemann, Mothers who breastfeed may be less likely to suffer from heart disease and stroke later in life, an interview with Sanne A. E. Peters, University of Oxford, Research Fellow in Epidemiology, June 21, 2017, researchgate.net blog post,   https://www.researchgate.net/blog/post/breastfeeding-may-have-long-term-health-benefits-for-mothers-too  Benefits were seen/measured with six months increments in breastfeeding duration, with a large group of Chinese mothers, “Mothers who had breastfed their babies had a nine percent lower risk of heart disease and an eight percent lower risk of stroke.” (2)
  3. Loren Lipworth, L. Reness Bailey, Dimitrios Trichopoulos,

    History of Breast-Feeding in Relation to Breast Cancer Risk: a Review of the Epidemiologic Literature, JNCI: Journal of the National Cancer Institute, Volume 92, Issue 4, 16 February 2000, Pages 302–312, https://academic.oup.com/jnci/article/92/4/302/2624708 “Overall, the evidence with respect to “ever” breast-feeding remains inconclusive, with results indicating either no association or a rather weak protective effect against breast cancer. […] It appears that the protective effect, if any, of long-term breast-feeding is stronger among, or confined to, premenopausal women. It has been hypothesized that an apparently protective effect of breast-feeding may be due to elevated breast cancer risk among women who discontinue breast-feeding or who take medication to suppress lactation; however, the evidence is limited and should be interpreted with caution” (3)

  4. Angela M. Leung, MD, MSc, Elizabeth N. Pearce, MD, MSc,* and Lewis E. Braverman, MD, Iodine Nutrition in Pregnancy an Lactation, Endocrinol Metab Clin North Am. 2011 Dec; 40(4): 765–777. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3266621/  Iodine needs are increased during pregnancy and lactation and in iodine replete geographic areas breast milk levels seemed adequate for the infant’s needs. 250-290 micrograms is estimated to be needed compared to the RDA of 150 micrograms. That level did not seem adequate in geographically low area of New Zealand: ” In a recent study, the iodine needs for breastfed infants in iodine-deficient New Zealand remained inadequate even when their mothers were supplemented with 150 μg/d of iodine during the first 6 postpartum months.” (4)
  5. Peter PA Smyth, The Thyroid, Iodine and Breast Cancer, Breast Cancer Res. 2003; 5(5): 235–238.   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC314438/ Autoimmune thyroid disease and goiter is more common in patients with breast cancer. Iodine and selenium may be protective against both conditions, a review of literature rather than a study. (5)
  6. Heart Risk of High Protein Diets, June 4, 2018, The Hippocrtic Post,  https://www.hippocraticpost.com/ageing/heart-risk-of-high-protein-diets/?utm_source=website&utm_medium=webpush&utm_campaign=notifications The group of men with the highest intake of protein in percentage of total calories had increased risk of heart disease, except for protein from fish or eggs. “When they compared men who ate the most protein to those who ate the least, they found their risk of heart failure was:33 percent higher for all sources of protein;
    43 percent higher for animal protein;
    49 percent higher for dairy protein;
    17 percent higher for plant protein.” (6)
  7. Sherwin RS, Hendler RG, Felig P.,  Effect of Ketone Infusions on Amino Acid and Nitrogen Metabolism in Man. J Clin Invest. 1975 Jun;55(6):1382-90.
       https://www.ncbi.nlm.nih.gov/pubmed/1133179 (7)
  8. Isabella Albanese, Kashif Khan, Bianca Barratt, Hamood Al‐Kindi, Adel Schwertani, Atherosclerotic Calcification: Wnt is the Hint, Basic Science for Clinicians, February 8, 2018 Journal of the American Heart Association,  http://jaha.ahajournals.org/content/7/4/e007356 (8)
  9. The Cardiovascular System in Disease, Diseases of the Vessels, Chapter 6, Ch006-M3430.indd 4/19/2007, http://booksite.elsevier.com/samplechapters/9780723434306/9780723434306.pdf (9)
  10. Mark C. Houston MD, MS, Karen J. Harper MS, PharmD,  Potassium, Magnesium, and Calcium: Their Role in Both the Cause and Treatment of Hypertension, JCH, Vol 10, Issue 7, pp 3-11, July 2008,  https://onlinelibrary.wiley.com/doi/full/10.1111/j.1751-7176.2008.08575.x (10)
  11. Fatih Kircelli, Mirjam E. Peter, Ebru Sevinc Ok, Fatma Gul Celenk, Mumtaz Yilmaz, Sonja Steppan, Gulay Asci, Ercan Ok, Jutta Passlick-Deetjen, Magnesium reduces calcification in bovine vascular smooth muscle cells
    in a dose-dependent manner, Nephrol Dial Transplant (2012) 27: 514–521, https://watermark.silverchair.com/gfr321.pdf?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAAZ0wggGZBgkqhkiG9w0BBwagggGKMIIBhgIBADCCAX8GCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMbSRHWigPf17i-jCnAgEQgIIBUIkKsm3S-WvD5qd-tNiIBBwsoiqBg-FrbTXdm2oS2q2AdX0wuviR-rsM-hi6IMVKWwMEinUYTbh7DopBg7SWLxBIi4bHXaQft3IHdQqhDKr_RiB69uxkVRwW_2aHFGYjR0FzhUSfhDrmVLweVHZRTIYDVbrSkgaVgLnFq4YHvxohG08oMbAeF4C26XL026jpA7J1xbOodHz_o5MUvoQgVcxwhrIFuu7ysxD_B7bjJehfrw6SLjkrm3Q43jrsS3vS37v_hIig_lTQyFCPe5L6UhFwlQvH1mwPIKPNituSvoob5OxY5odMFjtcXNg0Wz2tqLajbKP_Cg4Rt1X0c67CLvTGMkos_d7QLKbxwiFibtfpcrPJlIfbPPEIjd4jKRI2MWFePBaQTQLnUOoC934JHOp4abLCC5jRaOAgHykzJhZPOpvgmvrgj-jJmZBtfdgW9g (11)
  12. Kashmira Gander, Having More Kids Linked to Heart Disease Risk in Mothers, According to New Study, June 4, 2018, newsweek.com, http://www.newsweek.com/kids-linked-heart-disease-risk-mothers-according-new-study-956066 (12)

