A Brewer Diet Timeline

1803--Brunninghausen, a medical school professor, wrote on the subject of weight restriction during pregnancy resulting in smaller babies.

1899--Prochownick, a medical school professor, wrote about the link between weight restriction in pregnancy and smaller babies.

"There is no denying that weight restriction results in smaller babies. Nineteenth-century medical school professors from Brunninghausen in 1803 to Prochownick in 1899 wrote extensively on the subject." ~ Tom & Gail Brewer

1900--Dr. Adolph Pinard: "Since 1873, the year in which this prophylactic treatment was first followed by all the pregnant women in the Maternity, the results have not varied. Those which I have recorded, in the thousands of albuminuric women in my service have been similar to those which I observed in 1873, when I was an intern of Stephen Tarnier. Although scientifically conducted observations - and I possess several of them - have revealed that a woman can have eclamptic seizures without having previously shown albumen in her urine during the course of her pregnancy…that proves only one thing: that there is never a rule without an exception. However, you must never be unaware of the woman, for it is the only means we have at the present time of discerning the presence of toxication; and the clinical results are there to show that the complete milk diet constitutes truly the prophylactic treatment of eclamptic seizures. [emphasis added by Joy]

Therefore I can terminate what I wished to say to you about this subject with the following consoling sentence: If the nineteenth century did not arm obstetricians with the means of curing eclamptic seizures, at least the twentieth century provided sufficient weapons to prevent them."
Progrès Reálisés En Obstétrique Pendant Le XIXe Siècle.
Extrait des Ann. De Gynécologia et d’Obstetrique, Déc. Paris (10-13), 1900 p. 13

"All textbooks still teach toxemia of pregnancy can not improve before birth, and cannot be prevented. It is a lie! They just don’t know how.

I refuse to believe that pregnant women can’t understand the role of dietary protein-calorie-salt-pure water lacks, and other dietary deficiencies in the cause of Metabolic Toxemia of Late Pregnancy.

Do the least! Teach women the truth!"

~ Tom

April 9, 1925--Birth of Tom Brewer, in Houston, Texas. Tom "grew up in Houston, Texas, the only child of Mary and Horace H. Brewer, who was treasurer of the Rouse Company, a real estate development concern. Among his ancestors was Horatio Chriesman, who came to Texas in 1822 and was a surveyor for Stephen F. Austin and fought in the army of General Sam Houston."

1929--Acosta-Sison, Honora. "Relation between state of nutrition of the mother and the birthweight of the fetus: a preliminary study." J. Philippine Islands Med. Assn. 9 (1929):174. The incidence of low birth weight was found to be nearly 10 times higher among poorly nourished women than in those determined to have good nutritional status.

1933--Mellanby, Edward. "Nutrition and child-bearing." Lancet 2:1131, 1933. Discussed the need for protective nutrients in human pregnancy and that eclampsia is a metabolic common nutrition-deficiency disease. He noted: "nutrition is the most important of all environmental factors in childbearing whether the problem be considered from the point of view of the mother or that of the offspring."

1935--Strauss, M.B. "Observations on the etiology of the toxemias of pregnancy: the relation of nutritional deficiency, hypoproteinemia, and elevated venous pressure to water retention during pregnancy." Am. J. Med. Sci. 190 (1935):811. Internist at Harvard recognized the role of proteins and related deficiencies in the etiology of eclampsia. Toxemia subsided in women placed on a 260-gram protein, well-balanced diet, with injections of vitamin B.

1935--Theobald, G.W. "Discussion on diet in pregnancy." Proc. R. Soc. Med. 28:1388, 1935. Refuting various speculations about the causes of toxemia, the author concluded that its etiology is malnutrition.

1935--Ross, Robert A. "Relation of vitamin deficiency to the toxemias of pregnancy". Southern Medical Journal, 28:120, 1935. In North Carolina, he identified role of malnutrition and poverty in eclampsia and other human reproductive casualties.

1938--Ross, Robert A. "A study of certain dietary factors of possible etiologic significance in toxemias of pregnancy". American Journal of Obstetrics and Gynecology, 35:426, 1938

1938--Dodge, Eva, & Frost, T. "Relation between blood plasma proteins and toxemias of pregnancy." JAMA 111 (1938): 1898. The authors observed that low-protein diets, often prescribed by physicians for the treatment of toxemia of pregnancy, increased the severity of the disease. They successfully improved the condition with diets consisting of six or more eggs daily, one to two quarts of milk, lean meat, legumes and other nutritious foods; and they directly linked toxemia with low serum albumin and inadequate protein intake.

1941--Ebbs, John, et al. "The influence of prenatal diet on the mother and child." J. Nutr. 22:515, 1941. The low-birth-weight incidence was 2.2 percent in the best nourished group.

1941--Tompkins, Winslow T. "The significance of nutritional deficiency in pregnancy". Journal of the International College of Surgeons, 4:147-153, 1941. Eradicated pre-eclampsia/eclampsia, low birth weight, and stillbirth at Philadelphia Lying-in Hospital. Infant mortality was reduced to 4 per 1000 births.

Complications	Control Group (750)	Nutrition Group (750)
Preeclampsia	59	0
Eclampsia	5	0
Prematures (5 lb. or less)	37	0*
Infant Mortality	54.6/1,000	4/1,000

--Adapted from Winslow Tompkins. Journal of International College of Surgeons 4:417, 1941.
(*Smallest baby weighed 6 lb. 4 1/2 oz.)

See Dr. Brewer's comment on Tompkins' work, after the reference for Tompkins' 1955 paper on nutrition in pregnancy.

1942--"During Tom Brewer's freshman year at the University of Colorado, where he planned to study for the Episcopal ministry, he enlisted in the United States Army at the age of 17 and served in the 33rd Infantry in the Philippines, Leyte, and Okinawa during World War II. He was wounded in action and received the Purple Heart and Bronze Star, among other military honors. After being discharged he entered the University of Texas as a pre-med student."

