Here’s my review of Dr. Bernstein’s Diabetes Solution: The Complete Guide to Achieving Normal Blood Sugars, published in 2007. Per Amazon.com’s rating scale, I give it five stars (I love it).
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Dr. Richard K. Bernstein gives away thousands of dollars’ worth of medical advice in this masterpiece, Diabetes Solution. It’s a summation of his entire medical career and a gift to the diabetes community.
The book starts off with some incredible testimonials: reversal of diabetic nerve damage, eye damage, and erectile dysfunction. They’re a bit off-putting to a skeptic like me, like an infomercial. Dr. Bernstein is either lying about these or he’s not; I believe him. His strongest testimonial is his own. He’s been a type 1 diabetic most of his life, having acquired the disease at a time when most type 1’s never saw 55 candles on a birthday cake. He’s in his mid-70s now and still working vigorously.
I only found one obvious error and assume it’s a misprint. He writes that 95% of people born today in the U.S. will eventually develop diabetes. That’s preposterous. The U.S. Centers for Disease Control predicts that one in three born in 2000 will be diagnosed.
Dr. Bernstein delivers lots of facts that I can neither confirm nor refute. He’s a full-time diabetologist; I am not.
"Put down the bread and no one will get hurt!"
The central problem in type 1 diabetes is that, due to a lack of insulin, ingested carbohydrates lead to spikes (elevations) in blood sugar. The sugar elevations themselves are toxic. The usual insulin injections are not good imitators of a healthy pancreas gland. So Dr. Bernstein is an advocate of low-carb eating (about 30 g daily compared to the usual American 250-300 g). He says the available insulins CAN handle the glucose produced by a high-protein meal.
Dr. B reminds us that insulin is the main fat-building hormone, which is one reason diabetics gain weight when they start insulin, and why type 2 diabetics with insulin resistance (and high blood insulin levels) are overweight and have trouble losing weight. You can have resistance to insulin’s blood sugar lowering action yet no resistance to its fat-building (fat-storing) action. Insulin also stimulates hunger, so insulin-resistant diabetics are often hungry.
“Carbohydrate counting” is a popular method for determining a dose of injected insulin. Dr. B says the gram counts on most foods are only a rough estimate—far too rough. He minimizes the error by minimizing the input (ingested carbs). From his days as an engineer, he notes “small inputs, small mistakes.”
Dr. B also cites problems with the absorption of injected insulin. Absorption is variable: the larger the dose, the greater the variability. So don’t eat a lot of carbs that require a large insulin dose. For adult type 1 diabetics, his recommended rapid-acting insulins doses are usually three to five units. If a dose larger than seven units is needed, split it into different sites.
He recommends diabetics aim for normal glucoses (90 mg/dl or less) almost all the time, and hemoglobin A1c of 5% or less. This is extremely tight control, tighter than any expert panel recommends. He says this is the best way to avoid the serious complications of diabetes.
Here’s a smattering of “facts” in the book that made an impact on me, a physician practicing internal medicine for over two decades. I want to remember them, incorporate into my practice, or research further to confirm:
- Hemoglobin A1c of 5% equals an average blood sugar of 100 mg/dl (5.56 mmol/l). For each one % higher, average glucose is 40 mg/dl (2.22 mmol/l) higher.
- He’s against any drugs that overstimulate (“burn out”) the remaining pancreas function in type 2 diabetics: sulfonylureas, meglitinides, “phenylalanine derivatives”. Pancreas-provoking agents cause hypoglycemia and destroy beta cell function.
- The insulin sensitizers are metformin and thiazolidinediones. He likes these.
- Blood sugar normalization in type 2 diabetes and early-stage type 1 can help restore beta cell function.
- He often speaks of preserving beta cell function.
- He believes in “insulin-mimetic agents” like alpha lipoic acid (especially R-ALA, and take biotin with either form) and evening primrose oil. These are no substitute for insulin injections but allow for lower insulin doses. ALA and evening primrose oil don’t promote fat storage like insulin does.
