How Many Carbs?

[Cajunboy47]

Can anyone tell me how many carbs are allowed on a Bernstein Diet Plan?

Is it a specific amount, or does he recommend a lowest and highest range of carbs?

[CarolynC]

It is 30 g daily carbs total: 6 at breakfast, 12 at lunch, and 12 at dinner.

[Lisa N]

It is 30 g daily carbs total: 6 at breakfast, 12 at lunch, and 12 at dinner.

If you tend to keep long days, he also allows another 12 gram meal (if you're hungry and feel like you need it) as long as you wait at least 5 hours between meals.
Most people who follow his plan, however, go with the 6-12-12 formula.

[Cajunboy47]

So, if someone is saying that they follow the Bernstein diet, but they are eating 30-40-40, they are misinformed, right? I'm guessing that anything that deviates from 6-12-12 is not a Bernstein diet, but rather just something else....

[Lottadata]

Technically, Bernstein tells you to test to see how many grams you can eat and still get normal blood sugars, but then he immediately adds that for many people that will be 6-12-12.

But Bernstein's idea of what a normal blood sugar might be is not entirely accurate, as he insists normal people are always at 82 even after eating and that is simply not the case. I've looked into quite a few continuous glucose monitor studies of normal people and that data points to normal being in the 70-80s fasting but going up to about 120 mg/dl shortly after eating, but then dropping below 100 mg/dl within the hour.

His scheme is very helpful to people who are Type 1s for whom insulin can be very difficult to use because they have lost the counterregulatory hormones that avoid hypo. But I have observed over the years that very few Type 2s can eat at that low a level of carb intake for very long. So they start out with great enthusiasm, but then 3 years later they crash off the diet. That's what happened to me. I've been through the whole "new convert" enthusiasm, evangelistic preaching, struggling to stay on track and then, saying "to hell with it" and losing control thing. For me the catalyst for the meltdown was a cancer diagnosis. If I was going to die, by golly I was going to get to eat a muffin or two before I went!

About a year after I was told I was going to survive it struck me that it would be much healthier to find a way of eating that will keep blood sugar in a safe range but which I could eat for decades without risking that crash that comes from depriving myself too much. So I have periods like now when I'm eating only 22 grams a day for several months, and other periods when I eat 110 grams with insulin. The constant is that I hit my blood sugar targets and keep my A1cs in the 5% range.

Diabetes is a marathon, not a sprint. I'm going to hit my 10th anniversary of controlling both carbs and blood sugar this August and hopefully I'll see 20 or 30 more.

[Lisa N]

Technically, Bernstein tells you to test to see how many grams you can eat and still get normal blood sugars, but then he immediately adds that for many people that will be 6-12-12.

That's probably a better way to put it, Jenny. I think if you asked Dr. Bernstein about it, he'd tell you that if you can hit normal blood glucose while eating more than 6-12-12, more power to ya, but in his experience, not many folks can do that consistently. I think he even gives examples in his book of people that do eat higher levels but also stresses the discipline and sacrifices those patients made to do so, such as exercising strenuously.

As for feeling deprived, it really helped me personally to examine what my definition of 'deprived' was and I came to the conclusion that it was silly of me to feed myself 'I'm so deprived' self-talk while I had the choice to either eat whatever it was that I was craving or not. True deprivation involves not having a choice at all and has nothing to do with self-imposed abstinence because I don't happen to like the consequences, either real or perceived, of eating foods that make my blood sugar spike.
What I had been interpreting as deprivation was really my own anger at not being able to eat whatever I wanted whenever I wanted like a non-diabetic and get away with it; sort of a 'it's SO not fair' tantrum.
Then again, does the rest of the world really 'get away with it' long term? ;)

[Cajunboy47]

To Jenny and Lisa,

thanks for the responses.

About deprivation. If I hear the suicide rate is going up in my country, do I feel deprived because I am not committing suicide? I don't think so....

I apply that attitude to foods that I don't eat because they are bad for me, with the exception of course that I do play with the gun, but without the intention of shooting myself.. :)

Jenny more or less says, whatever works for you, go for it.. Well, I can tell you that while in China and living a lifestyle that involved hours of walking each day, I could push the carbs to 100 or so a day and easily maintain steady normal readings.. It ain't so here in the USA. I'm convinced that diabetes is caused by too many comfortable places to sit and not enough good reasons to walk to someplace we need or want to go.....

