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Oct202012

Brewer Diet Be Damned

This could have been written to many people, but just happened to come up with the Hypnobabies course I am auditing. It's an issue with Bradley and any number of midwives and doulas as well. They ALL need to just stop referring to the Brewer Diet. It's crap. It's even dangerous to susceptible women. So while this letter goes to Hypnobabies, fill in the blank with who you know who uses the Brewer Diet; they need to dump it, too.

Dear Hypnobabies Folks, 

I’m sitting in on a Hypnobabies series and we’ve just finished the second chapter on nutrition. As you know, the chapter focuses on the Brewer Diet, Hypnobabies clearly advocating and recommending the Brewer Diet (BD) for those who take the course. As a midwife, I’ve followed the BD through many years, first through the Bradley classes as a student, then with peer pressure and finally, I started learning about the BD on my own because I kept seeing clients getting sick despite being on the BD, getting preeclampsia, including postpartum preeclampsia. I started reading studies about preecplamsia and reading about Pregnancy Induced Hypertension, opened my eyes to the amount of babies there were that were over 9 and a half pounds when their mom adhered to the BD religiously, bigger still, the more protein she took in. I saw shoulder dystocia over shoulder dystocia with these over-nourished babies. When midwives began talking about it honestly, we saw the same things and quit recommending the BD to our clients.

How did this diet come to be so ingrained in the natural birth world when only one doctor claimed it worked? There weren’t even studies that could replicate what Brewer claimed all that protein could do! For groups of people who demand evidence-based care, this is a glaring example of ignoring what we require of others.

For those that believe Brewer could do anything at all to prevent or help PIH or preeclampsia at all, you need to visit Preeclampsia.org and listen to what the women there have to say about The Brewer Diet. Here are the massive amounts of links the women have compiled that discuss the science of PE/HELLP/PIH.

None of this is to say I think a balanced diet isn’t important, but the Brewer Diet isn’t balanced at all. It is protein and calorie overload which taxes the kidneys and the body, especially during pregnancy. Women absolutely need protein during gestation, but not 80-120 grams a day as Brewer recommends.

What I would love Hypnobabies to recommend is a balanced diet of heavy on fruits and vegetables, quality protein, complex carbohydrates, water and minimal processed foods… what we all know to eat anyway!

I love Hypnobabies. I want to put everything I have behind this method. I don’t want to have to say, “Except for <fill in the blank>.” From what I understand, you’re changing the manual; I hope this is one thing you’re completely transforming.

With respect and admiration,

Barbara E. Herrera, LM, CPM

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Reader Comments (32)

Thank you for sharing this. I love your posts on info you've come across and trends you've seen that need to be abolished in your many years of midwifery and doula care. You have a seasoned and knowledgeable perspective.

October 20, 2012 | Unregistered CommenterLaura

I followed what I guess would be something like a Brewer Diet (extremely high protein) for my last pregnancy, and my baby was significantly larger than my last two (9#9 instead of 7#12 and 7#15). However, it was my fastest birth, my fastest second stage (under five minutes), my best nurser - and the diet really helped my issues with hyperemesis, which was the reason I was doing it. So while the diet may cause bigger babies, I will definitely try it again to help with the HG. I'm interested in the subject, though, for sure!

I didn't comment, but just an FYI that I loved your last two entries with the great pictures! You always have the best pictures!!! :)

Love,
Diana

October 20, 2012 | Unregistered CommenterDiana

Hear, hear!

October 20, 2012 | Unregistered CommenterJennifer Thorson, Doula

Beetlejuice, Beetlejuice, Beetlejuice... here comes Joy Jones, RN to tell you how wrong you are. Anytime anyone talks about the Brewer diet she shows up, tells everyone off, fails to respond to reasonable inquires for recent studies, replicated data, etc then she flounces.

Her website says that the IUGR that complicated my first pregnancy could have been cured by eating lots of protein. Joy and I have gone the rounds on here as well as on other websites. I don't have a lot of nice things to say about her, so I will stop talking.

October 20, 2012 | Unregistered CommenterWendyLou

I remember my midwifery tutor, back in the 70s, in the UK, telling us that basically a pregnant woman ISN'T "eating for two", she's eating for "1/12", while a nursing mother IS "eating for two" and that, when looked at in that light, that breastfeeding is the "most expensive" way to feed a baby.

Once again, as in so much else, it all boils down to moderation and common sense. A healthy diet for a woman in her reproductive years is a healthy diet, basically, for a pregnant woman.

Even now, when so much more is known about the causes of pre-eclampsia, the actual cause remains unknown. We do know how to treat pre-eclampsia, in most cases, however, while most of the treatments are symptomatic, one thing we do know is that diet is completely ineffective, either in prevention or treatment.

