Today I want to talk about hemoglobin A1c (HbA1c) the levels the charts how to read
them and why A1c may be the single most important marker on a blood test and yet
it's often not even measured I going to explain everything that you need to know
Hey I am doctor Ekberg with Wellness For Life and if you like to truly master health
by understanding how the body really works make sure that you subscribe and
hit that notification bell so that you don't miss anything. A lot of people have
heard about A1c and glucose and insulin resistance and diabetes and they know
it's a big deal so we're gonna explain all the different pieces you need to
understand to make sense of all of that so first of all why is A1c measured?
well blood sugar is important but blood sugar can fluctuate tremendously
especially with a diet of refined foods so if you measure something at a certain
time then you could get a very different reading depending on the time you pick
so measuring glucose is difficult because it changes by the hour or even
by the minute so what they found was that the red blood cells these are red
blood cells they're floating around in the bloodstream and if there's a lot of
sugar in the bloodstream meaning high blood glucose some of that sugar is
gonna get stuck to the red blood cells to the hemoglobin and if there's more
sugar in the bloodstream there's going to be more sugar stuck to the hemoglobin
so they can measure the percentage of hemoglobin with glucose stuck to it and
they come up with a measurement hemoglobin A1c (HbA1c). So how did they do this
simply they took 500 people they did a long study they measured the glucose and
the A1c at varying times they plotted all of this and they came up with a
remarkably straight line so they knew that there was a very strong correlation
a very tight relationship between glucose and a1c then they came up with a
formula so now we can measure one marker a1c and get an average
of what the average glucose is because a red blood cell lives about three to four
months and during its lifetime it gets more and more sugar more and more
glucose stuck to it so depending on how much glucose is stuck we can measure and
figure out pretty much exactly what the average glucose was so now we have a
much much better measurement because even if it goes up and down a lot we can
still figure out what it was on average and that's much more important to know
than knowing what it was over here or over here so now we can create a chart
and we can figure out we know that an average glucose of 91 is equivalent to
an a1c of 4.8 average glucose of a hundred is equivalent to a 5.1 and so on
and they have defined normal as being anything up to a 5.7 between 5.7 and 6.4
is pre-diabetes that means that you don't have diabetes yet but you're
probably going to get it and above six point four or six point five six point
five and up is called diabetes they've defined that as diabetes but here's the
thing to understand that even though they have imposed these sharp
delineations they've put these these limits and say here it is this thing and
here it's something else it's all gradual okay here it does very little
damage and here it does a tremendous amount of damage because we know
diabetes it's just a label at one it's got over a certain point but diabetes is
associated with blindness with amputations and with kidney failure it's
the leading cause of all those things it's devastating in in today's society
but if we understand that the higher the number the more of these complications
we have then we also understand that a 6.4 is not as good as a 5.1 there's a
huge difference so we don't want to just look at this number and say oh good I'm
normal if we're after optimum health we want to understand this and try to bring
it in to the optimal range which in my experience and opinion and belief is
somewhere between four point eight and five point one so then people say well I
had my on my last blood test they measured my glucose and he came back at
a 90 so does that mean I have an a1c of four point eight no because when they
measured the glucose that means that was your fasting glucose level they caught
it at a certain time and we don't know where on that scale it was but if you
have an average glucose of a hundred that means a lot of times it's going to
need to be lower than that and sometimes it's going to be higher than that so for
example if you wake up in the morning and you have a fasting level of 80 and
then you eat something like something healthy like an omelet or some avocado
then it's probably going to gum up a little bit but not tremendously it's
probably going to stay in the 120 range and then as your body digests this over
several hours it's gonna gradually come back down again
your average level there might have been a hundred even though you're fasting
level was an eighty so that's the thing with the a1c it measures the average so
in a good day it will look like this for people who aren't quite so healthy but
still considered normal they might look something like this so
they wake up and they're starving they have hypoglycemia they're lightheaded no
energy they need to get something in them before they start functioning and
so they have some cereal and a doughnut and low-fat milk and now it jumps up to
a hundred and eighty and then it comes crashing down because of all the insulin
required to get this blood sugar out and it comes up and down up and down
throughout the day and yet their average is a hundred and twenty which by the
official guidelines is still normal it is not even pre-diabetic but this is not
healthy because this is toxic to the brain and
this level is toxic to the brain so here's sort of how it works this is not
an absolute but just like a scenario to give you an idea normal would be average
of a hundred and within a very tight range then we start eating some
processed foods and the blood sugar goes crazy but when it comes crashing down
the body still has some reserves we release some cortisol to bring up the
blood sugar the liver is working so it can break down some glycogen and get the
blood sugar up so we never totally crash but if we keep doing this now we develop
even larger swings and at the bottom here we get something called reactive
hypoglycemia because now the organs are little too tired that are a little worn
