63: HbA1c Levels Explained: Why They May Be High Without High Blood Sugar

HbA1c Levels Explained: Why They May Be High Without High Blood Sugar

Michael Kummer: Is your HbA1c elevated even though you are on a low carb or even a ketogenic or carnivore diet? Well, the same thing happened to me just recently. I got my blood work done and my HbA1c came back at 5. 7 or 5. 8 putting me into the pre diabetic range and I'm like What the heck, you know, I'm eating fairly low carb, I mean not zero carb, I'm not in ketosis every day, but there is no way my blood sugar would be, my average blood sugar over the past 90 or so days would be in the 110 115 range.

That's impossible!

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Michael Kummer: So I slept on a continuous glucose monitor and lo and behold, my blood sugar on average hovered around 85 to 89. And I'm like, that doesn't make any sense at all. So I started investigating what could cause elevated HbA1c levels. And could be because of certain variants, genetic conditions, iron deficiency, anemia, vitamin B12 deficiency or folate deficiency, kidney disease, liver disease, certain medications I'm not taking, splenectomy, uh, meaning removal of the spleen, um, hyperbilirubinemia, alcoholism, et cetera, et cetera.

None of that made any sense to me. None of that really applied to me. I'm like, this is odd. You know, what could it possibly be? And then I ran into Dr. Sean Baker, who explained what could be going on here. And so just to give you a rough understanding of what is HbA1c and you know, how everything makes sense.

Once you know that information, let me give you a brief overview. So as you know, you know, hemoglobin. HbA1c, found in red blood cells, carries oxygen from the lungs to the rest of your body. And glucose in the blood can attach or glycate to hemoglobin, forming glycated hemoglobin, or HbA1c. And the amount of glucose that attaches to hemoglobin is proportional to the average blood glucose concentration over time, and that's why you can see that correlation.

And HbA1c is expressed as a percentage of the total hemoglobin. So for example, if your HbA1c is 7 percent which would be already in the diabetic range, then it means that 7 percent of the hemoglobin is glycated. And an important factor in all of that is the, the red blood cells or RBCs. And because red blood cells obviously have a lifespan, you know, they live about 120 days or 4 months.

And since RBCs live for about three to four months, the HbA1c test reflects the average blood glucose levels over the past couple of months, two to three months usually, with the most recent 30 days having a slightly greater influence on the reading or on the test results. And now here's the thing, If your red blood cells have a shorter lifespan because of metabolic conditions, medication, whatever the reason might be, there will be fewer older RBCs, which means less time for glucose to attach to the hemoglobin.

And that can result in lower HbA1c levels than you actually have, or then, you know, that reflects your, um, blood sugar, blood glucose levels. And Dr. Sean Baker actually told me that he has seen a couple of diabetics actually. That, you know, have metabolic syndrome, metabolic conditions, um, and who have red blood cells with such a short lifespan that they are HbA1c reading is actually artificially suppressed, so they might come back with a reading below 5%, which might indicate, you know, excellent blood sugar levels on average, but that's not really the case.

That's not what's going on. And conversely, RBCs can also have a longer lifespan. Span, and that could be because of certain conditions or you don't have a spleen to clean anything up. Uh, but it could also just be because you have incredibly healthy bone marrow, uh, that makes incredibly healthy red blood cells that just happen to live a little longer than average.

And if that's the case, more glucose can attach over time, and that can result in higher HbA1c levels than what matches your average blood sugar levels. And in my case, based on the discussions with Dr. Baker, That seems to be the case. And I'm like, okay, you know, this makes a whole lot of sense. And in particular also, because my wife has noticed the same, um, you know, our HPA1Cs were always in the quote unquote normal range, so 5.

2 to 5. 5 in that kind of range, and it's not. Since the last blood test and it wasn't I think we it took us like a maybe a year over the last year I've seen that slowly increase without any dietary changes And so but what we've been doing is we've been taking a lot of bone and marrow to support our well bone marrow And a lot of we've consumed a lot of free stirred beef organs that support red blood cell formation and red blood cell health and so it Based on that, I conclude that our healthy lifestyle has actually positively impacted our, the lifespan of our red blood cells.

And so we have artificially elevated HbA1c levels, even though our CGM readings, uh, our fasting glucose, our fasting insulin in particular, my last test, my fasting insulin was below two. Um, so there is definitely, I definitely don't have a blood sugar issue. Um, I don't have any deficiencies that I could tell from my blood work.

I don't have any issues with kidney or my liver or any other organs based on my blood work and based on how I feel. So that's the most probable reason. And if that happens to you as well, You know, don't just brush it off. Obviously do additional tests, try to find out what's going on. But if everything else checks out, chances are you just have very healthy red blood cells that live a little bit longer than average and that artificially inflates your HbA1c.

Uh, with that, we're going to wrap it up. I hope you liked this quick tip and I'll see and hear you in the next episode.

In the next episode:

In the next episode of the Primal Shift podcast, we're diving into the transformative power of meditation. Have you ever wondered how simply sitting in stillness can completely change your mental and emotional landscape?

We'll explore the science behind meditation and how it helps us manage stress, emotional triggers, and everyday distractions. We'll break down how learning to focus your mind and resist urges during meditation can ripple into the rest of your life, helping you stay calm, focused, and in control, even in the most chaotic situations.

Plus, we'll talk about tools that can guide your practice and provide real time feedback on what's happening in your brain. If you've been struggling to meditate or want to understand how it can enhance your life, you won't want to miss this episode. Stay tuned.