August 4, 2025 • 15 mins
Metformin is the most prescribed diabetes medication in the world, yet it remains shrouded in misunderstanding and hesitation. In this episode of The Health Pulse, we unravel the science behind metformin—how it works, why it’s so widely used, and the facts that dispel long-standing myths.
You’ll learn how metformin lowers blood sugar through a triple-action mechanism: reducing liver glucose output, enhancing insulin sensitivity, and slowing carbohydrate absorption—without overstimulating the pancreas or triggering hypoglycemia. We also spotlight its unexpected benefits, from cardiovascular protection shown in the landmark UKPDS trial to its growing roles in PCOS, modest weight control, and even healthy aging via the ongoing TAME trial.
We address the most common concerns—kidney safety, side effects, dependency fears—and clarify where caution is warranted. Most importantly, we emphasize how metformin fits best as part of a comprehensive lifestyle strategy that includes nutrition, movement, and metabolic testing.
Whether you're considering metformin, already taking it, or simply want to make more informed decisions about metabolic health, this episode offers a clear, evidence-backed perspective.
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Disclaimer: The information provided in this podcast is for informational purposes only and should not be considered medical advice. The content discussed is based on research, expert insights, and reputable sources, but it does not replace professional medical consultation, diagnosis, or treatment. We strive to present accurate and up-to-date information, medical research is constantly evolving. Listeners should always verify details with trusted health organizations, before making any health-related decisions. If you are experiencing a medical emergency, such as severe pain, difficulty breathing, or other urgent symptoms, call your local emergency services immediately. By listening to this podcast, you acknowledge that The Health Pulse and its creators are not responsible for any actions taken based on the content of this episode. Your health and well-being should always be guided by the advice of qualified medical professionals.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
Welcome to the Health Pulse, your go-to source for
quick, actionable insights onhealth, wellness and diagnostics
.
Whether you're looking tooptimize your well-being or stay
informed about the latest inmedical testing, we've got you
covered.
Join us as we break down keyhealth topics in just minutes.
Let's dive in.
Speaker 2 (00:22):
Welcome to the Deep Dive.
Today we're looking atsomething pretty intriguing, a
medication used by millions, yetoften viewed with a lot of
suspicion.
We're talking about metformin.
It's prescribed to over 150million people worldwide for
type 2 diabetes.
All the big healthorganizations ADA, who they
recommend it as a first-linetreatment.
(00:42):
It's been around for decades,generally safe.
But here's the paradox Despiteall that, you hear patients
expressing real fear, worriesabout kidneys, side effects,
getting hooked on it.
It kind of reminds me of thatGrace Hopper quote the most
dangerous phrase is we've alwaysdone it this way.
These fears often come fromwell old information right
(01:03):
Misinformation.
So today we're going to unpackmetformin.
Really look at the evidence,separate the facts from the
myths.
Speaker 3 (01:08):
Exactly, and our goal here is simple to give you the
solid facts so you can makeinformed choices about your own
health, whether you're justdiagnosed or you've been
managing diabetes for a whileand, as we'll see, there's
actually more to metformin thanjust blood sugar.
Speaker 2 (01:25):
Think heart protection, maybe even healthy
aging.
Okay, let's unpack this then,before we get into the bigger
picture.
What exactly is metformin?
For anyone new to it, Sure.
Speaker 3 (01:31):
So it's in a class of drugs called big one-ides.
Basically, it works mostly inthe liver and gut.
It's not new either.
Introduced back in 1957 inFrance.
Speaker 2 (01:40):
Yeah, 57.
That's quite a history.
Speaker 3 (01:42):
Yeah, used widely in Europe for years before it got
FDA approval here in the US in1994.
Now it's the most prescribedoral diabetes med globally.
Speaker 2 (01:51):
So how does it work?
You said liver and gut.
Speaker 3 (01:53):
Right.
It does three main thingsreally elegantly.
First, it tells your liver toproduce less glucose.
That excess sugar production itdampens that Hepatic
gluconeogenesis is the term.
Second, it makes your musclesand fat tissue more sensitive to
insulin, so your cells getbetter at actually taking
glucose out of the blood.
Speaker 2 (02:12):
Okay, so it helps the insulin you already have work
better.
Speaker 3 (02:14):
Precisely.
And third, it kind of slowsdown how quickly you absorb
carbohydrates from your food inthe gut, leads to steadier blood
sugar.
And here's a key safety pointBecause it works with your
existing insulin, doesn't forceyour pancreas to pump out more.
It very rarely causes low bloodsugar hypoglycemia when you
(02:35):
take it by itself.
Speaker 2 (02:36):
That's a huge advantage, isn't it, compared to
some other meds.
