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Weight Loss Forum / Low Carb / January 2004Study: Metformin and Carbohydrate-Modified Diet May Help Sustain Weight Loss
Title: Metformin and Carbohydrate-Modified Diet May Help Sustain Weight Loss URL: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=R Retrieve&db=PubMed&dopt=Abstract&list_uids=14633321 Heart Dis 2003 Nov-Dec;5:6:384-92. "Long-term (2-4 year) weight reduction with metformin plus carbohydrate-modified diet in euglycemic, hyperinsulinemic, midlife women (syndrome w)" 12/16/2003 01:49:00 PM By Jill Taylor The combined regimen of metformin and a carbohydrate-modified diet promotes long-term weight stabilisation in obese, middle-aged, nondiabetic women with documented insulin abnormalities, say American researchers. The majority of patients who successfully lose weight in traditional dietary programs regain the weight within 2 to 4 years, and few treatment strategies for sustained weight reduction exist that are effective, safe, and acceptable. In a previous study, women with Syndrome W, an early variant of the Metabolic Syndrome, achieved significant weight loss with metformin and a carbohydreate-modified, hypocaloric, low-glycaemic-index diet. To assess the long-term efficacy this regimen, Harriette R Mogul, MD, MPH, and colleagues of New York Medical College, Valhalla, United States, conducted a retrospective analysis of 21 study participants who returned for medication renewal and annual surveillance visits. All patients included in the analysis had achieved a 1-year weight loss of more than 10% or body mass index (BMI) normalisation. Baseline characteristics included an average age of 55.2 years, BMI of 34.2 kg/m[2, and weight of 196.9 lbs. The researchers observed weight maintenance at the final (2 to 4 years) follow-up visit in 90.5% of the women, with the mean weight at final follow-up highly correlated with mean weight at 1-year protocol completion. Furthermore, a significant and robust decline in fasting insulin (-27.5% -43.8%, P < .002) was observed at all follow-up visits. Metformin was well tolerated, without reported side effects or electrolyte imbalance. Although researchers acknowledge clear methodologic limitation, they hope that the study findings will encourage clinicians to contemplate the potential viability of defining and treating insulin abnormalities in euglycemic women with midlife weight gain who fail to respond to other obesity interventions. "We believe this effective novel obesity treatment, which is easily implemented in a clinical setting, could have important implications for women with Syndrome W, and quite possibly for other subpopulations of obese nondiabetic Americans with progressive weight gain and documented hyperinsulinemia," they conclude. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=R Retrieve&db=PubMed&dopt=Abstract&list_uids=14633321 Roger, Of course, what the article fails to report is that a "carbohydrate modified diet" _without_ metformin will also produce long term weight loss for middle aged ladies too. <g> Metformin should only be considered after you've stalled for a long time while eating a controlled calorie, low carb diet., or when a low carb diet is not controlling diabetic blood sugar, or if you have have been diagnosed with PCOS. It's pretty nasty stuff, producing extremely unpleasant digestive problems in some people and a potentially fatal condition, lactic acidosis, in others. I tried it after my 3 year stall only to find that it caused two disturbing side effects. One, which is rare, is that it caused me to have intense reactive low blood sugar attacks which made me faint and dizzy (my blood sugar dropped into the low 60s after every meal after a few months on it.) The other was that it gave me wierd cramps in my upper left chest that felt like I was having a heart attack. The endocrinologist told me that was a "known effect." -- Jenny Cut the carbs to respond to my email address! Low carb facts and figures, my weight-loss photos, tips, recipes and more at http://www.geocities.com/jenny_the_bean/ Looking for help controlling your blood sugar? Visit http://www.alt-support-diabetes.org/Newly%20Diagnosed.htm > Title: Metformin and Carbohydrate-Modified Diet May Help Sustain Weight Loss > URL: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=R [quoted text clipped - 38 lines] > http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=R > Retrieve&db=PubMed&dopt=Abstract&list_uids=14633321 >It's pretty nasty stuff, producing extremely unpleasant digestive problems >in some people and a potentially fatal condition, lactic acidosis, in >others. It causes nausea and often diarrhea as digestive sx at the beginning, especially if not slowly titrated toward the total dose. Most folks get over this quickly. Lactic acidosis is hardly common, and occurs mostly in those with pre-existent kidney dysfunction, like the many diabetics this drug was developed for. >I tried it after my 3 year stall only to find that it caused two disturbing >side effects. One, which is rare, is that it caused me to have intense [quoted text clipped - 3 lines] >like I was having a heart attack. The endocrinologist told me that was a >"known effect." Pretty rare effects, from all I've read about it from many who are IR and who've taken it long term. IME, it made me extraordinarily fatigued, as does any drug that alters the way my liver works. Metformin has been around for many years, has a very good safety profile, is a highly potent antioxidant and a safe bet for those whose weight may be high enough to predispose to CVD and/or diabetes. Susan > Pretty rare effects, from all I've read about it from many who are IR and > who've taken it long term. IME, it made me extraordinarily fatigued, as does [quoted text clipped - 5 lines] > > Susan Metformin used as an antioxidant? What about a diabetic on low