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Dr. Bernstein and Erythritol?

K

kpa

Member
Hi everyone,

I've been looking into Dr. Bernstein's way to control your BGs. Have a few complications after having T1 for 17 years and not receiving proper information as to how to actually live well with it. So I'm trying to see if I can at least relieve my body of the stress my dieticians seem to keep pushing (like 125g carbs per day etc). My question is: Dr. Bernstein says no augar alcohols...I'm wondering if he knew about erythritol when prescribing this? I am not sure how it affects my bgs but others with diabetes (T1s and T2s) swear by it. Does anyone know if Dr. B is strictly against erythritol (I am not a big fan of Stevia and the other products where I live taste terrible or are mixed with starches). I've trawled the net but cannot really find ny updated answer to this. Anyone? Thanks in advance.

K.
 
Hello @kpa I did a Google just on the word "erythritol" and found a fair few references to it amongst many bloggers and diet places but one common thing that seem to be reported was the following:

Erythritol is described as having a zero glycemic index, and it has not been found to affect blood sugar or insulin levels. For these reasons, erythritol is popular with people on low-carb diets.

In a 1994 Japanese study published in the European Journal of Clinical Nutrition under the title "Serum glucose and insulin levels and erythritol balance after oral administration of erythritol in healthy subjects," of five healthy male volunteers aged 45-58 years, they found that "Erythritol did not increase serum levels of glucose or insulin." They also found that erythritol did not induce any significant effects on serum levels of total cholesterol, triacylglycerol or free fatty acids.

Not used it myself and do not know why Berstein is against them, but each to their own. Not a follower of him.

Hope the info helps a little.
 
I expect you will get very good results from his methods even if you do use erythritol. Therefore way not try his method with erythritol and once you have learned and kept to them for a few weeks, try a week without erythritol to see if the results are even better.
 
I largely follow Dr B and use erythritol in my occasional baking - it has zero effect on my BG levels. Many other people in the TypeOneGrit Bernstein FB group also use it with great success.
 
Reactions: kpa
Hi @tpa, reading Dr Bernstein's book Diabetes Solution, p 282, he says that because erythritol tasted less
sweet to him than sugar he tried a teaspoon of it and found that it raised his BSL.
There are comments elsewhere, as well as in his book on the previous page, that many artificial sweeteners are 'bulked up' with sugars such as fructose, dextrose etc.
Perhaps this was the case with Dr Bernstein and his personal experience caused him to veto erythritol..
The quote from @Knikki about the 5 subjects given erythritol may have led to the reported results either because they were given pure erythritol as opposed to some mix or the dose given may have been less than that taken by Dr Bernstein.
As a T1D working with a low carb diet, not as professional advice or opinion:
A) Rather than concentrate on sweeteners, would it not be better to concentrate on his low carb diet?
I presume most people use artificial sweeteners for carbs, whereas I assume you would be restricting carbs according to his recommendations.
His recipes may well have other suggestions for sweeteners where appropriate.
B) From what you are saying you are likely to run into resistance to this diet from your dietitian.
One argument I have heard against low carb diets is that some of the weight loss associated with the diet is from loss of stored sugar (called glycogen) from the liver and also from water loss as the body adapts to less sugar and more fat.
Secondly, as a consequence there is less stored sugar in the liver to respond to a hypo.
C) that you need lots of carbs to keep up insulin sensitivity as ketones cause insulin resistance.
D) That it is difficult on low carb diet to obtain all the necessary vitamins and minerals
Whilst the first argument sound right in theory and that people do feel unwell with lowering carbs
(called the keto flu) from what I have read, people use fluids and increased magnesium intake
(supervised to ensure no kidney problems beforehand) and weeks later it all settles.
And for the second argument, if about 50% of the protein intake is converted to glucose by the liver
some of that extra glucose can be stored in the liver. That has to be taken into account, not just the
low carbs intake.
Thirdly, Most people say their bolus insulin doses reduce as expected , but also to some degree so
do basal levels. That would suggest that the insulin sensitivity is NOT worse or resistance heightened.
Fourthly; With care and, if needed, the co-operation of a dietitian without an axe to grind, it is possible
to obtain all that is needed. Dr Bernstein is one such example.
The most important thing is to work with your doctor. As I lowered carbs my bolus doses had to be
lowered to prevent hypos and a little later the basal doses. You need your doctor onside to get the
insulin doses reduced right.
Best Wishes/.
 
Reactions: kpa
I have been following Dr Bernstein my solution for around 5 years now. His solution is (the way I read it) about keeping your BG levels to 4.8 two hours after eating and limiting them to 5.8 max one hour after eating. He recommends ways of doing this eg. One small tomato max per meal, and obviously low carb high fat, and exercising daily... but, as said, the ‘solution’ is keeping BG levels at normal levels. He does mention in his book that sometimes different foods affect different people, so it is paramount that you test regularly.... so why not just try erythritol and see.
 
