Ha1C has become the gold standard for looking at the body’s blood sugar regulation. But what is it really?

What is HA1C?

Imagine a red blood cell with little antennas (called glycoproteins)sticking out of it. As the cell travels through the bloodstream, these antennas attach to sugar that passes by. After the glucose enters the cell, it can combine with the hemoglobin inside. Since the lifespan of a red blood cell is approximately 120 days and the sugar-sticking-on process is irreversible, the red blood cells can be examined to see how much glucose has been in the bloodstream.

The end product is referred to as glycosylated hemoglobin. Since oxidative stress promotes the glycation process, HA1C may be a better marker for measuring the imbalance between free radicals and antioxidants rather than blood sugar regulation.

What is the optimal value for HA1C?

Healthy HA1C values should be between 4.9 and 5.6. This represents the percentage of red blood cells that have been glycated. With elevated blood sugar level and/or free radicals, the amount of glycosylated hemoglobin increases.

Lower values, on the other hand, mean that the body may have had problems with either the supply or processing of sugar and/or less amounts of oxidative stress.

What factors effect HA1C?

Issue with normal value

From a blood sugar perspective, I have found that even those folks with “normal” HA1C levels still report symptoms related to blood sugar issues. This is why it is important to look at signs and symptoms as well as the test data—then you’ll get the whole picture.

Since HA1C offers an average value over a period of time— some of that time you may be high while other times you’re low. This causes you to experience symptoms of both while maintaining a “normal” value.

Lifespan of red blood cell

Also, the HA1C test is based on the fact that your blood cells live for 120 days. In a study published in the 2004 Diabetics Journal, researchers found that the lifetime of hemoglobin cells of diabetics could be as little as 81 days, while in non-diabetics, they survived longer—up to 146 days. Therefore, a person with normal blood sugar has their hemoglobin in the bloodstream for longer period of time, which may allow more sugar to accumulate. The result? Higher HA1C levels.

Anemia

Another condition which may affect hemoglobin HA1C values is oxygenation issues. Just like diabetics, folks with certain types of anemias may have short-lived red blood cells, which may have falsely effect HA1C levels.

For example, a client tested for very high HA1C. His doctor told him to quit eating sugar. Now, this guy eats better than anyone I know, exercises on a daily basis, and laughs frequently…sugar consumption for him is not the issue. Turns out he carries genes which cause him to have a high amount of very small red blood cells–increasing his HA1C value. Just for fun, he tested his blood sugars for a full week and saw no dysregulation that would relate to high HA1C.

According to the Mayo Clinic, the following may also affect HA1C readings:

• If you experience heavy or chronic bleeding, your hemoglobin stores may be depleted. This may make your HA1C test results falsely low.
• If you have iron-deficiency anemia, your HA1C test results may be falsely high. A substance called malondialdehyde enhances the glycation of hemoglobin.
• Most people have only one type of hemoglobin, called hemoglobin A. If you have an uncommon form of hemoglobin, your HA1C test result may be falsely high or low.
• If you have had a recent blood transfusion or have other forms of hemolytic anemia, test results may be falsely low.

Oxidative Stress

From an oxidative stress perspective, less amounts of oxidative stress with high antioxidant reserve would result in lower glycation and corresponding HA1C value.

On the other hand, high amounts of oxidative stress with low antioxidant reserve would result in high HA1C. 

Other

• Sickle cell anemia or thalassemia may cause HbA1C to be abnormal.
• Liver disease may cause HbA1C to be abnormal.
• Kidney disease may cause HbA1C to be abnormal.  Since the kidneys clear AGEs, those with high HA1C may need to also monitor kidney function.
• B6 and zinc deficiencies per Dr. Ron Grisanti, DC.

Are there other tests better than HA1C to measure blood sugar?

It is important to look at the complete picture: glucose, HA1C, fasting insulin, lipid markers, etc. to get an idea of how your body is handling blood sugar.

Another useful blood sugar test, fructosamine, reflects blood glucose concentrations over a period of three weeks. According to Johns Hopkins, “Consider [monitoring glycated albumin] in patients with patient visits less than one month apart. Because the half-life of albumin and other serum proteins is shorter than that of hemoglobin, concentrations of fructosamine and glycated albumin will change more rapidly than HbA1c and can serve as an index of intermediate-term glycemic control.”

Glycomark is a great test for measuring hyperglycemic spikes in a 1–2 week span