Book Summary: Dr. Bernstein's Diabetes Solution
The Complete Guide to Achieving Normal Blood Sugars
By Richard K. Bernstein
Diabetes (both T1 and T2) are increasingly common (especially T2) and yet so little people and so few physicians really understand what it is and how to treat it. Both diseases—despite their similar name they’re causes are completely unrelated but their effects are similar—run in my family and extended family so I’ve been reading and learning about it for years.
This book, published in 1997, is by far the best resource and explainer I’ve found on the topic. Dr. Bernstein—a T1 diabetic himself—explains the effects of high blood sugar and describes how a low-carb high-fat diet can be life-changing for people with diabetes.
Insulin also stimulates centers in the hypothalamus of the brain responsible for hunger and satiety. (Page 38)
Insulin also instructs fat cells to convert glucose and fatty acids from the blood into fat, which the fat cells then store until needed. (Page 38)
Too much and it can cause excessive growth as, for example, of body fat and of cells that line blood vessels. (Page 38)
Glucagon signals the muscles and liver to convert their stored glycogen back into glucose (a process called glycogenolysis) (Page 38)
A common misconception-even by those in the health care professions. Injected insulin doesn’t work the same as insulin created naturally in the body. (Page 48)
The fastest insulin we have starts to work in about 20 minutes, but its full effect is drawn out over a number of hours, not nearly fast enough to prevent a damaging upswing in blood sugars if fast-acting carbohydrate, like bread, is consumed. (Page 49)
A vitamin D deficiency can cause insulin resistance. (Page 64)
Type 1 Diabetes#
The causes of type 1 diabetes have not yet been fully unraveled. Research indicates that it’s an autoimmune disorder in which the body’s immune system attacks the pancreatic beta cells that produce insulin. Whatever causes type 1 diabetes, its deleterious effects can absolutely be prevented. The earlier it’s diagnosed, and the earlier blood sugars are normalized, the better off you will be. At the time they are diagnosed, many type 1 diabetics still produce a small amount of insulin. It’s important to recognize that if they are treated early enough and treated properly, what’s left of their nsulin-producing capability frequently can be preserved. Type 1 diabetes typically occurs before the age of forty-five and usually makes tself apparent quite suddenly, with such symptoms as dramatic itself weight loss and frequent thirst and urination. ( Page 39)
You will note that in some literature on diabetes, “normal” may be defined as 60–120 mg/dl, or even as high as 140 mg/dl. This “normal” is entirely relative. No non-diabetic will have blood sugar levels as high as as 140 mg/dl except after consuming a lot of carbohydrate. “Normal” in this case has more to do with what is considered “cost-effective” for s the average physician to treat. Since a post-meal (postprandial) blood sugar under 140 mg/dl is not classified as diabetes, and since the individual who experiences such a value will usually still have adequate insulin production eventually to bring it down to reasonable levels, many physicians would see no reason for spending their valuable time on treatment. Such an individual may be sent off with the admonition to watch his weight or her sugar intake. Despite the designation " normal," an individual frequently displaying a blood sugar of 140 mg/dl is a good candidate for full-blown type 2 diabetes. I have seen “non-diabetics” with sustained blood sugars averaging 120 mg/dl develop diabetic complications. (Page 46)
Once glycogen storage sites in the muscles and liver are filled, excess glucose remaining in the bloodstream is converted to and stored as saturated fat. (Page 47)
long-acting insulin at bedtime, I might awaken with a normal sugar, but if I spend some time awake before breakfast, my blood sugar may rise, even if I haven’t had anything to eat. Ordinarily, the liver is constantly removing some insulin from the bloodstream, but during the first few hours after waking from a full night’s sleep, it clears insulin out of the blood at an accelerated rate. This dip in the level of my previously injected insulin is called the dawn phenomenon (see page 97). Because of it, my blood glucose can rise even though I haven’t eaten. A non-diabetic just makes more insulin to offset the increased insulin clearance. Those of us who are severely diabetic have to track the dawn phenomenon carefully by monitoring blood glucose levels, and can learn how to use injected insulin to prevent its effect upon blood sugar. (Page 48)
Large doses of insulin can make you more obese and more resistant to insulin. ( Page 97)
If I decide to fast for 24 hours—eat absolutely nothing—I will need to inject 4 units of long-acting insulin in the morning to prevent gluconeogenesis for 18 hours.
Research suggests that the liver deactivates more circulating insulin during the early morning hours than at other times of the day (Page 97)
prolonged emotional stress rarely has a direct effect upon blood sugar.
This kind of stress can, however, have a secondary effect by precipitating overcating, binge eating, or indulgence in kinds of eating that will increase blood sugar. (Page 99)
You might not be able to release insulin, but will still release glucagon, which will cause gluconeogenesis and glycogenolysis and thereby raise your blood sugar. Thus, if you eat enough to feel stuffed, your blood sugar can go up by a large amount, even if you eat something indigestible, such as sawdust. (Page 102)
Big inputs make big mistakes; small inputs make small mistakes.
The name of the game for the diabetic in achieving blood sugar normalization is predictability (Page 108)
High triglyceride levels are not so much the result of intake of dietary fat as they are of carbohydrate consumption and existing body fat. (Page 43)
(Dietary fat, by the way, has no direct effect on blood sugar levels, except that it can slightly slow the digestion of carbohydrate.) (Page 49)
it is the ratio of total cholesterol to HDL (total cholesterol + HDL) that is significant. (Page 60)
Most of the cholesterol in our bodies, both good and bad, is made in the liver; (Page 60)
Associated with the test for particle size is apolipoprotein B. When the Apo B test result is lower than 120 mg/dl, or when LDL particle size is type A, even high LDL levels are considered benign and should not be treated with statin drugs. (Page 60)
diabetics tend to have lipid profiles that suggest increased cardiac risk, if their blood sugars have been elevated for several weeks or months.
