Berstein and Adkins

[doctordun]

I just received the two books that Dr. Berstein wrote and it seems his diet doesn't vary too much from the Adkins Diet. Of course I've only begun reading them, but his recommendation of only 30 carbs a day is very close to the maintainence diet the Adkins diet recommends.
I found the Adkins diet very hard to maintain and, although I have more motivation now that I have diabetes, I fear this diet will be hard to maintain also.
Am I missing something?
I do believe that my dietician is wrong when she told me to eat 120 carbs a day, because that keeps my bg at 120 and up. According to Dr. Bernstein, I need to be shooting for under 100. I can do that if I have less than 20 carbs a day, but I suffer. I've never been a vegetable eater and besides meat and cheese, green veggies are about all I can consume. It's too bad that I dislike most of them.

[princesslinda]

I'm with you doctordun, i'm not a big fan of "green veggies" myself...green beans are now a staple at our house;) and I eat a LOT of salads.

I've read the Bernstein book, have actually done the recommended 6, 12, 12 carbs per day with excellent results. Unfortunately, for me, it was just too limiting, as i'm a picky eater and just wasn't getting enough food. There are many who continue to have excellent results with that way of eating, so it does work if you can stick with it.

When I saw the dietitian, she recommened 3-4 servings of carbs per meal...and I quickly realized I couldn't get the numbers I needed eating that amount.

If you test your blood sugars 2 hrs after eating, you'll find your carb tolerances and know which foods are best for you.

To me, eating by the results of my meter is easier than worrying about having "X" amount of carbs. After all, your blood sugar results are the true test of whether your way of eating is working for you or not.

[BlueSky]

.... I've never been a vegetable eater and besides meat and cheese, green veggies are about all I can consume. It's too bad that I dislike most of them.
I am familiar with the Bernstein approach, which makes very good sense. But I feel that his diet is too restrictive. Fortunately, it is is also possible to embrace the sound Bernstein principles and to compromise on the diet. ;)

You mention that you don't like the foods, which is fair enough. But bear in mind that your taste preferences have been created by the way you have been eating in the past. Your taste buds can be reprogrammed simply by changing your eating habits and sticking with the new food choices. Because of changes I made many years ago, I don't like the taste of potatoes, bread and sugar in my coffee anymore. :(

[doctordun]

I guess 60 years of meat, potatoes and gravy will kind of train your taste buds. I'm not looking forward to the retraining.

[xMenace]

Warning! Data Dump:

American Diabetes Association Annual Meeting, June 2003: Gastrointestinal and dietary aspects of diabetes -- Bloomgarden 26 (10): 2941 -- Diabetes Care (http://care.diabetesjournals.org/cgi/content/full/26/10/2941)

The role of protein in diet

Marion Franz, Mineapolis, Minnesota, introduced a symposium on the role of protein in diabetes, addressing issues of nutrition and metabolism. There is a great deal of research on one of the macronutrients, carbohydrate, but evidence is relatively limited addressing the roles of protein. Protein intake is remarkably consistent across all age-groups (16% of energy intake), amounting in general to 100–125 g in men and 80–100 g in women, levels approximately twice the recommended daily allowance (RDA) needed to replace body protein losses. In the U.K. Prospective Diabetes Study dietary recall, protein intake was 21% of total energy intake in subjects with type 2 diabetes, who consumed 1,800 and 1,400 kcal (men and women, respectively), suggesting that as energy intake is reduced, protein intake remains relatively constant. Over the past 90 years, protein intake has been remarkably consistent in the U.S. population, while carbohydrate and fat intake have been reciprocally related. One reason for the difficulty in changing protein intake is that there are very few foods solely containing protein, so that "cold cuts," for example, are mainly fat, with egg white and shrimp the foods highest in protein. Protein digestion begins in the stomach, is continued by pancreatic proteinases, with subsequent protein breakdown into di- and tripeptides and then absorption as amino acids across the intestinal mucosa, entering the portal vein, although glutamine, glutamate, and aspartate are used in part for fuel by gut mucosal cells. The nonessential amino acids are deaminated and their nitrogen converted to urea, with 50–70% of a typical protein meal used in this fashion for conversion into glucose. None of this glucose, however, appears in the general circulation, perhaps because the protein was slowly digested, the glucose was stored as glycogen in the liver, or the amount converted into glucose had not been accurately calculated. The effect of protein depends on the availability of insulin and on glycemic control. Adequate insulin is required for control of protein catabolism and gluconeogenesis.

