Dr Bernstein and me against the medical establishment of Italy

Sleepless in Rome… I’m up at 1.30am with an experience that keeps rolling around in my head, so I thought I’d put it to rest (hopefully) with a probably lengthy blog entry.

I started a 60g carb/133g protein/118g fat per day diet three weeks ago (now modified to 40g carb, 64g protein, 158g fat), following some of Dr Bernstein’s advice and more of Jenny Ruhl’s (www.bloodsugar101.com and the low carb website, especially the calculator). From the beginning, I had been afraid that my diabetologist “wouldn’t let me” do this kind of diet. And indeed, when I went to my hospital checkup appointment today, it turned out they would not.

When I got there, in order to get through the waiting time (usually about an hour and a half), I started chatting to the local diabetes association representative. I wanted to find out if she knew anyone else who was controlling his/her diabetes with food rather than insulin (as I have managed to do for the last two months). When I showed her the results of my last three weeks - my usual range had evened out at 75-95 mg/dl, with the occasional 110 “spike” - she was amazed and asked me all sorts of questions about my diet. No, she had never heard of anyone trying to do what I did, could not imagine not eating bread and pasta, but was interested, friendly and supportive. At that point, I asked her if she could accompany me to my doctor’s appointment, the reason being that I am a foreigner in Italy and although I speak Italian well enough, I find that doctors sometimes get impatient and don’t let me give them the full story, so I thought her presence would be a welcome “reinforcement”.

The first shock was that the doctor seeing me was not my usual one but one I had never talked to before. And the first question the doctor asked about the representative was “What is she doing here? Is she a relative?!” in a pretty hostile tone. After we explained that I had asked her to come along to explain my diet, the doc calmed down and we sat down to talk about the food I was eating (leaving aside almost entirely the results I was getting).

Luckily, I don’t recall all the details, but some of the words she used to describe me and what I was trying to do were “crazy”, “complete folly”, “dangerous”, while explaining to me that while I might help my pancreas, I would destroy my kidneys (with the protein) and heart (with the fat) in the process. She also told me that their guidelines for what to eat were based on scientific research and “international standards” and were recommended by all diabetologists in Italy, and that I would not find a single person supporting me in my way of eating. Here is what she wrote down for me as the diet I would have to follow:

1800 cal per day, divided into:
45-60% carbohydrates, equivalent of 200-220g of carbs per day
20% protein equivalent of 90g of protein per day
30% fat equivalent of 60g fat per day

This would be the healthy diet that would keep my organism intact. According to her, I should really be taking basal insulin to save my pancreas but luckily she didn’t prescribe it (after I had started a “sort of low carb” diet in November, the other doctor took me off insulin because I was too low too often - here is the full story). This at least was one point we agreed on: in order to save the pancreas, the bloodsugars should stay in a healthy range at all time.

During the conversation, the diabetes association representative increasingly nodded along and made all sorts of comments to let the doctor know that she agreed completely and that I was being irresponsible. Thank you very much…

Although I found it stressful to be told in such clear terms that I was wrong, I was happy to notice that I stayed completely calm throughout the “sermon”. I had read enough to know all the counter-arguments that the doc would come up with and just mentally checked them off as they appeared. I tried to argue on a few points, but in general I just nodded. The doc became increasingly aware that I was not going to do any of the suggested changes in diet, and let me know that she had understood that. Not aggressively, as I had expected and feared, but rather telling me (after what seemed like an eternity trying to convince me of her arguments) that I was intelligent enough to know what I was doing. I really appreciated that - and in turn I told her I would try it for another few months and then have a thorough checkup to see if my organs were reporting any problems. I also appreciated the fact that she realised that IF I was going to continue with this diet (I prefer to call it lifestyle, though), I would need more than the minimum prescription of testing sticks, so she prescribed 5 per day and that was really all I wanted :-).

