Wil Dubois

Hey, All -- if you've got questions about life with diabetes, then you've come to the right place! That would be our weekly diabetes advice column, Ask D'Mine, hosted by longtime type 1 and diabetes author Wil Dubois.

This week, Wil takes on a question about the wonders of food and those universally-questioned trends... you know, diets! Yep, they aren't all they're cracked up to be when it comes to diabetes meal-planning and carb-counting. Read on for Wil's take...

{Got your own questions? Email us at AskDMine@diabetesmine.com}

 

Lori, type 1 from California, writes: A year ago I took up rock climbing and was so inspired by the beauty of the desert and the thrill of climbing that I decided to get my diabetes under ‘perfect’ control. My A1C has been 6.2, but I have roller coaster spikes. So when I saw Dr. Bernstein’s nice flat lines I felt like, this is the way it has to be: I’ll do the diet, and everything else. Well, now I KNOW I cannot do this diet. I’ve been dizzy, weepy, anxious... and feeling the need to binge on carbs. I have friends who have taken his approach one step further and eat only meat, drink only water... and I have to say... they don’t worry about blood sugar anymore! Still, it’s just not for me. Do you have suggested reading to get a sense of how to find my way through the plethora of diets, advice etc... to find my own path? I just want as much stability as is reasonable and possible (living normal life)... and I’d like to not have early Alzheimer’s or blindness due to not being rigorous enough. I’m kind of tearful as I write this. I thought Bernstein’s protocol was the solution for me. Now, three weeks in, I can see it is not.


 

Wil@Ask D’Mine answers: Oh boy. I can see trouble coming a mile away with this question. Writing about Dr. Bernstein has always been a bit like kicking a hornet’s nest when it comes to stirring folks up—even back in the day when we were a more civilized society. But my job description, in part, says, “serve as lightning rod for heated online discussions of divisive issues,” along with answering, “all questions related to life with diabetes.”

So, once more unto the breach, Dear Friends, once more...

First, let me concede that Dr. Bernstein’s ultra-low-carb method works. No. Wait. That’s not true. Let me try again: If you have the personality to cope with Dr. B’s approach without losing your sanity, his method will absolutely work for you to control your blood sugar. That doesn’t mean it will work for everyone, as not everyone is made of the right stuff to use his approach.

Which is cool in my book. Just as Your Diabetes May Vary, so too Your Diabetes Diet May Vary. 

You’d think that would be obvious, and perfectly acceptable to everyone. And that’s what drives me crazy about this whole Bernstein thing: A small but highly vocal percentage of people using his method have adopted a level of absolutism that borders on religious zealotry. Don’t get me wrong; I actually have a healthy respect for zealots. At least the good kind, the people who just want to share a path that worked for them with others. What I don’t have the stomach for is the crowd who says they have the only way to heaven (spiritual or diabetic) and that the rest of us are going to hell (spiritual or diabetic).

Is it so unreasonable to acknowledge that different people have different needs?

I don’t think so.

Anyway, I like what you said about finding your own path, and I think you are on to something there. But a reading list? There I can’t help you, because all the diet books are written by people who want you to follow their path, not help you blaze your own.

Still, here are some thoughts to help you find your way. Instead of thinking of this as a wilderness guide, think of it as a list of things you should put in your backpack for the trip.

Pack as few carbs as possible

Carbohydrates are, indeed, the problem. They are what makes our sugar go up, and as you noted, your carnivore friends have admirable blood sugars. But the human body is designed, engineered, and evolved to function at least partly on carbs. As you discovered when your body rebelled, you need some carbs to stay healthy. Eating carbs as part of your diet is actually the natural approach, because, naturally, we humans are omnivores. You need to look no further than our teeth and our intestines to see that.

So what to do?

I think the secret is that not all carbs are created equal, and that we all respond to them in different ways. After studying thousands of blood sugar downloads and food logs back when I worked in the healthcare trenches, I realized that different people responded differently to the Big Four: Corn, Flour, Potato, and Rice. It seemed that most people had a hyper-response to even the smallest amounts of one of these broad categories of carbs, and did OK with the other three. So I urge you to run some experiments on yourself with your meter. Test before and after carb “dosing” and see which carbs love you best; then avoid or super-minimize the ones that kick you in the (sugar).

Time out your food

Carbs also hit some people worse in the morning, while they affect others more profoundly in the afternoon or evening; so get in touch with your body, and time your carb consumption for minimal impact on your blood sugar.

Sometimes it’s not the carbs so much as their dinner guests, the accompanying higher-fat food items. These can slow down the rate at which carbs hit your blood stream (much like fiber does), so you can use that fact to build in a partial antidote to blood sugar spikes. For instance, I find that eating a slice of cheese along with my bowl of cold cereal helps reduce the blood sugar spike. At least if the bowl isn’t too big…

Speaking of portion size, although I have a hard time controlling myself—especially when it comes to macaroni and cheese—I find that I can get away with almost anything if I really limit how much I eat. On one hand this does take a lot of discipline, but, I think, less discipline than the Bernstein abstinence method does.

Abstinence goes against human nature, after all.

Not all about the diet

And lastly, ya gotta remember that we’re type 1s. No matter how awesome or tightly controlled our diets are, we’ll die without insulin. So there’s no going drug-free with this disease. Good diet or poor diet, meds are part of the solution. So take a look at your medicine cabinet. Maybe it’s not working for you as well as it could.

You mentioned that you have bad post-meal spikes. You could talk to your doc about off-label use of a GLP-1 like Trulicity or Victoza, which help a lot of T1s with those spikes. You should also consider dosing in advance of your meals to let the insulin get up to speed before the carbs get into your blood. And don’t rule out a switch from one brand of insulin to another, to see if something else works better for you. Just like us, not all insulins are identical.

So can you get your diabetes under “perfect” control?

To be honest, probably not. But I’ll be willing to bet that you can get it under better control. And if you can do that without getting dizzy, weepy, or anxious, while living a normal life, it will be good enough.

 

This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.
Disclaimer: Content created by the Diabetes Mine team. For more details click here.

Disclaimer

This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.