High HbA1c: You're getting older . . . faster

Over the years, we all accumulate Advanced Glycation End-products, or AGEs.

AGEs are part of aging; they are part of human disease. AGEs are the result of modification of proteins by glucose. AGEs form the basis for many disease conditions.

Accumulated AGEs have been associated with aging, dementia, cataracts, osteoporosis, deafness, cancer, and atherosclerosis. Most of the complications of diabetes have been attributable to AGEs.

There's one readily available method to assess your recent AGE status: HbA1c.

Hemoglobin is the oxygen-carrying protein of red blood cells. Like other proteins, hemoglobin becomes glycated in the presence of glucose. Hemoglobin glycation increases linearly with glucose: The higher the serum or tissue glucose level, the more glycation of hemoglobin develops. Glycated hemoglobin is available as the common test, HbA1c.

Ideal HbA1c is 4.5% or less, i.e., 4.5% of hemoglobin molecules are glycated. Diabetics typically have HbA1c 7.0% or greater, not uncommonly greater than 10%.

In other words, repetitive and sustained high blood glucose leads to greater hemoglobin glycation, higher HbA1c, and indicates greater glycation of proteins in nerve cells, the lens of your eye, proteins lining arteries, and apoprotein B in LDL cholesterol particles.

If AGEs accumulate as a sign of aging, and high blood sugars lead to greater degrees of glycation, it only follows that higher HbA1c marks a tendency for accelerated aging and disease.

Indeed, that is what plays out in real life. People with diabetes, for instance, have kidney failure, heart disease, stroke, cataracts, etc. at a much higher rate than people without diabetes. People with pre-diabetes likewise.

The higher your HbA1c, the greater the degree of glycation of other proteins beyond hemoglobin, the faster you are aging and subject to all the phenomena that accompany aging. So that blood glucose of 175 mg/dl you experience after oatmeal is not a good idea. 

The lesson: Keep HbA1c really low. First, slash carbohydrates, the only foods that substantially increase blood glucose. Second, maintain ideal weight, since normal insulin responsiveness requires normal body weight. Third, stay physically active, since exercise and physical activity exerts a powerful glucose-reducing effect. Fourth, consider use of glucose-reducing supplements, an issue for another day.

While HbA1c cannot indicate cumulative AGE status, it can reflect your recent (preceding 60 to 90 days) exposure to this age-accelerating thing called glucose.

If your doctor refuses to accommodate your request for a HbA1c test, you can perform your own fingerstick test.

Comments (16) -

  • Dexter

    3/28/2010 3:08:24 AM |

    http://www.diabetesdaily.com/edelman/2010/03/interview-dr-bernstein-on-low-carb-diets-treatments-politics.php

    Dr Richard K. Berstein was interviewed on Mar 23 and was an eye opening regarding A1C and the incompetence of the mainstream medical community dealing with diabetics.  Author of many books for diabetics.

    http://www.amazon.com/gp/entity/Richard-K.-Bernstein/B001IOBDVW?ie=UTF8&ref_=s9_simh_gw_p14_al1

    Acceptable blood glucose levels of 250 and A1C levels of 7?  And not being accepted into diabetes clinics with A1C level less than 6.5  Criminal.

  • Denny Barnes

    3/28/2010 5:44:42 AM |

    HbA1c is a measurement of early glycation products which correlates with serum AGE levels, but is not a measure of advanced glycation end-products. For example, one Japanese study of cognitive decline in diabetes found, "Serum AGE levels were significantly associated with the impairment of complex psychomotor skills independent of HbA1c."

    You have written on the benefits of coffee.  While I share your love of coffee and believe coffee does not affect HbA1c, it clearly is one of the worst sources of AGEs.

  • Anonymous

    3/28/2010 1:12:09 PM |

    Use a BG meter to check effect of meals/foods on BG peaks, as described in this thread:
    http://www.imminst.org/forum/index.php?s=&showtopic=36724&view=findpost&p=373966

  • Anonymous

    3/28/2010 1:32:08 PM |

    btw, the case of high A1C with normal fasting BG is often due to high rates of gluconeogenesis (glucose from protein) that keeps BGs high between meals, but drops by morning as all remaining protein gets digested overnight.  A high rate of gluconeogenesis is often characteristic of insulin resistance, and is what forces many to eventually need the help of drugs to control BGs (i.e., reducing carb intake may not be enough to keep BGs low, and you're stuck consuming a certain amount of protein).

