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So What’s Low Carb? Chapter 4 – Part 9

Sep 16, 2015

The Diabetes Diet
Richard K. Bernstein, MD, FACE, FACN, FACCWS
Part 9 of Chapter 4
So What’s Low Carb?


It is common practice to prescribe supplementary vitamins and minerals for diabetics. This is primarily because most diabetics have chronically high blood sugars and therefore urinate a lot. Excessive urination causes a loss of water-soluble vitamins and minerals. If you can keep your blood sugars low enough to avoid spilling glucose into the urine (you can test it with Clinistix or Diastix), and if you eat a variety of vegetables, and red meat at least once or twice a week, you should not require supplements. Note, however, that major dietary sources of B-complex vitamins (folic acid is one of these) include “fortified” or supplemented breads and grains in the United States. If you’re following a low carbohydrate diet and therefore exclude these from your meal plan, you should eat some bean sprouts, spinach, broccoli, brussels sprouts, or cauliflower each day. If you do not like vegetables, you might take a B-complex capsule or a multivitamin/mineral capsule each day.

Supplemental vitamins and minerals should not ordinarily be used in excess of the FDA’s recommended daily requirements. Large doses can inhibit the body’s synthesis of some vitamins and intestinal absorption of certain minerals. Large doses are also potentially toxic. Doses of vitamin C in excess of 500 mg daily may interfere with blood sugar readings (causing them to appear erroneously low). Large doses of vitamin C can actually raise blood sugar, cause kidney stones, and even impair nerve function (as can doses of vitamin B-6 in excess of 200 mg daily, so beware of B-complex capsules). Vitamin E has been shown to reduce one of the destructive effects of high blood sugars (glycosylation of the body’s proteins),* with increased amounts providing increased benefit up to 1,200 IU (international units) per day.

*Glycosylation of protein — the bonding of glucose to protein — is essentially what you see in bread crust. Inside the bread loaf the proteins are supple, but the proteins in the crust have bonded with sugars and lost any resilience. Bad news when it happens inside your body.

It has recently been shown to lower insulin resistance. I therefore recommend 400–1,200 IU per day to a number of my patients. Be sure to use the forms of vitamin E known as gamma tocopherol or mixed tocopherols, not the common alpha tocopherol, which can inhibit the absorption of essential gamma tocopherol from foods. Vitamin E can reduce the ability of blood to clot and must therefore be restricted in some people. Consult your physician before using it.

The insulin-sensitizing agent metformin can cause systemic reduction of vitamin B-12. This can be corrected with calcium supplements or more calcium in your diet (cream or cheese, for example).


A new diet often brings about changes in frequency and consistency of bowel movements. This is perfectly natural and should not cause concern unless you experience discomfort. Increasing the fiber content of meals, as with salads, bran crackers, and soybean products, can cause softer and more frequent stools. More dietary protein can cause less frequent and harder stools. Calcium supplements can cause hard stools and constipation, but this is usually offset if they contain magnesium. Normal frequency of bowel movements can range from 3 times per day to 3 times per week. If you notice any changes in your bowel habits more or less than these frequencies, discuss them with your physician.


Most of my patients initially feel somewhat deprived, but they are also grateful to feel more alert and healthier — sometimes more so than they have in years. I fall into this category myself. My mouth waters whenever I pass a bakery shop and sniff the aroma of fresh bread, but I am also grateful simply to be alive and sniffing.

We would like to thank the publisher Little Brown and Company and Dr. Richard K. Bernstein, for allowing us to provide excerpts from The Diabetes Diet.

Copyright © 2005 by Richard K. Bernstein, M.D. All rights reserved. No part of this book may be reproduced in any form or by any electronic or mechanical means, including information storage and retrieval systems, without permission in writing from the publisher, except by a reviewer who may quote brief passages in a review.

Author’s Note:
This book is not intended as a substitute for professional medical care. The reader should regularly consult a physician for all health-related problems and routine care.

For more information on Dr. Bernstein’s and to purchase his books, CD’s or get access to his free monthly webinars, visit his website at DiabetesBook.com.