This is an old table with a new twist: the color code expresses an opinion... MY OPINION. ("Green" is good, but "orange" and "red" and "bright red" and "blood red" are progressively worse!)
4.0% to 4.6% A+ (Excellent)
4.7% to 4.9% A (Excellent)
5.0% to 5.2% B (O.K.)
5.3% to 5.4% C (a bit too High)
5.5% to 5.9% C- (Bad)
6.0% to 6.4% D (Very Bad)
6.5% to 6.9% D- (Very Very Bad)
7.0% or more F (Failure)
(Note: HbA1c values are measured by the number of red blood cells that appear in a certain AREA of the testing laboratory's microscopic view. The table above is adjusted for persons with NORMAL "hematocrit" of 45%.
If you have ANEMIA, ie, your blood cell count by volume is LESS than 40% "Hematocrit", your A1c will appear to be much lower than your actual blood sugars. Therefore, shift the colors to the Right.
Likewise, if "Hematocrit" is 50% or higher, your A1c will read higher than your actual blood sugars would seem to predict, so adjust the colors to the Left.)
It is different from all other tables you might find to convert Hb-A1c to approximate Median Plasma Glucose (MPG), because in this table "Optimal" Hb-A1c for diabetics and non-diabetics is 4.5% or less, and "Good" is less than 5.0 %... Diabetics don't get a break here... There is no forgiveness, and no special mercy for diabetics. You bend or you die, whether it is your fault or not, and whether or not it is more difficult for you than for non-diabetics.
The short advice of this table is: "Keep Your Glucose Levels Tightly Controlled Between 70 and 100 mg/dl all day long, everyday... or else you will pay the consequences."
This is true for everybody: "Diabetics and Non-Diabetics Only"...
NOTE: See another opinion below... Chad: "I feel obligated, based on my knowledge of this subject, to
attempt to prevent people (particularly diabetics) from reading the advice on your website and going out there and attempting it... and
NOTE: My opinion on the table above, which I wrote in 2002, about 4.5 to 4.9 ("Optimal, Good"),
5.0 to 5.4("Good, High"), 5.5 to 5.9 ("Bad"), and 6.0 to 6.5 ("Terrible"), was confirmed in 2011 in a study of 12,589 patients
whose HbA1c was followed for 8 years. See:
Use this table to find your average blood glucose when you know your HbA1c, and to interpret what that means to your health "according to Ellis." If you have checked your glucose levels several times per day for the past few months, you can also use this table to predict your Hb-A1c... (note: If your HbA1c does NOT come out in the vicinity of what was predicted by your average glucose levels, write to me to email@example.com and I will explore the reasons for this with you.)
Hb-A1c = 7.0% is "fine" according to the American Diabetes Association, but it is "Horrible" on my table... greater than HbA1c = 7.5% is either "Deathly" or it is "Suicidal"...
There is a bit of difference: "Deathly" means that high blood glucose will kill you "someday"... "Suicidal" means you are on a fast track to disaster. The difference is the number of years that it will take for high blood glucose to kill you... But rest assured, high blood glucose levels will kill you sooner or later.
Hb-A1c of 7.0 is the incredibly irresponsible, almost criminally negligent, guideline recommended for diabetics by the American Diabetes Association. They say they have an interest in the welfare of diabetics, but they seem to want to keep their patients in a state of chronic illness and dependence upon their member doctors...
If a patient dies in 10 or 20 or 30 years from a stroke or heart attack or cancer, or any other illness caused or aggravated by diabetes, almost nobody will blame a doctor for having caused the patient's death. It is difficult to see a cause and effect between high glucose levels today and cancer or a heart attack or stroke, or kidney damage tomorrow... 10 or 20 years later... Diabetes progresses so slowly that it is difficult to relate today's bad advice with death, 20 or 30 years later...
But I Accuse the A.D.A. of deliberately, or negligently, shortening the lives of millions of patients due to their bad advice, and of both causing and permitting the plague of diabetes on Earth today to grow worse because of their bad advice and leadership. It is obvious that bad health advice today will result in bad health results tomorrow, and there can be no doubt that to recommend blood glucose so much higher for diabetics than what we know is normal for healthy non-diabetics has to be terrible advice.
