An Interview with Low-Carb Pioneer Dr. Richard Bernstein
Dr. Richard K. Bernstein is famous as a champion of strict low-carb eating, and a controversial figure whose very name often sparks debate. Whether you're a fan or not, there's no discounting the reality that this New York physician is a pioneer who's changed lives over the decades and made a historic impression in the diabetes community.
He's authored six books on his low-carb doctrine over the years, including The Diabetes Solution and The Diabetes Diet -- made all the more notable since he's a veteran type 1 himself, diagnosed more than seven decades ago.
We were thrilled to have the opportunity to speak with the legendary Dr. Bernstein in February 2018.
During our interview, he certainly reinforced his controversial mantras that ultra-low-carb is the only way, and that he firmly believes in a decades-long "carbist conspiracy" by the professional medical establishment that is actually leading to complications and killing people with diabetes.
We're not endorsing those beliefs, but find Dr. B to be a fascinating character in the D-world. Please enjoy our lengthy interview with him today, and decide for yourself where you stand on his claims.
DM) Thanks for taking the time, Dr. B! First, can you tell us a bit about living with diabetes yourself for so long?
RB) I am 83 now, and was diagnosed at 12 years old in 1946. A couple of years ago, I marked my 70th diabetes anniversary. It was incredible. But I really enjoyed last year, on my birthday. Because I advocate for a target blood sugar of 83 mg/dL, people in the community who are part of a low-carb group called Type One Grit put together a video and sent it to me as a birthday present. There were more than 100 people, kids and adults from all over the world, briefly thanking me for what my book and advice has done for their lives. It lasted more than an hour, and it’s a very touching thing and I couldn’t have had a better present.
You’ve seen quite a bit of diabetes change over the years, haven’t you…?
The biggest change I’ve seen is the one I helped bring, home glucose meters. Knowing your own blood sugar changed the game. It was a big battle that took 10 years to win.
In 1969, I got my first blood glucose meter. It was being sold to emergency rooms to distinguish between the drunks and the diabetics, if someone came in unconscious. The labs were closed at night and everyone went home, so that’s how they did it. I was able to get one of these, even though I was not a physician.
I was interested in avoiding hypoglycemia because, back then, you just didn’t know. I actually went down to 0 mg/dL when I first started measuring, and I could go from there to over 1,000 mg/dL three times a day. You can imagine how miserable I was and to other people around me. I knew I was doing this, and that’s why I got the meter.
About that time, I was building a gym in my home and wanted a tax deduction from it. I wanted to see if exercise would prevent the complications of type 1 diabetes.
In those days, you had to go fill out a form at the local academy of medicine and they’d send that to the Library of Congress, to do a search request for $75 on a list of articles that you think might be pertinent. I found that you could reverse complications in animals, but there was nothing for humans.
So, I tried to prove this and reverse my complications – kidney disease, gastroparesis, and some others. It worked.
One of the first things I learned was that low-carb was absolutely essential.
How did you first stumble across the idea of eating low-carb?
I saw that my highest blood sugars were right after lunch, with my favorite being a sandwich with peanut butter and mayo, on date-nut bread. My blood sugars would skyrocket.
I tried to take pre-prandial insulin, which no one was doing at the time. But it was all over the place even when I ate the same thing every day. When I cut way back on the carbs, I saw two flat slopes. I found I could make it work better with slow amounts of carbs and insulin -- it was all trial and error. I was an engineer and was good at these experiments.
These little experiments were from 1969 to 1973, and I remember that because we’d built a new wing on our house about the time I discovered this. I was sitting on the toilet in my house one night, and realized that I’d escaped a prison, there was no longer a sword hanging over my head.
I was walking around with normal blood sugars, no more hypos, and wondered how I could spread the word about having a better mousetrap.
I wanted to tell the doctors so they could make use of it. Of course, it was ridiculed and the American Diabetes Association rejected my idea of self-monitoring of blood sugar, for over 10 years. They said if patients could measure their own blood sugars, doctors would lose business because patients wouldn’t need to come to their offices anymore. It’s been a battle ever since.