- He says many cardiologists take ALA for its antioxidant properties [news to me]
- He says rosiglitazone works within two hours [news to me] but later admits it may take 12 weeks to see maximal benefit
- One of his goals is to preserve beta cell function if at all possible
- He prefers rosiglitazone over pioglitazone due to fewer drug interactions
- “Americans are fat largely because of sugar, starches, and other high-carbohydrate foods.”
- He’s convinced that people who crave carbohydrates have inherited the problem, which also predisposes to insulin resistance and type 2 diabetes. Low-carb diets decrease the cravings for many, in his experience.
- In small amounts, alcohol is relatively harmless: dry wine, beer, spirits. Very few doctors have the courage to say this.
- If you’re in a restaurant, you can use urine sugar test strips and saliva to test for presence of sugar or flour in food
- A rule of thumb: one gram of carbohydrate will raise blood sugar about 5 mg/dl (0.28 mmol/l) or less for most diabetic adults weighing 140 lb (64 kg) and about 2.5 mg/dl (0.139 mmol/l) in a 280-pounder (127 kg). This must refer to type 1 diabetics or a type 2 with little residual pancreas beta cell function; variable degrees of insulin resistance and beta cell reserve in many type 2s would make this formula unreliable.
- Be wary of maltodextrin in Splenda: it does raise blood sugar.
- Much new to me in his section on artificial sweeteners. Be wary of them.
- He avoids all grains, breads, crackers, barley, oats, rice, and pasta.
- Most diet sodas are OK.
- Coffees with 1-2 tsp milk is OK. Cream is OK.
- He eats NO fruit and recommends against it.
- He avoids beets, corn, potatoes, and beans. A slice of tomato in one cup of salad is OK. A small amount of onion is OK.
- String beans and snow peas are OK.
- Cooked vegetables tend to raise blood sugar more rapidly than raw.
- Use “Equal” aspartame tabs as a sweetener. Don’t use “powdered” Splenda.
- Avoid nuts: too easy to overeat.
- For desert: sugar-free Jell-O Brand Gelatin.
- Yogurt? Plain, whole milk, unsweetened. Flavor with cinnamon, Da Vinci syrups, baking flavor extracts, stevia or Equal.
- Avoid balsamic vinegar.
- Need fiber? Bran crackers or soybean products.
- “Ideally, your blood sugar should be the same after eating as it was before.” 85 mg/dl (4.72 mmol/l) is his usual goal. If blood sugar rises by more than 10 mg/dl (0.56 mmol/l) after a meal, either the meal has to be changed or medication changed.
- Protein is a source of glucose: keep protein amounts at meals constant from day to day, especially if taking glucose-lowering drugs.
- The lowest-carb meal of the day should be breakafast. Why? Dawn phenomenon.
- He promotes strenuous, prolonged exercise, especially weight training (extensive discussion and instruction in book).
- Many diabetics on insulin need dose adjustments in 1/2 and 1/4 unit increments [news to me: if I ordered 4 and 1/4 units of insulin at the hospital, the nurses would laugh].
- Typical rapid-acting insulin doses for his adult type 1 patients are 3-5 units. The “industrial doses” of insulin seen or recommended by many physicians reflect diets too high in carbohydrate.
- He says Lantus only acts for nine hours (nighttime injection) or 18 hours (AM injection).
- He doesn’t like mixed insulins (e.g., 70/30).
- Humalog and Novolog are more potent than regular insulin, so the dose is about 2/3 of the regular insulin dose
- “Only a few of the 20 available [home glucose monitoring] machines are suitably accurate for our purposes.” “None are suitably accurate or precise above 200 mg/dl [11.11 mmol/l].”
- Vitamin C in doses over 250 mg interferes with fingertip glucose monitors. Later he says doses over 500 mg cause falsely low readings.
- He prefers regular insulin (45 minutes before meal) over Novolog and Humalog, because of its five-hour duration of action.
- Insulin users need to check glucose levels hourly while driving.
- His personal basal insulin is 3 units Lantus twice daily.
- He urges use of glucose (e.g., Dextrotabs) to correct hypoglycemia.
- He says hypoglycemia is rare on his regimen.
- He has an entire chapter on gastroparesis.
