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Special Health Alert!
For those of you who live North of the equator and are entering a season of hot and humid weather and increased outdoor activity,
please be aware that extra loss of salt (through sweat) and extra burning of calories can trigger a rising BP, and other pre-eclampsia
symptoms. Please see the "Special Needs" page and the bottom of the "Weekly Record" page for ideas on how to compensate for
these losses and thus help yourself to prevent pre-eclampsia and other complications related to low blood volume. Please
see the "FAQ" page for information about why just drinking extra water probably won't be enough to keep your blood volume
adequately expanded for an optimally healthy pregnancy.
For those of you who live South of the equator and are entering the cold winter season, please be aware that many homes and
work environments are over-heated (with very dry air) and may cause you to lose salt and fluids in the same way as hot weather
does. And shoveling snow or working out in a gym burns extra calories. These losses might also lead to a falling blood volume,
and its accompanying complications, just as the summer heat and activity can. So please be watchful and care for your personally
unique needs for salt and fluids, as well as your unique needs for calories and protein.
The Basic Twin Plan
For each additional baby add
30 grams protein
and
500 calories
every day
The following is reprinted and adapted from Eating for Two, by Gail Sforza Brewer (Krebs) and Isaac Cronin,
1983 (p. 15), and from The Brewer Medical Diet for Normal and High-Risk Pregnancy, by Gail Sforza Brewer (Krebs)
with Thomas Brewer, M.D., 1983 (p. 11).
See here for the Twin Pregnancy Brewer Diet Basic Plan Weekly Record for printing and putting on your refrigerator
See here for more information about twin pregnancy and birth
See here for "They Are What You Eat--Nutrition in a Plural Pregnancy"
You must have, every day, at least the amounts of food and types of food on the following diet lists (minimum
daily food intake). These foods are the best sources of key nutrients essential to healthy pregnancy. It is not healthful
for you to go more than twelve hours without good food. Eat a complete breakfast every morning and snack midmorning,
midafternoon, before bed, and at least once during the night to maintain a steady supply of nutrition to your developing baby.
Consult your doctor, midwife, or nutritionist immediately if you start to fall behind on your diet for any reason. Inability
to follow the diet is a medical emergency requiring prompt attention.
It is important to use the Brewer Diet's recommendations for salt, calories, and protein all together. If you try to use
lower amounts of salt or calories than is recommended by the Brewer Diet, and focus primarily on the protein, it is likely
that the Brewer Diet will not be as effective for you as it could be.
See here for the reasons that salt, calories, and protein are equally important in the Brewer Diet
For those who are wondering, it is best to not use protein drinks during pregnancy. It is better to get your
protein from food.
See Q&A section here for info on why not to use protein drinks
Please be aware that traveling and moving can disrupt your eating routine just enough to trigger a low blood volume problem
which can start the rising BP/pre-eclampsia/HELLP/premature labor/IUGR/abruption process. Putting the brakes on that process
can be more difficult than preventing it. Sometimes just being aware of this danger is enough to help you to remind yourself
to continue providing for your nutritional needs, in spite of any changes and stresses which may be going on in your life.
You must have, every day, at least: *
(plus 30 g protein and 500 calories for each additional baby)
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1. Milk and milk products--8 choices
1 cup milk: whole, skim,1%, buttermilk
1/2 cup canned evaporated milk: whole
or skim
1/3 cup powdered milk:whole or skim
1 cup yogurt
1 cup sour cream
1/4 cup cottage cheese: creamed, uncreamed,
pot style
1 large slice cheese (1 1/4 oz): cheddar, Swiss, other hard cheese
1 cup ice milk
1 1/2 cup soy milk
1
piece tofu, 3"x3"x 1/2" (4 oz)
2. Calcium replacements--as needed (2 per soy exchange from group 1)
36 almonds
1/3 cup bok choy, cooked
12
Brazil nuts
1 cup broccoli, cooked
1/3 cup collard greens
1/2 cup kale
2 teaspoons blackstrap molasses
4 oz
black olives
1 oz sardines
3. Eggs--2 any style
4. Protein Combinations--12 choices**
1 oz lean beef, lamb, pork, liver, or kidney
1 oz chicken or turkey
1
oz fish or shell fish***
1/4 cup canned salmon or tuna
3 sardines
3 1/2 oz tofu
1/4 cup peanuts or peanut butter****
1/8
cup beans + 1/4 cup rice or wheat
(measured before cooking)
beans: soy beans, peas, black beans, kidney beans, garbanzos
rice:
preferably brown
wheat: preferably bulgar
1/8 cup brewer's yeast + 1/4 cup rice
1/8 cup sesame or sunflower seeds
+ 1/2 cup cup rice
1/4 cup rice + 1/3 cup milk
1/2 oz cheese + 2 slices whole wheat bread or 1/3 cup macaroni (dry)
or noodles or 1/8 cup beans
1/8 cup beans + 1/2 cup cornmeal
1/8 cup beans + 1/6 cup seeds (sesame, sunflower)
1/2
large potato + 1/4 cups milk or 1/4 oz cheese
1 oz cheese: cheddar, Swiss, other hard cheese
1/4 cup cottage cheese:
creamed, uncreamed, pot style
5. Fresh, dark green vegetables--2 choices
1 cup broccoli
1 cup brussels sprouts
2/3 cup spinach
2/3 cup
greens
collard, turnip, beet, mustard, dandelion, kale
1/2 cup lettuce (preferable romaine)
1/2 cup endive
1/2
cup asparagus
1/2 cup sprouts: bean, alfalfa
Adapted from Eating for Two, by Gail Brewer and Isaac Cronin, from Right from the Start, by Gail
Brewer and Janice Presser Greene, from The Pregnancy After 30 Workbook, edited by Gail Brewer, and from The Brewer
Medical Diet for Normal and High-Risk Pregnancy, by Gail Brewer and Tom Brewer, MD.
* Each food you eat may be counted for one group only (in other words, count 1/4 cup cottage cheese as either 1 milk
choice or 1 protein combination choice, not both).
***Due to mercury content, do not eat shark, swordfish, king mackerel, or tilefish
--You may eat up to 12 oz a week of
a variety of fish and shellfish that are lower in mercury:
shrimp, canned light tuna, salmon, pollock, catfish
--Albacore
("white") tuna has more mercury than canned light tuna, so you may eat up to 6 oz of albacore tuna per week.
****Some sources suggest that one possible source of peanut allergies in children may be an excess consumption of peanuts
by their mothers during their pregnancy. If you know of any documentation about this, please let me know.
Here's one source of peanut allergy information
Here's another source for info about peanuts and soft cheeses
See Q&A section here for info on why not to use protein drinks
See here for information on the hazards of herbal diuretics in pregnancy
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6. Whole grains--5 choices
1 waffle or pancake made from whole grain
1 slice bread
whole wheat, rye, bran,
other whole grain
1/2 roll, muffin, or bagel made from whole grain
1 corn tortilla
1/2 cup oatmeal or Wheatena
1/2
cup brown rice or bulgar wheat
1 shredded wheat biscuit
1/2 cup bran flakes or granola
1/4 cup wheat germ
7. Potato--1 choice
Whole potato, any style, but preferably
baked or boiled with skin.
8. Vitamin C foods--3 choices
1/2 grapefruit
2/3 cup grapefruit juice
1 orange
1/2 cup orange juice
1
large tomato
1 cup tomato juice
1/2 cantaloupe
1 lemon or lime
1/2 cup papaya
1/2 cup strawberries
1 large
green pepper
1 large potato, any style
9. Fats and oils--5 choices
1 tablespoon butter or margarine
1 tablespoon mayonaise
1 tablespoon vegetable
oil
1/4 avocado
1 tablespoon peanut butter++
10. Vitamin A foods--1 choice
3 apricots
1/2 cantaloupe
1/2 cup carrots (1 large)
1/2 cup pumpkin
1/2
cup winter squash
1 sweet potato
11. Liver--at least once a week (optional)
4 oz liver
beef, calf, chicken, pork, turkey, liverwurst
12. Salt and other sodium sources--unlimited
table salt, iodized--to taste
sea salt--to taste
kelp powder--to
taste
soy sauce--to taste
13. Water--unlimited
Drink to quench thirst, but do not force fluids
Real juice or milk might make better
use of limited stomach space.
Avoid pregnancy teas and juices which include nettle, dandelion, alfalfa, bilberry, or celery (they have diuretic properties).
14. Snacks and additional menu choices--4 or more
Dried Fruits:
Raisins, apples (1/2 cup)
Dates, prunes (5)
Figs, pear halves (3)
Apricot halves (12)
Pure Juices (100% with no sweeteners):
Apple, grapefruit (1 cup)
Apricot, orange, peach, pear (1/4 c.)
Grape, cranberry (2/3 cup)
Nuts/Seeds:
Pistachio nuts (35)
Peanuts (20)
Peanut butter (1 Tbsp)
Almonds (18)
Pecans (12)
Cashews, walnut halves (10)
Macadamia, chestnuts (6)
Brazil (4)
Pumpkin, seseme, or sunflower seeds (2 Tbsp)
Soy nuts (1/2 cup)
Other:
Black olives (14)
Avocado (1/3)
Malted milk powder (1 Tbsp)
Brewer's yeast (4 Tbsp)
can be added to granola, muffins,
or bread dough
Cheese
Carrot Sticks
Fruit
More foods from groups 1-11
15. Optional supplements--as needed
Vitamin pills, powders, herbs, yeast, oils, molasses, wheat germ, etc.
"Note: Vitamin supplements are in routine use in prenatal care; they do not take the place of a sound, balanced diet of nutritious
foods." (The Pregnancy After 30 Workbook, ed. Gail Brewer, 1978)
(Floradix is the best iron supplement I know of, as needed)
Avoid supplements which contain nettle, dandelion, alfalfa, bilberry, or celery (they have diuretic properties).
++See peanut caution in previous column
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