Brewer diet

[djsnjones]

1) I have been using this diet for about 30 years, and it has always worked for my clients, so I have not felt the need to expend any energy to look for reasons that it might not work, or for proof that it does work.

I have also seen for myself what happened when a midwife in one homebirth practice I worked for was vehemently opposed to the use of the Brewer Diet and we had 2-3 patients hospitalized for pre-eclampsia and/or premature labor issues, in her first 6 mo of being there, something that we'd had happen maybe 0-2 times in my previous 4 yrs there.

Also, I have been too busy with the doing of my life and my practice to expend any energy doing a literature search. I expect that others in the Brewer camp with the energy for this type of research will do that as necessary.

It's kind of analogous to breathing. If I find that it's working for me, I do not feel motivated to expend the energy to conduct a literature search for proof that it does work. However, if one believes that the Brewer Diet doesn't work, I can see why one would want to conduct that literature search.

2) I don't know whether the kind of research that you have alluded to is being done or has been done, which doesn't mean that it's not being done. I do know that Dr. Brewer was adamently opposed to doing any research which would involve having one group of women doing something that he believed to be life-threatening to them and to their babies. He felt that such a study would be grossly inethical, especially since previous studies showed severe consequences from such studies.

He believed, and I agree with him, that earlier studies and history provides enough evidence that such diets are hazardous--historical events such as the starvation and resulting complications that happened in Leningrad in 1942, during the Nazi blockade, the results of which were documented in great detail by Dr. Anotov, a pediatrician who also lived in Leningrad during the siege, and whose report was published in the Journal of Pediatrics.

In addition, three of the Brewer books are loaded with studies too numerous to count off-hand--Metabolic Toxemia of Late Pregnancy, What Every Pregnant Woman Should Know, and The Brewer Medical Diet for Normal and High-Risk Pregnancy. For any one who might want to see this for themselves, these books are available through the local public library, or through inter-library loan.

3) The evidence that I have in my hands is listed in the Brewer books, and in the David Stewart books (David Stewart was a medical statistician PhD who directed NAPSAC for many years), all of which are available through inter-library loan for anyone who is interested. It is too volumimous for me to try to list it all for you here.

4) Do you want the explanations that I have to give? I get the impression that you do not, so I am not inclined to spend the time writing it out. But if you do want to hear it, I will gladly put in that time.

5) I hear you. I also hear that you don't like the evidence that I have, and that you don't want to hear about the physiology of how the body works, from a nurse's perspective. I don't have the kind of evidence that you like, which also does not mean that it doesn't exist.

6) It seems to me that it's unfair for you to allow inaccurate statements about the Brewer Diet and philosophy to stand uncorrected on your message board, but that is your prerogative.

I think that the kidney transplant failure analogy is one that does not fit the situation.

7) I don't agree that lots of new research has disproved Brewer's thesis. Most of the new theories have been disproved, even according to your New Yorker article. And the newest theory seems to me to be just a rehash of the old "ischemic placenta" theory developed by Ernest Page in 1939, in which he postulated that a "protein X" was a vasoconstrictor, and a later rehash of Page's theory by Hunter and Hunter, in 1960, in which they claimed to be able to name Page's "protein x". And Page borrowed his "ischemic placenta" theory from Goldblatt's "ischemic kidney" concept, which was developed from the earlier "view of homeostasis of the human body as developed by Claude Bernard and Walter Cannon". All of this is listed in Brewer's original thesis.

8) I do understand that the new research proposes that their mechanism is a cause of pre-eclampsia and not a symptom. I'm saying that from what I know it sounds as though they are likely wrong in that assessment and that this is in fact a symptom and not a cause.

9) Their own research is inconsistent...
http://www.sfgate.com/cgi-bin/article.cgi?file=/c/a/2004/02/06/MNGP04QGE61.DTL&type=printable

10) As I referred to earlier, you can find this perspective in the writings of Robbie Davis-Floyd...
http://www.davis-floyd.com/ShowPage.asp?id=51

The article I refer to most specifically is "The Technocratic Body: An American Childbirth as Culteral Expression", which you can view by PDF.

