Metformin Produces Weight Loss
You have all been around people who “eat like a bird”. These same people eat a saucer-full of food and say “ I just can’t eat another thing. In my meeting with nurse coaches this week, they told me about a woman with diabetes who had lost 30 pounds in a matter of months. She lost her appetite at exactly the time that she started metformin. Many describe appetite loss as a “side effect” of metformin. It is not a side effect. It is a beneficial effect. She did not have nausea or diarrhea. She only lost her appetite. She had an unusually strong effect that is often found in patients on metformin. Most patients with type 2 diabetes have strong appetites. Metformin blunts the appetite to some degree in many people.
Patients with diabetes treated with metformin experienced a 6 pound weight loss over a 4-year period, while patients on rosiglitazone and glyburide both gained 10 pounds and 3.5 pounds respectively. (Weight gain from rosiglitazone goes to the hips!) So, some treatments for diabetes cause weight loss and others cause weight gain. If your doctor prescribes rosiglitazone instead of metformin, the difference in weight over 4 years is 16 pounds or a about10 percent weight gain over what many of us should weigh. When I combined metformin treatment with advice to dramatically reduce sugar and starch intake and to eat real food, four patients lost over 100 pounds and the champ lost 150 pounds.
Metformin has these effects because it directly impacts the mechanisms of weight gain at the level of molecular biology. It increases the secretion of GLP-1 which is the active ingredient in diabetic drugs like Trulicity. Metformin directly switches off the master metabolic switch mTOR while switching on AMPK. mTOR activation favors fat accumulation. AMPK activation favors fat mobilization and use for energy production. Please. Treat patients with diabetes with a protocol designed to enhance their ability to lose weight. Patients who gain weight on glyburide or rosiglitazone are not non-compliant. The are taking a medicine that makes them gain weight. If a patient can lose a pound a month, that is a great result. The choice of medication makes a big difference.