Speaker 3 (02:39):
It really is a significant safety benefit.
Speaker 2 (02:41):
That's a really clever mechanism, just helping
the body do its job better.
But you mentioned otherbenefits beyond blood sugar.
This is where it gets reallyinteresting.
Speaker 3 (02:50):
Absolutely.
The research has uncoveredquite a bit more.
Cardiovascular protection is abig one.
Speaker 2 (02:54):
Like protecting the heart.
Speaker 3 (02:56):
Exactly the UK PDS trial, a huge long-term study,
found metformin reduced the riskof heart attacks and
diabetes-related deathssignificantly in overweight
patients.
Then there's weight.
Unlike some diabetes drugs thatcause weight gain, metformin is
usually weight neutral.
Some people even see modestweight loss.
Speaker 2 (03:15):
That's definitely a plus.
Speaker 3 (03:16):
For sure.
It's also used effectively forPCOS polycystic ovary syndrome
because it helps with theunderlying insulin resistance
and can help regulate cycles.
And maybe the most excitingarea is well anti-aging.
Research Studies like the TAMEtrial are looking at whether
metformin can extend health span.
You know, years lived withoutmajor chronic disease, delaying
(03:39):
age-related stuff.
Speaker 2 (03:40):
Wow, so okay blood sugar control, heart protection,
maybe weight loss, pcos,potentially even healthy aging.
It's easy to see why it's thego to the gold standard first
line treatment.
Speaker 3 (03:52):
It really is Proven track record.
It's affordable, low risk ofserious problems for most people
.
It ticks a lot of boxes.
Speaker 2 (03:58):
Which brings us back to the fears.
Speaker 3 (03:59):
Yeah.
Speaker 2 (04:00):
Given all this, why are people so hesitant sometimes
?
Let's tackle those mythsdirectly.
What's the evidence say?
Speaker 3 (04:05):
Let's do it.
Myth number one metformindamages the kidneys.
This is probably the mostcommon one.
Speaker 2 (04:10):
Right, I hear that all the time.
Speaker 3 (04:11):
The truth Metformin does not harm healthy kidneys.
It doesn't cause kidney damage.
Speaker 2 (04:16):
So where does the confusion come from?
Speaker 3 (04:17):
It's because the drug is cleared by the kidneys.
So if your kidney function isalready severely impaired like
really low and EGFR below 30,then the drug can build up and
in those rare cases it couldincrease the risk of a serious
condition called lactic acidosis.
But for people with normal orjust mildly reduced kidney
function it's safe.
We just monitor kidney functionregularly.
Speaker 2 (04:38):
Okay, that makes sense.
So it's not the cause.
It's about pre-existing severeissues.
Speaker 3 (04:42):
Exactly Now.
Myth two metformin causescancer.
Speaker 2 (04:47):
Is there any truth to that?
Speaker 3 (04:49):
No credible evidence at all.
In fact, some research suggestsit might actually lower the
risk for certain cancers likecolon, breast, pancreatic.
Speaker 2 (04:57):
What about that recall a few years ago with the
contamination?
Speaker 3 (05:00):
Ah, yes, that was 2019.
Some extended release batcheswere found to have NDMA
contamination.
That was a manufacturing issue,specific lots, not a problem
with metformin itself.
Those lots were recalled andstandards were tightened.
Speaker 2 (05:14):
Got it Manufacturing, not the drug, OK.
Next myth you get dependent onmetformin like you're addicted.
Speaker 3 (05:21):
Also not true.
Metformin isn't addictive.
There's no physical dependence.
Speaker 2 (05:25):
So why do people think that?
Maybe because if they stop,their sugar goes up.
Speaker 3 (05:30):
Precisely.
If you stop taking it, yourblood sugar might rise simply
because the underlying reasonyou needed it the insulin
resistance hasn't gone away.
Your body isn't craving thedrug hasn't gone away.
Your body isn't craving thedrug.
And, importantly, if you makesignificant lifestyle changes
weight loss, diet changes, moreactivity you can often improve
that insulin resistance so muchthat well, maybe you don't need
(05:51):
metformin anymore.
That's reversing the condition,not breaking dependence.
Speaker 2 (05:55):
That's a really key point.
It's about addressing the rootcause.
Yeah, okay, one more mythMetformin causes dangerous low
blood sugar hypoglycemia.
Speaker 3 (06:03):
Right and again.
When used alone, metforminalmost never causes hyposome
because, remember, it doesn'tforce your body to make extra
insulin.
Speaker 2 (06:11):
It just helps the insulin that's already there.
Speaker 3 (06:13):
Exactly.
The risk of lows only reallygoes up if you combine metformin
with other drugs that dostimulate insulin release, like
injected insulin or pills calledsulfonylureas.