The only diabetics who can accept a higher HbA1c than normal 85 mg/dl are those who have a digestive problem called "gastroparesis," which makes controlling blood glucose levels very difficult. But higher than normal glucose levels will harm them just the same, whether it is difficult for them to control their blood glucose, or not, so they should do all that they can to keep their blood sugars as close to "normal" as possible.
As I said, there is no forgiveness... high blood sugars will hurt you whether it is your fault or not, whether you can avoid it, or not.
The opinion expressed by the colors and the written portion of this chart is mine, based on the ideas I learned from Dr. Bernstein. But I caution you not to accept what I say because I am not a diabetic nor am I a doctor... Listen to your glucose meter.
Strict control of blood sugar, as taught by Dr. Bernstein, is the basis of my own theory of aging which I follow to slow down aging in my own body. I believe that aging is a direct function of average blood glucose levels, that is: the higher our glucose levels go, the faster we "cook" our body, and the faster we grow older...
Blood glucose is like a "fire within us" that gives us energy. We must keep the flame lit, but we also want it to be controlled, "a friendly fire," and not a blazing fire that is out of control.
Optimum glucose level for a non-diabetic is 70 to 85 mg/dl, and this is also the best glucose level for a diabetic according to Dr. Bernstein. In my opinion, everybody would be much better off in the long run if we would follow Dr. Bernstein's advice to be very strict with our blood glucose control, rather than follow the irresponsible recommendation of the A.D.A. to allow HbA1c of 7.0
My thanks to Dr. Richard K. Bernstein whose story, "My First Fifty Years as a Diabetic" shook me up and inspired me to seek better blood glucose levels in myself also. Now, with the use of Lantus (slow acting) and Humalog (fast acting) insulin, I am able to control my glucose levels all day, every day. - Ellis Toussier
Note: The table to convert Hb-A1c to Mean Plasma Glucose (MPG) is based on the following formulas:
HbA1c = (Mean Plasma Glucose mg/dl + 77.3) / 35.6
HbA1c = (Mean Plasma Glucose mmol/l + 4.29) / 1.98
Mean Plasma Glucose mg/dl = (HbA1c x 35.6) - 77.3)
Mean Plasma Glucose mmol/dl = (HbA1c x 1.98) - 4.29
(To convert from mg/dl to mmol/l, divide mg/dl by 18... or multiply mmol/l by 18 to get mg/dl)
The formulas were calculated by linear regression analysis, which is a mathematical way to predict a point based on known points. The data was obtained by analyzing the results from 1439 subjects enrolled in the Diabetic Control and Complications Trial (DCCT). Correlation between HbA1c and Mean Plasma Glucose (MPG) is not "perfect" but rather only .81 (1.0 would be a straight line, which has "perfect" correlation...) This means that to predict or estimate average glucose from Hb-A1c or vice-versa is not "perfect" but gives a good working ballpark estimate. Afternoon and evening results correlate more closely to HbA1c than morning results, perhaps because morning fasting glucose levels vary much more than daytime glucose levels, which are easier to predict and control.
The formulas are more accurate for adults than for infants or young children. They are not as valid for persons that have blood disorders or different hemoglobin composition other than what is "normal" for adults. If your average blood glucose results over a three month period do not coincide with the values above (plus or minus 15%) then you should get an additional blood test called "Hemoglobin Electrophoresis" which might disclose the presence of sickle cell anemia or other blood disorder.
Blood glucose measured in a laboratory spins red blood cells out of the sample, leaving only plasma. Blood glucose measured in a home glucose meter uses capillary blood, which has a different concentration of glucose. Virtually all new home glucose meters and test strips are callibrated to yield a plasma glucose value, so results should be close to lab readings taken at the same time, but can vary by up to 15%.
Therefore: Use the above table only as a useful tool to have a rough idea of what your average blood glucose was, if you don't already know it.
"It is helpful to measure HbA1c, but it is only a useful guide, very much like measuring the noise output of an engine. But what adjustment you make, and how you control your glucose level, is much more important than focusing on HbA1c or glucose level." - Dr. Jackson Liu
But much better than a rough idea of your average blood glucose based on a single lab reading and a projection of HbA1c, is an exact knowledge of what your average glucose levels have been for the past few months, based on many blood glucose tests before and after every meal, every day.
