Richard K. Bernstein
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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.
He was born in New York City in 1934. In 1946, at the age of 12, Bernstein developed type 1 diabetes. For more than two decades, Bernstein was what he calls "an ordinary diabetic"—one who dutifully followed doctor's orders. Despite his diligence coping with the condition, the complications from his diabetes worsened over the years; by the time Bernstein reached his 30s, many of his body systems had begun to deteriorate.
Learning of the blood sugar meter
In October 1969, Bernstein came across an advertisement in the trade journal Lab World. It was for a new blood glucose meter that would give a reading in 1 minute, using a single drop of blood, called the Ames Reflectance Meter. The device was intended for emergency staff at hospitals to distinguish unconscious diabetics from unconscious drunks. The instrument weighed three pounds, cost $650, and was only available to certified physicians and hospitals. Determined to take control of his situation, Bernstein asked his wife, a doctor, to order the instrument for him.
Bernstein began to measure his blood sugar about five times each day and soon realized that the levels fluctuated significantly throughout the day. To even out his blood sugars, he adjusted his insulin regimen from one injection per day to two and experimented with his diet, notably by reducing his consumption of carbohydrates. Three years after Bernstein began monitoring his own blood sugar levels, his complications were still progressing, and he began researching scientific articles about the disease. He discovered several studies on animals suggesting that complications from diabetes could be prevented, and even reversed, by normalizing blood sugars. This is in contrast to the extant treatment of diabetes which focused on low-fat, high carbohydrate diets and on preventing hypoglycemia and ketoacidosis.
Bernstein set out to achieve normal blood sugars; within a year he had refined his insulin and diet to the point that they were relatively normal throughout the day. After years of chronic fatigue and complications, Bernstein felt healthy and energized. His serum cholesterol and triglyceride levels were now in the normal ranges, and friends commented that his complexion was no longer gray. He was an early and vocal advocate for self-monitoring of blood sugar by diabetics.
Bernstein believed that the same technique could be used to assist diabetics whose quality of life could vastly improve if they followed a similar lifestyle. Despite his effectiveness in treating his own condition, as one without medical credentials (his training was as an engineer) he had difficulty gaining the necessary attention of the medical field to change the standard treatment of diabetics. Bernstein wrote a paper describing his technique and attempted to get it published in many major medical journals, but none would accept it, in part because he was not an MD. In 1977, he decided to give up his job and become a physician; "I couldn't beat 'em, so I had to join 'em," he said.
As of 2006, Bernstein had an HDL cholesterol of 118, LDL of 53, Triglycerides of 45, and average blood sugar of 83 mg/dl. By 2008, at age 74, Bernstein had surpassed the life expectancy of type 1 diabetics. He attributed his longevity to the low-carbohydrate dietary approach and lifestyle changes he had developed for diabetics.
Low-carbohydrate diabetes diet and treatment plan
Bernstein's program for treating diabetes is highly regarded amongst his patients and achieves great blood sugar control, which reduces some or all of the complications associated with diabetes. This was confirmed by a study published in Pediatrics that Bernstein co-authored. "Management of Type 1 Diabetes With a Very Low–Carbohydrate Diet" showed that, "In this survey of children and adults who follow a VLCD for the long-term treatment of T1DM, we observed measures of glycemic control in the near-normal range, low rates of hypoglycemia and other adverse events, and generally high levels of satisfaction with health and diabetes control. These findings are without precedent among people with T1DM, revealing a novel approach to the prevention of long-term diabetes complications. The tradeoff is compliance with a very restricted diet and in many cases, frequent testing and insulin shots.
Bernstein strongly opposes the dietary guidelines from the American Diabetes Association (ADA) for both type 1 and type 2 diabetics. His dietary recommendations are in contradiction to their and to most other diets.
Some of the highlights of his treatment program include:
- A very low carbohydrate diet to allow much tighter blood sugar control. But the diet is not the only thing, so you will not have normal blood sugars just by giving away pasta, rice, etc... and anything that will not provide nutrition but will only raise blood sugars and make them UNPREDICTABLE. It is about a full regimen, not a diet with any amounts. Even if you eat only the low carb foods but without following the regimen or respecting the amounts, you will not have normal blood sugars.
- You have to be aware that it is not only about carbs, but the insulin you use. He advice his patients to use the regular insulins, such as Humulin R (manufactured by Eli Lilly) and Novolin R (manufactured by Novo Nordisk). This is because regular insulins give better predictability, and their behavior matches the behavior of low carb diet's digestion better than other insulins, because these other insulins will work faster than the digestion of the low carb food.
Regular insulin is human insulin diluted 25 folds(1/25 of the concentration of human insulin).
