How To Reverse Insulin Resistance At Midlife

7 Ways to Combat Menopausal Weight Gain

by Christiane Northrup, M.D.

Diet & Detox Digestive Health Women's Health

Insulin resistance has become a huge problem in our culture and it can lead to many of the chronic health problems we see today, including obesity, type 2 diabetes, and heart disease. It is also linked to high blood pressure, high cholesterol, thyroid problems, muscle loss, fat gain, fatty liver, breast cancer, endometrial cancer, and other cancers as well. And, insulin resistance has even been implicated in Alzheimer’s disease.

In addition, did you know that insulin resistance can also cause many of the symptoms most women attribute to menopause? It’s true. Insulin has a cascading effect on all of your hormones, including estrogen, progesterone, and testosterone.  When insulin isn’t doing its job, it’s nearly impossible to reduce the symptoms of menopause, including hot flashes and night sweats. It also makes weight loss very difficult.

Jason Fung, M.D. – who you can listen to on my radio show, Flourish – has done much research in the area of insulin control.  His work shows that getting insulin in balance can be the key to getting your hormones and your health back in balance.

What is Insulin and How Does It Work?

Insulin is a hormone made by the pancreas.  Its main job is to manage how your body uses glucose for energy. When blood sugar levels rise after a meal, your pancreas releases insulin to help your body’s cells — especially cells in the liver and muscles — absorb glucose. Your liver converts stored glucose to glycogen for future use.

When blood sugar levels are too low, your pancreas releases a hormone called glucagon. Glucagon forces the liver to convert glycogen back to glucose, which causes your blood sugar to rise.  

You always have low levels of insulin circulating in your body. When insulin is out of balance, the result is abnormal blood sugar levels.  High insulin levels can make you feel tired, bloated and cause sugar cravings.  And, the more insulin you have circulating in your body, the harder it becomes to lose weight and burn fat.

What is Insulin Resistance?

Insulin resistance occurs when insulin is released by the pancreas, but your body doesn’t use it properly causing blood sugar levels to stay high instead of going down into the normal range. This can occur if you consistently eat too many carbohydrates.  

Some risk factors for developing insulin resistance include:

  • Family history of diabetes
  • Gestational diabetes
  • Apple shape (more weight around your middle)
  • Polycystic ovaries (PCOS)
  • Diet high in refined carbohydrates
  • Sedentary lifestyle
  • BMI greater than 29
  • Use of antidepressants (especially SSRIs)
  • Use of steroid medications
  • Holding onto fear and anger

Fear and anger are present in all diseases. This is because emotions, such as fear and anger, when held too long, create chemical reactions in your body that do not support your health. In this video, I share how fear and anger can manifest in your body. I also tell you how you can learn to peel back the layers and release your fear and anger to bring more love and light into your life.

                           

Here are some ways to determine if you have insulin resistance:

Find your waist to hip ratio

Measure yourself around your natural waist and also around the widest part of your hips. Divide your waist measurement by your hip measurement.  For women, the ratio should be no greater than 0.8.  If you are above that, it means that you are at risk for insulin resistance. The number for men is 1.0.

Get a fasting insulin test

Ask your doctor to order a blood glucose and insulin test.  Typically, you fast for 12 hours and then have your first blood draw.  Then you will eat a meal and get a second blood draw two hours after your meal. Fasting blood glucose levels should be under 90 mg/dL.  If your levels are 100 to 125 mg/dL you are considered in the pre-diabetes range and are insulin resistant. Fasting insulin levels should be around 5 mcU/ml (microunits per milliliter.) Anything higher indicates insulin resistance.

Get your cholesterol checked

Abnormal blood cholesterol in addition to abnormal fasting insulin and blood glucose may indicate that you have insulin resistance, especially if you have low HDL and high triglycerides. Typically fasting triglycerides should be below 150.  But, more importantly, you want to look for a 1:2 ratio of triglycerides to cholesterol.

Do a skin check

A skin condition called acanthosis nigricans is associated with insulin resistance. Look for darkened skin patches on your neck, elbows, knees, and armpits. Skin tags are also a sign of insulin resistance.

How To Reverse Insulin Resistance and Improve Your Hormonal Health

An imbalance in insulin and glucose levels can be easily managed with diet and lifestyle changes. If you are diagnosed with insulin resistance, here’s what you can do to reverse its course, reduce the symptoms of estrogen dominance, and stave off the hormonal cascade that causes inflammation and disease:

  • Eat a low carb, moderate protein, high fat (LCHF) diet. Weight loss can help the body respond better to insulin.  Canadian nephrologist Jason Fung, M.D. is a leading expert on low-carb, high-fat diets (sometimes called the ketogenic diet.)  For people with insulin resistance, he recommends increasing dietary fat while decreasing carbohydrates.  Dietary fat does not increase insulin because it is broken down into fatty acids by pancreatic enzymes (lipases) and bile salts.  In addition, Dr. Fung says that animal protein increases insulin. If you eat animal protein, aim for 0.8 grams (or less) of protein per kilogram of lean body mass. So, if you weigh 150 pounds, you would be getting around 50-55 grams of protein per day.  Of course, you should eliminate all refined carbohydrates, such as white bread, pasta, as well as alcohol and sugary drinks.
  • Start moving. A sedentary lifestyle is a risk factor for many health problems.  If you have been sedentary for a long time, start by walking and build up to more high-intensity cardio exercises and some light resistance training. Aim for 30 minutes or more 3–5 times per week.  This will help regulate your metabolic function and support hormonal balance. If you need a bit of motivation, workout with a friend or use an app to set goals and track your progress.
  • Stop smoking. Studies show that smoking is associated with insulin resistance. It is also associated with many other risk factors for disease.
  • Eat raw dairy. Some research shows that dairy intake is associated with a reduced risk of type 2 diabetes. If you want to add dairy to your diet, choose organic, raw sheep or goat milk.  You can also add raw kefir and raw cheese.
  • Get enough sleep. Sleep has a reparative effect on metabolism. Untreated sleep problems can increase the risk of insulin resistance, obesity and type 2 diabetes. Even one night of sleep deprivation can increase insulin resistance by up to 33%.  This is why sleep deprivation often results in weight gain. Plus, when you lose sleep, levels of the appetite-stimulating hormone ghrelin increase, which can stimulate cortisol production and decrease glucose tolerance.
  • Try intermittent fasting. Dr. Jason Fung’s work has shown that 12 hours of fasting per day very effectively lowers insulin levels in almost everyone. It’s easy to do. Just stop eating by 7 pm and don’t eat anything until the following morning at 7 am. That gives you an easy 12-hour fast per day. Over time you can increase your fasts to longer periods of time when convenient. For many, intermittent fasting a couple days per week is part of a healthy lifestyle. Fasting works for everyone. And, contrary to popular belief, it doesn’t lower your metabolic rate or result in loss of muscle. In fact, many athletes train in a fasting state.
  • Reduce stress. The stress hormone cortisol is needed to invoke the “fight or flight” response, which allows high levels of glucose to circulate throughout the body (while insulin is suppressed) during times of extreme danger.  But, constantly elevated levels of cortisol can lead to blood sugar imbalances, weight gain, and diabetes.  There are many ways to reduce stress, such as walking in nature, practicing yoga and meditation, or reading a great book.
  • Practice Mindfulness. Many people don’t know what it feels like to be full so they eat well past the point of satiety until they are actually uncomfortable. Take some time to relax or meditate before you begin eating. Stay mindful of what you are putting in your mouth and how much. Check in with your body every few minutes to assess whether you feel full. Eat smaller meals throughout the day, and try not to let yourself get too hungry, which increases your chances of overeating during your next meal.

