Dr Richard Bernstein and 'Diabetes Solution'

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Type 1 diabetics have traditionally been advised to have a diet high in carbohydrates and to use their insulin injections to keep their blood sugars under control. However frequently blood sugar control is poor with large fluctuations and high HbA1c levels.

For some time now, especially following the publication of Dr Richard Bernstein’s book Diabetes Solution, there has been a small but rapidly growing Facebook group mainly comprising of parents of children with Type 1 diabetes called TypeOneGrit. These people use a low carb diet to improve control of blood glucose levels and to lower the required dose of insulin.

This week in the medical journal Pediatrics a study was published which looked at the blood sugar control of a group of people from the TypeOneGrit group – 316 in all of whom 130 were children. The study was not a randomized controlled trial, but rather an observational trial which is not as rigorous. The most striking finding of the new report was that HbA1C levels, on average, fell from 7.15 percent, in the diabetic range, to 5.67 percent, which is normal.

The New York Times article below gives a good summary of the paper here.

Richard Bernstein has an interesting story. He was diagnosed with type 1 diabetes in 1946 at the age of 12. In 1969, after following diabetes guidelines for more than twenty years, Richard had many of the debilitating complications of the disease. Sick and tired of being at the mercy of his disease, he obtained one of the early blood glucose meters. He discovered that he could normalize his blood glucose through diet, exercise and medication.

When the then-engineer Richard Bernstein tried to persuade the medical community that he had found the answer, the medical community roundly ignored him—even told him that it was impossible. So, in his mid-forties, he decided to leave his successful career in business and go to medical school.

He then wrote his book Diabetes Solution in 1997 and it has had a massive impact on thousands of diabetics around the word. Bernstein has now been living with his diabetes for 72 years, possibly longer than any diabetic in the world. He is still going strong.



The Science of Sugar

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Three international obesity experts, NHS Consultant Cardiologist Dr Aseem Malhotra, Professor Robert Lustig of the University of California San Francisco and Professor Grant Schofield, Auckland University of Technology have authored the most comprehensive up to date report on the science of sugar with an eight point plan that if implemented will result in a reversal in the epidemic of type 2 diabetes within 3 years.

The peer reviewed academic publication entitled “ The science against sugar, alone, is insufficient in tackling the obesity and type 2 diabetes crises —we must also overcome opposition from vested interests” published in the Journal of Insulin Resistance makes comparisons with tackling the obesity epidemic with taking on Big Tobacco.

“We should not wait decades to solve our current problems with sugar. It took 44 years from the 1950 publication of the first study to link smoking to lung cancer, to the attorney general of Mississippi suing Big Tobacco to recoup medical costs related to the disease. Big Tobacco sowed doubt that cigarettes were harmful, confused the public, persistently denied their effects, bought the loyalty of scientists, and gave ammunition to political allies” they write.

“Now, the science demonstrating sugar’s role in diet-related disease is incontrovertible, but science alone cannot curb the obesity and type 2 diabetes epidemics. Opposition from vested interests that profit from diminishing society’s health must be overcome.”

“As with tobacco, policy changes that target availability, affordability or acceptability (the Mexico sugar tax, for example) are overwhelmingly effective in curbing sugar consumption. But the sugar industry, their partners, and political allies utilise numerous instruments to deflect culpability and derail policy change. Some involve influencing science, and some influencing public opinion” they continue

The authors describe in detail and reference examples adopted by the sugar industry to deflect blame away from sugar’s role in obesity and type 2 diabetes which includes paying scientists, obfuscating scientific research, co-opting public health experts and influencing public opinion.

“For years, soft drink companies’ public relations machinery, have pushed the lack of physical activity as a cause of obesity, when there is evidence to reveal that although sedentary lifestyle contributes to chronic disease physical activity, impact is minimal at best and you cannot outrun a bad diet.

The experts provide an eight point public health intervention plan, all of which are evidence based to reduce population sugar consumption, and all of which were successful in curbing tobacco use which will start to show a decline in the prevalence of type 2 diabetes within 3 years if implemented.

1.   Education for the public should emphasise that there is no biological need or nutritional value of added sugar. Industry should be forced to label added and free sugars on food products in teaspoons rather than grams, which will make it easier to understand.

2.   There should be a complete ban of companies associated with sugary products from sponsoring sporting events. We encourage celebrities in the entertainment industry and sporting role models (as Indian cricketer Virat Kohli and American basketballer Steph Curry have already done) to publicly dissociate themselves from sugary product endorsement.

3.   We call for a ban on loss leading in supermarkets, and running end-of-aisle loss leading on sugary and junk foods and drinks.

4. Sugary drinks taxes should extend to sugary foods as well.

5.   We call for a complete ban of all sugary drink advertising (including fruit juice) on TV and internet demand services.

6. We recommend the discontinuing all governmental food subsidies, especially commodity crops such as sugar, which contribute to health detriments. These subsidies distort the market, and increase the costs of non-subsidised crops, making them unaffordable for many. No industry should be provided a subsidy for hurting people.

7.   Policy should prevent all dietetic organisations from accepting money or endorsing companies that market processed foods. If they do, they cannot be allowed to claim their dietary advice is independent.

8. We recommend splitting healthy eating and physical activity as separate and independent public health goals. We strongly recommend avoiding sedentary lifestyles through promotion of physical activity to prevent chronic disease for all ages and sizes, because “you can’t outrun a bad diet”. However, physical (in)activity is often conflated as an alternative solution to obesity on a simple energy in and out equation. The evidence for this approach is weak. This approach necessarily ignores the metabolic complexity and unnecessarily pitches two independently healthy behaviours against each other on just one poor health outcome (obesity). The issue of relieving the burden of nutrition-related disease needs to improve diet, not physical activity.

To read the full study please click here.

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