I've had to reduce my carbs considerably since I am back. My numbers were creeping up on me, but gradually, I'm getting back to the under 100 mark. Luckily, the dawn phenomena thing hasn't returned to me yet... I'd say that is one thing I feel that has helped me have better health this last year. If I eat right, pretty much, my night numbers are about the same the next morning...

But, my concern about Bernstein, is that most folks follow his advice pretty good, I've never read his book and now, I'm just wandering about his diet somewhat.... If I can get more input from anyone concerning Bernstein, I'm listening, but as for reading his or any book right now, not likely to happen any time soon... :)

[Nancy LC]

I doubt the Chinese are all that insulated from diabetes either. Read this: http://forum.lowcarber.org/showthread.php?t=363596
From Family Practice News:

"A high intake of staples in the typical Chinese diet, particularly rice, moderately increased the risk of type 2 diabetes in a population-based study of Chinese women.

Raquel Villegas, Ph.D., of Vanderbilt University Medical Center, Nashville, Tenn., and her associates noted this finding could have "substantial implications" for public health. They analyzed data from the Shanghai Women's Health Study, a prospective cohort study of nearly 75,000 women aged 40-70 years at baseline in 1996-2000. They were followed every 2 years for an average of 5 years. A total of 1608 women developed type 2 diabetes.

A high intake of carbohydrates in the form of rice, noodles, steamed bread, and bread moderately raised the risk of developing diabetes. Compared with those in the lowest quintile of carbohydrate consumption (263 g/ day), those in the highest quintile (338 g/day) were at greater risk of developing diabetes. This association persisted across all categories of body mass index and waist-to-height ratio, and was somewhat stronger in overweight women (Arch. Intern. Med, 2007;167:2310-6).

The median intake of raw rice was 250 g/day. After adjustment for factors such as age and body mass index, those who ate at least 300 g/day of rice had a 78% increase in risk for diabetes, compared with those who ate less than 200 g/day."

[Cajunboy47]

Posted by NancyLC

I doubt the Chinese are all that insulated from diabetes either.

I've seen your posts all over the place and I just realized what the "LC" is in your name.... Duh! :)

I'm not sure how your post applies to this thread... But since we're talking about rice, noodles and chinese staple foods, I'll make this comment, not that I'm an expert on China from having lived there almost 7 months of the last year, but when living that long in a foreign country, certain things stand out...

Walking around in China, one sees perhaps one or two obese people in a hundred, whereas you walk around in the United States and obesity is almost the norm, especially in southwest Louisiana...

Anyway, the majority of Chinese are poor and they survive on the staple foods, not junk foods. The people (40 and above)who are not poor do not really eat that much of the staple foods, but rather consume a very healthy diet of whole foods rich in meats, seafood and non-starchy vegetables and they consume little to no junk foods. Among the younger Chinese who are not poor, it is becoming more and more common to see them snacking on junk food. I met several diabetic Chinese people and pretty much many of the friends I made had someone in their family with diabetes. So, yeah, they are not immune to diabetes............... So, I'm not really sure what you were implying by your post in this thread... (my assumption is you might think Chinese don't know much about health care and perhaps the majority don't, but the minority of them who do care amounts to more than the population of the United States)

But, I can say this, my Chinese fiancee certainly helped me improve my health and helped me reverse my diabetic symptoms and I can't wait till she arrives here and I can eat with her here, the same way we ate in China........

[dancinbr]

Welcome back Cajunboy.

Glad to see you posting again.

Lisa says it best about Bernstein.

It is a target a goal for T2 people and if you follow his program you will have good A1C's.

Right now, mine is 5.4. I started a basil insulin therapy rather than some of the prescriptions, such as Januvia to induce the pancreas to make more or release more insulin when needed.

I am still taking metformin ER 2000mg as well. This may come down lower soon.

I have not done too well losing more weight. I did lose 30 pounds last year and I want to lose 30 pounds this year.

The key to Bernsteins way of thinking is "small numbers" therefore small errors, therefore small movements in your BG count.

The 6-12-12 comes from his own empirical experience. The reason for 6 gms in the morning is he has found that T1s cannot handle many carbs in the morning fro whatever reason; I would have to go back and read the book again or find the reference. The idea is 6 gms x 5 =30 movement on your blood glucose is much easier to manage for a T1 and with experience they can time and dose their insulin before meals correctly to pretty much counteract the swings in your BG. The other important point is that he measures 2 hours after a meal; by then if you have done everything correctly your BG should be around 85. I believe Dr. Bernstein recognizes that your BG will go up after meals, but he is trying to minimize the swings and closely imitate a normal persons blood glucose pattern. I don't believe he thinks you will be flat at 85 all the time. He strives to get as normal as possible.