  13. Kelli K Ryckman, M.S., PhD, Cassandra N Spracklen, M.S., John M Dagle, M.D., PhD., Jeffrey C Murray, M.D., Maternal Factors and Complications of Preterm Birth Associated with Neonatal Thyroid Stimulating Hormone, J Pediatr Endocrinol Metab. 2014 Sep; 27(0): 929–938. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4260397/ “Maternal and neonatal thyroid levels are tightly correlated and hypothyroidism …. Multiparous women had infants with lower TSH levels (P=8×10−4) compared to …” (13)

  14. R. Swaminathan, Magnesium Metabolism and Its Disorders, Clin Biochem Rev. 2003 May; 24(2): 47–66.   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1855626/ (14)

  15. Oseni, Saheed & Quiroz, Elsa & Kumi-Diaka, Jim. (2016). Chemopreventive Effects of Magnesium Chloride Supplementation on Hormone Independent Prostate Cancer Cells. Functional Foods in Health and Disease. 6. 1-15.  https://www.researchgate.net/publication/291164181_Chemopreventive_Effects_of_Magnesium_Chloride_Supplementation_on_Hormone_Independent_Prostate_Cancer_Cells (15)

  16. Eby GA, Eby KL, Rapid recovery from major depression using magnesium treatment., Med Hypotheses. 2006;67(2):362-70. Epub 2006 Mar 20. https://www.ncbi.nlm.nih.gov/pubmed/16542786 (16) 

  17. Hee-Ju Kang, Seon-Young Kim, Kyung-Yeol Bae, Sung-Wan Kim, Il-Seon Shin, Jin-Sang Yoon, and Jae-Min Kim, Comorbidity of Depression with Physical Disorders: Research ad Clinical Implications, Chonnam Med J. 2015 Apr; 51(1): 8–18. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4406996/ (17)
  18. : Castiglioni S, Maier JAM. Magnesium and cancer: a dangerous liason. Magnes Res 2011; 24(3): S92-S100 doi:10.1684/mrh.2011.0285   http://www.mgwater.com/Magnesium%20and%20Cancer.pdf (18)
  19.  Pharmacology of Cardiac Potassium Channels, Cardiovascular Research, Volume 62, Issue 1, 1 April 2004, Pages 9–33, Oxford Academic – see Table 4, https://academic.oup.com/cardiovascres/article/62/1/9/373105 (19)
  20. Lakshman Goonetilleke, John Quayle, TREK-1 K+ Channels in the Cardiovascular System: Their Significance and Potential as a Therapeutic Target, Cardiovascular Therapeutics 30 (2012) e23–e29  https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1755-5922.2010.00227.x (20)
  21. University of Pittsburgh: Cardiovascular system during the postpartum state in women with a history of preeclampsia, Chapter 2: Cardiovascular System,  pp 190-191, Advances in Physiology Research and Application: 2012 Edition, Scholarly Editions, Dec 26, 2012, ebook, https://books.google.com/books?id=3SyvNMZLBU0C&pg=PA190&lpg=PA190&dq=TREK+1+preeclampsia&source=bl&ots=2SzKQHcFJ0&sig=fGwDeK6cMIkUXhtwPDNKqio1zIQ&hl=en&sa=X&ved=0ahUKEwirhN_h6-XbAhUSbq0KHWDZCS0Q6AEIUjAF#v=onepage&q=TREK%201%20preeclampsia&f=false (21)
  22. Ma R, Seifi M, Papanikolaou M, Brown JF, Swinny JD, Lewis A.TREK-1 Channel Expression in Smooth Muscle as a Target for Regulating Murine Intestinal Contractility: Therapeutic Implications for Motility Disorders.  Front Physiol. 2018 Mar 6;9:157, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5845753/ (22)
  23. Antidepressant Drugs Suppress Activity of Potassium Channels, Lawrence Berkeley National Laboratory, Feb. 8, 2011, psypost.org,  https://www.psypost.org/2011/02/antidepressant-ssri-potassium-channel-4068 (23)
  24. Nicholas J. Talley, SSRIs in IBS: Sensing a dash of disappointment. Clinical Gastroenterology and Hepatology, May 2003, Volume 1, Issue 3, Pages 155–159.  https://www.cghjournal.org/article/S1542-3565(03)70030-5/fulltext (24)
  25. Tülay Özkan Seyhan, Olgaç Bezen, Mukadder Orhan Sungur, İbrahim Kalelioğlu, Meltem Karadeniz, and Kemalettin Koltka,

