Category: Science

A1c Blood Test

Your Most Important Blood Test

This week, the British Journal of Cancer published an incredibly important report that found a strong relationship between a simple blood test and the risk for various forms of cancer. The study found that the common blood test used by diabetics to measure their average blood sugar, A1c, was strongly predictive in terms of cancer development.

For those of you who are not diabetic, you may not be familiar with this simple test that has profound health implications well beyond diabetes. Basically, the A1c test measures the amount of glycation that the protein hemoglobin has undergone. Glycation simply means that sugar has become bonded to a protein, in this case hemoglobin, and this is a relatively slow process. Hence, it’s a way to get a sense as to how high the blood sugar has been, in this case over a 3-4 month period of time, and this is why it’s so helpful for diabetics.

But with this new report, we now understand that having elevated A1c translates to risk for cancer, and as I’ve explained in Grain Brain, it is also a powerful indicator of risk for developing dementia. If you look at the chart on page 117 of the book, reproduced below, you’ll note that A1c is also directly related to the rate at which the brain shrinks on an annual basis.


Think of it, this one simple blood test can give you incredibly important information about cancer risk, risk for dementia, and even risk for shrinkage of your brain!

Most commonly people are told that having an A1c of 5.6 – 5.8 should be considered normal, but when you look at the graph above, these levels already put you in the second highest category for brain shrinkage! I believe that, based on this information, we should strive to keep our A1c at 5.2 or even lower. The way to accomplish this is simply by reducing your consumption of carbohydrates and sugar. Who knew!

Why the process of glycation is such a bad player for health likely stems from the fact that when proteins are glycated (bound to sugar), it dramatically increases the production of damaging chemicals called free radicals. Free radicals end up damaging our protein, fat and even our DNA.  In addition, glycation of proteins dramatically increases the chemical mediators of inflammation, and inflammation is the pivotal player in so many issues including diabetes, heart disease, cancer, Parkinson’s, Alzheimer’s, multiple sclerosis, asthma and arthritis, just to name a few.

Beyond keeping your carbs low, there are several “anti-glycating” supplements that are helpful to reduce this process. These include alpha-lipoic acid, the omega-3 DHA, and a form of thiamine called benfotiamine.

  • Brenda

    You are so wise Doctor! TY

    • David Perlmutter

      Thank you for your kind words Brenda.

      • Patricia

        Dr. Perlmutter thank you so much! I have something I struggle with and so does my sister. In the cold, rainy weather I want carbs – more than is appropriate for following this protocol. Do you have any suggestions or perhaps you could address this issue in a post of it’s own. Does anyone else have this problem and how do you handle it.

        • Karen

          For me, adding a TBSP of pastured butter or coconut oil during the day cuts my carb cravings in cold weather.

        • David Perlmutter

          indoor exercise

  • Luke

    I understand the importance of grain free and low carbohydrate for lowering A1c, but it had the opposite effect on me. I have been low carb paleo for over two years and mine keeps creeping up to now FBG is 110 and A1c is 5.7. Cholesterol is rising too. I am now on medication for both and remain grain free.

    • Piter Nortug

      i have difficulties to go down below 105 too and i have been on vlc for two years too? where is the take? now i am determined to stop diary too and see if i am sensitive to it.

      • David Perlmutter

        What is vic?

        • Boundless

          > What is vic?

          That was vlc, presumably Very Low Carb.

          In Luke’s case I wondering … so where is the BG coming from? Excess protein? Dairy? Endocrine issue? Genetic issue? Not as LC as imagined?

        • Piter Nortug

          sorry. in fact is very low carb

          • David Perlmutter

            so might consider an antiglycating agent as I described in the post

    • jerlands56

      I think Dr. Perlmutter is addressing AGE’s which have a lot to do with A1c levels too..


      As for Cholesterol.. I don’t think it’s advisable to block the production of cholesterol with statin drugs but rather determine why you’re body isn’t metabolizing it properly.