out to keep up with this abuse so now we get even bigger swings but we're still
considered normal maybe pre-diabetic maybe we're getting
into this range and then eventually the system just can't keep up at all it
can't get the sugar out of there quickly so now we have type 2 diabetes
maybe insulin dependent or non insulin-dependent but the blood sugar is
so high on average so consistently high that the pancreas can't create enough
insulin to push this out into the cells so now even though there's some swings
we have a steady high level and we're in diabetes so again it doesn't happen like
this every time but it's just a scenario of how this thing's can can happen over
time so what we want to understand is that even if the average isn't too
terribly bad we're still creating damage we're still not producing energy at a
steady level we're not functioning at our optimum and we're still developing
inflammation with all this insulin so there's lots and lots of different
different drawbacks to this scenario over this even though we're still
considered in the normal range and the other thing to understand about a 1c is
that because these blood cells live about 3 to 4 months these values
don't change very quickly so if someone says how do I bring down my a1c as fast
as possible well you start eating real food you eat you avoid the sugar and the
starches but it's still gonna take a while because let's say you start off
with a blood sugar of 180 and if you kept it there for a while
then your a1c would be about eight so you realize hey I'm killing myself this
is not a good thing let me change so you start eating real food and after a month
your average blood sugar as they measured with frequent pinpricks is
about a hundred and fifty and then in month three it's a hundred and twenty
five and in month four it's a hundred so then you go and you figure oh look I'm
gonna go get checked and my a1c should be about five no it's not going to be
because you still have some of the blood cells from previous months that were
still swimming around while your blood sugar was really high so even if you
follow this scenario and you're getting very healthy very quickly you're a 1 C
is going to be maybe 6.5 so the moral of the story is yes you definitely want to
do this but the a1c blood test may not reflect the true value because it's
lagging behind the if you get a 6.5 after four months you're actually doing
a whole lot better than this 6.5 is indicating so be patient with it and
realize that this is something you definitely want to keep track of but
it's not something that's going to change very quickly you want to have at
least the six or a nine month horizon on on getting this leveled out so we don't
do a whole lot of blood work in our office but I think there's a few markers
that are worth keeping track of and maybe at least get a baseline so that
you know where you're starting so you know what's been been going on and a1c
is one of those markers that we highly recommend and then we suggest for people
to get so while I was searching for a few questions on
Google I donned on me how many misconceptions there are out there so
one of the questions was what's a good a one see if you have type 2 diabetes
there is no answer to that because it is never good with diabetes but the problem
is people have been labeled they have been said oh look you have an a1c of 7
or 8 you are diabetic here's your medication instead of understanding that
this is physiology this is an adaptation your body has adapted to a long term
insult and if you stop the insult your body can reverse it so there is no good
a one-seed level for diabetes the only good way is to reverse the diabetes by
giving your body some real food and some good exercise and a healthy environment
and other people are asking how do I bring down my a1c quickly and again we
sort of talked about this that it isn't gonna go quick because there's gonna be
a lag but regardless you're gonna have to do the right things to get your body
healthy that's the only way that you can develop health and sustain health we
want to get rid of that idea of a quick fix ok you have to address the
underlying conditions you have to handle the cause of the problem and I can't
tell you how often I have people come into the office and they say oh you know
I have diabetes but my doctor says it's being controlled all right what that
means is that they are managing to keep it at an eight or a nine instead of a 14
so they're not going to develop as quickly as terrible complications as if
they didn't do anything but that's not a solution that's not
keeping it in control we have to understand that the body can heal if we
do the right things and the right things is to not listen to government
guidelines because they believe that grains and sugar and processed foods are
necessary in modern okay if you want to reverse this then
you get off sugar you get off of all the white flour but also you get off of all
the grain and all the processed foods you base your food on vegetables you
fill in with some protein and then you eat healthy fats until you're full
that's how you reverse this stuff because if you stop putting things in
the body that will cause blood sugar spikes then you will start reversing
this situation and what we've been talking about is a big problem because
there is probably less than 10% of the population that are in a good level
somewhere between 4.8 and 5.1 we have 50% or so at a level above 5.7 but again
in my mind I think 5.5 to 5.7 is like pre pre-diabetes it's not a place you
want to be if you're looking for optimal health just because something becomes
normal in the sense that most people have it that doesn't make it a good idea
or healthy just because you don't have symptoms yet doesn't make it healthy so
please share this information with as many people as you can because the more
we can get the truth out about how the body works and the optimum lifestyle the
better we can help people have quality of life if you have any questions let me
know I'll be more than happy to answer questions or make videos on additional
topics and if you have some experiences if you've been measuring your a1c s and
you have some feedback for me please share that as well I'd love to hear from
you thanks so much for watching