March 22, 2023

If you have diabetes, you very likely have heard of metformin, or if you have been paying attention to the news in the last couple of years, you may have also heard of it being recalled. Now I am not here to talk about how bad metformin is; actually, quite the opposite! Instead, today we are talking about why some people might lose weight when taking metformin.

So if you have diabetes you have likely heard of metformin or if you’ve been paying attention to the news in the last couple of years you might have heard that metformin or large batches of metformin tablets were being recalled now i’m not talking today about how bad metformin is quite the opposite actually i want to talk about a lot of the good things that come

From metformin and in particular i want to talk about how some individuals actually seem to lose weight when they take metformin but before we dive into all of that welcome back to the program you beautiful people my name is dr dan i am a pharmacist turned obesity expert and of course i want you to hit that subscribe button down below i want you to tap it i want

You to subscribe so that you don’t miss another episode that comes out from me as well turn on your notifications so you definitely get that notification piece that comes out there with it as well check me out on my other channels at the official dr dan i’m on the instagram the tick the talk the book you name it we are out there we are posting content there

Every single day so you can get the latest updates as to what i am talking about and what i got going on and of course if you need some additional support on your weight management journey check out my website where you can book a free consult with myself and you can book into yeah see if you’re a good fit for our program so the first thing

That i want to address here is that the reason metformin or large batches of metformin tablets were being recalled was not because of metformin the molecule itself causing something bad it was because large batches of metformin tablets were found to contain a potential contaminant and this contaminant is considered a possible carcinogen so it might in the right

Concentrations or concentrations that are high enough after a prolonged exposure lead to cancer now fortunately all of these drugs and while a large majority of just about everything that is used for human consumption undergoes a quality control testing all of the time and the reason for this quality control testing is in order to find different things like this

That might not or should not be within these tablets or various other products so the potential carcinogen causing component or contaminant that was found within these metformin tablets hasn’t been there for years and years and years it was only just recently found and it was found via quality controlled checks and now all of the batches and tablets that were found

To have this carcinogen have now been pulled from the market so that humans are no longer receiving them and getting them now fortunately if you happen to have a batch or you know a vial of metformin tablets that was found to have this potential carcinogen in it or you took say an entire vial of that medication and then we’re given a call hey your drug might have

Had some carcinogen in it not to worry not every single tablet seemed to have this potential carcinogen and if they did it was in a very very low concentration further when we say it’s a possible carcinogen again not everybody is going to develop cancer who comes exposed or gets exposed to this carcinogen it’s only going to possibly cause it in some individuals and

Again it has to be in a high enough concentration and over an extended period of time neither of which occurred in this situation it was found in very low concentrations but it was high enough that hey we need to pull these drugs from the market so that someone doesn’t get exposed to this long term but of course if you have any concerns in this regard please follow

Up with your care team and your care provider all right let’s dive into the good stuff here so metformin belongs to a class of diabetes medications called bigwinides and metformin is currently the most widely prescribed diabetes based medication and in fact it’s one of the most widely prescribed medications across the globe and that’s because it’s hella good at

What it does like i mean real hella good at what it does not only has it been around since like the 1950s so we literally have a mountain of data around the safety of this medication and how good it is but we also have a mountain of data that shows all of these like plethora of beneficial effects that the metformin molecule might have in the body everything from

Protecting your brain your heart maybe having some anti-aging properties potentially and even helping conditions like polycystic ovarian syndrome or pcos and further as more and more data comes out around metformin one could almost make an argument that literally everybody should maybe be on some amount of metformin for the beneficial effects of this medication

At least to say the beneficial effects outside of just managing blood sugars in diabetes and for the haters that i know are going to leave comments at the bottom of this video no i am not paid by big pharma in fact i very much would accept a payment from big pharma for my student loans that i currently have piled up yes i know i keep bringing this up it is it is

A stressor of mine because i have hundreds of thousands of dollars of student loan debt and it gets really old saying that i’m a paid actor the unfortunate piece here is that nobody is making money on metformin right now these tablets probably cost more to make than what they’re actually being sold or you have to make so many of them in such large amounts to make

