Ryan Attar: My 3 Days with Dr. Bernstein

By Ryan Attar

For those who may not know, Dr. Richard K. Bernstein is a world-renowned advocate for diabetes care and author of several best-selling books on the subject. Now 80, he developed type 1 diabetes when he was just 12 and spent the next 20 years following the standard regimen of high-carb meals, roller coaster blood sugars, and inevitable health consequences.

Well into adulthood and already suffering many complications from the disease, he eventually managed to acquire a blood sugar monitor (at the time, in the 1960s, blood sugar could only otherwise be tested by doctors in hospital laboratories). He found that by reducing his carbohydrate intake he could normalize his blood sugars, meaning he achieved non-diabetic blood sugars with the appropriate amount of insulin, of course, and thus he could reduce or reverse most diabetic complications.

He wrote a paper on his findings, but could not get it published, so in his words, “I couldn’t beat ‘em, so I had to join ‘em.”

Dr. Bernstein started medical school at age 45. Now he maintains an A1C in the 4s, as do his patients.

I first read his book, “The Diabetes Solution,” 4 years ago, and it changed both my life and my health tremendously. It’s because of him that I now have A1c’s in the 4s, which are in the normal, non-diabetic range (a shock to most people with diabetes whose physicians advocate a much higher range). These numbers are impossible to achieve following the ADA’s “healthy” nutrition guidelines. Frustrated with doctor after doctor who treated me and was uncomfortable with the healthy numbers I achieved through Dr. Bernstein’s method, I was inspired to enter the health field myself. And since my medical school is just 45 minutes away from his office, I decided to reach out to his office and see if he’d let me observe. I was ecstatic when he agreed to let me come in this summer.

When Dr. Bernstein first sees a new patient, he asks to them to come in for three days in a row. This was exactly the time I was in his office, so I would get to see his complete work on one patient. Thinking about this, three consecutive days with one patient, is incredible to me! My interactions with doctors in the past usually took place in a very rushed 10-15 minute window. A doctor never really gets to know a patient like this and cannot possibly explain all the in’s and out’s of diabetes management in this short time (even if they know how to correctly manage diabetes).

As I waited for Dr. Bernstein, a few interesting things jumped out at me. An avid painter and photographer, his work hangs all over his office. Every spot on the wall that doesn’t have his art is covered with countless awards and recognitions. His bookshelf, which I later found out was his “pleasure reading,” had books on string theory, quantum physics, and advanced mathematics, among many other very advanced texts. To me, it signaled an extraordinarily brilliant man.

When I finally met the patient, I admit that I was a bit disappointed. He was a type 2 diabetic and unfortunately by most people’s standards, well controlled. His last A1C was 5.4%, which would get him a pat on the back by most endocrinologists. I even thought that there would probably be nothing wrong with him, and he might be wasting his time and money visiting Dr. Bernstein. But over the next few days, I found my assumption to be very wrong!

On the first day, Dr. Bernstein went over all the previously-requested lab results and all aspects of the patient’s health. He also got the patient started on the diet and medication doses that would facilitate normal blood glucose levels.

On the second day, he went over a thoroughly detailed management of diabetes. He talked about how to deal with it under different circumstances, like when traveling, exercising, sick, or in the hospital. Dr. Bernstein mentioned that most hospitals will unnecessarily put a diabetic on a glucose drip, causing dangerously high hyperglycemia! He also checked on how the previous evening and morning had been for the patient’s assigned diet and medication regimes, and adjusted them as needed.

Since we were a little short on time that day, Dr. Bernstein had us take our lunches at his desk. I was excited for this… to actually see what Dr. Bernstein himself eats! Which was: a plate of salmon, some cubes of cheese, a small bowl of pistachios (he said just 19 pistachios and also mentioned they were very low in carbs for nuts), and half a piece of “plastic” – something like a low carb bread. This meal, as many followers of Dr. Bernstein’s method know, will not raise your blood sugar. With correct insulin dosing one could eat this meal and hover between 80-90 mg/dL during and after the meal without any spike.

On the third day, Dr. Bernstein conducts a very thorough physical exam. He performs more than a dozen tests for neuropathies and other diabetic complications. And it was this that made me realize why observing this patient, seemingly “well controlled” with an A1c of 5.4%, was so important. In nearly every test, this patient had mild to moderate symptoms. Not at all what one would expect from someone with an A1c like this. Everything from the eyes, to the autonomic nerves which control stomach emptying, to the arteries in the legs, to the sensitivity in the extremities, and several other tests. Normally, I would only expect these symptoms in someone with an A1c of something like 6% or more, so it means a lot to have seen this detected. It underscores the importance of maintaining normal, non-diabetic blood sugar (in the 80’s) and A1c levels (in the 4′s).

To this effect, I also want to mention a few devices that Dr. Bernstein (though very few, if any, physicians) uses. He has a slit light machine to look at patients’ eyes, something you would normally only see in an optometrist’s or opthalmologist’s office. Dr. Bernstein is the only diabetologist with one. He also has an oscillometer, which resembles a blood pressure cuff, but measures oscillations in the blood vessels. He uses this to measure sympathetic neuropathy innervating the smooth muscles in the arteries of the legs. These nerves die in neuropathy, and this leads to calcification of the blood vessels. His oscillometer can detect this. Oscillometry is used all around the world, but rarely in the USA. Dr. Bernstein mentioned that “hands on” care is becoming rarer and rarer in the USA and that these tests should be conducted on all diabetics; however, almost no other physicians do them.

In the end, these three days were very inspiring to me. This man is the best professional in the world for diabetes care. I thought that before this experience, but I have been completely reassured. His method should be the baseline standard for diabetes care. At 80 years old, Dr. Bernstein is still sharp, energetic and appears far younger than his peers. I learned so much over the course of these three days and am still pouring over my twenty pages of notes. I will definitely incorporate his methods into my practice after I graduate. I recommend that ALL persons with diabetes mellitus read his book. If one wants a healthy, complication-free life, this perhaps is the only way to it.

Check out Dr. Bernstein’s website which has info about his books, and also his monthly webcast where he will answer your emails and calls. 

http://www.diabetesdaily.com/

Graham