7 Ways to Combat Menopausal Weight Gain Due to Insulin Resistance

Many women find that they gain weight– sometimes a significant amount – during menopause.  And, to make matters worse, their old tried and true ways of getting the weight off simply don’t work.

There are many theories regarding the causes of weight gain (and other symptoms) at menopause.  It’s a complex issue that includes a combination of poor diet (i.e. eating too many of the wrong carbohydrates,) sedentary lifestyle, stress, and many other factors.  But, the truth is, whatever the underlying cause, insulin resistance is the primary driver of menopausal weight gain. And, the key to reversing it and achieving lasting weight loss is to keep insulin levels low.

Now, to be clear, menopause does not cause insulin resistance. Insulin resistance is the result of overall poor hormonal health. If you are struggling with post-menopausal insulin resistance and weight gain here are some additional recommendations:

  1. Get your cortisol levels checked. Stress during menopause can cause steroid sex hormones, such as estrogen, to be metabolized into cortisol. Increased cortisol levels stimulate sugar to be released into your bloodstream, increasing insulin and ultimately thwarting your efforts to lose weight. Ask your health care provider to prescribe the DUTCH test to track and evaluate your hormone levels, ensuring they are at their optimum balance.  If your cortisol levels are out of balance (i.e. not high enough in the morning and too high later in the day), be sure to avoid caffeine and other stimulants. You may also want to try an adrenal support supplement and or adaptogenic herbs, such as ashwaganda or maca to help balance your cortisol levels.
  2. Take a magnesium supplement. Fully 80 percent of people have a magnesium deficiency. If you have a high sugar diet or take certain medications, you can become deficient in magnesium even if you eat foods that contain the mineral. And, according to Carolyn Dean, M.D., many symptoms attributed to menopause are actually identical to symptoms of magnesium deficiency, including hot flashes, night sweats, insomnia, and anxiety.
  3. Salt your food. Sodium supports adrenal function. And, despite what you have probably heard about sodium intake, most people do not get enough sodium in their diet. It’s easy to become sodium-deficient, especially if you exercise or are under stress. When you are sodium-deficient your cortisol and insulin levels will be out of whack, and your muscles can become stiff. (Sodium relaxes soft tissue.) Try adding a good Celtic sea salt to your food (not regular table salt.) You can also put 1/4 tsp of Celtic sea salt in warm water first thing in the morning. Gargle then swallow.
  4. Don’t over exercise. When it comes to exercise and weight loss, one size does not fit all. And, some forms of exercise can actually put an increased demand on your body increasing cortisol and insulin. If you are working out a lot and are not losing weight– or you’re actually gaining weight or fat, especially around your middle — you may need to adjust your exercise routine and frequency. Try different types of low-intensity workouts, such as walking, yoga or Pilates. Adjust the frequency and intensity of your workouts based on your body’s needs, the amount of stress you are under, and your overall health. Your goal should be to feel energized afterward, not exhausted.
  5. Eat enough calories. When you were in your twenties, you probably lost weight easily by restricting calories. But, caloric restriction puts increased stress on your body and when you are menopausal it can backfire, increasing cortisol and insulin, and decreasing thyroid function causing you to gain weight. This is especially true if you are restricting calories and exercising more. Be sure to get enough calories from real whole foods to provide your body with the building blocks for energy production.
  6. Skip alcohol. Alcohol is sugar. Drinking alcohol regularly causes insulin resistance and weight gain. In addition, alcohol is processed through the liver.  When your liver is busy breaking down alcohol, it can’t process hormones, creating further imbalances in estrogen and cortisol and converting the excess glucose it stores to fat. Remember fat cells are loaded with glucose receptors so they crave more sugar. If you do have the occasional drink, take fiber to help stabilize your blood sugar and slow down the absorption of alcohol.
  7. Check in with your emotions. Creating health at mid-life requires learning to take care of yourself instead of everybody else. This includes regaining body acceptance and the self-esteem that many of us lose in adolescence, or if we’ve been in relationships with energy vampires. Are you in a relationship with someone out of fear of being alone? Do you constantly seek approval of others? If so, why? Are you afraid to take care of yourself? What might happen? Remember, emotions are energy. Unresolved emotions stagnate the energy in your body. Releasing them can do wonders for helping to also release the unwanted pounds.

Do You Have a Meno Belly?

Many women—even those who have been thin and fit for their entire lives—reach menopause and then notice they have developed the dreaded “Meno Belly.” And this can occur even if the number on the scale has not changed significantly. It’s as if suddenly your waist disappeared, and you can’t button the pants you wore just last week.

For many women this increased fat in the midsection occurs without weight or fat increase anywhere else in their bodies. And diet and exercise don’t seem to help. So what can you do?

When it comes to Meno Belly, there can be a few different factors at play—and you may need to address each of them.