- As a starting dose for a non insulin resistant who makes no insulin (0 cpeptide), 8 grams of carbohydrates require 1 unit of regular insulin, and 2 ounces of protein food require 1 unit of regular insulin. An ounce of protein food is the amount that contains 6 grams of protein, like one egg, or 30 grams (or 1 ounce) of meat....
for the first time, you may lower the dose covering the protein by 25%, so let's say you use the above formula, you eat 4 oz of protein food and will cover them with 2 units of R(regular insulin), so you will start with 75% which is 1.5 units.
- If for some reasons you need to stay with faster insulin analogues such as Humalog or novorapid/ Novolog, for example if you cannot wait the 30 minutes( the waiting time could be as much as 90 minutes and is not the same for every one) that are required with regular insulins, you may use these analogues(which require waiting about 20 minutes, so that when food is eaten there is insulin in the blood ready to lower the blood sugar rise from food, keeping blood sugars stable as possible , but again it is not the best thing to do (the analogues). Then with these analogues you will start with half the dose, and probably end up with 2/3, compared to regular insulin. So for instance you will start with 1 unit of Humalog or novorapid/Novolog for every 16 grams of carbohydrates, and 1 unit for each 4 ounces of protein foods. Then 2/3 will means that you will inject 1 unit of Humalog or Novorapid/Novolog for each 12 grams of carbohydrates, and 1 unit for every 3 ounces of protein food. Humalog may be the most potent, and 2 or 2.5 times more potent than regular. Apidra and Novolog/Novorapid may be 1.5 times more potent than regular insulin.
- Dr Bernstein says that initially (maybe later things will change when good control is achieved) you to have to fix your meals and adjust the dose, and know the optimal dosage, timing (after how many minutes of injection should you eat), and when you get bored you change and readjust the dosage settings. So same breakfast everyday, same lunch, same dinner. This means the same amount and types of protein for breakfast every day, and the same amount for lunch ....As well as amount of carbs, even if below the maximum (6, 12,12), and of course the same carb food, not because the amount is fixed you have the right to get another food that is carb equivalent. Then you can have equivalents when good control is achieved, for instance egg with sausage (please see the video "10 essential ...." on dr.Bernstein's YouTube channel). NOTE: not fixing meals and having variability in meals will make it very hard, and it is not boring.
- The allowed carbohydrate amounts are a maximum of 6 grams for breakfast, 12 grams for lunch, 12 grams for dinner for a combined maximum of 30 grams of carbohydrate per day for a 140 pounds patient. So if a child weighs 35 pounds, he should get 7.5 grams instead of 30 grams per day. (See March 2017 teleseminar on YouTube). However these 30 grams are not to be adjusted for instance if one weighs 130 pounds. Also if one weighs 200 pounds and these 30 grams do not give him enough healthy vegetables, he can increase the amount of VEGETABLES(see September 2015 teleseminar).
- Avoiding all foods with added sugar or honey such as desserts, candies, and pastries; all foods made from grains and grain flours such as breads, cereals, pasta, and rice; all starchy vegetables such as potatoes, corn, carrots, peas, tomatoes, and beans; all fresh or preserved fruits and fruit juices; all dairy products except for butter, cream, and fermented cheeses, as well as full fat yogurt(for dairy products the more the fat content the less carbohydrate content)
- The patient takes responsibility for blood sugar control including blood glucose testing up to 8 times per day.
- You have the right to have normal blood sugars like a healthy non diabetic, so even when you eat, your bs should stay constant (see March 2017 teleseminar).
- Target blood glucose levels that are nearly constant for the entire day. For adults target is 83, for children before puberty normal is in the 70s, for pregnant women 65 is good. (Please refer to the teleseminar because this information is not in the book).
- If you were used to high blood sugars for instance 200 mg/dl (which is very high), you cannot go straight to 83 mg/dl because you will face symptoms of hypoglycemia, but you can set a higher target first, let's say 140 mg/dl. Same if you have normal blood sugars and got used to it, if your blood sugar reaches 120 mg/dl you may feel symptoms of hyperglycemia that others with non normal blood sugars feel at higher blood sugars (happened to Dr. Bernstein Himself, see the video "Top 10 myths ...." By dr.Bernstein on YouTube"
- Weight loss for obese people with type 2 diabetes.
- Exercise (strenuous) for all those with type 2 diabetes.
- Basal and bolus dosing for insulin users.
He is Director Emeritus of the Peripheral Vascular Disease Clinic of the Albert Einstein College of Medicine, at the Bronx Municipal Hospital Center.
- Bernstein, Richard K. Dr. Bernstein's Diabetes Solution: My Life with Diabetes. Retrieved 2010-06-27., selected chapters available online
- Dr. Bernstein's Diabetes Solution, p. 113
- 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
- Dr. Bernstein's Diabetes Solution. A Complete Guide to Achieving Normal Blood Sugars. Official Web Site, retrieved 2010-06-27
- Dr. Bernstein's Diabetes University. Official Web Site, retrieved 2015-01-06