Hard evidence of benefits of A1C in the 4s?

Hi all,

I just recently started reading Dr. Bernstein's Diabetes Solution, and I'm undecided about whether I'll give the program a try (I was dxed almost exactly 8 years ago as a t1). What I'm concerned about is that there is no evidence cited in the book (aside from anecdotal evidence from Dr. Bernstein himself and his patients) that an A1C in the 4.2-4.6 "normal" range for non-obese non-diabetics is actually a significant benefit vs. perhaps an A1C of about 5.5, which I have achieved before without resorting to such drastic carbohydrate restriction.

Does anyone know if there actually is some evidence from a large-scale study that there are significant reductions in risk between an A1C of ~5.5 and A1Cs in the 4s?


I think this carbohydrate debate for diabetics will never end and diabetics should pick the best eating plan for themselves. I believe simple carbs not complex carbs is the enemy , it's crazy to ban all carbs. Diabetes should stick to eating high fiber,whole grain complex carbs ( small portion). Are we every going to get a reliable study on A1c and Dr Bernstein diet or other carb diets? ??

When I read your question the first answer I had of the top of my head was the Norfolk EPIC trial - not sure of the reference but ran in Cambridge UK. I might have this wrong but believe it looked at NON diabetics re heart disease and found increased risk for every point increase in HbA1c (ie they measured HbA1c in non diabetic patients as part of the heart disease trial). So even in non diabetics a lower HbA1c seems to stop clogging arteries...

As far as I'm aware, the predominant view of the medical profession is still that "Tight control" is harmful. Of course it is when achieved by using large doses of varieties of medications.
Studies tend to be funded by the drugs industry and there's no profit to them in a low carb way of eating. Unless one of the charities picks up on it, It seems unlikely that anyone will study A1cs in the 4s.
PS I'm consistently in the 5s myself

Agreed - again only off the top of my head but i believe there are 3 or 4 more recent trials of tight control all showing worsened outcomes (!). However this is probably in the face of normal carb intake hence much larger doses of glucose lowering medication (insulin, glipizide etc). Whilst all these agents are good (by lowering blood sugar) too much of them causes problems (many have side effects and at higher doese will have bigger side effects. Large doses of insulin risk hypos which leads to sympathetic nervous system response which can lead to heart problems - especially if already suffering vascualr damage from glucose). The early trials showed better control improved outcomes (tho there they were going from HbA1c of say abvove 9 to (say??) 7 - so still high levels by Bernstein so probably not applicable to this argument. Does having an HbA1c in the 4's help?? I don't know but I think that the higher your A1c's the worse things are. Whether if your A1c is normal you should go lowere I don't know (other than Norfolk EPC mentioned above). On this reasoning I am guessing tight control via a low carb diet (hence minimising amount of medication required to get that control) is probably the best way to go and is how i approach things. I follow Bernstein, take about 16 U total insulin per day (3U long acting morning and night and 2.5-3.5 U per meal plus an occasional 0.5-1U if my CGMS shows glucose of 5 mmol (90mg/ml) (checking first with fingerstick). I have had a few HbA1cs of 4.7 or so but only on testing each month using the home HbA1c testing kits. My lab value is 5.0 and i have failed to yet get a lab in the 4's (which surprises/disappoints me! - still shall see next time!). I think Bernstein may have some disadvantages such as restricted diet, lowering salt but I guess you can adapt to these over time. Dr B appears to follow a punishing exercise schedule on his v low carb intake...
PS I have only had chance to run 2 lab results compared to the HbA1c now home kit but both values were close (0.1 (1.8mg/dl) out and 0.3mmol (5.4mg/dl) out. Best wishes, Ralph

Having studied biochemistry a tundergraduate level [in the UK 40 years ago!] I have serious reservations about the distinction between simple and complex carbs. If your complex carb is "cellulose" It is hardly broken down by digestion and has minimal effects on blood glucose. If it's "Starch", it's rapidly broken down and causes spikes. Sucrose is described as a simple sugar, yet only half the molecule is Glucose. the other half is Frucose, which doesn't affect blood glucose levels.
GI tables show quite clearly that the speed at which a carbohydrate is broken down is not directly related to the size of the molecule. Just check out GI for bread, which is full of starch.
Many people truly think that starch as a "Complex carb" is broken down to glucose slowly. It isn't. Providing the starch has beeen cooked, the process is pretty fast.

I am in agreement with you Hana Rous, I experimented with my diet (which I recommend everyone do) and discovered that Starch is my enemy, bread, rice, pasta, potatoes. I eat fruit and veg every meal, and yes, it does raise my BG but I do not get the spikes like I do with starch. I have read a lot about whole grains and complex carbs but I just follow my meter (YMMV) though lately I don't test as much as I have in the past, I just kind of feel my way through it.