Speaker 2 (06:23):
So on its own very low risk, Extremely low.
Speaker 3 (06:26):
So bottom line for most people the benefits
massively outweigh the risks,assuming it's prescribed
correctly and you get monitored.
Speaker 2 (06:32):
That's really clear.
Debunking those helps a lot,but let's reinforce the positive
side too.
You mentioned that big UKPDSstudy.
Can we dig into that evidence abit more?
Speaker 3 (06:41):
Definitely the UKPDS study.
Can we dig into that evidence abit more?
Definitely, the UKPDS wasgroundbreaking.
It followed over 5,000 peoplewith type 2 diabetes for more
than 10 years, a long time.
Speaker 2 (06:51):
And what were the key findings for metformin?
Speaker 3 (06:53):
For the overweight group taking metformin.
The results were reallystriking A 32% reduction in
diabetes-related deaths, a 36%drop in deaths from any cause
and a 39% reduction in heartattacks 39%, that's huge.
It is, and what's maybe evenmore amazing is the legacy
effect.
Speaker 2 (07:11):
Legacy effect.
What's that?
Speaker 3 (07:12):
It means these benefits the reduced risk of
death and heart attack actuallycontinued for years, even after
the official study ended.
It suggests metformin doessomething fundamentally
beneficial, not just a temporaryfix.
Speaker 2 (07:24):
Wow, that's powerful Lasting benefits.
Speaker 3 (07:27):
Absolutely, and other research supports this, showing
generally neutral to positiveeffects on overall heart health,
reducing heart disease andstroke risk.
And, like we touched on thepotential benefits, keep
expanding PCOS symptomimprovement, maybe supporting
healthy aging by tacklinginflammation and oxidative
stress.
The TAMI trial is specificallylooking into that aging aspect
(07:48):
plus that potential cancer riskreduction.
Speaker 2 (07:51):
It's an impressive list.
Now, you did mention sideeffects.
Even if serious ones are rare,let's be realistic about those.
What can people expect?
Can people expect?
Speaker 3 (07:58):
Good point.
No drug is perfect.
The most common side effectsare gastrointestinal things like
bloating, maybe some diarrhea,stomach discomfort.
Speaker 2 (08:07):
Are those usually permanent?
Speaker 3 (08:12):
Often not.
They tend to be mildest whenstarting the drug or increasing
the dose, and they frequentlyimprove or disappear within the
first few weeks as your bodyadjusts.
Starting with a low dose andtaking it with food helps too.
Speaker 2 (08:19):
OK, so usually manageable and temporary.
What else?
Speaker 3 (08:22):
Well, with long term use we're talking years there is
a possibility of vitamin B12deficiency.
It's not super common but itcan happen.
Ah so that's why doctors checkB12 levels Exactly.
Periodic B12 testing isrecommended, especially if
you've been on it a long time orhave symptoms like fatigue or
nerve issues.
It's easily treatable withsupplements if needed.
Speaker 2 (08:44):
And the scary one lactic acidosis.
You said very rare.
Speaker 3 (08:47):
Extremely rare the estimates are around three to 10
cases per 100,000 patient yearsand it almost always happens in
people who shouldn't have beenon metformin in the first place,
due to severe kidney disease,liver disease or other specific
critical conditions.
Speaker 2 (09:02):
OK, so incredibly rare, and mainly if other major
health issues are present.
This raises an importantquestion, though.
While it's safe and beneficialfor most, when might metformin
not be the right choice?
Are there definite no-goes?
Speaker 3 (09:17):
Yes, there are specific situations, what we
call absolute contraindications,where metformin is generally
avoided.
Top of the list is severelyimpaired kidney function, that
EGFR level below 30.
We talked about Critical kidneyfailure.
Right, because the drug canbuild up levels, like after a
(09:38):
recent major heart attack orduring a severe infection like
sepsis.
Severe liver disease is anotherone, because the liver helps
clear lactate and if it's notworking well, that adds to the
risk.
Speaker 2 (09:48):
And alcohol.
Speaker 3 (09:49):
Yes, acute binge drinking or chronic alcohol use
disorder.
Alcohol also affects lactatemetabolism and increases risk.
In all these cases, the body'sability to handle lactate might
be compromised, raising thatvery small risk of lactic
acidosis.
Speaker 2 (10:03):
Okay, so those are the main times to absolutely
avoid it.
What about situations where itcan be used but maybe needs
extra care?
Speaker 3 (10:10):
Right.
There are scenarios needingcareful monitoring, for instance
moderate kidney dysfunction andEGFR between 30 and 45.
Metformin might still be usable, but likely at a lower dose and
with more frequent kidneyfunction tests.
