Dr. Bernstein diet for the underweight?

I was thin before I was diagnosed with type 1 (LADA) in June, but now that I’m eating even fewer carbs, the weight loss I’ve been experiencing concerns me. (At 5”11, I weighed 161 last year at this time; now I’m down to a pants-sagging 149.) The dietician affiliated with my endo wants me to eat more carbs to gain back some of the weight, at least 30 grams with meals and 15 grams with snacks. I’m worried that this many carbs will send my BG through the roof (and I’ve really been struggling with high fasting numbers lately). I became interested in Dr. Bernstein’s book, which I learned about from posts on this site. His 6-12-12 carb recommendation is radically different from that of my dietician’s, but I’m concerned that I’ll completely waste away on so few carbs. So my question is this: Is anyone out there following Dr. Bernstein’s 6-12-12 diet who has actually been able to GAIN weight? If so, any particular food/menu suggestions would be hugely appreciated.

I lost a lot of weight on a very low carb diet when I was first diagnosed. I still eat pretty low carb, (about 20 per meal and 8-10 for snacks) mostly from fruits and veggies. I have manage to gain back a few pounds now that I’ve started on basal insulin. I make up the difference in calories by eating a much higher fat diet. I prefer that to higher protein. I haven’t gained back all the weight, but I’ve stabilized now at 120 pounds. Since I’m 5’7" that’s still a little bit thin, but OK.

Steven, are you on a long acting and fast acting insulin?
Personally …IMHO … I think the 6-12-12 would be way too radical for me. As long as you cover your carbs with insulin, your BG shouldn’t go through the roof. However, if they do you just may need to adjust your ratio. (My Endo has done this 4 times until we got it right) I also think the 30-15 carbs is still even low and would assume your dietician went with that because you want to keep them low. I am on a 1:12 Ratio and since I’m taking MDI’s I try to keep my meals to carbs divisible by 12 (24, 36, 48) I find 36 works best for me because I don’t feel deprived and the portions sizes are sufficient. If you are thin and losing, I don’t see how you can gain any weight on 6-12-12… especially if you are active. Just my two cents… I’m still learning as I go too :slight_smile: Diabetes Self Managementhas some good info and resources.

“Unhealthy metabolic state (ketosis). Low carb diets can cause your body to go into a dangerous metabolic state called ketosis since your body burns fat instead of glucose for energy. During ketosis, the body forms substances known as ketones, which can cause organs to fail and result in gout, kidney stones, or kidney failure. Ketones can also dull a person’s appetite, cause nausea and bad breath. Ketosis can be prevented by eating at least 100 grams of carbohydrates a day.” quoted fromWebMD

Hi Steven,

I was diagnosed Type 1 in late May. Been thin my whole life, but now I’m way too thin. I dread getting on the scale because weight loss has been steady. I have been following Dr. Bernstein’s dietary recommendations. I feel a lot better & my BG is better controlled, but I don’t like being this thin. Pant-sagging–I hear ya! My doctor is on my case also to add more carbs to gain weight. What I’ve been doing lately is adding, slowly adding, more fat to my diet. For example, I usually have eggs for breakfast & add cheese & heavy whipping cream. My dawn phenomenon is bad, so I basically have no carbs for breakfast to try to keep this under control & have 15 carbs each for lunch & dinner. For snacks, I eat nuts or cheese. Lately, I’ve been having protein shakes for lunch–1 cup almond milk, 1/3 cup whey powder, 2 tablespoons of peanut butter, some heavy whipping cream, vanilla extract & some ice cubes mixed together in a blender.

Higher fat is keeping me from losing more weight. But, I can’t say that I’m always good at figuring in the slow acting fat into my insulin needs. I’ll have good post meal numbers, but hours later when the fat kicks in my BG starts to creep up.

I’m 5’2" so I don’t want to overdo the protein because someone my size doesn’t need too much. Though I’ve never lifted weights, I’m going to start doing this to put some shape on my arms:) I’ve had a hard time with other types of exercise sending my BG really high.

