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How to Lower Non-Diabetic A1C

A patient recently showed me their A1C of 5.5 and expressed their concerns, wanting to lower it closer to 5.0. The main reason for this was that she knew from the research data that all-cause mortality is higher for those with a higher A1C, even if they don’t have diabetes. So, how can we lower non-diabetic A1C, and more importantly, should we?

Check out a great YT video by Rhonda Patrick and Peter Attia on the metabolism of glucose in the body.

A1C Can Be Misleading

If you are using a handheld glucometer or a CGM, you’ll have seen various numbers and charts to illustrate the behavior of both interstitial glucose (a proxy for serum glucose) and insulin.

We all experience blood sugar spikes, and some spikes are good while others are bad. Wild fluctuations seem to be more problematic, but they can still result in the same A1C levels in two people.

For example, Mike’s A1C is 5.5%, but the CGM shows blood sugars in the 70s and some in the 180s. The graph would be wild, with up and down swings.

Maya also has an A1C of 5.5, but her CGM has blood sugar values of no less than 85 and not much higher than 125 mg/dl.

2 people, same A1C but different insulin patterns. So, the details matter, not just the percent of these glycosylated hemoglobin.

Causes of Blood Glucose Spikes

There are a few common culprits when it comes to big spikes in glucose, which you have to keep in mind if your goal is to lower non-diabetic A1C levels:

  1. High glycemic load foods
  2. Medications
  3. Stress
  4. Insomnia
  5. Vigorous exercise
  6. Infection or illness
  7. Alcohol (sometimes a dip)
  8. Menstruation

We’ve talked about meal timing and food order as a way to prevent glucose crashes or spikes.

Lowering Normal A1C

Presumably, your A1C is in the normal range, i.e., under 5.7%, but you want it to be even lower. The question is whether that’s a good idea.

Sure, observational studies have shown that 5.0 is better than 5.5. But what population was observed to derive this?

If I do the test in fairly active individuals, then I would expect more spikes in those who do higher-intensity training because they are getting transient glucose spikes from their more intense exercise.

If I’m looking at a more sedentary population, then, of course, stress and diet are often the causes of higher glucose spikes and the associated A1C.

Should You Lower Your A1C?

If you are having frequent glucose spikes past 140 that are not exercise-induced, then it’s worth addressing just that. The goal of lowering the A1C itself may not impact your health quite as much.

If you aren’t active much other than walking, then your higher A1C is likely due to episodes of higher blood sugar due to certain foods, alcohol, stress, or poor sleep. So, it would be worth addressing that and aiming for an overall lower A1C.

Digital Nomad Health’s mission is to keep you healthy by preventing chronic diseases and helping you maximize your wellness metrics. We’ll help you think through your tough medical decisions!

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