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Please be aware that traveling and moving can break up your eating routine just enough to trigger a low blood volume problem
which can start the rising BP/pre-eclampsia/HELLP/premature labor/IUGR/abruption process. Putting the brakes on that process
can be more difficult than preventing it. Sometimes just being aware of this danger is enough to help you to remind yourself
to continue providing for your nutritional needs, in spite of any changes and stresses which may be going on in your life.
The following is the "Chapter 1" reprinted from Eating for Two, by Isaac Cronin and Gail Sforza Brewer, 1983.
"The Complete Pregnancy Diet: Meeting Your Special Needs", by Gail Sforza Brewer (p.1)
Making your diet satisfy your pregnancy nutrition needs may be as easy as adding a few servings of high quality foods to what
you usually eat, or it may be so complicated that you will want to consult a dietician or nutrition counselor for expert advice.
What makes the difference are the special circumstances you find yourself in during this pregnancy, the unique combination
of strengths and stresses in your life right now that create nutritional pluses or minuses. No two pregnancies are ever conducted
under exactly the same conditions, so even if you've had a pregnancy before, you need to plan your diet based on your current
lifestyle, appetite, philosophical beliefs, religious practices, family traditions, medical care, and all the many other factors
that affect your everyday eating habits.
The goal, of course, is to obtain every day throughout gestation all the essential nutrients you and your unborn baby need
for healthful growth and development. A complete pregnancy diet consists of all the foods necessary to provide those nutrients
in the proper proportions, and in forms that are easily assimilated and used by your body. This means that your diet must
contain adequate proteins, fats, carbohydrates, vitamins, minerals (including sodium), fiber, water, and calories to meet
the daily demands of your particular pregnancy.
A minimum adequate diet for pregnancy, a concept introduced by Winslow Tompkins, M.D. of Philadelphia Lying-In Hospital in
the 1930s, has been outlined in the medical and nutrition professional literature by numerous researchers. Whenever there
has been a conscientious effort made to insure that pregnant women actually followed this basic pregnancy diet, researchers
have reported dramatic reductions in pregnancy and pediatric problems. (An annotated bibliography of much of this work is
available from the Foundation for Perinatal Education, Box 221, Bedford Hills, NY 10507.) [as of 1983] This has been true
not only in the United States, but also in clinics located in countries with as diverse populations as Scotland, India, Australia,
Ethiopia, and the Philippines. Pregnant women everywhere have the same biological makeup: the support systems that are responsible
for a successful pregnancy do not vary from country to country, age group to age group, or social class to social class.
While there are obviously many different kinds of diets that can be adequate for pregnancy in terms of the food choices made,
all of the adequate diets somehow provide the essential nutrients that are universally needed by expectant mothers. In other
words, they are complete.
This cookbook focuses on getting the most, nutritionally, from the foods you eat. We include the minimum adequate diet list
as a guide to those foods which are of highest nutritional value--that is, they provide the most essential nutrients in their
respective food groups per given serving. The recipes demonstrate how to use the highest quality foods as the basis for daily
family cooking and how to arrange the recipes in interesting combinations to create menus that assure balanced and complete
nutrition every day of your pregnancy.
The Complete Pregnancy Diet list which follows was originally designed for use in the nutrition education program of the California's
Contra Costa County prenatal clinics. It has been used in other clinics throughout North America and has appeared, with minor
modifications, in numerous books dealing with childbirth preparation and in brochures distributed by public and private health
agencies and organizations working to improve maternal and child health.
The foods on this list are generally available to most people in ordinary supermarkets. Some seasonal and ethnic variations
are mentioned; vegetarian alternatives to animal products are also suggested. However, a single diet list cannot possibly
be all-inclusive. If you have particular food requirements that differ markedly from the foods on this list, you may well
need to consult a professional nutritionist to construct a diet plan that will be both adequate for pregnancy and within your
range of acceptability. The bibliography at the end of this book can direct you to some resources for reliable information
about diets that diverge from the norm.
