Type 1s: Bernstein for T1

Hi Robbins,I don't agree with every thing Bernstein says or recommends. but there is a great deal of sense in most of it.I maintain my blood/glucose at between 90 and 92 for the past 30 odd years,albeit I have been on a pump for the past 18 months and my diet is 120 gms/carbs per day.I have been type1 for over 54 years and the only complications I have is that I lost my hypo awareness about 4years ago but I am slowly getting it back, since being on a pump and CGM.

There are many here who think Bernstein is the Holy Grail of diabetes management with diet because he has stayed free of diabetic complications. The thing is though is that no one not even himself can say that he may never have had any complications anyway whatever he had done. There are thousands of diabetics in the world who have never heard of Bernstein yet will not have complications and those who follow him but will still get them that is something no one can predict. Yes of course it is good to keep our blood levels as good as we can get them and diet does help but we can only do that with trial and error it is all about what suits us personally because we are all different people. As to the..magic 83... it is obviously a level that does not suit everyone as you have found out I think we all have a level that suits us best

I prefer Think Like A Pancreas. Bernstein makes many sensible points and is very focussed but his actual diet is not for me.

Eating a moderate level of carbs is sensible. I eat approx 180g per day, and I think that's more in keeping with many Type 1s here.

I also think about all those people we hear about who've lived with Type 1 for 50, 60, 70 or even 80 years. Their 'secret' seems to be moderate carbs (way above Bernstein level) and a routine. They may also, of course, be lucky with their genes.

Achieving tight control is important, but, having experimented on my lucky (!) friends who don't have diabetes, I've seen a broader range of results than Dr B allows for. So I personally aim to be below 7.8 two hours after meals, ideally 7 or below.

We all vary and we all have different things to consider so each person must make their own decisions : )

I think the point Bernstein makes is that he managed to reverse complications with his approach, and the "law of small numbers" does make sense.

I strongly dislike his diet though, and whilst he may be eighty-something, I'm not sure how you can do significant amounts of exercise on his approach.

Hi. Always put any book on diet into perspective with other authors and make you own decision after that; this forum can add to that as well. NovoRapid is one of the most popular rapid insulins and I've never seen anything to suggest that it's not suitable with low-carbing. It may be true but I'd like to see some scientific evidence first. There are other insulins, but each has it's pros and cons including cost.

Pinkorchid said:

There are many here who think Bernstein is the Holy Grail of diabetes management with diet because he has stayed free of diabetic complications. The thing is though is that no one not even himself can say that he may never have had any complications anyway whatever he had done. There are thousands of diabetics in the world who have never heard of Bernstein yet will not have complications and those who follow him but will still get them that is something no one can predict. Yes of course it is good to keep our blood levels as good as we can get them and diet does help but we can only do that with trial and error it is all about what suits us personally because we are all different people. As to the..magic 83... it is obviously a level that does not suit everyone as you have found out I think we all have a level that suits us best

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Bernstein DID have complications. He talks openly about them in his publications.
He is left with permanent deformities in his feet as a result.
I recall him mentioning kidney and sight problems, but it is 3 years since I read the book.
Since adopting his very low carb, exercise and strict glucose control regime, he found all his other complications have improved to the extent he is symptom free in his 80s, and for the last few decades.

His perspective is that by keeping the blood glucose so low, the body can heal itself.

This is all discussed in his book Diabetes Solution.

tim2000s said:

I think the point Bernstein makes is that he managed to reverse complications with his approach, and the "law of small numbers" does make sense.

I strongly dislike his diet though, and whilst he may be eighty-something, I'm not sure how you can do significant amounts of exercise on his approach.

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Agreed. Yes, the law of small numbers makes total sense. For me though, I don't believe they have to be that small. Dr B's success is in great part due to his sheer determination and hard work. I admire him for that.

But I still believe an equivalent person with Type 1 who exerted the same level of application and control but with an ever so slightly higher target and more carbs could also have the same results re health and complications. Obsessing about being 89 instead of 83 or whatever doesn't seem necessary to me personally.

azure said:

Obsessing about being 89 instead of 83 or whatever doesn't seem necessary to me personally.

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Precisely. Bernstein's approach is inspirational but can also create a lot of confusion in someone who is new to T1 diabetes and tries to stick to the sometimes extreme principles as suggested by his book.

I can't say I 'follow' Dr B but I do follow the laws of small numbers. I eat 80% healthy fat ( avocado Evoo nuts and seeds and the fat that comes with my fish or poultry and red meats but I keep saturated fats low) 15% protein and 5% carbs mostly all from salad veggies. I have been doing this for over 25 years. I have only been diagnosed LADA 2.5 years ago at 50 years old. I was type 2 for who knows how long but after finding the Carbohydrates addict diet 25 years ago and going VLC I have felt tons better. I do best in ketosis so I need to keep carbs under 20 and protein moderate. I do have to bolus for protein just like he says, half.
85 is my bingo number and I'm usually within 10 points of it. There are other variables that factor in on different days. I eat the same macros at every meal at each meal. I am extremely insulin resistant in the morning so nothing other than a piece of lettuce for my wrap or celery for my avocado. I have one of two BFs that work in the morning. I do sometimes get a small spike after about 3 hours but the rest of the day is flat. I use novolog 1/2 unit pens and take 1/2 unit for meals. I don't feel well on larger doses and I tend to go low first and then spike. Some people can eat carbs and match their insulin to stay flat but I found it impossible. I am much flatter with VLC and moderate protein. I also don't want to bolus twice for one meal. The routine I have keeps me satisfied, level, and my weight stays the same.
I do want to keep my numbers around 85 to hopefully prevent any damage/ further damage. I feel best flat too and in the 80's. I found a lot of valuable information with Dr B. As I said, eating basically the same macros at each meal and find your bolus for it. That works very well for me. I vary my proteins and fats but same size of everything. Laws of small numbers works too for me. I was having too many hypos and spikes and lower insulin doses keep that much steadier. Think like a pancreas was ok too but his acceptable bs levels are not acceptable for me. I also found the Rosedale diet extremely valuable as a guide to diet but he doesn't talk about insulin. I do follow more of his plan. That is where I learned protein can raise bs and to put 4 hours between protein meals.

