The Brewer's Diet for pregnancy
An analysis of this high protein diet style
The Brewer’s Diet was developed by Dr Tom Brewer during the 1950’s and 1960’s. Dr Brewer theorised that the cause of pre-eclampsia and some other pregnancy and childbirth complications was an abnormal or inadequate blood volume, caused by malnutrition, or food deficiency. In 1983, he and his partner, Gail Sforza Brewer, wrote “The Brewer Medical Diet for Normal and High-Risk Pregnancy”.
The basics of the Brewer’s Diet involve a high amount of good quality proteins, a highly calorific diet (2600 calories a day), salt to taste and unrestricted weight gain during pregnancy. As outlined by Dr Brewer himself: “ well-nourished women develop far fewer complications in pregnancy, have more efficient labours, and give birth more easily to healthier babies than do their poorly nourished sisters. ”
Pre-eclampsia is a rather common condition during pregnancy in the majority of developed countries affecting 5 to 8% of all pregnancies. The causes of pre-eclampsia remain a mystery and the treatment and cure, arguably from a medical model point of view, involve bed rest, dietary restrictions, medication and often the pre-term delivery of the baby. According to the HSE: “The first signs of pre-eclampsia are high blood pressure (hypertension) and too much protein in your urine (pee).”
There is some evidence that the Brewer’s diet pregnancy nutrition type may help prevent some pregnancy conditions, such as, for example, pre-eclampsia. This progressive and potentially fatal condition remains a leading cause of miscarriage, premature birth, and infant mortality in the United States and around the world.
In her famous book “Ina May’s guide to Childbirth”, Ina May Gaskin indicates that the Brewer’s diet “convinced many midwives but few physicians or researchers”.
Let’s find out more about what the Brewer’s Diet is to begin with. Then, we will explore the main tenets of this diet type and find out what the outcomes of following the Brewer’s Diet can be. Finally, we will look at the evidence as well as the arguments for and against this diet type.
What is the Brewer’s Diet?
Dr Brewer believes the cause for pre-eclampsia is an abnormal blood volume, caused by malnutrition, or food deficiency. In his opinion, a high protein diet should be recommended in order to prevent some pregnancy conditions and complications, such a toxaemia, also known as pre-eclampsia. Dr Brewer recommends a daily intake of protein of 80g to 120g, as opposed to 71g daily recommended allowance during pregnancy, as established by the Institute of Medicine.
Protein is a building block to the human body and according to Dr Brewer’s research, a healthy pregnancy depends on the ability of the mother to increase her blood volume to cater for both her needs and the needs of the growing foetus.
This diet type also recommends eating on a regular basis throughout the day and also to have one night-time snack, thus never going more than 12 hours without food. With the Brewer’s Diet you should have a complete breakfast every morning and snack midmorning, mid-afternoon, before bed, and at least once during the night, in order to provide your growing baby with a steady flow of nutrition.
Dr Brewer also gives importance to salt intake into your diet during pregnancy, He recommends to season your food to taste and feels that salt intake may play a role in reducing certain pregnancy ailments, stating that “If your food tastes bland, or if you get leg cramps or feel tired and weak, just put a little more salt on your food.”
When following the Brewer Diet, you should pay close attention to the recommendations for salt, calories, and protein all together. If you solely focus on the protein intake for example, but lower your salt intake or try to lose or control your weight gain, then it is likely that you will not get the full benefits from the diet.
What are the main tenets of the Brewer’s Diet?
The Brewer’s diet contains very clear recommendations. Dr Brewer recommends 4 servings of milk /calcium and says that “A pregnant woman should drink one quart (four 8-ounce glasses) or more of milk every day. In addition, she should eat two eggs plus one or two servings of fish, chicken, lean beef, lamb or pork, or any kind of cheese.” This assures plentiful good quality protein intake and a steady supply to the rapidly growing foetus (Note: 1 serving of fish or meat = 65g to 100g depending on the type, so 2 servings a day = 130g to 200g).
As well as proteins, the pregnant woman should also “eat one or two daily servings of fresh, green, leafy vegetables” such as spinach, lettuce, broccoli, or cabbage (Note: 1 serving of green leafy vegetable = 75g).
“Five servings of whole-wheat bread, corn tortillas, or cereal”are also recommended and will provide extra proteins as well as a wide range of minerals and vitamins (Note: 1 serving = 16g of whole grain ingredients, so the recommended daily intake in this diet type is 80g of whole grain produce).
“The diet also includes five servings of yellow-or orange-coloured vegetables five times a week; liver once a week if you like it; a whole baked potato three times a week; all the water and fluids you need to prevent thirst; and all the salt you need to make your food taste good.” These, according to Dr Brewer are minimum amounts.
If following a vegetarian diet, it is possible to substitute meat for vegetable proteins “as long as they are “complete” proteins and you don’t have trouble digesting them” (Note: a “complete Protein” is a food source of protein that contains an adequate proportion of each of the nine essential amino acids necessary in the human diet.)
According to Dr Brewer, this diet will prevent toxaemia, as well as other conditions and developmental issues in the child. Dr Brewer tested this diet for over 30 years on thousands of patients and he believes that those who followed it “never had eclampsia, anaemia, abruption of the placenta, severe infections of the lungs, kidneys, or liver, low birth weight babies, premature birth, or miscarriage, and all of their children were healthy.”
