I will be adding to this list as I come across other inaccuracies.

See here for details of some of these studies, including many charts and tables

See here for 2006 studies which support the Brewer point of view on the link between restricted-salt diets and "PIH"

See here for the credentials of some others whose research supports the Brewer point of view

See here for "Preventing Toxemia of Pregnancy", by Bob Filice, MD

See here for a treatment for PE that incorporates the Brewer principles

See here for a description of some special circumstances which increase the mother's nutritional needs

See here for more information about fitting your nutrition plan to your unique situation (scroll past diet checklist)

See here for the importance of salt in pregnancy

See here for the possible risks of using diuretic herbs during pregnancy

See here for information about differential diagnosis and conditions which could mimic PE

See more information on this page about drinking water in pregnancy

See more information here about whether drinking water helps with "water retention" in pregnancy

See here for information regarding how diuretics are hazardous during pregnancy

See here for information about the use of herbal diuretics in pregnancy

See here for a history of the Brewer Diet, including information about the effects of diuretics

In pregnancy, diuretics increase the mother's urinary output, which decreases her blood volume at the very time in her life when her body is continually working to increase her blood volume. Then when the kidneys perceive that the blood volume is too low, they secrete renin, which constricts the capillaries, which makes the blood pressure rise.

The kidneys also start to conserve fluid to try to raise the blood volume. But if there's not enough salt, calories, and protein in the diet to create enough osmotic pressure to hold that fluid in the bloodstream, it will move out of the capillaries into the tissues of the ankles, fingers, or face, thus creating edema (swelling).

If a woman is taking nettle or dandelion, being on the Brewer Diet may not be enough to keep her blood volume where it needs to be, because of the diuretic actions of those herbs. In such a situation, the mother may see a rising blood pressure and edema, in spite of her best efforts to follow the Brewer Diet.

See the Basic Brewer Pregnancy Diet Plan here

Some prenatal classes teach that after the 4 servings of the "Milk Group", and the 2 servings of the "Egg Group", you need only 2 3-oz servings from the "Protein Group". This could cause some confusion, since later Brewer books teach that the protein servings should be 1 oz. each. If a woman followed the charts of this prenatal class and got only 2 servings of the "Protein Group" and used the 1 oz. servings of the later Brewer books, she could think that she was on the Brewer Diet when she really wasn't, and she could believe that the diet didn't work for her, when she wasn't actually on it.

The 2-serving version of the "Protein Group" was the recommendation from the first Brewer book written for consumers, What Every Pregnant Woman Should Know. In that book the servings of protein were about 3 oz. each, with varying numbers of grams of protein in each serving. In later books, the Brewers standardized the protein servings, so that following your diet could be done without the need for protein counters. They changed the description of the diet to say that the mother should have 6-8 servings from the "Protein Group", with each serving being 1 oz., instead of 3 oz.

See the Basic Brewer Pregnancy Diet Plan here

See more about responding to elevated blood pressure here

See more about pre-eclampsia here

For more about how the Brewer Diet works see here

For more about how Dr. Brewer learned his perspective and tried to make a difference in the mainstream medical system see here

Brewer: "Our culture has a long history of treating women as inferior, and that's especially true in medicine. Women who educate themselves, listen to their bodies, stay away from prescription drugs, and feed themselves the way healthy women have fed themselves for thousands of years, not the way Americans are feeding themselves today on low-fat, low-protein, high-carbohydrate, low-salt, low-calorie foods--those enlightened women are going to have healthy, full-term pregnancies with no complications."

See here for more of this 2004 interview with Dr. Brewer in Townsend Letter

See here for more response to those who feel blamed by the Brewer perspective (scroll to HELLP question)

Weight Gain Issues

There are some mothers who, sometimes on their own and sometimes on the advice of their doctors or midwives, are concerned about gaining too much weight. So they may decide to eat the protein of the Brewer Diet without eating the calories recommended by the Brewer Diet. By doing this they might believe themselves to be on the Brewer Diet, and when they develop pre-eclampsia or related complications, they might conclude that the Brewer Diet must be a fallacy.

The truth is that the Brewer Diet is designed as a holistic way of facilitating the expansion of the mother's blood volume, which is what her body is trying to do to preserve the pregnancy and nourish the baby. As part of that design, the diet includes calories and salt and other nutrients, as well as protein. If the mother eats even just 1/3 less calories than Dr. Brewer recommended (1/3 less than 2600 is about 1700), her body will resort to burning half of her protein intake for calories, and her blood volume will not be able to keep up with her body's needs. So even if she's eating 80-120 grams of protein, her body will be able to use only 40-60 of it for albumin-making, blood building, uterus building, and baby building, and the mother who believes that she's following the Brewer Diet might develop pre-eclampsia and come to the conclusion that it didn't work for her and therefore must be a fallacy.

