This is a blood test which I think we should all be aware of, and keep an eye on. It is a standard test which the doctor will do, and is a very good indicator of how well we deal with sugar (glucose) in our systems.
What it measures is the amount of 'glycated' haemoglobin in our blood. Glycated means it has sugar attached to it.
HbA1C is the measure used to see if somebody is close to, or in, the diabetic range. In the UK, around 42mmol/mol or 6% is defined as pre-diabetes, and diabetes is diagnosed when levels get to 48mmol/mol.
Basically, if you have a high HbA1C, it shows that your body isn't dealing so well with all the sugar (carbs) you eat - it means you aren't using up the sugar for energy, and have too much in your blood, and because it has nowhere to go, it sticks to the blood cells.
Red blood cells have a life of around 3 months, so this blood test is a good indicator of how well you are dealing with sugar in the blood over time, as opposed to 'spot check' glucose testing, which gives a snapshot.
Not only can too much sugar in the blood (glucose) lead to diabetes and all its complications, but it can increase inflammation, which you may or may not feel. It may have an effect on arthritic type symptoms, skin flare ups and visible effects of inflammation. But long term, low level inflammation which we can't feel has been implicated in heart disease, memory and cognitive challenges, mental health issues and more.
I've recently had a bit of a surprise with my HbA1C levels, which have risen slightly. A few years ago they were 29, then 32, now 35.
What is very interesting about this is that, since I really got into running regularly, I assumed I could manage a bit more carbohydrate than I'd previously been consuming, so over the last couple of years, I've included more potatoes, a few oatcakes, the occasional sweet treat etc. All 'healthy' foods, but an increase in my carb intake, nevertheless.
Like many people, I assumed that being physically active and having a healthy weight and body composition was a good indicator of how I was managing my blood sugar.
How wrong could I be!
In the last three years, since starting running, my body composition has changed:
You'd think that would mean I had nothing to worry about, yet my HbA1C has risen.
Although it's still within the range regarded as healthy, it's trends that matter, and my levels have been rising, despite being much more active than previously. So it's time to pay a bit more attention to the amount and types of carbohydrates I'm eating. Nothing like a blood test to show you that you're not getting it as right as you thought!
The interesting thing was that, just before I had this test done, I had been noticing my memory worsening, and a flare up of my arthritic discomfort, which has been quiet for a long time. That could be coincidence, but it seems to me that if I had more sugar in my blood than my body is comfortable with, these symptoms could be the result. I was also noticing an afternoon slump, which wasn't something I'd experienced for many years.
Something I think it's useful for everyone to understand is that all carbohydrate foods turn to glucose, which goes into the bloodstream. If it's not used fairly quickly, it has to go somewhere. We can store some of it in our liver and muscles for use later, but any excess gets turned into fat, which is a slow process, so extra in the blood can mean it gets stuck to the red blood cells.
A further aspect is that we are all different - some people are more carbohydrate tolerant than others. What works for your partner won't necessarily be the same for you.
AND different carbohydrates affect different people differently!
AND as we get older we may handle carbs differently from when we were younger.
So although my carbs are 'healthy' carbs - ie complex, slow releasing carbs, my body can't cope with very much of them, despite my level of physical activity.
Imagine what 'simple carbs' (the white flour/bread/rice/pasta and sugar) would do to someone like me, who couldn't tolerate carbs very well!
It is possible to have slim people with carbohydrate intolerance, therefore higher levels of glycated blood cells. Having diabetes, or approaching diabetes, is not always about being overweight.
The good news is this - even with a genetic predisposition to diabetes, or a carbohydrate intolerance, you can improve your HbA1C levels by simply reducing the carbs in your diet and making sure that the carbohydrates you do eat are moderate and complex (ie slow releasing).
There's a UK GP called Dr David Unwin, working in the NHS, who is pioneering the low carb approach to diabetes. It doesn't have to be a lifelong condition, and in most cases it should be able to be managed and even reversed with diet.
Some people adopt a ketogenic diet with great success, which is a very low carbohydrate diet (less than 40g of carbs a day); for most of us I would say it probably isn't necessary to be so extreme.
As an illustration, the average person, eating at least 50% (usually more) of their 2000 calories from carbohydrates a day means 1000 calories of carbs; one gram of carbohydrate contains 4 calories, so we are talking about at least 250g of carbs with a normal diet as opposed to 40g on a keto diet.
In the days when I had a lower HbA1C, a typical day would include:
These days, or up until recently, it's been:
The carbs which had increased were: potatoes, oatcakes, shop bought gluten free bread, biscuits (at my mum's, which I would never have eaten before), fruit, home made baked things. Again, generally 'healthy' (except for the bought gluten free stuff) and complex carbohydrates, and still not excessive.
I didn't put on weight or increase my body fat, so there was no indication, apart from my joint pain and memory problems, that anything was wrong.
The messages here are:
If you feel sluggish after eating, you might want to look at your carbs, and think about ways to reduce them. TIP: making sure you eat protein with every meal is a good way to help reduce carbs without feling deprived.
If you'd like to know more, we look at this in detail in my 4 week Healthy Eating course which you can find here.
What it measures is the amount of 'glycated' haemoglobin in our blood. Glycated means it has sugar attached to it.
HbA1C is the measure used to see if somebody is close to, or in, the diabetic range. In the UK, around 42mmol/mol or 6% is defined as pre-diabetes, and diabetes is diagnosed when levels get to 48mmol/mol.
