Metformin For Weight-Loss & More
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Metformin Without Diabetes?
Metformin is a diabetes drug; it works by:
- decreasing glucose absorption from the gut
- decreasing glucose production in the liver
- increasing glucose sensitivity
It doesn’t change how much insulin is secreted, and is unlikely to cause hypoglycemia, making it relatively safe as diabetes drugs go.
It’s a biguanide drug, and/but so far as science knows (so far), its mechanism of action is unique (i.e. no other drug works the same way that metformin does).
Today we’ll examine its off-label uses and see what the science says!
A note on terms: “off-label” = when a drug is prescribed to treat something other than the main purpose(s) for which the drug was approved.
Other examples include modafinil against depression, and beta-blockers against anxiety.
Why take it if not diabetic?
There are many reasons people take it, including just general health and life extension:
However, its use was originally expanded (still “off-label”, but widely prescribed) past “just for diabetes” when it showed efficacy in treating pre-diabetes. Here for example is a longitudinal study that found metformin use performed similarly to lifestyle interventions (e.g. diet, exercise, etc). In their words:
❝ Lifestyle intervention or metformin significantly reduced diabetes development over 15 years. There were no overall differences in the aggregate microvascular outcome between treatment groups❞
But, it seems it does more, as this more recent review found:
❝Long-term weight loss was also seen in both [metformin and intensive lifestyle intervention] groups, with better maintenance under metformin.
Subgroup analyses from the DPP/DPPOS have shed important light on the actions of metformin, including a greater effect in women with prior gestational diabetes, and a reduction in coronary artery calcium in men that might suggest a cardioprotective effect.
Long-term diabetes prevention with metformin is feasible and is supported in influential guidelines for selected groups of subjects.❞
Source: Metformin for diabetes prevention: update of the evidence base
We were wondering about that cardioprotective effect, so…
Cardioprotective effect
In short, another review (published a few months after the above one) confirmed the previous findings, and also added:
❝Patients with BMI > 35 showed an association between metformin use and lower incidence of CVD, including African Americans older than age 65. The data suggest that morbidly obese patients with prediabetes may benefit from the use of metformin as recommended by the ADA.❞
We wondered about the weight loss implications of this, and…
For weight loss
The short version is, it works:
- Effectiveness of metformin on weight loss in non-diabetic individuals with obesity
- Metformin for weight reduction in non-diabetic patients: a systematic review and meta-analysis
- Metformin induces weight loss associated with gut microbiota alteration in non-diabetic obese women
…and many many more where those came from. As a point of interest, it has also been compared and contrasted to GLP-1 agonists.
Compared/contrasted with GLP-1 agonists
It’s not quite as effective for weight loss, and/but it’s a lot cheaper, is tablets rather than injections, has fewer side effects (for most people), and doesn’t result in dramatic yoyo-ing if there’s an interruption to taking it:
Or if you prefer a reader-friendly pop-science version:
Ozempic vs Metformin: Comparing The Two Diabetes Medications
Is it safe?
For most people yes, but there are a stack of contraindications, so it’s best to speak with your doctor. However, particular things to be aware of include:
- Usually contraindicated if you have kidney problems of any kind
- Usually contraindicated if you have liver problems of any kind
- May be contraindicated if you have issues with B12 levels
See also: Metformin: Is it a drug for all reasons and diseases?
Where can I get it?
As it’s a prescription-controlled drug, we can’t give you a handy Amazon link for this one.
However, many physicians are willing to prescribe it for off-label use (i.e., for reasons other than diabetes), so speak with yours (telehealth options may also be available).
If you do plan to speak with your doctor and you’re not sure they’ll be agreeable, you might want to get this paper and print it to take it with you:
Off-label indications of Metformin – Review of Literature
Take care!
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The Recipe For Empowered Leadership – by Doug Meyer-Cuno
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This is not a “here’s how to become a leader, you young would-be Machiavelli”; it’s more a “so you’re in a leadership role; now what?” book. The book’s subtitle describes well its contents: “25 Ingredients For Creating Value & Empowering Others”
The book is written with the voice of experience, but without the ego-driven padding that accompanies many such books. Especially: any anecdotal illustrations are short and to-the-point, no chapter-long diversions here.
