The Golden Rule - Do Unto Others

I t is such a blessing that low carbohydrate diets have gained widespread acceptance, and that a lot of people now have some idea (but likely not a very

good one) about the role of insulin in building body fat. It is a bit of a curse, however, that the diets have taken hold so suddenly, because fads tend to promote false and misleading information.

A low carb diet is superior for one simple reason:

if done according to the guidelines in my new book, The Diabetes Diet, people don’t get fat, or don’t stay fat, even as they reach the years of the supposedly inevitable “middle-age spread.” In addition, all of the indicators for disease that are supposedly controlled by a low fat diet, such as triglycerides and LDL (or “bad”) cholesterol, improve for most people. It’s been shown over and over again that slim (not underweight) people live longer than fat people, or even people who are just heavy This diet is not just a diabetes diet, it’s a longevity diet, a disease prevention diet and a fitness diet.

                    General Principles for Tailoring your Meal Plan

If you use blood sugar-lowering medications such as insulin or oral agents, the first rule of meal planning is: don’t change your diet unless your physician first reviews the new proposed meal plan and reduces your medications accordingly Most, many, diabetics who begin our low-carbohydrate diet show an immediate and dramatic drop in blood sugar levels after meals, as compared to blood sugars on their prior, high-carbohydrate diets. If at the same time your medications are not appropriately reduced, your blood sugars can drop to dangerously low levels.

Unlike other diets, in negotiating the meal plan, I’d try wherever possible to incorporate foods you like. There are no prescribed meals. There is only one absolutely hard and fast rule: avoid fast-acting, concentrated carbohydrate.

If your ‘diet’ calls for a supper that does n’t satisfy you, it’s almost a given that later on, you’ll find yourself compelled to have a snack. (Of some size) The net result? You end up with high blood sugar and more calories than you would have consumed if you’d started with a sensible meal. My aim is to help you to avoid this. It’s really best to start with a plan that allows you to get up from the table feeling comfortable but not stuffed. Studies have shown that fat and protein both leave you considerably more satisfied than fast-acting carbohydrate.


Six Twelve Twelve

 My basic approach in helping someone put together a meal plan is that I first set carbohydrate amounts for each and every meal. The general parameters work like this: I recommend restricting carbohydrate to about 6 grams of slow-acting   carbohydrate at breakfast, 12 grams at lunch, and 12 grams at supper. Very few people would be willing to eat less

Carbohydrate is not established for good health but the nutrients in vegetables are. So the only nutritional reason for including any carbohydrate in our diets is to get vegetables. We then should use non-starch vegetables as our carbohydrate source. Although fruits may provide similar nutrients, modern fruits have been bred to be sweet. They will therefore not only facilitate weight gain but will make blood sugar normalization impossible to diabetics.

Ideally, your blood sugar should be the same after eating as it was before. If blood sugar increases after a meal, even if it eventually drops to your target value, either the meal content should be changed or blood sugar—lowering medications should be used before you eat.

                     The Timing of Meals and Snacks

Meals need not follow a rigidly fixed time schedule, provided that in most cases you do not begin eating within 4 hours of the end of the prior meal. It takes four to five hours for the effect of a meal on blood sugar to run its course. When you have overlapping blood sugar effects, it becomes more difficult to control blood sugar. If your breakfast is a low carbohydrate meal, but then you snack on a bagel or bun an hour or two later, you will negate whatever virtue the low carbohydrate meal had. The added insulin needed to cover the blood sugar spike from the snack will help pack away the fat you ate when otherwise it would have been metabolized.

