Dr. Richard Bernstein probably knows more about managing diabetes than anyone who has ever lived. He has had Type 1 diabetes since age 12. He is now in his late 60’s, still works full-time plus, exercises hours every day, and has more energy than most people of any age, with or without diabetes.

At age 35, his body was falling apart due to the ravages of blood sugar. He had signs of kidney disease and eye disease and nerve pain in his legs.

Then he discovered how to normalize his blood sugars through the program in this book. Most of his complications eventually disappeared, and he has had no new complications since. His theory (shared by most diabetes experts) is that the complications are due to high blood sugars. But his solution (keeping your blood sugars in the normal range 24 hours a day) is rejected by most doctors, who believe it is too difficult for most people.

The three keys to his program are: A very-low carbohydrate diet – This is the most important part and will probably be helpful even without the other parts. Bernstein prescribes NO sugars, grains, fruits, milk, or starchy vegetables (fast-acting carbs.) He does recommend relatively small amounts of green vegetables and other slow-acting carbs, because of their vitamins and other nutrients. This is not an Atkins-style, no-carb diet.

Frequent blood sugar monitoring to develop your “blood glucose profile.” You need to learn exactly how different foods affect your sugars, and how sugars change overnight and with exercise. By checking his blood sugars after each food he ate, Bernstein discovered how carbs raised his blood sugar faster than his injected insulin could catch up. He has you check your blood sugar many times a day.

Frequent dosing with fast-acting insulin or (for Type 2s) an insulin-sensitizing pill, to cover your meals, along with a low dose of long-acting insulin to get you through the night and early morning hours. He recommends insulin even for Type 2’s who make some of their own, because he believes the injected insulin will take the pressure off the pancreas and allow it to heal.

If this sounds like a difficult program, you haven’t heard half of it yet. He also recommends extremely vigorous, anaerobic exercise. He prefers prolonged weight or resistance training to the point of pain, because building muscle mass helps soak up blood sugar and lessens insulin resistance.

His program also requires you to counts carbs and proteins and calculate your proper insulin dose before meals. He recommends you have as many as four different kinds of insulin for different occasions. He wants you to floss after every meal to prevent dental infections. And there’s a lot more.

But is it worth it? In researching my upcoming book, “The Politics of Diabetes,” I have interviewed four people who read his book. Two thought it was too hard to try. One stayed with the program for a while and says it helped, but he has slacked off. One woman stuck with it and says it saved her life.

Diabetes experts I have queried are skeptical of how much the ultra-low-carb diet helps. They cite conflicting research and the success many patients have even on a balanced diet that includes fair amounts of carbs.

There is also no agreement on the need to get blood sugars down to “normal” (less than 95, say.) Many docs think getting sugars down to 120 or even 140 will be sufficient to prevent complications in most people. True, but SOME people will get complications that would not have gotten them if they kept their sugars lower.

You have to have some education and a lot of self-confidence to take this on, especially as it may mean educating your doctor as well. There is a steep learning curve, and this program will probably totally take over your life for the first weeks or even months. As you get used to it, it becomes less intrusive, but still much more so than the usual programs your doctor may put you on. It comes down to how important your health is to you, how much time and money you have to devote to your diabetes care, and especially how much support you have.

Bernstein is aware of these difficulties. He consistently advises lower-cost alternatives to various medications and equipment, which makes him one of the few docs or self-help writers to recognize that money is a problem for many of us. But the book is a demanding read – densely packed with valuable information on everything from insulin injection and blood glucose checking techniques to the different kinds of oral diabetes medicines, from what to do when you’re vomiting (call your doctor immediately!) to pages of low-carb recipes. The language and style probably work best for people with some college education, although a determined high school graduate could handle it. It also has a number of inspiring testimonials and a good sense of humor.

I think that people who are having trouble managing their diabetes might want to try this program, or at least the low-carb diet part of it. If you want to do the whole thing, this book by itself won’t be enough. You will need to get the help of a doctor and probably a diabetes educator as well, and having some supportive family wouldn’t hurt.

If you do try it, I support that decision. I’d like to hear how you do with it.

