#6 Home HbA1c, Hidden Risks, & Hollow Pills.

Welcome

Welcome, friend!

In this issue, we’re going to look at a great tracking tool you can use at home, see how to do keto diets without risking your health and tackle a major problem with supplements. It’s vital to know we are going in the right direction, don’t use a dangerous method to get there and put our efforts into things that will work. That’s what we’ll cover today.

But, before we dig in, can I ask you to share this newsletter with anyone you know who might benefit? And, if you’re feeling really kind, mention it on social media?

I would hugely appreciate it.

The link to post is this one: https://andrews-newsletter-eb86de.beehiiv.com/

Right. Let’s get started.

HbA1c at Home - Can You Really Do That?

HbA1c is your best indicator of long-term blood sugar control. That’s why doctors use it to diagnose diabetes, track progression, and decide if treatment is working.

Until recently you had to wait for a lab test, but there is now a home test available. A US company, Pts Diagnostics, makes a kit called A1CNow® that gives you an HbA1c reading in 5 minutes from blood taken from your finger in the usual way. You just have to squeeze out a little more than a standard blood glucose meter would need, but it’s very manageable and not too painful. I have a pretty serious needle phobia and do it once a month without difficulty.

Accuracy is in the same ballpark as a lab draw (within about ±0.2–0.3%) if you follow the instructions carefully. Do bear in mind, however: ALL tests, and particularly home tests, can give inaccurate readings. That’s why it’s important to repeat tests, keep everything in context and question outlier results.

Personally, I use A1CNow® to keep track of my average blood sugar each month between my 6-monthly blood draws from my doctor. It’s reassuring to see that everything is going well without the long wait. Even better, you can buy it on Amazon!

(If you’re wondering: I have no affiliation with Pts Diagnostics, or anyone else)

Low-Carb Without Spiking Your Cholesterol

Many people turn to low‑carb diets to control blood sugar. For most, this works well: triglycerides fall, HDL cholesterol rises, and blood glucose improves. But in some people LDL cholesterol shoots up, sometimes dramatically. 

First, a word on bile acids

Your liver takes cholesterol and converts some of it into bile acids. These are secreted into the small intestine to help digest fats. After doing their job, about 95% of bile acids are reabsorbed at the far end of the intestine and ferried back to the liver. This loop is called the enterohepatic circulation.

Think of it as a recycling system: the liver sends bile acids out, the gut sends them back. Only a small fraction is lost each cycle, which the liver then replaces by converting more cholesterol into bile.

Keep that loop in mind, because how tightly you recycle bile acids, and how much cholesterol you absorb from food, shapes how much LDL cholesterol hangs around in your blood.

You may have heard the term “lean mass hyper‑responder” for this recently, but it is more accurate to think of these people as hyper‑absorbers and strong recyclers of cholesterol.

Why LDL Can Rise on Very Low‑Carb

When you cut carbs sharply and raise fat intake, the body relies on fat as its main fuel. The liver exports that fat as VLDL particles, which also carry cholesterol. As tissues use the triglycerides for energy, VLDLs shrink and become LDL.

Normally, the liver clears LDL from the blood using LDL receptors. Clearance speed depends on how much cholesterol the liver already holds. If liver cholesterol stores are modest, receptors stay active and LDL is removed efficiently. But if the liver’s pool is well stocked - because of a diet high in cholesterol and because most bile acids are recycled rather than lost - receptor activity falls. LDL then lingers in the bloodstream and builds up.

In other words: keto raises fat export, and in hyper‑absorbers who recycle cholesterol tightly, LDL clearance slows. The combination is more LDL made and less LDL cleared.

And, despite the rash of social media influencers and magazine articles claiming that LDL is really harmless, or that it is even helpful, this is honestly not the case. LDL (and a few other particles) really do get stuck in artery walls and this really does lead to plaque buildup over time, so it is just not safe to leave it elevated. (And, no, I don’t work for Big Pharma!)

How to Respond

• Adjust the fat mix. Replace saturated‑fat‑rich foods like butter, cream, and coconut oil with unsaturated sources such as olive oil, nuts, seeds, and oily fish. These shifts improve LDL particle quality and lower particle concentration.

• Use soluble fibre as an excretion booster. Foods like psyllium husk, oats, barley, and beans bind bile acids in the gut and carry them out in stool. The liver must then draw on circulating cholesterol to make new bile acids. About 10–15 g/day of soluble fibre can lower LDL by 5–10% in a few weeks.

• Add back some carbohydrate if needed. A moderate intake of low‑glycaemic carbs (about 75–100 g/day) often brings LDL down while still keeping blood glucose stable.

• Reabsorption blockers. In some cases, doctors use medications such as ezetimibe, which reduce cholesterol uptake from the intestine, mimicking what soluble fibre does naturally.

The Takeaway

Reversing diabetes does not require pushing LDL into dangerous territory. If your cholesterol rises sharply on a very low‑carb, high‑fat diet, it is a sign to adjust. Focus on the fat sources, consider excretion‑boosters, and keep both glucose and cholesterol moving in the right direction. Talk to your doctor if this is a concern for you.