Blood Sugar, Hashimoto’s, Ozempic, Metformin and Berberine

One of the lesser-known, but common complications of Hashimoto’s, is blood sugar imbalances. The thyroid gland plays a crucial role in regulating metabolism, and when it is not functioning properly, it can lead to problems with blood sugar control.

Blood sugar dysregulation can also be a contributing factor to the development of Hashimoto’s and ongoing symptoms. This is because our body experiences blood sugar spikes and dips (the blood sugar “rollercoaster”) as a stressor, and these swings in blood sugar can weaken our adrenals and cause a spike in our thyroid antibodies.

I wasn’t aware that I had blood sugar issues when I was first diagnosed with Hashimoto’s (despite being a self-admitted sugar addict). I was thin — therefore, I assumed that I was healthy. However, I would get “hangry” (hungry + angry) multiple times per day, as the high carbohydrate foods I was consuming were causing me to experience huge blood sugar swings.

There is a known link between Hashimoto’s and type 2 diabetes, with up to 30 percent of those with Hashimoto’s developing the condition. Conversely, patients with type 2 diabetes are at an increased risk of developing a thyroid disorder, especially women.

According to a population-based study in Norway, adult women with type 1 diabetes have a twofold higher risk of having hypothyroidism, while men have a fourfold higher risk. Another study found that there was an even higher risk of developing hypothyroidism in patients with type 1 diabetes who also had TPO antibodies – they were 18 times more likely to develop hypothyroidism compared to patients with type 1 diabetes without TPO antibodies.

Blood sugar balance is such a big deal in Hashimoto’s that a blood sugar-balanced diet is a foundation for most of my Hashimoto’s protocols I share on my website, in my programs, and in my books. Oftentimes, people report their mood improves, thyroid markers improve, and weight improves with blood sugar balance. 🙂

As I mentioned, I am a big proponent of eating for blood sugar balance, and have written articles on how to do so. However, I’ve received a lot of questions about using medications and supplements for blood sugar balance and weight management, most notably metformin, GLP-1 medications like Ozempic, and the supplement berberine.

Metformin is the most commonly prescribed drug for type 2 diabetes and has a long history of use, as well as some interesting studies in Hashimoto’s. Ozempic is a recent blockbuster drug with benefits for diabetes and weight. Berberine — a long-time favorite supplement of mine — has been getting increased attention in the last few years, as people are discovering that it may support healthy blood sugar levels, gut health, and weight management goals. (More recently, it has been dubbed “nature’s Ozempic” – if you’re wondering whether that’s true, I’ll get to it later in the article.)

In this article, we’ll dig deep into berberine, metformin, and more, including:

• Signs and symptoms of unbalanced blood sugar
• When is metformin used, and what are risks and side effects to look out for?
• What is Ozempic, and is berberine an alternative?
• How berberine may support those with Hashimoto’s
• How to take berberine

Signs and Symptoms of Blood Sugar Issues

Here are some symptoms of low and high blood sugar. Please note that these are generalized lists of symptoms that are meant to help you address day-to-day changes in blood sugar levels and help you stabilize swings in blood sugar. However, they are also symptoms of diabetes. If you have ongoing and/or severe symptoms of this nature but have not yet been diagnosed with diabetes, please see your practitioner as soon as possible to get tested.

Symptoms of low blood sugar levels include:

• Craving sugary foods
• Irritability and lightheadedness if meals are missed, A.K.A. feeling “hangry”
• Dependency on caffeine
• Needing food to relieve fatigue
• Shaky, jittery, or tremulous feelings
• Nervousness or agitation
• Forgetfulness
• Blurred vision
• Mental fog
• Cold extremities

Symptoms of elevated blood sugar levels include:

• Fatigue, after meals and in general
• Persistent hunger
• Cravings for sugary foods that are not eliminated after eating them
• Needing desserts after meals
• Waist girth equal to or larger than hip girth
• Frequent urination
• Increased appetite and thirst
• Difficulty losing weight

Common symptoms of ongoing blood sugar issues include hormonal issues, fatigue, depression, anxiety, insomnia, poor brain function, and chronic pain (many of which are also common symptoms of Hashimoto’s). Polycystic ovarian syndrome (PCOS) is a condition that likely has a large blood sugar component. PCOS causes symptoms such as irregular menstrual cycles, insulin resistance, hirsutism (excess hair growth, especially on the face – think those pesky chin hairs!), acne, male pattern baldness, and anovulation.