  1. Keep insulin levels low: Typically insulin resistance plays a role. So you want to do what you can to keep your insulin levels low. When insulin levels are low, it’s much easier to lose weight and belly fat. The good news is everything I have mentioned above, including the dietary guidelines I’ve outlined will help you keep your insulin levels in check.
  2. Balance your hormones. Studies show that post-menopausal women with low estrogen levels have higher levels of abdominal fat. This is due to the higher number of estrogen receptor in abdominal fat cells compared to fat cells in other parts of the body. So as estrogen levels decline, your fat cells grow, and your body attempts to store more fat to keep estrogen levels balanced.
  3. Try a probiotic. According to studies, low estrogen levels can lead to an overgrowth of certain bacteria in the gut causing dysbiosis and leading to sugar cravings, poor digestion, and weight gain.

Another thing I highly recommend is that you eat purposefully.  Slow Down. Chew your food. Take notice of how you feel after each bite. Stop when you are full to prevent overeating, indigestion, and bloating. If you are an emotional eater or someone who is in the habit of eating a pick-me-up snack every day at 3 pm, ask yourself “why?” You may learn that you are in the habit of doing this out of stress or boredom. So you may want to take a short walk instead.

What About Meno Apron?

Some women start to notice sagging of the lower belly, often called “Meno Apron.” The term for this is pannus stomach. It is not related to menopausal changes directly, but it can occur at the same time as Meno Belly.  Meno Apron occurs with weight changes as the fat deposits underneath the abdominal muscles and in front of the intestines in an area called the omentum sag. This is not unique to women—even men can experience it. But menopausal weight gain can make a small pannus stomach grow larger. Pannus stomach can also occur after pregnancy.

A mild case of pannus stomach can be improved with diet and exercise. However, because it’s caused by excess fat deposits and loose skin sometimes other procedures are needed to reduce or remove a larger pannus stomach, especially if it gets in the way of daily activities.

Have you ever been diagnosed with insulin resistance?  What have you done to reverse it?

Additional Resources from Dr. Northrup

3 Tips for Weight Loss

The Effects of Stress

 

 

Last Updated: September 6, 2023

Christiane Northrup, M.D.

Christiane Northrup, M.D., is a visionary pioneer and a leading authority in the field of women’s health and wellness. Recognizing the unity of body, mind, and spirit, she empowers women to trust their inner wisdom, their connection with Source, and their ability to truly flourish.

Comments

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  1. Bj Howell
    2 years ago

    All this sounds great but I’m confined to a wheelchair and residing in a nursing facility.

    1. Amanda
      2 years ago

      There are many exercises specific to sitting in a chair, you can still get muscles burning! 🙂

      1. Joy
        10 months ago

        To: BJ (I’m Late to this thread—so you might not read this)….Same to Amanda….but maybe someone else that needs to hear this will read it! So the thing is BJ is not only stating that being in a wheelchair doesn’t help with being able to follow the info in this excellent article! Thank you Dr. Northrup! The other issue to being in a nursing facility is the diet—it’s totally awful and there’s no way (unless you are wealthy and can afford a very upscale place) that you can get good, healthy foods! I took care of my mom for 5 years and unfortunately had to spend many days in nursing rehab facilities with her each time she was sent home from the hospital. It was a nightmare! I got her on good foods, etc when she got back home. But in the facilities—very awful.

    2. Kathleen
      2 years ago

      PBS has a show in the early mornings called “Sit and Be Fit”. I used to watch this with my mom when I was her caregiver. She had mobility issues, but could do many of these exercises. Good luck!

  2. Sarah O White
    3 years ago

    I can so relate to everything in this article! I am a 54 years old women and have been in menopause since my hysterectomy in 2009 (age 43). I had poly cystic ovary disease, huge fibroid tumors on my ovaries and cervix that caused me to hemorrhage, which lead to having to have a hysterectomy. I have been overweight for decades, but now with menopause and ranging hormones out of balance… it is impossible to lose weight. I am pre-diabetic, but was severely diabetic in 2009, at the point where my doctor was going to put me on insulin. I have fought these last 11 years to change my diet, but those salty snacks and sweets continue to win the battle. I am having problems with my blood pressure as well.

    Knowing now, that it is a hormonal problem and eating the wrong things like most carbohydrates and such, I am now educated enough to do better, now that I know better! Women, we can do this!!!! I am thankful for the information to change my health and my life. Thank you Dr. Northrup!

  3. LeAnn Lyon
    3 years ago

    I love how content can be available and relevant for years, available for the right person at the right time! I just found Dt Northrup’s article this morning as I stare down my 52nd birthday, 3 months into Intermittent Fasting and grateful for the recomposition I am experiencing! I’d love to share this on my blog where I share my journey, if that is ok! Thank you!

  4. Marisol
    3 years ago

    In 2017, I was sort of dying of all the terrible symptoms described in this article so easily to understand now, yet, hugely ignored in conventional education-medicine–if one can call it such. At the time, I was in my late 30’s going to college at an all women’s well known college … my lifetime dream … my nightmare … my dark night of the soul … my greatest strength.

    Who knew my abusive- narcissistic mother had been repressed for so long and as I study my jam-major in psychology in a Plutonian-deep researched-investigation of why people do what they do and what motivates them to do so in order for me to transmute my mother’s cells that made me a biological evil woman who can never be a mother fearing continuing the chain of neglect across generations.

    Sad enough? Indeed, I too know very well what it is to be depressed, so tired I would get dizzy trying to get up to feed my cat. The mental fog that made me be perceived as mentally slow (but my mercury is combust, so in fact, I am highly intuitively intelligent which is hard to put in words since I see things in visuals).

    Anyhow, in case this touches a fiber in you—know there are many ways to bring back life as never before with the help of what I call new tech tools such as:

    –Being your own Health Coach, learning how to truly feed your physical-emotional hungers by nourishing your body as your ancestors did before the modern food industry. Cooking with your hands, energizing the meals your body will eventually convert to energy, body structures, and moods to inspire your motivation naturally.

    –Healing and Honoring your Ancestral Lineage to understand what ghosts are attached to your energy field while creating a spiritual nourishment for you as well as for your spirits. By feeding them the sense of service ignites the fire of gratitude which acts as a miraculous antidote for any melancholic dragging force

    –Grounding yourself to Mother Nature in your own backyard or long walks in the forest while breathing new, fresh air to calm the chaos of modern life. The presence of trees around you will hug you, keep you safe, and will teach you how to grow your own deep roots and never ever feel alone since we are all connected as neurons in the human brain and energy fields in the cosmos.

    –Energy Healing such as Tapping aka (EFT) along with a dash of positive psychology working-questioning old patterns of belief, creating new ones. Balancing Technique to organize the energy field of your soul, Tameana to clean the energetic overload you picked up along the way confusing your true self.

