Sunday, November 27, 2011

Thoughts about Bernstein

Seems like most diabetics who are serious about their control know about Dr. Richard K. Bernstein's books on diabetes management.

Bernstein demands a high degree of self-discipline and determination. He, himself, has had good success with a very low-carb diet, and has plenty of anecdotes about other people, both Types 1 and 2, who have also done well.

But I still don't know of any studies that have actually used a REAL low-carb diet (i.e 30g a day, as Bernstein calls for) in comparison with a low-fat diet for any significant period of time, and that's what the medical field is really waiting for. They are very cautious about accepting new practices without standard scientific evidence (yes, I know Bernstein isn't new, but he is to them). If anyone knows of such studies, it would be worth calling the attention of professional organizations to them.

The other thing is, some people feel they really CAN'T give up their carbs. It's a pleasure issue to them, and in a way, it's like smoking -- current gratification outweighs distant harm. Also, some people have reported success with McDougall -- if it works for them, great. I'm convinced that there are different types of metabolism in humans, and what works for one may not work for another. It would be nice to see research on defining those differences, so that dietitians could work, not only with a person's food preferences, but also with the way their metabolism functions.

As for me, I'm a picky eater, and I can't go with Bernstein all the way, but I've had some good success with a modified approach. My food palette is relatively limited (but NOT extreme, like Anderson Cooper!), but I'm pretty happy with mostly the same foods every day. I know I'm light on the veggies and meat, and I do eat cottage cheese, yogurt and a little milk, so my total daily carb intake is closer to 60 than to 30, but my weight is at a healthy place (BMI 24.1), my lab results are excellent (totally normal lipids, and an A1c of 5.8), and I feel good.

So I guess I'm trying to say there IS wiggle room, and people have to come to their own accommodation of what they are and aren't willing to do, and what risks they are willing to take. Humans are complex animals, and one size does not fit all.

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