1942--Balfour, M. I. "Nutrition of expectant and nursing mothers. Interim report of the People's League for Health." Lancet 2:10, 1942. Food supplementation and nutrition education contributed to significant reductions in toxemia, perinatal death and maternal mortality.

1943--Burke, Bertha S., et al. "Nutrition studies during pregnancy." Am. J. Ostet. Gynecol. 46 (1943):38. Confirmed nutritional thesis of the etiology of eclampsia and demonstrated the protective effect of adequate nutrition on the mother, fetus/neonate and infant.

1944--Cameron, C.S., & Graham, S. "Antenatal diet and its influence on stillbirths and prematurity." Glasgow Med. J. 24 (1944):1. In both prospective and retrospective studies, maternal malnutrition was found to cause low birth weights, stillbirth and infant mortality

1946 ?--"Dr. Brewer: I learned about the problem of eclampsia, or what I call the metabolic toxemia of late pregnancy, before I went to medical school. I was married and had a new baby, and we had a neighbor from Russia who often described conditions in that country and the toll they took on pregnant women. (7) Times were very hard, food was scarce, and many women died of hemorrhage or convulsions. The Russian people at that time believed such events were the will of God and that women were meant to suffer in childbirth, but my neighbor believed the problem was simply a lack of food."

1947--Anatov, A.N. "Children born during the siege of Leningrad in 1942." J. Pediatrics 30 (1947):250. War caused famine led to widespread incidence of infertility, amenorrhea, a low birth weight incidence of 49% and infant mortality of 500 per 1,000 live births.

1947--Ross, Robert A., "Late toxemias of pregnancy: The number one obstetrical problem of the South." Am. J. Obstet. Gynecol. 54:723, 1947. This grim report showed that the toxemia incidence and infant mortality were high among the malnourished poor.

1949--Mitchell, J., et al. "Dietary habits of a group of severe preeclamptics in Alabama." J. Natl. Med. Assn, 41:122, 1949. Toxemia was found to be closely associated with inadequate nutrition. When placed on a sound diet providing, on the average, 124 grams of protein per day, all of the toxemic women improved.

1947 to 1950--Tom Brewer continued his interest in Metabolic Toxemia of Late Pregnancy 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. Ferguson, one of Tom's professors, also conducted some research which seemed to confirm that of Strauss and Burke.
(What Every Pregnant Woman Should Know, p. 47)

"So in 1947, when I got into medical school at Tulane University, which was at that time in the middle of a New Orleans slum, I saw the problems he [the Russian neighbor] described first-hand.

In my first year, I went to a lecture given by James Henry Ferguson, (16) an instructor who came from Chicago, where he had worked with W.J. Dieckmann, a professor from Germany. Professor Dieckmann believed that protein deficiencies and malnutrition were the cause of most of the problems he saw in Chicago. He was then chair of the Chicago Lying-In Hospital."

1950--Ferguson, & Keaton, A.G. "Studies of diets of pregnant women in Mississippi: ingestion of clay and laundry starch." New Orleans Med. Sci. J. 102 (1950):460.

1950--Ferguson, J. H. and A. Keaton, II. "Diet patterns". New Orleans Medical and Surgical Journal, 103:81, 1950

1950--Toverud, Guttorm. "The influence of nutrition on the course of pregnancy." Milkbank Mem. Fund Qtr. 28:7, 1950. Proper nutrition reduced the incidence of low birth weight to 2.2% and halved that of stillbirths.

1951--Dieckmann, W.J., et al., "Observations on protein intake and the health of the mother and baby. I. Clinical and laboratory findings." J. Amer. Dietet. Assoc., 27:1046, 1951.

1951--Ferguson, James Henry. "Maternal death in the rural South: a study of forty-seven consecutive cases." JAMA. 146: 1388, 1951. The author described the severe poverty and malnutrition of toxemic women in rural Mississippi.

1952--Hamlin, Reginald H.J. "The prevention of eclampsia and pre-eclampsia." Lancet 1:64, 1952. Eradicated eclampsia by an aggressive nutrition education program in a prenatal clinic, Women's Hospital, Sydney, Australia.

(Date TBA)--"Dr. Brewer completed general practice residencies at Jefferson Davis Hospital - Baylor Medical School [Houston] and at Lallie Kemp Charity Hospital in rural Louisiana, where he found toxemia rates of 25% or higher. He had been instructed by his OB professor, Dr. James Henry Ferguson, that toxemia of pregnancy was linked to the severe malnutrition that Ferguson documented in his own research into maternal death in the rural South during the 1940's. Dr. Brewer developed the practice of asking women on the toxemia wards what they were eating. Finding that their diets indeed were typically of poor quality or wholly inadequate he started counseling women on what they should be eating, using guidelines from the U. S. Department of Agriculture as the basis for his recommendations. Dr. Brewer reasoned that by intervening early in pregnancy and changing the patients' dietary intake before they became ill to that of a well-balanced, adequate protein diet, toxemia could be eliminated, and prematurity reduced to 2% in this extremely high risk population."

Brewer: "For my internship, I went over to Baylor College of Medicine in Houston. There was a lot of toxemia there, too...As an intern, I studied them [the patients]. I did blood tests and liver function tests, and I asked them questions. As a result, I made several observations. For example, the blood gets thicker in toxemia because the woman gets dehydrated. (22-24,35,37,49,52,57) That's why diuretics are so dangerous in pregnancy. Also, toxemia is directly related not only to a lack of fluid in the body but a lack of protein, (5,6,14,18,38,45,54,56) salt, (13,21,36,42,44,46,47,49,59,69) vitamins, (4,18) minerals, (28,56) and other things. (7-9,14,30,56,62,63,65-68) Keep in mind that during my internship, there were only about 50 known nutrients. Now more are being discovered all the time. There may be a thousand nutrients. So I didn't know exactly how nutrition prevented toxemia, I just knew that it worked."

