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Dr. Bernstein Shares His Insights
If you happened to watch dlife our own feature writer, Richard K. Bernstein, M.D., F.A.C.E., F.A.C.N., C.W.S., was on the show. He had a great opportunity to explain his background and why he believes his method of controlling blood glucose is the best. His feature this week Some Basic Science Underlying the Diabetes Diet gives a more robust perspective about how he has stayed healthy for over 70 years.
The Diabetes Diet
Richard K. Bernstein, M.D., F.A.C.E., F.A.C.N., C.W.S.
Chapter 2
Some Basic Science Underlying
the Diabetes Diet
Part
1 of 2
Avariety of physiological factors other than the food you eat can and will affect
blood sugars. Some of these, such as exercise and insulin resistance, are obvious
and well known. Others are rarely if ever addressed in diabetes diets, but they’re
crucial if you are to be successful in normalizing your blood sugars. Most of
these are in some ways applicable to nondiabetics as well. The pages that follow
contain simplified discussions of these phenomena, in order to get you jump-started.
For those who want to know more, I’ve provided the page numbers in Dr.
Bernstein’s Diabetes Solution where further details can be found (all
page number references are to the 2003 edition).
THE LAWS OF SMALL NUMBERS
(Diabetes Solution, page 99)
“Big inputs make big mistakes; small inputs make small mistakes”
is an indispensable piece of wisdom for life as well as for diet.
Many biological and mechanical systems respond in a predictable way to small
inputs but in a chaotic and considerably less predictable way to large inputs.
As an example, think about traffic. Put a small number of cars and truckson
a given stretch of highway and traffic acts in a predictable fashion: you can
maintain speed, enter and merge into
open spaces, and exit with a minimum of danger. There’s room for error.
Double the number of cars and the risks don’t just double, they increase
geometrically. Triple or
quadruple the number of cars and the unpredictability of a safe trip increases
exponentially.
The name of the game for the diabetic in achieving blood sugar normalization
is predictability. It’s very difficult to use medications safely unless
you can predict the effect they’ll have. Nor can you normalize blood sugar
unless you can predict the effects of what you’re eating on your blood
sugars.
*I only recommend two kinds of oral agents for treating diabetes —those
that increase the body’s sensitivity to insulin, or those that act like
insulin without potential adverse effects. See page 224 of Dr. Bernstein’s
Diabetes Solution, 2003 edition.
If you can’t accurately predict your blood sugar levels, then you can’t
accurately predict your needs for insulin or oral blood sugar–lowering
agents.* If the kinds of foods you’re eating give you consistently unpredictable
blood sugar levels, then it will be impossible to normalize blood sugars.
For people who use insulin, the Laws of Small Numbers are absolutely crucial
because when you inject insulin, not all of it reaches your bloodstream. The
more insulin you
use, the greater the level of uncertainty. An unpredictable portion of injected
insulin is destroyed by the liver and the immune system. How and where you inject
can affect ab-s
sorption of the commonplace large doses as well. According to researchers at
the University of Minnesota, a 20-unit injection in your arm will result in
an average 39 percent variation in the amount that makes it into the bloodstream
from one day to the next. Abdominal injections had a 29 percent average variation.
These are enormous variations. These numbers are averages, remember, so on
any given day, your injection of the same amount could be twice or half as effective
as the one
on the day before. The larger your doses of insulin, the bigger the discrepancy.
So if you eat large amounts of carbohydrate that you need to cover with large
doses of insulin, your
ability to predict your insulin needs is almost nil. If you inject 20 units
of insulin at one time, a 29 percent variability will, on average, create a
6-unit discrepancy in your absorption (could be 8 units, could be 4). Since
1 unit lowers a typical 150-pound adult’s blood sugar by 40 mg/dl, the
result is, on average, a 240 mg/dl blood sugar uncertainty (40 mg/dl x 6 units).
The good news is that at doses smaller than 7 insulin units for adults, the
absorption uncertainty becomes negligible. This diet enables us to use smaller
doses of insulin, keeping unpredictability in check.
Another Law of Small Numbers relates to the fact that in the United States,
food manufacturers are permitted an error of plus or minus 20 percent when estimating
carbohydrate content on product labels. For a customary 150-gram carbohydrate
portion of pasta, this boils down to a typical blood sugar uncertainty of 150
mg/dl (5 mg/dl/gm x 150 gm x 20 percent). For 2 cups of salad containing a total
of only 12 grams carbohydrate, the blood sugar uncertainty would be only plus
or minus 12 mg/dl. The uncertainties in food value books may sometimes be double
or quadruple those
on labels, making high carb values even more risky.
Bottom line: observing the Laws of Small Numbers in counting carbs and, correspondingly,
injecting insulin will help you get control of your diabetes or your weight.
DIMINISHED PHASE I INSULIN
RESPONSE (Diabetes Solution, page 89)
The normal blood insulin response to a meal comes in two phases. During the
time between meals, your body stores up insulin in order to respond to the next
meal. When you eat, phase I is the instant release of stored insulin in response
to the “glucose challenge” of the meal you’ve started to eat,
and it prevents a sharp rise in blood sugars. Phase II is slower and longer
in duration, and consists of the release of insulin
as your body is making it.