Special diets are just another way of trying to have control over what is essentially outside our control to influence.

October 20, 2012 | Unregistered CommenterAntigonos CNM

For what it's worth, I took a hypnobabies class in LA with my first, 4 years ago, and BD was never mentioned. In fact, it was only from reading your blog that I'd ever heard of it. Great letter, though. With my second pregnancy, I had what I thought was a ton of protein (not really by design-- it just seemed like I was getting meat at *every* meal) and had a 7lb 13oz baby and gained 28lbs total from a healthy BMI.

October 20, 2012 | Unregistered CommenterIcedancer

I cannot reply to all of your points at the moment, due to time constraints, but I hope to reply in more detail later today. For right now, I will only say that most people who decry the Brewer Diet do not understand or use it correctly, including the Preeclampsia Foundation. For my responses to the most common claims by the PEF, you can see this page of my website....

http://www.drbrewerpregnancydiet.com/id79.html

October 21, 2012 | Unregistered CommenterJoy Jones

Thanks for this one!

October 21, 2012 | Unregistered CommenterMaryEliz

Hi Barbara,

How timely your post is, considering that we are updating our entire Hypnobabies course. However, I must correct you when you say "As you know, the chapter focuses on the Brewer Diet, Hypnobabies clearly advocating and recommending the Brewer Diet (BD) for those who take the course." Class # 2 in Hypnobabies does not focus on the Brewer Diet at all, and we only suggest 75-80 grams of protein a day, just like the World Health Organization does. The Brewer Diet is actually presented in Hypnobabies as a nutritious, balanced pregnancy diet, which it is, and students can consider using it…or not, just like everything else we teach in Hypnobabies. As a childbirth educator for 24 years, and having seen hundreds of expectant mothers actually *eliminate* pre-eclampsia by increasing their protein, salt and water intake, I know that the Brewer Diet can be very helpful in this area, and our moms can do more research on it if they wish, just like everything else we teach in Hypnobabies. Staying healthy and low risk is the *actual* focus of Class # 2 since we move on from nutrition to educate on many other subjects such as avoiding potentially toxic items, the stages of labor, comfort in pregnancy, prenatal exercises and much, much more. I’m so glad that you are enjoying auditing one of our Hypnobabies classes, and I would appreciate it if you would avoid giving people a false impression of what we “focus on” from now on. Your opinions are your own and you are welcome to them but please don’t present them as fact. I would *love* to see all of the research you have collected on pre-eclampsia.
Thanks, Kerry, Founder/Director of Hypnobabies

October 21, 2012 | Unregistered CommenterKerry Tuschhoff, HCHI

Thank you for bringing an important issue to light; we all should be teaching from an evidenced based perspective as much as possible. That changes on a regular basis and I'm glad you highlighted that the Hypnobabies program is being reviewed.

I find this post to be slightly misleading with regards to Hypnobabies protein recommendation. Hypnobabies recommends aiming for 75-80g of protein intake for pregnant moms, not 80-120g.

"What I would love Hypnobabies to recommend is a balanced diet of heavy on fruits and vegetables, quality protein, complex carbohydrates, water and minimal processed foods… what we all know to eat anyway!"

Absolutely! You will notice that the outline about dietary needs in the manual includes, milk, eggs, fresh dark leafy vegetables, whole grains, vitamin C foods, fats and oils, and vitamin A foods. Later there are pages talking about the importance of iron, calcium and water intake also. When I review the Canada's Food Guide, there is a fair amount of consistency with the Hypnobabies outline, including the specifications for protein. The Hypnobabies manual has a specific topic on "Avoiding Toxic Substances While Pregnant" that includes information on food additives and preservatives in Week 2's information also. The section concludes, "Eat a well-balanced, high-protein diet of whole (non-processed) organic foods." Following the formula for protein guidelines of weight kg x 1.1-1.3= grams means a 150lb pregnant woman should be consuming 75g of protein suggests that Hypnobabies doesn't seem to be recommending a protein count much higher than suggested by the Canadian and American Dietetic Associations by this formula.

Enjoy the rest of your Hypnobabies observation!

October 21, 2012 | Unregistered CommenterFiona

Do we need to get into the details?

On page 42 it says "Consider aiming for 75-80 grams of protein per day." Yet, on page 43, when it begins discussing The Brewer Diet in detail, which it does for several pages, says, (as you know), "120 grams of protein and that is said twice on the same page. On another page, an anecdote is used about a mother eating 52 eggs and drinking 6 quarts of milk in 3 days. These are examples of implying for the mother to eat more than 75-80 grams of protein a day, In fact, above the Daily Pregnancy Nutrition Checklist it says, "Can You Get in Your 75-80 Grams of Protein Every Day? You Can... and More!" That is more than an implication, that's an assumption that the woman will eat more than the 75-80 grams a day.