After my internship, I went to Lallie Kemp Charity Hospital, which was a rural hospital north of New Orleans. After a year there, I went into general practice in Fulton, Missouri. I had a partner, Dr. Jim Hill, who went with me from our General Practice residency at Lallie Kemp. Jim Hill and I were both studying toxemia. We did not restrict salt, we did not restrict food or weight gain, we did not use diuretics, we encouraged our patients to eat protein, and we had very healthy women giving birth to healthy babies. Prior to our arrival at Lallie Kemp Charity Hospital, 25% of the pregnant women there had toxemia. To go from a situation where one out of four women has hypertension, edema, and protein in the urine to where there's none at all was what I call a learning experience. It's not something I read in a book.

1954--Tompkins, & Wiehl, D. "Nutrition and nutritional deficiencies as related to the premature." Pediatric Clin. No. Amer. 1:687, 1954. Weight at birth was highly associated with prenatal nutrition, weight gain during pregnancy, and pre-pregnancy weight. The low-birth-weight incidence among women who received protein and vitamin supplementation, gained substantial weight during pregnancy, and were not underweight at conception was less than 2 percent. In contrast, 24% of the babies born to women most likely to be malnourished were underweight at birth.

1955--Tompkins, W.T., et al. "The underweight patient as an increased obstetrical hazard." Am. J. Obstet. Gynecol. 69 (1955):114.

1955--Jeans, P. C., et al. "Incidence of prematurity in relation to maternal nutrition." J. Am. Diet. Assn. 31:576, 1955. Low birth weight was found to be highly correlated to prenatal nutrition.

Brewer: "I was taught in medical school that if a pregnant woman gains over two pounds a week, she's about to die. That's how intense the fear of weight gain was. But I never told a single woman that she was gaining too much weight. The only reason I discussed weight with them at all was to be sure they were gaining enough, that they weren't too thin. Winslow Tompkins (8,18) studied this in the 1940s and '50s both in West Virginia and Philadelphia, and he discovered that the patient who does not gain weight is at high risk for toxemia. His work had a profound effect on me as I studied this problem. He worked for the government as head of the MIC (Maternal Infant Care) program, which was a forerunner of the WIC (Women, Infants and Children) program. The MIC program didn't work because so many doctors who worked in it ignored Tompkins' good advice and did what they were taught in medical school instead, so they got poor results. He had the right ideas, he articulated them and got the programs set up, but the program's doctors, who were scattered around the country, followed the advice of pharmaceutical companies and ignored nutrition. They prescribed diuretics and other drugs, and their patients suffered."

1956--Knobloch, H., et al. "Neuropsychiatric sequelae of prematurity: A longitudinal study." JAMA 161:581, 1956. A well-controlled and meticulously designed longitudinal scientific study linking low birth weight to neurological dysfunction and impaired cognitive potential.

1955 to 1958--Dr. Brewer's private general practice in Fulton, Missouri, of which he said, "I saw no cases of MTLP in one hundred pregnancies. The absolute difference between the malnourished women of the 'toxemia wards' and this better-fed group of mothers confirmed what the Houston obstetricians had told me. MTLP was, at that time, a rare complication in middle-class women."
(What Every Pregnant Woman Should Know, p. 52)

Brewer: "We used the same approach [as we'd used at Charity Hospital,] in our General Practice in Fulton, where we worked for three years. Out of 100 births, we had only one toxemic patient. She was a poor woman who came to us from a shack on the Missouri River easement. She was severely toxemic because of her deficient diet, and she had received no prenatal care at all.

1958--Hamlin, Reginald H.J. "Prophylaxis against toxemia." Clin. Obstet. Gynecol. 1 (1958):369.

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."

Brewer: "I went back to take a residency in obstetrics and gynecology, primarily to study this disease further and to try to prove the methods by which it occurred. The only professor who would support me in this effort was the same Jim Ferguson who had lectured at Tulane in 1947. By this time, he had become a professor and chairman at the University of Miami's Jackson Memorial Hospital in Miami, Florida.

I asked him to give me a research fellowship. He said there was no money for research on nutrition and pregnancy but to come anyway. In some ways that was a mistake because it's difficult to be a full-time resident and do research on the side, but I did it. I was there for four years, working with Jim Ferguson on a number of projects that interested him. We studied the placentas to see whether there was bleeding or what I now call toxic abruptio placentae, where the placenta just breaks loose, usually in the middle trimester. (33,57) This happens in the time span just beyond the spontaneous abortions that occur in the first trimester."

1958-- Robinson, M. "Salt in pregnancy." Lancet 1:178, 1958. Among 2000 pregnant women, those put on a "low-sodium diet" experimentally had over twice the incidence of toxemia and significantly higher perinatal mortality than those told to "eat more salt." This study should not have been done because it was unphysiological and needlessly harmed many mothers and babies.

	High Salt Diet	Low-Salt Diet
Toxemia	37/1000	97/1000
Perinatal deaths	27/1000	50/1000
C-section	9/1000	14/1000
Abruptio placenta	17/1000	32/1000

1960--Dr. Brewer's OB/GYN residency at Jackson Memorial Hospital. "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."

1) The mothers with pre-eclampsia "were placed on a high-protein (120 grams per day) diet."

2) "The mothers were placed on regular, rather than salt-restricted diets. A salt shaker appeared on the tray at each meal and the mother was instructed to salt her food to taste."

3) "The women were encouraged to stay out of bed as much as possible, even to do the chores on the ward if they were willing, rather than being ordered to the customary bedrest."

4) "Diuretics and drugs to lower blood pressures were not used."

5) "Following the work of Poth, on the most effective way to suppress bacterial flora in the bowel, patients received oral antibiotics to reduce the detoxication load on their damaged livers."