    Magnesium Therapy in Pre-eclampsia Prolongs Analgesia Following Spinal Anaesthesia with Fentanyl and Bupivacaine: An Observational Study., Balkan Med J. 2014 Jun; 31(2): 143–148.   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4115934/ Exerimental group needed less fluid replacement and waited longer before requesting additional pain killing medication than the women with normal (no preeclampsia) deliveries. (25)

  26. Ramanathan J, Vaddadi AK, Arheart KL. Combined spinal and epidural anesthesia with low doses of intrathecal bupivacaine in women with severe preeclampsia: a preliminary report. Reg Anesth Pain Med. 2001 Jan-Feb;26(1):46-51. https://www.ncbi.nlm.nih.gov/pubmed/11172511 (26)

  27. KCNK2 potassium two pore domain channel subfamily K member 2 [ Homo sapiens (human) ], Gene ID: 3776, updated on 23-May-2018,   https://www.ncbi.nlm.nih.gov/gene/3776 (27)

     

  28. Tayyba Y Ali, Fiona Broughton Pipkin, and Raheela N Khan, The Effect of pH and Ion Channel Modulators on Human Placental Arteries. PLoS One. 2014; 9(12): e114405. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4260857/  “In vessels isolated from placentae of women with pre-eclampsia (n = 6), pH responses were attenuated.” (28) *attenuated means a weakened response, less responsive to the stimulus.
  29. Qi Qian, Dietary Influence on Body Fluid Acid-Base and Volume Balance: The Deleterious “Norm” Furthers and Cloaks Subclinical Pathophysiology, Nutrients 2018, 10(6), 778; Open Access, http://www.mdpi.com/2072-6643/10/6/778/htm “Recently, Sun et al. [53] demonstrated a causal role for dietary K+ in the regulation of osteogenic differentiation and calcification of vascular smooth muscle cells, both in vitro and in atherosclerotic animal models. Specifically, lower levels of extracellular fluid K+ induce vascular smooth muscle cell osteogenic transformation by elevating intracellular calcium. The latter activates CREB (cyclic AMP response element-binding protein) leading to an enhanced expression of osteogenic markers, e.g., RUNX-2, and simultaneously reduced smooth muscle cell markers, e.g., α-actin. Remarkably, even a slight serum K+ reduction (mean K+ level, 3.70 ± 0.21 mEq/L) in mice can trigger significant vessel calcification associated with elevated pulse-wave velocity, a reliable indicator of aortic stiffness. On the contrary, when K+ levels are raised to ~4.73 mEq/L by dietary modification, signs of osteogenic differentiation were abrogated, and vascular calcification prevented. Consistent with the notion of K+ being protective to vasculature, a high ratio of urine Na+/K+ excretion (indicative of high Na and low K+ intake) has recently been linked to the genesis of HTN [54].?” (29)
  30.  Robert Vink, Mihai Nechifor, editors, Magnesium in the Central Nervous System, University of Adelaide Press, 2011, adelaide.edu.au, free ebook pdf, https://www.adelaide.edu.au/press/titles/magnesium/magnesium-ebook.pdf  See page 20 re TRPM7 channels and different effects of oxidative stress on calcium versus magnesium being allowed through the ion channel. Magnesium helps survival while calcium can increase risk to the cell.  other notes about the book:   https://twitter.com/deNutrients/status/1012685811001806849?s=19