13 minute read
The Best Place on Earth
HAYWARD CALIFORNIA PROBABLY DOESN'T COME TO MIND TO ANYONE WHEN THEY THINK OF THE BEST PLACE ON EARTH.
- By Nolan Halverson -
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Tucked on the corner of Industrial Boulevard and Depot Road is where Life West Chiropractic College has its roots. When you walk through the doors at Life West, something magical happens. You get transported to a place of love and positivity. The halls are not only full of warm welcomes and smiling faces, even on stressful midterm or final weeks, they are full of incredible stories, new health knowledge and Lasting Purpose which is what makes Life West the best place on earth.
My favorite question to ask people I meet in the Life West hallways is “Why do you want to be chiropractor”. First, imagine if you asked that question to most other professions. You would probably get a blank stare or an answer that reflects income or prestige. However, in the hallways of Life West you get stories of various ailments that no other doctor could help but through chiropractic adjustments they got their life back. You also hear the stories from students whose parent(s) is/are chiropractor(s) and have been adjusted since birth and never had a shot or pill put in their body and how they went to baseball games for “sick days” because they never got sick growing up.
From someone who grew up in the traditional medical paradigm, with no adjustments and lots of shots and drugs, I grew up accustomed to getting sick a few times a year it was hard to believe the stories of “chiro kids” who never got sick until I heard it for the umpteenth time in the hallways of Life West. They seemed to have a different health knowledge than the ordinary person. Before all these hallway talks, I didn’t know that people didn’t vaccinate their kids or didn’t take drugs to reduce fevers. As crazy as that sounded at the beginning, it’s hard to argue reducing a fever with drugs when you learn that the body creates the fever to kill off bad virus or bacteria or that the unvaccinated never suffered from or transmitted the disease they weren’t “protected” from. It’s not that one view of health is superior to another, but a person should have choices on what is best for them and their families and through the Life West hallways I was exposed to different ways of viewing and maintaining health that I never came across in my first 20 years of life.
In those first 20 years of life, I grew up in northern
Minnesota in a place known for the friendly “Minnesota nice” mentality and when I traveled to places outside of my home state, I would notice people would be a little less inviting to strike up a conversation with and more likely to just be “unfriendly”, for a lack of a better term. However, the Lasting Purpose mindset that runs deep through the culture of Life West puts the “Minnesota nice” mentality to shame. To give, to do, to love, and to serve out of your own sense of abundance, expecting nothing in return, runs through everything down to the screws that hold the building together. Students staying up late helping each other get through CNS and other tough classes, to club meetings at school before classes to practice technique, to professors dedicating extra time and knowledge to students outside of class, to a different fundraiser every quarter, to chiropractic mission trips around the world, to the President and his wife, Drs Ron and Mary Oberstein, hosting service groups at their house for dinners and so much more giving, doing, loving and serving done at Life West day-in-and-dayout, quarter-after-quarter. This is what separates Life West from the average campus.
Life West is a special place and being in a city without much natural beauty, only adds to special culture of Life West. There are around 600 students at Life West all who choose to live in Hayward
California for 3 years of their lives because what is offered at Life West cannot be found anywhere else. The incredible stories, new health knowledge and Lasting Purpose runs through the hallways of Life West and when you walk in the doors you instantly realize you are somewhere special and if you open your heart to it, you will walk away a better person. Life West is truly the best place on earth. §
POLICY
Lifelines is the official quarterly magazine of the LifeWest student body, and is funded by Student Council. Any articles published herein do not necessarily reflect the opinions or beliefs of Life Chiropractic College West.
