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
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Food and exercise can treat depression as well as a psychologist, our study found. And it’s cheaper
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Around 3.2 million Australians live with depression.
At the same time, few Australians meet recommended dietary or physical activity guidelines. What has one got to do with the other?
Our world-first trial, published this week, shows improving diet and doing more physical activity can be as effective as therapy with a psychologist for treating low-grade depression.
Previous studies (including our own) have found “lifestyle” therapies are effective for depression. But they have never been directly compared with psychological therapies – until now.
Amid a nation-wide shortage of mental health professionals, our research points to a potential solution. As we found lifestyle counselling was as effective as psychological therapy, our findings suggest dietitians and exercise physiologists may one day play a role in managing depression.
Alexander Raths/shutterstock What did our study measure?
During the prolonged COVID lockdowns, Victorians’ distress levels were high and widespread. Face-to-face mental health services were limited.
Our trial targeted people living in Victoria with elevated distress, meaning at least mild depression but not necessarily a diagnosed mental disorder. Typical symptoms included feeling down, hopeless, irritable or tearful.
We partnered with our local mental health service to recruit 182 adults and provided group-based sessions on Zoom. All participants took part in up to six sessions over eight weeks, facilitated by health professionals.
Half were randomly assigned to participate in a program co-facilitated by an accredited practising dietitian and an exercise physiologist. That group – called the lifestyle program – developed nutrition and movement goals:
Lifestyle therapy aims to improve diet. Jonathan Borba/Pexels - eating a wide variety of foods
- choosing high-fibre plant foods
- including high quality fats
- limiting discretionary foods, such as those high in saturated fats and added sugars
- doing enjoyable physical activity.
The second group took part in psychotherapy sessions convened by two psychologists. The psychotherapy program used cognitive behavioural therapy (CBT), the gold standard for treating depression in groups and when delivered remotely.
In both groups, participants could continue existing treatments (such as taking antidepressant medication). We gave both groups workbooks and hampers. The lifestyle group received a food hamper, while the psychotherapy group received items such as a colouring book, stress ball and head massager.
Lifestyle therapies just as effective
We found similar results in each program.
At the trial’s beginning we gave each participant a score based on their self-reported mental health. We measured them again at the end of the program.
Over eight weeks, those scores showed symptoms of depression reduced for participants in the lifestyle program (42%) and the psychotherapy program (37%). That difference was not statistically or clinically meaningful so we could conclude both treatments were as good as each other.
There were some differences between groups. People in the lifestyle program improved their diet, while those in the psychotherapy program felt they had increased their social support – meaning how connected they felt to other people – compared to at the start of the treatment.
Participants in both programs increased their physical activity. While this was expected for those in the lifestyle program, it was less expected for those in the psychotherapy program. It may be because they knew they were enrolled in a research study about lifestyle and subconsciously changed their activity patterns, or it could be a positive by-product of doing psychotherapy.
People in both groups reported doing more physical activity. fongbeerredhot/Shutterstock There was also not much difference in cost. The lifestyle program was slightly cheaper to deliver: A$482 per participant, versus $503 for psychotherapy. That’s because hourly rates differ between dietitians and exercise physiologists, and psychologists.
What does this mean for mental health workforce shortages?
Demand for mental health services is increasing in Australia, while at the same time the workforce faces worsening nation-wide shortages.
Psychologists, who provide about half of all mental health services, can have long wait times. Our results suggest that, with the appropriate training and guidelines, allied health professionals who specialise in diet and exercise could help address this gap.
Lifestyle therapies can be combined with psychology sessions for multi-disciplinary care. But diet and exercise therapies could prove particularly effective for those on waitlists to see a psychologists, who may be receiving no other professional support while they wait.
Many dietitians and exercise physiologists already have advanced skills and expertise in motivating behaviour change. Most accredited practising dietitians are trained in managing eating disorders or gastrointestinal conditions, which commonly overlap with depression.
