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Bernstein's Book

Discussion in 'Parents of Children with Type 1' started by Lakeman, Aug 8, 2012.

  1. Lakeman

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    I just finished Bernstein's book; "Diabetes Solution."

    He had some interesting things to say, things that I should have heard before (he even said: "sounds so simple and straightforward that is may make you want to ask why no one has told you about it before.")

    So I am curious to hear your take on a few things:

    The law of small numbers states that if you eat a large number of carbs any error in the count (or the way they effect you) will be larger than the error if you eat a small number of carbs. When you have large errors you will have less predictability in your results. It goes on to state that insulin does not always effect blood sugars exactly the same each time. If you take a large dose it may be absorbed poorly. So again, large doses result in less predictability. The two compound each other so that large amounts of carbs and large doses of insulin result in BG numbers that swing between a low number (we all experience these) and high numbers (think post-prandial highs as well as out of range results). The resulting highs (above 130) create insulin resistance which makes results even more unpredictable.

    He claims that his clients keep "normalized" BG numbers that mostly swing between a small range of say, and I am adding my own interpretation here, 70 to 130, and staying around 80. He also claims that his client's A1C's are in the 4's.

    He goes on to make the case that larger amounts of carbs are bad for us, that larger amounts of insulin are bad for us, that BG's above 130 are bad for us, and that A1C's higher than the 4's are bad for us. This goes against just about everything coming from my endo clinic that says you can eat whatever you want, never mentions how much insulin one has, says that BG's after two hours of less than 180 are ok, never mentions post prandial highs as bad, and lastly that says that an A1C as high as 7 is just fine.

    A couple of odd tidbits in the book are that one can do fingerpricks on the backs of one's fingers and that one can inject a correction in the deltoid muscle in the shoulder to bring down highs faster.

    My own take is that it just makes sense that lower carbs and lower doses of insulin would make things more predictable and easier to handle - though truly I don't know if I could ever take on the task of expecting my daughter to eat a very low carb diet all the time. Perhaps we could move in that direction.

    I would like more of a "flatline" (a term taken from another diabetic on the web) in which postprandial highs are not as large and a graph of one's numbers from meal to meal, are, well, flatter. And as far as I can see the only way to flatten the postprandial highs is to eat low carb and/or fine tune insulin timing. (Berstein does go on to make the claim that the glycemic index is over-rated and one really can't use it to achieve good (BG's in a narrow range) results.

    I wonder if he is right about BG's, including postprandial numbers, above 130 and being bad A1C's above 5 being bad? ((he does state that his formula for measuring A1C is different than that used by others)
     
    Last edited: Aug 8, 2012
  2. Lisa P.

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    The big problem with Bernstein is that he isn't about kids.

    Carbohydrates are a component in proper growth and development. Honestly, I'd go with a no carb diet for awhile for Selah if I thought all foods were equal. However, the consequences of feeding her a no carb or very low carb diet from the age of 17 months on could be very bad, and there's no going back.

    That said, my endo supports folks who want to "eat like everyone else" but he doesn't recommend it. He says the average American child's diet is much more carb heavy than it needs to be, essentially.

    So we have a lower carb diet as an entire family than the national average. Of course, that's not saying much.

    I have noticed another factor with lower carb to watch out for -- lower carb days affects her basals. It can actually make it harder to regulate her blood sugars when she has a run of very low carb days, the system is complicated and there's not necessarily a direct relationship of more even bg's to lower carb, in a small kid at least. I don't know how a larger kid with more muscle mass might be affected.

    Also, you have to watch out for ketones, for the pressure it can put on the kidneys and liver to have high fat and protein in the diet, for the affect on cholesterol of a diet with a lot of meat and dairy (although I personally discount this one, I don't buy it, it's something to remember).

    I met a woman last month who was in her 80s, has had diabetes since she was 13. She's awfully healthy. She was talking about how her bg swings --- that she woke up at 160 the other day for no good reason! She clearly has led a life where she keeps her bg in range with diet and careful care. She logs everything. She keeps a lower carb diet, eats very small portions of very little desserts. She grew up in a time when you had set carbs and set times and so she simply never moved to the "you can eat whatever you want whenever you want" mentality. I don't know if that is what has helped her be so healthy or if she has a physiology that helps keep her bg more even. She believes she is still producing some insulin sometimes. I believe her. I don't know, though, whether that's in her "nature", whether it has to do with her years of careful care, or both circle around to help.

    I like Bernstein, I think there's a lot to recommend a diet approach. One thing to think about also is the role of inflammation in diabetes, so that refined carbohydrates causing inflammation might be a complicating factor (although there are noncarb foods that are inflammatory too, an anti-inflammation diet is not a no carb diet). But I do think you have to keep in mind that children have different needs than adults.

