LL Magazine - Winter 2022

W i nter 2022

Editor’s Letter

O

oops, you caught me barefoot in the forest. Well, I couldn't let Alexis Griffith have all the fun "grounding" on the cover! Although, I can’t help but notice that the camera loves her just a touch more. Anyways, we have a great issue for you, with contributions from 3 first timers. Emma Harbage, our student council Vice President, tells us how her rugby training has cross-over potential to chiropractic training. Joyce Yeung and Melinda Pham, 2 student council representatives, outline how their Asian heritage has influenced their experience at Life West. We also have contributions from 3 loyal writers. Alexis Griffith tells us her story and how it brought her to Life West. Meagan Stachnik presents a Journal Club article that questions the reliability of leg checks and Nolan Halverson tells us where he believes is the Best Place on Earth.

This is my final issue as Lifelines Editor. I hope you have enjoyed flipping through these past 5 issues together. Though it’s a bittersweet exit for me, I am thrilled to leave you in the exceedingly capable, and infinitely more qualified, hands of Zeltzin Serrano, your new Lifelines Editor! She graduated from the University of California, Davis with a Bachelors in English with an emphasis on Literary Criticism and Theory (see?!).

In this final issue as Editor, I have included my first article contribution (opposite page), where I discuss the harms of low-carb diets, especially for people living with type II diabetes. It's text heavy and a bit cumbersome, but the message is important, so settle in.

In Gratitude,

Dr. Austin Bergquist, PhD abergquist@college.lifewest.edu IG: @plantedchiro 2 | LIFEWEST.EDU/LIFELINES-MAGAZINE/

| 15-min read |

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- By Austin Bergquist -

ype 2 diabetes (T2D) is a growing health concern here in America. By 2030, it is estimated that 1 in 3 Americans will be living with T2D, or prediabetes.1 Over the past hundred years, the role that nutrition plays in the development, progression, and reversal of T2D has become more and more evident. To this end, the American Diabetes Association has been producing periodic evidence-based dietary recommendations aimed at educating individuals on what to eat to help mitigate the negative consequences of the disease. Interestingly, the current dietary recommendations highlight that diet is not one-size-fits-all and that a variety of diets can be effectively adopted to manage T2D. However, common themes among the recommended diets include: 1) consumption of whole foods over processed foods, 2) limited intake of added sugars, refined grains and overall carbohydrate volume, with an emphasis on consuming only non-starchy vegetables, 3) further reduction of carbohydrates for select individuals not meeting blood glucose goals (i.e. induce a ketogenic state), 4) Lastly, energy intake (i.e. calories) should be reduced in overweight individuals.2 The emphasis on low or extremely low carbohydrate consumption in these recommendations seems sensible. Since diabetes is a blood glucose regulation issue, it follows that limiting carbohydrate rich foods (i.e. sources of glucose in the diet) should help limit the potential for large spikes in blood glucose levels (i.e. hyperglycemia). Management of blood glucose is of critical importance since we know that chronic hyperglycemia wreaks havoc on vascular endothelial function through oxidative stress and inflammation3 and predisposes individuals to cardiovascular disease, stroke and premature death4. Herein, we will review some of the relevant literature that demonstrates the effectiveness of low-carbohydrate and very-lowcarbohydrate (ketogenic) diets on addressing many of the “symptoms” of diabetes. Further, we will discuss whether a low-carbohydrate or ketogenic diet addresses the “cause” of diabetes, as well as some factors about the research which may make you “think twice” about adopting

a carbohydrate restricted diet yourself or about recommending one to your patients.

