A1C and carbs and me

[Katsmeow]

I posted previously about my recent blood test results. I was surprised by an A1C of 5.9% given that my fasting blood glucose as 84 and my triglycerides were 104. I also eat lowish carb usually in the 100 to 120g a day range, occasionally higher or lower.

An A1C at that level supposedly maps out to an average blood glucose of around 123. I know this can vary and be misleading if you have long-lived red blood cells.

From research, I know that results like I received could be valid if I was spiking really high blood sugars which took a long time to come down. I wanted to know so I bought a meter and have been testing my blood glucose. My fasting blood glucose in the mornings have 87 to 94. I had one outlier at 110, but I retested 20 minutes later (without having eaten) and got a reading of 87. So I think the 84 fasting result at the end of December seems reasonably accurate. (I'm using a Relion Prime meter which my internet research indicates tends to read slightly high).

I have also been testing after meals, usually 1 and 2 hours after although occasionally I vary from it. Some of the results have been surprising. It is clear to me that some foods do raise my blood sugar to a higher level than I would like. Others are a bit more equivocal. And, some carbs do nothing bad at all.

I read Jenny Ruhl's book on how to do this. She gives 2 potential targets to shoot for. One is to be at 120 after an hour, 100 after 2 which is what she says truly normal people end up at. Another option (which I gather is more for people not truly normal but which she seems to think is sufficient) is 140 after 1 hour and 120 after 2 hours. She says is up the individual which target to shoot for. My thought is to be close to the 120/100 most of the time, with it rarely going over and to work really hard to never go above the 140/120.


My results so far have been interesting. I’ve tried during this time to eat as normally as possible so I can get a feel for my usual diet. I did eat a few things that, in actuality, I eat only a few times a year but I wanted to see what they would do. I put things with carbs in 3 categories: OK, Problem, Borderline/Mixed. (Things that aren’t carbs are all OK for me in terms of blood sugar).


Since I’ve been testing my total daily carbs have ranged from 46 to 129. Average daily carbs is 99.

Would appreciate any feedback from those of you who have looked at this kind of thing.


Things that so far are OK:

Pistachios (9g carbs)


Quest bars (25g carbs, 16g fiber or 21g carbs, 17g fiber)


Dark chocolate square (4 to 7g carbs depending on whether 70% or 86%) – at least 70% cocoa (this is one square which isn’t a problem. That is only about 60 calories.)


Whole wheat tortilla with high fiber, with hummus, and half cup blackberries (25g carbs, 13g fiber) – I had this twice and neither time did do anything problematical


Whole wheat tortilla with high fiber, with scrambled egg, lowfat cheese, bell pepper (13g carbs, 8g fiber)


Tuna Salad Sandwich – this was on 2 pieces of 45 calorie whole wheat bread (19g carbs, 5g fiber) – Much better than I expected. 118 at 1 hour, 106 at 2 hours, and 100 at 3 hours.

Problem:


Salad with chicken, greens, bell peppers, cucumbers, cherry tomatoes, 3 T. friend wonton strips, 2 T. Lite honey mustard dressing (38g carbs, 6g fiber) – 140 at 1 hour, although it was down to 99 at 2 hours. Next time I will do this without the wonton strips


Tortilla chips (about 18), chicken fajitas with 2 whole wheat tortillas, about 3/4 serving Mexican rice, few bites of charro beans (94g carbs, 9g fiber) (this is a meal I rarely have, but wanted to see the result) – 160 at 1 hour, 135, at 2 hours, 116 at 3 hours, 90 at hours. Definitely not having this. I think at least the chips and rice have to go. I might be able to have 1 of the tortillas, but not sure. Will check next time we go there.


