As diabetes is a blood sugar disease, blood sugar monitoring and assessment is unsurprisingly a significant marker in diabetes treatment. Another closely related marker is called A1C, and getting one’s A1C levels to within a healthy range is often a top priority for a diabetic patient’s doctors. Doctors might assess their diabetic patients’ A1C levels several times a year to obtain critical information about the patient’s responses to whichever diabetes treatment they are receiving. In this article, we dive into the science behind A1C and discuss natural ways that patients might consider complementing anti-diabetic drugs in their efforts to reach health, balance, and targeted A1C levels.

What is A1C?

Our blood is a complex soup of biologically active molecules, all participating in an intricate choreography with the ultimate goal of transporting oxygen and nutrients to every cell in the body. One of the main players in this arrangement is the red blood cell, which binds and transports oxygen molecules to where they’re most needed. Red blood cells contain a specialised protein called hemoglobin which has an oxygen affinity – sort of like an oxygen magnet. However, hemoglobin can also bind with sugar in the bloodstream; when this happens, the resulting hemoglobin-glucose complex is referred to as hemoglobin A1C or glycosylated hemoglobin.

The process of hemoglobin glycosylation itself is not problematic and occurs in every healthy individual to some extent. However, the proportion of red blood cells that are glycosylated at any given time is proportional to long-term blood sugar concentrations, meaning that people with higher average blood sugar levels tend to have correspondingly high proportions of hemoglobin A1C.

The relationship between A1C proportions and average blood sugar levels has long been known to the medical community and has offered a unique way for doctors to assess what a patient’s blood sugar levels have been like for roughly three months before testing, despite requiring only a single blood sample. These properties have allowed A1C testing to become an important tool both for the diagnosis of diabetes and pre-diabetes, both of which are associated with increases in blood sugar and therefore A1C levels, as well as in monitoring the treatment progress for existing diabetes patients.

Why A1C Reduction May Be Desirable

These limitations suggest that A1C levels should probably not be used as the sole marker for measuring the progress of a patient’s diabetes, ideally. Nevertheless, A1C levels do offer some valuable insight into how a patient’s diabetes is behaving in response to treatment (or the lack of treatment), and reducing elevated A1C levels to a healthy range is generally advisable. This conclusion is the result of a great deal of research which has tended to show a correlation between lower A1C values and better health outcomes across a spectrum of areas for diabetic patients. In fact, each single percentage decrease in measured A1C values has been associated with a double-digit reduction in the odds of developing serious health conditions in the eyes, kidneys, and cardiovascular system.

Precise A1C targets will differ by doctor or professional organization, however, a general guideline for diabetic patients is to target A1C levels of 7% or less. Patients should defer to their doctors for a specific target as a variety of complex and individualized factors can create quite a wide range of acceptable targets.

Are Lower A1C Levels Possible?

If you’ve received unnerving news about your A1C levels, have no fear – A1C levels are dynamic and can be changed over time. And, luckily, there is a great deal of control that a patient can have over their A1C levels if they are willing to make the appropriate modifications to their behavior and lifestyle (under the direction of their doctor). Here, we present a list of natural strategies one might consider discussing with their doctor as potential interventions to lower A1C levels to a healthy range.

While medications for the management of blood sugar levels do exist and can help achieve A1C targets, this article will focus on non-pharmaceutical interventions exclusively. By excluding relevant medications from the discussion, we do not mean to suggest that medications should not be used where prescribed by a doctor. Always follow your doctor’s recommendations regarding diabetes management and only consider attempting any intervention, including those listed here, after receiving your doctor’s approval.

Diet

Likely the most significant and direct influence on the amount of sugar in your blood over a period of time (and your corresponding A1C levels) is the amount of sugar you put into your body in the first place. One’s dietary composition is critically influential to their A1C levels, making this an important part of your regimen to get right. Here are some important factors to keep in mind when reflecting on your diet.

Carbohydrates

Carbohydrates can be a sticky subject, mainly because the word is an umbrella term that captures many types of molecules. For instance, starches are a form of carbohydrate that is readily broken down by your digestive system into ready-to-use sugar. This makes starch a simple carbohydrate, causing it to have a much more dramatic and quick effect on your blood sugar levels. Compare this to fiber, for example, which is also classified as a carb, and is often found in nutrient-rich fruits and vegetables. Fibre is critical to digestive health and can have a stabilizing effect on your blood sugar. So, while carbs should generally be moderated, be mindful that the whole picture is a little more nuanced. A nutritionist or dietitian, or even your doctor, should be able to help you figure out how best to approach your carbohydrate intake.

Portion control

Understanding how much of which foods to eat per day is a great first step towards optimizing your diet. In order to put that knowledge into action, however, you will need to be armed with the right tools for the job. Invest in some measuring cups, spoons, and even a food scale, to fine-tune your portions.

