Quick reduction of hba1c and risk of dementia

chrisjohnh said:

Just to throw another spanner into the works in this fascinating thread (apologies Mods!) I was consumed yesterday in reading a paper giving evidence that those like me who are in our older years and have reduced A1c a great deal in a short time have thereby doubled our risk of dementia. Great! I don’t think Prof Taylor thought to do MRI on brains as well to monitor this. It’s all enough to make one crazy (well, look at me). I think I will now have my third tiny morsel of chocolate in two years and do a self-test with the Times crossword.

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Not really connected to ND is it? There is very little fat in the brain.
However there is a growing acceptance that there is a link between Type 2 Diabetes and some forms of dementia, to the point where there is a movement to class alzheimers as Type 3 diabetes but that is not resolved

This paper is behind a paywall, as all Lancet papers are now that Elsevier has taken it over. But there is an interesting list of referenced papers at the end of the abstract.

Oldvatr said:

There is very little fat in the brain.

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" The human brain is nearly 60 percent fat." ?

chrisjohnh said:

Just to throw another spanner into the works in this fascinating thread (apologies Mods!) I was consumed yesterday in reading a paper giving evidence that those like me who are in our older years and have reduced A1c a great deal in a short time have thereby doubled our risk of dementia. Great! I don’t think Prof Taylor thought to do MRI on brains as well to monitor this. It’s all enough to make one crazy (well, look at me). I think I will now have my third tiny morsel of chocolate in two years and do a self-test with the Times crossword.

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Do you have a link to the paper?

How had they reduced the HbA1c in a short time?
Drugs or some other method?

In my experience of going from a non keto diet to a fasting test in hospital for over four days to a keto diet afterwards. My brain switched back on!
the continuous cycle of high spikes and hypos were very similar to losing so much memory especially memories of the past few years. But since, it's like a light went on and my recent memories are very good for an old codger of my age.
the interesting item that I'm fascinated with is the amount of fat in the brain, could this be natural fats, which could be associated with similar natural fats in other mammals?
And avoidance of these fats could be detrimental to everyone's health?

i stand corrected. The brain needs fat intake and largely Omega 3 fats. So there may be a concern for the ND diet,which is a crash diet, and an ultra low fat diet too. It may be starving the brain of this nutrient during the intense (8 week) phase. So dropping the A1c may indeed also lead to cognitive decline, which was not monitored during the studies. however, it would apply to any crash diet, and this is not a noted side effect of these diets. It would also surface in any population that a starvation diet would lead to a high incidence of dementia, so I do not think this is a significant effect. The risk may be high, but as has been said many times, the use of Relative Risk statistics can give a wrong impression.

Was it this study?
This paper looks a HbA1c vs dementia, but it does not drop the hba1c suddenly. so steady state conditions show that both high (>8%) and low (<5%) glucose levels make dementia more likely

Or there is this one

This one seems to imply that ANY change in HbA1c is a predictor of dementia coming dow n the track. Raising or lowereing hba1c seems to indicate a worsening outcome. Damned if you do, damned if you don;t.

The thing is, almost no matter what turns up, another report will come up to refute that assertion.

again, and again, it comes back to reading, and reading balance, then applying your own risk parameters.

I am low carb, and reduced my a1c from 73 to 37 in under 4 months. I might be a trifle eccentric, but I don’t believe I have dementia. Should I develop it in my autumn years I’ll still stand by the health bets I place in 2013 and since.

Make a decision, own that decision.

chrisjohnh said:

It’s probably best that we all stop reading these papers and just focus on enjoying our salads!

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Whats a salad? Is ir Tuesday? What did I have for breakfast? Papers are useful for putting under the cats litter tray.

For a minute I thought you might have posted a link to the one you read yesterday. I think it is important that we follow the research into a condition that can affect any one of us, and may be linked to our diabeets. That is why this thread suddenly jumped from the frying pan to this place in sole glory. I welcome such discussion

Vascular dementia is caused by reduced blood flow to the brain. Atherosclerosis will cause narrowing of the arteries and capilliaries leading to this condition. not sure why a sudden drop in A1c would cause this to worsen.

in my case my atherosclerosis was caused by 30 years of cigarettes and booze, My strokes successfully destroyed half my brain capacity so technically I have dementia, but I would not say it was due to my A1c levels. But I was able to work on past retirement date designing complex computer control systems.

chrisjohnh said:

I should have confirmed that the paper I’d read was indeed the second of those you cited above. Sorry for leaving that hanging.

