Ashlee Williams, MD: Is your A1C creeping up and you're not sure what to do about it; you are not alone. This number could hold the key to better managing diabetes, preventing complications, and even adding years to your life. Welcome to The Healthier You Podcast. I'm Dr. Ashlee Williams, and today I'm joined by Dr. Kwame Akoto, a Board Certified Family Medicine physician here at Kaiser Permanente. We're breaking down what A1C really means, why it matters, and simple effective ways to lower it. Whether you're newly diagnosed with diabetes are just looking to better understand your health, this episode will help you take control of your blood sugar and your future. Dr. Akoto, thank you so much for being here today.

Kwame Akoto, MD: Thank you so much for having me.

Host: We always like to start with the basics. What exactly is an A1C and why should everyone, not just people with diabetes, care about their levels?

Kwame Akoto, MD: So an A1C is a test that we use to measure your average blood sugar over 12 weeks or three months. And it's a little bit different than just checking your sugar in the moment. Like if you go to the lab, we can see what your sugar is right now. But the A1C kind of gives us a look back. So it gives us a lot more information to help us make determinations about your health.

It's how much sugar attaches to your blood cells. So normally when you eat, your body will break down the food into components, one of which is glucose, which will then be taken by a hormone called insulin into your cells for energy. So what we are doing is monitoring how well your body is able to perform that process to make sure that it's efficient.

When your A1C is creeping up, it means your sugars are not being used efficiently, staying in your bloodstream, and that can lead to other health complications. You can develop what's called insulin resistance, which can happen before you are officially diagnosed with diabetes. During that time, the sugar builds up in your bloodstream and that can lead to health complications. High A1Cs are associated with increased risk of heart attack, stroke, and a gamut of other issues. And when we catch it early, we can help you make interventions to help improve your sugars.

Host: Yeah. Great. So thanks for touching on like what complications can come from an elevated A1C. Diet plays a huge role in A1C. What are the most important dietary changes that people can make?

Kwame Akoto, MD: So I like to talk to my patients about refined sugars or white starches as you may hear them called, so rice, potatoes, pasta, things like that. These are refined sugars, and your body will take those sugars and spike it in your bloodstream instantly which doesn't give it enough time to properly break it down and use that energy.

So I like to really encourage people to look at high fiber alternatives when they're eating starches. These are the ones that are not refined. So, brown rice or wild rice instead of the white rice, sweet potatoes instead of regular potatoes. And when we talk about potatoes, we're also talking about things like french fries, right?

So, instead of regular french fries, you might want to substitute sweet potato fries in there. When you're doing mashed potatoes, you want, might want to use cauliflower mash instead. So the difference between these is they have a lower glycemic index, meaning they spike your sugar more slowly and they have more fiber, which allows your gut more time to process it. And that way your body can really adhere to that process more efficiently.

Ashlee Williams, MD: So we know diet plays a huge role. Can you talk a little bit about exercise and what role that plays in lowering our A1Cs?

Kwame Akoto, MD: So I love this question. So diet. There are a lot of barriers that people can have, we may not be able to get the food that we properly need. We may live in a food desert, but exercise, anyone can do, right? So any little bit of activity that gets your body moving counts as exercise. So you don't have to just go to the gym and do formal exercise.

I know that sometimes it's challenging for people. Schedules might not make it, or it might be too costly for you from an economic standpoint. But just getting your body moving, taking a brisk walk outside with your family, doing body weight exercises like pushups, sit-ups crunches, things like that.

When you exercise, your body will use that extra sugar for energy for your muscles. And also in particular, when you do things that involve resistance, you'll get what's called an afterburn. So it spikes your metabolism and it'll keep working even after your workout is over to burn more calories.

So that helps with the process. We've actually found that people that exercise can see a nearly 1% drop in their A1C or the average three month average sugars. So that's another really important component about this.

Host: Yeah, I think my patients, they get really discouraged when they see that their A1C is a little elevated and I tell them, even losing a small amount of weight can make a big difference. Can you explain this?

Kwame Akoto, MD: Yes. So losing five to 10% of your weight is enough to have a dramatic effect on your blood sugar. So for instance, someone who's 175 pounds, that's only nine to 17 pounds. So it's not as much as you think. Those small, little incremental changes will have a really big effect on your blood sugar. And that modest amount of weight loss has been shown to decrease your A1C by 0.5%.

Which then reduces your risk of developing also other conditions like high blood pressure and high cholesterol. It reduces the risk of that about 50%. So everything with exercise you get a positive impact all the way going forward. It also helps with your mood and energy, which is also going to be important in terms of improving your stress levels, which also has an effect on your blood sugar.

Host: Anything outside of diet and exercise, any other lifestyle changes that you can make to help lower your A1C?

Kwame Akoto, MD: So mental health, like I just mentioned, is very important. It's not just a state of mind. When we are stressed, we actually release hormones and neurotransmitters that can really disrupt our endocrine system and make our blood sugars rise over time. So it's really important, especially now when we are bombarded by text messages, emails, notifications, all the time.

Just take some time. Just try to relax and step back. So for instance, for me, I will take my phone, just put it on do not disturb, and maybe 10, 15 minutes in a day I'll just reflect back on my day or read something really quickly or sit there, meditate, whatever works for you. Just something to get your mind to relax and just step back from all the hustle and bustle that we all experience every day.

That's really important over time to help keep your blood sugars under control as well. So some people like to do things like meditation and yoga, and now there are all these different apps and other tools that you can use for that. I particularly like things like Calm and My Strength. I use those myself.