For more information about weight gain see here

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

For more about swelling see here

For more about salt see here

See here for a timeline of the Brewer Diet history and development

For a list of some of those studies see here

For more on this research and others see here

Here are Dr. Brewer's own words:

"After I finished my five-year contract with the clinics of Contra Costa County, I stayed on and worked with the people who were hired to do a statistical study. I'd spent two years in Richmond, then two years at the county hospital in Martinez, and then went to Pittsburgh, California, so I had worked at all three of the major county clinics. The data showed improvement in every category. There was a period during which the Pittsburgh clinic continued to use conventional methods while I used nutrition in the Richmond and Martinez clinics, so we used the Pittsburgh clinic as a control. The Pittsburgh clinic had 10 times more hypertension in first pregnancies than the Richmond and Martinez clinics. Those findings were published in the Journal of Reproductive Medicine as a preliminary report. (51) A team of eight government researchers spent three years going over 5600 cases. They studied every blood pressure reading, every urinalysis, and every other test recorded on the charts, and they verified our results."

See here for more of this 2004 interview with Dr. Brewer in Townsend Letter

This response comes from an article by Amy Hass, in Midwifery Today.

"The fact is that research has been done on this subject, but with the exception of folic acid, it stopped somewhere around the 1980s when the focus shifted to drugs as the answer to curing all ills. The research that was done was not widely accepted due to the fact that it could not include clinically controlled studies. It would not show common sense or ethics to starve a group of pregnant women in order to supply a control group. The researchers did the logical thing and used the women's previous diet and circumstances as the control (Brewer 1982). The results were amazing. Dr. Tom Brewer totally eradicated preeclampsia in specific populations where the former rates were upwards of 40 percent. He had the women eat a healthy, varied, well-balanced diet that included high quality foods, adequate protein and complex carbohydrates. He also had them drink water to thirst, salt to taste and avoid drugs. Unfortunately, the National Institutes of Health refused to publish the results because he couldn't do a clinically controlled study.

So what's the problem with pregnancy nutrition? The standard medical community does not believe that women need to eat this way. Doctors keep saying that they don't know the cause of preeclampsia, but they are madly searching for a 'magic pill' or single cause to shed some light on the mystery..."

"...This attitude means that the majority of women receive no education on nutrition in pregnancy. Desperate treatments of preeclampsia, such as diuretics, elimination of salt intake and calorie and weight gain restriction, only exacerbate the problem by further reducing and restricting much-needed blood volume (called hypovolemia) and reducing the blood supply to the placenta and fetus."

See here for the rest of "Preventing Complications with Nutrition", by Amy Haas

You may have heard the claim that Dr. Brewer was just the author of "a bunch of pop pregnancy books."

The truth is that Dr. Brewer first became interested in MTLP before he became a medical student, when his Russian neighbor was describing the horrific effects of the WWII starvation in Russia on pregnant mothers. Tom continued his interest in MTLP/pre-eclampsia when he was a medical student and read in his obstetrics textbook about the "'nutritional' theory of the origin of toxemia based on work done by Maurice Strauss and Bertha Burke at Harvard and Ferguson's work [one of his professors] seemed to confirm it." He continued to study this perspective as he progressed through medical school and internship. While there, he observed the treatments for pre-eclampsia that were the standards of care at that time, and the outcomes of those treatments, a process that included "thousands of hours spent pouring over scientific reports." He went on to work for a couple of years in private general practice in Fulton, Missouri, which included the care of 100 pregnancies with only one case of pre-eclampsia--one case in which the woman was poor and malnourished and had had no prenatal care. "In 1958, Dr. Brewer completed a residency in obstetrics and gynecology at the University of Miami Medical School where he was also a research fellow at the Howard Hughes Medical Institute, studying the formation of collagen in the uterus during pregnancy, a process that is directly linked to efficiency of labor."* Then, "in his last year at Miami's Jackson Memorial Hospital, Tom became chief OB/GYN resident with the authority to test one of the results of his research: a new method of managing the mother acutely ill with MTLP...human serum albumin...It worked...Since then other researchers have confirmed his clinical trials." Dr. Brewer later supervised a demonstration toxemia prevention project in the prenatal clinics of Contra Costa County, California. The project started in 1963 and continued for 12 1/2 years. During this time, "Tom supervised the prenatal management of over seven thousand mothers from the lowest income group in the San Francisco Bay area," and the incidence of toxemia among these mothers "was 0.5 percent, with no cases reaching the convulsive stage." During this time he also "published journal articles about the project and began lecturing at medical meetings and hospitals around the country." It wasn't until 1977 that Dr. Brewer and his wife Gail finally turned to writing directly to the mothers themselves, teaching them how to be advocates for themselves in the absence of that advocacy from their doctors.