Panera – Thai Chicken Salad, Mediterranean Flatbread, chips - (73g carbs, 8g fiber) 158 at 1 hour, 136 at 2 hours, 108 at 3.5 hours. I was surprised by this as it was so much worse than the BBQ chicken salad, turkey chili, and chips that I have in the borderline/mixed category. However, this meal has more refined carbs and slightly more carbs and a little less fiber.. Specifically, the fried wontons on this salad (the BBQ chicken has corn and beans instead) and the flatbread itself (the other meal has turkey chili with beans instead). Both meals have 1 oz. chips. I don’t actually usually eat this meal, but wanted to test it out. The BBQ Chicken salad with turkey chili is my common meal there.


Panera – Cinnamon Crunch bagel. I expected this to be bad. I don’t often have this, but was curious. My blood glucose was 87 right before starting to eat it. An hour after eating it was 179. Holy cow! At 3 hours (I was not able to test at 2 hours) it was back to 100. No more of these for me.


Potato chips, 1.87 oz (35g carbs, 2g fiber) – 121 at 1 hour, 131 at 2 hours, 102 at 3 hours. This is a larger serving than I usually eat (1 oz). 1 oz. might work out OK for me, perhaps with a meal, but need to check.

Borderline/Mixed (these are things that don’t go above the 140/120 and are close to the 120/100 but might go a bit above or where I need to investigate more)

Panera – BBQ chicken salad (half), cup turkey chili, 1 oz. Panera potato chips (64g carbs, 14g fiber) – Somewhat to my surprise this was 118 at 1 hour. I wasn’t able to test at 2 hours, but it was at 112 at 3 hours and was 79 at 4 hours. I was reasonably happy with it and think it would be fine if I dropped the chips. I’m going to try this meal again and test at 2 hours.


Luvo Chicken Verde Poblano Burrito (38g carbs, 6g fiber) – I had this a couple of times. Did not go above 120 at one hour but was a little over 100 at an hour. It was....OK...but I don't love it that much that I necessarily want to keep it to try again.



Luvo Breakfast Burrito (38g carbs, 4g fiber) – Was 95 at one hour, 111 at 2 hours, 124 at 3.5 hours and 107 at 4.5 hours.

Grilled fish with a Green Giant vegetable medley that had potatoes as one of the vegetables. (32 g carbs, 2g fiber) – Kind of surprised that it was at 126 at 1 hour, but was 95 at 2 hours. I want to test this one again.


Skillet crisp fish with green beans and almonds. (27g carbs, 3g fiber) (This is Gorton’s Skillet Crisp Fish with have a light flour coating. This was baked in the oven) – 122 at 1 hr, 20 minutes. 116 at 2 hours 20 minutes and still at 109 at 3 hours. This didn’t come down as quickly as I would like. Again, I probably just won't buy this fish again.



Mediterranean buffet – Hummus, Falafel, tabouli, small amount of pasta salad (oil dressing), chicken shwarma, fattoush salad, 1 small piece of baklava – (82g carbs, 10g fiber – this restaurant doesn’t give nutritional info – estimated from similar items elsewhere) - Was not able to test at 1 hour. Was 111 at 2 hours. Will try this again and not include any baklava. I think without the baklava, it will probably be OK for me.


Conclusions – I don’t really see anything that would equate to an A1C of 5.9%. Most of the food that I ate during these several days didn’t create any issue at all and isn’t mentioned. There were only a few times that my blood sugar ever got above 140. I looked back at what I was eating before the A1C. It was a little higher carb (my test was on 12/30 right after holidays). So I could see my average blood glucose being a little higher then than it is now, but looking at what I was eating then I can’t see it actually being that high. I wonder if I'm just one of those people with long-lived red blood cells.


That said, it is clear that I do react negatively to some carbs so I want to modify my diet so I don't have it going as high as it did with some of those meals.


Going forward, pretty much any meal below 25g carbs seems OK. Meals between 25g carbs and 65g carbs may be OK depending on what it is. The more refined carbs the less OK it is, even if the total carbs are still relatively low. The few things that I ate above 65g carbs (the Mexican food meal, the bagel and the salad/flatbread Panera meal) all raised my blood sugar a lot compared to anything else and what is notable are the refined carbs in them.