I’ve borrowed money to consult with Dr. Bernstein & haven an appointment for mid October. I’ll let you know what he suggests for weight gain.

Hi Steven! There are many people that live healthy lives following Dr. Bernstein’s plan (including Dr. Bernstein himself). I agree with most of his ideas, but i don’t follow the diet myself (I find it too limiting / expensive unless you eat only eggs). I imagine, but I don’t know for sure, that it would be hard to gain weight on his plan.

BUT you should be able to eat 30g of carb without your blood sugar soaring. It took me a long time to figure this out, but it was well worth it! I can eat 30g without ever going above 140mg/dl. One of the biggest secrets is taking fast-acting insulin (Humalog/Novolog-- I don’t know about Apidra) 15 MINUTES BEFORE EATING. Many times they tell you to take it when you eat or EVEN after you eat. You will almost always go high when you do this (the only time that I take it WHEN I eat is if I just had a low).

Sometime when you have a good blood sugar reading (80-120), take your insulin for 30g of carb, wait 15 minutes, then eat, and measure your blood sugar every 30-60 minutes to see what is happening.

I find that if I eat more than 30g, it’s hard to keep normal blood sugars-- but with 30g, it is definitely possible!

Dr. Bernstein suggests eating more fat in that situation. Or you could add protein.

You can gain weight by increasing your carbs and your fast acting insulin, BUT you may find that the weight you gain goes right onto your tummy–insulin does that.

Many of us find that we do drop weight immediately after starting an Low Carb diet, but the weight loss stops after a month or two–even if we are trying to lose. At that point, you probably can gain weight by adding protein and more fat without too much difficulty or increasing your carbs slightly.

But too much carb means you have to use enough insulin to risk hypos. I find that Dr. Bernstein’s carb levels are too low for my body. I can maintain normal blood sugars with fast acting insulin and 20-40 g per meal, but I do not ever go over the amount of carbs that requires an amount of insulin high enough that if something happened and the food did not hit my system I would have a severe hypo.

Things do happen. You inject, take a bite and start vomiting thanks to some stomach bug. Or you are in a restaurant and the food doesn’t come when you expect it. Or it is disgusting. Or you inject and the pan on the stove catches fire. Or just plain you inject for 100 g but the food you thought had 100 g of carbs had 45 g of carbs. Or you inject for 100 g and your stomach doesn’t digest the food when you expect and the insulin hits your blood stream before the carbs.

That is pretty much the main thing I got from Bernstein–besides the idea that cutting carbs lowers blood sugars and that I should aim for normal blood sugars. The idea that small inputs make for small mistakes.

Thanks, Libby, and glad to hear your weight has stabilized.

Thanks, Kristy, I appreciate that. Currently I’m only on long-acting insulin (Levemir), so maybe I need to consider talking to my endo about including fast-acting insulin for mealtimes.

Hey Kristin, that’s really great info–thank you! At the moment I’m only on basal, but as I mentioned to Kristy, it may be time for me to consider fast-acting insulin. It’s certainly encouraging to know that you’ve been able to eat 30g and stay below 140.

Hi Steven! I didn’t realize that you were only using basal so far. Now I can understand why it is hard to eat any carbs! Hope that you are able to figure out a way with the Bernstein diet to gain weight OR that you are able to start on fast-acting with carb counting!

Keep us posted!!

Sounds like we’re in the same boat, Gerri. The weight loss is really frustrating. It’s to the point where my clothes are swimming on me and friends are commenting. Also like you, my dawn phenomenon is bad, and often gives me my highest readings. (Yesterday, for instance, I was 118, and my endo wants me under 100.) I will try to boost the fat, and I appreciate the food/menu suggestions. That’s really exciting that you have an appointment with Dr. Bernstein himself—you’ll be in the best of hands!