  • Carl M.

    3/28/2010 1:41:08 PM |

    Question: does this test measure just proteins reacted with glucose or also those reacted with fructose? I recall hearing somewhere that fructose was seven times as reactive.

  • Dr. William Davis

    3/28/2010 2:18:52 PM |

    Exactly right, Denny.

    HbA1c can only provide an indirect indicator, and only a short-term one at that. However, it's better than no indicator at all.

  • DrStrange

    3/28/2010 4:35:55 PM |

    " the case of high A1C with normal fasting BG is often due to high rates of gluconeogenesis (glucose from protein) that keeps BGs high between meals, but drops by morning as all remaining protein gets digested overnight."

    Also, can result from too frequent eating.  By adding a couple light, between meal snacks to my 3 meals per day I jumped my A1c from 5.1 to 6 in a few months.  Won't do that again!

  • Anonymous

    3/28/2010 9:11:18 PM |

    Dr. Davis,

    Have you ever looked into the potential for substances like taurine, benfotiamine, pyridoxamine, carnosine?  I've seen passing mention of these as potential glycation inhibitors.

    I've also seen sources that suggest that R-ALA and ALCAR can be of possible help in reducing glycation damage.

    While the comment in your post seems to point a bit more to the latter, I realize that you mentioned that glucose-reducing supplements are a topic for another day. But perhaps this can add to the mix for a possible future post on those topics.

    Doug Rafferty

  • Anonymous

    3/29/2010 12:59:45 AM |

    I've now gone back and read all the recent blog posts about BGs made by Dr. Davis, and would like to point out several issues:

    - first, it's great to see someone finally pushing BG measurements for non-diabetics; however, there's a lot to know about this, and I encourage others to read the imminst thread referred to in comment #3 above

    - for low-carb dieters with insulin resistance, their average BG (and A1C) will usually be dominated by glucose produced from protein digestion (i.e., it's not just about carb intake)

    - the most accurate and precise meter I've seen is AccuChek Aviva, where precision is mainly determined by strip quality, and crummy strips will cost you a lot more money and blood, since you'll need to make a lot of extra measurements (i.e., with crummy strips you may have to average 3 results to get an accurate number)

    - disease risk rises exponentially with BG levels, which is why peaks matter most

    - the time to your peak BG after meals depends on so many factors that you'll have to determine that yourself (i.e., don't assume 1 hour; mine is 30-60 minutes for most meals)

    - exercise after meals can reduce your BGs to fasting levels, but they will soon rise again due to continued protein digestion (or even low-glycemic carb digestion); so the benefit of regular exercise is mainly in a general lowering of insulin resistance, and greater glucose uptake by muscle mass when at rest

  • stcrim

    3/29/2010 1:09:07 AM |

    Cinnamon - a simple recipe with a double punch.  Take a couple of cups of almonds and wet them.  Shake them in a bag with a couple of teaspoons of Ceylon Cinnamon.  Make sure you use Ceylon for best Blood Sugar results.

    Preheat your oven to 350.  Spread the almonds on a cookie sheet.  Pop them in the oven and turn it off.  20 to 30 minutes later the Cinnamon will be dried to the almonds - let cool and enjoy.

    What was it they were eating in the 20s and 30s to cause heart disease?  My grandfather died in 1934 of quote, acute indigestion.

  • Anonymous

    3/29/2010 1:43:44 AM |

    With respect to weight loss and BG measurements, some of you may find my story encouraging:

    - starting at 205 lbs, I lost about 20 pounds basing decisions mainly on carb counts and low glycemic index

    - after getting a meter and eliminating foods causing high-post meal BGs (such as oatmeal!), I dropped another 10 pounds

    - after fixing a testosterone deficiency (andropause), I dropped another 10 pounds

    which puts me at about 165 and BMI near 22.  (All that was done over the course of about 5 years, but it took me that long to figure out this stuff!)

  • stcrim

    3/29/2010 1:43:44 AM |

    Oops! I forgot to mention I use a little Stevia with the Ceylon Cinnamon and almonds.  It also works great with walnuts.

