If you missed, it, Dr. Richard K. Bernstein had a special request for all of us and we posted the audio and transcript here earlier this week in Part 1, along with our plea to the diabetes community.
Dr. Bernstein's been fighting for a long time, for all of us.
Now, it's our turn to spread the word of Dr. B's methods, and the control and empowerment it brings to our lives.
Since our full interview is nearly and hour in length with a 4700+ word transcript (Dr. B likes to tell stories), we've decided to split the interview into segments by subject. This way, we can address certain topics of interest without having to read/listen to the interview in its entirety.
The first interview segment here discusses:
- Intro/Dr. Bernstein's history
- How Dr. B first experimented with his health to discover low carb eating
- Stress relief and what Dr. B personally practices
- Beta Blockers for people with task-specific/performance stress
- The basics and benefits of EMDR
Click below to listen to the interview and/or read the full transcript below.
Lisa: Hello, my name is Lisa La Nasa from diaVerge Diabetes. I'm joined today by Dr. Richard K. Bernstein, diabetes expert and best selling author of Dr. Bernstein's Diabetes Solution book.
Now, as just a little bit of history, for those who don't know: Dr. Bernstein was diagnosed with type 1 diabetes at the age of 12 in 1946. Dr. Bernstein originally trained as an engineer and became the first person to privately own a blood glucose monitor and begin testing his own blood glucose levels in 1969. Through much trial an error, as well as research, Dr. Bernstein discovered the connection between normalized blood sugar levels and reduced & reversed complications, and that eating a diet low in carbohydrates will achieve these results. Dr. Bernstein went to medical school in his mid-40s and opened a private medical practice in 1983 in New York state.
Dr. Bernstein, thank you for taking the time to speak with us today.
Dr. Bernstein: Good to be with you, Lisa.
Lisa: Thank you. Starting to ask some questions: Dr. Bernstein, in 1972, you discovered the research that normalized blood glucose levels could prevent and indeed reverse complications in animals and you started to experiment on yourself.
Dr. Bernstein: Well, I started experimenting on myself before that because of severe hypoglycemia... not the severe that is loss of consciousness, only occurred once when I was 16 and I chipped a tooth and for 30 years, I had this... I looked like Dracula and my wife said, "You can straighten out your diabetes, why don't you fix your tooth!" So I had it bonded....
But I was always getting into trouble. I would antagonize my bosses when I was an employee because I was smarter than they were and if I disagreed with something they said or something they wanted us to do, ordinarily I'd be reasonable and I'd give in if they insisted. But if my blood sugar was low I'd yell at them. And they figured I was intermittently crazy and I didn't even realize that when I was yelling at them, I was hypoglycemic, I had no blood sugar meter, no idea what the blood sugars were. And on top of that, it was hard for my family. If my wife thought I was low and tried to give me a glass of orange juice, I'd throw it in her face. And when I tell this story to patients, their wives tell me the same story.
So my main goal was to prevent the hypoglycemia and I saw this ad in a trade journal for those in the medical equipment business, something to distinguish the drunks from... the unconscious drunks from the unconscious diabetics at night when the labs were closed. This was for the emergency rooms. And it was being sold to emergency rooms. And I said that's what I need; know when I'm hypoglycemic and maybe I can do something about it.
And then I started trying to calibrate myself. How much would one gram of glucose raise my blood sugar, how much would one unit of insulin lower it and so on. And I ended up by doing this with what's now called basal-bolus insulin dosing, which didn't exist then. Back then it was one shot a day of long acting insulin. The avant-garde people would give 2 shots a day and it was only after I saw these articles about reversing... I had severe kidney disease and I read about kidney disease in animals being reversed with normal blood sugars... and my doctor was president of the ADA was against this. He said "You're not a rodent" etc. and I nevertheless set about trying to normalize the blood sugars. Then I discovered there's no way to do it on a high carbohydrate diet.
Not only that, it's wasn't just a low carb diet, but it was a diet that varied from day to day that didn't work. You had to be eating the same thing every day. You work out the amount of insulin for a meal and that's what you stick with. Now you get tired of that meal, okay, you're gonna have to experiment and come up with a new dose of insulin for the same meal, so those are the major discoveries.