Which we love!
Equally helpful is where the author does spend a little more time and energy: on the “down to brass tacks” of how exactly to do various things.
In short: if instead of a lofty-minded book of vague idealized notions selling a pipedream, you’d rather have a manual of how to actually be a good leader when it comes down to it, this is the book for you.
Pick Up The Recipe For Empowered Leadership On Amazon Today!
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Get Better Sleep: Beyond The Basics
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First though, for the sake of being methodical, let’s quickly note the basics:
- Aim for 7–9 hours per night
- Set a regular bedtime and (equally important!) regular getting-up time
- Have a 2-hour wind-down period before bed, to decompress from any stresses of the day
- Minimal device/screen usage before bed
- Abstain from stimulants for as long before bed as reasonably possible (caffeine elimination halflife is 4–8 hours depending on your genes, call it 6 hours average to eliminate half (not the whole lot), and you’ll see it’s probably best to put a cap on it earlier rather than later).
- Abstain from alcohol, ideally entirely, but allow at least 1hr/unit before bed. So for example, 1hr for a 1oz single shot of spirits, or 2–3 hours for a glass of wine (depending on size), or 3–4 hours for a martini (depending on recipe). Not that that is not the elimination time, nor even the elimination halflife of alcohol, it’s just a “give your body a chance at least” calculation. If you like to have a drink to relax before bed, then well, only you can decide what you like more: that or actually getting restorative sleep.
- Consider a warm bath/shower before bed, if that suits your schedule.
- Wash and change your bedsheets more often than seems necessary. Or if that’s too onerous, at least change the pillowcases more often, which makes quite a difference already.
- Lower the temperature of your bedroom shortly before bedtime; this will help cue the body to produce melatonin
- Make your bedroom as dark as reasonably possible. Invest in blackout blinds/curtains, and remove any pesky electronics, or at least cover their little LEDs if it’s something that reasonably needs to remain on.
Ok, now, onwards…
Those 7–9 hours? Yes, it goes for you too.
A lot of people mistake getting 6 hours sleep per night for only needing 6 hours sleep per night. Sure, you may still be alive after regularly getting 6 hours, but (unless you have a rare mutation of the ADRB1 gene) it will be causing harm, and yes, that includes later in life; we don’t stop needing so much sleep, even stop getting it:
Why You Probably Need More Sleep
With this in mind, it becomes important to…
Prioritize your sleep—which means planning for it!
When does your bedtime routine start? According to sleep scientist Dr. Lisa Matricciani, it starts before breakfast. This is because the things we do earlier in the day can greatly affect the amount (and quality) of sleep we get later. For example, a morning moderate-to-intense exercise session greatly improves sleep at night:
Planning Ahead For Better Sleep
As for quality, that is as important as quantity, and it’s not just about “soundness” of sleep:
The 6 Dimensions Of Sleep (And Why They Matter)
“What gets measured, gets done” goes for sleep too
Sleep-deprived people usually underestimate how sleep-deprived they are. This is for the same reason as why drunk people usually underestimate how drunk they are—to put it in words that go for both situations: a cognitively impaired person lacks the cognitive function to realize how cognitively impaired they are.
Here’s the science on that, by the way:
How Sleep-Deprived Are You, Really?
For that reason, we recommend using sleep-tracking software (there are many apps for that) on your phone or, ideally, a wearable device (such as a smartwatch or similar).
A benefit of doing so is that we don’t think “well, I slept from 10pm to 6am, so that’s 8 hours”, if our device tells us we slept between 10:43pm and 5:56 am with 74% sleep efficiency because we woke up many times.
As an aside, sleep efficiency should be about 85%, by the way. Why not 100%, you ask? It’s because if your body is truly out like a light for the entire night, something is wrong (either you were very sleep-deprived, or you have been drugged, that kind of thing). See also:
An unbroken night’s sleep is a myth. Here’s what good sleep looks like.
