10 I Winter 2018 www.anjc.info www.njchiropractors.com I 11 NUTRITION COUNCIL Update DICARE Q&A Legislative Update Legal Ease LEGAL Chiro Assist TECHNIQUE Council NUTRITION Council REHABILITATION Council adership uarters UPDATE Legal Q&A S C H O L ARSHIP WI N N E R S A high-fat, very low-carbohydrate diet, otherwise known as the ketogenic diet, may be the key to reversing Type 2 diabetes. This eating plan goes against much of the conventional guidelines given to people with Type 2 diabetes. However, it is being proven successful in much of the new research being conducted. Dr. Stephen Phinney MD, PhD, and chief medical officer and co-founder of Virta Health, a clinic special- izing in lifestyle-based treatment for diabetes, is very pleased with many of the results of recent research. Data from a new study by McKenzie A, et al. in JMIR Diabetes reveals the substantial effects the ketogenic diet can have on diabetics. After 10 weeks on the plan, 36 percent of diabetics were able to completely stop their insulin therapy while 51 percent were able to lower their doses significantly. Additionally, mean hemoglobin A1C (a biomarker for long-term glucose damage) plummeted from 7.5 percent to 6.5 percent, while over half of patients even reached below the diagnos- tic threshold for diabetes. Not to mention, almost 75 percent of subjects in the study lost a clinically significant amount of weight. Despite the increase in popularity of the ketogenic diet, the science behind it is not new. Research on this diet has been conducted since as early as the mid-70s, however the studies were done in an institutional setting and could not be easily applied to patients in the real world. In the ketogenic diet, the body becomes better adapted at burning fat for fuel instead of carbohydrates. The fat the body burns is in the form of ketones, such as the 4-carbon beta-hydroxybutyrate (BOHB). These ketones are water soluble and are much easier for the body to use for energy metabolism than the typical long-chain fatty acids. These ketones become most abundant when insulin levels are low, glycogen (stored carbo- hydrates) is depleted, and the fat-burning hormones epinephrine and norepinephrine are high. Ketone levels can vary widely in the blood stream. The optimal level of ketones is 1.5-3.0 mmol/L .Levels of 0.1-0.3 can be obtained simply from fasting for a day or two while levels of 5-7 mmol/L are obtained from prolonged fasting (one week). The optimal ketone levels of 1.5-3.0 mmol/L can typically be obtained by a diet consisting of roughly 70-75 percent healthy fats, 15-20 percent protein and 5-10 percent carbs. However, it is important to note that the majority of carbs should come from non- starchy vegetables such as greens, broccoli, cauliflower, etc. Some fruit is permitted with a focus on dark blue and red berries. Quality protein sources include lean red meats, fish, poultry, eggs and some dairy. Healthy fat sources include avocados, nuts, seeds, olive oil and coconut oil. Food should ideally be from organic, minimally processed sources. Many clinicians recommend avoiding high fat diets for fear of increased health risks, but the data does not support this. Consuming a high amount of healthy fats teaches the body to burn fat as its fuel source, and health markers improve when patients go on the high-fat, ketogenic diet. A 2009 study com- pared subjects who ate a low-fat, high-carb diet to those who ate a high-fat, low-carb diet. Subjects on the low-carb diet lost significantly more weight than those on the high-carb diet. They also improved their lipid profile and biomarkers of metabolic syndrome. This was true despite the high-carb diet being restricted to 1,500 calories while the low-carb diet was given no caloric restriction! One of the most surpris- ing outcomes of the study was that despite the subjects on the low-carb diet consuming threefold more dietary fat, they had lower serum levels of saturated fat. This is because the low-carb subjects became more efficient at burning fat while the insulin created by the high- carb diets produced more saturated fat in the liver. It is import- ant to note that this fat-burning adaptation takes a few weeks to develop. Additionally, the low-carb diet can help reduce inflammation. One study from Forsythe CE, et al. in 2008 showed that seven out of 14 biomarkers for inflammation including TNF-a, IL-6, and IL-8 all improved when on a ketogenic diet. (Continued on Page 15) By Dr. Tom Bilella ANJC Nutrition Education Council Chairman KETOGENIC DIET: The Solution for Diabetes? (Smart Healthcare Solutions Continued from page 1) to be paid what they are owed makes Smart Healthcare Solutions stand out. The partnership is truly a win for the profession in New Jersey.” Heather is a Certified Medical Biller, Certified Medical Administrative Assistant and Certified Billing and Coding Specialist. Garcia has been published with the American Academy of Professional Coders (AAPC) five times. She also has served as an expert witness in New York no-fault cases and sat on the Medical Assistant/Medical Coding and Billing Advisory Board for Lincoln Technical Institute. Smart Healthcare Solutions will handle your insurance coding, claims and patient billing, including invoicing and collections, for you, or they will train your office staff to do it. Other services the company provides are front desk staff training, such as scripting for phone calls to bring in more patients. “Our philosophy is get somebody through the door. They are more likely to treat with you after meeting you than just talking to you over the phone,” Heather said. 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