See here for vegetarian versions of the Brewer Diet -- Lacto-Ovo and Vegan
The portion sizes on this diet list are geared to average needs and should be viewed as a nutritional floor,
not a ceiling. Of course, the "average" woman for whom this diet would be perfect does not really exist: she is a statistical
abstraction--neither overweight nor underweight, neither very short nor very tall, with a metabolism neither exceedingly fast
nor exceedingly slow, moderately active, and carrying a single baby. You are a unique individual, so keep in mind that this
diet is the minimum adequate diet for the "average" woman, and that most mothers will need to eat more of everything
on the diet to obtain the extra calories they need to feel their best. In most cases, your appetite will tell you (you will
feel hungry) when you need a snack between regular meals. Most pregnant women find themselves eating at least seven times
a day: breakfast, midmorning, lunch, midafternoon, dinner, before bed, and middle of the night (when they have to go to the
bathroom). Nutritious snack foods and other "portable" foods can be found in Chapter 10. An occasional indulgence in a piece
of cake or a candy bar doesn't mean you are harming your baby (these foods do contribute needed calories, if almost nothing
else, to your nutritional requirements). Pregnancy is not meant to be a time of dietary martyrdom--just the opposite--but
as a general rule your should be trying to get your extra calories from more nutritious sources.
See here for the Basic Plan of the Brewer Pregnancy Diet
DAILY NUTRITION SUMMARY:
What the Complete Pregnancy Diet Provides
When you follow the diet, eating to appetite, salting to taste and drinking to thirst each day, you will obtain these key
nutrients from your food. Each key nutrient is listed, along with the amount of each provided by the Complete Pregnancy Diet
and the sources of each among the twelve food groups named by the diet. Figures are approximate, reflecting variations in
daily intake depending on specific foods chosen. These figures meet all recommended allowances of the National Academy of
Science/National Research Council [as of 1983], and, in most cases, provide additional amounts of nutrients where clinical
work in obstetrics has shown that healthier mothers and babies result with additional intakes. When key nutrients are supplied
in abundance from a wide variety of foods, deficiencies of other essential nutrients required in much smaller quantities (such
as trace minerals) do not occur.
DAILY NUTRITION SUMMARY
KEY NUTRIENT -- AMOUNT/SOURCE -- IMPORTANCE IN PREGNANCY
CALORIES (ENERGY) -- 2,600-3,000 -- Groups 1,2,3,4,5,6,7,8,9,12 -- Supply food for all the work of the body. Extra
required in pregnancy to spare protein for tissue growth. Not getting enough calories results in protein being burned for
energy and mother and baby suffering from protein deficiency.
PROTEIN (complete in all eight essential amino acids) -- 80-100 grams -- Groups 1,2,3,5,9) -- Supports growth via its
component element, nitrogen. Extra needed in pregnancy, 1)to develop baby's tissues and brain, 2)to promote growth of mother's
uterus, breasts, and blood volume, 3)to form the placenta, 4)to meet increased demands on the liver for detoxification and
synthesis of plasma proteins, and 5)to form hormones, enzymes and antibodies to provide reserves for labor, delivery and lactation.
VITAMINS:
A (oil soluble, stored in liver in large amounts) -- 15,000-30,000 International Units (I.U.) -- Groups 1,2,4,6,8,9 --
Assists in preventing infection by maintaining integrity of mucous membranes. Helps regulate thyroid gland. Necessary for
cell formation, bone growth, normal vision, strong hair and nails, and the depositing of enamel on the unborn baby's teeth.
D (oil soluble, stored in liver and fatty tissues, synthesized by skin after exposure to ultraviolet light) -- 400
I.U. -- Groups 1,7 -- Influences absorption of the minerals calcium and phosphorus. Essential to bone formation and calcification
(hardness). Deficiency of vitamin D causes rickets.
