HbA1C and Dr. Boz

[Fearchar]

Sept 23, 2023 15:50:56 GMT yakers said:

I was diabetic and reversed it for 4 years ago, key elements for me is 1) anti sugar 2) Low carb3) Timed eating/interminment fasting (I try to eat only betweed 10 AM and 6 PM) and exercise (I try to get 10,000 steps a day and dance a couple times a week) My blood sugar went up a bit (A1C to 5.9) after a month travel in Euoppe which threw off my usual food system. So I'm back home on the path again. Will see the results in 3 mo.

.....

I am not sure that anything works for everyone but this works for me.

This is good!

Many of us on this board are not diabetic.
However, there are health benefits to lowering ones Hb A1c.

Optimum Hb A1c is 5.0 or less.

Last I heard, Dr. Boz herself was around 5.6 and some what disappointed with that.
So, as much as she tests, she has room for improvement.
Don't know if she cheats or what, but I do appreciate her and wish her the best.

[uncleharley]

My A1C spiked at my last check-up, 4 months ago. Since then, I have discovered the so-called Mediterranean diet. The Mediterranean diet, along with prescribed medication & light exercise has brought my glucose level back to about 100. We do not follow the diet religiously, but my wife bought the cookbook and has been preparing our meals exclusively from that book. I have found that we eat less red meat and more fish and chicken since she got the cookbook. She also uses olive oil rather than vegetable oil. She also cooks more vegetables, especially garlic, onions, & herbs. She does love to cook and it has been an adventure. I have also discovered that certain wines have a lot of sugar in them, especially white wines. Fruit juices also have large sugar contents. For wine, a Cabernet or a Pino Noir are very good. For juice, I have switched to tomato juice. BTW, I will soon be celebrating my 81st birthday. So it does work after 60.

[Deleted]

There is literature suggesting different A1C goals versus age.
diabetesjournals.org/care/article/43/Supplement_1/S152/30489/12-Older-Adults-Standards-of-Medical-Care-in

Six years ago when I was 76 yo I had my first A1C test. It was my first A1C test because this was a new GP since my previous GP retired. He never ordered A1C. This new office took blood at the physical appointment so I found out the results over the phone. The person said I have diabetes and there was a prescription for metformin waiting for me. I said "wait, I have questions." She replied that she was only the messenger. I found out the number was 6.5%. I never went back to that office and never filled the prescription. My 2nd new GP visit yielded 6.1%. So many new drugs to attack the A1C number. How did we ever get along without this test and all these drugs that are being consumed primarily for weight loss.$$$

I wonder how many people progress from prediabetes, as defined by A1C, to full blown diabetes with no drugs. I'm already passed my expiration date.

[yogibearbull]

Diabetes DM II is a silent disease/killer that hurts the body over time. HbA1c over 6 shouldn't be ignored.

Drugs have different effects - some increase insulin production, others increase glucose uptake by muscles, others decrease glucose absorption, even others just expel excess sugar.

I take 2-3 meds to avoid insulin injections.
Only borderline cases can avoid meds with dieting & exercise. These of course help.

DM I is another matter.

[retiredat48]

Fearchar ,steelpony10 ,Chahta ,richardsok ,win1177 ,liftlock ,Majick ,sam ,archer ,bd1 ,yogibearbull ,retiredat48 ,Norbert ,yakers ,...

I usually do not "tag all" for replies, but for this thread, thanks to the posters who are participating...most posts get a thumbs-up from me. Useful information. Keep it coming, including on the "exercise thread"...

R48

[FD1000]

Sept 23, 2023 18:12:54 GMT uncleharley said:

My A1C spiked at my last check-up, 4 months ago. Since then, I have discovered the so-called Mediterranean diet. The Mediterranean diet, along with prescribed medication & light exercise has brought my glucose level back to about 100. We do not follow the diet religiously, but my wife bought the cookbook and has been preparing our meals exclusively from that book. I have found that we eat less red meat and more fish and chicken since she got the cookbook. She also uses olive oil rather than vegetable oil. She also cooks more vegetables, especially garlic, onions, & herbs. She does love to cook and it has been an adventure. I have also discovered that certain wines have a lot of sugar in them, especially white wines. Fruit juices also have large sugar contents. For wine, a Cabernet or a Pino Noir are very good. For juice, I have switched to tomato juice. BTW, I will soon be celebrating my 81st birthday. So it does work after 60.

I'm glad you found the Mediterranean diet. I was born into it and think it's the best.
But, cutting carbs is one of the best recommendations.
When you go to supermarkets skip all boxes and prepared food in the middle, and buy fresh or frozen which is on the outside walls.
Hard cheese is great too.
Aldi has great prices for hard cheese, wines, fruits and vegies(some are not great). Instead of sweets and cakes go for chocolate, at least 50% cocoa(I can't stand above it).
Fat is also good for you. We go for high fat. I eat 5% yogurt, FAGE which fills you up. Whole milk too.
Eggs are great too.
We stopped using vegetable oil, just extra virgin olive oil and avocado oil because olive can't be used for everything.

