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The Ultimate Blood Sugar Test: Understanding your A1c
At Relish Health, a hemoglobin A1c (HbA1c or A1c) is a routine lab. It measures the extent to which hemoglobin in the blood has been affected (“glycosylated’) by blood sugar. Optimizing blood sugar balance is important for controlling inflammation and promoting longevity. With over 100 million Americans living with diabetes or pre-diabetes and millions more with suboptimal blood sugar balance, having a clear picture of your blood sugar levels is crucial.
At Relish Health, a hemoglobin A1c (HbA1c or A1c) is a routine lab. It measures the extent to which hemoglobin in the blood has been affected (“glycosylated”) by blood sugar. Optimizing blood sugar balance is important for controlling inflammation and promoting longevity. With over 100 million Americans living with diabetes or pre-diabetes and millions more with suboptimal blood sugar balance, having a clear picture of your blood sugar levels is crucial.
What Is Diabetes And Prediabetes?
Type 2 diabetes is an impairment in the way the body regulates and uses sugar (glucose) as a fuel. For the development of the disease, there are primarily two interrelated problems at work. Your pancreas does not produce enough insulin — a hormone that regulates the movement of sugar into your cells — and cells respond poorly to insulin and take in less sugar. These insulin management concerns can start to occur years or decades before a formal diagnosis of diabetes.
Prediabetes is a serious health condition where blood sugar levels are higher than normal, but not high enough yet to be diagnosed as type 2 diabetes. The CDC estimates that more than 1 in 3— American adults have prediabetes with more than 80% unaware of their condition.
How Is Diabetes And Prediabetes Diagnosis?
There are several ways to diagnose diabetes. Each way usually needs to be repeated on a second day to confirm the diagnosis.
Measuring A1C:
The A1C test measures your average blood glucose for the past two to three months. The advantages of being diagnosed this way are that you don't have to fast or drink anything.
Your A1C test result is given in percentages. The higher the percentage, the higher your blood sugar levels have been:
A normal A1C level is below 5.7%
Prediabetes is diagnosed if the level is between 5.7 to 6.4%. Having prediabetes is a risk factor for getting type 2 diabetes.
Type 2 diabetes is diagnoses if a level is above 6.5%
Fasting Plasma Glucose (FPG):
This test checks your fasting blood glucose levels. Fasting means not having anything to eat or drink (except water) for at least 8 hours before the test. This test is usually done first thing in the morning, before breakfast.
A fasting glucose is only designed to measure glucose levels during the fasting period. It does not give a full picture of how a person’s body is handling sugar over a period of days or weeks. It does not provide any predictive insight into trends toward diabetes, prediabetes or other blood sugar handling issues. Fasting glucose levels can be highly affected by factors completely outside of diet such as poor sleep the night before or high stress levels.
Normal Fasting Glucose: less than 100 mg/dl
Prediabetes: 100 mg/dl to 125 mg/dl
Diabetes: 126 mg/dl or higher
Oral Glucose Tolerance Test (OGTT):
The OGTT is a two-hour test that checks your blood glucose levels before and two hours after you drink a special sweet drink. It tells the doctor how your body processes sugar.
Normal OGTT: Two-hour blood glucose less than 140 mg/dl blood
Prediabetes: Two-hour blood glucose of 140 to 199 mg/dl
Diabetes: Two-hour blood glucose of greater than or equal to 200 mg/dl
Random Plasma Glucose Test:
This test is a blood check at any time of the day when you have diabetes symptoms. Diabetes is diagnosed at a blood glucose of greater than or equal to 200 mg/dl.
What Are Optimal Glucose Levels?
In functional medicine, we are always looking beyond “normal” when it comes to lab marker ranges. When interpreting labs, “normal” does not necessarily equate to optimal if you are interested in preventing disease.
Optimal/Functional A1c Ranges:
Optimal Range for A1c: less than 5.3%
Less than Optimal/Pre-diabetic stage: A1c 5.4-6.0% (Your lab will call this “normal” but, in functional medicine we consider this a concerning zone.)
