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?)
Hi Negg.
I tried to order Dr Bernsteins book from 'Book World' Espania but they could not get it! I asked a friend in UK to get it, but no luck there!
But I would have thought it would be known in Israel!
Maybe someone could give you the ISBN number from a copy they have and you could then try Amazon. I recently found it on Amazon so you could order it online.
Americans may find this quite strang but anything from the USA, even CD?s are now customs checked and it took 8 weeks for a 10 CD music study course to be released by Spanish customs for me! Next time I order via Amazon.es! If you have an Israly Amozon site you may find you save yourself a load of waiting time. I also had to pay 21%tax to! If you decide to go ahead I hope this will be healpful! Albert.
no problem to buy the book - i bought the ebook and have a copy on my phone, kindle and computers... I read it many times and try to follow what he says.
What I wanted to know is why do the doctors ignore this valuable source of information!
Throughout most of Dr. B's career, he has been an outcast from his profession. For years, he was considered a "wacko" by many. The attitude continues and his name is not well known, and that is sad.
This is despite what he has contributed. Think about it. He was the first one to do self monitored blood sugars at home. And he advocated tirelessly against the establishment to make that a standard of care, which it is now.
And of course Dr. B invented the basal-bolus regime in 1972, the core principle behind all current insulin regimes.
In the end, even his stauchest critics have to admire his contributions. But the damage over the years from him being marginalized means that most endochronoligsts are not taught about him and are absolutely clueless. So next time, ask them who invented the basal-bolus regime and see what they say.
The reality is Negg, that low carb does not work for everyone. it does not work for me for instance. Absolutely it does not!
Each country has it's culinary culture and poorer people (The majorority) in many countries eat what's readily availible and cook it traditionally! Medicine respondes realistically (usually)in each home country! I have lived in more than 20 countries. World wide Dr Bernstein is not rated up there with Fleming! That's the reality!
My personal physician had never heard of him, either. But he was overjoyed at my A1C score of 5.3 in August after having read his book and followed the guidelines for a couple of months prior. When I told my physician about the book, he immediately went online searching for Dr Bernstein information. I, too, bought the ebook version and suggested to my physician he also get it. Whether or not he does buy the book, I have no way of knowing. But his curiosity suggested too me that he certainly would. I have been diagnosed a Type II for nearly 20yrs and have used an insulin pump for a year and a half.
I've spoken to any number of "Experts" over the years and all deny any knowledge of Bernstein. His books are not even available in my local library. I'm in the South of England!. It's only the paients who want to get on top of their errant metabolism, who havee the motivation. I think I came to bernstein via David Mendosa, but i can't remember. I do remember all the blinds flying open as everything made sense.
Hana
Ps I even had one tell me that Bernstein had been sued over the wrongful death of a patient. { Never happened!] He's the only one who knew the name.
My doctor has definitely heard of him (am in America) and is familiar with his ideas. He has a problem Bernstein's anti-pump stance, at least as a strict rule, but did not discourage me from following him, and was pleased with the results.
Two separate questions here: (1) do doctors know about him, and (2) do they agree with his philosophy and methods? I'm going to take them in reverse order, for a reason that I hope will be obvious.
Regarding question #2, many (probably most) doctors completely buy into the traditional wisdom on diabetes, as promulgated by the American Diabetes Association and similar institutions. They flatly reject and actively oppose viewpoints that don't hew to the established party line. Those who deviate are labelled as mistaken or mavericks or worse. Back in the day, when Bernstein would stand up at a conference and say that diabetics are entitled to normal blood sugars, he would actually be booed.
As to question #1, the answer is that a great many doctors -- actually a majority, in my admittedly unscientific sample -- are not aware of Bernstein or his data or his approach. This is most likely due to a complex of reasons, not one single one. In the first place, physicians tend to read only material written by doctors for other doctors. They do not seek out nor pay attention to books written for the lay audience; such things simply are not on their radar unless and until someone actively points them out. And, of course, a doctor who does know about Bernstein but disagrees with him is hardly likely to go about spreading the word, is he?
This is only one part of the picture, of course, because Bernstein does publish articles in medical journals too. The fact is that many doctors are so overworked that they don't do as much reading and keeping up with current developments as they would like to, or even can. As I said, it's a complex pattern.
