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The Brewer Pregnancy Diet

By Joy Jones, RN

The specifics of the diet (available at diet) were compiled by Dr. Tom Brewer, an obstetrician, after years of studying research on the effects of nutrition in pregnancy. He lived to see his philosophy used to prevent or treat various complications of pregnancy, including pregnancyinduced hypertension, pathological edema, eclampsia (toxemia), pre-eclampsia, HELLP syndrome, premature labor, anemias, placental abruption, intrauterine growth restriction (IUGR) and low birth weight. All of these problems have a common source— food deficiency and low blood volume.

The Importance of Blood Volume

One of the main functions of the pregnant body is to preserve the pregnancy and nourish the baby. The body’s ability to do this well depends a great deal on its ability to increase the mother’s blood volume. Normally, this blood volume is expected to increase by 50 to 60 percent by the end of the second trimester. From there, the body needs to maintain this expanded blood volume throughout the third trimester. For a woman with a pre-pregnant weight of 130 pounds, this would be a increase of about 2.1 quarts of blood (from about 3.5 quarts at the beginning of the pregnancy to about 5.6 quarts at the end of the second trimester).

The pregnant woman’s liver makes albumin to facilitate this expansion of blood volume. When albumin is in the mother’s bloodstream, it creates strong colloid osmotic pressure, which pulls extra fluid out of her tissues and into the blood circulating in her blood vessels. The only way that the liver can make this albumin is from protein eaten by the mother.

However, if the mother is trying to restrict her weight gain to someone’s “ideal” number—either by eating less food, or by going on a high-protein, low-calorie diet, much of the protein that she eats will get burned up for energy. Brewer found that when a woman eats one-third fewer calories than the 2,600 he suggested (about 1,700 calories), half of the protein that she eats gets used for energy. In that case, only 60 of her 120 grams of protein is available to make albumin (and baby cells, and uterine muscle cells), and she will probably have trouble expanding her blood volume adequately.

Salt also creates osmotic pressure in the bloodstream, which helps to pull extra fluid out of the tissues and into circulation. While salt restriction may be helpful for pregnant women who have unhealthy hearts or kidneys, it is dangerous in healthy women. A healthy woman’s taste buds are usually the most accurate indicator of the amount of salt she needs, and studies have shown that it is not possible for a healthy pregnant woman to eat too much salt. Her kidneys will simply excrete whatever extra salt that she eats. In fact, it has also been shown that after just two weeks of using salt in moderation, the expectant mother’s blood volume will begin to drop.

When a mother’s blood volume starts dropping, or simply stops increasing too early in the pregnancy, the body has no way of knowing that she is just eating less food than she needs. All the body knows is that the blood volume is less than it’s supposed to be. So it starts the same processes that it uses when the blood volume is dropping due to hemorrhage. The kidneys produce an enzyme called renin, which causes the arteries to constrict. During hemorrhage, this response is a stop-gap measure, decreasing the amount of blood in the limbs and sending more to the internal organs to keep the body functioning until help arrives. During pregnancy, however, when no hemorrhage is occurring, this arterial constriction causes a rise in blood pressure. Attempting to treat this rising blood pressure with a salt or weight restriction only causes the blood volume to drop even more, leading to further production of renin and more arterial constriction. And the blood pressure continues to rise.

Meanwhile, the kidneys are desperately trying to increase blood volume by reabsorbing as much water and salt as they can from fluid that they filter out of the blood. They return this reabsorbed fluid and salt to the bloodstream. However, since there isn’t enough albumin and salt in the mother’s blood to create enough osmotic pressure to hold this reabsorbed water in the circulation, much of it leaks out into the tissues. The kidneys keep reabsorbing water at one end of the process, and the water keeps leaking out of the capillaries at the other end. The mother sees rapid swelling in her ankles, fingers and face, and experiences rapid weight gain from the extra water in her tissues.

At this point, the mother is developing pre-eclampsia. If her nutrition is not improved quickly, or if diuretics are prescribed (in medications, herbal teas or supplements), her blood volume will continue to drop, and she will develop eclampsia (toxemia). Toxemia can culminate in convulsions, coma, HELLP and death. Many sources maintain that there is no known cause of toxemia, and therefore many practitioners continue to try to manage the situation by treating the symptoms alone, but they do so without success. The symptoms not only persist, but the mother will also continue to experience one complication after another.

Some pregnancy teas, supplements and juices contain nettle, dandelion, alfalfa, bilberry or celery—all of which have diuretic properties and should be diligently avoided in pregnancy. It is vitally important for pregnant women and those who care for them to understand that there is a huge difference between the edema and hypertension of non-pregnant people with heart or kidney disease and the edema and hypertension of normal, otherwise-healthy pregnant women. The edema and hypertenistockphotosion of the diseased body is caused by an abnormally expanded blood volume, and must be treated with therapies which help the body deal with that expanded blood volume—therapies which may include diuretics. The normal pregnant body that is developing pathological edema or hypertension is suffering from an abnormally contracted blood volume—and the only way to turn that condition around is to assist the body in its efforts to expand the blood volume again. Diuretics counteract the pregnant body’s efforts to increase the blood volume and can lead to the mother’s developing hypovolemic shock. Helping the pregnant mother to eat more calories, more salt and more protein is the therapy which will help her body expand its blood volume to the level needed to sustain a healthy pregnancy.