All these tests are more potent indicators of impending heart attack than the lipid profile. (Page 61)
High Triglyceride (the storage form of fat) levels a direct cause of insulin resistance, but they also contribute to fatty deposits on the walls of your blood vessels (Page 135)
Diet and treatment#
The ADA Internet food pyramid recommendations advocate at least 84 grams of carbohydrates per meal. Food producers are permitted a margin of error of plus or minus 20 percent in their labeling of ingredients (Page 109)
The idea is to stick with low levels of slow-acting, nutritious carbohydrates (Page 110)
When you inject insulin, you’re putting beneath your sling a substance that isn’t, according to your immune system’s way of seeing things, supposed to be there. (Page 111)
If you think you’ll miss out on the ADA’s great high-carb, low-fat diet which, statistically, has only succeeded in raising levels of obesity, elevating triglycerides and LDL, and causing an epidemic of diabetes and early death-there is considerable evidence that restricting carbohydrate is healthier not only for diabetics but for everyone. This is supported by a twenty-year study of 82,802 nondiabetic nurses published in the November 9, 2006, issue of the New England Journal of Medicine. (For more details on this point, see Protein Power, by Drs. Michael and Mary Dan Eades, Bantam Books, 1996.) (Page 113)
Nondiabetics who eat a lot of protein don’t get diabetic kidney disease. Diabetics with normal blood sugars don’t get diabetic kidney disease. High levels of dietary protein do not cause kidney disease in diabetics or anyone else. There is no higher incidence of kidney disease in the cattle-growing states of the United States, where many people eat beef at virtually every meal, than there is in the states where beef is more expensive and consumed to a much lesser degree. Similarly, the incidence of kidney disease in vegetarians is the same as the incidence of kidney disease in nonvegetarians. It is the high blood sugar levels that are unique to diabetes, and to a much lesser degree the high levels of insulin required to cover high carbohydrate consumption (causing hypertension), that cause the complications associated with diabetes.* (Page 131)
If famine struck today in the United States, guess who would survive most easily? The same people who are most at risk for type 2 diabetes. For those living in a harsh environment where the availability of food is uncertain, bodies that store fat most efficiently when food is available. If a farmer wants to fatten up his pigs or cows, he doesn’t feed them meat or butter and eggs, he feeds them grain. If you want to fatten yourself up, just start loading on bread, pasta, potatoes, cake, cereal, and cookies. Dietary fat, when consumed as part of a high-carbohydrate diet, was converted to body fat. You could acquire, in theory, more body fat from eating a high-carbohydrate " fat-free" dessert than you would from eating a tender steak nicely marbled with fat. (Page 134)
Eating fat with carbohydrate can actually slow the digestion of carbohydrate, ( Page 136)
Fat alone will be burned off. A combination of high-carbohydrate foods and fat will foster fat storage. (Page 138)
Ethyl alcohol, however, can indirectly lower the blood sugars of some diabetics if consumed at the time of a meal. It does this by partially paralyzing the liver and thereby inhibiting gluconeogenesis so that it can’t convert enough protein from the meal into glucose. For the average adult, this appears to be a significant effect with doses greater than 12 ounces of distilled spirits, or one standard shot glass.
If you have two 1½-ounce servings of gin with a meal, your liver’s ability to convert protein into glucose may be impaired. If you’re insulin-dependent and your calculation of how much insulin you’ll require to cover your meal is based on, say, two hot dogs, and those hot dogs don’t get 7.5 percent converted to glucose, the insulin you’ve injected will take your blood sugar too low. You’ll have hypoglycemia, or low blood sugar. (Page 143)
Keep the protein and carbohydrate content for each meal consistent from one day to the next. (Page 147)
Skim milk actually contains more lactose per ounce than does whole milk. (Page 154)
Tomatoes, the prolonged cooking necessary for the preparation of tomato sauces releases a lot of glucose, and you would do well to avoid them.
Onions, despite some sharp flavor, they’re quite sweet. (Page 156)
Where dairy products are concerned, the lower the fat, the higher the sugar lactose, with skim milk and “no-fat” cheeses containing the most lactose a and the least fat, and butter containing no lactose and the most fat. (Page 163)
If you eat red meat at least once or twice a week, and a variety of vegetables, you should not require supplements, except for vitamin D-3, which is deficient in most people in the industrial world (Page 173)
Large doses of vitamin C can actually raise blood sugar and even inmpair nerve function (as can doses of vitamin B-6 in' excess of 200 mg daily). Vitamin E has been shown to reduce one of the destructive effects of high blood sugars ( glycosylation of the body’s proteins), in a dose-dependent fashion–up to 1,200 IU (international units) per day. (Page 173)
“The Dawn Phenomenon” (pages 97-98), I usually suggest half as much carbohydrate at breakfast as at other meals. Your body will probably not respond as well to either the insulin it makes or to injected insulin for about 3 hours after you get up in the morning because of the dawn phenomenon. (Page 183)
There is growing evidence that the incidence of many forms of cancer goes up considerably for people with elevated blood sugars.
There is probably not a tissue in the body that escapes the effects of the high blood sugars of diabetes. People with high blood sugars tend to have osteoporosis, or fragile bones; they tend to have tight skin; they tend to have inflammation and tightness at their joints