Retrospective #131: Bernstein Goes Paleo, sort of…

Richard K. Bernstein, MD, a Type 1 diabetic, single-handedly innovated and championed the wide-spread use of the personal glucose monitoring device. It all began fifty years ago when he was a practicing engineer and his wife an MD. So, he had access to her medical equipment, “in the old days” the only way to measure blood glucose. Up to that point Bernstein had been following medical guidelines for Type 1s and was able to see his elevated glucose. He was also dismayed that, in his early 30’s, he was developing diabetic “complications” (neuropathy and retinopathy). Using his wife’s machine, he learned that certain foods caused his blood sugar to rise a lot, and others less so, so he got the idea that he could control his blood sugar by what he ate. Sounds reasonable, right?

From that Bernstein went on to advocate that every Type 1 diabetic should be testing 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.” 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 a 2013 article in the magazine “Diabetes Health,” Bernstein said, “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 developed the Bernstein Diet. 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 Dawn Phenomenon (DP): Upon waking the body makes a little glucose and circulates it for quick energy to get you started (before caffeine).

Bernstein recommends that you eat 3 small meals a day, evenly spaced about 5 hours apart. Because a large part of protein’s components (amino acids) are glucogenic (i.e., will make glucose), Bernstein recommends roughly equal amounts in each meal and not too much. Gluconeogenesis can sabotage very low carbohydrate (VLC) eating. Metformin suppresses this unwanted glucose production by the liver from eating too much protein in one meal.  

His encyclopedic book, “Diabetes Solution,” has gone through several editions and is a best seller. Beware though: it’s heretical. 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 on that. No bones about it.

But here’s what blew me away about the 2013 Bernstein article in “Diabetes Health.” Bernstein said, “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 then concluded, “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.

Seventeen years ago, I bought a meter and used it to “eat to the meter” and thereby learn what foods impacted my blood sugar and by how much. It was an invaluable adjunct to the general principles and guidelines of eating VLC. It enabled me to fine tune my eating habits to the point where I was able lower my A1c’s from the mid-8s, while maxed out on 2 oral diabetes meds and starting a 3^rd, to the mid-5s, by diet alone, except for Metformin.