What, you don't bow down to Dr. Bernstein??? :O
I certainly respect his considerable achievements and ability to steer a different and successful path. I believe he's said something to the effect that people with diabetes deserve to have normal blood sugars. I'd agree with that although I'm not quite on his "solution"?
Eh, it's just that I checked into his books after people recommended them... and honestly, even just reading the previews, I didn't feel that his recommendations were very well founded. Too many changes and advances in insulin therapy during his lifetime to use him as a model for how to live with T1.. IMHO.
Of course when someone restrict carbs to an insanely low degree they'll get better BG control.. but to each his own.
Exactly! I think that it's possible to get reasonable results with a more, uh, liberal approach? I find eating less carbs more of a useful tactical tool than a lifestyle I've needed to commit to. I could consider that I sort of cheat by exercising a lot too but, at least for now, that works ok for me? I suspect that it could work for other people ok too however I don't think that the medical/ insurance industry is really supportive of the process.
Yes, Dr. Bernstein isn't for everyone. I respect him, even though I don't low carb (I call myself low/moderate - under 100)
Much of it didn't interest me and at least the version I have (updated 2003) seemed dated in some ways. But what I do feel he was a "diabetes revolutionary" and dared to fly in the face of the medical establishment and the ADA which right there brings my respect. I think we all choose what to do for our blood sugar levels, and some of us have it chosen for us by a more difficult management ("the luck of the draw"). But the idea that we can have "good" A1C's defined as less that the standard <7.0 - is radical and I agree. For me, perhaps I most like his "principal of small numbers". In an "you can eat whatever you want and bolus for it world" he says that less carbs = less insulin = less chance to miscalculate and go too high or too low. That makes lots of sense to me. I do very much like
I can see respecting him for that.
I agree with less carbs too, even after being told that I can eat whatever I want. But the dietitian I met with said a good number is between 40 and 60 per meal.. more than that and it's harder to control what will happen afterwards.
That's kind of a boundary for me as well, palamino. While I definitely eat less than that for breakfast and lunch, at times I go over the 50 carb mark for dinner and find that bolusing with my I:C ratio is unpredictable over that. Similar to some foods that I can't eat at all - it's different for everyone, but for me rice, cereal and to a lesser extent pasta just don't work predictably for me.
For me, no, I think I've gotten what I needed out of the older version, and I have the more basic stuff in Using Insulin. But it's good to know he's updated.
I HOPE you're kidding about a book called "think like the ADA" LOL but yeah, unfortunately it would probably sell!
Those are good goals and I try to meet them. I was actually given a pre-meal target of 100 with no more than a 30 point rise which is not all that different. Higher goals aren't bad if they are used to help a person get down to 120 from 150 or 180. Once that is achieved, one can take the next step and I really believe that nothing succeeds like success.
Maurie
Another thing I'd suggest is that it's not good to have a fixed goal. The goal should change with your success. When I studied martial arts, each belt had requirements and then, at certain levels, the "earlier" round of requirements would pop back up and become part of your syllabus for the next level, along with new requirements so you'd take what you'd learned and apply it to the stuff you'd learned before, a long time ago.
One thing we'd do at the "advanced class" is all the forms and then get done and the Master would say "ok, white belt [first] poomsae [form]...backwards" and everyone would say "yes sir" and many of us would sort of fumble and sort of run into each other the first time and then do it again and figure it out as we continued. There's always something to learn and make progress with if you challenge yourself. If not "lower" then "smoother" or "healthier" or "stronger" are all out there to be achieved?
I think that TLAP and "Pumping Insulin" may be a bit conservative/ heavy handed in their approach to fueling for workouts. I looked at their charts before some of the longer runs I did and got through them with considerably less carbs than they calculated. Just a small point, and I still recommend them both all the time but I think there's room for tweaking?
Zoe,
Alan's kidding, of course. But the everything we read, hear & learn might as well have that stamp on it because they are all thinking like & following ADA dictates. Their influence is everywhere, sadly.