Dr. Bernstein’s recommended eating program in a nutshell:
- Some similarities to the Atkins diet, which he never mentions.
- No simple sugars or “fast-acting” carbs like bread and potatoes, because even type 2s have impaired or nonexistent phase 1 insulin response.
- Limit carbs to an amount that will work with your injected insulin or your remaining phase 2 insulin response, if any.
- “Stop eating when you no longer feel hungry, not when you’re stuffed.”
- Follow a predetermined meal plan (each meal: same grams of carb and ounces of protein)
- Six g (or less) of carbs at breakfast, 12 g (or less) at lunch and evening meal. So his patients count carb grams and protein ounces.
- Supplements are not required IF glucoses are controlled and eating a variety of veggies. Otherwise you may need B-complex or multivitamin/multimineral supplement.
- Recipes are provided.
His has four basic drug treatment plans, tailored to the individual. They are outlined in the book. Dr. B provides detailed notes on what he does with his personal patients.
Overall impressions:
- Too complicated for most, and they won’t give up higher carb consumption. It requires a high degree of committment and discipline. In fact, I’ve never had a patient tell me they were on the Bernstein program.
- If I had type 1 diabetes, I might well follow his plan or the Low-Carb Mediterranean Diet, NOT the high-carb diet recommended by the ADA and many dietitians.
- And if I had type 2 diabetes? Low-Carb Mediterranean Diet first, Diabetes Solution as second choice.
- If one can get his hemoglobins A1c down to 5% with other methods, would that be just as good? Dr. B would argue that all other methods have blood sugar swings that are too wide.
- Many new ideas and techniques here, at least to me.
- He pretty much reveals his entire program here, which is priceless.
- I’m not sure this plan will work unless the patient’s treating physician is on-board.
- His personal testimony and breadth of knowledge are very persuasive.
Disclosure: I was given nothing of value by Dr. Bernstein or his publisher in return for this review.
Diabetic Mediterranean Diet 
What’s the dawn phenomenon?
I’d be curious to know the rationale and data supporting ALA.
Thank you for your great review of Dr. Bernstein’s book – I wish it were more widely known.
His was the first book I read after being diagnosed (T2). Although I’m not quite as strict with my routine as his plan requires (I eat some berries and citrus), I credit his approach and the knowledge I gained from his book with my ability to keep my A1c at 4.9, without medication.
I’ve passed his book along to my father, aunt and sister-in-law, but they haven’t been able to commit, unfortunately.
During the first few hours of arising from a good night’s sleep, the liver removes or deactivates more insulin than it does during other times of the day. Less insulin would mean rising blood sugars (20-100 mg/dl, for example). Non-diabetics simply secrete more insulin to make up for the higher liver deactivation rate, so they wouldn’t see the Dawn Phenomenon.
Dawn Phenomenon is more apparent in type 1 diabetics, although Bernstein says many type 2s show signs of it.
Regarding ALA, Bernstein does not provide specific scientific references, just mentioning “many German studies” supports its use. I can sort of understand that since the book is for the general public and is 519 pages already.
-Steve
Thank you for this great review of Dr. B’s life saving book. I read his first edition about 9 years ago and it saved my husband’s life! At the time, my husband had T2D for over 20 years! He was 80 pounds overweight, had neuropathy in both feet (so bad that he couldn’t walk over 75 feet without pain and so bad that it had to be controlled with neurontin), he was by that time on 43 units of insulin a night, night time hypoglycemia and his HA1c was around 8% (actually down from the high of 11%). I told my children that I’d be pushing Dad around in a wheel chair before too long. He saw his doctor regularly, took his meds faithfully and tried to lose weight.
As I read Dr. B’s book, I was astonished at how the case studies sounded so much like my husband. I couldn’t believe that something like diabetes and neuropathy could actually be reversed.
My husband and I went on a low carb lifestyle — eating low carb and exercising. Don’t forget my husband could not walk 75 feet before. Within 2 weeks on low carb he was able to walk the track at the gym.