Basically, if you have a high HbA1C, it shows that your body isn't dealing so well with all the sugar (carbs) you eat - it means you aren't using up the sugar for energy, and have too much in your blood, and because it has nowhere to go, it sticks to the blood cells.
Red blood cells have a life of around 3 months, so this blood test is a good indicator of how well you are dealing with sugar in the blood over time, as opposed to 'spot check' glucose testing, which gives a snapshot.
Not only can too much sugar in the blood (glucose) lead to diabetes and all its complications, but it can increase inflammation, which you may or may not feel. It may have an effect on arthritic type symptoms, skin flare ups and visible effects of inflammation. But long term, low level inflammation which we can't feel has been implicated in heart disease, memory and cognitive challenges, mental health issues and more.
I've recently had a bit of a surprise with my HbA1C levels, which have risen slightly. A few years ago they were 29, then 32, now 35.
What is very interesting about this is that, since I really got into running regularly, I assumed I could manage a bit more carbohydrate than I'd previously been consuming, so over the last couple of years, I've included more potatoes, a few oatcakes, the occasional sweet treat etc. All 'healthy' foods, but an increase in my carb intake, nevertheless.
Like many people, I assumed that being physically active and having a healthy weight and body composition was a good indicator of how I was managing my blood sugar.
How wrong could I be!
In the last three years, since starting running, my body composition has changed:
- 32% body fat to 25%
- 29% muscle to 34%
- And my weight has reduced from 65kg to 58/59kg
You'd think that would mean I had nothing to worry about, yet my HbA1C has risen.
Although it's still within the range regarded as healthy, it's trends that matter, and my levels have been rising, despite being much more active than previously. So it's time to pay a bit more attention to the amount and types of carbohydrates I'm eating. Nothing like a blood test to show you that you're not getting it as right as you thought!
The interesting thing was that, just before I had this test done, I had been noticing my memory worsening, and a flare up of my arthritic discomfort, which has been quiet for a long time. That could be coincidence, but it seems to me that if I had more sugar in my blood than my body is comfortable with, these symptoms could be the result. I was also noticing an afternoon slump, which wasn't something I'd experienced for many years.
Something I think it's useful for everyone to understand is that all carbohydrate foods turn to glucose, which goes into the bloodstream. If it's not used fairly quickly, it has to go somewhere. We can store some of it in our liver and muscles for use later, but any excess gets turned into fat, which is a slow process, so extra in the blood can mean it gets stuck to the red blood cells.
A further aspect is that we are all different - some people are more carbohydrate tolerant than others. What works for your partner won't necessarily be the same for you.
AND different carbohydrates affect different people differently!
AND as we get older we may handle carbs differently from when we were younger.
So although my carbs are 'healthy' carbs - ie complex, slow releasing carbs, my body can't cope with very much of them, despite my level of physical activity.
Imagine what 'simple carbs' (the white flour/bread/rice/pasta and sugar) would do to someone like me, who couldn't tolerate carbs very well!
It is possible to have slim people with carbohydrate intolerance, therefore higher levels of glycated blood cells. Having diabetes, or approaching diabetes, is not always about being overweight.
The good news is this - even with a genetic predisposition to diabetes, or a carbohydrate intolerance, you can improve your HbA1C levels by simply reducing the carbs in your diet and making sure that the carbohydrates you do eat are moderate and complex (ie slow releasing).
There's a UK GP called Dr David Unwin, working in the NHS, who is pioneering the low carb approach to diabetes. It doesn't have to be a lifelong condition, and in most cases it should be able to be managed and even reversed with diet.
Some people adopt a ketogenic diet with great success, which is a very low carbohydrate diet (less than 40g of carbs a day); for most of us I would say it probably isn't necessary to be so extreme.
As an illustration, the average person, eating at least 50% (usually more) of their 2000 calories from carbohydrates a day means 1000 calories of carbs; one gram of carbohydrate contains 4 calories, so we are talking about at least 250g of carbs with a normal diet as opposed to 40g on a keto diet.
In the days when I had a lower HbA1C, a typical day would include:
- 2 eggs for breakfast, sometimes with a piece of ham
- A super salad for lunch with a tin of sardines or other protein
- An evening meal of steamed or stir fried vegetables with some protein
These days, or up until recently, it's been:
- Berries, yogurt, hazelnut butter and cacao for breakfast
- Super salad for lunch with protein
- Chocolate after lunch or some home made baked thing (lower sugar and made with ground almonds, but still more starchy than previously)
- Cheese and oatcakes or similar in the evening
- Snacks sometimes between meals
The carbs which had increased were: potatoes, oatcakes, shop bought gluten free bread, biscuits (at my mum's, which I would never have eaten before), fruit, home made baked things. Again, generally 'healthy' (except for the bought gluten free stuff) and complex carbohydrates, and still not excessive.
I didn't put on weight or increase my body fat, so there was no indication, apart from my joint pain and memory problems, that anything was wrong.
The messages here are:
- Don't be fooled by a healthy body composition and BMI
- All carbs turn to sugar in the blood
- Diabetes could be described as 'carbohydrate intolerance'
- Being active, even athletic, may not stop you from getting diabetes
If you feel sluggish after eating, you might want to look at your carbs, and think about ways to reduce them. TIP: making sure you eat protein with every meal is a good way to help reduce carbs without feling deprived.
If you'd like to know more, we look at this in detail in my 4 week Healthy Eating course which you can find here.