Speaker 2 (10:23):
So adjusting the dose and watching closely.
Speaker 3 (10:25):
Correct and, as we mentioned, yearly vitamin B12
checks, especially for long-termusers.
Also, sometimes it needs to bepaused temporarily before
certain medical procedures, likeimaging scans that use
intravenous contrast dye, as thedye can temporarily affect
kidney function.
Speaker 2 (10:41):
It really underscores why that regular lab work is so
crucial, doesn't it?
Speaker 3 (10:45):
Absolutely essential.
Your provider needs to keep aneye on your EGFR for kidney
function, check B12 periodicallyand maybe liver enzymes like
ALT and AST if there are otherconcerns and you know,
convenient options like at-homelab collection services can make
this monitoring much easier.
Getting those tests done helpsensure the treatment is still
safe and effective for you,allowing adjustments based on
(11:08):
real-time data.
Speaker 2 (11:09):
Makes sense Keep the data flowing to guide the
decisions.
So metformin is clearly apowerful tool, but I imagine it
doesn't work in a vacuum.
What helps it work best?
Lifestyle must play a roleright.
Speaker 3 (11:19):
Oh, absolutely.
Metformin works optimally whenit's part of a bigger picture.
It works best when combinedwith lifestyle changes that get
at the root cause of type 2diabetes, which is usually
insulin resistance.
For many people, the ultimategoal isn't just to manage blood
sugar with pills forever.
It's to improve theirunderlying metabolic health so
much that maybe just maybemedications become less
(11:41):
necessary or even optional.
Speaker 2 (11:44):
So what are those key lifestyle pieces?
Speaker 3 (11:46):
Well, diet is fundamental, shifting towards
low-glycemic, nutrient-densefoods Think Mediterranean style
or maybe lower carb or evenketogenic approaches, depending
on the individual.
Reducing processed foods andsugars is key.
Then there's movement.
Regular physical activity ishuge for improving insulin
sensitivity, both cardio and,importantly, resistance training
(12:07):
.
Building muscle helps your bodyhandle glucose better.
Even just walking after mealscan make a difference.
Speaker 2 (12:12):
Simple but effective.
Speaker 3 (12:13):
Very, and weight loss , especially losing fat around
the midsection, has a massiveimpact on improving glucose
control and reducinginflammation.
When you pair metformin withthese kinds of dedicated
lifestyle efforts, the drug canbe even more effective.
And yes, some people undertheir doctor's guidance, find
drug can be even more effective.
And, yes, some people undertheir doctor's guidance find
they can eventually reduce theirdose or potentially stop
metformin because their body ishandling glucose so much better
(12:36):
on its own.
Speaker 2 (12:37):
That's really empowering.
So how do you track thatprogress?
How do you know if thoselifestyle changes are working
well enough?
What data should you look at?
Speaker 3 (12:44):
Great question.
You need objective markers.
Your HbA1c gives you thelong-term blood sugar picture,
say over three months.
That's crucial.
But to really see insulinresistance you ideally want to
look at fasting insulin andfasting glucose together.
You can use those to calculatesomething called HAIR, which is
a really good score of howinsulin resistant you currently
(13:04):
are.
Watching that number go down isa great sign.
Speaker 2 (13:07):
Okay, hba1c fasting insulin.
Hma IR.
Speaker 3 (13:17):
What else?
A lipid panel is useful too.
Improving insulin resistanceoften leads to better
triglycerides and higher HDL thegood cholesterol.
So tracking those changes andmaybe checking inflammation
markers like C-reactive marotinor HSP.
Lowering inflammation goeshand-in-hand with better
metabolic health.
Speaker 2 (13:31):
So it's a whole panel of markers that tell the story.
Speaker 3 (13:33):
Exactly and again.
Being able to conveniently testthese markers, maybe even at
home, gives you and yourprovider the data you need.
It helps answer that questionIs metformin still doing the
heavy lifting or is yourimproved lifestyle taking over?
That data drives the decisionsabout medication needs.
Speaker 2 (13:52):
Okay, let's wrap this up.
We've covered a lot of groundin this deep dive on metformin.
The core message seems clear.
Metformin is one of the moststudied, most prescribed drugs
we have and, while nothing'sperfect, a lot of the fear out
there seems rooted in myths, notthe actual evidence.
It doesn't wreck healthykidneys.
Serious side effects are rare.
You don't get dependent on it.
Speaker 3 (14:10):
That's right.
And on the flip side, thebenefits are substantial
protecting your heart, helpingwith weight management, maybe
even contributing to a longer,healthier life Real advantages,
but it's not magic.
The best results always comefrom that combination Using the
medication smartly, alongsidereal commitment to lifestyle
changes, diet, exercise andkeeping track with regular lab
monitoring.
