Dr. Bernstein: a challenge to read

i dont know about any of you guys, but this book came highly recommended from several people both on this forum and in the chat room. so i bought the book. it weighs three hundred pounds, and i feel like i need a doctorate just to read the first chapter. so i am skimming through it, one section at a time, thinking that eventually i will come to a place where the mighty doctor makes sense, but noooo, i cant make heads or tales of it. maybe i bought the wrong book. i bought:

Dr. Bernstein's Diabetes Solution: the complete guide to achieving normal blood sugars.

any suggestions appreciated. maybe i bought the wrong book (?)

That's the book. My edition doesn't weight that much but it's pretty *heavy*. I read it again a few years ago. I like the way he attacks the medical profession for not attacking diabetes aggressively enough. I have found it possible to achieve ok BG results while eating maybe 4-5x as many carbs as he recommends so I am not entirely buying his approach on that as being necessary however I will admit that eating less carbs is less work, which can be a good thing!! *runs around house* I can't find my copy to see what the first chapter is (and it may be different, as mine is like 15-20 years old...). I find the book interesting but there's so much about eating ultra-low amounts of carbohydrates that I don't find it entirely credible. Although I think that most food discussions here @ Tu tend to be dominated by the very smart low-carb advocates here. I also "cheat" by exercising pretty aggressively, for which one may need to eat bit more. Compared to a lot of runners, I don't eat a lot.

I'd recommend "Think Like a Pancreas" by Gary Scheiner, "Using Insulin" by John Walsh and/ or "Your Diabetes Science Experiment" by Ginger Vieira as much more readable and realistic guides.

dear acidrock23, i cannot fathom eating the way he perscribes. i MUST have my carbs Breakfast, Lunch, and Dinner. its not like i use a lot; my days basal rate is 11 units. after all is said and done and tallied up, at the end of my day i average about 30 units of Novolog per day. i shoot for about 35 grams of carbs per meal and sometimes a snack, desert, or cup of coffee. i have NO problem eating dark chocolate, so i indulge every now and then; i am not someone who needs to watch my weight, so the calorie aspect isnt at issue.

how can anyone adhere to such extremes which Dr. Bernstein proposes. whats the point of life if all we do is control our carbs? isnt it enough that we are D?
this is a real ballancing act.

There's a whole group here on Tu. They may be sleeping in today or something but I'm sure they'll be along! I read both of Gary Taubes' interesting books on the subject and don't disagree that eating carbs appears to have risks associated with it and the general assertion of "common knowledge" that fat is bad and carbs are good appears to be misplaced. He also suggests that there are benefits to eating less carbs however he doesn't say exactly how many you should eat. One of those books (I think "Why We Get Fat") seemed to put the high end of "low carb" at around 75G of carbs, from studies from some scientist or other, or maybe a couple, which seems much more reasonable than 25/ day that Dr. B recommends (ok, it's 24...to me, 1 carb is relatively inconsequential...).

I agree that the balancing act is the crucial part for us. I suspect that if your ratios are correct, eating big carbs is manageable however the balance part of it is *extremely* precise and, if you are off by just a smidgen in ratios and/ or rates, a bigger meal will make a bigger mess to clean up.

I also think that part of the problem is that many doctors, at leaast the ones I've seen, are averse to discussing food at great lengths. It may be that I don't engage with my doctors that much because I think I know everything and mostly go to get blood tests, rx's refilled and get patted on my head. In most cases though, the initial conversations have been "if you want to talk about food, I'll get you an appointment with the dietitian..." which I've done and, perhaps unsuprisingly, their rx is for more carbs than I need, like 180-270G of carbs/day, which is more than I eat, even on a wild binge day.

I read the older edition years ago at a time when I was about 23 and just starting to get interested in diabetes and read everything I could get my hands on. I found the book interesting, especially the science behind how insulin secretion and such works since I had no idea about that at the time. I just ignored all the stuff about carbohydrates. At the time I was still on NPH so didn't even have I:C ratios and such yet.

I bought the latest edition a few months ago because I saw it on sale. I haven't read it yet. I know I won't follow the diet, and don't really like some things about Bernstein either, but the book still has interesting information to consider in there. I do tend to like "heavy" books, though; I read more nonfiction than I do fiction (my dad is the same way, so I think it's genetic!).

