My first introduction to diabetes specialist Richard K. Bernstein was from a YouTube video in which he debates registered dietician Hope Warshaw.  Bernstein handily puts Ms. Warshaw in her place. It is no injustice to Warshaw to characterize her approach to diabetes treatment as a pharmaceutical approach: “The vast majority of people with diabetes need medication.” But Bernstein says, “Large doses of insulin don’t work in a predictable fashion.” Bernstein’s solution is to greatly limit the intake of carbohydrate and protein, and to permit the patient to eat fat to make up any calorie deficit. This is quite clearly because protein and carbohydrate require an insulin response. But as he explains in his book, Diabetes Solution, the absorption rate of doses of insulin above 7 cc is unpredictable, and therefore it is necessary to keep numbers low: small amounts predictable quantities of protein and carbohydrate accompanied by small doses of insulin will help type 1 diabetics (and type 2 diabetics needing insulin) to maintain glucose control. In this manner, a type 1 diabetic has the best ability to eliminate diabetic complications and to live out a full and healthy life. Thus, Bernstein recommends that both type 1 and type 2 diabetics eat no more than 30 gm of carbohydrate, and also only enough protein in the diet to provide satiation.

Thus, Bernstein’s approach puts nutrition on equal footing with pharma–indeed, a higher footing in the case of type 2 diabetics and “prediabetics”  who can often control their diabetes through diet alone.

Now Bernstein’s approach is fully integrative of the old and the new.  It is entirely reductionist to believe as Warshaw that a pharmaceutical approach will make it possible for diabetics to eat what she calls healthy carbohydrates, e.g., fruit and whole grains.  While diabetics may “deserve” to be able to eat such things, before insulin, treatments of diabetes recognized the toxic nature of carbohydrate and protein in the diet, and therefore, placed very strict limits on the quantity of each.

In the pre-insulin study, The Starvation Treatment of Diabetes (1915), Massachusett’s General Hospital physicians, Hill and Eckman, explain their treatment of both adult (type 2) and juvenile (type 1) diabetes. The therapy consisted of starving diabetic patients on a strict diet of coffee and whiskey until they  stopped peeing sugar. At that point, they would gradually introduce extremely limited carbohydrate and protein into the diet of their patients until once again they urinated glucose, at which point they would once again cut back protein and carbohydrate from their diet to the point that sugar no longer appeared in the urine tests. The bulk of the calories which the patients would need for their daily energy requirements would come from fat. The whiskey therapy is a curiosity, but we can now scientifically verify its usefulness: the liver busily converts the alcohol to usable form, thus reducing concomitantly the liver’s production of glucose from protein (gluconeogenisis). Now, when the patients left the hospital, their dietary profile might look something like:  “Carbohydrate, 20 grams. Protein, 40 grams. Fat, 200 grams.”  This equals 80 calories from carbohydrate, 160 calories from protein, and 1800 calories from fat for a total, 2040 calories: certainly enough to live on. These numbers are similar to those in Bernstein’s Diabetes Solution.  Only today, we can also add drug therapy to greater enhance glucose control.

In 1922, 14-year old Leonard Thompson, was the first patient to receive insulin to treat his diabetes. This was an unquestionable breakthrough in diabetes treatment, and insulin treatment is undoubtedly, along with antibiotics for the treatment of infectious diseases, what has greatly established the reputation of the medical profession today. Child patients, who would otherwise die within a brief time, could now live into adulthood, and even carry out a normal life, almost. A devastating consequence of this breakthrough is the vast ignorance of the dieticians regarding the toxic effect of carbohydrate in the diet of diabetics.  As Warshaw suggests, just take insulin, and you can eat the food you deserve.  This approach has led diabetics to suffer decades of diabetic complications and death, because of still uncontrolled blood sugars.  Bernstein, in his own testimony (in Diabetes Solution), said that he developed his method in order to eliminate the multitude of diabetic complications from which he suffered, and his method has been very successful.

How great has the supplanting of the dietary approach been?  In her Diabetic Cookery (1917), Dr. Ruth Oppenheimer lists baking ingredients that even the internet knows not from what they are made: Casoid flour and Aleuronat flour. She writes regarding the former:

Casoid takes the first rank as a flour for diabetics, and therefore a special chapter is devoted to its use in the preparation of Bread, Muffins, Desserts, etc. Casoid, to a great extent, has solved the problem which confronts the cook as to a substitute for wheat bread, and, as a diabetic naturally craves bread, the substitute must come as near to the real article as possible.

Oppenheimer also employed ground almond, which is the most common substitution for wheat in today’s Wheat Belly cookbooks, and she claims that Casoid flour is better. So why would Casoid and Aleuronat flour have disappeared from our usage and knowledge? My guess is that apparently no one still saw the need for the best substitutions for wheat flour, because diabetics could, as of 1922, eat standard bread and shoot themselves with insulin. They weren’t going to die right away. But eventually, with such an approach, their unregulated blood sugar levels would cause them to die either of a diabetic coma from fatally low blood sugar or too high regular blood sugar which leads to such complications as retinopathy, kidney disease, peripheral neuropathy, cancer, heart disease and Alzheimer’s disease, to name a few. Clearly, an integrative approach, which implements the strict dietary approach of the pre-insulin treatment and judicious usage of insulin and other drug therapies, is superior. Hats off to Dr. Bernstein!