My recommendation is that everybody, type 1, type 2, and non-diabetics, should test blood glucose several times a day, and then take corrective action when necessary to lower blood glucose. Do what a "Future Diabetic" like me has done for many years to stay healthy and young: check your blood glucose several times a day, every day, and take corrective action when your glucose levels are higher than optimal. There is only one way to know your blood glucose levels, and that is to test them with a glucose meter. 100 tests with a home glucose meter costs about $50 dollars, and the information you get from it is priceless for your health.
I know that I might convince some type 2 diabetics to test their blood glucose more often, but I am not going to convince many non-diabetics to test their blood glucose many times per day. But if you are not diabetic, and if you are interested in slowing down the aging process and thus prolong your good health, at the very least I recommend that you should own a home glucose meter and a box of test strips so that you can test your blood glucose whenever you are curious to see what your blood glucose might be after eating a heavy meal.
If the result scares you, as it sometimes scares me, take corrective action... I inject a small dose of insulin, even if I am not a diabetic, and I test more often. This keeps my blood glucose in a much narrower good range than if I try to control it only with correct diet and exercise, as most doctors tell their diabetic patients to do. There is no doubt that controlling blood sugar will prolong the healthspan of diabetics, so it makes sense that it will extend the life and health of non-diabetics, also.
if you are any type of diabetic, 1 or 2, you should definitely check your blood glucose several times each day, no matter what your doctor tells you the A.D.A. says is not necessary... (The A.D.A. actually say that diabetics type 2 do not need to check their blood glucose every day, for which reason test strips are not covered by many insurance policies... Can you believe the A.D.A. would say this?)
HbA1c, ("H-B-A-one-c" which means "hemoglobin type A, subtype 1c") is a simple blood test which measures the percentage of red blood cells that have been damaged because a molecule of glucose is stuck to the hemoglobin within the red blood cell. To find HbA1c, the percentage of red blood cells that are damaged are counted under a microscope.
The HbA1c blood test shows the average amount of glucose (or "blood sugar") that has been present in your blood over the last two to three months. I call blood glucose "the fire within you" because glucose is the energy that is used by our body. We don't want it to be too low, because we will die without energy, but we don't want it to be too high either, because it will cause a lot of other damage to our health. According to Dr. Bernstein, and also according to my "Glucose Theory of Aging" average blood glucose for diabetics should be the same as that of a healthy non-diabetic.
"Normal" blood glucose is 83 mg/dl. but it increases 20 minutes after eating almost anything. Different foods cause it to go up different amounts. ONE LARGE POTATO or ONE GLASS OF ORANGE JUICE or ONE BREAD ROLL will raise my blood glucose to 160 or 170. So it is not EASY to keep glucose levels below 100 all day long, everyday, as Dr. Bernstein and his students do, but it can be done if you learn to eat correctly. It takes up to two hours for blood glucose to come down in a non-diabetic, or much longer in a diabetic.
According to Dr. Bernstein, diabetes progresses whenever blood glucose is higher than 83 mg/dl... According to me, you grow older faster every second that your blood glucose is higher than the minimum at which it should be... As it goes up, your body temperature rises slightly. Higher body heat causes "an event" which might be the destruction of a Beta cell, and/or the ultimate flow and loss of heat from our body according to the Law of Thermodynamics (which says that heat flows from hot to cold)... and we slowly disintegrate, even if it is only a little, according to the Law of Entropy.
The higher our blood glucose, the more glucose can and does become attached to hemoglobin (the part of the cell that carries oxygen) in red blood cells. This process is called glycosylation (pronounced gli-kos-sil-LAY-shun). Once the glucose is attached to hemoglobin, the red cell is permanently damaged and cannot do its function to carry oxygen anymore. Glucose stays stuck for the life of the red blood cell, which is about 120 days. The higher the level of blood sugar, the more sugar attaches to red blood cells. The hemoglobin A1c test measures the amount of sugar sticking to the hemoglobin in the red blood cells. Results are given in percentages.
