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clear search termsThe Surprising Reason Most Practitioners Quit – And What You Must Know about Insulin Resistance
I hope this is helpful to you! This is one of the top three root causes of dis-ease, imbalance, and dysfunction I see in my own clients. And I bet you’ll see them in yours too! Get savvy. Because wildly satisfied clients build wildly successful practices!
Please feel free to post any follow-up questions or comments below. I am happy to provide more detailed guidance on any of the pearls I shared. I want to hear from you!
- If you want more fundamental info on insulin resistance, please check here. And yes, there are many practitioners who did not have heavy science backgrounds who are now powerfully and confidently comfortable with all of this detail. If you are passionate and committed, you can absolutely learn the pearls of functional medicine know-how.
- In general, sustained, elevated blood sugar is toxic to nearly all tissues in the body. This is why there are so many debilitating secondary effects to insulin resistance. The kidneys and the eyes (as well as various types of neuropathy) are of the tissues which are most often affected first.
- Yes, fasting glucose tolerance test (which also measures insulin) is definitely the “gold standard” of blood sugar dynamics. However, this is a cumbersome, multi-hour test and not very practical for gauging ongoing progress in addressing the root cause of insulin resistance. Thus, fasting insulin (or c-peptide, less often available but even more accurate given the longer half-life in the body) is perhaps the best practical lab gauge of progress.
- Both fructosamine and HbA1c are markers of blood sugar levels over a longer period of time, but both have pitfalls. In the moderate stages of insulin resistance progression, patients can actually struggle more with low blood sugar – and hypoglycemic episodes – vs. high blood sugar – for the very fact that insulin is so high.
- Typical fasting insulin lab reference ranges are 0-25 mIU/L. However, as we know, a reference range is not an optimal target, or even a healthy range, for that matter. Sources and studies disagree somewhat on the exact level of optimal fasting insulin, and consensus appears to be around 5. The point is that it’s certainly not 12! The mid-point of the range! Studies have shown that levels of ~9 or more accurately indicate existing pre-diabetes .
- Yes, there are certainly other, more options such as adiponectin as a marker of insulin resistance (but alas, less readily available than fasting insulin).
- Sure, happy to share some of the clinical studies (here and here) showing that aggressive lowering of average blood sugar via medication did not decrease the risk of cardiovascular disease in high-risk patients. Similarly, aggressive lowering of blood pressure and serum cholesterol in Type 2 diabetic patients did not reduce the risk of cardiovascular events or death. Again, we have to get to the root cause of the insulin resistance itself for the body to heal itself.
- Yes, there are many, many sources of oxidative stress and inflammation. Beyond what I mentioned in the video, I definitely agree that both food sensitivities and gut microbial imbalances can be major contributors.
- Yes, there is labwork that can measure oxidative stress/damage, in particular a marker called 8-OHdG (that is, 8-Hydroxy-2-deoxyguanosine). Dozens of clinical studies validate its utility, and this organic acid can be measured in blood or urine. Another more readily available marker is GGT (that is, gamma glutamyltransferase), the enzyme that allows the body to recycle glutathione to handle more oxidative stress and/or detoxification (especially of heavy metals).
- As an interesting aside, subclinical elevations in GGT are more common in those diagnosed with Type 2 diabetes than any other lab marker (including things we might assume would be highly correlated such as BMI or blood sugar levels). If you wish a deep dive in this topic, you might appreciate this study.
- I’ve written about berberine before; you can find much more detailed information in this post. Clinical studies which compared Berberine to Metformin can be found here.
- Yes, elevated cortisol (stress hormone) can also contribute to elevated blood sugar. However, cortisol tends to suppress insulin secretion (from the pancreas) in an effort to keep blood sugar high for immediate (presumably emergency) use. Ongoing elevated cortisol can definitely create insulin resistance as well. This can be caused by mental/emotional stress (e.g. workaholic mentality) but also by physiological stress (e.g. heavy metal toxicity, pervasive food sensitivities). Overall, indeed, the work we do to support our clients with sustainable stress relief is critically important.
- The form of magnesium I most commonly recommend for clients with insulin resistance (with or without secondary hypertension) is magnesium glycinate. If clients also need help with constipation, I recommend mag citrate. I’ve written before about magnesium in detail.
The next two videos mentioned in this series can be found here: Part 2 and Part 3
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25 Questions for “The Surprising Reason Most Practitioners Quit – And What You Must Know about Insulin Resistance”
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Switching from Metformin to berberine and the potential overlap treatment should be supervised by a physician. Technically, there could be an overlap in the use of Metformin and berberine but one needs to be careful about the blood sugar potentially dropping too low. Please explore this post:
https://schoolafm.com/ws_clinical_know/blood-sugar-busting-berberine/
and and also this article:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5839379/
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Thank you for this information!
