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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.
Vegan Brewer Pregnancy Diet *
Reprinted and adapted from The Brewer Medical Diet for Normal and High-Risk Pregnancy (p. 76)
See here for a weekly record chart to print and post on your refrigerator
If you plan to avoid eating animal products during pregnancy, you will have to be the most careful of all the mothers we counsel.
There is absolutely no room in your diet for nonnutritious foods, primarily because of the high proportion of food fiber
which fills you up fast. This characteristic also accounts for most of our hotline calls from vegetarians who are getting
behind on their pregnancy nutrition requirements. It's hard to consume all the food you need to make our calorie goal. Fewer
calories than you need for your level of activity and stage of pregnancy means a reduction in the amount of protein you have
available for your baby's growth and the maintenance of your own tissues. This is a major hazard of the vegan diet, but with
proper dietary choices, it can be overcome. Vegetable oils and fats from nuts give a much-needed boost to your overall calorie
intake. In a typical meat-eater's diet, nuts are generally regarded as a luxury item. For you, they are a staple.
Other features of your diet that make it radically different from both the Basic Plan and the Lacto-Ovo Vegetarian Diet:
If you get the impression that we're concerned about the adequacy of the vegan diet for pregnancy, you're correct. Two or
three times a week we have unfortunate consultations with women who are very well meaning, but whose diets just don't meet
the minimum nutrient level for successful pregnancy. However, we are also realistic enough to know that if you are a dedicated
vegan, merely reading our advice to use animal milks and cheeses and eggs for a concentrated protein-calorie source during
pregnancy isn't going to change your mind at all. Instead, we've decided to rev up the vegan program to a level that is compatible
with a healthy outcome for you and your baby.
The Farm, a spiritual community in Summertown, Tennessee, has adopted a soy-based diet for everyone living there, including
pregnant women, and their most recent statistics are excellent (good birth weights, an extremely low rate of maternal illness,
most deliveries conducted by midwives in the parents' homes). Margaret Nofziger, Farm nutritionist, travels the country lecturing
on vegetarian nutrition for the entire family and has been instrumental in training the Farm midwives to emphasize a high-protein,
high-calorie, high-sodium diet in pregnancy and lactation. We have been influenced by the Farm experience to consider a soy-based
diet as a reasonable alternative for those who, for whatever reason, cannot accommodate any animal products in their diets.
Please be aware that traveling and moving can break up 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.
Individuals who use no animal products whatever (vegan) should have, every day, at least:
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1. Soy Milk, soy products--4 choices
Each exchange provides approximately 9 grams of protein, however, soy milk as it comes from the beans may not be substituted
cup for cup for animal milks. It contains only 20% of the calcium, 7 percent of the sodium, 75 percent of the fats, and half
the calories, and it significantly undersupplies the amino acids isoleucine, leucine, valine, and methionine. It is possible
to compensate for these deficiencies by choosing wisely from other food groups and eating those foods at the same time as
you drink your soy milk. However, in the interest of making room for all the rest of the food on this diet, we strongly advise
using soy milk fortified according to the recipe (see below) and using your other food exchanges to satisfy your other nutritional
requirements.
Soy milk, fortified and flavored as you prefer (see recipe link, below)....1 cup
2. Calcium Replacement--2 per unfortified soy choice from Groups 1 and 4
If you use only unfortified soy milk or other unfortified soy products such as tofu, tempeh, okara, miso, yuba, soy nuts,
or soy flour, your diet will need calcium supplementation. Each exchange (choice) from this group provides approximately
100 mg. calcium. If you are expecting more than one baby, you may also use this list to increase your calcium intake from
strictly non-animal sources.
Almonds....2 oz., 36 nuts
Bok choy, cooked....1/3 cup
Brazil nuts....2 oz. 12 nuts
Brewer's yeast....5 tbsp.
Broccoli, cooked....1 cup
Buckwheat flour....3/4 cup
Carob powder....1/4 cup
Collard greens, cooked....1/3 cup
Dandelion greens, cooked....3/4 cup
Dulse (seaweed)....1oz.
Fennel....1 large stalk
Filberts....2 oz., 1/2 cup
Kale, cooked....1/2 cup
Kelp (seaweed)....1/2 oz
Molasses, blackstrap....2 tsp.
