What is HbA1c and Can Keto Improve It?

Type 2 Diabetes has reached epidemic proportions as a result of chronic carbohydrate consumption, especially processed carbohydrate consumption, and a lack of physical activity. 

 When we consume carbohydrates, our body breaks them down to glucose causing a rise in blood sugar.  This stimulates the pancreas to release insulin which communicates with all of the cells in our body to tell them to let glucose in to be used for energy to carry out the functions of our body.

 When this process is chronically stimulated, like it is on a high carb diet, the cells in our body become desensitized to insulin’s action and no longer respond as effectively.  This is known as insulin resistance, which is not just a sign of prediabetes but also a common contributor to numerous other chronic health diseases and obesity.

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While monitoring blood glucose and insulin levels is a great way to keep track of your health, Hemoglobin A1c or HbA1c has become the most common blood marker used to assess the severity of diabetes, test for prediabetes, and gauge the success of strategies aimed to improve metabolic health (1).

What is HbA1c?

HbA1c is a component of total hemoglobin content.  Hemoglobin is an oxygen carrying protein that gives blood its red color. Hemoglobin is also the predominant protein found in red blood cells. HbA1c is formed when glucose binds to hemoglobin. The more glucose present in the blood, the more glucose is attached to the hemoglobin and thus a higher HbA1c. What makes HbA1c so effective is that it actually reflects blood sugar concentrations over the previous 6-8 weeks. 

As previously, mentioned diabetes results in chronic elevations of blood glucose levels making HbA1c a good indication of diabetes risk. HbA1c can be reported as a percentage or absolute terms. Normal HbA1c levels are considered < 42 mmol/mol or <6%. Pre-diabetes is referenced at 42-47 mmol/mol or 6%-6.4%. Lastly, diabetes starts at >48 mmol or 6.5% (2). 

How Can I Improve My HbA1c?

There are a variety of ways to improve your HbA1c levels including dietary interventions, fasting, and physical activity. To have the greatest effect on lowering your HbA1c levels multiple interventions should be implemented.

 The dietary intervention that has the strongest ability to manage diabetes and HbA1c is the ketogenic diet.  In fact, many researchers are now suggesting that the ketogenic diet should be the first course of action in diabetes treatment. 

This should not come as a surprise given the physiology of diabetes.  If your body no longer effectively metabolizes carbohydrates, which it does not when you are insulin resistant, prediabetic, or diabetic, then doesn’t it make more sense to find a way to provide the body with a different fuel? 

Instead, conventional wisdom is to not change anything in the diet and provide exogenous insulin and other blood glucose lowering medications, many of which can come with numerous side effects.  

On a low carb or ketogenic diet, you remove the carbs and replace it with fat to fuel the body.  When you do this for long enough, your body begins producing ketones, an additional fuel source that can be used in place of glucose.  Note that this is not the same as diabetic ketoacidosis and is completely safe and healthy.   

You may be surprised to find out that there is a ton of research pointing to the use of the ketogenic diet in diabetes management, especially from the great Dr. Eric Westman of Duke University and Dr. Sarah Hallberg, Dr. Jeff Volek, and Dr. Stephen Phinney at Virta Health.

In fact, a 262 subject type 2 diabetes study published by Virta Health in 2017 found that using individualized nutrition programs that incorporated nutritional ketosis increased the number of subjects with an HbA1c lower than 6.5 from 19.8% at the beginning of the study to 56.1%.  This study also demonstrated reduction or elimination in medications for many patients and improvements in glycemic control (3).   

A review published in 2015 summarizing all of the available literature provides a strong case for the ketogenic diet.  This review demonstrated that the keto diet consistently reduces high blood glucose levels and HbA1c, the most prominent features of diabetes. Additionally, carbohydrate restricted diets have consistently demonstrated an ability to reduce or eliminate the need for medication. Lastly, there are no side effects comparable with those typically seen in traditional treatments (4).

Conclusion

To wrap things up HbA1c is a measurement that gives a good insight to blood glucose levels which is a good indicator for prediabetes and diabetes.

 Research now demonstrates that the ketogenic diet is a safe and effective alternative method to traditional medicine for reducing HbA1c levels which is why we are beginning to see a more wide acceptance of the use of this diet for diabetes management.  If you want to see some of the incredible life changing research that is occurring on this front, check out Virta health and see how they are using the ketogenic diet to help people suffering from diabetes!  

References

  1. Johnson, R. J., Segal, M. S., Sautin, Y., Nakagawa, T., Feig, D. I., Kang, D. H., ... & Sánchez-Lozada, L. G. (2007). Potential role of sugar (fructose) in the epidemic of hypertension, obesity and the metabolic syndrome, diabetes, kidney disease, and cardiovascular disease–. The American journal of clinical nutrition86(4), 899-906.

  2. Weykamp, C. (2013). HbA1c: a review of analytical and clinical aspects. Annals of laboratory medicine33(6), 393-400.

  3. McKenzie, A. L., Hallberg, S. J., Creighton, B. C., Volk, B. M., Link, T. M., Abner, M. K., ... & Phinney, S. D. (2017). A novel intervention including individualized nutritional recommendations reduces hemoglobin A1c level, medication use, and weight in type 2 diabetes. JMIR diabetes2(1), e5.

  4. Feinman, R. D., Pogozelski, W. K., Astrup, A., Bernstein, R. K., Fine, E. J., Westman, E. C., ... & Nielsen, J. V. (2015). Dietary carbohydrate restriction as the first approach in diabetes management: critical review and evidence base. Nutrition31(1), 1-13.

Christopher Irvin