Wow. Can you walk us through your definition of low-carb?
I invented the 6-6-12 Rule, where you eat no more than 24 grams of carbs per day -- six grams for breakfast, six for lunch, and twelve for dinner. You could say that Atkins came out about the same time, and it was about the same except that he pushed a bit more fat. In a sense, it’s sad because many people are going through gruesome lives because of the misinformation they’ve been given.
The literature shows damage to children’s brains from high blood sugars, and it’s false that your child won’t grow if they don’t get 137 grams of carb per day. You see almost every month in one of the journals at least, imaging studies of children’s brains when they’re exposed to higher blood sugars caused by high-carb.
There is one basic rule: the whole family should be on it. What I also see is that people who gradually try to reduce their carbohydrates never end up on a low-carb diet. I do not think you should come into this delicately.
And you’ve lived this yourself, keeping strict low-carb to achieve lower blood sugars?
I work to keep my blood sugar at 83, plus or minus 10 points, and we’re are just starting to look at Afrezza inhaled insulin as an option in my practice. They are sending me samples and I’ll try that on myself as an experiment, before giving it to my patients. I was one of the first patients to use Tresiba (basal insulin from Novo), and I use that twice a day.
There have been several studies of general populations – not those with diabetes – but hundreds of thousands of people, at what blood sugar leads to the lowest mortality. It appears that the lowest is about 83 mg/dL, so I say those with diabetes are entitled to have the same lifespan of those non-diabetics. But the powers that be are very much against (recommending such low BG targets).
Are you still actively maintaining your endo practice?
I’m practicing three days a week, and the fourth day is for catching up on chores and other errands. Every night, I work for three nights going through journals and paperwork. New patients come in three days in a row, for history physical and training. We get their labs before I see them.
Can you tell us about your Ask Dr. Bernstein webcasts and your Dr. Bernstein’s Diabetes University?
I do a webcast once a month. About a year ago, we merged the two – the Ask Dr. Bernstein webcast that’s audio, and then we take the questions and put them on the Diabetes University in video format. We’ve been doing that for about five years now. There’s an excess of more than 100 videos online, and another 100 in reserve waiting to be edited. They are broken into small segments so no one has to watch a single video for an hour. We don’t want people getting bored. If you go through the list, it gives people a chance to watch me age.
What have you been up to personally of late?
My wife passed away about two years ago, so I’m on the market… (chuckles).
I’ve sort of rebuilt the house in this time, while working at the same time. I work out more than five hours a week going to the gym, and I recently purchased an elliptical machine to use at home because I couldn’t get my heart rate high enough on my bike. The circulation to my lower extremities is so good that my heart rate wouldn’t go up, so had to get the arms into the act. If I do both my arms and legs simultaneously, I can get my heart rate above 160 – my theoretical maximum is 150, and I’ve always maintained that keeping yourself in good shape is getting your heart rate above your theoretical maximum twice a week.
Ever since my wife died, I do use a CGM. She was my CGM before. If I had a cold sweat or erratic breathing, she’d say ‘Check your blood sugar.’
You've always been very adamant that the medical community has wrongful views on low-carb eating and diabetes management overall. Can you expand on that?
It’s sad that the big shots in charge of deciding how we go about the treatment of this disease aren’t on the side of the patients.
It’s for two reasons:
- They just don’t know how to treat diabetes. They’d have to read my book, but doctors don’t have time to read because the hours they put in are gruesome and they have to see many patients in the day to barely earn a living.
- What someone who’s involved in writing the guidelines says is this: ‘If I, as a doctor, have 3,000 patients and they all suffer from complications… that’s a consequence of the disease. If one person out of 3,000 dies from hypoglycemia, I can get sued. And I don’t need to get sued, so I pursue blood sugars that are two or three times what’s normal as a target and that gives you an A1C of 6.5-7%.’
Everything is stacked up against the patient.