    Steve

  • Anonymous

    3/29/2010 2:33:34 PM |

    To my above list, I'd like to add a few points about "grazing":

    - from the plots in the blog, it appears that evidence of "stacking" comes mainly from excessive fructose consumption; my own experience with a TG meter does not show stacking of TGs when grazing on fat-rich mini-meals

    - it's irrelevant whether grazing is "self-indulgent"; diet needn't be torture, and you're unlikely to stick with something you don't enjoy doing

    - it's also irrelevant whether grazing is "unnatural", since the optimal diet (to reach, for example, age 100) is unlikely to be one followed by people who rarely lived beyond age 50; to reach extraordinary ages, you'll likely need to do extraordinary things (niacin? fish oil capsules? D3 capsules? etc.)

    - peaks matter, and fewer meals means larger peaks (as well as increased acid reflux, esp. bad when large meals are consumed late in day)

    imho, i don't think the data currently exists to prove the case one way or the other, and suspect that the optimal solution will turn out to be very person-specific

  • Anonymous

    3/29/2010 6:50:12 PM |

    More thoughts on "stacking": If one spread one's consumption across 24 hours, then food would be being burned at exactly the same rate as it was being consumed, and no significant stacking would occur. Thus stacking results from compressing consumption into smaller time frames. In fact, the ultimate "stack" is formed by consuming a single meal per day (i.e., all the TG and BG is forced to pile up over a very short time frame).

    The caveat to this is that it may be the case that larger TG and BG peaks create more efficient processing (i.e., ice cream is somehow better handled after a big meal than when consumed in isolation), or that the benifits from lows between meals outweigh all the highs during meals. But I remain skeptical that such stress (high peaks, high insulin, etc.) is ultimately a good thing (esp. since I've already taken the trouble to control acid reflux by spreading intake across the day).

    But wouldn't be surprised either way. There's already a camp that believes that BG spikes are necessary for optimum bone formation, etc., so who knows?

  • Anonymous

    3/30/2010 9:38:06 PM |

    I've found every article in this blog really interesting and helpful and everything seems to make a lot of sense.
    But I still fail to see how it fits for people that don't want/need to loose weight.
    Say a 190pound healthy athlete with a very active live.
    How do you feed him without gazing, only two meals per day, 50g carbohidrates per day and 40g of fat per meal?
    How would you feed Michael Phelps?

  • Anonymous

    3/31/2010 3:55:27 PM |

    Dr. Davis,

    In this latest post, you said "Fourth, consider use of glucose-reducing supplements, an issue for another day."

    I would very much like to read your thoughts on these supplements and would look forward to a blog post on this topic.

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Low Thyroid and Plaque

Low Thyroid and Plaque

Having now tested the thyroid status of several hundred patients over the last few months, I have come to appreciate:

1) That thyroid dysfunction is rampant, affecting at least 25% of everyone I see.
2) It is an enormously effective means to reduce cardiovascular risk.


I'm not talking about flagrant low thyroid dysfunction, the sort that triggers weight gain of 30 lbs, gallons of water retention, baggy eyes, sleeping 14 hours a day. I'm talking about the opposite extreme: the earliest, subtle, and often asymptomatic degrees of thyroid dysfunction that raises LDL cholesterol, lipoprotein(a) (Lp(a), a huge effect!), and adds to coronary plaque growth.

Correcting the subtle levels of low thyroid:

1) Makes LDL reduction much easier

2) Facilitates weight loss

3) Reduces Lp(a)--best with inclusion of the T3 fraction of thyroid hormone.

Recall that, 100 years ago, the heart implications of low thyroid weren't appreciated until autopsy, when the unfortunate victim would be found to have coronary arteries packed solid with atherosclerotic plaque. It takes years of low thyroid function to do this. I advise you to not wait until you get to this point or anywhere near it.

I find it fascinating that many of the most potent strategies we are now employing in the Track Your Plaque process are hormonal: thyroid hormones, T3 and T4; vitamin D (the hormone cholecalciferol); testosterone; progesterone; DHEA, pregnenolone. Omega-3 fatty acids, while not hormones themselves, exert many of their beneficial effects via the eicosanoid hormone pathway. Elimination of wheat and cornstarch exert their benefits via a reduction in the hormone insulin's wide fluctuations.

