How do you lower your Hemoglobin A1C (HbA1c) levels?

How to Lower Your A1C

The most effective way to lower your A1C is through a combination of dietary changes focusing on carbohydrate reduction, regular physical activity, weight management, and appropriate medication use when necessary. 1, 2

Understanding A1C

A1C (Hemoglobin A1C or HbA1c) is a blood test that measures your average blood sugar levels over the past 2-3 months. For most adults with diabetes, the American Diabetes Association recommends a target A1C of less than 7%, though targets may vary based on individual circumstances 2.

Dietary Strategies

Carbohydrate Management

• Reduce overall carbohydrate intake: Low-carbohydrate eating patterns have shown strong evidence for improving glycemia and reducing A1C 1
  • Target 30% of total energy from carbohydrates (versus the conventional 50%) 3
  • Focus on high-quality, minimally processed carbohydrates high in fiber 1
  • Consume at least 14g of fiber per 1,000 calories 1
  • Minimize intake of refined carbohydrates and added sugars 1

Protein and Fat Intake

• Increase protein intake to about 30% of total energy (versus conventional 17%) 3
• Cook with healthier oils like olive and canola oil instead of saturated fats 1
• Include lean sources of protein, including plant-based options 1

Meal Planning

• Monitor carbohydrate intake and consider its effect on blood glucose 1
• Plan meals ahead of time to ensure balanced nutrition 1
• Ensure adequate carbohydrate intake (at least 150g/day) before A1C testing to avoid falsely elevated results 1

Physical Activity

• Aim for at least 150 minutes of moderate-intensity physical activity per week 2
• Include both aerobic exercise and resistance training 2
• Even modest increases in physical activity can help lower A1C levels 4

Weight Management

• For those who are overweight, aim for 5-10% weight loss 2
• Even modest weight loss can significantly improve glycemic control 3, 5
• A study showed that participants following a carbohydrate-reduced diet decreased their A1C by 0.7% compared to a conventional diet, even with similar weight loss 5

Medication Management

• If lifestyle changes aren't sufficient, medications may be necessary 2
• Metformin is typically the preferred first-line medication for type 2 diabetes 2
• Other medication options include:
  • Sulfonylureas
  • DPP-4 inhibitors
  • SGLT2 inhibitors
  • GLP-1 receptor agonists
  • Insulin therapy for more severe cases 2, 6

Monitoring and Adjustments

• Regular blood glucose monitoring helps track progress 1
• Target fasting plasma glucose of 70-130 mg/dL 1
• Target postprandial glucose (1-2 hours after meals) of less than 180 mg/dL 1
• Regular A1C testing (typically every 3-6 months) 1

Recent Research Highlights

• A 2022 randomized clinical trial found that a low-carbohydrate diet (less than 40g net carbs initially, then less than 60g) led to significant A1C reductions (-0.23% compared to usual diet) over 6 months 7
• A 2019 study showed that substituting carbohydrates with protein and fat for 6 weeks reduced A1C by 0.6% and decreased liver fat content in people with type 2 diabetes 3

Important Considerations

• A1C results may vary based on race/ethnicity and presence of certain conditions like anemia, hemoglobinopathies, or kidney disease 1
• If you have conditions affecting red blood cell turnover (like sickle cell disease, pregnancy, or hemodialysis), A1C may not be reliable 1
• Marked discrepancies between A1C and blood glucose levels should prompt consideration of using alternative testing methods 1

By implementing these strategies consistently, most people can achieve significant reductions in their A1C levels, improving both short-term blood glucose control and long-term health outcomes.