Lisa: Now can I ask was that a gradual realization or was it kind of an "aha"moment, that the.....
Dr. Bernstein: The carbohydrate effect was an "aha" moment because at that time, the guys at the greasy-spoon next to my office would talk to me, the crazy guy, they named my lunch... after me. I would have peanut butter-mayo-tuna-on-datenut-bread. It tasted great!
Lisa: That's an interesting combination!
Dr. Bernstein: And that was the Bernstein sandwich. And I noticed that my worse blood sugars were after lunch. So, I said to myself, well would... let's see what would happen if I cut out the carbohydrate and just had the tuna. And whammo! I was able to control my blood sugars after lunch. So right away, I applied that to all the meals and that was the eye-opener. So, it was pretty sudden.
Lisa: Okay. That's something that I... you talked about the kind of Eureka moment when you discovered the research saying that complications could be prevented and reversed in animals but yes, I was wondering about how that happened as far as the carbohydrates.
Dr. Bernstein: One might ask, how did I stumble on the research? Why did I do the research? My father thought ... there was a tennis pro named Billy Talbert, a world champion, Type 1 diabetic. He as it turned out, he ended up going blind in his 50s and probably died in his late 50s. But at that time, he was younger and everyone thought he was without complications, so my father thought maybe if you do exercise, it'll prevent the complications. So, I went to the gym, started doing exercise and I felt a lot better with the exercise and I ended up... oh, my work. I used to take my lunch hour and go to the gym during my lunch hour, then eat while I was working, but things got so busy I couldn't take off, so I built a gym in my house, and I did a search on the complications of diabetes. How do you do that? Go to the academy of medicine, shell out 75 bucks, write down the subject you want them to search. They did that and they came up with only two, only a couple of things that were of interest. French conductors on buses had less diabetes than those who drove the buses, because of getting exercise. The other thing was that exercise lowered serum triglycerides. The third thing was that diabetic kidney disease had been reversed in mice, or rats, with normal blood sugars. And that was, that was what turned me on, over and above avoiding the hypoglycemia.
Lisa: Using that, what you were talking about with the conductor vs the driver and the benefits of exercise, I know a lot of people in the GRIT group as well as people who follow low carb are also followers of your recommendations of strenuous exercise, not only for blood glucose control but stress release and a variety of reasons. Now, in a 2014 interview with Adrian Bye, you discussed stress and you shared a quote by Elliot Joslin. Would you share that now again?
It's one of my favorites.
Dr. Bernstein: He was quite a character. He was very smart and colorful and his son would come around with him on rounds, and he treated his son like he was an idiot. Very unfair. The son later on became a top guy in the organization after Elliot died. Anyway, he would hold these classes, and I went to his classes for the several days I was there. And I only remember one thing. He said, "Don't run a block for a bus, If you're going to run for a bus, run a mile." Because you're going to produce stress hormones that are going to raise your blood sugar if you're diabetic and you don't want that. Where as if you run a mile, the exercise will offset the blood sugar effect of the stress hormones.
Lisa: I'm very interested in stress and how that will effect our blood glucose levels. And I'm a firm believer in using exercise, breathing techniques, yoga, meditation, things like that to reduce stress, but sometimes it's unavoidable. What do you personally practice?
Dr. Bernstein: We have tricks... Well, I'll tell you my experience with the kind of stress that affects blood sugar. Overall I'm a pretty relaxed person and I don't... I have to be really put under big prongs to feel stress. But when I first was interviewed for my book on the radio, by blood sugar would go up by about 100. And after a while I got used to being interviewed on the radio and it no longer went up. Then television came along and I got interviewed on television and I would check my blood sugar in the so-called green room or whatever it was and see what it was, and then when I got finished and went behind the lights, I checked my blood sugar again and it would be up by 100. After a few television appearances that stopped happening.
I have patients who tell me of similar experiences that keep happening. For example kids who are on teams, have team sports. And they usually do okay for an in-house game, but if it's a competitive game with another school, their blood sugar levels go sky high.
Lisa: That's an interesting differentiation there.