Sub-optimal: Any A1c above 6.0% reveals a problem with blood sugar control.
In functional medicine, and at Relish Health, we want to catch blood sugar issues as early on as possible. The A1c test offers us a window into your last 8-10 weeks of blood sugar balance. It gives us clues into how sugars may be affecting your cells and tissues and can predict if you may progress to having diabetes. Prediction is key to prevention when it comes to disease.
Health Effects of Chronically High A1c
The consequences of sub-optimal blood sugar balance over time include an increased risk of:
Cardiovascular disease including elevated blood pressure, increased risk of heart attacks and strokes, and even impotence
Diabetes
Increased annual brain shrinkage and risk for cognitive decline
What Causes A High A1c?
It is tempting to place all the blame for a high A1c levels on too much sugar in the diet. In reality, there are many lifestyle factors that can directly affect your A1c levels such as:
Sleep issues. Sleep deprivation is a leading causal factor behind blood sugar imbalances.
Stress. Chronic stress can trigger excessive stress hormones that raise blood sugar and can create insulin resistance.
Too many carbs, or too many of the “wrong” carbs. Excessive consumption of sugar and refined carbohydrates can trigger blood sugar imbalances. However, not all carbs will hurt you. “Good carbs” like those found in moderate amounts of whole fruits, vegetables and even sweet potatoes or white potatoes with the skins-on can be included in a healthy diet.
Artificial sweeteners. Artificial sweeteners like aspartame, sucralose and saccharin have recently been shown to affect blood sugar and insulin levels.
Not enough muscle mass and lack of exercise. Muscle helps your body regulate blood sugar. If you have a low lean muscle mass due to lack of exercise this could contribute to higher A1c levels.
Ways to Lower your A1c Levels
Relish Health can help you develop a personalized plan, but in general you can lower your A1c levels by:
Reducing your intake of refined carbs and sugar. Minimize consumption of pastries, bagels, breads, pastas, cereals, and candy. Focus on eating non-starchy vegetables, proteins, fats, and small amounts of whole grains, fruits, and starchy veggies like sweet potatoes or beets.
Increase your protein intake. Protein helps stabilize blood sugar while increasing satiety. Aim to have a small amount of lean animal or plant-based protein at every meal and snack. Relish Health can help you determine your protein needs with body composition analysis.
Exercise regularly. Focus on exercises that build muscle mass. High intensity interval training (HIIT), weight training, yoga, and other weight-bearing exercises are excellent choices.
Manage stress. This is one of the most profound things you can do to impact your blood sugar levels. Stress managing activities include exercising, listening to music, journaling, spending time with friends, laughing, meditation, spending time in nature and limiting your screen time.
Optimize your sleep. Aim for 7.5-9 hours of sleep a night. Sleeping less may cause your blood sugar balance to suffer.
How Often Should You Check Your A1c?
Physicians typically recommend patients with type 2 diabetes check their A1c every three to six months to ensure adequate treatment. At Relish Health, we believe in the same vigilance to make sure that your lifestyle changes are giving you the results you want. If your A1c level falls in the concerning zone, we will recommend you check your A1c progress at least every 6 months.
If your A1c level is currently at an optimal level, we recommend checking your A1c once a year or every other year as part of routine preventative care. Many lifestyle choices over time can influence insulin resistance and blood sugar imbalances. Knowing your A1c level empowers you to manage your blood sugar balance proactively before it ever has the chance to become disease.
The Ultimate Blood Sugar Test: Understanding your A1c
At Relish Health, a hemoglobin A1c (HbA1c or A1c) is a routine lab. It measures the extent to which hemoglobin in the blood has been affected (“glycosylated’) by blood sugar. Optimizing blood sugar balance is important for controlling inflammation and promoting longevity. With over 100 million Americans living with diabetes or pre-diabetes and millions more with suboptimal blood sugar balance, having a clear picture of your blood sugar levels is crucial.
