18 I Winter 2019 www.anjc.info CHIRO ASSIST TECHNIQUE Council NUTRITION Council REHABILITATION Council OUR HEALTH The Next Step… As new chair of the ANJC NEC, I plan to create the best year yet for nutrition integration into your practice. We’re using digital videos for health tips and clinical pearls and social media to create an educational continuum. We are uniquely positioned to communicate with our patients about their intake and lifestyle. And it is a wellness approach that we all need to adopt. Helping patients with a more whole approach only helps support our structural work and overall patient health. In 2016 an independent, single blind study by Patient Preference Adherence concluded: “There was an increase in lumbosacral angles in individuals with raised BMI (weight) and WHR (girth). This may result in biomechanical changes in the lumbosacral spine, which increases the incidence of low back pain” – As we know. The study originated as it was already concluded that immobility and pain was a contrib- uting factor to weight gain and other metabolic issues, but they wanted to conclude that joint stress/dysfunction was a causal pain factor… We are so ahead of the game, we are the future! These two parameters, BMI and WHR (waist hip ratio) are the acceptable, baseline standard for primary physicians to assess patients for their healthful weight and, thus, risk for chronic disease and are quickly gaining acceptance as a standard of care vitals parameter. Our initial target should also be this largest, most looming problem - obesity and the disease cascade it presents. The CDC states a 42.8 percent obesity rate in middle-age adults (2016). We see these patients more, spend more time and mostly we speak to them. Let’s make every minute count and round out that visit -- make it more whole. The first place to start is to know our food if we are addressing weight or negative body composition. And the glaring misunderstood culprit is still sugar. There are popular diets that almost totally stamp out any sugar intake and are good alternatives at least for the short run. These can be good tools. But as practitioners, we also need to own the basic concepts. So initially, lets understand the classification, the why and how of the impact of sugar. We’ve all heard the term Glycemic Index, but what is this really and what are its clinical applications? Of course, as the name implies it relates to sugar. It is a science-based application that classifies foods in relation to their impact on blood glucose. There are charts and resources readily available for us and our patients. Adherence to this can really decrease weight and improve metabolic status. The glycemic index factor was popularized by the Zone Diet, Sugar Busters and the Slow-Carb Diet. These outline this science-based tool. They are not just diets, not another quick shift in your body’s chemistry and presto the pounds fall off like, for instance, the Grapefruit Diet, which allows you to predominately eat one type of food – yes, grapefruit -- and theoretically you can lose weight. Obviously it is difficult to stick to, and it is not very nutritionally balanced. As the term GI does not contain the word diet, it is not a diet. It is a way to measure foods’ carbohydrate content. Any food that contains carbohydrates has to some degree a physiologic effect on blood sugar levels (BG), insulin and ultimately, fat storage. Understanding and using the GI can help us decrease our sugar intake with knowledgeable choices, which leads to better BG numbers and overall body composition. Overall, better body composition; less fat and improved lean tissue contributes greatly to better metabolic numbers. Some of those important numbers impacted are cholesterol, triglycerides, HDLs, insulin and HbA1c. We can design a GI-based food intake regime that creates lower, steadier, blood glucose levels throughout the day. This is proven to be useful in managing DMII (diabetes Type 2), and general inflammation can benefit from better, GI intake. The GI was originally developed in 1981 by diabetes researchers to study blood sugar levels and potential controls. Researchers wanted to measure the ability that different foods had to raise blood sugar levels, which is referred to as a “glycemic response.” The higher the response or rise in blood sugar levels that a food elicits, the greater insulin response occurs from the pancreas. All foods were categorized based on their ability to raise insulin levels into high, moderate and low GI response categories. All foods are based on or compared to pure table sugar (glucose). This has the highest single index (100). Let’s compare similar low, moderate and high index food values. Higher value foods are definitely to be considered in smaller intake amounts due to their ability to quickly raise blood sugar levels and their generally higher calorie/carbohydrate values. High GI values foods are typically above an index of 70 like: parsnips Nutrition Council UPDATE By Dr. Julianne Monica Chair, ANJC Nutrition Education Council