    That leaves out, also the psycho-social aspect, but I think each family can deal with that if they have a well-adjusted family life. Plenty of kids can't eat this or that and they don't grow up neurotic or get eating disorders, you can do it right if you do it right!
    :)
     
  3. hawkeyegirl

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    I am of the opinion that it is possible to achieve good A1Cs without going to Dr. Bernstein's extremes. I am also of the opinion that it is not necessary to achive A1Cs in the 4s in order to avoid complications and live a long happy life.

    I don't find any of Bernstein's ideas novel, and I find his reputation for abusing his patients reprehensible.
     
  4. emm142

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    I have to say, this chart of Bernstein's makes me feel sick. If a vulnerable person saw that, it could be catastrophic, and as a doctor he should NOT be posting things like that (extreme, not supported by science, with a high potential for causing mental damage) on line IMHO.

    That said, I think that a low carb diet is the only way I'm going to be able to get my a1C below 7.5. I'm still thinking it through because being a low carb vegetarian is kind of tough, but I think my next a1C will be above 8 and if that happens then I have to do something. I've done everything other than low carb, so...
     
  5. Lisa - Aidan's mom

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    Wow, that chart Emma posted is harsh :(
     
  6. Lee

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    I agree with Emma - I HAVE seen that chart before when looking at my meter average. I had no idea it was from Bernstein's book. When my child is older, if she decided she wants to try some ideas in the book - ie - less carbs - I will help her with that decision. But she is child and children need carbs.
     
  7. hawkeyegirl

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    To be fair, I don't think that's Bernstein's chart, is it? It appears to be created by one of his followers, based on Bernstein's beliefs.

    As for the chart itself? Rubbish.
     
  8. caspi

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    Looks like someone named Ellis Toussier. His comments that follow at the bottom "in defense" of his chart are even more whacky! :eek:
     
  9. coni

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    The only thing I found particularly helpful was the tip on injecting through clothes, but we've only done it a few times. Oh, and melting cheese in the microwave for a snack.

    But, seriously, I think he has a point about a low carb diet and the effects of fluctuating BGs, but I'm raising a child in the real world, and his book isn't for that audience. I would be concerned about the psychological effect of using his methods on a child. My overall impression was "fringe".
     
  10. Christopher

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    To me he sounds like a nutjob and I would never have my CHILD with diabetes follow his extreme advice.
     
  11. Lovemyboys

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    He might be a nutjob, but he's an 78 year old T1D with no complications, so I think we can learn something from him. Our diet is a modified version of Berstein's, for our whole family, not just our little guy. I say modified because we give Owen apples and other low glycemic fruits, which Dr. Bernstein says no fruit whatsoever. I have to say that by following this we have really leveled out his blood sugars (highs and lows). But it does take some getting used to. And yes, the other boys complained a little about their burgers without buns, etc. but now they are fine with it.

    One of the big things I took away from the book is to bolus for protein. About 35% of protein is converted to glucose, but we can't bolus for it up front, we have to do a combo. Bernstein takes regular insulin for the protein, but we bolus a 1.5 hr combo for it.

    Eating this way has really taken the stress out of eating for us. We no longer have to prebolus, which wasn't a problem most of the time, but our little guy is 3 and every once in a while he'd be bolused and then throw a tantrum and refuse to eat. Now, since we bolus after he eats, if he doesn't want to eat, fine, no problem.

    A couple other things that eating this way has done: 1) it has greatly increased our food bill. Carbs are cheap, good meat, cheese, vegetables, fruit and nuts are not. 2) I've had to learn a whole new way to cook. No more easy pasta casseroles, etc. With lots of research, I have found pretty much a good substitute for "most" high carb things. Jicima chips anyone? A few days ago we had great low carb pancakes and today my older son made a batch of low carb cookies (made with almond flour and coconut flour).

    It is a lot of work, but it generally works for our family. We did find out that Owen's cholesterol is high (it was also high at dx, but not this high). I have heard that when you switch to a lower carb diet you have a transient increase in cholesterol. So we're going to watch that and maybe make some modifications if necessary.
     
  12. Christopher

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    I don't know him personally, so I have no idea if he has any complications or not. If he doesn't have any, he could be one of the lucky ones that wouldn't have gotten them no matter what his diet was. Who knows. But I guess I would rather have a happy, well adjusted adult with some complications, than a nutjob with no complications.