C’mon Dr. Bernstein, is that fair?
Well, a little bit has changed. Now they’re down on sugar-sweetened beverages. But they advocate fruit, orange juice, whole-grain breads, and several doses of that per day. They’re still trying to kill people, even if it’s not deliberate.
Remember the article a year and a half ago in the JAMA journal, reporting that going back to the 1960s, the sugar industry and sweet food makers were bribing investigators, institutions and organizations to put the blame on fats instead of carbohydrates? That made headlines in the New York Times, and then everyone forgot about it.
The ADA is still pushing high-carbohydrate eating, with the organization receiving a half-million-dollar grant from Domino’s Sugar and that the preferred sweetener for diabetics is half Domino’s Sugar and half Stevia.
You clearly believe that extreme low carb eating is the answer...
Yes, when you let people eat this way and you see the results, they learn that it works right away. They can experiment on themselves, with a blood sugar meter. Those people come around very readily. Those people who have to believe one guy versus another guy, in all likelihood are going to believe the guy with a bigger voice – such as an institution that backs thousands of doctors. For example, there’s a conspiracy brewing in March on the Dr. Oz Show with the American Heart Association and American Diabetes Association, pushing the high-carb diet they all advocate. People will listen to that.
It’s very clear in my experience that there is a carbist-conspiracy, and that carb consumption is the main culprit in the treatment of diabetes these days. It’s also a reason for the obesity epidemic today. Our ancestors did not evolve by consuming high carbohydrate foods like these, and prehistoric times before agriculture, these foods didn’t exist.
A conspiracy, really? Haven’t we seen low-carb becoming more and more popular?
There are clusters of knowledge out there. Yes, there is a group of 21,000 people with type 1 in the United Kingdom that follow a low-carb diet. I don’t know any of them, but I’m told most of them are using my book.
Of course, there are several thousands of the Type One Grit people on Facebook. They post pictures of their CGM graphs and these straight, horizontal lines for the world to see on the Internet. There are clusters here and there of people successfully following low-carb diets, and my basal-bolus insulin dosing has pretty much become standard for this community.
But to me, it’s too little.
I write about it in my books and advocate. I’m not overjoyed, and I put a lot of work into this when I could be off singing, painting, traveling and doing photography with my interest in eclipses. I don’t have time for any of that, because I’m too busy battling the people with the voice and the money.
What about gluten — any thoughts there?
Well, the foods that are often high in gluten are also high in carbohydrates. Gluten is a protein and comes in grains, so the two go hand-in-hand.
Now occasionally, you’ll find someone who is actually a diabetic and has celiac disease. I usually have one or two patients at a time, but it’s not a majority by any means.
Do you have any thoughts about next-generation technology like closed-loop systems?
These devices are based on algorithms that allow for high carbs and high doses of insulin, in order to work. People are not remotely doing as well as they can on those, when they switch to my system (of low carb eating).
It becomes easier if someone is using both – a closed-loop and low-carb. But then you don’t need it, because it’s so easy to do on your own without the technology.
What else do you want to say to the D-Community?
If anyone’s interested in hearing me sing, stay tuned for the next teleseminar in mid-February.
It happens that a guy from Spain was told by his doctor that he couldn’t go on a low-carb diet because he could get ketoacidosis. I replied that ketoacidosis is caused by high blood sugars and dehydration, not from a low-carb diet. But things might be different in Spain…
According to Mozart, at the beginning of the Don Giovanni opera, (the character) La Scala) tells of his exploits around the world and says, “In Spagna, son gia mille e tre” – which must means that in Spain, they want your blood sugars to be 1003. (chuckles)
Thanks for taking the time, Dr. Bernstein! We appreciate all you've done, even if we aren't as ultra-low-carb as you are. Clearly, to each their own, in finding a path to diabetes management that works best for them.
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UPDATE: It was a shame to hear about Dr. Bernstein's passing in April 2025. He was 90 years old. You can read his family obituary here.
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This article was originally published on DiabetesMine.
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