An aside: It's really important to know how sugar-laden milk is. Milk makes for giant babies and women's glucoses go sky-high after drinking milk. Plus, there are hormones in milk that cause calves to grow extra fast and those hormones do the same to humans. IF a woman drinks *any* milk, which I've heard recommended not to drink 6 weeks before birth, she should only drink organic without the hormones of regular milk. But, no milk products is even better. Using milk as a protein is inappropriate and dieticians that work with diabetics would cringe to hear anyone recommend milk as a protein "food."

Kerry, you say, " ...having seen hundreds of expectant mothers actually *eliminate* pre-eclampsia by increasing their protein, salt and water intake, I know that the Brewer Diet can be very helpful in this area..."

Hundreds? HUNDREDS? I haven't even known 25 women with preeclampsia in 30 years. And there is no way the Brewer Diet eliminated preeclampsia because diet has zero to do with the mechanism of preeclampsia. I encourage you to read through the FAQ on the Preeclampsia.org site about what causes preeclampsia:

http://www.preeclampsia.org/health-information/faq#seven

Nowhere does it say that protein deficiency will cure PE. It's cruel to lead women to believe it will. Reading through the Preeclampsia.org boards gives a window into what it feels like to be told it's your fault you have PE... because you didn't do the Brewer Diet correctly or eat enough protein when the women did the diet religiously. THE DIET DOESN'T WORK. It is merely a diet of food. It isn't a medication.

Those that read my words are aware they are my opinion. I don't usually have to say, "these are my opnion," so not going to start now, but I understand how someone who hasn't read me before might think I'm blanketly speaking about a method or cause. Not at all.

And just so we're clear. I *love love love* Hypnobabies... more than I ever thought I would love a childbirth method. I think it's magnificent and love it's comprehensiveness and all the hypnosis and bio-feedback. It's simply awesome. But, as a blogger who writes about my experiences with life, including my midwifery life, I speak out about the good AND bad that happens. It's just the way I am. Not going to explain my blogging Self... I'm a navelgazer... read the blog to get to know me more. :)

October 21, 2012 | Registered CommenterNavelgazing Midwife

Thank you for this post, NGM. You are correct that Brewer was a single individual who promoted this diet, and it has been shown not to work. Despite what the childbirth educators commenting here think they have observed, PIH (in our communities) is not diet responsive.

Brewer made an illogical link between the swelling suffered by people with gross protein malnutrition (low oncotic pressure due to decreased albumin in the blood) and the hydrostatic swelling of pregnancy caused by pressure on the venous system by the growing uterus. Then he made another leap to the additional swelling of PIH caused by leaky capillaries. All of these pregnancy-related conditions cause swelling, but all by different mechanisms.

The fact is, unless one has gross protein malnutrition (like people enduring famine) , the serum protein is kept within a tight range, and does not vary with diet. This is easy to demonstrate by directly measuring serum protein.

Those who still espouse this mechanism should look up some physiology and see that Brewer was wrong. Well-meaning, but wrong in this case.

October 21, 2012 | Unregistered CommenterSue

Just my anecdota here regarding dairy, first pregnancy, ate a lot of dairy products, had a 10 lb 4 oz baby. Then heard about how milk supposedly makes for bigger babies, so second pregnancy only ate very minimal amounts of dairy. Guess how big my second was? 10 lbs 4 oz. Yeah, so that didn't work.

October 21, 2012 | Unregistered CommenterJessica

Since I have a few moments now, I will give you the responses that I promised earlier.

I disagree with the characterization of me that was mentioned earlier in these responses. I do not tell people off on this subject--not ever. I simply calmly and respectfully present the truth about the Brewer Diet and let it speak for itself. Most of the information about the Brewer Diet that comes out of the PEF is either misleading half-truths or complete fabrications and falsehoods. My hope is that those who read about the Brewer Diet anywhere would be glad to get another perspective about the BD from me, and one that is more based in facts and truth.

I do not flounce off, either. I am usually running several directions at once and usually cannot spend much time writing. Yesterday morning, when I was first made aware of this blog entry by someone else, I had a meeting to go to in which I had to run the sound system. Then in the afternoon I had a committee meeting to attend which supports the work of an African psychologist who is teaching local leaders how to help families in eastern Congo to deal with trauma. Then I had to spend the rest of the day helping my son and daughter-in-law in their transition as my second grandbaby joined their family just last Thursday.

So now, starting with the initial post of the blog....

