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Hemoglobin A1C (HbA1C) Test is not Reliable

Hemoglobin A1C
What is hemoglobin A1C (HBA1C) test ?

Hemoglobin A1c (HbA1C), is a form of hemoglobin that is bound to glucose. Your A1C measures the amount of advanced glycogenated end products (AGEs) that have accumulated in your bloodstream during the past three months. This test is routinely done for people with type 1 and type 2 diabetes. 

What is the normal HbA1c level?

According to the latest guideline by ACP for ‘most’ diabetes patients, clinicians should aim to achieve an HbA1c level of between 7 to 8%.

What are the a1c guidelines?

ACP recommends that most patients with type 2 diabetes should aim for HbA1Cs — between 7 and 8 percent.

There are different ways to test your blood glucose levels and thus, potentially predict and/or prevent diabetes. One such test is hemoglobin A1C (HBA1C)

What is hemoglobin A1C (HBA1C) test ?

Hemoglobin A1c (HbA1C), is a form of hemoglobin that is bound to glucose. Your A1C measures the amount of advanced glycogenated end products (AGEs) that have accumulated in your bloodstream during the past three months. This test is routinely done for people with type 1 and type 2 diabetes. 

What is the normal HbA1c level?

According to the latest guideline by ACP for ‘most’ diabetes patients, clinicians should aim to achieve an HbA1c level of between 7 to 8%.

What are the a1c guidelines?

ACP recommends that most patients with type 2 diabetes should aim for HbA1Cs — between 7 and 8 percent.

The other tests are,

Fasting Blood Sugar/Glucose Levels (FBG)

The most common is the fasting blood glucose tests (FBG). Basically, you don’t eat anything for at least 8 hours and then do a blood test and they see your fasting blood glucose levels. This is typically done first thing in the morning. You see this all the time with a regular blood test. Healthy levels are between 70-100 mg/dL.

Oral Glucose Tolerance Test (OGTT) In this test, you’re given sugar, about 75 grams of glucose dissolved in water. You drink it and then your blood sugar is test after 1 and 2 hours to see how your body handles all of this sugar.
This method does not work because nobody has 4 cups of soda or something else with that much glucose… all at once… by itself … and without any other food.

What is the accurate method ?

You eat a meal, you do a blood tests with a simple glucometer and you see what your blood sugar levels are after your meal.

Hemoglobin A1C test has become more popular over the past 10-15 years. This is done because its thought to be more accurate and reliable than the “fasting blood glucose” (FBG) test. Also it is a lot cheaper and easier than the older, “oral glucose tolerance test” (OGTT). Basically, A1c is a “snapshot” or the “average” blood sugar levels for the past 60-90 days. Specifically, the A1c test measures what percentage of your hemoglobin — a protein in red blood cells that carries oxygen — is coated with sugar (glycated). The higher your A1C level, the poorer your blood sugar control and the higher your risk of diabetes complications.

In theory, this makes sense and seems like a better indicator. Unfortunately, there’s a big problem with Hemoglobin A1C levels that most people won’t tell you and your doctor doesn’t know.

The main problem is that how long your hemoglobin survives, varies greatly in people. One study in Diabetes Journals, showed that red blood cells live longer than average at normal blood sugars. Researchers found that the lifetime of hemoglobin cells of diabetics decreased as few as 81 days, while they lived as long as 146 days in non-diabetics.

This proves that the assumption that everyone’s red blood cells live for three months is false, and that hemoglobin A1C can’t be relied upon as a blood sugar marker. In a person with normal blood sugar, hemoglobin will be around for a lot longer, which means it will accumulate more sugar. Thus, in normal, non-diabetic people, this will drive up the A1c test result – but it doesn’t mean that the person had too much sugar in their blood. The result is that people with normal blood sugar often test with unexpectedly high A1c Levels. The post meal is the most accurate test, but also takes more time and effort.

Conclusion

The usual methods of testing for blood sugar are all flawed, when used individually. There are many people who have higher hemoglobin A1C levels, while their fasting blood sugar and post meal blood sugar levels were all great. If you want to lower your blood sugar and help avoid or reverse diabetes, you’ll need to make simple lifestyle changes.
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10 Negative Effects Of Sugar On Your Body

sugar

Today we’re going to be looking at the 10 negative effects of sugar on your body.

