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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.
Diabetes Diet Smackdown | Richard Bernstein, MD vs the ADA
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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