Mustard greens, cooked....1/2 cup
Okra, cooked....3/4 cup
Olives, black....4 oz.
Pancakes, wheat, 5" diameter....4
Peanuts, roasted....5 oz.**
Pistachios....3 1/2 oz., 2/3 cup
Seseme seed meal....2 tbsp.
Soybeans, cooked....1 cup
Soybeans, fermented (tempeh)....2 large patties
Soybean curd (tofu)....3 1/2 oz.
Soy flour, full fat....2 oz.
Soy flour, defatted....1 oz.
Sunflower seeds....3 1/2 oz.,2/3 cup
Tortillas, made with lime....2
Waffles, wheat....3
Walnuts, English....2 oz., 1/4 cup
Wheat germ....4 1/2 oz.
Note: Other foods, such as spinach, 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.
3. Eggs--Omit on this plan
(See Groups 4,9,and 14)
4. Protein Combinations--6 to 8 choices
Each individual exchange on this list provides 7 grams of protein. Each individual exchange by itself, however, is incomplete
in its amino acid pattern because all these choices are of plant origin. To complete the amino acid patterns and obtain protein
of the same quality as that found in eggs or milk, here are a dozen delicious vegan combinations.
Combination 1 (Soy PLUS)
To fill in the gaps in the soy amino acid pattern, combine soy foods, with foods containing leucine, isoleucine, methionine,
and valine. You may combine any of the soy exchanges with any of the complementary foods in the amounts shown to obtain the
desired result. One combination equals one exchange for Group 4.
Soy Exchanges
Soy milk, unfortified....1 cup
Soybeans, cooked....1/4 cup
Soybeans, fermented (tempeh)....1 cake
Soybean curd (tofu)....3 1/2 oz.,3"x 3"x 1/2"
Soy nuts....1/3 cup, 1 oz.
Okara....7 oz.
Miso....4 tbsp.
Yuba, dried....1/2 oz.
Yogurt (from soy milk)....1 cup
Complementary Foods
Almonds....1 oz.
Brazil nuts....3 oz.
Cashews....3 oz.
Filberts....1 oz.
Walnuts....1 oz.
Pumpkin seeds....2 oz.
Seseme seeds....2 oz.
Sunflower seeds....2 oz.
Cowpeas (black-eyed peas)....3 1/2 oz.,
dry measure, 1/2 cup
Mushrooms, cleaned....3 1/2 oz.
Millet....3 1/2 oz., dry measure
Whole wheat flour....1 cup
Gluten flour....3 1/2 oz.
Wheat germ....3 1/2 oz.
Brewer's yeast....1/2 oz.
Combination 2 (Fortified Soy Milk PLUS)
To any of the following plant sources of protein, add 1/2 cup fortified soy milk at the same meal or snack. The extra
1/2 cup of fortified soy milk contributes the extra amino acids needed to fill out what these other foods need in order to
be complete. One combination equals 1 1/2 Group 4 (Protein) exchange.
Legumes, cooked:
--black beans....1/2 cup
--chick peas (garbanzos)....1/2 cup
--common beans (red,white,pinto)....1/2 cup
--cowpeas (black-eyed peas)....1/2 cup
--fava beans (broad beans)....1/2 cup
--kidney beans (red,white)....1/2 cup
--lima beans, mature....1/2 cup
--mung beans....1/2 cup
--split peas....1/2 cup
--turtle beans....1/2 cup
--lentils....1/3 cup
Legumes, other forms:
--soybeans, fermented (tempeh)....1 cake
--soybean curd (tofu)....3 1/2 oz.
(3"x 3"x 1/2")
--soy nuts....1/3 cup, 1 oz.
--okara....7 oz.
--miso....4 tbsp
--yuba, dried....1/2 oz.
--yogurt (from soy milk)....1 cup
Grains:
--barley.......1/3 cup, dry measure
--bread, whole wheat or rye.......3 slices
--buckwheat flour, dark.......2/3 cup
--bulgur.......1/3 cup, dry measure
--cous-cous (parboiled semolina)
......1/3 cup,dry measure
--corn meal.......3/4 cup
--gluten flour.......1/4 cup
--millet.......1/3 cup, dry measure
--macaroni or shaghetti,durum wheat,cooked
.....1 1/4 c.
--macaroni or spaghetti,high-protein,cooked
.......2/3c.