I thanked the diabetes association representative from my heart because I don’t think I would have been as calm, especially at the beginning, if she hadn’t been around. She wasn’t helpful in the conversation, of course, and afterwards stressed twice (in a very friendly manner) that she was not going to be in solidarity with me (non vogliamo solidarizzare con te, ma…). So I don’t think I will join her association, for some reason ;-).

Have you had similar experiences with your doctor’s “non-compliance” when trying to do follow Dr Bernstein’s or similar advice? How have you dealt with it? Do you think I should look for a different hospital? I think there may be a choice of 5-10 here in Rome with a specialist diabetes team, but it would probably be a bureaucratic nightmare to change - and no guarantee that they would treat me any different, of course.

Thanks for your story Uta. I’ve read some of Dr. Bernstein’s stuff online and just got his book delivered in the mail today. Really psyched to read it, it sounds like way too much common sense with results. I read in Mens Health this was, at one time very similar to how diabetics were treated before insulin. I also read of a female Dr. in Kansas City prescribbing very similar diet with great results. I don’t know all of the details in Dr. Bersteins book yet but I’m very hopeful. I have quit following the 60g of carbs per meal recomended by my nutritionist the last 5 days and have stayed closer to 30g complex per meal. I’ve been >120 post except for one day I got stuck in a business lunch eating pizza. Hit 189 3 hrs post and felt horrible. It’s really great to see others empowering themselves and think outside the box. It’s not like we’re trying to kill ourselves, quite the opposite, we hope to preserve our health and prevent death by sugar.

Hey Uta, My doctor told me I would burn my brains out on his diet and that I was in a marathon not a sprint. He could not argue with my improved Lipid profiles and improved A1C though and was totally amazed at the last checkup. Now he says I am one of his better diabetic patients Yes Dr B works. I follow it about 90-95%. Any carbs really spike me though and deviation from Dr B methods one pays the price. My Doctor wrote down the name of Dr B’s book as his dad has diabetes and is concerned he could get it too. The dietician I saw loathes his methods and gave me the ADA website for reference. My numbers are not prefect but I keep on Keeping on. Take care and as Judith says be strong…

I’ve encountered the same with lectures, finger wagging & tales my brain would starve. I’ve heard the kidney warnings & was ignored when I asked if this was based on the disproved rumors about the Atkins diet.

One nurse reprimanded sternly me for not snacking & my doctor was concerned I was too thin. (I did lose a bit too much weight at first, but gained some & have maintained it with more protein.) I was told I could never keep up this “starvation” diet for long. Nice undermining of my confidence. Been following Dr. B for over 1.5 years with no problem.

At first, I countered the arguments because it was upsetting how medical professionals were shoving carbs down diabetic throats. Angers me still. Now, I smile & don’t listen. They can’t argue with my numbers. My current endo is more supportive, but I think it’s because he’s given up lecturing me. In the future I’m not telling new docs what I eat

Dietcians & nutrionists are the most gung ho about eating high carb. I refuse to go to them again.

When I was in the hospital DKA, I was stunned at the meals. Pancakes, French toast, sandwiches, potatoes, rice. I kept asking if my meals were correct. The nurse would point to the sugar-free pudding & can of diet soda & say yes. I was scolded when I didn’t want to eat it. I was just diagnosed & didn’t know anything, but I couldn’t fathom this was what I supposed to eat.

In what universe does eating more carbs make sense for us?

If you know Dr. B’s story and the history you will realize that while Dr. B may be rigid and strict, a modern day Elliot Joslin, he is generally right and time will prove him out. He was right about home glucose testing, he was right about carbs affecting blood sugar, he was right about the basal-bolus regime and I fully expect that time will show that he is right that a carb restricted diet is best for diabetics (at least until we perfect a automated pancreas).

