What’s Inside This Episode?

• Are You Sabotaging Your A1C Without Realizing It? – Why the way you’re avoiding carbs might be doing more harm than good
• The Keto Mistake No One Talks About – What happens when you cut out too many carbs, and why some people’s blood sugar worsens over time
• Good Carbs vs. Bad Carbs – Are You Getting It Wrong? – If all carbs aren’t created equal, which ones actually help lower A1C?
• What Your Doctor Won’t Tell You About A1C – Is a “normal” 5.6 actually putting you at risk? When does insulin resistance really start?
• The Gut-Blood Sugar Connection You Can’t Ignore – How does your microbiome play a role in insulin resistance and metabolic health?
• How to Customize Carb Intake – Why one-size-fits-all nutrition doesn’t work and how to tailor your diet for optimal A1C levels

Resources and Links:

• See the Full Transcript here
• Get Your FREE Guide: FREE CHECKLIST: Foods that Can Reverse Belly Fat, Fatigue, and Lack of Focus
• Join the Next-Level Health Practitioner Facebook Group here for resources and community.
• ReInvent 2025 Replay and Slides: Watch a deep dive into gut health, genetics, and lab testing here.
• Check out our Insulin Resistance Mastery Program for Practitioners and/or The Sweet Spot Solution for a metabolic reset.
• Explore Advanced Training and Resources: Visit INEMethod.com to take your practice or personal healing to the next level.
• Check Out Related Podcast Episodes: Dive into more metabolic health strategies here.

Dr. Ritamarie Loscalzo’s Bio

Dr. Ritamarie Loscalzo is a pioneering expert in functional nutrition and metabolic health, with over 33 years of clinical experience. As the founder of the Institute of Nutritional Endocrinology, she’s dedicated to training health practitioners to uncover root causes and create lasting results for their clients. Her mission is to reinvent healthcare by empowering practitioners to integrate personalized, science-backed approaches to health restoration.

Ready to transform your practice or personal health? Dive into this episode and discover the tools to make it happen!

Transcript

Dr Ritamarie

Today, I want to talk to you about lowering hemoglobin A1c with carbs.

So hemoglobin A1C is a measurement that is really basically telling you what the percentage of your red blood cells that are coated with sugar, glycosylated in scientific terms, right? So how much of your red blood cells are coated with sugar? 

Ideally, that number should be in the range of 4.8 to 5.2, ideally between 4.5 and 5.0. The lower, the better, because it means that you haven’t been having a lot of high glucose swings. And you’re going to see that in a lot of your patients that they have high glucose swings, and their hemoglobin A1Cs are too high.

When the hemoglobin A1C is too high, what happens is those sugar coated red blood cells become kind of sticky, and they don’t move and flow as well as they ought to. They also, if you think about it,  if you’ve ever made taffy when you were a kid, or you take molasses and you put it in a pot and then you start to stretch it. And then when it cools down, there’s these sticky parts to it. 

That’s what happens to the red blood cells in your body. They get sticky, and they can create inflammation in the blood vessels. So that’s why we want to lower it. The other reason we want to  lower it is because lowering it indicates that we’re in a state where we are having good glucose control. So for example, the ranges in conventional medicine, we want to have it below 5.7.

Dr. Ritamarie Loscalzo (01:59)

Above 5.7, you are considered to have insulin resistance. And then when it gets into the 6s, it’s considered to be diabetes. And it’s kind of like a marker of where you are in your glucose control. So we want to get it low. I mean, we’re not going to get it all the way down to zero because obviously we have sugar in our blood all the time. We have to, to have energy. So somewhere in that 4.5 to 5.0, a little bit higher than that can be okay. But right around that 5, I think is that sweet spot for an A1C when we think about optimal ranges for A1C.

It’s really kind of crazy in medicine that you can be at 5.6, and you’re fine. There’s no danger, and you’re at 5.7, and now you’re insulin resistant. The truth of the matter is you’ve been in danger ever since it got above 5.0.. You’re increasing the risk factors associated with insulin resistance and glucose dysregulation. 

So all the problems that happen when people are diagnosed with insulin resistance, those have been happening for decades before. And that’s why we make a distinction in our community of pre-insulin resistance. 

Once you get into the range where you’re fasting blood sugars over 90, your A1C is over 5, you’re in a state called pre-insulin resistance. And all of the damaging things that happen when you’re diabetic are starting to happen to you, even though you don’t have the diagnosis. I think it’s really, really important for us to keep this in mind and for us to be teaching our clients and our patients that this is so critical. 