--I feel very muzzled in this discussion. I am disappointed that you are not willing to let me fully explain the inaccuracies expressed in this thread.

--You can find the information you're looking for in your local library.

Joy

[onesock]

Joy, I am not sure why you would feel muzzled...we have asked you questions, yet we have gotten no answers. You keep saying that you don't want to expend the energy looking for reasons that it might not work,or proof that it does work, but we are talking about the lives of mothers and babies here. In my opinion, it is worth the energy to make sure it is safe and everything is claims to be, which if it really were, it should not be that hard to prove. We just want proof...that is all. I was reading one of the PE stories on your website where the lady developed high blood pressure in her pregnancy and it was blamed on stressful relationships that she was involved in...once again blaming the mother for the problem. Around here, we never blame the mother for PE, particularly when it comes to the mother inducing her own high blood pressure, or not eating the right foods.

[caryn]

So you have only anecdotal evidence, of the "it worked for me" variety, and one news article from 2004 (woefully behind the curve, as the theory has undergone further modification based on new data since that article was written, like all good scientific theories.)

Well, I have anecdotal evidence -- I was on the diet, and it didn't work. I followed the checklists. I ate high-quality food to appetite above and beyond the checklists. I drank water to thirst and salted to taste. My Bradley instructor direct-entry homebirth midwife kept a close eye on me while I did this. And my blood pressure spiked up to 220/116 on admission at 33 weeks 5 days, with a 24-hour proteinuria of 17,000. And I am not the only poster here with this experience.

I *own* all three of those Brewer books you mentioned, and have looked at the research articles he references. They have since been superceded by new research. For starters, I provided you with a link, in my first post, to the Cochrane review of studies showing that protein and protein-calorie supplementation does not affect preeclampsia rates.

Be assured you are not the only nurse familiar with human physiology posting here. [;)] We in fact have several nurses and at least a few PhDs, including a biology researcher into the chlamydia infections thought to underly at least some cases of preeclampsia. (Note: this wouldn't produce elevated sFlt-1 several weeks prior to the development of PE, but it *would* be the result of an immune response that would affect the placenta. PE is sneaky that way.)

The "kind of evidence we like" is the kind that's been peer-reviewed and stood up to scrutiny from multiple different research teams over the course of years -- and the reason for that is that we expect anything we recommend to our readers to have met a very high standard of quality.

Brewer's data simply hasn't met that bar, and in addition, we have lots of anecdotal evidence to suggest that those who do recommend it are conveniently dropping us from the data when they explain how it "works". You yourself suggested that anyone who hadn't had success with the Brewer Diet was doing it wrong -- we had the wrong care providers, we didn't eat more eggs when our symptoms began to appear, or whatever. Well, the only response I have to that is that it's cherry-picking your data to eliminate us from the pool, and count women who were likely no more and possibly less compliant in your data set *just because they didn't happen to get preeclampsia.*

As soon as those advocating a particular diet for preeclampsia can be bothered to produce studies showing that eating said diet really does reduce preeclampsia rates, they will be taken seriously by the scientific community. I've spoken to researchers at the NICHD about this; have you?

ETA: asking for real evidence isn't "muzzling" you. As Paul Boghossian famously put it: " If I say that the earth is flat, and you make no assertion at all, but instead tell me an interesting story, that has no potential for raising deep issues about the objectivity of what either of us said or did." You can tell all the interesting stories you'd like, but at the end of the day, we need some reason to believe them. (ETA: link to the Boghossian paper here: http://www.nyu.edu/gsas/dept/philo/faculty/boghossian/papers/bog_tls.html)

[caryn]

Also, it's common epistemological practice for people with no reason to question "common sense" to accept it, and for those of us with reason to question it to go do some science and figure out whether or not the ideas everyone accepts are actually true.

You haven't experienced preeclampsia or seen it often in your work, so you haven't done this. But now that we've pointed you to studies showing that protein and protein-calorie supplementation don't actually lower preeclampsia rates, are you concerned about your practice and your quality of care? After all, this research suggests that you've just gotten lucky...

