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Old 03-14-2012, 11:40 AM   #1
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The Diabetes Solution, 2011 edition, by Dr. Richard Bernstein

I finally got my own copy of The Diabetes Solution, and am happily writing notes, questions, and remarks in it.

Dr. Bernstein addresses some things that are new to this edition that are useful to low carbers who are not diabetic (as well, of course, many life-saving things for diabetics).

I'll bring my copy with me, when I use the internet sometimes, and post things of particular note.

If you have $20 to spend on a book, and wish to have a book that explains what food is and what it does after you've swallowed it, and how LC could save your life, this one is a great choice.

Dr. Bernstein explains what protein, fat, and carbohydrates are, and what they do in the body, in language that is very easy to understand. He explains very specifically the relationship between types of food, blood sugar levels, insulin and how those can be normalized.

To me, Dr. Bernstein is a genius. His own history of being a Type 1 diabetic, and discovering how to eat, and for him, how to use what kind of insulin, and how much, how often, so that a type 1 can have normal blood sugars, and prevent the disastrous consequences of high blood sugars, is brilliant. He explains how a Type 2 can achieve this, or anyone with "pre-diabetes", etc.

He explains the differences between Type 1 and Type 2, and how to eat and use insulin, or medicines such as Metformin, or supplements. I don't have diabetes, so can't post about how his way of using insulin or medicines is different from other approaches.

His diet recommendations are to eat very low carbohydrate. He recommends 6 grams of CHO at breakfast, and 12 each for lunch and for supper. He says that one can eat less CHO, if one wishes, and that no CHO at breakfast is necessary. He recommends eating the same amount of CHO and PRO from breakfast to breakfast, lunch to lunch, etc,. from day to day.

I follow this and find it a stable way to eat.

The crux is low carb and progressive, graded exercise. The progressive exercise means exercise which is increased over weeks, months, or years. He gives examples, principles, and scientific explanations for how this exercise approach increases insulin sensitivity, and can greatly help normalize blood sugars, as well as other benefits.

He explains digestion, and metabolism in a plain, clear way. He explains how eating too much protein can raise blood sugars, and how eating too much altogether causes higher blood sugars (The Chinese Restaurant Effect). His explanations of what causes insulin resistance and what we can do about it are clear, easy to understand, and, IMO immensely helpful.

He also addresses diagnosis, tests, symptoms, supplies, etc.

If you want to understand exactly how eating LC stabilizes blood sugar, insulin, and improves health, I highly recommend this book.

It is a super reference and resource, even for those who are not diabetic.

Here is one, short excerpt from his website on The Law of Small Numbers. This does not cover the subject, but gives an example of his approach:

Obeying the Laws of Small Numbers

Essential to "obeying" the laws of small numbers is to eat only small amounts of slow-acting carbohydrate when you eat carbohydrate, and no fast-acting carbohydrate. Even the slowest-acting carbohydrate can outpace injected or phase II insulin if consumed in greater amounts than recommended.

If you eat a small amount of slow-acting carbohydrate, you might get by with a very small postprandial blood sugar increase. If you double the amount of slow-acting carbohydrate, you'll double the potential increase in blood sugar (and remember that high blood sugar leads to even higher blood sugar). If you fill up on slow-acting carbohydrate, it will work as fast as a lesser amount of fast-acting carbohydrate, and if you feel stuffed, you'll compound it with the Chinese Restaurant Effect.

All of this not only points toward eating less carbohydrate, it also implies eating smaller meals 4 or 5 times a day rather than three large meals. If you're a Type II diabetic and require no medication, eating like this may work well for you. One difficulty with this sort of plan is its inconvenience, but some people don't mind and actually prefer to eat this way. I have one patient, a Type I diabetic who still makes some insulin. She eats a couple of bites of protein every 15 minutes and takes long-acting insulin. In a 16-hour day, that adds up to a lot of meals and a lot of clock-watching. This routine would drive a lot of people nuts, but it works for her. As long as she keeps up with her frequent little meals and covers the insulin, she's fine. If she misses a few "meals," there could be trouble.

The major problem with multiple small meals for Type 1 diabetics lies in the importance of correcting high or low blood sugars with insulin or glucose respectively, throughout the day. Since pre-meal regular or lispro insulins, even in small doses, continue to affect blood sugar for at least 5 hours, it is potentially dangerous to correct an elevated blood sugar with “fast acting” insulin before the prior dose has finished working. Thus meals should be spaced at least 5 hours apart if such corrections are to be made without risk. Such timing is impossible with multiple small meals.

For the Type II diabetic who doesn't need insulin injections, smaller meals throughout the day can be a very effective way of maintaining a constant level of blood sugar. Since this kind of diet would be tailored to work with a phase II insulin response, blood sugars should never go too high. It would, however, involve a certain amount of daily preparation and routinization that could be thrown off by changes in schedule—illness, travel, houseguests, and so forth. (People with gastroparesis, or delayed stomach-emptying, may have to eat this way. We will discuss this phenomenon in a future article.


I am so delighted with this book, that I wish I could just put the whole text here, and his charts, so you could be as delighted.

His focus on achieving normal blood sugars and maintaining normal blood sugars has given thousands the chance for a healthy, happy life. Thank you, Dr. Bernstein.



Much of the previous edition of The Diabetes Solution can be read at the site diabetes-book.

If you'd like to hear a lecture which Dr. Bernstein gave to the Nutrition and Metabolism Society in 2010, here is a .
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Best wishes for happy, healthy LCing.

