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Metformin Used for Diabetes Depletes These Important Nutrients – InViteⓇ Health Podcast, Episode 481
Hosted by Jerry Hickey, Ph.
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Jerry Hickey, Ph.: Metformin is a very important drug. It’s probably the most commonly prescribed drug for type 2 diabetes mellitus. It works. It has a bunch of advantages. It also is useful for some other conditions. It does have some drawbacks, we’ll discuss that too, but where we’re really going to go into detail is the nutrients that metformin depletes.†
Hi, my name is Jerry Hickey and I’m a nutritional pharmacist. I’m also the Senior Scientific Officer over here at InViteⓇ Health. Well, welcome to my episode, Metformin Depletes These Important Nutrients. Thanks for tuning in today to the InViteⓇ Health Podcast. You can find all of our episodes for free wherever you listen or just visit invitehealth.com/podcast. Please subscribe and leave us a review. You can also follow us on Twitter, Instagram and Facebook, whatever that’s called today, @invitehealth. The information on this episode is linked at the episode description.†
So, here is the issue. First of all, metformin is… The original name for metformin was glucophage, but you can get it generically. Like I said, it’s a first-line treatment for type 2 diabetes. It’s often the drug that doctors first prescribe to see if it’s enough. And especially it works well in those who are overweight.†
Interestingly, it’s based on an ingredient from a plant. It was discovered, oh, almost a century ago in France and it was based on constituents in a plant called French lilac, so it’s been around for a long time. That means doctors know how to use it, doctors know what to expect from it, doctors know the problems with it, doctors know who to use it in. It’s been around in Europe since the 1950s and the United States since the 1990s.†
Now, there are some common side effects, usually with the digestive tract, like gassiness, nausea, cramping, stomach cramps, intestinal cramps and diarrhea. But these usually disappear within weeks and you can avoid them, or try to avoid them, if you start off with a lower dose. So frequently, doctors might start a patient on 500mg of metformin once a day and work it up to 500mg twice a day and slowly but surely work it up to the dosage they need, which could be 1000mg twice a day.†
So, metformin is a biguanide. When I went to pharmacy school, it wasn’t in the United States yet. We were using sulfonyureas and sulfonyureas… one of the big problems with them, drugs like diabinese and tolbutamide, is they caused hypoglycemia. It was very easy to lower the blood sugar way too much. So you had to be really careful with them and then metformin came along and it was less likely to cause hypoglycemia and excessively low blood sugar.†
There is a little issue with lactic acidosis, but I don’t know if it’s real. Lactic acidosis is also called ketoacidosis. It can happen to anybody. It’s more common in diabetics and there are some medications that are connected with diabetic ketoacidosis or lactic acidosis. And it’s dangerous. It’s dangerous because your blood is supposed to be a certain pH, which is slightly alkaline. Alkaline is the opposite of acid. So your blood is just slightly alkaline, slightly not acidic, and if it goes towards acidity, you can go into a coma and your organs, like your lungs and your heart and your kidneys, can shut down, so obviously it’s a dangerous situation. But I have to be honest with you, with all of the reports I’ve read, it’s really not common with this particular drug.†
Now metformin, what it does is it suppresses the formation of sugar by the liver. So when you eat food, there’s a lot of sugar in the blood, so the pancreas… it’s involved with digesting food, but it’s also involved with regulating sugar. The pancreas releases insulin and that stores away the sugar. It can store it in your muscles, which is good because muscles never let the sugar go. They convert it into glycogen and they use it when you do some exercise. So having more muscle makes it easier to control your blood sugar. It’s stored in your fat cells, but it’s also stored in your liver. That’s a major site of sugar storage and when the body wants to release some of that sugar in between meals cause you need some energy, you go through something called gluconeogenesis. The alpha cells in the pancreas release glucagon, that’s a different hormone that’s kind of like the opposite of insulin, and the glucagon causes the liver to release the sugar, the stored sugar. So what metformin does, it helps slow down gluconeogenesis. In between meals, you’re releasing less sugar.†
