Three Days with Pioneering Diabetes Physician Richard K. Bernstein

Dr. Richard K. Bernstein, MD, is a world-renowned advocate for diabetes patients and the author of several books on the subject, including his bestselling The Diabetes Solution. After developing type 1 diabetes at age 12, Dr. Bernstein spent the next 20 years following the standard dietary recommendation for high-carb meals, which he found—and later proved—to be a roller coaster for blood sugars with serious consequences.

 

Suffering from many complications of the disease, years later, Dr. Bernstein managed to acquire a blood sugar monitor. (This was the 1960s when blood sugar was tested only by doctors in hospital laboratories.) He soon discovered that by reducing his carbohydrate intake and using an appropriate amount of insulin, he could achieve and maintain non-diabetic blood sugars. Thus, he was able to reduce or reverse most of his diabetes-associated health complications.

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Unable to publish his findings as a layperson, Richard Bernstein made a big decision: In his words, “I couldn’t beat ’em, so I had to join ’em.” At age 45, more than 30 years after his original diagnosis of type 1, he enrolled in medical school. Today, decades later, he maintains an A1C level in the 4s. And so do his patients.

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Following Dr. Bernstein’s Methods

The Diabetes Solution changed my health and therefore my life. I too have had A1c levels in the 4s for years, which are in the normal, non-diabetic range—a shock to most people whose physicians advocate a much higher range. Consistent A1C levels like mine are impossible to achieve following the ADA’s “healthy” nutrition guidelines.  Frustrated by the numerous doctors who were uncomfortable with the healthy numbers I achieved with Dr. Bernstein’s method, I, too, was inspired to enter the healthcare field.  Since my medical school was just 45 minutes away from Dr. Bernstein’s office, I reached out to his office to see if he would allow me to observe him at work. I was ecstatic when he said yes.

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Shadowing Dr. Bernstein

Waiting to meet Dr. Bernstein, I saw that his office walls were covered with his paintings and photographs along with countless awards and recognitions. His bookshelf, which I later learned was his “pleasure reading,” had books on string theory, quantum physics, and advanced mathematics, among other challenging subjects. Clearly, I was about to shadow a brilliant man.

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Dr. Bernstein asks new patients to see him every day for three days. This was and is unheard of. My own doctor appointments usually took place during very rushed ten-to-fifteen-minute windows. An amount of time, though standard, in which it’s impossible to understand a patient or to explain all the ins and outs of diabetes management.

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I was disappointed when the first new patient of Dr. Bernstein’s that I met had type 2 diabetes that unfortunately, by most people’s standards, was well controlled. His latest A1C was 5.4%, a number that would earn him a pat on the back from most endocrinologists. I also assumed he’d have no other health issues and that he was likely wasting his time and money visiting Dr. Bernstein. I couldn’t have been more wrong.

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Over the Next Three Days

On day one, Dr. Bernstein went over the patient's previous lab results and all aspects of his health. He also started the patient on diet and medication doses that he knew would facilitate normal blood glucose levels.

On day two, Dr. Bernstein explained to the patient in great detail how to manage his diabetes generally and under varying circumstances: when he traveled, exercised, and when he was sick both at home and in the hospital. I learned the terrible truth that most hospitals will automatically put a diabetic on a glucose drip, only to cause dangerously high hyperglycemia. Dr. Bernstein also asked his patient about how the previous evening and morning, following his new diet and medication recommendations, had gone for him, adjusting them appropriately.

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Dr. Bernstein and I ate our lunches at his desk. I was anxious to see exactly what Dr. Bernstein himself eats! That day Dr. Bernstein’s lunch consisted of salmon, cheese, and 19 pistachios, a very low-carb nut. He also had half a piece of low-carbohydrate bread. Followers of Dr. Bernstein’s method know that this meal would not raise anyone’s blood sugar. With correct insulin dosing, you could eat this meal and hover between 80-90 mg/dL during and after the meal without any spike.

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On day three of a new patient visit, Dr. Bernstein conducts a thorough physical exam, performing more than a dozen tests for neuropathies and other diabetic complications. At this point, I saw why understanding this new patient whose diabetes seemed “well-controlled” was so important. In nearly every test the patient underwent, he had mild to moderate symptoms—unexpected for someone with an A1c in the low 5s. Dr. Bernstein found problems with his eyes, his autonomic nervous system—which controls stomach emptying—with the arteries in his legs, as well as sensitivities in his extremities. Until then, I would have expected to see these symptoms in someone with an A1c of something like 6% or more. To have seen so many symptoms in this patient underscores the importance of maintaining normal, non-diabetic blood sugar (in the 80’s) and A1c levels (in the 4s).

Dr. Bernstein also used devices that very few, if any other physicians, used at the time. He looked into his patients’ eyes with a slit light machine, a machine normally used only by optometrists and ophthalmologists. Dr. Bernstein was the only diabetologist who used one. He also employed an oscillometer—common in doctors’ offices in Europe but not in the USA. Visually similar but unlike a blood pressure cuff, an oscillometer measures oscillations in the blood vessels. Dr. Bernstein measured sympathetic neuropathy by innervating the smooth muscles in the arteries of his patients’ legs. Nerves in this area die in neuropathy, which leads to calcification of the blood vessels. With “hands-on” doctoring having become so rare in the U.S., these tests, which should be conducted on all diabetics, rarely are.

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Inspiring My Own Practice

Dr. Bernstein remains the best professional in the world for diabetes care. Exceeding my expectations, his method should set the baseline standard for diabetes care. Ten years later, Dr. Bernstein is sharp and energetic, appearing far younger than his peers. I learned so much over the three days I spent with him, pouring over my twenty pages of notes for years, and incorporating his methods into my practice after I graduated. ALL persons with diabetes mellitus should read his book. If one wants a healthy, complication-free life, Dr. Bernstein more than points the way.

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Check out Dr. Bernstein’s website (link in Word doc went nowhere) and sign up for all his updates.

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Learn more about A1c, Dr. Richard K. Bernstein, insulin, low-carb diet, and neuropathy.

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