Excerpted from The Brewer Pregnancy Hotline by Gail Sforza Krebs and Dr. Tom Brewer  2000 Kalico Communications http://ebooks.kalico.net

                                                                            The Basic Diet

Following is the basic, carnivorous diet plan from The Brewer Pregnancy Hotline.   There are also questions and answers at the end.

PART 3, CHAPTER 2
THE BREWER PREGNANCY DIET: THE BASIC PLAN
Group 1 (milk and milk products)
Group 2 (calcium replacements)
Group 3 (eggs)
Group 4 (meat, seafood, and meat substitutes)
Group 5 (dark green vegetables)
Group 6 (whole grains, starches, carbohydrates)
Group 7 (vitamin C foods)
Group 8 (fats and oils)
Group 9 (vitamin A foods)
Group 10 (liver)
Group 11 (salt and other sodium sources)
Group 12 (water)
Group 13 (snacks)
Group 14 (supplements)
About this Program: This program is designed for you if you are expecting one baby and you have no significant additional protein/calorie requirements, based on your responses to the BrewerPregnancy Nutrition Profile (see Part Two of this book).
 

Group 1
Whole Milk, Milk Products and Milk Substitutes
Daily Exchanges: 4
[table of contents]
One exchange provides approximately 8 grams of protein plus considerable amount of calcium, fats,and other essential vitamins and minerals.
For each soy milk or other low-fat milk, yogurt or cottage cheese exchange you choose, add two extra exchanges from Group 7 (fats and oils). In addition, for each soy exchange, select two fromGroup 2 (Calcium Replacements). For every three soy exchanges, add one extra selection from Group 9 (Vitamin A foods).
 

GROUP 1 FOODS PORTION SIZE FOR ONE EXCHANGE
Cow's Milk buttermilk, from whole milk 1 cup (8 oz.)
evaporated, whole, reconstituted 1 cup
evaporated, whole, from can 1/2 cup
nonfat, dried powdered 1 cup
nonfat, reconstituted 1 cup
skim 1 cup
2% fat 1 cup
whole 1 cup
yogurt 1 cup
Cheese: Cheddar, Swiss, Muenster, Jack, mozzarella, Edam, Gouda, Brie, feta, etc. 1 1/4 oz.
Cottage or ricotta 1/4 cup
Parmesan or Romano, grated 3 Tablespoons
Ice Cream, Ice Milk
Ice milk 1 cup
Ice cream, homemade or all natural 1 cup
Other Milks, Soy Products
Goat's milk 1 1/8 cup
Soy milk, fluid, unfortified 1 1/2 cup
Soybean curd (tofu) 1 piece, 3" x 3" x 1/2" (approx. 4 oz.)
 

Group 2
Calcium Replacements
Daily Exchanges: as needed based on soy exchanges chosen
(2 per soy exchange from Group 1)
[table of contents]
GROUP 2 FOODS PORTION SIZE FOR ONE EXCHANGE
Almonds 2 oz. or 36 nuts
Anchovies 2 1/2 oz.
Beef tripe 3 oz.
Bok choy, cooked 1/3 cup
Brazil nuts 2 oz. or 12 nuts
Bread crumbs, wheat 3 1/2 oz.
Brewer's yeast 5 Tablespoons
Broccoli, cooked 1 cup
Buckwheat flour 3/4 cup
Carob powder 1/4 cup
Caviar, sturgeon 1 1/2 oz.
Collard greens, cooked 1/3 cup
Dandelion greens, cooked 3/4 cup
Dulse (seaweed) 1 oz.
Eggs, whole 4
Fennel 1 large stalk
Filberts 2 oz. Or 1/2 cup chopped
Herring 3 oz.
Kale, cooked 1/2 cup
Kelp (seaweed) 1/2 oz.
Molasses, blackstrap 2 teaspoons
Muffins, wheat or corn 2
Mussels 5 oz.
Mustard greens, cooked 1/2 cup
Okra, cooked 3/4 cup
Olives, black 4 oz.
Oysters 4 oz.
Pancakes, wheat 4 (5" diameter)
Peanuts, roasted 5 oz.
Pistachios 3 1/2 oz. Or 2/3 cup
Sardines 1 oz.
Scallops 3 1/2 oz.
Sesame seed meal 2 Tablespoons
Shrimp, cleaned 3 1/2 oz.
Smelt 1 oz.
Soybeans, cooked 1 cup
Soybean curd (tofu) 3 1/2 oz.
Soy flour, full fat 2 oz.
Soy flour, defatted 1 oz.
Soy protein, textured 3 1/2 oz.
Sunflower seeds 3 1/2 oz. Or 2/3 cup
Tortillas, made with lime 2
Waffles, wheat 3
Walnuts, English 2 oz.
Wheat germ 4 1/2 oz.
Note: There are other foods that contain a considerable amount of calcium, but because of other
factors present in those foods, such as oxalic acid, the calcium is unavailable to the body.
 

Group 3
Eggs
Daily Exchanges: 2
[table of contents]
One exchange provides six grams of protein, and vitamins and minerals in abundance, including one milligram of well-assimilated iron and 600 units of vitamin A, the anti-infection vitamin. Added together, the milk and egg exchanges provide a baseline of 44 grams of protein and a vitamin, mineral and calorie foundation for the rest of the diet.
GROUP 3 FOODS PORTION SIZE FOR ONE EXCHANGE
Egg, whole, any style 1
 

Group 4
Meats, Poultry, Seafood, and Meat Substitutes
Daily Exchanges: 6
Foods in Group 4 are exceptional sources of high-quality protein. One exchange provides approximately 7 grams of protein. Vegetable sources of protein are mixed in proper ratios to make their amino acid patterns equivalent to or surpassing those of animal sources. However, if you rely exclusively on grains, seeds, beans and other plant foods, you may be consuming fewer calories than are required in pregnancy, since these foods are low in fats. Therefore, for each vegetarian meat substitute you chose, except peanut butter, add two extra exchanges from Group 7 (Fats and Oils).
GROUP 4 FOODS PORTION SIZE FOR ONE EXCHANGE
Beef, any cut, cooked 1 oz.
Lamb, any cut, cooked 1 oz.
Pork, any cut, cooked 1 oz.
Organ meats: liver, heart, kidney, sweetbreads - cooked 1 oz.
Poultry: chicken, Cornish hen, duck, pheasant, turkey, goose - cooked 1 oz.
Veal, any cut, cooked 1 oz.
Delicatessen meat (thin sliced) 4" x 1/8" 1 slice
Frankfurter 1
Fish, fresh or frozen, cooked 1 oz.
Shellfish: clams, oyster, scallops, shrimp - cleaned 5 large or 2 oz.
Canned seafood: crab, lobster, salmon, tuna 1/4 cup
Sardines, canned 3
Anchovies 1 oz.
Cheese: hard or semi-hard, such as Cheddar, Gouda, Monterey Jack,
Mozzarella, Swiss, Blue, Camembert, Brie, Colby, Edam, Feta, Jarlsberg, Provolone 1 oz.
Cheese: American slices 2 slices
Cottage or ricotta 1/4 cup
Parmesan or Romano, grated 3 Tablespoons
Sample vegetarian substitutes (See BREWER VEGETARIAN DIETS below for complete list):
Soybean curd (tofu) 3 1/2 oz
Peanuts 1/4 cup
Peanut butter 2 Tablespoons
Beans with brown rice or bulgur wheat (uncooked) 1/4 cup beans; 1/2 cup grain
Seeds (sesame or sunflower) with rice (uncooked) 1/4 cup seeds; 1 cup grain
Beans with cornmeal 1/4 cup beans; 2 muffins
Beans and seeds 1/4 cup beans; 1/3 cup seeds
Potato, baked and stuffed or scalloped with cheese (or soy
products) 1 large; 1/2 cup milk, 1/2 oz. cheese
Noodles or bread (preferably whole grain) with cheese 1/3 cup, or 2 slices and 1/2 oz. cheese
 

Group 5
Dark Green Vegetables (preferably fresh or frozen)
Daily Exchanges: 2
[table of contents]
Foods in Group 5 are rich in vitamins and minerals such as A and the B complex, which is necessary to aid your body in making use of the protein provided by other foods. This is a reminder of the importance of a complete diet: All of the nutrients are needed to assist the others in making their full contribution to your well-being and that of your baby. This group also contains food fiber to promote normal digestion and bowel movements -- significant during pregnancy when constipation can sometimes be a problem.
GROUP 5 FOODS PORTION SIZE FOR ONE EXCHANGE
Broccoli, cooked 1 cup
Brussels sprouts, cooked 1 cup
Spinach, cleaned, raw 2/3 cup
Greens: Collards, turnip, beet, mustard, dandelion, kale -- cooked 2/3 cup
Lettuce, raw (Romaine is best) 1/2 cup
Endive, raw 1/2 cup
Watercress, raw 1/2 cup
Bok choy, raw 1 cup
Swiss chard, raw 1 cup
Sprouts, bean or alfalfa, raw 1/2 cup
Asparagus, cooked 1/2 cup
 

