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The Bernstein diet is a low-carbohydrate, high-fat diet for people with diabetes (diabetics). It goes against the conventional high-carbohydrate, low-fat diabetic diet recommended by much of the medical community.
The diet was developed by endocrinologist and Type I diabetic Richard K. Bernstein and first published in his 1997 book Dr. Bernstein’s Diabetes Solution: A Complete Guide to Achieving Normal Blood Sugars. It is intended for diabetics and people with insulin resistance syndrome. Diabetes is a disease in which the body does not produce or properly use insulin. Insulin is a hormone that is needed to convert sugar, starches and other food into energy. Insulin resistance often goes along with other health problems, like diabetes, high cholesterol, high blood pressure and heart attack. When a person has many of these problems together, it is called insulin resistance syndrome.
Bernstein was diagnosed with diabetes in 1946 at the age of twelve. He was put on the standard low-fat, high-carbohydrate diet for diabetics. He remained on this diet, even though his condition worsened and he developed many complications of the disease, until 1969. During this time, he experienced frequent bouts of hypoglycemia (excessively low blood sugar) along with headaches and fatigue, which he said was caused by the large doses of insulin he was taking to help regulate his blood sugar levels. He blames this cycle of hypoglycemia followed by insulin injections on his high-carbohydrate diet. Doctors recommend a high-carbohydrate diet for diabetics because it raises blood sugar. When blood sugar levels get too high in Type I diabetics, they must be brought down with insulin injections. In 1969, Bernstein, an engineer, began adjusting his insulin regimen from one injection a day to two and cut down on carbohydrates in his diet. The changes had only minimal effect. In 1972, he began checking his blood sugar levels five to eight times a day, making small changes to his insulin regimen and diet to see what the effects would be. Within a year, Bernstein said he had refined his diet and insulin injection schedule to the point of having nearly constant normal blood sugar levels. His health improved considerably. He spent the next few years trying to convince the major medical journals and physicians who treated diabetes that his method of closely monitoring his blood sugar levels and maintaining a relatively constant, normal blood sugar level could help other diabetics. The attempts failed. So in 1979, Bernstein quit his engineering job and entered medical school. In 1983, he opened his own medical practice in New York. After that, he began formulating his diet plan that became the focus of his 1997 book.
The Bernstein diet doesn’t recommend a specific ratio of the three main food groups: proteins, fats, and carbohydrates. Instead, he advocates an individualized approach to a diabetic’s diet. At the center of the diet is the need for diabetics to test their blood sugar levels at least five to eight times a day. On his Website, (http://www.diabetes-normalsugars.com) Bernstein states, “There is simply no way to determine objectively how any given food at any given time is going to behave in any given individual, unless blood sugar is tested before and for a number of hours after its consumption.” In his books and on his Website, Bernstein details how each of the three primary food groups, protein, fats, and carbohydrates, fit into his diet.
Bernstein has three basic rules for diabetics when developing meal plans that normalize blood sugar levels. They are:
- Eliminate all foods from the diet that contain simple sugars, which are fast-acting carbohydrates. These foods include table sugar, most starchy foods such as breads and pasta, grains, and potatoes.
- Limit total carbohydrate intake to an amount that will work with insulin, either injected or produced naturally by the body. This will avoid a post-meal blood sugar increase, and will avoid any remaining insulin-producing beta cells of the pancreas.
- Stop eating when there is no longer a feeling of hunger. He says people should not leave the table while they are still hungry but should also not wait until they feel stuffed to stop eating.
Bernstein tells diabetics to avoid hidden dangers in foods, especially sugar-free foods, that can cause blood sugar levels to rise too much and too rapidly. Food labels should be carefully checked for these substances and foods containing any of them should be avoided. These include carob, honey, saccharose, corn syrup, lactose, sorbitol, dextrin, levulose, sorghum, dextrose, maltodextrin, treacle, dulcitol, maltose, tur-binado, fructose, mannitol, xylitol, glucose, mannose, xylose, and molasses.
The Bernstein diet recommends diabetics avoid eating the following foods: breakfast cereals, snack foods (candy, cookies, cakes, potato and tortilla chips, popcorn, and pretzels), protein bars, milk and
cottage cheese (except for soy milk), fruits and fruit juices, certain vegetables (beans, beets, carrots, corn, potatoes, tomatoes (including tomato sauce and paste), canned and packaged soups, and most ‘health’ foods.
Foods that are allowed under the Bernstein diet include meat, fish and seafood, poultry, eggs, tofu, soy meat substitutes, cheese, butter, margarine, cream, yogurt, soy milk, soy flour, and bran crackers. Other food items allowed include toasted nori (seaweed), artificial sweeteners (Equal, Sweet’n Low, Nutra-Sweet, and Splenda), No-Cal brand syrups, Da Vinci Gourmet brand syrups, flavor extracts, herbs and spices, low-carbohydrate salad dressings, nuts, and sugar-free gelatin and puddings.