Franz summarized the latest ADA recommendations pertaining to dietary protein. For individuals with controlled type 2 diabetes, and perhaps for those with type 1 diabetes, protein ingestion does not increase plasma glucose concentrations. With less than adequate glycemic control, protein requirements may exceed the recommended dietary allowance, although not exceeding usual dietary intake levels. For people with nephropathy, although there is somewhat less evidence, protein intake should be reduced to 0.8 g · kg body wt-1 · day-1, and for those with microalbuminuria, protein intake should be 0.8–1.0 g · kg body wt-1 · day-1; there is no evidence as to whether animal or plant sources of protein are preferable. If renal function is normal, there is no evidence as to the benefits of changing dietary protein intake. The long-term effects of diets high in protein and low in carbohydrates are unknown, although it appears that such diets do lead to weight loss and improvement in glycemia, although not necessarily to a greater extent than that with other diets. There is no evidence that protein slows carbohydrate absorption or that adding protein to food ingested for hypoglycemia or ingesting protein-containing foods at bedtime is helpful for the prevention of subsequent hypoglycemia, although these measures have typically been recommended for subjects with type 1 diabetes. Franz reviewed a study showing that for glucose levels >180 mg/dl, a bedtime snack is not required. For levels between 120 and 180 mg/dl, snacks with or without protein have similar effects, whereas with lower glucose levels, bedtime snacks are not only useful but necessary, again without particular evidence of a benefit from protein.

Errol Marliss, Montreal, Canada, discussed the implications of altered protein turnover in diabetes. Glucose production, related to the fall in insulin with rise or lack of change in glucagon, leading to gluconeogenesis, is accelerated under conditions of insulin deficiency. With exogenous amino acids and glucose, as seen after a meal, glucose production increases further in the insulin-deficient patient. There is not, however, evidence of abnormal protein metabolism in treated subjects with diabetes. This may be due to the focus on the fasted state of most existing research. Worse degrees of glycemic control are associated with various degrees of protein catabolism. Oral hypoglycemic agents and exogenous insulin increase protein synthesis and decrease protein catabolism. In studies of obese individuals, a low-energy high-protein diet tends to be associated with similar degrees of protein balance with and without diabetes. Marliss concluded that with hyperglycemia, dietary protein requirements may increase, and he recommended that individuals with diabetes avoid very-low-protein diets.

Mary Gannon, Minneapolis, Minnesota, reviewed the effects of dietary protein on circulating insulin and glucose concentrations. The amino acids that result from protein digestion have long been known to be available for gluconeogenesis, with 56 g glucose theoretically available to be produced for every 100 g meat protein ingested and the glucose-generating capacity of 100 g of various proteins ranging from 50 to 80 g. Glucose concentrations do not, however, change after ingestion of protein. This appears to be mainly due to the increase in insulin after protein ingestion. Gannon noted that when 50 g protein was given to control and type 2 diabetic subjects, there was no increase and a small decrease in glucose, respectively, in association with an increase in insulin levels, which occurred to a greater extent in people with diabetes. The integrated insulin response after protein ingestion is 28% of that after glucose ingestion in nondiabetic individuals, with the two additive, while the insulin response to protein is as great as that to glucose in subjects with type 2 diabetes and the response to glucose plus protein is greater than the sum of the individual responses. Studying a variety of protein sources given with dietary carbohydrate, cottage cheese, beef, turkey, gelatin, egg white, fish, and soy all stimulate insulin secretion to varying degrees. Increasing dietary protein from 15 to 30% for 5 weeks, approximately the half time of HbA1c, without changing calories or weight, was shown in 12 subjects with diabetes to not affect urine microalbumin or creatinine clearance, with a 38% decrease in integrated postprandial glucose levels and 0.8% decrease in HbA1c from baseline levels of 8%, an effect, Gannon noted, that is similar to that for oral hypoglycemic agents, suggesting a particular benefit of high dietary protein in subjects with diabetes.

Julie Eisenstein, Boston, Massachusetts, reviewed the relationship between dietary protein and weight loss. Although, she noted, epidemiologic studies suggest a positive correlation between dietary protein and weight gain, the popular conception is that dietary protein can be helpful in causing weight loss. "Calories are not the whole story here," she pointed out. Although the RDA is 0.8 g protein · kg body wt-1 · day-1, actual protein intake in the U.S. ranges from 10 to 35% of total energy, with adults in the U.S. typically consuming 50% more protein than the RDA. High-protein diets, she suggested, should be defined as 25% of dietary calories in weight maintenance and twice the RDA in weight loss, and very-high-protein diets should be defined as 35% of dietary calories and three times the RDA. Energy expenditure is comprised of the resting energy expenditure, typically 60–70% of the total, the thermic effect of eating, usually comprising 10–15% of energy, and physical activity, which is tremendously variable from one person to another. Proponents of high-protein diets suggest that protein decreases energy intake by decreasing hunger and/or increasing satiety and that energy expenditure may be increased with such diets.