6) "Tom personally discussed the program with each mother to obtain her permission and cooperation, then made a conscientious effort to see that each followed her diet well."
(What Every Pregnant Woman Should Know, pp. 59 & 62)

(Date TBA)--"Dr. Brewer was an instructor in the Department of OB/GYN at University of California at San Francisco Medical School, a position he left to develop a prenatal nutrition program as part of the public prenatal clinics in the Contra Costa County, CA Medical Services in the East Bay area of San Francisco."

1962--Brewer, T. H. "Limitations of diuretic therapy in the management of severe toxemia: the significance of hypoalbuminemia". American Journal of Obstetrics and Gynecology, 83:1352, 1962. First published account of the threat diuretics pose to the health of mothers and their unborn by attacking maternal and fetal plasma volumes. This warning went unheeded, as the use of sodium diuretics became a routine practice in prenatal care among most obstetricians in the US.

1962--Green, G. H. "Maternal mortality in the toxemias of pregnancy." Aus, N.Z.J. Obstet. Gynaecol. 2:145, 1962. Ten toxemic women died in hypovolemic shock, without excess blood loss or infection.

1963--Metabolic Toxemia of Late Pregnancy: A Disease of Malnutrition, by Tom Brewer, written for prenatal care providers.

1963--Brewer, T. H. "Administration of human serum albumin in severe acute toxemia of pregnancy." J. Obstet. Gynecol. Br. Cwlth. 70:1001, 1963. Rejected by editors of U.S. medical journals, this paper demonstrated the nutritional pathogenesis of metabolic toxemia of late pregnancy, stressing the problem of maternal hypovolemia.

1963 to 1976--Dr. Brewer supervised a demonstration toxemia prevention project in the prenatal clinics of Contra Costa County, California..."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."
(What Every Pregnant Woman Should Know, p. 44)

Brewer: "Improving the diet is the most effective and least expensive way to prevent toxemia and insure the delivery of full-term, healthy babies. The dietary guidelines I developed in the early years of my medical practice are still working well. When I went to Richmond, California, and ran the prenatal clinics of Contra Costa County from 1963 to 1976, over 25,000 women followed these guidelines with success. (51)"

"Throughout my 12 years in these clinics, I met face-to-face with about 7,000 pregnant women. Many people came to sit in on my lecture discussions to see if I was a charlatan, nutrition faddist, quack, or nut. Some of these visitors were from Planned Parenthood, March of Dimes, State colleges, or UC Berkeley, or they were public health nutritionists. At the end of the discussion, after the patients had left to be examined, someone would always say, "That's a very nice presentation, Dr. Brewer. Your advice isn't likely to kill any pregnant mom or fetus. But do you think these people can understand it and apply it in their daily lives?" My patients might have been poor and mostly black or Mexican, but they got my message.

Five years after one woman gave birth to a healthy 8-pound baby, she came back because she was pregnant again. She told me that when she was there the first time, she was illiterate, but she had since gone to school and learned how to read and write. I was very happy for her, as that was quite an achievement. Then I asked her what I had told her to eat, and she rattled off the list that had kept her healthy five years before. I said, "Isn't it amazing? Even when you didn't know how to read or write, you knew more than most professors at the University." And that was the truth.

1966--Knobloch, H., and Pasamanick, B. "Prospective studies on the epidemiology of reproductive casualty: Methods, findings, and some implications." Merrill-Palmer Qtr. Behav. Dev. 12:27, 1966. Maternal health is linked directly to child development.

1966--Merrill-Palmer Qtr. Behav. Dev. 12:7, 1966. A continuum of neuropsychiatric disorders in this review of 49 scientific studies is associated with low birth weight and the presence of complications during pregnancy.

1967--Brewer T. H. "Human pregnancy nutrition: A clinical view." Obstet. Gynecol. 30:605, 1967. Advocates application of scientific nutrition and physiology in human prenatal care.

1968--Schenider, Jan. "Low birth weight infants." Obstet. Gynecol. 31:283, 1968. Documents the alarming rise in low birth weight in the US after 1950.

1968--Iyengar, Leela. "Urinary estrogen excretion in undernourished pregnant Indian women: Effect of dietary supplements on urinary estrogen and birth weights of infants." Am. J. Obstet. Gynecol. 102:834, 1968. Demonstrated beneficial effects on fetal growth by improving maternal diets as late as the 36th week of gestation.

1968--Singer, J. E., et al. "Relationship of weight gain during pregnancy to birth weight and infant growth and development in the first year of life." Obstet. Gynecol. 31:417, 1968. Weight gain during pregnancy is statistically related to birth weight and infant mental, neurological, and motor function. Unfortunately, the paper ignores the question of the quality of diet causing the weight gain.

1969--Brewer, T. H. "A case of recurrent abruption placentae." Del. Med. J. 41:325, 1969. Dietary history recorded of a woman who had two abruptions and two neonatal deaths of low-birth-weight babies in one year. After her malnutrition was corrected, she had a normal baby with no complications.

1969--Drillien, C. M. "School disposal and performance for children of different birth weight born 1953-1960." Arch. Dis. Child. 44:562, 1969. Low birth weight is associated with an increased proneness to handicap and a lowered IQ. Birth weight was found to influence child development more than socioeconomic background.

1969--Winick, M., and Rosso, P. "The effect of severe early malnutrition on cellular growth of human brain." Pediatric Res. 3:181, 1969. Malnutrition during pregnancy is shown to lead to a significant reduction of brain cells in the newborn. Impaired hyperplasia of brain cells was reflected in their finding that brain weight, protein, RNA and DNA were substantially reduced in newborns of malnourished women.