But again, his major theory is "small numbers" therefore small errors and therefore small more manageable swings in BG readings.

On top of this he advocates plenty of exercise, which you have discovered in your journey to China to be so key to maintaining good A1Cs. He works out I believe a couple of times a day or more and does so at appropriate times to keep his BG numbers down.

As for T2's we have more latitude than a T1, but again small numbers is recommended to keep our BG from spiking. I have messed around with foods all year and I know I can emulate a normal person by doing the right thing and I try to approach 6-12-12-12 as best as possible. When I don't I get a BG spike and that can cost me in the long run.

I think I had about 100 spikes last year. If I follow the program more diligently and stay close to 6-12-12-12 I can just about emulate a normal BG curve.

I am now using a basil insulin to get my level BG down to 85 rather than the 100-110 that is tends to stay at during those 5 hour fasting times.

By doing so, I will get my A1C down below 5.0. Dr. Bernstein says a normal persons A1C should be 4.2-4.6. Those folks heading up to 5.0 may be on their way to T2 diabetes; not sure. Perhaps there are many who do fine with A1Cs approaching 5.0.

What I also know after listening and reading to so many knowledgeable people here, including but not limited to Lisa and Jenny's site, is that the lower your A1C the less risk of diabetes related complications. In fact, if I have learned anything, getting A1C below 5.0 is my goal above everything else. That is why for now I have started a basil insulin.

Hopefully, as I drop more weight this year I will find that I can lower the does of basil insulin I must take daily. We will see.

Again, welcome back.

Ralph

[Cajunboy47]

HI Ralph,

I have mixed emotions about being back, but it is nice to be in old familiar places and with family and life long friends...

I'm thankful for your honest self evaluation. That information is valuable to me. Your experience with insulin combined with metformin is that you can keep your numbers steady. Also, even when you mess up and get spikes, you get the numbers back down quickly...

I have two questions though as a result of your information... At the time you inject yourself with insulin, do you know your BG count? and when you inject, can you predict how many numbers your BG will come down, based on the units you inject?

My thinking is that insulin brings BG down quickly, and you have to hurry and eat "X" number of carbs to keep from getting a hypo. Please explain how you get "steady" numbers to me in my simple minded logic....

So you can understand where I'm coming from; I have low numbers with just herbs, diet and exercise, avg is under 100 for last 90 days, with the exception of the last 2 1/2 weeks when I returned home. I'd love to avg numbers in the 80s' but my thinking is that would only be possible if I use insulin and that will probably mean eating more carbs and more calories to offset the probable hypos and thus end up with better numbers and a weight gain... Is my thinking flawed?

Ron

[Lottadata]

One thing to keep in mind is that it costs something like $10,000 to see Dr. Bernstein, not paid for by insurance. That means that his patients are people who have forms of diabetes that are TERRIBLY hard to control. Otherwise they wouldn't spend that kind of money to see him.

For people with certain kinds of Type 1 and Type 2 where long term exposure to high blood sugars has killed off all their beta cells, it can be EXTREMELY hard to control blood sugar and his regimen may be all that works.

But because of the type of patient he sees are those with severe control problems, I think his experience is skewed. I don't question that his patients do bets on 6-12-12, but I think that is because they are people with extremely tough control problems who seek him out as a last resort.

I know plenty of people with both Type 1 and Type 2 who use carefully titrated insulin to get 5% a1cs eating 20-30-30 and a snack here and there.

As far as the issue of deprivation goes, you may not understand where I'm coming from until you have eating a very low carb diet for three or four years. Some people do very well at that point, but many others of us don't, not because of moral weakness but because we run into major problems with energy level that may have something to do with subtle thyroid changes.

Whatever the explanation, over many years of reading the low carb newsgroup I saw a lot of people maintain their enthusiasm for a year or two and then disappear only to reappear a year or two later having regained all the weight. These were people who had been just as enthusiastic the first year or two as everyone here.

To downplay the issues involved in long term control and weight maintenance, or to suggest they can be easily solved with "attitude" is to set yourself up for some known problems.

My goal is to maintain a 5% A1c and blood sugars under 140 mg/dl at all times for the rest of my life, and whatever tools it takes to achieve that, I'll use.