The good news is that there are a number of lifestyle interventions, pharmaceutical options, and natural alternatives that can help support healthy blood sugar levels.

History and Use of Metformin

Metformin is a diabetes drug that has been used for decades to help lower blood sugar levels in people with type 2 diabetes. In the search for antimalarial agents in the 1940s, metformin was rediscovered, and its blood glucose-lowering abilities came to light. ^[1] It was first used to treat diabetes in 1957, however, it received limited attention since it was less potent than other medications. Over time, metformin’s ability to treat insulin resistance without weight gain or increased risk of hypoglycemia was recognized, and it was introduced to the US in 1995. Shortly after that, it was shown to have long-term cardiovascular benefits, and today it has become the most prescribed glucose-lowering medicine worldwide.

It can also be used in the management of PCOS, and has been shown to restore ovulation, reduce weight, reduce circulating androgen levels, reduce the risk of miscarriage, and reduce the risk of gestational diabetes. ^[2]

More recently, biohackers are tapping into the potential of metformin for its anti-aging properties. Recently, metformin has gained attention in the field of anti-aging research for its ability to modulate numerous aging-related pathways. ^[3]

Research is also emerging on how metformin might be useful in the treatment of Hashimoto’s. Studies have shown that metformin may actually help lower thyroid antibodies, reduce inflammation in the thyroid tissue, and improve overall thyroid function. ^[4]

While the primary benefits come from metformin’s ability to lower thyroid antibodies, there is some research that suggests it can result in improved thyroid hormone levels and help to lower TSH. ^[5] It may even be able to alter the affinity and quantity of thyroid hormone receptors, which results in enhanced effects of thyroid hormones.

Interestingly, it’s been shown that combining metformin with vitamin D seems to enhance the positive effects of metformin, including reducing thyroid antibodies, improving insulin sensitivity, and improving thyroid hormone levels. ^[6]

Lastly, there is also research that suggests that metformin can have a positive effect on the microbiome. ^[7] As we know, the gut plays a large role in the development of autoimmune disease, so this is another mechanism through which metformin may be helpful for Hashimoto’s.

While the root causes of Hashimoto’s will still need to be addressed, even with the use of metformin, this sounds promising right? And while it certainly is, there are still risks and side effects to consider when thinking about using metformin, whether it’s for Hashimoto’s or type 2 diabetes.

Risks and Side Effects of Metformin

As I mentioned earlier, there are side effects that some people experience with metformin, namely digestive side effects such as nausea and diarrhea. There is also the rare chance of developing lactic acidosis, which can be life-threatening, and certain people taking metformin may have a risk of kidney damage.

Another important risk of using metformin that I want to highlight is the risk of nutrient deficiencies.

Vitamin B12

There is substantial evidence that metformin use is associated with low serum vitamin B12 levels. ^[8] Interestingly, vitamin B12 deficiency has similar symptoms to diabetic neuropathy, which affects an estimated 40 to 50 percent of those with type 2 diabetes at some point.

Vitamin B12 deficiency may be exacerbated by the use of proton pump inhibitors (PPIs) or histamine-selective H2 receptors (H2RAs), both of which are commonly co-prescribed with metformin.

I recommend that anyone taking metformin (and anyone with Hashimoto’s, as B12 is a common deficiency), get their levels tested. You can ask your healthcare provider for the B12 (or cobalamin) test, or you can self-order the B12 test via Ulta Lab Tests. When you receive your test results, it’s important to note that optimal B12 levels should be between 700 and 900 pg/mL. Most labs will not flag B12 levels unless they are under 200 pg/mL.

If you come up with low B12 levels, I suggest a liquid form of B12 like Pure Encapsulations B12, which can be administered sublingually for optimal absorption. The active form of B12 in this formulation is methylated and, thus, highly bioavailable.

Sublingual doses of 5 mg (5000 mcg) of B12, daily for ten days, then 5 mg once per week for four weeks, then 5 mg monthly, have been found to be effective in restoring B12 levels in those with a deficiency.

Folate

Folate, also known as vitamin B9, has been found to be low in diabetic patients with both proliferative diabetic retinopathy and non-proliferative retinopathy, compared to diabetic patients without retinopathy, and healthy patients. ^[9] Additionally, studies have shown that type 2 diabetic patients who take metformin for 16 weeks have reduced folate levels. So in this case, if someone already has type 2 diabetes, they may be low in folate, and treatment with metformin may further drive a folate deficiency.

