first and foremost compared to physical activity and weight loss, for example. Those are the main things that are— they're going to move the needle with respect to improving HbA1c levels. Even something like doing these vigorous intensity lifestyle, you know, this physical activity lifestyle sort of short bursts of just high intensity exercise. So like let's say you like do you know, 10 to 20 bodyweight squats and you're doing that, you know, for like a minute, that can really significantly improve blood glucose levels as well. So making sure you're getting the at least that what the guideline, you know, the recommended guidelines for physical activity are. So that would be 150 minutes a week of moderate intensity physical exercise or 75 minutes a week of high intensity exercise.

Combined with 2 to 3 days of strength training, resistance training, you know, the more muscle you're building, muscle is a sink for glucose. And the more muscle mass that you're building, the better your glucose regulation is going to be. So, you know, adding in resistance training is every bit as important as also doing some cardiovascular and endurance exercise as well. So making sure you're hitting those goals, number one, that'll have a huge— that makes a huge difference in like glucose regulation, full stop. The second thing again would be, you know, weight loss. If you are overweight, then you have to like— you're going to have to find whatever type of way to lower your calorie intake that works best for you.

I think a lot of people do like intermittent fasting, time-restricted eating. Naturally, if people are doing an 8-hour eating window and they're fasting for, you know, 10 hours or so— sorry, 16 hours or so— they are more likely to reduce their calorie intake naturally by anywhere between 200 to 500 calories a day. Okay, so whatever works best for you. Some people like to count calories. There's not a one-size-fits-all recommendation for weight loss for people that are overweight, but Like I said, time-restricted eating is one thing that really works well because people don't even have to think about the calories. They just naturally don't eat as much. You just have to make sure you're getting enough protein and doing your resistance training and being physically active as well.

Now, there's also dietary recommendations. So this is for people, of course, that need to lose weight, but also that perhaps are still trying to tweak their HbA1c. They're already at a healthy body weight. We've talked a lot about glycemic index, glycemic load. There's definitely not a one-size-fits-all in terms of how your body responds, how your glucose regulation is going to respond to different dietary macronutrients like protein versus carbohydrates versus fat. People do have, you know, some people do respond with a higher insulin response, for example, or glucose response to protein than others. I think one thing that is pretty well known is the more refined the carbohydrate, the more you're going to have a Higher glucose response, right?

Glycemic load is—it's a little different than the glycemic index. So glycemic load is—it's a way of rating foods based on how high your blood glucose can go and how quickly your blood glucose rises after eating a particular food. The the first part of that, the load, is how high it goes. That's the load. The second part of it is how quickly your blood glucose rises after eating a particular food. That's a glycemic index. I don't— I think glycemic index is interesting, but I think it's not as important as the glycemic load. Generally speaking, the more processed the food, the higher the glycemic index, especially if you're going to have something that strips away the food matrix and the fiber and everything as well. Like making sure you have a lower glycemic load.

There's been a lot of meta-analyses looking at, you know, people with a lower glycemic load if they have diabetes and how having a lower glycemic load can reduce their HbA1c in a dose-dependent manner. So there's a meta-analysis of 29 different randomized controlled trials showing that people with diabetes can significantly reduce HbA1c by, you know, in a dose-dependent manner, by like 0.31%. There was also small reductions in fasting glucose and Some other secondary outcomes like improving lipids, triglycerides, body weight, blood pressure, things like that as well. The certainty of evidence was high for reducing HbA1c; wasn't as high for those secondary outcomes.

So again, I think I think looking mostly you know a high a high glycemic load food is going to be you know a more refined carbohydrate meal. It's not going to be something. Like a fruit that while it still has, you know, some glucose, it has a food matrix, it has a lot of fiber, it does— it slows the glucose response and it's different than other high glycemic index foods or high glycemic load foods that just raise your blood glucose levels extremely high. There's some modest evidence. I wouldn't say it's There's not a ton of studies out there.

I've talked a little bit about your meal sequence or food order, eating pretty much anything like protein, fat, fiber before a carbohydrate that might be a little bit more refined, or even just generally speaking, you can sort of lower your blood glucose response somewhat. And these studies have been done mostly in people with type 2 diabetes. Interesting. It's not a huge effect, you know, but for someone that's really trying to control every little measure, particularly if they have prediabetes and they're trying to prevent transition to diabetes, you know, focusing on the exercise, on the caloric, you know, reduction to lose some of the body fat, but also food order might help a little bit. Certainly, the glycemic load, lowering that seems to be strong evidence.