--"clients getting sick despite being on the BD"--

Without being able to review the "BD" that each of these clients was on, I cannot analyze where the gaps may have been in each situation, but there are several reasons for this kind of development which are very common causes.

1) There are so very many, many versions of what people are calling the "Brewer Diet" out there that there is no way for us here to know whether these that got sick were actually on the real BD, or not. It is most likely that these clients were not following the BD at all, through no fault of their own. There are many, many people out there who are teaching this diet incorrectly.

2) The fallacies of these fake "Brewer Diets" include

a) focusing completely and exclusively on the protein intake (when women skimp on the other two legs of the diet, the calories and salt, the diet will not work);

b) drinking too much water, instead of getting their fluids from drinks with some kind of nutrition in them (when women drink too much water during pregnancy, especially in the middle and last trimester, their stomachs are too crowded to then incorporate the amount and types of foods that will prevent and reverse the PIH/PE/E/HELLP syndrome, among other complications associated with low blood volume);

c) using diuretic herbs, in their prenatal vitamins, pregnancy teas, and other supplements (these decrease the mother's blood volume at the same time that she is valiantly trying to increase it by following the BD).

--"big babies and shoulder dystocia"

1) The term big is a very relative term. While this author mentions 9 lbs specifically, usually a specific weight is not mentioned, and it is left for the reader to fill in the blanks with their own definition. So it is usually very difficult to distinguish one person's "big" from another person's "big" when this issue is brought up on forums or in discussions of any kind. Then the readers of those posts can go away saying, "I've heard that the BD causes big babies", when the size has not been defined at all. This is how misleading rumors get passed around about the BD.

2) Usually, shoulder dystocia is relatively easily resolved with the skills that are taught by Gail Tully at her shoulder dystocia workshops.

3) Usually, when a baby is any size over 7 lbs due to the mother's well-rounded prenatal nutrition, she also has the additional uterine muscle cells needed for pushing out that baby. The uterus starts out weighing 2 oz, and ends up weighing 2 lbs--a growth of 1 lb 14 oz of new muscle cells. When the baby is smaller than 7 lbs due to less nutrition, the uterus most likely also has had less nutrition and has less muscle cells to push her/him out. Thus, depending on the nutrition involved, a larger baby can often be easier to push out than a smaller baby (again, very relative terms without specific weights).

4) It may be that "beauty is in the eye of the beholder". I do not hear about women frequently or commonly or usually having babies that are over 10 lbs (my own definition of "big"), when they use the BD. In all my teaching and counseling and traveling, this is not feedback that I get from people, except from people who are connected to in some way or in support of the PEF. In my 35 years of assisting with about 500-700 births, I personally only remember 2 of those "big" babies. One was a difficult birth with shoulder dystocia, at a time before Gail Tully was teaching those skills, (a homebirth in which the baby and mother recovered well without need for transport), and that other was one in which the mother had no apparent trouble pushing her baby out at all.

5) From what I have heard from experienced midwives, shoulder dystocia can occur at any birth weight, and it occurs as much with babies that are smaller than 7 lbs as with babies that are over that weight.

--"only one doctor claimed that it worked"

This is a complete and total lie, or at best a misleading half-truth, which has been invented and propagated by the PEF. These principles have been used for hundreds of years successfully, although Dr. Brewer is the most famous one for having distilled it into a form that is the most user-friendly. There is evidence in the hieroglyphics that the ancient Egyptians used them. There is evidence in the writings of the doctors of ancient Greece that they used them. In more modern times, Dr. Adolph Pinard, a French obstetrician, used these principles successfully from the 1870s to 1900, when he exuberantly proclaimed,

"Therefore I can terminate what I wished to say to you about this subject with the following consoling sentence: If the nineteenth century did not arm obstetricians with the means of curing eclamptic seizures, at least the twentieth century provided sufficient weapons to prevent them."

They were researching and successfully using these principles throughout the early 1900s.

They were teaching these principles in the medical schools and in the medical textbooks, in the 1940s, when Dr. Brewer was a student there, which is where he picked it up.

In addition, there were many doctors before Dr. Brewer, and contemporary to Dr. Brewer, who also found success with using these principles, independently of him in different countries. One of these, Dr. Hamlin, in Australia, had a practice in which he typically saw 1 in 350 women developing eclampsia. After teaching these principles to his patients for only 3 years, with no other interventions, he had 0 in 5,000 women developing eclampsia.

