Dr. Bernstein Review

So, I've recently decided I need to get my diabetes management in line so that I can have a child in the next couple of years. So, I joined this site and I checked out Dr. Berstein's book Diabetes Solution: The Complete Guide to Achieving Normal Blood Sugars.

To be honest, this information has been pretty altering. In the past I've tried vegetarian and vegan diets, convinced eating animal protein was toxic and making us fat. I lost 30lbs staying off animal protein and cut my insulin in half, but still had a 7.2%A1C. My care wasn't that good. And it was incredibly hard to stick to.

Anyway, this information is far from what I was practicing, and I'm having trouble believing it. I have heard a lot of bad things about the similar diet,the Adkins diet--like that it's causes keytones. Anyway, I'd love to hear from folks who have experience with Dr. Berstein's regimen or any counter arguments.

I am too much of a junk food junkie and slacker to Bernstein all the time. At the same time, I've gotten things very much in line and have always found that if I can cut carbs out here and there, it makes diabetes less work, which is a ***HUGE*** win in my book. The ketones from Bernsteinism (ketosis...) are different from damaging ketoacidosis from hyperglycemia. I've tasted them a few times but, any time I drop 5 lbs behaving myself, I go find them in the potato chip aisle.

To me, the biggest advantage of going low carb is that it reduces the margin of error for calibrating your basal rates and ratios. If you are bolusing 10G of carbs/U and eat 20G, there's 2 units floating around so, if you're off by 25% either way, the "oops" isn't as much as if you eat 70U and are bolusing 7U? Once I have my rates nd ratios set, I feel more comfortable saying "ok, this is 9U...". As I'm horrible, I use this to inform my "burrito blasts" but I think that if you have other goals and want to try it it may work very well for you. I like eating less carbs in the summer as I can come home from work and fire up the grill and it's a piece of cake. Oh wait...

I have followed Bernstein for years. I've owned like 5 copies of his book, having given away copies to others. I am also quite familiar with Atkins. After years, I have no trouble eat a low carb diet, usually less than 50g/day. I eat like a king. People love coming to my house for dinner. But I don't really eat carbs. And I don't miss them.

Some people reject Bernstein, arguing that his 30g/day diet is way too extreme. And it can be hard. But we are all intelligent adults. We should read the information and consider the evidence and adapt advice to meet our own personal needs and goals. And make no mistake, Bernstein's dietary advice is not that you should eat 30g/day. His advice is the "Law of Small Numbers."

The Law of Small Numbers is based on the observation that normalizing blood sugar is achieved by controlling the inputs (food and insulin) so that you can bring down your average blood sugar and reduce the varation so that you can avoid hypos. It is that second part that is the killer, if you don't reduce the swings, you cannot achieve tighten control. And hence, the Law of Small Numbers. If you reduce the rise in blood sugar by reducing the carbs, you reduce the blood sugar variation. You can achieve a benefit by simply reducing carbs, it doesn't have to be 30g/day. I eat about 50g/day of carbs.

And the "Low Carb Wars" have resulted in a lot of disinformation. When you eat low carb, your body naturally shifts to burning fat. This process happens in everyone, even a "carb addict" overnight will shift to burning fat. And when you burn fat, fat is mobilized from your stores and your liver converts them to ketones. These ketones are then taken up by your cells and burned for energy. It happens all the time. In a low fat diet, it can happen around the clock. But that is not DKA. And low carb diets and burning body fat does not cause DKA. That is just part of the misinformation.

I have to tell you. Maybe some other diets will enable you to tighten your control. Maybe you will be "lucky" like some of us who can eat a high carb diet, run a marathon and bolus precisely and achieve good control. But, chances are, you are like most of us. This diabetes thing is a real struggle. If you eat a meal and do "everything" right, counting the carbs, calculating the insulin dose and taking it at the right time, stuff will happen and you will often be over 200 mg/dl 2hrs later or stuffing glucose tabs with a hypo. I never have that happen. I don't eat enough carbs to ever go over 200 mg/dl and I never bolus enough insulin to cause a harsh hypo. That is the Law of Small Numbers.

I find the Bernstein/low carb diet to be very valid but it isn't mainstream and you have to be a bit independent. If I were to go that low carb, my biggest challenge as a vegetarian is getting enough protein and not becoming totally sick of eating eggs!

This is helpful information for me too. I have Dr. Bernstein's book, but haven't made it but a quarter of the way through. There's so much information! I've been T1 for 13 years and I find his advice amazing, but very hard to do in my "real" life.

Here's a few links you might find useful:

The Bernstein Group here on tuD.

A discussion about the difference between ketosis and Ketoacidosis.

A link to a video discussing metabolic changes when adopting a low carb diet.

I have not read Bernstien, but I do understand the concepts. I also agree with BSC. We are all different and you will need to experiment and test a lot to find what works best for you, but the small numbers concept is a winner.