To read the chapter the quotes in this paragraph are taken from see here

See here for a timeline of the development of the Brewer Diet

*Obituary on website of American College of Traditional Midwives

Dr. Brewer: Research that's focused on "genetics" or speculative biochemical enzymatic equations never addresses the underlying cause of an illness or condition. I don't doubt that unusual proteins are produced by a starving fetus or a starving mother, but those proteins don't cause eclampsia. They're just another symptom. Inadequate nutrition causes eclampsia.

In a New Zealand sheep experiment published in the journal Science, none of the ewes on a normal diet had premature births, but half of the ewes that were put on a moderate weight-loss diet at the time of conception gave birth prematurely. (83) The researchers decided that a mother's diet before and around the time she conceives can profoundly influence the length of pregnancy, and they called this a stunning scientific breakthrough. This is what I mean about medical researchers knowing nothing about nutrition. It's obvious, but they didn't have a clue.

Sheep have been studied before, and they have shown all the same symptoms and problems that humans have. In one study, pregnant sheep were starved at the very end of their pregnancies, and most of them died. Other researchers have found that sheep giving birth to twins, triplets, or quadruplets are more likely to have toxemia than those giving birth to single lambs.

This is true for humans, too. A woman pregnant with twins has to eat for three, for herself and each of her babies, and a woman pregnant with triplets has to eat for four. It isn't easy to do this, but the more good nutrition a woman can provide for her developing babies, the healthier they will be. (72)"

See here for more of this 2004 interview with Dr. Brewer in Townsend Letter

See here for homeopathy suggestions for morning sickness

See here for a resource for herbal responses to morning sickness

I also advise teachers and midwives to spend more time with their mothers who have blood pressures that are creeping up. Avoid sending them home with vague instructions to eat a little more protein. Explain the importance of expanding their blood volumes and how the body works on that process. Encourage them to eat something with protein in it every hour that they are awake, including a bedside snack for middle-of-the-night wakings. Take a thorough history to discern their lifestyle. Find out whether they are on an exercise program, or have a lot of stress in their lives, or work or live in over-heated conditions, or love to garden even when it's hot outside--conditions which could lead to their losing extra calories or salt. If they do have these factors in their lifestyle, talk with them about ways to add extra calories and salt to their diet, and possibly ways to modify their lifestyle so that they don't lose as many calories or as much salt. Talk with them about ways to lessen the stress in their lives, and thus burn fewer calories. Have them monitor their blood pressures a couple of times a day, at the same times every day, while you are discerning whether these changes are making an effective difference. Encourage them to call you once a day with their most recent blood pressure readings, and more often if they become concerned. If necessary, send a midwife's note to their employers, prescribing a change in work responsibilities or conditions.

See here for more information on elevated blood pressures

I have heard some people confuse the physiology of chronic hypertension with the physiology of "pregnancy induced hypertension." They ask how extra protein can be good for "PIH", if it's not good for non-pregnant people with chronic hypertension.

The truth is that the pregnant body works differently than the non-pregnant body does. The causes of chronic hypertension in the non-pregnant body range from stress, arteriosclerosis and atherosclerosis to kidney diseases, adrenal tumors, and coartation of the aorta. In those cases you might want to watch the amount of protein that the patient eats. But in pregnancy, if those diseases have been ruled out with a proper differential diagnosis, proteins are necessary for maintaining the healthy nourishment of the kidneys and liver so that they can meet the extra stresses of pregnancy, for the formation of serum albumin, for the maintenance of the clotting mechanisms, and for the maintenance of a healthy blood volume. This is a mechanism that occurs only in pregnancy.

Another truth is that often those who object in this vein may not understand that the protein needed in pregnancy can come from a variety of places--beans, nuts, dairy products, fish, and chicken. The protein needed in pregnancy does not need to come from sources which may also come with a high-cholesterol component.