There are many other names and successes that I could list for you, but anyone who may be interested can see a very small portion of a "Brewer Timeline" on this page....

http://www.drbrewerpregnancydiet.com/id80.html

--"the massive amounts of links on the PEF forum that discuss the Brewer Diet"

1) The women who unfortunately experienced many painful devastations of the PIH/PE/E/HELLP syndrome are giving anecdotal evidence in their stories, not the evidence-based info that you are wanting to espouse. I have read many of those, in my 3-month sojourn on their forum, and I feel for their pain and loss. I personally believe that anecdotal evidence is valuable. However, there is no way for us to evaluate where the gaps may have been in their situations by the amount of story that they tell. It seems to me that it is unrealistic to be able to claim that their complications resulted from their use of the BD, when we do not know which "BD" version they were using, or what other factors were present in their lives that could have been thwarting their valiant attempts to succeed with the BD.

2) The links provided on the PEF forum are completely one-sided. When I was posting there, they refused to allow me to post anything in support of the Brewer Diet--no facts, no information that would clear up the misunderstandings and mis-statements about the BD that were being freely posted there.

3) The links that they provide for studies regarding various theories on the issue of the PIH/PE/E/HELLP syndrome do not relate to the BD at all. As far as I know, none of them mention the BD, none of them incorporate the BD or even the principles behind the BD, and none of them even factor in the mother's nutritional status or practices at all. They simply research the effects of this syndrome and then claim that those are the causes, which is a perspective that I disagree with.

--"the Brewer Diet isn't balanced"

The accurate form of the Brewer Diet is indeed balanced. It includes much more than protein and calories. It incorporates 14 groups of nutrients for the mother to choose from. If you want to exclude the last 5 groups (liver, sodium, water, snacks, supplements), it still includes 10 food groups which incorporate all kinds of fruits, vegetables, grains, dairy, and eggs--as many as exist on the face of the planet, and as many as the mother wants in addition to the baseline numbers of servings recommended.

One of the problems with the way that the BD is often taught is the use of diet tracking sheets which include only the protein. I strongly discourage the use of this type of diet tracking in pregnancy, because they lead the women to incorrectly deduce that the BD is all about the protein, and then they tend to neglect all of the other components of the BD, thus engaging in an unbalanced diet inadvertently.

The more accurate way to engage with the BD is to use the chart created by the Brewers themselves, in which the mother only needs to put a check mark in a box for each serving of each food group that she eats. At the end of the day, when this chart is followed a very balanced diet is the result.

http://www.drbrewerpregnancydiet.com/id89.html

--"It is a protein and calorie overload which taxes the kidneys and the body, especially during pregnancy"

This is an opinion that we just disagree on. It is the pregnancy that is stressing the kidneys, not the protein. It is the protein and other nutrients of the Brewer Diet that give the kidneys the nutrients that they need to successfully handle the stress that is already put on them by the pregnancy. A Dr. Maurice Strauss, a noted internist at Harvard, was consistently successful in reversing the PE/E/HELLP syndrome with protein levels up to 260 grams, with no ill effects on mother or baby whatsoever. You can read more about the BD perspective on this issue from Gail Brewer on this page (scroll down to find it)...

http://www.drbrewerpregnancydiet.com/id13.html

Now on to some of the comments posted--

--"No recent studies to support the use of the Brewer Diet"

1) I do not have access to the studies that Gail Brewer has been collecting. She is coming out with a new book soon, so hopefully they will be listed there.

2) The many midwives who use this diet in their practices and I are planning to start a data base soon, so that all the anecdotal evidence that we have can be organized in a way that is more easily accessed and examined by anyone who would choose to do so.

3) No one has been able to tell me what exactly they want to see studied. Every piece of the principles behind the Brewer Diet are commonly taught every day in every medical school in the country--the blood volume increase during pregnancy, the secretion of renin during hypovolemia, the effects of renin which increase the BP in the absence of hemorrhage, the fluid preserving functions of the kidneys, the need for adequate osmotic pressure in the circulation, the development of abnormal edema in the absence of adequate osmotic pressure in the circulation, etc. These are commonly accepted principles commonly taught every day in medical schools across the country and around the world. Which part of those are they wanting more studies about?

--"Her website says that the IUGR that complicated my first pregnancy could have been cured by eating lots of protein"

That is simply not true. The truth is that the information on my website includes a lot of other issues, besides protein, which contribute to the development of IUGR--all of them nutritional, to be sure, but most decidedly not focused solely on protein.

--"We do not know what causes PE, but we definitely know that it is not nutritional in cause"

This is also not true. There are hundreds of midwives and mothers across the country and across the world who are successfully preventing and reversing the symptoms and roots of the PIH/PE/E/HELLP syndrome. You can see a small sample of them in the 3 registries that are listed at the end of my website. I even heard from at least one mother that her doctor was so impressed with how quickly and thoroughly she was able to reverse her PIH/PE with the use of these principles, that he told her that he was planning on teaching it to his other patients as well.