Here is what I do and how it works for me. First of all, not all carbs are the same. Some will spike badly and some will not. How they are prepared will make a difference as well. For instance, sweet potatoes work much better than regular. I eat about 100 carbs per day more or less. I limit my intake of high glycemic foods in both frequency and quantity, but I do "treat" myself from time to time. I test before I eat, take my activity level into consideration and ear foods that will require the least insulin and provide the meal I want. What these meals and snacks consist of is determined by experimenting, which I do continually. Following this method I have reduced my basal by 12U and have gone for as long as a week without any fast acting. I rarely go below 65 or over 140. I am able to be more active than before without going hypo. For the last 6 weeks My fasting numbers have been almost entirely between 70 and 100. It has amazed me. It may not last and I may just be lucky, but I;m sticking with it because what they had me doing before, well frankly it sucked.

It IS working for me and I do not feel deprived. It takes some planning and preparation, but the way I now feel and my long term health make any so called sacrifice more than worth it.

My diet is not nearly as strict as Dr. Bernstein would recommend, but I think he's definitely on the right track when it comes to trying to control BG both in Type 1 and Type 2.

Although there are tons of people who claim they can eat anything and match it up with insulin, the fact of the matter for me is I can't match the timing of my insulin to eating large numbers of carbs. People who are able to eat lots of carbs and keep post-meal spikes under 120 are living in a different world than I do. But at the same time, I find it difficult to get my basals so perfect that I am flatlining all of the time when eating low carb. Type 1 is just plain hard to be "perfect" at.

I am a big fan of Bernstein's book. His philosophy that everyone can take control of their diabetes is very empowering. Even if you don't follow his advice exactly, I think all of us can improve our BG numbers by adopting at least some of his recommendations. When eating low carb, I still get highs but I actually get a lot fewer lows, especially severe lows. So my life becomes much easier.

For me, eating lower carb means I have even bigger problems with basal issues because the protein and fat causes blood sugar spikes later on down the road and is much harder to dose for. Also I have pancreatitis and can't tolerate a lot of fat, prefer eating vegan, and really can't afford to lose weight (am already too skinny).

I have found using CGM and waiting to eat until I see a drop in blood sugar, and switching to Novolin R (from Novolog) and eating lots of small meals, to be the most useful changes for me.

This is absolutely wonderful, helpful information. I am very grateful.

I was dx'ed T1 in Oct 2011, early stage, a1c 5.7 fasting BG 130 GAD positive. Found Dr.Bernstien and implemented his program on November 1st. I am still enjoying my honeymoon and taking no insulin, max BG 130 only when I treat myself to a small portion of fruit and or low carb chocolate, otherwise rarely over 110. Fasting BG's from 90 to 105 depending on previous evening carb intake. I am 5'7'' and weighed 212lb at dx, dropped to 172lb in five months and have stayed that weight for 4 months now. Had blood work a couple months ago and tryglicerite went from something like 135 to 55, LDL from 109 to 128 and HDL from 40 to 55. I eat tons of high fat beef (ribs, serloin, filet), fish, bacon, sausage, dark meat chicken with skin, pork rhines, tree nuts, eggs, letuce, asparagas, saturating all meats and veggies cooked at home with butter. I treat myself occasionally (maybe once a week) with low sugar chocolate and or a small portion of fruit and whip cream from a can. I drink coffe in the morning, then lots of water, and red wine or scotch and soda in the evening. I have a good sense of my carb to BG spike ratio (1gm carb = 1.5 BG increase) so as my pancreas deteriorates to the point of having to take insulin I will be one step ahead of the learning curve as to dosage and will be in the realm of small numbers. Dr. Bernstien makes total sense to me and frankly I miss carbs but no longer crave them. I feel fantastic, I have a very stressful sometimes physical job and never feel burned out. I am regular way more often than before and my urology symptoms have dramatically improved. Thank you Dr. Bernstien.

I've been following Dr. Bernstein's recommendations for 4 years. Changed my life. I have only positives to report including, a greatly improved lipid profile, low insulin doses, low A1c (mine has been between 4.7-5.2 consistently), no carb cravings & increased energy.

Both Dr. Atkins & Dr. Bernstein have been unfairly maligned with no facts to back up the criticism.

The best way to know if something is right for you is to try it & have empirical evidence.

Ketones are a natural by-product of burning fat for energy--ketosis. The purpose of fat stores are for energy reserves. Our ancestors probably survived on ketones & were in ketosis regularly. Non-diabetics have ketones. Consistently high BG (that can't be brought down) & high ketones is a symptom of DKA. Just having ketones from burning fat is not cause for concern. This isn't high ketones. Ketones don't turn into DKA (diabetic ketoacidosis).

