Post Time: 2025-09-01

A1C, Insulin & the Damn Randle Cycle with Dr. Ben Bikman

Dr. Ben Bikman is a renowned scientist and professor in the field of metabolism, and in his work, he consistently highlights the critical links between insulin, A1C, and the metabolic pathways, especially the Randle cycle. Understanding these interconnected concepts is crucial for grasping how metabolic health works and how to address many common health issues. This article aims to break down these complex topics into understandable terms, making them accessible to everyone.

Understanding the Players: A1C and Insulin

Before diving into the Randle cycle, let's first clarify two key players in metabolic health: A1C and insulin.

A1C (Glycated Hemoglobin): A1C is a blood test that provides an average measure of your blood sugar levels over the past 2-3 months. When glucose (sugar) is elevated in the bloodstream, it binds to hemoglobin, the protein in red blood cells that carries oxygen. The more glucose present, the higher the A1C value will be. Therefore, A1C serves as an indicator of long-term blood sugar control.

• Ideal A1C level: For most individuals, an A1C level of below 5.7% is considered normal.
• Pre-diabetes: An A1C level between 5.7% and 6.4% indicates pre-diabetes, a state where blood sugar levels are higher than normal but not yet diabetic.
• Diabetes: An A1C level of 6.5% or higher is considered diagnostic of diabetes.

Insulin: Insulin is a hormone produced by the pancreas. Its primary role is to help glucose (sugar) enter cells, where it can be used for energy. It acts like a key, opening the doors to cells, enabling glucose to leave the bloodstream and enter the cell. When cells become resistant to insulin, blood sugar levels tend to go up, while energy production is inefficient.

Why These Two Matter Together?

Both A1C and insulin work together in a critical dance, and when they are misaligned, health issues tend to occur. If insulin sensitivity decreases (meaning that insulin has less effect), your pancreas has to secrete more insulin to get the same effect - this eventually may not work, leading to elevated blood sugars over time, resulting in elevated A1C. For example, here's how a healthy metabolism can be contrasted with the progression to insulin resistance and eventual diabetes:

Stage	Insulin Sensitivity	Insulin Secretion	A1C	Glucose Metabolism
Healthy	Normal	Normal	< 5.7%	Optimal
Early Insulin Resistance	Decreased	Increased	5.7% - 6.4%	Inefficient
Diabetes	Highly Decreased	Reduced (over time)	≥ 6.5%	Severely impaired

This is also very important for a better understanding of insulin and its role in the human body. Insulin doesn't just clear glucose out of the bloodstream - it affects almost every system and organ in the body - and as such, its chronic elevation (which we can call chronic hyperinsulinemia) is an issue that goes well beyond the topic of diabetes.

The Randle Cycle: A Deeper Look at Fuel Selection

Now, let’s delve into the Randle cycle, also known as the glucose-fatty acid cycle. This concept is crucial to understand how your body prioritizes its energy sources. The Randle Cycle describes a seesaw relationship between carbohydrate and fat utilization as energy sources. In the cycle:

1. Increased circulating glucose/glycogen stores leads to preferential use of glucose for energy over fats, even in muscle and fat tissue.
2. Increased circulating free fatty acids cause decreased use of glucose in tissues, thus decreasing its uptake from circulation.

In simpler terms, the body’s preference to burn fats or carbohydrates depends on the availability of each fuel. When both fat and glucose are readily available, the Randle Cycle has mechanisms to favor one over the other, with that one becoming the dominant fuel for oxidation (use for energy). In essence:

• High glucose levels favor glucose utilization and decrease fat burning.
• High free fatty acids (the body's usable form of fat) promote fat burning and suppress glucose usage.

This is important because insulin is also a main controller of these mechanisms. Elevated insulin does two key things:

1. It inhibits the breakdown of fats into fatty acids, decreasing fat availability.
2. It promotes the entry of glucose into cells for energy, encouraging the burning of sugars over fats.

When someone becomes insulin resistant, the body can't effectively use the glucose in circulation as a fuel source - but insulin is still being secreted, further inhibiting fat usage, and thus resulting in the paradox of high circulating blood glucose and very low glucose uptake and oxidation by the body.