But during a meal, metformin helps insulin work better. Insulin is released from the beta cells in the pancreas. Glucagon’s released from the alpha cells in the pancreas. The insulin stores the excess sugar away. The problem with diabetics is the insulin can’t cling onto the cells and it doesn’t work, so they have insulin resistance and their sugar stays up after a meal. Metformin, besides slowing down the production of sugar and the release of sugar in between meals from the liver, also improves insulin sensitivity during your meals. It also enhances the uptake of sugar into your cells, so the cells can use it more efficiently. It increases what we call fatty acid oxidation. Any of those bodybuilding types, weight trainers, etc., they’ll discuss fatty acid oxidation. It’s burning energy. It’s burning energy. And that’s one reason why, when you use metformin, then you might lose some body fat.†
The other thing that metformin does, it a little bit reduces the absorption of sugar from your intestines. So the question is, how well does it work? It seems to work exceedingly well. In fact, they found in some studies that overweight people, really obese people with heart disease, it helps prevent them from having serious complications in their heart. It may even lower their risk of developing heart disease in the first place. You can’t use it… you don’t use it in people with severe liver disease. Even though it’s not really excreted by the liver, it can be stored in the liver. But you have to be careful in people with kidney disease because metformin is very water-soluble, it’s excreted from the body through the kidneys, so if you have reduced kidney function, the level of metformin can go up and it’s easier to have the side effects, complications and toxicities such as lactic acidosis.†
Now, in about 2017, the American College of Physicians, they updated their guidelines. They said, “Hey, metformin, that’s the drug we go to first for people with type 2 diabetes.” So what else can it do? It can do a bunch of things. There’s some evidence that metformin can help people with lung cancer and pancreatic cancer. There’s more recent research showing that women with diabetes, if they’re on metformin, they have a much greater chance of surviving their breast cancer. Now metformin can help these people lose weight because it increases fatty acid oxidation and it seems to be safer than a lot of other diabetes drugs. Commonly, it’s prescribed along with other diabetes drugs. In fact, there’s certain pills where they combine metformin with other drugs.†
Now, a common use of metformin would be polycystic ovarian syndrome. In polycystic ovarian syndrome, women, young women, get cysts on their ovaries. If it’s really severe, they can even get these cysts on their kidneys, which can be potentially dangerous. But because they’re developing cysts on their ovaries, it affects all kinds of hormones, sex hormones, etc., so their blood sugar goes up. When you give them metformin, it helps with the blood sugar. Their cholesterol levels go up and they develop hirsutism, like a mustache. They lose the hair on their scalps and go bald a little bit. They get very big. The metformin can help with some of these. But I tell you something, if you add to the metformin, in women with polycystic ovarian syndrome, a couple of supplements, it’ll work a lot better. We’ve done a podcast episode on that, but for a young woman with polycystic ovarian syndrome, yes the metformin, but add a supplement called NAC (N-acetyl cysteine), add a supplement called resveratrol and especially a supplement called inositol, which is a type of B-vitamin. It will really help.†
Now let’s talk about the nutrient depletions, cause that’s really important. Metformin commonly reduces your blood level of B12, so you could become fatigued for a number of reasons. B12 blood levels drop. Part of this is thought that you’re absorbing less B12 from the digestive tract. One thing you can wind up with is a type of anemia that has nothing to do with iron. It’s called megaloblastic anemia, where your red blood cells get very big and it’s hard for them to carry oxygen, so you get fatigued. But you also need B12… so you need B12 to make your red blood cells. You need B12 for the myelin sheath on your nerves and your brain cells. So the myelin sheath transfers messages from the body to the brain faster, so if you lack B12, you can end up with nerve damage.†