The problem in this world is to decide: Who Shall I Believe?
I recommend that you should not believe any "expert"... Don't believe Dr. Atkins... Don't believe Barry Sears, or Dr. Dean Ornish... Definitely don't believe the attrocious U.S.D.A. Food Guide Pyramid, or the American Diabetes Association (A.D.A.)... In fact, you should not believe any doctor or expert... not even Dr. Bernstein...
Don't even believe ME...
You can ONLY believe the glucose meter. Check your glucose level before and after meals, and take corrective action to bring it down "by hook or by crook" to 70 to 85 mg/dl whenever necessary.- Ellis Toussier Bigio, June, 2002
IN DEFENSE OF MY VERY STRICT INTERPRETATION OF BLOOD GLUCOSE:
A1c and diabetes
Date: Sat, 16 Jan 2010
I found your web page while looking at some A1c conversion charts.
You do have some good points on health, but I disagree with your
hypothesis regarding A1c levels.
I am 53 years old and have been an insulin dependent diabetic since
November 1970 (39 yrs 2 months). My A1c used to run in the 7's.
I changed my eating habits in November 2003, lost 40 pounds and my
A1c now run in the 6's.
This has caused my to suffer from low blood sugars more frequently.
As additional information I have not shown any signs of retinopathy,
neuropathy, or heart problems. My eye doctor actually doesn't
believe I have been a diabetic as long as I say.
I just thought you should know that your "opinion" on A1c levels
is just an opinion. You should make that more clear on your web
site so diabetics are not "scared to death" by your chart.
I will say, it was interesting reading. - A Diabetic Type I
Ellis: I will have to answer "in defense" of my very strict
interpretation of blood glucose, which translates to my table of
HbA1c which the writer refers to above.
In short: my interpretation of Blood Glucose as measured with a home blood glucose meter, is as follows:
20 Dangerous Hypoglycemia
30 Hypoglycemia - too low but not yet "dangerous". This is the edge of the cliff, for me.
50 Mild Hypoglycemia - I feel weak, but it is not dangerous, and it is good for my health.
60 Very low
70 to 85 Optimal
110 Very High
200 and more: Attempted Suicide.
So... my HbA1c table says the same thing: 4.5% which corresponds
to 83 mg/dl is Optimal; less than 5.0 is "Good"; 5.0 to 5.4%
(100 to 115) is "High"; 5.5 to 5.9 (118 to 133) is "Bad"; and 6.0 to 6.9 (136 to 168) is "Terrible" or "Horrible"...
So... The 53 year old diabetic type 1 writes to protest that
my table is too strict. He doesn't say where he is on the
6's scale, but he is in the 6's so he is between 136 and 168,
and this, he protests, is NOT "terrible" or "horrible"...
So I am "scaring diabetics to death" when I tell them it is
"terrible" or "horrible".
Let's see what we know from his e-mail:
He is 53 years old. His HbA1c is somewhere in the 6's so it is
between 138 and 168 AVERAGE...
According to him, dropping his average blood glucose has also
caused him to suffer from "low blood sugar" more frequently...
He says he does not have retinopathy (eye problems), neuropathy
(loss of neurons), or heart problems... And his eye doctor
thinks the condition of his eyes is not as "bad" as others he
has seen, so he told him that he doesn't appear to have had
diabetes for 39 years.
He obviously LIKES to get a pat on the back from his eye doctor.
But a pat on the back isn't doing him any favors to his health.
If I was his eye doctor I would tell him to try to get his
average blood sugar lower. I would NOT tell him how well he is
doing, because he can do better. And he would probably CHANGE EYE
DOCTORS if I was his eye doctor and I told him this.
So... the implication is that MY TABLE is wrong because HE
is 53 years old, HIS HbA1c is in the 6's and he says he has
no complications from diabetes, and his EYE DOCTOR also agrees with him...
So... In defense of my table... I AGREE that it is "just my
opinion"... In fact, the very first sentence of my page says
"This is an old table with a new twist: the color code expresses
an opinion... MY OPINION."
So... this is as if I tell you that IN MY OPINION it is safer
to drive no faster than 40 miles per hour, and HE SAYS that he
drives at 70 miles per hour and HE HAS NOT HAD an accident...
and a policeman has told him he thinks he drives very well.