Dr. Bernstein: And I have patients who are teachers. And some of these teachers, their blood sugars go up when they teach, especially if it's a college class. And patients who are performers, their blood sugars go up when they preform. And you'd think they'd get used to preforming but I've seen interviews with opera singers, and they're always nervous when they preform, so what do we do about this? I give them a beta blocker. A rapid-acting beta blocker. It doesn't make them feel badly, or better, but it stops the blood sugar rise.
Lisa: And they use that only at those specific times.
Dr. Bernstein: And it works for a few hours and it's very easy and you don't have to learn meditation, etc, etc. My relaxation is singing and even if I'm all alone, I'll rehearse the pieces that I'm working on. I'll sit... we have a terrace upstairs and I like to sit in the sun if we have sun and I'll rehearse songs.
Lisa: That's wonderful. Do you preform?
Dr. Bernstein: Well, I'm waiting to get good enough. When I think I'm good enough, we'll do some videos.
Lisa: Somewhat related to this and the idea of stress, in chapter 13 of the Diabetes Solution, you discuss Dr. Spiegel's technique of self-hypnosis to help control overeating. Is this something that could also be applicable to stress relief?
Dr. Bernstein: It could probably be applicable to a lot of things and I'll go into another approach in a minute. The problem for autohypnosis for eating, well first of all, not everyone is hypnotizable. Probably I guess 60% of the population so you're leaving out maybe 40% of the population, then what I found was that it worked for the overeating, but you have to do it at least 10x a day, including before meals and if you don't do it 10x a day, it's not going to work. If you do it 10x a day for a year, you change the wiring of your brain and you just lose the cravings, but most people got tired of doing it and stopped. So int he long pull, it did no benefit. We're of late finding a lot of benefit from EMDR and we've talked about it I think on one or more of these videos and it's quite amazing.
Lisa: Can you describe for just a moment what EMDR is?
Dr. Bernstein: Oh, you don't know what EMDR is?
Lisa: I want to hear it from you.
Dr. Bernstein: Okay, It sounds like magic. It was devised by a female colonel in one of the armed services during, during the I believe it was the Vietnam war for treating Post Traumatic Stress Disorder and it involves looking at, in her case, it was a stick with a red ball on it that you follow with your eyes while you answer questions and now they have moving lights and all kinds of mechanical devices and whatnot. And it was suggested to me by my daughter who is a clinical psychologist who had not yet learned it but has read a lot about it, and new practitioners and whatnot so I asked my wife who is a professor of Psychiatry and wrote several textbooks, and I expected her to panic because she's really strict in her science, and she says, "This is the latest, hottest thing around and it seems to work better than anything else and faster for a lot of situations but in particular for stress" and what we see is a lot of people who have had childhood trauma that they don't even remember. A classic example of what happens during a session was a patient of mine in London, you can get this all over the world, I had him do this because he was overeating and he said the first session the therapist said "Why did you come?" He says, "Because I'm a type one diabetic, I'm overeating and it screws up my blood sugars." And he says, "Are you angry because you're a diabetic?" and he says "Very angry" and he suddenly gets a sharp pain in his side, and he asks him some more questions and the pain gets worse and worse and unbearable. And asks another question, the pain goes away and the pain goes away and he feels more relaxed than he's ever felt. Then some more questions start pain in the other side. Then I get these stories from the people who go through this that there's pain, there's sleepless nights after the session, or nightmares but over the long pull, first of all, lots of early material comes out. Things they didn't even know happened to them, or things they never thought of consciously, but when it comes out, now I remember it. And it in effect, relieves anxiety fear etc. probably more dramatically than anything else we have. the problem is finding a good therapist. Some therapists are outstanding and some therapists are mediocre or poor and I've had patients who had to switch therapists. Not only that, it's costly and in the New York metropolitan area, it may be around $175 an hour... 45 minutes I should say. But it's a very valuable tool.
Lisa: Excellent, and to continue discussing overeating, which I personally have challenges with and which a lot of people have challenges with, An A-Ha moment for me was when you've spoken of amylin deficiency and the origins of amylin in the body. This is something I had no idea about. I've seen many many endocrinologists. Nobody's ever mentioned amylin. Can you just talk about amylin in the body and what amylin's effect is?