      • David Perlmutter

        I agree with both points

    • vewh

      Can’t overeat protein either.

      • StevetheHun

        I thought that the liver can take excess protein and make carbohydrates out of it. Which is why most calories should come from fat. I avoid all carbs but if I eat too much protein my blood sugar goes up

        • Jennifer

          It doesn’t make “carbohydrates” out of it. That’s impossible. It makes glucose. As a Type 1 Diabetic, protein does cause a glucose spike and I need to inject insulin for it 🙂 I know other diabetics who won’t eat protein after a certain time in the evening, or can’t exceed more than 4oz of red meat, or won’t eat white meat for dinner.

          • StevetheHun

            Isn’t glucose a member of the group of carbohydrates?

          • Prfandy

            glucose is a monosacchride sugar and is definitely a carbohydrate’s carb! It’s hard to get more ‘carby’ than glucose.

    • Ellis Toussier

      You should probably visit a doctor who is a diabetic himself, and who uses insulin himself, because it might be that you should be taking insulin instead of pills to control your blood sugar, but your doctor (as most doctors do…) thinks of insulin as a last resort… and… it will, indeed be your last resort, but when diabetes complications have advanced in your body.

    • Lorah

      This might explain why your levels are high even though eating a low carb diet: “One caveat here is that very low-carb diets will produce elevated fasting blood glucose levels. Why? Because low-carb diets induce insulin resistance. Restricting carbohydrates produces a natural drop in insulin levels, which in turn activates hormone sensitive lipase. Fat tissue is then broken down, and non-esterified fatty acids (a.k.a. “free fatty acids” or NEFA) are released into the bloodstream. These NEFA are taken up by the muscles, which use them as fuel. And since the muscle’s needs for fuel has been met, it decreases sensitivity to insulin. You can read more about this at Hyperlipid”


      • Lorah

        Oh. I realize this was 2 years ago from this point in time. Did you learn this since?

    • sab1053

      Magnesium is critical for controlling insulin resistance and diabetes. It’s also a natural statin. Ask for an RBC Magnesium test. Serum tests are useless. But rising cholesterol levels can be an issue with the liver. My mother’s total cholesterol was over 300. After the Functional Medicine Doctor did extensive blood work, it turned out that she was copper deficient. Once she was placed on a copper supplement, her total cholesterol dropped over 80 points with no diet change. Copper is critical for liver health. Copper deficiency can mimic iron anemia as well.

      Hope this helps.


    • Randall Burns

      Luke, lowering grain and sugar consumption may help, but they aren’t the only factors here. A lot of modern fruits are practically like a candy bar from a tree. You may also need a substantial exercise routine to get your FGL and A1c down where you want them as well as supplments like alpha lipoic acid and fish oil. If you haven’t done so, you may want to consider a sleep study. Also look at how you deal with stress

  • allison chapman

    Maybe more low glycemic index vegetables and more omega-3 rich oils, more fish and more organic offal would help—and less muscle meat. Reading The Paleo Approach by Sarah Ballentyne, Ph.D. Great Book to read after reading Grain Brain, Wheat Belly and Why We Get Fat…trying to do this for cancer, heart disease, diabetes and Alzheimer’s prevention.

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  • Sheila DeRuzza

    Dr. Perlmutter, Just wondering if too much damage is done already, will following the diet, which I am now on for two months, halt further progression. Two years ago my Ac1 was at 5.7 which I see is too high. I also deal with 31 years of Fibro/CFIDS/CFS, which must be contributing to my high reading and am hopeful that the diet will give me some relief in that area. Mom died of Alzheimer’s related issues and really concerned for myself.

    • David Perlmutter

      Actually, based on your description, you are in an ideal position to take full advantage of the program – check with your healthcare provider

  • Ri

    you are an everyday hero Dr Perlmutter-your wealth of knowledge and information that you so generously share saves lives everyday-literally thank you ! <3

    • David Perlmutter

      Thank you for those kind words RI.