THAT DOES NOT MEAN MY OPINION IS MISTAKEN... it just means that
we are talking of different levels of risk, and he is willing to
take more risk.
I point to the following:
1. 83 is LESS THAN 138... That is a FACT.
It is FIFTY FIVE POINTS less than 138 and it results in
an A1c of 4.5% instead of a 6.0%. THAT IS A HUGE DIFFERENCE.
I HAVE NO DOUBT that persons with 4.5% A1c have less chance of
heart attacks, cancer, and senility than persons with much higher
blood glucose... And this is the reason why I think that 4.5%
is OPTIMUM, 5.0% is GOOD, 5.5% is HIGH, 6.0 - 6.9 is Terrible or
Horrible, and 7.0 and above is DEATHLY or SUICIDAL.
I agree that I might be mistaken. We'll see if the person
who wrote the e-mail is well at age 80, and we'll see if I will
be well at age 80... I DON'T KNOW YET.
I KNOW THAT I AM VERY WELL at age 64, going on 65 (in 2015).
2. Dr. Bernstein's A1c is 4.5% and Dr. Bernstein has been a
diabetic more than 50 years...he has been on insulin since he
was age 12 and now he is about age 75.
Not only is he ALIVE, but he is still working and practicing as
a very good doctor.
So if Dr. Bernstein who has zero help from his pancreas can do it,
every diabetic and every non-diabetic can do it. Period.
3. If he has gotten more hypoglycemia trying to keep his HbA1c
lower than 7.0 it is BECAUSE HE HAS USED INSULIN incorrectly, ie,
too large a dose of long-lasting insulin will cause hypoglycemia. It was
not caused by eating low carbs or exercising too much, his hypo
glycemia was caused in every instance, I will bet, from TOO MUCH (Long-lasting) INSULIN,
at the wrong time.
He doesn't say it in his e-mail, but this is the ONLY cause of
hypoglycemia in a diabetic type 1, so it is HIS FAULT, and his doctor's fault for
not teaching him how to use insulin correctly. (most doctors don't know how to use
insulin correctly, unless they are diabetic and use insulin themselves.)
not mean that my table is mistaken for saying that 6's is TOO HIGH.
Driving at 70 miles per hour is more dangerous ipso facto than
driving at 40 miles per hour, and this is true whether you are
diabetic or not diabetic. As it is true that 6's is too high
"according to Ellis" whether you LIKE IT or DON'T LIKE IT.
Sent: Sun, Feb 27, 2011 2:07 pm
Subject: [Rejuvenation] * * * Ellis, please stop advising people to attempt HbA1c 4.5%
I received an e-mail from "Chad" who I believe is a doctor,
or diabetologist, and who writes among other things:
"I feel obligated, based on my knowledge of this subject,
to attempt to prevent people (particularly diabetics) from
reading the advice on your website and going out there and
attempting it... and killing themselves."
I paste his e-mail below, and I answer, and I have also
posted his e-mail on my page:
and I will also post his warning on my page:
======= Chad's e-mail and my response, below...
I would like to talk about a few things.
First, I am very interested in how your health (and the
health of those that follow your Insulin-blood glucose-HbA1c
advice) is these days.
Ellis: My health is Ultra-good, thank you. I am 65 years old,
and I have been looking at myself in the mirror for many years.
I think I look a bit more beat up than when I was 40, but I
look and walk and talk much younger than most men I know who
are age 65.
(Actually, I look MUCH younger than EVERY man I know who is
age 65... I am not bragging... I AM the youngest 65 year old
man that I know... I really am "The Incredible Dirty Old Man
Who Does Not Grow Older..." )
I don't know about the health of anybody else, but I have not
received any complaints in 13 years since I wrote my anti-
aging program. I am not sure who reads my pages and who
decides to do what, but I receive e-mails almost every day
from people who write to thank me or to say something good
about what they learned from me, including using insulin.
I don't remember ever receiving a complaint about low blood
sugar caused from anything they learned from me. - Ellis
Chad: I would also like to know if you have ever read any
studies (like randomized controlled clinical trials) about
the management and maintenance of blood glucose and HbA1c...
and the beneficial and deleterious effects that it can have
on your health.