There is also a cost argument. It is overall cheaper to train a dietitian ($153,039) than a psychologist ($189,063) – and it takes less time.
Potential barriers
Australians with chronic conditions (such as diabetes) can access subsidised dietitian and exercise physiologist appointments under various Medicare treatment plans. Those with eating disorders can also access subsidised dietitian appointments. But mental health care plans for people with depression do not support subsidised sessions with dietitians or exercise physiologists, despite peak bodies urging them to do so.
Increased training, upskilling and Medicare subsidies would be needed to support dietitians and exercise physiologists to be involved in treating mental health issues.
Our training and clinical guidelines are intended to help clinicians practising lifestyle-based mental health care within their scope of practice (activities a health care provider can undertake).
Future directions
Our trial took place during COVID lockdowns and examined people with at least mild symptoms of depression who did not necessarily have a mental disorder. We are seeking to replicate these findings and are now running a study open to Australians with mental health conditions such as major depression or bipolar disorder.
If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.
Adrienne O’Neil, Professor, Food & Mood Centre, Deakin University and Sophie Mahoney, Associate Research Fellow, Food and Mood Centre, Deakin University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Strong Curves – by Bret Contreras & Kellie Davis
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The title (and subtitle) is, of course, an appeal to vanity. However, the first-listed author is well-known as “The Glute Guy”, and he takes this very seriously, not just for aesthetic reasons but also for practical reasons.
After all, when it comes to posture and stability, a lot rests on our hips, and hips, well, they rest on our butt and thighs. What’s more, the gluteus maximus is the largest muscle in the human body, so really, is it a good one to neglect? Probably not, and your lower back will definitely thank you for keeping your glutes in good order, too.
That said, while it’s a focal point, it’s not the be-all-and-end-all, and this book does cover the whole body.
The book takes the reader from “absolute beginner” to “could compete professionally”, with clearly-illustrated and well-described exercises. We also get a strong “crash course” in the relevant anatomy and physiology, and even a chapter on nutrition, which is a lot better than a lot of exercise books’ efforts in that regard.
For those who like short courses, this book has several progressive 12-week workout plans that take the reader from a very clear starting point to a very clear goal point.
Another strength of the book is that while a lot of exercises expect (and require) access to a gym, there are also whole sections of “at home / bodyweight” exercises, including 12-week workout plans for such, as described above.
Bottom line: there’s really nothing bad that this reviewer can find to say about this one—highly recommendable to any woman who wants to get strong while keeping a feminine look.
Click here to check out Strong Curves, and rebuild your body, your way!
PS: at first glance, the cover art looks like an AI model; it’s not; that’s the co-author Kellie Davis, who also serves as the model through the book’s many photographic illustrations.
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Natto vs Tofu – Which is Healthier?
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Our Verdict
When comparing nattō to tofu, we picked the nattō.
Why?
In other words, in the comparison of fermented soy to fermented soy, we picked the fermented soy. But the relevant difference here is that nattō is fermented whole soybeans, while tofu is fermented soy milk of which the coagulated curds are then compressed into a block—meaning that the nattō is the one that has “more food per food”.
Looking at the macros, it’s therefore no surprise that nattō has a lot more fiber to go with its higher carb count; it also has slightly more protein. You may be wondering what tofu has more of, and the answer is: water.
In terms of vitamins, nattō has more of vitamins B2, B4, B6, C, E, K, and choline, while tofu has more of vitamins A, B3, and B9. So, a 7:3 win for nattō, even before considering that that vitamin C content of nattō is 65x more than what tofu has.
When it comes to minerals, nattō has more copper, iron, magnesium, manganese, potassium, and zinc, while tofu has more calcium, phosphorus, and selenium. So, a 6:3 win for nattō, and yes, the margins of difference are comparable (being 2–3x more for most of these minerals).
In short, both of these foods are great, but nattō is better.
Want to learn more?
