What Is Dr. Bernstein's Diabetes Diet?

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At its core, Dr. Bernstein's Diabetes Diet (created, as the name suggests, by a physician) is a very low-carbohydrate diet designed to help people with diabetes achieve and maintain normal blood sugar levels and reverse and/or lower the risk of complications. It is not a weight loss diet, although it's likely that anyone who follows it will shed some pounds. The Bernstein diet is based on eating three meals a day, choosing from a list of "allowed" foods, steering clear of "forbidden" foods, and sticking with a prescribed amount of carbohydrates at each. There are no restrictions or guidelines regarding protein or fat intake. The diet is the cornerstone of an overall protocol for managing diabetes that includes tweaking supplemental insulin and getting a prescribed amount of anaerobic cardiovascular exercise. Because it limits carbohydrates so dramatically, the Bernstein diet differs from the dietary guidelines for diabetes promoted by most major medical organizations and has been criticized for this reason. However, it has many proponents and appears to be safe for most people.

Background

The Berstein diet has an interesting history. It was created by an engineer-turned-endocrinologist named Richard K. Bernstein, M.D. who was diagnosed with type 1 diabetes in 1946 at the age of 12 and who suffered for many years from serious complications of the disease.

In 1969, while still an engineer, Bernstein purchased a blood glucose monitor, which at the time was used only in hospitals. He began testing his blood sugar throughout the day to try to figure out what factors would cause his levels to rise and fall. Eventually, he discovered he could manage them with a combination of a low-carb diet, exercise, and smaller doses of insulin than he had been taking. What's more, many of the complications of his diabetes resolved.

In order to earn respect for his ideas from the medical community, Dr. Bernstein went to medical school and became an endocrinologist. Since then he has written six books about his diet and overall approach to managing diabetes, starting with Dr. Bernstein's Diabetes Solution: The Complete Guide to Achieving Normal Blood Sugars, originally published in 1997 and updated in 2011 to include information on new technology (such as insulin pumps and continuous blood sugar monitors), medications (including inhaled insulin), and recipes.

Now in his early 80s, Dr. Bernstein maintains a thriving medical practice and has a robust following of people with both type 1 and type 2 diabetes who have had success in maintaining normal blood sugar levels by following his diet.

How It Works

The Bernstein diet limits the number of carbohydrates a person eats to 30 grams per day. To put this in perspective, note that according to the American Diabetic Association, on average most people with diabetes get 45 percent of total calories from carbs. For someone who eats 2,000 calories per day, that would around 900 grams of carbs. The Bernstein diet has no rules or guidelines regarding protein, fats, or total calories.

What to Eat

Dr. Bernstein divides foods into two categories based on the number of carbs they contain and how they affect glucose levels. Foods known to cause a rapid rise in blood sugar are forbidden; foods that don't have this effect are allowed.

Compliant Foods

  • Most meats

  • Eggs

  • Tofu

  • Any vegetable not on the forbidden list

  • Cheese

  • Cottage cheese (in very small amounts)

  • Full-fat unsweetened yogurt

  • Cream

  • Butter and margarine

  • Unsweetened soymilk

  • Soy flour

  • Certain bran crackers

  • Artificial sweeteners that do no have added sugar

  • Nuts

  • Herbs and spices

  • Mustard

  • Sugar-free and low-carb salad dressings

  • Sugar-free flavorings and extracts

  • Water, sparkling water, club soda, diet soda, coffee, tea, low-carb alcoholic beverages in moderate amounts

  • Ready-made sugar-free gelatins (check for hidden sugars such as maltodextrin on the label)

  • Sugar-free puddings made with low-carb dairy alternatives (6 grams of carb)

  • Homemade low-carb desserts

Non-compliant Foods

  • Fructose, corn syrup, molasses; agave nectar, dextrose, sorghum; maltitol, sorbitol and other sugar alcohols

  • Most desserts (pies, cakes, cookies, etc.)

  • Powdered artificial sweeteners that add carbs

  • Breads and crackers

  • Cereal, including oatmeal

  • Pasta

  • Pancakes and waffles

  • Foods or flours made from wheat, barley, corn, rice, quinoa, or rye

  • Certain vegetables including potatoes, parsnips, winter squash, beets, carrots, corn, yellow peppers

  • Legumes

  • Raw tomatoes (except in small amounts)

  • Cooked tomatoes; tomato paste or sauce

  • Packaged vegetables containing sugars or flour

  • All fruits and fruit juices

  • Milk

  • Sweetened yogurt; most low-fat and nonfat yogurts with added carbs

  • Powdered milk substitutes; coffee lighteners

  • Evaporated or condensed milk

  • Nuts (except in small amounts)

  • Most processed foods and snack foods

  • Most condiments, including balsamic vinegar

Meats and proteins: No meat, poultry, or other form of protein is off-limits, with the exception of any to which carbs have been added (bread crumbs in meatloaf, flour on fried chicken or fish).

Vegetables: Compliant veggies include asparagus, avocado, broccoli, brussels sprouts, cabbage and sauerkraut, cauliflower, eggplant, onions (in small amounts), peppers (any color except yellow), mushrooms, spinach, string beans, summer squash, and zucchini. Note that cooked vegetables tend to raise blood sugar more rapidly than raw vegetables because the heat makes them more digestible and converts some of the cellulose to sugar. 

