A1C Meaningless?

[openmind]

Just heard Dr. Norton Hadler on "On Point with Tom Ashbook" (NPR Radio) who stated A1C is essentially meaningless, even though diabetics are taught it is the holy grail of good health and longevity.

I'll have to listen to it again, but what he stated seemed to be consistent with the medical heresy often heard on this forum .

[pundit999]

Just heard Dr. Norton Hadler on "On Point with Tom Ashbook" (NPR Radio) who stated A1C is essentially meaningless, even though diabetics are taught it is the holy grail of good health and longevity.

I'll have to listen to it again, but what he stated seemed to be consistent with the medical heresy often heard on this forum .

Great. Now I have to re-calibrate what I know about diabetes!

So what did the doctor say about how to know if you have diabetes?

[openmind]

Just heard Dr. Norton Hadler on "On Point with Tom Ashbook" (NPR Radio) who stated A1C is essentially meaningless, even though diabetics are taught it is the holy grail of good health and longevity.

I'll have to listen to it again, but what he stated seemed to be consistent with the medical heresy often heard on this forum .

Great. Now I have to re-calibrate what I know about diabetes!

So what did the doctor say about how to know if you have diabetes?

I'm not sure 'meaningless' is the exact quote. I'll have to listen to it again. But it kind of jives with stuff I've heard Dr. McDougall say-here's the link

http://www.npr.org/podcasts/510053/on-p ... m-ashbrook

(as of today, the second podcast from the top).

The quote came toward the very end- maybe the last 10 minutes of the podcast. And he definitely said something along the lines that they can't tie a lower A1C to the avoidance of complications from diabetes.

[openmind]

Just heard Dr. Norton Hadler on "On Point with Tom Ashbook" (NPR Radio) who stated A1C is essentially meaningless, even though diabetics are taught it is the holy grail of good health and longevity.

I'll have to listen to it again, but what he stated seemed to be consistent with the medical heresy often heard on this forum .

Great. Now I have to re-calibrate what I know about diabetes!

So what did the doctor say about how to know if you have diabetes?

The interview is not about diabetes, it is about the doctor patient relationship in America. He just used A1C as an example of the overuse of certain metrics by doctors.

[geo]

Just heard Dr. Norton Hadler on "On Point with Tom Ashbook" (NPR Radio) who stated A1C is essentially meaningless, even though diabetics are taught it is the holy grail of good health and longevity.

I'll have to listen to it again, but what he stated seemed to be consistent with the medical heresy often heard on this forum .

What medical heresy is being promoted here?

A1C is just another biomarker among many. Understand, it is a biomarker and not the disease itself. It simply shows a path towards the disease as do all biomarkers. How important a biomarker is to any relevant disease must be taken within the proper perspective and context.

Also understand that biomarkers may be important to many diseases and conditions and taken simply on its own is never proof of any one particular condition on its own. Again context and perspective are needed.

I have never heard of Dr Hadler nor his claims, but I would be careful to understand the context and perspective from which he is speaking before making up my mind that he is right or wrong...so much talk can be misunderstood/misconstrued/misspoken without proper context. Also the burden of scientific proof is on the one making the claims, not on others to prove him right/wrong. Engaging in such games is always a losing proposition and time waster, see these posts from our resident RD, Jeff Novick:

viewtopic.php?f=22&t=27778&start=60
viewtopic.php?f=22&t=52871

[pundit999]

Oh. I have read that reducing H1Ac through drugs does little to control the complication of diabetes. So may be that is what he is saying.
You will have good numbers but you won't be well.
Same applies to cholesterol too. If you just use statins to lower it, it does not help much.

Adopting a whole plants only diet is what actually will change your risk profile.

[colonyofcells]

I heard type 1 usually use a gadget that can monitor blood sugar for 24 hours every day. For diagnosis, the common mainstream tests are (starting with most accurate) : after drinking sugar water, hba1c, fasting blood sugar. Personally, I just use the more convenient fasting blood sugar. For regular monitoring, hba1c is more accurate bec it gives average for about 3 months.

[openmind]

I heard type 1 usually use a gadget that can monitor blood sugar for 24 hours every day. For diagnosis, the common mainstream tests are (starting with most accurate) : after drinking sugar water, hba1c, fasting blood sugar. Personally, I just use the more convenient fasting blood sugar. For regular monitoring, hba1c is more accurate bec it gives average for about 3 months.

Yes. The issue is, though, can lower A1C predict less complications from diabetes. This Dr. seemed to imply the use of A1C is not as predictive of future complications (or lack thereof) as diabetics have been led to believe.

[colonyofcells]

If the lower hba1c is achieved thru diet and exercise, low hba1c should be a sign of good health. If the lower hba1c is achieved thru drugs, drugs do have side effects so it might not lead to longevity.