    — Learning accurate descriptions of what I call the Soul Map based on your birth date, time and place makes you a unique being on this planet since statistically the chances of being born in the same time-place-body-parents is quite nearly impossible even among twins or siblings.

    Hope this is helpful for someone as it was when I needed it the most and immense gratitude to Dr. N. for her generosity.

  5. Annie Ocean
    3 years ago

    what a beautiful smile and such a calming voice of positivity and connection. thank you.

  6. Michelle
    4 years ago

    I am so very very tired of being told all my tests are normal. My body is not noReal!!! I’m covered in black hair where it should not be, I’m apple shaped and very overweight when I eat just normal. Told I’m PCOS and insulin resistant. Not given any options. Just suffer. Typical response to female issues. If I were a man trying to become a woman I’d have all the hormone treatments. Am I angry as hell??? YES!!!!!!!

    1. Jeanne
      4 years ago

      Michelle,
      Yes be angry and then make smart decisions – such as forget your regular Doctor for testing. Go to a functional naturopathic whatever name they use and get their blood panel done. Way more comprehensive like twice as much information. The way you describe yourself tells me that this type of Doctor will believe you from your appearance (one) and from what you tell him/her (two). Don’t waste another minute on western medicine. My story was the issue I had they couldn’t find the problem but said go to emergency if it happens again! My alternative Doctor I had no Vit D no Vit 12 and a mutation! Life began again! Don’t walk – run!

    2. Sarah Martin White
      3 years ago

      Hi Michelle, I am angry too! But I am also encouraged, because now we have the information to change our health and quality of life. It will be difficult to eliminate sugar and most carbs from our diet. But I did it before and lost 30 lbs. and know that I can do it again. My symptoms greatly improved or went away entirely. I had no more arthritis pain, hormonal systems, headaches, blood sugar was much more in control even my asthma was much better. I was severely diabetic, and by changing slowly it made it manageable. Now, my blood sugar is only 3 pts away from normal range. But the sugar has eluded me from reaching my goals. So now, it is time to fight back for the home stretch!!!

      First, get off ALL sugar, including drinks and Get off chips and salty snacks. (there is one exception, but I will mention that later (it may take 3-4 weeks.

      Next, eat healthy carbohydrates like sweet potatoes or plant based crackers (only 3 times per week). That is all the carbohydrates your body needs. Cauliflower Rice is plant based and you can substitute it in place of rice dishes. I make a mean stir-fry with it! Make sure 1/2 of your plate are a mix of lightly sautéed and/or raw vegetables. Eat plant based protein (make your own or buy low sodium), 3-4 oz. of organic chicken or wild-caught fish or salmon. for (1) meal only per day.

      For breakfast stick to Dr. Sara Gottfried’s Reset360 Protein Shakes (vanilla or chocolate and add 8-10 oz. coconut or almond milk and a handful of spinach). She is also is a physician who specializes in Hormonal Health for women. Her book is called, “The Hormone Reset Diet”, I had great success, until I went back to eating sugar. You can find her book and the shakes on Amazon or http://www.reset360.com.

      Make you some bone broth soup (low sodium) with tons of vegetables and a little chicken. Eat it every night for dinner. Bone broth has so much health benefits and can heal your gut.

      Make sure you also have a large leafy-green salad everyday with colorful vegetables (stay away from tomatoes or sauces made with tomatoes they stimulate hunger and can cause or make acid reflux worse).

      I am seeing results and feeling better, and it has only been 1 week. Work on one meal at a time. Once you master it, then move on to the next meal. Remember eat (3) meals a day and one plant based snack (celery and hummus or plant based crackers and hummus are great) and one low-glycemic (low sugar) fruit serving like (berries, apple or jicama).

      You can do this!!! Just know I am doing it with you too! It can be reversed!!! You can send me a Facebook request, if you like for moral support. After I return from vacation (in 2 weeks) I will start making and posting plant based and healthy meals. So that will help you a lot. My account is under the name SarahMartinWhite (I am the only one). Wishing you much success!

  7. Aimee Moore
    4 years ago

    Dr. Northrop. You are a Rockstar and a Goddess. Thank you for all you do. I am grateful for the Holistic approach you offer for different illnesses not just suggesting pharmaceuticals. Unfortunately I have Type 2 Diabetes, my Mother and Brother both died of it.
    My Endocrinologist keeps giving me “meds” with triple warning and others which causes cancerous tumors in mice. I refused them and trying to find alternative methods such as following Dr. Fung and others to get my blood sugar under control.
    I agree Nutrition is a very confusing topic, Medical Medium says one thing, Dr. Fung just the opposite. Discernment is not always easy. Thank you for your wonderful Spirit.

  8. G
    4 years ago

    I don’t get the whole releasing unresolved emotions thing. How exactly does one do that? What does it look like?

    I have some traumas that I want to work through, and I suspect releasing would help, but no one seems to ever explain how to do this. It eludes me.

    1. DBHamilton
      4 years ago

      Hello,
      There are several methods out there such as Emotional Freedom Technique(EFT), Faster EFT(Eutapics), EMDR Therapy, Hypnosis, NLP, Meditation practices, etc.. The good news is that the internet and specifically YouTube is a great place to research most of these techniques and more. Many of these techniques can be used as “self help” tools, however if you have significant trauma issues it’s recommended that you find a skilled practitioner to assist you in the process. I hope that this helps to get you started on your healing path!

    2. ray
      4 years ago

      Tapping (emotional freedom technique) is a good place to start. Look up Brad Yates on youtube. He has videos on several subject. It is no substitute for 1 on 1 sessions with a talented practitioner, but it will give you an idea of one tool that is out there.

  9. karen
    4 years ago

    Hi Dr Northup I have read all your books and enjoy them greatly. I am going to condense this as much as possible and look forward to your reply. I am canadian so my blood references are different but I will quote them.
    My medicial doctors has gone back to school and only deals in bioidential hormones. I have been taking hormones for eight years but slowly decreased and went off them 3 months ago. I was having such a problem sleeping and night sweats that I went back on them after my doctor ordered blood work. My sugar has since 2016 been a little high at this time it is 5.6 reference in canada is 3.9-5.5 My surprise was my HDL 1.19 reference in canada is 1.20-2.21 as well my triglycerides are 1.87 reference is 0.60-1.70 My question is could this be because i went off my hormones and my body was ajusting? I became a vegan 2 years ago eat healthy and work out all my life I do weights and not excessive. I still work part-time. Are these numbers really riskie?