Historically, the medical profession has always been as insular and parochial as any other. Given human nature, why expect otherwise? Sad, but there it is.
For the record, the ISBN number is 978-0-316-18269-0. The compete citation is:
Richard K. Bernstein, Dr. Bernstein's Diabetes Solution: The Complete Guide to Achieving Normal Blood Sugars, 4th ed. (New York: Little, Brown and Company, 2011)
I think the main problem is that most people believe that fat is bad for you and that "healthy whole grains" are good (or better) for you. As a doctor I believed that. It seemed obvious fat clogs arteries (like drains!). When I got T1 diabetes I read Bernstein but thought (with the benefit of my medical education!) the man's mad, he is gonna give me a heart attack with that diet. It was his engineers advice- try it, measure your blood sugars and insulin usage, measure your cholesterol and then again in 3-6 months and if it doesn't work, change the diet to your old high carb one approach that convinced me as I saw results: insulin use and cholesterol drop, trigs disappear, my HDL go above the normal high value and my cholesterol ratio improve to very healthy but most of all, stable, controlable blood sugars around 85mg/dl without hypos! Then I read more and got to see the medically advised highcarb/low fat diet does have probs - esp for diabetes / sedentary folk. I regarded myself beforehand as an open minded doctor simply looking for best advice for patients but I so had it wrong and probably would not have changed were I not able to see the effects of low carb/high fat on myself as a T1. The mix up is that fat IS bad for you but most of it in the blood comes from excess carbs (like fois gras liver is from feeding geese grain not fat) but the raised blood lipids caused by the carbs supports the medical anti fat stance -as they assume the fat comes from dietary fat hence they advise high carbs instead! Recently a new CDE saw my continuous glucose monitor screen and her eyes opened wide - "wow that's flat - flatter than a non diabetic, how do you get such good control". Then, on looking closer, "wow you are running far too low. 4.6 (83mg/dl) is far too low to be safe, you must run at 7 (126!) or you will get ill. If you are ever below 126 at bedtime, eat a sandwich and glass of milk". Following Dr B I never have sandwiches/bread/milk etc. As a neurotic T1 I try to never go above 95!! I don't think I have been anywhere near 126 for the last 3 years and believe running as high as she advised would cause/worsen any diabetic complications (stroke heart attack neuropathy gangrene of legs etc) - at least in my case. I try and explain this but not being able to see the effects of low carb, they just repeat what they are taught. I would do the same had i not developed this disease. In summary, doctors may not have heard of Dr B but that is the problem with the system / teaching / the Mcgovern committee in the 1970's declaring war on fat and advising high carb diet without waiting for evidence! I am afraid Dr B is right. Whilst not everyone may be able to manage low carb - pr as low as Dr b's strict regimen, I am pretty sure that keeping insulin use as low as possible and keeping carbs (and hence average blood sugar and HbA1c) as low as you can manage is (generally) better for you and am so pleased to have found Dr B else I would still have been cramming in "healthy" breakfasts of cereal and hating myself for my inability to control blood sugars!! He really altered my life (and probably significantly lengthened it). You have to read around the subject and so much on the net is just wrong but I am pretty sure Dr B has most of it right. You have to make your own mind up but I think as part of that process you should try out Dr B's ideas, see the effects on your control / blood lipids / inflammatory markers / whatever you can get tested then compare to other things (e.g. a vegetarian approach (avoiding starches) also works as has the advantage of less protein (protein also makes glucose) but for me personally, is harder to follow...) Best wishes whatever you find works for you but relying on medical advice - even from well meaning apparently well educated doctors may not always be the best treatment for you - try various approaches and see what actually works day to day for you rather than just taking someones word for it! Regards to all, Ralph
Ralph,
Or should I say Dr. Ralph? (That's respect, not sarcasm.)
Your story resonates in so many ways I can't list them. Being an engineer by training, temperament, and experience, Bernstein appeals to me intuitively because he is a pragmatist -- his approach is relentlessly empirical. He doesn't say, "this is what I know." Rather, he says, "this is what I've measured." Without even getting into the substantive issues, that basic mindset resonates so powerfully that its basic rightness seems self evident -- to me, anyway; obviously not to many professional providers, though. Unfortunately.
And, like you, when I cut back on the carbs my LDL and trigs plummeted. My most recent total was 148, up from 123, and the difference was almost entirely an increase in HDL.