[dailycarbs]

You can hear the lead up and comment at about 32:00 minutes. The reasoning is sound and any mcdougaller will understand it in context. Using drugs to change biomarkers does not equate to health.

http://www.npr.org/podcasts/510053/on-p ... m-ashbrook

AUGUST 22, 2016
Saving The Doctor-Patient Relationship
Lifetime M.D. Dr. Nortin Hadler joins us to look at what's happened to the doctor-patient relationship, and how to save it.

[katgirl55]

This is another one of those nitpicky things that make little sense to me, such as the recent "flossing" controversy. http://www.newsobserver.com/living/health-fitness/article96150582.html We cannot wait for the science to catch up to common sense before we take action. A1c is an average but cannot give a doctor the whole picture of a person's health. In the case of my partner, A1c has come down, but after many years of high blood sugars and blood pressure, the kidneys are failing. So yes, in this case the A1c will not be a good indicator of complications, because these are chronic diseases, and effects are cumulative over years, not months.

I am not sure this information would be very helpful to the individual.

[Spiral]

I think fasting insulin levels might be a better biomarker for diagnosing type 2 diabetes. But I am guessing that even then a physician would want to back that up with other tests, such as an oral glucose tolerance test.

[colonyofcells]

It is possible that diabetes drugs are only treating the symptoms so even with good hba1c numbers, it might not lead to longevity.

[StarchHEFP]

One problem with A1c is that it can be variable and unreliable, differ based on blood disorders and anemia, and doesn't really say what the high/low values are. For example if you take readings of 75 and 225, average them you come up with avg. of 150. Similarly if you take 125 and 175, you also come up with average of 150. A1c is giving you an average, not the overall spread. Here is a discussion of A1c pros and cons:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632159/

I like to take A1c in context of what is the fasting and post prandial reading as well. I would rather have an A1c which is slightly higher in exchange for less hypoglycemia. A1c isn't the end-all and be-all of diabetic control. Tight A1c control has not been shown to prevent macrovascular complications such as heart disease; only microvascular complications are reduced such as kidney disease and retinopathy. In the end, a fully whole food plant based diet is the solution not more insulin or drugs with a moderately controlled A1c. My target for a diabetic patient is 7.

Many in the "paleo" community want A1c to be under 5, and this is ridiculous these are the people who chase after glucose to get it the lowest they can get it. And for what purpose?

Fasting insulin IMHO is very useful because it can distinguish those who need insulin from those who don't. If someone has blood glucose readings in the range of 200-300, and fasting insulin is below normal, then I won't bother adding more and more oral meds, I will go to insulin. I did have such a patient who was on WFPBD and killing it at the gym, with muscles sticking out of places I didn't know muscles could exist, who really needed insulin based on his fasting insulin level.

Conversely, if a patient has hyperinsulinemia and elevated blood glucose then there is a role of medical treatment besides insulin, and lifestyle changes.

So in conclusion A1c should not be taken by itself, it depends on their lipid profiles, post prandial and fasting glucose values, insulin levels, etc. and it's just 1 number. Another number used is so called "Glycomark" which is so new I don't really order it but still interesting for short term glucose control for near normal A1c.

http://www.questdiagnostics.com/testcenter/TestDetail.action?ntc=19599

[openmind]

Tight A1c control has not been shown to prevent macrovascular complications such as heart disease; only microvascular complications are reduced such as kidney disease and retinopathy. In the end, a fully whole food plant based diet is the solution not more insulin or drugs with a moderately controlled A1c. My target for a diabetic patient is 7.
http://www.questdiagnostics.com/testcenter/TestDetail.action?ntc=19599

1. From his talk which is available on YouTube, 'Diabetes and Drug', Dr. McDougall seems to imply that there isn't much of a link between blood sugar and microvascular complications either. I think he states that the only real link is increased protein in the urine (which should not be a problem if you eat a WFPB). Of course, that lecture was from a few years ago.

2. Isn't even 7.0 now considered too stringent a target for a lot of patients? I've read up on the issue and it seems there is a debate even within the mainstream medical community that the number should really be 8.0 for most patients. And from one of the talks from Dr. Gilbert Welch, Dr. Welch seems to imply 9.0 is the real number where complications increase significantly.

So I guess this search for a 'magic' A1C line, beyond which no diabetic should cross, is ever more confusing. I am glad there are doctors like you out there, looking at the whole patient, rather than excessively focusing on one metric as the single indicator of good or bad health in diabetics.

When my wife first became diabetic, we were told 7.0 was the magic number. Below that were healthy and happy people, above that there miserable people suffering through dialysis, amputations and strokes. It was explained that the excess sugar in the bloodstream itself caused the complications- never was there any mention that the same people with high blood sugars were the same people stuffing themselves with jelly donuts and sausages, and that it may be difficult to separate the effects of the high blood sugar and of itself from the effects of the poor diet that the high blood sugar pointed to.