HbA1c: What's Optimal, What's My Data?

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Papers referenced in the video:
Age-related changes in clinical parameters and their associations with common complex diseases

Predicting Age by Mining Electronic Medical Records with Deep Learning Characterizes Differences between Chronological and Physiological Age

Glycated haemoglobin A1c as a risk factor of cardiovascular outcomes and all-cause mortality in diabetic and non-diabetic populations: a systematic review and meta-analysis

[davidgifford]

Another great example of if low is good, lower is better, being a fallacy. There a plenty of sights urging HbA1c should be below 5, which the data shows is false. Excellent presentation.

[mime]

I think it might not be survivor bias, but very old people eat less. My grandma barely ate at all before she died.

[andrewtaylor]

5.1% is quite good. We find that short walks after meals helps to keep HbA1c low. The association with increased mortality risk for HbA1c below 5% may be due to the lowered HbA1c values in old age, as presented in the video

[aljosarojac]

Great analysis and overview of HbA1C vs All-Cause-Mortality risk. 👍

[jamesgilmore]

HbA1c is an integrated measure over the lifetime of RBCs and as such is changed by many things, such as blood sugar levels, RBC lifetime, glycation efficiency etc.

Continuous glucose monitoring is a better way to establish actual average glucose levels. If you use CGM and measure HbA1c and absolute reticulocytes/reticulocyte index that gives better insight into this system.

A short RBC lifetime results in a low HbA1c which I would argue is not a good thing. There is also some evidence of higher reticulocytes being less favourable.

I would argue that we want low glucose and also long RBC lifetime with retained function across that lifetime. Those are in conflict in HbA1c.

[karlint]

The famous warning by my introductory statistics class professor: "Association does not prove causation." come s to mind. I suppose I have been brainwashed to think that keeping blood sugar low reduces glycation, and glycation is bad, and HbA1c is a function of the average blood glucose level over the last 3 months... all point to having a lower HbA1c as being better.
Obviously the meta analysis data doesn't seem to fit that, but WHO are the people with the low HbA1c levels? I'm not sure what conditions might cause someone to have a very low HbA1c, but if (this is just made up) cancer or type 1 diabetes or some other conditions, if common enough, are being mixed in with "healthy" people with low HbA1c, this analysis would need to be adjusted, I think.
Were you able to find out if the people with low HbA1c were heterogeneous in some way as I speculate above? Sorry that this is just speculation and not an answer, but this is the first question that comes to my mind when seeing this, especially after hearing so much that lower HbA1c is optimal.

[HailMasterChief]

Probably the best level of discourse on comments I have seen across all biohacking channels.

[haroldpierre]

This is fascinating and far from what the "standard of care" is.

[jasonbrice]

Got diagnosed 6 months ago hba1c 9.8 now it's 5.4 no exercise just some weight loss and diet

The meta-analysis did control for illness causing low A1C:
"Lastly, since many confounders were controlled for in most studies when computing HR, the external validity of our estimates of all-cause mortality, cardiovascular mortality and risk of cardiovascular events, in both diabetic and non-diabetic populations, could be reinforced."

Like most epidemiological studies It has to be taken with a grain of salt as there could be undiagnosed illness or other unknown factors causing low H1C.

[Battery-kfvu]

Just speculating, perhaps in old age the lifespan of RBCs is shorter so there is less time for them to be glycated, hence the decrease in glycated hemoglobin.

[spoudaois]

I reduced my a1c from 5.2 to less than 4.8 by switching to a low fat high starch diet. One can also reduce a1 c from a low carb diet but the glucose tolerance test will worsen meaning that the insulin resistance is worse you just aren't eating carb s.

[robevans]

Not sure about using averages. Average means alive but not necessarily healthy. I am assuming that as people get older they lose control of their blood sugger and become more and more diabetic so there HbA1c increases. I think a 5 is associated with a fasting Gl level of 100 which is health.

[HarryJensen-krqz]

70-80 range drop = Metformin? They throw "Met" like candy starting in that age range.

[peterz]

mmm. So, what would be the mechanism for a 4.8% HbA1c being riskier than 5.1%? And isn't there data which shows that as you approach prediabetic (5.7%) risk gets higher for CVD?

[HateDietPepsi]

My HgA1C shot up 0.5 mg/dl in 6 months by replacing regular protein bars, sweetened with sugar, with keto friendly protein bars, sweetened with alcohol sugars.

[nickchristopherson]

COULD THE RAISE IN ALL CAUSE MORTALITY WITH AN A1C BELOW FIVE BE DUE TO THE FACT THAT CERTAIN PATHOLOGIES LOWER BLOOD SUGAR LIKE CKD OR TYPES OF CANCER...SARCOPENIA

[ChessMasterNate]

I like those big data graphs too. It is a shame the first one did not have many data points in the 90s and above and the young. It looks like, men averaging higher A1C is another candidate for the explanation of why there is reduction in male centenarians relative to female.
It would be interesting to do a study like these with a population with very low obesity, like Vietnam. And maybe the other extreme as well, such as one done on the population of some Polynesian island.

[KoiRun]

If you had one choice what would you like optimized, your lipid panel or your hgb a1c?

[ccamire]

the problem with large number of people is comparing healthy to sick people. It would be nice to have a group of healthy people (definition to be discussed) to compare what could be optimal, but it could be difficult. I am happy to be still in the optimal range at 68 yr old along with my wife eating more a meat based approach. It would be interesting to find a person willing to parallel your approach using a meat based strategy. in any case, all your videos are useful to map a strategy