Ellis: Yes. I have read some studies. They are all flawed,
because they did not require the subjects to eat low carb,
so that the dose of insulin that they require to regulate
their blood sugar is miniscule.
Chad: Many of the things you mention on your website about
this topic are far from what actual clinical trials would
Regardless of whether maintaining a HbA1c of 4.5% has an
increased ability to prevent the progression of vasculopathy,
neuropathy, and retinopathy than maintaining a 7.0% -- it
has been repeatedly shown to increase the incidence of life-
threatening hypoglycemic events.
I understand your point that maintaining a lower HbA1c may
"prevent aging" by decreasing the deleterious effects that
hyperglycemia can have on the body...
But I must ask - At what cost?
To you, maybe not much... some testing, some insulin, and
But to someone else (who's body may not be as good at
tolerating exogenous insulin), that cost may be death.
Has this occurred to you? Has anyone ever told you? Do you
Ellis: I have only one patient: me. I have never told
anybody to do what I do. If they want to learn from me,
I am happy to teach them. It is very easy to use insulin
But insulin is like a gun... if you don't use it correctly,
insulin can kill. I don't recommend that anybody should
Chad: Your advice may be killing people.
I can say, in good faith, that I have never given someone
health advice that would kill them.
Ellis: Did you ever buy a car for your sons or your daughters?
A car is easy to learn to use, and it is very useful if you
use it correctly... But a car can kill you if you use it
Chad: You make another point (directed at medical doctors and
the ADA) -- that possibly the system is intentionally telling
people to keep their HbA1c at 7.0% so that continue to be
unhealthy and therefore continue to rely on that system for
Have you ever heard of the Hippocratic Oath? No doubt you have.
And you would probably argue that does not mean that every
doctor actually intends to do right by his patients all the
But do you honestly think that the entirety of the medical
community - endocrinologists, primary care physicians,
internists, cardiologists, nephrologists, pediatricians,
Ob/Gyn's, and all of the other doctors (and associations,
like the ADA) that help to take care of people with diabetes
mellitus types I and II are all working in cahoots against
the diabetic population?? If so, I find this an odd opinion
Ellis: This is what I say on my page. I copy and paste:
===== copied from http://www.rajeun.net/HbA1c_glucose.html
Hb-A1c of 7.0 is the incredibly irresponsible, almost
criminally negligent, guideline recommended for diabetics
by the American Diabetes Association. They say they have
an interest in the welfare of diabetics, but they seem to
want to keep their patients in a state of chronic illness
and dependence upon their member doctors...
If a patient dies in 10 or 20 or 30 years from a stroke
or heart attack or cancer, or any other illness caused
or aggravated by diabetes, almost nobody will blame a
doctor for having caused the patient's death.
It is difficult to see a cause and effect between high
glucose levels today and cancer or a heart attack or stroke,
or kidney damage tomorrow... 10 or 20 years later...
Diabetes progresses so slowly that it is difficult to
relate today's bad advice with death, 20 or 30 years later...
But ***I Accuse*** the A.D.A. of deliberately, or
negligently, shortening the lives of millions of patients
due to their bad advice, and of both causing and permitting
the plague of diabetes on Earth today to grow worse because
of their bad advice and leadership.
It is obvious that bad health advice today will result
in bad health results tomorrow, and there can be no
doubt that to recommend blood glucose so much higher
for diabetics than what we know is normal for healthy
non-diabetics has to be terrible advice.
Ellis: I said: "They *seem* to want to keep their patients in
a state of chronic illness..." They DO SEEM to want to keep
their patients in a state of chronic illness.
READ DR. BERNSTEIN's "My Fifty Years as a Diabetic" and you
will see that HE AGREES WITH ME.
Also... Read Part 2 of this post, which is Dr. Bernstein's
answer to Diane Schafer, LDN, RD, CDE.
Dr. Bernstein wrote these paragraphs below, so you will
see that I am not alone in my feeling that the A.D.A. is
deliberately or negligently responsible for the diabetes
epidemic on planet Earth, because of their mistaken advice
to recommend HbA1c = 7%...
