Why The Hemoglobin A1c Test Is So Important

The Hemoglobin A1c test sounds like something you would have had to take back in AP bio class, but it’s actually a fairly common blood test. Your doctor may even have suggested you have one done in the past.

The A1c can be used to determine whether someone is diabetic or pre-diabetic based on the amount of sugar in the blood over the past 3 or 4 months. If someone has already been diagnosed with diabetes, this test helps their doctor determine whether or not they’ve been managing their blood glucose effectively or if their treatment needs to be adjusted.

How the A1c Test Works

The carbohydrates we eat get converted into glucose to power our body. Any extra glucose that does not get used or stored stays in the blood and attaches to red blood cells. These cells live in the bloodstream for about three to four months.

The amount of glucose that clogs up the hemoglobin in your red blood cells is shown in your A1c test results as a percentage. The test results may also show what is called your estimated Average Glucose, or eAG.

The eAG reflects an estimation of your average blood sugars over the past three or four months.  Instead of being reported as a percentage, your eAG will be in mg/dl units, the same as your blood glucose meter.

Both your A1c and eAG reflect your average blood sugars over a given period of time, and these results help your health team determine whether or not your treatment plan is working.

“Talk with your doctor about what A1c and daily blood sugar levels you should aim for. This means choosing targets that are safe and realistic for your age, health, and lifestyle and that will lower your chances of developing problems from diabetes.” – David McCulloch, MD

The A1C Test Also Shows Your Real AGE (AGE = ADVANCED GLYCATION END-PRODUCTS)

Besides monitoring long-term glucose control in patients with diabetes, the A1c blood test also helps identify AGE – advanced glycation end products in the body.

Advanced glycation end-products (AGEs) form when sugars bind with proteins or amino acids in the body. [1] These compounds become like a sticky plaque that makes its way into our brain and nerve tissues and the rest of our organs. And, once our body absorbs these AGEs, they set up residence and it’s hard to get this gooey, nasty substance out of our cells.   This can lead to significant oxidative stress, further inflammation, and long term damage to our cells and organs.

While every bit of our bodies is susceptible to this damage, the lining of our blood vessels is particularly sensitive to AGE damage, as well as certain nerves cells like the ones found in our brain, eyes, and kidneys. Even our very DNA is at risk of AGEs moving in and wreaking havoc. [2]

AGEs are also responsible for wrinkly, sagging skin, [3] high blood pressure, and most chronic diseases like heart disease, cancer, and stroke. They are also responsible for helping to form the sticky amyloid proteins and neurofibril tangles that destroy the brains of those people with Alzheimer’s and dementia. [4]

In short, AGEs are some of the nastiest and most detrimental compounds on the planet, and you want to stay as far away from them as you can.

Food Sources of AGEs

Besides being formed in the body when blood sugar remains elevated, AGEs are also found in the foods we eat. And some of these foods may surprise you.

For instance, do you love a good BBQ? BBQ meat that has been cooked just right so it’s crispy and caramelized is found by many people to be delectable. Not many will argue that heating meat and adding some form of sugar and fat to caramelize it adds flavor, but the result is the formation of AGEs.

Knowing how much we love these kinds of flavors, food manufacturers have developed synthetic AGEs and added them into more and more of our packaged foods. These manmade AGEs give many of the foods we eat an extra dose of deliciousness and a pleasing brown color.

Foods that include these synthetic AGEs include brown breads, crackers, brown, crispy cookies, donuts, bacon, dark roasted coffee and dark sodas and beers, to name just a few. But it doesn’t stop with just brown foods.

Fried foods cause the sugar in the food to bind with the proteins and/or fats to form AGEs. Love French fries? Well, you’re eating AGEs. Just about any food that is high in fat, protein and sugar (or starch) will most likely cause AGEs to form when cooked at high temperatures. For this reason, cooking foods at lower temperatures is recommended, as is using water to steam, boil or poach foods. Doing so prevents the sugars from attaching to proteins and fats.

The bottom line is, though people with type 2 diabetes, who have chronically elevated blood sugar are definitely at high risk for AGE cellular damage, anyone that eats the foods I’ve listed (or any kind of fast or packaged food) is susceptible to the same damage.

How to Minimize your Exposure to AGE’s

While there’s not much that can be done about the damage already caused by AGEs, there are things you can do to keep them out of your body:

1) Avoid high sugar foods, especially high fructose corn syrup and fruit juices.

2) Avoid grains, particularly corn and wheat, which tend to elevate blood sugar. These grains are also often baked or fried to a crispy, golden brown color, which makes them a double threat because they contain their own AGEs.

3) Cook meats at lower temperatures and try to avoid BBQ meats.

4) Eat fruits and vegetables either raw, stewed or steamed to stop the glycation process.

5) Do NOT eat junk foods and prepackaged foods that contain higher amounts of sugar and added synthetic AGEs.

6) If it’s golden brown, put it down.

7) Avoid anything with caramel color added to it such as soda and other packaged foods.

8) Up your antioxidant intake by adding green tea, turmeric, berries and even quality supplements, like selenium, to your diet. These will help fight the damage that can be caused by some of the AGEs that slip into your foods without you knowing it.

9) Use good old common sense, like eating whole organic foods, getting plenty of exercise, hydration and rest.  This will do wonders to help your body stay healthy and age well.

If you’ve never had a hemoglobin A1c test and would like to have one done, speak to your doctor about ordering one for you. It’s really a great way to find out about your current overall health, where your health is headed, and what you can do to change its course if necessary.

“Managing diabetes requires a lifestyle of healthy self-care practices. The keys to bringing down A1C levels are the same as for bringing down blood sugar levels.” – Audrey Demmitt, RN, BSN

Resources:

[1] Advanced glycation end products: a Nephrologist's perspective, Am J Kidney Dis. 2000 Mar;35(3):365-80 [NIH]

[2] Genotoxicity and immunogenicity of DNA-advanced glycation end products formed by methylglyoxal and lysine in presence of Cu2+, Biochem Biophys Res Commun 2011 Apr 15;407(3):568-74. doi: 10.1016/j.bbrc.2011.03.064. Epub 2011 Mar 21 [NIH]

[3] Advanced glycation end products: Key players in skin aging?, Dermatoendocrinol. 2012 Jul 1; 4(3): 259–270. doi:  10.4161/derm.22028 [NIH]

[4] Consequences of Advanced Glycation End Products Accumulation in Chronic Kidney Disease and Clinical Usefulness of Their Assessment Using a Non-invasive Technique – Skin Autofluorescence, Maedica (Buchar). 2011 Oct; 6(4): 298–307 [NIH]