At Relish Health, a hemoglobin A1c (HbA1c or A1c) is a routine lab. It measures the extent to which hemoglobin in the blood has been affected (“glycosylated”) by blood sugar. Optimizing blood sugar balance is important for controlling inflammation and promoting longevity. With over 100 million Americans living with diabetes or pre-diabetes and millions more with suboptimal blood sugar balance, having a clear picture of your blood sugar levels is crucial.
What Is Diabetes And Prediabetes?
Type 2 diabetes is an impairment in the way the body regulates and uses sugar (glucose) as a fuel. For the development of the disease, there are primarily two interrelated problems at work. Your pancreas does not produce enough insulin — a hormone that regulates the movement of sugar into your cells — and cells respond poorly to insulin and take in less sugar. These insulin management concerns can start to occur years or decades before a formal diagnosis of diabetes.
Prediabetes is a serious health condition where blood sugar levels are higher than normal, but not high enough yet to be diagnosed as type 2 diabetes. The CDC estimates that more than 1 in 3— American adults have prediabetes with more than 80% unaware of their condition.
How Is Diabetes And Prediabetes Diagnosis?
There are several ways to diagnose diabetes. Each way usually needs to be repeated on a second day to confirm the diagnosis.
Measuring A1C:
The A1C test measures your average blood glucose for the past two to three months. The advantages of being diagnosed this way are that you don't have to fast or drink anything.
Your A1C test result is given in percentages. The higher the percentage, the higher your blood sugar levels have been:
A normal A1C level is below 5.7%
Prediabetes is diagnosed if the level is between 5.7 to 6.4%. Having prediabetes is a risk factor for getting type 2 diabetes.
Type 2 diabetes is diagnoses if a level is above 6.5%
Fasting Plasma Glucose (FPG):
This test checks your fasting blood glucose levels. Fasting means not having anything to eat or drink (except water) for at least 8 hours before the test. This test is usually done first thing in the morning, before breakfast.
A fasting glucose is only designed to measure glucose levels during the fasting period. It does not give a full picture of how a person’s body is handling sugar over a period of days or weeks. It does not provide any predictive insight into trends toward diabetes, prediabetes or other blood sugar handling issues. Fasting glucose levels can be highly affected by factors completely outside of diet such as poor sleep the night before or high stress levels.
Normal Fasting Glucose: less than 100 mg/dl
Prediabetes: 100 mg/dl to 125 mg/dl
Diabetes: 126 mg/dl or higher
Oral Glucose Tolerance Test (OGTT):
The OGTT is a two-hour test that checks your blood glucose levels before and two hours after you drink a special sweet drink. It tells the doctor how your body processes sugar.
Normal OGTT: Two-hour blood glucose less than 140 mg/dl blood
Prediabetes: Two-hour blood glucose of 140 to 199 mg/dl
Diabetes: Two-hour blood glucose of greater than or equal to 200 mg/dl
Random Plasma Glucose Test:
This test is a blood check at any time of the day when you have diabetes symptoms. Diabetes is diagnosed at a blood glucose of greater than or equal to 200 mg/dl.
What Are Optimal Glucose Levels?
In functional medicine, we are always looking beyond “normal” when it comes to lab marker ranges. When interpreting labs, “normal” does not necessarily equate to optimal if you are interested in preventing disease.
Optimal/Functional A1c Ranges:
Optimal Range for A1c: less than 5.3%
Less than Optimal/Pre-diabetic stage: A1c 5.4-6.0% (Your lab will call this “normal” but, in functional medicine we consider this a concerning zone.)
Sub-optimal: Any A1c above 6.0% reveals a problem with blood sugar control.
In functional medicine, and at Relish Health, we want to catch blood sugar issues as early on as possible. The A1c test offers us a window into your last 8-10 weeks of blood sugar balance. It gives us clues into how sugars may be affecting your cells and tissues and can predict if you may progress to having diabetes. Prediction is key to prevention when it comes to disease.
