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Dr. Richard Bernstein Re: Why a Low Carb Diet?
Introduction: From Rejuvenation
I copy this from the March 2004 issue of
I copy this question from Diane Schafer, LDN (licensed dietetics
and nutrition), RD (registered dietician), CDE (certified
diabetes educator) who is opposed to a low-carb ("Atkins") diet and the
answer by Dr. Richard Bernstein, author of "Diabetes Solution" and my
personal mentor, ie, everything I know about diabetes that I think is
correct I learned from Dr. Bernstein. (This is the reason why I believe
in a low carb diet... to keep my glucose levels between 70 and 105 as
much as possible.)
In this question and answer you see a diabetes EXPERT (Diane
Schafer) who is also an insulin dependent diabetic, but who is
CONVINCED that low-carb diets are BAD for diabetics. On the
contrary, she is convinced that HIGH CARBs have been proven to be
the CORRECT DIET for a diabetic...
She asks why they should even PRINT information recommending
low-carb diets in a serious Diabetes magazine, and she protests
that somebody who writes about low carb diets is given a monthly
column in the magazine.
Dr. Bernstein's answer reveals the deep differences that exists
between his advice for low carbs high protein, and the high
carb-low fat advice of the American Diabetes Association.
Dr. Bernstein says that the ADA 7% guideline for Hb A1c, that
corresponds to an average blood glucose level of 170 mg/dl,
(which I call "HORRIBLE/DEATHLY" in my table of interpretation
of glucose) ATTESTS TO THE LACK OF INTEREST OF THE A.D.A. IN
"TO THIS DAY," he writes, "THE A.D.A. OPPOSES BLOOD GLUCOSE SELF
MONITORING FOR THE 90 PERCENT OF PEOPLE WITH DIABETES WHO DON'T
TAKE INSULIN. AS A RESULT, MEDICARE WILL NOT PAY FOR BLOOD
GLUCOSE SELF MONITORING FOR THIS 90 PERCENT. (!!!-Ellis)
DOESN'T THIS SUGGEST THAT ALL OF US WITH DIABETES HAVE AN
'ORPHAN' DISEASE WITHOUT STRONG ORGANIZED SUPPORT FOR OUR
(This is also why I find diabetes doctors IN MEXICO who oppose
blood glucose self monitoring on diabetics type 2.... I thought
they were ignorant ASSES... Now I realize they are only ignorant
SHEEP, because they are only FOLLOWING IN THE FOOTSTEPS and
doing whatever the American Diabetes Association recommends!)
I copy Dr. Bernstein's answer, with emphasis in CAPITALS added by
me. I am adding this to Dr. Bernstein's My First Fifty Years
as a Diabetic which is an unbelievable story which I recommend everybody
should read, for the first time if you have never read it, or again,
if you have already read it.
Diane Schafer, LDN, RD, CDE writes:
"I struggle to understand why you are publishing information recommending low-carb or
no-carb meals for people with diabetes.
As someone who has taken insulin for 29 years, I would expect
you most of all to understand the relationship between
carbohydrates and insulin. I have to fight this confusion
with my patients on a regular basis.
Do you not agree that people with Type 1 Diabetes who take
insulin are at a high risk of hypoglycemia and ketoacidosis
when they deplete carbohydrate from their meals? What
happened to the knowledge that carbohydrate is our body's
primary fuel source as well as B vitamins and fiber?
I truly wish that we would stop confusing our diabetes
population by giving them so much conflicting information.
Many of the patients are advised to avoid carbohydrates to
promote "weight loss" by most of our primary care and
family practitioner physicians.
Unfortunately, many of them are also on long acting insulin
or sulfonylureas. These patients will be causing
hypoglycemia and possible ketosis by following their
Also, many dietitians who read your publication will not
agree with Joy Pape's "point of view".
My request to you is to stop publishing articles that
contain controversial, unproven, and possible harmful
advice. Let's give people clear, concise, proven, and
recommended guidelines from health organizations with
credibility, shall we?
Diane Schafer, LDN, RD, CDE (certified diabetes educator)
Dr. Richard Bernstein answers:
I was present in the late 1940's when
the American Diabetes Association (ADA) first recommended a
high-carbohydrate diet. At that time, it was believed that
the long-term complications of diabetes were due to the high
cholesterol levels so common to people with diabetes. It
was assumed that this was a consequence of dietary fat and
that by dramatically reducing fat and substituting large
amounts of carbohydrate, these complications would be avoided.
