Raise in A1C

(Kathy) #1

Hello,

Happy spring to all.

I am a little puzzled, I just had my A1C done yesterday, this is the third slight raise in a row!!
Last time the Doctor said, do don’t be concerned as there is very little difference between 5.6 and 5.8. Now the lab report, which is posted online, is at 6.0 With a Red Flag.

This creep up has been happening since last June. I am still Keto, most days OMAD, other days 16-20 hour fasting.

My meals are the same, other than I know I have been adding more carrots and yam squash, about 2-3 times a week, not all at the same time and not large portions. The fruit I eat is only berries 2-3 times a week.and a 1/2 apple at a time (twice a week).

I bake Keto muffins and cookies with almond or coconut flour and Monk fruit is always about 1/2 of what the recipe calls for. I do this mostly for my partner, I am not a sweets person. I am lucky if I get 2 out of a batch of 12!

We do buy Carbornaut Bread but that is limited to 3-4 slices a week for me.

I used to love my red wine, but I rarely touch it (almost 2 years).

I do have gin and club soda and lime each day before dinner, the od one after dinner. I have been doing this since I first started Keto.

I have been at my goal weight since October 2021, only bouncing one pound on and off through out the week.

Just coming through winter, my activity levels have been up and down, at the pool 1-2 times a week, get in a good walk 3-4 times a week, generally 3-4 K’s. I play Golf Croquet 2-3 hours 2-4 times a week weather permitting. ( not your back yard game).

I am just feeling very frustrated that the a1c has crept up!!!
Anyone have any ideas, with what I have posted; where I could be going wrong??

I also reversed my R Arthritis, going Keto and I.F. it thankfully is still at bay!

Hopefully I will get a chance to have a doctor go over my numbers soon. We have a horrible doctor shortage right now.

Thanks for letting me vent !!

(Joey) #2

@Sunlove It sounds like you’re taking really good care of yourself. There’s a lot of chatter on this forum about slowly rising blood glucose after long term keto - not to “dangerous” levels - but to levels that are vastly more stable ranges compared to SAD-eaters. But still, it’s often just above the “normal” range.

The Normal range is based on 95% of the lab population (i.e., our incredibly unhealthy population) so, for starters, it’s not a terribly relevant reference point.

As you appreciate A1c is an average of serum glucose. Not a perfect one for technical reasons, but an average of sorts none the less.

I would suggest you search around for discussions on rising glucose on long term keto here and elsewhere and put your mind at ease.

FWIW, I too have experienced what you’re describing and have NO concerns whatsoever once I did some deep diving on the reasons and issues involved.

Best wishes! :vulcan_salute:

(You've tried everything else; why not try bacon?) #3

Well, it seems as though your carbohydrate intake is quite high, at least from a cursory glance at your post. Try totalling up the amount of carbohydrate in all those foods you eat, including the wine you are drinking (wines have more carbohydrate than hard liquor by the way), and you may be surprised at the amount you are actually getting.

Although you have reduced the monkfruit from the amount specified in the recipes, be aware that many people find they have an insulin response to one or another of the non-sugar sweeteners. This can also hamper progress. The good news is that you may respond badly to one sweetener, but there are likely to be plenty of others that do not affect your insulin.

Lastly, be aware that HbA1C is not a perfect measurement. Firstly, it makes the assumption that your erythrocytes (red blood corpuscles) are living for precisely 90 days. If they live longer, they will be correspondingly more glycated, but that is not necessarily indicative of a rise in your serum glucose. Also, the measurement is subject to variations in your hydration level at the time of the blood draw, and how long you had been fasting before they took the blood.

To get a true measure of your health, we would need to see all the blood work numbers, to get the entire context. If your HbA1C is a bit high but your inflammatory markers, your fasting glucose and your fasting insulin are all normal, say, and your ratio of triglycerides to HDL is good, and so forth, then a slightly high HbA1C might very well not be a problem at all.

(Joey) #4

I read through the OP’s typical menu descriptions and thought it sounded fairly low-carb - certainly enough to maintain ketosis and keep glucose low and stable. Perhaps you’re right, though… @Sunlove: Do you keep track of your dietary (non-fiber) carbs enough to know how many grams/daily you’re typically consuming?

(You've tried everything else; why not try bacon?) #5

I don’t know. It is very easy to believe we are eating less than we actually are. I saw mentions of “carrots and yam squash,” “keto muffins and cookies with almond or coconut flour,” Carbonaut bread, and so forth, which prompted my reaction. I just noticed that the wine intake is lower than I first spotted, however, nor should the berries and 1/2 apple really be a problem, given the level of intake mentioned. And there shouldn’t be much carbohydrate in the gin, I don’t think (missed that on the first reading). But in any case, totaling up the amount of carbohydrate will be a worthwhile exercise, regardless.