Last edited by Auntie Em; 03-14-2012 at 11:53 AM..
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Old 03-15-2012, 08:19 AM   #2
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Here are some things I find useful:

p. 100:

There are at least five causes of insulin resistance: inheritance, dehydration, infection, obesity, and high blood sugars. Insulin's ability to facilitate the transport of glucose from the blood into liver, muscle, fat, and other cells is impaired as blood sugar rises. This reduced effectiveness of insulin, known as insulin resistance, has been attributed to a phenomenon called postreceptor defects in glucose utilization.

p. 106:

Although insulin resistance can occur at many sites oalong the pathways involved in glucose metabolism, there appears to be a common factor causing defects at a variety of sites--inflammation. Inflammation results from the response of the immune system to intrusions such as infection. When a wound becomes infected, the pain, swelling, redness, warmth, and production of pus or fluids are all part of the immune response that aims to destroy the intruding organisms. Other causes of inflammation that can generate insulin resistance include mesenteric fat that covers the intestines (abdominal obesity), autoimmune disorders such as systemic lupus erythematosus, juvenile rheumatoid arthritis, and celiac disease. It is likely that even unlucky genetic inheritance can casue other, unknown inflammatory disorders.

...

I have seen reports of many studies where anti-inflammatory anti-oxidants have supposedly been successfully used to reduce insulin resistance, but I have never observed this firsthand. I do not object to experimentation, but I also do not expect dramatic results. Some of the treatments discussed include green tea and green tea extract, R-alpha lipoic acid (R-ALA), and sources of omega-3 fatty acids such as fish oil, flaxseed, and perilla oil.

p. 135:

If you become overweight, you'll produce more insulin, become more insulin-resistant, (while will require you to produce yet more insulin), and become even more overweight because you'll create more fat and store more fat. You'll enter the vicious circle depicted in Figure 1-1 (page 43).

p. 502:

I may also use some of the supplements recommended in Chapter 15 for the amelioration of insulin resistance...d-chiro-inositol.

pp. 251 and 252 on Insulin-mimetic agents, just a few bits from this section:

R-ALA, like high-dose Vitamin E, can impede glycosylation and glycation of proteins, both of which cause many diabetic complications when blood sugars are elevated.

R-ALA with equal amounts of Evening Primrose oil, with Biotin.... When I use R-ALA, I recommend two 100 mg. tablets every 8 hours or so, and with one 500mg capsule EPO.

.... Again, it's all trial and error. The same can be said for whether R-ALA will work at all. It appears to lower blood sugars for some people, but not for everyone.

Warning: Cancer cells can thrive on anti-oxidants. If you have a family or personal history of any form of cancer, it would be wise to steer clear of R-ALA and other antioxidants.
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Old 05-23-2012, 03:11 PM   #3
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AntieEm--Thank you so much for the review. Any more nuggets to share? I will be getting this new book. Next Amazon order I receive will have this in it. I have the older version, but love Dr B!!!! He is so wonderful to share this info with all of us, as are you! Thank you again!!!
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Old 05-25-2012, 05:49 AM   #4
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Dawn, thanks for your kind post. I don't have Dr. B's book with me, so no gems to post today. When you get your copy, please do post whatever you think might be of help to others, if you'd like to.

Best wishes to you.
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Old 05-26-2012, 08:02 PM   #5
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I'd like some educated opinions please. Results from my first ever A1C test was 5.7. Some opinions have that as prediabetes and some opinions have that as normal healthy as the range is 4-6. Thoughts?
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Old 05-28-2012, 08:05 AM   #6
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What does your doctor say?

I'm hypothyroid, and my endo does an A1C every 4 months when he checks my thyroid hormones because all my siblings are Type 2 diabetics.

My A1C ranges from 5.4 to 5.7 regularly (over the past 5 years), which I believe is high, considering the fact that I eat very low carb. However, my endo calls those numbers "ideal," and he has never used the term 'pre-diabetes.'

Nevertheless, he also believes that my WOE is what's keeping me from developing diabetes as my siblings have.

For my endo, over 6.0 is a cause for concern, but I've never been that high.
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Old 05-28-2012, 08:37 AM   #7
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Thank you!

I picked up my report when I ran late for my appt... so never saw him for the run down of the report.

The other thing I have discivered that is giving me pause - non fasting triglyceride levels. My tri's (thanks to the LC WOE) are 150, after being in the 200s for a long time, yet my non fasting tri's were 325 at 4pm. The reading I'm doing lately says the non fasting triglycerides are of more concern in regard to metabolic syndrome.

Sheesh

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Old 05-29-2012, 07:29 AM   #8
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I've never had non-fasting trigs checked because it's always done as part of a lipid panel, and that requires 12 hours of fasting.

Are you sure that non-fasting trigs are so significant? I ask because if they are, why don't doctors test that? Every trig test I've ever had has been fasting.
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Old 05-29-2012, 09:10 AM   #9
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Heck, I don't know - I just Googled the topic due to having read my report findings - and came to discover that there is an entire world of info on the topic. Perhaps that is something to make a note of when you see your Dr. I know I will when I reschedule an appt. Then again, some Drs are not all that up to date on LC etc. Mine is not.

Some info to get you started:

"The use of nonfasting levels of triglycerides in risk assessment provides several potential advantages to clinical practice. Much of the 24-hour day is spent in the nonfasting state, especially considering the fact that triglycerides may take up to 12 hours to return to fasting levels after a meal."

JAMA Network | JAMA: The Journal of the American Medical Association | Fasting Compared With Nonfasting Triglycerides and Risk of Cardiovascular Events in Women
///////////////////


"There is increasing interest in measuring triglycerides in people who have not fasted. The reason is that a non-fasting sample may be more representative of the “usual” circulating level of triglyceride since most of the day blood lipid levels reflect post-meal (post-prandial) levels rather than fasting levels. However, it is not yet certain how to interpret non-fasting levels for evaluating risk so at present there is no change in the current recommendations for fasting prior to tests for lipid levels."

Triglycerides: The Test
/////////////////////
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