Group 6
Grains (preferably whole), Starchy Vegetables and High-Carbohydrate Fruits
Daily Exchanges: 5

Foods in Group 6 are prime sources of the carbohydrates you need to fuel your body. Each exchange provides approximately 12-15 grams of carbohydrate. If you consume too few carbohydrates, your body burns the protein you eat for energy, thus robbing you and your baby of the building blocks needed for tissue growth and repair. Grains are also sources of B vitamins. You may also obtain moderate amounts of carbohydrates from nuts (each ounce provides anywhere from 5 to 10 grams of carbohydrate) and other fruits and vegetables not in Group 6. These foods, while containing moderate amounts of carbohydrates, also provide other essential fats, vitamins, and minerals.  Note: Outside of Group 6 there are two other major sources of carbohydrates. The first is prepared foods such as frozen entrees, batter-dipped products, bottled gravies and sauces and other condiments, canned main dishes and soups (most of these contain added sugars and other carbohydrates in some form -- fructose, glucose, sucrose, corn syrup, cornstarch and other thickeners -- total carbohydrates per serving are noted on the labels). The second source of additional carbohydrates is the occasional non-diet soda pop, sweetened tea or coffee, candy, sugar, chips, snack foods, pudding, jams and preserves, honey, or baked goods, ice cream and frozen yoghurt, or gelatin desserts you may indulge in AFTER all your other exchanges for the day have been satisfied. These items would fall under Group 13 -- Snacks.
GROUP 6 FOODS PORTION SIZE FOR ONE EXCHANGE
Bread, (preferably whole wheat, oat, mixed whole grain or rye) 1 slice
Bagel 1/2
English muffin 1/2
Dinner roll or biscuit 1
Frankfurter or hamburger bun 1/2
Hard roll or sub roll 1/2
Corn tortilla, 6" diameter 1
Corn bread, 2" x 2" x 1" 1 piece
Corn or bran muffin 1
Egg noodles 1/2 cup
Pancake, 5" diameter 1
Waffle, 5" diameter 1
Crackers Buttery snack type 5
Graham, full oblong 1
Matzo, 6" x 4" 1/2
Saltines 6
Rice cakes, puffed type 2
Cereals
Shredded wheat 1 biscuit or 2/3 cup mini-wheats
Bran flakes (with or without raisins) 1/2 cup
Granola 1/2 cup
Boxed (preferably unsweetened) 2/3 cup
Puffed type 1 cup
Cooked (oatmeal, wheat, rice, etc.) 1/2 cup
Wheat germ 1/4 cup
Grits, cooked 1/2 cup
Popcorn, popped 3 cups
Pasta, cooked 1/2 cup
Rice, cooked 1/2 cup
Flour (as an ingredient or thickening agent in sauces) 2 1/2 Tablespoons
Cornstarch 1 Tablespoon
Chocolate (baking) 1 oz.
Tapioca, dry 1 Tablespoon
Vegetables
Corn kernels 1/2 cup
Corn on the cob 1 ear
Lima beans 1/2 cup
Parsnips 2/3 cup
Peas, green 1/2 cup
Potato, white 1 small
Potato, mashed 1/2 cup
Potato chips 15
Baked beans, canned 1/4 cup
Beans, peas, lentils, chickpeas/garbanzos, cooked 1/2 cup
Beets, cooked 1 cup
Carrots, cooked 1 cup
Carrots, raw 2
Cucumber 1 large
Onion, raw 1 (2 1/2" diameter)
Onion, cooked 3/4 cup
Pickles, dill 10
Pickles, sweet 2
Pumpkin, cooked 1/2 cup
Sauerkraut, prepared 1 cup
Winter squash, cooked 1/3 cup
Summer squash, cooked 1 1/2 cup
Sweet potato 1/2
Tomato, fresh 1 1/2
Tomato, purée 1/2 cup
Turnips, cooked 1 1/4
Water chestnuts 3/4 cup
Fruits
Apple 1/2
Apple juice (preferably unfiltered) 1/3 cup
Apple sauce 1/4 cup
Apricots, fresh 3
Apricots, canned 1/2 cup
Apricot nectar 1/3 cup
Avocado 1 cup pieces
Banana 1/2
Blackberries 1/2 cup
Blueberries 1/2 cup
Cantaloupe 1/2 melon
Cherries 1/2 cup
Cranberry juice cocktail, sweetened 1/2 cup
Cranberry sauce 1/2 Tablespoons
Dates 2
Figs, fresh or dried 1
Fruit cocktail, canned in juice 1/3 cup
Grapefruit 1/2
Grapefruit juice 1/2 cup
Grapes, purple 1 cup
Grapes, green or white 1/2 cup
Grape juice 1/3 cup
Honeydew melon 1/8 melon
Lemonade, from concentrate 1/3 cup
Mango 1/2
Nectarine 1 small
Orange 1/2
Orange juice 1/2 cup
Papaya 1/2 cup pieces
Peach, fresh 1
Peach, canned in juice 1/3 cup
Peach, dried 1/8 cup
Pear, fresh 1/2
Pear, canned in juice 1/2 cup
Persimmon 1/2
Pineapple, fresh 1/2 cup piece
Pineapple, canned in juice 1/3 cup
Pineapple juice 1/3 cup
Plantains, cooked 1/4 cup
Plum, fresh 2
Plums, canned in juice 1/3 cup
Prunes, cooked 3
Prunes, dried 3
Prune juice 1/4 cup
Raisins 2 Tablespoons
Raspberries, fresh 1/2 cup
Strawberries, fresh 1 cup
Tangerine 1
Watermelon 1 section, 2" x 5"
 

Group 7
Vitamin C Foods
Daily Exchanges: 2
[table of contents]
Vitamin C is important for the body's manufacture of collagen, the connective substance that holds tissues together. Without adequate C, your uterus is less strong and may not perform well in labor.  Vitamin C is also crucial in the body's defense system against infection.
GROUP 7 FOODS PORTION SIZE FOR ONE EXCHANGE
Cabbage, raw 1 cup
Cauliflower, cooked 1 cup
Cantaloupe 1/2 medium
Grapefruit, preferably pink 1/2
Grapefruit juice 2/3 cup
Lemon 1
Lime 1
Orange 1
Orange juice 1/2 cup
Papaya 1/2 cup
Pepper, green or red, raw 1
Potatoes, cooked in their skins 2
Strawberries, fresh 1/2 cup
Tangerines 2
Tomato 1 large
Tomato juice 1 cup
Tomato purée 2/3 cup
 

Group 8
Fats and Oils
Daily Exchanges: 5
Needed in your diet to help your body absorb the fat soluble vitamins, A, D, E, and K, fats and oils also contribute to fine-textured, well-functioning skin. They are also a concentrated source of calories, the food energy for which your need is greatly increased during pregnancy.
GROUP 3 FOODS PORTION SIZE FOR ONE EXCHANGE
Butter 1 Tablespoon
Mayonnaise 1 Tablespoon
Vegetable oil (olive, canola, corn, safflower, sunflower, peanut, etc) 1 Tablespoon
Avocado 1/4
Coconut, grated 3 Tablespoons
Peanut butter 2 Tablespoons
Chocolate 1 oz.
Sausage 1 link
Cream, light 1/4 cup
Cream, heavy or whipping 2 Tablespoons
Cream cheese 2 Tablespoons
Sour cream 1 1/2 Tablespoons
French fries 10
Potato chips 10
Lard 1 Tablespoon
Bacon, crisp 2 strips
Salad dressings 2 Tablespoons
Olives 10
Almonds, whole 20
Pecans, whole 4
Peanuts, whole 30
Walnuts 12
 

Group 9
Vitamin A Foods
Daily Exchanges: 1
[table of contents]
Vitamin A is known for its role in preventing infection. During pregnancy, when the pressure of the growing uterus on the bladder is constant, extra vitamin A helps protect you against bladder and kidney infections. During breastfeeding, it helps keep you free from breast infections.
GROUP 9 FOODS PORTION SIZE FOR ONE EXCHANGE
Apricots, fresh 3
Cantaloupe 1/2
Carrots, cooked 1/2 cup
Nectarines 3
Peaches, dried 4 halves
Pumpkin, canned 1/2 cup
Sweet potato or yam 1
Sour cherries, canned 1/2 cup
Winter squash, cooked 1/2 cup
 

Group 10 -- OPTIONAL
Liver
Recommended Weekly Exchange: 1

Liver is a powerhouse of nutrition, however today there are serious concerns about consuming these detoxification organs since commercially raised animals receive so many more hormones and antibiotics and other additives in their diets. Liver is not an ESSENTIAL component of the Brewer Diets. Note: Apart from the additives issue, liver is often poorly prepared and therefore unpalatable to many people. Isaac Cronin's Eating for Two: The Pregnancy Cookbook (New York: Bantam, 1983) has an entire section devoted to making liver more enticing. If you choose not to eat liver, add 4 additional ounces of protein per week.
GROUP 10 FOODS PORTION SIZE FOR ONE EXCHANGE
Liver: beef, calf, chicken, pork, turkey, liverwurst, or liver sausage 4 oz.
 

