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Blood Glucose and Cognitive Decline
July 09, 2018Reference: Crane, NEJM, Lancet Neurology, ELSA Study, Diabetes Care,
Your HgbA1c is your most important blood test. Get to know it well. It is a simple concept. When blood sugar gets higher, more of it sticks to different proteins. Glucose is a very reactive molecule, ready to stick to anything. You know that from spilling a Coke on your car seat and having sticky goo for weeks thereafter. When you eat 4 scoops of ice cream your blood sugar shoots up for 6-8 hours. In that time it sticks to everything in sight, including your hemoglobin molecules in your red cells. That makes it a nice surrogate marker for glucose also sticking to the proteins in your blood vessels, your kidneys, your brain, your joints and on and on. You can sample your blood and there it is, a nice marker. Now, red cells live about 100 days more or less, so your A1c becomes the average of your glucose over the last 100 days. As fat cells get bigger, they require a higher insulin level to make them react to rising glucose, so A1c becomes a marker of how overweight your body thinks you are. Not your spouse, or your friends, your own internal body signal.
We define adult-onset diabetes as a blood sugar of 126 after an overnight fast. That leads to an A1c of about 6.4. But is that accurate? Is blood sugar healthy at 126? The answer is absolutely not. The Whitehall Study from England shows decreasing cardiac mortality down to a blood sugar of 85 before leveling off. Hmmm. Heart disease is one thing, but which would you rather die from, heart disease or dementia? I'm going for neither. I want old age to just spirit me away.
That's what this week's studies relate to. What is the risk of dementia from elevated blood sugar? Turns out, a lot. In fact, much lower than 126 or A1c of 6.4.
Crane's study in the New England Journal is the hallmark study. The Adult Changes in Thought Study took 2067 elderly adults (average age 76) who yielded 524 folks with dementia. The simplest conclusion of the study was that a blood sugar of 100 compared to 115 raised risk of dementia by 18%. Going the other way, dropping blood glucose from 100 to 95 lowered risk 14%. One could extrapolate and say that dropping from blood glucose of 115 to 95 lowers dementia risk 32%.
There are now more studies following this seminal study that say the same thing. Lancet Neurology confirmed the danger in the ELSA Study.
There are some of us who spike our blood sugars quite high when we sneak that ice cream and that is even riskier. The science of that isn't completely known but it can be measured with a nifty new test called 1,5-AG ratio that adds a layer of understanding to the risk. This may or may not play out. Something to watch. I want to know mine.
We don't mean to belabor this point. The message is clear. The size of your fat cells matter. If you are overweight, your blood sugar will likely be higher, and your risk of dementia will be higher. Losing weight and lowering your A1c matters. What's the target? A1c of 5.5 should be your minimum. 5.1 is perfection.
WWW. What will work for me? Well, with a mother with dementia and a father that had diabetes, my genes are in the crosshairs. I was running an A1c of 5.2 for a couple of years there then suddenly I popped up to 5.9 last year. (Nothing like a wedding in the family to gain a little weight and a broken food to cut the exercise.) I've been doing the fast mimicking diet for 5 months now and I'm back down to 5.6. This perfection stuff is a pain in the proverbial.....So, I still have a ways to go. Join me. I'm doing the FMD diet last week of the month. Every month until I'm below 5.5. Each month it gets easier.
Your A1c reflects what? Answer: Your average blood glucose over the last 100 days.
How can you lower it? Answer: Stop eating foods that make it go up like grains and sugar, and lose weight with the Fast Mimicking Diet.
The current definition of diabetes is based on sound science. T or F Answer: It was a committee decision that was made 40 years ago. Now way out of date.
What's the first step most folks need to do to lower their blood sugar? Answer: Stop drinking it. The calories you drink are the calories your store. Sugared soda is the worst. Orange juice and energy drinks, ditto.