Rambling,,,,, yes I do follow to a degree Bernstein. But I also add other books information in. Like no grains or dairy, even low carb grains. Keep saturated fat low, eat the same macros and smaller meals and snacks everyday. Find your meals and your bolus.
You will find what works for you. I think people think my diet is extreme and it probably is but for me it takes the stress out of food and insulin. I'm on auto pilot now. When I first started insulin it was way too stressful. All that is gone now. I eat to live, not live to eat. And I love all my food.

There are many here who think Bernstein is the Holy Grail of diabetes management with diet because he has stayed free of diabetic complications.

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He is completely hypo unaware which as far as I know is a complication of diabetes.
Anyone who makes a ton of money from diabetes management books is very unlikely to say anything else except how well s/he is, so I tend to take people like this with a very large pinch of salt.

The best way to manage your diabetes is to do what suits you and gives the desired results in the long run, at the same time remembering that you need to live a life without becoming bogged down and or obsessed by anything and everything diabetes related.

Personally speaking I can't run that low and not feel terrible. I try and keep my levels at as close to 7 as I can and always in single figures. I think I'd be eating nothing but lettuce (if that) to get close to much better!

azure said:

I also think about all those people we hear about who've lived with Type 1 for 50, 60, 70 or even 80 years. Their 'secret' seems to be moderate carbs (way above Bernstein level) and a routine. They may also, of course, be lucky with their genes.

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Definitely agree with this, my Nan is also type 1 and refuses to go to bed below 10 (else shell have some grapes) and she's just passed her 88th birthday!

Robbins said:

Thanks PinkOrchid, see what you're saying, but thats what I used to say about smoking, some of us will make it to 90 with no issues, and some will not. Surely we have to go for the best scenario we can, which is why I gave up smoking.
There are some things Bernstein says which seem to be point of scientific fact. For example, the fact it's almost impossible to match your food spike, with the profile of fast acting insulin, and that it must be beneficial to get as close a match as possible between your food and insulin profile, so that your body 'behaves' as near as possible to how it would behave if we did not have diabetes? That premise, seems to be the only one I can find, that despite any concrete evidence, and everyone being different, makes any common sense?

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I know I am not T1 but am T2 not on insulin so I can't really say what is best for a T1. Yes you are right about smoking some will suffer bad affects from that some will not so the same with diabetes and diets. Bersteins may suits any number of people but others it may not suit at all

If Dr Bernsteins diet was the answer to diabetes control why hasn't it been endorsed by every health authority in the world and every scientist doing diabetic research but it hasn't been so what does that tell us only that nothing has been proven yet that it will work and halt complications in the long term Scientific diabetic research has to prove that a certain regime will work for the majority of diabetics for their life time and then they will recommend it and that just hasn't happened yet.

We basically follow the Bernstein approach with my 5 year old T1 daughter. As a family we all eat about 30g carbs a day. and it works well for us. I love the idea of the rule of small numbers, less carbs, less insulin, so fewer highs and lows. My daughter generally runs between 4 and 7 mmol at all times and it's taken her off the roller coaster. Low carb plus dexcom has given her a hba1c of 5.7% so I'm a fan, but everyone is different.

CathP said:

We basically follow the Bernstein approach with my 5 year old T1 daughter. As a family we all eat about 30g carbs a day. and it works well for us. I love the idea of the rule of small numbers, less carbs, less insulin, so fewer highs and lows. My daughter generally runs between 4 and 7 mmol at all times and it's taken her off the roller coaster. Low carb plus dexcom has given her a hba1c of 5.7% so I'm a fan, but everyone is different.

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When I was eating more carbs when 1st starting insulin I was hypoing all the time and then spiking. Then reduced carbs and insulin and I can only go so far in either direction. Laws of small numbers was key. I don't digest carbs well anyway so no love lost kicking them to the curb

I bought his book... twice lol

Everything he says makes very much sense. I feel like he took a path I would have ended up taking had he not already done so (we are both engineers, both T1D, and i have though many times that had i been diagnosed sooner i would have likely tried to get into med school - which he did)

I don't follow his diet, but a lighter version of my own. My main goal is 'keep carbs as low as possible for as long as possible -without it ruining my life' because like many his diet is very strict.

I believe he is legit, and knows what he is talking about - his age is good factor, and the fact that he has recovered from his complications help build trust. It just makes sense to take advice on diabetes from a doctor who has it.