(14:31):
Metformin can be a fantastically on your health journey, but
it's often a bridge, not thefinal destination.
The real win is improving thatunderlying insulin sensitivity,
calming inflammation and trulyregaining control of your health
, whether that ultimatelyinvolves medication or not.
Speaker 2 (14:47):
So the final thought for you, the listener, is this
Don't let fear, based onmisinformation, guide your
health choices.
Dig into the facts.
Look at your own data.
Let evidence and personalinsights lead the way.
That's how you truly empoweryourself on your health journey.
Speaker 1 (15:02):
Thanks for tuning into the Health Pulse.
If you found this episodehelpful, don't forget to
subscribe and share it withsomeone who might benefit.
For more health insights anddiagnostics, visit us online at
wwwquicklabmobilecom.
Stay informed, stay healthy andwe'll catch you in the next
episode.
Welcome to the Health Pulse, your go-to source for
quick, actionable insights onhealth, wellness and diagnostics
.
Whether you're looking tooptimize your well-being or stay
informed about the latest inmedical testing, we've got you
covered.
Join us as we break down keyhealth topics in just minutes.
Let's dive in.
Speaker 2 (00:22):
Welcome to the Deep Dive.
Today we're looking atsomething pretty intriguing, a
medication used by millions, yetoften viewed with a lot of
suspicion.
We're talking about metformin.
It's prescribed to over 150million people worldwide for
type 2 diabetes.
All the big healthorganizations ADA, who they
recommend it as a first-linetreatment.
(00:42):
It's been around for decades,generally safe.
But here's the paradox Despiteall that, you hear patients
expressing real fear, worriesabout kidneys, side effects,
getting hooked on it.
It kind of reminds me of thatGrace Hopper quote the most
dangerous phrase is we've alwaysdone it this way.
These fears often come fromwell old information right
(01:03):
Misinformation.
So today we're going to unpackmetformin.
Really look at the evidence,separate the facts from the
myths.
Speaker 3 (01:08):
Exactly, and our goal here is simple to give you the
solid facts so you can makeinformed choices about your own
health, whether you're justdiagnosed or you've been
managing diabetes for a whileand, as we'll see, there's
actually more to metformin thanjust blood sugar.
Speaker 2 (01:25):
Think heart protection, maybe even healthy
aging.
Okay, let's unpack this then,before we get into the bigger
picture.
What exactly is metformin?
For anyone new to it, Sure.
Speaker 3 (01:31):
So it's in a class of drugs called big one-ides.
Basically, it works mostly inthe liver and gut.
It's not new either.
Introduced back in 1957 inFrance.
Speaker 2 (01:40):
Yeah, 57.
That's quite a history.
Speaker 3 (01:42):
Yeah, used widely in Europe for years before it got
FDA approval here in the US in1994.
Now it's the most prescribedoral diabetes med globally.
Speaker 2 (01:51):
So how does it work?
You said liver and gut.
Speaker 3 (01:53):
Right.
It does three main thingsreally elegantly.
First, it tells your liver toproduce less glucose.
That excess sugar production itdampens that Hepatic
gluconeogenesis is the term.
Second, it makes your musclesand fat tissue more sensitive to
insulin, so your cells getbetter at actually taking
glucose out of the blood.
Speaker 2 (02:12):
Okay, so it helps the insulin you already have work
better.
Speaker 3 (02:14):
Precisely.
And third, it kind of slowsdown how quickly you absorb
carbohydrates from your food inthe gut, leads to steadier blood
sugar.
And here's a key safety pointBecause it works with your
existing insulin, doesn't forceyour pancreas to pump out more.
It very rarely causes low bloodsugar hypoglycemia when you
(02:35):
take it by itself.
Speaker 2 (02:36):
That's a huge advantage, isn't it, compared to
some other meds.
Speaker 3 (02:39):
It really is a significant safety benefit.
Speaker 2 (02:41):
That's a really clever mechanism, just helping
the body do its job better.
But you mentioned otherbenefits beyond blood sugar.
This is where it gets reallyinteresting.
Speaker 3 (02:50):
Absolutely.
The research has uncoveredquite a bit more.
Cardiovascular protection is abig one.
Speaker 2 (02:54):
Like protecting the heart.
Speaker 3 (02:56):
Exactly the UK PDS trial, a huge long-term study,
found metformin reduced the riskof heart attacks and
diabetes-related deathssignificantly in overweight
patients.
Then there's weight.
Unlike some diabetes drugs thatcause weight gain, metformin is
usually weight neutral.
Some people even see modestweight loss.
Speaker 2 (03:15):
That's definitely a plus.
Speaker 3 (03:16):
For sure.