On the other hand, there may well be some unrelated problem going on with the OP. But a look at a complete set of bloodwork might indicate the nature of the problem, if there is one. It’s one thing if all the other numbers look good, quite a different thing if there are signs of inflammation or other problems.

(Joey) #6

How true.

Another missing piece of the puzzle is how the OP is actually feeling since going keto. Kathy notes that her arthritis has been reversed and her target weight is stable. This would suggest good health outcomes with low inflammation.

Still, more info would shed brighter light on whether she’s experiencing a fairly common slow/stable rise in glucose (i.e., from gluconeogenesis) as many others experience, or she is somehow becoming prediabetic due to seemingly trace carbs entering her diet. Hopefully @Sunlove shares more details.

(You've tried everything else; why not try bacon?) #7

With no arthritic pain, it is likely that systemic inflammation, if any, is quite low or gone. It would be highly unlikely for anyone to become prediabetic on a low-carbohydrate diet. However, it is possible that there is some residual insulin-resistance from before keto. Wasn’t it you who had that rise in CAC score for a while? And didn’t it eventually reverse itself? I wonder if this rise in HbA1C could be a similar phenomenon.

Of course, this is all speculation, and the OP should probably take it as being worth what she paid for it, lol!

(Bob M) #8

I would first start checking blood glucose multiple times per day, preferably by CGM. This site says 6.0 = 126 (7*18, just multiply by 18).

If you take pin-prick samples a few times a day and they are all below 126, something else is up.

And I know that some people get rising blood sugar, but I’ve been doing this over 9 years, and that hasn’t happened to me. In fact, I had one-month CGM graphs separated by 16 months, and they were basically exactly the same.

(Joey) #9

Indeed, that was me. Very concerning at the time, but I chalked the rising calcification without carbs as reflecting the process of plaque healing. And then most recently, my latest CAC score finally dropped precipitously after 2 yrs of keto - even as density (mass divided by volume) continued to rise. Supplementing with K2/D3 likely played a role, too.

Perhaps the OP is experiencing a similar phenomenon regarding HbA1c. But I’m experiencing the same (slightly) elevated glucose levels (FG of roughly 100 mg/dL) and am highly insulin sensitive.

As for the value of free advice, mine remains overpriced.

(Kathy) #10

Hello,
Thanks for your comments, my post states I no longer drink red wine, almost 2 years, I only drink Gin and club soda 0 carbs . :slight_smile:

Regarding the Monk fruit, and the amount I consume, would it really have that much of an affect? I use 1/2 in most baked items and get 10-12 muffins or 24 cookies, of which I might get 2 muffins or about 4 cookies and that is over a week.
I have eaten potatoes through out my 18 months of keto, the original Dr. who suggested I try Keto, said have a baked potato once or twice a week if you want for the fiber and good vitamins. Rarely have it twice, just once a week.
I lost 35 pounds in 12 months. The last time I saw him ( before he left the province) DARN! He suggested could take in up to 100 carbs a day and maintain. I may hit that on a rare occasion when dining out or holiday dinners with family. But day to day total carbs are very low. When I do have a high carb veggie, it is usually with protein and a salad with good fats.

As someone suggested I will do some searching on here about Levels of A1C.

Thank you !

(Joey) #11

@Sunlove Sounds like you’re comfortably on top of your carb intake. Many folks find they can tolerate more than the “20 g/day advice” often shared around here, which is primarily designed to ensure maximum benefits for those aiming for a much-needed pre/diabetes turnaround.

There is a rather lengthy exchange that’s been going on for several years now (including a few meandering side discussions - guilty as charged), that might be of interest. There’s a lot to read but it will also offer some additional links along the way that might be of interest.

Most importantly, you’ll see there is a range of thoughtful opinion on the question of whether a slightly higher - but more stable - serum glucose level is (or isn’t) a health concern on keto.

Hopefully this link works for you. Enjoy:

https://www.ketogenicforums.com/t/does-a-healthy-ketogenic-diet-cause-irreversible-insulin-resistance/

(You've tried everything else; why not try bacon?) #12

No one really knows. Since there is no way (yet, at least) to test insulin outside of a lab, the only way is to try to infer an insulin response from the pattern of blood sugar after ingestion. Blood sugar should not rise, because the U.S. Food and Drug Adminstration will not permit a sweetener to be sold in the U.S. if it has an effect on blood sugar, but if it drops significantly, that is evidence of an insulin spike. Unfortunately, unless the drop is particularly large, it is difficult to tell whether the drop is real, or an effect of the inherent inaccuracy of home glucometers.

Unfortunately, the FDA is stuck in the old paradigm that considers diabetes solely a matter of glucose control, whereas there is a growing amount of evidence to suggest that we should really be far more concerned with what the patient’s insulin is doing.

(Kathy) #13

You were not kidding when you said there is a lot to read… Thx for the link

I guess I kind find it odd that with a raise in A1C, it has not affected my weight.

I am a clean Keto eater, no processed foods, well, ok I do love a good smokie about 3 times a tear, no bun! I do not buy any "Keto " treats, most of them are not true keto and at a ridiculous price!
I go extremely sparingly on condiments, even the “No sugar” ones, unlike my partner who is Keto as well and at his goal weight too, who has a shelf full in the fridge. :roll_eyes: along with lots of no sugar chocolate and store bought N/S cookies, none of which temp me.

Thank you all

#14

You don’t need ideas, because ideas are useless guesses. Nobody knows more about what you’re doing than you… and you don’t know why its up so we have no hope. Start tracking what you eat and track your blood sugar. Won’t take long to identify what’s doing it. You’re raising it up enough and frequently enough to raise your A1C, so it shouldn’t be hard to find.

(Joey) #15

The OP is already tracking her blood sugar trends with her physician. She is already closely monitoring what she eats. Having shared the details on this keto forum, she is asking for ideas from others. Got any?

(Kathy) #16

Thank you , not sure how to take that post…

(Joey) #17

I’ve read (and learned from) a number of @lfod14’s posts in the past. Perhaps just a rough day? Having made great success through keto, perhaps he’ll share a good idea or two after all. :man_shrugging:

#18

@Sunlove, I have the same problem: A1c going up with keto. There are others on this forum, too, like @SunnyNC. And famous people, like Dr Bikman.

Before keto, did you have normal A1c, or were you prediabetic, or diabetic?

When you read around, have in mind that many people who do keto are diabetics and they’ll be happy with an A1c of 6, because perhaps before keto it was 7, or 8, or more. It doesn’t mean a A1c of 6 is healthy. If I was coming from 7, I’d be happy with 6, while hoping to get it lower.

I’ve found a book/website that tries to give information about how high your blood glucose (BG) needs to be to start causing diabetic complications such as eye problems and kidney problems. Unfortunately, it may start at the high 100s and low 110s. If you want to have a read, it is blood sugar 101, by Jenny Huhl. Or you can just do an internet search on “blood glucose and kidney disease”, or “blood glucose and retinopathy”, and the same, but replacing blood glucose by HbA1c, etc. Add “scientific paper” to your search to avoid opinion sites.

Now, is high-ish BG ok if one has a clean keto diet? No one knows. It could be, or not. Dr Bikman says he doesn’t know, though he wants it to be ok. I want it too.

There are articles (not of the scientific kind) and podcasts and youtube videos where they say it’s fine, call it sparring insulin resistance, or adaptive glucose sparing and then don’t worry about it. But these are opinions, not scientific data. I hope being keto is protective because my A1c also rose on keto and obviously, I desperately want it to be ok… But it is just a hope. In the meantime, I’m trying to get my A1c down, because I don’t want to wait 10 years for research only to find out my hopes were unfounded and I’ve lost 10 years I could have done something about it.

For both of us, and many others with the same problem, I hope it is ok to have high A1c if one has a clean keto diet. I’m just not betting my eyes and kidneys on it.

I found 2 types of responses to keto:

  1. Lowers blood sugar and it stays low for years, perhaps forever
  2. Lowers blood sugar, but after a few years blood sugar starts to creep up

Unfortunately, I found that some of the people for whom it works well have no real empathy for those for whom it doesn’t, and keep sending people like us to read opinions on the net and watch videos about opinions, instead of just saying that we don’t know yet if it is ok to have high A1c if one is on a keto diet.

#19

Watching blood sugar (trends) when you’re with a doc doesn’t tell you anything about what in your diet is causing the problem, it only gives you an end result. Checking itself yourself postprandial does. You say closely monitoring what she eats, I saw a sample menu, but nothing to indicate tracking, which is require for troubleshooting, at least if you want to get to the answer in a reasonable amount of time. If there was specifics spoken of, they weren’t in the OP, and that’s what I’m replying to.

So ya, I do have a good idea… and it was my reply.

#20

Take it literally. Track everything you eat, preferably with something like cronometer, start checking postprandial blood sugar, and you’ll have your answer pretty quickly on why your A1C is creeping up because you’ll see it happening in real time.