[djsnjones]

--"Joy, I am not sure why you would feel muzzled...we have asked you questions, yet we have gotten no answers."

*I feel muzzled because you decline to allow me to correct the incorrect information posted here about the Brewer Diet and viewpoint.

*I feel muzzled because you only want one kind of answer. I do understand, however, that this perspective is the focus of your forum, so it is understandable.

*I have given you many answers to your questions.

*Now that I have heard more about where you all are coming from,I understand better why you're so strong about what you want.

--"In my opinion, it is worth the energy to make sure it is safe and everything is claims to be, which if it really were, it should not be that hard to prove."

*I agree with you. It is simply not the role given to me in this life.

*In the role that I have been given, the Brewer philosophy has proven to be safe, and so I have no reason to look elsewhere for myself, for the purposes of the role that I have been given. I hope that others who may have had this role will come to light soon.

--"I was reading one of the PE stories on your website where the lady developed high blood pressure in her pregnancy and it was blamed on stressful relationships that she was involved in...once again blaming the mother for the problem. Around here, we never blame the mother for PE, particularly when it comes to the mother inducing her own high blood pressure, or not eating the right foods."

*I entered this discussion hoping that the blame card would not be played. I am disappointed that you are using it now. At the same time, I am very sympathetic to the pain that is caused when it feels as though someone is laying blame in this direction, and I think that the professionals need to be much more sensitive about how that feels and learn to be much more careful to not come across in this way.

*In my opinion this is not blaming the mother. Part of the proper use of the Brewer Diet involves doing a thorough assessment of the mother's life, just as taking a thorough history is vital to every medical, or nursing, or midwifery assessment. Unless we take a proper and thorough history and assessment of the client's life, we cannot fully see where changes can be made to help that client achieve the level of health that she desires.

--For Caryn and others...

*I'm not sure that I'm allowed to answer specifics here, since that would be in the category of answering from the Brewer perspective, as defined by Onesock, and I do know that I do not have the time or energy to answer each member's story individually, at least not today...but I will respond to this question...

*Did you follow the Bradley version or the Brewer version of the diet? The Bradley version can be rather confusing, because it is taken from the earliest consumer book by Brewer. The servings are not standardized, and it calls for only 2 servings (3 oz) from the protein-source group, where later books call for 6-8 servings (1 oz.)

*Was a detailed history taken to ensure that the basic Brewer Diet fit your unique needs, including your daily activity level and personal habits (TBMDFNHRP, p. 106-133)?

*When your BP spiked, were you given IV albumin? If not, were you given the IV albumin substitute--52 eggs and 6 qt milk in 3 days?

--"I *own* all three of those Brewer books you mentioned, and have looked at the research articles he references. They have since been superceded by new research. For starters, I provided you with a link, in my first post, to the Cochrane review of studies showing that protein and protein-calorie supplementation does not affect preeclampsia rates."

* I simply respectfully disagree.

* I also have no reason to trust the Chochrane review, especially since I have no way of knowing what biases they may have brought to their review.

--"You yourself suggested that anyone who hadn't had success with the Brewer Diet was doing it wrong -- we had the wrong care providers, we didn't eat more eggs when our symptoms began to appear, or whatever."

*I cannot begin to address each story individually, even if I did have access to them. So I generalized, which is all that I'm left with.

--"Joy, I too want to say that most of our posters would never intentionally be condescending, and I'm sorry if things have seemed that way.

I, like many other women here, researched everything - and I mean everything - I could find on this disease after my first train wreck pregnancy. Please believe me when I say that if I had found an ounce of concrete evidence to support this diet I would have been elbowing my way to the front of the line to try it. I can attest that if this diet were truly the cure-all that it claims to be the women of these forums would be it's greatest champions. Unfortunately we have yet to see any concrete evidence, so please forgive us for not jumping for joy - no pun intended."

*Thank you to all of you for your thoughtful, compassionate responses to me. I'm not sure that I can respond to them all, and at some point I will need to get on with the rest of my life for today, but I will take a stab at responding to some of them.

