In this section, I will respond to questions that are often asked, and I will add your questions as you email them to me. I will answer the questions from my own experience and education, and from what I have learned from Dr. Brewer and others, but I will be relying on you to use your own wisdom and intelligence and responsibility to choose which information fits your needs, your belief system and values, and your situation. Please consult your own midwife for her feedback as part of your process of making your final decisions.


For example:

Q: What is the Brewer Pregnancy Diet?

A: It is a diet that was developed in the 1950's and 1960's by an obstetrician, Dr. Tom Brewer, to help women have healthier pregnancies and healthier babies. In the process of his medical education, and researching the work of Hamlin, Strauss, Burke, and Ferguson--doctors who had worked on this issue in the 40 years previously--he discovered that the cause of pre-eclampsia and some other complications was an abnormal blood volume, caused by malnutrition, or food deficiency. The diet consists of 14 food groups. However, it can be summarized as starting with 4 basic components: 2600 calories, 80-120 grams of protein, salt to taste, and unrestricted weight gain.

Q: How many pounds can I expect to gain on the Brewer Diet?

A: The average weight gain when using the Brewer nutrition plan is 35-45 pounds. But a weight loss of 5 pounds could be healthy on this plan, or a weight gain of 60 pounds also could be healthy (or more for twins or other multiples). The bottom line is that it's not the number of pounds that should be the issue. The primary concern should be what kinds of food are creating that weight gain. You could gain 35 pounds on refined carbohydrates, and fried foods, and sodas. Or you could gain 35 pounds on lean meats, fruits and vegetables, and whole grains. The second kind of eating style and weight gain would create a healthier pregnancy and baby, even though the number of pounds gained is the same for both.

When Dr. Brewer worked as an obstetrician, he would come out of his office and meet with his patients in the waiting room before their prenatal visits. His first question to them was about what they had been eating that week. Many patients who were accustomed to eating less on the days of their prenatal visits with previous birth attendants, so that they would weigh less, quickly learned that in his practice they had to switch that around and be sure to eat well that day, so that they could give a good answer to his first question, "What have you been eating?"

Q: I want to eat enough protein for my baby, but I don't want to gain too much weight. So would it be okay for me to eat 80-120 grams of protein, but skimp a little on the calories?

A: It is important to use all of the the components of the Brewer Diet together. If you eat the suggested amount of 80-120 grams of protein, but eat as little as 1700 calories, half of the protein that you've eaten will get burned up for the calories that your body needs for all the things that it needs to do. As a result, you will be getting only 40-60 grams of protein for building new baby cells, new blood cells, and new uterine muscle cells.

During a healthy pregnancy, the uterus gains a remarkable amount of new muscle cells during the pregnancy. When the uterus is not pregnant, it weighs only 2 ounces. At the end of a healthy pregnancy, the uterus alone weighs 2 pounds. This means that you need to grow about 1 pound and 14 ounces of new uterine muscle cells with every pregnancy. If you are skimping on calories and burning some of your protein intake for calories, your uterus will probably not have as many muscle cells as it should have, and it could have a more difficult time pushing a baby out than it would have had, if your diet had included more appropriate amounts of both calories and protein.

In addition, a low carb diet could lead to your body breaking down body fat for calories. A by-product of that process is ketones, and ketosis (ketones in the blood) can cause a lack of energy and decreased appetite for you, and brain damage in the unborn baby.

See here for information on the dangers of a low-carb diet in pregnancy

Q: Can I get some of the protein I need by drinking protein drinks, instead of working at getting it all from food?

A: It is better to not use protein drinks during pregnancy (referring to drinks which are made from powdered preparations--sometimes used by athletes for building muscle mass). It is better to get your protein from food. One of the homebirth doctors in the Chicago area has noted that when his clients use protein drinks as one of their sources of protein, the babies tend to become bigger than the babies whose mothers get their protein from food.

As a reference point, most of the homebirth midwives and doctors that I'm familiar with in the Chicago area consider birth weights of 7 lbs to 9 1/2 lbs to be average weights for a well-nourished baby. So a baby would have to be over 9 1/2 or 10 lbs to be considered to be on the higher end of normal.

About 10-15 years ago, one Chicago-area practice of homebirth doctors had a client who gave birth to a 15 lb baby at home, with no problems and no perineal tears.

Tom Brewer considered any birth weight below 7 lbs 2 oz to be less than optimal.

So what a birth attendant considers to be "big" for a baby is quite relative. Those who would consider a baby over 8 1/2 pounds to be "too big" have probably had their view influenced by their having seen a predominance of pregnant women who aren't as well nourished as they could have been. However, the homebirth practice that noticed that babies seem to grow bigger when the mothers use protein drinks has been practicing with the philosophy that the Brewer Diet is important in pregnancy, and they would most likely be familiar with the 7 to 9 1/2 pound average birth weight for well-nourished babies. So it is my impression that they were referring to babies being bigger than that average when mothers in their practice used protein drinks.

In answer to the question, "Can protein powders or pills substitute for some of the protein exchanges on this diet?" Gail and Tom wrote the following, in The Brewer Medical Diet for Normal and High-Risk Pregnancy (p.104).