Any kind of cash flow off of them that literally no one’s going to give whatever little profit they have left over to some lowly pharmacist that’s making youtube videos about it and that’s like including in the states where the price of drugs are absolutely ridiculous the cost of metformin in the states is like minimal compared to other medications anywho metformin

And weight loss so metformin’s main mechanism of action is reducing insulin resistance thereby the insulin that your body does produce and insulin is the hormone that our body releases when we eat a meal when our blood sugar levels are high in order to bring our blood sugar levels down and so what it’s doing is that the insulin that your body is producing it allows

It to work more easily to be more effective if you will so that it can open up the doors on our various cells and allow the sugar that is in our bloodstream to go from the bloodstream to inside of the cells so that our cells can do the cell things that they need to do such as running our body keeping our brain functioning all of those beautiful things and by doing

This it helps to bring our blood sugar levels down helps to control our blood sugar levels and ultimately manages diabetes however some other hormones that metformin has been found to act on are number one the glp1 hormone so it seems to allow for the increase of glp1 in our bodies it also acts on a hormone called gdf15 and if you’ve been following me for a little

While now you’ll know that glp1 is the hormone that is found within the medications wagovi ozempic saxenda trulicity and that sort of thing and that the glp1 hormone and those medications are not only very good at lowering your blood sugar levels but they’re also very effective in weight management because they act within the brain and help us to reduce our wanting

And our food seeking behaviors so if metformin is increasing the levels of glp1 in the body you’re likely or potentially going to get some blood sugar lowering effects for sure but it might also have some effects in the brain in decreasing your food seeking behaviors thereby getting you to eat less thereby helping you to lose weight but what about gdf15 what does

That hormone have to do in the whole mix of things and that’s where things get really interesting because a recent paper found that metformin increases the levels of this hormone gdf15 or growth differentiation factor 15 which we’ve also come to find is a satiety hormone or helps us to feel full and what the authors of this paper found is that when gdf level 15

Levels were increased by metformin there was a mild correlation with weight loss and what the authors found is that the participants that were taking metformin lost approximately 3.5 percent of their baseline body weight compared to the placebo group now we don’t know all the ins and the outs as to how gdf 15 might help with the satiety weight loss process but

What we seem to think is going on is that it does have some action or mechanism within the brain similar to glp-1 but maybe in some slightly different areas that ultimately helps to reduce again your food seeking and wanting behaviors now we don’t know all the ins and the outs as to how gdf 15 seems to work but it does seem to have a role within the brain and in a

Slightly different area compared to say glp-1 it seems that for weight loss it helps by acting in a brain stem mediated receptor of some kind and ultimately decreases your food seeking and food wanting behaviors which i personally think is pretty darn cool and really is showing again that obesity and our satiety appetite and eating behaviors are extremely complex

And we’re only just starting to scratch the surface as to everything that is going on there now i want to say a big caveat here because again i’ll have another group of people that come in my comments and say i’ve been on metformin for years and years and years and haven’t lost any weight and yeah not everybody is going to experience this effect of the gdf-15

Hormone increasing and thereby not everybody is going to get a weight loss benefit from taking metformin however some individuals that are taking metformin may full well enjoy this potential benefit i also want to mention that metformin is currently not being used as a stand-alone agent for obesity and weight management now the other thing that i need to mention

About metformin here is that metformin is not currently being prescribed solely for weight loss and weight management while it does have some evidence for weight loss weight management and that sort of thing it would currently be considered off label as per fda health canada and the other regulatory bodies that have approved this medication to be on the market so

If you are prescribed this medication for say other reasons such as anti-aging for weight loss for what have you it would be considered off-label this would be a bit of a gray area i’m not saying that there’s not clinicians out there that are doing it there certainly are i have prescribed metformin in the case of individuals that are on antipsychotics they don’t have

Diabetes but they have been gaining weight or trying to prevent weight gain due to the antipsychotic medication because that antipsychotic medication is more beneficial for whatever condition it is treating and so we would want to mitigate and manage that aspect so it is off-label prescribing anytime it’s off-label there is a gray area there is some potential issues