To assist in assessing the literature, it is important to define the criteria by which diabetes is diagnosed. When establishing a diagnosis of prediabetes or diabetes, there are 4 main tests: 1) HbA1C test, 2) Fasting blood glucose test, 3) Glucose tolerance test and 4) Random blood glucose test. The HbA1c test is a measure of your average blood sugar over a 3-month period. An HbA1C below 5.7% is considered healthy, between 5.7% and 6.4% indicates prediabetes, and 6.5% or greater indicates diabetes. The fasting blood glucose test measures your blood glucose after an overnight of not eating. A fasting blood sugar level of 99 mg/dL or lower is considered normal, 100 to 125 mg/dL indicates prediabetes, and 126 mg/dL or greater indicates diabetes. Following a fasting glucose test, a glucose tolerance test can be conducted by having the patient drink a specified amount of glucose (75-g) dissolved in water, and monitoring blood glucose levels for 2 hours thereafter. In response to this glucose challenge, blood glucose levels of 140 mg/dL or lower are considered normal, 140 to 199 mg/ dL indicates prediabetes, and 200 mg/dL or greater indicates diabetes. Lastly, the random blood glucose test measures your blood sugar at any point in time during the day, without fasting. A blood glucose level exceeding 200 mg/ dl at any point during the day, even after a meal, indicates diabetes. Importantly, failing any one of these tests would support a diagnosis of either prediabetes or diabetes.5 Potential Benefits of Carbohydrate Restricted Diets in People Living with T2D There are several studies that support positive effects of carbohydrate restricted diets in people living with T2D. In a 12-week randomized controlled trial (RCT) of 49 patients living with T2D, researchers compared the efficacy of a low-carbohydrate diet (39% carbohydrate; 42% fat) versus a low-fat diet (56% carbohydrate; 26% fat) and found that only CONTINUED ON PAGE 19... #LIFELINES | 3

HARMS OF LOW-CARB IN TYPE II DIABETES

Harms of Low-Carb in Type II Diabetes

MEET OUR EMMA HARBAGE (Quarter 8; @eharbage) Emma hails from Burntwood, England. Prior to Chiropractic College, she was a strength & conditioning coach for UK sport scholarship athletes and was completing a masters in strength & conditioning. Emma knew she would work within the field of sport performance, given the numerous opportunies her own sporting career provided her. She's played rugby for 10 years, having now represented England for 7s and 15s, as well as playing premiership rugby across the world. Emma loves to travel, eat all the things, and be with family! Being in the USA is almost perfect for all of that.

ALEXIS GRIFFITH (Quarter 11; @aye.lexis) Before attending Life West, Alexis studied fine art, art history and general biology. Her more recent chiropractic education has revealed her fascination for the human body and its physiological functions, leading her to work in the Life West anatomy lab as a dissector. She is also currently a Research Honors candidate, working with electroencephalography technology and its clinical applications in the Human Performance Lab on campus. While this keeps her quite busy, in her free time she enjoys painting, modeling, reading and lifting.

NOLAN HALVERSON (Quarter 11; @nolanhalv29) Nolan Halverson started LifeWest at 20 years of age, and in his time at Life West has served as president to the Dynamic Essentials, SICA, and NUCCA clubs and is a captain on the school’s hockey team. Nolan has served as his class representative for all 11 quarters at Life West, as the Athletics Coordinator for 4 quarters, as a large group tutor for 7 quarters, and as a student ambassador for 1 quarter. He has been the recipient of the “VOXX Leadership” and multiple “Commitment to Excellence” scholarships. Once in clinic, Nolan fulfilled his preceptorship adjusting requirements (100 outpatient and 50 student) in just under one quarter!

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MEET OUR PEOPLE.

PEOPLE. MELINDA PHAM (Quarter 9; @mayleelivewell) Melinda Pham graduated from the University of California, Irvine with a Bachelor of Science in Pharmaceutical Sciences. While in her upper division courses, she realized that many common diseases and illnesses are preventable, steering her towards her journey in chiropractic. After graduation, Melinda plans to work with the Vietnamese community back in Southern California and educate people of all ages and colors about the importance of chiropractic care!

JOYCE YEUNG (Quarter 8; @csyeung) Joyce was born and raised in Hong Kong in a chiropractic houshold. She is fascinated by the inborn wisdom and self-healing power of the body. Joyce is on a mission to inspire people to thrive and live abundantly with a connected nervous system that everyone deserves. In college, Joyce majored in Cultural Anthropology at Wheaton College in Illinois.

MEAGAN STACHNIK (Quarter 7; @megschirolife) A Canadian in California - Meagan is a registered Kinesiologist who worked with special populations as well as in the Occupational testing field prior to attending LifeWest. Meagan aspires to continue to work in the sport and fitness industry with a focus on prenatal/postpartum and pediatric care after graduation.

Animal Chiropractic has a special place in Meagan’s heart as she comes from a long line of farmers. Meagan always enjoys a trip to the beach, a hot cup of tea (no, not coffee, sorry) and a good movie on a sunday night.