========= From "My First Fifty Years as a Diabetic"
Charlie Suther was travelling around the country to
university research centers with copies of my unpublished
article. The rejection by doctors of the concept of blood
sugar self-monitoring was so intense, however, that the
management of his company had to turn down the idea of
making meters available to patients until many years later.
The backlash from the medical establishment prevented it
on a number of counts. It was unthinkable for patients to
be allowed to "doctor" themselves. They knew nothing of
And if patients could take care of themselves, how would
doctors earn a living?
By this time, I was being invited to speak at international
diabetes conferences, but rarely at meetings in the United
States. Curiously, more physicians outside the United States
seemed interested in controlling blood sugar than did their
Much of what I will cover in this book is in direct opposition
to the recommendations of the American Diabetes Association
(ADA) and other national diabetes associations.
Why? Because if I had followed those guidelines, they would
have killed me long ago.
Such conflicts include the low-carbohydrate diet I recommend;
the avoidance of oral agents (such as sulfonylureas) that burn
out surviving insulin-producing beta cells in type 2 diabetics;
my utilization of certain nutrients to lower insulin resistance
(new to this edition); my preference for certain insulins
over others, which I avoid; my desire to preserve remaining
beta cells (an alien concept to traditional practice); and
my insistence that diabetics are entitled to the same, normal
blood sugars that non-diabetics enjoy, rather than the ADA's just-sort-of-in-the-maybe-normal range.
Most important, unlike the ADA guidelines, ours work."
- Dr. Richard K. Bernstein (from the introduction to the new
edition of "Diabetes Solution") .
Chad: Another point you make, which actually is not that
bad, is that a lower HbA1c probably decreases your risk of
developing certain hyperglycemia-related complications
(retinopathy, vasculopathy, neuropathy, etc).
Which is almost definitely true according to the evidence.
So I applaud you on your benevolent attempt to relay this
message to all diabetic and non-diabetic peoples.
Ellis: HbA1c is the percentage of red blood cells that have
been DAMAGED by blood sugar. 4.5% is "OPTIMAL" because it
is 25% fewer damaged cells than 6.0% and nearly 36% fewer
damaged cells than 7.0% And BLOOD touches EVERY SINGLE
CELL in our body...
It is MUCH BETTER for a cell to be touched by blood with
83 mg/dl sugar than with 133 mg/dl or 160 mg/dl sugar.
FEWER CELLS are damaged when blood has 83 mg/dl than when
blood has 50 points MORE SUGAR.
Chad: But did you know, however, that "intensive glycemic
control" has been shown to have a two-fold increase in the
incidence of "severe hypoglycemic events?"
I will define (as the studies defined) the terms I have in
quotes, so that it is more clear: "Intensive glycemic control"
in these studies was no where near the 4.5% HbA1c that you
preach - it was less than 7.0% with a goal of 6.0%.
And "severe hypoglycemic events" was defined as a hypoglycemic
state that resulted in the affected person requiring the
assistance of another person.
Assistance for what? - You might ask. In most cases -- for
anything. These people have severe enough hypoglycemia that
they are unable to even drink a coke to raise their blood
sugar... they're lying on the floor, moaning and writhing
in fear... hoping that someone comes to help them... so they
Many of these people would have died if not for the assistance
of other people. And many others did die because they were
unable to get the assistance of another person.
Ellis: The problem is not that my table is mistaken. My
interpretation of blood glucose is correct, according to
what we know of telomere shortening.
The problem is that they overdosed on insulin. IT IS THE
HIGH-CARBOHYDRATE DIETS COVERED BY MEGADOSES OF INSULIN
THAT INCREASE THE LIKELIHOOD OF HYPOGLYCEMIA.
This is a problem caused by DOCTORS who don't teach their
patients to use micro-doses of insulin, as Dr. Bernstein
Chad: What I am trying to say is --- please stop advising
people to attempt to attain an HbA1c of 4.5%. I understand
that you are able to do this and feel that it has benefited
your own health.