Health Effects of Chronically High A1c
The consequences of sub-optimal blood sugar balance over time include an increased risk of:
Cardiovascular disease including elevated blood pressure, increased risk of heart attacks and strokes, and even impotence
Diabetes
Increased annual brain shrinkage and risk for cognitive decline
What Causes A High A1c?
It is tempting to place all the blame for a high A1c levels on too much sugar in the diet. In reality, there are many lifestyle factors that can directly affect your A1c levels such as:
Sleep issues. Sleep deprivation is a leading causal factor behind blood sugar imbalances.
Stress. Chronic stress can trigger excessive stress hormones that raise blood sugar and can create insulin resistance.
Too many carbs, or too many of the “wrong” carbs. Excessive consumption of sugar and refined carbohydrates can trigger blood sugar imbalances. However, not all carbs will hurt you. “Good carbs” like those found in moderate amounts of whole fruits, vegetables and even sweet potatoes or white potatoes with the skins-on can be included in a healthy diet.
Artificial sweeteners. Artificial sweeteners like aspartame, sucralose and saccharin have recently been shown to affect blood sugar and insulin levels.
Not enough muscle mass and lack of exercise. Muscle helps your body regulate blood sugar. If you have a low lean muscle mass due to lack of exercise this could contribute to higher A1c levels.
Ways to Lower your A1c Levels
Relish Health can help you develop a personalized plan, but in general you can lower your A1c levels by:
Reducing your intake of refined carbs and sugar. Minimize consumption of pastries, bagels, breads, pastas, cereals, and candy. Focus on eating non-starchy vegetables, proteins, fats, and small amounts of whole grains, fruits, and starchy veggies like sweet potatoes or beets.
Increase your protein intake. Protein helps stabilize blood sugar while increasing satiety. Aim to have a small amount of lean animal or plant-based protein at every meal and snack. Relish Health can help you determine your protein needs with body composition analysis.
Exercise regularly. Focus on exercises that build muscle mass. High intensity interval training (HIIT), weight training, yoga, and other weight-bearing exercises are excellent choices.
Manage stress. This is one of the most profound things you can do to impact your blood sugar levels. Stress managing activities include exercising, listening to music, journaling, spending time with friends, laughing, meditation, spending time in nature and limiting your screen time.
Optimize your sleep. Aim for 7.5-9 hours of sleep a night. Sleeping less may cause your blood sugar balance to suffer.
How Often Should You Check Your A1c?
Physicians typically recommend patients with type 2 diabetes check their A1c every three to six months to ensure adequate treatment. At Relish Health, we believe in the same vigilance to make sure that your lifestyle changes are giving you the results you want. If your A1c level falls in the concerning zone, we will recommend you check your A1c progress at least every 6 months.
If your A1c level is currently at an optimal level, we recommend checking your A1c once a year or every other year as part of routine preventative care. Many lifestyle choices over time can influence insulin resistance and blood sugar imbalances. Knowing your A1c level empowers you to manage your blood sugar balance proactively before it ever has the chance to become disease.
Tips for Dry January Success
If you are taking a month off from drinking alcohol, you are not alone. Going “dry” for the month of January is on trend. “Dry January” has become a robust movement that started in 2012 from a public health initiative in the UK. Now millions of people around the globe are expected to abstain from alcohol this month.
Wondering if this is for you?
If you are taking a month off from drinking alcohol, you are not alone. Going “dry” for the month of January is on trend. “Dry January” has become a robust movement that started in 2012 from a public health initiative in the UK. Now millions of people around the globe are expected to abstain from alcohol this month.
Wondering if this is for you? The research shows that pushing the reset button on drinking after the holidays can benefit everyone, not just heavy drinkers. All types of drinking patterns, from light (1-6 drinks per week) to heavy (3 or more drinks in one day or more than 7 per week for women; more than 4 drinks in one day or more than 14 per week for men), report short-term improvements in deeper sleep, better food choices, improved lab markers, and even weight loss.
Why do Dry January?