Reactions: kpa
I get on with erythritol better than any other sweetener.

Having said that, I try to avoid sweeteners most of the time.

One of the best things about being very low carb is that over time your taste buds adapt and you stop missing sweetness at all.

So if I were you, I would get some erythritol, give it a try, and then decide whether you want to buy more, or try something else.

It has been a while since I read Bernstein’s book, but I recall him suggesting some VERY odd desserts and recipes. Almost odd enough to put me off trying his way of eating. Most unappetising.

Fortunately I then came across the Dietdoctor.com website which is stuffed full of mouthwatering menus and recipes, almost all of which come in under Bernstein’s carb quotas.

So I learned that you can eat excellently and deliciously on 20g carbs a day, or less.

I wish you all the very best for your low carb and Bernstein’s methodology. And for your future health too.
 
Thank yoi so much for your reply. However, the last five years have gone by with me trying to talk my doctors into low carb. I even showed an HbA1c of about 4.9% (which was a lot better than previous results with their diet and prescriptions) and they still shook their heads. Their method of something being treatable is only after the worst happens. As a result, I have kidney stones and am at beginning stage kidney disease....I want no more complications and IF there is a possibility to reverse the ones I have, I will try it out. Hypos are not so much a problem at the moment but I am keeping my eye on bgs at least 10 times a day, and am hoping to lower the doses slowly and safely. I'm not advising anyone else...but like Dr. B, Ifeel I have to go my own way now, as putting my faith in these doctors here has made it's damage.

Kind regards,
Kpa
 
That's what I'll try. But forgive me if Iam mistaken, isn't it 4.8 on average and up to 6.7 mmol/L 2 hours after a meal? I have at least had that impression from what I have read on TypeOneGrit and other Bernstein forums, but perhaps I'm mistaken? Thanks for the comment - I'll give it a try and see if I am one of the lucky ones ot doesn't affect.

Kind regards,
KPA
 
Yes I am also a follower of dietdoctor.com but have been told by Andreas Eenfeldt (the lead doc on that site) that I should not try 20g or less as it can be dangerous for T1s. Nonetheless, a keto meal here or there does wonders I feel. However, I wonder if more fat than protein is sensible for someone with CKD? The traditions say that protein is baaaaad for kidneys but I think I will stick to Dr. B...who says that keto or high fat diets might not be good for T1Ds anyway. As you however mentioned....he has some odd recipes and is definitely not a foodie like me
Thanks for the input - good luck low carbing!

Regards,
KPA
 

It’s 5 years since I read dr Bernstein book, so you may well be right. I just try to keep to 4.8 / 5.8 ( but don’t always achieve it). I am, and have been, ketogenic for 5 years now. Much stronger and healthier than I was, can’t imagine not following his guidelines.
 
Reactions: kpa
Hi @kpa, From what I could find in his book, Dr Bernstein seems to recommend keeping BSL at 80 to 85 mg/dL ( = 4.4. to 4.7 mmol/l), with minimal deviation for meals etc, part of his small changes theme.
Good luck with your journey and endevours.
Please let us know how you travel and if you need support or queries answered along to way.
As you have read, and as some on site have experienced, complications have reversed/lessened on tight control and low carbs diets.
 
Reactions: kpa
Thank you! I have been trying to find the range of bloods but have a hard time finding it and have only just started the book. Am anxious as it might be too late for some of my complications but I want to try. As a foodie, I think it might be hard to reach 4.4 - 4.7 all the time. Are there any tips you could give to get to and keep that range? More fat or protein? Thanks again. All help is needed as I might have had diabetes for 16 years but it seems everything I was told was wrong.

