She did everything right for four years. One number went the wrong way.
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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 pounds off. And her A1c went from 5.3 to 5.7, which is the line where a doctor writes "prediabetic" in your chart. Every number that measures how her body handles fuel got better. The one number that supposedly summarizes how her body handles fuel got worse. Both of those things cannot be true about her metabolism. It tells you about time, how long the boat's been in the water, at least as much as it tells you about the water. A red cell that lives longer because it is healthier, spends more time in the glucose bath and picks up more glucose. That is arithmetic, not pathology. Every textbook says red cells live about 120 days. That average is doing a lot of hiding. The real spread between healthy people is wide, and nobody measures yours. So when your A1c moves, you are looking at a number with two inputs and being told it has one. The full story is here
Which of the two moved in you? You cannot answer that from the A1c. You need the fasting insulin, the HOMA-IR, and a CBC sitting next to it. Most people have none of the three. You'll know if that's you. Dr. Karl Goldkamp Keto Naturopath Link to books Consider becoming a client |
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Hey Reader, Dr Karl here. A1c tracks glucose beautifully, in only one group of people. A1c tracks glucose tightly in insulin resistant people. In everyone else it barely tracks at all. Two groups. One line is steep. The other is almost flat.That is one sentence and it undoes most of what A1c gets used for. Glucose verses Hemoglobin A1c Red line is the insulin resistant group. Steep. As glucose rises, A1c rises with it, more or less the way the textbook promises. Green line is everyone else....
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...
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...