*I am also truly sympathetic to all of the pain that all of you have experienced, and I admire all of the work that so many of you have put into understanding what has occurred for you, and how to prevent it in the future.

--I am sympathetic to the huge amount of work that many of you have put into your website and your publications. Thank you for telling me more about that.

--"The classic example of Dr. Semmelweis has little to do with modern publishing and peer review. Publishers and reviewers generally jump at the opportunity to take on unpopular or untested views, if only to reveal their flaws. There will always be examples of closed minds and narrow views, but can you seriously claim that Brewer has been unfairly shut out of hundreds of peer-reviewed publications consistently for 40 years? That none of them are interested in being the first to publish groundbreaking results?"

*I respectfully disagree with the notion that Semmelweis's experience has little to do with modern experience, although I do hear where the differences may lie.

*Brewer was published in many professional publications/journals which I presume were all peer-reviewed. In many other situations, he was shut out unfairly.

--"Brewer's site promotes the diet as straightforward and foolproof. Are you now saying it's too complex to be used except by doctors with special training?"

*No, I am not saying that. What I am saying is that the BD and philosophy is often misinterpreted and incompletely used, and that there's no way of knowing off-hand in which of these situations represented on this board it was interpreted and used correctly and in which ones it was not.

--"Keep in mind that many of the women here have been followed very closely by OBs and perinatologists--often experts in hypertensive disorders of pregnancy--with extra blood work, urine tests, ultrasounds, NSTs, Doppler, you name it. What further training and monitoring would you suggest to detect our critical dietary deficiencies?"

*I would suggest that each of those experts study Brewer's original thesis thoroughly, complete with case studies and prescribed tests and description of test results. I would also suggest that they apply those suggestions, especially when nothing that they are trying is working.

--(Anyone who knows the story of Stone Soup will see where I'm going with this.)

*I do know the story of Stone Soup, and I don't see the connection.

--"And isn't the diet supposed to PREVENT preeclampsia? If so, why wouldn't a doctor prescribe it to ALL pregnant patients--no judgment calls required?"

*Yes, it does claim to prevent PE. And yes, many practitioners do prescribe it to all pregnant women. But each woman's metabolism, activity level, lifestyle, history, and stress level is unique to her alone, and sometimes some adjustments need to be made in order for the diet to be the most effective that it can be for her unique self.

--"With all due respect, the claims you've presented hinge on guesswork and nihilism. In the absence of controlled trials or at least a compellingly plausible mechanism of action, the Brewer diet doesn't even measure up to the many well-balanced pregnancy diets available from any OB or dietician. To claim otherwise IS victim blaming: It implies that blind faith in one particular, untested approach would have succeeded where all our best efforts failed."

*I respectfully disagree with this viewpoint and characterization.

--"We now know that many underlying disorders such as certain clotting disorders etc, can contribute to PE (it is suspected that I have one of these by my doctors due to my multiple miscarriages, though I have not been tested yet but will be before TTC again). How does the Brewers diet propose that by following it it can stop a person who has an underlying disorder that predisposes them from developing PE? It seems like if the Brewer's diet could cure PE in even before mention women, then why is it not being used to treat those underlying disorders by themselves sans pregnancy?"

*The Brewer Diet is primarily designed for pregnant women who start the pregnancy with no pre-existing disorders, if I understand him correctly. The reason that a non-pregnant person develops hypertension, for example, is completely different than the reasons that a pregnant person develops hypertension, so it would not be appropriate to try to use the BD in a non-pregnant hypertension . By the same token, the clotting mechanisms that go awry with HELLP, which can be addressed with the BD, are different than those that go wrong in a non-pregnant situation, so they cannot be addressed with the BD. Other pre-existing clotting abnormalities are unrelated to these physiologic mechanisms of pregnancy, so they cannot be addressed by the BD, but often other treatments for various pre-existing conditions can be augmented in pregnancy with judicious adjustment of the BD, to the advantage of the mother and baby.