See here for the vegetarian versions of the Brewer Diet

See here for more information about salt in pregnancy

See here for the Basic Brewer Diet Plan

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

See here for most of the quotes used in this paragraph

See this source (p. 15-16) for the rest of the quotes from this paragraph

In fact, in a 2004 interview for Townsend Letter, Dr. Brewer described the further damage that can be caused by anti-hypertensive drugs, to mothers' livers and kidneys already ravaged by the pre-eclampsia process...

Brewer: "Low blood volume, which is the inevitable result of dehydration and the use of diuretics, contributes directly to eclampsia, premature birth, and low birth weight. (23,35,36,38) And now there's a whole group of hypertension drugs that have come out in the last 10 to 15 years. These drugs just ravage women. They cause direct damage to all of the cells in the mother's body, particularly to the liver, a little to the kidneys, and then to the placenta and fetus."

See here for more of this 2004 interview with Dr. Brewer in Townsend Letter

See here for a timeline of the Brewer Diet history and development

Anne Frye recommends having the mother eat a high protein item every waking hour. She also suggests, "Initially recommend an increase to 150 to 200 grams of protein daily (250 to 350 grams or more with multiple gestations), with 3,000 to 4,000 calories and 500 mg of choline daily...If the woman has a history of liver disorders, recommend less protein (120-150 grams for a single fetus); her liver may be overwhelmed otherwise, and monitor her lab work closely for changes...Once liver enzymes and blood proteins have normalized, the hemoglobin has dropped appropriately, the fetus is an appropriate size for dates and secondary symptoms have subsided, the woman can cut back to 100 grams of protein daily (150 grams with multiples)."

See here for more information on the best ways to treat pre-eclampsia

There are some who say that they were on the Brewer Diet and were well-nourished and it didn't work for them, so therefore it must be a fallacy.

There are some who say that they have seen women who were well-nourished and who still got pre-eclampsia, so therefore it must be a fallacy.

At least part of the truth is that there are other diseases that look like pre-eclampsia but aren't pre-eclampsia. The doctors need to do a thorough differential diagnosis on all their patients, and not jump to snap judgments when they see symptoms that look like pre-eclampsia.

Some of the diseases which can look like pre-eclampsia/eclampsia include urinary tract infections, kidney infections, glomerulonephritis (Bright's disease), chronic pyelonephritis, kidney cysts and tumors, chronic hypertension, pheochromocytoma, epilepsy, brain tumor, coarctation of the aorta, hyperthyroidism, molar pregnancy, and heart failure. One of the dangers in jumping to the conclusion that the mother's symptoms indicate that she is developing pre-eclampsia is that if she is not developing pre-eclampsia her true illness will not get treated. Another danger is that in the process of treating her for pre-eclampsia with mainstream "standards of care" and "anti-hypertensive therapies", which often include low-salt, low-calorie diets, she might well develop the pre-eclampsia that initially she did not have.

Doctors should also be more diligent about taking a history that includes an accounting of what supplements and herbal teas the mother is using. Any supplements or herbal teas or juices which contain nettle, dandelion, celery, bilberry, or alfalfa could be contributing to the "toxemia syndrome" which they are seeing, since all of these herbs have diuretic properties.

See here for more information on mistaken diagnoses

See here for more information on the risks of using herbal diuretics during pregnancy

You may have heard that the cause of clots forming behind the placenta is usually a clotting disorder, and that the preferred treatment is the use of anticoagulants. You may have also heard that the mother's nutrition has no effect on whether her body will form clots behind her baby's placenta or not.

The truth is that the formation of clots behind the placenta is usually caused by an inadequately expanded blood volume, which results in a reduction in velocity of blood flowing through the intervillous space behind the placenta, an increased viscosity of maternal blood associated with hemoconcentration and hypoalbuminemia and hypovolemia, and an increased fibrinogen concentration of maternal blood associated with hemoconcentration and probably hepatic injury from the Pre-eclampsia process (which is also caused by a low blood volume).

When the placenta first implants on the inner uterine wall, it secretes enzymes which dissolve the ends of the capillaries which come to the inner surface of the uterus. As a result, the open ends of the arterial capillaries spout little fountains of blood behind the placenta, and the open ends of the venous capillaries return the blood to the mother's heart, like little bathtub drains. This is called an arterial-venous shunt. A lake of blood forms behind the placenta, and the baby's capillaries in the placenta, which remain intact (like little loops), are continually bathed in this lake of the mother's blood. Through this process, oxygen and nutrients pass from the mother's lake of blood, through the baby's capillary walls, and into the baby's blood stream, and waste products pass from the baby's capillaries to the mother's blood.