--oatmeal.......2/3 cup,dry measure
--rice, all varieties
.......1/2 cup,dry measure
--rye flour.......1/2 cup
--triticale flour.......1/2 cup
--wheat bran.......3/4 cup
--wheat flour,whole.......1/2 cup
--wheat germ.......1/4 cup
Nuts and seeds, without shells:
--almonds.......2 oz.
--Brazil nuts.......2 oz.
--cashews.......1 1/2 oz.
--chestnuts,before cooking.......4 oz.
--filberts.......2 oz.
--hickory nuts.......2 oz.
--peanuts,roasted.......1/4 cup**
--peanut butter.......2 tbsp.**
--pecans.......3 oz.
--pignolias.......2 tbsp
--pistachios.......1 1/2 oz.
--pumpkin seeds.......1 oz.
--sesame seeds.......1 oz.
--sunflower seeds.......3 tbsp.
--walnuts,black.......1 oz.
--walnuts,English.......2 oz.
Vegetables:
--artichoke,cleaned.......7 oz.
--asparagus,cleaned or frozen.......7 oz.
--Brussels sprouts,fresh or frozen.......5 oz.
--broccoli,fresh or frozen.......2 cups
--cauliflower,fresh or frozen.......7 oz.
--collard greens,cooked.......6 oz.
--corn,fresh or frozen.......2 ears
--kale,cooked.......6 oz.
--lima beans,baby,fresh or frozen.......3 oz.
--mung bean sprouts.......6 oz.
--mushrooms, cleaned.......7 oz.
--mustard greens,cleaned.......7 oz.
--peas,green,fresh or frozen.......4 oz.
--potato,whole.......2 large
--spinach,cleaned,fresh or frozen.......7 oz.
--soybean sprouts.......4 oz.
--turnip greens,cooked.......7 oz.
--yams,whole.......2
Combinations 3-12 (Mixed Plant Proteins)
To mix plant proteins in the correct ratios to achieve complete proteins, look up the amount of the food you desire in the
portion exchange lists, then mix it at the same meal or snack with the indicated amount of the complementary food.
One combination equals 2 exchanges for "Group 4, Protein".
Protein Complements...........Exchange Ratio
3.......Legumes and grains.......1/2 to 3
4.......Legumes and nuts/seeds.......1 to 1
5.......Legumes and brewer's yeast......1 to 1/2oz.
6.......Grains and sesame meal.......1 to 3 1/2 oz.
7.......Grains and nuts.......2 to 3
8.......Potatoes and nuts.......1 to 2
(1 potato exchange is 2 large potatoes)
9.......Spinach and sesame meal......1 to 3 1/2oz.
10.......Peas and nuts.......1 1/2 to 2
11.......Peas and grains.......1 1/2 to 1
12.......Rice and vegetables.......1 to 1
Note: You may not count any protein exchanges anywhere else on the diet. You must have additional servings
of these foods to satisfy the requirements of other groups and to ensure an adequate caloris intake. Be sure you eat everything
on the diet every day. This diet is your nutritional "floor" for a healthful pregnancy.
5. Dark Green Vegetables--2 choices
These vegetables 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. They remind us of the idea of a complete diet: All of the food items are
needed to assist the others in making their full contribution to your nutritional well-being. This group also contains food
fiber to promote normal digestion and bowel movements.
Broccoli.......1 cup
Brussels sprouts,cooked.......1 cup
Spinach,cleaned,raw.......2/3
Greens--collards,turnip,beet,
mustard,dandelion,kale,cooked.......2/3 cup
Lettuce,raw (romaine is best).......1/2 cup
Endive,raw.......1/2 cup
Cress,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
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6. Whole Grains, Starchy Vegetables, and Fruits--5 choices
These foods are prime sources of the carbohydrates you need to fuel your body. On a vegan diet you may also obtain some of
your protein from these sources as noted under "Group 4--Protein Combinations". However, you may not count the carbohydrates
from your Group 4 choices under this group as well. If you do, you short-change yourself on calories, and your body then
burns your protein exchanges for energy. This robs you and your baby of the building blocks essential for tissue growth and
repair. It is the indirect route to protein deficit and a compromised pregnancy outcome. The complex carbohydrates from
whole grains and starchy fruits and vegetables affect you differently than simple sugars found in candy, honey, jams, soft
drinks, bakery goods, and in the sugar bowl. These complex carbohydrates are also important sources of B vitamins.
