What Is Dr. Bernstein's Diabetes Diet?

Dr. Bernstein's Diabetes Diet is a very low-carbohydrate diet designed to help people with diabetes achieve and maintain normal blood sugar levels and reverse and/or lower the risk of complications.

It is not a weight loss diet, although it's likely that anyone who follows it will shed some pounds.

The Bernstein diet is based on eating three meals a day, choosing from a list of "allowed" foods, steering clear of "forbidden" foods, and sticking with a prescribed amount of carbohydrates. There are no restrictions or guidelines regarding protein or fat intake.

Because it limits carbohydrates so dramatically, the Bernstein Diet differs from the dietary guidelines for diabetes promoted by major medical associations. For this reason, the diet is controversial.

Background

The Bernstein Diet has an interesting history. It was created by an engineer-turned-endocrinologist named Richard K. Bernstein, MD. He was diagnosed with type 1 diabetes in 1946 at the age of 12 and experienced serious complications of the disease for many years.

In 1969, before his career change, Bernstein purchased a blood glucose monitor, which at the time was used only in hospitals. He began testing his blood sugar throughout the day to try to figure out what factors would cause his levels to rise and fall.

Eventually, he discovered he could manage them with a combination of a low-carb diet, exercise, and smaller doses of insulin than he had been taking. What's more, many of the complications of his diabetes resolved.

In order to earn respect for his ideas from the medical community, Dr. Bernstein went to medical school and became an endocrinologist. Since then, he has written six books about his diet and overall approach to managing diabetes.

His first was "Dr. Bernstein's Diabetes Solution: The Complete Guide to Achieving Normal Blood Sugars," originally published in 1997 and updated in 2011 to include information on new technology (such as insulin pumps and continuous blood sugar monitors), medications (including inhaled insulin), and recipes.

Now in his 80s, Dr. Bernstein maintains a thriving medical practice and has a robust following of people with both type 1 and type 2 diabetes who have had success in maintaining normal blood sugar levels by following his diet.

How It Works

The Bernstein Diet limits the number of carbohydrates a person eats to 30 grams per day. To put this in perspective, on average, most people with diabetes get 45% of total calories from carbs, according to researchers.

For someone who eats 2,000 calories per day, that would be around 900 calories from carbs, which is 225 grams.

The Bernstein Diet has no rules or guidelines regarding protein, fats, or total calories.

In addition to the diet, Dr. Bernstein's protocol includes recommendations about taking supplemental insulin and engaging in exercise.

What to Eat

Dr. Bernstein divides foods into two categories based on the number of carbs they contain and how they affect glucose levels.

Foods known to cause a rapid rise in blood sugar are forbidden; foods that don't have this effect are allowed.

Meats and proteins: No meat, poultry, or other form of protein is off-limits, with the exception of any to which carbs have been added (e.g., bread crumbs in meatloaf, flour on fried chicken or fish).

Vegetables: Compliant veggies include asparagus, avocado, broccoli, Brussels sprouts, cabbage and sauerkraut, cauliflower, eggplant, onions (in small amounts), peppers (any color except yellow), mushrooms, spinach, string beans, summer squash, and zucchini.

Dairy: Yogurt is allowed, but only plain, unsweetened, full-fat varieties. For all types of cheese, count 1 gram of carbs per ounce. Although cottage cheese is generally regarded as non-compliant, some people may be able to eat up to 2 tablespoons without causing a blood sugar spike.

Nuts: Although nuts do contain carbs, Dr. Bernstein says they tend to raise blood sugar levels slowly. However, because it can be hard to eat just a few nuts, it's important when following the diet to look up the number of carbs in a serving of any type of nuts to avoid going overboard. Peanut butter, even unsweetened, may raise blood sugar levels. For some people, a tablespoon can be too much.

Artificial sweeteners: Those allowed include saccharin tablets or liquid (Sweet’n Low); aspartame tablets (Equal, NutraSweet); acesulfame-K (Sunette, The Sweet One); stevia (powder or liquid); sucralose tablets (Splenda); and neotame.

Alcoholic beverages: One and a half ounces of distilled spirits or one can of beer tend to have negligible effects on blood sugar levels. Spirits should not be combined with sugar-sweetened mixers.

