Dr. Richard Bernstein is the author of “Dr. Bernstein’s Diabetes Solution.” He’s also got a website (http://www.diabetes-normalsugars.com/) actually many websites and he’s a frequent guest on the “dLife” television show as well as a popular speaker on diabetes and diabetes treatment.
He’s a Type 1 diabetic who became a physician specializing in diabetes because he wasn’t satisfied with the answers and results he was getting with his own doctors. Talk about dedication to self-care. He has gained some notoriety because of his sharp disagreements with the ADA and the medical community on what are acceptable and achievable blood sugar levels, he thinks the accepted standards are dangerously high, and because of his advocacy of a very low carbohydrate diet.
He has a very strict regimen for controlling blood sugars which many people swear by. Other people find it too tough to stick with. Love him or hate him, I think his book “Dr. Bernstein’s Diabetes Solution” should be in every diabetic’s library.
Just want to point out that Bernstein has been a type 1 since 1946. He went to medical school AFTER becoming the first patient with diabetes to buy a glucose monitor in the 1960s. Before that he was an engineer.
So he isn’t exactly standing outside of the situation telling people with diabetes what to do as do so many doctors. He’s lived with it for 61 years.
He also developed complications on the ADA diet plan and meeting the ADA targets which is why he developed his own approach.
I’m with you! I don’t eat the way Bernstein tells people to eat, anymore. But I still learned more from his book which I’ve read maybe 10 time in ten years (and 3 editions) than any other resource about diabetes. And the law of small numbers governs how I use insulin.
I think there’s a lot of anger against Bernstein because he tells people with diabetes that they are living in a dream world if they think 7% A1cs are going to prevent long term complications. People do NOT want to hear that. They also don’t want to hear that they can’t eat 300 grams of carbs every day and just match the carbs with insulin.
If you think the hostility to him now is something, in 1998 when I wandered into a diabetes discussion group and mentioned that I was eating Bernstein’s diet I was accused of “trying to murder diabetics.” Really. That was the height of Low Fat/High Carb Diet fad and all these Type 2s NOT on insulin were eating 300 grams of carbs with almost no fat under the impression this was going to help their health.
Not pretty. Things are MUCH better now. And mostly people just argue with Bernstein over HOW low the carbs have to be. Not whether controlling carbs makes sense for people with diabetes.
It’s also worth remembering that he does see a lot of patients with Type 1, but mostly they are people who have not been able to get control using more standard approaches. So I think that may color his experience. His services are expensive–he gives people a couple days of time which insurance won’t cover. So people who aren’t in really bad shape don’t seek him out.
It’s not a point of like or dislike for me. I found his book informative, and I would recommend it, but his methods are too extreme for me. Maybe that puts some people off. I think diabetes is a constant learning curve that requires choices then sometimes daily adapations to the choices. I thinks it’s probably best to learn about as much as you can from whatever source then make the choice that works best for you.
Do you follow his diet? I am going to go and try and find the book - can’t hurt to read it. But, I was curious to see if you followed it and had success with it.
Hearing “low-carb” scares me - I feel like I don’t eat enough as it is. lol
Ok I will give cred when it due and sure he has earned his spurs.
Last night after I finished my workout, I go 4 nights a week for 40 to 60 minutes and stationary cycle extrememly hard, I talked with a guy that was about mid to late 30s who swims 2 miles, bikes and lifts weights. Guess what his A1C runs…5.4. He is a pumper and has for 10years. He has zero complications.
So if you are willing to fight for the right to be healthy then no doctor with whatever carb deal, is going to to make a difference…see, it all starts with you.
I don’t follow his diet strictly all the time. I fall off frequently and my bg’s will pay for it. But I do avoid carbs and have had much better control then.
Dr. B recommends against most fruits, but I love fruit, so I eat fruit. It has to be pretty fresh and crunchy, though, because the really ripe fruit kills my bg. I also eat whole grains, although Dr. B would prefer we avoid them altogether.
