I've read a lot of discussion on this site on the merits on Bernstein's low carb diet. I just finished reading his book and was shocked by the BG and HbA1C targets he recommends. My doctor was thoroughly impressed with a HbA1C of 6, and told me that it would be dangerous for me to aim any lower.
I am wondering whether the targets Bernstein suggests are realistic for someone who is type 1. If anyone is type 1 and has tried his diet, I would love to learn about your experience with it.
Were you able to achieve a HbA1c<5 and BGs around 85?
What happened to your insulin use?
How closely did you follow his regimen? For how long?
Also, did you discuss the diet with your doctor before starting it?
I've been following Dr. B's guidelines for over 2.5 years. I'm T1. My A1c has stayed between 5.2 & 5.3 consistently. Because I have gastroparesis, I don't think it's possible for me to get much lower. Unpredictable stomach emptying is a huge challenge to level BG. I believe it would be under 5 if gastroparesis wasn't a big factor.
My insulin doses decreased dramatically. I didn't discuss with my doctor beforehand. I told him after that I was doing it. I heard the usual myths: I'd never be able to maintain this for long, my brain would starve, I'd have no energy, I'd lose too much weight. I tuned it all out. I felt horrible on the ADA nonsense (even on less than the usual 45-60 carb meals) & spent most days swinging from high to low & back. Made no sense to me to eat that way & I kept cutting back carbs on my own. When I found Dr. Bernstein's book, it was the first thing that made sense.
I am a follower of Bernstein, but am diagnosed T2 and have not been using insulin, but I do know of a fair number of people who have had long term success on the diet. There is a specific forum Diabetes Solution where you will find more personal stories, there is also a specific group here where you may get more specific help from Bernstein followers (Dr. Bernstein Diabetes Solution Group. Insulin use on Bernstein's diet goes down, in some cases way down particularly if you have been following a high carb diet. As would be expected bolus requirements fall quite low when there is little dietary glucose load and that also drops total daily dose. Many people also find their basal requirements also drop.
You will find that the vast majority of people that follow Bernstein follow his principles. To most people, the "Law of Small Numbers" is more important to embrace than a strict 6-12-12 limit on carbs. I have found that most doctors do not understand when I have discussed diet, virtually none of them understand the diet I am following, they generally only make it to the words "low carb" and think maybe 45% of calories from carbs. Then there is the problem that most doctors I have encountered have almost no training in nutrition and merely echo the ADA diet with no understanding.
I have followed Dr Bernstein for several years but recently tweaked it and added a few more natural carbs like sprouted bread and sweet potatoes. I keep my bgs between low 70's and 120 after meals. I know this is higher than he recommends but it works for me. I am only on metformin and not insulin. I found with his diet you need to do tons of exercise to keep bgs low. Since I added the Eziekel bread and a few more veggies like tomatoes, sweet potatos and onions I am happier and have stopped losing weight. I stay in the 112-114 range which is as low as I want to go. I am not a huge meat eater and try to avoid soy products due to thyroid problems, so I can't eat the amount of meat he suggests at each meal. But I do use his basic framework and tweak it to what works for me. Now I exercise every 2-3 days and mainly walking. No more intensive gym workouts. I have also reset my metabolism with Coconut Oil and am burning much more fat, now.
I'd like to note that both Jeannie and I have struggled for years to lower our fasting blood sugars. While Jeannie has had some luck, neither diet, exercise nor medication regime has worked for me. Dr. B has always been clear that if the diet doesn't work, you just move on to insulin. In both our cases, if Dr. B had been our doctor, we would have likely been started on a basal insulin a long time ago. I am still amazed at Jeannie's accomplishments.
Jeannie, I had a difficult time eating a lot of protein also. I felt like I was going to explode. Maybe it was due to being a vegetarian for a long time. I had to slowly add an ounce to each meal & go up from there to adjust to it. I also use protein powder in shakes & add to baking. Easier for me to digest than meat. I heard Dr. Bernstein comment on one of his web casts that his patients often find it difficult to increase protein.
I tried that for the last two days, although I still had some moderate carbs @ night. I think the results proved my prior remarks entirely incorrect and I was pleased to discover, particularly on Monday, that I had lots of energy w/ only a small handful of nuts and some wasabi peas beforehand.
