Diabetes + Low Carb Diet

[Guest guest]

You might be interested in this article which was in the Toronto

Globe and Mail recently.

Lorne stein is the golf columnist who seems to have his head

screwed on right. I trust his judgement.

The Atkins of diabetes

LORNE RUBENSTEIN

When I was diagnosed with Type 2 diabetes four years ago, I

immediately adopted a new diet, carefully following Canadian

Diabetes Association guidelines. But despite sticking to the

regimen, my blood sugar was still off the charts. I feared

blindness, a stroke. Or perhaps the loss of a leg.

Then I heard about Bernstein. The endocrinologist is often

described as a " maverick " for his diabetes treatments.

Flying in the face of guidelines set by the American Diabetes

Association (and, by extension, the Canadian Diabetes Association),

the 72-year-old advocates a radical decrease in blood-sugar levels

through major carb-cutting. So major in fact, that one could say Dr.

Bernstein " out-Atkins " Atkins, recommending a sustained ultralow-

carb diet, rather than easing diabetics off and back onto their

bread baskets.

Though Dr. Bernstein is a Type 1 diabetic himself, his approach is

of particular interest to Type 2 diabetics. A Type 1 diabetic

doesn't produce any insulin, so has to take the hormone, usually by

injection. A Type 2 diabetic, on the other hand, either doesn't

produce enough insulin to control blood sugar, or doesn't use it

efficiently — which means diet is crucial to controlling blood sugar.

Type 2 diabetes accounts for 90 per cent of diabetes diagnoses, or

about 1.8 million Canadians. That number is expected to rise to 2.7

million by 2010, along with costs to the health-care system as

diabetics who don't control their blood sugar are forced to deal

with complications.

In both Dr. Bernstein's Diabetes Solution and The Diabetes Diet

(which he recommends for non-diabetics as well), Dr. Bernstein

argues that the ADA and CDA have set blood-sugar controls too high

and their diets allow for too many carbs.

The critical measure for blood sugar is haemoglobin A1C. The ADA and

CDA encourage A1C levels under 7. Dr. Bernstein believes diabetics

should strive for A1C levels that match sugar levels of those

without the disease — which range from 4 to 6. " I think diabetics

should have the same chance to have normal blood sugars as non-

diabetics, " he says.

, a family medicine and endocrinology professor at the

University of Western Ontario, was the chair of the group that set

the CDA's A1C guidelines in 2003. He agrees that, ideally, a

diabetic should strive for an A1C of under 6, and that proper eating

is important for blood-sugar control.

But Dr. adds that people develop strong cravings while on

diets, and that it takes incredible willpower to overcome them in

the long run. Ultimately, he thinks Dr. Bernstein's approach is

impractical for most people. He is also not convinced by Dr.

Bernstein's informal proofs (his patients are his study group),

calling his findings " expert opinion, " rather than " conclusive

evidence. "

Dr. Bernstein's A1C goals certainly seemed unrealistic to me when I

was first diagnosed at the age of 54. Even when I followed CDA

eating recommendations rigorously, my blood sugar often soared to

12.9, far beyond acceptable levels. After eating carbs, in

particular, my blood sugar seemed to spike.

Still, Dr. Bernstein's experience intrigued me. After all, he had

become an endocrinologist later in life as an answer to his own life-

threatening experience with diabetes.

Dr. Bernstein's life expectancy was about 30 years when he was

diagnosed with Type 1 diabetes in 1946 at the age of 12. He

carefully followed the ADA's diet, but by his late 20s, he had both

kidney stones and peripheral nerve damage in his feet.

He realized then, as he writes in The Diabetes Diet, that " my death

would not have come from diabetes per se. I am pretty certain that I

would have died of kidney failure, a direct result of the low-fat,

high-carbohydrate, ADA diet I followed for 24 years after my

diagnosis. "

Then Dr. Bernstein came across an ad in a scientific journal for a

glucometer, or blood-sugar monitor. It was used in hospital

emergency rooms to distinguish unconscious drunks from unconscious

diabetics. The device cost $650, and only doctors could purchase one.

Luckily, Dr. Bernstein's wife is a doctor (he was an engineer at the

time). He used her stationery to order a glucometer, and became the

first diabetic to monitor his own blood sugar. He checked his sugars

five to eight times daily for a year, to gauge the effect of

different foods. Carbohydrates raised his blood sugars. By

restricting them dramatically, he achieved normal readings.