E (fat soluble, mixed tocopherols) -- 15 I.U. -- Groups 1,2,3,4,5,8 -- In experiments, has been shown necessary for
proper placental implantation. Promotes longevity of living cells by slowing oxidation. Protects function and structure
of smooth muscles (like the uterus), skeletal muscles, cardiac muscle (your heart has to pump all that extra blood as pregnancy
advances), and vascular tissue (supplemental E has been shown effective clinically in the treatment of varicose veins of the
legs, vulva and anus). Helps maintain integrity of liver tissue (liver works overtime all during pregnancy).
B-COMPLEX (water soluble) -- B1 Thiamine (3 mg) -- B2 Riboflavin (4.5 mg) -- Niacin (40 mg) --
B6 Pyridoxine,synthesized in the gut (2 mg) -- B9 Cobalamine, synthesized in the gut (6 mg) -- Groups
1,2,3,4,5,9 -- Essential to proper metabolism of proteins, carbohydrates, and fats. Increased quantities of food require increased
amounts of the B vitamins. Helps in formation of red blood cells which carry oxygen to developing baby via the placenta.
Too low an intake of B vitamins results in loss of appetite, indigestion, deficient hydrochloric acid secretion, apathy and
fatigue, tingling and/or numbness in the hands and feet, failure to heal, skin eruptions. One tablespoon daily of brewer's
yeast and dessicated liver tablets (if you won't eat liver) are excellent sources.
C (water soluble) -- 400-700 mg. -- Groups 4,6,8 -- Essential for formation of collagen (the substance that bonds cells
together)--especially needed by rapidly growing uterus for efficient action and strength during labor. Promotes wound healing
and healthy capillary walls (if you are bruising easily or your gums are tender and bleed after brushing, you may be an individual
with needs above the average). Helps maintain resistance to infection when the body has optimum tissue stores. Stored in
adrenal tissue for response to stress. Promotes absorption of iron and maturation of red blood cells.
MINERALS:
CALCIUM (stored in bone, plus additional .5 g in body fluids) -- 1.5-2 g. -- Groups 1,2,4,5 -- Builds and maintains skeletal
tissue and teeth in mother and baby. Promotes normal blood clotting after birth. Essential to normal contraction-relaxation
cycle in muscles, especially heart. Required for proper functioning of central nervous system of mother and baby.
SODIUM (stored in bone and in body fluids) -- 3-4 g. from foods on list and widely varying amounts from table salt
used to taste -- Groups 1,3,10 -- Assists in maintaining dramatically expanded blood volume needed for placental circulation.
Needed for normal functioning of muscles--lack of sodium often causes leg cramps during pregnancy, a clear sign to add more
at the table. Essential component of amniotic fluid surrounding baby. A major element in control of the body's fluid balance,
glucose transport through cell walls (getting energy into each cell so it can perform), and the acid-base balance essential
to life itself. Inadequate sodium intake can result from vomiting, diarrhea, failure to consume enough high-protein foods
of animal origin (meats, seafood, milk, eggs--all of which also happen to be high in naturally occurring sodium), excess losses
in perspiration during hot weather, in overheated workplaces or while engaging in strenuous sports. All these are indication
for adding more salt at the table; generally your food will taste flat and unappetizing when you need sodium, a response of
your taste buds to your body's need. Deliberate attempts to restrict sodium in the diet, were at one time a popular component
of standard prenatal advice--advice which has now been proven to be detrimental to normal pregnancy adjustments in the mother's
body. Salt to taste. Use iodized salt.
