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.

Natural Nutrition: Homemade Bread

Good nutrition is important for everyone, but we know it's especially important during pregnancy when your body needs extra nutrients to build a body for your child. Dr. Tom Brewer, who worked with mostly low-SES populations, found that helping women eat healthier during pregnancy significantly reduced the rates of pregnancy and birth complications among his patients. The Dr. Brewer Diet is recommended by many childbirth educators and midwives as a way to increase your odds of having a healthy baby and low risk birth.

One good building block for a healthy diet is whole grains. There are a lot of white bread products in America, though there seems to be a trend recently to return to whole grains. I used to eat a lot of white bread, white pasta, etc. I have learned, however, to love the flavors of whole grains. Some of the best premium whole grain breads, however, are quite expensive. I have found that after an initial investment in some equipment (which I recieved as gifts!) you can get get all the great nutrition at a lower price, and you can also know what everything that's in your bread is.

I got a grain mill from my parents for Christmas (I asked for one). I wanted to mill my own whole wheat flour because I heard that the kind you buy from the store lacks some of the nutrition of home-milled. I used my home-milled flour for pancakes, waffles, and chocolate chip cookies (they also have chopped rolled oats in them, so you don't taste the wheat-y flavor). I wanted to make bread but it's kind of an all-day thing that kind of takes a lot to commit to. I had been talking about how I would like a bread machine because they really simplify the process.

Well, Husband got me a bread machine for mother's day. He told me he felt like it bordered on the taboo of giving a wife cleaning supplies as a gift, but I told him I didn't care, because the bread machine was what I had wanted.

I made a one pound loaf the day I got it, using part home-milled flour and part all-purpose. It turned out pretty good, despite not having bread flour. I didn't have any powdered milk, so I looked up how to replace powered milk with fresh, and found this in response to an online Q&A:

If you are asked for dry milk for a bread recipe you can use the following substitution:

3 Tbsp dry milk = 1/2 cup+1 Tbsp fresh milk

2 1/2 Tbsp = 1/2 cup

2 Tbsp = 3/8 cup

1 1/2 Tbsp = 5 Tbsp

1 Tbsp = 3 Tbsp

1/2 Tbsp = 2 Tbsp

The milk solids add only colour and a dash of nutrients so you can either sub some of your water for milk or skip it all together without any problems. (09/28/2008)

By Wendy R.

Anatomy of a Wheat Kernel

(http://www.horizonmilling.com/wheat/wheat_parts.shtml)

The wheat kernel is made up of three parts: the germ, the endosperm, and the bran. The germ is the embryo of the wheat plant and contains oils and vitamin E. All commercial flours (including those called "whole wheat") have the germ removed because it is what causes flour to spoil quickly. Removing the germ extends the shelf life of the flour but changes the taste, texture, and nutritious content of the bread it makes. Commercial "whole wheat" flour is made of the endosperm and the bran. The bran is the outer protective layers of the wheat kernel. Bran is kind of like the membranes a human fetus has or the shell of an egg. Bran contains fiber and nutrients. White flour contains only the endosperm. The endosperm is the food source for the plant embryo, sort of like an egg yolk. The endosperm is mostly carbohydrate and a little protein. The protein in wheat is called gluten. I have known people who had gluten allergies, but I never really understood what exactly it meant. Gluten is also what a vegetarian meat substitute called seitan is made out of.

The difference between commercial all-purpose flour and commercial bread flour (whether white or wheat) is the gluten content. Higher amounts of gluten in the flour will give the dough more rise, and will cause the bread that is produced to be chewy. There is an ingredient you can buy called Vital Wheat Gluten which you can add to any flour to make it a high-gluten flour. I don't see anything wrong with adding gluten, since it is a natural part of the wheat, you're just changing the ratio of the wheat contents. And protein is good for you, especially during pregnancy--it is one of the most stressed parts of the Brewer Diet. I bout some at my local natural foods store and added it to a loaf I made entirely of home-milled flour. It baked up nice and big and had a great taste and texture. I looked at the ingredients on a bag of tasty oat & honey bread I had from the supermarket. Sure enough, vital wheat gluten was on the list.

Here are some pictures of my lovely bread made with added gluten:


I also want to mention I great site I found called www.breadmachinedigest.com. Lots of good info on home milling, bread machines, and different bread ingreidents.