Group 11
Salt and Other Sodium Sources
Daily Exchanges: unlimited
Salt your food to taste. Cutting back on salt can cause a fall in the amount of blood circulating through your placenta, thus reducing the supply of nutrients passing to your baby. Too little salt in the diet leads to leg cramps as well, since all the muscles of your body require sodium for efficient functioning.  Note: If you grew up in the recent "no-salt age" (when all were advised to avoid salt in order to prevent hypertension and heart disease, your mom cooked without it, and it was never on the table, or if it was, you were frowned at for using too much), you may be accustomed to the unseasoned taste of foods and may not pay attention to your body's signals for more salt until they become extreme. The practice of adding salt to your food during pregnancy may take some getting used to, but it is an essential part of expanding and maintaining your extra blood volume throughout pregnancy.
GROUP 11 FOODS PORTION SIZE FOR ONE EXCHANGE
Table salt, iodized as desired, to taste
Sea salt as desired, to taste
Kelp powder as desired, to taste
Soy sauce as desired, to taste
 

Group 12
Water
Daily Exchanges: a minimum of eight 8-ounce glasses of beverages per day to unlimited
[table of contents]
Drink to quench thirst, but do not force fluids. Fruits, vegetables, and juices all contain a goodly proportion of water plus additional nutrients. Forcing water may fill you up without giving you much nutrition - a hazard in late pregnancy, when you have to make every bite count and you have less and less space in which to put the food. Diet beverages, coffee, teas, and imitation fruit drinks should be avoided for the same reason. If you are thirsty drink water or something nutritious (real juice or a milk beverage) or an occasional tea.  Note: If your drinking water is from a well, you may wish to have it tested by your health department before drinking it during pregnancy to make sure it does not contain contaminants such as MTBE,
PCBs, and/ or organisms such as giardia that can cause chronic intestinal upsets. Reports from the EPA published in 1999 and 2000 on water quality in the United States indicate that more than a third of all wells in the U.S. (some of them supplies for municipal water systems) contain higher than permissible amounts of these contaminants. Based on the results of your testing, you may wish to filter and/ or treat your drinking water.
GROUP 12 FOODS PORTION SIZE FOR ONE EXCHANGE
Mineral water, spring water, sparkling water, carbonated water, bottled water, flavored water, municipal water (tested), well water (tested) 8 oz.

Group 13
Snacks and Additional Menu Choices
Daily Exchanges: unlimited after completing Groups 1-12 daily
If you are still hungry after eating everything on the above lists first, you may eat more exchanges from Groups 1-11, or as much as you desire of other fresh fruits and vegetables, nuts and seeds, dried fruits or home-prepared baked goods and desserts such as custard, pudding, fruit tarts, fruit whips, milkshakes, or novelty breads. For recipe suggestions, see the BlueRibbonBaby.org web site.

Group 14 -- OPTIONAL
Supplements
Vitamin pills and other dietary supplements are not for everyone. If you are following the Brewer Pregnancy Diet diet to the letter, you probably don't need them. However, there are many women for whom a vitamin-mineral supplementation program is appropriate, especially with today's processed foods and depleted soils. If you find yourself bruising easily or your gums bleeding when you brush your teeth then you might do with some extra vitamin C, a gram or two a day. If you lost a good deal of weight before you became pregnant, if you were underweight before you conceived, if you were taking birth-control pills and not adding extra B vitamins (especially folic acid) to your diet to compensate for losses due to the Pill, if you bruise easily, if you are carrying more than one baby, if you are under stress, if you are a vegetarian, if you have any flu, colds, or other infections during pregnancy -- then you would be a candidate for supplementation. But even under these special conditions, it is preferable for you to eat more of the best foods than to rely on pills. Some researchers studying how well most commercial preparations are absorbed point out that most brands are incomplete and unbalanced in their formulation, making them of questionable help to you in attaining your nutrition goals, anyway.  Despite these drawbacks, Dr. Brewer provided standard prenatal vitamins to mothers in the Contra Costa (California) Medical Services toxemia prevention program. The supplements were included in the service package for mothers attending the public prenatal clinics. He looked on the supplements then as an "insurance policy" -- in case the mother went off the diet for a day or two when she went visiting somewhere, or if her food supplies became scarce toward the end of the month, or just because she happened to be an individual with higher nutritional requirements than some other people. The primary thrust, though, remains to encourage mothers to have all the foods needed first and to view any supplements strictly as additions to an adequate pregnancy diet, not as substitutes for one.  Because of increased media coverage of all aspects of nutrition, more people are aware that B
vitamins are helpful in stress situations, that vitamin E can relieve varicose veins and painful breast lumps (cystic mastitis), the needs women have for more iron than men (due to menstruation), and the controversies about how much protein is adequate and what are the best sources.
Protein
There's no denying that protein needs to increase dramatically in pregnancy. The best sources are foods, not powders, pills, or potions -- especially when you price them and discover that the same amino acids can cost four to ten times as much in pill form as in milk, eggs, nuts and grains, or meats and seafood. Also, much literature boosting pill-protein seems to accept that somehow a mother can make it through a pregnancy on half of the NAS-NRC Recommended Daily Allowances (RDAs) for a non-pregnant woman!  It is of no clinical or intellectual interest to determine the absolute minimum intake of nutrients that will keep a mother and baby just barely alive. Instead, the goal should be to ensure that every mother
and baby will have nutrition adequate for vibrant good health and a chance to make a contribution to society.  Bertha Burke, a nutrition researcher at Harvard University in the 1940s, showed conclusively that when mothers' dietary intake fell below 75 grams a day of high-quality, complete protein, their rates of serious pregnancy complications rose proportionately. In her studies, all the sickly, underweight babies came from mothers whose diets had been found deficient in protein and other vital nutrients.  So, in the Brewer Pregnancy Diet, 75 grams a day is the clinical "floor" for protein intake. Childbirth educators who incorporate the Brewer nutrition approach in their classes do protein-calorie checks at least twice during each series to keep the issue alive in the minds of their students as they go through pregnancy. The message bears repetition!  If you use the exchange system on this diet, your protein portions are already determined, and you will obtain all you need from high-quality sources. The figure, in grams, runs between 100 and 120 a day, depending on the specific food choices you make. That's the amount in the foodstuffs, but since certain proteins are assimilated less well than others, the total protein actually available to your body for tissue growth and maintenance is less. So, the end result is to approximate Burke's 75 grams and thus keep mothers and babies protected from protein-calorie deficits.
Iron
Iron, as previously discussed, is adequately provided by the foods on this diet. However, many women have not been eating this way before they became pregnant, so their iron stores are not what they should be. The use of cast-iron cooking utensils two or three times a day (for your morning eggs, your grilled cheese sandwich at lunch, and your evening vegetable), plus making sure to eat a food containing vitamin C with these dishes (orange juice with the eggs, a tomato in the salad with the sandwich, an avocado-based dip just before dinner) to boost iron absorption, will make it less likely that you will need to take iron supplements. If you are anemic at the beginning of your pregnancy, it may not just be a deficiency of iron that's wrong. It's pretty hard to be deficient in a single nutrient unless you are subsisting on an experimental diet in a laboratory somewhere. Your entire diet may need upgrading since it takes more than just iron to make red blood cells. We discuss the problems surrounding pregnancy anemias later on, but anyone who is anemic at the beginning of pregnancy needs a complete dietary work-up, not just a prescription for iron.
Vitamin E
Doses of vitamin E in the range of 200-400 milligrams per day alleviate many problems with varicosities of the legs, vulva, and anus (hemorrhoids) without any deleterious effects on the
pregnancy.
The B Complex
B vitamins are a family of nutrients that work together in many biochemical reactions in the body.  They should be supplied in supplement form only in correct proportion, one to another. Few B-complex tablets do this, instead offering a uniform 25 or 50 milligrams of each B vitamin. Milk  products, meat, and vegetables are excellent sources of these vitamins, so supplementing them isn't usually necessary, except in cases of severe nausea and vomiting (which sometimes responds to B6) or numbness and tingling of the hands (also B6), as indicated by the work of Dr. John Ellis of Texas.
Other Supplements
Vitamins, herbs and supplements are hot topics among the general public, childbirth professionals, and expectant mothers today. Many midwives prescribe calcium/magnesium tablets to ease labor, alfalfa to prevent hemorrhage, curb late pregnancy contractions and boost vitamin K levels in breastmilk, and herbs to reduce hypertension. The question arises: How often can you pinpoint and treat a particular deficiency to achieve a given outcome? While many of these treatments seem to be effective in practice, all are indicative of deficiencies in our overall diets. All the nutrients are vital to optimum health -- during pregnancy and beyond. All of them are involved in thousands of complex chemical reactions every time we eat, and deficiencies in any of them have disastrous consequences. Deficiencies of single nutrients are very rare -- find one deficiency, you'll find many more -- and all are sign of general undernutrition. The necessary vitamins and minerals should be available through the food we eat, and they are best assimilated by the body when they come from food sources...but
that is not always possible today because of poor eating habits, food processing and depleted soils.  That is why Dr. Brewer has always recommended that pregnant women look upon their prenatal vitamin as an insurance policy, but not the main source -- and do a good job in getting most of their nutrients from foods.
OTHER SUPPLEMENTS (that are also foods) PORTION SIZEFOR ONE EXCHANGE
Brewer's yeast 1 Tablespoon
One tablespoon a day gives you around 300 micrograms of folic acid -- about a third of your daily pregnancy requirement -- and 0.4 milligrams of zinc, a mineral that's easily lost because the body has no reserve in store and it leaves the body in perspiration. Just for good measure, it also gives you 3 grams protein, 1.4 milligrams iron, and a generous distribution of the B vitamins. Sprinkle it on cereal.
Molasses 1 Tablespoon
The darker, the better: One tablespoon of blackstrap sends 3.2 milligrams of iron your way. Spoon it on a bran or corn muffin or stir into baked beans.
Sunflower or safflower or walnut or wheat germ oils 1 Tablespoon
Three to eight times the amount of vitamin E of corn or soy or other vegetable oils is provided by these. One tablespoon of safflower oil has 8.5 I.U., sunflower 10, walnut 13 I.U. and wheat germ oil 28 I.U. Combine with olive or canola oil for salad dressings and reap the benefits.
Wheat Germ 1 Tablespoon
One tablespoon (toasted is fine) gives you B vitamins, 0.5 milligrams of iron, a couple of grams of protein, 3 milligrams zinc, and 4 I.U. of vitamin E -- an impressive assortment in such a small quantity of crunchy goodness. Sprinkle on cereal or into pancake batter.  If you are a vegetarian, you will find all these foods included on the vegetarian diet as required
exchanges in the next section of this chapter. They are optional on the basic diet.
 