But you have not done randomized controlled clinical trials,
or retrospective cohort studies, or prospective cohort
studies, or meta-analyses to determine the affect it might
have on other people (if you have, I would like to hear
There have been several studies of all of these types done
that have repeatedly and consistently shown that the lower
a person's HbA1c goal is below 7.0% the higher and higher
his/her incidence of severe hypoglycemic events becomes.
I can not even imagine what the incidence of these events
would be in a trial that had people try to attain a 4.5%.
It would be illogical, and what's worse - unethical to even
Several studies were even stopped early (on an ethical basis)
because the incidence of severe hypoglycemic events (and
resulting deaths) at lower HbA1c levels was killing too many
people as to continue the trial.
I feel obligated, based on my knowledge of this subject, to
attempt to prevent people (particularly diabetics) from reading
the advice on your website and going out there and attempting
it... and killing themselves.
And as part of the Hippocratic Oath -- "I will apply, for the
benefit of the sick, all measures that are required, avoiding
those twin traps of overtreatment and therapeutic nihilism,"
and "I will remember that I do not treat a fever chart, a
cancerous growth, but a sick human being," and "I will prevent
disease whenever I can" --
Ellis: Hello Chad. Welcome to Rejuvenation. And thanks
for writing that I should not advise people to attempt
But I never gave such advice. My table says that 4.5% is
Optimal. It is optimal. That is what it is. I never said you
should or should not try to get it. If you want to keep
your telomeres long, you should avoid or delay cell damage
as much as you can.
I can understand that you don't agree with my table. But
my table is right. What is wrong is that somebody dies
because he doesn't eat correctly and then he overdoses on
oral medicines that cause the pancreas to release insulin,
(which burns out the pancreas...) or they overdose on
My table does not give advice. It says what is. I give
an interpretation of what the various blood glucose means,
but that is just MY OPINION. It is not advice.
HbA1c of 4.5% is OPTIMAL, because it is as good as it gets...
That is like saying, "it is better to live a long and healthy
life than to live a short and unhealthy life." It is... from
my interpretation of how I wish I will live.
If it goes lower, it is too low, if it goes higher, it is not
as good because the damage to cells is greater, so cells will have to divide sooner to repair themselves, and therefore telomeres will be shortened faster.
4.5% (83 mg/dl) is simply the BEST average glucose that you
can have, because it is what NORMAL HEALTHY NON-DIABETICS
have, and as Dr. Bernstein says, "it is essential to the best
thing that can be offered to us short of a cure... normal
my interpretation of Blood Glucose is as follows:
50 and less: Hypoglycemia - too low.
60 Very low
70 to 85 Optimal
110 Very High
200 and more: Attempted Suicide.
So... my HbA1c table says the same thing:
4.5% which corresponds to 83 mg/dl is Optimal;
less than 5.0 is "Good";
5.0 to 5.4% (100 to 115) is "High";
5.5 to 5.9 (118 to 133) is "Bad";
and 6.0 to 6.9 (136 to 168) is "Terrible" or "Horrible"...
Of course, if you DIE trying to get 4.5%, you will age
very very fast. I don't want you to age so fast.
I have seen diabetics inject 50 iu of fast acting insulin.
That can certainly kill. It doesn't matter if their blood
glucose is 350... (it should never have gotten to 350 in the
first place, and if it did, it is the fault of the doctor
who recommends that his patient can eat a high carb diet
and balance it with a mega dose of insulin.)
Even with blood sugar at 350, it is madness to inject a
mega dose of insulin.
So, Chad, please tell us YOUR interpretation of blood sugar,
and I will add it to my page, so that everybody can
decide WHO do they want to believe.
I always tell everybody that I am not a doctor, so please
don't do what I do, and don't believe me, unless YOU decide
to do it yourself because you think I might be right.
NOBODY KNOWS if I am right or wrong, but I know I am VERY
HEALTHY at age 65.
Does anybody want to lose a bet? I will bet that I am
right, who wants to bet that I am wrong? No money, just
a "Gentleman's bet..."
Thanks for your e-mail criticizing my interpretation of
HbA1c but PLEASE tell us YOUR interpretation, and why
you believe it to be correct.
Diabetics and Doctors, I would like to hear your opinions
too. Support my interpretation, or attack my interpretation
of blood glucose, but please write and don't stay silent.
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This page created November, 2011