In type 1 diabetics both phases of blood insulin response are nonexistent.
In type 2 diabetics the first phase is diminished or absent. This is one of
the hallmarks of type 2,
and the reason blood sugars can rise sharply shortly after beginning a meal.
Intramuscular insulin injections approximate the phase II response, but there
is no way, medically,
to mimic the phase I response. Thus a low-carbohydrate diet, which requires
less insulin, is absolutely essential for normalizing blood sugars.
GLUCONEOGENESIS (Diabetes Solution, page 90)
Gluconeogenesis is essentially Latin for “new creation of glucose.”
If you were a healthy nondiabetic and hadn’t had a meal in 3 days, your
blood sugar levels would probably
still be essentially within a normal range. Why? The body can convert protein
to glucose. This includes protein you eat, but also stored protein — as
in your muscles and other
tissues, which continually receive amino acids (the “building blocks”
of protein) from and return them to the bloodstream. This constant exchange
makes amino acids always
available for conversion to glucose. So (to simplify) for the nondiabetic, if
you haven’t eaten, your body senses the drop in blood sugars and converts
stored protein to glucose;
meanwhile, the normal insulin response keeps blood sugars from going too high.
For the diabetic with a major insulin deficiency, the problem is that insulin
response may not be enough to bring blood sugars back into line. So even though
you haven’t eaten, if
you test your blood sugars you’ll find they’re high. In the old
days, before insulin became available for injection, type 1 diabetics were said
to melt away into sugar water.
In all likelihood, you won’t be able to control this phenomenon by diet
alone, particularly if you’re a type 1 diabetic or a type 2 making too
little insulin to offset your insulin
resistance (see below). For type 2s, appropriate weight loss and vigorous exercise
may be essential to improving your body’s sensitivity to insulin.
Too Be Continued in Part 2
We would like to thank the publisher Little Brown and Company and Dr. Richard
K. Bernstein, for allowing us to provide excerpts from The Diabetes Diet.
Copyright © 2005 by Richard K. Bernstein, M.D.
All rights reserved. No part of this book may be reproduced in any form or by
any electronic or mechanical means, including information storage and retrieval
systems, without permission in writing from the publisher, except by a reviewer
who may quote brief passages in a review.
Author’s Note
This book is not intended as a substitute for professional medical care. The
reader should regularly consult a physician for all health-related problems
and routine care.
For information on how you can purchase Diabetes
Diet, go to www.Diabetes-solution.net
Now on Special for $18.99. Regular $24.95
"Getting to the Heart of Diabetes" is a guide to understanding
CVD, diabetes and insulin resistance. This is a small guide with 4 chapters,
Diabetes, Insulin Resistance, Controlling Diabetes and Warning Signs for heart
attacks and strokes. After reading the booklet, your patient can take the next
step by putting their new knowledge into action. As part of the program patients
receive the following free of charge………….
1. Heart of Diabetes Journal to track your progress in managing your diabetes
and reducing your risk for cardiovascular disease;
2. 12-month subscription to Diabetes Positive magazine; and
3. Incentives throughout the year to help stay motivated.
Other Products by Dr. Richard K. Bernstein.
 The
Diabetes Diet
Dr. Bernstein's Low-Carbohydrate Solution
Richard K. Bernstein, M.D., F.A.C.E., F.A.C.N., C.W.S.
In
the midst of an obesity epidemic, Americans are in search of the perfect
diet--one that will help them shed pounds quickly and make them feel their
best.
Although some diets, like South Beach
or Atkins, will lead to weight loss in the short term, they don't teach
dieters how to make the lifestyle change necessary to keep the pounds
off. Such diets don't remain faithful to the science behind low-carb eating,
but instead allow the return of bad habits to undo their early benefits.
The Diabetes Diet(Little, Brown & Company; January 3, 2005; $24.95), by
Richard K. Bernstein, M.D., however, is the diet that will teach Americans
how to eat for life.
http://www.diabetes-solution.net/diabetesdiet.php
|
 For
the first time, you can now listen and learn from Dr. Bernstein, how to
control your diabetes.
Dr. Richard Bernstein’s
groundbreaking approach to diabetes care enables you to take control-of
the disease by normalizing your blood sugar. Dr. Bernstein, is recognized
as one of the foremost experts on diabetes and its complications. His
private practice in Mamaroneck, New York, is devoted solely to diabetes
and prediabetic conditions.
These CDs were recorded during actual visits to Dr. Bernstein’s
office. He reviews with
you the steps you need to take in order to control your blood sugars and
prevent the complications from diabetes. http://www.diabetes-solution.net/
A
Complete Education Program and Guide to
Achieving Normal Blood Sugars.
Recorded
Individualy
For Type 1 and Type 2 Diabetes,
These "LIVE" 5 CD Sets Contain The
Personal Diabetes Education Program
taught by Dr. Bernstein to his patients.
For Type 1 or Type 2
|
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