1. The Brewer Diet

2. Dr. Tom Brewer  Dr. Brewer spent more than 50 years researching and studying the relationships between an adequate maternal diet and improved pregnancy outcomes and was an outspoken advocate for the establishment of practice protocols for nutritional guidance, surveillance, and intervention as mandated, reportable components of routine prenatal care.

3. Dr. Brewer, continued  Published more than 40 journal articles  Books include "What Every Pregnant Woman Should Know; The Truth About Diets and Drugs in Pregnancy” and "The Brewer Medical Diet for Normal and High-Risk Pregnancy" among others  Dr. Brewer took the position that failure to maintain a diet adequate for pregnancy is a matter of clinical significance and a matter that should be addressed by the prenatal caregiver at every visit: In other words, inadequate prenatal nutrition has predictable obstetrical and neonatal consequences that matter for mother and baby.  Published more than 40 journal articles  Books include "What Every Pregnant Woman Should Know; The Truth About Diets and Drugs in Pregnancy” and "The Brewer Medical Diet for Normal and High-Risk Pregnancy" among others  Dr. Brewer took the position that failure to maintain a diet adequate for pregnancy is a matter of clinical significance and a matter that should be addressed by the prenatal caregiver at every visit: In other words, inadequate prenatal nutrition has predictable obstetrical and neonatal consequences that matter for mother and baby.

4. The Diet Every day: 80-100 grams of high quality protein from 6-8 choices/combinations Milk and milk products--4 choices Calcium replacements--as needed (2 per soy exchange from group 1) Eggs- 2 any style Fresh, dark green vegetables -2 Whole grains - 5 choices Vitamin C foods- 2 choices Fats and oils - 3 choices Vitamin A foods- 1 choice Liver once a week (optional) Salt to taste Unlimited water Every day: 80-100 grams of high quality protein from 6-8 choices/combinations Milk and milk products--4 choices Calcium replacements--as needed (2 per soy exchange from group 1) Eggs- 2 any style Fresh, dark green vegetables -2 Whole grains - 5 choices Vitamin C foods- 2 choices Fats and oils - 3 choices Vitamin A foods- 1 choice Liver once a week (optional) Salt to taste Unlimited water

5. The Diet, continued  2600 calories  Protein is just the sign of an adequate diet---not the ultimate goal.  A balance of carbohydrates, fats, protein, vitamins, minerals, and water is what makes the diet work.  Must be obtained from a variety of whole food sources.  14 food groups (if you count snacks and supplements), including 4 servings of milk products or milk substitutes, 2 servings of eggs, plus 6-8 1-oz servings of other proteins.  2600 calories  Protein is just the sign of an adequate diet---not the ultimate goal.  A balance of carbohydrates, fats, protein, vitamins, minerals, and water is what makes the diet work.  Must be obtained from a variety of whole food sources.  14 food groups (if you count snacks and supplements), including 4 servings of milk products or milk substitutes, 2 servings of eggs, plus 6-8 1-oz servings of other proteins.

6. The Pregnancy Nutrition Principles #1: Mother and baby are one unit. Whatever affects one affects the other; nourishing the mother is the only way to nourish the baby.

7. PNP continued #2 A little malnutrition is a dangerous thing.  Pregnancy imposes a nutritional stress on every mother.  This stress increases as pregnancy advances to term. #2 A little malnutrition is a dangerous thing.  Pregnancy imposes a nutritional stress on every mother.  This stress increases as pregnancy advances to term.

8. PNP continued #3 Many life situations can create nutritional problems.  Identify them and make the changes necessary to supplies the needed nutrients during your pregnancy. #3 Many life situations can create nutritional problems.  Identify them and make the changes necessary to supplies the needed nutrients during your pregnancy.

9. How the diet works  During pregnancy, blood volume increases 40- 60%.  Liver produces albumin to facilitate expansion of blood volume. Albumin in bloodstream creates osmotic pressure (pulling extra fluid out of her tissues back into the blood, circulating it in her blood vessels).  The only way for the liver to produce albumin is from the protein the mother eats.  During pregnancy, blood volume increases 40- 60%.  Liver produces albumin to facilitate expansion of blood volume. Albumin in bloodstream creates osmotic pressure (pulling extra fluid out of her tissues back into the blood, circulating it in her blood vessels).  The only way for the liver to produce albumin is from the protein the mother eats.

10. Osmotic Pressure  Albumin is normally too large to pass through the capillary walls, so it stays inside the capillaries.  The structure of albumin is such that it pulls fluid towards itself.  This effect of albumin is colloid osmotic pressure, which keeps too much fluid from leaving the capillaries.  Hydrostatic pressure is the pushing power of circulating blood; osmotic pressure is pulling power of fluid into a vessel. What results is fluid balance.  Albumin is normally too large to pass through the capillary walls, so it stays inside the capillaries.  The structure of albumin is such that it pulls fluid towards itself.  This effect of albumin is colloid osmotic pressure, which keeps too much fluid from leaving the capillaries.  Hydrostatic pressure is the pushing power of circulating blood; osmotic pressure is pulling power of fluid into a vessel. What results is fluid balance.