For the past 6 weeks I've been eating at even lower than a Bernstein level: 22 grams a day, total. That's why my sig says "Bernstein" now. I'm gradually upping my carbs and will be getting back on insulin within the next couple weeks as I reach my weight goal, and then I'll go back to my usual regimen.

Almost 10 years after diagnosis--blood sugars testing over 250 mg/dl at the doctors office--I have no diabetic complications except for tendon problems, which are associated with very mild blood sugar abnormalities--"pre-diabetes". They may be diabetic or they may be wear and tear from age. It's tough to know.

I weigh what I weighed 12 years ago before my blood sugars went entirely out of control, too.

That is the goal, not adhering any particular way of getting there.

[Cajunboy47]

Posted by Lottadata...

To downplay the issues involved in long term control and weight maintenance, or to suggest they can be easily solved with "attitude" is to set yourself up for some known problems.

My goal is to maintain a 5% A1c and blood sugars under 140 mg/dl at all times for the rest of my life, and whatever tools it takes to achieve that, I'll use.

Hi Jenny,

You gave me a good laugh this morning... My hypothetical question is this: How do any of us ever really know when our attitude is not setting ourselves up for a fall?????

I'm beginning my 11th year as a diabetic. I've had my BG under 7 for about 4 or 5 years now if my memory serves me correctly and almost 2 years hovering at or below a 6, and I'm hoping to see 4.8 or less one day...

Since 10/2006, I've kept off every single pound I've lost, with the exception of 1 to 2 pound variations on the scales as we all see as we lose weight, and I'm aware that gives me no guarantee of anything, but it is encouraging...

I don't think any of us can claim that we'll never fail again, but I certainly am not in an "Enthusiastic" mode, such as one would be if they were sprinting when they should be jogging. I have a self awarness that sort of makes me realize, I'm never going to be more than 2 meals away from wreaking havoc on my BG numbers...

I believe I eat a lot more variety of foods (greeen veggies) than what I see most diabetics post and I don't know if that is where I get my energy from, but that, in combination with a lot of walking seems to keep my energy level pretty high... Maybe its the herbs... :)

Considering that a little over 4 years or so ago, I had severe diabetic neuropathy in my hands and feet and could hardly walk at all, and I couldn't hold an ink pen long enough to sign my name, I feel like I have a new lease on life and I know I'm onto something positive and I do reflect optimism and enthusiasm when I talk about my dealing with diabetes...

There is a two edged sword to the "enthusiastic" frame of mind. The opposite of success is failure, so remaining aware and not naive while being enthusiastic is not a bad thing, but rather a very good thing. I would call that "healthy enthusiasm", if I had to call it anything at all... Getting ourselves out of a slump is easier when we establish a lot of self-awareness and I see many people in this forum who are this way and that also is encouraging to me.

And as a final comment about successes and failures... We are all fighting to maintain good health for as long as possible, but diabetes is a progressive disease and even if we can manage to live long enough to die of something else, we'll all have to adjust the things we do as we age, that's a given. So, if I or you or anyone else proclaims that our experience proves this or that is the right thing, at some point in our struggle, we'll be re-adjusting what we feel "the right thing" is....

[Daryl]

Great thread, folks :)

[Lisa N]

diabetes is a progressive disease

I'm not convinced that this is unavoidably true.
True when following the standard ADA diet? You betcha.
True when following a controlled carb lifestyle that doesn't continue to feed your IR and burn out your pancreas? I'm skeptical of that claim since I'm 15+ years post diagnosis and have no evidence of complications to date. Out of those 15 years, I was what would be considered 'out of control' for probably 3 months and have been low carbing for nearly 7 of those 15 years now.
Good control = fewer (or no) complications long term. :thup:

[Daryl]

I agree, Lisa. If you normalize your blood sugar, then there should be no diabetic damage, generally speaking. That's a very general statement, of course, and I'm not talking about pre-existing problems (though even some of those can be reversed).

[RobLL]

After two sessions of retinopathy since 2005 after my last optholmologist check up (preceded by checkups every 3-6 months) he told my my eye blood vessels were in good enough shape that once a year would be enough. And he said low carbs, work for normal blood sugars.

[dancinbr]

Hi Canjun Boy,

What you need to understand is there are two types of insulin.

I am using the basil insulin that releases slowly during a 24 hour period.

