If there was a blood test that could give you valuable information about a major, yet reversible risk factor for Alzheimer’s disease and age related dementia, would you want to take it? What if that same blood test could also give you information about your risk of heart disease, high blood pressure, diabetes, vision loss, cancer and how fast you can expect your body to age? What if the test was really cheap?
Now, what if you knew that what you were going to have to do to reverse your risk of all these conditions was going to be personally challenging, maybe even really hard, would you still want to take the test?
Something to think about, isn’t it?
The test I’m talking about does exist. It’s a simple little test that’s run all the time. It’s full implications are rarely considered, however.
It’s called “hemoglobin A1c” and is sometimes referred to simply as the “A1c” test. In essence, it measures the amount of sugar that has become stuck to the hemoglobin in your red blood cells (hemoglobin is the component in blood that carries oxygen). Because red blood cells live for about 3 to 4 months, the test is usually used to estimate an “average blood sugar” for the previous 3 months. The more sugar floating around in your blood on a daily basis, the higher you A1c value will be.
In conventional medicine the test is used to diagnose and monitor treatment goals for diabetics. The implications of a person’s A1c value run much deeper, however. Sugar within the body doesn’t just stick to hemoglobin. It sticks to many tissues that are made of proteins and fats (this accounts for most tissues in your body by the way) and can bind directly to DNA. The compounds formed by this process are called advanced glycation end products or “AGEs” for short. Clearly, the person who named these compounds was thinking about the big picture because many of the adverse health effects they cause are generally regarded as being a “normal” or “inevitable” part of aging.
As a society, we expect to get sick as we get older. I can’t count the number of times I’ve heard someone say “Getting old isn’t for the faint of heart” or some similar comment. But to what degree are the “ravages of time” truly inevitable as we age, and to what degree are age related illnesses really just a consequence of unhealthy personal and cultural habits? As it turns out a simple little thing like our average blood sugar and the level of advanced glycation end products (AGEs) produced by it seems to be a significant factor in most of the common age related illnesses we dread.
Once AGESs are formed, they cause a whole host of adverse effects in the body, including inflammation, oxidative damage (tissue damage at the molecular level), activation of immune responses against effected tissues and disruption of DNA expression.
For example, it is well established that when AGEs form on the interior surfaces of blood vessels, they promote the development of atherosclerotic plaques. This leads to diminished blood flow to critical tissues and organs such as the heart, brain and kidneys, and puts us at risk for heart attacks, strokes and other blood vessel diseases.
AGEs also damage nerve cells, both peripherally and within the brain and are hence a significant cause of Alzheimer’s disease and other forms of dementia, not to mention the painful neuropathies that many diabetics and older persons suffer from.
One of the hallmarks of aging is a degradation in the function of connective tissue. AGEs damage collagen and other forms of connective tissue leading to many visible and invisible signs of aging such as wrinkles and loss of elasticity in the skin.
Now, at this point you might be thinking “Wait a minute, the body can’t live without a certain amount of sugar in the blood so doesn’t that make damage from AGEs inevitable?”
A matter of balance
As with many things in life, it’s a matter of balance. It’s true that too little sugar in the blood can lead to harmful, even fatal consequences. High blood sugar, on the other hand, creates excessive formation of AGEs and overwhelms the body’s ability to repair itself and maintain health.
As long as the body can repair the amount of damage being done so that all organs and tissues continue to be healthy and function optimally, AGEs are not a problem.
If the amount of AGEs being formed and the damage done by them exceeds the body’s reparative capacity then the degree of damage builds up over time until disease develops.
AGEs were once considered to be permanent once formed. It is now known, however, that they are cleared slowly from the body by two mechanisms:
- When dying cells are broken down and eliminated from the body, the AGEs associated with them are also eliminated. If blood sugar levels improve, then new cells will have a lower level of AGEs and thus be healthier and function better than their predecessors.
- The body produces enzymes that actually remove AGEs from glycated tissues. This means that long living cells, such as neurons and connective tissue cells can heal, so long as the rate at which new AGEs are formed does not exceed the rate at which the body can clear them.
This means that if we improve our blood sugar levels, the degree of damage from glycation in our bodies will also go down over time. In a very real sense, this means we can actually reverse our level of physiological aging to a degree.
How high is too high?
The target goal for hemoglobin A1c that conventional doctors are currently trying to reach with their diabetic patients is 7.0. This represents an average blood sugar of about 154 (diabetes is diagnosed when A1c levels exceed 6.4). A hemoglobin A1c of 5.6 or less is considered normal and therefore theoretically should not present any health risk. An A1c of 5.6 equates to an average blood sugar of about 115.
So, how safe is 115?
A recent study in the New England Journal of Medicine involving over 2000 elderly participants found that individuals with average blood sugars of 115 developed dementia at an 18% higher rate than those with an average blood sugar of 100. In other words, an average blood sugar that is at the high end of “normal” is actually disease causing.
Now, if a drug was developed that could reduce your risk of dementia by almost 20% it would be a blockbuster. You would be seeing ads for it everywhere. Guess what, all you have to do is lower your average blood sugar to 100!
Furthermore, it is well established that as hemoglobin A1c levels increase, so does the incidence of coronary artery disease (the kind of heart disease that causes heart attacks). In a recent review of 20 studies examining the relationship between hemoglobin A1c levels and deaths from coronary artery disease it was found that non diabetic patients with elevated A1c levels (i.e. 5.7 to 6.4 or average blood sugar levels between 115 and 135) had an 85% increased risk of mortality from their disease. This is an astounding effect!