But also you need B12 to lower a molecule in the body called homocysteine. Homocysteine is an intermediary in protein metabolism and there’s three B-vitamins involved with its degradation into healthy things. One of them is Vitamin B6, you only need a little. One of them is folate and then the other is B12. So if you lack B12 because you’re on metformin, your homocysteine levels could go high and that’s really bad because if you have other risk factors for your heart, which diabetics commonly do, plus the homocysteine is elevated, it becomes very dangerous for the heart. So homocysteine on its own when it’s elevated may or may not be terrible for the heart. It’s hard to tell. But if there’s other things elevated, like blood pressure, like cholesterol, like uric acid, like triglycerides, like your blood sugar, then it becomes more dangerous. So homocysteine is bad for the heart. Homocysteine is bad for the brain. It’s terrible for the brain. In the brain, homocysteine inflames the brain. Homocysteine, once again, is an intermediary in protein metabolism. It’s not what the body’s trying to make, it’s kind of like the halfway point to what the body’s trying to convert it into. But if you lack B12, it stays as homocysteine and if it’s elevated in the brain, it’s involved with depression. It depresses the brain. It inflames the brain and causes depression. It just screws up all the workings of the brain, brain metabolism. But also, if you have elevated homocysteine in the brain, it literally strongly increases your risk of Alzheimer’s disease.†
Now, the other thing is, if you’re low in B12, it’s not just bad for your brain and your heart and your red blood cells, it’s bad for your bones. Lacking B12 is connected with bone loss, a hollowing out of the bones. But also brain shrinkage. There’s a number of studies, if you lack B12, your brain shrinks. Now, it seems to be tied into low levels of fish oils and low levels of Vitamin D, but it’s not unusual to have all three in a diabetic: low B12, low fish oils and low Vitamin D. Nutrition’s very important for diabetics. In fact, I did an episode on nutrients that are clearly incredibly beneficial and important for diabetics because diabetics do not use them efficiently, so they need a little more, or diabetics use them in their urines, so they need a little bit more. It’s just very important.†
Now, besides B12, metformin lowers your folate level. Well, that can happen because you’re lacking B12. If you lack B12, you can’t activate folate. Once again, if you lack B12, it leads to low folate. People on metformin are commonly in their blood on folate, so once again, homocysteine could go up, which is bad for your bones, bad for your brain and bad for your heart. We just explained it with the B12. Also, just like B12, if you lack folate, you develop megaloblastic anemia. Your red blood cells are too big and they don’t carry oxygen well and you get all kinds of symptoms, including fatigue. If you lack folate, which is a B-vitamin, it’s sometimes called Vitamin B9, there’s terrible birth defects of the brain and the spine and the face and the heart. But also if you lack folate, it can lead to cancer. Folate attaches to the genes in your chromosomes and prevents things like radiation and viruses and toxins and pesticides and other pollutants from damaging them. So if you lack folate, it’s easier to go through the initiation and progression phases that lead to cancer. If you’re on metformin, you really need to get a good B12 and a good folate. I recommend the active forms. B12 would be methylcobalamin and folate would be methyltetrahydrofolate. That’s the active form.†
But there’s also some evidence that metformin depletes your ubiquinol, which is the active version of coenzyme Q10. I’ve done podcast episodes on that also. But it doesn’t matter if it depletes ubiquinol because all diabetics should be on ubiquinol anyway. All diabetics should be on ubiquinol anyway. They cannot convert CoQ10 into ubiquinol effectively and this leads to some of the problems you see in diabetics, like they have a higher risk of kidney damage, nerve damage, fatigue, heart problems, brain fatigue, etc. if they lack ubiquinol. When I see diabetics, these are just some of the supplements they need and commonly I group these together. They don’t have to take, like, a million different supplements, but they need B12, they need folate and they really should be on ubiquinol if they’re on the drug metformin.†
So, thank you for joining in today for the InViteⓇ Health Podcast. You can find all of our episodes for free anywhere you listen to podcasts or just visit invitehealth.com/podcast. Please subscribe and leave us a review. You can also follow us on Metaverse, Twitter and Instagram @invitehealth. Hope to see you next time on another episode of the InViteⓇ Health Podcast. Thank you so much for listening. Jerry Hickey signing off, have a great day.†
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