Is there any sense in the recommendations of biohackers to drink metformin, does this drug prevent obesity-related heart diseases, can you not get better from antidepressants and what will happen if you take the medicine from the lists of the World Health Organization for other purposes, read in the section “How we are treated” on Indicator.Ru.

Thinking of losing weight by the summer, many are disappointed in the effectiveness of diets (after which you want to eat again) and sports (which also do not reduce appetite). Rejecting, often through trial and error, dozens of dubious dietary supplements, you can go to the “heavy artillery” – real medicine. On forums for those who are losing weight, Glyukofage will be an almost obligatory participant in all the top 10/20 along with Reduxin – and he can get there two or three times under different names buy metformin online. Let’s see if he deserves such an honor.

From what, from what

Siofor, Glucofage, Mohammed, Glycon, Glyformin, Metformin, Pramlintil – all of these drugs have one thing in common: the active substance metformin from the biguanide group. It was created to treat diabetes in people with normally functioning kidneys, but supporters of biohacking, headed by Sergey Fage (which we examined in a separate article), urge healthy people to drink it to reduce blood sugar.

The blood glucose level must always be in balance: a high sugar level is typical for type 2 diabetes, in which the cells become resistant to insulin and do not want to store glucose in the form of glycogen (more about the mechanism and the connection of diabetes with cancer and sweetness for us told in an interview with Lewis Cantley). In such patients, glucose production from non-carbohydrate compounds (scientifically called gluconeogenesis) is tripled – and metformin, as the authors of the article in the journal Diabetes indicate, helps to reduce it by about a third. Most likely, the drug makes the cells more sensitive to insulin, which commands them to store glucose, removing it from the blood and sending it to the “warehouse” in the form of glycogen. At the same time, it is possible that the medicine also fights with another way of filling the blood with glucose, interfering with the work of the hormone glucagon, which releases glucose, which is already stored in the liver.

But what exactly Metformin is associated with in order to influence these processes is not yet fully understood. The experiments are conducted both in vitro and in mice, but the question is still open. Be that as it may, metformin in the body binds little to blood plasma proteins and immediately rushes into the cells, where it strikes targets not yet known to us, it is not processed in the body, and 24 hours after administration it already leaves the body and is not detected in blood plasma (For more information on pharmacokinetics, see Diabetes & Metabolism). But it’s more important for us that the drug works. Does metformin help for its intended purpose? And people without diabetes, but overweight?

A hundred-year-long path from diabetes to obesity

Metformin, discovered in 1922 and later proposed to pharmacologists as a replacement for effective, but sometimes deadly “relatives,” phenformin and buformin, went to patients for a long time. Trials on people began in the fifties, and it went on sale in the United States only in 1995. But the drug received its share of fame in full. In the 80s and 90s, doctors conducted a study on the effectiveness of the drug in seven hundred patients from dozens of medical centers and found that metformin reduces the risk of heart attacks and death from diabetes-related cardiovascular diseases better than insulin and sulfonylurea-based drugs . However, he was less likely to threaten hypoglycemia (a sharp and dangerous decrease in blood sugar). Results triumphantly published in The Lancet. More recent studies have shaken confidence in metformin as a medicine for the prevention of heart disease, and in modern European and American guidelines, that is, for doctors (for example, 1 and 2), evidence of this property of the drug remains in doubt.

But no one has denied that he lowers blood sugar over the years, so now they continue to prescribe metformin to patients with diabetes. In the US, the drug is confidently in the top five most prescribed drugs. No wonder: it became the “first line” of treatment, that is, the first prescribed drug in this condition. Now he was on the list of essential drugs according to the World Health Organization. There is speculation that metformin has become the most prescribed diabetes drug in the world.

So metformin has become one of the most popular drugs for combating diabetes, and patients with type 2 diabetes, as you know, often suffer from obesity. When testing a new drug, scientists noticed that patients were less hungry and sometimes lost weight. This sparked the interest of the medical community with renewed vigor. Whether the well-known and registered drug for obesity, which threatens health, will help? Maybe it will become a hope for those who were not saved by bariatric surgery (operations to change the volume of the stomach), diets and sports? But what if metformin turns out to be a magic pill that helps to lose weight effortlessly (and promises huge amounts to manufacturers)? Inspired by a tempting prospect, scientists around the world have begun the clinical trials that we are now discussing.

A double-blind, randomized, placebo-controlled method is a method of clinical drug research in which subjects are not dedicated to important details of the study. “Double blind” means that neither subjects nor experimenters know who is being treated with what, “randomized” means that the distribution into groups is random, and placebo is used to show that the effect of the drug is not based on auto-suggestion and that This medicine helps better than a tablet without an active substance. This method prevents subjective distortion of the results. Sometimes the control group is given another drug with already proven efficacy, rather than a placebo, to show that the drug not only treats better than nothing, but also surpasses analogues.

Listed (not) listed

In a study (2017 article), on 100 women aged 35–65 years with diabetes and overweight who received 850 milligrams of metformin twice a day, they managed to lower the average body mass index of patients in the metformin group by 26 for 26 weeks. Blood sugar, waist circumference and women’s insulin resistance also decreased.