We haven't yet had sufficient time to gauge an effect on coronary plaque and heart scan scores. In other words, will perfect thyroid function increase our success rate in stopping or reversing coronary plaque? I don't know for sure, but I predict that it will. In fact, I believe that we are filling a large "hole" in the program by adding this new aspect.

Comments (12) -

  • Stephan

    12/2/2008 10:17:00 PM |

    I suspect gluten sensitivity could play a role in many thyroid cases.  Celiac disease associates with autoimmune thyroid problems.  About 12% of Americans are verifiably gluten sensitive.  The number may actually be much higher if you include people who have a less pronounced immune reaction to gluten.  What do you think of this idea?

  • Fitness blogger

    12/3/2008 2:58:00 AM |

    That is very concerning. What are the typical symptoms of a low thyroid. I must get it checked.

  • Anonymous

    12/3/2008 3:03:00 AM |

    Dr.Davis,
       This post has convinced me that
    your eventual protocol will be THE
    standard MO in just a few short
    years.Many thanks for your blog.

  • Anonymous

    12/3/2008 2:34:00 PM |

    Now the question is, how to get a doctor to treat you for low thyroid function?  I went from doctor to doctor for a number of years complaining of most of the clinical symptoms of low thyroid.  Since my labs were "within the normal range", not one of them would prescribe any form of thyroid.

    Finally, in desperation, I went to a "wellness" doctor who did put me on a trial of Armour thyroid.  MAGIC!  I suddenly had some energy, the gray clouds lifted, and I was finally able to begin to lose some weight... which eventually led to a 50 pound weight loss, which had been impossible before treatment.

    Unfortunately, by then I had achieved a heart scan score which put me in the high 90th percentile for a 55 year old woman.  Thanks docs!!!

    The average doctor out there seeing patients is still treating based solely on lab numbers, NOT on the (obvious) clinical symptoms sitting in front of them.  Such a patient is far more likely to be given a script for an antidepressant... I had plenty of doctors who were MORE than willing to write scripts for those!

    I hope the TYP treatment protocol will eventually begin to make a dent in this situation.  I now know that years of untreated low thyroid certainly contributed to my high heart scan score.

    Thank you, Dr. Davis, for Track Your Plaque!

  • rnikoley

    12/3/2008 6:24:00 PM |

    Dr:

    I have recently been reading your blog lately, and referring lots of readers from my own blog.

    I'd be interested to get your "take" on this -- not diagnosis.

    'Bout 18 months ago, I was at 230 (5'10) and looked awful. I was on Omeprezol for years for gastric reflux, a variety of prescription meds since early 20s for seasonal sinus allergies, culminating finally in the daily, year round squirts of Flonaise-esque sprays (the best for control without noticeable side-effects), and finally, Levothroid for about the last 7 years or so, as I had elevated TSH (around 9ish).

    My BP was regularly 145-160 / 95-110.

    I decided to get busy. I modified diet somewhat, cutting lots of junk carbs, and began working out -- brief, intense, heavy twice per week. BP began coming down immediately, such that within only a couple of weeks I was borderline rather than full blown high. Then after about six months, a year ago, I went to full blown low-carb, high fat, cutting out all grains, sugar, veg oils, etc, and replacing with animal fats, coconut, olive oil. You know the drill. Then, first of the year I felt great and simply stopped all meds, including the thyroid. I also began intermittent fasting, twice per week, and for a twist, I always do my weight lifting in some degree of fast, even as much as 30 hours.

    That's when the weight really started pouring off. Take a look:

    http://www.freetheanimal.com/root/2008/09/periodic-photo-progress-update.html

    http://www.freetheanimal.com/root/2008/08/faceoff.html

    In July I figured it's about time for a physical. Here's the lipid panel, demonstrating am HDL of 106 and Try of 47, great ratios all around:

    http://www.freetheanimal.com/root/2008/07/lipid-pannel.html

    However, my TSH was even higher -- 16ish. It seems odd that I was able to lose 40-50 pounds of fat (10-15 pounds of lean gain for a 30 pound net loss at that time -- now an additional 10 pounds net loss).