THE BREWER PREGNANCY DIET -- THE BASIC PLAN AT A GLANCE
Group 1 (milk and milk products) - 4 choices
Group 2 (calcium replacements) - as needed (2 per soy choice)
Group 3 (eggs) - 2 choices
Group 4 (meat, seafood, and meat substitutes) - 6 choices
Group 5 (dark green vegetables) - 2 choices
Group 6 (whole grains, starchy vegetables and high-carbohydrate fruits) - 5 choices
Group 7 (vitamin C foods) - 2 choices
Group 8 (fats and oils) - 3 choices
Group 9 (vitamin A foods) - 2 choices
Group 10 (liver) - 1 choice per week
Group 11 (salt and other sodium sources) - unlimited, to taste
Group 12 (water) - unlimited, to thirst
Group 13 (snacks) - unlimited, to appetite
Group 14 (supplements) - optional
SAMPLE MENU PLAN: BREWER PREGNANCY DIET
If your first reaction is "I can't possibly eat all that food," you are not alone. Nor have you yet arrived at the point in your pregnancy when your appetite zooms and you find yourself hungry an hour or so after eating! Remember, you don't have to eat all the foods on the list every day -- just those you select to fulfill the required number of exchanges. One day's sample menu and snack plan from Isaac Cronin's Eating For Two shows that while it seems like a formidable amount to eat, proper spacing through the day makes it possible. One thing you will notice immediately is that there's hardly any room for anything that's not on the Brewer Pregnancy Diet list. If you are accustomed to a daily ration of junk foods, you will find yourself making changes to get all the nutrients you need. Start gradually to wean yourself from empty-calorie foods, and you'll be pleasantly surprised to find more than enough room for the best foods.
 

Breakfast
Orange juice
Corned beef hash with an egg
Bran muffins with butter
Postum® with cream or coffee lightener
Midmorning snack
Yogurt with fresh fruit
Lunch
Salad Niçoise
Whole wheat or rye crackers
Milk
Mid-afternoon snack
Peanuts or Almonds, salted
Milk
Dinner
Spinach salad
Moroccan Chicken (with almonds, prunes, and apricots)
Cous-cous
Milk
Dessert (before bed)
Honey Sponge Cake
Middle of the night
A serving of protein: a piece of cheese, a hard-boiled egg, a slice of meat, something left
over from dinner, to keep your blood sugar up and avoid a lightheaded or nauseated feeling
first thing in the morning.
Note: for a complete Nutrient Analysis of this meal plan see Chapter 3 of this section.
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THE BREWER PREGNANCY HOTLINE: PART 3, CHAPTER 3
THE BREWER PREGNANCY DIETS: QUESTIONS AND ANSWERS ABOUT THE BASIC PLAN

QUESTION 1. NUTRIENT ANALYSIS. [back to top]
How can I be sure, without totaling up my foods every day, that I'm getting all the nutrients I need?
ANSWER 1. NUTRIENT ANALYSIS.
All the analyzing is already done for you by the diet list. Each exchange is the nutritional equivalent of every other exchange in its group. All you have to keep track of is whether you have eaten the required number of exchanges in each group each day. Just for the record, let's break down the sample Brewer Pregnancy Diet menu into some of its major nutritional components to see what it contains.  While it might be fascinating to see what's really in the foods we eat, just spending a few minutes looking over this table gives us a hint of the complexities involved whenever we enjoy a meal. And this table only represents eight of the fifty-two nutrients known to be essential to the health of human beings! Trying to chart all fifty-two -- and the staggering number of biochemical interactions among them as they are metabolized by the body -- would probably tax the capacity of even the most sophisticated computer.  Nutritionists are keenly aware of the problem, hence their development of the concept of food exchanges. Keeping tabs on a few food groups is certainly much simpler than taking hours every day figuring out portions, nutrients in each, and proper balance among the groups. And, for ordinary purposes, it's a very effective way to monitor your diet. Of course, if you were involved in metabolic research or investigations of a newly discovered compound, much closer calculations would be required, and other types of laboratory tests could be done to determine exactly how much of the given substance was provided in a given amount of food.  But you are not in a research setting. Your goal is simply to make sure you obtain sufficient amounts of the nutrients known to be required for pregnancy. And the proven way to accomplish that goal is to take care of your daily food exchanges.  On this particular day, for example, the nutrients we've analyzed stack up this way in comparison to amounts suggested by the National Academy of Sciences-National Research Council. By the way, their reference woman is between the ages of eighteen and thirty-five, weighs 128 pounds, is five feet four inches tall, lives in a temperate climate, is moderately active, and is healthy. Many nutritionists point out that large numbers of women vary widely from this reference standard, and so the NAS-NRC figures should be viewed only as averages.
KEY NUTRIENT SAMPLE MENU:
BREWER NAS-NRC REFERENCE
Calories 3,300 2,300
Protein (gm.) 143 76
Iron (mg.) 23 18
Calcium (gm.) 1.9 1.2
Vitamin A (I.U.) 17,000 5,000
Vitamin C (mg.) 387 60
If you didn't feel like having the afternoon snack, or you skipped the before-bed cake and milk, you might have 300 or so fewer calories (and a corresponding drop in all the other nutrients in those foods), but even so, you'd definitely wind up ahead of the minimal NAS-NRC amounts.  Appendix III includes a food exchange checklist, keyed to the diet, designed so you can record your progress over a week's time. Duplicate this page for as many weeks as you have left in your pregnancy, and set a daily goal of filling in each box. If you tape the checklist to your refrigerator, your older children will enjoy reminding you every night what you still need before they let you go to bed! In hospitals today, the obstetrics suite is outfitted with fetal monitors that give a beat-to-beat analysis of your baby's response to labor. This chart gives a bite-to-bite analysis of how you're doing on your Brewer Pregnancy Diet.
 