Hi Jenny, thanks for pointing out the fact that there are unknown/unexpected variables that may enter the equation with fast-acting insulin. The small inputs/small mistakes philosophy is an excellent one.

My friends have commented, too. Even if they don’t say something, it’s the looks as well. Know how frustrating it is. But, I’d rather be too thin that deal with out of control BG. I pay no attention to what the dietician tells me & my doctor has given up on me regarding weight :slight_smile:

What have your post meal numbers been without taking fast-acting insulin? I’m new to all this, but I thought it was pretty much pro forma that endos prescribed this for Type 1’s. Once you’re on this, you should be able to eat better & gain back some weight. I’d be way high even on no carbs without insulin before meals. Sometimes I take it before meals, sometimes with meals, depending on what my BG is before eating. I use Apidra & it seems to leave my body quickly. If it’s really a high fat meal, I wait until I’m about halfway through the meal to inject. Everyone’s different, so find what works for you.

I had to play around with doses to get my basal (Lantus) right. Though, I can often wake up with numbers over 100. I’ve tried snacking before bed & not snacking. Can’t say that it makes a difference for me. It’s more dependent on what my BG is before I go to sleep.

My doctor didn’t suggest spliting the basal dose between morning & evening. I was told to take basal in the morning. I learned to divide the dose from Tu Diabetes! Splitting the dose helped a lot.

I got an Eat Smart scale & it’s great. I basically eat 4 oz of protein at lunch & dinner with veggies, but I’m a small person. Lately, I’ve been eating a lot of cauliflower, dark green leafy vegetables, summer squash, cabbage because they’re so low carb. Anything I can fry & cover with cheese, adds needed calories. Before being diagnosed, I never ate anything fried, was vegetarian & rarely ate dairy products. Been a major change for me to eat meat, but I can’t seem to do vegetarian now without going way overboard in carbs. I eat a lot of peanut butter, too. Found a lot of great low-carb recipes on-line: www.lowcarbcafe.com, http://www.scribd.com/doc/24632/Low-Carb-Recipes, http://genaw.com/lowcarb/recipes.html.

I keep small cans of tuna fish stocked for days when I don’t have time to cook & mix it up with ripe avocado. I eat that frequently for lunch. Make my own cured salmon (easy & happy to send you the recipe) & keep that in the fridge. Rolled up in sheets of nori seaweeed with cream cheese, scallions & avocado it’s delicious & filling.

Hi Gerri, we really do have a lot in common. I too was vegetarian before I was diagnosed, but I’ve started eating things like chicken and tuna (that’s a good idea to eat w/avocado!) because a low-carb diet is already so restrictive. (Or at least it feels that way to me.) Since I’m LADA, my endo says I’m still in the “honeymoon period,” so I guess he wants to see how I fare just on long-acting insulin before starting me on bolus. Most of my post-meal numbers are usually between 120-140, but that’s after a very low-carb meal. Yesterday I had a few too many blueberries after lunch and shot up to 157. (Oops.) Thanks for the idea of splitting the basal dose–that’s really clever. I usually take it in the morning, too, so maybe splitting it will help with my dawn phenomenon problem. Thanks also for the link to low-carb recipes, I’ll be sure to check it out! I hope we both can put on some weight without the BG levels going crazy; it’s such a tricky balancing act.

We do! Am going to have to ask my mother if I have a brother she hasn’t told me about:)


How low carb are your meals? Don’t want you to waste away.

I buy avocadoes by the bag now. I really miss eating all the veggies I used to eat in the quantities I used to eat them. I miss eating really good crusty bread. I eat a lot of fish. If I become lactose intolerant from all this dairy, I’m going to starve to death. Low carb feels restrictive to me, too. Finding interesting recipes has helped. I’ve never cooked this much before! I try to vary what I eat because I know it will be easy to get bored. Don’t want to fall off the carb wagon.