So waking up during the night is normal, and nothing to worry about per se. If you do find trouble getting back to sleep, though:
How to Fall Back Asleep After Waking Up in the Middle of the Night
Be careful about how you try to supplement sleep
This goes both for taking substances of various kinds, and napping. Some sleep aids can help, but many are harmful and/or do not really work as such; here’s a rundown of examples of those:
Safe Effective Sleep Aids For Seniors?
And when it comes to napping, timing is everything:
How To Nap Like A Pro (No More “Sleep Hangovers”!)
Want to know a lot more?
This is the book on sleep:
Why We Sleep – by Dr. Matthew Walker
Enjoy!
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How to Read a Book – by Mortimer J. Adler and Charles Van Doren
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Are you a cover-to-cover person, or a dip-in-and-out person?
Mortimer Adler and Charles van Doren have made a science out of getting the most from reading books.
They help you find what you’re looking for (Maybe you want to find a better understanding of PCOS… maybe you want to find the definition of “heuristics”… maybe you want to find a new business strategy… maybe you want to find a romantic escape… maybe you want to find a deeper appreciation of 19th century poetry, maybe you want to find… etc).
They then help you retain what you read, and make sure that you don’t miss a trick.
Whether you read books so often that optimizing this is of huge value for you, or so rarely that when you do, you want to make it count, this book could make a real difference to your reading experience forever after.
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How Ibogaine Can Beat Buprenorphine For Beating Addictions
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It’s Q&A Day at 10almonds!
Have a question or a request? We love to hear from you!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝Questions?❞
It seems that this week, everyone was so satisfied with our information, that we received no questions! (If you sent one and we somehow missed it, please accept our apologies and do bring our attention to it)
However, we did receive some expert feedback that we wanted to share because it’s so informative:
❝I work at a detox rehab in Mexico, where we can use methods not legal in the United States. Therefore, while much of the linked articles had useful information, I’m in the “trenches” every day, and there’s some information I’d like to share that you may wish to share, with additional information:
- Buprenorphine is widely used and ineffective for addiction because it’s synthetic and has many adverse side effects. For heavy drug users it isn’t enough and they still hit the streets for more opioid, resulting in fentanyl deaths. Depending on length of usage and dose, it can take WEEKS to get off of, and it’s extremely difficult.
- Ibogaine is the medicine we use to detox people off opiates, alcohol, meth as well as my own specialty, bulimia. It’s psychoactive and it temporarily “resets” the brain to a pre-addictive state. Supplemented by behavior and lifestyle changes, as well as addressing the traumas that led to the addiction is extremely effective.
Our results are about 50%, meaning the client is free of the substance or behavior 1 year later. Ibogaine isn’t a “magic pill” or cure, it’s an opening tool that makes the difficult work of reclaiming one’s life easier.
Ibogaine is not something that should be done outside a medical setting. It requires an EKG to ensure the heart is healthy and doesn’t have prolonged QT intervals; also blood testing to ensure organs are functioning (especially the liver) and mineral levels such as magnetic and potassium are where they should be. It is important that this treatment be conducted by experienced doctors or practitioners, and monitoring vital signs constantly is imperative.
I’m taking time to compose this information because it needs to be shared that there is an option available most people have not heard about.❞
~ 10almonds reader (slightly edited for formatting and privacy)
Thank you for that! Definitely valuable information for people to know, and (if applicable for oneself or perhaps a loved one) ask about when it comes to local options.
We see it’s also being studied for its potential against other neurological conditions, too:
❝The combination of ibogaine and antidepressants produces a synergistic effect in reducing symptoms of psychiatric disorders such as bipolar disorder, depression, schizophrenia, paranoia, anxiety, panic disorder, mania, post-traumatic stress disorder (PTSD), and obsessive–compulsive disorder. Though ibogaine and the antidepressant act in different pathways, together they provide highly efficient therapeutic responses compared to when each of the active agents is used alone.❞
Read more: Ibogaine and Their Analogs as Therapeutics for Neurological and Psychiatric Disorders
For those who missed it, today’s information about ibogaine was in response to our article:
Let’s Get Letting Go (Of These Three Things)
…which in turn referenced our previous main feature:
Which Addiction-Quitting Methods Work Best?