LOL @ "I just ignored all the stuff about carbohydrates!". Me too, almost exactly the same! I think I may have been fumblingly carb counting in that for bigger food, I'd take bigger shots but just guessed at it for years! Dr. B lost me w/ the "Swedish crackers" that are his only permitted junk food, even though he helpfully included the contact info for the supplier!

Funnily, I remember the book most because it was the first time I came across U.S. measurements for blood sugar. Before that I didn't even realize there were different scales. For the longest time I could not figure out what he was talking about when he referred to blood sugars of 80 or 200.

I first read Dr. B's book in 2006. I have since read it many times and purchased a number of copies. The current version was released in 2011. His book is not an entertaining book. It is detailed, often technical and there is a lots of subtle things about what he writes. His book is a reference book. Many of us have the same difficulties reading this book that we do reading the encyclopedia.

And while he recommends a very strict diet (6-12-12), that is only one part of his teachings. Just look at how much he talks about subjects such as gastroparesis. It is important to understand, only a small fraction of those that follow his teachings necessarily strictly follow 6-12-12. But you will find that all of those who claim to follow his principles restrict carbs and understand his "Law of Small Numbers."

In truth, none of us really "MUST" have carbs. We may crave them and go through withdrawal when we stop eating them, but carbs are not essential nutrients. It can be very hard to make the transition from a heavy carb diet to a low carb diet. The Atkins diet has an induction phase to help. Bernstein just expects us as diabetics to have the ultimate motivitation and just do it like we are in the Marine Corps.

I would recommend that you read the up front parts of the book, learn what you can from it and "skim" most of it. Think about what he says. You may disagree or question. Look to what other sources say. Think about it some more and reread sections. Although I am what would be considered a follower of Bernstein, I don't always agree with him. And most of all, I adapt what I learn to my situation, which is after wall what you should do.

dear acidrock, i believe i am on the low end of carb consuming. i shoot for about 90 - 100 gms a day. thats close to 3 meals at 30+ grams each. i dont have to worry about my weight. i am a skinny little thing. 108lbs at 5'4".
so i am not witholding carbs for the sake of loosing weight.(Phew; thank god!!)

my numbers this month have been excellent as i made some tweeking changes in my basal to carb ratio and its been working out great. my numbers have come down from 180/200 to 75s and 110s. wow. i am just getting use to it.

as far as the doctors go, my endo has a complete team: nutritionist, pump educator, nurses, and the doctor. he takes his time and is very encouraging, as are the others who are under his employ. and these services are 100% free. i see them every three months (thats what Medicare requires in NY state)

i have been with this paricular doctor since 1991, and have never sought medical attention anywhere else. he's wonderful and i recommend him to every D i know.(they all are very pleased).

I read an earlier version of the book. It was the first book I read on D. I found it very engaging and readable, and I'm no rocket scientist. Maybe the newer edition added more medical jargon?

I did learn a few important things from the book, particularly the danger and inaccuracy of large injections, Protamine in insulin, using Urine stips to test food, and the importance of proper dentistry for diabetics.

I was about 20, on MDI, and the diet advice and A1c targets did not seem at all realistic to me. I incorporated bits and pieces of the advice, but my control remained poor-fair.

I revisited the subject of LC diet after I started following TuD, and switching to the pump. I also read Dr. B's diet book (most of the recipes aren't great). I eat 20-40g carbohydrate / day. My control is still not perfect, but much better than it has ever been. I still enjoy eating and cooking. I'm just a little skinnier and eat less.

Although I don't follow the Bernstein protocol, I am very very glad I read the book because I learned a lot.
I deeply admire Dr Bernstein because having Type 1 himself, he developed this management plan for the benefit of all of us - even went to med school.
As Brian said, take what you need and leave the rest.

I found the whole premise that Engineer B wanted a 1969 BG machine and they wouldn’t give it to him unless he was a doctor so he went to medical school pretty funny and that it made the whole diet/ law of small numbers bits more credible. Plus the notion of this old dude w/ a ghastly, chronic disease lifting weights awesome too!