QUESTION 2. UNLISTED NUTRIENTS.
This looks great for the nutrients listed, but what about others, like vitamin E and folic acid and zinc? Aren't they important, too?
ANSWER 2. UNLISTED NUTRIENTS.
Every essential nutrient is important. Your body doesn't function properly if even one is in short supply. That's why this diet encourages generous portions of the most nutritious foods, and why there are a wide variety of food choices within each food group. By selecting several different foods from each group every few days, you will cover all bases: The major nutrients and those you need in much smaller quantities will be present in the foods you eat.  For instance, the sample day's menu we've been looking at provides 1 milligram (1,000 micrograms) folic acid, 25 I.U. of vitamin E, and 25 milligrams zinc. The NAS-NRC reference standards for these nutrients are 800 micrograms, 15 I.U., and 20 milligrams, respectively. Of course, your actual rate of absorption of all nutrients varies depending on how they are combined in the diet, your state of health, and your biochemical individuality. This is another reason why it is important to provide a margin of safety in the diet by allowing intakes somewhat higher than the absolute rock bottom needed to scrape through pregnancy.
 

QUESTION 3. PROTEIN INTAKE.

I've read that that too much protein is harmful. What is the upper limit of safety in pregnancy?
ANSWER 3. PROTEIN INTAKE.
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 concern 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 rates with no difficulty whatever. In short, you can't overdose on the levels of protein the Brewer Pregnancy Diet provides - and probably not at levels significantly higher, either.  This was proved conclusively with regard to pregnancy in the 1930's. Dr. Maurice Strauss, a noted internist at Harvard Medical School, 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, this this amount of protein is not included in the Brewer Pregnancy Diet every day, but Strauss' work makes the point that protein per se will not poison you or your unborn baby. The real problem, which is encountered over and over in discussing various aspects of pregnancy, is protein deficiency in pregnancy, not protein excess.

QUESTION 4. CALORIE INTAKE/ PROTEIN-CALORIE RELATIONSHIP.
Three thousand calories! That's almost twice my usual. Why does pregnancy require so much more?
ANSWER 4 . CALORIE INTAKE/ PROTEIN-CALORIE RELATIONSHIP.
The main reason is to provide plenty of fuel for your body's daily work so that you won't start using up the protein you eat to do the same thing. If you don't have enough calories, your body automatically burns some protein to make up the difference. When this happens, that protein cannot be used for the job that it alone can do -- growth and maintenance of body tissues (i.e., growing your baby's body and brain and supporting all your own body systems in tiptop form). So you slide into a protein deficit, even though it seems that you are getting plenty from your diet when you just calculate protein grams.  This has been a long-standing problem for women because for years a high-protein, reduced-calorie diet was in vogue for pregnancy. This happened because doctors thought that by controlling weight gain they could prevent toxemia of pregnancy. The emphasis on weight control became fixed in obstetrics long before nutrition science worked out the crucial relationship between protein and calories.  Confusion about the role of calories in pregnancy is still the number-one concern of Brewer Hotline callers. The typical situation involves a mother who's been told to eat 90-100 grams of protein a day, but only 1,800 calories, a standard diet that many midwives and doctors give to mothers at their first prenatal visit. It appears to be an excellent diet, as far as protein level is concerned. But if, for example, the mother's energy needs are for 2,600 calories, she turns up 800 short. And more research is endorsing the 2,600-3,000-calorie range for the best obstetrical outcomes now that strict weight control regimens have been linked to low-birth weight babies and higher rates of toxemia and stillbirth. Should she happen to be working full time or carrying on a very vigorous sports program (or looking after three or four other children), her calorie needs might be upped by a thousand per day. Seldom has the mother's individual activity pattern been evaluated. She has just been handed a
printed sheet or a small booklet and told to follow what it says. End of discussion. She calls the Brewer Hotline when she starts feeling tired or weak or her blood pressure goes up.
Here's what nutritionists know about protein and calorie interaction: If you are not obese and your calories are one-third less than what you need (roughly the situation of our caller), then half the protein you eat is going to be burned for energy! So your 90 grams of protein are whittled down to 45 -- far below the 75 grams that Burke and others have identified as the bare minimum for a nutritionally secure pregnancy. This is serious business because this is serious malnutrition - disguised as a sound diet. There is another consideration. It's virtually impossible to obtain all the other essential nutrients you need in pregnancy on such a calorie-restricted program. Iron, zinc, folic acid, vitamin E, and many others are undersupplied. This probably explains how doctors began the practice of prescribing pills to provide these nutrients. The diets they were using just weren't complete. Advances in understanding of pregnancy nutrition keep escalating the numbers in the vitamin and mineral columns, so calorie intake must also increase from the additional foods you eat to meet the additional nutrient requirements. Furthermore, every day nutritionists begin research into other factors essential to human nutrition, such as enzymes, which aren't to be found in any pill. They only come in food, another reason eating nutritious meals is preferable to swallowing a handful of pills every day. The calories you obtain from your food are protective. Eat the nutritious foods on the diet to appetite and you will satisfy the basic pregnancy requirements. Keep in mind, though, that you may need more because of a variety of stress situations discussed later in Part Five, or because of the demands of your job or lifestyle (as identified in your responses to the Personal Nutrition Profile in Part Two).

QUESTION 5. NUTRITIONAL NEEDS OF OVERWEIGHT WOMEN.
Do overweight women need all those calories, too?
ANSWER 5. NUTRITIONAL NEEDS OF OVERWEIGHT WOMEN.
Maybe not, but they certainly need all the other essential nutrients on the charts -- all the protein, vitamins, minerals, fiber, fats, and water. The Brewer Hotline gives overweight women the same advice as that given to women of average weight for their height: Eat to appetite nutritious foods from the Brewer Pregnancy Diet list.  Most often, people become overweight by eating the wrong foods, those that provide lots of calories but not much else in the way of nutrients. You know the kind of foods in this category -- candy, cake, pies, cookies, commercial snack foods, sugared soft drinks and imitation fruit punches, alcoholic beverages, fruits packed in heavy syrups, and all the sweeteners: sugar, honey, molasses, corn syrup,
maple syrup. These fill you up, but don't contribute much besides calories to your pool of necessary nutrients. An occasional candy bar isn't going to make you fat, nor is it going to harm you or your baby during pregnancy. What does cause problems is the habitual use of these products, to the point where they begin to squeeze other foods from your diet because they satisfy your appetite without meeting your body's nutritional needs.  When the woman who is truly overweight at the beginning of pregnancy (say, more than 20 percent over her best weight) goes on this diet, she may actually be getting fewer calories than she was eating before, although the amount of food has increased. That's because this diet is high in fresh fruits and vegetables and whole grains, all of which take up more room in the stomach for far fewer calories than a high-sugar diet does. So her nutritional status is improved dramatically by all measures, and she may lose a few pounds or stay about the same over the course of pregnancy - without ever being hounded about pounds or placed on a strict calorie-watching program. The focus here is on ensuring that the overweight mother corrects her nutritional problems. Her weight problem usually follows suit. Over the course of pregnancy she can use up some of her stored calories (that is, fat), and she and her baby will be perfectly healthy as long as all her protein, vitamin, mineral, and other nutritional needs are met by her diet. Exercise helps, too. Agnes Higgins, the pioneering director of the Montreal Diet Dispensary and a luminary in the field of pregnancy nutrition, always commented in her spirited lectures that she loved to see a plump woman come into her clinic! It meant she wouldn't have to worry about calorie deficiency, the way you must when you are working with a thin, underweight woman who has no calorie reserves at the start of pregnancy.  These are the basic principles of nutrition education for overweight mothers. Overweight mothers who are properly managed with regard to their nutritional needs are not automatically at high risk of pregnancy problems, though many medical people believe this to be so. In the experience of many
practitioners and researchers including Dr. Brewer, an overweight mother whose nutritional problems are dealt with positively can be removed from the high-risk category.
 