    Don't get me wrong, if this type of extreme diet works for you and your family, who am I to judge? More power to you. :cwds:
     
  13. emm142

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    Oh, whoops. Sorry - took the chart from someone else being pissy at Bernstein and assumed that what they said was correct. One day I'll learn to read the text. ;)

    Whatever, I still think Bernstein's diet is very extreme, although some elements of it (the law of small numbers) seem true, almost without a doubt.
     
  14. C6H12O6

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    What would you eat if you were low carb and vegetarian? I have come up with nuts, cheese, greens and eggs

    I think there is something wrong with me because I tried a low carb diet (including meat) – and within the day I developed large urine ketones - the ketones were bad to the point I had abdominal discomfort and my bg was around 180
     
    Last edited: Aug 8, 2012
  15. 3kidlets

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    Have nothing to offer as far as the diet etc, because it's making my head spin.

    However, as far as bringing highs down faster by injecting in to the deltoid muscle, yes, I was taught this by Gary Scheiner. In terms of Hana swimming and having her numbers in the low end of normal in order to compete well, he told us that if she was high prior to a swim meet and needed to get her in to range fast, to have her hold her arm out straight and tense up the arm and inject in to the tricep muscle. We have used this several times and it works. It works FAST! Kind of scary fast actually. So I have her eat a snack when I do it so she doesn't crash. But she's gone from high 200s to 120 in less than an hour before a meet before. I only use this when absolutely necessary. Unfortunately, most swim meets are early in the morning and morning/breakfast time is the worst for spikes and her numbers, so I've had to use it several times for morning swim meets.
     
  16. emm142

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    Yeah. Basically that. I don't think I could ever get much below 100g carbs per day, realistically.

    Some meat substitutes (e.g. Quorn) are also low carb, so there's that.
     
  17. TheFormerLantusFiend

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    No, Bernstein had major complications- major kidney disease, cholesterol deposits on his eyes, don't remember what else- more than fifty years ago, and they improved dramatically once he got his blood sugar controlled. But he developed his complications with what sounds like really poor control and my take is that he's the sort who gets complications only with really poor control. Frankly, if everybody was like Bernstein then you could figure you could have terrible control for decades and then get the control you needed in order for them not to kill you- and it doesn't work that way.

    I don't eat low carb, in fact I eat extremely high carb. I find that trying to inject for protein and fat, which is what I end up having to do if I eat low carb, is too difficult. The problem with eating low carb, in my estimation, is that the body then uses some of the protein as carbohdyrate, and the timing and percentages on that are way too hard.
    The other problems with low carb include:
    - As he says, low carbers are known for losing weight. I'm already underweight, and nobody wants kids to lose weight.
    - Vegetarians in general live longer with less heart disease. And I want to be vegetarian. He proposes a diet that is pretty meat based.
    - Like Karla says, he discounts other methods of getting control of diabetes.
    - I don't think the relationship between blood sugar and complications is actually that straightforward.
    - I have no gallbladder, and have pancreatitis. I can't eat much fat without being sick to my stomach.
    - And the kicker is, I have better blood sugar when I eat sugar than otherwise.

    I also couldn't figure out how to check my blood sugar on the backs of my fingers. I tried it about a dozen times, including with and without the cap for alternate testing on my pricker, and dialed all the way up to 5, and it hurt and didn't draw enough blood.
     
  18. Sarah Maddie's Mom

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    I know that I, non-D, feel good on a very low carb diet and since I can't eat gluten anyway, find it pretty easy, but I'd never propose it to my kid. When she's older she can decide if she wants to try it, but for now I put more value on her being able to eat with her friends and be "normal" during her teen years. And for a young child, I'd never even consider it.
     
  19. Lisa P.

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    It is an expensive way to eat.

    Another thing to look at is the anti-inflammation diet.
     
  20. Ali

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    Couple of thoughts. I do not find his views reflect the better management available today with the newer insulins, more frequent testing of BG and the CGMS. I was always a bit concerned that his diet assumed your only issue was being T1, not cancer issues, heart issues unrelated to T1, digestive issues etc. I did find his discussion about larger usage of insulin complicating BG results due to a larger chance of error in dosages, absorption, carb counts etc. valuable. However many parents of T1s and adult T1s learn to compensate for some of those errors over time, but it does involve a bit more work. I had so many years of going low fast on the older insulins that I in fact eat a lower carb diet. (But not his low carb)But I also tend to snack more to spread out my carbs. The issue with snacking is that if you do not match insulin to carbs right on you may stay above 150 all day, so you have to have a really good sense of what is going on with your body. I suspect that those of you who are vegan or vegetarian while eating more carbs probably eat so much fiber that you may rarely spike very high. I am always concerned with a professional that is adamant that their way is the only way, while also trying to sell books.:p ali
     

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