#LIFELINES | 5

CONTENTS 03 | Harms of Low-Carb Should people living with type II diabetes adopt a carbohydrate restricted diet?

By Austin Bergquist

08 | Good Hands Learn how our student council Vice President's rugby training has cross-over potential to chiropractic training.

By Emma Harbage

10|Courageous Chiropractors Discover how two of Life West's budding chiropractors' Asian heritage has influenced their college experience.

By Joyce Yeung & Melinda Pham

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12| What’s Your Story?

What makes my story unique is not how I found chiropractic, but how I found myself through my pursuit of chiropractic.

By Alexis Griffith

14 | Journal Club

Most chiropractors are taught leg checks, but are they reliabile?

By Meagan Stachnik

16 | 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 6 | LIFEWEST.EDU/LIFELINES-MAGAZINE/

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CONTENTS

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| 4-min read |

GOOD HANDS - By Emma Harbage -

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ll my life I have been involved in elite sport. First it was gymnastics … then somehow rugby! I have been playing rugby since I was 17 years old, and a decade later, I love it as much as the day I started.

For many, chiropractic college helps students find themselves and their power, but for me it was rugby that helped me find myself, and then rugby is what lead me to chiropractic college at Life West.

I am asked, “how do you fit it all in?”. For me, it’s a choice. It’s how it’s always been and it’s all I really know! Having rugby at Life West is like my anchor, my home. The Women’s and Men’s teams are family and the support from them and our director, Adriaan Feris, is everything to me. Rugby keeps me on track and reminds me that the finished product doesn’t happen overnight. Rugby keeps me motivated and gives me family.

During my rugby career, I represented England in both Rugby 7s and 15s. I then spent the next few years playing premiership Rugby in England, Canada and in the USA. Being an athlete has given me such an awesome life! It’s provided so much fun, competition, and the fundamentals for succeeding in life. Rugby has taught me to train hard, even while nobody is watching. Then come game day, I get to have fun and display my hard work. For me it’s the exact same mindset for my future as a Chiropractor. The studying, adjusting drills, seminars, late nights, these are all training for the “Big Game” or “Championship”. It’s all training for my future practice and my future patients. All the fine details matter and all the hours count.

In addition to staying fit and conditioned, rugby gives me many other opportunities such as leadership, confidence, and body awareness, while training gives me strength, power, and speed; funny enough, some of the same principles we talk about when it comes to training our chiropractic adjustments. I think of myself as an athlete of chiropractic. When it comes to training for chiropractic, you must train your body and your mind, and to be disciplined and committed to yourself and your team.

I am so grateful to have rugby teach me these lessons and to discipline me the way it has. Often,

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Life West gives me my two biggest passions and for that I am truly grateful. Thank you to my Rugby Family for keeping me accountable and motivated to be the best I can be … you are a huge part of my development as a Doctor of Chiropractic and as a rugby player. §

GOOD HANDS

"Emma is an exemplary student athlete; her effort, commitment and performance in all areas of her life here at Life West illustrate a determination to be the very best version of herself. As a rugby player, she is fearless and switches into "beast-mode" easily - again, just another example of her ability to give it her all."

- Adriaan Ferris (Athletics Director) -

#LIFELINES | 9

| 6-min read |

ASIAN HERITAGE CULTIVATES COURAGEOUS CHIROPRACTORS - By Joyce Yeung & Melinda Pham -

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s an international student from Hong Kong, I think of chiropractic as a culture. A culture among the many in the health care system.

Modern medicine focuses on getting quick results and focuses on a physical component to identify the cause of the discomfort.

On the other hand, chiropractic, like most holistic professions, focuses on the ability of the person to heal itself, and the connection between the mind and the body.

The culture I grew up in is most familiar to me. A lot of my habits and ideas are cultivated because of the culture I am surrounded by. It is the lens I use to make sense of this world.

There may be times when you feel like you don’t fit in, you may feel like something is off, and one day, you may find a group that understands you and thinks more similarly to you despite the culture you grew up with. When you go to college, you may formulate new ideas and start looking at the world differently when you make new friends and read new books.

Oftentimes, I think about myself as an international student when I feel alone, frustrated or when I am explaining chiropractic. I think about how different cultures inform one’s worldview and how I find common ground to share something that we both value in a language that we both understand. I also think about how language is usually not the barrier to seeking mutual understanding, but ignorance and arrogance. I check with myself first, am I judging the others based on my own understanding? How do I get to think from another person’s shoes? How did they get to where they are now?