The “Damn” Part of the Randle Cycle: Dysfunctional Metabolism

The term "damn" in this context, as popularized by Dr. Bikman, indicates the negative impact of a dysfunctional Randle Cycle. Here’s why this is problematic:

• Insulin Resistance: When cells become resistant to insulin, they don't respond effectively to this signal. This leaves glucose in the bloodstream, resulting in chronically elevated blood sugar and insulin levels (hyperinsulinemia) - this causes the liver, muscles and other tissues to decrease glucose uptake.
• Metabolic Inflexibility: A dysfunctional Randle cycle impairs the body's ability to switch between fat and glucose burning based on availability - you may end up using mostly carbs even if you are in a low-carbohydrate diet.
• Increased Fat Storage: With decreased fat burning (insulin is very anabolic in nature) the body becomes more efficient at storing fat, potentially leading to weight gain, and specifically fat gain, since glucose is preferentially being used and excess fat cannot be efficiently used for energy.
• Chronic Health Issues: Over time, this dysregulation increases the risk of type 2 diabetes, cardiovascular disease, and other metabolic disorders.

It's important to note that it is possible for individuals to burn fat as the main fuel source and achieve a good "metabolic flexibility," which means the body can transition smoothly between fuels as needed. That is achieved when insulin resistance decreases, which is a key objective.

Actionable Strategies for a Healthy Randle Cycle

So, what can you do to optimize your Randle cycle and overall metabolic health?

1. Dietary Adjustments: Reduce refined carbohydrates and sugars. Increase the consumption of whole, unprocessed foods such as complex carbohydrates, vegetables, healthy fats, and moderate amounts of protein. These dietary adjustments are helpful in decreasing blood glucose spikes, and therefore decreasing chronically elevated insulin.
2. Exercise: Regular physical activity enhances insulin sensitivity. This can allow for the muscles and other tissues to respond effectively to the signal of insulin, allowing it to transport glucose efficiently from the blood to the tissues. Both cardio and resistance training are beneficial.
3. Prioritize Sleep and Manage Stress: Chronic stress and poor sleep affect hormones, including cortisol, which can exacerbate insulin resistance. Aim for 7-8 hours of quality sleep and implement stress-management techniques such as yoga, meditation, or spending time in nature.
4. Intermittent Fasting: Research shows that well-structured intermittent fasting can improve insulin sensitivity. By creating time windows where the body isn't continuously digesting, fasting may improve insulin resistance and help regulate blood sugar levels, with the end result of lowering the average insulin secretion for the day.
5. Consider Supplements: Certain supplements, such as magnesium and omega-3 fatty acids, may support metabolic health, but consult with a healthcare provider before starting any new supplementation.

Real-Life Example

Consider two individuals, Alex and Jamie, with the following scenarios:

• Alex:
  • Has a diet high in processed carbs and sugars.
  • Has a sedentary lifestyle, and is overweight with increased fat mass.
  • High stress levels and poor sleep habits.
  • Result: The Randle cycle becomes dysfunctional; Alex's body burns primarily glucose, with decreased fat utilization, high A1C, increased circulating insulin, increased fat mass, and metabolic inflexibility.
• Jamie:
  • Eats a balanced diet of whole, unprocessed foods with adequate protein and fat.
  • Engages in regular strength and cardio exercises.
  • Prioritizes sleep and stress management.
  • Result: The Randle cycle functions well; Jamie is metabolically flexible, burns both glucose and fat efficiently, has a healthy A1C and improved insulin sensitivity, leading to a more lean composition.

Conclusion: Optimizing the Metabolic Dance

Understanding the intricate connections between A1C, insulin, and the Randle cycle is essential for metabolic health. A high A1C and chronically high levels of insulin both play a significant part in the development of metabolic issues, but when you address the root causes of insulin resistance and work toward restoring metabolic flexibility, you will improve your health parameters and be able to burn the best fuel for your body in an efficient way.

By adopting a holistic approach that includes dietary adjustments, physical activity, stress management, and other lifestyle strategies, you can work toward restoring this metabolic dance and reducing your risk of chronic disease. Always consult healthcare professionals for personalized recommendations and to work on any health issues, using this information as educational purposes, so you can start to improve the health outcomes for you and your loved ones.

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