One of the things you learn with Dr. Bernstein’s book is that excessive eating (even when you don’t overeat carbs, but other food types) leads to high sugars, due to the so-called “Chinese Restaurant Effect”. Well, if you were to devour this hefty book (like you will, once you get your hands on it) you will not see your blood sugar rise. If you are a diabetic (type I or II), you will find in Dr. Bernstein’s book a wealth of information that will answer the questions you’ve ALWAYS had, and even those that you didn’t know you had, about diabetes and how to keep your blood sugars in control.

His approach is very unconventional (coming from a diabetic childhood, being an engineer first and a doctor later in life). But you will be fascinated with the amount of “Eureka!” moments throughout the book. I was unable to put it down from the moment I picked it up, and I am grateful to him for having taken the time to share so much wisdom from his years as a practitioner and from his many, many years as a diabetic and experimenter. His lessons are not easy to follow, but they are the way for those who want to live a long and healthy life with diabetes.

I leave you with a thought. If you knew what you need to do to prolong your life and live it in a healthy manner, in spite of what you’ve been told about typical lifespans in diabetics and all the ailments we seem to be bound to suffer later in life, wouldn’t you do it? I would. And I hope you do too. So I recommend you take the time to read what Dr. Berstein has to say to you.

Amazon delivered my copy of “Dr. Bernstein’s Diabetes Solution (Revised &
Updated) The Complete Guide to Achieving Normal Blood Sugars” and I’ve had a
couple of days to digest the contents. This isn’t a review, per se, but a
few points on some interesting parts of the book.

First off, the foundation of the book is that having “normal blood sugars”
will eliminate 100% of the complications of diabetes. Extrapolating from
the results of the NDDT, Bernstein asserts that diabetics must keep their
blood glucose levels between 80-100mg/dl ALL OF THE TIME.

Specifically, knowing that non-diabetics will very rarely have blood glucose
excursions are outside 80 to 100mg/dl, Bernstein’s targets are 85mg/dl for
non-insulin dependent diabetics and 90 mg/dl for insulin dependent
diabetics. To achieve this target, Bernstein recommends a low-carbohydrate
diet combined with insulin-sensitizing and mimetics agents and/or insulin.

The book starts off with the requisite “Bernstein has worked for me”
profiles and has an interesting account of Bernstein’s life, including his
early attempts at blood glucose monitoring (he is believed by many to have
invented the concept of using blood glucose testing for diabetic blood
glucose control) and his decision to attend medical school so that he might
be able to get his findings published.

Bernstein believes that sensitizers & mimetics such as metformin, Avandia &
Actos are the best choices for lowing blood glucose because they increase
the body’s ability to use insulin without making the pancreas produce extra
insulin. Additionally, aside from the fact that sulfonylureas stimulate
insulin production, Bernstein avoids them because they can cause
hypoglycemia.

Insulin use gets over seventy pages and has what appears to be some
excellent information in calculating dosages for an intensive insulin
regimen that keeps the blood glucose very close to 90mg/dl even after meals.
Bernstein advocates using regular insulin instead of a rapid-acting insulin
such as lispro or aspart before each meal. He reserves rapid-acting insulin
for special situations such as dining-out.

He is not an insulin pump fan and does not believe that pumping gives better
control over a properly executed intensive insulin regime.

Regarding the appropriate blood sugar and HbA1c levels, Bernstein asserts
that values exceeding 75mg/dl on average increases risk of cardiac and all
other causes of death, however, he does not reference the research that
supports this claim.

The book winds up with 40 pages of low-carbohydrate recipes. I have tried
some of the recipes and they were good. It’s interesting to me exactly how
very low carb they are. It would be difficult to put together a complete
menu with more than 10g carbs per serving. Quite a contrast to this month’s
“Diabetes Forecast” meatloaf dinner with whipped potatoes clocking in at
over 70g carbs per serving!

An appendix does a good job defending a diet higher in protein & fat and
does cite relevant research.

On top of all of this information, Bernstein includes some good information
on how to deal with hypoglycemia, how to receive the proper care in
hospitals and what tools diabetics should have in their kit.

SUMMARY

I found the book to be very interesting and informative. I’m not sure that
I agree with keeping my blood glucose at a flat 80mg/dl, but much of the
information in the book is invaluable. This, along with Gretchen Becker’s
“The First Year: Type 2 Diabetes” are the two books I recommend to those
who ask me about diabetes.