As the placenta grows, the lake of blood behind the placenta needs to grow, and the mother needs to grow more blood in order to keep this lake of blood well-supplied. By the end of the pregnancy, she needs to grow her blood volume by 60% for a singleton pregnancy (about 2 quarts/liters of blood) and 100% for a twin pregnancy (about 3.5 quarts/liters of blood). In order to help her body to increase her blood volume in this way, the mother needs to eat a daily minimum of 2600 calories, salt to taste, and 80-100 grams of protein for a singleton pregnancy, and more than that for a multiple pregnancy.

When the mother's blood volume fails to keep up with the growth of the placenta, through inadequate food intake, loss of salt and fluids (from over-heated conditions or herbal diuretics), or through lifestyle conditions which use up extra calories, the flow of blood through the a-v shunt behind the placenta slows down. The blood that is supposed to be spurting out of the open arterial capillaries behind the placenta like little fountains, slows to a trickle, and the blood flowing through the lake of blood behind the placenta to the open venous capillaries slows down to such a very slow rate that it begins to clot, as blood always does when it is not flowing at a good rate.

The best way to prevent this clotting behind the placenta is for the mother to eat according to the recommendations of the Brewer Pregnancy Diet, plus making daily adaptations, increasing the minimum levels of the Basic Plan to accommodate her personally unique lifestyle and needs. By doing this, she will enable her body to continually expand her blood volume to normal levels, and maintain it at a well-expanded level for the rest of the pregnancy--keeping the little capillary fountains spurting at a good pressure, and the little capillary drains draining at a good rate, and the lake of blood behind the placenta flowing at a good pace so that it doesn't begin to clot.

The following is reprinted from Metabolic Toxemia of Late Pregnancy, by Thomas H. Brewer, M.D., 1966 & 1982.

"Toxic Abruptio Placentae"--(p. 61)

"Elisabeth Ramsey and her co-workers have given us a clear, scientific picture of how the placental circulation works. Maternal blood enters the intervillous space by small uterine veins on the floor of the intervillous space. Thus, the placenta has been shown anatomically to be an arteriovenous shunt, a condition for which have had good evidence from clinical pysiological observations. Any conditions which will lead to clot formation in the intervillous space may be regarded as playing some role in the pathogenesis of abruption.

The following factors occur in severe MTLP [Metabolic Toxemia of Late Pregnancy/Pre-Eclampsia] and can play a role in promoting the formation of a clot behind the placenta:

1. Reduction in velocity of blood flowing through the intervillous space associated with arteriolar spasm (of uterine spiral arterioles);

2. Increased viscosity of maternal blood associated with hemoconcentration, hypoalbuminemia, and hypovolemia;

3. Increased fibrinogen concentration of maternal blood associated with hemoconcentration and probably hepatic injury; and

4. Widespread endothelial injury of unknown cause which can damage the fetal cotyledons and release thromboplastin to trigger the clotting mechanism.

See here for more information about the role of low blood volume in clot formation and abruption of the placenta

Five Minute Lesson in Preventive Obstetrics
Tom Brewer, MD
12-12-1980

There are two central facts which need emphasis:

1. The human placenta creates an ARTERIO-VENOUS SHUNT (A/V) in the maternal circulation. During the last trimester of normal pregnancy, 50 to 60 jets of arterial maternal blood spurt up against the fetal cotyledons with each maternal cardiac systole. This blood swirls about in the intervillous space and passes via "tub drains" back into the uterine venous system.

2. The A/V shunt requires for optimal fetal growth and development an INCREASING MATERNAL BLOOD VOLUME throughout the second trimester to a plateau which must be maintained throughout the entire third trimester.

Failure to recognize these two well-established facts has created havoc in human maternal-fetal health throughout the whole western world, especially in the USA, Canada, and the United Kingdom. The observed reduction in utero-placental blood flow associated with common human reproductive pathology has not been correctly interpreted as the result of hypovolemia, failure to maintain a physiological expansion of maternal blood volume.

Physicians commonly carry out dietary restrictions of calories and sodium and give drugs, diuretics, sodium substitutes, anorexiants, vasodilators etc. which actually cause and/or enhance maternal hypovolemia. Intrauterine fetal growth retardation (IUGR) and small for gestational age (SGA) babies have increased dramatically since the 1950s, especially in these three nations, where the role of prenatal malnutrition in causing human reproductive casualty is still universally denied by medical authorities. Applied physiology and basic nutrition science in human prenatal care as a routine for all women all through gestation must form the basis of true, primary prevention in this field.