Brewer’s Diet: Evidence and criticism
The word ‘diet’ itself is sometimes perceived as controversial. A ‘diet’ bears the connotations of losing weight and changing what you normally eat in order to change your weight or health outcomes. Diets are also associated with ‘fads’, plans we simply cannot follow for too long as they are restrictive or complicated. Over the past few decades, nutrition during pregnancy hasn’t necessarily been well researched and some doctors encourage minimal weight gain during pregnancy. The main critics for the Brewer’s diet have the following arguments:
- It is not evidence based. This means that there are no clinically controlled studies to prove the accuracy of the benefits. It appears that in order to compare 2 groups of pregnant women in a clinically controlled study, you would have to apply the Brewer’s diet with one group and compare how they are doing with another group who would be left to a poor diet and potentially more at risk to pre-eclampsia and other ill health conditions. This wouldn’t be very ethical and so, in the 1980’s Dr Brewer and his team, “did the logical thing and used the women’s previous diets and circumstances as the control (Brewer 1982). The results were amazing. Dr. Tom Brewer totally eradicated preeclampsia in specific populations where the former rates were upwards of 40 percent.” This is According to Amy V. Haas, a childbirth educator and writer, in an article for the ‘Midwifery Today’ Journal.
- The amount of protein recommended is too high and may result in kidney issues. Dr Brewer recommends an intake of 80 to 120g of protein a day during pregnancy. There seems to be quite a wide range of protein intake recommendation. The HSE recommends “0.83g/kg with an additional 1g, 9g and 28g/day in the first, second and third trimesters respectively.” This represents 57g of protein daily for a person who weighed 68kg pre-pregnancy during the first trimester and 84g of protein daily during the 3rd trimester. According to Lily Nichols, a well-known registered dietician and nutritionist, “you calculate protein requirements based on pre-pregnancy body weight. So for somebody who weighs 150 pounds (approximately 68kg) , pre-pregnancy, you’re looking at about 80 grams minimum of protein in the first half of pregnancy, and 100 grams of protein in the latter half of pregnancy.” The American Pregnancy Association recommends on their website 75 to 100g of protein daily. Studies have shown that under and over consumption of protein during pregnancy can have detrimental effects on the mother and foetus. All those studies agree that protein intake during pregnancy must be higher than outside of pregnancies and that the increase needs to be gradual throughout the pregnancy and not too much too soon. Within all the ranges of daily protein intake recommendations I came across researching for this blog, the Brewer’s diet recommendation is the highest.
- The ratio of whole grain to vegetables is not balanced. In terms of daily recommended intake for wholegrain foods, the Brewer’s diet is not very different from the ‘regular’ food pyramid. Brewer recommends 5 choices of wholegrain foods a day while the food pyramid as endorsed by the HSE recommends 3 to 5 portions of ‘wholemeal cereals and breads, potato, pasta or rice. The main difference resides in the fact that the traditional food pyramid recommends 5 to 7 servings of fruit ad vegetable each day, while Dr Brewer recommends 2 servings of dark green leafy vegetables as well as 2 servings of Vitamin C foods.
- This diet is too calorific and suggests the intake of unnecessary amounts of food. The Brewer’s diet recommends 2600 calories each day where more traditional sources suggest 1,800 daily calories during the first trimester of pregnancy, 2.200 calories during the second trimester and 2,400 calories during the 3rd trimester. Dr Brewer found that “when a woman eats 1/3 less calories than the 2600 calories that he suggests, or about 1700 calories, half of the protein that she eats will get burned for calories. In that case, only 60 of her 120 grams of protein would get used to make albumin (and baby cells, and uterine muscle cells), and she will probably have trouble expanding her blood volume adequately.”
From all the articles I read researching this blog, it is clear that there is a divide in opinion and faith on the Brewer’s diet between the holistic community and the medical professionals. It appears that within the medical world, pe-eclampsia and related conditions are unexplained, complicated issues that need a cure, treatment and complex medical protocols.
Therefore, medical based websites merely mention diet during pregnancy and instead explain in great detail how physicians and consultants can offer treatment during pregnancy for those suffering from pre-eclampsia. Many other perinatal health professionals on the other hand such as midwives and nutritionists see the value of the Brewer’ diet and do not hesitate in recommending it.
Over more than 30 years of study and observation, Dr Tom Brewer designed a complete diet plan which, he believes, would prevent conditions such a pre-eclampsia as well as developmental issues in the baby. There are nowadays many websites and nutritionists who recommend to follow this diet throughout pregnancy and it appears that there may be evidence that this diet style indeed prevents toxaemia and pre-term childbirth.
A good amount of quality protein, salt to taste and unrestricted weight gain are promoted by this diet. When looking at the recommendations made by Dr Brewer and daily meal plans following his recommendation, it appears to be a healthy and sustainable diet plan for pregnant women, and one to know for Birth and postpartum Doulas to inform clients about. However, like with all diet plans and other recommendations made during pregnancy, caution id to be advised and anyone intending on changing their diets during pregnancy should consult a medical professional and seek advice from knowledgeable sources.
References:
https://lawrencebriobirth.webs.com/BrewerPregnancyDietChecklist.pdf
http://drbrewerpregnancydiet.com/id96.html
https://karacarrero.com/brewer-diet-for-pregnancy/
http://healthybirth.net/an-interview-with-dr-tom-brewer/
https://www.hse.ie/eng/services/publications/clinical-strategy-and-programmes/diagnosis-and-management-of-pre-eclampsia-and-eclampsia.pdf
https://www.nhs.uk/conditions/pre-eclampsia/causes/
https://www.midwiferytoday.com/mt-articles/preventing-complications-nutrition/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5882021/
https://www.hse.ie/eng/about/who/acute-hospitals-division/woman-infants/clinical-guidelines/nutrition-during-pregnancy.pdf