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Thank you. i have just said good bye to my Xmas bottle of whisky, so I will review it in more detail. later since I think the doubling of risk does not tie up with real life experience. Night night (hic)

Lamont D said:

In my experience of going from a non keto diet to a fasting test in hospital for over four days to a keto diet afterwards. My brain switched back on!
the continuous cycle of high spikes and hypos were very similar to losing so much memory especially memories of the past few years. But since, it's like a light went on and my recent memories are very good for an old codger of my age.
...

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I agree with @Lamont D - I switched back from several years spent as a befuddled brain dead zombie to a thinking being again. I was eating a high carb diet during that zombie period, but after T2 diagnosis and immediately starting to cut out carbs, my HbA1c rapidly reduced to pre-diabetic levels, and my brain worked as it should again. I'm now 80 and my dozy old brain has been running quite happily on its keto based fuel for the past 9 years now.

Dementia isn’t something that switches on like a switch. We ‘cultivate’ it for decades before it becomes so obvious it gets diagnosed.

My father was diagnosed with Alzheimer’s at 87, which was 20+ years after he slowed down his responses to questions, and became tunnel visioned during certain activities. Also started to lose his navigation skills and (slowly) to lose his problem solving capacity. He kept his sudoku abilities to near the end. Each symptom developed at glacier speed and was only noticeable in retrospect.

We can fight the foreshadowing of Alzheimers all our youth and middle years, with a combo of good diet (omega 3s, since the brain is largely fat, and certain key nutrients), mental challenges, physical activity, and so on. Genetics and family history also play a large part.

So it actually astonishes me that any study can link dementia (of any kind) to a single bout of rapid HbA1c reduction.

My personal view is that a bigger factor is likely to be the hyperinsulinaemia which predated (and probably post dated) the rapid A1c reduction. Or chronic inflammation. Or the endless nutrient poor carbs we are all encouraged to eat. Or malnutrition due to 30 years of dieting. Or sleep apnea (also v common in T2s)…

And if we rapidly lower A1c in (for example) our 50s, are now in our 60s, and won’t develop dementia til our 80s, then can we really blame a rapid HbA1c reduction 30 years earlier? How do we even identify that link?

AndBreathe said:

The thing is, almost no matter what turns up, another report will come up to refute that assertion.

again, and again, it comes back to reading, and reading balance, then applying your own risk parameters.

I am low carb, and reduced my a1c from 73 to 37 in under 4 months. I might be a trifle eccentric, but I don’t believe I have dementia. Should I develop it in my autumn years I’ll still stand by the health bets I place in 2013 and since.

Make a decision, own that decision.

Click to expand...

Only way to never make a bad decision
Is to never make any decision .


Fully agree,
read up, reference it, make it personal.

I agree the posts & discussions are very interesting @Oldvatr .

Having been up close & personal with my mum's decline.

I took great notice of possible links once I was DX'd and read dementia 'might' be a form of diabetes.

Personally, if BG levels can affect so much of our bodies, is it really a stretch of imagination to consider the damage it could be doing to the pathways in our brains ?

As for HBA1c.
I'm with @Brunneria point.

And think it MUCH more likely it is the years ( & decades likely ) of undiagnosed diabetes that causes the damage NOT the response to the warning once
DX 'd that causes many to reduce their BG/HBA1c levels.

Though I do wonder about how sensible the near starvation level of ND or crash diets could be, could the same be said for any long term fasting ?

Ok looking at that second study, it was a large case study (n=18,298) and had the follow up at 6 years after baseline. All participants were dementia free at initial assessment were all established T2D, and the study reports on those that were dx'ed with dementia at the study follow up.

However Table 1 is a comparison at 6 years that has much smaller participation numbers in the follow up, than the apparent baseline. so it is not clear how these were selected for this Table. Going by the Table 1 figures, it seems that at 6 years, 2004 subjects were still dementia free, and 242 had dementia. The table then examines these groups in terms of their Hba1c.

So the first observation is that only 12% of the observed group at 6 years had developed dementia which is relatively low. we do not get insight as to what proportion of the total baseline group also developed dementia or how this group compares to a homgenous public grouping or how it compares to the non diabetic community. It seems to be a very narrow selective slice. In other words, it is not a very useful study.

