Jewels Doskicz is a registered nurse, freelance writer, patient advocate, health coach, and long-distance cyclist. Jewels is the moderator of Diabetic Connect’s weekly #DCDE Twitter chat, and she and her daughter both live healthfully with type 1 diabetes.

Some people swear by low-carbohydrate diets such as the Dr. Bernstein Diet. But if they are a sound way to manage blood sugar, why aren’t they more widely accepted among healthcare practitioners, dietitians, and people with diabetes?

Does one diet fit all?

Any successful diet requires vigilance and adaptation. Rigid diets may have their place, but they usually don’t work in the long run.

Diabetes is the common denominator as we consider what to eat, but we’re all different and one diet won’t be right for everyone. While one person may sit at a desk all day, another is building a house or training for a marathon. Our needs are different.

Carb counting and low-carb, moderate-carb, and high-carb diets leave lots of room for subjective interpretation of the restrictions. Most people settle on a flexible, balanced approach to limiting their carbohydrates, and discover that it becomes easier as they get used to it.

There will always be staunch supporters of a “regular diet.” Some people want to keep eating what they ate before their diagnosis, counting carbs for doughnuts and foot-long subs. They manage carbs with insulin, the American Diabetes Association (ADA) way. Nailing insulin needs for meals with large amount of carbs is a difficult, but not impossible, task to master.

At the end of the day, it’s about finding a sweet spot that works for your diabetes. It doesn’t have to be black and white. Every day is different; our needs will vary and our responses can too.

Low-carb diets don’t eliminate low or high blood sugars, but they’re effective at decreasing them.

Dr. Bernstein’s approach

Dr. Richard Bernstein has a camp of believers and data that seem to prove his approach works. He goes against the grain of conventional diabetes teaching with his low-carb, high-fat, and high-protein diet.

Dr. Bernstein, an endocrinologist and type 1 diabetic himself, popularized his diet management style in the 1997 book Dr. Bernstein’s Diabetes Solution: A Complete Guide to Achieving Normal Blood Sugars. Other publications include The Diabetes Diet.

He advocates an individual approach to diet which usually amounts to 20–30 grams of carbs per day, paired with blood glucose testing 5–8 times a day. (Keep in mind that many people with diabetes eat more carbs than that at each meal.)

The Dr. Bernstein Diet was born from his own personal dietary successes that he says resulted in decreased blood sugar swings, less need for insulin, and reversed complications.

The ketone question

Low-carb diets usually suggest eating 50 grams or fewer of carbohydrates per day, which places the dieter in a state of nutritional ketosis. Instead of using glucose for energy, the body turns to burning fat in the absence of glucose because of the low amount of carbs consumed, resulting in a low level of substances called ketones entering the bloodstream.

Nutritional ketosis can happen after a skipped breakfast or one that only included eggs and coffee. Or it can happen after eating a low-carb lunch followed by nothing else until dinnertime. It can also happen overnight with a long lapse between meals.

Nutritional ketosis differs from diabetic ketoacidosis or DKA. In nutritional ketosis, blood sugars are within normal limits. In diabetic ketoacidosis, blood sugars are elevated due to a lack of available insulin. Insulin must be present to transfer glucose from the bloodstream into the body’s cells to use for energy.

Nutritional ketosis is usually benign but could lead to harm if ketone levels rise. But DKA is a dangerous condition, and may be life-threatening if left untreated. DKA is most often seen in people with type 1 diabetes, but can be seen in people with type 2 diabetes as well.

How does Dr. Bernstein’s diet differ from the ADA’s?

The American Diabetes Association continues to recommend a carbohydrate counting method, with a tailored daily carbohydrate budget. Many low-carb proponents feel the ADA way promotes an unhealthy low-fat, high-carbohydrate way of eating.

Any restrictive diet can have complications:

• They’re difficult to maintain over time
• Exercising with minimal carbs has its challenges
• Restrictive diets may create issues with the social aspects of eating
• They may not be nutritionally balanced
• Weight management may become an issue

It’s important to talk with your healthcare provider and a nutrition specialist before changing your diet. When new and different diabetes management ideas are discussed, sometimes it creates confusion and friction between patients and providers. Be clear about your goal of finding the best possible care, lend a listening ear to your provider’s advice about what they think is in your best interest, and make an educated decision together.

Have you tried the Dr. Bernstein Diet? Share your experiences by adding a comment below.