QUESTION 6. EXCESS WEIGHT GAIN.
Doesn't the advice "Eat to appetite" give women license to eat anything they want -- and gain lots of extra weight they'll never be able to get rid of once pregnancy is over?
ANSWER 6. EXCESS WEIGHT GAIN.
Absolutely not. The message of this book is NOT : "Eat to appetite." The message is: "Eat to appetite nutritious foods from the diet list." That's quite a different message! The Brewer Pregnancy Diet does not promote obesity, during pregnancy or at any other time. Your appetite for food, by the way, is not unlimited. Your "appestat" is a regulating mechanism that controls, with remarkable consistency, how much food you desire.  This is a normal feature of the adult human body that enables us to maintain weight to within a few pounds one way or the other most of the time. Granted, some people have cravings for food that exceed all normal bounds, and there are many others for whom eating on and off throughout the day
has become a habit. These are disturbances in normal appetite that may reflect other kinds of problems -- anxiety, depression, grief, boredom -- that need to be resolved. Some people get into the constant-eating syndrome as the result of breaking the cigarette habit. But by far the vast majority of adults arrive at a weight they can maintain, at which they feel the most energetic and stay the most healthy, without continuously monitoring every calorie they consume. Their appetite is the regulator.  It also works the other way: Your appetite usually picks up when you spend a few days at hard physical work (just think of the traditional lumberjack of folk tales). This prevents you from losing excessive weight. During pregnancy you may have a ravenous appetite, even if you have never been a big eater, just because you have so many more metabolic demands than ever before. This is especially true for women who begin pregnancy underweight -- they may gain 20 pounds in the first four or five months, which only brings them to what they should have weighed to start with. They may then go on to gain another 20 to 40 pounds -- the range that most women fall into for a pregnancy gain. They, too, have been eating nutritious foods from the diet list to appetite: the same advice we've given to women of average and extra weight.

 

QUESTION 7. TOTAL WEIGHT GAIN.
So, there's no set number of pounds that's healthy to gain in pregnancy?
ANSWER 7. TOTAL WEIGHT GAIN.
Right. And this is one of the hardest ideas to grasp, since women and their doctors as well have been conditioned to accept the scale as the infallible arbiter of how well their pregnancies are going. The numbers on the scale do not differentiate the kind of weight gain (or loss). Nobody can tell, just from weighing you, whether the 6 pounds you gained this past month represents additional fat, muscle, water, or baby - or a combination thereof. In Norway, you can go for a series of twelve prenatal visits and never once be weighed! And, except for identifying the mother who is thin and failing to gain, it is hard to justify the dreaded weigh-in at every prenatal visit. All it contributes to most prenatal visits is anxiety on the part of both mother and health workers.  The number of pounds shown on the scale is absolutely irrelevant to the outcome of pregnancy. What does matter is the adequacy of the mother's nutrition. What she needs to be asked about, in detail, at each visit is whether she's having any problems following the diet and whether she's facing any additional demands that might make the basic diet inadequate for her own life situation. Far better to have every woman bring in her own food record sheets (kept a couple of days each week, as a sample) and have them looked over by the midwife or doctor than to spend five minutes in a harangue over what the scale shows. Keeping a careful watch on the nutritional components of the diet is the key to successful pregnancy, not trying to force every mother into some statistical average of pounds gained or pattern of pounds gained.  All the well-done research supports Dr. Brewer's clinical observations and patient records on this, by the way. In the most comprehensive of such studies, and one of the few in which the nutrition of the pregnant women in the study was actually accounted for, the distribution of weight adjustment over the last half of pregnancy followed the pattern shown in the chart below (this chart also appears in Part 1, Chapter 4).
 

CHART #1. DISTRIBUTION OF MATERNAL WEIGHT GAIN IN NORMAL PREGNANCY
--
SECOND HALF OF GESTATION
Source: Hytten, F. E. and Thomson, A. E. Maternal physiologic adjustments. In Maternal Nutrition and the Course of Pregnancy. Washington, DC: Committee on Maternal Nutrition. Food and Nutrition Board, National Research Council - National Academy of Sciences, 1970. In this study by Dr Frank Hytten, published by the National Academy-National Research Council, all the mothers were normal, all the pregnancies were uncomplicated, the deliveries went well (no Cesareans), the babies were healthy, and the postpartum course for all mothers and babies was smooth. All of the mothers had been advised what a good pregnancy diet was, none was restricted in any way, they were encouraged to salt their foods to taste, and no diuretics or amphetamines or other appetite-control drugs were used. The goal of the study was to find out what a completely normal woman could expect to gain over the course of a well-nourished pregnancy. The researchers, who had hoped to present a scientifically determined number that could then be used as a standard for all pregnancies, were sorely disappointed when this bell-shaped curve emerged from the computer!  Though all mothers, babies, pregnancies, labors, and postpartum courses had gone well, there was an
enormous range of weight lost and gained over the last twenty weeks of the pregnancies studied. On the left side of the chart, a very small percentage of the mothers (2 percent) actually lost an average of a quarter-pound each week over the last twenty weeks of pregnancy -- for a total loss of 5 pounds.  In the center of the chart, the mean weight gain (attained by 25 percent of the women) averaged a pound per week each week over the last half of pregnancy -- for a gain of 20 pounds in the last twenty weeks. This, incidentally, is two pounds more than many obstetricians held to for years (the old 2-pounds-a-month rule) for the entire pregnancy.  On the right side of the chart, another 2 percent of the mothers gained, on the   average, two pounds a week in the last twenty weeks -- a total gain of 40 pounds, presumably added to whatever the mothers had put on in the first half (perhaps another 10 to 20 pounds). And none of them got sick, had premature babies, or any other pregnancy problems -- because they were on adequate diets. Their pounds were healthy pounds, gained on sound diets composed of nutritious foods.  Thinking further about this issue, it's tempting to try to figure out who might have been in the weight-loss group and the 40-pound-gain group. From experience with callers to the Brewer Hotline, it's likely that the mothers who tolerated a weight loss and still produced healthy babies must have been overweight to start. Those who gained 40-plus pounds in the second half pregnancy could have been any of the following: the thin, underweight woman who really ate well;  the mother with twins or triplets who had exceptional needs because of having to nourishmore than one baby; the mother who followed the basic diet, but who led a very sedentary life and so stored some of the extra calories she didn't burn up in exercise or other activities; the enthusiastic eater who just ate a great deal of nutritious foods -- more than she really needed to support her pregnancy;
the mother who ate the basic diet, plus extra high-caloric snacks she loves (candy, hot fudge sundaes, cheesecake, etc.), even though she didn't really need them to satisfy her hunger. All
her nutritional needs were met, but she gained extra pounds from non-diet snacks.  All of this goes to show that there is no set number of pounds that any one person should gain in
pregnancy. If you are pregnant today, you need to pay close attention to your diet, maintain a moderate activity level, and just stop worrying over pounds. You will gain (or lose) what's right for you.

QUESTION 8. WEIGHT LOSS AFTER PREGNANCY.
Suppose there are 25 pounds left over after the baby's born? What then?
ANSWER 8. WEIGHT LOSS AFTER PREGNANCY.
Give yourself a reasonable time to take the weight off. After all, it took nine months for it to accumulate. Nine months (not six weeks) after your baby weans is a far more realistic time frame for returning to your pre-pregnancy weight. When you are breastfeeding, you still have to provide all your baby's nutrients from the foods you eat, so your appetite is likely to continue in high gear until your baby starts taking nourishment other than breast milk as part of his or her diet. If you get regular postpartum exercise, your weight should gradually taper down to what it was before you became pregnant.  The bottom line has to do with your baby's health and development, not just as a newborn, but for life. If you have to choose (and you really don't have to) either having a few extra pounds for a few months and a normal baby or getting right back into designer jeans and a lifetime of caring for a retarded or developmentally handicapped baby, it seems to us that the choice is obvious. The problem for most women is that nobody ever told them that their diets really made that much difference, so the near obsession to avoid becoming overweight has been the top concern of everyone, medical professionals included.