  10. Cara
    4 years ago

    I just got the results back from a fasting 3 hour blood glucose test with insulin readings. Fasting glucose was 91, and insulin 3.7. After one hour after the glucose drink, glucose 149( normal), insulin in high range. 2 hours- glucose 118 (ok), insulin still high but lower. 3 hours- glucose 89, insulin normal. Is this the beginning of insulin resistance? I get debilitating brain fog around two hours after eating. Would intermittent fasting help with this? How about low carb dieting, and if so, how low carb? Also to mention female hormone symptoms have been bad, lost my father 3.5 months ago, and sleep has been off. 52 peri menopausal.

  11. Dawn Howell
    5 years ago

    I’m 55 and have a A1c of over 10. I’ve been diagnosed with type 2 diabetes and placed on Metformin and Lantus. I’ve continued to get worse especially after being put on invokana. My body felt like a rubber and was being pulled as tight as possible and I envisioned never being able to get back. My BSL would never go above 250 until I started to recieve steroid injections for a bad neck and back.
    I feel like everything the medical establishment has done has made my condition worse. I’m now suffering from forgetfulness and it lapses on dementia at times. I so need help on where to begin.

    1. Donna Mueller
      5 years ago

      Hi Dawn. I am reading Dr Fung’s books. He has 4. All about diabetes, fasting, and the like. He is a nephrologist and helps cure many people of type 2 diabetes. I am in his fasting FB group. There are lots of success stories and great help there.

      1. Christiane
        5 years ago

        I love Jason Fung and his work.
        Thanks for posting this!

  12. Isabelle
    5 years ago

    I live in Western Australia, in a beautiful coastal suburb. I just love reading your articles and your books. I had rheumatic fever as a five year old, had Mitral Stenosis until I had a valve replacement at the age of 39 back in 1999. Everything went well until I went through peri menopause and developed an irregular heart beat. 4 cardio versions later & a few drug trials, I was told that I have to live with it and manage it. I take Digoxin, warfarin, thyroxin & cholesterol lowering medication as I also have familial high cholesterol. I’ve never carried excess weight, even through my pregnancies (2) full term & 1 miscarriage due to warfarin. I clean houses for a living and Walk most days with my gorgeous 4 legged girl, so I’m always moving. I eat well, no fast food or too much sugar. I cook all our meals unless we go out for dinner for special occasions. My sleep pattern has suffered since menopause even though I didn’t suffer with many night sweats & hot flashes. So I’m just wondering, if there’s anything else I can do to improve things. Thank you for being such an inspiration ❤️

    1. Christiane
      5 years ago

      I would try my Amatalife Pueraria mirifica product. Might well help. http://www.amatalife.com

  13. Sarah
    5 years ago

    Hi– I was just diagnosed as being right on the border, almost prediabetic, based on my lab tests. I went through menopause last year.
    Dr. Northrup, which glucometer do you recommend now?
    I have read some of Dr Fung’s work and am doing IF, reducing carbs, exercising more, and working on losing weight. I wondered if you recommend Dr Fung’s Diabetes book or his other ones, and if you recommend Dr. Hyman’s Blood Sugar book. (Have not read those two).
    Thank you.

  14. Roz B
    5 years ago

    Thank you for the wonderful article! I have PCOS and due to a right arm DVT went off my birth control in July. I’m 35 and am still working on regaining my cycle. I’ve started tracking my blood sugar based on blood sugar posts and recommendations, and have found my fasting readings to consistently be 95-99. However, during the day my blood sugar is much lower, even 1-2 hours after meals it will hover around 80-90. Just today my blood work recently came back and my fasting insulin is 2.4. Could you point to any resources for insulin being too low, not too hight? Thank you!!

    1. Christiane
      5 years ago

      Your insulin and blood sugar are just fine. I wouldn’t change a thing as
      Long as you are feeling fine.

  15. Jan Loftin
    5 years ago

    Hi I can’t find any real information regarding how long it usually takes to reverse IR so you can start losing weight again?

    1. Christiane
      5 years ago

      Check out The Setpoint Diet by Jonathan Bailor or Always Hungry by David Ludwig, MD, PhD

  16. Deana
    6 years ago

    I have dealt with PCOS for 18 years (probably more). I always ate low carb and yet still had issues with my weight and PCOS. I was recently diagnosed with diabetes (I have also been hypothyroid for 17 years and probably longer). I was so irritated and wondered what to do, I felt like my body and I needed to become a better team. June 2017, I became vegetarian and I was starting to feel better and have more energy. Once I was diagnosed with diabetes I knew I didn’t want to be on medication for the rest of my life so I began to research. I stumbled on to the Mastering Diabetes program and it has been life changing. I started to see I had too much fat in my diet even though I was vegetarian so I followed the program, not 100 % but close. I noticed my energy levels were going up and my weight was dropping. Since April I have lost 30 pounds, my A1c went from 10 to 6.9, my insulin went from 23.9 to 8.4, my blood sugar averages went from 232 to 140 (that has gotten better still). My fasting blood sugars are getting better and better. I used to deal with them being 150 even on Metformin but with exercise and adding cinnamon and amla to my regimen they are between 100-120. I have been insulin resistant most of my life and I can see where I went wrong with my eating. I notice what foods raise my sugars (white potatoes, rice, too much fat, quinoa) so until I am more insulin sensitive I will continue to keep a food diary, exercise, and listen to my body. I almost went on the keto diet but then I remembered how I felt all these years being low carb. I feel free, lighter, and more energized when I have a lot of vegetables and fruits in my diet. Oh and my cholesterol is down from 189 to 150. I am currently listening to your Goddesses Never Age book and I love it :).

    1. Christiane
      6 years ago

      I am so grateful you shared your story here! It’s the perfect example
      Of one size doesn’t fit all. I also applaud you on all this work! Bravo!

    2. Carolina
      2 years ago

      Hello! ThNk you for sharing. I am 46 and have done mostly low carb for many years. It has worked off and on and then I tried vegetarian, keto, vegan etc. I dohave hereditary high cholesterol. There is so much information out there that I don’t know what to listen to. Should I do IF if stressed, low fat, keto, cardio, more exerxise or less etc.