  • Karel Creason

    Where can I post general questions, not necessarily on one topic?

    • David Perlmutter

      Here is fine – I do my best to answer whatever is posted with any of the blogs

      • Karel Creason

        Oh, good. Thank you. I have a couple of questions as I try to get my husband more invested in the diet. He is a life-long “meat and potatoes” man and he resents any suggestion I make about his eating habits. Now that he agreed to try your plan with me, he is pushing against the guidelines. He doesn’t want to give up at least 1 glass of low-fat milk a day, orange juice every morning and late night, potatoes, etc., and he balks at the large amount of vegetables he should now be eating.

        To tackle just one of these now, we looked up orange juice on the glycemic index chart, and it doesn’t seem to be much higher than whole oranges. If he drinks juice without added sugar, is that alright? Is V8 juice okay?

        Also, I can’t find the expanded glycemic index list of 1,000K foods on the American Diabetes Association link you provided. I’ve searched every way I can think of. Thanks for your help.

      • Maryann

        Hi Doctor Perlmutter, I understand how busy you are and that some questions can’t be answered because you can not give medical advice; but I thought that you might like to know that it is frustrating for me, and perhaps others who really are interested in your work, to spend time reading the blog. People submit interesting questions and very few get answered. Your readers can spend hours looking through the many topics you post only to find you didn’t answer anything since the last time we scrolled through it all. It gets more time consuming with every new post you add, because people can also respond to any of the many previous posts at any time. Perhaps you could not accept questions and just post. Or perhaps you could do what Dr. Attia does and have a comments section that would allow your readers to quickly access your responses from any post. I completely understand that you are researching, on the road, have a family, have a practice, a new journal, and have a life 🙂 I love your book and I appreciate all you are doing for so many people. Thank you …God bless you, maryann

  • amyK

    I learned the hard way that being anemic can cause you to have a higher than average A1C result. A great test, but a good suggestion is to have all of your mineral levels checked and recheck your A1C result after a few months if you are found to be iron-deficient.

  • Mistagee

    I wonder how this would affect gut diseases like crohns and such.

    • David Perlmutter

      Great question. Ultimately the best therapy for inflammatory bowel diseases is care and feeding of the gut bacteria, the microibiome. And again, low carb high fiber and low fat are the keys

  • Lynn Dell

    Thanks for these reminders. Now, on to read about benfotiamine!

  • Juliet

    Just as Lynn and Ri said below thank you for the daily info feed on whys and hows of the Grain Brain Diet. I confess that the transition to low carb was very difficult for me. However, reminders/explanations like this keep me motivated. I will pass this info on as people ask me about why sugars/carbs (even speciously healthy fruits, rice & honey) are “damaging” in large quantities. (The transition from “regular American diet” to gluten free was not nearly as difficult as giving up sweets/carbs.)

  • Sandra Clagett

    Thank you so much for keeping us informed. I check your site often and constantly share with my friends who are new to your diet. Keep the articles coming.

    • David Perlmutter

      Will do Sandra.

  • Jan in KW

    It looks like benfotiamine is synthetic thiamine (B1)….. And from what I’ve read, there’s no down-side to overconsumption, is that correct? If one has a healthy (pastured meats, eggs, organic veggie) diet consisting of 60 to 65 % fats, 25 to 30% protein and the remainder LC veggies, no grain/sugar etc….would one need to supplement?

    • David Perlmutter

      I judge the need for this supplement based on A1c and diet

  • Mike Marq

    Dr. Perlmutter, I have just finished reading Grain Brain. You are saying that statins are not good for the brain. My 89 year old father is taking 20mg Lipitor which his doctor says is for stroke prevention when I questioned him. So I accepted his explanation and then found out his readings. Dad’s LDL is 82, HDL is 51, Glucose fasting is 94 and BP is 140/75. Besides the Lipitor he takes a baby aspirin, B12, Fish Oil, Proscar. He is having memory problems and some balance issues and can not function on his own without supervision (wife). Based upon what you are saying I want him to stop taking the Lipitor but I thought I would ask you your opinion.

