Physicians Should Not Use HbA1c Alone to Screen for Diabetes

Greetings,

In case you missed it, in my last newsletter, I shared a new article that explores the manifestations of under-fueling in female athletes. You can read that article here.

In this issue, you can find the following:

• Practice News: Welcoming new patients in CA and VA; TX coming soon.
• New Article: “Physicians Should Not Use HbA1c Alone to Screen for Diabetes”
• Testing New Device: O2 Trainer

Practice News: Welcoming new patients in CA and VA; TX coming soon.

Residents of Pennsylvania, Maryland, South Carolina, California, and Virginia are now welcome to join the practice. Texas is in the works. I’m hoping it will be completed within several weeks at most.

If you’re interested, you can read more about my practice or schedule a free discovery call.

Feel free to contact me using this form or by replying directly to this email.

“Physicians Should Not Use HbA1c Alone to Screen for Diabetes”

You can read this new article on my website or my Substack.

Summary

In this article, I make the argument that the HbA1c test, despite its popularity, is a blunt and inadequate instrument for diagnosing diabetes. By the time an individual is diagnosed with diabetes based on an A1c greater than 6.5%, they are already at risk for complications like nephropathy and retinopathy.

A serious approach to longevity requires early detection and prevention of disease, not identification of disease when it’s already reached an advanced state. To this end, I explore the utility of measuring fasting insulin levels to detect insulin resistance before an individual develops diabetes.

I discuss the challenges in interpreting fasting insulin levels, but ultimately advocate for its use within a comprehensive approach to the assessment of metabolism, insulin resistance, and glucose tolerance.

Topics covered within the article:

• A brief description of the nature of type II diabetes and the history of its diagnostic criteria
• An explanation of hemoglobin A1c, how it’s measured, what it represents, how its use is recommended by the guidelines, and its shortcomings
• A discussion of insulin resistance as the precursor to type II diabetes
• A brief history of the insulin assay, the utility of measuring fasting insulin levels, and how to interpret the results
• An indication of a comprehensive strategy for recognizing and reversing insulin resistance

You can read this new article on my website or my Substack.

Testing New Device: O2 Trainer

I’ve been using a device called the O2 Trainer for about a week now. The device is designed to train the respiratory muscles by providing resistance during inspiration. It’s a mouthpiece with a set of progressively smaller apertures through which the user breathes. As you become stronger, you can decrease the size of the aperture, thus increasing the resistance during inspiration. I first learned of this device while listening to retired MMA fighter Bas Rutten on Tim Ferris’s podcast episode #621. You can watch Bas demonstrate the device on Youtube.

The concept of training respiratory muscles appeals to me because I do experience respiratory muscle fatigue early during my cardiopulmonary and metabolic training. I also have occasional problems with reactive airway, especially in the cold or during allergy season. Finally, there is compelling data suggesting that training of the respiratory muscles has benefits for blood pressure, arterial compliance, nitric oxide production, and other cardiovascular measures that correlate with long-term health.

You can buy the O2 Trainer from Amazon (associate link) or Rogue Fitness.

I’m curious if anybody is using this device, or other similar devices (e.g. POWERbreathe K3).

I’m planning to write an article about the concept and utility of respiratory muscle training in the near future and I’m interested in hearing about your experiences.

-Steve