QUESTION 9. SALT TO TASTE
So often we hear that too much salt is bad for us and that we should be cutting down on it. Why, then, do you say pregnant women should salt their food to taste?
ANSWER 9. SALT TO TASTE.
The last word on salt for non-pregnant people probably hasn't been written yet, but it definitely has for pregnant women. You need more of the sodium it contains when you're pregnant --ever-increasing amounts, actually, as your pregnancy progresses. Sodium helps keep your placenta adequately supplied with blood, enabling it to pump nutrients to your developing baby. The salt you shake on your food is just one source of the sodium you need. There is also a good amount in most high-protein foods, such as milk, meats, and seafood, and in some vegetables. Of course, the more highly processed foods you eat, the more sodium you're likely to be getting, since salt is used in these products both as a flavor enhancer and as a preservative. If you are a vegetarian and think you've been avoiding sodium by eliminating salt from cooking, but you use kelp powder and soy sauce for seasoning, you're getting essential sodium from both.  Your body signals when it needs more sodium by the taste buds on your tongue and in your cheeks that are sensitive to salt. When you need more, your food tastes flat and unappetizing, and so you add some salt. This is what is meant by "salting to taste". No one is suggesting that you coat everything you eat with a mantle of salt! (Although even if you did, it wouldn't do you any harm as long as your heart and kidneys are healthy and you take in enough fluids to keep your body in balance).  You have numerous mechanisms in your body to do just that, pregnant or not, because none of us takes in exactly the same amount of sodium day by day. There are wide variations, both in sodium supplied and in sodium needed. The temperature has a lot to do with how much you need on a daily basis. When it's hot, you lose up to 20 grams of sodium a day in your perspiration. This must be replaced in your diet; otherwise your blood levels of sodium fall to perilously low levels.  That is just one example. By the same token, if you are in an air conditioned building and happen one day to eat lots of foods that are high in sodium, it would be possible for your blood levels of sodium to rise too high - except that your kidneys act to eliminate the excess through your urine before it does any harm. This action in the kidneys is automatic, one of the many self-regulating features of our bodies that most of us know little about but which protect us from danger hundreds of times a day.  During pregnancy you need sodium to keep the correct concentration in your bloodstream (the amount of water in your blood that needs to be balanced increases by about 60 percent by the end of your pregnancy); to keep the correct concentration in the amniotic fluid that surrounds your baby (and that the baby drinks); to aid your heart, which is just a muscle, after all, and like all muscles needs more sodium when called upon to do extra work (like pumping all that extra blood around for
months); and to help your leg muscles, which carry your extra weight (and often respond to a lack of sodium by cramping very painfully -- usually just after you've fallen asleep at night).
Incidentally, the Brewer Hotline is not the only source encouraging pregnant women to salt their food to taste. Ever since 1977, the American College of Obstetricians and Gynecologists (ACOG) has officially agreed. The 1977 manual that explained basic guidelines for ACOG members, Standards for Ambulatory Obstetric Care (Chicago) stated: "Sodium is required in pregnancy for the expanded maternal tissue and fluid compartments as well as to provide for fetal needs. The normal patient may use the level of sodium she prefers. Routine sodium restriction is not advised."  This was big news when it was published because for years routine salt restriction was the order of the day in obstetrics. Even now, 23 years after the ACOG changed its advisory to the profession, popular magazines, newspapers, and other media also sometimes publish an article or small feature in a pregnancy column giving women hints on how to follow a reduced sodium diet in pregnancy.  

 

QUESTION 10. WATER RETENTION.
But if I salt my food to taste for nine months, won't that cause a lot of swelling from excess water retention? Many women cut out all added salt during the last few days of their menstrual cycles, anyway, because it helps get rid of that bloated feeling. Aside from the discomfort, isn't swelling a danger sign in pregnancy?
ANSWER 10. WATER RETENTION.
It certainly can be a danger sign - but only when the swelling is caused by not eating enough of the right foods (including sodium-rich ones) or by a medical condition that would cause swelling in a non-pregnant woman or a man as well, such as heart failure or kidney disease.  The swelling that accompanies the normal course of pregnancy while you are on the Brewer
Pregnancy Diet is attributable to an entirely different cause - your healthy, well-functioning placenta. The same hormones that you've noticed make you swell up somewhat just before your period (some women hold an extra 5 to 7 pounds of water) are made in ever-increasing amounts by your placenta as pregnancy goes along. By the eighth month, in the well-nourished mother, the placenta makes every day the equivalent of the hormones in a hundred birth control pills! This swelling is not hazardous to you or to your baby. In fact, it's a natural way for your body to prepare for labor and breastfeeding by storing fluids you may need to avoid dehydration if your labor lasts a long time and to establish and maintain quality milk production.  Though all swelling may look the same, the situation inside your body is critically different when you are swelling on a good diet. On a nutritionally sound diet your liver has all the building blocks it needs to manufacture adequate amounts of a protein, albumin, that holds water in your circulation -- the primary means by which your increased blood volume needs are met during pregnancy. The larger volume of nutrient-rich blood servicing your placenta results in the larger production of female hormones and, so, more water retention than in a mother with average nutrition. It is possible for your tissues to hold 10 to 15 pounds of fluid for this reason without causing much change in your appearance -- perhaps the fine lines in your face disappear and your rings feel somewhat tighter.  This "hidden" water retention in the well-fed pregnant woman (plus the increased size of her baby) has seldom been accounted for in the charts that break down the components of average weight gain in pregnancy, so they typically show a total of 24 to 28 pounds, whereas women on the Brewer Pregnancy Diet gain, on the average, 35 to 45 pounds. Of course, many women gain less and many gain more based on their pre-pregnancy weights, metabolism, and activity level. It is not correct to
use the average as a rule (either as a floor or as a ceiling) for weight adjustment in pregnancy: It only demonstrates that the average figure used elsewhere fails to consider the additional, beneficial water retention that comes with an adequate diet.  When your diet is not meeting your nutritional needs, the internal events are exactly the opposite. If the liver is undersupplied with the nutrients needed to produce albumin (and this is one of the most complicated functions the liver performs, so it's one of the first to go when nutrients are scarce), it cuts back. This decrease in production is detectable by analyzing a sample of blood: anything below 3 grams per 100 cubic centimeters of serum indicates a problem. With less albumin circulating and drawing fluid into the circulation, water that should be held inside your blood vessels cannot stay there. Instead, it leaks out into your tissues. Voilá! You're swelling up, and the scales tell you about the water you're retaining -- but they don't tell you where it is. Nor do they tell you that your blood volume is falling below the needs of healthy pregnancy and that your placenta is starting to malfunction because of the reduced amount of blood flowing through it. The pregnant woman on a poor diet (or even one on a basically nutritious diet who is not eating enough to meet her calorie needs) is not swelling from the influence of an increase in female hormones generated by a generous, healthy placenta. She is experiencing a shift of essential body fluids out of her circulation and into her tissues. If the situation continues, her other critical body organs, like the kidneys, liver, heart, lungs, and brain, become adversely affected by the dwindling blood supply (the kidneys respond, for example, by raising the blood pressure), and her baby begins to suffer intrauterine malnutrition. Most commonly this situation is diagnosed after a few weeks when the baby's failure to grow is noted at subsequent prenatal appointments. The medical terminology for this condition is intrauterine growth retardation (IUGR). If caught early enough, the situation can be reversed with appropriate nutritional intervention -- by getting the mother on a diet suitable for her pregnancy needs and keeping her on it for the rest of her pregnancy. This includes salting to taste.  This interconnection between the foods you eat, how your liver works to keep your blood volume
expanded, and the transfer of nutrients to your baby via the placenta is central to every successful pregnancy. It is impossible for anyone to evaluate what's happening internally from looking at your swelling or pressing your shinbone to see if you have water retention. Laboratory work measuring your blood proteins and hematocrit reading must be done before any diagnosis is made. Swelling on a good diet is a sign of health in pregnancy. So, salt to taste as an integral part of your pregnancy nutrition program. Do not restrict salt. Do not take diuretics or appetite suppressants to control your weight. Any of these actions is a direct attack on the expansion of your blood volume and places you and your baby in jeopardy for the most serious pregnancy complications.
 

QUESTION 11. OVER-EXPANDED BLOOD VOLUME AND SODIUM RESTRICTION.
The ACOG statement says "normal" patients can use all the salt they want. When would a pregnant woman have to restrict salt?
ANSWER 11. OVER-EXPANDED BLOOD VOLUME AND SODIUM RESTRICTION.

The only indication for this would be if the mother had any medical condition that was causing an over-expansion of fluid beyond the needs of pregnancy in her circulation. The major problems that cause this are failing kidneys or heart disease. These mothers have an excess of fluid in their circulation, and sometimes in their lungs as well, which means that by cutting way down on salt and all other foods containing sodium -- plus some judicious diuretic therapy, in most cases -- the excess fluid can be mobilized and eliminated. Of course, such a mother should be in the hospital, where her condition can be carefully monitored and controlled.  All medical authorities now agree that salt restriction is not warranted in cases where the blood pressure is rising, unless there is also this excess fluid buildup beyond the expansion required for pregnancy in the bloodstream. Dr. Brewer discusses more about this aspect of medical management of complicated pregnancies later in PART FIVE : HIGH-RISK PREGNANCY.