  17. SusieHmMkr
    6 years ago

    I’m 48. Known for 30 yrs that I have PCOS, and 11 yrs that I have insulin resistance. Since 2007 I’ve checked my bg every morning and 2 hrs after dinner, ate very low carb, kept a food diary, lost 45 lbs over 4 mos. Kept it off for a few yrs, then 6.5 yrs ago at the end of 2011 perimenopause became obvious. The weight became very difficult to keep off! I’ve had several sudden 10 lb gains (each time in a month), I can barely lose 2-3 lbs now and need to lose 40 lbs, I’d be happy with 25 though, I can handle chubby vs fat. My morning bg was slowly getting higher (125-130). Recently on a whim I changed my last snack from protein (eggs) to multi-grain Cheerios, and my morning bg is now 101-105. I always have gotten at least 7.5 hrs of sleep, but my body prefers 9 hrs. I also know I can’t eat a full meal anymore (can’t have salad and a small meal, it’s too much for me). I can no longer have 1 glass of wine 1-2 nights a week (I usually eat out Sat n Sun and have a glass of wine), I will gain .5 to 1.5 lbs from the wine. It’s perplexing that nearing menopause (8 mos no period as of today), and the major ups and downs of hormone fluctuations over the last 3 yrs, exasperated PCOS symptoms (lots of excess hair, thinning head hair, major debilitating cystic acne, fatigue, a uterus full of fibroids, etc), that now I can eat some carbs but zero sugar. Ive always eliminated sugar, rarely cheat (not even on my b’day and zero cookies at Christmas), but now I can’t have a glass of wine 🙁 My life has been an ongoing science project! lol So for me, while tedious, by keeping track of everything meticulously I’ve been able to see how food affects me, what worked and what didn’t, making changes regularly, has hugely helped me from going on any diabetes meds, but, losing weight is near impossible now. The exercise, that’s a whole other story!

  18. Amanda
    6 years ago

    Thank you! I experienced gestational diabetes while pregnant, and my body has always had a more challenging time processing sugar. I am reading “Dodging Energy Vampires” and was excited to learn that I am not alone experiencing these symptoms. I do not drink alcohol anymore, I exercise regularly, and I actually became a fitness instructor to help my daughters learn to dance and share what I have learned with others, (I also became a certified personal trainer through the National Academy of Sports Medicine this past week). I am now going to do a specialization in Nutrition through NASM and I am very interested in how our diets affect us and living our best lives. Thank you for this wonderful information!

    1. Christiane Nortbrup
      6 years ago

      Thanks so much for posting. And helping others know that change is possiible!

  19. Mary Kiningham
    6 years ago

    Thank you for the wonderful blog post! The waist to hip ratio is a real eye opener. I have been learning and slowly changing my diet to high fat, moderate protein and low carbs. I have released fat easily and the cravings are gone. I am very excited about this protocol. It is very satisfying and freeing.
    Intermittent Fasting has been very interesting for me to try and I love Bulletproof Coffee!
    Just think what effect this has on our environment to keep our protein consumption lower. 150 lb person 50 to 55 grams a day. 4oz of chicken is 31 grams 4oz ground beef is 29 grams. Those are small servings and you are over your limit. If you add an avocado to your meal, you are completely satisfied!

    Thanks, Chris!!

    1. Christiane
      6 years ago

      Thanks Mary. Great info on protein and waist /hip ratio. Small steps to health. The best way to go!

  20. Michelle
    6 years ago

    I am shocked that you are recommending a low carb, high fat diet given what you’ve learned from Anthony William.

    1. Christiane Northrup
      6 years ago

      Everyone is different. There is no “one size fits all”.

    2. Maddy
      4 years ago

      Anthony William is a quack. He has no medical knowledge, repackages information others shared ages ago and makes outlandish claims while asserting that “science won’t catch on to this for many years yet” to avoid proving anything. All of his claims are pilfered, fabricated and allegedly given to him by a ghost. Stop looking to him for health. I beg you.

  21. Linda Pryor
    6 years ago

    Just ran across this article and was pleasantly surprised that in my search for answers for my uncontrollable high blood pressure spikes, I had discovered all of these recommendations separately from extensive reasearch and have been utilizing them in my life to great effect. Intermittent fasting, Keto diet, stress and fear management through self analysis, mindful gratitude and prayer, walking daily, light weights. The result has been the normalizing of my BP, no spikes and feeling better than I have in years. So gratifying to see this all in one simple article! I can attest that these changes can transform a life.

    1. Christiane
      6 years ago

      Thank you!!

  22. Your articles are always wonderful, but please address those of us who need to gain weight, not lose. Our population gets hardly any attention, and there are many of us. Low carb just doesn’t work; without sweet potatoes, acorn squash, breadfruit, carrots, beets, etc., I lose weight. Please count us in and address this very much overlooked quandary. Blood sugar is high from indiscriminate sweets of the past.

  23. li
    6 years ago

    what’s CHO? TY

    1. Leanne
      6 years ago

      cholesterol

    2. popcornsally
      5 years ago

      CHO is carbohydrate.

  24. Sharon
    6 years ago

    I went through menopause about 8 years ago. Have not had any symptoms (hot flashes, etc.) since then. In October I gained 10 pounds and have not been able to get it off. I exercise daily (walk 1 mile, 1/2 hour cardio/weight combo – I get 10K steps a day, most days). I do crave sugar. I eat pretty clean. I have upped my protein intake. It says something about bile salts in the article and increased protein intake. I had my gall bladder removed 6 years ago. Should I be added bile salts as a supplement? Thank you

  25. Sara J. Nowell
    6 years ago

    I am insulin resistance, weigh 214, 5’2″ and my A1C is 8.8 last done on 3 Feb 2018. I will be 69 years old this September, is thee any hope for me? what can I do to change this around?

    1. Kathryn
      6 years ago

      Definitely check out the ketogenic diet. It was made for people with your health profile. I just started 2 months ago, and have already lost 20 lbs and I am never hungry! You’ll love this WOE (way of eating)!

      1. cheryl
        6 years ago

        Please ladies..

        Take care with a Keto diet. I lost half my hair doing Keto.

        We do Grass fed all organic, raw dairy, etc.
        I am a long time licensed nutritionist. It can impacted your thyroid in a bad way.
        Also younger woman should Not restrict CHO if planning on having children. Research has shown certain birth defects can occur with low CHO.
        I do agree it works for some but I followed what has been highly recommended here.
        Stress and unresolved grief are huge issues.