I think it's really important. If you are a smoker, that's another lifestyle change where you can actually improve your blood sugar. Smoking, for some reason we're not totally understanding, it does increase your blood sugars as well. So, trying to quit smoking is important. So of course, talk to your healthcare team about that.

Alcohol is just empty calories and sugary drinks in general are just empty calories, so you can get sugar from your drink, but it doesn't really have much other nutrition in there. And because there's no fiber and there's no protein, it spikes your sugar instantly, so you don't want to fill up on sugary drinks and in particular things like alcohol as well.

So if you think about a soda, an average soda can have a 12 ounce can of soda, can have up to 10 teaspoons of sugar in there, put in by the manufacturer, which tastes great. However, that 10 teaspoons is about the total amount that we recommend for most adults. Most sources say between six to 12 teaspoons depending on whether you're a woman or a man, and your activity level.

So right there, if you have just a few cans of soda in a day, you have already gone over your daily limit and those empty calories will add up. And that's the kind of thing that your body will have difficulty processing later.

Host: When should someone consider medication and how do lifestyle changes compare to medication?

Kwame Akoto, MD: So a normal A1C is 5.6% or less. If your A1C is between 5.7 and 6.4, then you are in the category that we consider pre-diabetic. So when you're in that level, that's when it's really good time to have a sort of nuanced conversation with your physician about what's going to work best for you. There are some studies showing that a drug called metformin, which is a drug we've always used for diabetes itself, is also effective at helping to reverse pre-diabetes, as part of a healthy lifestyle. So the things that I've mentioned before, getting good sleep, exercising, eating well, and then considering the metformin, all of these components can help you to try to reverse and get yourself back into a normal range with your sugars. And even if you become a full-blown diabetic, there actually is a chance to get into what we call diabetic remission.

 So making these lifestyle changes can actually get you back into normal sugars, which will then lower your risk of heart attacks, strokes, and kidney disease. For instance, diabetes is the number one cause of kidney disease in the world. So it's really important to be aggressive about these changes with your healthcare team.

And then other things that might be part of this that you want to look into as far as like a healthy lifestyle, remember diabetes can go hand in hand with other lifestyle conditions, especially metabolic conditions like high blood pressure. So you want to get those things checked. You want to get your cholesterol checked.

We even have now these predictive scores that have been developed by the American Heart Association where you can actually sort of predict over 10 years what your risk of developing some of these complications like stroke and heart attack might be. And now they actually do include things like your blood sugar, which is new, that's just been over the last few years.

And getting that score calculated with your physician is really important so you can kind of have a mindset of where you are and what changes are going to work best for you.

Host: How often do you recommend checking an A1C? And if you have an elevated A1C and have the diagnosis of diabetes, what other things should people be monitored?

Kwame Akoto, MD: The American Heart Association has this really great program is called Know Your Numbers and A1C or blood sugar is part of that. So it's really important to know that. Like I mentioned before, your blood pressure is really important. Your cholesterol is really important. I would recommend anyone over 40 to go ahead and get your A1C checked annually, even if you feel well.

That's the sort of tricky part about this condition is most people don't even know that they have it. Something like 98 million Americans are estimated to have pre-diabetes and out of that 80% do not know it. You don't feel any symptoms and you're not going to know until you get that test.

So it's really important to check that regularly. So at least annually I would check that with your doctor. If you do, of course, have full-blown diabetes, then the recommendations are a little bit different depending on what you and your doctor are looking to do. Because there can be genetic triggers that might predispose you if you've got a strong family history.

Like for instance, my family, both parents were diabetic. I have multiple siblings that are diabetic, so I actually get my A1C checked far more frequently. But that's a discussion that I had with my physician. So, have that discussion with your physician if you have a family history about what's going to work for you and your doctor will recommend the schedule that's most appropriate.

The other thing to look at if you are actually diabetic is having regular foot and eye exams. Diabetes is actually also a blood vessel disease, right? That's really what it does at its most basic level, which means it can affect things like the blood vessels going to your eyes and to your nerve endings.

And that can lead to a condition called neuropathy where you can get numbness, tingling, burning, pain in your extremities. And it's a really debilitating condition, which is irreversible. So we really want to evaluate you for that sooner rather than later. And then for your eyes, recommend annual exams if you are diabetic, to make sure that it's not affecting the blood vessels in your eye and leading to diabetic eye conditions is actually, is the leading cause of blindness as well. So, I think of it as a whole body disease and you really want to look at all the things you can do to improve it.

Host: Yeah, it really is a whole body disease, and knowing your family history is so important. Thanks for the insight, Dr. Akoto. Here are some key takeaways from today's episode. One: A1C measures your average blood sugar over three months and is a crucial indicator of your metabolic health. A normal level is below 5.7%. Two: High A1C significantly increases your risk of heart disease, stroke, kidney problems, and other serious complications that can impact your quality of life.

 Three: Small weight loss brings big benefits. Losing just five to 10% of your body weight can dramatically improve your A1C and overall health. Four: Don't overlook lifestyle factors like managing stress, quitting smoking, limiting alcohol, and getting quality sleep as these all affect your blood sugar control.

 And five: Work with your healthcare team to determine if medication might help, but never abandon the healthy lifestyle habits that form the foundation of good blood sugar management. For more expert advice, visit kp.org and listen to more episodes of Healthier You wherever you get your podcast. If you found this episode helpful, don't forget to subscribe and share it with others.

Thank you, and from all of us at Kaiser Permanente, be well.