1970--Bletka, M., et al. "Volume of whole blood and absolute amount of serum proteins in the early stages of late toxemia of pregnancy." Am. J. Obstet. Gynecol. 106 (1970):10. Valuable observation documenting that hypovolemia and hypoalbuminemia precede hypertension and other signs of metabolic toxemia of late pregnancy.

1970--Brewer, T. H. "Human pregnancy nutrition: an examination of traditional assumptions". Australian — New Zealand Journal of Obstetricians and Gynaecologists, 10:87, 1970. Exposes the incorrect ideology and dangers of the routine obstetrical practices of weight control, salt restriction and the use of sodium diuretics.

1970--Pike, R. L., and Gurskey, D. S. "Further evidence of deleterious effects produced by sodium restriction during pregnancy." Am. J. Clin. Nutr. 23:883, 1970. The consequences of sodium deficiency, such as hypovolemia and stress on the renin-angiotensin-aldosterone homeostasis, are well documented.

1971--Duffus, G. M., et al. "The relationship between baby weight and changes in maternal weight, total body water, plasma volumes, electrolyte and proteins and urinary oestriol excretion." J. Obstet. Gynaecol. Br. Cwlth. 78:97, 1971. Total circulating protein mass correlated most significantly with infant birth weight.

1971--Schewitz, L. "Hypertension and renal disease in pregnancy." Med. Clin. No. Am. 55:47, 1971. This erudite review of 100 studies demonstrated the absence of scientific validity driving a low-salt diet and/or sodium diuretics to edematous or hypertensive expectant mothers. Severely hypertensive pregnant women received 14 grams of salt daily without demonstrable harmful effects or increased blood pressures.

1971--Brewer, T. H., "Disease and Social Class," in The Social Responsibility of the Scientist. Martin Brown, ed. New York: Free Pres, 1971. Examines mechanisms by which poverty and malnutrition cause human diseases including maternal and infant morbidity and mortality. Stresses the need for primary prevention.

1971--Platt, B. S. and Stewart, R. J. C. "Reversible and irreversible effects of protein-calorie deficiency on the central nervous system of animals and man." World Rev. Nutr. Diet. 13:43, 1971. Neurological dysfunction is extensively linked to malnutrition in both animal and human studies in this review of 177 works.

1971--Fort, A. T. "Adequate prenatal nutrition." Obstet. Gynecol. 37:286, 1971. Proper fetal development and birth weight, the author states, are directly dependent upon the pregnant woman's nutritional intake.

1972--Cloeren, Stella et al. "Effect of plasma expanders in toxemia of pregnancy." New Eng. J. Med. 287 (1972):1356

1972--Brewer, T. H. "Human maternal-fetal nutrition". Obstetrics and Gynecology, 40:868, 1972. Another call for the application of physiology and basic nutrition science in human prenatal care, this paper criticizes the positions of the American College of Obstetricians and Gynecologists in this field; i.e., "nothing is known."

1972--Kelman, L., et al. "Effects of dietary protein restriction on albumin synthesis, albumin catabolism, and the plasma aminogram." Am. J. Clin. Nutr. 25:1174, 1972. A valuable study done on men in South Africa which demonstrates the critical role of dietary protein intake in maintaining hepatic synthesis of serum albumin. Such studies, in which daily protein intakes were reduced to 10 grams, cannot be done ethically on human pregnancies, yet they demonstrate the pernicious effects of both low-protein and low-calorie diets.

1972--Chesley, Leon C. "Plasma volume and red cell volume in pregnancy." Am. J. Obstet. Gynecol. 112:440, 1972. Leading expert in the field of "pre-eclampsia/eclampsia" condemned the use of sodium diuretics in toxemic patients because of their hypovolemic state. Subsequently, his highly regarded chapter entitled "The Hypertensive Diseases of Pregnancy" was dropped from Dr. Jack Pritchard's edition of Williams Obstetrics.

1972--Lowe, C. U. "Research in infant nutrition: The untapped well." Am. J. Clin. Nutr. 25:245, 1972. Emphasizes that the abandonment of weight control, low-salt diets, and diuretics is necessary to significantly reduce the rates of prematurity and low birth weight.

1972--The foundation of the Society for the Protection of the Unborn through Nutrition (SPUN), a non-profit organization committed to the establishment of scientific standards of nutrition management in American obstetrics.

"Through the organization's multitude of educational services--which include the publications and distribution of materials for both pregnant women and health care professionals; involvement at training seminars for obstetrics practitioners and childbirth educators; presentations at workshops and conferences; prenatal nutrition counseling; referrals; and a hotline service--tens of thousands of individuals have become enlightened on the most effective means of safeguarding maternal and infant health. Due largely to its efforts, trends have been established for physicians becoming more nutrition conscious and, therefore, tolerating increased weight gains, recommending that the pregnant woman salt her food to taste, and abandoning the use of diuretics. In fact, SPUN played an active role in the initiation of and participation at an FDA OB/GYN Advisory Committee hearing on the use of diuretics in pregnancy. At the July 17, 1975, hearing, diuretics and low-salt diets were determined to be contraindicated in pregnancy and potentially hazardous, especially in the presence of MTLP. Currently [as of 1982], the organization is involved in a similar campaign to encourage the FDA to withdraw its approval of ritodrine, a drug used to prevent or postpone premature labor, which is more effectively averted by improved nutrition..."

"SPUN also provides medical research and recommends expert witnesses when individuals file claims for damage resulting from medical/nutritional mismanagement. In one such case that was decided on September 17, 1977, the organization was instrumental in convincing a jury that the use of a low-calorie/low-protein diet, salt restriction and diuretics caused a child's retardation, thereby establishing for the first time judicial recognition of the consequences of malnutrition during pregnancy."
(Metabolic Toxemia of Late Pregnancy, 1982, p. 169)

Dr. Brewer was the medical director of SPUN for the 15 years of its existence.