Interestingly, supplementation with folate has been found to be about one-third as effective as metformin in reducing insulin resistance and even preventing type 2 diabetes, suggesting it has blood sugar regulating properties.

Low folate levels may also be associated with the MTHFR gene variation, which you can read more about in this article.

You can work with your doctor to get your folate levels tested, or self-order through Ulta Lab Tests. You can do a standalone serum folate test. Ulta Lab Tests also offers a B12 and folate panel.

It may seem like common sense to take a supplement to address a deficiency in folate, but not all sources of vitamin B9 are created equally. While vitamin B9 can be found naturally in foods in the form of folate, it can also be found in the form of folic acid, a manufactured and synthetic version of folate that is present in most bargain-priced multivitamins, as well as often added to processed foods.

Unfortunately, synthetic folic acid can be highly problematic for individuals with the MTHFR gene variation, as they may have a difficult time processing this form of folate. Some professionals claim that this type of synthetic folate may even cause a build-up in the body, leading to toxicity.

Rootcology’s MTHFR Pathways supplement contains synergistic nutrients, including an activated form of folate, to support homocysteine pathways, which in turn supports detoxification, healthy immune function, ideal joint and cartilage structure, and brain and cardiovascular health. I also like Folate 5,000 Plus from Pure Encapsulations.

Magnesium

While there is some conflicting research on the connection between magnesium levels and metformin use, a large cohort study of almost 400 patients with type 2 diabetes took a deeper look at metformin’s impact on magnesium status. ^[10] The study found that 62 percent of the patients who were using metformin had reduced plasma magnesium levels, while 45 percent of patients who were using PPIs also had reduced magnesium (these medications are often co-prescribed).

Magnesium deficiency itself may be a factor in those with type 2 diabetes, as magnesium plays a role in blood sugar regulation. Magnesium supplementation has been shown to be helpful in improving glucose control and insulin sensitivity in those with diabetes, as well as reducing the progression from pre-diabetes to diabetes. ^[11] The research also suggests that magnesium status may influence the progression of hypertension, atherosclerosis, and kidney disease, which are common comorbidities of type 2 diabetes.

In patients with type 2 diabetes, magnesium deficiency occurs at an increased frequency of 13.5 to 47.7 percent, compared to those who don’t have diabetes, at a rate of 2.5 to 15 percent. ^[12]

I generally don’t test people for magnesium deficiency, as not all tests are reliable, and my experience has shown that most people with type 2 diabetes (and Hashimoto’s) are deficient in magnesium. Additionally, it is generally safe to take without testing.

However, if you wish to assess your magnesium levels with blood testing, I recommend the Spectracell Micronutrient Test Panel or Magnesium, RBC test.

The recommended daily value of magnesium is 400 mg per day, and most adults eating the Standard American Diet are getting less than 300 mg per day. I recommend Magnesium Citrate Powder by Rootcology, which can also be useful for constipation, which is a very common digestive complaint in those with diabetes.

For people who tend towards diarrhea, I recommend Magnesium Glycinate by Pure Encapsulations. This type of magnesium has been shown to relieve magnesium deficiency on blood tests, but does not loosen stool. However, for some people, magnesium glycinate can worsen anxiety symptoms.

Vitamin D

Research is divided on whether metformin lowers vitamin D levels, but I wanted to include it in this article because it’s an important nutrient that plays a number of critical roles in our health and well-being, and I’ve found that most people (regardless of health status) are deficient in it!

Studies have linked vitamin D deficiency with obesity, elevated insulin resistance, and decreased insulin secretion. ^[13]

One Dutch study found that after adjustment for gender and age, there was a statistically significant negative association between the use of metformin and vitamin D status, with those who did not use a vitamin D supplement having levels of vitamin D 14.4 percent lower than controls. ^[14] Other recent studies have found that vitamin D status is unaffected by metformin use, and one study found no noticeable impact of metformin on vitamin D levels at four and 16 months of use in people with type 2 diabetes. ^[15]

There are two available tests to check your vitamin D levels: 1,25(OH)D (which checks for the active form of vitamin D) and 25(OH)D (which checks for both D2 and D3). The 25(OH)D (25-hydroxyvitamin D) test is preferred, as it tests for both vitamin D2 and D3 levels and more accurately reflects one’s vitamin D status.

One of the best ways to restore optimal vitamin D levels is through sun exposure. (As a bonus, sunlight has natural immune-modulating benefits, and can also lift your mood. You could say that boosting your vitamin D levels can be a “walk in the park.” 🙂) Vitamin D advocates recommend 15 minutes of unexposed skin, without sunscreen, around noon.

However, this can be difficult for many of us due to where we live, work schedules, and other factors. In this case, an oral vitamin D3 supplement can be hugely helpful. The vitamin D supplements I recommend include:

• Pure Encapsulations Vitamin D 5000 IU (without vitamin K) — you can also purchase this through Fullscript. If you don’t have a Fullscript account, you can sign up with my credentials here.
• Designs for Health Vitamin D Supreme (with vitamin K*) — you can also purchase this through Fullscript. If you don’t have a Fullscript account, you can sign up with my credentials here.

If you’re already taking metformin, I highly suggest assessing and correcting any deficiencies in these important nutrients.

What is Ozempic?

The medication Ozempic (generic name: semaglutide) has been trending over the past year or so, and has mostly been popularized by celebrities for its weight loss effects.

Ozempic is a GLP-1 agonist and is actually marketed as a diabetes drug, but many physicians are prescribing it for weight loss (off label-use). The mechanism of action (MOA) of GLP-1 drugs involves mimicking the natural hormone glucagon-like peptide-1, which has several beneficial effects in managing blood glucose and supporting weight loss. ^[16]

It helps to lower blood sugar by helping the pancreas produce more insulin. Ozempic also helps users to feel fuller, and it slows digestion by increasing the time it takes for food to leave the body. It can also reduce the risk of major cardiovascular events such as stroke, heart attack, or death. ^[17]

Ozempic is a once-weekly injection that was approved by the FDA in 2017 for use in adults with type 2 diabetes. Ozempic is not approved for weight loss. There is, however, another higher-dose semaglutide medication that is approved for weight loss by the name of Wegovy. Additional GLP-1 drugs include Trulicity (dulaglutide), Victoza (liraglutide), Saxenda (liraglutide), Byetta (exenatide), Zepbound (tirzepatide), and Mounjaro (tirzepatide), and they all have risks and benefits.

Commonly reported side effects of GLP-1 include nausea, vomiting, diarrhea, abdominal pain, and constipation. Rare but serious side effects may include pancreatitis, hypoglycemia, gallbladder problems, allergic reactions, kidney failure, and changes in vision.

GLP-1 drugs also carry an increased risk for thyroid tumors, including cancer. Ozempic’s label warns, “In studies with rodents, Ozempic® and medicines that work like Ozempic® caused thyroid tumors, including thyroid cancer. It is not known if Ozempic® will cause thyroid tumors or a type of thyroid cancer called medullary thyroid carcinoma (MTC) in people.”

A 2023 study found that using these drugs for one to three years was associated with a 58 percent increased risk of all thyroid cancers, and a 78 percent increased risk of medullary thyroid cancer. ^[18]

As a pharmacist who has dedicated my life’s work to thyroid health, I can’t help but take special note of that warning.

Additionally, the box warns not to use Ozempic if you or anyone in your family has ever had MTC, or if you have an endocrine system condition called Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).

I would also be concerned with people who already experience constipation or slow transit time, as it can further reduce it.

That said, many people are finding that semaglutide and the other GLP-1 drugs do help them lose weight and feel better! Those with PCOS and fertility issues caused by excess weight are also having an easier time conceiving much wanted babies. ^[19]

Clinical trials are reporting weight loss of 20 to 40 lbs per year of use. Some women are reporting that it “takes the edge off,” and it makes them less likely to take part in addictive behaviors like binge eating, drinking, smoking, and impulsive shopping. ^[20]

As a pharmacist, I can appreciate why such a profile has made this drug the next blockbuster. I also prefer semaglutide drugs over other weight loss drugs out there (for example, phentermine, a controlled substance that can be habit forming, or orlistat, a drug that results in fat malabsorption and “disaster pants”).

Most GLP-1 drugs are usually given as injectables and are typically administered once per week. However, an oral, daily semaglutide was also approved in 2019, under the name Rybelsus, and other companies have oral GLP-1s currently in their pipeline. Most doctors will have patients start with low doses to reduce any potential GI side effects, then increase the dose based on their response and tolerance.

Compounding pharmacies will sometimes repackage these drugs, or create lower or different concentrations than what’s typically available. However, recently there has been a crackdown on this practice, with drug companies sending cease and desist letters to compounding pharmacies, telehealth practices, and medspas who are creating their own versions of these drugs (that’s how you know it’s a money-making drug!).

Please note that while GLP-1 drugs can be helpful for some, those who are using it for weight loss will need to consider other lifestyle modifications, such as weight-bearing exercise, to make sure they’re not losing too much muscle mass. Ultimately, the trouble with using medications like this for weight loss is that once you stop taking them, the weight tends to come back.

Berberine

Berberine is a natural compound found in several plants, including goldenseal and barberry. I first heard about berberine from a functional medicine doctor at a conference a decade ago. He said he used it for all of his Hashimoto’s patients, as it helped them with gut health, which piqued my interest in it.

Berberine has numerous beneficial properties that make it a valuable supplement for supporting metabolic and immune health, which may be helpful for people managing Hashimoto’s. It has been studied for its role in helping to support healthy blood sugar levels, promoting insulin sensitivity, and modulating inflammatory responses. ^[21]

In my own health journey with Hashimoto’s, I’ve included berberine among other herbs and strategies as part of my approach to overall wellness. At one point, I discovered I had multiple gut imbalances, including Blastocystis hominis (Blasto). With the use of berberine, along with other herbs and medications, I worked toward eliminating Blasto!

More recently, after mold exposure, I experienced changes in my health, including Candida and blood sugar fluctuations. I also noticed changes such as new chin hairs! Berberine became an essential part of my approach to help me manage these new symptoms and support my body in maintaining balance (and rid myself of the pesky chin hairs).

Benefits of Berberine

Let’s discuss the potential benefits of berberine in supporting healthy blood sugar levels, metabolic function, and other factors that may influence thyroid health, including Hashimoto’s.

Blood Sugar

Some studies suggest that berberine may help support healthy blood glucose levels, including fasting and postprandial levels, as well as A1C and insulin levels. It may also contribute to promoting insulin sensitivity and supporting healthy metabolic function. ^[22]

Berberine may further support carbohydrate metabolism in the intestines, sometimes called “a carb blocker.” Personally, I like to take berberine before carb-heavy meals, like gluten-free pizza night. 🙂

Supports Inflammatory Balance

Berberine has antioxidant and anti-inflammatory properties, which may help support general metabolic health. Oxidative stress and inflammation can influence metabolic function, and research suggests that berberine may support the body’s natural processes related to these factors. A 2014 review of studies indicated that berberine may help maintain healthy oxidative balance and inflammation in various tissues, including the liver, adipose tissue, kidneys, and pancreas. ^[23]

Helps with Weight Management

Berberine may support healthy blood sugar and insulin levels, and some studies suggest it could be beneficial for supporting healthy body composition. A 2022 review of studies on berberine and body composition found that individuals who took more than one gram per day for eight weeks showed changes in their weight and BMI. ^[24] However, the study also highlighted that results varied, and further research is needed to better understand berberine’s role in weight management. Other studies suggest that berberine may have an impact on factors such as waist-to-hip ratio and fat distribution, which are associated with overall health. ^[25]

Cardiovascular Support

Berberine has been studied for its potential effects on various cardiovascular markers. Some studies suggest that berberine may support healthy triglyceride, LDL cholesterol, and total cholesterol levels. ^[26] Additionally, recent research has explored its role in supporting healthy blood pressure and lipid levels. ^[27] Preliminary studies indicate that berberine may be a consideration for individuals who are looking for alternatives to statins, but further research is needed.

Supports Gut Health

Berberine’s alkaloid compounds may help support a balanced gut microbiome. In functional health circles, berberine is often paired with oil of oregano to support general gut health and maintain microbial balance.

Berberine has been studied for its potential role in supporting healthy intestinal function. For example, a 2017 study on diabetic rats found that berberine may have an impact on intestinal health, but further research is needed to better understand its effects on intestinal permeability. ^[28]

Supports Cellular Health

Berberine has been studied for its potential effects on cellular health, including its role in processes like autophagy, which is the body’s natural process for recycling damaged cells. ^[29]

Some research suggests that berberine may support these cellular processes, including those in human gastric cells and animal models. ^[30] While more research is needed, berberine’s potential to support metabolic health may offer benefits for individuals looking to maintain overall wellness.

