The People's Perspective on Medicine

Diabetes Diet Smackdown | Richard Bernstein, MD vs the ADA

Following a diabetes diet that is ultra low in carbohydrates can help people with type 1 diabetes normalize their blood glucose.
Grilled chilli chicken with steamed broccoli snow peas green beans and ginger

Dr. Richard Bernstein has had type 1 diabetes since he was a kid. That was a long time ago. He will soon be 84. Because people with type 1 diabetes mellitus (T1DM) can’t make insulin they have to inject themselves daily with this hormone. They also have to watch their diet even more carefully than people with type 2 diabetes . Dr. Bernstein began measuring his blood sugar levels in 1969 with the very first blood glucose meter. He tested himself multiple times a day and discovered that a very low-carbohydrate diet and careful insulin adjustment could normalize blood glucose levels. Thus began a long-lasting battle with the American Diabetes Association (ADA) about recommendations for the diabetes diet.

What’s the Best Diabetes Diet?

The Good Old Days:

Diabetes experts have been debating the most appropriate diet for people with type 1 diabetes for years. Prior to the discovery of insulin, experts were able to prolong the lives of people with T1DM by telling families to increase fat, cut carbs to the absolute minimum and increase protein (JAMA Internal Medicine, June 1, 1921). Here’s their introduction:

“In a previous communication we discussed in outline the advantages of the use of a high fat diet in the treatment of diabetes mellitus. We reported briefly the results of an investigation of the effect of a diet whose energy came largely from fat, to which was added sufficient protein to maintain nitrogen balance and the minimal carbohydrate necessitated in making up a diet that a human being can eat over a long period of time. It was shown that with such a diet, glycosuria [sugar in the urine] was avoided in severe diabetics, and that acidosis was not produced.”

Modern Times:

During the 1980s many diabetes experts embraced the low-fat diabetes diet craze. In those days the American Diabetes Association recommended that:

“The amount of carbohydrates should be liberalized, ideally up to 55-60% of the total calories…”

The ADA’s ideal diabetes diet restricted protein, total fat and cholesterol (Diabetes Care, Jan-Feb, 1987).

In other words, the diabetes diet of the 1980s was just the opposite of the diabetes diet of the 1920s. Carbs were supposed to make up more than half of a diabetic diet.

Fast Forward to A Modern Day Diabetes Diet:

The ADA now recommends individualization of diet. But many diabetes experts still suggest that patients get about 45 percent of their daily calories from carbohydrates. And they still caution against too much fat and protein.

What’s Old Is New Again: Dr. Richard Bernstein’s Study:

Some patients with diabetes have adopted the diabetes diet recommendations from Dr. Richard Bernstein. He has been advocating a very low-carb diet (VLCD) for people with diabetes for decades.

Now, Dr. Bernstein and his colleagues have published results of a survey of 138 individuals with type 1 diabetes (Pediatrics, May 2018). These volunteers are part of a Facebook community dedicated to low-carb diets in diabetes.

The participants reported an average daily carbohydrate intake of 36 grams. This made up about only 5 percent of their daily caloric intake. The researchers collected information on diagnoses, blood sugar levels and blood lipids from medical records.

The average HbA1c, a way of measuring blood sugar over time, was in the normal range at about 5.67 percent. The authors conclulded that a very low carbohydrate diet facilitated excellent blood sugar control in children and adults with type 1 diabetes mellitus.

In Their Own Words:

The authors of this study noted:

“In this survey of children and adults who follow a VLCD [very low-carbohydrate diet] for the long-term treatment of T1DM, we observed measures of glycemic control in the near-normal range, low rates of hypoglycemia and other adverse events, and generally high levels of satisfaction with health and diabetes control. These findings are without precedent among people with T1DM, revealing a novel approach to the prevention of long-term diabetes complications.”

The authors point out that low blood sugar (hypoglycemia) has been a serious complication of intense treatment. Low blood sugar can be very dangerous for people with diabetes. The idea that a low-carb diet could get blood sugar control into the normal range without overshooting into hypoglycemia is revolutionary.

The Polarization of the Diabetes Diet:

One of the tragedies of mainstream thinking about the best diabetes diet is the polarization that has occurred. Parents may feel restrained from discussing the low-carb diet they rely on.

Dr. Bernstein and his colleagues point out:

“Although participants reported high levels of satisfaction with health and diabetes control, relationships with diabetes care providers were often fraught. A minority of participants did not disclose their adherence to a VLCD to their providers, citing concerns for being criticized, pressured to change behavior, or accused of child abuse.”


This very low-carbohydrate diet study has broken new ground.