Bread,whole wheat or rye.......1 slice
Bagel.......1/2
English muffin.......1/2
Dinner roll or biscuit.......1
Frankfurter or hamburger bun.......1/2
Corn tortilla,6" diameter.......1
Corn bread,2"x 2"x 1".......1 piece
Corn or bran muffin.......1
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
--bran flakes.......1/2 cup
--granola.......1/2 cup
--unsweetened,boxed.......3/4 cup
--puffed.......1 cup
--cooked (oatmeal,wheat,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.......2 1/2 tbsp
(as an ingredient or as a thickening agent in sauces)
Corn,kernels.......1/2 cup
Corn on the cob.......1 ear
Lima beans,baby.......1/2 cup
Parsnips........2/3 cup
Peas,green.......1/2 cup
Potato,white.......1 small
Potato, mashed.......1/2 cup
(with soy milk and margarine or sesame butter)
Potato chips.......15
Baked beans,canned(no pork).......1/4 cup
Cooked legumes(beans,peas,lentils).......1/2 cup
Beets,cooked.......1 cup
Carrots,cooked.......1 cup
Carrots,raw.......2
Cucumber.......1 large
Onion,2 1/2" diameter,raw.......1
Onion,cooked.......3/4 cup
Pumpkin,cooked.......1/2 cup
Sauerkraut,prepared.......1 cup
Winter squash,cooked.......1/3 cup
Summer squash,cooked.......1 1/2 cups
Sweet potato.......1/2
Tomato,raw.......1 1/2
Turnips,cooked.......1 1/4
Apple.......1/2
Apple juice.......1/3 cup
Applesauce.......1/4 cup
Apricots,fresh.......3
Apricot nectar.......1/3 cup
Avocado.......1 cup pieces
Banana.......1/2
Blackberries.......1/2 cup
Blueberries.......1/2 cup
Cantaloupe.......1/2 cup
Cherries.......1/2 cup
Cranberry juice.......1/2 cup
Cranberry sauce.......2 tbsp
Dates.......2
Figs.......2
Grapefruit.......1/2 cup
Grapefruit juice.......1/2 cup
Grapes,purple.......1 cup
Grapes,green or white.......1/2 cup
Lemonade,from concentrate.......1/3 cup
Orange.......1/2
Orange juice.......1/2 cup
Papaya.......1/2 cup pieces
Peach.......1
Pear.......1/2
Persimmon.......1/2
Pineapple.......1/2 cup pieces
Pineapple juice.......1/3 cup
Plum.......2
Prunes,cooked.......3
Prune juice.......1/4 cup
Raisins.......2 tbsp
Raspberries.......1/2 cup
Strawberries.......1 cup
Tangarine.......1
Cornstarch.......1 tbsp
Chocolate (baking).......1 oz.
Tapioca,dry.......1 tbsp
7. Vitamin C Foods--4 choices
Vitamin C is important for the body's manufacture of collagen, the substance that holds tissues together. Without adequate
C, your uterus is less strong and may not perform well in labor. Vitamin C also plays a crucial role in the body's defense
system against infection. As a vegan you need even more C than other pregnant women because the high fiber content of your
diet tends to impair iron absorption. The extra servings of high-C foods remedy the imbalance. Try to eat them along with
your soy exchanges since the soy products are your major sources of iron.
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 pieces
Pepper,green or red,raw.......1
Potatoes,cooked in their skins.......2 small
Strawberries,fresh.......1/2 cup
Tangerines.......2
Tomato.......1 large
Tomato juice.......1 cup
Tomato puree.......2/3 cup
8. Fats and Oils--9 choices
Needed in your diet to help your body absorb the fat-soluble vitamins A,D,E, and K, fats and oils also contribute to a fine-textured
skin. They are a concentrated source of calories, which you need in greatly increased amounts during pregnancy and which
are easy to miss in the vegan diet since plant foods are notoriously low in calories for their volume. The six extra choices
(exchanges) in the vegan pregnancy diet are necessary to make up for the approximately 60 grams of fats provided by milk,
eggs, and meats in the Basic Plan and not completely replaced by your fortified soy milk. Margarine appears on this list
and nowhere else on our diets, because most people want something to spread on their bread or muffins. Select the softest
margarine you can find (in tubs rather than sticks). It's the least hydrogenated. Each exchange provides 8 grams of fats.
