Hey Reader, Dr Karl here. A1c is not a glucose test. It is a protein test. It measures the percentage of your hemoglobin that has glucose stuck to it. Hemoglobin lives inside red blood cells. A1c has two inputs, not one: 1. how much glucose is in your blood, and 2. how long your red cells stay Nobody tells you about the second one. Here is a client. Four years of work. Fasting insulin down 65%, from 9.6 to 3.4. Glucose down 16 points, from 108 to 92. CRP down 87%, from 3.6 to 0.47. Eleven...
3 days ago • 1 min read
Hey Reader, Dr Karl here. Last time: her insulin, glucose, inflammation and weight all improved over four years, her CGM went flat, and her A1c went up to 5.7 and parked at the prediabetes line. Here is what A1c actually is, because almost nobody is told. A1c is not a glucose test. It is the percentage of your hemoglobin that has glucose stuck to it. Hemoglobin lives inside red blood cells. Glucose attaches slowly and it does not come off. So the number depends on two things, not one: how...
18 days ago • 2 min read
Hey Reader, Dr Karl here. Four years of work. Here is what moved. Fasting insulin 9.6 to 3.4. Fasting glucose 108 to 92. CRP 3.6 to 0.47. HOMA-IR 2.6 to 0.8. Thirty-five pounds over ideal body weight down to twenty-four. No medication for any of it. And her hemoglobin A1c went from 5.3 to 5.7. Up! In the wrong direction. And 5.7 is not a neutral number. It is the exact line where the American Diabetes Association says prediabetes begins. Four years of doing everything right and the one marker...
25 days ago • 1 min read
Hey Reader, Dr Karl here. Your health is in your own hands, about 95 percent of it. Four years. One woman. Insulin 9.6 to 3.4, glucose 108 to 92, CRP 3.6 to 0.47, HOMA-IR 2.6 to 0.8, and a move from one population into the other. She did the work. I read the numbers. Those are two different jobs and only one of them is mine. Which brings me to the thing I actually believe, and it is the reason I make these at all. Your health is in your own hands. Not all of it. Genetics is real, luck is...
29 days ago • 1 min read
Hey Reader, Dr Karl here. Nobody thinks iron has anything to do with insulin resistance. Nobody pairs iron with insulin resistance. There is no reason to, if you are reading labs one at a time. Here is what her iron and ferritin did across four years while she was busy fixing her insulin. Iron went from 105 down to 85. Twenty points, downward, which on its own looks like the wrong direction. Ferritin went from 160 up to 288. Ferritin is storage. It is what she calls on if iron ever runs low....
30 days ago • 1 min read
Hey Reader, Dr Karl here. She didn't improve. She relocated. This is the sentence I most want you to take from all of this. Her HOMA-IR went from 2.6 to 0.8. The easy way to describe that is "she improved." It is also the wrong way, and the difference matters more than almost anything else I could tell you. She did not get better inside a category. She changed which category she is in. She left the country. She was living in the insulin resistant population, and she is now living in the non...
about 1 month ago • 1 min read
Hey Reader, Dr Karl here. Here is the thing almost nobody does, and it is the reason this work looks different from everything else you have seen. I take every client I have ever worked with, every lab, twelve years of it. Each person becomes a row. Each lab becomes a variable. Then I split the whole thing in half using HOMA-IR, which is a formula use to calculate Insulin-Resistance built from fasting insulin and fasting glucose. My cutoff is 1.4. Above are people who are IR, below that they...
about 1 month ago • 1 min read
Hey Reader, Dr Karl here. Flat and boring. If you have ever worn a continuous glucose monitor, you already know what I am about to show you, and you probably did not know it was the point. Four years ago her CGM trace was jagged. Peaks, drops, more peaks. Today it is a low flat line that barely moves all day. Flat and boring. That is the target. I have been saying it since before CGMs were fashionable, and I still say it. Put two people in front of the same ice cream cone. Both spike. But the...
about 2 months ago • 1 min read
Hey Reader, Dr Karl here. Nine point six. That is where her fasting insulin sat four years ago. On a Labcorp range runs 2.6–24.9 µIU/mL so 9.6 prints without a flag. Nobody called. Nothing was said.Four years later it is 3.4.Her glucose came down 16 points, from 108 to 92. Her CRP fell from 3.6 to 0.47, which is an 87 percent drop. She was 35 pounds over her ideal body weight and she is now 24. No medication for any of it. She takes progesterone for a twenty-year history of endometriosis,...
about 2 months ago • 1 min read