How to Take Berberine

Due to its potential benefits for overall wellness, I formulated a Berberine supplement as part of my Rootcology line. Each capsule contains 400 mg of berberine (from Berberis aristata) with Evail™ technology, an all-natural formulation to support absorption and delivery. I’ve also recommended Candibactin BR and Integrative Therapeutics Berberine to clients with excellent results (both are available on Fullscript; if you don’t have a Fullscript account, you can sign up with my credentials here).

In studies, berberine is typically taken at 500 to 1500 mg per day, divided into doses (often with meals). For supporting gut health, I often suggest 1200 mg daily (one capsule of Rootcology Berberine, three times a day), alongside oil of oregano (Rootcology has a version of Oil of Oregano here).

For a limited time, I am offering a 10% discount on Rootcology Berberine to my readers. Simply enter the code BERBERINE2024 at checkout through November 22nd at 11:59 pm PT.

Please note that berberine is not recommended for long-term use, as it may reduce levels of beneficial gut bacteria. I usually suggest taking it for two to eight weeks. Also, people with ulcerative colitis or Crohn’s disease should consult their healthcare provider before using berberine, as it may exacerbate symptoms. Additionally, talk to your doctor before starting any new supplement, especially if you are taking medications.

Potential side effects of berberine may include headaches, digestive upset (such as nausea or diarrhea), abdominal discomfort, and, in rare cases, skin irritation.

Is Berberine Nature’s Ozempic (or Nature’s metformin)?

I wanted to write this article to correct some of the ideas thrown around in the interwebs. While berberine, metformin, and Ozempic (semaglutide) share some similarities, calling berberine “nature’s Ozempic” is a bit of a stretch due to important differences in their mechanisms and effects!

Mechanism of Action

• Ozempic: Ozempic is a synthetic GLP-1 receptor agonist, meaning it mimics the GLP-1 hormone, which enhances insulin release in response to meals, slows gastric emptying, and suppresses appetite.
• Berberine: Berberine primarily acts by activating AMPK (adenosine monophosphate-activated protein kinase), an enzyme involved in cellular energy regulation. This pathway affects glucose uptake, insulin sensitivity, and lipid metabolism, supporting blood sugar balance. However, berberine does not directly act on GLP-1 receptors.
• Metformin: Metformin primarily reduces glucose production in the liver and enhances the body’s response to insulin. It also activates AMPK. This dual effect helps lower blood glucose levels and improves insulin sensitivity. Metformin may also impact the gut microbiome, contributing to its metabolic effects, though it does not act directly on GLP-1 receptors or suppress appetite.

Effects

Berberine does have some benefits for weight management and blood sugar balance, but they’re not as profound as the effects of Ozempic/metformin. That said, I think it can be a helpful start for many, especially when combined with a healthy diet and exercise.

In contrast to Ozempic, berberine does not slow down GI motility. In fact, it seems to speed it up, causing malabsorption of carbs, and may make diarrhea worse in some cases. The effects on the gut aren’t as intense as the effects of metformin. Metformin has been associated with bile acid malabsorption, which can cause severe diarrhea. ^[31] Something to consider, if you are dealing with constipation versus diarrhea.

My Experience

I believe that all three can have pros and cons for a person with Hashimoto’s who is concerned about blood sugar balance, gut health, and weight management (please note that you should not take all three at once!).

I personally have never taken Ozempic and metformin, but would consider taking them if I had 20 or more pounds to lose, diabetes, and/or PCOS.

I have taken berberine on numerous occasions, and have found it helpful for overall gut health, immune balance, and weight management. It’s become one of my favorite supplements to take and recommend. 🙂

Takeaway

Blood sugar imbalances are often seen in individuals with Hashimoto’s, and while I am a big proponent of eating for blood sugar balance, I’ve been getting a lot of questions about using medications and supplements.

While metformin is commonly used to support blood sugar management, it can have side effects, as can other diabetes medications.

Ozempic is a new-ish medication that has gained popularity, due to its effect on blood sugar and weight.

Berberine is a natural supplement that has been studied for its potential to support healthy blood sugar levels, as well as provide other general health benefits, such as supporting cardiovascular health, reducing inflammation, supporting healthy weight management, and promoting gut health.