--"Brewer made an illogical link between the swelling suffered by people with gross protein malnutrition (low oncotic pressure due to decreased albumin in the blood) and the hydrostatic swelling of pregnancy caused by pressure on the venous system by the growing uterus....."

This statement is also an untrue statement.

Anyone who really wants to search for the truth can test the albumin levels in their mothers who are suffering evidence of the PIH/PE/E/HELLP syndrome, and they will find that her albumin levels are too low for increasing and maintaining the 60% blood volume increase that her body is trying to create. Albumin levels that are normal and adequate will keep the osmotic pressure up to the levels that are needed for increasing and maintaining that 60% increase for pregnancy.

Another easy way to investigate this issue in any individual woman is to test her Hgb/Hct. When the Hgb/Hct of the woman with symptoms of PIH/PE/E/HELLP syndrome is compared to those that were taken at the beginning of her pregnancy, it can easily be seen that her Hgb/Hct levels are staying the same or rising, which is evidence of her blood volume staying the same or falling, which triggers the whole fluid-preserving responses of the body, which results in a rising BP and rising edema, and the organ damage that occurs throughout this syndrome process.

Dr. Brewer very definitely made a distinction between the abnormal levels of edema that are caused by the disease processes of this syndrome and the normal hydrostatic swelling of pregnancy caused by pressure on the venous system by the growing uterus--and he did so every time that he discussed or wrote about this issue.

That is my response to the posts that have been written so far. I may not have time to return with more responses, but I am not putting anyone down, telling anyone off, or flouncing away. I have a part-time job as a school nurse sub, plus a new family to care for, plus an occasional doula client, plus a teaching job for various CBE and midwifery organizations, plus various writing and production assignments, plus mountains of housework.

If anyone has specific questions about anything I have said, or anything that others have said about the Brewer Diet, I welcome your questions via my business email pregnancydiet at mindspring.com

I am not so much interested in debate for its own sake, but I most definitely do welcome the open and searching mind.

Peace to you all,
Joy

October 22, 2012 | Unregistered CommenterJoy Jones

You know, the onus is on Kerry and Hypnobabies to do the research on Pre-E if they're the ones putting blatant disinformation in their publications. I find it a tad rich that they thing that NgM needs to do it for them. I also don't believe that she has seen "hundreds" of women resolve pre-e by following their diet. The mechanism that causes pre-e is still a mystery, but it's quite clear that diet is not a contributing factor. I truly wish that the Brewer Diet would fall into the obscurity that it deserves.

October 23, 2012 | Unregistered Commentermoto_librarian

Less water, more salt, and more protein for a woman with PreE/E/HELLP. Talk about your backwards logic.

Convenient isn't it, that anyone for whom the diet does not work must have been doing something wrong. It doesn't matter if we can't identify what they did wrong. We'll just assume that their prenatal vitamins did it, or they drank too much water, or that they're lying about what they ate.

If your medicinal diet is that easy to foible, it's not an effective diet.

"It is the pregnancy that is stressing the kidneys, not the protein....Dr. Maurice Strauss, a noted internist at Harvard, was consistently successful in reversing the PE/E/HELLP syndrome with protein levels up to 260 grams, with no ill effects on mother or baby whatsoever.
http://www.drbrewerpregnancydiet.com/id13.html"

A link to the brewer diet page is not a valid defense of your point. Cite an actual study. It is well established and agreed upon by nutritionists and dieticians world wide that high protein diets stress the kidneys. Pregnancy does put strain on the kidneys, but adding more stress via high protein diet will not help.
http://hyper.ahajournals.org/content/57/2/269.short
http://ajcn.nutrition.org/content/90/6/1509.short

Studies, show them. Provide links to published studies. Not a book that references a study, not a cite that claims to have heard of a study. Not the brewer diet homepage. An actual study published in an independent medical journal. It's called google scholar. Use it. If Gail Brewer is in fact compiling studies to put in a book, they should be easy to find. She does not have a monopoly on scientific studies regarding renal function, preE/E/HELLP during pregnancy.

Show me one study where a high protein diet (which regardless of other nutritional factors is a core tenant of the brewer diet) has had a positive impact on renal function in anyone, let alone a pregnant woman with, as you say, an already stressed kidney.

High protein=bad for kidneys. High sodium=water retention(sign of dehydration), swelling, and bad for kidneys. Drink less water=bad for kidneys. This is basic common sense stuff.

October 23, 2012 | Unregistered CommenterMona

It seems ironic to me that the PEF calls and calls for studies on bodily functions that are commonly taught every day in every medical school, and yet they cannot be bothered to fact-check their statements about Dr. Brewer and the Brewer Diet, apparently having no compunctions at all about consistently and frequently stating one lie after another on those topics.