Is it the ADA or the AMA? I don't think the ADA is actually in a position to "prescribe" anything that anyone could use in a court if one were say, trying to file a class action suit against an insurance conspiracy to cut test strip prescriptions or something like that?
I would be careful about using emotionally-charged words like "insanely low" when referring to the choices of other diabetics. With so many long-term diabetics struggling to fight off serious, life-crushing complications, one person's "insanely low" is another person's formula for a "miraculous recovery".
Dr. Bernstein was staring down the double-barrel shotgun of a host of complications, which he arrested and reversed using "the magic of small numbers" at a time when virtually NO ONE in the field agreed that diabetics had a right to -- or could safely achieve -- normalized BG values.
No one will try to force you to follow his advice -- and plenty of us who respect his dedication, his discoveries and his recommendations don't follow his advice to the letter -- but "insane" he is not.
I think of him as the Thomas Jefferson of diabetes doctors. While not agreeing 100% with all of his choices and recommendations, he had made (and continues to make) enough incredibly valuable contributions to the health and well-being of diabetics that he deserves thoughtful consideration -- and certainly our respect.
I think that as a newly diagnosed diabetic you'd be making a mistake to reject his work out of hand and unread based on prejudgements about him.
Acidrock,
Yes, the ADA. What doctors, nurses, dietitians, registered nutritionists & CDE's prescribe & advocate are ADA guidelines. I was given all ADA info when diagnosed, as many others have. Don't we hear incessantly the ADA says? They're a powerful, well-funded, highly organized & influential group as the lead diabetic organization. ADA most certainly has far reaching influence.
Not sure what suing in court has to do with it. The ADA sets the terms of the discourse. Millions of PWD follow what the ADA states as the self-appointed authority.
Gerri's number is more correct. A newer study than the DDCT was conducted by the ADA, EASD and IDF from 2006-2008 that changed the eAG calc. The newer calculation is:
28.7 X A1C – 46.7 = eAG
With this calc, an A1c of 6.9 translates to 151 mg/dL, right at Gerri's number. Still high, yes, but not nearly as high an avg as the 168 the old DCCT calc (incorrectly) renders out.
Here's a calculator at the ADA's Diabetes Pro site: Glucose Calculator
Using this method, an A1c of 5.1 gets you to a target of 100 mg/dL, or absolute avg for non-diabetics. Therefore, "A normal A1c would be in the 4's" is incorrect -- a 'normal A1c' is right at 5.1.
/\/\
Agree & well stated, LaGuitariste.
Dr. Bernstein has my respect, gratitude & admiration. For decades, he's been fighting the good fight as the lone voice. He was an early advocate for home glucose meters when others, including the ADA, were against diabetics testing themselves. We take meters for granted.
Alternatives to the mainstream exist.
The initial reaction is to freak at the suggestion of eating very low carb as leading a life of deprivation. I never feel deprived & am never hungry.
I think that the ADA is a smokescreen, albeit a vocal one, for the AMA, or maybe the AACE, who are actually responsible for setting guidelines that are used. They are all on the same page but "legally", I think that one would be better served to refer to the AMA for one's guidelines, were one to be "fighting" about something. I get riled up about this stuff every year when I get letters from Blue Cross about their rewriting my prescriptions.
I'm not sure 100 is correct though, as I think "straight" people will usually run a shade lower than that? It would be nice, of course, if medical science would clear this up...
I used the words insanely low to refer to the number of carbs he suggests. If you find that offensive, then I apologize.
However, I believe moderation is key and going to extremes of any sort is not healthy.
I also plan to rely on things that were determined using a sound scientific method, not just someone's opinion (again, if someone wishes to follow that, fine- but not for me).
Moving on, as everyone is so concerned with the ADA's recommendations, I'm going to suggest reading the AACE's recommendations. They tend to be more strict.
https://www.aace.com/publications/guidelines
They recommend an A1C <6.5%.