    • David Perlmutter

      I would advise you to consider yesterday’s post on cholesterol

    • Harry Bombardi

      Statins have been known to mimic symptoms of Alzheimer’s and the FDA has reported it. I experienced it with my wife and a doctor in practice with my GP noticed it also. What they claim to do for the prevention of a 1st heart attack seems specious.

  • mary sennewald

    Dr. Perlmutter, I just joined your website. I read your book with Alberto Villoldo, “Power Up Your Brain,” and I am wondering if the two of you are still working together. I didn’t see anything about the seven-day instensive. I would appreciate information if you are still doing this.


    I’m in to see my internist this week for an annual. What others tests–beyond this one–would you recommend?

    • NWTRNR

      Never mind — found the list on page 221!

  • Fern Chamberlain

    These comments are so helpful as I struggle to stay on the grain free diet. The results so far should be enough to keep me on the diet for life but there are those times that I mindlessly eat the cheese cake or take a taste of ice-cream etc. But the truth is, I feel relief from the endless cycle of cravings throughout the day when I stick to the diet. I just keep going back to it because for the first time in my life I feel the free from the roller coaster of sugar highs and lows. I am so grateful to Dr Perlmutter for getting this information out to the public. I can’t imagine what my state of health would have been like if I had not found these guidelines for a new way of looking at food. Food for health, but more important for me personally, a clarity of mind I have not experienced in years.
    It’s a struggle, an adjustment but I can’t imagine doing anything else.
    Thanks you Dr. Perlmutter!

  • Al

    Is Glutathione supplementation effective in lowering A1c?

  • Al

    I mean Glutathione accelerators like MaxGXL?

  • Jen

    Dr. Perlmutter, I saw your program on PBS and immediately went out and bought Grain Brain. Your book is amazing and I find it has alot of wonderful information in it. I seriously can’t put it down and I tell everyone to pick up your book.

    I called to make an appointment with you but you are booked up for the entire year, therefore, I am now on your waiting list.

    In the meantime, I was diagnosed with Cadasil, two years ago. My Dad and Aunt are both in the advance stages, my brother is also believed to have it based on his MRI images and I also have a 14 year old daughter who has a 50% chance of having it, however, she is too young to be tested.

    I find your information absolutely intriguing and I wonder what your thoughts are with regard to Cadasil and your proposed lifestyle, i.e., eliminating grains? I have followed the Paleo approach on and off for the past couple of years and can attest to all of the benefits that you talk about because I have experienced them first hand, however, with that said, I am always still a little weary not knowing if I am doing the right thing for my particular condition. As you can imagine I am pretty desperate to find something that may give us a glimmer of hope as my entire family has been affected by this dreadful disease.

    With that said, would you be willing to talk a little bit or write a small article about Cadasil to help us raise awareness?

    Thank you very much.

    • David Perlmutter

      Hi Jen,
      I’ll absolutely consider this. It’s a rare condition so may not be appealing to a wide audience

      • Jen

        Thank you so much for your consideration Dr. Perlmutter. I truly, don’t believe that it is as rare as believed to be. How weird is it that I know another family in the next town over from me who is affected by Cadasil as well?

        I truly hope that by being on your waiting list, I will have the opportunity to meet you at some point to discuss my condition. I am going to follow what I have learned in your book and continue to hold hope for those of us affected by Cadasil.

        Thank you for everything that you are doing.