QUESTION 12. SODIUM SOURCES.
Does it make any difference if sea salt or refined salt is used?
ANSWER 12. SODIUM SOURCES.
No. Both contain the same amount of sodium, which is what is of primary interest here. However, some people prefer to avoid the additives in refined salt (added to make it easier to pour, for example) and so prefer sea salt. All salt, of course, was at one time in the sea, and sea salt retains all the trace minerals that naturally occur, including iodine. The trace minerals are stripped from refined salt in production, so make sure you select iodized salt when you buy it. This is especially critical in areas of the country where the level of iodine in the soil is low and people don't get iodine in their diet from any other source. Women who use soy sauce as a staple in meal preparation or kelp power are also obtaining the naturally occurring sodium in these products without using the salt shaker.
 

QUESTION 13. ORGANIC FOODS.
What about additives and preservatives? Should pregnant women try to eat only organically grown food?
ANSWER 13. ORGANIC FOODS.
Avoid as many questionable chemicals as possible in pregnancy. That's just a basic rule of thumb. If you have a choice between sprayed and unsprayed produce, take the unsprayed. Fresh or frozen vegetables are preferable to canned, just because of the loss of nutrients involved in the processing and the likelihood that some stray chemicals have also been added. Compare labels and choose brands with the lowest number of ingredients you can't pronounce. To say that only organically grown foods should be eaten in pregnancy would condemn large numbers of women to having nothing to eat, because our food supply is so dependent on non-organic items. If you eat a wide variety of foods from the diet list and fulfill all your nutritional requirements, your liver will be able to detoxify your body -- another good reason for staying on the diet.

QUESTION 14. CAFFEINE.
Although caffeine isn't an additive, it has been linked to birth defects. How much is safe?
ANSWER 14. CAFFEINE.
The research on caffeine is like that on smoking and alcohol. Seldom has anyone controlled for the nutrition of the mothers in these studies. So, although the research on caffeine shows a strong association between the heavy use of caffeine-containing beverages (coffee, tea, colas) and birth defects, it's still not clear whether there's a direct caffeine effect or whether the problems have resulted from the malnutrition of the mothers involved. Let's face it, anyone who's drinking the equivalent of ten cups of coffee or soft drinks a day just hasn't much room left for nutritious foods. Plus, the stimulation from the caffeine depresses the appetite. All this adds up to a seriously nutrient-deficient mother, a classic type of affluence-related malnutrition. They don't give soda pop or coffee away. That money might better be spent on nutritious beverages, milk being the winner in terms of nutrients provided per dollar spent. This is particularly true if you're on a limited income. You must buy wisely, putting the best foods at the top of your shopping list, and maybe no extras at the bottom. Again, Dr. Brewer has cared for thousands of mothers who drank a cup of coffee or tea with breakfast or after dinner -- and who were following the diet -- and he observed no ill effects in them or their babies. Sometimes pregnant women prefer to use decaffeinated coffee or mild herbal teas, but even so, the warning still holds. Too much of these no-nutrient beverages robs you of critical space for more nutritious foods. So, don't overdo. A couple of cups a day ought to be enough. The rest of the time, drink real fruit or vegetable juices, broth or bouillon, or milk.
 

QUESTION 15. MILK INTOLERANCE.

What if milk gives me cramps or makes me break out? Can I substitute something else on the diet for the milk exchanges?
ANSWER 15. MILK INTOLERANCE.
The milk exchanges on the diet are extremely important. Almost everyone knows about the calcium in milk and how pregnant women need extra calcium to give their babies wonderful teeth and bones.  But the milk exchanges also provide 32 grams of high-quality, complete protein, 400 units of vitamin D, 1,400 units of vitamin A, 0.4 mg. iron, 9 grams of fat, which helps your body use the vitamins A and D and the 1.2 grams of calcium, and 640 calories. All these nutrients must be obtained from other sources when milk cannot be taken. Often, a mother who is intolerant to milk, or who just doesn't like it, is told to take some calcium pills to make up for her milk. Clearly, this is misleading. Within the milk exchanges some provision is made for this situation. Many people who can't tolerate milk straight can enjoy yogurt (which has already transformed the lactose in the milk into a less upsetting compound). Goat's milk has long been used as an alternative to cow's milk in people with allergies. And the rediscovery of the soybean as a staple food item in many households has led to the commercial production of good-tasting soy milk and soy cheeses, which can also be substituted for cow's milk, as indicated on the diet list. These can also be prepared at home. An excellent source of information about the home use of soybeans is The Farm Vegetarian Cookbook (Summertown, Tenn.: The Farm Book Publishing Co., 1978), which can be ordered from the publisher (156 Drakes Lane, Summertown, TN 38483) if your bookstore doesn't have it in stock.

 

QUESTION 16. EGG CONSUMPTION.
Two eggs a day seem like a lot. What about all the unfavorable publicity about the cholesterol in eggs that we heard a few years ago?
ANSWER 16. EGG CONSUMPTION.
More recent research has shown that if you restrict your dietary intake of cholesterol from foods below what your body needs, it simply makes more on its own. And some people (those with the highest risk of heart attack) seem to over-manufacture cholesterol independently of what they eat or need. Pregnant women, and all women of childbearing age, appear to have some protection from the deposit of atherosclerotic plaque inside their blood vessels, thanks to their level of female hormones.  So eating two eggs a day is not going to send you to the emergency room.  Eggs have a good deal of cholesterol, yes, but they also have naturally occurring lecithin - the emulsifier that keeps fat particles in suspension and prevents them from clogging your arteries. Eggs have an undeserved reputation as prime causes of heart disease. In pregnancy they are a rich source of essential nutrients. Each one gives you 6 grams of excellent protein (three in the yolk, three in the white), a full gram of iron, 600 units of vitamin A, hard-to-obtain zinc, and 80 calories. The eggs and milk on this diet provide you with an excellent protein-calorie and vitamin-mineral foundation for a well-nourished pregnancy. And it doesn't matter if they're scrambled, fried, poached, baked, coddled, whipped into milkshakes or sauces, or eaten as crèpes or the coating on French toast. Enjoy!

 

QUESTION 17. FOOD CRAVINGS.
Is there any meaning to food cravings?
ANSWER 17. FOOD CRAVINGS.
A lot of it seems to be learned: Women see pregnant friends or relatives eating clay, laundry starch, dry grains, refrigerator ice, and the like, so they do it, too, when they become pregnant. Some people  have theorized that eating river clay, a common practice in the South, originated in Africa as a way to satisfy hunger pangs when no other food was available. Today, when women live in large cities and can't get their favorite type of clay, they substitute. The problem, obviously, is that when mothers eat a box of cornstarch every day (and studies done in prenatal clinics have recorded such usage), they are obtaining a tremendous amount of calories and nothing else. The starch satisfies hunger, so the mother may become very obese -- and very malnourished. These are not healthy pounds gained on a good diet. The malnutrition endangers both mother and baby.

QUESTION 18. ALCOHOL AND SMOKING.
What about smoking and drinking?
ANSWER 18. ALCOHOL AND SMOKING.
Smoking kills people in some of the most prolonged, agonizing ways possible: emphysema and cancer of the mouth, lips, tongue, throat, lungs, stomach, and bladder. If you want to be around to play with your grandchildren, stop all forms of smoking. Your children will also benefit directly from a smoke-free household-fewer upper-respiratory infections and many, many saved trips to the pediatrician. Women who eat well in pregnancy do not produce low-birth weight babies, by the way, even if they smoke two packs a day. People who have a confirmed habit often smoke instead of eating. We are sure this explains the reported links between smoking and low-birth weight babies. Alcohol is safe in moderation (moderation means one glass of wine or beer or one ounce of liquor) -- and only with meals. Studies that show reduced head size and mental retardation in infants born to mothers who drink were done on mothers who really drink -- hard-core alcoholics. They drink and don't eat: very simple, very tragic. A glass of wine with dinner or a beer with a picnic lunch is not going to damage you or your baby as long as the rest of your diet is adequate.

 

QUESTION 19. VEGETARIAN DIETS. Is a vegetarian diet safe in pregnancy.?
ANSWER 19. VEGETARIAN DIETS.
It depends which one you're on. The basic Brewer Pregnancy Diet list needs to be modified for women who use no animal products as well as for those who use eggs and milk. This subject is complicated and is covered in the next chapter. It is possible to have a healthy pregnancy and not compromise your vegetarianism. It just takes a very carefully planned diet.