Reality Check: The Brewer Diet is Not Evidence-Based

Many Childbirth Education methods teach that following the Brewer Pregnancy Diet will reduce the expectant mother's risk of complications, including pre-eclampsia. I have promoted the Brewer Diet myself in the past. The truth is that the Brewer Diet does not have any good research out there backing it up. Dr. Brewer's statistics from his patients are very un-scientific. It is hypocritical for people to accuse obstetricians of not following evidence by requiring intravenous fluid and continuous fetal monitoring (procedures not proven to be beneficial), and at the same time encourage pregnant women to follow a specific nutritional plan that has no randomized controlled trials backing it up. "But isn't good nutrition always a good thing?" you ask. Well, yes, but there are some specific problems with the Brewer Diet itself (many of these I learned from reading a comment response by Navelgazing Midwife on her blog post, Hypocrite in the Middle).

Drawbacks of the Brewer Diet:

• The Brewer Diet can create stress in the pregnant woman by encouraging her to agonize over all of her food decisions. I would think that stress could have the opposite intended effect by actually causing high blood pressure.
• The Brewer Diet is a lot of food. It is not natural or healthy for women to eat more than they feel hungry for. There is some concern that the caloric requirements of the Brewer Diet may grow overly large babies in women who are adequately nourished.
• The high amounts of protein in the Brewer Diet may put stress on some women's kidneys, if their kidneys are over-taxed, and women usually do not know whether or not their kidneys are over-taxed.
• There are many, many women who have followed the Brewer Diet and still gotten pre-ecampsia.
• Claiming that the Brewer Diet prevents pre-eclampsia equates to patient-blaming and making women feel like their pre-e diagnosis is their fault.

Instead of promoting a specific one-size-fits-all diet, why don't we focus on a few sound nutritional principles?


Sound Nutritional Principles for Pregnancy:

• Try eating frequent small meals during pregnancy. This may help with nausea (no guarantees, though) and will accommodate for the decreasing size of your stomach as your baby grows. Listen to your body about how much to eat.
  
• Avoid eating too many high-carb and sugary processed foods (white bread, baked treats, etc.) and opt instead for whole grains--oats, multigrain bread, brown rice, whole wheat pasta, etc.
• Include protein in your diet each day, but don't worry too much about getting a specific number of grams. Meats, eggs, dairy, beans, and nuts can all be good sources. Many beans and nuts are not complete proteins by themselves, but create a whole protein when eaten along with whole grains. (Edited to Add: Experts now recommend 60-80 g of protein for pregnant women. If you don't eat much meat and/or dairy, you may want to keep track to be sure you're getting enough.)
  
• Include a variety of colorful fruits and vegetables in your diet, especially ones where the flesh is colorful, not just the skin. Leafy greens are especially healthy--romaine lettuce, spinach, kale, etc.
• Include healthy fats and oils in your diet, but remember that a serving of fat is very small and there is some fat in other foods you are eating.
  
• Have water on hand throughout the day and drink enough that you are not getting thirsty.
  

If you are at risk for high blood sugar, have insulin issues, have been diagnosed with gestational diabetes before, or have a history of large babies, there are other considerations for you.