Recommended Timing

The Dr. Bernstein Diabetes Diet limits the total number of carbohydrates eaten over the course of the day to 30 grams. The recommended breakdown is as follows:

• Breakfast: 6 grams
• Lunch: 12 grams
• Dinner: 12 grams

There are no built-in between-meal snacks, nor are there guidelines regarding the timing of meals.

Recommended Products

The food lists published in Dr. Bernstein's books include a number of brand-name foods that are considered compliant with the diet, including:

• WestSoy Organic Unsweetened Soymilk
• G/G Scandinavian Fiber Crispbread
• Wasa Fiber Rye
• DaVinci Gourmet Sugar Free Syrups
• Ready-to-Eat Sugar-free Jell-O Brand Gelatin

Pros and Cons

It is important to remember that Dr. Bernstein's diet is not a weight-loss diet but one intended to lower blood sugar. The diet also cannot be considered "low-calorie" given that there is no restriction to the amount of protein or fat you can eat (much like the Carnivore Diet based on the consumption of meat and dairy only).

As with the Carnivore Diet, the Bernstein diet can lead to significant weight loss but carries many of the same health concerns.

Here is a look at the some of the benefits and drawbacks:

Pros

Because the lists of foods that are allowed and not allowed on Dr. Bernstein's diet are so thorough and specific, following it requires very little guesswork.

What's more, there are at least as many "allowed" foods as there are "forbidden" ones, as well as plenty of variety to prevent boredom and promote well-rounded nutrition.

The diet also is, by default, low in calories. For most people, it can lead to weight loss in addition to normalized blood sugar levels. This may be especially important to people with type 2 diabetes for whom even a modest amount of weight loss can lower the risk of complications such as heart disease and high blood pressure.

There's evidence a low-carb diet might be effective for normalizing blood sugar levels and reducing the risk of complications from diabetes.

In a Duke University study, for example, researchers found that people who were obese and ate 20 grams of carbs or less per day (10 grams fewer than the Bernstein limit) for six months had better blood sugar control and more effective weight loss than participants who followed a low-glycemic/reduced-calorie diet.

Cons

The diet limits daily carbs to 30 grams, and specific amounts are allowed for each of your three meals, which can be limiting and require planning.

Between-meal snacks do not appear to be factored into the basic diet. This could feel highly restrictive for people accustomed to eating more carbs.

Despite the long list of approved foods, it's likely that at least some of the non-compliant ones will be favorites. This could make the diet feel restrictive for some people.

Perhaps the most important strike against the Bernstein Diet is that it goes against the recommendations of major medical organizations, including the American Medical Association, the Academy of Nutrition and Dietetics, the American Diabetes Association, and the American Heart Association.

It also conflicts with recommendations set by the U. S. Department of Agriculture (USDA) and the Physicians Committee for Responsible Medicine.

How It Compares to Guidelines

The most significant way in which it differs from standard medical guidelines is that it emphasizes dramatically limiting carbohydrates to 30 grams per day.

The ADA acknowledges that "monitoring carbohydrate intake and considering the blood glucose response to dietary carbohydrate are key for improving postprandial glucose management." However, the organization's Standards of Medical Care in Diabetes stop short of quantifying how many grams of carbs should be eaten each day. Their stance is that the intake of macronutrients should be based on an individual's situation.

The Bernstein Diet also takes a different view of dietary protein than most medical guidelines do. Whereas limiting protein has been a mainstay of classic diabetes nutritional advice, Dr. Bernstein sees no reason to limit protein intake.

Likewise, Dr. Bernstein diverges from the standard thinking that a diet high in fat is unhealthy and the primary cause of obesity. His diet does not impose limits on protein or fat.

A Word From Verywell

There is no question that diet plays a key role in the management of diabetes—particularly type 2 diabetes, which sometimes can be headed off or reversed with lifestyle changes.

Dr. Bernstein's Diabetes Diet aims to do this with a protocol that differs largely from conventional guidelines. If you have diabetes and would like to try it, it's imperative that you speak with your healthcare provider and/or a dietitian who specializes in diabetes first.