It's also used effectively forPCOS polycystic ovary syndrome
because it helps with theunderlying insulin resistance
and can help regulate cycles.
And maybe the most excitingarea is well anti-aging.
Research Studies like the TAMEtrial are looking at whether
metformin can extend health span.
You know, years lived withoutmajor chronic disease, delaying
(03:39):
age-related stuff.
Speaker 2 (03:40):
Wow, so okay blood sugar control, heart protection,
maybe weight loss, pcos,potentially even healthy aging.
It's easy to see why it's thego to the gold standard first
line treatment.
Speaker 3 (03:52):
It really is Proven track record.
It's affordable, low risk ofserious problems for most people
.
It ticks a lot of boxes.
Speaker 2 (03:58):
Which brings us back to the fears.
Speaker 3 (03:59):
Yeah.
Speaker 2 (04:00):
Given all this, why are people so hesitant sometimes
?
Let's tackle those mythsdirectly.
What's the evidence say?
Speaker 3 (04:05):
Let's do it.
Myth number one metformindamages the kidneys.
This is probably the mostcommon one.
Speaker 2 (04:10):
Right, I hear that all the time.
Speaker 3 (04:11):
The truth Metformin does not harm healthy kidneys.
It doesn't cause kidney damage.
Speaker 2 (04:16):
So where does the confusion come from?
Speaker 3 (04:17):
It's because the drug is cleared by the kidneys.
So if your kidney function isalready severely impaired like
really low and EGFR below 30,then the drug can build up and
in those rare cases it couldincrease the risk of a serious
condition called lactic acidosis.
But for people with normal orjust mildly reduced kidney
function it's safe.
We just monitor kidney functionregularly.
Speaker 2 (04:38):
Okay, that makes sense.
So it's not the cause.
It's about pre-existing severeissues.
Speaker 3 (04:42):
Exactly Now.
Myth two metformin causescancer.
Speaker 2 (04:47):
Is there any truth to that?
Speaker 3 (04:49):
No credible evidence at all.
In fact, some research suggestsit might actually lower the
risk for certain cancers likecolon, breast, pancreatic.
Speaker 2 (04:57):
What about that recall a few years ago with the
contamination?
Speaker 3 (05:00):
Ah, yes, that was 2019.
Some extended release batcheswere found to have NDMA
contamination.
That was a manufacturing issue,specific lots, not a problem
with metformin itself.
Those lots were recalled andstandards were tightened.
Speaker 2 (05:14):
Got it Manufacturing, not the drug, OK.
Next myth you get dependent onmetformin like you're addicted.
Speaker 3 (05:21):
Also not true.
Metformin isn't addictive.
There's no physical dependence.
Speaker 2 (05:25):
So why do people think that?
Maybe because if they stop,their sugar goes up.
Speaker 3 (05:30):
Precisely.
If you stop taking it, yourblood sugar might rise simply
because the underlying reasonyou needed it the insulin
resistance hasn't gone away.
Your body isn't craving thedrug hasn't gone away.
Your body isn't craving thedrug.
And, importantly, if you makesignificant lifestyle changes
weight loss, diet changes, moreactivity you can often improve
that insulin resistance so muchthat well, maybe you don't need
(05:51):
metformin anymore.
That's reversing the condition,not breaking dependence.
Speaker 2 (05:55):
That's a really key point.
It's about addressing the rootcause.
Yeah, okay, one more mythMetformin causes dangerous low
blood sugar hypoglycemia.
Speaker 3 (06:03):
Right and again.
When used alone, metforminalmost never causes hyposome
because, remember, it doesn'tforce your body to make extra
insulin.
Speaker 2 (06:11):
It just helps the insulin that's already there.
Speaker 3 (06:13):
Exactly.
The risk of lows only reallygoes up if you combine metformin
with other drugs that dostimulate insulin release, like
injected insulin or pills calledsulfonylureas.
Speaker 2 (06:23):
So on its own very low risk, Extremely low.
Speaker 3 (06:26):
So bottom line for most people the benefits
massively outweigh the risks,assuming it's prescribed
correctly and you get monitored.
Speaker 2 (06:32):
That's really clear.
Debunking those helps a lot,but let's reinforce the positive
side too.
You mentioned that big UKPDSstudy.
Can we dig into that evidence abit more?
Speaker 3 (06:41):
Definitely the UKPDS study.
Can we dig into that evidence abit more?
Definitely, the UKPDS wasgroundbreaking.
It followed over 5,000 peoplewith type 2 diabetes for more
than 10 years, a long time.
Speaker 2 (06:51):
And what were the key findings for metformin?
Speaker 3 (06:53):
For the overweight group taking metformin.