8 years later we are still on a low carb lifestyle! My husband walks 2 miles on the track at least 3 or 4 times a week. He came off of insulin within 2 months of starting on low carb. He is totally off of neurontin and the neuropathy has gone from a pain level of 10 to a pain level of 2. He tells us that the pain used to be with him all the time and now he only feels a twinge now and then. Oh, and he lost 80 pounds within 9 months and has NEVER gained it back. We both feel and look better than we ever have. We go out and give talks about low carb and reversing diabetes. We urge people to TELL their doctors that they want to do this and they want their doctors help. We give these talks as coaches and as information — we stress to our clients that we are not doctors nor nutritionists, etc. but that we are telling them what happened to us and what we did so that they do not suffer like my husband did for as long as he suffered. It is my passion to get the word out about the false information being given to diabetics by their well meaning but poorly informed physicians. My husband’s doctors can not believe the change in him. They take him off of medication nearly every time he goes in for a check up.
Dr. B’s book started all of this for us. I have never met him but have read all his books and I listen to his teleclasses every month.
I give people at my workshops a recommended reading list and his book is number one on the list.
Thank you again. I could go on and on (and have) 🙂
Mary, thanks for taking the time to share that story. Dr. Bernstein writes about similar cases in his book.
-Steve
“The Diabetes Diet: Dr. Bernstein’s Low-Carbohydrate Solution” is way easier for us non-rocket scientists to grasp – the section on gastroparesis frightened the life out of me! I think the program is better explained and easier to grasp. Dr B has made his program available to everybody who can read with this book
Thanks for your input, Jonathan. I was not aware of that book.
-Steve
Thanks for the great post. I’m really excited to read this book, do they sell it on amazon or at Barnes and Noble? I work with one other RD at a small hospital and we also run the outpatient diabetes center. We are bound by the ADA (Diabetes and Dietetic) associations to teach carb counting/continuous carbs through out the day. However, thanks to all the recent research coming out, we plan on teaching continuous low carb intake instead of the 45% recommended by both ADAs.
Dear Dr. Parker, I have seen you post on other sites and have read some of your articles here as well. I’m especially interested in your approach using the diabetic mediterranean diet – and will be following your feedback more closely now since that is my preferred way of eating – but grains do raise my BS.
BTW I have never been a junk food eater nor drank sodas. I cook all my own food from scratch. (My interest in food goes way back to Carlton Frederick and Adell Davis! You may be too young to remember them.)
Apparently, I have been pre-diabetic for at least 10 years that I know of – maybe longer – but as you know, until recently a fasting blood sugar from 110 to 125 was considered ok and my doc never said anything. Now that I know better and my A1C is creeping up to 6 I have become concerned.
I’m puzzled why I don’t fit the profile of a (pre) diabetic: I have always been slender, low/normal blood pressure, low triglycerides (around 50), high HDL (around 70/80) but also high cholesterol (around 250) (though on a recent 15 months vegan diet it plummeted to 156). I am also slightly hypothyroid.
At 67 I am still very active (yoga, running, gym) and have no aches or pains.
For the last 6 months I’ve played around with low carb but I am not quite comfortable going all the way since it is so restrictive in that most of the food allowed nearly all has to be ‘refrigerated’ or cooked- not very practical! I bet you’ve never heard that excuse before :-). And I have found that my fasting BS has now gone up again (from 104/110 closer to 120 now) .
Anyway I will be checking this blog on a regular basis to monitor your progress in this area.
Thank you for sharing your insights with us.
On page 172, he says,”Snacks are permitted but certainly not required. The carbohydrate content of snacks may duplicate but should not exceed that allocated for lunch or supper.” He goes on to give examples. In this way, as a type 2, if I ate at 7am, noon, 5pm, and 9pm, my BG numbers stay stable. In my case, I keep my first and last meal lower than the other two, which works for me. So I have about 36 grams of carbs a day, and since I don’t take insulin, I could even have more meals (I don’t) as long as 4-5 hours are between the end of one meal and beginning of the next, and I can maintain good BG control and don’t have gastroparesis. He also emphasizes customizing the diet based on what you liked to eat and enough protein to stay satisfied and lose weight if needed.
Bonnie, I appreciate your comments.
