HbA1c chart for John

In your blood work, your HbA1c level refers to your glycated hemoglobin, i.e., the sugar (glycogen) attached to the hemoglobin in your blood. Standardly speaking, below 5.7 is non-diabetic. From 5.7 to close to 6.5 is pre-diabetic; above 6.5 is definitely diabetic. Many clinicians think you actually need to be under 5.5. Your A1c is a three-month average score. How do you get a three-month average from a single sample of blood? Your red blood cells have a life span of about three months, so a single blood sample will contain "newborn" cells, middle-aged cells, and senescent cells—a three-month spectrum. That's how that works, and a single day of fasting won't budge that. Here's a handy A1c chart:

If I remember correctly (I'll have to check), I've been as high as 9.6 and as low as 5.7. We now know that diabetes is reversible, but just as it's possible to escape diabetes, it's possible to backslide and fall back into it. It's a constant battle.

Ways to keep your blood sugar low:

• low-carb eating habits

• activities that lower blood sugar, such as long walks and HIIT training

• intermittent fasting*

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*Any food ingestion spikes blood sugar, which spikes insulin. Too many insulin spikes throughout the day will lead to insulin resistance, i.e., to your body's becoming numb to the effects of insulin. Insulin is a hormone that lowers blood sugar, but it also facilitates fat storage, so you really don't want to spike it. Intermittent fasting basically means eating less often, so there are fewer insulin spikes throughout the day. This philosophy also rejects the idea that you should eat many small meals per day: you're simply inviting more insulin spikes when you do that. Bad idea. So numerous meals, frequent drinking, etc., are all bad news: you spike your insulin every time you ingest or imbibe. The ideal might be OMAD: one meal a day, i.e., all of the day's calories consumed in an hour—the ultimate form of intermittent fasting, with only one insulin spike for the day. Most people who practice IF, though, will usually do a 6/18 routine: eat within a six-hour window, then fast for eighteen hours (usually including sleep time). So: eat at noon, then from 5 to 6 p.m., then fast until noon the following day. Researchers now say that "Breakfast is the most important meal" is a load of hogwash, and most American breakfast foods are bad for you anyway unless you eat only eggs, cheese, and sausage seasoned only with salt and pepper. Remember, too, that there is almost no correlation between dietary fat and body fat. Butter doesn't cause heart disease or atherosclerosis: carbs do that. Toast, muffins, syrup, fruit—these all have carbs. And shifting to wheat bread makes almost no difference at all. Carbs are carbs, complex or not. Dr. Sten Ekberg has a ton of videos on the subject. Eat less, eat less frequently, and exercise. Build muscle to increase your basal metabolism and burn more fat. Walking lowers blood sugar, but walking isn't enough by itself to help you to lose weight: adding intensive activities will be more helpful—things that get the heart and lungs going, things that develop your strength and improve your tendons' robustness, things that enhance your flexibility. All signs point to going out and living life. As David Goggins might say, Move your ass!