The results were reallystriking A 32% reduction in
diabetes-related deaths, a 36%drop in deaths from any cause
and a 39% reduction in heartattacks 39%, that's huge.
It is, and what's maybe evenmore amazing is the legacy
effect.
Speaker 2 (07:11):
Legacy effect.
What's that?
Speaker 3 (07:12):
It means these benefits the reduced risk of
death and heart attack actuallycontinued for years, even after
the official study ended.
It suggests metformin doessomething fundamentally
beneficial, not just a temporaryfix.
Speaker 2 (07:24):
Wow, that's powerful Lasting benefits.
Speaker 3 (07:27):
Absolutely, and other research supports this, showing
generally neutral to positiveeffects on overall heart health,
reducing heart disease andstroke risk.
And, like we touched on thepotential benefits, keep
expanding PCOS symptomimprovement, maybe supporting
healthy aging by tacklinginflammation and oxidative
stress.
The TAMI trial is specificallylooking into that aging aspect
(07:48):
plus that potential cancer riskreduction.
Speaker 2 (07:51):
It's an impressive list.
Now, you did mention sideeffects.
Even if serious ones are rare,let's be realistic about those.
What can people expect?
Can people expect?
Speaker 3 (07:58):
Good point.
No drug is perfect.
The most common side effectsare gastrointestinal things like
bloating, maybe some diarrhea,stomach discomfort.
Speaker 2 (08:07):
Are those usually permanent?
Speaker 3 (08:12):
Often not.
They tend to be mildest whenstarting the drug or increasing
the dose, and they frequentlyimprove or disappear within the
first few weeks as your bodyadjusts.
Starting with a low dose andtaking it with food helps too.
Speaker 2 (08:19):
OK, so usually manageable and temporary.
What else?
Speaker 3 (08:22):
Well, with long term use we're talking years there is
a possibility of vitamin B12deficiency.
It's not super common but itcan happen.
Ah so that's why doctors checkB12 levels Exactly.
Periodic B12 testing isrecommended, especially if
you've been on it a long time orhave symptoms like fatigue or
nerve issues.
It's easily treatable withsupplements if needed.
Speaker 2 (08:44):
And the scary one lactic acidosis.
You said very rare.
Speaker 3 (08:47):
Extremely rare the estimates are around three to 10
cases per 100,000 patient yearsand it almost always happens in
people who shouldn't have beenon metformin in the first place,
due to severe kidney disease,liver disease or other specific
critical conditions.
Speaker 2 (09:02):
OK, so incredibly rare, and mainly if other major
health issues are present.
This raises an importantquestion, though.
While it's safe and beneficialfor most, when might metformin
not be the right choice?
Are there definite no-goes?
Speaker 3 (09:17):
Yes, there are specific situations, what we
call absolute contraindications,where metformin is generally
avoided.
Top of the list is severelyimpaired kidney function, that
EGFR level below 30.
We talked about Critical kidneyfailure.
Right, because the drug canbuild up levels, like after a
(09:38):
recent major heart attack orduring a severe infection like
sepsis.
Severe liver disease is anotherone, because the liver helps
clear lactate and if it's notworking well, that adds to the
risk.
Speaker 2 (09:48):
And alcohol.
Speaker 3 (09:49):
Yes, acute binge drinking or chronic alcohol use
disorder.
Alcohol also affects lactatemetabolism and increases risk.
In all these cases, the body'sability to handle lactate might
be compromised, raising thatvery small risk of lactic
acidosis.
Speaker 2 (10:03):
Okay, so those are the main times to absolutely
avoid it.
What about situations where itcan be used but maybe needs
extra care?
Speaker 3 (10:10):
Right.
There are scenarios needingcareful monitoring, for instance
moderate kidney dysfunction andEGFR between 30 and 45.
Metformin might still be usable, but likely at a lower dose and
with more frequent kidneyfunction tests.
Speaker 2 (10:23):
So adjusting the dose and watching closely.
Speaker 3 (10:25):
Correct and, as we mentioned, yearly vitamin B12
checks, especially for long-termusers.
Also, sometimes it needs to bepaused temporarily before
certain medical procedures, likeimaging scans that use
intravenous contrast dye, as thedye can temporarily affect
kidney function.
Speaker 2 (10:41):
It really underscores why that regular lab work is so
crucial, doesn't it?
Speaker 3 (10:45):
Absolutely essential.
Your provider needs to keep aneye on your EGFR for kidney
function, check B12 periodicallyand maybe liver enzymes like
ALT and AST if there are otherconcerns and you know,
convenient options like at-homelab collection services can make
this monitoring much easier.
Getting those tests done helpsensure the treatment is still
safe and effective for you,allowing adjustments based on
(11:08):
real-time data.
