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Thursday, October 10, 2013

Postprandial glucose levels, HbA1c, and arterial stiffness: Compared to glucose, lipids are not even on the radar screen

Postprandial glucose amounts are the levels of blood glucose after meals. In Western urban environments, the main contributors to elevated postprandial glucose are food items prosperous in refined carbs and sugars. Although postprandial glucose stages might differ fairly erratically, they are especially elevated in the morning after breakfast. The main reason for this is that breakfast, in Western city environments, is typically quite substantial in refined carbohydrates and sugars.

HbA1c, or glycated hemoglobin, is a evaluate of typical blood glucose over a interval of a number of months. Blood glucose glycates (i.e., sticks to) hemoglobin, a protein discovered in red blood cells. Crimson blood cells are fairly prolonged-lived, lasting around three months. Hence HbA1c (provided in percentages) is a very good indicator of average blood glucose levels, if you really don't suffer from anemia or a couple of other blood abnormalities.

Dependent on HbA1c, 1 can then estimate his or her typical blood glucose level for the preceding 3 months or so prior to the take a look at, making use of a single of the subsequent equations, relying on whether or not the measurement is in mg/dl or mmol/l.

Common blood glucose (mg/dl) = 28.7 × HbA1c − 46.seven
Average blood glucose (mmol/l) = 1.59 × HbA1c − two.fifty nine

Elevated blood glucose amounts lead to injury in the physique mostly by way of glycation, which prospects to the development of superior glycation endproducts (AGEs). Offered this, HbA1c can be noticed as a proxy for the amount of injury accomplished by elevated blood glucose stages to a variety of entire body tissues. This harm occurs more than time usually following a lot of many years of high blood glucose amounts. It involves kidney damage, neurological damage, cardiovascular damage, and hurt to the retina.

Most typical blood exams focus on fasting blood glucose as a evaluate of glucose metabolic rate standing. Numerous medical practitioners have as a focus on a fasting blood glucose stage of a hundred twenty five mg/dl (7 mmol/l) or much less, and largely disregard postprandial glucose ranges or HbA1c in their administration of glucose fat burning capacity. Leiter and colleagues (2005 entire reference at the stop of this post) showed that this concentrate on fasting blood glucose is a blunder. They are not alone several other individuals made this level, such as some really educated bloggers who concentrate on diabetic issues (see “Interesting links” segment of this blog). Leiter and colleagues (2005) also provided some fascinating graphs and figures, like eye-opening correlations amongst numerous variables and arterial stiffness. The figure underneath (click to enlarge) displays the contribution of postprandial glucose to HbA1c.


Notice that the reduced the HbA1c is in the determine (horizontal axis), the larger is the postprandial glucose contribution to HbA1c. And, the reduced the HbA1c, the nearer the individuals are to what a single could take into account possessing a completely normal HbA1c degree (all around 5 percent). That is, only for individuals whose HbA1c ranges are really higher, fasting blood glucose stages are comparatively trustworthy steps of the tissue harm completed be elevated blood glucose ranges.

The table underneath (click to enlarge) shows P values linked with the impact of a variety of variables (shown on the leftmost column) on arterial stiffness. This evaluate, arterial stiffness, is strongly connected with an enhanced danger of cardiovascular activities. Seem at the middle column exhibiting P values altered for age and peak. The reduced the P benefit, the a lot more a variable impacts arterial stiffness. The variable with the lowest P value by much is 2-hour postprandial blood glucose the blood glucose stages measured 2 several hours right after foods.


Fasting glucose amounts were reported to be statistically insignificant because of the P = .049, in terms of their result on arterial stiffness, but this P price is really considerable, though hardly, at the .05 degree (ninety five percent self-assurance). Interestingly, the following actions are not even on the radar monitor, as considerably as arterial stiffness is concerned: systolic blood strain, LDL cholesterol, HDL cholesterol, triglycerides, and fasting insulin ranges.

What about the lipid speculation, and the “bad” LDL cholesterol!? This research is telling us that these are not very related for arterial stiffness when we control for the impact of blood glucose measures. Not even fasting insulin levels matters significantly! Wait around, not even HDL!!! A substantial HDL has been certainly revealed to be protective, but when we appear at the relative magnitude of a variety of consequences, the story is a little bit diverse. A substantial HDL’s protecting impact exists, but it is dwarfed by the adverse impact of higher blood glucose amounts, especially following meals, in the context of cardiovascular illness.

What all this points at is what we could phone a postprandial glucose hypothesis: Decrease your postprandial glucose stages, and dwell a longer, more healthy existence! And, by the way, if your postprandial glucose levels are under manage, lipids do not make a difference considerably! Or possibly your lipids will fall into spot, with no any need for statin drugs, soon after your postprandial glucose levels are under control. One particular way or yet another, the final result will be a good 1. That is what the data from this review is telling us.

How do you lower your postprandial glucose levels?

A very good way to commence is to remove foodstuff rich in refined carbs and sugars from your diet. Almost all of these are foodstuff engineered by humans with the goal of becoming addictive they typically occur in packing containers and brightly coloured plastic wraps. They are not hard to overlook. They are generally in the central aisles of supermarkets. The faster you get rid of them from your diet program, the better. The far more fully you do this, the greater.

Observe that the proof discussed in this put up is in relationship with blood glucose levels, not glucose metabolic rate per se. If you have impaired glucose metabolic rate (e.g., diabetes type two), you can nonetheless keep away from a lot of troubles if you successfully handle your blood glucose stages. You might have to be a bit far more aggressive, incorporating minimal carbohydrate dieting (as in the Atkins or Best diet plans) to the removing of refined carbs and sugars from your diet regime the latter is in a lot of methods similar to adopting a Paleolithic diet. You may have to take some drugs, such as Metformin (a.k.a. Glucophage). But you are undoubtedly not doomed if you are diabetic.

Reference:

Leiter, L.A., Ceriello, A., Davidson, J.A., Hanefeld, M., Monnier, L., Owens, D.R., Tajima, N., & Tuomilehto, J. (2005). Postprandial glucose regulation: New knowledge and new implications. Scientific Therapeutics, 27(2), S42-S56.
Title: Postprandial glucose levels, HbA1c, and arterial stiffness: Compared to glucose, lipids are not even on the radar screen
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