Everyone can benefit from reevaluating their relationship with alcohol. Being alcohol-free for 31 days reminded us that we don’t need alcohol to have fun, relax, or socialize. Additionally, we strengthen our skills needed to manage our drinking. That means that for the rest of the year we are better able to make decisions about when we drink and how much, so we can avoid slipping into drinking more than we really want. In fact, a University of Sussex study showed that 70% of people who took part in Dry January were still drinking less six months later, especially if they use the Try Dry app developed by Alcohol Change UK. Other short term perks like better sleep, more energy, healthier skin, and sharper concentration seem to persist past the 31-day dry challenge too. And, even those who fell short of abstaining the entire month were drinking less after 6 months.
In another study from the UK, researchers confirmed the old adage that avoiding alcohol gives our liver a break. The participants of the study saw improved liver enzymes even when they kept their eating, smoking, and/or exercise habits the same. The study participants also enjoyed reductions in weight, blood pressure, insulin resistance, and cancer-related growth factors.
Dry January Benefits:
What you'll notice Quickly(1):
70% of people sleep better
86% of people save money
65% of people notice generally improved health
Short-term medical benefits(2):
Reduced diabetes risk
Improve blood pressure (BP)
Lower cholesterol
Reduced level of cancer-related proteins in the blood
Improved liver function tests
Long-term benefits:
Alcohol is linked with more than 60 health conditions including liver disease, high blood pressure, depression and seven types of cancer. Cutting back on alcohol long-term reduces your risk of developing these conditions.
Tips to improve your success completing a 31-day alcohol free challenge:
Fennel Shrub Mocktail (Click here for the recipe.)
Find a substitute non-alcoholic drink. For social situations, or when you crave a cocktail after a long day, reach for alcohol-free beverages like sparkling water, kombucha, or virgin beverages (non-alcoholic versions of alcoholic drinks.) There are many new and delicious non-alcoholic options on the market these days. I personally like to make a mocktails by combining sparkling water (love my soda stream) with a splash of bitters and an herb or citrus garnish. Experiment with a variety of bitters for fun flavors and combinations.
Non-alcoholic beer or wine is also an option, but some brands still contain up to 0.5% alcohol by volume, so check the label. Sugar is often added to these beverages to improve the taste, so try to choose ones that are low in sugar.
“Shrubs” also make excellent alternative to alcohol. Shrubs are sweetened vinegar based syrups that can be mixed with sparkling water. They can be fruity, spicy or herbaceous with a kick from the vinegar. I like to use apple cider vinegar because it has health benefits on its own.
Avoid temptations. Keep alcohol out of your house. When you are invited to someone’s home, bring your favorite non-alcoholic drinks with you to share.
Create a support group. Let friends and family know about your intentions and encourage them to keep you accountable. Better yet, enlist someone to do the challenge with you.
Use the Try Dry app. This free app is sponsored by the non-profit Alcohol Change UK. It helps you track your drinking, set personal goals, and offers motivational information like calories and money saved from not drinking. It’s aimed at cutting back on or cutting out alcohol, depending on your choices. Use of the app has been shown to double your success of completing a dry month challenge.
Don’t give up. If you slip up, don't feel guilty. Tomorrow is a fresh start.
Warning:
Stopping drinking suddenly can be very dangerous, and can even kill you, if you are dependent on alcohol. If, after a period of drinking, you experience any of the following symptoms, you may be dependent on alcohol and you should NOT suddenly stop drinking completely: seizures, hand tremors, sweating, visual hallucinations, depression, anxiety or insomnia. You can still take control of your drinking. Speak to your health care provider to get help for you to reduce your drinking safely.
References:
1. Alcohol Change UK. Accessed 1/7/2022.
2. Mehta G, et al. BMJ Open 2018;8:e020673. doi:10.1136/bmjopen-2017-020673
3. Thinking of trying Dry January? Steps for success. Harvard Health Publisher. Accessed 1/7/2022.
HOW ABOUT A “QUARANTINI?”
FIRE CIDER MOCKTAIL RECIPE
ELDERBERRY SHRUB MOCKTAIL RECIPE