Jim Thompson april13, 2012
I am a T2, 67 years old and have just read Dr. B’s book and have started the low carb diet and my blood sugar has dropped dramatically. It works or at least it has so far. My only concern is, like most medical treatments, that it deals with the disease at its surface and not its crux. Where is the cure? I remember Dr. Saulk and the polio vacine. I do realize that our super refined food diet is the problem still I remember my grandparents eating anything they wanted ( whole milk, real butter, cream, pork, eggs, fruits, berries, bisquits, bread, potatoes, onions, cornbread etc. and they lived long lives. So where was and is the breakdown?
Hey, Jim. Good to hear from you.
I hear from lot’s of folks that they get on Dr. Bernstein’s program and see significant decreases in blood sugar levels. Not once have I heard or read a comment from someone who actually followed the program and reported, “It really didn’t do anything for my sugars.”
Regarding the cause and cure for type 2 diabetes:
Our grandparent’s generation burned a lot more calories than we do (physical activity), didn’t eat as much refined sugar and starch as we do, and kept their weights under better control. That’s it in a nutshell.
-Steve
I am a 74 year old diabetic (T2) and have been following Bernstein’s plan for 26 months. I have lost 51 lbs, lowered my intake of insulin and have had reversal of several diabetic complications. My blood chemistry is much better than before and my A1c has gone from 9.1 to 5.0. My blood pressure is lower and I am healthier in virtually every measured way.
I cannot bring myself to abandon all fruits but I found I can satisfy myself with a quarter of an apple, a half of an orange, a quarter of a grapefruit, etc. I eat them much more slowly and with concentrated mental feelings of enjoyment. I currently limit myself to 40 grams of carbs per day and I continue to lose weight at the rate of a pound and a quarter a month. There was a long plateau period of no weight loss in the middle of the two years (13 months) but I kept at it. It has paid off.
Several writers on dieting say one cannot continue indefinitely on a low carb diet. I think they have the wrong attitude. The word “diet” has two distinct meanings. It can refer to what people eat on an ongoing basis. “The Inuit live on seal fat and protein in the winter and the same supplemented by summer time vegetative materials found on land.” The Inuit do not give up their diet or they would starve.
The other meaning is a special temporary change in one’s eating habits. As long as one considers what they are doing to be temporary they are doomed to drop off the temporary diet and resume their normal faire.
I have found a useful mental image to conjure up to help me. I once lived in the Mariana Islands where I could eat breadfruit. It was a wonderful food and in season very abundant. Breadfruit could be eaten every way that potatoes can. One can make breadfruit chips, french fries, mashed breadfruit, etc. A typical tree could produce thousands of lbs. However, now living in the Seattle area, I have no chance to obtain breadfruit. It is just a memory from earlier years. I find it OK to remember breadfruit with fond affection, even though I will never taste it again.
Now being on Bernstein’s diabetic diet, I no longer eat a number of once-loved foods: pizza, bread, corn-on-the-cob, catsup, etc. I just have the same fond memories of my lifestyle then as when I had breadfruit. It is OK to think of how I used to like ice cream, candy and cake. I just no longer live so that I can have those items. Pizza and french fries are just fond memories. They are just like the breadfruit. It is true that I could go to the supermarket and buy them. I could also take a plane flight to Guam and enjoy breadfruit. I don’t do either.
It is important to learn new concepts about food and invent new recipes.
One example is that I put store mix cabbage slaw in a bowl and added small defrosted salad shrimp. I added bacon bits, chopped radishes and green onions, along with both chopped black olives and a special brand of green olives. The latter were very large olives double stuffed with both garlic and jalapeno peppers. For dressing I mixed a store bought creamy Ranch dressing with raw tomato salsa and added the juice of half a lemon and half a lime. It is an absolutely wonderful taste combination. For side crunch and texture I used an idea of Dr. Bernstein, a couple of squares of processed cheese heated briefly in the microwave to become substitutes for crackers or bread, on the side. This tastes simply wonderful and I can eat it always as part of my new survival-to-old age diet.
That’s a great testimonial, Jerrymat. Thanks for sharing. I’m going to make a blog post out of it if you don’t mind.