There are weight loss plans called ketosis diets. Very low carb to burn fat. Carbs are restricted until the dieter is in ketosis, then carbs are slowly reintroduced.

People eating low carb burn fat & have ketones, but not high ones. Nothing unhealthy about this. Almost everyone has mild ketones in the morning simply from not eating for 8-12 hours.

Unless it is a special day I stay around 50 - 100 carbs a day . I use to could eat a high carb meal andBS would be a little high but now when I do it my BS is high the first 2 hours after eating then I fight lows for the next 3-4 hours . It ain’t worth feeling like crap. My BS stay more level when I eat low carb most days at 50 unles I am low at bedtime. My mom stays under 30 carbs a day she has read his book

I was a vegetarian for many years, and have been roughly following Dr Bernstein's diet for 3 months, now. His advice sounds more realistic if you read his diet book, and I have found it to be very accurate. I still don't eat a lot of meat. I snack on spoonfuls of Greek yogurt and peanut butter.

It was hard in the beginning. I felt very hungry for the first few days. I had moderate to high ketones for the first week, but once my body adjusted, everything went back to normal. I just eat less now, but I'm less hungry and my BG is a lot more stable. Good luck with whatever you decide to do.

I've followed Dr. B's law of small numbers since the book came out. I had reduced carbs long before Bernstein, however. His book made me research myself with low numbers, and it made me test and get a CGM so I learned my body wouldn't take more than only so many grams each meal without going high. I couldn't give enough insulin to keep from a high without then going low. SO, I set a top for each meal. Each meal has been set so my blood sugar does not rise. With low carb I can eat and dose and at 1/2 hr to 1 hour I'm within my target zone of 100-120. That's what I wanted. Grains/cereals/rices are out. Hypoawareness is a definite plus with this, and it can be set high enough, too, to make one stay out of the low zone. My A1c stays at 5.7, done at 6 mos intervals. I love Bernstein.

I'm reading his book currently and I have been low carbing for the past 8 wks or so, this is the only thing that has lowered and stabilized my bg for the most part.

I am very carb sensitive I mostly do a 1:10 or less ratio now for any carbs and I have had to cut out things like bread, rice, potatoes etc. as I have to overdose insulin to eat them and usually go hypo after.

I don't follow his plan completely to a T, I eat 30-40 per day, I still eat some fruit and I eat snacks, as well as 3-4 smaller meals per day with no more than 18 or so g per meal, my breakfast is usually about 6-7g carbs. I eat eggs, chicken/fish, organic unsweetened almond milk, cheese, seeds, low sugar berries, no fat unsweetened yogurt, lots of lower carb veggies, olive and almond oils and almost no grains now. Almost everything I eat has no added sugar in it now except for atkins bars which have some and some sorbitol. I usually try to stick with stevia for my tea and things like that.

I have found recently I can eat slightly larger meals now with just a 1/2 unit more insulin which is great, because the insulin makes me so hungry and I feel less hungry that way.

I don't think you need to go as extreme as an induction in the Atkins diet to get the benefits of low carb eating though.

Ketosis is not ketoacidosis and it will not turn into that, it is just a small amount due to burning your fat.

I am also using 80-90 as my target bg now and I think this is important too, the lower numbers. My A1c is much lower already since my diagnosis and I hope the next one will be even lower.

Good luck if you try this.

I forgot to say that Atkin's book is worth reading- the idea behind the induction where you eat no carbs is to start weight loss if you want and need that and to break the carb addiction cycle in your brain and its effect on your bg. Then you can slowly add back the healthier carbs. First you start with green veggies and then eventually grains.

I have not read all of the other replies but wanted to say - low carb and eating real(natural) food is the best - i eat lots of meat fat and veggies and feel great (i am also very active and have no issues- Dr. B is great also check out the primal blue print for good info on how to eat and manage the low carb real food- you will not regret it

I have asked about 5 highly qualified endocrinologists what they think of Richard Bernstein's diabetes philosophy. NONE OF THEM EVER HEARD OF HIM. I don't live in America. I was wondering if in America, or other English-speaking countries, his methods are known to doctors in the profession. Anyone? (and also, of course, what do those doctors have to say about him?)

I don't think that a lot of doctors are too on board with what I would consider a very low carb strategy (like 30/ day...). It may be that the people who eat low carb will say "that's not low carb, that's what you need..." or whatever but few doctors will get on board with it. That being said, Dr. Bernstein's arguments are very compelling as he's 1) old 2) has had diabetes for long time 3) to all appearances, looks to be in great shape for a guy his age (in the book, he mentions he lifts weights...). The way he tells the story is very compelling and believeable. I'm a bit too addicted to carbs to give them up but I've lost some weight and do OK BG wise and, every time I think "I need to tighten things up", I often find it easiest to accomplish a goal by looking at my carb intake and cutting back somewhere.