1972--Pike, Ruth L., and Smiciklas, H. "A reappraisal of sodium restriction during pregnancy." Intl. J. Gynaecol. Obstet. 10:1, 1972. Demonstrates that salt is an essential, protective nutrient for human pregnancy and not a "poison," as is still thought by many OB/GYN physicians in the US.

1972--Cloeren, Stella, et al. "Effect of plasma expanders in toxemia of pregnancy." New Eng. J. Med. 287 (1972): 1356.

1973--Cloeren, S. E., et al. "Hypovolemia in toxemia of pregnancy: plasma expander therapy with surveillance of central venous pressure." Arch. Gynak. 215 (1973): 123.

1973--Foote, R.G., et al. "The use of liberal salt diet in pre-eclamptic toxemia and essential hypertension with pregnancy." New Zealand Med. J. 77 (1973):242. More clinical observations which destroyed the "salt is a killer" myth in human pregnancy.

1973--Hibbard, Lester. "Maternal mortality due to acute toxemia." Obstet. Gynecol. 42:263, 1973. Reports alarming increase in maternal deaths from metabolic toxemia of late pregnancy. Most of the toxemic women had been placed on low-salt and/or low-calorie diets. Some were also given sodium diuretics.

1974--Howard, Peggy. "Albumin concentrate can be used for pre-eclampsia." OB/GYN News, Oct. 1, 1974. All of the toxemic women given 50 grams of serum albumin daily gave birth to babies in good health. Infusion of serum albumin improved renal function, increased estriol excretion, prevented eclamptic convulsions, and resulted in a reduction in perinatal mortality to 1/4 the rate of the "controls" and eradication of abruptio placentae.

1974--Brewer, T. H. "Metabolic toxemia of late pregnancy in a county prenatal nutrition education project: a preliminary report". Journal of Reproductive Medicine, 13:175, 1974. Data from National Institutes of Health retrospective study of 5,615 pregnancies delivered in Contra Costa County, CA, 1965-70, a 5-1/2 year period. No cases of eclampsia were found, nor were there any maternal deaths in the nutrition project pregnancies. Not one woman had a cesarean for "severe pre-eclampsia" or "hypertension."

1974--Brewer, T.H. "Iatrogenic starvation in human pregnancy." Medikon 4:14, 1974. A call for major changes in current US. OB/GYN nutrition and drug practices and antenatal care. Advocates that constructive actions be taken immediately to improve human maternal/fetal and neonatal health in the U.S. and to protect all pregnant women and their unborn from the ravages of prenatal malnutrition and harmful drugs.

1974--Brewer, T. H. "Pancreatitis in pregnancy." J. Reprod. Med. 12:204, 1974. Another painful, often fatal complication of pregnancy linked to the use of sodium diuretics and low-sodium, low-calorie diets.

1974--Brewer, T. H. "Toxemia- a disease of prejudice?" World Med. J. 21:70, 1974. Includes a review of Pathology of Toxemia of Pregnancy by H. L. Sheehan and J. B. Lynch (Edinburgh and London: Churchill Livingston, 1973). A great deal of emphasis is placed on the specific liver pathology associated with eclampsia.

1974--Habicht, J. P., et al. "Relation of maternal supplementary eating during pregnancy to birth weight and other sociobiological factors," in Nutrition and Fetal Development. M. Winick, ed. New York: John Wiley & Sons, 1974. Caloric supplementation among low-income women resulted in eradication of stillbirth and a reduction of the incidence of low birth weight from 13.4% to 3.5 percent. Demonstrates the protein-sparing effects of calories from carbohydrates and fat among women on low-protein diet.

1975--Lechtig, A., et al. "Effect of moderate maternal malnutrition on the placenta." Am. J. Obstet. Gynecol. 123:191, 1975. Placental weight, associated with birth weight, increased with caloric supplementation, providing more evidence of the protein-sparing effect of calories.

1975--"Dr. Leon Chesley, distinguished author of the toxemia chapter in Williams Obstetrics, the most widely used obstetrics textbook, now challenges this traditional approach to pregnancy swelling. After forty years of research in the field, he has concluded that normal swelling, or physiologic edema, is a sign of health in pregnant women, and not a pathological condition.

At a July 17, 1975, hearing of the Food and Drug Administration on the use of "water pills," or diuretics, in pregnancy, Dr. Chesley testified that 60 to 70 percent of normal pregnant women will have benign swelling of their faces and hands--in addition to that of their feet and ankles.(1) This single statement is of enormous significance because up to two million pregnant women a year since 1958 have been placed on potent diuretics to "treat" the very edema Professor Chesley termed normal.

Citing study after study, going back as far as Dexter and Weiss's classic book on toxemia (1941), Dr. Chesley criticized the routine American obstetrical practice of "treating" pregnancy edema at all. Instead, he argued for an appreciation of its underlying physiologic causes. Dr. Chesley, in his FDA testimony, consistently associated the presence of physiologic edema with better infant outcome. On two critical measures, birth weight and infant mortality, mothers with normal swelling did far better than those without it. Drawing attention to a major conclusion of the 1968 NIH Collaborative Study of Cerebral Palsy, Dr. Chesley noted that babies born to mothers with normal swelling were of higher birth weight than those born to mothers with no swelling. The Collaborative Study also found that a baby's birth weight is the most reliable indicator of future neurologic development. Low-birth-weight babies have a much higher likelihood of starting life with significant brain damage or growing up to face learning difficulties in school.

Dr. Chesley also reported a review of the medical records of 17,000 American mothers pregnant for the first time. In this study edema was associated not only with higher birth weight, but also with lower infant mortality. In 10,126 mothers who at no time had edema of the hands or face, the infant death rate was 26 per thousand. In the 6,963 mothers who did have edema of hands and/or face, the infant death rate was 18 per thousand. There was 44 percent higher infant mortality in the no-edema group.