See here for an illustration of the placenta and the a-v shunt which creates the lake of maternal blood

You may have heard the emphatic assertion by some people that there is no connection between maternal nutrition and the development of pre-eclampsia.

The truth is that a recent study from Denmark (Sept. 2008) seems to support the Brewer principle that there indeed is a connection between nutrition and the development of pre-eclampsia. This study has found that there is a correlation between certain amounts of recreational exercise in pregnancy and the development of pre-eclampsia. For over 30 years, those who support the Brewer principles have been saying that when pregnant women have extra recreational exercise or other physical exertion in their lives, they need to compensate for the extra losses of salt, fluids, and calories that result from that extra exercise and physical activity. When they do not increase the levels of salt, calories, fluids, and protein in their diets to compensate for their personally unique lifestyle, they will probably experience a falling blood volume. A blood volume that is too low for the stage of pregnancy that the mother is in will result in the development of a rising BP, pathological edema, pre-eclampsia, and HELLP, as well as other complications associated with low blood volume, such as IUGR, premature labor, placental abruption, and low birth weight.

This particular study was looking at only pre-eclampsia, and only at recreational exercise, but those of us who understand the Brewer principles understand that the same principles do apply to all of the other complications associated with low blood volume as well, and to any source of salt/fluid/calorie/protein loss.

"Pregnant exercise 'unsafe'"

Read more.......

"Women who exercise during pregnancy face risk of pre-eclampsia, researchers warn"

Read more.......

"Exercise in pregnancy linked to fatal raised blood pressure condition"

Read more.......

You may have heard some mothers tell of how they were on a healthy enough diet during pregnancy, even though it was not a Brewer-style diet, and still got a high blood pressure, or pre-eclampsia, or HELLP, or IUGR, or premature labor, or some other complication associated with low blood volume.

You may have heard other mothers tell of how they were on the Brewer Diet and still got a high blood pressure, or one of the other complications listed above.

You may even have heard of one mother who tells of how she was eating some protein every hour to try to alleviate her pre-eclampsia symptoms, and that in spite of all of her valiant efforts, she still developed pre-eclampsia.

The truth is that the standard of what is included in the definition of a "healthy" diet is so variable from person to person that there is no way to know whether each mother who says that she was on a healthy enough diet was on a diet that was adequate for her stage of pregnancy and her lifestyle. So there is no way to know whether those mothers were actually eating enough of the foods needed for keeping their blood volumes well expanded.

See here for a comparison of the Brewer Diet and the ACOG diet

The truth is that even when a mother believes herself to be on the Brewer Diet, there are so many different definitions out there of "Brewer Diet" that there is no way to know whether these mothers were actually on the version of the Brewer Diet that is the most helpful and effective for keeping the blood volume well expanded.

See this FAQ page for a brief definition of the Brewer Diet

The truth is that even when a mother tells of how she was working so hard to eat some kind of protein every hour, there is no way to know whether she was also eating enough salt and calories every hour as well. Without enough salt and calories in the diet, as well as enough protein, the Brewer Diet is not likely to work as well as it could for expanding the mother's blood volume to where it needs to be.

See here for more information on the importance of salt and calories in addition to protein

The truth is that we usually don't hear any of these mothers tell us whether they were also on low-salt diets or low-calorie diets during the time that they were trying to fight pre-eclampsia (or some other complication) with a high-protein diet, or some other diet they believe was healthy enough.

See here for more information on the importance of salt in pregnancy

The truth is that we usually don't hear from any of these mothers about what kind of lifestyle they were experiencing at the time that they were developing pre-eclampsia, or HELLP, or IUGR, or some other complication associated with blood volume issues. We don't hear how much exercise they were doing every day, or what kinds of physical exertions they were having to perform every day, or whether they were living or working in over-heated environments, or whether they were outside on hot days (gardening or on vacation or at theme parks), or whether their jobs were physically demanding (like dancing, or teaching, or nursing, or teaching exercise classes, or waitressing, or working in a factory), or whether they were having to go through a move during the pregnancy, or how many other children or parents they were caring for at home. If the mother is not taught how to compensate for these kinds of stressors and salt-fluid-calorie losses, all of these factors can contribute to a falling blood volume and resulting complications, such as a rising BP, PE, HELLP, IUGR, premature labor, and other complications associated with a low blood volume.