IRON (stored in red blood cells as part of hemoglobin, and in liver, spleen and bone marrow in combination with protein)
-- 30-40 mg. -- Groups 1,2,3,4,5,6,8,9 -- Required for formation of the hemoglobin molecule, the carrier of oxygen to all
body cells. Extra needs in pregnancy due to 1) expansion of red cells in circulation by approximately 25 per cent, 2)increased
stores required in anticipation of blood loss at delivery, and 3)demands of developing baby for iron stores (well-nourished
baby at birth has iron stores in liver that last for 4-6 months). Cessation of menstruation during pregnancy prevents the
monthly loss of approximately 20 mg. toward buildup of reserves. Virtually everything grown in the earth's crust contains
some iron. Most of the time, only about 20 per cent of iron ingested is actually absorbed. Absorption of iron is enhanced
by presence of adequate hydrochloric acid in the stomach, and by calcium and vitamin C in the diet. Occasional use of cast
iron cookware will boost iron intake higher than amount listed. When tissues are saturated and additional iron is not needed,
excess is excreted in feces (your stool will look very dark, nearly black, with extremely high doses of supplemental iron
from pills or tonics). Excessive iron intake can irritate the gut, causing nausea and/or constipation.
FATS (stored in body as adipose tissue, a metabolically active tissue once thought to be only a static deposit, located
in a layer just below the skin, in the abdominal lining, and in muscular connective tissue) -- 140-180 g. -- Groups 1,2,3,5,7,9
-- Concentrated source of fuel (9 calories per gram) for all the extra work of the body in pregnancy. Essential for the body's
absorption of fat soluble vitamins. Protects vital organs from external injury. Insulates body against rapid temperature
changes and excessive heat loss. Fat-related compounds affect the production of sex hormones and adrenal hormones--necessary
to support pregnancy--and the function of brain and nerve tissues. Help to maintain skin integrity by strengthening capillary
and cell wall structure, resulting in fewer skin eruptions.
CARBOHYDRATES (stored in very small amounts in liver and muscle) -- 350-400 g. -- Groups 1,3,4,5,6,8,12 -- Major source
of energy for the body (4 calories per gram). Carbohydrates must be consumed regularly and at frequent intervals to keep
energy availability optimal; the body stores only enough for about eight hours of moderate activity in pregnancy so if you
miss dinner, you are likely to have ketones in your urine at the doctor's office the next morning. Helps liver in detoxification.
Helps regulate protein and fat metabolism. Provides glycogen stores in the heart for contractile action. Brain and nervous
tissue contain no stored glucose, and therefore must rely on minute-to-minute supply from the bloodstream. Carbohydrates
provide a first-choice source of energy, thereby freeing proteins for their vital work in tissue-building: so to get the most
benefit from your protein intake during pregnancy you must eat heartily from foods high in carbohydrates. Because absorption
of glucose into cells is sodium-dependent, obtaining adequate amounts of sodium is essential also.
CORRECTIVE ALLOWANCES
Agnes Higgins, past president of the Canadian Dietetic Society and director of the Montreal Diet Dispensary [as of 1983],
has developed a procedure for estimating calorie and protein requirements in excess of the pregnancy levels we've already
established as a baseline. She emphasizes that any of the following factors increases a mother's nutritional needs:
As a corrective allowance, Mrs. Higgins and her staff counsel mothers to add twenty grams of protein and two hundred calories
to their basic daily pregnancy diets for each condition listed above (an individual mother may be experiencing more
than one of these stress conditions).
Multiple pregnancy is the only exception: each extra baby requires a nutritional supplement of thirty grams of protein
and five hundred calories per day. Higgins comments that this requirement can be met most economically by adding one
quart of whole milk a day to the expectant mother's diet (to be drunk, used in cream soups, custards, milkshakes, cream pies
and tarts, or as exchanges in yogurt, ice milk, and natural cheeses). Of course, there are many other ways to increase the
protein and calories during pregnancy by eating an additional four-ounce serving of meat, fish, shellfish, poultry, or meat
substitute as detailed on the diet list. A sample daily menu plan for a mother expecting twins would look something like
this:
Twin Brewer Pregnancy Diet (click for details)
You must have, every day, at least:
(plus 30 g protein and 500 calories for each additional baby):
Group 1 (milk and milk products)--8 choices
Group 2 (calcium replacements)--as needed
Group 3 (eggs)--2 choices
Group 4 (protein sources)--12 choices
Group 5 (dark green vegetables)--2 choices
Group 6 (whole grains, starchy vegetables & fruits)--5 choices
Group 7 (potato)--1 choice
Group 8 (vitamin C sources)--3 choices
Group 9 (fats and oils)--5 choices
Group 10 (vitamin A sources)--1 choice
Group 11 (liver)--Optional
Group 12 (salt and sodium sources)--unlimited, to taste
Group 13 (water)--unlimited, to thirst
Group 14 (snacks)--4 or more
Group 15 (supplements)--as needed
See here for more details on serving suggestions and portion sizes
See here for twin diet checklist for printing and putting on your refrigerator
Generally speaking, these conditions result in an increased appetite; however, women who are working, moving their
households, or under emotional stress sometimes fail to pay attention to their bodies' signals for more food. Calling
special attention to their extra needs by assigning specific goals for extra protein and calorie consumption makes it much
less likely that their nutritional needs will go unfulfilled.