No. They are extremely expensive sources of protein. They are often incomplete sources of protein (deficient in one or more of the essential amino acids, or containing them all, but in a most unbalanced form). They are often derived from milk, so why not just use the real food--milk? You do not obtain all the other factors found in real food when you pop a pill or pour out a powder. About the only time we have ever recommended these supplements was when a woman expecting quadruplets called us on our hotline. She knew she had a tremendous nutritional challenge to meet, and by the sixth month of pregnancy she had almost no room to put her food. By concentrating protein and calories into the same amount of milk she had been drinking all along, she was able to keep up with her protein requirement.

For more of the potential hazards of using protein drinks in pregnancy, see here...

A: No. In a normal pregnancy, the hormones of pregnancy protect the mother from the cholesterol concerns that men and non-pregnant women need to be careful about. In addition, the benefits of eating these eggs include vitamin A in the yolk which helps protect women from bladder infections, and albumin which helps protect pregnant women from high blood pressure, pre-eclampsia, and toxemia.

Q: Doesn't eating this much protein place stress on the pregnant body? Couldn't eating this much protein cause kidney problems?

A: "The stress in pregnancy comes from the continuous demands of the growing baby, the growing placenta, and the expansion of your blood supply to keep the placenta in good working order. All these considerations require protein above and beyond what would be adequate for a nonpregnant woman. So adding protein to your diet does not constitute a stress--in fact, it's helping to counteract a stress that pregnancy itself imposes.

Additional protein could cause difficulty only if your liver were impaired and couldn't clear the body of the waste products of protein metabolism, or if you were undergoing severe kidney failure. In each of these circumstances, eating protein in large amounts could be toxic, but eating protein sufficient for a healthy pregnancy would not cause the problems to arise. High blood pressure in pregnancy can be triggered by a lack of protein, not an excess."

The Very Important Pregnancy Program, by Gail Sforza Brewer, p. 87

Q: Some people say that too much protein is harmful. What is the upper limit of safety in pregnancy?

A: Nobody knows, but it certainly isn't the 45 to 60 grams a day some writers propose. In very carefully controlled research at the University of California at Berkeley, for instance, pregnant women were fed diets that contained varying levels of protein--up to 120 grams a day--and it was found that their bodies were still using the protein even at the highest levels of intake.

The theory behind the thinking of those who are leery of protein is that when you eat large amounts of protein, you create a higher level of metabolic by-products that the liver and kidneys must clear from the body. The fear is that the by-products will overpower the body's ability to handle them. This line of reasoning misses an important point: When you have a completely adequate diet, the liver and kidneys get their share of essential nutrients and so step up their clearance rate with no difficulty whatever. In short, you can't overdose on the levels of protein this diet provides--and probably not at levels significantly higher, either.

Dr. Maurice Strauss, a noted internist at Harvard in the 1930s, placed toxemic pregnant women on therapeutic diets up to 260 grams of protein a day and had consistently excellent results in turning their disease around. Of course, we're not advocating this amount of protein for every pregnant woman every day, but it should make the point that protein per se will not poison you or your unborn baby. The real problem, as we will see over and over as we discuss various aspects of pregnancy, is protein deficiency, not protein excess.

The Brewer Medical Diet for Normal and High-Risk Pregnancy, by Gail Sforza Brewer with Thomas Brewer, M.D., p 37-38

For more on the misinterpretation of proper levels of protein in pregnancy, by the Cochrane Review, due to misuse of protein drinks in pregnancy, see here...

Q: Since the various Brewer books have different levels of protein that are recommended, how can we know which level to aim for?

A: The basic place to start is with the 4 glasses of milk (or an equivalent) and 2 eggs every day. Each glass of milk should be only 1 cup, which gives you 8 grams of protein. Each egg gives you 6 grams of protein. So from this starting place you already have 42 grams of protein.

If you add 1 serving of salmon (1 oz), you add about 6 grams of protein. And if you add 1/2 cup (1 oz) of walnuts, you add another 7 grams of protein. So in this case, just adding 2 servings of protein to the basic milk and eggs, gives you only 55 grams of protein, where the Brewer minimum is 80 grams.

Adding 6 servings instead--1 oz salmon (6 grams), 1/2 c. walnuts (7 grams), 1 c. bean soup (8 grams), 1 oz chicken (7 grams), 1/2 c. almonds (13 grams), and 1 c. yogurt (8 grams)--gives you 91 grams of protein, which is much closer to the Brewer minimum.

Just for reference, if you eat a portion of chicken or fish which is the size of the palm of your hand, or the size of a deck of cards, that portion is about 3-5 oz of protein. A 3-5 oz portion of salmon will give you about 18-30 grams of protein, and a 3-5 oz portion of chicken will give you about 21-35 grams of protein.

A 3-5 oz portion of animal protein (such as chicken, fish, or beef) will count for 3 servings of protein in the Brewer Diet--see the Brewer Diet chart in Right from the Start (pp.11 & 19).

Whether the 80 gram Brewer minimum, or something higher, works for your pregnancy or not is another question. I once had a student who was apparently getting 90 grams of protein a day, and she still was having some kind of problem which looked as though she wasn't getting enough (edema or elevated blood pressure--I can't remember). In such a case, I would suggest that the mother aim at a higher protein level in the 80-120 gram range, or even something higher, increasing it as quickly or as gradually as she needs to, until she finds the level at which her body responds and the symptoms go away (see answer to previous question). She should also increase her calorie intake, to preserve all the protein that she's eating, and prevent it from getting burned up for calories. It could be that some people need more protein and calories to get their blood volume to increase to the point that whatever unhealthy process they are experiencing will turn around and become a healthy process.