Speaker 2 (11:09):
Makes sense Keep the data flowing to guide the
decisions.
So metformin is clearly apowerful tool, but I imagine it
doesn't work in a vacuum.
What helps it work best?
Lifestyle must play a roleright.
Speaker 3 (11:19):
Oh, absolutely.
Metformin works optimally whenit's part of a bigger picture.
It works best when combinedwith lifestyle changes that get
at the root cause of type 2diabetes, which is usually
insulin resistance.
For many people, the ultimategoal isn't just to manage blood
sugar with pills forever.
It's to improve theirunderlying metabolic health so
much that maybe just maybemedications become less
(11:41):
necessary or even optional.
Speaker 2 (11:44):
So what are those key lifestyle pieces?
Speaker 3 (11:46):
Well, diet is fundamental, shifting towards
low-glycemic, nutrient-densefoods Think Mediterranean style
or maybe lower carb or evenketogenic approaches, depending
on the individual.
Reducing processed foods andsugars is key.
Then there's movement.
Regular physical activity ishuge for improving insulin
sensitivity, both cardio and,importantly, resistance training
(12:07):
.
Building muscle helps your bodyhandle glucose better.
Even just walking after mealscan make a difference.
Speaker 2 (12:12):
Simple but effective.
Speaker 3 (12:13):
Very, and weight loss , especially losing fat around
the midsection, has a massiveimpact on improving glucose
control and reducinginflammation.
When you pair metformin withthese kinds of dedicated
lifestyle efforts, the drug canbe even more effective.
And yes, some people undertheir doctor's guidance, find
drug can be even more effective.
And, yes, some people undertheir doctor's guidance find
they can eventually reduce theirdose or potentially stop
metformin because their body ishandling glucose so much better
(12:36):
on its own.
Speaker 2 (12:37):
That's really empowering.
So how do you track thatprogress?
How do you know if thoselifestyle changes are working
well enough?
What data should you look at?
Speaker 3 (12:44):
Great question.
You need objective markers.
Your HbA1c gives you thelong-term blood sugar picture,
say over three months.
That's crucial.
But to really see insulinresistance you ideally want to
look at fasting insulin andfasting glucose together.
You can use those to calculatesomething called HAIR, which is
a really good score of howinsulin resistant you currently
(13:04):
are.
Watching that number go down isa great sign.
Speaker 2 (13:07):
Okay, hba1c fasting insulin.
Hma IR.
Speaker 3 (13:17):
What else?
A lipid panel is useful too.
Improving insulin resistanceoften leads to better
triglycerides and higher HDL thegood cholesterol.
So tracking those changes andmaybe checking inflammation
markers like C-reactive marotinor HSP.
Lowering inflammation goeshand-in-hand with better
metabolic health.
Speaker 2 (13:31):
So it's a whole panel of markers that tell the story.
Speaker 3 (13:33):
Exactly and again.
Being able to conveniently testthese markers, maybe even at
home, gives you and yourprovider the data you need.
It helps answer that questionIs metformin still doing the
heavy lifting or is yourimproved lifestyle taking over?
That data drives the decisionsabout medication needs.
Speaker 2 (13:52):
Okay, let's wrap this up.
We've covered a lot of groundin this deep dive on metformin.
The core message seems clear.
Metformin is one of the moststudied, most prescribed drugs
we have and, while nothing'sperfect, a lot of the fear out
there seems rooted in myths, notthe actual evidence.
It doesn't wreck healthykidneys.
Serious side effects are rare.
You don't get dependent on it.
Speaker 3 (14:10):
That's right.
And on the flip side, thebenefits are substantial
protecting your heart, helpingwith weight management, maybe
even contributing to a longer,healthier life Real advantages,
but it's not magic.
The best results always comefrom that combination Using the
medication smartly, alongsidereal commitment to lifestyle
changes, diet, exercise andkeeping track with regular lab
monitoring.
(14:31):
Metformin can be a fantastically on your health journey, but
it's often a bridge, not thefinal destination.
The real win is improving thatunderlying insulin sensitivity,
calming inflammation and trulyregaining control of your health
, whether that ultimatelyinvolves medication or not.
Speaker 2 (14:47):
So the final thought for you, the listener, is this
Don't let fear, based onmisinformation, guide your
health choices.
Dig into the facts.
Look at your own data.
Let evidence and personalinsights lead the way.
That's how you truly empoweryourself on your health journey.
Speaker 1 (15:02):
Thanks for tuning into the Health Pulse.
If you found this episodehelpful, don't forget to
subscribe and share it withsomeone who might benefit.
For more health insights anddiagnostics, visit us online at
wwwquicklabmobilecom.
Stay informed, stay healthy andwe'll catch you in the next
episode.
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