Saturday, August 3, 2013

The Nutrition Debate #131: Bernstein Goes Paleo

If you don’t know who “Bernstein” is, let me explain. Richard K. Bernstein, MD, is a type 1 diabetic who, in my opinion, single-handedly innovated and championed the wide-spread use of the personal glucose monitoring device. Forty odd years ago he was a practicing engineer, and his wife an MD, so he had access to her bulky hospital equipment that was the only way of determining blood sugar measurements “in the old days.” Bernstein had been following medical guidelines for type 1s up to that point in his life and was dismayed to see that he was developing diabetic “complications” (neuropathy and retinopathy) in his early 30’s. With the meter, he observed that certain foods caused his blood sugar to rise, and others not, so he reasoned that he could control his blood sugar by what he ate. Sounds reasonable, right?

Every diabetic in the world, and ideally every pre-diabetic too, should be using a meter both before and after meals and at other critical times of the day and night. When Bernstein did, he gained control over his blood glucose and reversed his complications. Ever since, his over-arching philosophy has been that “people with diabetes are entitled to the same blood sugar as people who don’t have the disease.” Bernstein has been a type 1 for 69 years. His A1c’s today are always in the 4s.

So, Bernstein went to school, both literally (to medical school) and figuratively, and has been promoting very low carbohydrate eating ever since. In an article in the magazine “Diabetes Health,” which I read recently through a link in Low Carb Diet News, Bernstein says, “To get normal blood sugars you have to do certain things, and one of the key things is a very low carbohydrate diet. This is because nothing else works. I’ve tried other approaches throughout my 69 years of having diabetes. I got my first meter in 1969, so I’ve had plenty of time to experiment and see what works.”

Over the years Bernstein has developed a “concept diet,” the Bernstein Diet, also called a Way of Eating (WOE). In it, you eat 30 grams of carbohydrates a day: 6 grams at breakfast, 12 at lunch, and 12 at dinner. The lower amount at breakfast is due to something called Dawn Phenomenon (DP) which some people experience. The body makes a little glucose and circulates it upon waking to enable it to be used for quick energy to get you going (before caffeine). Bernstein recommends that you eat 3 small meals a day, evenly spaced about 5 hours apart. He advocates that protein, a large part of which is glucogenic (i.e., will make glucose if it is not taken up my muscles, etc.), be roughly equal amounts in each meal and not too much. Gluconeogenesis, where the liver makes glucose from excess amino acids (digested protein), can sabotage very low carbohydrate (VLC) eating.

His popular book, “Diabetes Solution,” has gone through several editions and is a best seller. If you decide to try VLC, don’t be afraid to eat saturated fats. In fact, Bernstein says in the Diabetes Health article, “There’s no way the ADA diet or any high-carbohydrate and low-fat diet will enable you to control blood sugars.” He’s very definite about that.

But here’s what blew me away about the Bernstein article. He goes on to say, “It turns out that the kind of diet I recommend is essentially a Paleolithic diet, which is what humanity evolved on. Our ancestors did not have bread, wheat, sweet fruits, and all of the delicious things we have today. These have been specially manufactured for us nowadays. For food, our ancestors ate a paucity of roots, some leaves, and principally meat. If they lived near the shore, they had fish.”

Bernstein concludes, “My dietary recommendations boil down to what our ancestors ate. The ADA repeatedly says that while low-carbohydrate diets may work, they’re an experiment, and we haven’t had enough years of trial of these diets to see if they do any harm. But in reality the ADA diet is an experiment that was never based on any history. In fact, it is the cause of the epidemic of obesity and diabetes that is currently shaping our nation. Whereas the original diet, the Paleolithic diet, has been tested for hundreds of thousands of years, and it’s the only one when you deviate from it that you end up where we are now.” He’s absolutely right, of course. That’s the simple truth. I’m just surprised he said it.

So, my hat is off to Richard K. Bernstein, MD, for seeing “the big picture” and speaking the truth. It’s rare enough for someone “inside” the medical establishment to see, much less speak, truth to power, even as it takes the focus off his own well established brand and carb-centric reputation. In my view, it elevates him a notch or two. Dr. Bernstein’s place among the pioneers of medicine is secure. And his place in the firmament of diabetes treatment is likewise assured. Now, in advocating Paleo principles, his vision is more far reaching yet and embraces how all of us should eat going forward.

Eleven years ago I bought a meter and used it to “eat to the meter” and thereby learn what foods had an impact on my blood sugar and by how much. It was an invaluable adjunct to general principles and guidelines and enabled me to fine tune my eating habits to the point where I was able lower my A1c’s from the 8s, while maxed out on 2 oral diabetes meds and starting a 3rd, to the mid 5s, today, by diet alone, except for 500mg of Metformin once a day. This medication works to suppress unwanted glucose production by the liver, from eating too much protein in a meal. My pancreas is spared.
Do others see how Very Low Carb and Paleo can be compatible? For caveats on the Paleo part for type 2 diabetics, see The Nutrition Debate #124, “A Lamentable Confusion Between Diets.” Do you know any diabetics (type 1s or 2s) in their 70’s?

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