October 23, 2012 | Unregistered CommenterJoy Jones

I'm not any kind of expert but I really just do not get why Hypnobabies would recommend a diet that was designed to address a particular pregnancy health issue that doesn't actually do that.

It's kind of like saying blueberries help prevent a broken leg, well they don't but eat buckets of them anyway because they're healthy. Okay but why provide the fake information and why use a debunked diet rather than some simple nutritional guidelines. It's not respectful to women.

As a consumer I assure you that it really reflects poorly on the Hypnobabies brand for them to ally themselves with something that has been so thoroughly debunked.

October 24, 2012 | Unregistered CommenterJenn

There are a lot of great points made here on both sides of the issue. Navelgazingmidwife provided a link to preeclampsia.org which points to the complexity of the problem and shows that nutritional deficiency is indeed one of the potential causes of pre-e, amidst a host of other factors. Hypnobabies instructors have been trained to present Class 2 with the caveat that Brewer Diet is simply an example of a diet that works well for pregnant women. Hypnobabies does not recommend anything and does not dispense medical advice; never has and never will, no matter how much of the manual is revised (which I know they are working diligently on) in order to perhaps improve the flow of information. But I would not expect the approach to teaching Class 2 to change much if at all in this next revision. The BD is a balanced pregnancy diet. It just is. A woman should always discuss specifics, such as amounts of protein and other components to her diet, with her care provider to determine whether needs are being met. I would hope that her care provider would be looking at her as an individual and that any health concerns she may have would be addressed by taking a look at her diet as well as many other potential contributing factors.

October 24, 2012 | Unregistered CommenterJenny

the Brewer Diet is NOT a balanced diet. It is not. It just is not. Saying it is doesn't make it so. It is not. Ask any nutritionist who specializes in pregnancy. That much protein taxes the kidneys.

I'll try to get Jill Heller in here to explain the mechanisms of what that much protein does to the body. She had postpartum preeclampsia twice... almost dying twice... the first time having it worse BECAUSE of the Brewer Diet. If I recall correctly, her kidneys failed that first time. She's become an expert on protein in the Brewer Diet in preeclampsia. Let me see if I can get her in here.

I agree that it reflects poorly on Hypnobabies to use/recommend a diet that is so controversial and so debunked in their materials. They can say they defer to the women's providers all they want, but having it in the material at all speaks volumes about their belief in the diet.

It also reflects poorly on Bradley, but the Brewer Diet is almost synonymous with the Bradley Diet and if someone takes Bradley, I've just told them to ignore the Brewer stuff. If Hypnobabies insists on including the Brewer Diet again, I'll do the same.

October 24, 2012 | Registered CommenterNavelgazing Midwife

I agree with NgM. When I see Hypnobabies and Bradley supporting something as ridiculous as the Brewer diet (and yes discussing it as a valid option is giving it support!), the organizations lose credibility in my eyes. If we are going to demand evidence based/science based maternity care, we need to demand it from ALL organizations.

October 24, 2012 | Unregistered CommenterMargaret

Okay, I'm listening. So is 80 grams of protein a day too much?

October 24, 2012 | Unregistered CommenterJenny

NgM, THANK YOU for posting this.

I read through the thread on preeclampsia.org. Joy's bibliography salad is absolutely ridiculous. She's asking us to write off those women's experiences as anecdotes, when that's all she offers here -- anecdotes. That's totally nonsensical. I can't even put in words how absurd I find the pro-Brewer arguments in light of what current science says about PE.

In what other area of life would trusting stuff written 50+ years ago that's since been overturned by countless authorities make ANY sense?? If the potential results of this blind faith (and in some cases, willful ignorance) weren't so tragic, it would almost be funny.

October 25, 2012 | Unregistered CommenterLH

We've had the discussion with Joy before (in my "Suddenly" comments) and it was extensive, demonstrating the absurdity of her beliefs, showing how she doesn't show Peer-Reviewed studies at all, but ARTICLES written a zillion years ago and the comments deteriorated into a pile of She Said/Science Says and it was pointless to go on. It's mainly why I've chosen not to engage her here even though I probably should have at least said something to explain why I haven't said anything after her long comment. Take this as to why. If you want to read the give and takes, go to the "Suddenly" post and go about a third of the way down the 100+ comments to find when the Brewer Diet discussion begins. It is worth reading.

I've noticed the lack of midwife interaction here and thought midwives are probably just rolling their eyes and telling their clients I'm full of crap and to ignore me and what I'm saying. I think I'm going to write a follow-up: "What to say to a midwife who insists on your doing the Brewer Diet during your pregnancy." I think women need to have the words to tell the midwife she isn't going to do something so dangerous to her body despite what the midwife insists she do, even if the midwife threatens to drop her as a client. I can hear the midwives now.