The beauty of diversity reveals when everyone walks an extra step and is a little bit uncomfortable to learn from each other.

It helps increase our awareness of our beliefs and behavior when we pause and ask, “why?” when we see differences. § - Joyce Yeung

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Due to the language barrier, I couldn’t explain how much chiropractors are capable of. I told my parents that chiropractors relieve pain naturally, but I wanted to tell them so much more. I wanted to explain to them how a subluxation occurs and how chiropractic has the power to address it. I wanted to explain how getting adjusted paved the way for an optimally functioning nervous system. Although I wanted to say so many things, I was able to at least convey that chiropractic sees the patient as a full person- not just as an organ in dire need of help- and that it has the power to help the body heal itself. I was able to explain that I chose Life West because it had the most techniques offered compared to any other chiropractic school- that I chose Life West specifically to learn about these different techniques that can help people through all walks of life.

I chose Life West because I resonated with its values, “To Give, To Do, To Love, To Serve.”

about how I want my future practice to be a community.

Although I may have felt alone in the huge crowd at school, I know that people did their best to reach out and be inclusive and supportive. It made me reflect that when building a relationship with someone, I should have a genuine desire to understand the person sitting across from me, to understand how they might be feeling and what it might be like to be in their shoes.

At the end of the day, the people that I want to support need a strong and true connection to me and my values.

Whether these values are “To Give, To Do, To Love, To Serve,” I need to show up to listen and to learn… and I ask for you to do the same. For those who show up to reflect and respond, thank you. §

- Melinda Pham

A few months later, Asian hate crimes became prevalent in the United States. At that time, I was already back in school, and I was a few hundred miles away from my parents. Both of my parents, believe it or not, are old enough to be my grandparents. When I saw that many of the victims were elderly Asians, my heart sank as I felt my anxiety rise- fearing for my parents’ and extended families’ safety. My friends in the Asian community at Life West and I talked about the current events, but everyone else seemed to be silent about it. I wasn’t sure whether it was because they were unaware or because they were unaffected.

Reflecting on this moment in time, it makes me realize how much community means to me and what community truly means to me. Community is more than just the people I’m around- it’s the connections that we cultivate together, it’s the support we have for each other- even when we’re feeling alone. During this time, my close group of friends became even more close knit to the point where I consider them practically family. It made me think #LIFELINES | 11

ASIAN HERITAGE CULTIVATES COURAGEOUS CHIROPRACTORS

I

can still recall when I told my parents I wanted to be a Doctor of Chiropractic. I remember seeing my parents again after my first quarter ended, just when the pandemic hit. My dad commented on how he was excited for me to graduate so I could prescribe him medication. I told him that as a D.C, it wasn’t in my scope of practice to write prescriptions. He was confused.

| 6-min read |

WHAT'S YOUR STORY?

WHAT MAKES MY STORY UNIQUE IS NOT HOW I FOUND CHIROPRACTIC, BUT HOW I FOUND MYSELF THROUGH MY PURSUIT OF CHIROPRACTIC. - By Alexis Griffith -

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hile everyone’s chiropractic story is unique, I’ve always considered mine to be unusual and inspiring. I didn’t grow up influenced by the pursuit of higher education. It just wasn't a focus in my household. Quite honestly, art class was possibly the only thing keeping me in school. I didn’t take the SATs and never planned on going to college, against the persistent wishes of my high school advisors. I never envisioned myself achieving anything great in my life, partly from not believing I was capable and partly from not being passionate enough about anything.

I was already working full time during high school and moved out as soon as I turned 18 into a dingy little apartment. After a summer of struggling to make ends meet, even while working 50+ hours a week, I decided I’d better at least consider community college. I signed up for the first program I saw, which was an associate’s degree in kinesiology. While still working full-time, I also attended classes that fall, but it was to no avail as I ended up failing all 12 | LIFEWEST.EDU/LIFELINES-MAGAZINE/

my classes and dropping out. That was the ultimate deciding factor that college just wasn’t for me, and I turned my efforts to becoming a tattoo artist, having most of the tattoos you see on me today done before the age of 19.