Of running into problems around if something does go wrong and that sort of thing so you’re not actively seeing it prescribed for weight loss at the present time and i’m doubtful that metformin will ever get an indication for weight loss or weight management in the future the reason being is that someone needs to submit all of this data and information to the fda

To health canada and that sort of thing and if it doesn’t make business sense where say a company is going to make money off of a said medication well they’re probably not going to do it and as i said previously no one’s really making money on metformin anymore it costs penny on the pennies on the dollar for an individual to purchase metformin so we’re likely not

Going to get that indication and it’s likely going to be off label further the weight loss benefits that did come with metformin for some people were relatively modest at you know only about 3.5 percent of their baseline body weight generally when we’re looking at a weight management obesity management medication we’re wanting to aim for at least five percent body

Weight loss there is still some benefits that can be conferred at 3.5 percent but it’s not really enough to say this is a sole weight loss weight management medication generally we want to see it over that five percent mark to really say it is providing a benefit in that regard of obesity and weight management so unless you have pcos another extenuating circumstance

Or what have you where a physician or clinician can make the argument to prescribe this medication you’re likely not going to get it prescribed by your general practitioner or family physician maybe a specialist but again they’re likely seeing you for some other potential reason now one final note on metformin yes metformin definitely can have some side effects in

Particular those that are gi in nature sometimes the long-acting version of metformin called glu mezza can be more beneficial and cause less gi distress not everybody is going to get this gi distressed and if you take the medication with food it can mitigate it but some people definitely do get these gi side effects and sometimes they’re intolerable and they need

To stop the medication which it’s totally okay if that is the situation and finally because i know there’s going to be a million and one comments about how metformin destroys your kidneys destroys your liver does this that and the other thing blah blah blah yes there are very very small risks with metformin and potentially causing a condition called lactic acidosis

Again this is very very rare and most of the data around this lactic acidosis was seen in the case of fenformin which was kind of a sister molecule to metformin which has now been pulled from the market metformin has been shown to cause that in very very rare circumstances generally there’s something else that’s going on that ultimately leads to this condition in

Terms of kidney and liver stuff yeah we don’t suggest metformin in those situations if you already have kidney damage or liver damage because we don’t want metformin to build up in your body and lead to that lactic acidosis it’s not that the metformin is causing the damage itself likely potentially more often than not if you will the condition that we’re treating

Such as diabetes has led to that damage already to things like the kidneys so it’s not the metformin itself that is harmful it is other conditions that we’re ultimately treating that are likely contributing and causing that issue and in fact once again there’s been good evidence to show that metformin may actually be protective of your kidneys your liver and your

Heart so for a vast majority of people metformin has been shown to be very safe and very effective with 70 plus years of data to fully back it up a lot of drugs haven’t been on the market that long and have that much safety data behind it metformin is definitely one of the rare ones so it is we can be very sure is a very safe medication if you are able to tolerate

Potential gi side effects that might come with it which a vast majority of people are anyways that is enough of me ranting and being on my soapbox i’ve posted other videos and stuff like that on this and i’ve just gotten a breed of various comments so i just wanted to make sure we hit on every single point and hopefully the individuals that are going to leave the

Comments ultimately listen to the entire video and we’ll make some kind of coherent argument instead of just saying whatever in the comments if they do well it is what it is so metformin is a interesting wonderful fascinating little molecule as i said it is very effective at what it does and the plethora of benefits that come with metformin is continuing to grow

Every single day as we get more and more literature and research out there some people might even get the weight management weight loss benefit because of its activity at the gdf-15 hormone and increasing it in your body so there is that potential benefit that comes with it but other than that metformin is a very effective diabetes medication and will continue to

Be our first line therapy in that regard for many years to come that is all for today you beautiful people as always don’t forget to hit the subscribe button down below and of course check me out on the other channels the instagram the facebook the tick tock the tweeting you name it i am out there go and follow me at the official dr dan and of course if you need

Some additional support on your weight management journey go to my website book a free consult with myself and we can see if you are a good fit for the program or not and as always don’t forget that small tweaks lead to massive peaks until next time

Transcribed from video
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