I ran out of gas (BG wise...) a bit on the treadmill but I think that was b/c the 'random' setting went all sadistic on me and put up some monstrous hills for all four miles. I was very encouraged though and am going to trim the carbs back a bit. I am not by any means a low carber but I was very encouraged. Plus I lost like 4 lbs in two days during the holiday season. Boo yeah!
The main principle of Bernstein is really the law of small numbers. When you eat only as little carbs as your body can need or handle, then you reduce the amount of insulin you require... and have less errors. To only eat to our meters, and basically dis the superfluous carbs... Dr B recommends using glucose tabs for treating lows, and I don't think it counts toward your total of carbs a day at all... With the law of small numbers, well... most people may be able to do 36 g of carbs a day, but one can increase that if one does activity, and one needs it... I think, in my mind, it's similar to balancing one's budget... Eating too many carbohydrates, when we're not going to perhaps spend them on some activity, or when we have to perhaps give ourselves a lot more insulin to deal with than would be reasonable, is similar to getting in debt. The "debt" comes out in other ways, like swinging back constantly between highs and lows, or weight gain, etc.
I'm not following Bernstein, but I do know a few people who have, with very good results. In my case, I'm aiming at 60 carbs per day, but usually get around 70-75. I have lost 16 lb. on this regimen, and I don't feel tired or weak. I call it reduced carbs rather than low carb! I don't know what my A1c will be, because I'm doing this after coming out of a coma, and my previous A1c was 10.7. The next one should be in the 6's so far as I can tell. My BGs are averaging around 135, which, if higher than Bernstein recommends, is still a lot better than it was before.
It hasn't reduced my insulin use, but I think I went into the coma because more of my beta cells have pooped out, and so I need more insulin than I did before that happened.
I did discuss reduced-carb with a dietitian, who insisted that the brain needs 130g of carbs a day in order to function, but I don't believe that, because I know too many people who are going lower than that and functioning just fine.
Dieticians sadly don't know enough about biochemisty. They know the food pyramid.
About 58% of protein is converted to glucose (Dr. B says it's less), so the brain isn't starved for glucose. A very small percentage of fat is also. Every diabetic knows that protein effects BG. Interesting that the people "in charge" of diabetic care don't know this simple fact. I've heard the starved brain theory so frequently that I just laugh at this.
Not to get all science-y, but sometimes the kinesiologist in me kicks in.
For anyone interested, Protein actually doesn't contain glucose (not to say that foods that we count as protein don't have some glucose in them, many do, like what DWQ said above). Protein DOES provide energy, though, but it is through a process of structural reorganization of a the protein molecule that occurs through digestion. The body can rearrange all of the amino acids in a protein to completely bi-pass the stage of 'glucose' (hence, protein never producing glucose) and break a protein down directly into ATP (actual energy) and several other biproducts (carbon dioxide, water, urea, ammonia).
Ahhh, feels good to actually use my degree! Hope someone out there will appreciate this info, or at least find it useful :)
Do you mean ATP? I've always learned that it gets converted into ATP, which is the same thing that glucose gets converted to (sorry, I'm sure you already knew that!) I'm wondering whether Dr. B's terminology (saying that it's converted into glucose) is just a simpler way of understanding... because essentially glucose is just the step before energy, right?
Do you have any more details (studies or websites, etc)? I know I'm very research oriented, but it's the way I've been taught to think, haha.
Disclaimer: I'm not a biochemist but I play on on TV. The following is the result of a short web search
The amino acids that form protein are preferentially used by the body for building and repair purposes. Any excess can be used directly as energy or stored for later use as energy.
Protein can be either converted to ATP and used by the cells directly or be converted to glucose in the liver. At this point it can either be stored as glycogen or burned directly. Glucose also ultimately is converted to ATP. Protein can also be converted into fatty acids for energy storage.
My take on this is that protein can be used directly as a replacement for glucose or turned directly into glucose. Apparently this second use is common since insulin users often find the need to bolus for it. Here's a link from the Bernstein group on this forum discussing this issue.
Links: general metabolismamino acid metabolism this second one is very technical but the intro is useful. There is lots of material on WikiPedia about metabolism that is well organized and not too technical.