See here for more information about the unique needs of individual women during pregnancy

The truth is that even if a mother was using an excellent version of the Brewer Diet, and had adapted it to fit her unique needs, and had adjusted her lifestyle in a way that should assist her body in its blood-volume-expansion task, we have no way of knowing whether she was also taking some herbal tea or herbal supplement which has diuretic properties and was counteracting all of her great efforts to expand her blood volume through nutrition.

See here for more information on the potential effects in pregnancy of herbs which have diuretic properties

The truth is that even anti-hypertensive drugs can contribute to liver damage, which can add to the low-blood-volume issue, adding to the development of BP issues, PE, HELLP, or other complications. When the liver is compromised, it cannot produce the amount of albumin that is necessary to help expand the blood volume during pregnancy, and it cannot produce the clotting factors that are necessary for keeping the clotting mechanisms of the body at a normal capacity.

Brewer: "Low blood volume, which is the inevitable result of dehydration and the use of diuretics, contributes directly to eclampsia, premature birth, and low birth weight. (23,35,36,38) And now there's a whole group of hypertension drugs that have come out in the last 10 to 15 years. These drugs just ravage women. They cause direct damage to all of the cells in the mother's body, particularly to the liver, a little to the kidneys, and then to the placenta and fetus."

See here for more of this 2004 interview with Dr. Brewer in Townsend Letter

The truth is that many of the "anti-hypertensive treatments" and "standards of care" of mainstream obstetrics and perinatology can counteract the efforts of the mother to eat the amount and type of food that she needs to maintain her blood volume at the well-expanded level needed for whatever stage of her pregnancy she has come to.

See here for more of this 2004 interview with Dr. Brewer in Townsend Letter

The truth is that at the first sign of a rising hemoglobin/hematocrit, or of a rising BP, or of any other symptom of PE, or IUGR, or premature labor, some kind of experienced Brewer Diet counselor should sit down with the mother and examine with her all of the components of her diet and of her lifestyle.
In this way, together they can develop a plan for a good fit between the needs of her pregnancy,
the needs of her lifestyle, and the needs of her diet.

See here for a method of early detection and treatment of pre-eclampsia that is in keeping with the Brewer principles

You may have read on an anti-Brewer forum a post which implies that only DEMs (direct entry midwives) are in support of the Brewer Diet,
and that they do so only because they don't know any better.

You may have also read in that post the opinion that DEMs "have very little scientific or medical training", and that they are "not very grounded in sound risk management techniques".

You may have also read in that post the implication that the reason that DEMs have chosen to not become CNMs, or DOs, or MDs is that they don't want to take the time to do that.

The truth is that many childbirth professionals other than DEMs use and support the use of the Brewer Diet in pregnancy. In the fall of 2008 I started a registry of Brewer Diet supporters. By the end of 2008, hundreds of people had asked to join that registry--professionals from 13 countries and 49 US states. They include NDs (naturopathic doctors), DOs (doctors of osteopathy), including one who is a FACOOG (the DO version of an obstetrician/gynecologist), PhDs (including a nutritionist), an MPH (Masters in Public Health), MSWs, CNMs, MSNs (Masters of Science in Nursing), RNs, LPNs, DEMs, CPMs, LMs, doulas, and childbirth educators.

I am especially encouraged by those who sent me notes along with their requests for being listed on the registry. Many of these notes told of their successful use of the Brewer Diet in their practices, and some of them had been seeing this success for 30 years! It is so encouraging to know that thousands of women and their babies have been helped and protected for so many years, through the teaching and guidance of so many highly educated birth professionals.

See here for the first page of the Brewer Diet Registry

The truth is that there is more than one kind of DEM. There are DEMs who may choose to not be licensed anywhere, for any number of valid reasons, but some of these may also be RNs, or CNMs from other countries, or even MDs from other countries, or even professionals who are well-educated by other means. There are also DEMs who are CPMs (certified professional midwives) or LMs (licensed midwives). These latter two categories are midwives who have undergone a rigorous education and certification and licensing process. According to the North American Registry of Midwives (NARM), "The Certified Professional Midwives' credentialing process was evaluated by independent researchers at Ohio State University as a credential that exemplified the established standards for educational and psychological testing, as determined by the American Educational Research Association, American Psychological Association, and the National Council of Measurement in Education". The CPMs hold valid, state-recognized licenses in the states where they are licensed. There are at least 23 US states which license direct-entry midwives who are certified through these direct-entry midwifery programs.

