Richard K. Bernstein
This article has multiple issues. Please help improve it or discuss these issues on the talk page. (Learn how and when to remove these template messages)
Richard K. Bernstein (born June 17, 1934) is a physician and an advocate for a low-carbohydrate diabetes diet to help achieve normal blood sugars for diabetics. Bernstein has type 1 diabetes. His private medical practice in Mamaroneck, New York is devoted solely to treating diabetes and prediabetes. He is a fellow of the American College of Nutrition, the American College of Endocrinology, and The College of Certified Wound Specialists. He is the author of six books on diabetes and normalizing blood sugars.
Bernstein was diagnosed with Type 1 diabetes at age 12 in 1946. In 1969, he sought to acquire a blood glucose testing kit, which at the time were only sold to doctors. At the time, he was a systems engineer. He bought a blood glucose meter manufactured by Miles Laboratories because he was not a doctor the meter was issued to his wife, who was a psychiatrist. He became the first diabetic patient to monitor their own blood sugar. By trial and error, he found that he could keep his blood sugar at normal non-diabetic levels by eating small low-carbohydrate meals covered by small doses of insulin (Bernstein 2011).
Bernstein's efforts to publish articles on his experience in medical journals were rejected because he was not a doctor. He therefore joined New York Medical College in middle age and graduated as an endocrinologist. He proceeded to establish a clinical practice using treatment methods based on his own experience.
Bernstein's diet is extremely low-carbohydrate in that it completely eliminates all simple sugars and starches, and restricts other carbohydrates to 30 grams a day spread out over 3 small meals (6g at breakfast, 12g at lunch and 12g at dinner), with gaps of around 4 hours between meals to enable more accurate postprandial blood glucose tracking. This diet is combined with exercise with an emphasis on resistance-based muscle-building exercise, and supported by medication if needed. For insulin-dependent diabetics, he advocates taking insulin as small doses before each meal, to exactly cover that meal. The goal of the program is to simulate the blood sugars of non-diabetics, which according to Bernstein are close to 83 mg/dl or 4.6 mmol/l most of the time. If this goal can be reached and maintained, further complications due to high blood sugar would stop, though earlier damage cannot be reversed. Diabetes is perfectly controlled, in effect "cured". (Bernstein 2011)
The rationale behind the approach is what Bernstein calls "the law of small numbers" (Bernstein 2011). For Type 1 diabetics, there is always inevitable error in predicting the insulin dose to cover a meal, and this error is bigger when the meal is high-carb and the required insulin dose is bigger (inevitable error because the insulin absorption process is part of a complex system with non-linear dynamics, making exact predictions impossible). Restricting to small doses of both insulin and carbs reduces this error sharply and makes control more precise. In other words, taking small doses of insulin to cover a small dose of slow-acting carbs prevents inadvertent big under- or over- doses that could cause dangerous spikes or crashes in blood sugar. The logic extends somewhat to early-stage Type 2 diabetics who depend on their body's own erratic production of insulin. When smaller doses of insulin are needed from their body, their ability to control blood sugars improves.
Bernstein's patients include vegetarians, for whom the low-carbohydrate meals include a variety of non-starchy vegetables, tofu, and cheese or yogurt where permitted. (Bernstein 2011)
Dr. Bernstein contends that high blood sugars are the cause of all diabetic complications, and therefore that tightly controlling blood sugar eliminates complications. This contention was at first at odds with established medical opinion, as the sugar-complications link was not yet clearly established from scientific studies. A 1993 study supported Bernstein's position that tight control of blood sugar leads to better health.
Bernstein's low-carbohydrate diet was initially opposed by the American Diabetes Association, which recommended a high-carbohydrate low-fat diet for diabetics. The ADA has since changed its position to allow a low-carbohydrate diet as an acceptable option for diabetics. The UK NHS has also introduced a low-carbohydrate plan for diabetics and prediabetics.
Bernstein's focus on maintaining low blood sugar targets conflicts with mainstream guidance to maintain a higher fasting blood sugar target for insulin-dependent patients (such as Type 1 diabetics). This higher target is to reduce the risk of hypoglycemia which can be fatal. Bernstein's Type 1 patients need to be constantly on guard against hypoglycemia.
- Bernstein, Richard K. (November 1, 2011), Dr. Bernstein's Diabetes Solution: The Complete Guide to Achieving Normal Blood Sugars (Hardcover 4th ed.), Little, Brown & Company, ISBN 978-0-316-18269-0
- Bernstein, Richard K. (January 3, 2005), The Diabetes Diet: Dr. Bernstein's Low-Carbohydrate Solution, Little, Brown & Company, ISBN 978-0-316-73784-5
- Bernstein, Richard K. (November 1990), Diabetes Type II: Living a Long, Healthy Life Through Blood Sugar Normalization (1st ed.), Prentice Hall Trade
- Bernstein, Richard K. (February 1, 1981), Diabetes: The GlucograF Method for Normalizing Blood Sugar, Crown
- Roth, Margaret C. (July–September 2018). "Patient, Test Thyself". Army AL & T Magazine: 101–111.
- "Early history of blood-glucose meters".
- Singer, Penny (April 3, 1988). "Diabetic Doctor Offers a New Treatment". The New York Times.
- Singer, Penny (July 18, 1993). "'Vindication' for a Diabetes Expert". The New York Times.
- Diabetes Control Complications Trial Research Group; Nathan, D. M.; Genuth, S.; Lachin, J.; Cleary, P.; Crofford, O.; Davis, M.; Rand, L.; Siebert, C. (1993). "The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus". The New England Journal of Medicine. 329 (14): 977–986. doi:10.1056/NEJM199309303291401. PMID 8366922. S2CID 21528496.
- "Bernstein Diet". MSN. 1 January 2013.
- "American Diabetes Association endorses low-carb diet as option". Diet Doctor. April 25, 2019.
- "Low Carb Program - Sustainable Weight Loss and Blood Glucose Control". Low Carb Program - Sustainable Weight Loss and Blood Glucose Control.
- "Diabetes UK standard blood sugar ranges for diabetics and non-diabetics". 15 January 2019.
- "Bernstein video lecture on hypoglycemia".
- "A Tribute to Richard K. Bernstein MD, FACE, FACN, FCCWS, on His 83rd Birthday". Diabetes in Control. 24 June 2017.
- Dr. Bernstein's Diabetes University. Official Web Site, retrieved 2015-01-06