On the other hand, I don’t see a need to avoid all grains. A single whole wheat tortilla with hummus or with a scrambled egg in it did fine. Also, a square of dark chocolate was totally fine so I don't see a reason to avoid eating that which I do a few times a week.


My sense from this is that I can fairly easily tweak my diet to avoid refined carbs that raise my blood sugar. I already don’t eat them a lot (I ate more during this period so I could test what was problematical). Some of the problem or borderline meals could be easily modified (no baklava, no chips, etc.). My 100g or so of carbs doesn’t seem to be a problem. Even my higher carb days (in the 120s) weren’t problematical as a whole, unless individual meals created a problem.

I don’t see a reason from this to lower my total carb intake specifically, but this does suggest to watch how many total carbs I eat at a meal and to avoid even relatively small amounts of refined carbs (such as the wonton strips). Those don't seem very difficult changes for me to make.

[audreyh1]

Oh wow! You might even have me going out to get one of those meters!

[Katsmeow]

Quote:

Originally Posted by audreyh1 Oh wow! You might even have me going out to get one of those meters!

It was actually pretty interesting to do. I bought a Relion Prime from Walmart because its strips are cheaper then others. I would caution not to expect absolute accuracy but it does give you a good idea of how you react relatively to different things.

For me, what was interesting was that I didn't actually thing carbs had any particular detrimental effect on me. A few years ago I actually went low carb for awhile and went through induction and eliminated grains, etc. Then, I slowly added carbs back in.

Unlike some people I didn't find that going low carb helped me less hungry. Some people as they add back in carbs start feeling bad or they start having carb cravings. I didn't.

I basically concluded that I wasn't particularly sensitive to carbs. I stayed lowish carb (around 100 to 120g a day) since I did cut way back on refined carbs. But, that just sort of happened. It wasn't that I felt I wasn't able to handle carbs.

So - I've been very surprised to see how much some carbs raise my blood sugar (particularly since I have fairly low triglycerides and eat lowish carbs).

As best as I can tell, carbs really do not cause me to be hungry and I don't feel craving when my blood sugar goes down. (For example, I was at 178 when I ate that bagel and when my blood sugar went down I didn't feel particularly hungry).

So - while I don't "feel" that I react badly to carbs - the meter tells me pretty clearly that I react badly to at least some carbs, especially refined carbs.

[audreyh1]

How do those meters work? Do you put a drop of blood on the strip?

[Katsmeow]

Quote:

Originally Posted by audreyh1 How do those meters work? Do you put a drop of blood on the strip?

Basically, yes. Actually you put the strip next to the drop and it sort of "sucks" the blood up the strip. It takes very, very little blood for it to work.

I was sort of a wimp about this so I didn't want one of the cheap lancets from the pharmacy. But, I didn't want to spend a fortune either.

So I bought:

https://www.accu-chek.com/us/lancing.../fastclix.html

This is super easy to use, you don't have to actually touch the lancets and you can adjust the pressure it uses. It doesn't hurt which was the most important part to me.

[Sunset]

I know of a diabetic who by cutting out carbs pretty drastically was able to stop taking the medicine. But of course I'm not really privy to all the details.
So your post of how carbs affects blood sugar levels is not surprising, and in fact is a bit hopeful in that it points to complex carbs as generally being better.

[audreyh1]

Eating salads with low-fat dressing - usually eating salads with full-fat dressing can slow carb absorption which lowers the insulin response. This goes for eating low-fat meals in general. Moderate fat is usually a lower glycemic load. Full-fat cheese instead of low-fat, etc.

It just seems like it's tough to do low-fat and low-carb and be limited to the leanest of proteins all at the same time. Where are the avocados and good oils like olive oil and nuts? I notice you don't look at fat or protein in your analysis.

Since you are experimenting.....

[harley]

+1 on the low fat dressing. If you read the labels you'll see that in order to maintain flavor with low fat foods they usually increase the sugar content. Recent science has shown that fat is not the demon that it has been portrayed as. Obviously minimize the trans fats, but other than that I wouldn't worry about them.

