Rant #34: Dr. Richard Bernstein: The Diabetic's Unsung Hero

In the course of ongoing attempts to "hack" my diet and lifestyle, with the objective of living a long and healthy life (which is more important and challenging than ever given my recent diagnosis as a Type 1 diabetic), I have just finished reading Dr. Bernstein's Diabetes Solution, which was made known to me toward the end of Gary Taubes' recently published Rethinking Diabetes book I wrote about last month. I wish I'd "discovered" Bernstein a LONG time ago, and I wish more people struggling to manage Type 2 Diabetes or optimize their T1D blood sugar levels could more easily find out about this book. 
       Having contracted Type 1 Diabetes more than 50 years ago (and still living to tell his story and provide treatment to others), Bernstein is a true diabetes-war veteran with battle scars and decades of experience fighting a medical establishment that continues to stand by its advice for more carbohydrates, more insulin, and less fat and cholesterol, despite lack of scientific proof that any of this advice actually helps people (with or without diabetes). Now in his 80s and living with health statistics a 25-year-old would envy, he -- and the hundreds of patients he has treated (and documented) over the years -- provides a lot of compelling proof that there is a "better" way to control blood sugar that may not be "easy," but is more likely to fend off complications of diabetes (blindness, neuropathy, etc.), as well as cancer and heart disease. 
       As was the case with my other recent "favorite" but almost-equally controversial blood sugar evangelists (Taubes and Attia - see Rants #32 and 33), even though the writers help make scientific and esoteric facts more accessible for the average reader, it still takes them all nearly 400 pages to make their cases known. Not only is this incompatible with the "Reader's Digest" world of the past several decades, but it's even more challenging for the Tweet/TikTok/soundbite-fed masses of the past 10 or so years. But, in the hope that my inadequate-but-brief summary will encourage more people to seek out this information, here is my attempt to "sell" people on Bernstein's method, which I'm now "sold" on and starting to incorporate into my own diet/insulin-management plan.... 
       Though the mainstream diet/nutrition/medical world is reluctantly beginning to acknowledge the possibility that a lower-carb eating regimen (Atkins, keto, etc.) can be helpful in weight management and blood sugar control for diabetics, there is still a good deal of pushback -- at least in my personal experience -- that such a program is "unsustainable" and deprives people of the "normal eating pleasures" (cake, cookies, soda) of non-diabetics.
       I understand this perspective, because I was all too happy to hear from my diabetes dietitian at the Mayo Clinic that "there is no such thing as a diabetes diet" when receiving my first coaching session. But while it was important for me to know that I could eat my favorite sweets if I wanted to, and still keep my blood sugar under control (with the help of insulin shots), the more I read, the more I realize that this is a self-defeating notion if I truly cared about my long-term health and minimizing the damage that higher blood sugar levels do on the bloodstream and ultimately the eyes, feet, heart, pancreas, etc. 
       So if the medical community is barely making space for "lower-carb" eating regimens, it's not surprising to imagine that they have been even more reluctant to embrace Bernstein's SUPER-LOW-CARB eating regimen, which tops out at 30 carbs PER DAY, while the conventional ADA-approved diet recommends 165 carbs PER MEAL! This is a chasm that, like our current polarized political system, will possibly never be bridged. But the more I read, the more I am convinced that Bernstein's super-low-carb diet is the way for me and my diabetic condition, and should be made known to diabetics willing to discipline themselves for the sake of a better life. 
       Diet choices aside, Bernstein's regimen is most likely being rejected (or ignored) by mainstream doctors and dietitians because they fear his recommended (lower) blood sugar management levels increase the potential for hypoglycemia and ketoacidosis. Bernstein advocates -- and provides instructions for -- managing blood glucose levels in a tighter 60-100 range all day long with 80 for an average, and promises diabetics that they can have "normal" non-diabetic a1C levels of 4.5%. Currently, in contrast, my endocrinologist recommends I keep my glucose between 70-150, with an average about 110, and target 6.0% for my a1C as the bottom limit. This is because the use of insulin to offset food (especially carbohydrate) consumption can cause blood sugar levels to drop below 50 when too much insulin is used, and can lead to coma or death when not treated quickly. 
       But while this perspective is not completely unfounded (at least with T1 diabetics; Bernstein says he hasn't encountered the problem with T2 diabetics), Bernstein argues convincingly that the "good enough" blood sugar levels that doctors advocate are not good enough to sufficiently lower risk levels for heart disease, retinal damage, and other problems. And, because his program makes it possible to reduce insulin use and minimize the blood sugar "swings" one encounters with a higher-carb diet, the risks of hypoglycemia - especially with the help of CGMs (continuous glucose monitors) that set off alarms well before blood sugar drops to a dangerous level - start to pale in the face of the scarier prospect of dying from all the other complications that diabetes and a high-carb diet offer. What it all comes down to, in my view, is whether one is willing to give up a sizable list of "no-no" foods (which include not just sugary desserts, potatoes and pasta, but ANYTHING with more than a few carbs, including corn, cottage cheese, onions, tomatoes, and even powdered artificial sweeteners) in exchange for normal, healthy blood sugar levels. For me, it's a no-brainer, especially since I can do this and still enjoy animal proteins, a long list of "yes" vegetables, and a few of my dairy favorites including cream, butter and Greek yogurt.
       My only regret about Bernstein's book is that the most recent edition was printed in 2011, and many things have changed in terms of science and insulin and other discoveries on how to treat and prevent diabetes, which are covered in depth in his book. But the foundations still hold in terms of tight blood sugar control with disciplined eating. And he does have a website (www.diabetes-book.com) where devotees can access newer videos and other content that is more up-to-date than his printed books. 

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