  • dianne jones

    Now I agree with you. I would also like to add some things. Is it the food or is it the air, the water, the chemicals that are sprayed onto the foods. I happen to have a supper sniffer. I can smell chemicals coming off people. I called it my mothers diazonon rage and her pesticide rampage. Or is it the depletion of minerals like zinc manganese and copper depleted by certain pesticides. and then the zinc B6 and B12 by soy. The anti nutrients. The affects of deep well water with arsenic and inorganic manganese now added to the crops. Grains in its original none sprayed sprouted form they kept the hard workers in b vitamins and chromium. Since all health problems are going up and going younger. Maybe it is the lack of hard work. Maybe JFK had it right. He was going to put in a pesticide and radiation act back in the 60’s to protect us from ourselves. Maybe he would have added a soy one as well. What is in your well. Anyways I have lots to say….story’s of many years history’s. Thankyou for writing this book. It has kept my father on a path to save his wife. Then again my mother would not listen about the sprays, the soaps, the soy. Then again some say that xylene and the new octane boosters are far worse than the old unleaded gas. They definitely interfer with the brain and it all started to get worse about the same time in history. Soy, pesticides, car exhausts industrial pollution. Radiation. Healthy on the farm is not what you think. If the animals are fighting what hope is there for us. Hopefully god will forgive us all.

  • Al

    Can Glutathione supplementation (MaxGXL) help in lowering A1c?

    • David Perlmutter

      I don’t know if that particular study on that product has been performed

  • kate

    my husband diabetic type 2 A1c is 6.3 the lowest in a long time. He is 87 and the Drs have told him it is better to stay at least in the 6 range as one gets olde. we remember when thy just wanted us to be under 7. What do you think? Also has pacemaker for Av

  • NA

    Great info. Carnosine can be added to the list of de-glycating supplements. I use a product in my practice manufactured by Life Extension called Mitochondrial Energy Optimizer with BioPQQ. Among others, it includes the alpha lipoic, benfotiamine, and carnosine mentioned above all wrapped up in one. My patients love its mental and physical energy enhancing effects.

  • Al

    Thxs Doc. Are Glutathione accelerators/supplementation something you recommend for the general health of the brain?

  • I had as many of the tests done from the Grain Brain book as my doctors had available. The c-reactive protein test result that was given was <0.5 mg/dL. That result does not seem like it gives me enough information to find out if my c-reative protein is between 0.00 to 3.0 mg/L or not like it says it should be in Grain Brain. Am I correct? If so, where can I get this type of test? Thanks!

  • Jose

    Hi Dr. Perlmutter,
    I need help. I’m type 2 diabetic (I don’t take meds). I switched to grain free after reading your book (as well as Wheat Belly and The Perfect Human Diet). After 3 weeks, I went in for blood tests and my A1c was 6, although I’m pretty sure its lower now after 2 months of gf and low-carbs (at first, I lost 18 lbs then weight loss has stopped).

    My concern is that no matter how much I exercise and eat a low-carb gf diet, I awaken with blood glucose levels over 100 – often averaging from 112 to 130. I then eat a small protein-fat breakfast meal that may, or may not, lower it (sometimes it goes higher). If not, I do aerobic exercise for about an hour and that does the trick: After exercising and for the rest of the day – until I go to bed at night – my blood glucose levels remain between 78-low 90s, until I awaken with high numbers again.

    What can I do to lower my waking blood glucose levels while I sleep?

    Last year, I went on a 60 day green juice fast ( leafy greens with some green fruit). I not only lost 95 lbs, but would awaken with blood glucose levels in the 80s to low 90s and my A1c was 5.6.

    • Ellis Toussier

      It is a BIG mistake that you know you are a Type 2 diabetic, and you are not on medication. If your doctor suggested that to you, then you should find another doctor who is a diabetic himself.

      What you are doing right is that you are doing aerobic exercises. That does the trick, but you still need to see a doctor to help you control your blood glucose when you are not able to exercise (as, when you are asleep and your liver decides to throw out some blood sugar…)

  • Mike

    Fruit has fructose, so is a handful of blueberries in the morning (with no other fruit the remainder of the day) acceptable?

    • David Perlmutter

      More than okay Mike! Berries are one of the best fruit choices.

