One break is a question. Three are a finding.

Hey Reader, Dr Karl here.

What I think is happening, and what I cannot prove.
I ruled things out before I landed anywhere.

Was her blood sugar getting worse? No. ​
Glucose fell 16 points over the four years and direct monitoring agreed.

Was she iron deficient, which genuinely does distort A1c? No. ​
Serum iron fell from 105 to 85, but ferritin nearly doubled, 160 to 288.
That is not depletion.

Was it a lipid shift? No. ​
HDL went 58, 63, 76, 64. It wandered and came back.
It cannot explain a one-directional four-year move.

Did she gain weight?
The opposite. Eleven pounds off.

So what did move together?

Her red blood cell count fell, 4.91 to 4.5 million.
Her hemoglobin fell, 15.2 to 14.1.
Her hematocrit fell, 46.4 to 43.6.
And her A1c rose.

Three independent markers, all pointing the same way, in the same person, over the same four years.

My read: her red cells are living longer. ​
A cell that survives longer spends more time in circulation collecting glucose,
so each one carries more glycation even though her blood sugar went down.
​
And when cells last longer, the body needs fewer replacements, so the count drifts down.
Fewer cells, each carrying more.

Now the honest part. I cannot prove this in her.

What is not circumstantial is the mechanism. ​
A 2023 review in Diabetes Technology and Therapeutics states plainly that A1c is subject to distortions related to altered red blood cell properties, including changes in cellular lifespan, and that the ordinary variation between people is large enough to alter clinical interpretation. ​
​
​That is their language, not mine.
I found it in one woman’s labs before I found it in the literature.

One break is a question.
Three pointing the same way is a finding. Full Story video Here.

~Dr. Karl Goldkamp
Keto Naturopath

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