I have gone through the arguments with Drs and with CDEs and dieticians. At first it is difficult, you are just learning and they are supposed to be the experts on diabetes. But over time, you will feel much more informed and more confident in your decisions. I told my endo that I followed a strict carb limited diet and kept to less than 50g/day. I did not discuss Dr. B with him, there is no point. I interact regularly with CDEs and dieticians, the ones I know best accept my informed decisions on my diet and I will accept their need to follow the ADA line.

One must realize that many in the diabetic care profession (such as CDEs) have to follow the ADA guidelines or they don’t get certified and don’t work. Doctors have to give out the standard USDA nutrition info and they have to hassle you about low fat diets and cholesterol because they are under pressure to. Standard quality measures demand that they toe the line.

In the end, no doctor is going to “make me” follow a diet. I will make an informed choice about what diet I want to follow. If they have further information for me to consider, I always like to see that. But in the end, I will not just bow to a doctors “authority” when I have in fact peaked beneath the curtain and seen that the emperor truly wears no clothes.

It’s not only doctors…I come across many other Type 1’s that think I’m crazy for limiting my carb intake as I do.

The greatest revelation in my diabetic life was the day I stopped eating like the outsiders. You’re doing fine Uta, it takes a lot of courage to change your nutritional lifestyle like you have.

I think any diet different than the standard junk food eating diet, and huge large portions, will get criticized now that I think about it… From people who’ve only made small changes, to people who’ve gone vegetarian, or vegan, to low carb… to poor people just trying to follow a weight loss program… People get guilted and put down for being on a diet… Like they’re just being too serious about their health, and that they just need to ‘get real’ and continue eating like everyone else. I’ve explained to my best friend how I can’t eat certain things anymore, including high carb meals, and her husband insists on keep making pizza nights, and italian food nights, etc… So I had to call her, and basically plead to her to be my advocate… so now dinner night was cancelled. lol Don’t know if they’ll ever call me up again… but if they do, I am bringing my own dish to share.

Just re-reading the posts here and I’m really glad to be in with good company. I just reported my last two weeks of meals to my dietician including glucose results and to no suprise she responded to where my carbs were in my salmon/brocolli diner last night and my other meals. She did’nt answer any of my other questions or really say much on my numbers (109 average and dropping). So I have to laugh a bit knowing others have gone before me with the same. It really helps knowing this and the insights you all have are very comforting. I really like the thoughts bsc shared with ADA guidlines and employment. I’m wondering if I should bother with my follow up class or share my real meal plan with them. Maybe I could use donut as a code word for brocolli and chocolat malt for salmon. That might get some attention! Thanks all for blazin new trails for us newbies to follow.

Thank you so much everybody for your comments, like Scott I am really glad to be in YOUR company! This week has been tough, and your comments really brightened my days.

The episode at the hospital (possibly the stress of it) triggered a huge migraine which I have fought with various types of medication and which is STILL ongoing. I have never had a migraine for more than 3 days, but this one is now 6 days “old” and I really don’t know what to do. It comes and goes depending on the drugs I take, but it is still the same one, I’m quite sure.

Of course, I am now really worried that my diet may be the main contributor to it. I had the same kind of migraine (but not nearly as long) when I came off carbs after the Christmas indulgences, so I am wondering if it may be the change in protein intake, or the seriousness of my low-carbing with constant checking (after a week of having to guess my carb intake)? Or do I need to pay more attention to my fat intake, as my body should (according to Jenny’s website) now have switched to ketones for its energy and maybe isn’t getting enough?

The only link with migraines I can find on TuDiabetes is with high and low bloodsugar, so it might be that my body is taking my constant 70-90 mg/dl range as “too low” and is letting me know that my brain is not getting enough sugar? Or is it the metformin dose that I have now reduced from 1500mg to 1000mg? All those questions all week long and no answers… And on top of all that my worry that if I don’t find the answer right now, today (or more like yesterday), something terrible is going to happen to my body, like I will cause permanent damage to my brain… which makes me try to read as much as possible, search groups, google things - and I do find some answers, but not to the migraine question. Help?