      • Graziella

        Half a small papaya? Sometimes even 1/4.
        I’ve been on 12h fasting (9 PM to 9 AM), and then eating fruit to start the day. I noticed that now that I don’t eat bread in the morning anymore, I don’t feel like eating until lunch time. Lost 4 kgs (some 8 pounds) in the last 2 months and I feel great.

  • Jose

    When considering our evolutionary Paleolithic diet, it makes sense that AGEs are caused by glycation of starchy sugars, denatured proteins and oxidized fats. It stands to reason that early humans avoided starchy foods until they learned to cook them – and there begins the problem: heat denatures protein and oxidizes fats.
    Early humans who, more than likely, scavenged their foods from the leftover kills of more able predators, had to eat the bone marrow and brains encased in skulls because they were the “slim pickings” available to them. When human babies breastfeed, they consume fats, proteins, and sugars at an ideal temperature that promotes healthy brain development. Therefore, shouldn’t we eat our fats and protein as raw or uncooked as possible to avoid glycation in the first place? And, since that may not be practical, what are the best sources of raw saturated fats and denatured protein available?

  • Sarah Lewis

    My mother has had Labyrinthitis for five days. She can’t walk without holding on to things and the room is spinning when she closes her eyes. She had this previously and was ill for 9 months and finally diagnosed with Hashimoto’s Thyroiditis which they thought had been triggered by the Labryinthitis. She is on Thyroxine permanently now. At the moment she is really terrified of being ill for that long again and terrified of damage happening to her brain. She has a fear of Alzheimers. She hasn’t absorbed enough information yet to make any big changes to her diet in terms of giving foods up but is open to suggestions of foods and supplements she can add or take. Is there anything you can recommend that might speed up her recovery or any useful pieces of information regarding her condition that i could read for her please?
    Thank you

  • Vahe

    You are one of the best Dr. Perlmutter, Thanks!!!!

    • David Perlmutter

      Thank you Vahe!

  • Vahe

    If you have any tips or commentson my protocol dr Perlmutter. Please speak your mind.

    I had high hair lead levels, 1.5 years ago and removed my 9amalgum fillings around that time and started Chelation(low frequent dose AlA, DMSA) I have been mostly low carbs and sugar eating high fat organic meats and fermented bread when ieat them. I fixed some strange testicular problem but still working on my fertility, I was diagnosed with gallstones, IBS, testicular lesions(gone now) and my liver function tests are better, bowels are regular just need to fix digestion completly and fix candida/leaky gut. I’m starting this GAPS program (which is gut healing program starting with mainly broths and egg yolks excluding gut damaging foods and including probiotics. I got histamine intollerance it seems so i’m going slow with it i might start using HAO enzymes to help histamine assimilation.

    Wondering if you have anything to add from your point of view. So far from what i learned from you it doubled my efforts to avoid cheating on my diet and to lower my AC1 and also have less AGE foods like my lamb being fried so it is all crispy and golden and have stews instead.

    • Guest

      The GAPS program is the absolute worst thing for those with histamine intolerance. Quite telling that the doctor had no advice on histamine, since he recommends all these high histamine fermented foods.

      • Vahe

        Well Dr Natasha Campbell says that for that reason you have to start slow with the fermented foods and as your digestive system improves on foods that are easy to absorb and don’t feed bad bacteria or fungus your ability to tolerate higher histamine foods will improve and in my case i was able to have broths easy after a few days/week where in the first attempts i got rashes. I just feel like the GAPS protocol may not be the ultimate solution since you cannot regrow strains of bacteria that have gone extinct. With this in mind I am now thinking that Fecal transplant from a healthy donor is the only way and perhaps with a combination of other measures such as GAPS diet, chelation, cleanses and maybe more.

        • Guest

          I’d recommend researching various probiotic strains — some lower histamine, others dramatically raise it.