Avocado....1/4
Coconut, grated....3 tbsp.
Olives....10
French fries....10
Potato chips....10
Soy mayonaise....1 tbsp.
Salad dressing....2 tbsp.
Vegetable oil....1 tbsp.
Vegetable oil margarine....1 tbsp.
Almonds, whole....10
Brazil nuts, whole....10
Cashew nuts....10
Peanuts, chopped....2 tbsp.**
Pecans, chopped....2 tbsp.
Walnuts, chopped....2 tbsp.
Chocolate (baking), bitter....1/2 oz.
Chocolate (baking), sweet....1 oz.
9. Vitamin A Foods--2 1/2 choices
Each exchange (choice) provides approximately 7,000 units. 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. Because four glasses of milk
and two eggs on the Basic Plan provide 2,600 units of vitamin A and your soy milk contains only 360 units, you need an extra
1/2 exchange to make up the difference. Your other extra exchange, compared with the Basic Plan, substitutes for the vitamin
A in the liver you are not eating.
Apricots,fresh,whole.......7
Apricots,dried,halves.......1/2 cup
Cantaloupe,5" diameter.......1/2
Carrots,cooked.......1/2 cup
Carrots,raw.......1
Mango.......1
Nectarines,whole.......3
Papaya,fresh.......1 1/2
Peaches,dried,halves.......1 cup
Pumpkin,canned.......1/2 cup
Persimmon,whole.......2
Sweet potato or yam.......1
Watermelon.......3 slices
Winter squash,cooked.......3/4 cup
10. Liver: Omit on this plan
(See Groups 9 and 14, Vitamin A Foods and Required Supplements)
11. Salt and Other Sodium Sources--unlimited
Salt or season your food to taste. Cutting back on salt or other sources of sodium 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 action.
Table salt,iodized.......as needed,to taste
Sea salt.......as needed, to taste
Kelp powder.......as needed, to taste
Soy sauce.......as needed, to taste
Miso.......as needed, to taste
12. Water--unlimited
Drink to satisfy thirst, but do not force fluids. Fruits, vegetables, and juices all contain a good proportion of water plus
additional nutrients. Forcing glasses and glasses of 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 to put food in! Diet beverages, coffee,
teas, and imitation fruit drinks should be avoided for the same reason. If you are thirsty, drink a glass of water or something
nutritious (real juice, a soy milk beverage) or an occasional mild herbal tea.
Avoid pregnancy teas which include nettle, dandelion, alfalfa, bilberry, or celery (they have diuretic properties).
13. Snacks--unlimited choices
If you are still hungry after eating everything on the above lists first, you may eat more exchanges from Groups 1-12,
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. See The Farm Vegetarian
Cookbook (Summerstown, Tenn.:1977); and The Book of Tofu, The Book of Miso, and The Book of Tempeh
(Shurtleff and Aoyagi) for some recipe ideas and a wealth of detailed information about the soy-based diet. Eat good foods
to appetite.
14. Required Supplements--6 choices
These supplements are required on the vegan diet to increase your iron intake, your vitamin E and linoleic acid,
and to take care of your vitamin B12 requirement, one nutrient that is not supplied by plant foods. We include the daily
vitamin-mineral pill as added insurance against a deficiency.
Avoid supplements which contain nettle, dandelion, alfalfa, bilberry, or celery (they have diuretic properties).
Brewer's yeast (1.4 mg iron)....1 tbsp.
Blackstrap molasses (3.2 mg iron)....1 tbsp.
Wheat germ (0.5 mg iron)....1 tbsp
Prune juice (10.5 mg iron)....1 cup
Sunflower,safflower,soy,wheat germ oil....1 tbsp.
Pill--Multiple vitamin-mineral supplement, 1 per day, with a meal. Non-prescription health-food brands tend to have more
B-vitamins and less unnecessary iron than prescription brands.
* Each food you eat may be counted for one group only (in other words, count almonds as either 1 "calcium replacement" choice
or 1 "protein combination" choice, not both).
**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 another source for information about peanuts and soft cheeses
See recipe for Fortified Soy Milk here
See Lacto-Ovo Brewer Pregnancy Diet here
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