Dairy: Yogurt is allowed, but only plain, unsweetened, full-fat varieties. For all types of cheese, count 1 gram of carb per ounce. Although cottage cheese is generally regarded as non-compliant, some people may be able to eat up to two tablespoons without causing a blood sugar spike.

Nuts: Although nuts do contain carbs, according to Dr. Bernstein they tend to raise blood sugar levels slowly. However, because it can be hard to eat just a few nuts, it's important when following the diet to look up the number of carbs in a serving of any type of nuts to avoid going overboard. Peanut butter, even unsweetened, may raise blood sugar levels. For some people, a tablespoon can be too much.

Artificial sweeteners: Those allowed include saccharin tablets or liquid (Sweet’n Low); aspartame tablets (Equal, NutraSweet); acesulfame-K (Sunette, The Sweet One); stevia (powder or liquid); sucralose tablets (Splenda); neotame

Alcoholic beverages: One and a half ounces of distilled spirits or one can of beer tend to have negligible effects on blood sugar levels. Spirits should not be combined with sugar-sweetened mixers.

Recommended TIming

The Dr. Bernstein Diabetes Diet limits the total number of carbohydrates eaten over the course of the day to 30 grams, broken down as follows:

  • Breakfast: 6 grams
  • Lunch: 12 grams
  • Dinner: 12 grams

There are no built-in between-meal snacks, nor are there guidelines regarding the timing of meals.

Recommended Products

The food lists published in Dr. Bernstein's books include a number of brand-name foods that are considered compliant with the diet, including:

Pros and Cons

Pros

  • Simple to follow

  • Wide variety of compliant foods

  • Conducive to weight loss

  • Growing body of research showing a low-carb diet can be effective for managing type 2 diabetes

Cons

  • The allowed intake of carbohydrates may feel too low for some

  • Favorite foods may not be allowed

  • Runs counter to dietary guidelines for managing diabetes endorsed by major medical organizations

Pros

Because the lists of foods that are allowed and not allowed on Dr. Bernstein's diet are so thorough and specific, following it requires very little guesswork. What's more, there are at least as many "allowed" foods as there are "forbidden" ones, as well as plenty of variety to prevent boredom and promote well-rounded nutrition.

The diet also is, by default, low in calories and so for most people can lead to weight loss in addition to normalized blood sugar levels. This may be especially important to people with type 2 diabetes for whom even a modest amount of weight loss can lower the risk of complications such as heart disease and high blood pressure, research has found.

There's evidence a low-carb diet might be effective for normalizing blood sugar levels and reducing the risk of complications from diabetes. In a Duke University study, for example, researchers found that people who were obese who followed a very low-carb diet of 20 grams or less a day (10 grams fewer than the Bernstein limit) for six months had better blood sugar control and more effective weight loss than participants who followed a low-glycemic reduced-calorie diet.

Cons

The diet limits daily carbs to 30 grams to be eaten in specific quantities at three meals: 6 grams at breakfast and 12 grams at lunch and at dinner. Between-meal snacks do not appear to be factored into the basic diet. This could feel highly restrictive for people accustomed to eating more carbs.

Despite the long list of approved foods, it's likely that at least some of the non-compliant ones will be favorites. This could make the diet feel restrictive for some people.

Perhaps the most important strike against the Bernstein diet is that it goes against the recommendations of organizations such as the American Medical Association and the Academy of Nutrition and Dietetics, as well as the American Diabetes Association.

How It Compares

Dr. Bernstein's Diabetes Diet differs from the dietary guidelines endorsed by major medical organizations for managing diabetes, including the ADA, the Academy of Nutrition and Dietetics, the American Medical Association, the American Heart Association, the U. S. Department of Agriculture (USDA), and the Physicians Committee for Responsible Medicine.

The most significant way in which the Bernstein diet differs from conventional medical advice is its emphasis on dramatically limiting carbohydrates to 30 grams per day. Although the ADA, for example, acknowledges that "monitoring carbohydrate intake and considering the blood glucose response to dietary carbohydrate are key for improving postprandial glucose control," the organization's Standards of Medical Care in Diabetes stop short of quantifying how many grams of carbs should be eaten each day, taking the stance that the intake of macronutrients should be based on an individual's situation.

The Bernstein diet also takes a different view of dietary protein than most medical guidelines do. Whereas limiting protein has been a mainstay of classic diabetes nutritional advice, Dr. Bernstein sees no reason to limit protein intake.

Likewise, Dr. Bernstein regards the standard thinking that a diet high in fat is unhealthy and the primary cause of obesity. His diet does not impose limits on protein or fat.

A Word From Verywell

There is no question that diet plays a key role in the management of diabetes—particularly type 2 diabetes, which sometimes can be headed off (for someone who's been diagnosed with prediabetes) or reversed with dietary changes, exercise, and weight loss. Dr. Bernstein's Diabetes Diet aims to do this with a protocol that differs largely from conventional guidelines, but that in fact is in keeping with emerging research about the value of limiting carbohydrates. Even so, if you have diabetes and would like to try it, it's imperative that you speak with your doctor and/or a dietitian who specializes in diabetes first. In addition to the diet, Dr. Bernstein's protocol includes recommendations about taking supplemental insulin and exercise that also should be vetted by a doctor. The diet appears to be safe, but when you're dealing with your health you cannot be too careful.

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