You might like to read:
21% Stronger Bones in a Year at 62? Yes, It’s Possible (No Calcium Supplements Needed!)
Take care!
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Brazil Nuts vs Pecans – Which is Healthier?
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Our Verdict
When comparing Brazil nuts to pecans, we picked the pecans.
Why?
In terms of macros, Brazil nuts have more protein while pecans have more fiber. Both of these nuts are equally fatty, though Brazil nuts have much more saturated fat per 100g, which still isn’t terrible, but it does make pecans’ profile (mostly monounsaturated with some polyunsaturated) the healthier. They’re about equal in carbs. All in all, a win for pecans here.
In the category of vitamins, Brazil nuts have more vitamin E, while pecans have more of vitamins A, B1, B2, B3, B5, B6, B7, B9, C, K, and choline. An easy win for pecans.
The category of minerals is an interesting one. Brazil nuts have more calcium, copper, magnesium, phosphorus, potassium, and selenium, while pecans have more iron, manganese, and zinc. Before we crown Brazil nuts with the win in this category, though, let’s take a closer look at those selenium levels:
- A cup of cashews contains 21% of the RDA of selenium. Your hair will be luscious and shiny.
- A cup of Brazil nuts contains 10,456% of the RDA of selenium. This is way past the point of selenium toxicity, and your (luscious, shiny) hair will fall out.
For this reason, it’s recommended to eat no more than 3–4 Brazil nuts per day.
We consider that a point against Brazil nuts.
Adding up the sections makes for an overall win for pecans; of course, enjoy either or both, just be sure to practise moderation when it comes to the Brazil nuts!
Want to learn more?
You might like:
Why You Should Diversify Your Nuts
Enjoy!
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Dr. Suzanne Steinbaum’s Heart Book – by Dr. Suzanne Steinbaum
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The book is divided into three parts:
- What you should know
- What you should do
- All about you
This is a very useful format, since it lays out all the foundational knowledge, before offering practical advice and “how to” explanations, before finally wrapping up with personalizing things.
The latter is important, because while our basic risk factors can be assembled in a few lines of data (age, sex, race, genes, diet, exercise habits, etc) there’s a lot more to us than that, and oftentimes the data that doesn’t make the cut, makes the difference. Hormones on high on this list; we can say that a person is a 65-year-old woman and make a guess, but that’s all it is: a guess. Very few of us are the “average person” that statistical models represent accurately. And nor are social and psychological factors irrelevant; in fact often they are deciding factors!
So, it’s important to be able to look at ourselves as the whole persons we are, or else we’ll get a heart-healthy protocol that works on paper but actually falls flat in application, because the mathematical model didn’t take into account that lately we have been very stressed about such-and-such a thing, and deeply anxious about so-and-so, and a hopefully short-term respiratory infection has reduced blood oxygen levels, and all these kinds of things need to be taken into account too, for an overall plan to work.
The greatest strength of this book is that it attends to that.
The style of the book is a little like a long sales pitch (when all that’s being sold, by the way, is the ideas the book is offering; she wants you to take her advice with enthusiasm), but there’s plenty of very good information all the way through, making it quite worth the read.
Bottom line: if you’re a woman and/or love at least one woman, then you can benefit from this important book for understanding heart health that’s not the default.
Click here to check out Dr. Suzanne Steinbaum’s Heart Book, and enjoy a heart-healthy life!
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A new government inquiry will examine women’s pain and treatment. How and why is it different?
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The Victorian government has announced an inquiry into women’s pain. Given women are disproportionately affected by pain, such a thorough investigation is long overdue.
The inquiry, the first of its kind in Australia and the first we’re aware of internationally, is expected to take a year. It aims to improve care and services for Victorian girls and women experiencing pain in the future.
The gender pain gap
Globally, more women report chronic pain than men do. A survey of over 1,750 Victorian women found 40% are living with chronic pain.
