012: What Is Measuring Our Hba1c REALLY Telling Us About Our Blood Glucose and Diabetes Risk?
Mastering Nutrition Episode 12
Introduction
In response to popular demand, this week is glycation week. In this episode, I discuss the strengths and limitations of using Hba1c to measure our cumulative recent exposure to blood glucose and diabetes risk.
Many people will be familiar with the fact that variation in red blood cell turnover confounds this measurement. Less well known is that variations in the deglycating enzyme fructosamine 3-kinase (FN3K) also confound the measurement.
Counter-intuitively, if you have a higher rate of this deglycating enzyme but a lower rate of downstream metabolism of 3-deoxyglucosone, your lower Hba1c could actually mean MORE glycation. I conclude that Hba1c is a useful test, but only in the context of a bigger picture put together with more information.
Show Notes
In response to popular demand, this week is glycation week. In this
episode, I discuss the strengths and limitations of using Hba1c to measure our cumulative recent exposure to blood glucose and diabetes risk.
Many people will be familiar with the fact that variation in red blood cell turnover confounds this measurement. Less well known is that variations in the deglycating enzyme fructosamine 3-kinase (FN3K) also confound the measurement.
Counter-intuitively, if you have a higher rate of this deglycating enzyme but a lower rate of downstream metabolism of 3-deoxyglucosone, your lower Hba1c could actually mean MORE glycation. I conclude that Hba1c is a useful test, but only in the context of a bigger picture put together with more information.
In this episode:
0:50 Sneak peaks of PUFA Report Part 2 on Snapchat (chrismasterjohn)
1:10 Facebook Live this Saturday, June 11, 2:00 PM Eastern time (remember to adjust for the time zone if necessary)
1:50 Cliff notes on Hba1c
4:14 Update on the audio quality
7:55 Diversify your working positions PSA: I recorded this in vajrasana
11:00 Intro to Hba1c as a marker of cumulative recent hyperglycemia
16:46 variations in red blood cell turnover
18:10 deglycation of Hba1c by fructosamine 3-kinase (FN3K)
20:38 genetic variation in FN3K activity (and maybe nutrition and metabolic rate?)
26:20 Hba1c does not seem to causally contribute to diabetes or its complications
31:57 small aldehydes, particularly methylglyoxal, and maybe 3-deoxyglucosone, do causally contribute to diabetes and its complications
38:15 lower Hba1c due to higher FN3K means MORE formation of 3-deoxyglucosone!
40:15 strong insulin signaling and polyphenol-rich fruits and vegetables are likely to protect against 3-deoxyglucosone accumulation
41:55 practical conclusions about using Hba1c
Research and Other Links Discussed in this Episode
This is the microphone I use. Please let me know in the comments if adding Garage Band’s compressor for the first time in this episode seems to help the consistency of the audio quality.
Start here for all my writings on glycation.
This is my recent Examine.Com Research Digest editorial.
Here is a paper on red blood cell turnover (free), and here is one on genetic variations in fructosamine 3-kinase (also free).
Here is research showing FN3K knockout mice do not develop diabetes (free),
but that methylglyoxal causes acute hyperglycemia (free), and severe diabeteswhen administered chronically (free).
Here is a review on 3-deoxyglucosone and methylglyoxal (free) and a paper on the metabolism of 3-deoxyglucosone to 3-deoxyfructose (paywall).
Do you use Hba1c to measure your health status? How has it helped you? Does this episode change your interpretation at all?
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