Second point is that most T2D elderly patients tend to be what we would call progression diabetics, who either are or will be insulin users. So hypoglycemia is a real possibility especially if dementia is taking hold slowly in the background. So an increase in hospital admissions in that group is not unexpected if tight glycemic control is attempted. The minimum age of 65 means that most participants will be 71 or more when the study follows up, and wil be generally more prone to falls and fits and frailty due to ageing, so using hospital admissions as the main criteria is probably invalidated due to the test subjects becoming invalid. As one at that stage of life I am personally lucky to be relatively able, but I know many younger than me who are struggling.

So I would not put my faith into this report. I suspect that any effect of the HbA1c is due to problems of treatment, not the glycation effect.

Brunneria said:

Dementia isn’t something that switches on like a switch. We ‘cultivate’ it for decades before it becomes so obvious it gets diagnosed.

My father was diagnosed with Alzheimer’s at 87, which was 20+ years after he slowed down his responses to questions, and became tunnel visioned during certain activities. Also started to lose his navigation skills and (slowly) to lose his problem solving capacity. He kept his sudoku abilities to near the end. Each symptom developed at glacier speed and was only noticeable in retrospect.

We can fight the foreshadowing of Alzheimers all our youth and middle years, with a combo of good diet (omega 3s, since the brain is largely fat, and certain key nutrients), mental challenges, physical activity, and so on. Genetics and family history also play a large part.

So it actually astonishes me that any study can link dementia (of any kind) to a single bout of rapid HbA1c reduction.

My personal view is that a bigger factor is likely to be the hyperinsulinaemia which predated (and probably post dated) the rapid A1c reduction. Or chronic inflammation. Or the endless nutrient poor carbs we are all encouraged to eat. Or malnutrition due to 30 years of dieting. Or sleep apnea (also v common in T2s)…

And if we rapidly lower A1c in (for example) our 50s, are now in our 60s, and won’t develop dementia til our 80s, then can we really blame a rapid HbA1c reduction 30 years earlier? How do we even identify that link?

What's the relationship between diabetes and dementia? - Harvard Health

It has been known for many years that type 2 diabetes increases a person's risk for stroke and heart disease, and more recent studies have shown that diabetes also increases risk of dementia. But n...

www.health.harvard.edu

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this report is interesting. It starts off talking T2D and then ends up saying tight glyccemic control causes memory loss and damage to the hippocampus through hypoglycemia. So it seems that they are only considering T2D on insulin therapy. This ties in with some reports I have seen where tight control is maintained by IV induced insulin when treating in A&E, where it was found that the endpoints were not moved by the intervention. Because of the frequent occurrence of hypos with this carefully (?) controlled (???) intervention they have given tight glycemic control (TGC) the colour Black, and listed it as harmful (in the USA) I have suffered hypos when being treated post op so I can vouch that the monitoring of patients is poor,

Their treatise on insulin being the cause of Alzheimers is a bit strange. Yes, insulin is the gatekeeper for most cells in the body, but actually it plays no part in brain or nerve cells. They should know that. The brain cells only use the GLUT-3 and GLUT-1 portals, and have no GLUT-4 ports.

Oldvatr said:

Was it this study?

Incident Dementia, Glycated Hemoglobin (HbA1c) Levels, and Potentially Preventable Hospitalizations in People Aged 65 and Older With Diabetes - PMC

This study was aimed to determine whether incident dementia and HbA1c levels are associated with increased rates of potentially preventable hospitalizations (PPHs) in persons with diabetes. A total of 565 adults aged 65+ ever treated for diabetes ...

www.ncbi.nlm.nih.gov

This paper looks a HbA1c vs dementia, but it does not drop the hba1c suddenly. so steady state conditions show that both high (>8%) and low (<5%) glucose levels make dementia more likely

Or there is this one

Higher dementia incidence in older adults with type 2 diabetes and large reduction in HbA1c

AbstractBackground. although type 2 diabetes increases risk of dementia by 2-fold, whether optimizing glycemic level in late life can reduce risk of dement

academic.oup.com

This one seems to imply that ANY change in HbA1c is a predictor of dementia coming dow n the track. Raising or lowereing hba1c seems to indicate a worsening outcome. Damned if you do, damned if you don;t.

Click to expand...

But the inference from both papers is that the population they studied were T2s on medication - otherwise, how did they see hypos in the study groups? There was a correlation between high blood glucose and dementia, and a possible correlation between sudden decreases in blood glucose that they linked to hypos - nothing about people like me who have never taken any diabetic meds.