Beyond that, the only thing I would suggest is to not get too obsessive about numbers and control. There's nothing in your numbers that would indicate any problems other than an extremely mild pre-diabetes A1c. I'd recommend waiting a couple of months without getting too extreme about your diet, then re-testing and see what happens. Could be much ado about nothing. I've found the Walmart mail in tests to be pretty reliable, in as much as I do a test a day or two before having the lab do one, then compare the results. They tend to be pretty close.

We're all going to die someday. To me it's more important that I die with a smile on my face remembering a life I enjoyed immensely than to die with perfect numbers. So far I'm smiling. A lot.

[highlow65]

They have home A1C kits available at pharmacies, if it gives you piece of mind well worth it.

[Bestwifeever]

My A1C test result from November this year was 5.7, and the report gave this range for acceptable results: HEMOGLOBIN A1C 4.0 - 6.0 %

I thought this was pretty good and my doctor did not call it out as something to watch out for. Maybe not?

[donheff]

I eat lowish carb like you - probably in the same range. My latest A1C was 5.6 which is just below the pre-diabetes level (my test identified 5.7 as the lower limit, I have seen 6.0 cited elsewhere). But I am not going to worry about it unless things change dramatically. I dropped from 195 to 163 three years ago and have stayed there (I am 6') and my BP is consistently in the 110/60 110/70 range. Have you checked to see if you have low iron or a hemoglobin variant? Both of those can conditions can produce false high A1C levels although I have no idea how high, maybe higher than your borderline level.

I want a testing mechanism that gets results automagically - maybe with scent or something. 5 years out?

[harley]

Quote:

Originally Posted by donheff Have you checked to see if you have low iron or a hemoglobin variant? Both of those can conditions can produce false high A1C levels although I have no idea how high, maybe higher than your borderline level.

My experience has been that anemia results in a lower A1c, due to having less hemoglobin to carry the sugars. I'm slightly anemic, and my A1c's have always been below 6, even when my daily fasting tests were showing 150-200. In my case I tend to disregard the A1c and pay more attention to the daily numbers.

Edit: A quick google shows your statement to be pretty accurate. Once again I have no explanation for my weird readings.

Edit2: A more in depth search shows other viewpoints that agree with what I see, like this one (disregard the sales pitch). So since nobody knows anything I'm going back to my enjoy life and die smiling theory.

[robertf57]

Quote:

Originally Posted by Katsmeow I posted previously about my recent blood test results. I was surprised by an A1C of 5.9% given that my fasting blood glucose as 84 and my triglycerides were 104. I also eat lowish carb usually in the 100 to 120g a day range, occasionally higher or lower. An A1C at that level supposedly maps out to an average blood glucose of around 123. I know this can vary and be misleading if you have long-lived red blood cells.

Not certain where you are getting your A1C conversion, but a 5.9 is more like an average glucose of 112 or so. You current values are quite good!

Although your targeting of carbohydrate is right on, you might want to think about how you look at them. All carbohydrates are not created equal. For example, fiber (which is non digestible) is measured as carbohydrate and labelled as such on your food items. However, it does not negatively impact blood glucose (in fact probably helps). Some people recommend subtracting the fiber carbohydrates from the total to get a "net carbohydrate" figure. Even that is a little misleading as a bolus of simple sugars is very different than the same number of carbs in a complex carbohydrate.

[RonBoyd]

I don't remember where I got these links (it could well have been from your earlier thread) but seems pertinent to this conversation:


Plasma Glucose Meters and Whole Blood Meters | Joslin Diabetes Center

Quote:

What's the difference?" you might ask. The difference is that plasma numbers read about 10 - 12% higher than the older whole blood numbers. So if your fasting and pre-meal blood glucose target is 90 - 130 mg/dl plasma glucose, it would be 80 - 120 mg/dl if your meter reads whole blood.

