Wednesday, January 11, 2017

Wisdom Wednesday: Gycohemoglobin A1c

This blood test measures the percentage of RBCs (red blood cells) saturated with glucose. RBCs live about 120 days. During that span they can slowly be glycosylated by high levels of serum glucose. Assuming the average age of an RBC to be 60 days, this test reveals what your glucose levels have averaged over the course of the past two months. By comparison, the fasting glucose only measures the glucose level after eight or more hours for fasting, with no stress on glucose metabolism.

For the past several years the A1c has been used to monitor diabetics to see how effective they are managing their disease. However, in July of 2015, the A1c was established as the medical standard for diagnosing diabetes. This big step forward that has met with either resistance or indifference from the medical community as less than half of primary care physicians currently order this test for their patients.

The new standard recommends physicians begin to test patients who are obese between the ages of 40 and 45. I have been using this test on my patient population for several years. I do not restrict the test by age or weight status. Clinically, I have found that this test often begins to elevate in patients by their late 20’s, even when they are at ideal weight.

The normal range for the A1c is 4.8 to 5.6%. However, the diagnosis of diabetes is restricted to levels at or above 6.5%. A “well controlled diabetic” will have an A1c of 7% or less. Levels between 5.6 and 6.5% are considered “pre-diabetic”. Currently, over 50% of all Americans are estimated to be either diabetic or pre-diabetic and that percentage is still increasing.

In my office, anyone exhibiting symptoms of metabolic syndrome – central obesity, hypertension, high serum lipids, hypothyroidism, or insulin resistance – is a candidate for A1c testing, regardless of age. Additionally, using the QA (Quintessential Applications) protocol, if a patient tests for sesame seed oil to block prostaglandin inflammation (PG2) I also recommend an A1c. Clinically, over 90% of patients demonstrating a need for sesame seed oil have an elevated A1c. The remaining 10% typically have altered serum lipids or hypothyroidism.

Of course, this test needs to be correlated with the serum lipids, thyroid profile, fasting glucose, and liver enzymes (from the CMP). I have found a few instances where the A1c was normal but the fasting glucose was elevated.

The A1c readily responds to dietary and lifestyle improvements. Even diabetics, with an A1c above 6.4% can reverse the disease process. However, it takes at least 3 months to see these changes as the test measures two months of your glucose average.

The herb gymnema is also highly effective at reducing the A1c and the phytochemical berberine, found in turmeric, goldenseal, and boswellia is also of great benefit. The side effects of all these herbs can be hypoglycemia, so their use should be monitored by a qualified nutritionist.

An A1c below 4.8% is indicative of hypoglycemia. However, most hypoglycemics have wildly fluctuating blood glucose but the average glucose over two months is often normal.

The Bottom Line:
I recommend the A1c be an integral part of annual laboratory testing. If you have not had this test run, talk to your PCP (primary care physician) and ask them to include this test in your next evaluation.

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