After presenting this evidence and a very erudite discussion of the other harmful effects of "water pills" (which called into question the validity of the research which had originally persuaded the FDA to allow them to be used in pregnant women), Dr. Chesley went on record in opposition to the use of diuretics in human pregnancy. He stipulated only one exception to the blanket contra-indication. Diuretics may appropriately be used when the mother suffers heart failure, kidney malfunction, or other medical disease which results in abnormal water retention in both the tissues and the circulation.

This exception does not apply to toxemia, Dr. Chesley asserted. He adamantly stated that diuretics do not prevent or ameliorate toxemia. This bold conclusion descredited the slick, four-color spreads promoting diuretics which have appeared in every American OB/GYN journal since 1958. To the contrary, Dr. Chesley blamed diuretics for aggravating a significant abnormality present in mothers with toxemia, low blood volume (hypovolemia). The diuretics act to drive salt and water from the circulation, thus shrinking the blood volume even more. When used in conjunction with a low-salt diet from early pregnancy on, as the drug companies urged in their promotions, the diuretics may actually bring on the toxemia the doctor seeks to prevent.

What has been the outcome of this hearing? Up to now [1977], most practicing obstetricians do not even know it was held. No testimony from the several physicians who appeared at the hearing has been publicized. The FDA has not called a public press conference to warn our public directly about the hazards of these drugs, even though millions of women and unborn babies continue to be exposed to them. Nor have the customary warnings been sent to physicians as was done recently after the disclosures that certain hormones often used to prevent spontaneous abortions cause vaginal cancer in female children born to mothers who took them in early pregnancy. Rather, the FDA has merely issued regulations requiring a change of labeling on the drugs, removing the indication that they are effective in toxemia. Most obstetricians practicing today have been trained to use these drugs as part of routine pregnancy management. Without special warnings, this labeling change in the fine print of the doctors' portion of the package insert will probably go unnoticed by the busy physician. Alarmingly, the American College of Obstetricians and Gynecologists, whose representative at the hearing argued that the drugs should continue to be prescribed if the mother is "too uncomfortable" at the end of pregnancy due to edema, still clings to this position [as of 1977]. As a result, many thousands of women each year will continue to take these drugs because their doctors will continue to write the prescriptions."

(1) A complete transcript is available from: FDA, Bureau of Drugs, 5600 Fishers Lane, Rockville, MD 20852.

1975--Brewer, T. H. "Consequences of malnutrition in human pregnancy". CIBA Review: Perinatal Medicine, Basel, Switzerland: CIBA-Geigy, Ltd., 1975, p. 5. Discusses the role of malnutrition, including iatrogenic malnutrition, via physician-prescribed low-calorie, low-sodium diets and sodium diuretics in the etiology of metabolic toxemia of late pregnancy, abruptio placentae, low birth weight, prematurity, severe infections and brain damage in children. Another call for applied science in this field on the clinical level in human prenatal care.

1976--Higgins, Agnes C. "Nutritional status and the outcomes of pregnancy." J. Canadian Dietet. Assoc. 37 (1976):17. Documents the value of nutrition education and food supplementation in the increasing birth weight, lowering infant mortality, and eradicating eclampsia.

1976--Brewer, T. H. "Role of malnutrition in preeclampsia and eclampsia". American Journal of Obstetrics and Gynecology, 125:281, 1976.

1977--Brewer, T. H. "Etiology of eclampsia." Am. J. Obstet. Gynecol. 127:448, 1977. Refutes the age-old myth that eclampsia is a disease limited to the first pregnancy and another myth that it is caused by an occult "uteroplacental ischemia." The well nourished primigravida, protected from hypovolemia (the real cause of "uteroplacental ischemia") all through gestation, never develops eclampsia.

"A mentally retarded Lake County, Ind., woman was awarded $50,000...by an Indiana jury in a medical malpractice suit that charged her retardation was linked to a protein-deficient diet prescribed for her mother shortly before her birth."

1977--What Every Pregnant Woman Should Know: The Truth About Diets and Drugs in Pregnancy, by Gail Sforza Brewer, with Tom Brewer, M.D. The physiological adjustment of pregnancy and how to meet its nutritional stresses to help the expectant mother maintain proper nutritional status and problems caused by conventional care. Spanish translation: Lo Que Toda Mujer Embarazada Debe Saber: La Verdad Acerca de las Dietas y las Medicinas Durante el Embarazo. Mexico, D. F.: Editorial Diana, S.A., 1980.

1978--Matthews, D. D., et al. "Modern trends in the management of non-albuminuric hypertension in late pregnancy." Br. Med. J. 2:623, 1978. Challenges the traditional therapies of hypertension in pregnancy: bedrest, sedation, low-sodium diets and sodium diuretics and pre-term induction. These are shown to be of no value or harmful. The authors still exhibit no conception of the role of malnutrition in causing hypovolemia.

1978--The Pregnancy After 30 Workbook, edited by Gail Sforza Brewer [Krebs]. Includes a chapter by Dr. Brewer, "The No-Risk Pregnancy Diet."

1979--Porapakkham, Saroj. "An epidemiological study of eclampsia." Obstet. Gynecol. 54:26, 1979. Reports on 298 cases of eclampsia involving 14 maternal deaths in one hospital in Bangkok, Thailand, among malnourished women, many of whom were given furosemide.

1979--Shanklin, Douglas, and Hodin, Jay. Maternal Nutrition and Child Health Springfield, IL: C. C. Thomas, 1979. Extensive review of prospective and retrospective scientific studies, physiological and neurological evidence, and epidemiological reviews linking prenatal malnutrition to a wide spectrum of perinatal complications.

1980--Beerers, D.G., et al. "Salt and blood pressure in Scotland." Brit. Med. J. 281 (Sept. 6, 1980): 641.