There are a limited number of studies in this area of nutrition, and it is noteworthy that a high-protein calorie-restricted diet may actually not be high in protein, but instead may be low in other macronutrients. In short-term studies, a high-protein meal is associated with decreased subsequent food ingestion, suggesting suppression of hunger. Long-term studies, however, show equivocal evidence of decreased energy intake. An additional factor is that the thermic effect of feeding as a percent of energy intake appears to double after a protein meal compared with a fat or carbohydrate meal. Furthermore, the decrease in resting energy expenditure after weight loss may be lessened in individuals following a high-protein diet.

[xMenace]

"The ultimate question is, ‘Do high protein diets lead to greater weight loss?’" Analyzing nine earlier studies with similar calorie intake, Eisenstein stated that there was no evidence of difference in either weight loss or fat loss, which "discounts dietary protein having a major role." A more recent 6-month study of ad libitum high versus normal protein diet, however, showed lower calorie ingestion for those on the former diet. The two most studies appeared in the May issue of the New England Journal of Medicine. The first, which compared 25 vs. 12% protein diets for 6 months, showed a similar advantage in weight loss, with improvement in insulin sensitivity and fasting triglyceride levels (2). The second study instructed patients in the "Atkins diet" approach and showed greater weight loss at 6 months, although not at 12 months (3). Eisenstein concluded that in diets of similar calorie content, there is no evidence of benefit, but that with ad libitum diets, there is some evidence of benefit of high-protein approaches, although more data on long-term safety are needed.

Madelyn Wheeler, Indianapolis, Indiana, ended the symposium with a discussion of the relationship between dietary protein and early renal disease, addressing two questions, "Is protein amount or source a risk factor for the development of microalbumin?" and "Can protein amount or source be of benefit?" The highest quintile of protein intake is 19% or more of energy, which would be 1.3 g/kg protein in a 65 kg woman, while the average intake is 14–16% (1–1.1 g · kg-1 · day-1), of which 70% is of animal origin. Low levels of dietary protein are <12% of energy intake, or 0.8 g · kg-1 · day-1, which is the RDA for "good quality protein." A low-protein diet for a typical person ingesting 1,800 calories, therefore, includes 56 g protein/day. Some studies show a relationship between dietary protein and microalbuminuria (4), but other studies have not confirmed this relationship (5). It may be that high dietary protein intake is particularly associated with microalbuminuria in people with particularly high protein (>20% of energy) intake who have multiple risk factors such as both diabetes and hypertension (6).

Short-term studies have addressed the early phase of renal disease, with one study showing that high (1.5 vs. 0.5 g · kg-1 · day-1) dietary protein intake was associated with hyperfiltration (7), although another study of 1.45 vs. 0.76 g · kg-1 · day-1 protein showed no effect on the glomerular filtration rate (8). In a practical sense, studies have shown that it is very difficult to decrease protein intake to levels <1 g · kg-1 · day-1; therefore, it has been difficult to adequately compare long-term effects of different diets. In individuals with macroalbuminuria, there is only equivocal evidence of benefit. As far as the protein source, there is some evidence of benefit of a low-calorie soy protein diet (9), but the comparison of low-calorie plant protein with animal plus plant protein has shown no difference in albuminuria or glomerular filtration rate. One study suggested lesser levels of albuminuria with a diet containing protein derived from chicken than one using beef (7). Wheeler suggested that the interrelationships between various protein-containing foods may be important, as may be the "quality" of various proteins.

[doctordun]

Boy, all of that sailed right over my head. It sounds like, at the end of the day, protein neither help or hurts the symptoms of diabetes.

All I know is that if I stay with the proteins, my bg stays down and there is no such thing as good carbs.

[matingara]

i have said this before (and i will say it again). a salad can be improved out of sight by preparing a really high quality, home made salad dressing.

i also find that a small sprinkle of table salt on the salad before tossing also makes a huge difference.

i use Rick Stein's vinaigrette recipe and it is fabulous.

one key with these dressings is to use the best quality ingredients you can afford. funnily enough, the quality of the red wine vinegar you use makes the largest difference! cheap vinegar ruins a dressing!

regarding green beans, after i cook them (in the microwave) i toss them in salt and butter (REAL butter). this makes them so, so, so much better!