See here for more information about the North American Registry of Midwives (NARM)

The truth is that medical training is only for medical doctors. Direct-entry midwives prefer to be educated in programs which will prepare them in caring for women planning to have natural childbirth, an area of the childbearing field that medical schools in the United States teach nothing about, and an area about which most US medical doctors know very little, if anything. Those US medical doctors who do understand and support natural childbirth are few and far between. They are the heroes of our time, the hidden treasures in our communities. If any of you come across one of them, please let them know that I would gladly welcome any of them to the Brewer Diet Registry, a registry of childbirth professionals who use and support the use of the Brewer Diet and Brewer principles.

According to NARM, CPMs are educated in giving the following kind of care:

NARM goes on to say, "The application of this woman-centered model of care has been proven to reduce the incidence of birth injury, trauma, and cesarean section."

If that kind of care is unscientific, then we are living in a sad and deplorable era of science.

So, yes, CPMs are "grounded in sound risk management techniques".

See here for "Technology in Birth: First Do No Harm", by Marsden Wagner, MD, MSPH, perinatologist

See here for "When Research is Flawed: Critiques of Influential Research Studies", by Henci Goer

The truth is that DEMs do not choose against becoming CNMs, or DOs, or MDs to avoid taking the time to do the work of that option. The truth is that DEMs probably choose to become DEMs because they prefer to perform in the style and scope of care that DEMs provide, rather than in the styles and scopes of care that CNMs or DOs or MDs provide.

As a matter of fact, one of the CPMs on our registry of Brewer Diet supporters is a woman who is a former CNM (certified nurse midwife) who also went on to get her MSN-NM (Masters of Science in Nursing-Nurse Midwifery). She "began a hospital based practice", and "over a 3 year period [she] introduced water birth and many other natural child birth friendly options for mothers" there. But at the end of that time, she "fulfilled a long time dream and opened a home birth practice. She dropped her certification as a nurse-midwife and took yet another national board exam and became a certified professional midwife through the North American Registry of Midwives." So as you can see through this midwife's choices, there is a lot more substance to a woman's choice to become a CPM rather than a CNM than might immediately seem apparent to those with a mainstream medical perspective.

See here for "Some Thoughts on Bridging the Gap Between Nurse and Direct-Entry Midwives", by Robbie Davis-Floyd

See here for "Fish Can't See Water: The Need to Humanize Birth", by Marsden Wagner, MD, MSPH

You may have heard that eating extra protein in pregnancy can cause kidney damage.

You may have heard that eating extra protein in pregnancy can cause protein to appear in the urine.

The truth is that during pregnancy the kidneys are stressed by the pregnancy itself,
and that eating extra protein during pregnancy actually protects healthy kidneys
from being damaged by those extra stresses.

The truth is that the appearance of protein in the urine can suggest
either kidney damage (from pre-eclampsia or from other causes),
or a kidney or bladder infection,
or some other kidney disease,
such as glomerulonephritis (Bright's disease), chronic pyelonephritis, kidney cysts, or tumors.

The truth is that protein in the urine does not occur as a result of whatever amount of protein is in the mother's diet. Under normal circumstances (pregnancy being one of the normal states of the female body), the protein molecule is too large to pass through the filtration system of the kidney,
no matter how much protein the mother eats.
That is why protein in the urine can suggest that there is possibly some kind of damage
somewhere in the kidney's filtration system,
damage which is allowing the large protein molecule to slip through where ordinarily it would not be allowed to slip through.

Sometimes protein can get added to the urine after it leaves the kidneys,
and thus it would not be connected to any kind of kidney damage.
Sometimes this can happen when there is a bladder infection.
Sometimes it can happen when there is a yeast infection in the vagina and some protein from that infection can accidently get into the urine when the specimen is being collected.
Sometimes protein can get into the urine specimen when normal discharge from the vagina
gets mixed with the urine specimen as it's being collected.

So if protein shows up in your urine specimen, the first idea you can try is to ask your midwife or the nurse in your doctor's office to teach you how to do a "clean catch" for your urine specimen, to eliminate any source of any kind of discharge that may have accidently been added to the specimen as you were urinating into the cup the previous time. The second idea you can try is to ask your midwife or doctor to send your urine specimen to a lab to see if you might have a kidney or bladder infection. The third idea you can try is to ask your midwife or doctor to do a differential diagnosis for the other illnesses which could cause protein to appear in the urine.

The following is copied from the FAQ page of this website.

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

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

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

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

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

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

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

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

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

See here for more information on the misinterpretation of proper levels of protein in pregnancy, by the Cochrane Review, due to misuse of protein drinks in pregnancy

Perinatal Support Services: pregnancydiet@mindspring.com