In 1976, Dr. Bernstein submitted his findings to the Journal of the

American Medical Association and the New England Journal of

Medicine. The journals refused to publish his findings. " How many

patients would use the electric device for measurement of glucose,

insulin, urine, etc.? " the JAMA editor wrote in a letter. " You are a

spartan and a paragon, but, I fear, not common clay. "

But Dr. Bernstein persisted. He enrolled in medical school at the

age of 45, specializing in endocrinology, and now treats diabetics

from around the world.

I was a quick convert to his approach. After incorporating his

suggestions — eating much more protein and fat (more eggs in a week,

for instance, than I'd had in the previous six months) — my blood

sugars came right down, and my lipid profile improved.

I was concerned that a diet without fruit, which raised my blood

sugar, wasn't healthy. But my Toronto endocrinologist,

Goldenberg, tells me that no long-term studies show any problems

associated with a diet lacking fruit.

At the same time, I was on, and remain on, medication for diabetes,

blood pressure and cholesterol, but I continue to notice that my

blood sugar rises to a worrisome level any time I cheat on my diet.

Carbs make the difference. Low carbs. Very low carbs.

But one question remained: An important long-term study showed that

complications are most likely to kick in only when one's A1C is

above 7 — so why go lower, why not have that cheesecake or bagel?

And so last month I travelled to Dr. Bernstein's office in

Mamaroneck, N.Y., where he has been practising for nearly 25 years.

His method is painstaking. His first consultation with a patient

takes 13 hours, over a couple of days. He asks every patient to

complete a 100-item questionnaire. " Every `yes' answer leads to a

discussion, " he says.

In answer to my question about what can happen without tight control

of blood sugars, Dr. Bernstein was very clear: " Every tissue in the

body is being damaged by high blood sugars. "

As for his spartan diet, his meal plan allows for only six grams of

carbohydrates at breakfast, 12 at lunch and 12 at dinner. Four years

ago, my nutritional counsellor recommended that, at 6 feet, 3 inches

and a fit 202 pounds, I eat at least 200 grams per day. One piece of

whole-wheat bread alone includes 15 grams of carbohydrates.

Whenever I think of having a sandwich, I recall a demonstration Dr.

Bernstein did last February on a CNBC show about diabetes. In

response to Hope Kershaw, the author of The Complete Guide to Carb

Counting, who was insisting that whole-grain bread was fine for

diabetics, Dr. Bernstein chewed on a slice just long enough to mix

it with his saliva. He then used a test strip to show that the

carbohydrates in the bread had turned to instant glucose.

" My blood sugar would go sky high if I ate this whole piece of

bread, " he said. Ms. Warshaw responded, " I feel that people need a

realistic way of eating. "

Dr. Goldenberg, my own endocrinologist, agrees. " What raises blood

sugar is carbohydrate, " he says. But he adds, " The problem is that

many people won't live with the [very low] amount of carbohydrate

Bernstein suggests. "

It's true that Dr. Bernstein's patients need to be unusually

diligent. But after following his diet, I can't revert to meals

loaded with carbs. Besides, his recipes are delicious. I have never

felt deprived eating his Caesar salad with Gruyere croutons (5.7

grams of carbs) or his sweet ricotta torte (4.7 grams of carbs).

And after spending four hours with Dr. Bernstein, I was even more

motivated. I had been watching my carbohydrate intake before our

meeting, but wasn't eating strictly according to his approach. My

post-meal blood sugars ranged from 5.3 to 10.7. Now, after following

the diet strictly for a couple of months, my sugars have been in a

tight range, from 4.2 to 6.7. I feel great.

" You're not overeating, and you're exercising, and if you're really

following the regimen, you probably have better blood sugars than a

non-diabetic your age, because they're eating all the sweet stuff

that sends them up after every meal, " Dr. Bernstein told me. " So, in

a sense, we can do better than non-diabetics. "

>

> In the past year I've lost 25 lbs on a 5'3 " body.

> My daughter also lost a considerable amount of weight and I'm very

> proud to say we did it the correct way.

> Nutrition is priority using protien as our main source food source.

> When diagnosed with hypoglycemia, diabetes on all sides of the

family

> tree, it made sense that we take matters into our hands,

correcting

> things naturally.

> We're a work in progress and this looks like a great place to be.

> Thank You,

>

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