EDITOR/DESIGNER/PHOTOS
Dr. Austin Bergquist, PhD
FACULTY ADVISOR
Dani Lorta, MA
PRINTING Michael Poss
CONTACT
abergquist@college.lifewest.edu
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CREDITS
COVER Alexis Griffith; @georgechemas 2 EDITOR’S LETTER Austin Bergquist; Zeltzin Serrano 3 HARMS OF LOW-CARB no images 4-5 MEET OUR PEOPLE Emma Harbage; Alexis Griffith; Nolan Halverson; Melinda Pham; Joyce Yeung; Meagan Stachnik; 6-7 CONTENTS 03 Carbs/PixaBay; 08 Emma Harbage; 10 Flowers and Fans/PixaBay; 12 STarbucks/ PixaBay; 14 Leg Checks/PixaBay; 16 You Are Here/PixaBay; 8-9 GOOD HANDS Emma Harbage (Multiples) 10-11 ASIAN HERITAGE Joyce Yeung & Melinda Pham 12-13 WHAT'S YOUR STORY Alexis Griffith and her arm. 14-15 JOURNAL CLUB: LEG CHECKS Meagan Stachnik in the cold. 16-17 THE BEST PLACE ON EARTH Earth/PixaBay 18-19 CREDITS No images BACK COVER No images
References for "Harms of Low-Carb in T2D": 1. Rowley et al. Popul Health Manag. 2017 2. Evert et al. Diabetes Care. 2019 3. Paneni et al. Eur Heart J. 2013 4. Capes et al. Stroke. 2001 5. American Diabetes Association. Classification and diagnosis of diabetes. Diabetes Care. 2015 6. Wang et al. Nutrients. 2018 7. Tay et al. Am J Clin Nutr. 2015 8. Walton et al. J Diabetes Res. 2019 9. Westman et al. Nutr Metab (Lond). 2008 10. Goday et al. Nutr Diabetes. 2016 11. Athinarayanan et al. Front Endocrinol (Lausanne). 2019 12. Boden et al. Best Pract Res Clin Endocrinol Metab. 2003 13. Samuel & Shulman. J Clin Invest. 2016 14. Vessby et al. Diabetologia. 2001 15. von Frankenberg et al. Eur J Nutr. 2017 16. Numao et al. Eur J Clin Nutr. 2012 17. Brinkworth et al. Am J Clin Nutr. 2009 18. Nordmann et al. Arch Intern Med. 2006 19. Noto et al. PLoS One. 2013 20. de Koning et al. Am J Clin Nutr. 2011 21. Lim et al. Diabetologia. 2011 22. Dattilo et al. Am J Clin Nutr. 1992 23. Bueno et al. Br J Nutr. 2013 24. Resnik et al. Account Res. 2013
... Continued from Page 3 those following a low-carbohydrate diet had a significant reduction in their HbA1C values.6 No differences in fasting blood glucose were observed. In a longer, 52-week, RCT of 115 obese participants living with T2D, researchers7 randomized participants to either a lowcarbohydrate, high-unsaturated fat diet (14% carbohydrates; 58% fat) or a high-carbohydrate diet (53% carbohydrates; <30% fat) meant to reflect the dietary guidelines at the time. Both diets resulted in equivalent reductions in HbA1C and fasting blood glucose. However, participants on the low-carbohydrate diet were found to spend less time in the hyperglycemic state. In the short-term (<1-year), low-carbohydrate diets can produce some favourable changes in blood glucose markers for people living with T2D.
When carbohydrates are further lowered intentionally to induce ketosis (i.e. a metabolic state when fat is used as the primary energy source), there may be even further improvements in observed glucose markers among people living with T2D. In a small 90day pre-post intervention study of 11 women living with T2D, the effects of a ketogenic diet (5% carbohydrate; 75% fat) on the symptoms of T2D were assessed.8 All 11 participants lost substantial weight (~20 lbs) and HbA1c levels decreased from diabetic (8.9%) to non-diabetic (5.6%) levels. In a larger 24-week RCT of 49 people living with T2D, researchers9 allocated participants to either a ketogenic diet (less than 20 g of carbohydrates per day) or a low glycemic reduced calorie diet (500 kcal reduction per day). Both groups lost significant weight and reduced their HbA1c within the first 12-weeks, and this reduction was maintained for the remainder of the trial. In an even larger 24-week RCT of 89 obese participants living with T2D, researchers allocated participants to either a standard lowcalorie diet (restriction of 500-1000 kcal/day; ~55% carbohydrate; ~30% fat) or to a ketogenic diet (less than 50 g of carbohydrates per day).10 Participants in both groups lost weight and reduced their HbA1c from diabetic (6.8%) to prediabetic (6.0% to 6.4%) levels. Finally, one of the longest prospective trials to date (2-years), researchers allocated 349 overweight participants to either a ketogenic diet (less than 30 g of carbohydrates per day) or a standard American Diabetes Association diet.11 Only participants in the ketogenic diet experienced reductions in weight, HbA1c, and fasting glucose. For this group, HbA1c levels dropped from 7.7%, but remained at diabetic levels (6.7%) by the end of 2 years. Fasting glucose dropped from 163 mg/dL, but also remained at diabetic levels (134 mg/dL) by the end of 2 years. Together, the data from these studies indicate that both lowcarbohydrate and ketogenic diets can assist in weight-loss and decrease both HbA1c and fasting blood glucose in people living with T2D. “Thinking Twice” About Low-Carbohydrate and Ketogenic Diets in People Living with T2D
While low carbohydrate and ketogenic diets improve key "symptoms" of T2D (e.g. high blood sugar), these diets do not address the underlying "cause" of the disease, and likely make it worse. For some time now, it has been known that diabetes begins with insulin resistance, and that insulin resistance arises due to either excess calorie consumption and/or dietary fatty acid consumption that accumulates in skeletal muscle and liver.12, 13 Saturated fatty acids, and not mono- or polyunsaturated fatty acids, are specifically implicated in insulin dysregulation.14, 15 When saturated fatty acids accumulate in muscle and liver, they interfere with insulin signalling, such that insulin cannot do its job, and glucose begins to accumulate in the blood. Then more and more insulin is required to transport glucose within the cell. The pancreas struggles, chronic elevated blood sugar results and the person presents with diabetes. Low-carbohydrate and ketogenic diets cut the dietary source of glucose which can help with some of the “symptoms” of T2D (e.g. lower HbA1c, lower fasting glucose), but do so without correcting the underling cause (i.e. insulin resistance). In a small (n=9) prospective cross-over study design,16 researchers had participants follow a low carbohydrate diet (20% carbohydrate; 69% fat) and a “normal” diet (67% carbohydrate; 22% fat) each for 3 days, and then assessed blood glucose following an oral glucose tolerance test. The oral glucose tolerance test is the only diabetes classification criteria that truly assesses the underlying cause of diabetes, by applying a glucose challenge and seeing how the system responds. After following a low-carbohydrate, high-fat diet for only 3 days, individuals who consumed 75 g of sugar dissolved in water had higher spikes in blood glucose that lasted longer (i.e. insulin CONTINUED ON BACK COVER (OF ALL PLACES!)... #LIFELINES | 19
... CONTINUED FROM PAGE 19...."ON THE BACK PAGE?!"... YES, IT'S MY LAST ISSUE, I'M TAKING LIBERTIES! was less effective or was not being produced), compared to eating the "normal" diet for 3 days. Whether living in an insulin-resistant state itself is inherently unhealthy will require further longterm research. However we know that diets low in carbohydrates and high in saturated fat raise LDL cholesterol9, 17, 18 increase the risk of dying from all causes by 31%19 and increases the risk of developing T2D by 37%20 .