Despite feeling content outwardly about my life decisions, there was still an underlying desire to do something more with my life. Luckily at the time I was working for StarbucksTM and found out that they pay for their employees’ college tuition, and that I could major in art. I attribute my going back to college, and thus also going to chiropractic college, solely to StarbucksTM (shoutout StarbucksTM!).

"I’ve learned that where there is passion, there is a way" I had worked my way through two years of art school when I had another epiphany. Here comes my long-awaited magical chiropractic story. I sustained a rotator cuff injury and ended up going to a chiropractor who was able to help get me completely out of pain in only a few visits. Up until that point, I’d always regarded chiropractic as pseudoscience and never gave it the time of day, but at that point I realized, “hey, there’s actually something to this!”

"Far and away the best prize that life offers is the chance to work hard at work worth doing."

- Theodore Roosevelt -

As I stated at the beginning of this article, my chiropractic story is not so much about how I found chiropractic, but about how it helped me find myself. Yes, that must be about the cheesiest thing I have ever written or said, but it’s true. This journey has taught me to never put a limit on myself or my potential, no matter how daunting things may seem. I’ve learned that where there is passion, there is a way. I’ve often gotten questions from classmates or lower quarter students on how I find the time or motivation to study and do well in school, and it ultimately comes down to having a passion for what you’re doing. When you realize what truly excites you about life (in my case, the opportunity to help others) there is no exam too daunting, no late night of studying not worth it, no amount of reading too much. Theodore Roosevelt was right when he said that “far and away the best prize that life offers is the chance to work hard at work worth doing.” § #LIFELINES | 13

WHAT'S YOUR STORY?

I got to know my chiropractor pretty well and he suggested, and eventually persisted, that I go to chiropractic college myself, to which I always laughed and told him I wasn’t smart enough.

While I did truly believe I wasn’t capable enough, deep down I was also scared of changing my career path, especially after struggling so much to create one in the first place. I had finally found passion in studying art, receiving straight A’s for the first time in my life and I didn’t want to let go of that feeling of success. But eventually it dawned on me that I was truly meant to do something more, so I dropped out of art school. That was probably the hardest and most frightening thing I’d ever done. I began taking pre-med courses back at the community college that I had previously flunked out of (hello academic probation) and quit my job at StarbucksTM to become a chiropractic assistant. I thought working full time as a barista during art school was tough, but pre-med night school after a 10hour day at the chiropractic office was something else.

I struggled a lot and broke down on a regular basis.

Despite being scared to death of science, I ended up shocking myself by excelling in those pre-med courses.

I remember struggling to barely pass an exam early on in one of my biology classes, and then later that year the head of the biology department informing me that I’d reached the top of the class. I slowly chipped away at the requirements to get into chiropractic school and finally started summer of 2019. At that point, even before my first day, I knew that I’d made it. After all the struggles I faced through undergrad, from actual schoolwork to supporting myself, I knew that whatever chiropractic school threw at me I could handle.

| 6-min read |

JOURNAL CLUB: RELIABILITY OF LEG CHECKS - By Meagan Stachnik -

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he Chiropractic community is considered a group of professionals educated in the musculoskeletal system, neurology, vitalism, and scientific evidence approaches. Diversity in Chiropractic technique, analysis and philosophy that exists within the profession offers opportunity for clientele to choose the correct approach for their bodies and take control of their care and treatment plan. Patients may not necessarily know the differences and similarities of the assessment techniques performed by chiropractors, but they are always familiar with certain things every chiropractor may perform in one way or another. They’ll say, “My chiro pops my hip”, “My chiro does this hip pull on me”, and “my chiro does this leg sweep”.

The terminology is often difficult to interpret when a patient is requesting an adjustment after seeing a different chiropractor, however, one analysis most chiropractors are taught one form of analysis leg length inequality check (LLI). Known by many names such as Derefields or prone leg check, the LLI is one of the most noninvasive tests that can provide a considerable amount of valid functional and structural information regarding a patient. However, should chiropractors trust the reproducibility and validity the LLI? Nguyen and colleagues (1999) sought to answer this question, and herein is a summary of their results and interpretation to shed some light on the LLI technique.