    One disclosure is that I was drinking too much, almost daily, and quite a bit (gotta save some vices...). Anyway, I'm at the point now where I want to drill down. I know I need to see an endocrinologist and have T3 and T4 looked at, but in advance, I wanted to see if the recent changes I've made could make a difference:

    1. Stopped all alcohol.
    2. Stopped most dairy, except ghee and heavy cream, and cheese is now used as a "spice," i.e., tiny quantities -- no more milk.
    3. 6,000 IU Vit D per day.
    4. 3 grams salmon oil, 2 grams cod liver oil.
    5. Vit K2 Menatetrenone (MK-4) -- side story: getting off grains reversed gum disease for which I have had two surgeries, then supplementing the K2 DISSOLVED calculus on my teeth within days -- hygienist and dentist are dumbfounded. Stephan (Whole Health Source), who comments here, has an amazing series on K2.

    Well, that's about it. I'd be interested in your general take on this.

  • Dr. William Davis

    12/3/2008 8:26:00 PM |

    Stephan--

    I suspect that there is indeed a connection.

    I personally feel that wheat, for a variety of reasons, has NO place in the diet whatsoever.

  • Hannah

    12/4/2008 3:18:00 AM |

    I agree with anonymous. It is incredibly difficult to find a doctor who'll will diagnose and treat hypothyroid, whether mild or not. There are many people whose FT3 and FT4 levels are low (whether the lab considers them in range or not) yet their TSH is "normal" either because their pituitary gland has not responded to the situation yet or because the lab range for normal is outdated.

    Many labs still use a TSH range of 0.3 - 5.0, when the American Association of Endocrinologists has recommended 3.5 be the upper limit, with many individual thyroid specialists pointing out that the healthy population's TSH readings have a mode of about 1.0 and a TSH of 2.0, or even 1.5 in older people, can be considered suspect when there are symptoms. And of course if someone has hypopituitarism the TSH range has no meaning at all.

    So we have an unknown number of people in various stages of dysfunction because many doctors aren't knowledgeable about what the TSH reading means. Not to mention issues like T3 resistance. They are often misdiagnosed as having chronic fatigue, fibromyalgia, depression, and so on, or just told to go lose weight. I know personally of one lady who went to her doctor - she is overweight, 46, had the symptoms of early hypothyroid, and tested for high cholesterol and elevated blood sugar. The doctor told her she had diabetes and wanted her to begin metformin. Luckily, she went for a second opinion and low thyroid levels were found. She's feeling much better now with T4/T3 combo therapy.

    There are also a lot of hypothyroid cases that aren't receiving adequate treatment. Some people receive relief with synthetic T4 replacement, some need a combination of T3 and T4, and others seem to need dessicated thyroid (eg Armour). Go to any thyroid support group and you will find people desperate for relief, their doctors are telling them their Synthroid is adequate, they must just be depressed or not eating well. Often the person will need to be treated for adrenal or pituitary function as well - as you have stated the hormones are all linked.

    If anyone believes they are having thyroid problems, do your best to shop around for a doctor who believes in testing Free T3 and Free T4 thyroid hormones and treating based on symptoms not strict lab results. Doctors who are both traditional practitioners as well as having an interest in "holistic" or "alternative" medicine may be the best place to look. But be wary of alternative health practitioners who claim they can cure hypothyroid with diet or homeopathic remedies, etc. A certain diet free of goitrogens will certainly help support your recovery but treating your hormones is necessary.

  • Dr. B G

    12/4/2008 5:50:00 AM |

    R Nikoley,

    Thank you so much for your efforts in promoting TYP at your informative health site! I've been keeping up with your blog posts and love your approach to optimal health and exercise regimens. Congrats with the incredible body recomposition shifts.  

    Your experience with butter oil and vitamins ADEK2 are esp informative for me.

    Your TG + HDLs ROCK!

    I'm stopping/limiting alcohol as well -- I think the health benefits can be immense.