At the Montreal Diet Dispensary, underweight is defined as weighing five per cent or more less than the weight recommended
for your height in the Table of Desirable Weights of the Metropolitan Life Insurance Company, a standard used for thirty years.
You should use the column for a "large frame" as the company recently disclosed that they have been underestimating all the
optimal weights on the chart by ten per cent ever since they first published it! If you really do have a large frame, use
the standard for the next taller height.
Undernutrition means any protein deficit between what you're used to getting from your food and the minimum adequate pregnancy
requirement (eighty to a hundred grams per day). The Higgins nutrition intervention method uses a twenty-four hour diet recall,
a technique you can use on your own to see how close your regular diet has been coming to what you actually need. You will
need to write down everything you've eaten for the past twenty-four hours (pick a typical day for you), including all
snacks, all beverages, and all second helpings. Note what the food was, how much you ate, then consult the Protein-Calorie
Counter (see Appendix) to check the amount of protein contained in those portions of those foods. For each gram of protein
you lack, add that to your personal protein goal, plus an additional ten calories to free that protein for its most important
work in pregnancy: keeping you own tissues healthy and building those of your unborn baby. If you come up with a deficit
of ten grams of protein, then, you also need to add a hundred calories to your basic requirements.
If you take supplemental vitamins and minerals, brewer's yeast, wheat germ, or other dietary supplements (such as protein
drinks, powders, or pills), be sure to take them with meals, since their absorption is enhanced in the presence of complete
foods, which provide enzymes necessary for their metabolism. Many people turn to these nutritional aids when they find they
have significant nutritional problems in pregnancy; however, it's important to keep in mind that a pill two or three times
a day cannot substitute for the foods on the Complete Pregnancy Diet list. These preparations must be viewed strictly as
supplements to a good diet, not the diet itself. There are many factors in food substances, such as enzymes, that
are not contained in pills or powders, and there may be other substances in foods that are essential to human life that have
not yet been isolated by nutrition scientists. So relying on the protective foods on the diet list is the best guarantee
of satisfactory pregnancy nutrition.
This food record chart should help you keep track of your daily progress on the diet. Just check off each requirement as
you meet it, day by day, week by week, month by month.
See the Brewer Pregnancy Diet Basic Plan Weekly Record here
If you encounter any difficulties with any aspect of the diet, or any questions about the nutritional management of your pregnancy,
you may telephone a national pregnancy nutrition hotline, co-sponsored by the Foundation for Perinatal Education and the Toxemia
of Pregnancy Foundation. The line is staffed twenty-four hours a day and referrals to pregnancy nutrition consultants can
be had for many parts of the country. The number: (914)666-5199.
May all your meals bring you and your family pleasure, an energetic pregnancy, and a strong baby born in excellent health.
Note from Joy: Unfortunately, I was unable to find either of these two organizations on the internet, so it's probably
the case that neither one still exists. If anyone knows otherwise, please let me know and I will post their contact information.
Eating for Two, by Gail Sforza Brewer and Isaac Cronin, available here
To Be Continued....
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