:)

-- Joel.

[BlueSky]

My view is that we should eat the amount of protein we feel comfortable eating. But that, as diabetics, we are better off getting our protein from animal sources (meat, fish, chicken, eggs etc) than getting it from high carb plant sources (bread, or anything else made with flour or grains). Four slices of bread contain the same amount of protein as a steak. But the steak contains no carbohydrate ;) .

[matingara]

My view is that we should eat the amount of protein we feel comfortable eating. But that, as diabetics, we are better off getting our protein from animal sources (meat, fish, chicken, eggs etc) than getting it from high carb plant sources (bread, or anything else made with flour or grains). Four slices of bread contain the same amount of protein as a steak. But the steak contains no carbohydrate ;) .

i agree. this type of high quality protein is also "self limiting" to some extent. in other words, you get to a point where you just do not want anymore - so you stop eating. (i suspect because of the fat content - not the protein???).

this does not happen as readily when you indulge in high carb food , in my experience.

-- Joel.

[princesslinda]

I LOVE making my own salad dressings. You're right, good vinegar is critical. I have a great red-wine vinaigarette dressing and its perfect with grilled chicken atop spinach or mixed greens with a handful of toasted almonds. I also enjoy a mix of field greens as opposed to plane old lettuce.

[mark-TN]

I do not think protein is even an issue. As mentioned, it is pretty much self regulating. Over all I probably eat less protein since starting Bernstein. If Bernstein is followed correctly a self determining amount of protein is consumes at each meal. This amount stays the same for each particular meal each day. Before doing Bernstein when I went out to eat I would order the largest steak on the menu and I would eat the whole thing. Now being on Bernstein I also order the largest steak on the menu, but I only eat a portion of it and take the remainder home to be eaten at subsequent meal(s). I’m more conscious of the amount I eat at each meal so subsequently I feel over all I eat less. I’m 6’0”, 172lbs, very active, and I eat less than 100g of protein a day. (In total I get about 80g of protein from my entrées during the day, and then I may get a few odd grams from plant sources in my meals also).

Mark

[soso]

wI have found the same thing as Mark... I probably eat less meat per meal now than I used to.. I don't measure, but I can see my portions are way smaller, I eat to appetite now...

Doctordun

have you tried mashed cauliflower (use cream cheese and drain it well before mashing... have your meat and pour your gravy over the cauli...it's a good sub... and that's what cutting carbs is about at first—bluesky is right, you will start to like things you previously didn't and vice versa... my advice, don't force it. Try a few different things, but make sure there is something you enjoy on every plate. Also, what about making good low carb cheese sauce to pour on broccoli or cauli or eggs and spinach.. if you pm your email to me I will send to a pdf of low carb recipes (about 300 of them) there are a couple of good low carb microwave breads in it, very quick and easy to make.

Don't worry, it does get better...

[Scrabblechick]

Oh, I HAVE to do the baby spring mix or a romaine mix for a salad. The iceberg just makes me go "BLAH!" I do a salad dressing of apple cider vinegar, olive oil and about 1/4 teaspoon of sugar. That's in the whole bottle, not per serving. LOL. That tiny bit of sugar takes the edge off the vinegar bite without running up my BG.

I admire those who have the discipline to stick to the Bernstein diet. I just don't, myself. I rarely eat as many carbs as my meal plan allows, but neither could I keep it to 30. But I do applaud those who can!

[jerryn]

Boy, all of that sailed right over my head. It sounds like, at the end of the day, protein neither help or hurts the symptoms of diabetes.

All I know is that if I stay with the proteins, my bg stays down and there is no such thing as good carbs.
I found high protein meals with some low carb veggies work for me. If I'm running +30 to +60 higher than usuall I will have just have hard boiled eggs for breakfast (with cayenne pepper on them) and 1 cup of coffee,no sugar.

maybe once / week I will consume more carbs in my meal, like a baked or mashed potatoe.

[mimianvy]

I'm really trying to loose my extra weight by not eating any starches (bread,rice,potatoes,pastas) and this seems to be what I need to keep my fasting BG in the 80-90's range. I have cut down my lantus from 20 to 15.

But this morning my fasting BG was 101, I was shocked! I haven't done anything different so I'm not quite sure what is going on.

I get my carbs from other veggies.

Mimi