Get the book, or find it in the library. If you like it, buy a copy for yourself.
Disclaimer: I don’t know anything about this Dr’s program beyond what has been said in this post, but…
I think what it comes down to is quality vs. quantity of health. If restricting your carb intake as much as this program requires lowers your quality of life, making it impossible to get through the day happy and awake, or go cycling for more than 10 minutes, or enjoy a friends birthday party while everyone is eating cake, then this is not the program for you. If, on the other hand, “treating your numbers” (as I would call it – aiming for the lowest A1c, rationing vs. counting carbs, etc.) is the important thing, then more power to you.
As for me, I’d rather take a moderate approach of mindful carb consumption and counting and not be miserable every time I walk by a bake shop, or restaurant or not be able to enjoy a social gathering with food. If my A1c is 5.5% and not 4.2%, I can be happy with that. Dr. Bernstein’s mantra, as I understand it, is that diabetics can have the same blood sugars as non-diabetics. But my question would be can they also enjoy life as much?
If my A1c is 5.5% I’m thrilled. I only got one of those in the past 5 years.
One major thing to remember, though, if you are a Type 1 is that most Type 2s get offered no treatment except for oral drugs that only drop A1c about 1%. And many are over 10% at diagnosis. If they don’t cut carbs, they will have A1cs of well over 8% and most do–even while taking the expensive oral drugs. Most doctors won’t give people with Type 2 insulin until they have neuropathy, retinopathy and nephropathy. Then they give them Lantus only and about 5 minutes of instruction and set Lantus doses that guarantee they’ll always be high even though they’re using insulin.
So for type 2s treated by family doctors (as most are) Dr. Bernstein’s diet can be the difference between going blind or not. It certainly was for me. It took me 7 years to get an accurate diagnosis and permission to use the insulin I needed. Before that, “enjoying” a piece of birthday cake meant going up to 275 -300 mg/dl and feeling sick as a dog for 3 hours afterwards. And having infections all the time. And having doctors tell me that I was doing great because my fasting bg was only 110 so I didn’t need any other treatment!
My form of diabetes comes with normal basal secretion and, at this point, NO post-meal secretion.
Jenny, you make an important distinction that I neglected to make myself. Thank you for correcting me.
Hopefully, as the tide changes and more T2 diabetics begin treatment with insulin, management of the disease will become easier. The current AACE guidelines do now recommend the use of insulin, in addition to the normal pharmacologic regimens, in T2 diabetics with exaggerated postprandial hyperglycemia or fasting hyperglycemia even when A1c values are below 8% (ref: AACE Diabetes Mellitus Guidelines, Endocr Pract. 2007; 13 (Suppl 1) 2007, p.18).
I think one of the biggest things Dr. Bernstein ignores is exercise. My blood sugars are WAY better when I exercise than when I don’t, and I know peole with non-diabetic A1c’s who don’t eat low carb but who do exercise regularly. I see all this mention of low carbing and no mention of exercise because it has a “risk of lows.” Well if you know how to adjust basal rates and boluses for exercise (which takes practice) then there’s not much risk of dropping super low.
And I still don’t understand how people on his diet don’t go low at all. I’m a teacher and by it’s nature that job sometimes is very active and sometimes is not active at all. This is what causes almost all of my lows, and it has nothing to do with how many carbs I eat.
I don’t know. I just don’t think carbs are the be-all-end-all of diabetes control like he and so many people make it sound.
Where did you get the idea that Bernstein ignores exercise? Bernstein goes into great detail about exercise in his book, describing the differences between anaerobic and aerobic exercise, their relative benefits and specifying training programs for each of them. He says that he exercises daily and it’s part of the treatment program he gives to his obese and T2 patients.
It’s been a few editions since I’ve read his book, but from what I remember he only mentioned resistence training types of exercise, rather than aerobic stuff. I don’t think this would have the same effects on lowering blood sugars as aerobic exercise does. Am I totally wrong here?