A drug that could decrease your risk of death from coronary artery disease by 85% would be heralded as a major breakthrough in medicine! . . . Um . . . you can do that without a drug, just by lowering your A1c to below 5.7 (or your average blood sugar below 115).
So how high is too high? It seems to me that if increasing your average blood sugar from 100 to 115 increases your risk of dementia by almost 20%, then any level of increase above optimum is inducing some level of damage. Because glycation occurs in many tissues, it is likely that damage is occurring in other organs as well at even modest increases above optimum. All of this suggests to me that if we want to maintain a high level of health as we age we need to be serious about bringing our average blood sugar levels to optimum and keeping them there.
What is optimum?
I consider an optimum average blood sugar to be right around 100. Fluctuation over the course of the day should be relatively modest, from about 80 at the low end to about 120 at the high end. These are not recommendations made by an advisory group within conventional medicine, they are the numbers that I have found to be clinically relevant in my practice.
Blood sugar values between 80 and 120 provide optimum levels of fuel for the brain and body tissues and almost never result in blood sugar related symptoms. Values below 80 can leave the brain with inadequate fuel and lead to fatigue, foggy thinking, irritability and tremor. I have also found that truly healthy individuals who are physically well conditioned rarely have blood sugar readings above 120, even after a high carbohydrate meal. This translates to an average blood sugar of about 100 or a hemoglobin A1c of about 5.0. I tell my patients that I want to see their A1c between 4.8 and 5.2.
The view from 30,000 feet
Obviously a major point of this article is that chronically high blood sugars have a dramatic impact on our health as we age and that this fact is grossly under-appreciated. As a society we are sick, and the older we get, the sicker we become. We fear the diseases of old age: cancer, heart disease, diabetes and dementia. We live in a society where the attitude is that it is somehow a part of the natural order of things that many of us will get these diseases and that it is really a matter of chance wether or not we are among the “lucky” or “unlucky”. Of course, luck has very little to do with it.
In the last century we have made dramatic changes to the way we live. As an example, our sugar consumption has more than quadrupled over that period from about 30 lbs per person/year to 130 lbs per person/year. In addition, we have increased our consumption of refined grain products and dramatically decreased our levels of physical activity. (Other aspects of these changes have been detailed in other blog posts).
The point is, while we certainly can’t account for, and don’t have control over all causes of the “diseases of aging”, we do know enough to greatly reduce our risk of these conditions and dramatically enhance our wellbeing along the way.
Good news / bad news
The good news:
It is well within the range of achievability for virtually everyone with high average blood sugars to restore them to optimum values (even diabetics).
The bad news:
It largely has to do with how we eat and how we live.
First of all, it’s important to know where you stand. If you are over the age of 45, I would recommend getting a hemoglobin A1c test, regardless of what past testing has shown and regardless of what your conventional doctor has told you. It’s a simple and inexpensive test that will give you extremely valuable information about your health trajectory.
If you know now (or discover later) that you do have a high A1c value then the essentials of change are this: cut out all concentrated sugars (including fruit juices); reduce or eliminate refined flour products such as bread, pastries and pasta; focus on whole, unrefined starches like brown rice, quinoa and legumes (beans, peas, lentils); eat lots of fresh, non-starchy vegetables; eat adequate high quality protein every day and finally, increase your physical activity as much as you can.
The degree to which you will need to change depends on where you are starting from. Also, the more you exercise, the fewer dietary changes you will need to make, however, everyone is different. Follow up A1c tests will tell you how you are doing. You will probably be more successful if you work with a knowledgeable health care practitioner.
I am refraining from going into great detail about diet here, partially because people have quite variable needs, but also because I have written about diet quite a bit elsewhere. For further help with making healthy dietary changes please see my posts on the Universal Diet Principles.
A final but important note
Believe me, I understand the pleasures of chocolate chip cookies and Frappuccinos . . . but let’s face it: we eat too much sugar and refined carbohydrates (flour based foods). We all know we eat too many of these foods, but, darn it, they’re comforting, convenient and they taste sooooo good!
Frankly I think changing the diet is one of the hardest things for patients to do. Our diet is part of what defines us: the foods of our culture, the foods of our childhood, those special foods we have discovered that give us a little something special (did I hear somebody say chocolate?). So much is wrapped up in how we eat.
Central to all of this is that we tend to gravitate towards foods that buffer the effects of stress and soothe us emotionally. More than anything, this may be what makes it hard for us to change our dietary habits. I’m afraid steamed broccoli just isn’t much of a comfort food. Our need to buffer our stress and comfort ourselves is real and legitimate. The thing is, if we’re doing it by eating health damaging foods we’re essentially shooting ourselves in the foot by scratching our itch with a loaded pistol.
We need to find healthy ways to manage our stress and provide enjoyment in our lives. When I ask patients to make dietary changes, I often also ask them to identify alternate ways to meet the needs they were meeting with food and then prescribe those activities as part of their treatment plan.
We are whole, integrated beings. We need to meet all of our genuine needs to be truly healthy but we are only really meeting them if we do it in a way that isn’t damaging some other aspect of our health. You can think of dietary and lifestyle changes as a necessary but unpleasant task, or you can think of them as an adventure. If you approach them as an adventure they will be just that. I think you deserve to be truly healthy and to stay healthy as you get older. You deserve to live in a body that is a comfortable and pleasant place. Most importantly, you deserve to be happy. That can only happen if you take all of your needs seriously.
Food Cravings: why we have them, what to do about them