Sugar can give you wrinkles and your face looks older. Scientists from Leiden University Medical Center in the Netherlands measured the blood sugar levels of 600 men and women aged between 50 and 70. They then showed the photographs of these people to 60 separate participants and found that those with higher blood glucose looked older than those with lower blood sugar levels. In fact for every one millimetre per litre increase in blood sugar the perceived age of that person rose by five months.

Sugar is associated with acne. Foods ranking higher on the glycemic index such as refined carbs have been associated with greater amounts of acne on the face and body according to the latest study of Australian men.

Sugary drinks cause 83 % increased risk in developing type 2 diabetes. In one study of 91249 women showed that those who consumed one sugar sweetened beverage per day had an 83 % percent increased risk of developing type 2 diabetes compared to those that only had one a month.

Sugar intake increases the risk of developing certain types of cancers. There has been a direct link seen between breast and colon cancer with sugar consumption. This is likely due to the fact that insulin is one of the key factors behind the growth and multiplication of cells and sugar spikes insulin to abnormally high levels.

Sugar can ruin your teeth. A study done by the American Journal of Clinical Nutrition showed that it destroys the healthy bacteria in the mouth which can cause tooth erosions.

Sugar is made up of empty calories with no real nutritional value. There are no nutrients, minerals,  proteins or fiber in sugar just calories.

Sugar makes you feel hungry. A study done by Yale University showed that those who consume sugar had an increased appetite and desire for more. This happens when sugar screws up the hormonal levels in the body.

Sugar blocks leptin and raises insulin to very high levels. Leptin is a hormone in charge of telling us that we’re full and need to stop eating. It also tells us that we have energy and should go out and use that energy. Sugar consumption blocks this hormone from doing its job and from reaching the brain.

Sugar causes belly fat.  Numerous studies have shown direct links from sugar to the increased accumulation of belly fat. This is the worst kind of fat because it is the one associated with all sorts of diseases including heart disease.

Sugar is addictive. Just like cocaine scientists have shown that sugar causes a very similar dopamine release in the brain. Studies on neuroplasticity have also shown that drug users have very similar behavioral addictions to those addicted to sugar.

Fruit has fiber, vitamins, minerals, water and tons of nutrients that refined sugar does not have. This is why when studies compare diets with refined sugar to fruit sugar the negative effects are not the same.

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Sona Moti The Wheat grain With Folic Acid

wheat grain

On 18 March 2019, Gurudev Sri Sri Ravi Shankar, Founder of The Art of Living launched ‘Sona Moti’ a natural wheat grain variety that is highly nutritional with 3 times more folic acid than any other grain. It has nearly 267% more minerals and 40% more protein than any other wheat variety.

The name was given by Gurudev Sri Sri Ravi Shankar after its almost round shape and golden hue.

Gurudev shared, “When I came to Punjab many years ago a local farmer showed me seed of local variety of wheat, which Sri Sri Institute of  Agricultural sciences got it tested in laboratory and found out that the Folic acid content is 12% higher than any other grain. Folic acid is important to for a healthy body. Many type of diseases like heart attack, blood pressure is caused by lack of folic acid. This wheat variety can solve many such issues and the grain that goes out of Punjab will spread health all around.”

This wheat grain variety has low glycemic index and less gluten which is very healthy for those consumers with life style diseases such as diabetes.

It was discovered that there was a variety of wheat grain that is 2,000 years old at least. This is an Emer wheat which belongs to the species triticum dai kokum and has been grown for centuries in India but in the recent past it has almost become extinct because of the rampant use of the hybrids.

This wonderful variety looks very different from the other wheat because it is round in shape almost like a pearl.

This is the only wheat which has folic acid. There is no wheat variety in the world which has folic acid. Scientists have been trying to put folic acid in wheat but never succeeded. The bread industry actually puts folic acid artificially or mixes multi grains in the bread.

Also more remarkable is its mineral content which is two hundred and forty one percent higher than the other wheat that is grown today. The protein and fat content are also 40% higher.

So we can conclude that growing this variety of wheat grain is the best way forward.

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High Insulin Levels Can Lead to Complication

high insulin levels

The human brain is programmed to keep the blood sugar levels in check. To achieve this, it will stimulate the pancreas to produce more Insulin. This also means high Insulin levels in the blood which will lead to various complications in the body. Some of these are,

All kinds of cancer

High Insulin levels in the blood promotes the production of IGF (Insulin like growth factor). This is a special chemical responsible for muscle and tissue growth. But unusually high amount of IGF causes abnormal growth of certain cells of the body. This is the first step towards development of tumors. For cancerous growth the cells need energy and that is provided by the excess sugar already circulating in the body. According to research published in the Lancet Oncology 2010, the women with high concentration of IGF in the blood had higher chances of cancer.

All kinds of inflammatory diseases

High Insulin levels in the blood cause various kinds of inflammation all over the body including vital organs. Which organ will succumb to the inflammation depends on various factors.

Hormonal diseases

Increased or decreases production of Insulin directly affects the production of other hormones. The connection of abnormal production of Insulin can be seen in the following disorders:

Polycystic ovary syndrome

Erectile dysfunction

Weight gain

High blood pressure

Insomnia

Obesity and mental disorders

Too much Insulin promotes fat storage and stops your body from breaking down fats. Indians are more prone to fat accumulation near the belly whereas Europeans are more likely to accumulate fat around the thighs and buttocks. Fat around the belly is called visceral fat and tends to clog the arteries resulting in heart diseases and mental disorders like Alzheimer’s and Dementia. This is also referred to as Diabetes type 3. That is the reason why it is seen that once the patient is cured of Diabetes automatically he shows improvement in the symptoms of mental disorders.

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Multi organ failure

High Insulin levels leads to fat storage and inflammation which in-turn results in increase in the level of cholesterol (LDL) and triglycerides, thereby causing micro-blockages all over the inner lining of the arteries resulting in the risk of heart disease and even heart attacks. It also causes your kidney to retain more water and salt, which increases your blood pressure and kidney dysfunction.

Pancreatic cancer

In order to achieve the targeted homeostasis of blood glucose, the pancreas gets overburdened and exhausted resulting in Beta cells themselves becoming incapable of producing Insulin. This results in substantial damage to the pancreas, resulting in complications such as pancreatic cancer.

Conclusion

Here one must understand that despite of consuming high amount of refined carbohydrate the blood sugar level may be within the normal range. This does not necessary mean that a person is free from complications. The body is producing high Insulin levels to maintain the blood sugar level which will cause problems in the future.

By changing the diet to plant based foods these complications can be reversed.

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The Real Mechanism of Heart Failure

heart failure

Our heart can be compared to the central warehouse of a nationwide supply chain system. The fleet of vehicles is our blood, transporting oxygen and nutrients to all parts of the body. The arteries and veins are the highways with secondary roads connecting cities. Normally the system is working efficiently. But what would happen if the supply was disrupted. Trucks with goods would be jammed and empty trucks would be stranded at remote areas. Customers would not get supplies. This is what happens during heart failure.

Disease, injury, and years of wear and tear take a toll on the hearts pumping ability. When the muscles of the heart struggle to circulate blood efficiently, a cascade of physiological changes is set in motion. Heart failure is not a disease. It is a set of diverse symptoms.

Working of the healthy heart

The heart contract and relaxes approximately 100,000 times a day. The cardiovascular system comprises a complex network of channels that convey oxygen, nutrients and waste products to and away from your organs. Your heart, the size of two fists, propels a Herculean 2,000 gallons of blood daily. Extending from the heart is a network of blood vessels that reach to the farthest areas of the body. Laid end to end, these vessels would stretch more than 60,000 miles.

What is the mechanism of heart failure?

The mechanism of heart failure may start with injury from heart attack, develop due to damaged valves, or be brought on by an infection or a disease. Many times, it is a product of years of toil against high blood pressure and clogged arteries.  Heart failure culminates in a progressive weakening of your heart’s ability to pump. Consequently, blood circulates through your heart and body more slowly; your cells get less oxygen and nutrients. Outward signs may remain hidden for months or even years while heart failure advances. To compensate for its weakened state, the heart undergoes a series of structural transformations known as cardiac remodeling. To expel blood more forcefully the walls of the left heart chamber thicken, or the chamber may dilate and take on a rounder shape, which allows it to hold larger amount of blood. Levels of stress hormones, which signal the heart to beat faster and harder in times of need, rise. Blood vessels constrict to keep blood pressure stable even though lower quantity of blood is being pumped out. Circulation is diverted away from the skin and other less important tissues so that the heart and brain receive a steady supply of oxygen and nutrients. The reduced flow of blood to the kidneys activates a set of hormones that prompt the body to retain sodium and fluid to supplement the total volume of circulating blood. These fixes enable the heart to deliver a near-normal level of blood to the tissues. This is a temporary solution. The heart’s modified shape increases the stress on the muscle as it attempts to consume more oxygen. The faster heartbeat and narrowed blood vessels amplify the hearts workload, and the costs of the additional yield outweigh the advantages of increased output.

Symptoms of heart failure

Mental confusion

The brain doesn’t get enough oxygen.

Lung congestion

Excess fluid backs up from the heart into the lungs.

Shortness of breath

Fluid in the lungs causes difficulty in breathing.

Coughing and wheezing

Fluid in the lungs causes these problems.

Fatigue

Less blood reaches the muscles.

Loss of appetite

Accumulation of fluid in liver and stomach causes feelings of nausea.

Weight gain

The build-up of fluid causes an increase in body weight.

Change in skin color

Blood is diverted to vital organs, causing skin to get cold and take on a bluish color.

Swelling in feet, legs and abdomen

Excess fluid settles in tissues.

Causes of heart failure

The defining characteristic of heart failure is a malfunctioning cardiac muscle. This can happen due to many reasons.

Coronary artery disease

Two out of three cases of heart failure can be traced to coronary heart disease, the narrowing of arteries that feed the heart muscle cells.

Dying heart disease

When one of the fatty deposits on the inside of the artery wall bursts open, the blood forms a clot. If the clot is formed in one of the arteries that feed the heart muscle, it can cut off the flow of oxygen to the tissue beyond the clot. This is called a myocardial infraction, or heart attack.

Hypertension

The higher the blood pressure, the harder the heart must work. The heart muscle thickens in response to pumping against extra resistance. The thickened muscle consumes more oxygen. It also cannot fully relax between contractions. Then the heart muscle gradually stops beating as forcefully as it should. High blood pressure precedes heart failure in 75% of cases.

Cardiomyopathy

This is a term used to describe a number of diseases that result from damage to the heart muscle.

Heart valve damage

Faulty heart valves that don’t open or close efficiently put additional strain on the heart.

Diabetes

Over time, uncontrolled Diabetes weakens the heart muscle by causing coronary artery disease.

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Heart rhythm disturbances

An abnormally fast heartbeat can produce structural changes in the heart’s left ventricle.

Conclusion

Our heart is a very important organ because it supplies oxygen and nutrients to all parts of our body. Whether you  are suffering from heart disease, or Diabetes or even cancer, you heal yourself, that too without any medicinal intervention.

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How to Know If You Have High Blood Sugar

high blood sugar

How do you know that you have high blood sugar level?  Let us first understand that Diabetes is not a disease. It is a condition in which, if the level of blood sugar is higher than a certain level, the risk of heart disease, kidney failure, blindness, and even death are substantially high. Of course, even with normal sugar levels there still is 20% risk of these diseases.

The real question is how many grams of sugar per liter of your blood is safe. Various institutions have carried out trials for deciding a cutoff point. Around the mid-1990’s, the American Diabetes Association (ADA) convened an expert committee to re-examine the diagnosis of Diabetes in light of the new information available. They considered the following trials:

  • PIMA Indians trial of 960 individuals.
  • Egyptian trial of 1081 individuals.
  • The Third National Health And Nutrition Examination Survey (NHANES III) of 282 individuals.

The mid cut off point obtained for 2hr OGTT of the above 3 trials were 298mg/dL, 252m/dL and 292mg/dL respectively.

Here, development of retinopathy was taken as a basis to decide the cutoff point above which the patients had substantially higher chances of developing retinopathy.

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Instead of considering the above-mentioned mean value of the bimodal threshold, which is the standard followed in such research analysis, they chose to adopt the lowest glycemic level of each of initial decile in which the prevalence of retinopathy increases which were  244mg/dL, 218mg/dL and 195mg/dL respectively. Even the mean of the 3 values is 219mg/dL but ADA decided to retain the initially proposed value of 2hr OGTT by NDDG i.e. 200mg/dL which is misleading and has great potential of diagnosing a false positive case of Diabetes.

Hence, to arrive at a proper 2hr OGTT threshold, we must consider controlled trial on different populations. Following table shows the cutoff point after 2hr 75gm of oral glucose consumption (OGTT).

PopulationYearPublication2 hr Glucose
Samoa1984Diabetes Research208
Mexican Americans1985Journal of Chronic Diseases231
Kiribati1993Journal of Diabetes and its Complications228
Wanigela1994Medical Journal of Australia268

 

The above mentioned 2hr glucose cutoff point value is of the population in the age group between 35 years to 50 years. We have to find the mean value of the cutoff point in the above four populations to define a reference point.