The other thing is, that like Bernstein, you differ from the average doctor in one very fundamental way: you have skin in the game. Amazing how that sharpens the thought process and clarifies the mind, isn't it?
Best,
David
Ralph, Thanks for that (long) summary. I have only been diabetic and on low-carb for a few months so far. I haven't managed yet to get near that flat line - but I hope to, and believe I can do it, using Dr. B's method. It's good to hear this all from others - esp. a doctor - to counteract what all the endo's I've spoken to ("you must eat 1/2 calories from carbs or else"). Negg.
All these comments confirm my "prejudice?" about education. Too many students learn from textbooks, which were written by people who learned from an earlier set of standard texts. Thus myths are perpetuated and no-one demands proper evidence. As a student of life science over 40 years ago, I was often ridiculed by my fellows for refusing to accept something just because it was in a text-book. Luckily I had a couple of enlightened professors: they supported my questing mind and backed my reasoning, because I did reason and not follow accepted ideas like a sheep.
I still question and weigh up scientific ideas.
I should have stayed in the academic world and continued fighting, but I did become what I MOST wanted i.e. a parent and then grandparent.
My adult daughter still comes to me if she has ideas to work out.
Medical schools are supposed to take the brightest and best students, but then the try to reshape them into clones.
Why should anyone think that fat clogs arteries? It actually doesn't make sense. Fats are broken up by the digestive processes, so don't go unchanged from the mouth to the arteries! If they did, why would anyone worry about the Calorie count of fats?
I've even seen a TV demonstration of someone squeezing a fatty substance through a piece of rubber tubing to demonstrate the artery clogging effect.
Wha do these people think is the function of Lipases?
Hana
In the last 15 years I've only consulted two primary care physicians. The first one diagnosed me with Type II diabetes. One day in glancing at her bookshelf I saw the 1st edition of Diabetes Solution. I asked her what she thought of it and she replied that she hadn't read it. But she went along with my low carbing ways and we got my HgbA1c down to 4.3% in about 3 mos. This doctor no longer takes my insurance so I had to get a new one.
I lent my current doctor the second edition of Dr. Bernstein's book. He said he glanced through it but didn't read it. He refuses to treat me for diabetes unless my HgbA1c is >7.0%. Why does this not surprise me?
Many thanks for the above comments which I agree with. As well as my post above I have written in other posts on this site on the same subject of being told to run at minimum 7 (126mg/dl) and take extra carbs if it gets that LOW! I know that is repetition but it is just that it still surprises me that such bad advice can be mainstream (and felt to be good advice) and here is yet another example from Jim. As David says "having skin in the game" concentrates the mind (not so much because if it is not you, you want to give bad advice but more that actually seeing the effects of such advice then makes the situation clearer!).
(PS re the doctor label, I am a surgeon so can't be relied on to know anything about diabetes! In the UK you leave med school as a doctor but once you get your surgical qualification later you revert back to being "Mr" (as the physicians say we are not clever enough to be called Dr and in the old days -especially before anaesthesia - surgeons were tradesmen not professionals). This sounds like a demotion yet UK surgeons are all extrmemly proud when they revert to "Mr" again!! STrange world!).
HgbA1c of 7.0=average plasma glucose of 171.9 mg/dl, not 126. Very damaging level. To calculate: HgbA1c% * 35.6 - 77.3=average plasma glucose in mg/dl. This formula is from Dr. Bernstein.
Ralph,
Being something of an Anglophile, I was aware of the "Dr/Mr" dichotomy. I am always amused by the strange turnings that language takes in response to culture and the social order. (I'm not throwing any stones; we have just as many semantic oddities as anyone.) But it is fascinating, if you are interested in language to begin with.
David
Jim,
Not 100% positive, but I think the "7" that Ralph mentioned meant 7.0 mmol/l, which would be 126 mg/dl. I don't think he was referring to an A1c reading.
David
Another British oddity in medicine!
until recently and as far as I am aware it's still law that a veterinary surgeoen may treat humans, but a medic of the human kind may NOt treat any other species.
I think it dates to cavalery wars, during which the horses were of more value than the men.
Hana
Ah, my mistake. This is why I always include units of measure for any numbers I post. Sorry, Ralph, for my false assumption.