    I have some questions for you:
    --Have you considered getting a heartscan eval?
    --Have you considered all the causes of Hashimoto's/HLA DR5 allele association? (it's an autoimmune disease just as HDL B27 is assoc with alkylosing spondylitis in many men; my sister had Grave's which is HDL DR 3 associated)
    --Have you had the vitamin D level evaluted? goal 25(OH)D 60-80 ng/ml
    --Have you had iodine testing? Deficiency leads to Hypothyroidism
    --Have you considered the role of casein as a food allergen (subsequently triggering the immune system to continue to attack the thyroid gland -- effectively killing it off like Oklahoma bombings)? Cream has casein -- though minute enough to trigger autoimmunity reactions.
    --Have you considered resumption of Levothroid or Armour Thyroid to control TSH to goal 1.0 to prevent further inflammatory responses?
    --Other factors related to Hashimoto triggers are: stress, high cortisol, adrenal depletion, zinc deficiency, iodine deficiency, B-vitamin deficiencies,  vit ADEK deficiencies, food allergies (wheat barley rye corn/maize egg whites casein), heavy metal accumulation (mercury, lead, etc).

    Hope that helps! I find it spectacular you cured your own gum disease.

    -G

  • Dr. B G

    12/4/2008 5:50:00 AM |

    R Nikoley,

    Thank you so much for your efforts in promoting TYP at your informative health site! I've been keeping up with your blog posts and love your approach to optimal health and exercise regimens. Congrats with the incredible body recomposition shifts.  

    Your experience with butter oil and vitamins ADEK2 are esp informative for me.

    Your TG + HDLs ROCK!

    I'm stopping/limiting alcohol as well -- I think the health benefits can be immense.

    I have some questions for you:
    --Have you considered getting a heartscan eval?
    --Have you considered all the causes of Hashimoto's/HLA DR5 allele association? (it's an autoimmune disease just as HDL B27 is assoc with alkylosing spondylitis in many men; my sister had Grave's which is HDL DR 3 associated)
    --Have you had the vitamin D level evaluted? goal 25(OH)D 60-80 ng/ml
    --Have you had iodine testing? Deficiency leads to Hypothyroidism
    --Have you considered the role of casein as a food allergen (subsequently triggering the immune system to continue to attack the thyroid gland -- effectively killing it off like Oklahoma bombings)? Cream has casein -- though minute enough to trigger autoimmunity reactions.
    --Have you considered resumption of Levothroid or Armour Thyroid to control TSH to goal 1.0 to prevent further inflammatory responses?
    --Other factors related to Hashimoto triggers are: stress, high cortisol, adrenal depletion, zinc deficiency, iodine deficiency, B-vitamin deficiencies,  vit ADEK deficiencies, food allergies (wheat barley rye corn/maize egg whites casein), heavy metal accumulation (mercury, lead, etc).

    Hope that helps! I find it spectacular you cured your own gum disease.

    -G

  • Anonymous

    12/5/2008 12:59:00 AM |

    Dr.Davis no where on your site do I see the importance of Vitamin C mentioned.Are you aware of the work of Linus Pauling concerning Vit C and the amino acid Lysine on calcification?
    Paulibng summarised that subliminal Scurvy was to blame and the RDA for Vitamin C is far too low.
    Ps. He did win a Nobel Prize for his research.
    Many thanks for a very interesting and informative site.

    http://www.vitamincfoundation.org/vitcheart.htm

  • Ryan W.

    3/1/2010 6:42:44 AM |

    Two things;

    1. Dr. Davis, can you provide any evidence that supplementing D3 will decrease arterial calcification? From what I've read, increased D3 (especially absent K1 menaquinone/K2) leads to increased calcification. It seems quite likely that the low levels of 25D3 observed in people with heart disease may be due to overconversion to calcitriol rather than lack of intake.  

    2. Anon wrote; "Dr.Davis no where on your site do I see the importance of Vitamin C mentioned."

    Ascorbate uses the same transporter as glucose (sodium mediated, IIRC.) Most animals make ascorbate from glucose and if your blood sugar is high, your body won't absorb vitamin C. So while mild scurvy may very well be a component of diabetes, it's questionable how well increasing oral intake will fix that problem, if the nutrient is simply not absorbed.

  • Anonymous

    3/11/2010 3:53:04 PM |

    I've come to believe my MANY health problems are hormone related but it's extremely difficult getting effectively tested and treated. I finally have some symptoms lessened by desiccated thyroid and am trying to sneak bioidentical low-dose estradiol, progesterone, DHEA past my migraine sensors. Hormones seem to be the most basic part of your system--if they could be in proper balance.

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