October 25, 2012 | Registered CommenterNavelgazing Midwife

Is 80 grams of protein a day too much for a pregnant woman?

October 25, 2012 | Unregistered CommenterJenny

A pregnant woman needs about 70 grams of protein a day during pregnancy. Some days she may take in 60 grams, others, 80 grams, so being anal about the grams isn't the point. The point is to *not* count grams of protein a day, but to eat a balanced diet and trust that your diet is getting you what you need. Checking once in awhile is fine, but counting every day like Bradley wants you to do is absurd.

Is 80 grams every once in awhile too much? Nope. Is it too much every single day? Depends on the woman's size. She might be growing a pretty big baby if she's not a big woman herself. Hard to say.

Best to just eat a balanced diet -like we ALL know how to eat- and our babies will grow beautifully. If, of course, we have GDM or eating disorders that require special eating rituals, we need to follow those to the letter, too. We are smart women. Use your brains.

October 25, 2012 | Registered CommenterNavelgazing Midwife

Certainly, common sense should rule. I do like how Hypnobabies provides a chart showing how much protein different foods have. That's helpful. And it also seems like a good exercise to keep track of what you eat for a week to make yourself more aware of it.

October 25, 2012 | Unregistered CommenterJenny

Oh, I also should have said to ask your provider... s/he has the best gauge for how many grams of anything you/a woman should be eating.

October 25, 2012 | Registered CommenterNavelgazing Midwife

"Certainly, common sense should rule. I do like how Hypnobabies provides a chart showing how much protein different foods have. That's helpful. And it also seems like a good exercise to keep track of what you eat for a week to make yourself more aware of it."

Are there any pregnancy guides or childbirth classes that don't recommend something similar? With all three of my kids my providers gave me information about the latest advice about what not to eat, basic nutritional information, sample meal plans and a list of foods with various nutritional breakdowns and a bibliography for more books. That's what kills me about this discussion; it's not like everyone else out there is telling pregnant women to eat french fries all day.

I also think Michael Pollan on nutritionism is helpful here: http://www.nytimes.com/2007/01/28/magazine/28nutritionism.t.html?pagewanted=all&_r=0

October 26, 2012 | Unregistered CommenterJenn

First - MANY thanks to you for decrying what is fundamentally a dangerous myth that women who have preeclampsia can control the outcome by eating the Brewer diet.

Second - I say this as the founder of the Preeclampsia Foundation. For the record, when I nearly died in 1996, I worked with a midwife and a hypnotherapist. I followed (due to a previous experience with preeclampsia) the Brewer diet. Suffice it to say, I nearly died. That is why I started the Preeclampsia Foundation - because Brewer not only doesn't work - it is downright dangerous.

Preeclampsia is a multi-factoral complication with no known cause, and no known cure. It is, frankly, unethical to suggest to women that they either a) caused preeclampsia or b) could have cured it by eating "just so".

I am working with Jennifer Carney on an important documentary, "Unexpected" about the increasing number of MATERNAL deaths and illness in the USA. We cannot blame interventions for all of them - we have to look at the rhetoric we are teaching our nurses, midwives, and doctors, and consider - perhaps if we educated the women about a healthy diet, signs and symptoms, and had informed patients - we might have better outcomes.

Thank you for saying what NEEDED to be said.

November 1, 2012 | Unregistered CommenterAnne Garrett Addison

I am a former Bradley teacher and a labor and delivery RN. I took a class with Brewer himself in the early eighties. I applaud your post Barbara. Much harm can come from the Brewer diet and you obviously know the subject well. It is disgusting to me that those who promote it will dismiss all the reports of women who developed the preeclampsia as having followed the wrong diet or wrong version of the diet. I am embarrassed I ever taught Bradley! I am concerned about Hypnobabies because of the response here...she would "love" to see....it read she would NOT love to see anything the contradicted her cherished belief. I understand that being a former Bradley teacher; but to not be open to things we do not want to believe is the polar opposite of being evidence based.

November 3, 2012 | Unregistered CommenterSusan

What's your opinion on The Pregnancy Diet as referenced here: http://www.whattoexpect.com/pregnancy/eating-well/pregnancy-diet/protein.aspx (I know that What to Expect is like, the anti-natural-childbirth text) however it's one that has some practical information and pops up frequently in searches.

What is The Pregnancy Diet exactly and how is it different (better, worse than or the same as) The Brewer Diet? To me, the two seem very similar.

November 5, 2012 | Unregistered CommenterJenny

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