You were just told that your A1C is creeping up and you’ve done your online research, you’ve ordered your supplements, and been down the keto rabbit hole. Now, are you ready to embrace the evidence and do what’s been proven to work?
This comes from the archives of the many patients with high A1Cs in my practice who have reversed their prediabetes and even diabetes.
Western Medicine doesn’t want us to use the term “reverse”, they prefer “remission.” Whatever you want to call it, what I care about is that my patient’s metabolic health is repaired.
Welcome to the Physician-Led Health Coaching weekly newsletter. I’m Dr. Ashori, a board-certified physician & health coach. I help people fix brain fog, fatigue, and stubborn weight before they turn into real disease.
The Heart of Prediabetes
At the core of prediabetes is liver and pancreas fat. It’s not being able to properly use the insulin in your body, which negatively affects your blood sugar.
The problem with prediabetes is that it causes many of the problems you’ll have with diabetes - fatigue, infections, skin and eye damage, higher dementia risk, and joint degeneration.
Fix your metabolic health and you’ll reverse your diabetes risk.
Top 10 Actions in Descending Order
90% of adults only need to do the top 3. That’s it. The other 7 are for very resistant cases or the hardcore dedicated.
1. Fix Body Composition
A DEXA scan is the best place to start. We have tons of data on this, so it’s easy to look at your DEXA Body Composition report and see if you’re lacking muscle and/or too much visceral fat.
Most will achieve this by cutting back on calories and losing weight. But remember that prediabetes is very different from person to person; one having a more dietary issue and another from lack of movement.
2. Increase Your Glucose Transporters
You need many more cell transporters that take the glucose in your blood and store it in your liver and muscle.
The best way is with working out your muscles. Lifting weights or calisthenics works really well. Cardio does too but you’ll have to experiment to see which is best for you.
3. Increase Gut’s SCFAs
Your gut bacteria need fiber to create short chain fatty acids (SCFA) to help improve your body’s ability to manage glucose.
Fiber also blocks some glucose absorption. It won’t block a Coca Cola but if you’re having a healthy meal, the fiber will block any excess glucose from the veggies and scratches from getting absorbed.
4. Drop Your Post-Meal Glucose
Right after eating your body will see the highest spikes of glucose. Lower it by going for a walk right after your meal.
You don’t need a CGM, here. If you’re having prediabetes then you are definitely getting either glucose spikes or long-hauls of elevated glucose. Walk it off.
5. Decrease Fasting Insulin + 2-Hr OGTT
A1C is a very crude marker. If you’re going to do a blood test then do a fasting insulin and a fasting 2-hour glucose tolerance test. This tells you whether your metabolic system is moving in the right direction.
If it’s not then you might need to change the macro composition of your meals or adjust your activity level. Usually it’s the former.
6. Shift Your Calorie Timing
Most of us eat the heaviest meal at night. Don’t worry, you don’t have to starve.
Try having most of your calories early in the day and have larger volume food (read, more fiber) later in the day.
7. Drop Your Cortisol
Cortisol and insulin are fairly proportional for most people. Lowering cortisol helps lower your insulin which is a good thing for your blood glucose because it fights insulin resistance.
Stressed? Meditate or strategize good stress coping mechanisms.
Not getting enough sleep or ruining it with sleep apnea? Bock more time for sleep and wind down your cabeza in the evening.
8. Review Your Medications
There are a few medications that interfere with your metabolism which are worth discussing with your doctor. Any LLM these days can tell you whether your meds are or aren’t a problem and fortunately there are lots of alternatives available for most.
9. Cut Out Your Supplements
Supplements cause more harm than good. That’s what the evidence shows. Try stopping them for 6 months and see how your insulin, OGTT, and A1C respond.
10. Improve Glycogen Storage
We all have glucose in our blood stream but it needs to be tightly regulated. It’s okay to have a giant birthday cake as long as your body can stash that glucose away.
Having a cake right after a tough workout often repletes your glycogen stores which means less sugar floating around in the bloodstream causing damage.
Meds are also great for this. There are lots of options available from metformin to GLP1s. But they won’t rebuild your metabolic system. The other 9 options above will.
Disclaimer:
Dr. Mohammad Ashori is a U.S.-trained family medicine physician. The content shared here is for education and general guidance. It is not personal medical advice, diagnosis, or treatment, and it does not create a doctor-patient relationship. Humans are complicated and your personal details matter. Your healthcare team is your best resource before making medical decisions, changing medications, or managing symptoms. This information is to help you add more depth to those conversations.
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You forgot the strategy that should be number 1 or 2: Change to plant- based nutrition, or at least the Mediterranean diet. Tons of evidence it can prevent, even reverse, type 2 diabetes, high blood pressure, and more. Besides saving the planet. We made the switch 50 years ago. Both 90 and active now. No pills. No supplements. Daily walks. Resistance training 3 times a week.
Great article! Thanks