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.

Making baby food is easy. Toddler food, not so much.

I have made baby food for both of my kids. I mostly did purees frozen in ice cube trays. The Wholesome Baby Food website has been my go-to resource for this. I have found it is pretty easy to make purees, but really struggled when my babies got old enough to not want purees but not quite old enough to always eat everything the rest of the family was eating (say we were having pork chops and a baby spinach salad for dinner--not exactly 11-month-old friendly). I often end up resorting to the expensive pre-made "todder food"--those sauce-less ravioli things are pretty neat, after all.

But I would love to have some resources for more homemade options for my son's current age. Especially because I'm pretty sure my son has problems digesting dairy. I'm not sure if it is a problem with the milk sugar (lactose) or the milk protein (casein) yet--still trying to figure that out (that matters because some dairy foods, such as cheese, do not contain lactose). Many commercial toddler meals contain dairy, so I have to check the labels, and it limits the selection for him.

I was intrigued back in December when I read Enjoy Birth's review of the book So Easy Toddler Food and thought it might be something our family could use sometime. This was before I discovered my son's dairy issues and before he decided he didn't want to be spoon-fed anymore. I forgot about the book at the time, but now I realize that I also think some of the info in the book would also be helpful for my 3-year-old, since food battles are pretty common with her. And I could use the recipes for both of my kids. I was excited to learn today that Enjoy Birth is having a giveaway of a free copy of the book. Click here to find out how you can enter the giveaway.

Review of Nonichai Nursing Mothers (Part 2)

Read about the ingredients found in Nonichai Nursing Mothers in Part 1.

I began taking my two-week sample of Nonichai Nursing Mothers in early December. On day 2 of taking it, I noticed the distinctive maple syrup odor in my sweat from the fenugreek. I drank herbal tea made from whole fenugreek seeds I bought at the health food store several months earlier, so I was familiar with this effect of fenugreek.

whole fenugreek seeds

Towards the end of the first week on the supplement , I began menstruating. Many women report experiencing dips in milk supply during menstruation. I have never really noticed, but I do think the supplement may have helped a little with this.

I missed a few days taking the pills here and there since we were traveling, but overall I did notice an increase in my milk supply. Not enough that I started experiencing engorgement or felt a need to pump excess, but enough that my son seemed to get all the milk he wanted faster. He actually started spitting up small amounts after nursing--probably a sign that there was more milk there than he needed, and something he hadn't done since he was quite a bit smaller (he was much more of a spit-up baby than big sister was, though).

All said, I would recommend the Nonichai Nursing Mothers supplement to any breastfeeding mom dealing with low milk supply or slow let-down.

my handsome son, age 9 1/2 months
photo by the owners of JCPhotography

The Federal Trade Commission16 CFR, Part 255 Guides Concerning the Use of Endorsements and Testimonials in Advertising requires that I disclose that I received one or more of the products mentioned above as a free sample, which was offered to me by an email inquiry. Reguardless, I only recommend products I have used myself and that I believe could benefit my readers.

Review of Nonichai Nursing Mothers (part 1)

I was recently given the opportunity to try a free sample of the Nursing Mothers herbal supplement from Nonichai Health. (The page for the supplement has some excellent pro-breastfeeding information on it). This is the first offer I've received to review a product. I have looked up all the ingredients in the supplement. They are

• Noni leaves
• Cardamom
• Marshmallow root
• Fennel
• Fenugreek

Marshmallow, fennel, and fenugreek are all traditional herbal galactophages. Cardamom is a spice used in Traditional Chinese Medicine to treat digestive issues. I was very interested in the use of noni leaves. I am familiar with the use of the juice of the noni (Morinda citrifolia) fruit as a dietary supplement. My mother-in-law grew up using noni juice as a tonic in her native country of Tahiti.

the Noni (morinda citrifolia) plant

My husband's family is friends with the owners of the Tahitian Noni company, who have managed to create a blend of the juice with other fruits that is not completely impossible to swallow to people who have never tasted the fruit before (though the noni juice is still a very pungent flavor in it--it is kind of an acquired taste--I can tolerate it, while my husband actually likes it).

Tahitian Noni brand juice and lotion

I did not know before getting the offer to review this product that the noni leaf has also been traditionally been used as a medicine in Tahiti. The site I linked to above on Noni Leaves claims that tea made from these leaves is rich in antioxidants and flavinoids and aids in digestion and maintaining blood sugar levels.

Since my son is a bit small (issues with his doctor over this is another story for another day) and occasionally he has to work hard to get as much milk as he wants in the evenings, I decided I would give the free sample of Nonichai Nursing Mothers a try.

In my next post, I will talk about my experience taking this supplement.

