Hemoglobin A1C: The “Swiss Army Knife” Of Diabetes Assessment

Hemoglobin A1c (HgbA1c) is one of the most useful and important biomarkers available to us as clinicians. It accurately predicts the risk of diabetes long before the disease advances, and it can be used to assess the impact of any form of therapy aimed at regulating blood sugar and insulin sensitivity.

HgbA1c accurately measures average glucose over long periods of time. This one biomarker encompasses age-related glycation products (AGEs), glucose, insulin, and energy efficiency. There's a lot of valuable information contained in this one measurement.

For decades, physicians have relied on fasting and two-hour post-prandial blood sugar to get information about patients' metabolic states & risk of diabetes. More recently, there's been a shift toward assessing insulin and glucose/insulin ratios to better understand sugar energy metabolism.

A growing number of researchers and clinicians are becoming convinced that HgbA1c better predicts average blood sugar level over time than any other lab test.

The advantages of measuring HgbA1c rather than relying on simple blood glucose measurements are several:

  • HgbA1c is an average of extra sugar over the lifespan of red blood cells (usually 3-4 months). While blood sugar is easily influenced by momentary stress including adrenalin or cortisol surges ('White coat hyperglycemia"), HgbA1c is not.
  • Day-to-day blood sugar levels are affected by many pre- and post-analytic variables such as exercise, meal timings, or medications; HgbA1c is not nearly as volatile.
  • To obtain a truly accurate fasting blood sugar value, the patient should be on water-only for at least 12 hours prior to the blood draw. In practice, this important pre-analytic variable is often ignored.
  • By the time blood sugar levels rise to the point of raising clinical attention, the disease process is far advanced. HgbA1c is much more predictive of actual and future risk (Hinzmann R, et al. Int J Med Sci 2012; 9(8): 665-681).

Just as 'white coat hypertension' often leads to elevations in blood pressure because of the stresses some people experience in a doctor's office, there is also "white coat hyperglycemia" that occurs when blood sugar is measured in the office or clinic due to adrenalin and cortisol surges associated with that stress response. Hgb A1c has the advantage of not being influenced by such transient effects on blood sugar.

In addition, Hgb A1c has been validated for all ethnic and socioeconomic groups over the past 50 years since Paul Gallop (a mentor of mine) made the serendipitous discovery that extra sugar in cells is stuck onto many proteins to prevent more harmful effects. Hgb A1c is often preferred clinically because it is an average value over months. Fructosamine, or any other glycation analyte, has a shorter lifespan in the body--usually 3-4 weeks.

Elevated HgbA1c is also strongly linked to inflammation as well as increased risk of chronic, degenerative, autoimmune disease because repair deficits and loss of immune tolerance are related to impaired sugar/energy metabolism. An HgbA1c of <5% is the desired or goal value and translates into a 99% probability of living ten years longer, independent of age, socioeconomic status, or ethnicity.

When Hgb A1c levels rise above 5%, we suggest a shift to an immune-tolerant whole foods diet with targeted supplementation based on a standardized questionnaire (http://www.perque.com/haq/) to improve sugar, energy, repair competence and health status. Such a whole food diet will include 40 g fiber and 40 billion probiotic organisms daily, to help maintain adequate glucose control.

There are many nutraceuticals and herbs that are promoted for regulating glucose. I recommend the following:

  • Chromium citrate/picolinate (250 mcg) and Vanadium ascorbate (250 mcg): Chromium is needed for blood sugar metabolism and improving glucose tolerance. It also helps to lower body weight. Vanadium enhances sugar metabolism and reduces the need for insulin in those who have diabetes.
  • Standardized 4% corosolic acid (50 mg): This compound is derived from the Banaba (Lagerstroemia) leaf. It activates glucose transport, enhances energy production naturally and more safely and naturally lowers blood glucose levels. It also assists in sustained weight management.
  • French lilac (Galega officinalis) (150 mg): This herb has been studied widely and found to relieve symptoms of diabetes mellitus by decreasing insulin resistance.
  • Bitter melon / Marah (Momordica elegans) (150 mg): A popular vegetable in many Asian cultures, Bitter Melon has anti-bacterial and anti-parasitic properties with the potential to regulate insulin and slow the aging process.
  • Huckleberry / Bilberry (Vaccinium myrtillus) (100 mg): Leaf extracts can lower blood sugar levels and have traditionally been used in treatment of diabetes.
  • Chaste Tree berry (Vitex Agnus castus) (150 mg): Widely promoted for regulation of menstrual symptoms, this herb also improves HPA axis function and enhances hormonal influence on blood glucose maintenance.

A synergistic blend of these ingredients, micellized with phosphatidylcholine and medium chain triglycerides in a single softgel, is now available.

Dietary changes and nutraceutical interventions are important elements of diabetes prevention and management, but there's more to it: Physical exercise and mindfulness practices, 20-40 minutes each per day, are also important to evoke healing responses.

We recommend alternating days that emphasize cardio fitness with those emphasizing weight bearing. Active meditation or similar mindfulness practices also help people achieve better outcomes and to evoke innate healing response. A pilot outcome study in both type 1 and type 2 diabetes suggest that this comprehensive approach improves upon current best standard of care (Jaffe R, et al. Diabetic Medicine, 2006; 23:924-5).

END

Russell Jaffe received his MD and PhD from Boston University School of Medicine in 1972. He is a Senior Fellow of Health Studies Collegium (www.HealthStudiesCollegium.org) and founding chairman of the Scientific Committee of the American Holistic Medical Association. Dr. Jaffe developed the lymphocyte response assays (LRA) that enable physicians to rule in/out 491 common allergenic substances based on delayed hypersensitivity by functional LRA by ELISA/ACT. He is also founder of PERQUE, a practitioner-only nutraceuticals company (www.PERQUE.com).