11. How the diet works, continued  Protein is just the beginning, though--if the mother is on a calorie restrictive diet (example: eating 1/3 less calories than recommended by Brewer) then 1/2 of the protein she eats will be burned for energy rather than used for blood volume expansion support.  Salt also supports osmotic pressure, which is why the diet recommends salt to taste (a pregnant woman cannot eat too much salt).  Protein is just the beginning, though--if the mother is on a calorie restrictive diet (example: eating 1/3 less calories than recommended by Brewer) then 1/2 of the protein she eats will be burned for energy rather than used for blood volume expansion support.  Salt also supports osmotic pressure, which is why the diet recommends salt to taste (a pregnant woman cannot eat too much salt).

12. Avoiding Diuretics and low- sodium diets  Dandelion and nettle (among others) are popular additives to pregnancy teas = diuretics  By increasing urinary output, blood volume can decrease. If the kidneys sense a decrease in blood volume, they secrete renin which constricts the capillaries (causing BP to rise). {The body has no way of knowing why blood volume is not at optimal levels, so it acts in the same way it would during a hemorrhage---constricting capillaries to conserve as much blood as possible.}  Kidneys also conserve fluid to try and raise blood volume, but w/o adequate salt, calories, and protein to maintain osmotic pressure to hold fluid in the bloodstream, it (fluid) will move out of the capillaries into the tissues (edema).  Dandelion and nettle (among others) are popular additives to pregnancy teas = diuretics  By increasing urinary output, blood volume can decrease. If the kidneys sense a decrease in blood volume, they secrete renin which constricts the capillaries (causing BP to rise). {The body has no way of knowing why blood volume is not at optimal levels, so it acts in the same way it would during a hemorrhage---constricting capillaries to conserve as much blood as possible.}  Kidneys also conserve fluid to try and raise blood volume, but w/o adequate salt, calories, and protein to maintain osmotic pressure to hold fluid in the bloodstream, it (fluid) will move out of the capillaries into the tissues (edema).

13. Controversies  ‘Pre-eclampsia is not proven to be diet- related, so therefore you cannot use diet to prevent PE.’  Response: There is no proof that diet is NOT a cause of PE.  ‘Pre-eclampsia is not proven to be diet- related, so therefore you cannot use diet to prevent PE.’  Response: There is no proof that diet is NOT a cause of PE.

14. Controversies, continued  ‘The Brewer diet is a high protein diet (similar to Atkins) that is not healthy; it is not recommended for normal people to eat that much protein.’  The Brewer diet is a high-quality diet, and a pregnant woman is not your “normal” person- --she is a normal condition with special dietary requirements.  ‘The Brewer diet is a high protein diet (similar to Atkins) that is not healthy; it is not recommended for normal people to eat that much protein.’  The Brewer diet is a high-quality diet, and a pregnant woman is not your “normal” person- --she is a normal condition with special dietary requirements.

15. Developing pre-eclampsia while eating the Brewer diet is likely the result of:  Incorrect eating (lack of education and support to eat as much as the diet recommends, eating a low-calorie diet, eating a low sodium diet, not eating enough protein.)  Emesis lasting longer than 3 months/hyperemesis.  Stress, over-exertion, or other disruption in eating patterns (moving, vacation, etc.)  Misdiagnosis of PE which lead to unhelpful dietary changes/restrictions  Being pregnant and overheated consistently  Using herbs w/diuretic properties, or experiencing GI issues or flu.  May have a pre-existing condition which contributes to PE.  Incorrect eating (lack of education and support to eat as much as the diet recommends, eating a low-calorie diet, eating a low sodium diet, not eating enough protein.)  Emesis lasting longer than 3 months/hyperemesis.  Stress, over-exertion, or other disruption in eating patterns (moving, vacation, etc.)  Misdiagnosis of PE which lead to unhelpful dietary changes/restrictions  Being pregnant and overheated consistently  Using herbs w/diuretic properties, or experiencing GI issues or flu.  May have a pre-existing condition which contributes to PE.

16. A Final Word  "Our culture has a long history of treating women as inferior, and that's especially true in medicine. Women who educate themselves, listen to their bodies, stay away from prescription drugs, and feed themselves the way healthy women have fed themselves for thousands of years, not the way Americans are feeding themselves today on low- fat, low-protein, high-carbohydrate, low-salt, low- calorie foods--those enlightened women are going to have healthy, full-term pregnancies with no complications." - Dr. Brewer

17. Resources  Books by Tom Brewer, Elizabeth Noble, Gail Sforza Krebs, Isaac Cronin, and Anne Frye  http://www.blueribbonbaby.org/  http://www.drbrewerpregnancydiet.com http://www.drbrewerpregnancydiet.com  Books by Tom Brewer, Elizabeth Noble, Gail Sforza Krebs, Isaac Cronin, and Anne Frye  http://www.blueribbonbaby.org/  http://www.drbrewerpregnancydiet.com http://www.drbrewerpregnancydiet.com