208 + 231 + 228 + 268 / 4 = 233.75

233mg/dL is very close to the 2hr OGTT cutoff point arrived by the PIMA Indians trial on 941 individuals i.e. 227mg/dL.

It may be appropriate for us to conclude that for an individual up to 50 years of age the plasma random blood sugar or 2hr Oral Glucose Tolerance Test value for being diagnosed as a diabetic can be > 230mg/dL.

Another factor to consider is that the above results are from blood samples taken from veins whereas at home, normally blood is taken from capillary of the fingertip using a glucometer to measure sugar levels.  It is universally accepted that glucose concentration in the blood taken from the capillary is around 10% higher.

It means you have to add 10% i.e. 23mg/dL to 230mg/dL to arrive at the value of the random blood sugar cutoff point. This means capillary blood sugar level of 230 + 23 = 253mg/dL should be considered as the cutoff point for diabetes (for people up to 50 years of age).

It has been a trend in medical science to round off diagnostic figures to the nearest whole number (as in case of blood pressure and total cholesterol). So we can round off the value of 253mg/dL to 250mg/dL.

This cutoff point of 250mg/dL is of less value if we do not consider other factors. The prominent one being age. Due to evidence-based medicine, science has understood that metabolic activities in the body show a dramatic change with age. Blood sugar and blood pressure are two such metabolic activities °which are influenced by the age factor. So keeping a single cutoff point across a wide spectrum of age is not of use in the real clinical diagnosis. One trial on over 2900 PIMA Indians was conducted to see the effect of age on blood sugar levels, two hours after 75gms of carbohydrate load.

Age GroupNo. of Examined MalesMean 2hr GlucoseNo. of Examined FemalesMean 2hr Glucose
5 - 14 years55099.9mg/dL606104.89mg/dL
15 - 24 years245107.49mg/dL314112.19mg/dL
25 - 34 years139154.49mg/dL186226.29mg/dL
45 - 54 years96208.79mg/dL112256.69mg/dL
55 - 64 years83214.99mg/dL106293.19mg/dL
65 - 74 years81210.09mg/dL52229.49mg/dL
Total13401571

Conclusion:

  • A clear increase in blood sugar with age.
  • After the age of 65 years, the blood sugar level tends to drop a bit (same for blood pressure).
  • There is no clear-cut rate of increase of blood sugar in relation to the age.
  • In the 25 to 35 years bracket, there is a trend of steep increase in blood sugar value i.e. more than 40mg/dL.

It would be wise to include age adjustment factor to the value of 250mg/dL 2hr OGTT, so as to avoid detection of false cases of diabetes in individuals above 50 years and false negative cases of diabetes in individuals aged 25 years. Conservatively, on the basis of the observation, we can safely add 1mg/dL for every added year after 50 years.

So for a 60 year old individual, capillary blood sugar after 2 hour of consuming 75gms of glucose should be 250mg/dL + 10mg/dL = 260mg/dL to become a diabetes patient.

A similar approach can be applied to obtain a more practical value of fasting blood sugar and HBA1C.

Here one must consider the fact that the major trials specifically on PIMA Indians were done where the day temperature varied between 18°C to 38°C. So the previous cutoff point is suitable for a place where day temperature is not below 10°C. Hence, the population living in a cold climate must consider temperature change factor.  It has been observed that in winters the blood sugar increases roughly by 10mg/dL. So the figure for a 50-year-old person during winter in capillary blood sugar 2hr PG > 250+10=260mg/dL should be diagnosed as a diabetic patient. We must also check if the person is suffering from viral infection/fever as there is a 10% increase in blood sugar during sickness.

To avoid a false diagnosis of high blood sugar, the final value  of random blood sugar should be adjusted by:

  • Adding Age Adjustment factor.
  • Adding Winter Adjustment factor.
  • Adjustment because of viral infection/fever.
  • If you have eaten recently, the blood sugar level from blood taken from fingertip can be up to 70mg/dL higher than blood taken from a vein.

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Finally, I have to add that there is also a variation of about 10 to 20% between different glucometers. This is how you know if you have high blood sugar.

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Here I have to mention that HBA!C is not an accurate or recommended test.

It is not measuring your blood glucose levels directly. It is giving you a rough estimate of your blood sugar over 3 months. It is actually measuring the percentage of haemoglobin that is bound to glucose.

If you have the low iron enema you will have an abnormally high HBA1C reading which is not accurate. There is another enema in which you will have low HBA1C. In case of live of kidney disease the number is again not going to be accurate.