Patient exclusion criteria included structural short leg, significant leg trauma, cancer or infection diagnosis, paralysis, prosthesis, fractures or current sprains, and replacement surgery to the knee or hip. Examiners had 15 years of clinical and instructor experience of the activator method. The examiners were unblinded throughout the process. Appropriate footwear coined ‘laced-up oxford shoes’ were key to their protocol to ensure adequate reliability for the test. Inadequate shoes were removed, and the examiner prompted the patient onto a Hi-Lo table. The testing examiners each took turns administering the LLI.

Nguyen et al. examined LLI with an activator method approach with a subject base of 34 patients.

6. Headward pressure applied with thumbs.

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Protocol performed by examiners: 1. Reference point of the leg length - welt of the heels of the shoes.

2. Palms of their hands cupped the lateral malleoli and brought legs together until heels touched and formed horizontal right angles.

3. Thumbs under heel of each shoe, index fingers on posterior aspect of lateral malleolus indicated a ‘finger gun’ position.

4. Examiners used their thumbs for removal of inversion or eversion and dorsiflexed feet.

5. Flared or externally rotation of the feet so toes abducted to a natural angle of 10-20 degrees.

7. Leg length then observed and documented.

JOURNAL CLUB: RELIABILITY OF LEG CHECKS

Agreement between examiners was statistically significant (P<0.05) and reported at 85%. Further analysis using Kappa coefficient, which excludes the agreement you might expect by chance, demonstrated a k>0.75 which is considered excellent reproducibility. Unfortunately, the research results collected had a small sample size with a higher evaluation result of right LLI (potential bias). Other potential bias considerations include type l and ll examiner error, other health care treatment plans, equipment or patient position differentiations, and lack of radiographic findings. Leg length limitations could also be indicative of scoliosis to impede the structural or functional integrity of the findings.

Further studies will need to research other methodological evidence to support the findings while taking the elements listed above. Proper leg measurements due to potential fluctuations that can vary between leg lengths of patients and different LLI methods (e.g. drop table) should be considered.

Activator method indicates bias between the examiner's dominant hand to be able to apply more force headward compared to their non-dominant hand which could orchestrate a skewed result. This could be indicative of more right LLI compared to left as both examiners were right hand dominant.

Variation in gait among patients could deplete shoe ware patterns and provide inconsistencies in LLI. Shoe wear patterns may depend on whether a patient wears orthotics. Are the orthotics structural and functionally accurate for the patient? Does the patient

follow appropriate upkeep and check-in to ensure the orthotics are correctly fitted?

Nguyen et al. established a reproducible study, however, failed to prove clinical significance or validity of LLI. Chiropractors require more justification of their analysis technique to not only defend chiropractic but to expand more research into analysis systems and approaches. The rationale behind the “why” and “success” of certain chiropractic techniques will be able to go further with other health care professionals, patients and ultimately, other chiropractors when we can provide sufficient evidence of clinical and statistical significance of analysis. Reasonable evidence can give grounds for chiropractors to flourish under their respected and chosen technique. § #LIFELINES | 15

| 5-min 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.

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- By Nolan Halverson -

ucked 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

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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. §

#LIFELINES | 17

THE BEST PLACE ON EARTH

"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."

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.

CREDITS

COVER Alexis Griffith; @georgechemas 2 EDITOR’S LETTER Austin Bergquist; Zeltzin Serrano 3 HARMS OF LOW-CARB no images EDITOR/DESIGNER/PHOTOS 4-5 MEET OUR PEOPLE Dr. Austin Bergquist, PhD Emma Harbage; Alexis Griffith; Nolan Halverson; Melinda Pham; Joyce Yeung; FACULTY ADVISOR Meagan Stachnik; Dani Lorta, MA 6-7 CONTENTS 03 Carbs/PixaBay; 08 Emma Harbage; 10 PRINTING Flowers and Fans/PixaBay; 12 STarbucks/ Michael Poss PixaBay; 14 Leg Checks/PixaBay; 16 You Are Here/PixaBay; CONTACT 8-9 GOOD HANDS abergquist@college.lifewest.edu Emma Harbage (Multiples) 10-11 ASIAN HERITAGE ARTICLE SUBMISSION Would you like to write for Lifelines magazine? We look Joyce Yeung & Melinda Pham 12-13 WHAT'S YOUR STORY for chiropractic articles that inspire & challange. Email Alexis Griffith and her arm.

CONTACT for more information.

14-15 JOURNAL CLUB: LEG CHECKS Meagan Stachnik in the cold.

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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

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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

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

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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-for-

profit 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. §