There never were, and there still have never been, any studies
supporting this hypothesis. So if anything is "unproven," it
is the A.D.A. hypothesis. Except for a brief change of mind
in 1975-76, it wasn't until the Diabetes Control and Complications
Trial terminated that the ADA acknowledged that the real culprit
might be high blood sugars.
More recently, studies comparing high and low-carbohydrate
diets have finally been performed AND SHOW THAT LOW-CARBOHYDRATE
DIETS REDUCE BOTH BLOOD SUGARS (HB A1C) AND CONVENTIONAL
CARDIAC RISK FACTORS. A number of these studies were actually
PUBLISHED IN A.D.A. research journals such as "Diabetes Care."
IN SPITE OF THIS, probably because a rigid adherence to tradition,
THE ADA CONTINUED TO RAISE CARBOHYDRATE GUIDELINES, and EVEN NOW
RECOMMENDS THE USE OF RAPID-ACTING CARBOHYDRATES SUCH AS TABLE
SUGAR, BREAD, POTATOES, PASTA, ETC. THE NEW BUT UNPROVEN
A.D.A. HYPOTHESIS IS THAT PEOPLE WITH DIABETES CAN KEEP BLOOD
SUGARS NORMAL BY COVERING LARGE AMOUNTS OF CARBOHYDRATE WITH
"INDUSTRIAL" DOSES OF INSULIN.
THIS HAS NEVER WORKED FOR ME (I've had diabetes for 58 years)
OR FOR MY THOUSANDS OF PATIENTS!
The reasons for this include the following:
1) We can never know the exact carbohydrate content of a meal.
In the United States, labeling laws permit an error of plus
or minus 20 percent of the carbohydrate content of a serving.
For a typical A.D.A. meal containing 150 grams of carbohydrate,
the uncertainty is plus or minus 30 grams (ie, it can vary
between 120 and 180 grams of carbohydrate.) ONE GRAM OF
CARBOHYDRATE WILL TYPICALLY RAISE THE BLOOD SUGAR OF A
TYPE 1 PERSON BY 5 MG/DL for a NET UNCERTAINTY of plus or
minus 150 mg/dl. Carbohydrate estimates in books are even
2) For a given individual from day to day, the uncertainty of
insulin absorption from typical A.D.A. megadoses varies from
plus or minus 29 percent to plus or minus 39 percent. The
timing action of these large doses is likewise highly variable.
Thus, IT IS THE HIGH-CARBOHYDRATE DIETS COVERED BY MEGADOSES OF
INSULIN THAT INCREASE THE LIKELIHOOD OF HYPOGLYCEMIA.
THE AMERICAN DIABETES ASSOCIATION's DESIGNATION OF HIGH BLOOD
SUGAR - AN A1C OF 7 PERCENT (corresponding to an average blood
glucose of 170 mg/dl) WHEN NON-DIABETICS WHOM I HAVE TESTED
SHOW ABOUT 4.2% TO 4.8%--- ATTESTS TO ITS LACK OF INTEREST
IN BLOOD SUGAR NORMALIZATION.
This may further explain the A.D.A. failure to give up on its
high-carbohydrate diet. This likelihood is also supported by
ADA OPPOSITION TO BLOOD GLUCOSE SELF MONITORING FOR 14 YEARS,
from 1969 when I first demonstrated it to their president until
1983 when pressure from patients became overwhelming. TO THIS
DAY, THE A.D.A. OPPOSES BLOOD GLUCOSE SELF MONITORING FOR THE
90 PERCENT OF PEOPLE WITH DIABETES WHO DON'T TAKE INSULIN. AS
A RESULT, MEDICARE WILL NOT PAY FOR BLOOD GLUCOSE SELF MONITORING
FOR THIS 90 PERCENT.
DOESN'T THIS SUGGEST THAT ALL OF US WITH DIABETES HAVE AN
"ORPHAN" DISEASE WITHOUT STRONG ORGANIZED SUPPORT FOR OUR
If some readers still consider this subject "controversial," they
should log on to the internet and search for my book "Diabetes
Solution" to read what hundreds of readers over the years have
been saying about the lifesaving effects of their new low-carb
Remember, however, that lowering dietary carbohydrate without
drastically lowering insulin doses and doses of other blood-sugar
lowering medications can cause severe hypoglycemia.
"Diabetes Interview" asked Joy Pape to write a low-carbohydrate
column for an obvious reason... it is essential to the best thing
that can be offered to us short of a cure... normal blood sugars.
- Richard K. Bernstein, M.D., F.A.C.E., F.A.C.N., C.W.S.
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