A1C going the wrong way on long term keto


(Ursula wagner) #1

I’ve been doing keto for about 4 1/2 - 5 years but the last two A1C ( Nov 2021 and May 2022) have gone up. I lost about 88 pounds and brought my A1C down to 5.2. Starting last year, it went up to 5.7 and now it’s 5.9. I’m getting scared. What could be happening? I’m a creature of habit. I eat a lunch and sometimes I have a small snack for supper but mostly I fast until the next lunch. I thought perhaps I was drinking too much wine so I cut it out completely but it’s still increasing. I walk 2-3 times a day, putting in 15,000 + steps. I’ve also started using cannabis oil ( a small amount before bed) for RLS and increased my magnesium and potassium for the same reason. I increased my carbs a small bit because I was losing too much weight and I was looking anorexic. What can I look for? What can I do? Does anyone have any thoughts or suggestions?


(Bob M) #2

How do you feel? Do you have any symptoms such as like those you had pre-keto? Are you exercising (or are more active) more than you did say 4 years ago?

Have you worn a CGM or done other blood sugar testing to see of the A1C result is actually true?

My theory (assuming the A1c is true): your body is making more blood sugar to provide support for whatever it is you’re doing (such as walking).

By the way, wine should actually reduce your blood sugar.


(Bob M) #3

You might get a fructosamine test, which does not rely on red blood cells:


(Ursula wagner) #4

I’ve been using a CMG and I test 2-3 times a day with finger sticks. My glucose numbers and my A1C seem to be at odds. It doesn’t make sense. I definitely walk more than 5 years ago. Maybe I’m walking too much or maybe I’m walking at the wrong times. I feel better and I’m off all my medications for everything ( which I now realize were all due to high insulin levels). I have some understanding of glucose sparing as my numbers tend to be higher in the mornings but I’m wondering if it affects my A1C as well. Could my insulin be too low? The reason I talked about the wine is because, although it brought my glucose levels down, it affected my insulin levels and my liver enzymes so I believed it would affect my A1C as well over time.
I’ve never heard of a fructosomine test. What does that do?


(Bacon is a many-splendoured thing) #5

Well, one thing that Benjamin Bikman suggests is that given how healthy you are, your red blood corpuscles (erythrocytes) could well be living longer. The value of HbA1C as a measure of average glucose levels is predicated on the assumption that erythrocytes live for precisely 90 days. They always pick up some glycation, that is normal, but if they are living longer, then the amount of glycation will be measured as being proportionately higher, even if your serum glucose is fine.

The same is true in reverse, of course; Prof. Bikman believes their are some people who are highly insulin-resistant, but whose HbA1C reads lower, because their erythrocytes aren’t living as long as they should.

HbA1C is too useful a measure to give up on, but we do need to recognise its limits.


(Ursula wagner) #7

I didn’t even think of that. I wonder if there’s a way to figure out how long they live.


(Allie) #8

I heard that HBA1C isn’t really a good guide for anyone who doesn’t have blood sugar issues as all the research has been done on people who do have issues.

Maybe helpful discussion here -


#9

You’re not alone. Even Ben Bikman has this problem.

My A1c and FBG (fasting morning glucose) went up with keto and carnivore. Like you, I also exercise. I have never been overweight and I’m not diabetic.

I’ve managed to go back to normal levels by cutting drastically on the saturated fat while keeping carbs as low as possible. It wasn’t easy, but it seems it’s working.

I think people like you, I and others who reported the same problem must have some genotype that makes us more sensitive to fat, but I have no idea if I’m right.

Is your cholesterol high? Mine went up with keto, too. I’m hoping it’ll be normal next time. I’m thinking that the two phenomena are related, at least in my case.

So, I’m intolerant to high carbs and high saturated fat, I think.

Ben Bikman is trying to understand the problem. I’ve seen in a video that they have lots of people using CGMs and testing with different foods.


(Ursula wagner) #10

Thank you. I’ll review that thread.


(Ursula wagner) #11

Great. That’s a place I can start and tweak. Hopefully it will help me.


(Robin) #12

Thanks for always bringing the joyfulness! :no_mouth: