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Hypothyroidism and Insulin Resistance [4 Steps to Reverse it and Finally Lose Weight]

Do you feel like it's impossible to lose weight with Hypothyroidism?

​It actually isn't impossible and I will explain how later, but first I need to share a story with you. 

​I had a patient who came to see me in the office recently. 

She was 43, on levothyroxine (for years), about 60 pounds overweight, and wanted my help in balancing her hormones and help her lose some of that weight. ​

Like most other people, she had tried to lose weight following every diet you can think of, but nothing seemed to work for her. 

So I got to testing her labs.

Know what I found? ​

More...

Elevated insulin with hypothyroidism

Insulin resistance. ​

And THAT was her primary problem.

Her thyroid wasn't all that bad, she ultimately did better on Armour thyroid - but her main problem was the insulin.

Once we got her on the right regimen, cleaned up her diet, fixed her adrenals, replaced nutrient deficiencies and put her on a fasting program her weight started to shed off.

And that's what we are going to talk about today.

​Hypothyroidism and Insulin Resistance. And why it's impossible to lose weight unless you address BOTH issues. 

What is Insulin Resistance?

​Insulin is the hormone that increases after you eat a lot of sugar. 

It puts sugar inside your cells and protects your body from high levels of sugar in the blood.

That's what it's supposed to do - when everything is working correctly.

When insulin levels remain chronically elevated (like when we eat a lot of sugar in our diet), your body becomes resistant to insulin. And that's where all the problems start.

High levels of insulin cause you to store the calories you eat from your diet as fat in your belly.

​So high levels of insulin = you gain weight (even if you eat fewer calories). 

I've put together a list of some symptoms I see in my patients that have insulin resistance: (But don't worry I will tell you how to order and treat your insulin resistance below)​

  • Inability to lose weight
  • Belly fat (or visceral abdominal fat)
  • Cravings for sugary foods
  • Irritability when going long periods of time without food
  • Dizziness and lightheadedness when fasting

Any of these symptoms sound familiar?

Let's talk about why insulin resistance is a big deal...​

Hypothyroidism is common but so is Insulin Resistance

If you count all of the people with Hypothyroidism you get pretty close to about 1 in 20 adults in the US. It's INCREDIBLY common.

Prevalence of hypothyrodism

​And on the other hand you have insulin resistance (AKA Diabetes) of which about 1 out of every 10 people have... 

Prevalence of diabetes and insulin resistance in the USA

​Not only are they both common, I find that most Hypothyroid patients are ALSO suffering from insulin resistance on top of their Hypothyroidism. 

And this can lead to weight loss resistance, inflammation and worsening hypothyroid symptoms. ​

Is Insulin Resistance Sabotaging your Weight Loss Efforts?

​Identifying and diagnosing insulin resistance is the first step to treatment. 

To understand why reversing insulin resistance is critical to weight loss we have to talk a little bit about physiology.

​We already mentioned that in the presence of insulin your body will store all calories you eat as fat. 

​But it also does something worse...

When insulin levels are high, your body is unable to burn your fat cells as a fuel source.

This process is mediated through a hormone known as hormone sensitive lipase.

So, in order to burn fat (and actually lose weight) you HAVE to reduce insulin levels.

To depict this I like to use this graph:

Burning fat in the presence of insulin

​(Photo credit: Peter Attia of Eating Academy) 

​As you can see: 

As insulin levels fall, your body is able to actually unlock your fat cells and start to burn them for energy.

When insulin levels are high, your body can't unlock your fat cells to use as energy.

That means your body uses primarily glucose as an energy source. Which can cause a lot of the symptoms I mentioned above...

As Glucose levels drop in the blood your body tells your brain to increase your cravings for sugary foods, it also makes you irritable, and sluggish.

Are any of these symptoms sounding familiar?

So how do you know if you have Insulin Resistance?

Diagnosing insulin resistance is actually pretty easy once you know what you are looking for.

The problem is that most Doctors will NOT be ordering these tests at baseline.

So, in order to get the proper evaluation, you may have to ask for and interpret your own tests.

Don't worry.

I can walk you through it. 

Ask your doctor for the following lab tests: ​

  • Fasting Insulin levels
  • Hemoglobin A1c (Abbreviate Hgb A1c)
  • Fasting blood sugar
  • You may ultimately need post meal glucose levels as well

Now that you have your lab tests in front of you, let's go over the "optimal" ranges:

  • Fasting Insulin levels: This should be < 5 (note that < 5 does NOT rule out insulin resistance) 
  • Hemoglobin A1c (Abbreviate Hgb A1c): Should be < 5.3 (note that Hgb A1c is not a perfect test by itself and a number of conditions can falsely elevate or decrease this value) 
  • Fasting blood sugar: Should be < 85
  • Post meal glucose: 2 hour post meal glucose should be < 120
Early signs of insulin resistance

​Believe it or not diagnosing insulin resistance can be very difficult, when in doubt I would recommend that you consult with your Doctor - just make sure you find one that is knowledgeable. 

*Resources and links for optimal ranges are at the end of this article. ​

Now that we know WHY insulin resistance is a problem, let's talk about how you can reverse it...​

​How to Reverse Insulin Resistance and Heal your Thyroid

Despite what conventional medicine would have you think, insulin resistance IS treatable. 

In the conventional medical world treatment is targeted at blood sugar. The problem with that method is that you are only going after the symptom of insulin resistance. 

Blood sugar rises as insulin resistance increases, and when it gets too high that's when Doctors diagnose you with Diabetes.

But diabetes is really just advanced insulin resistance.

And, while some medications can be helpful in reversing insulin resistance, the majority of your treatment should focus on the following areas:​

Diet to reduce Insulin levels

Diet i​s important in reversing insulin resistance, but alone it is usually not enough - especially for advanced insulin resistance. 

Increased insulin leads to obesity

​Consider the image above. 

What you put into your mouth can certainly cause increased level of insulin and ultimately lead to insulin resistance.

However, once insulin levels get high enough they can cause insulin resistance by themselves in a vicious cycle.

That's why diet is a good first step but usually not enough.

I recommend focusing on a nutrient dense, real whole-food diet, low in refined carbohydrates and sugar. You can get an exact idea of what I'm talking about by checking out my Thyroid Reset Diet here. ​

High intensity exercise routine

Everyone knows exercise is important, but the type of exercise matters a lot. Especially if you are trying to lose weight and reverse insulin resistance.

Studies show that High Intensity Interval Training is especially helpful in sensitizing your body to insulin.

​In addition, you can get more bang for your buck in a smaller amount of time. 

Not sure what High Intensity Interval Training (HIIT) is?

Let me explain:

​HIIT focuses on small bursts of all-out, maximum effort for about 30 seconds followed by 60-90 seconds of moderate activity. 

This process is repeated 5-8x in a single session at least once per week.

​This once per week activity is more beneficial to your body than doing an elliptical for 30 minutes and takes a much smaller amount of time. 

A word of warning for Hypothyroid patients:

Do not attempt high intensity interval training unless your thyroid hormone is optimized and your adrenals can handle the stress.

Exercise (of any kind) puts a physiologic strain on the body. It's the healing process, release of endorphins and cellular changes which cause all of the benefits of exercise.

And while exercise is important, it's better to take it easy at first otherwise you risk making your thyroid and adrenal function worse. ​

  • Quick Tip: If after exercising you are fatigued for several days then that is a sign you need to look at your thyroid and/or adrenal function. Exercising should make you tired and sore, but it shouldn't last more than 3 days. 

Intermittent fasting protocol

Fasting is a 4 letter word for a lot of people.

​But the truth is that fasting is probably the single most effective way to treat insulin resistance

​Here's how it works:

The longer you spend without eating the lower your insulin levels fall.

Once your body uses up the majority of stored glucose in the liver, your body MUST use triglycerides from your fat cells to provide your body with energy. 

As insulin levels fall your fat cells become "unlocked" by hormone sensitive lipase, and you are now burning fat for fuel and sensitizing your body to insulin in the process. 

This is obviously over simplified, but you get the point!

Fasting = good for reducing insulin resistance

​BUT, and this is a big but...

Like high intensity exercise, I don't recommend starting intermittent fasting unless your adrenals and thyroid function are optimized.

If you start fasting and you experience any of the following you may need to optimize your thyroid and adrenals first:

  • Dizziness or lighteadedness
  • Headache
  • Extreme cravings
  • Tremors or "shakes"
  • Intense thirst
  • Increased urination

​Do not attempt fasting if you are on insulin and a diabetic. You WILL need medical supervision and if you try to do it by yourself you may put yourself in danger from hypoglycemia. 

This is how I start patients on a gentle intermittent fasting program:

Start with 12-14 hours.

Eat an early dinner at 7pm.

Eat a late breakfast/early lunch at 11:00am the following morning.

Repeat this process twice per week. ​

Supplements to Treat Insulin Resistance

I saved this part for last, because it's typically the first thing people want to do!

While supplements can definitely help reverse insulin resistance and help you lose weight, they should NEVER be used in isolation.

If all you do is grab your supplements and go, you will not experience the results you are looking for.

Having said that these are the supplements I recommend to my patients which have scientific studies backing them:

  • Berberine - I recommend using 1,000mg at least daily. Berberine has been shown to be as effective as Metformin in reducing Hgb A1c
  • Pure Lean PurePack - This has a combination of Cinnamon, Alpha lipoic acid, Chromium and Green tea - all of which have been shown to decrease insulin resistance. I use this because it puts everything in a nice convenient to use package and includes other helpful nutrients that most people are deficient in. 
  • Konjac root - This supplement is a viscous fiber that expands in your stomach helping to keep you full, feed good gut bacteria and reduce insulin resistance. It's also been shown to actually help with weight loss. For maximum benefit take 4 capsules 15 minutes before each meal and while intermittent fasting throughout the day. 

We are going to put this all together at the end for maximum effect, so keep reading. 

Do you have debilitating fatigue?

When trying to add these tips into your regimen it's VERY important that you don't do more harm than good. 

Before you start doing high intensity interval training or intermittent fasting you need to make sure that your thyroid hormone medication is optimized and that your adrenals can handle the stress. 

If you aren't sure whether or not you should start I would recommend you check out this post here.

If you are still having hypothyroid symptoms, or the signs and symptoms of adrenal fatigue I would caution against exercising and fasting.

​Also take note that there is a difference between brain based fatigue and physical fatigue. 

In brain based fatigue you will get fatigued after heavy thinking or mental activity. If you are experiencing this type of fatigue then exercise CAN help. 

In physical fatigue you will be wiped out after exerting yourself physically. If you are experiencing this type of fatigue then exercising and fasting may make your condition worse. 

Medications that help sensitize your body to insulin​

In addition to supplements there are some medications that can actually help sensitize your body to insulin.

Most of the time this won't be an issue if early insulin resistance, but if you have diabetes (and advanced insulin resistance) you may be on 1 or more medications.

If you fall into this category I would recommend you optimize your medications and consider getting on one or more of the following:

​Other medications may actually cause an increase in insulin (especially if they stimulate the release of insulin). 

See your doctor for further information. ​

Here's what you need to do now​

​You won't start feeling better and losing weight unless you take ACTION. 

With that in mind I've come up with 4 steps that I want you to follow to get the process moving:​

  • Change your diet: You have all of the resources here to make it happen in my Thyroid Reset Guide. My guide has all the guidelines including what foods to eat, what foods to avoid and what portion sizes you need. 
  • Balance and check your hormone levels: Insulin resistance is made worse by other hormonal imbalances like increased levels of leptin. You can find out what hormones I'm talking about here and how to go about getting the right tests. 
  • Get your supplements and start using them: These are the supplements that I recommend and use in my clinic - Berberine, Purelean Pure Pack, Konjac root
  • Consider adding intermittent fasting and HIIT into your regimen (advanced): Use caution when adding these into your routine. I recommend starting with the other options above first. 

Now I want to hear from you

​Are you suffering from Insulin Resistance as well? How did you manage to lose weight and fix the problem? Hypothyroidism and Diabetes can be a tricky situation so let's share the information to help as many people as possible. 

*Additional resources:

Screening for Diabetes and Pre-Diabetes With Proposed A1C-Based Diagnostic Criteria

Glycemic Control and Coronary Heart Disease Risk in Persons With and Without Diabetes

Glycemic control and coronary heart disease risk in persons with and without diabetes: the atherosclerosis risk in communities study


Dr. Westin Childs
 

I'm Dr. Childs and I write these posts. I'm a physician that specializes helping patients lose weight, have more energy and FEEL better. My practice focuses on hormone imbalances, thyroid issues and weight loss resistance. My goal is to provide the BEST information out there on the internet that is both actionable and trustworthy. Get my free ebook: Hashimoto's Diet Guide here. You can also find more about my personal journey back to health here.

Click Here to Leave a Comment Below 16 comments
Shellie Friend - March 16, 2016

Dr. Westin- I have been monitoring my weight for the last couple of weeks – it jumps 2-6 pounds a day ! I exercise and I am taking thyroid meds and all suggested supplements. Not sure why it jumps like that from day to day . If you have any ideas please let me know .

Reply
    Westin Childs - March 16, 2016

    Hey Shellie,

    It’s hard to say for sure, but in general large swings in weight like that are probably related to fluid shifts more than anything else. Your body shouldn’t burn through fat mass that quickly.

    The supplements will help regulate your thyroid and as your thyroid becomes more stable it should improve your metabolism. I don’t recommend using only supplements by themselves for weight loss however, you really need a comprehensive treatment plan.

    I also recommend checking all other hormonal systems in the body.

    Changes in body weight like you describe can be related to estrogen/progesterone balance.

    Reply
Jennifer - April 30, 2016

My doctor told me I am insulin resistant. I am on 1000 metformin a day. I have taken fruit out of my diet and am eating clean. I am eating around 1200 calories a day, and I have not lost one pound. Since doing this beginning in January, I am up 7lb. I am at such a loss. My TSH is down to 1.9 starting at 5.8, and I am taking 65 mcg of Naturthyroid. I have requested possibly adding T3 (Cytomel) as I don’t know if I’m getting enough to work. I am normally 135 lbs. and I am stuck at 177 lbs. This is not me. I realize I may not get back to where I was, but would really like to lose 20-25 lbs. I feel like I am doing all my own research as my doctor is open to some treatments such as a natural thyroid medication, but she has admitted she doesn’t look at all the areas a holistic doctor may. I am looking into using HIIT, fasting, and just hoping to find something that works. I also take 8000 Vitamin D a day, Vitamin B, and Magnesium. I try to get Selium naturally. Any suggestions would be greatly appreciated. My A1C was at 5.9 in January, and is now 5.8 after starting metformin 6 weeks ago. Thank you for your time!

Reply
    Dr. Westin Childs - April 30, 2016

    Hey Jennifer,

    It sounds like you understand all of the things you need to be doing you just need someone to create a treatment protocol to make it happen, and that can be the hard part. Also, it’s important to realize that your thyroid is only one part of the equation – with high levels of insulin you will never be able to lose weight, even with cytomel or NDT.

    Reply
      Jennifer - April 30, 2016

      Where do I go next? My endocrinologist, a holistic dr., who is best to find the “formula” I need to see success? I also have estrogen dominence and am on progesterone cream. I feel like I have pieces and yet there’s still a missing link…

      Reply
        Dr. Westin Childs - April 30, 2016

        I wish I had a good answer for you. I had to learn all of this stuff myself, there is no specialty that focuses on it. Most doctors specialize so they understand a part of it, but very few have the understanding to put it all together.

        An endocrinologist is likely the last place I would look and a holistic doctor will be hit or miss depending on the skill.

        Reply
        Trupti Sharma - January 27, 2017

        I hear you. sailing in the same boat since 1 yr.. diagnosed with insulin resistance 1 month ago. I have hashimotos too.. it’s like I am looking for the missing piece in the QUEST TO LOSE WEIGHT puzzle

        Reply
Kelly - August 22, 2016

Hi Dr. Childs,
I enjoyed your article and how you broke it all down to make sense. I have been suffering with hypothyroidism since after the birth of my son 9years ago, although the I suspect it was before that. Anyway to make a long story short I have not been regularly going to my endo because she is cold and purely looking at my TSH as a road map and not my T3 and only tests free T4 sometimes. Others didn’t take my insurance at the time and just had baby #2 4.5 months ago and honestly haven’t been back to have my thyroid checked. I brought myself back down with extra pills of synthroid I’ve had to 75mcg because that’s around where I was at before but know and feel this isn’t right. It took me almost arguing with my endo to even try armour and when I missed one spot when I came back she immediately started me back on synthroid no ifs ands or buts :(…I did well on it but I can’t say that it made a huge difference, but my #s always looked good and I felt good.
I did lose weight on my own several years ago with lots of cardio/some weights and cutting out as much sugar as I could and eating as clean as I could. I lost 30lbs in two months and kept it off for quite some time. I’m 5’2″ and weighed 170 then after losing 30lbs and now am 227 after having my daughter :(. I now have a different insurance and not sure where to turn honestly. I read an endo might not be the best to go to, should I try a family dr? I was never told I have hashimotos but assume I do since my endo told me there was no cure for my hypo and I have an autoimmune disease with high inflammation in my body. She told me I will have to take thyroid replacement for the rest of my life. My dad, sister, aunt and uncle all have hypo and my uncle had to have his thyroid removed. I’m 28 and there isn’t a place on my body near my joints that isn’t sore. I’m not a lazy person at all but I’m not running or making an effort to walk daily like I use to though. I’m just at a loss and feel lost where to turn where they won’t just look at #s and assume things are A-OK when they’re not. I need someone to actually listen to me and. It assume I’m just trying to play dr and know it all, I’m not and would truly love someone to guide me.

I felt my absolute best and as shedding lbs and inches when my TSH was 0.28 but not sure what the my free t4 or t3 was. I do assume and feel I have insulin resistance if I try to cut out sugary foods now and the sugar cravings are SO intense I just want to have a huge sugar binge and have to find things to occupy me and I try drinking a lot of water to try and help curb it. Ita awful and I’m just having a hard time all around. I have the typical moon face, dry skin, cracked heels, major hair loss, moody, brain fog, memory loss, half my eyebrows are gone, over weight of course, joint and all over pain, easily fatigued mentally and just over all feel BAD. Some days I’m literally fighting to get through and now that we have our 4.5month old that has slept awful since birth I feel like a walking zombie.

If you can offer any guidance, of any kind I would appreciate it.

Thank you!

Reply
    Dr. Westin Childs - August 22, 2016

    Hey Kelly,

    Thanks for the comment! Unfortunately, when it comes to patients like yourself you really need a complete workup. There isn’t a lot of information I can provide that will be actionable to you because I really have no idea what is happening inside your body without looking at labs, etc.

    It sounds as if you are likely being under treated with your thyroid hormone, but I’m sure you also have other issues going on as well.

    Reply
M. Luca - February 7, 2017

You need to distinguish between type 1 and type 2 diabetes. Not all diabetes is the same. Type 2 has many factors including genetics, lifestyle, and diet. Type 1 is an autoimmune disease, is not preventable and has no cure. Insulin resistance can happen in both diseases, since people with Type 1 must administer insulin themselves and can build up a resistance over time due to this. Please clarify your facts, this is damaging and spread wrong information. Insulin Resistance should not be labled as “AKA DIABETES”

Reply
    Dr. Westin Childs - February 7, 2017

    Naturally I am referring to type II diabetics with insulin resistance if I say it is reversible. Any type I diabetic should understand that their disease isn’t reversible (in most cases). Regardless, the point still stands for type I Diabetics – you can still use these therapies to reduce insulin resistance and increase the effectiveness of insulin in type I diabetics, I have done it many times in both type I diabetics and latent adult onset diabetics (type 1.5). I think you should use the recommendations to help reduce your stress 🙂

    Reply
Neha Scott - February 10, 2017

What an amazing article with best knowledge I had been detected with insulin resistance and thyroid from 2012 its a tough battle after my doctor removes me from medication I tend to put on weight back again. I have from your article gained knowledge on supplements and high intensity work outs shall work on them.

Reply
Joe - February 16, 2017

Hello

I am a hypopituitarism patient taking replacement Cort, T3 & Armour, Testosterone, Fludrocort, and HGH. Dysfunction is likely in the hypothalamus. It came on slowly and was missed for several years.

I strongly suspect that I’m now suffering thyroid resistance and insulin resistance. It’s been one severe complication after another, and my endo is now stopped at antioxidants. My thyroid was always “normal” but I still had severe hypothyroidism symptoms. Labs can mean squat.

I’m using supraphysiological Cytomel T3 and Armour but could be a lot better. I was “normal” for almost 90 days once, but it didn’t last. I remain dragging. Sleep is erratic and is now being monitored.

I’ve exercised cardio almost 400 days consecutively and lost more weight that I care to. I’ve started weight training again. I am serious about recovery.

Any direction or suggestions would be forever appreciated!

Reply
Cat M. - March 1, 2017

Hi,

I found the information in this article very helpful! I am a 50 year old female with longstanding Hashimoto’s (diagnosed at age 16). I’ve been on synthroid most of my life with no problems until 2 years ago when I began menopause and began suffering severe fatigue. At the time, my ferritin and vitamin D were very low but with supplementation they are now good. The last 2 years have been very tough as I have not felt well and I put on 20 pounds when I tried switching my thyroid medication. I tried NDT but didn’t do well. I am now on a combination of synthroid and T3 and feeling somewhat better but not 100%. Recently my blood work has revealed pre diabetes. On 10/24/16 my fasting insulin = 6, my fasting glucose = 91 and my HbA1c = 5.8. I made some dietary changes, lost 8 pounds and 3 months later my numbers are fasting insulin = 3, fasting glucose = 86 and HbA1c = 5.7. Better but still at risk I understand. My question is with my insulin being on low end, is this still insulin resistance? Or could I possibly have developed an autoimmune attack on my insulin producing cells? My doctor thought I should take Berberine, but I’m a little nervous that it could make my blood sugar drop too much. If i do get my blood sugar lowered and normalized, would that help with T4 to T3 conversion which seems to be very poor at this time. Also, I am experiencing intermittent blurry vision and tinnitus and don’t know if they are related to thyroid or blood sugar. I would love your input.

Thank you,
Cat

Reply
    Dr. Westin Childs - March 1, 2017

    Hey Cat,

    More important than your fasting insulin is your post prandial insulin level. It’s possible, but highly unlikely that you’ve burned out your pancreas and your insulin levels are low as a result. It would be very easy to check what your 2 hour post prandial insulin is, which would likely prove you have insulin resistance.

    Reply

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