Being precise about food intake may bring about several benefits. Not only will it offer more granular information about the effects of certain diets on your diabetes outcomes (including your A1C levels), it will also allow you to be intentional about what you eat, and stop you from making inaccurate assumptions about what you’re putting into your body. While tracking your meals and controlling your portions can be a pain, understanding the nutritional content of your food, particularly when it comes to the main macronutrients (carbohydrates, protein, and fat) can be a game changer in fine-tuning your diet for A1C reduction.

Physical Activity

After controlling what goes into your body, controlling the activity performed by your body is probably the most important lifestyle factor in determining your A1C. After all, sugar is energy, so increasing your body’s energy output through physical activity increases your cells’ energy demands and creates a downward pressure on your sugar levels. Being active also comes with a whole host of other health benefits that make it worthwhile, such as improvements to cardiovascular health, hormonal health, and even self-confidence.

There are two general categories of physical activity, both of which can improve your A1C: cardiovascular activity and resistance training. The former involves any activity that gets your heart rate elevated – this can include running, cycling, or even a brisk walk. Resistance training involves lifting, pushing, or pulling against resistance, such as that provided by weights, resistance machines, or even one’s body weight.

A balanced exercise plan will incorporate a reasonable amount of both categories. However, each individual will have a unique capacity for exercise, and pushing yourself too hard can be quite dangerous. If you are not very active but would like to be, it may be worth consulting a physical therapist, personal trainer, or your doctor, for advice on how to start safely.

Stress management

Stress is a great example of a lifestyle factor often overlooked by those looking for better control of their blood sugar. While not as obviously connected to the amount of sugar entering the bloodstream as, say, the amount of sugar in your diet, stress levels can have a real, measurable impact on how your blood sugar fluctuates over time.

While some stress is an inevitable and even healthy reaction to certain of life’s unpleasant moments, it’s the chronic stress that will wreak havoc on your A1C. Having a constant background level of stress can raise your blood sugar levels over time and increase your insulin resistance too, creating a vicious cycle as less and less of the elevated blood sugar can be absorbed by cells responding to the presence of insulin in the bloodstream.

Fortunately, the reverse of this correlation seems to exist as well. In other words, reducing your stress levels and finding ways to allow your body to de-stress and relax regularly can cause your blood sugar levels and A1C metrics to drop. Now, this doesn’t mean that relaxing all the time is good, either – remember the important role of a physically active lifestyle for your A1C and overall health. Rather, it suggests that meditation, mindfulness, therapy, breathing exercises, or other means of mentally unwinding may be worth pursuing and incorporating into your routine.

Weight management

Direct correlations have been observed between a lower percentage of excess body fat, and improved pancreatic function and insulin sensitivity. In short, if you are carrying some extra pounds, dropping them might help your body better regulate your blood sugar and A1C levels, while improving other areas of your health at the same time.

Staring down the barrel of a weight loss program can be daunting, to say the least. Losing weight in a safe and healthy way typically requires adopting a modest weekly target of no more than a few pounds lost each week. This means that losing any significant amount of weight is bound to take many weeks of diet and/or exercise, which can make even starting the process too difficult to contemplate.

Fortunately, weight loss for A1C reduction need not be such a drastic or arduous feat. Certain studies have found that even a relative decrease of only 5 – 10% of a diabetic person’s body weight can triple their odds of reducing their A1C by half a percent.

If you still feel daunted by the idea of a weight loss regimen, try adopting a perspective of holistic health rather than narrowly focusing on the number on your scale. Many of the other tips on this list, such as a controlled diet and regular exercise, may unintentionally promote weight loss as a knock-on effect while also improving other aspects of your health and diabetes management simultaneously.

Still, if the pounds are stubbornly sticking around despite improving other aspects of your lifestyle, a thoughtful and safe weight loss program can help impose a bit of structure on your efforts and increase your odds of success. Just be careful not to choose any drastic diets or “fad” programs; not only can some programs advise unhealthy practices, but studies have shown that those who use such programs typically regain their weight once the program has concluded. Your best bet is likely to make incremental changes to your lifestyle that are sustainable and easy to incorporate indefinitely.

Conclusion

When facing a chronic condition like diabetes, keeping track of numerical trackers of your condition’s progression can be a great way to remain objective in the face of a lifelong challenge. A1C is a mainstream biomarker that many doctors will track because of how much insight it can offer with only a single measurement. It also allows patients and their doctors to regularly reflect on what may or may not be working in their diabetes management plan and allows them to update accordingly and try again.

Medications will probably play a role in many patients’ management strategies, and that is solely for the patient and their doctor to decide. However, for many patients, factors beyond their prescriptions can be a potent part of their disease management and should not be overlooked.