The Federal Trade Commission16 CFR, Part 255 Guides Concerning the Use of Endorsements and Testimonials in Advertising requires that I disclose that I received one or more of the products mentioned above as a free sample, which was offered to me by an email inquiry. Reguardless, I only recommend products I have used myself and that I believe could benefit my readers.

"No Nutritional Benefit?" A Breastfeeding Myth Debunked

Welcome to The Breastfeeding Cafe Carnival!

This post was written as part of The Breastfeeding Cafe's Carnival. For more info on the Breastfeeding Cafe, go to www.breastfeedingcafe.wordpress.com. For more info on the Carnival or if you want to participate, contact Claire at clindstrom2 {at} gmail {dot} com. Today's post is about child-led weaning. Please read the other blogs in today's carnival listed below and check back for more posts July 18th through the 31st! 

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 Lately I've been hearing women at my playgroup or in the church mother's lounge passing around the idea that that breastfeeding has "no nutritional benefit" after the first year. Women say this with the implication that the only reason to breastfeed your baby is because it feeds them. I have been responding that even though children at age one and beyond are able to eat table food and therefore do not "need" breastmilk, their immune systems benefit from breastfeeding and they get comfort from the nursing relationship.

But then I decided to do some research. And I found multiple sources of evidence that breastfeeding after the first year does, in fact, have nutritional benefits. And why wouldn't it? Breastmilk is nature's tailor-made food. It is not as if the milk that keeps babies healthy for their first year suddenly becomes diet coke after a year. The fat energy content of breastmilk actually increases with prolonged lactation. It probably changes in composition to meet the needs of the nursing child as she grows and begins to eat complimentary foods.

And even though one year olds can eat a balanced variety of table food, it doesn't mean that they will. Toddlers are notoriously picky eaters. That is why companies design drinks for them to "fill in the gaps" in their diet from the things they refuse to eat. Obviously, continued breastfeeding works the same way. One study of children in Kenya found that the more deficient the food diet of the child, the more nutrition the child got from breastfeeding. Nursing does not provide complete nutrition for toddlers, but it does complement the diet they eat.

When my daugher started solids (we did both finger foods and homemade purees) at 6 months, I followed the recommendations at kellymom. I offered solids about an hour after nursing, so she was never very hungry when she ate and never ate a lot. When she started eating table food around 12 months, she was still nursing a lot and not eating large amounts of food. I was glad that even if she didn't eat much food, I knew she was at least getting nutrition from breastmilk. I knew she was just not ready to wean. No one really seemed to be bothered by the fact that she was still nursing, but we didn't get out much at the time, so not a lot of people even knew. A few months later, after she and I both got sick and my milk supply suffered, she was nursing only to fall asleep. That decrease in nursing increased my fertility, and since we were "not preventing" pregnancy anymore at that point, I got pregnant with my son the following cycle.

At that point, either continuing or stopping wouldn't have affected either of our lives verey much. I knew that nursing throughout pregnancy and tandem nursing are options, but I chose to wean her a few weeks after I found out I was pregnant. We weaned slowly, over the course of about 3 weeks so that my milk would decrease slowly and avoid the risk of mastitis. She learned to fall asleep with snuggles instead of nursing, and it was so gradual, that I didn't even realize when it was the "last time" for her to nurse. I can't imagine mother-guided weaning going more smoothly.

I am grateful that I chose to not to automatically wean at an arbitrary age, like one year. I feel that the choice to wean when we did was the best choice for us, and everyone has to make the best choice for them. People aren't making informed choices if they are basing them on inaccurate information, like the myth that breastfeeding after a year has "no nutiritonal benefit. 

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 Here are more posts by the Breastfeeding Cafe Carnival participants! Check back because more will be added throughout the day.

• Sylko @ Chaotic Mama—Breastfeeding Carnival: Child-led Weaning


• Shary Lopez @ Mama Fish—On How We Concluded Our Breastfeeding Relationship...


• BoobiesNBabies @ Num In Mind—She Will Let me Know


• Claire @ The Adventures of Lactating Girl—Facing It As It Comes


• Lexi @ Life As A Mommy—She's Done When SHE'S Done


• Timbra @ Bosoms & Babes—Where she leads


• Charity @ Imperfect Happiness—Child-led Weaning Breastfeeding Cafe Carnival Post


• Natasha @ naturalurbanmama—Mutual Weaning - My New Terminology


• Renee @ Just the 5 of us!—Weaning


• Brittany @ Birth Unplugged—No Nutritional Benefit Breastfeeding


• Kimberly @ Monkey Tales Mama Thoughts—End of Nursing


• And of course the guest poster on the Breastfeeding Cafe’s Blog today is Marilee Poulson—The Normal Course of Breastfeeding

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.