Richard K. Bernstein and the Horse Needle
Dear Friends,
When I was 12, I loved the Indiana Jones and Star Wars movies. I loved the impossible situations, like the escape from the trash compactor. There was something fascinating about tropes like The Descending Ceiling and its close cousin, The Walls Are Closing In. Who doesn't love puzzling their way out of a good old-fashioned deathtrap?
Richard K. Bernstein was also 12 years old when he encountered a deathtrap. Except, this was a real life deathtrap that he was stuck in rather than watching safely from a cushy seat and a sticky floor. He developed diabetes in 1946, when very little was known about the disease. “The 1940's were the dark ages of diabetes treatment,” he wrote in his book. There was a certain life expectancy at the time as the complications of the disease chipped away at a patient’s health. He had thirty years to escape a deathtrap that his doctors said had no escape.
For over twenty years Richard dutifully followed doctor's orders. Back then, diabetics were put on a low fat, high carbohydrate diet in hopes that vascular complications like heart disease, kidney failure, and blindness would not occur. He needed so much insulin that he had to inject it using an oversized 10cc "horse syringe" and accompanying needle. They had to be disinfected in boiling water because disposable ones hadn't been invented yet.
Richard studied to become an engineer, got married, and started a family. His wife was a doctor and he took a job designing medical equipment. I wonder if he'd been drawn to the medical field because of his illness. Perhaps he knew that becoming, say, an astronomer and marrying a lion tamer just wouldn't be helpful, even if he wasn't quite sure how his actual choices were going to help.
Despite the large doses of insulin, complications of the disease continued to worsen as Richard rounded his 30th birthday. His face turned gray. His body had started to fall apart. He had constant burning in his chest, "frozen shoulders", deformed feet, lost hair on his lower legs, scar tissue in his heart, poor vision and night blindness. Everyday things that we take for granted were painful for him. Lying in bed made his thighs hurt. His shoulders made putting on a t-shirt an agonizing task. He was already showing signs of kidney disease, which was fatal. He now had a life expectancy of 5 years.
The walls were closing in.
Going through the mail one night, Richard noticed an ad in Lab World magazine, which he received because of his job at the medical device maker. It was for a device called the Ames Reflectance Meter and it was meant to be used by hospital ERs. It measured blood glucose levels to distinguish between passed-out diabetics and passed-out drunks. He called the company and tried to buy one, but they refused because he wasn't a doctor. So he asked his wife to buy one. It cost $650, or nearly $5,000 in today's dollars.
One piece of the puzzle was in place. Richard could now test himself several times a day. He was the first diabetic to self-monitor his own blood glucose.
Richard approached the puzzle with the methodical rigor of an engineer. After he began testing in real time, he discovered that his sugar levels were all over the place, like a roller coaster. He noticed that exercising and eating fewer carbs helped stabilize his blood sugar somewhat, but his levels still weren't normal. Most importantly, his complications continued to worsen. 3 out of the 5 years of life expectancy had passed.
The walls continued to get closer.
Richard was out of ideas. He had assumed that exercise was the key to managing the complications of his diabetes, but it didn't seem to help. In 1972, he ordered a search of the research journals, hoping to find some insight into which exercises to do. It took 2 weeks and $75 for the papers to arrive. (Today, that search is more or less instant and free.)
What Richard found from reading the studies was that exercise had nothing to do with the progression of diabetes. Experiments showed that consistently normal, stable levels of blood sugar halted the progression of the disease. In fact, normalized blood sugar could not only prevent but reverse the complications. The only catch was that the experiments had only been done on animals, not humans.
"I was desperate. I had no choice but to pretend I was an animal."
Through a routine of constant experimentation with food and insulin shots, Richard normalized his blood sugars and figured out how to keep them stable. His symptoms disappeared. His gray complexion was gone. His cholesterol levels dropped. He was able to put on muscle. He had taken himself off the blood sugar roller coaster and taken control. It took less than a year.
Ka-chunk. The walls had stopped inching closer.
Richard turned his attention to helping others like him. Eager to share his learnings, he submitted a research paper but was rejected because, you guessed it, he wasn’t a doctor. So he went to medical school and became a doctor. He wrote 4 books, several papers, and opened up his own practice in the suburbs of New York. He runs a weekly Q&A session on his website and still runs his practice today. He is 88.
There has been some controversy over Dr. Bernstein’s approach, and the American Diabetes Association has been slow to embrace low-carb diets, perhaps due to existing advertiser relationships with diabetes journals. I’m not going to focus on that. My focus is how Dr. Bernstein entered Hard Mode when he was 12, and his life got steadily worse until he was 39. Even though it seemed hopeless, he chipped away at his problem for 28 years, noticed and took opportunities, and simply just tried stuff until something worked.
Keep Going,
Geoff
Notes
Richard K. Bernstein’s website has information about all of his work. His book, Dr. Bernstein’s Diabetes Solution begins with a more detailed version of the above story before diving into the nuts and bolts of his system.
The The Walls Are Closing In and the Descending Ceiling are, surprisingly, distinct tropes that are both well-worn yet somehow irresistible.