The main function of the Bernstein diet is to help people with diabetes to maintain constant, normal blood sugar levels throughout the day. Maintaining control of their blood sugar levels can help diabetics avoid long-term complications of the disease, including neuropathy of the feet, amputation, cataracts and blindness, heart disease, erectile dysfunction, glaucoma, ulcers of the feet, high blood pressure, and high cholesterol. Since the diet is similar to the Atkins diet in that it emphasizes low-carbohydrate foods, people who are overweight or obese can lose weight on the Bernstein diet.
The primary benefits of the Bernstein diet come from diabetics being able to maintain constant, normal blood sugar levels. Doing this over the long-term can help reduce the number of diabetics who develop complications from the disease. These complications include heart disease, high blood pressure, eye problems, serious conditions affecting the feet that sometimes lead to amputation, gastroparesis (a condition in which the stomach requires significantly longer than its normal time to empty), kidney disease, and fatigue. The importance of maintaining constant, normal blood sugar levels (by checking the levels at least five to eight times a day with home glucose monitors and then adjusting insulin levels accordingly) was proven by the Diabetes Control and Complications Trial, a study of diabetics from 1983–1993, the most comprehensive large-scale diabetes study ever conducted. The study found that in diabetics who intensely controlled their blood sugar levels, the risk for eye disease was reduced by 76 percent, nerve disease by 60 percent, and kidney disease by 50 percent. The diet can also help diabetics who are overweight or obese to lose weight.
There are no major precautions associated with the diet, although it is not recommended for diabetics by major medical organizations including the American Medical Association, American Dietary Association, and American Diabetes Association. Diabetics should discuss the diet with their doctor or a specialist in diabetes called an endocrinologist, who may refer the person to a diabetic dietician or nutritionist. The diet is high in fat so people on it should use fats from
monounsaturated and polyunsaturated sources such as olive and canola oils.
There are no general health risks associated with the Bernstein diet. Critics of the diet say it contains too much fat, is not nutritionally balanced, and is not a long-term solution for losing weight and keeping it off. They also say it is difficult for many people to maintain a low-carb diet over the long-term. Also, people with type 1 diabetes who take insulin are at a high risk of hypoglycemia (abnormally low blood sugar levels) and ketoacidosis (dangerously high blood sugar levels) if they remove too much carbohydrate from their meals.
Critics of the Bernstein diet for diabetics are quick to point out that there are no major long-term scientific studies on the effectiveness of the low-carbohydrate, high-fat diet. However, the same can be said for the traditional low-fat, high-carbohydrate diet that has been the standard diabetic diet for more than 50 years. In one review of Bernstein’s 1997 book, Dr. Bernstein’s Diabetes Solution: A Complete Guide to Achieving Normal Blood Sugars, the diet was criticized because it required diabetics to be meticulous in self-managing the disease. But there are major long-term scientific studies that show that there is significant benefit in such meticulous self-management, including the landmark Diabetes Control and Complications Trial and the United Kingdom Prospective Diabetes Study.
Among the critics of the Bernstein diabetic diet are the American Diabetes Association, American Dietary Association, American Medical Association, American Heart Association, United States Department of Agriculture, and the Physicians Committee for Responsible Medicine. They say that high-fat, low-carbohydrate diets are generally unhealthy because they are low in fiber, calcium, fruits, and vegetables, and high in cholesterol, fat, and saturated fat. On the surface, it would seem that a diet that is the opposite of what the world’s leading diabetes organization recommends would not be acceptable for diabetics. However, since 2002, a number of scientific studies that compared high- and low-carbohydrate diets concluded that a low-carbohydrate diet reduces blood sugars and risk factors for heart disease. That is why many practicing endocrinol-ogists endorse the Bernstein diet and other low-carbohydrate diets for their patients. They point out that the American Diabetes Association (ADA) has always been very slow in reacting and adjusting to new development in diabetes monitoring and treatment. For example, the ADA did not endorse patient blood glucose monitors until 1983, about 10 years after they were developed. What is lacking in the low-carb versus high-carb diet controversy is major long-term studies that track patients for longer than a year.
People with Type II diabetes may be able to improve control of their blood sugar levels, lose weight, and lower cholesterol levels significantly with a low-carbohydrate diet, such as the Bernstein diet, that with diets that restrict calorie intake, according to two studies presented in 2006 at the American Diabetes Association annual scientific sessions. One of the studies, conducted by Duke University researchers, was funded by the Robert C. Atkins Foundation. Atkins authored a number of popular books on the Atkins low-carbohydrate diet.
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American College of Nutrition. 300 South Duncan Ave., Suite 225, Clearwater, FL 33755. Telephone: (727) 446-6086. Website: http://www.amcollnutr.org.
American Diabetes Association. 1701 N. Beauregard St., Alexandria, VA 22311. Telephone: (800) 342-2383. Website: http://www.diabetes.org.
American Dietetic Association. 120 South Riverside Plaza, Suite 2000, Chicago, IL 60606-6995. Telephone: (800) 877-1600. Website: http://www.eatright.org.
American Society for Nutrition. 9650 Rockville Pike, Bethesda, MD 20814. Telephone: (301) 634-7050. Website: http://www.nutrition.org.
Center for Nutrition Policy and Promotion. 3101 Park Center Drive, 10th Floor, Alexandria, VA 22302-1594. Telephone: (703) 305-7600. Website: http://www.cnpp.usda.gov.
Ken R. Wells.