I do have a question about “hypoglycemia”. How do I approach hypoglycemia? My client is struggling with this most of her adult life. She is super fatigued. Her fasting glucose was elevated and her diet is relatively ok, there needs to be some tweaking. I used one of your templates to ask her Dr. to run additional blood tests (full thyroid panel, A1C, fasting insulin, RBC magnesium and a cardio IQ). I remember you saying that low blood sugar is also a flag for insulin resistance, but I can’t remember where 😮 Her TSH was elevated. She is 59, 5’4″, 110 pounds.
I started her on magnesium, B-complex and a few other things… Blood Values that were flagged in my eye related to this concern:
Total Protein: 7.5
Albumin: 4.4
Globulin: 3.1
Glucose: 102
TSH: 4.570, T4: 7.8, Total T3: 128-
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Hypoglycemia is typically caused in the early stages of high blood sugar and insulin resistance and happens due to an ‘overshooting’ of insulin by the pancreas and lowering the blood glucose too much. Keep in mind that insulin resistance is often a result and a cause of low thyroid function. Everything that supports the reversal of the insulin resistance will help this condition as well. In hypoglycemia specifically, it may be helpful to ensure more frequent meals that include primarily protein and healthy fats as well as complex carbohydrates to keep the blood sugar more stable and prevent the ‘dips’ that are the hallmarks of the hypoglycemia.
In the case of your client, the “relatively ok diet” and struggling with having good energy may mean food sensitivities that she’s not honoring. Eating the foods that constantly trigger the immune system can lead to the feelings of poor energy and exhaustion.
In addition, the hypothyroid state will exacerbate the insulin resistance and low energy.
Think also what are other sources of inflammation and oxidative stress for her. You’ve mentioned the estrogen dominance that is likely still at play, stress, and migraines. You certainly can help this woman by honing in on a true insulin reversing diet, making sure that her digestion is strong and detox pathways are clear and the body can get to a better hormone balance. Getting a full thyroid panel and getting her on a more targeted thyroid support may be a good idea as well. Also supporting her in dealing better with stress is key.
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I have been plugging along slowly for years, hoping to take it to the next step. This info always boost my confidence. THanks so much, Celeste BTW I am looking for a video you sent recently on allergies. Can you share how I can find it again, thanks
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SAFM Team says:
Thank you so much, Celeste! I believe you might be talking about this post on histamine intolerance? If that’s not it, please post again, and we’ll find what you need. Enjoy! https://schoolafm.com/ws_clinical_know/can-you-spot-histamine-intolerance/
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Ah, Yes, thanks so much! I was able to explain it to my client simply and she it really resonated with her. Woo HOO!!
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Samantha says:
Tracy,
I have a client who has type 2 Diabetes and has made some amazing progress over the past year. He has lost over 30 pounds, and is back down to his High School Football weight. He feels better than he ever has. He eats more organically, and low glycemic. He is on a few supplements as well one being Curamed by Terry Naturals and he shortly regained feeling in his feet for the first time in several decades. He wants to get off Metformin and I am familiar with Berberine, but it is my understanding that it can be hard on the liver? Is that the case, or can it be taken long term? IF so, how should he wean off Metformin while introducing Berberine? I know to start slow of course. Please advise.
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Good for you and him both! I would add fish oil to his regimen if it’s not already there, if there is any residual neuropathy at all. Yes, many practitioners progressively titrate metformin down and berberine up, and that is something he could do in partnership with his prescribing physician. Keep in mind that the goal here – in the true spirit of FM – is not to need *either* agent but to keep working progressively to reverse the insulin resistance fully. Berberine is a potent antimicrobial, so I don’t recommend ongoing use, but I have had several clients use it successfully for 6-12 months to reverse the insulin resistance. Chronic use of metformin can readily deplete Vitamin B12, but its modes of action can also have lasting negative consequences and not reverse the innate insulin resistance at all (which is how one ends up remaining dependent on it for life to “manage” the T2D). The drug, in part, works by activating a gene that prevents the liver from producing blood sugar. You may find this interesting: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5552828/ .
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Yes, NAC is also another good supplement for reversing insulin resistance. It helps in a bit of a unique way – by countering the advanced glycation end products (AGEs) that are naturally created when we have high blood sugar and which damages tissue. AGEs cause oxidative damage and exacerbate insulin resistance, creating a vicious spiral downward. NAC counters the AGEs directly with strong antioxidant potential. Benfotiamine (a fat-soluble form of thiamine) also counters AGEs, especially in their damaging effects on kidneys (commonly one of the first body parts to begin to have dysfunction due to the damage caused by high blood sugar). NAC has been particularly well studied for the benefits of improving PCOS by addressing insulin resistance (a common cause/exacerbating component of PCOS). You might be interested in this http://www.ncbi.nlm.nih.gov/pubmed/19275668 and this http://www.ncbi.nlm.nih.gov/pubmed/12057717 . Thanks!
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Amanda Buse says:
Hi Tracy,
I have a client with insulin resistance and PCOS. I think NAC would be very beneficial for her but she is still taking Metformin. Will that create a problem for her to take both? Thanks!