Dr. Bernstein: Yes, I've done videos on this, but I can repeat it. It's a sequence of hormones and we only know part of the sequence. but what we know is very informative. When you eat anything that either contains a nutrient or volume and you're not diabetic, that volume could be pebbles, the intestines secrete a host of hormones, but the one that interests us is IGF-1 (insulin like growth factor-1 ). Wait, It's GLP-1 glucagon-like-protein-1 and GLP-1 gets secreted into the bloodstream and it tells the pancreas "Hey, there's food here, you better make insulin before this guys blood sugar goes up" so a normal body prevents a blood sugar increase. But human blood sugar is extremely potent. I don't know if you remember from my video how much one unit of true human insulin will lower your blood sugar...
Do you have any idea? I've never met a doctor who had any idea.
Lisa: Hmmm. One unit of true human insulin. I don't remember hearing that one. I remember hearing what your sensitivity
Dr. Bernstein: I'll tell you how we calculate it. I know from my experience that one unit of the true injectable human insulin, which is regular insulin will lower me by 60. but it's diluted 25-fold. So true human insuln, that humans secrete is 25x as potent [00:24:44] So what's 25x60 ... 10x 25 is 250 ... I think it's over 15...close to 2000. (gets calculator) 2x x 60 = 1500.
So one unit, it's almost invisible, it's so tiny...
Lisa: Yes, it's a droplet.
Dr. Bernstein: Will lower a human blood sugar my size by 1500. Someone twice my size, I weigh 110 lbs, will lower them onky by 750. But a kid, a quarter my size, it will lower them by 6000. SO there must be a mechanism to fine-tune this insulin or humanity would never have survived the first meal. So hoe do we fine-tune it? With another hormone called glucagon, that raises blood sugar. Glucagon is weaker than insulin. So you need a weaker substance for fine-tuning. Just like the old television sets that had a switch and then a dial that went round and around and around. That was the fine tuning dial, it had a lot of turns. Glucagon, you need a lot if it to fine tune a little bit of insulin and that way you get precision. Now, as it turns out, the native glucagon that's made by alpha cells is too potent for the fine-tuning, so we there's another hormone that the beta cells make. The beta cells make insulin, they also make insulin. Amylin reduces the potency of the glucagon. So lets say, hypothetically, glucagon is a tenth as potent as insulin, you make amylin, it's 100th as potent as insulin and now you can get good fine tuning of your blood sugar,
Lisa: But with type 1 diabetics that don't make insulin, we also don't make amylin.
That's correct, so the Type 1 diabetics are in big trouble, they could eat a handful of pebbles and their blood sugar would go sky high. [00:27:04] now amylin does other things. it slows stomach emptying, so if our ancestors downed a wooly mammoth and they think they're going to eat the whole thing before the guys on the next block spot it, they're wrong because their amylin stops them from eating the whole thing by slowing stomach emptying. Amylin is also a major satiety hormone. It makes you feel full. and without amylin, you're hungry, and that's one of the many reasons why many diabetics are chronically hungry. [00:27:44]
Now it's interesting that I was teaching this to my patients long before the GLP-1 Agonists because drugs on the market. And it's also interesting while the ADA is promoting this class of drugs because it lowers A1C slightly, from .1% to .3%, which is almost nothing, I use it for totally different purpose, to curbe hunger, to curb cravings.
If you're snacking between dinner and bedtime because you get a craving for carbohydrate, we give you a shot of a GLP-1 Agonist after dinner and it's working an hour or two later, you don't get the craving. And you don't snack before bedtime and wake up with a high blood sugar.
And I know, that's a problem for many people, or the time 3oçlock 4 oclock in the afternoon is a very dificult for people.
And I have one other trick that I can't talk about yet because we only have put three patients on it, we're experimenting with it, and if it works, I'll do a video on it.
Lisa: Wonderful, we can't wait to hear!
Dr. Bernstein: It'll be the easiest one of all.
The final part of Dr. Bernstein's interview, to be posted Friday of this week will be linked here. There we discuss Dr. B's family, their history of autoimmune disorders, what he sees as the largest problem facing diabetics my the medical community and how this low carb battle is not yet won.