I hope this information helps you on your journey!

I’d love to hear from you! Do you have type 2 diabetes or other blood sugar issues? Have you ever tried berberine?

P.S. I love interacting with my readers on social media, and I encourage you to join my Facebook, Instagram, TikTok, and Pinterest community pages to stay on top of thyroid health updates and meet others who are following similar health journeys. For recipes, a FREE Thyroid Diet start guide, notifications about upcoming events, and the Nutrient Depletions and Digestion chapter from my first book for free, be sure to sign up for my email list!

References

^[1] Bailey CJ. Metformin: historical overview. Diabetologia. 2017;60(9):1566-1576. doi:10.1007/s00125-017-4318-z
^[2] Lashen H. Role of metformin in the management of polycystic ovary syndrome. Ther Adv Endocrinol Metab. 2010;1(3):117-128. doi:10.1177/2042018810380215
^[3] Hu D, Xie F, Xiao Y, et al. Metformin: A Potential Candidate for Targeting Aging Mechanisms. Aging Dis. 2021;12(2):480-493. Published 2021 Apr 1. doi:10.14336/AD.2020.0702
^[4] Jia X, Zhai T, Zhang JA. Metformin reduces autoimmune antibody levels in patients with Hashimoto’s thyroiditis: A systematic review and meta-analysis. Autoimmunity. 2020;53(6):353-361 doi:10.1080/08916934.2020.1789969; Jia X, Zhai T, Qu C, et al. Metformin Reverses Hashimoto’s Thyroiditis by Regulating Key Immune Events. Front Cell Dev Biol. 2021;9:685522. Published 2021 May 28. doi:10.3389/fcell.2021.685522
^[5] Meng X, Xu S, Chen G, Derwahl M, Liu C. Metformin and thyroid disease. J Endocrinol. 2017;233(1):R43-R51. doi:10.1530/JOE-16-0450
^[6] Krysiak R, Kowalcze K, Okopień B. The impact of combination therapy with metformin and exogenous vitamin D on hypothalamic-pituitary-thyroid axis activity in women with autoimmune thyroiditis and high-normal thyrotropin levels. J Clin Pharm Ther. 2020;45(6):1382-1389. doi:10.1111/jcpt.13233
^[7] Jia X, Zhai T, Qu C, et al. Metformin Reverses Hashimoto’s Thyroiditis by Regulating Key Immune Events. Front Cell Dev Biol. 2021;9:685522. Published 2021 May 28. doi:10.3389/fcell.2021.685522
^[8] Wakeman M, Archer DT. Metformin and Micronutrient Status in Type 2 Diabetes: Does Polypharmacy Involving Acid-Suppressing Medications Affect Vitamin B12 Levels?. Diabetes Metab Syndr Obes. 2020;13:2093-2108. Published 2020 Jun 18. doi:10.2147/DMSO.S237454
^[9] Ibid
^[10] Kurstjens S, de Baaij JH, Bouras H, Bindels RJ, Tack CJ, Hoenderop JG. Determinants of hypomagnesemia in patients with type 2 diabetes mellitus. Eur J Endocrinol. 2017 Jan;176(1):11-19. doi: 10.1530/EJE-16-0517. Epub 2016 Oct 5. PMID: 27707767
^[11] Veronese N, Dominguez LJ, Pizzol D, Demurtas J, Smith L, Barbagallo M. Oral Magnesium Supplementation for Treating Glucose Metabolism Parameters in People with or at Risk of Diabetes: A Systematic Review and Meta-Analysis of Double-Blind Randomized Controlled Trials. Nutrients. 2021 Nov 15;13(11):4074. doi: 10.3390/nu13114074. PMID: 34836329; PMCID: PMC8619199.; Hruby A, Meigs JB, O’Donnell CJ, Jacques PF, McKeown NM. Higher magnesium intake reduces risk of impaired glucose and insulin metabolism and progression from prediabetes to diabetes in middle-aged americans. Diabetes Care. 2014 Feb;37(2):419-27. doi: 10.2337/dc13-1397
^[12] Pham PC, Pham PM, Pham SV, Miller JM, Pham PT. Hypomagnesemia in patients with type 2 diabetes. Clin J Am Soc Nephrol. 2007 Mar;2(2):366-73. doi: 10.2215/CJN.02960906
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^[27] Ibid
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