I am hoping this will bring my BG range down into the 80s on a consistent basis. I can maintain BG swings within a 40-50 point range. So if I have 80 starting a meal I would not go higher than 120-130; almost normal. Even if I went up to 140 would be OK. I am starting to see some progress in this area. I am getting more readings under 100 and I am topping out at around 140 right now. Low carbs works and keeps my BG range tighter.

There is also the fast acting insulin, which you inject just before a meal, that tries to replicate the quick acting insulin release that all T2's have lost.

This injection size is based on your estimate of how much you are going to consume in carbs. And this is where the Bernstein theory of small numbers become so important. Small numbers mean small estimates, mean small errors in your estimate and therefore small swings in your BG. Even the estimates on a package of food, I believe are + or - 10-20% off. So small numbers keep you from having huge swings in your BG and this is especially important for T1's who can swing too low.

And Jenny I called Bernsteins' office. The fee is $6000. And yes, he would be out of network for me and my insurance program, but I believe I would get back at least a 1/3 up to 1/2 of the fees after my out of network deductible.

Best wishes,

Ralph

[Lottadata]

Ralph,

I believe that when you see Bernstein there may be a lot of expensive lab tests that are what drive up the cost of treatment. I'm pretty sure I got that $10K figure from reading patient reports.

The problem with the insurer reimbursement, based on what he said in one of his teleconferences, is that what he is providing is coded as "diabetes education" which, ironically, many insurers will not reimburse when provided by MDs. So if you are counting on insurance coverage, you should go over it very carefully with the insurer before you have the appointment.

BTW, it's BasAL insulin not Basil, which is an herb.

Lisa,

I have been arguing exactly what you've been saying for many years. Diabetes does not have to be a progressive disease, at least not if by that you mean progressing to serious complications.

That said, if the damage to your beta cells has gone past a certain point at the time of diagnosis, even maintaining normal blood sugars may not be enough to prevent a bit more deterioration from happening to your insulin production because you may not have enough beta mass left to handle even 30 grams of carbs a day, which is why quite a few of us who have low carbed for many years do add insulin to our regimens.

But what is important to note is that we do it while having blood sugars most doctors consider "excellent". My A1c when I started with insulin was 5.9% another friend's was in the middle 6% range. Both of these are so low that an endo told me he wouldn't even SEE a patient with those A1cs as he didn't think they needed his attention.

We're taking the attitude that it is better to protect our remaining cell function than to push those fading beta cell too hard. I saw my fasting blood sugar inching up and for me insulin has been about protecting what I have left, which is something that Bernstein urges.

Ideally I'd like my A1c to be closer to 5% than to 6% because of the lowered risk of heart disease. But my form of diabetes is one where it is almost impossible for me to get my fasting blood sugar down to true normal even with insulin, due to an overactive counterregulatory system.

And having seen what happens to people in my family who do NOT have heart disease as they approach their 90s I have to say I've concluded there are a lot worse ways to go than heart disease. Because the sad truth is that if you don't get heart disease you get to choose from cancer, stroke, pulmonary disease, or dementia all of which are slow and miserable ways to go.

[dancinbr]

Jenny - Well I was injecting an herb in me. :)

That was funny OK basal not basil.

I got a chuckle out of that.

Thanks for alerting me.

Now, I am sure my Bloos sugars will drop even more :lol:

On the cost, well yes no matter what it is expensive to see him.

I have thought about it since I am all of 50 miles away from his office. However, I think I am doing pretty well managing this on my own with the support of this forum and the Bernstein forum and certainly all the information you have posted.

I don't mean to exclude all the other contributors in this forum including Lisa, Rob, Daryl and others.

It is so good to have an active community unfortunately living the experience first hand and willing to share their thoughts, experience and continuing education.

You can not learn too much on this topic.

One of the key thoughts that I even told my Doctor was lower A1C is more important than all the other noise like lower LDL in your cholesterol.

All my life I have had good cholesterol with numbers under 200 and good HDL and a good ration. Suddenly, as a result of diabetes LDL is now a threat.

He had me try Zocor; well forget it. The drug is so debilitating giving me muscle cramps and terrible weakness of my legs with aches all over the body in less than one week. I stopped.

This is when I came to the forums and learned more about LDL and the different particles in its makeup and that low carbers probably had a lot of "neutral" LDL particles and therefore this is NOT a factor.

So, we now focus on A1C since all the data says the lower your A1C the lower your chances of complications including heart disease.

Thanks to everyone,

Ralph