--I hope that you will forgive me if I don't make this post any longer than it is already, by taking on more of the individual points made here. I hope that the responses that I've given here covers them all generally, without leaving anyone feeling overlooked or slighted.

Joy

[heather100]

How is a debate a true debate when only one side offers facts and the other offers opinions and personal experiences backed up by no research or evidence?

[djsnjones]

It seems to me that I am offering facts that are being rejected because they don't fit the definition of "fact" that has been adopted by this forum--which is a decision, after all, that is the right of any forum to make. :-)

Joy

[fiona]

Joy, how about we take the dictionary definition of fact and go from there? I have the Cassell to hand:

Fact: Something that has really occured or been done; something known to be true or existing, as distinct from an inference or conjecture.

We just want to see evidence. I hope you agree that Caryn and Heather and Wendy and others have devoted a great deal of their own time to searching out and bringing our evidence to the debate. We are here, we are engaging with you.

List the 'facts' - and we will be happy to discuss them.

[hhbeachgurl]

Joy, I want to thank you for respond, but as someone who has been trained in research, I have my Masters in a Scientific Health Field, I have to say that seeing someone say that because it has always worked for them they have no reason to do further research bothers me. It is my honest opinion that you have been very blessed not to have to suffer from pe, not to lose a chld from it, a friends from it, a family member from it, sufer the lasting effects of a premeture baby from it. It feels quite condescending of you to spurt things out, come on here and tell us that "had we followed it correctly, would not have suffered from any of this. You do not know us or the depth of our situations. I did follow it correctly, the Brewer diet, and it failed me....many women on here and across the world have. It is great that it has worked so well in your expereince and i think every single on of us on this board would give our right arm for it to work for all of us.....but it didn't. My life is forever changed because of my experience with PE and I am thankful everyfay for the medical interventions of my doctors, the steroid shots for my baby lungs, and the emergency c section that saved mine and my daughters life. Another pregnancy is extreamly frightening for me, and I would jump on the Brewer bandwagon again in a heartbeat, even though it failed me, if I truely thought it would prevent PE. Show me one peer reviewed, well respected article and you may just get somewhere with many of us, but until you can (which you can't because since I was in med school and had access to the libraries and I did those searches) you will probably not convince any of us with anecdotal evidence. We have our own ancedotal evidence and our own peer reviewed research articles, an as they say, your own experience is always stronger, then just learning from someone else. If I had been among the 95% of women who will not go on to not develop PE in pregnancy, and I had been on the Brewers diet I too would have said it works. Please understand that when we ask you for hard evidence it is not to bash you or his theory, I would pay a million dollars for a "cure" or a way to prevent it, but there isn't one plain and simple. I have said my piece and do not wish to debate anymore. i am extreamly blessed that I have a healthy baby girl home with me.... I know many others who have not been so lucky from this disease, so unless you have experience the pain this disease brings or can bring recent peer reviewed, scientific studies to the table, I really see no need for me to further continue reading this post. I am done, have said my to cents, and i will not allow anyone, Dr. Brewer, you, or anyone, make me feel responsible for what I and my baby girl went through by saying "Did you follow the Bradley version or the Brewer version of the diet? The Bradley version can be rather confusing, because it is taken from the earliest consumer book by Brewer. The servings are not standardized, and it calls for only 2 servings (3 oz) from the protein-source group, where later books call for 6-8 servings (1 oz.)" To me that is blaming me pure and simple....had I done it right, eaten healthier, better, the right way none off this would have happened. Well it would have, I did it right, and it did. So until you have been through someting horrible, that nothing you could or anyone could do to prevent it almost takes your life, I really think you will never understand were we on this board are comming from. I am sorry if any of the above sounds condescending, but I have been through enough in my life and with PE to believe miricle cures, preventions, that have no scientific basis (and don't say it does, because until you present it you will be waisting your breath).

[aundapenner]

I'm curious too to see what comes about.

Joy - for what it's worth, you say that you don't have much time, yet seem to have written lots!!!

At this point, it's too exhausting to try to sort through all the statements ... can you just summarize your viewpoint?

Thanks.