          • Vahe

            Ya I feel that probiotics could help. I have had some benefit taking different probiotics like soil based probiotics but ultimatly i believe that the solution lies in fecal transplant because those strains are the strains humans need for health living and they are only found inside healthy peoples guts, are rare thing now a days.

  • Daniella

    My last A1c was 4.6 a year ago. I was a type 2 diabetic on metformin, which I no longer take. Now I am having issues with my daily bgl going down into the 3’s. So far the lowest was 3.1. This is common when I keep my carbs down. I have still got 20 kg to loose having lost 32 already , but the weight has not moved for over 12 months. I have hashimoto thyroid disease, chronic fatigue , ,arthritis and severe depression. I battle these and go to the gym 5 days a week. Any advice please on what I should do?

  • howzaou812 .

    Another point about A1c is that how valid is the test for low carb
    diet? Chris Kresser mentioned that low carbers tend to have hemoglobin
    that hangs around longer, therefor the A1c levels will be reported
    higher than they actually are. Since hemoglobin hanging around longer
    than average will allow for more binding of sugar and inflate the actual

  • Vahe

    Is there any danger of having your average blood glucose level too low by restricting carbs from diet. whats the best number for 0 brain shrinkage?
    Anybody know?

  • Russell Raath MD

    Hi. I live in south Africa and am a medical specialist – anaesthesiologist and pain management. After reading both Power up you Brain and Grain Brain I am very interested in coming to spend time at your centre to learn more about Glutathion therapy etc . I m using it already but more than likely would benefit from training. I have sent numerous email which have not elicited any response. help please.

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  • clayton

    Dr. Perlmutter,
    I have fasting blood suger around 130 and A1C of 5.4. I have tried to lower this fasting blood sugar by eating better and exercising more but it still reamains around 130. My quetion is should I start taking medicaton to lower this as my risk for Alzheimers is high, both my parents had it at a fairly young age? Late 50’s and early 60’s.
    I hate to start the medication, but it may be the lesser of two evils.

    • Ellis Toussier

      You should not “hate to start medication” at all… and medication is absolutely NOT “the lesser of two evils” since it is not an “evil” in any way. Thank your lucky stars that today there exist medications that can help you to control blood sugar, because barely 100 years ago (1915) we didn’t know anything at all about “insulin” (not even that it “exists”) and you would have been condemned to death.

      Because of your fasting blood glucose of 130, which is 45 points above the aprox 85 – 90 that it should be, I will guess that you are already “diabetic”, So you should run (don’t walk…) to see a diabetes doctor. But go to a doctor who is diabetic himself, because they understand diabetes much better than a doctor who “studied” diabetes in medical books. There is no substitute for “being” a diabetic, to understand diabetes well.

  • gary

    What if you have an A1C of 24 and losing protein through the urine?

  • Elizabeth

    Dr. Perlmutter, I have followed the “Grain Brain” diet religiously for four months. I have lost over 30 pounds and my A1C, cholesterol, and other important blood values have changed dramatically for the better. I am, needless to say, filled with gratitude for the work you are doing as I have seen the results firsthand. I have given your book to several friends and family members, including my mother who had Parkinson’s. In three months, my A1C dropped from 6.1 to 5.6. I would like to lower it so am purchasing the supplements you recommend. Where can I purchase thiamine? I don’t see it offered on your website. Much gratitude, Elizabeth

  • ThisIsMe

    I keep hearing about the correlation between High triglycerides and insulin resistance. However, my triglycerides have been consistently low (80 to 60 to 50), but my A1c borderline at 5.6. HDL at 54, total 160. I exercise and try to eat right (could do better), but I’m not sure what’s going on with my triglycerides with regard to the A1c.

  • nancypray

    Before an A1C blood test, am I allow to eat food prior to this test?