So a lot of people are thinking that carbs are bad, the bad carbs are bad, and there are good carbs that are not bad. So yes, in order to lower A1C and in order to reverse insulin resistance and prevent diabetes, we need to avoid the bad carbs, the carbs that cause blood sugar spikes, the carbs that are not, as Mindy Pelz calls them, nature’s carbs, right? 

The ones that are processed in a lab, the ones that are isolated, the ones that are starches that are made into breads and flours, the ones that are sugars of any name, shape, or form, honey, molasses, sugar, maple syrup, et cetera, that all have the ability to spike the glucose. Those are the carbs that we do need to lower in order to lower A1C. 

Dr. Ritamarie Loscalzo (04:20)

So what’s happening in the keto community is people are being instructed to avoid carbs like the plague. Keep the carb numbers low, like keep it down below 50, below 25, below 10, some people are saying, in terms of grams of carbs. And what people are doing is, I get to have this much lettuce. I get to have this little scrawny piece of lettuce. That’s all I can have, because it’ll raise my carbs too much. And that’s where the misconception comes in. 

The good carbs are those non-starchy vegetables that are loaded with phytochemicals and loaded with nutrients that people are avoiding, and they’re just pushing towards that. And they’re getting some results immediately, but they’re not having long-term health results. So it’s really important that when we look at carbs, we don’t just identify that the carb in sugar is the same as the carb in cauliflower. It’s not. 

In some people, the carbohydrate content in a cauliflower might raise their sugars a little bit too much. And that’s part of what we do to customize for each person. But the truth of the matter is most people can eat unlimited amounts of non-starchy vegetables, high water content vegetables. And so we have to look at what’s called the net carb. So what does sugar have as a net carb? That means the carb after you subtract the amount of calories from fiber. 

Generally speaking, the carb content is the same as the net carb content, because there is no fiber. In some foods, which might be like a potato, there’s a little bit of fiber compared to the amount of carb. And so the net carb is a little bit lower than the total carb. 

But if you take something like your non-starchy vegetables, romaine lettuce, kale, arugula, all of these foods, and when you start with the carb content of these wonderful high water content veggies, and you subtract the fiber, there’s a big difference between the carb content and the net carb content. 

And it’s the net carb content that’s problematic and can cause problems with rising A1Cs. So some people wonder, oh, how much lettuce can I have? And how much arugula can I have? And how much broccoli can I have? For most people, as much as you want. Here’s the deal. You’re not going to sit and binge on it like you could cotton candy.

Dr. Ritamarie Loscalzo (06:41)

 And when we look, and I’ve been studying this for decades, and watching people measure their glucose, and watch what happens after a meal. You can eat an unlimited amount of most of these. Things like cauliflower are a little higher, so they’re more medium carb content. So if you’re cooking cauliflower, and you make three heads of cauliflower, and you eat it, that might be a little too much. But if you eat three big bags of arugula, for example, it’s unlikely to have a negative impact on your blood sugar. 

And remember that A1C is related to the excursions in our glucose levels. So if you can keep the carb intake, those good carb intake, the high water content vegetables, and if you can keep that and keep your glucose nice and steady, and we’re going to see that over the course of two to three months of doing this, that the A1C lowers, even though the carb content is high. 

Understanding the interaction between the microbiome and the metabolic rate, microbiome and A1C, the microbiome and insulin resistance is something people don’t think about very often, except when it comes to some of the drugs that are on the market. We’ll go through that in another episode. But what happens is the microbiome and the metabolism are so intimately connected.

So like anything in health, one size does not fit all. It doesn’t work in shoe sizes, it doesn’t work in health. And so we have to be able to tailor our plans for each individual person.

One person might be able to eat a half a cup of sweet potatoes and their sugar goes up and another person eats three sweet potatoes and nothing happens. So the way that we know and the way that we can customize this for each individual is to be able to measure. Yes, testing the A1C every three months as we’re watching it go down, but also a CGM, which is an amazing tool that all of us should be able to have access to and it measures your glucose continuously.

Dr. Ritamarie Loscalzo (08:43)

You can check and have people look and test meals and see what causes it to go up and what causes it to go down. So if you’re going from a keto plan where you’re eating mostly meat and fat, and you’re going into and starting to include more of these carbs, then the way to test how they do for you is to check. 

You can do it with a glucometer, with a traditional little finger stick, or you can do it with a glucose meter. And it’s phenomenal to keep track of it. And then on top of that, check the A1C every three months to just monitor your progress and see that it’s getting better. We’ve covered a lot here on A1C. 

We’ve covered a controversial topic, but like I said, one size doesn’t fit all. Test it out with your own clients. You have the power to change people’s lives by helping them to see what needs to change in their diets and their lifestyles and their attitudes. So keep it up. 

You have a big mission in life and check out the website for more resources, and until next time, shine on.