Approximately half of chronic pain conditions have a higher prevalence in women compared to men, including low back pain and osteoarthritis. And female-specific pain conditions, such as endometriosis, are much more common than male-specific pain conditions such as chronic prostatitis/chronic pelvic pain syndrome.
These statistics are seen across the lifespan, with higher rates of chronic pain being reported in females as young as two years old. This discrepancy increases with age, with 28% of Australian women aged over 85 experiencing chronic pain compared to 18% of men.
It feels worse
Women also experience pain differently to men. There is some evidence to suggest that when diagnosed with the same condition, women are more likely to report higher pain scores than men.
Similarly, there is some evidence to suggest women are also more likely to report higher pain scores during experimental trials where the same painful pressure stimulus is applied to both women and men.
Pain is also more burdensome for women. Depression is twice as prevalent in women with chronic pain than men with chronic pain. Women are also more likely to report more health care use and be hospitalised due to their pain than men.
Women seem to feel pain more acutely and often feel ignored by doctors.
ShutterstockMedical misogyny
Women in pain are viewed and treated differently to men. Women are more likely to be told their pain is psychological and dismissed as not being real or “all in their head”.
Hollywood actor Selma Blair recently shared her experience of having her symptoms repeatedly dismissed by doctors and put down to “menstrual issues”, before being diagnosed with multiple sclerosis in 2018.
It’s an experience familiar to many women in Australia, where medical misogyny still runs deep. Our research has repeatedly shown Australian women with pelvic pain are similarly dismissed, leading to lengthy diagnostic delays and serious impacts on their quality of life.
Misogyny exists in research too
Historically, misogyny has also run deep in medical research, including pain research. Women have been viewed as smaller bodied men with different reproductive functions. As a result, most pre-clinical pain research has used male rodents as the default research subject. Some researchers say the menstrual cycle in female rodents adds additional variability and therefore uncertainty to experiments. And while variability due to the menstrual cycle may be true, it may be no greater than male-specific sources of variability (such as within-cage aggression and dominance) that can also influence research findings.
The exclusion of female subjects in pre-clinical studies has hindered our understanding of sex differences in pain and of response to treatment. Only recently have we begun to understand various genetic, neurochemical, and neuroimmune factors contribute to sex differences in pain prevalence and sensitivity. And sex differences exist in pain processing itself. For instance, in the spinal cord, male and female rodents process potentially painful stimuli through entirely different immune cells.
These differences have relevance for how pain should be treated in women, yet many of the existing pharmacological treatments for pain, including opioids, are largely or solely based upon research completed on male rodents.
When women seek care, their pain is also treated differently. Studies show women receive less pain medication after surgery compared to men. In fact, one study found while men were prescribed opioids after joint surgery, women were more likely to be prescribed antidepressants. In another study, women were more likely to receive sedatives for pain relief following surgery, while men were more likely to receive pain medication.
So, women are disproportionately affected by pain in terms of how common it is and sensitivity, but also in how their pain is viewed, treated, and even researched. Women continue to be excluded, dismissed, and receive sub-optimal care, and the recently announced inquiry aims to improve this.
What will the inquiry involve?
Consumers, health-care professionals and health-care organisations will be invited to share their experiences of treatment services for women’s pain in Victoria as part of the year-long inquiry. These experiences will be used to describe the current service delivery system available to Victorian women with pain, and to plan more appropriate services to be delivered in the future.
Inquiry submissions are now open until March 12 2024. If you are a Victorian woman living with pain, or provide care to Victorian women with pain, we encourage you to submit.
The state has an excellent track record of improving women’s health in many areas, including heart, sexual, and reproductive health, but clearly, we have a way to go with women’s pain. We wait with bated breath to see the results of this much-needed investigation, and encourage other states and territories to take note of the findings.
Jane Chalmers, Senior Lecturer in Pain Sciences, University of South Australia and Amelia Mardon, PhD Candidate, University of South Australia
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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