The Bernstein diet is a low-carbohydrate, high-fat diet for people with diabetes. It goes against the conventional high-carbohydrate, low-fat diabetic diet recommended by much of the medical community.
The diet was developed by endocrinologist Richard K. Bernstein, who has type 1 diabetes. It was first published in his 1997 book Dr. Bernstein's Diabetes Solution: A Complete Guide to Achieving Normal Blood Sugars. The diet is intended for people with diabetes and 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, including diabetes, high cholesterol, high blood pressure, and heart attack. When a person has many of these conditions together, it is referred to as insulin resistance syndrome.
Bernstein was diagnosed with diabetes in 1946 at the age of 12 and was put on a low-fat, high-carbohydrate diet. He remained on this diet 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 blamed this cycle of hypoglycemia followed by insulin injections on his diet. Doctors typically recommend a high-carbohydrate diet for people with diabetes because it raises blood sugar. Bernstein, an engineer, began adjusting his insulin regimen and diet to see how it affected his condition. Within one year, Bernstein said he had nearly constant normal blood sugar levels, and his health improved considerably. He spent the next few years trying to convince others that his methods were effective, but his attempts failed. 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, which became the focus of his 1997 book. Bernstein went on to publish several more books, the most recent being Dr. Bernstein's Diabetes Solution: The Complete Guide to Achieving Normal Blood Sugars, 4th edition, published in 2011.
The Bernstein diet is designed as a medical diet rather than a diet for weight loss, although people can lose weight on it. It is similar in many respects to other high-fat/low-carb diets, such as the Atkins diet. Both diets stress foods that are high in fats and protein and low in carbohydrates. This formula is controversial in weight loss and health circles, and the Bernstein diet as a treatment for diabetes is especially controversial in the medical community.
The Bernstein diet does not recommend a specific ratio of the three main food groups: proteins, fats, and carbohydrates. Instead, Bernstein advocates an individualized approach to diet. He recommends that people with diabetes test their blood sugar levels at least five to eight times a day to learn how different foods affect them.
Bernstein has three basic rules for developing meal plans that normalize blood sugar levels. They are:
Bernstein advises people with diabetes 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 foods containing carob, honey, saccharose, corn syrup, lactose, sorbitol, dextrin, levulose, sorghum, dextrose, maltodextrin, treacle, dulcitol, maltose, turbinado, fructose, mannitol, xylitol, glucose, mannose, xylose, and molasses, which are all forms of sugars.
The Bernstein diet recommends avoiding eating 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 and tomato products), and canned and packaged soups.
Foods that are allowed on the Bernstein diet include meat, fish and seafood, poultry, eggs, tofu, soy meat substitutes, cheese, butter, margarine, cream, yogurt, soymilk, soy flour, and bran crackers. Other food items allowed include toasted nori (seaweed), artificial sweeteners (Equal, Sweet'n Low, NutraSweet, 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.
Bernstein admits that his diet is somewhat restrictive and that people will still have cravings for sweets and bakery items, but believes that the benefits of the diet (such as improved health) help override these urges.
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 blood sugar levels can help avoid long-term complications of diabetes, 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 may lose weight on the Bernstein diet.
The Bernstein diet goes against the recommendations of major medical organizations such as the American Medical Association, Academy of Nutrition and Dietetics, and American Diabetes Association (ADA). According to an article published in Diabetes Forecast, most people with diabetes obtain about 40%–45% of their daily calories from carbohydrates, which is in line with ADA recommendations. People with diabetes should not start the Bernstein diet without first discussing it with their doctor or a specialist in diabetes, called an endocrinologist. They may also wish to consult a diabetic dietitian or nutritionist.
People with diabetes should never use a diet as a substitute for medication without first talking to their doctor. They should not stop taking any prescribed medications without their physician's approval.
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 diet. It is also important for people with diabetes to eat enough calories, which can be difficult when removing food sources. Following a low-carbohydrate diet requires proper planning and should not be attempted without consulting a physician or dietitian.
Critics of the Bernstein diet say that it contains too much fat and is not nutritionally balanced. The high fat intake may especially be an issue for people with type 2 diabetes who are trying to lose weight. Critics also say it is difficult for many people to maintain a low-carb diet over the long-term.
Among the critics of the Bernstein diabetic diet are the ADA, Academy of Nutrition and Dietetics, American Medical Association, American Heart Association, United States Department of Agriculture, and the Physicians Committee for Responsible Medicine.
They state that high-fat, low-carbohydrate diets tend to be lower in fiber, calcium, fruits, and vegetables, and higher in cholesterol, fat, and saturated fat. However, since 2002, a number of scientific studies that compared high- and low-carbohydrate diets concluded that low-carbohydrate diets reduced blood sugars and risk factors for heart disease. Many practicing endocrinologists endorse the Bernstein diet and other low-carbohydrate diets for their patients. They point out that the ADA has traditionally been slow to adopt new developments in diabetes monitoring and treatment; for example, the ADA did not endorse patient blood glucose monitors until 1983, about ten years after they were developed. Still, further research is needed on the effectiveness of low-carbohydrate diets in treating diabetes.
People with type 2 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, than with diets that restrict calorie intake, according to two studies presented in 2006 at the ADA 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 books on his own low-carbohydrate diet.
See also American Diabetes Association ; Artificial sweeteners ; Atkins diet ; Diabetes mellitus ; Diabetic diet ; Gestational diabetes ; High-fat, low-carb diets ; Insulin .
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Ken R. Wells