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  • I recently had complete blood work done. The Doctor said everything came back normal and very good. I scrutinized everything on my test results and am now a little concerned. My fasting blood sugar was 84. My Hemoglobin was 5.6! I am a bit of a hypochondriac, but according to the range this is at the very highest degree of normal. I am not overweight. I am 5’7″ and weigh 114 lbs. In fact, technically I am underweight but have always been very thin. I don’t have any symptoms of Diabetes and it doesn’t really run in the family. A few people have Type 2, but they are all obese. I am freaked out and imagining all things. I have been online and I’m reading a lot of things that scare me. I do eat sugar and I know it isn’t healthy to have too much sugar, regardless of whether you have a tendency to get Diabetes or not. I have read studies that sugar also ages you. I have decided to stop eating refined sugar (no more candy, pastries, ice cream, etc.). I will allow myself to have treats once a week which a Health Car Professional told me is fine. He said a cheat day once a week is sometimes good as you won’t feel totally deprived. Am I worrying for nothing? I feel good, look younger than I am, am in good physical shape and never get sick. I can’t get this out of my mind. I do believe in preventative Medicine and I believe it is in my best interest to make changes. Longevity runs in my family and if I make it to 95 like many have, I still want to be healthy. I would like to lower my AC1 to 5.0 within 6 months. Is this too lofty of a goal? I am going to get another blood test in 6 months. Any insight is much appreciated.

    • Jason Mitchell

      I’m in a similar position. I’m a 5’8″ 126 lb male and recently got a check up done. My fasting blood sugar was at 83 but my A1C was 5.7%. My body fat is also very low, so it really doesn’t make sense. Do you exercise? I wasn’t very active before, so maybe that could have something to do with it in my situation.

  • BenzoSt

    My HbA1c is better than ever at 4.7 after several months of eating high-carb, low-fat with some fish but no meat, cheese, or egg yolks. My carbs are almost exclusively from fruit, potatoes, sweet potatoes, organic corn, sprouted grain bread, beans, peas, lentils, and oatmeal.

  • Lisa

    i am a normal weight 40-ish very active female (5’3/107 lbs) on 1000 mg of metformin who eats very low carb and stll my A1c has crept up from 5.9 to 6.2 over the past year. aren’t there other reasons that A1c might be an unreliable marker? all my other blood work is normal/good.

  • Shawna

    My test come back it’s 5.8 am I pre or am I full diabetic

    • Ellis Toussier

      We are all pre-diabetic… some more pre than others… Yes, I would say you are already diabetic, certainly pre diabetic… HbA1c of 5.8 equals fasting blood glucose about 130… that is average… sometimes it is 100, and sometimes it is 160… When it is 160, you are killing neurons, you are damaging hemoglobin, you are clogging up the circulatory system…

      I say you should think of yourself as diabetic already. And you should eat as if you are already a diabetic, and do exercise as if you are already a diabetic… and visit a good diabetes doctor, as if you are already a diabetic.

      • Brenda

        Thank you Ellis T. for you reply. I just cut back on my carbs and sugar. And that seems to help so far. I have switched to sugar-free cookies and they taste
        great 🙂 I get overwhelmed sometimes with this disease, just trying to make sure I don’t over do it. But when I get that way, I just lay down and rest. And that helps to. One day my sugar was 93 and my fingers and hands started jerking. Is this normal?

  • Jess

    Can having cholesterol at 100 be the reason why my a1c is 6.3? I’m a vegetarian and only eat fruit once a day and I’m 22.

    • Ellis Toussier

      Excuse me for answering your post, but I can answer it.

      No, cholesterol 100 or any number is probably NOT why your A1c is 6.3… the reason your A1c is 6.3 is because your blood sugar is not falling fast enough after you eat… that probably means that your pancreas is shot… that means you are diabetic…

      Go visit a diabetes doctor… I suggest you should visit a diabetes doctor who is a diabetic himself. I say that doctors can’t learn to treat diabetes from medical books. They learn best by treating their own body.

  • Tammie Rea

    What would Fasting BSGs need to be to achieve an A1c of 4.4 – 5.2?

  • lynette mayo

    Have you updated Grain Brain !

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