[Deleted]

Sept 23, 2023 18:22:15 GMT @axe said:

There is literature suggesting different A1C goals versus age.
diabetesjournals.org/care/article/43/Supplement_1/S152/30489/12-Older-Adults-Standards-of-Medical-Care-in

Six years ago when I was 76 yo I had my first A1C test. It was my first A1C test because this was a new GP since my previous GP retired. He never ordered A1C. This new office took blood at the physical appointment so I found out the results over the phone. The person said I have diabetes and there was a prescription for metformin waiting for me. I said "wait, I have questions." She replied that she was only the messenger. I found out the number was 6.5%. I never went back to that office and never filled the prescription. My 2nd new GP visit yielded 6.1%. So many new drugs to attack the A1C number. How did we ever get along without this test and all these drugs that are being consumed primarily for weight loss.$$$

I wonder how many people progress from prediabetes, as defined by A1C, to full blown diabetes with no drugs. I'm already passed my expiration date.

I came across this JAMA paper that provides insight into my question.   At least see the conclusion. jamanetwork.com/journals/jamainternalmedicine/fullarticle/2775594

A quote from the paper... 
"The findings of the current study support a focus on lifestyle improvement when feasible and safe, especially given the broader benefits of lifestyle modification beyond diabetes prevention. Given the low risk of diabetes progression in this study (especially relative to mortality risk), it is unlikely that pharmacologic intervention or other aggressive approaches to diabetes prevention in older age will provide large benefits and could have unintended harmful effects (eg, overdiagnosis, anxiety, and implications for insurance coverage)."

[Fearchar]

Update:


Dr Boz in the following Youtube video reviews a recent paper regarding CVD risk factors:

www.youtube.com/watch?v=jq50sqWZW7E&t=2715s

The paper was written by a Kevin Forey M.D. : kevinforeymd.com/insulin-resistance/


The following chart is key:



Lipoprotein Insulin Resistance factor (LPIR) is not a common blood test.
It is though a far better CVD risk factor than all others; especially for people under age 55.
However, even for older people, it is still the highest risk factor.

HbA1C, is actually a weaker risk factor than what I had been lead to believe.
Systolic Blood Pressure and Triglycerides are better, but not as strong as LPIR.

C-Reactive Protein (CRP) is a good measure, especially for people in the 65-75 age group.
It's not standard, so you'll have to ask for it during a physical exam.

Anyhow, buried within his paper Dr. Forey points out that eliminating refined foods, sugars and
especially high fructose corn syrup along with exercise are the best methods to control LPIR.

[fritzo489]

Fearchar, Was there a chart for men ?

[Fearchar]

No chart for Men my friend...

This all came from a Mayo Clinic study of 28,000 female health professionals.
None had known CVD initially. 
The follow up time is an average of 21.4 years.

They state that because women experience lower rates of CVD and later in life, 
this study is still likely to provide insight for men.

So, big picture of this study is just how important LPIR is.

Also, while this thread is about HbA1C, notice that as a risk factor it is actually near the bottom
of the list.  This includes the <55 year population as well as the 65-75 group. 
The challenge for everybody should be improving your insulin resistance.


Now; bringing this home...

My HbA1c has been pretty good.  Typically 5-5.2.
No idea what the LPIR score may be.
Fortunately, Systolic BP was 103, Triglycerides 38 and BMI is near optimal.
CRP is not being measured.  So, I'll ask about that next time.

Calcium score from June 2022 was 100; about average for my age.
However, the worst of it is in the left anterior descending artery (LAD) also known as the Widow Maker.
Calcium was <5 in 2013 and 12 in 2018; below average.

With Doctor urging, I started statins in 2018 thinking it would help control calcium.
After the 2022 reading, I did more research and found papers which recognize that statins actually rise calcium scores.
So, stopped the statins, lost weight, exercised more and watched the diet as best as I can.
However, I must admit, those sweets are tempting!

My Doctor keeps talking about statins, but I'm just not encouraged from what I've read about them.
What makes more sense to me is diet, exercise and another heart scan.
A scan is scheduled about 2 weeks from now.
Hopefully, progression has been arrested.
Either way, summer is coming and I'll be more comfortable exercising outside.

Just in case, I do keep 2 adult aspirins in my cell phone wallet folder and a whole jar in the car!
I know somebody that survived a CVD attack that way.



Wishing everybody here the best possible health.
This is not medical advice, but hopefully it will be helpful.
When I started this thread, I thought HbA1C was a much better measurement.
With this study in mind, it's still a good measurement, but not the best.

[yogibearbull]

As has been noted, HbA1C is about a 3-mo average of blood sugar. It's nature's 3-mo MA (there is a good theory for it). So, it's important along with other tests, especially, the daily AM fasting (at-home) blood tests.
As in the markets, any one test or indicator has its limitations.

[johntaylor]

If Bezos and GF have time for workouts (video at 5:40), so does Musk:   www.youtube.com/watch?v=OOJU4be4X2M

Back when they did heart scans, the docs told us lipid levels were nice but what mattered was lumen diameter (stenosis), but heart scans might reveal hard plaque.   Our coronary artery calcium content scores were zero.   

Or c-reactive protein if ya buy the cardiac inflammation notion for heart attack.

[Majick]

Fwiw...Medicare Fully covers A1c testing after 90 days, with your Internal Dr.MD, PCP prescribed in any test lab in the USA. Also a yearly, after 365 days, Free full medical checkup. Majick