                         Negotiating your target weight

Standard formulas and tables are commonly used by nutritionists to determine caloric needs of theoretical mdividuals—a 120-lb woman who is 5’2” and exercises moderately needs X number of calories per day If she’s overweight (say 140 lbs) all she has to do is cut her caloric intake so hat the number of calories being eaten are fewer than the number of calories burned. Sounds sensible, like spend less, earn more, but its not. If our hypothetical woman cuts her caloric intake too much, she could lose muscle as well as fat. So she could lose her 20 pounds, but if half of it were muscle, then she’d be worse off than when she started. Everyone has some level of caloric intake below which they will lose weight. The only way to find out how much food you need in order to maintain, gain, or lose weight is by experiment. Here is an experimental plan you may find useful. This method usually works, and without counting calories.

Begin by setting an initial target weight and a reasonable time frame in which to achieve it. Estimate your target weight by looking at your body in the mirror after weighing yourself. (It pays to do this in the presence of your health care provider, because he/she probably has more experience in estimating the weight of your body fat.) If you can grab handfuls of fat at the undersides of your upper arms, around your thighs, around your waist, or over your belly, it is pretty clear that your body is set for the next famine.

Your estimate at this point need not be precise, because as you lose weight your target weight can be re-estimated. Say, for example, that you weigh 200 pounds. You and your physician may agree that a reasonable target would be 150 pounds. By the time you reach 160 pounds, however, you may have lost your visible excess fat so settle for 160 pounds. Alternatively, if you still have fat around your belly when you get down to 150 pounds, it won’t hurt to shoot for 145 or 140 as your next target, before making another visual evaluation. Gradually you close in on your eventual target, using smaller and smaller steps.

Once your initial target weight has been agreed upon, a time frame for losing the weight should be established. Again, this need not be precise. It’s important, however, not to “crash diet.” This may cause a yo-yo effect by slowing your metabolism and making it difficult to keep off the lost bulk. If you starve yourself, you may lose as much muscle as fat, which will result, eventually, in gaining back more fat than you originally lost.

Look at your diet not just as a short term means to losing weight (which it will be) but as a long term means for optimal health. Weight loss must be gradual. If your target is to lose 25 pounds or less, I suggest planning on a reduction of 1 pound per week. If you’re heavier, you may try for 2 pounds per week. You’re 25 pounds overweight and if you lose one pound per week—Hey! That’s six months! And you’ve probably heard about crash diets on which you can lose that much in one or two or three weeks. No way is one pound or even two pounds a week going to cut it. If this is the way you’re thinking, then you need to think more carefully The best way to lose body fat is the same way you gained it. Gradually avoiding the big mistakes.

So you negotiate your meal plan with yourself. Start out with enough protein at each meal that you think will keep you satisfied. Weigh yourself once weekly before breakfast naked if possible, consistently using the same scale. If, after one week, you’ve lost the pound, don’t change anything. If you haven’t lost the pound, reduce the protein at any one meal by one-third. For example, if you’ve been eating 6 ounces of fish or meat at dinner, cut it to 4 ounces. You can pick which meal to cut. If, one week later, you have lost a pound, don’t change anything. If you haven’t, cut the protein at another meal by one-third. If you haven’t lost the pound in the subsequent week, cut the protein by one-third in the one remaining meal. Keep doing this, week by week, until you are losing at the target rate. Never add back any protein that you have cut out, even if you subsequently lose 2 or 3 pounds in a week.

If you’ve managed to lose at least 1 pound weekly for many weeks and then your weight levels off and you’ve hit your target weight—then you’ve got your lifetime diet.


Richard K. Bernstein, M.D., FACE., F.A.C.N., C.W.S. is the author of the best-selling Dr. Bernstein’s Diabetes Solution. He is recognized as one of the foremost experts on diabetes and its complications. His private practice in Mamaroneck, N.Y., is devoted solely to diabetes and prediabetic conditions. The Diabetes Diet will be available in January, 2005, wherever books are sold.



November 1, 2004

From The Diabetes Diet: Dr Bernstein’s Low Carbohydrate Solution

by Richard K. Bernstein, M.D. Copyright ©2005 by Richard K. Bernstein, M.D.

 Published by permission of Little, Brown and Company (Inc.). All rlghts .reserved.

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