Here’s another easy, quick recipe, from one former vegetarian to another. Hope you like it. There’s a brand of meatless Canadian bacon called Yves. Very low carb. Three slices are only 2 grams of carbs. Fry the slices in a little olive oil–takes only a few minutes. Then pop them in the toaster oven with cheese to melt the cheese. Top with slices of half an avocado.

I looked at a lot of meat substitues, but most have way too many carbs, not to mention lots of chemicals. Funny thing is that I never ate meat substitutes before because I don’t like the taste of meat.

Everyone’s body is different, but I’ve found that tempeh doesn’t mess with my BG. Maybe because it has a lot of fiber. I slice tempeh & fry it. Then roll it up in lettuce leaves with a small serving of veggies. Of course, lots of people don’t like tempeh.

If you like sauerkraut, it’s super low carb, like anything in the cabbage family. Cauliflower fried “rice” is really good. Grate raw cauliflower. Saute in a skillet with chopped garlic, fresh grated ginger, some tamari & scallions.

It won’t take the place of real pasta, but check out Miracle Noodles. They’re more like Asian cellophane noodles. They have no carbs, no calories, are all fiber. You just rinse them off & they’re ready to eat. They don’t work for Italian recipes, but are really good for Asian type recipes, or in soup. I fry them with shrimp & vegetables, or top with peanut sauce (peanut butter whisked with water, tamari, ginger, hot pepper flakes & garlic granules). You can also use sesame tahini, which tastes great but has more carbs than peanut butter.

Wow, you’re doing great to have numbers like these with no rapid acting insulin. I wish you a long honeymoon period. Mine didn’t last long. My doctor put me on insulin pronto, but the doses were quite low. I had a C peptide test & my insulin output was so low as to be non-existent . I’ve seen my insulin needs rise the last few weeks & it’s frustrating. But compared to what most people seem to take, I try not to get too frustrated. My goal–low carb, low insulin. I rarely take more than 2 units per meal, except for breakfast. If I get a little low, I’m happy to eat more. Even with virtually a no carb breakfast, my dawn phenonmenon is bad. Something else I learned from Dr. B’s book, don’t exercise in the morning with dawn phenon. It sends BG through the roof for people like us. I took a long walk after breakfast one morning (up & down a lot of hills) & my BG shot up to 175. My head was pounding so that I felt it would explode. When high, my heart races & my head throbs.

One thing I’ve noticed about splitting the basal dose is that I couldn’t half it. I had to up the dosage. I was only taking 5 U of Lantus when I was taking it in the morning. When I divided the dose, I had to take 5 in the morning & 4.5 at night. I read somewhere (maybe Dr. B’s book) that basal gets used up more quickly overnight. How much basal do you take? Since my doses were low maybe that’s why I had to increase it. Since I’m small, I don’t need large doses. You might need to experiment to see what works best for you.

Interesting that you were told to take your basal in the morning also. Seems that most people are told to take it at night. When I spoke to my dr about splitting my dose, he told me not to bother & that it wouldn’t make a difference. HA! Lantus doesn’t last 18+ hours in my body at all. Good thing I don’t listen to doctors. I will listen to Dr. B, though:)

Steven, why don’t you ask your endo for a prescription for rapid acting insulin? You test and pay attention to your BG so well that it isn’t a risky thing to add in a couple of units with your meals. Ask if you can do this just to try it and see what a difference it can make. I have had to ask my endo (and my GP) every time I wanted to change my treatment because catching LADA in the honeymoon phase is rare and there isn’t a lot of info on what works.