carbs? Wouldn't that lower the BG too much if used as an antioxidant? Just wondering. Myway >Metformin used as an antioxidant? What about a diabetic on low carbs? >Wouldn't >that lower the BG too much if used as an antioxidant? Just wondering. > >Myway Hi, I didn't say used AS an antioxidant, just that this is one of its beneficial effects. I wouldn't load up on it like vitamin C for this effect. Susan > Pretty rare effects, from all I've read about it from many who are IR and > who've taken it long term. IME, it made me extraordinarily fatigued, as does > any drug that alters the way my liver works. I'm just suffering the effects of moving up to a full dosage over the last few days ... I'm interested in your comments about the liver - should I be asking the doc to give me liver function tests from time to time, or is it not that sort of liver effect? cheers Rachel (New Zealand) Rachel, Lactic acidosis causes muscle pain and muscle weakness along with the usual gastrointestinal symptoms. . If you google "lactic acidosis" on the Google Groups Search you'll find quite a few people posting about their experiences with it. If you've had any blood tested recently, your doctor might have included a liver enzyme test. It might be worth asking him. It's not an expensive test and it does give you a baseline against which to check for any changes. Since most of us only get one liver, and don't last very long when it is broken, it's worth doing. Is the metformin helping with weight loss? When it works, it seems to work extremely well for people. I hope you are one of them! -- Jenny - Low Carbing for 4 years. At goal for weight. Type II diabetes, hba1c 5.2. Cut the carbs to respond to my email address! Low carb facts and figures, my weight-loss photos, tips, recipes and more at http://www.geocities.com/jenny_the_bean/ Looking for help controlling your blood sugar? Visit http://www.alt-support-diabetes.org/Newly%20Diagnosed.htm > > Pretty rare effects, from all I've read about it from many who are IR and > > who've taken it long term. IME, it made me extraordinarily fatigued, as [quoted text clipped - 9 lines] > Rachel > (New Zealand) > Lactic acidosis causes muscle pain and muscle weakness along with the usual > gastrointestinal symptoms. . If you google "lactic acidosis" on the Google > Groups Search you'll find quite a few people posting about their experiences > with it. Thanks Jenny. My GP went through the lactic acidosis risks and stuff like don't take metformin if you have been vomiting or have severe diarrhoea (something I find deeply ironic since the stuff gives you just that!). That was a few years ago, pre-LC and didn't make any different to my weight (I think my max dose was 1500mg/day at the time). It was prescribed by an endocrinologist again recently (2000mg/day), but she never went into any of the risks (I'm very distrustful of any medical professional who can be a spokesperson for a group called "FOE - Fight the Obesity Epidemic" anyway - annoying skinny person who runs 3 times a day or something excessive like that). I was told I had a fatty liver before starting LC, but after 6 months on LC the last test was normal (had a slightly abnormal liver test about 6 years back when I was on roaccutane too, so I'm thinking it's been like that for years prior to starting low carb, which is another plus for the diet!). So I guess I sort of have a baseline to work from. The endocrinologist has given me a form to have blood tests a week or so before my follow-up appointment in 3 months, and "liver tests" is among them, which is good to know. > Since most of us only get one liver, and don't last very long when it is > broken, it's worth doing. Don't I know it - my dad died of liver cancer 4 years ago next month. :o( > Is the metformin helping with weight loss? When it works, it seems to work > extremely well for people. I hope you are one of them! Fingers crossed - it's probably too early to tell at the moment. I haven't been taking it regularly - just got up to the full dosage and then went off-plan (and off the metformin) when I went away to a friend's wedding, and stayed off both for the following week as I had some minor surgery ... then of course went back to one tablet twice a day, but had trouble remembering the evening dose - this went on for a couple of weeks then I took 10 days off again around Christmas ... so I'm back on everything with a vengeance this week, so fingers crossed it will help, as I have been LC for about 18 months now but wasn't losing anything - not even during induction. Lost the 4kgs I'd gained when I started taking Avandia when we knocked off the cream cheese desserts and started walking, but the walking's fallen by the wayside with all the other disruptions of the past couple of months. (I tried avandia hoping it would have the beneficial effects of metformin without the risks or side-effects, but all it did was make me gain weight!) Interesting losing those 4kgs made one of my spare tyres change a little - not sure if it's smaller or just lower - either way it was a positive change - of course have regained 2kgs with all my misbehaving over the last month, but that is the last cheat for quite some time, I would hope. cheers Rachel (New Zealand) Rachel, Metformin is the only medication that has been proven to reverse fatty liver, so it shouldn't worsen that problem even if you had it. But it is good that your doctor is keeping an eye on the tests. So sorry to hear about your dad's sad death. Someone who had once been very important to me died of liver cancer this past year, too. As far as Avandia goes, the endocrinologist I consulted told me it packs weight on most people, mostly on the arms and legs. I read up about it and it seems that the way it works is to make it easier for insulin to push glucose into the muscle tissues, which would make weight gain easier. Here's hoping that low