6 Years Keto and A1C is climbing

(Nicole Sawchuk) #1

Hi there - I have been keto (low carb for 6 years) but carnivore-ish for the last 2 years. Last year my A1C was 5.1 but last month I got it measured and it was 5.7 and my fasting glucose was 5.1. Year before that was 5.0, and year before that was 5.0.

I’m scratching my head because I test my blood glucose a couple times a day and its rarely above 4.8. I’ve been testing 2 hours post meals and its been always below 4.0.

I did a search on this forum but what are some of the theories to why it would raise like that other than lab error?

HbA1C and Fasting sugar has been steadily increasing over the past 4 months, while on Keto?
Hba1c and glucose rise on keto
(Justin Jordan) #2

Well, a1c is calculated based on an average lifespan of red blood cells. If you’re above or below that average, your score will be less accurate.

My A1C actually often seems to be somewhat lower than what you’d expect from my meter readings, and that MAY be something red cell life span related.

I’ve actually wondered if things like giving blood would affect a1c.

#3

Are you worried Nicole?

You have experience in this WOE, so it is likely you may have done some research along with applying it.

You may be improving the health span of your red blood cells eating the carnivore adjacent Keto diet that results in less glycation and damage of the cells, particularly in the presence of carnisine (from meat).

You may be becoming diabetic if your Kraft test is outside a health pattern response alongside that increased HBA1c.

The other comparison test is to consider a continuous glucose monitor (CGM). The results will differentiate between persistent high blood glucose vs extended red blood cell circulation lifespan. Your home tests already indicate that your blood glucose is under control and it’s more likely that you have more robust red blood cells.

Worth looking into with some more tests. Interesting stuff.

(Bob M) #4

That’s an interesting theory. Here’s an article describing possible parameters that might affect HbA1c:

See the part about iron deficiency. I give blood all the time and my iron status is OK when I give, but I’m sure goes down when I give. Since I give every two months, but HbA1c is about 60-90 days, maybe I’m affecting the value of it?

(Justin Jordan) #5

My thinking was that it seems likely when you give blood, the body replaces the lost blood cells faster than you would get from normal cycling of the red blood cells - either that, or people like you who donate frequently are always down a couple units.

Which would lower your a1c - and that article seems to indicate this is the case. Like I said, mine is somewhat lower than I’d expect, and I’ve always wondered whether this is down to me having reasonably frequent (albeit not particularly severe) nosebleeds.

Although in my case, since I don’t have a CGM, I can’t rule out that it’s just a math thing - that my blood sugar is running lower during a good chunk of the day.

#6

maybe this? just an option to read?

(mole person) #7

I agree with this. Two weeks on a CGM should tell you if you are having glucose spikes that you might be missing throughout the day. If it’s stable below 4.8 you can probably assume something is wrong with the A1c test.

If not I’d consider whether your protein is too high. I’ve heard at least three keto doctors now saying that they had patients on keto with rising A1c’s and it was always fixed by reducing the protein macro which had crept well above keto levels.

(Bob M) #8

My A1c increased slightly from 4.9 to 5.1. I don’t know whether that’s of any consequence, though. I assume these have margins of error.

I can also cite to other studies where A1c between different people are different due to the length of time red blood cells remain “alive”. And we really don’t know what happens over time with people in low carb.

I further think that as I lose weight and get in better shape and exercise more, this also causes my overall blood sugar to rise (even though I’m low carb). Why? Because glucose sparing kicks in for longer and exercise causes glucose to go up. Both of which I assume (though don’t know) are the body’s response to get glycogen back to the muscles.

(Nicole Sawchuk) #9

Thanks for your response. I am concern because in my family we have a lot of type 1 diabetics. But I’ve been rigorous with my diet and eat in a tight eating window, never snack and do monthly intermittent fasts. So these results shocked me, Today I did an hourly Glucose test after eating a giant lunch meal.
Pre lunch 4.1
1 hr post lunch 3.9
2 hr post lunch 3.9
4 hrs post lunch 3.7

So I think I’m pretty flatline after a meal. I think I’ll get my fasting insulin checked.

I know I had read somewhere about the red blood cell life span but I couldn’t find where.

I wish I could afford a CGM!

(Rebecca 🌸 Frankenfluffy) #10

Leaving it two hours might mean you’re missing some spikes - I’d experiment with test timing to see if you can identify any. I’d suggest testing at 45 minutes, an hour, an hour and a half, etc.

It always made me wonder, the advice given to us diabetics as to what our blood glucose should be two hours after meals - over here it’s ‘4-7mmol/l before meals, and under 8.5-9mmol/l two hours after a meal.’

They don’t tell you what happens in that two-hour gap. In my experience… quite a lot!

But if yours is always below 4 after meals, heck, that sounds amazing!

To me your HbA1c and fasting glucose numbers look just great. (But I don’t know what the expectations of a non-diabetic would be!)

EDITED: Sorry, I hadn’t read your latest post before replying!

(Bob M) #11

Here’s a blurb about the study I can’t find for some reason:

(Bunny) #12

I like these two explanations about ‘red blood cell life spans’ by Masterjohn & Kresser they explain why the higher HBA1c may actually be a better marker (less glycation) of improved health being you don’t eat so much refined sugar:

[1] “…Many people will be familiar with the fact that variation in red blood cell turnover confounds this measurement. Less well known is that variations in the deglycating enzyme fructosamine 3-kinase (FN3K) also confound the measurement. Counter-intuitively, if you have a higher rate of this deglycating enzyme but a lower rate of downstream metabolism of 3-deoxyglucosone, your LOWER Hba1c could actually mean MORE glycation. I conclude that Hba1c is a useful test, but only in the context of a bigger picture put together with more information. …” - Chris Masterjohn

[2] “…To put the most accurate picture together, I like to have all four: fasting blood glucose, A1c, post-meal glucose and fructosamine. But if I only had to choose one, it would definitely be post-meal glucose. …” …Chris Kresser

(Cancer Fighting Ketovore :)) #13

@N1coleS I’d suggest testing every 15 minutes over a 2-3hr period. Its likely that you are missing some data points. Its good that your glucose comes down like that. Mine doesn’t follow that pattern at all, but I do eat less than 15g of carbs in a meal (not counting the cream I drink).