Conversion Table for Blood Glucose Monitoring | Joslin Diabetes Center

Conversion of Glucose Values from mg/dl to mmol/l

[RonBoyd]

Quote:

Originally Posted by robertf57 Even that is a little misleading as a bolus of simple sugars is very different than the same number of carbs in a complex carbohydrate.

For those (of us) that have to look things up:

bo·lus
ˈbōləs/
noun
noun: bolus; plural noun: boluses

1. a small rounded mass of a substance, especially of chewed food at the moment of swallowing.
   • a type of large pill used in veterinary medicine.
   • Medicine
     a single dose of a drug or other medicinal preparation given all at once.

And if I might ask; Where did you find the graphic?

[FIRE'd@51]

Quote:

Originally Posted by robertf57 Not certain where you are getting your A1C conversion, but a 5.9 is more like an average glucose of 112 or so. You current values are quite good! Although your targeting of carbohydrate is right on, you might want to think about how you look at them. All carbohydrates are not created equal. For example, fiber (which is non digestible) is measured as carbohydrate and labelled as such on your food items. However, it does not negatively impact blood glucose (in fact probably helps). Some people recommend subtracting the fiber carbohydrates from the total to get a "net carbohydrate" figure. Even that is a little misleading as a bolus of simple sugars is very different than the same number of carbs in a complex carbohydrate.

This table doesn't look right to me. It looks like the mg/dL column may be from whole blood (which the old meters used to display) instead of plasma, which is what a laboratory (and the newer meters) would report. A reading from plasma is about 10% higher than one from whole blood. A conversion formula from A1c to a reading from plasma is:

mg/dL = 28.7 x A1c - 46.7

which agrees with the numbers that Katsmeow reports.

[RonBoyd]

An interesting chart on the carbohydrate, caloric, and glycemic densities of certain foods:

PubMed Central, Figure 1: Diabetes Metab Syndr Obes. 2012; 5: 175–189. Published online 2012 Jul 6. doi:Â* 10.2147/DMSO.S33473

Quote:

The carbohydrate densities of ancestral foods are distinctly lower than those of the Westernized diet. (A) The carbohydrate density (excluding fiber) of a broad selection of foods, in descending order of carbohydrate density (data from USDA).112 Modern foods (gray bars) are those that have undergone refinement or desiccation, or are derived from grains. “Ancestral” foods (white bars) are unprocessed whole-foods from the categories of meats, eggs, fish, nuts, fruits, tubers, and leafy vegetables

[Katsmeow]

Quote:

Originally Posted by audreyh1 Eating salads with low-fat dressing - usually eating salads with full-fat dressing can slow carb absorption which lowers the insulin response. This goes for eating low-fat meals in general. Moderate fat is usually a lower glycemic load. Full-fat cheese instead of low-fat, etc. It just seems like it's tough to do low-fat and low-carb and be limited to the leanest of proteins all at the same time. Where are the avocados and good oils like olive oil and nuts? I notice you don't look at fat or protein in your analysis. Since you are experimenting.....

Oh, I do look at fat and protein. I record everything I eat in MyFitnessPal so I see all the nutrients. I just didn't put all that in the post since I knew it was already super long.

I don't really go out of my way to eat low fat foods, but there are a few things that I have around here that are lowfat. I do check the carb content before buying since I know they often add sugars to make up for the fat. I actually prefer to make my own salad dressing (with olive oil and balsamic vinaigrette), but I was in a hurry the day I ate the salad I mentioned. Normally, I eat about 40% to 45% of my calories as fat.

I hate avocados so don't eat them. I use olive oil as my fat whenever possible. I eat 1 ounce of nuts almost every day (usually pistachios, but can be almonds or walnuts). I've done this for many, many years.

Quote:

Originally Posted by Bestwifeever My A1C test result from November this year was 5.7, and the report gave this range for acceptable results: HEMOGLOBIN A1C 4.0 - 6.0 % I thought this was pretty good and my doctor did not call it out as something to watch out for. Maybe not?