1980--Gormican, Annette, et al. "Relationships of maternal weight gain, prepregnancy weight and infant birth weight." J. Amer. Diet. Assn. 77:662, 1980. A retrospective controlled study documented that weight control and salt restrictions significantly reduced birth weight and resulted in other deleterious consequences

1980--"Prenatal nutritional counseling substantially reduces low birth weight deliveries." Group Health News, March 1980. A voluntary prenatal nutrition education program at a Health Maintenance Organization resulted in a 61% reduction in the incidence of underweight births in addition to a significant decline morbidity and mortality.

1980--Brewer [Krebs], Gail, and Greene, Janice Presser, R.N. Right from the Start Emmaus, Pa.: Rodale Press, 1981. Incorporates the nutritional perspective on all aspects of fetal development, labor and delivery, breastfeeding, and first month after birth for mother and baby.

1982--Ahokas, R.A., et al. "Maternal dietary restriction and repletion: effects on cardiac output and placental blood flow in the rat." Paper presented to Society of Perinatal Obstetricians, annual meeting, San Antonio, Tex., Feb. 1982.

1983--The Brewer Medical Diet for Normal and High-Risk Pregnancy, by Gail Sforza Brewer [Krebs], with Thomas Brewer, M.D.

Janine Ricozzi's medical malpractice lawsuit for "wrongful death" was settled out of court today for only $335,000. Involved in paying this settlement are her two OB/GYN doctors, the United Hospital where Janine died on March 10, 1977, and Abbott Labs, for the misuse of their thiazide, Enduron, in Janine's prenatal care. This is the first time a drug firm has been challenged in court for their role in the diuretic disaster in U.S. obstetrical care. (White Plains, New York, N.Y. State Supreme Court)

1998--The publication of Dr. Clegg's Machete, by John Hargreaves, a novel based on the life of Dr. Brewer. It is a gripping, eye-opening account of the evolution of the Brewer Diet and the kinds of things Dr. Brewer had to deal with as he tried to save lives by educating his peers and his patients. This book is a must-read for every student of the Brewer Diet.

2003--Bloomfield, Frank, et al. "A periconceptional nutritional origin for noninfectious preterm birth." Science 2003;300:606

November 22, 2005--Dr. Tom Brewer died at the age of 80, in Middlebury, Vermont. He is survived by his former wives, Nancy Brewer, and Gail Krebs; his children, Eric Brewer, Laurie Brewer, Claire Lohmann, Daniel Hayes, Bruce Brewer, Cornelia Brewer, and Thomas Brewer; former step-children, Marisa Bellingrath, Ginevra Blumenfeld, Elizabetta Krebs and Francesca Krebs; a son-in-law, Willard Chastain; a cousin, Gerald Harrington; 11 grandchildren; and a lifelong friend, Norman Kittrell.

2006--At the Salt & Pregnancy Forum of May 2006 (1), organized by EuSalt, Prof. Dr. Markus G. Mohaupt already underlined that pregnancy is no time to reduce salt intake and that additional salt may benefit women suffering from pre-eclampsia.

Recently, Prof. Dr. Mohaupt published a case study (2) showing that an additional salt intake of 20g stopped hypertension during pregnancy… In this case, a 33-year-old woman with normal renin activity was diagnosed with essential arterial hypertension 15 years ago. During the 6 month period before conception, her blood pressure was well-controllable by dual antihypertensive treatment. Throughout pregnancy, blood pressure recordings were collected daily, and at five weeks of gestation in her first pregnancy, she stopped all antihypertensive drugs. As a result, the average blood pressure increased, whereas the expected increase in aldosterone synthase activity in pregnancy did not show. Given this hypoaldosteronism, sodium supplementation aiming at 20g total NaCl intake per day was initiated, and pursued throughout pregnancy, and resulted in a decrease of the blood pressure during pregnancy.

After delivery, maternal blood pressure rose again, NaCl supplementation was terminated and antihypertensive treatment was reinstalled. The observation that blood pressure was responsive to NaCl supplementation is in line with the hypothesis that intravascular volume decrease causes increased blood pressure in pregnancy. The absence of the expected increase in aldosterone synthesis was associated with a mutation of the aldosterone synthase gene, similar to earlier findings in pre-eclamptic women. This persistenthypoaldosteronism together with earlier findings on NaCl supplementation led the researchers to supplement salt in this woman. This salt supplementation was associated with a reduced blood pressure throughout pregnancy. In addition to this case, Mrs Sabine Kuse, founder of a support group (1984) for women in acute state and after pregnancy with pre-eclampsia or HELLP-syndrome, and her team have been advising more than 20.000 women during their high-risk pregnancies over the past 22 years.

They found that in most cases, additional salt helped within hours. More importantly, during all those years, they haven’t seen one case where salt supplementation has caused negative effects. The worst effect was no effect. (1) Support for this critical role of NaCl intake during pregnancy, was already provided by Robinson in 1958, who found a reduced incidence of pre-eclampsia in pregnant women on a high salt diet (3).

This study introduced substantial data for bias in other studies, of which all data suggest that salt restriction during pregnancy does not seem promising for the prevention of pre-eclampsia. Or, as the study of Mohaupt et.al concludes: pregnant women with even subtle signs of volume deficiency might benefit from salt supplementation in pregnancy.

Footnotes:
1. EUSALT Newsletter. Salt, blood pressure and pregnancy: a critical relationship? August 2006.
2. Markus G. MOHAUPT et.al . Blood pressure reduction in pregnancy by sodium chloride. Oxford University Press, 2006.
3. M. ROBINSON. Salt in Pregnancy. Lancet, 1958, 1: 178 – 181.

Source: 4th April 2007 12:23:26 / Femalefirst.co.uk

	Number of Pregnancies	Cases of Convulsive MTLP (Eclampsia)
Tompkins 1941	750	0
Hamlin 1952	5,000	0
Bradley 1974	13,000	0
Davis 1976	500	0
Brewer 1976	7,000	0
Total	26,250	0