Take care!
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Migraine Mythbusting
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Migraine: When Headaches Are The Tip Of The Neurological Iceberg
Yesterday, we asked you “What is a migraine?” and got the above-depicted, below-described spread of responses:
- Just under 46% said “a headache, but above a certain level of severity”
- Just under 23% said “a headache, but caused by a neurological disorder”
- Just over 21% said “a neurological disorder that can cause headaches”
- Just under 10% said “a headache, but with an attention-grabbing name”
So… What does the science say?
A migraine is a headache, but above a certain level of severity: True or False?
While that’s usually a very noticeable part of it… That’s only one part of it, and not a required diagnostic criterion. So, in terms of defining what a migraine is, False.
Indeed, migraine may occur without any headache, let alone a severe one, for example: Abdominal Migraine—though this is much less well-researched than the more common with-headache varieties.
Here are the defining characteristics of a migraine, with the handy mnemonic 5-4-3-2-1:
- 5 or more attacks
- 4 hours to 3 days in duration
- 2 or more of the following:
- Unilateral (affects only one side of the head)
- Pulsating
- Moderate or severe pain intensity
- Worsened by or causing avoidance of routine physical activity
- 1 or more of the following:
- Nausea and/or vomiting
- Sensitivity to both light and sound
Source: Cephalalgia | ICHD-II Classification: Parts 1–3: Primary, Secondary and Other
As one of our subscribers wrote:
❝I have chronic migraine, and it is NOT fun. It takes away from my enjoyment of family activities, time with friends, and even enjoying alone time. Anyone who says a migraine is just a bad headache has not had to deal with vertigo, nausea, loss of balance, photophobia, light sensitivity, or a host of other symptoms.❞
Migraine is a neurological disorder: True or False?
True! While the underlying causes aren’t known, what is known is that there are genetic and neurological factors at play.
❝Migraine is a recurrent, disabling neurological disorder. The World Health Organization ranks migraine as the most prevalent, disabling, long-term neurological condition when taking into account years lost due to disability.
Considerable progress has been made in elucidating the pathophysiological mechanisms of migraine, associated genetic factors that may influence susceptibility to the disease❞
Source: JHP | Mechanisms of migraine as a chronic evolutive condition
Migraine is just a headache with a more attention-grabbing name: True or False?
Clearly, False.
As we’ve already covered why above, we’ll just close today with a nod to an old joke amongst people with chronic illnesses in general:
“Are you just saying that because you want attention?”
“Yes… Medical attention!”
Want to learn more?
You can find a lot of resources at…
NIH | National Institute of Neurological Disorders & Stroke | Migraine
and…
The Migraine Trust ← helpfully, this one has a “Calm mode” to tone down the colorscheme of the website!
Particularly useful from the above site are its pages:
Take care!
Don’t Forget…
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Celeriac vs Celery – Which is Healthier?
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Our Verdict
When comparing celeriac to celery, we picked the celeriac.
Why?
Yes, these are essentially the same plant, but there are important nutritional differences:
In terms of macros, celeriac has more than 2x the protein, and slightly more carbs and fiber. Both are very low glycemic index, so the higher protein and fiber makes celeriac the winner in this category.
In the category of vitamins, celeriac has more of vitamins B1, B3, B5, B6, C, E, K, and choline, while celery has more of vitamins A and B9. An easy win for celeriac.
When it comes to minerals, celeriac has more copper, calcium, iron, magnesium, manganese, phosphorus, potassium, selenium, and zinc, while celery is not higher in any minerals. Another obvious win for celeriac.
Adding these sections up makes for a clear overall win for celeriac, but by all means enjoy either or both!
Want to learn more?
You might like to read:
What’s Your Plant Diversity Score?
Take care!
Don’t Forget…
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