carbing and the metformin together work for you this time! -- Jenny - Low Carbing for 4 years. At goal for weight. Type 2 diabetes, hba1c 5.2. Cut the carbs to respond to my email address! Low carb facts and figures, my weight-loss photos, tips, recipes and more at http://www.geocities.com/jenny_the_bean/ Looking for help controlling your blood sugar? Visit http://www.alt-support-diabetes.org/Newly%20Diagnosed.htm > > Lactic acidosis causes muscle pain and muscle weakness along with the > usual [quoted text clipped - 53 lines] > Rachel > (New Zealand) > Metformin is the only medication that has been proven to reverse fatty > liver, so it shouldn't worsen that problem even if you had it. But it is > good that your doctor is keeping an eye on the tests. That's handy. I'm a little nervous of any liver abnormalities, since dad's liver cancer was a primary, so we're not sure whether there is likely to be any hereditary risk or not (there's some toxin that people pick up from rice in tropical climates that somehow can cause primary liver cancer, so since dad lived in Indonesia in his early years we're hoping that was the cause ... but I'm keeping an eye on things just in case, as I know that by the time you have symptoms liver cancer is usually too advanced for any treatment). > So sorry to hear about your dad's sad death. Someone who had once been very > important to me died of liver cancer this past year, too. I'm only thankful dad's illness it wasn't as drawn-out as some I've heard of - diagnosed something like September and was gone by the following February. People say you have time to get used to the idea with terminal illnesses, but personally I don't believe it makes a difference, except you get to grieve for a lot longer in anticipatin! I was expecting a miracle right up until he went into the hospice 2 days before his death ... it was a dreadful shock to realise that he really was dying and there was nothing anybody could do about it. > As far as Avandia goes, the endocrinologist I consulted told me it packs > weight on most people, mostly on the arms and legs. I read up about it and > it seems that the way it works is to make it easier for insulin to push > glucose into the muscle tissues, which would make weight gain easier. That's interesting - I asked the Doc if I could try it because from what I'd read it was insulin sensitising without the side effects, with a small chance of initial weight gain, which I assumed would go again once my body adjusted. I don't think she knew much about it at the time either, just looked up and figured the worst it could do would be if I gained more weight. I wonder why the weight is on the arms and legs. > Here's hoping that low carbing and the metformin together work for you this > time! Thanks! I think the side effects might actually be starting to subside - I still wouldn't dare take it without food, but I don't have a crook tummy every afternoon like I did last week. cheers Rachel (New Zealand) Rachel, Avandia and Actos put weight on the arms and legs precisely because it is muscle tissue of the arms and legs that have their insulin resistance decreased. Unfortunately, when you decrease insulin resistance but not insulin, you end up making it easier for insulin to push fat into the cells. So improving the insulin sensitivity of muscle cells can mean improving their ability to deposit fat. Or at least, that is how it was explained to me. From what I've read, if there is a hereditary component to liver cancer, the only thing you can do to improve your chances is stay away from alcohol completely. -- Jenny - Low Carbing for 4 years. At goal for weight. Type 2 diabetes, hba1c 5.2. Cut the carbs to respond to my email address! Low carb facts and figures, my weight-loss photos, tips, recipes and more at http://www.geocities.com/jenny_the_bean/ Looking for help controlling your blood sugar? Visit http://www.alt-support-diabetes.org/Newly%20Diagnosed.htm > > Metformin is the only medication that has been proven to reverse fatty > > liver, so it shouldn't worsen that problem even if you had it. But it is [quoted text clipped - 47 lines] > Rachel > (New Zealand) >I'm just suffering the effects of moving up to a full dosage over the last >few days ... I'm interested in your comments about the liver - should I be >asking the doc to give me liver function tests from time to time, or is it >not that sort of liver effect? Many folks report short term fatigue on it. If you're taking it, odds are your routine lab work includes liver enzymes/routine chemistry. If you get severe fatigue, headachey and body aches, I'd ask the doc about it right away. Susan > Rachel wrote ... > [quoted text clipped - 8 lines] > If you get severe fatigue, headachey and body aches, I'd ask the doc about it > right away. heh none of the above more than usual for me, at any rate. :o) Rachel (New Zealand) >It's pretty nasty stuff, producing extremely unpleasant digestive problems >in some people and a potentially fatal condition, lactic acidosis, in >others. Nasty is correct! I tried EVERYTHING, eating it with food, before food, after food, even on an empty stomach (not recommended) and it made me feel queasy, runny and TIRED. I could barely function on that stuff. Sleeping 20 hours a day would have been easy if my work/family had allowed it. After about 6 weeks I had to toss it. If I keep my carbs at 20-30 grams per day, there's no need for it anyway. And I feel better than ever! LCing since 12/01/03- Me- 265/240/140 & hubby- 310/271/180 Agreed. Metformin is not without its risks. But it may be an extemely effective drug for insulin insensitivity. In some animal experiments, it appears to increase maximum life-span. It also displays some metabolic effect that may inhibit and prevent cancer. > Roger, > [quoted text clipped - 20 lines] > > -- Jenny |
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