I think it is not scientifically sound to claim that carbs are not essential nutrients. I think the whole increase in life expectancy we have seen for the last 300 years can be attributed to the general availability of carbs.

I know multiple people with a very unhealthy lifestyles that got very old. Still they are by no means the role model or inspiration for our way of eating. Dr Bernstein has no Diabetes related complications and that is fine. But his genetic disposition might be more effective against the complications than his lifestyle. What about residual beta cells and their long term benefit for glucose control. What about the protective genetic features of the nervous system to be protected against the harmful effects of elevated glood glucose? What about the other long term diabetics with minor complications that admittedly say the had long periods in their life with little control (they even had no meter then). Is it valid to just reduce the problem to "eleminate the carbs and D Life is good"?

To me someone on the strict Bernstein Diet is also risking something. Other risks and complications than the risks of uncontrolled diabetes but still risks. Potentially the strict Bernstein diet has the same risks than having an A1c of 7.5. Seen from this perspective I would like to make the point here that there are shades in between. An underweight person with a very active lifestyle will need something like 100g of carbs per day to keep its weight. To recommend less carbs just for the sake of picture perfect A1c is unbalanced in my view. Even with an A1c of 5.5 the risk of diabetic complications is not taken away - it is just reduced. So why not having an A1c of 6 with 100g per day and feeling very energetic and well? Why not trying day by day to learn something new about carbs and how to handle them? Why not acquiring an arsenal of experiences with food you can utilize when needed? It is not that people always fail to handle higher loads of carbs with exogenous insulin. Actually they can become very good at carb guessing and dosing.

In truth, none of us really "MUST" have carbs. We may crave them and go through withdrawal when we stop eating them, but carbs are not essential nutrients.

Sorry Brian, but the way you phrase this statement makes it a fallacy and feeds into propaganda by the low-carb establishment. Fundementally, this is a misrepresentation of what research actually says. I'd ask you to clarify why you have must captalized and quoted for emphasis.

You absolutely require some carbs and the fact that gluconeogenesis from protein is a central process to keeping a low-carb diet sustainable shows that carbs are necessary. The fact that glycogen stores sustain muscle function shows that carbs are necessary. The fact that if your Blood Glucose levels drop below a certain level your body will scramble to provide circulating glucose from glycogen stores in your liver shows that carbs are necessary. Heck, the fact that we actually work like demons to keep our BG between 70 and 120 mg/dl and that it is physiologically impossible to allow it to drop to 0, which would be the absence of any carbs, means that we require carbs.

The question is, do we require exogenous sources of carbs from our diet to supplement any gluconeogenesis from protein sources?

The answer, honestly, is that it depends.

Of course, many people have successfully brought their dietary carb intake down to very low levels, adhering very strictly to Bernstein numbers but has anybody ever successfully brought dietary carb intake to 0 and been able to sustain it at 0?

There's plenty of propaganda on both sides of this ongoing debate but unless the information we get is absolutely free of bias and questionable language then how can we honestly make the correct decisions that benefit us as individuals?

Daisy Mae, In another life Dr.B was an engineer, perhaps that explains the technical nature of the book, which can make the eyes glaze over. Perhaps reading in smaller chunks would help.

Lots of folks influenced by Dr. B. eat more than his 30g/day, so I it can be helpful to read the book even if you don't buy in 100%. I'm around 30 to 50. BTW further down the thread you said you are at 90 to 100, that's fairly low in my book. The book can help you understand in more detail how diabetes works. This can help you tighten up your control even if you decide to keep your carbs where they are at.

The main thing I picked up From Dr.B's book was that all carbs are not created equal. As a T2 not on insulin, his advice to eliminate sugars and starches was spot on. Understanding how and why all carbs are not equal helps T1's also.

For T1's, understanding the "Law of Small Numbers" is also a very useful tool.

There are lots of good things left I can eat. So after 3yrs+ I have no trouble sticking with the program. Continued good readings on my meter keep me motivated. Most who have eliminated fast acting carbs acknowledge they are addictive. Having said that, I can understand why some choose to keep eating grain, potatoes etc. They were formerly some of my favorite foods.