        I did not gain weight for 10 yrs and then hit too many family deaths. Major life Crisis and then the weight piled on.
        Limiting needed nutrients and cutting calories does not lead to long term success as everyone knows.
        Being Creative happy and fulfilled create a happy body.

        Best to all..thanks Dr C…

        1. li
          6 years ago

          what’s CHO? TY

        2. Christiane Northrup
          6 years ago

          You make some really good points here. There are always emotional triggers for weight gain– it’s not as simply as just low carb.

      2. Michelle
        6 years ago

        Keto diets are a trendy fad. Fruit is what heals us. High fat is what hurts our livers and keeps our blood slow moving. Check out Anthony William for health information.

        1. Janet
          6 years ago

          Ask Steve Jobs about that “fruit is what heals us” statement. Oh, yeah, he died of pancreatic cancer.

          1. Kristin
            6 years ago

            Exactly.

        2. Christiane
          6 years ago

          There is huge biochemical variability among different people. Low carb keto works for many. Not all. Low fat, lots of fruit works for others. We must each find our way.

          1. Maddy
            4 years ago

            I agree on different bodies needing different paths. I find living in survival mode, aka keto, to be horrific and a total disaster, not to mention counter intuitive. But certainly a high fruit approach is also not a panacea for all, either. Bio individuality is crucial.

  26. Karen
    6 years ago

    My 12yr old daughter was diagnosed with PCOS last year. They tried Metformin which lowered her blood sugar too much and she was getting dizzy. So they put her on birth control pills. I am looking for a natural way to help balance her hormones to help her live a more healthy life without drugs.
    Thank you.

    1. Tani
      6 years ago

      Karen, Has her endocrinologist or obgyn ruled out everything before they came to the PCOS diagnosis? They are finding more and more women who were diagnosed with PCOS at a young age to have syndromes such as Cushing’s that can be cured unlike a PCOS diagnosis. Have a peek on Google under women with Poly Cystic Ovaries who have Cushing’s syndrome. Most doctors don’t think about this other diagnosis they just jump to PCOS if they see the three base indicators.

    2. Christiane Northrup
      6 years ago

      PCOS is quite easy to treat and reverse with a whole food diet. I suggest the book ( and cookbook) Always Hungry by David Ludwig, MD of Boston Children’s Hospital. It is very well researched and easy to follow. And lowers insulin beautifully.

  27. LeAnn
    6 years ago

    Just received my first bottle of Amata Life. I have been on Serenity progesterone cream for several years, can I use both of these products simultaneously?

    1. Christiane
      6 years ago

      Yes. You can use both. But generally you don’t need progesterone if on Pueraria mirifica.

  28. Jenna W
    6 years ago

    What advice can u give for a recent diagnosis of an “atrophying vaginal wall”? I am 50yrs of age, one year post menopausal. I,’ve been blessed w/ very few Peri, menopausal or post-memo symptoms. What are the bare minimums I ought to be taking/doing now that i.m a year into full menopause to support this change? I am a vegetarian. Thank you!

    1. Nancy Pavia
      6 years ago

      Look into Mona Lisa Touch, a laser treatment for rejuvenation of the vagina. Works wonders for many women. http://www.monalisatouch.com/

      1. Angie
        6 years ago

        Try vaginal dilators

  29. Jean S.
    7 years ago

    As always Dr. Northrup, thank you for such vital and life changing information. My husbands fasting insulin level was 121. That needed to come down! We got rid of all the cruddy carbs, do not eat grains except some organic brown rice from time to time, quit processed dairy and eat raw cheese, olive oil, cold pressed organic coconut oil, avocados, grass fed meats, no chicken as most of it is cheaply produced and fed grains as well, lots of greens, pasture raised eggs, etc. Wow! His level is now 77! Not to mention that his weight is perfect! Thank you, thank you, thank you for spreading the word education people on how to turn their health around. Love you!!!!!

    1. Maddy
      4 years ago

      That is so wonderful to hear! Raw dairy is so healing, I wish it was legal and readily available everywhere. The fact that cigarettes and booze are ubiquitous, alongside fast food, but raw dairy is illegal all over is nuts.

  30. Anne
    7 years ago

    Your articles are always wonderful, but please address those of us who need to gain weight, not lose. Our population gets hardly any attention, and there are many of us. Low carb just doesn’t work; without sweet potatoes, acorn squash, breadfruit, carrots, beets, etc., I lose weight. Please count us in and address this very much overlooked quandary. Blood sugar is high from indiscriminate sweets of the past.

  31. Lori L Hill
    7 years ago

    Can’t thank you enough. I just went to my library (large library) last week-and guess what? They didn’t have one book- about insulin resistance. Thank God for this article!

  32. star
    7 years ago

    I am on metformin for pre diabetes as my Aic is 6….how can I get off and lower insulin….Diabetes in family

  33. Johanne Spenard
    7 years ago

    Hello Dr Northrup
    I’m a nutritionnist in Montréal, Québec
    I question Dr Fung’s diet high in fat, especially in presence of metabolic syndrome and obesity. Fat should be mostly unsaturated.
    Patients would benefit nutritional consultation with registered dietician- nutritionist because it is so easy to get confused about what one should eat or not considering health condition.

    I follow you in many ways.
    Thank you for your positive interests in women’s health.

    1. Margaux De Rothschild
      6 years ago

      I think you might like to read more recent research, in particular any data regarding autophagy.

      Moreover, from your comment I do not believe you have read Dr. Fung’s publications.

      What Dr. Northrup has advised here is correct, if you update your research you will concur.

  34. lisa
    7 years ago

    This is fabulous. It’s a real up and coming threat to people predisposed to migraines. Thank you.

  35. Kathy Cinquemani
    7 years ago

    Hi! I quit smoking years ago with Nicorette, but 7 years later I was still chewing it. So I put a stop to Nicorette Easter 2017. I think I was addicted to sweetness of the gum–or either an oral fixation. I started chewing xylitol gum instead, but then worried it was contributing to my IBS (diarrhea), so I quit it about 3 weeks ago. I’m getting relief with help from you and Dr. Mark Hyman. I’m back to regular BM’s. I drink a cup of herbal tea each night that has stevia in it, could this still be causing insulin resistance problems with my stubborn weight loss? I’ve got to drop this weight! I’m 5’3″ and 162lbs. Help?