Over a longer period of 12 months, a similar group of women in another study (an article in Endocrine Practice) lost about 10% of their body weight (8–9 kg), however, the drug did not work alone, but with a low-carb diet. A number of clinical trials (for example, 1, 2) show that metformin helps not to gain body weight when taking antipsychotic drugs that have such a side effect, and sometimes reduce it. At the same time, lifestyle changes (diet and exercise) and metformin turned out to be effective separately, but together their effect intensified.

In a Chinese study (an article was published in 2012), which involved 360 patients with obesity and hypertension, but without diabetes, the blood sugar level from the drug in patients did not decrease, nor did the pressure drop. However, participants had lowered cholesterol and decreased body fat – both subcutaneous and around internal organs, which was evaluated using computed tomography. The decrease in body weight, which the researchers called significant, is not impressive: patients lost 0.7 kg in 24 weeks. Although, perhaps, the matter is in the dosage: patients received only 500 mg of metformin per day.

Several articles (1, 2) and even the Cochrane review confirm the small effect of metformin against obesity in children and adolescents.

The Cochrane Library is the database of the international non-profit organization Cochrane Collaboration, which is involved in the development of guidelines for the World Health Organization. The name of the organization comes from the name of its founder, the 20th century Scottish medical scientist Archibald Cochrane, who defended the need for evidence-based medicine and competent clinical trials and wrote the book “Efficiency and Effectiveness: Random Thoughts on Health Care”. Medical scientists and pharmacists consider the Cochrane database one of the most authoritative sources of such information: the publications included in it have been selected according to the standards of evidence-based medicine and talk about the results of randomized, double-blind, placebo-controlled clinical trials.

A review summarizes these effects in the International Journal of Obesity: the effects of metformin on body weight vary widely across populations, and more research is needed to evaluate them. To lose weight, metformin can help both healthy and diabetes patients, but it is unlikely to prevent cardiovascular diseases. Everything becomes complicated if you remember that diabetes of the second type in itself can cause a sharp decrease in body weight, and it is difficult to keep track of where to “thank” the disease and where is the medicine.

Indicator recommends: consider whether you need a drug

We have relatively good news for you. Although Glucophage is not approved for use as a remedy for obesity, it is likely that it will help to lose weight – both with diabetes and without it. In addition, he does not allow to gain weight during treatment with drugs in which this can be a side effect. The effects of metformin vary in different populations. In short, it can help healthy people lose weight (but this is not accurate) or prevent diabetes (which is more likely), and at least it will not allow patients with diabetes to recover, unlike many other diabetes drugs. However, losing weight quickly and strongly with it will not work: a few kilograms in four to six months will not impress anyone. So the authors of clinical trials recommend reinforcing the action of metformin with lifestyle changes: diet and the addition of physical activity. But is metformin needed if you almost certainly lose weight without it, changing your lifestyle? Another point: the purity of the experiment when combining metformin with diet and exercise is doubtful. You can make a dummy pill instead of metformin for the control group. But how to replace diet and physical activity?

The medicine is contraindicated for people with severe kidney diseases and is dangerous for people with heart failure, alcoholism or respiratory system diseases, since they have an increased risk of lactic acidosis – complications due to the accumulation of lactic acid in the muscles, which threatens coma. Moreover, for healthy patients, he, in contrast to the biguanides already withdrawn from the market, does not pose such a danger. In addition, metformin more often than most diabetes medications (as shown by many studies, for example, 1) causes gastrointestinal disorders with a set of unpleasant symptoms – diarrhea, vomiting and nausea. Long-term use of the drug prevents the absorption of vitamin B12 (for more details, see the article). Is it worth the desired goal (and even without a guarantee) of such victims or is it better to lose weight in the old fashion – you decide.

In conclusion, we can not do without a digression. We remind you that fats turned out to be less evil than “fast” carbohydrates, since the notorious cholesterol (excess of which in the blood is more a symptom of atherosclerosis than a cause) will be produced in the body itself, even if there is none at all. If a diet with a reduced sugar content and a reduced number of calories, as well as a change in lifestyle to a more active and active, do not help you, this is an occasion to think. Perhaps you have a hormonal background disorder, which may be a sign of various metabolic disorders, and here you need to look for and eliminate the cause, rather than mask the consequences. Another thing is if you decide, for example, to go in for sports, but you want to eat a lot more from this and you get all the calories you have consumed back. Metformin helps reduce appetite so that it can be a solution to the problem.

In any case, if you are determined to reduce body weight, remember that your goal should not be treasured indices or a beautiful number on the scales, but better health, well-being and physical fitness. Is it worth recalling that people with the same body mass index can look completely different? You can weigh 80 kilograms with a height of 180, and with a height of 150, while having a body that has spread out from hypodynamia and is pulled up in a sporty way. Obviously, these people will have different health indicators. Even striving for the desired body mass index, where growth is taken into account, do not forget about the constitution (not the Russian Federation, but about the physique), especially if you are losing weight for purely aesthetic reasons.

On the issue of body weight acceptable for health and personally for your satisfaction, everything is very individual, and it’s important to stop in time on the path to imaginary perfection so that you don’t lose this health – along with hair, nails, good skin and a desire to live. If you allow Instagram photos and the “40 kg” public stars to constantly disgust themselves in the mirror, but your body is within the medical norm, then you need to ask for help not from a nutritionist, but from a psychotherapist: eating disorders aren’t anyone brought to good. In the end, the hated number of kilograms is not written on your forehead, and the exhaustion from eating one buckwheat and anger all over the world from constant restrictions are quite noticeable to the naked eye.