You’re mistaken to say he ignores exercise, but you’re probably right to say he ignores exercise’s immediate or short-term effects on lowering blood sugars. He gives it short shrift, at least.
Instead, he advocates exercise for its long term fitness affects and for reducing insulin resistance/increasing insulin reception. He does advocate anaerobic over aerobic exercise because, he says, anaerobic exercise is a more effective way to make muscles more receptive to insulin.
In other words, he doesn’t approach exercise as a way to lower a high bg on a day-to-day/workout-to-workout basis (which is kind of the way I look at it), but as a way to keep bgs level over the long term by making the body more receptive to insulin.
Unfortunately, the AACE’s recommendations are known only to its members. Most family doctors don’t seem to have ever even heard of them. They follow the ADA recommendations which are that the target is 7% and that after a YEAR above that level they should start metformin. Then a year later add another drug, and then another.
Most family doctors and many endos (including the 2 I saw) are convinced that giving a Type 2 insulin will only make them gain weight so they delay it as much as possible.
Now with Byetta on the market doctors are delaying insulin even further though Byetta only works for a small percentage of those who use it. The rest just burn out the rest of their beta cells.
I still hear from a lot of type 2s who believe that it is eating fat that raises their blood sugars. That’s why they believe the doctor told them to eat the low fat diet. Needless to say, they report “I tried the diabetes diet but it didn’t work.”
For those people, just reading Bernstein is a huge eye-opener. Most people WON’T eat his diet, but if they drop from 100 grams per meal to 40 it’s going to make a huge difference in their long term health.
Katrina, the book is not just about the diet. It also gives you tips about managing D in general. I would suggest you pick it up… I am a long-time T1 and even I learned some things!
Unfortunately, most doctors are very poor nutritionists. Even when you go see a nutritionist it is often hard to listen to what they are saying because so many have eating disorders.
Here is my approach for dealing with my diabetes for what is is worth. Extremes in any situation are bad and are not good for you. Too much exercise–bad, no exercise–bad, eating hardly any carbs–bad, avoiding fruits all together–bad. If people would do things in moderation they would have a much better life and a much easier time controlling their diabetes.
Dr. Bernstein seems to take the treatment of diabetes to an extreme. However, some people may need an extreme to get them back in line with where they should be. Many may just give up because his plans are extreme and fit poorly into their lives. Hopefully for the more average person they will fall somewhere in the middle.
Your research isn’t slanted. Dr. Bernstein (whom I respect and who’s book gave me some great pointers) is only one of many Doctors who treat Diabetics, and some of his views are not very well accepted by many other Doctors in the field. So his opinion, shouldn’t necessarily be taken as any more or any less authoritative than the opinion of another Doctor specializing in Diabetes.
Scar tissue can be, and often is, a problem with both injections and pumps (it’s not an either or situation). To put it simply, the more frequently you insert a sharp object into an area of your body, the more likely you’ll develop scar tissue in that area. The more regularly you rotate sites (injections or pump catheter) the less likely you’ll develop a scar tissue problem.
Leaving the pump catheter in for extended periods of time does increase the risk of infection and scar tissue, but regular rotation and changes can mitigate or eliminate that risk. If you try to get 5, 6, or 7 (as I know some have) days from a single catheter you’re increasing the risk of problems. But likewise, if you have a limited area of your body where you give yourself injections and you inject 5 - 10 times daily, you’re also increasing your risk of scar tissue problems.
Any decent Endo will carefully check your sites for potential problems. If they are detected, they may recommend changing the catheter every 2 days vs. every 3 days. I’ve not been able to find a single study that would indicate using a pump catheter (rotated properly) is any more likely to cause scar tissue issues than MDI. So don’t let this opinion discourage you from enjoying your pump. Just rotate sites appropriately.