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Oh this is a great question! There is actually evidence that this particular combination therapy is not as effective as either agent alone, especially in regard to reducing testosterone. This will be of interest to you: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4107684/ . What I would use in this case actually is berberine – 500mg three times daily and advising your client to carefully monitor her blood sugar to ensure it doesn’t dip aggressively. In many cases, adding berberine allows these clients to reduce their metformin. (Remember she needs to be boosting Vitamin B12 while using metformin too.) Of course, I know you will be advising her on the importance of a consistently low-glycemic diet to counter the insulin resistance. Optimal magnesium is also key. As is getting savvy about xenoestrogens and avoiding them in all her personal hygiene products and other lifestyle choices. As another option, sometimes a medical food shake as a meal replacement once daily is a convenient way for these clients to get key, supportive nutrients for boosting insulin sensitivity e.g. Thorne’s Medibolic. Hope that helps!
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Thanks for the clarifications Tracy! I should also add that my client with PCOS who is on Metformin also had her gallbladder removed quite some time ago. She is willing to do the berberine, B12, mg, and also will need vitamin D. Any thoughts as to how the lack of gallbladder might be a problem?
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Unless she’s directly supporting digestion, lack of a gallbladder can dramatically impair digestion and absorption of both dietary fats and fat-soluble vitamins. This may be at play with her low Vitamin D. She may also have impaired absorption of essential fatty acids, especially omega-3s. Make sure she’s supporting her digestion during meals with bile salts (or a multi-digestive formula e.g. Thorne’s Biogest). Over time, a missing gallbladder might also increase the risk of dysbiosis, intestinal permeability, or inflammation-causing substances from our gut and gut microbial byproducts (e.g. LPS).
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Kathleen Mitchell says:
So happy to be joining in with your Tracy and in this community. Wooo Whooo! I loved listening to this recording. It was so informative and empowering! I have also heard that Chromium is helpful to opening the doors and getting the glucose into the cells as well as the magnesium, and I have heard that turmeric could be as helpful as metforim as well as the berberine. It is such an exciting time in medicine and the difference is all about understanding how the body works and supporting it on a deeper level.
Thank you Tracy for being the person who I have been praying for:)-
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Oh my goodness, you are so very welcome, Kathleen! I love your enthusiasm. Yes, chromium is critical for normal insulin sensitivity. Alpha lipoic acid is also helpful choice. And yes, curcumin (extracted from turmeric) has also been shown clinically to improve insulin sensitivity. In the Reversing Diabetes clinical course, we go through many different options; berberine is just definitely my first choice and go-to as a starting point to counter insulin resistance. Welcome!
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Tracy, this is so empowering! Not only for our clients who come to us, but also for us as coaches. With the “pearls” I’ve learned from this course, I’ve been able to help 100s of clients (yes, I said 100s) not only get to the weight they want, but get rid of the symptoms that keep them from fully enjoying their life. My job has become more rewarding as my confidence as a health coach has increased dramatically with the education and expertise you’ve given me. I hope other health coaches out there, reading this, can do what I did, and get out of their own way and start learning the very important clinical aspects to health.
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Woohoo, Shanti! Thanks for sharing. You are indeed a great role model of a wildly successful practitioner. Go, go, go!
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Yeah, the burn out feeling is very familiar to me – and I agree with all three reasons that you enumerate. I’m looking forward to remedying that very soon. Thank you for touching on this topic as the burn out can feel shameful – nonone wants to be ‘a quitter’. Love and truly appreciate your support on all levels 🙂
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Oh, I am sending you a big, warm hug and much love and encouragement, Kasia. I do indeed think SO many practitioners can relate. I appreciate your honesty in sharing; that very self-awareness is the most important step in keeping ourselves on track and making sure we purposefully get the support we need. Good for you!
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WOW. You are SO right on, Tracy!! In the beginning of my practice, I truly think (if I am being honest with myself) that the number one cause of my burn out was not feeling “good enough” in helping my clients. I would put so much time and effort into our sessions, yet success on their end would be “good” but usually not mind-blowing, raving-fan kind of good. And let me tell you, that gets tiring and frustrating quickly. Now it can feel like the opposite with a complex client: Because I can help them on a much deeper level than I used to, I find we both leave the sessions feeling hopeful and energized and enthused. LOVE THAT! THANK YOU, THANK YOU for helping me help my clients on such a deep level. It truly has made all the difference in my practice, and I am forever grateful!!!
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You are so very welcome, my friend! You are an awesome example of a wildly successful practitioner. Who knew a TV producer had it in them to build such a large and ragingly popular practice?! You are on fire!
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Here, Tracy’s given you the exact information you need to support clients with insulin resistance in order to prevent Type 2 Diabetes from developing and/or reverse it.
Several years ago, the first 2 people I helped with this issue (both 70+ y/o women) were eternally grateful for the education and support I provided. Now that you know this, YOU can too. Get out there and do it!-
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Thanks for chiming in, my friend. You are indeed a Rockstar health coach. I am amazed at the number of people you have helped to truly get out of their own way and find true healing in this particular area – clearly an expertise!
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I’m sure you probably stated, but I am having trouble finding it, is it ok to begin the Berberine while they are still on the metformin?