Metformin is an oral medication used for the treatment of type 2 diabetes in addition to diet and exercise. Metformin, also sometimes referred to by its trade name, Glucophage, is the only medication available in the United States in the class of medications called biguanides. Metformin acts at several different locations in the body, but its most important actions occur in the liver by decreasing the amount of sugar produced while you are fasting. Given that metformin is considered by most experts to be the first-line medication for type 2 diabetes, the majority of the evidence on its weight effects is in people with diabetes. Researchers noted initially that in patients treated with metformin, as compared to other more traditional diabetes medications, blood sugars were reduced without weight gain. Additionally, some early studies showed that metformin was associated with weight loss in those with type 2 diabetes.
How does metformin help you lose weight? Is metformin an appetite suppressant?
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Exactly how metformin assists with weight loss is still unknown. One major hypothesis is that metformin keeps insulin levels lower by improving insulin resistance in a part of the cell called the mitochondria. Mitochondria are responsible for generating energy in a chemical form that helps fuel all the reactions that occur inside the cell. Being that insulin is a storage hormone that causes sugar and fat to be stored for use later, keeping insulin levels lower might lead to less weight gain. Because of metformin’s effect on lowering circulating insulin levels, many physicians use metformin as a part of a weight-loss protocol that includes a low-calorie and carbohydrate-limited diet. There is also some information available suggesting metformin will decrease food intake in patients with diabetes. Decreasing the amount of food consumed leads to calorie restriction and subsequent loss of body weight.
Can metformin be used for weight loss in non-diabetics (people without diabetes)?
People without diabetes may also benefit from metformin’s effect on weight. In fact, in a series of female patients without diabetes, Dr. Harriette Mogul published findings where female patients on metformin in addition to a low glycemic diet lost more weight than those on the carbohydrate modified diet alone. We should be clear that metformin does not have an FDA indication for weight loss. Meaning, its use is considered to be off label because studies in non-diabetic patients do not confirm metformin’s weight loss effect. This general consensus is that metformin must be used in addition to dieting to have its best weight-related effect.
Average weight loss result on metformin
While some studies refute the idea that metformin causes weight loss in a real clinical setting, overweight or obese individuals without diabetes have been shown to lose over ten pounds while taking metformin. One correlation that seems certain is that those patients with insulin resistance seem to respond the most dramatically to metformin.
Metformin HCl vs. ER. Can metformin ER help you lose weight?
Standard metformin comes in a preparation called Metformin HCl. Metformin HCl is metformin hydrochloride. Metformin HCl is the most common way this medication is prescribed, and it should be taken twice per day. Metformin is also available in an extended-release formulation often abbreviated on prescriptions as Metformin HCL ER. In certain patients, like those with gastrointestinal side effects or those having difficulty taking metformin more than once per day, extended-release metformin might give some benefit as it can be taken only once per day. The most commonly reported side effect of metformin is gastrointestinal, of which diarrhea is the most often reported. Metformin HCl ER causes slightly less diarrhea than the traditional HCl preparation. There is no study comparing metformin HCl vs. extended-release metformin to evaluate for weight differences. However, once per day medications are generally thought of as more easily followed and adhered to.
So, does metformin work for weight loss or not?
Studies are conflicting, but chances are if you have some element of insulin resistance, metformin will help you lose weight if it is taken in addition to a carbohydrate-restricted diet. Being that metformin is considered off-label for weight loss, you will need to consult with a health care provider first. Certain conditions, like weakened heart, kidney, or liver function prohibit the use of metformin even in those with full-fledged diabetes.
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