15 Evidence-Based Ways To Lower Your HbA1c

Dr. Alex Wibberley presents the options:

Less glucose, more insulin sensitivity

HbA1c (glycated hemoglobin) is a useful measure, because instead of taking a snapshot of your blood sugar levels in the moment (missing the big picture), it reflects your average blood glucose over approximately 3 months, because glucose irreversibly binds to hemoglobin in red blood cells (Why three months? Because that’s how long RBCs usually live).

This makes it a very strong predictor of many maladies including not just diabetes, but also heart disease, kidney failure, neuropathy, stroke, dementia, and even cancer, and it provides this indicator even when you feel completely well.

A quick word on how it’s measured:

• In most of the world (in fact, the entire world except the US), it’s measured in mmol/mol (the international units)
  • This can be arrived at by measuring how many mmol of glycated hemoglobin there are per mol of hemoglobin
• In the US, it’s measured as a percentage standardized against the 1999 Diabetes Control and Complications Trial (DCCT)
  • This can be arrived at by measuring how many mmol of glycated hemoglobin there are per mol of hemoglobin, dividing by 10.929, and then adding 2.14

However we measure it though, the actual physiology is the same, so without further ado, here are 15 ways to lower your numbers:

• Reduce refined carbohydrates and added sugar: limiting white bread, white rice, pastries, cereals, sugary drinks, and other rapidly absorbed carbohydrates reduces glucose spikes that quietly push hba1c upward over time.
• Increase dietary fiber: aiming for 30–40 grams or more daily from vegetables, legumes, whole grains, nuts, and seeds, as this slows slows glucose absorption as well as supporting a healthier gut microbiome that, as a bonus, further improves insulin sensitivity.
• Get the right amount of protein: eating adequate protein improves satiety, supports muscle preservation, and (due to the metabolic effect of muscle costing energy to maintain) stabilizes blood sugar the rest of the day too.
• Enjoy a Mediterranean diet: a Mediterranean-style diet rich in extra-virgin olive oil, vegetables, legumes, fish, and nuts, and low in ultra-processed food, improves insulin sensitivity and cardiovascular outcomes.
• Achieve sustained weight management: if (and only if) overweight, losing 5–10% of your body weight can lower HbA1c by reducing visceral fat, which is metabolically active (in a bad way).
• Prioritize resistance training: skeletal muscle (which can be built and maintained with resistance training) is the primary site of glucose disposal, and using your muscles further increases glucose uptake independently of insulin, making 2–4 sessions per week very effective for lowering HbA1c.
• Add consistent aerobic exercise: regular moderate activity such as a daily 30-minute walk improves mitochondrial function and insulin receptor sensitivity, with consistency mattering more than intensity.
• Increase daily steps: reducing sedentary time and adding post-meal walks significantly flattens glucose spikes and improves overall glycemic control; this goes even without it being in the realm of what is normally considered exercise (being rather more in the domain of non-exercise activity thermogenesis, which is NEAT).
• Improve sleep: regularly sleeping 7–9 hours improves insulin sensitivity, whereas sleep deprivation can induce insulin resistance comparable to early type 2 diabetes, much more quickly than you might expect (the study linked in the video gives this happening over the course of just 6 nights of 4-hour sleeps).
• Reduce (or ideally eliminate) alcohol intake: alcohol consumption impairs liver glucose regulation, increases liver fat, and worsens insulin signaling, and really is just terrible for everything, including HbA1c levels.
• Reduce visceral fat: visceral fat actively drives inflammation and insulin resistance, but there is some good news, as it also improves itself as overall insulin sensitivity improves through consistent lifestyle change (yes, the kind of lifestyle changes that this list is detailing).
• Manage chronic stress: chronically high cortisol levels increase hepatic (liver) glucose output and receptor-level insulin resistance, meaning psychological stress produces measurable metabolic consequences.
• Consider time-restricted eating: intermittent fasting with an early eating window (i.e. yes breakfast, no bedtime snack) may improve insulin sensitivity and blood pressure by aligning eating with circadian rhythms, though it benefits some people more than others.
• Replace ultra-processed foods with whole foods: ultra-processed diets drive higher calorie intake and weight gain even when compared to a macronutrient-matched whole foods diet, which really highlights the metabolic importance of food quality.
• Consider medication when appropriate: when lifestyle changes are insufficient, medications such as metformin, GLP-1 receptor agonists, and SGLT2 inhibitors lower HbA1c and reduce complications

For more on all of this, enjoy:

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Take care!