Oh Daisy, this has made me laugh " thinking that eventually I will come to a place where the mighty doctor makes sense ". When I first read the book, well I didn't read straight through, I read parts of it, made little notes, did little experiments, went back over it. Anyway, when I first read it, I was absolutely terrified of ever eating a carb again and I didn't, for a while. I used to carry the book with me everywhere, took it with me in the car, would read it while children took dance class. I was so excited that this man had D and had figured out the proper way to do the multiple injections, low carb while keeping his bg under control. I soon found out however that my new strict way of life wasn't really making me happy. I have since increased my carb intake and my insulin needs have gone up a bit, but I am happier. I take very little insulin like yourself, overall about 22-28 units. I did laugh at little bits of his book, like when he said that if you think frequent visits for dialysis is a nice way to meet people, its wise to have your kidneys tested. I was blown away at how much he improved his own health. I do think maybe we are all different and don't need to follow, what was it 6g of carbs per meal. Come to think of it I'm going to read, or rather go over this book again. Have also been meaning to buy other books that have been mentioned on TU.

When my son was first dx'd in August I set about reading every book and study that I could find on diabetes. I decided that Dr. B's approach made the most sense, and indeed my sons BG averages have come down from 240 to 97 in a very short time. I believe a newly diagnosed person in particular should eliminate as many carbs as possible just to know how eating carbs affects one individually. If my son were to eat the recommended ADA 60-65% carb diet we would have an almost impossible time determining the minimum amount of carbs his body can handle with the minimum of insulin. Also, he had an extreme addiction to fast carbs which he has largely overcome by going cold turkey.
I think people can do very well on different diets. The Okinawan diet is a complex carb, low fat diet and the traditional Inuit diet is 75% fat, 23% protein, and 2% carbs. What they have in common is no processed grains, and no processed sugar. Maybe that's why it seems that a vegan diet can benefit diabetics as well as its polar opposite the high fat, low carb diet.
No one can have all the answers, but I think Dr. B comes fairly close. I think that diabetecs should be supported in achieving the goals they set for themselves. If someone wants to achieve an A1c of 4.3 they should be encouraged to do it by their doctors instead of encountering ignorant advice that they are harming themselves by maintaining low numbers. Dr. B calls this the rape of the diabetic because so many doctors and medical associations are beholden to corporate interests that profit from selling processed, high carb food and dangerous drugs.

I think I eat 6G of carbs/ bite when I have a burrito or something like that. I don't think that it's really good for anyone to have that sort of stuff all the time but, every now and then I like to let 'er rip. I think that it's important to be happy and 6G carbs/ meal generally won't make me happy.

Carbohydrates are not "essential." Even the Institute of Medicine which establishes the Dietary Reference Index (DRI) for the USDA recommenations says this. They say "The Recommended Dietary Allowance (RDA) for carbohydrate is set at 130 g/d for adults and children based on the average minimum amount of glucose utilized by the brain. This level of intake, however, is typically exceeded to meet energy needs while consuming acceptable intake levels of fat and protein (see Chapter 11)."

If you eat the recommended levels of fat and protein, you can generate enough blood sugar (through gluconeogenesis) to meet all the needs of the brain. In my view carbohydrates are not an "essential" nutrient, you can be perfectly fine without dietary carbs. As to whether that leaves with a diet that is easy and satisfying, that is another question.

I think there is a valid argument that lowering carbs without clearly understanding how to adjust your insulin can leave you vulnerable to dangerous lows and these are as much of a risk as complications. And while we may always be at some risk of complications no matter what our A1c, the DCCT clearly showed that for A1cs above 6% our risk of complications rise exponentially.

I feel very comformtable with my decision to restrict carbs and work towards tight control.

I am claiming we don't technically require dietary carbs (see above). I think there are a variety of reasons to eat at least some carbs. The key thing is that we have dieticians that tell us that dietary carbs are "essential" and that we will absolutely die if we don't eat 45-65% of our calories from carbs. This is what makes my head spin like Linda Blair in the exorcist.

ps. And as to questions about whether it is technically possible to go to zero carbs, I offer the case of Owsley "The Bear" Stanley who claimed to have eaten nothing by "meat, eggs, butter and cheese since 1959 until is death in 2011 at age 76 in an auto accident.