Regards,
K
 
Hi @kpa, I must admit I have only been on the low carb diet, managing about 40 to 45 g carb per day for about 6 weeks although been reading about it for longer. I will say though that the increase in fat intake does a lot to curb appetite.
Dr Bernstein does give a pretty reasonable explanation from its own experience about how he manages and how he helps people who find it difficult to not eat more than a certain amount. He also relates his own history of having complications and how they improved over time, even proteinuria and gastroparesis (autonomic neuropathy).
I started off with his recommendations, found that I could not quite fit in with the 30 g carbs per day because of the 50% protein weight being added to the carbs but got pretty close and so far so good.
If I remember correctly he also demolishes the argument about increased protein intake affecting kidney function except for very advanced kidney problems.
The home-home message is that improving BSLs, HBA1Cs seems to be that sudden improvement is more likely to lead to a worsening of complications before they improve and raises the question about whether to aim for an intermediate improvement first.
Of those on site @Mel dCP who posted above is very experienced in low carb. She also has a blog on recipes.
She is on an insulin pump but the diet part is fairly standard, but a pump certainly makes the insulin and BSL management easier.
You might also wish to consider whether an insulin pump is a possible way to get things improving as well. With the pump you can set the BSL you would like the pump to calculate any correction doses ect to, so you can grade the improvement.
For example, you might wish to correct the level to a standard of 6 or 6.5 mmol/l to start with and later on ease that down so that the improvement is not too sudden. But also to note that Dr Bernstein managed to succeed without a pump (and has some criticisms to make about them)
Being in Australia I am not au fait with what the UK criteria and what the hoops to run through are but others on site will be and your own Health area and DSN should be able to inform you about the local set up.
I gather there are also advocate groups who can assist you if you seem to meet the criteria but are rejected or if the process is taking an inordinate amount of time.
Please do ask questions as you go because I am learning more over time or to compare notes on how you are travelling. I have aded the following. If you are not sure about things like insulin to carb ratios or correction ratios and how to work them out please ask me or Mel or post a question on site..
Insulin to carb ratios tend to come under a term called carb counting for which there are courses. You may be am to avail yourself of one of these and of course your DSN should be able to help, too.
ADDIT. One thing that tended to happen to me was that on low carb bolus (pre-meal, short-acting insulin) doses dropped first, as expected (I have an insulin:carb ratio for breakfast of about one unit (short-acting insulin) to about 6 g carbs) whereas it is about 1 unit to 8 g in the evening. (Noting that I was following the 'Bernstein formula" of including half the protein content of the meal as grams of carbs). Some people find that certain types of protein affect their BSL more than others and so dose accordingly.
My insulin to carb ratios made it easy to adjust the bolus (pre-meal) doses and of course check BSLs around the 2 to 2 1/2 hour mark afterwards ( I delay my meal about 40 minutes after the injection of insulin to give the insulin a better chance of meeting the BSL peak) you may not need such a delay, only by checking pre and post the meal can you gauge this.
I also took into account that the 50% conversion of protein there could be a flatter wave of BSL happening at about the 3 to 3 1/2 hour mark.
What I had not expected was that the basal insulin(long-acting insulin, if not on a pump) would also need to adjusted down.
I was waking up with fasting BSLs too low. The basal insulin requirement during the daytime eased up a little but I suspect that the BSL due to the protein was probably being partly "soaked up" by the basal as well as primarily by the past peak end of the bolus, short-acting insulin. So in my case from about 40 units total insulin per day at bolus to basal ratio of 50:50 to about 25 to 27 units total with bolus:basal of a 30:70 ratio. Every one is different and other factors like exercise will cause some changes in insulin requirements ect. Hypos were mild to non-existent , there were no wild swings in BSL (in case someone tries to scare you about low carb diets).
I hope that helps. Keep in touch as you go !!
 
Only use it in baking and I use stevia. No impact on my bg levels. Those are the only sweeteners I can use without digestive distress.
 
@kitedoc thank you! Well, I'm completely new to the Diabetes Solution and am finding it very hard to comprehend as much of it is detail. I dont know my ratios as none of my docs really believe in this way of treating T1. So where do I actually start? Is the 30g of carbs including the protein? I'm so awfully confused and terribly scared. Since starting a LCHF diet (not Bernstein) I improved the HbA1c but my kidneys have taken a hit...and I'm afraid as I dont know how far along the renal failure slide I am...can I reverse it, or is it just a slow ride down the slide from now on? In his Appendix A part of the book he does state that there is a point of no return...but when is this and how do I know? Since June of 2018 I've had kidney stones and infection after infection (been in hospital once every month for the last 6 months!). I'm so confused and could use a step by step guide. Could you suggest where to start? My docs are completely hopeless on this and I have been pleading with them for years...they still recommend 125g of carbs a day which I know and can feel is WAY too much. Thank you
 
ringi said:
@kpa where to you live?
Click to expand...
Copenhagen. Danish docs are a little slow (ahem) in the uptake. Took them 6 months to find and treat kidney stones. Went from infection to infection before someone decided to do a scan and lo and behold I had 4 tiny stones. The discussion went from kidney dysfunction to full-on kidney failure with need for dialysis in just one of the 20 weeks I spent in hospital.
 
@kpa maybe worth emailing dietdoctor.com to see if they can recommend someone who can surport you, as I expect they will know a few doctors doing lowcarb.
 
Reactions: kpa
ringi said:
@kpa maybe worth emailing dietdoctor.com to see if they can recommend someone who can surport you, as I expect they will know a few doctors doing lowcarb.
Click to expand...
I have already tried that route. I get no answer...even as a member many of my mails to them are ignored. I have tried looking for my answer there but now I use it for inspo for certain meals.
 
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