Science-based lifestyle strategies for lowering HbA1c

If you’re concerned about your risk of developing pre-diabetes or diabetes, you may have heard of the hemoglobin A1C test. But what is it, how is it calculated, and what does it tell you about your health? Before diving into what science has to say about reducing HbA1c, let’s discuss each of these points in more detail.

What is HBA1c?

If you have an excess buildup of glucose, it binds to a protein called hemoglobin in your red blood cells. Hemoglobin A1c (also known as HbA1c) is a blood test used to measure how much glucose is bound to your red blood cells and reflects what percentage of your red blood cells have sugar-coated hemoglobin [

2

]. It indicates blood sugar levels over the last 2-3 months and as such, it’s most often used to diagnose pre-diabetes and diabetes as well as monitor the effectiveness of interventions to manage blood sugar. 

Since symptoms of pre-diabetes and diabetes often go undetected, it’s beneficial to know your A1c level even if you’re not at high risk for developing these conditions.  

Interpreting HbA1c levels

HbA1c measures your average blood sugar levels over the course of the last 2-3 months, and is reported as a percentage [

1

]. This biomarker provides a deeper insight into blood sugar levels, and can help determine if your body is producing enough insulin or encountering insulin resistance. 

Here are what the results of an HbA1c test mean [

1

]: 

• Optimal: Your levels are considered normal if they are below 5.7%. For people without diabetes, the normal range for hemoglobin A1c is between 4% and 5.6%.

• Elevated: If your levels are between 5.7-6.4%, you might be pre-diabetic, which increases your risk of type 2 diabetes, heart disease, and stroke. 

• High: Levels at or above 6.5% are typically an indicator of diabetes, which raises your risk of heart disease, stroke, kidney disease, visual impairment, neuropathy, and various other conditions.  

You should discuss your HbA1c levels with a healthcare provider to determine if a treatment plan is necessary.

What impacts HbA1c? 

Many factors play a role in your A1c level, such as:

• Diet, particularly those high in refined carbohydrates and added sugars, and low in fiber

• Overweight or obese individuals

• Sedentary lifestyle 

• Age (specifically adults ages 45 or older)

• High blood pressure

• Low HDL cholesterol levels

• Race (people of Black, Hispanic/Latino, American Indian, Asian American, or Pacific Islander descent are at greater risk for pre-diabetes/diabetes.)

• Stress

• Certain medications, including glucocorticoids

• Genetics (family history of pre-diabetes or diabetes)

• Pregnancy

• PCOS

Let your doctor know if any of these apply to you to determine if you need follow-up testing.

How to lower HbA1c

Making changes to your diet and lifestyle habits can have a positive effect on HbA1c. Here are some science-backed ways that you can lower HbA1c levels over time. 

Focus on nutrition.

Studies have found that a diet focused on whole grains, lean protein, non-starchy vegetables, and plant-based fat can significantly help with blood sugar control [

4

,

5

]. Conversely, diets rich in refined carbohydrates and added sugar have been shown to increase HbA1c levels, and consumption of those foods should be limited.

Engage in physical activity.

Regular exercise is a great way to improve your A1c. While all forms of exercise offer incredible health benefits, studies have shown that a combination of strength training and aerobic exercise is even more beneficial in lowering HbA1c [

7

]. To reap the benefits, aim for 150 minutes of moderate physical activity/week. Consult with your physician before beginning any exercise program.

Maintain a healthy weight.

If you’re overweight or obese, losing excess weight can greatly benefit HbA1c levels, as research shows a 0.1% reduction in HbA1c for every 1 kg of body weight lost [

3

].

Reduce stress and get adequate sleep.

High stress levels and poor sleep quality have a linear relationship with

weight gain

and elevated HbA1c levels. Studies have found that stress levels cause an increase in A1c, while those who sleep less than 5 hours each night tend to have higher blood glucose levels compared to those who sleep more than 7 hours [

6

,

8

].

If you have trouble falling (or staying) asleep, here are some

supplements that may help

.

Consider a supplement.

According to research, supplementation may help with blood sugar control. Cinnamon, probiotics, berberine, vitamin D, and magnesium are just a few supplements that have been shown to decrease A1c and improve insulin sensitivity [

9

,

10

,

11

,

12

,

13

]. Learn more about supplements for improving A1c

here

. 

While supplementation can be an effective way to lower A1c levels, they aren't a standalone strategy. Talk with your healthcare provider to see which supplements may work best for you.

Summary

HbA1c provides a deeper insight into blood sugar levels, and can help determine if your body is producing enough insulin or encountering insulin resistance. As such, it’s most often used to diagnose pre-diabetes and diabetes and monitor the effectiveness of interventions to manage blood sugar. While it’s recommended to speak with a healthcare provider to determine a treatment plan, you can also lower HbA1c levels through diet, exercise, and other positive lifestyle changes.

Disclaimer: The text, images, videos, and other media on this page are provided for informational purposes only and are not intended to treat, diagnose or replace personalized medical care.