    1. Moni
      6 years ago

      There is a Glycemic Index that classifies types of food (apples, meat, poultry, fish, etc.) and how much they raise our blood sugar levels. At the same time, there is also an Insulinemic Index that also classifies types of food and how much they raise insulin levels. Surprisingly, not all foodstuff raise blood sugar levels and insulin levels in the same exact proportion. Despite this, everyone is focused on blood sugar levels only. Dr. Fung has explained on his blog that you have to be checking both indexes. Some types of food do not raise blood sugar levels but do increase insulin. Look for those indexes online. You will find interesting surprises. For example, in the protein category, eggs raise insulin very little. Then, poultry a little bit more, followed by meats of different types. Fish raises it more than meat. And lobster, crab and oysters are the type of protein that raise insulin the most. Being aware of how insulin levels are raised appears to be crucial but no one tells us to look into that. I have found very contrdictory information regarding insulin and insulin resistance online. The Insulinogenic Index itself is not yet complete and it comes out of a mere PhD thesis. A lot more research is needed but no one is focusing on where the problem starts: insulin levels, insulin resistance. Diabetes is just a symptom of a situation that has gotten totally out of control. Supposedly, insulin resistance can be reversed and corrected while Diabetes can only be controlled. What is known appears to be unclear. I find stevia affects me badly and in fact Dr. Fung says any kind of artificial sweetener (even stevia, which I used to buy in its totally natural pulverized form –green in color– should be avoided. I think Dr. Fung is completely right because a clear symptom of insulin level rise is tinnitus. When I chew “sugar free” Trident gum I immediately get tinnitus. We also have to be aware of the 40 something different names used for sugar in product labels. Supermarket stevia (the white one) has dextrose or maltodextrose (at least the one I can find where I live). Those are hidden names for sugar. It’s important to identify them and always check product ingredients carefully having those names in mind. There are also other types of sugars called “alcohol sugars” (sorbitol, xyltol and similar names), like the ones used in the gum I mentioned. Those always give me tinnitus. Apparently there is not a lot of knowledge regarding insulin and insulin resistnce and it is slowly emerging. If doctors checked everyone’s insulin levels instead of just focusing on blood sugar levels, prediabetes and diabetes could be prevented. Instead, people are getting diagnosed only when they have gotten sick. What a crime, don’t you think? I know it’s hard but I do think we should stay away from any kind of sweetener, as Dr. Fung recommends.

  36. Julie
    7 years ago

    I am a tall thin woman who has struggled w prediiabetes for 5 years from age 51-56. I reached meapause at 52. I have just turned 56. My naturalist MD put me on the whole 30 program and a Glucose Defend supplement. Since then my fasting glucose went from 125 to 97, and my A1c was reduced from 6.1 to 5.5 as of my last reading end of August. I still practice 12–15 hour daily fasting 6-7 days a week, and mini resets to the whole 30 program. In addition I have reduced my charbohydrate and sugar intake significantly. I do drink wine though and am not so successful in limiting it to 3 servings a week unfortunately.

    Thank you Doctor Northrup for all your contributions to women’s health.

    1. Carla
      6 years ago

      Julie, could you tell me how long it took you to get your blood sugars back in the normal range? 8 weeks ago I was given the pre-diabetes diagnosis with a HBA1c of 6.1% and since then I have been on a LCHF diet. I have never been overweight, having a BMI of 19.1 at diagnosis and now 18.5. I have been practising intermittent fasting for over 4 years. After 8 weeks of my low carb diet, which I have absolutely kept to, my blood sugars are still over the normal range, fasting level approx 100 to 125 most days. I exercise in different ways several days a week. I am beginning to think I’ll never see any change in the levels and wonder what else I have to do to get there.

      1. Scott Dages
        6 years ago

        When do you take your fasting glucose test? Is it right after you wake up? Are you in ketosis? I ask because after being in ketosis for a certain amount of time and being “fat-adapted”, you may see higher than average levels of blood glucose when you first get out of bed which can be related to the dawn phenomenon.

  37. Donna Bishop
    7 years ago

    Thank you for that video today. So many pieces of it hit home with me. I have to let go of trying to change someone’s raising of my great granddaughter and the formula she’s putting into her. Today I’m going to take steps to free myself from this pain by getting rid of all thing baby in my house that keeps reminding me of it. I got sick this week and know it’s the stress of this situation. I will still watch her as needed and love her as I do and chant to myself the serenity prayer.

  38. Holly
    7 years ago

    I got a glucometer as you suggested and am terrified to see my fasting glucose this am is 126! I do not eat carbs, I use my CSA for fresh vegetables. I’ll start the 12 hour fast today.
    I do have one cup of espresso with almond milk, no sugar or sweetener, each day. Do I need to forego that?
    I’m 5’3″ and weigh 148.6 today.

    1. Iris
      6 years ago

      Hi Holly. Not sure that you will get this but…I have the same issue and do not have an answer however Dr Fungs book talks about coffee being good. Get his book. Also listen to dr northrups interview with him on her Hay House Radio Show. You can find it in the archives. Many blessing to you for success.

  39. Karren
    7 years ago

    Thank you for helping us to be proactive towards our health. So many problems can be avoided. My grandfather had diabetes and I was always told it skips a generation and so I am careful about what I eat and do. Thank you for sharing your enthusiasm for life. I am always delighted to hear what you have to say.

  40. Lynn W
    7 years ago

    Thank you! This is very helpful! I’ve been insulin resistant for a few years and now that I’m over 40 I’m starting to see symptoms. No health professional ever shared all the potential health problems it causes. I will be implementing this plan effective today!

  41. Anne Vanderlaan
    7 years ago

    great article know more now then I have ever been able to find out. Thanks Dr. Northrup

  42. Tani
    7 years ago

    I was diagnosed with PCOS at the age of 15 based on excess facial hair and periods that were on again off again. I was placed on the pill to help get my periods regulated. My cousin mentioned to me that a friend of hers that was diagnosed with PCOS actually had Cushing’s syndrome. Her gynecologist said that there are a lot of women who have been misdiagnosed with PCOS when what they have is Cushing’s Syndrome.

    My PCOS then lead to insulin resistance and then type 2 diabetes. My endocrinologist said that this was normal and that nothing could be done but increasing medications over the years to come.

    How can one tell if one has Cushing’s rather than PCOS as it seems that symptoms for both are relatively the same. I would like to have some facts to provide to my endocrinologist when next I meet with her.

    Thank you in advance for your assistance,
    TM

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