The researchers conclude:

“We suggest that a VLCD may allow for exceptional control of T1DM without increased risk of adverse events…The results, if confirmed in clinical trials, indicate that the chronic complications of T1DM might be prevented by diet.”

People’s Pharmacy Perspective:

We think Dr. Richard Bernstein is onto something. We have interviewed him on our syndicated public radio show on a couple of occasions.

He has stated:

“…over forty years ago…I discovered that more and more of the things that the American Diabetes Association had been telling me were perfectly fine to eat made blood sugar control impossible.”

Instead, Dr. Bernstein suggests non-starchy vegetables like asparagus, beet greens, bell peppers, broccoli, cabbage and spinach as well as meat, fish, fowl, seafood and eggs. He has found that even whole grains raise blood sugar unacceptably.

For more details on this promising approach, you may want to check out the book, Dr. Bernstein’s Diabetes Solution, or our Guide to Managing Diabetes. We have also described in some detail what a low-carb diet really looks like in our Quick & Handy Home Remedies Book. We list 34 of our favorite low-carbohydrate foods. There are also some breakfast, lunch and dinner menus. Here is a link. Another book that is crammed full of healthy recipes is Recipes and Remedies from The People’s Pharmacy. You can save 50% off the regular price when you buy both books together at this link.

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    About the Author
    Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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    Just curious about cardiac status. High fat supposedly puts these people at risk for CAD. and how is weight control?

    This is not the ketogenic diet, you’re not putting butter in your coffee, this is a very balanced way of eating. In no way does Dr. Bernstein push fat. This is a very low carbohydrate diet, about 36 grams of carb spread out over the day. Fish and chicken are wonderful choices, as are lean meats. My diet consists primarily of vegetables, meat, and dairy. Since I’m not eating sugar and not eating flour, I’m eating basically no processed foods, with the exception of low carb meal replacement shakes on occasion. This is GREAT for heart health and health in general, as it is anti-inflammatory and great for weight control. It’s been great for my diabetes. For the last year of doctor visits, my blood glucose was low enough that I wasn’t in the diabetic range. I owe that to this way of living.

    I love Dr. Bernstein’s work. My husband has diabetes. I’ve known for years that empty carbs are bad news, for anyone, with or without a health problem…whether cancer, heart, diabetes or just general health and well-being. For shame on the doctors, healthcare industry and pharmaceuticals for making a fortune by lying to us.

    But I have read that people with type 1 diabetes are most likely to die of heart disease? How does this high animal fat diet recommended here square this that?

    I was diabetic for 13 years and was taking metformin 1000 mg twice daily. Last A1C was 15. My symptoms have always been stomach and bowels. I am a 54 year old male. the metformin wasn’t really working so this year, our family doctor started me on Natural Herbal Gardens Diabetes Disease Herbal mixture, With the help of Natural Herbal Garden natural herbs I have been able to reverse my symptoms using herbs, my symptoms totally declined over a 7 weeks use of the Natural Herbal Gardens Diabetes disease natural herbal formula. My diabetes is totally reversed! Visit their website www . naturalherbalgardens . com I am thankful to nature

    A type II diabetic, I have negative reactions to any foods containing oats. Would like to know about breads that I can eat that don’t have oats.

    Is this diet recommended for people who have Type II diabetes also?

    It is absoultely essential for type II diabetics to follow this very low-carbohydate diet to keep their disease from progressing. With weight loss and diet it is possible to reverse the disease.

    Leigh, good for you in standing up to your doctor (now ex-). Too many people have an unhealthy parent-child relationship with their doctors. A lot of times, its just not worth the trouble to try to change or convince them.

    And what to do for my friend with renal disease? Protein is poison for him.

    Wheat has one of the highest rates of increasing blood sugar higher than even sugar itself.

    I limit how much I eat or contact. Remember, they use grains to fatten up cattle before marketing them!

    I’ve had Type 1 diabetes for 36 years but have only been following a low-carb (not very low), few processed foods and gluten-free diet for the last 5 years based on the advice of my naturopath.

    I had struggled for years trying to keep my blood sugars from going to extremes despite being on an insulin pump or multiple daily injections. When I went low-carb (25 grams or less per meal) it made such a difference in my control.

    I’ve read both of Dr. B’s books but concluded it was just too extreme for me. Interestingly enough, I had spoken with my former endocrinologist about going low-carb, she discouraged it.

    When I decided to go low-carb anyway, she was absolutely furious with me and questioned what was I going to eat, I was going to get sick, etc. That was the last time I saw her.

    My A1c’s have lowered and my blood sugars are more even than they ever have been. I’ve not been sick and use less insulin.

    The trick is to find what works for the individual since the disease is different for each person.

    * Be nice, and don't over share. View comment policy^