Hi Steven,
I was diagnosed with T1 while I was pregnant, so a no-carb-wait-and-see approach wasn’t an option……sounds like I was actually fortunate. I was put on long and short-acting insulin immediately, with the restriction of 30 carbs for lunch, 45 for diner and 15 for snacks. I can’t imagine why your endo wouldn’t want to start you on short-acting insulin. You’re going to need it and I think it would make your life a lot easier.
Personally, I’m of the viewpoint that the body needs a good balanced diet…including carbs. I eat mostly what I want, as long as it isn’t too processed. It’s not uncommon for me to have 80 or 100 carb diners. I’ve monitored my numbers carefully enough to figure out good insulin:carb ratios and my BGs almost always stay within the target range. I don’t have a weight issue now, although I have been way too thin in the past with other endocrine disorders.
I was a vegetarian for 14 years when diagnosed and now eat meat. It’s not so bad but a lot of my meals still don’t have meat in them. I use meat-substitute for sandwiches. I’m one of those weirdos who actually like it  I also still have totally vegetarian meals at home all the time. Pea soup with crusty bread and cheese is one of my favorites.
When I was still on MDIs, I always split my basal as Gerri suggested. I’m a little surprised that your endo hasn’t suggested this to you, as your fasting sugars are a little high.
Things will get easier. Once you’re ready to start on a pump, you’ll be surprised how much of a “normal” diet you can eat if you take the time to track your patterns. Has your endo mentioned pump therapy as a future option? Mine did within the first month of diagnosis. If yours hasn’t maybe it wouldn’t be a bad idea to get a second opinion? You’re diagnosed now and with all the treatment options available, you shouldn’t be wasting away. Also, I’ve heard that the “honeymoon” period can last years and it seems silly to try to wait-it-out. My endo actually said that taking short-acting insulin as soon as possible would extend any pancreas function that might be left because it takes some of the strain off of your body. …Made sense to me.

I agree with Julie that “taking short-acting insulin as soon as possible would extend any pancreas function that might be left because it takes some of the strain off of your body”. That’s why my GP started me first on Novolog. However, it seems that for me, the basal insulin is also important and that the two, acting in conjunction, give me way better numbers than just using short acting. My fasting BG is never over 100 so my endo didn’t want me to start using basal. I insisted and she was amazed at the difference. I can eat a low carb snack or meal and stay level without Novolog, and I can eat a much more normal carb load occasionally without a spike, when I bolus 2-4 units Novolog. I take just 5U Levemir in the morning. I did try adding a night time shot of Levemir and it made no difference to my morning numbers, (mid 90s) whereas a couple of units of rapid with my evening meal gives me mid 80s in the morning. So I highly recommend the combination of bolus and basal to give you better control and more normal food possibilities. I primarily use Novolog to allow me to eat fruit and an occasional serving of fresh corn or new potatoes. When I eat out I do an extra unit and allow myself a piece of crusty artisan bread but I don’t keep it in the house as it’s too hard to limit myself all the time.

First let me say that I am jealous of you and I wish I had that kind of metabolism.

I say up the proteins and fats big time if you want to gain weight without affecting your blood sugar. If you have normal cholesterol, then go for the eggs, cheeses, and other high quality protein sources that are dense in calories. Go get some high fat nuts like macadamia, pine nuts, almonds…they will give you another good high fat protein source that is also very dense in calories. If you can do it, eat spoonfuls of peanut or almond butter as snacks or right before you go to bed. Try drinking whey protein shakes (I drink two to three a day) for even more high quality protein calories in between meals. You just have to eat more of the good stuff, which can be tough without a lot of carbs, but it is doable.

And it’s not only diet, but activity. If you aren’t already, start doing some serious resistance training to complement your diet and build up that muscle. Lift heavy on your legs to boost testosterone levels and your body will react by increasing muscle throughout your body. Gaining weight with carbs will just add fat to your body, which weighs a lot less than muscle…and looks a lot less flattering. Pair a high protein, high calorie diet with a strength training regimen and you’ll be packing on muscle weight in no time. Also look into a lower carb creatine supplement if you are still having trouble putting on weight while working out.

I respect you tremendously for doing whatever it takes to keep the sugars at bay, even if it means sacrificing a “normal” diet. Diabetes is such a weird science…but there is always a way to reach your goal you just have to be creative.

Hey Libby, thanks for that. It sounds like the fast-acting insulin might be a good addition if I monitor it carefully, so I’m going to take your suggestion and ask for a prescription. Thanks again!