The glycemic benefits of a ketogenic diet stem largely from the weight-loss associated with what inevitably is a hypocaloric diet. We know that a hypocaloric diet (600 kcal per day) alone, without a change in macronutrient composition, can reverse abnormal insulin sensitivity21 and reduce blood lipids (LDL and triglycerides22) in participants with T2D. In RCTs that test the efficacy of low-carbohydrate and ketogenic diets, improvements in HbA1c and fasting glucose always parallel weight-loss. For example, in one of the longest trials to date,11 participants lost weight on a ketogenic diet during the first year of the study, and their HbA1c and fasting glucose levels dropped concurrently. However, when followed into the second year of the study, participants started to regain their lost weight and observed parallel increases in HbA1c and fasting glucose. Therefore, we do not know if the benefits of a ketogenic diet are the result of weight-loss, or the result of the macronutrient composition of the diet. Further, the view that ketogenic diets allow for greater weight-loss than other diets is misrepresented. A meta-analysis of 13 trials lasting up to 2 years demonstrate that there are no differences in weight-loss between low-carbohydrate and “low-fat” diets by the 2-year mark.23 This means that the short-term benefits of the ketogenic diet are not likely to be sustained in the long-term, while the known harms remain.
It is difficult to find clinical studies that support a low-carbohydrate or ketogenic diet in the prevention of T2D that are NOT tied to industry funding. Of the 6 papers highlighted in this essay, all 6 were either directly funded or the authors were tied to industry that stands to gain from the positive outcome (e.g. Atkins Foundation; Virta Health Corp., DietDoctor; Insulin IQ; Unicity International, Pronokal Protein Supplies). This is problematic because we know that positive clinical research findings are 2-4 times more likely to come from industry versus not-forprofit funded research.24 This is not to say that industry funded research is not to be trusted entirely. Rather, it indicates that the research should be reviewed with an especially keen eye. This does present a problem because not everyone reads research closely, nor do they have the expertise to be able to discriminate between high- and lowquality research within a given field of study. Whether explicit or implicit, researchers may misrepresent their data in favor of their sponsor (i.e. the act of reciprocity) under the pressure to generate positive research findings. Consider the Athinarayanan et al 2019 study11 funded by Virta Health Corp, a company that sells ketogenic dietary programs for people with T2D. When you look to the data of the study at the 2-year mark, we find that patients had on average an HbA1c of 6.7%, and a fasting blood glucose of 134mg/dL. According to the American Diabetes Foundation, both of these levels would indicate that patients remained diabetic. However, the concluding sentence of the abstract states that the diet was, “…effective in the resolution of diabetes and visceral obesity…”. What is even more surprising about this statement is that patients in the study remained on glucose lowering medication (e.g. metformin). Along with their blood work, the finding that patients remained on diabetic medication indicates that patients did not come to a “resolution” of their disease. Summary
In the short term (<1-year), adopting a lowcarbohydrate or ketogenic diet can confer some health benefits to people living with T2D. Participants generally lose weight, and this weight reduction is associated with improvements in blood glucose measures like HbA1c and fasting blood glucose. However, diets low in carbohydrates and high in fat, especially saturated fat, lack long-term efficacy. Based on the best balance of the current evidence, I would advise my family and patients to avoid an animal based ketogenic diet, high in saturated fat. In long-term observational studies, avoidance of whole grains, fruits, and vegetables, required to sustain a low carbohydrate or ketogenic diet, demonstrates poor health outcomes among its adopters. §