The American Diabetes Association says that 5.7% to 6.4% is prediabetes.

5.7% is not horrible, but it might mean your body isn't handling some carbs very well.

Jenny Ruhl suggests that most people with truly normal blood sugars will have a level between 4.6% and 5.4%

What is a Normal Blood Sugar?

It is only within recent years that the A1C has been used for diagnosis. Some people feel that it isn't that accurate for the individual.

Why hemoglobin A1c is not a reliable marker

Some people have longer lived red blood cells than others so the result can be misleading.

That said, my 5.9% number was high enough for me that I wanted to see how my body was handling carbs and to see if my blood sugar was going up higher after eating them.

Quote:

Originally Posted by robertf57 Not certain where you are getting your A1C conversion, but a 5.9 is more like an average glucose of 112 or so. You current values are quite good!

On the conversion, I looked at various calculators.

This one says it maps out to 123 and gives the formula

Blood Sugar/A1c Calculator

Another chart (also showing the formula) that comes to a similar conclusion:

http://www.diabeteschart.org/bloodsugarchart.html

Quote:

Originally Posted by robertf57 Although your targeting of carbohydrate is right on, you might want to think about how you look at them. All carbohydrates are not created equal. For example, fiber (which is non digestible) is measured as carbohydrate and labelled as such on your food items. However, it does not negatively impact blood glucose (in fact probably helps). Some people recommend subtracting the fiber carbohydrates from the total to get a "net carbohydrate" figure. Even that is a little misleading as a bolus of simple sugars is very different than the same number of carbs in a complex carbohydrate.

And, yes, I do understand about fiber. In the records that I keep I actually do track both my carbs eaten and my net carbs (carbs-fiber). Some people figure net carbs by deducting sugar alcohols, but I don't.

I usually eat about 20g to 25g fiber a day so my net carbs are typically 20g to 25g less a day than just my carbs.

[haha]

Quote:

Originally Posted by robertf57 Not certain where you are getting your A1C conversion, but a 5.9 is more like an average glucose of 112 or so. You current values are quite good! Although your targeting of carbohydrate is right on, you might want to think about how you look at them. All carbohydrates are not created equal. For example, fiber (which is non digestible) is measured as carbohydrate and labelled as such on your food items. However, it does not negatively impact blood glucose (in fact probably helps). Some people recommend subtracting the fiber carbohydrates from the total to get a "net carbohydrate" figure. Even that is a little misleading as a bolus of simple sugars is very different than the same number of carbs in a complex carbohydrate.

I believe that this is far too optimistic. Those who find themselves in the orange area are very likely headed toward macro vascular or micro vascular difficulties.

I don't know any more about this than other interested people, but I hold no attachment to what someone might call "moderate". Moderate according to which criteria? Anything we think in the US is likely to be heavily influenced by media and advertising, and these actors rarely have our best interests and only our best interests in mind.

Jenny Ruhl is a careful blogger on whose website can be found a lot of quality research information. A1c and High Post-Meal Blood Sugars Predict Heart Attack

I believe that most of us could improve our health outcomes if we vastly curtailed our carbohydrate eating, and there is a lot of information on her site that supports this idea.

Growing up in 20th century western nations or at least western influenced nations, has already changed our physiology (negatively IMO).

Ha

[meekie]

Wow! so much detail, I'm impressed! I'm definitely going to look up the book by Jenny Ruhl, it sounds great. Hopefully it can get me motivated enough to do some similar testing.

One thing to remember is other things like amount of sleep, stress, exercise can change your numbers as well. A meal could be a problem meal one day, and not a problem another day, especially once you figure the error range on those meters.

But overall, it looks like you're doing really well with finding meals that work for you, and stuff that tends to make you react too much.

And I agree that the A1C looks high for your numbers. Mine was 5.8 at last testing, my fasting were numbers are 110-120, and after food was in the 140 range most times.