Early time-restricted eating, I talked about that. If you're doing, like, an 8-hour time window where you're eating your food in 8 hours, people are naturally reducing their caloric intake. That's one thing. But also there are studies showing it improves glucose regulation even when calories are equated. So another way to do that, another way to, you know, tweak, tweak the needle a little bit is I would say doing practicing some form of time-restricted eating like an 8:16 where you're eating, eating your food within 8 hours most of the time and then fasting for 16. That may also help on top of everything else I said. Now, with that said, there are some supplements that have been shown to affect HbA1c. Again, we're moving down the list here from most important to least.

I would say don't start focusing on taking supplements if you're not doing the— if you're not putting in the effort for the exercise and the time for exercise, if you're not thinking about your foods that you're eating, you know, your eating window. I think these things are all more important, and there's much stronger evidence in those lifestyle modifications affecting blood glucose regulation. But with that said, berberine is probably one of the— there's a couple of supplements, berberine being one of them, that does seem to consistently show promise for lowering blood glucose levels, improving insulin resistance.

There was a meta-analysis of 37 studies involving people with type 2 diabetes that showed berberine could significantly reduce fasting blood glucose levels by about 14.8 milligrams per deciliter, and it could reduce HbA1c by about 0.63%. It also could reduce plasma blood glucose levels after the oral glucose tolerance test. So that oral glucose tolerance test that we talked about, those levels could be reduced by about almost 21 milligrams per deciliter. 37 trials, I would say not all of those trials are high quality, you know, but that's the whole— that's the problem that is, you know, ubiquitous within clinical trials and nutrition. Not every study is high quality. Nonetheless, it is promising.

I do think a lot of times the dose range you'll get, you'll see around 500 to 600 milligrams a day of berberine. It does seem to have an effect in many, many studies that have been published. And so I do think it has a pretty good safety profile overall. We have a topic page on berberine. Please go look at it on our topics pages. Lots of references there. You can ask more questions about it. We've talked about berberine a lot in a lot of other Q&As as well. So that's, that's another little tool in the toolkit. And then I would say the other main one is alpha-lipoic acid. So this has also— there's been some studies carried out in people with type 2 diabetes that's been shown it can improve glycemic control.

So I would say it's not as strong of evidence as berberine, but it does seem as though alpha-lipoic acid could affect— it seems to really mostly affect insulin sensitivity, I think, is the main one. And then also HbA1c was reduced as well. Not as many studies. This is up to about 600 milligrams a day of alpha-lipoic acid. So I, which also has a pretty good safety profile. The other thing I like about alpha-lipoic acid is it also, there's also clinical studies that have shown it can reduce advanced glycation end products, which is one of the bad side effects of high blood glucose levels. And that is what damages, it cross-links proteins. And so it damages proteins in our body, lipids, it damages DNA, collagen in particular is very sensitive to it.

So it affects skin aging, but it also really affects cardiovascular health because, you know, your collagen that's surrounding Your heart, for example, it's stiff. It plays a role in stiffening of the heart with age, advanced glycation end products do. And so anything that can lower advanced glycation end products is going to be good for cardiovascular health. And sorry, I should have mentioned this before the supplements. Sleep. Sleep is one of the most important lifestyle factors along with exercise and again, your diet quality, quantity that affects blood glucose regulation. getting, you know, night after night of sleep restriction, like, really does disrupt glucose regulation.

Some of that can be improved if you do something like very physically active the next day, like, you know, high-intensity interval training, for example, has been shown to improve blood glucose dysregulation caused by sleep restriction. But even like getting less, like getting— so the average amount of sleep that you're supposed to be getting that's on the lower end, I would say, of good sleep would be 7 hours. So like once you, once you dip below 7 hours of sleep a night, so you start to get to 6.5, for example, or 6, then you are, you're getting into territory where, you know, metabolic regulation, blood pressure, these things start to be affected a little bit more in a dose-dependent manner.

In other words, the more the sleep restriction, the more intense the adverse effects on metabolism and cardiometabolic effects in general. So making sure you're getting good sleep every night is also very important for regulating HbA1c levels. There's some other interesting supplements that I see out there, like cinnamon and apple cider vinegar. There's some studies suggesting these supplements can also have somewhat of an effect on glucose regulation. I would say it's not terribly strong data, so it's kind of down on the list, but there's evidence and there's more than one study. I mean, there's quite a few, there's maybe 10 or so studies showing that cinnamon does seem to lower HbA1c very, very subtly, so 0.1%, which is You know, small, but you know it's something.

So you know that is something that people are also interested in. Again, it's one of those things. I don't know it's going to have a big effect. I would try the other things first. But you know if you like cinnamon, then you know adding cinnamon to to your coffee and and tea or whatever, go for it.