As unfortunate as it may sound, the fanaticism over weight loss is still ‘trending’ in today's world!
A while back, the telehealth company Hims & Hers made waves for its Super Bowl ad that plugged its lower-priced form of injectable semaglutide, which is the active ingredient in weight loss juggernauts Wegovy and Ozempic. However, some people who filled out the company's screening questionnaire report being prescribed a different medication instead: metformin.
Reportedly, metformin is a much more affordable medication than GLP-1s, even the cheaper, compounded, or non-FDA regulated versions offered by Hims & Hers.
What is metformin?
Metformin, sold under the brand name Glucophage, among others, is the main first-line medication for the treatment of type 2 diabetes, particularly in people who are overweight.
Metformin is an old drug. In its earliest form, it was an extract from lilacs and was purportedly used in the 1700s to treat what the French called “sweet urine disease,” which we now know as diabetes. A more modern form was introduced in the 1950s in Europe, and the main active ingredient is still derived from French lilacs.
How does metformin work?
Metformin primarily works by combatting insulin insensitivity, the main precursor of type 2 diabetes, and reducing the amount of glucose produced by the liver, thereby lowering blood sugar levels, by inhibiting a process called gluconeogenesis, and by improving the body's sensitivity to insulin, allowing cells to better absorb glucose from the bloodstream; it achieves this mainly by activating an enzyme called AMPK within the cells, which regulates metabolism.
Metformin combats insulin insensitivity, the main precursor of type 2 diabetes, and reduces the amount of glucose that the liver produces. These two functions can help slow the progression of type 2 diabetes and may even help to prevent it in those at risk for developing the condition.
Key points:
Liver impact: Metformin's primary site of action is the liver, where it decreases the production of glucose by inhibiting gluconeogenesis, a process that creates glucose from non-carbohydrate sources.
AMPK activation: Metformin activates an enzyme called AMP-activated protein kinase (AMPK), which acts as a cellular energy sensor, leading to reduced glucose production and increased insulin sensitivity.
Gut involvement: Recent research suggests that metformin may also influence the gut microbiome, potentially contributing to its blood sugar lowering effects by altering how glucose is absorbed in the intestines.
Who is it for?
Metformin is a medicine used to treat type 2 diabetes and gestational diabetes. It's also used to help prevent type 2 diabetes if you're at high risk of developing it. Type 2 diabetes is a condition where the body does not make enough insulin, or the insulin that it makes does not work properly.
The Food and Drug Administration approved metformin for treating people with type 2 diabetes in 1994. It’s also frequently prescribed for those under age 60 with prediabetes.
However, research suggests that it can help a wide variety of health conditions. People with type 2 diabetes taking metformin face lower risks of death from heart disease. The drug helps to treat gestational diabetes and polycystic ovarian syndrome, both of which cause high blood sugar and insulin resistance in women. Studies also suggest it may even lower the risk of cancer, dementia, and stroke and also slow aging, leading some physicians to ask whether metformin, like aspirin, is a veritable wonder drug.
Metformin is also sometimes prescribed to help prevent excess weight gain for people taking antipsychotic medications, for which weight gain is a common side effect.
Is metformin a good weight loss drug?
The FDA has not approved metformin as a stand-alone weight loss drug. However, people using metformin for its FDA-approved use may lose weight as a side effect. The exact mechanism of why weight loss may occur is unclear. Unlike other diabetes medications, metformin does not cause weight gain.
Dr. Arti Thangudu, an endocrinologist and founder of Complete Medicine, told Yahoo Life, “Most of the data we see finds metformin to be fairly weight-neutral.”
Studies show that people on metformin tend to have “modest” weight loss of about 2% to 3% of their body weight. While it’s known that excess body weight, high blood sugar, and insulin resistance often go together, scientists only recently began to learn how metformin may aid weight loss. It’s still not entirely clear, but the drug appears to mimic the hunger-fighting effects of vigorous exercise, according to a study published last year.
That said, experts don’t consider metformin a substitute for medications like Wegovy, which are FDA-approved for weight loss. As per Thangudu, “Sometimes people do lose weight on [metformin], and most people don’t gain weight on it, but we don’t typically use it as a weight loss medication because there just isn’t great data on it.”
Does metformin have side effects?
Metformin has relatively mild side effects. At higher doses, in particular, it can cause an upset stomach, nausea, and diarrhea. However, most people tolerate it well, especially by going to a lower dose and building back up. According to the Mayo Clinic, it shouldn’t be taken by those with liver or kidney disease, heart failure, or type 1 diabetes.
However, taking metformin can cause vitamin B12 deficiency if you take it for a long time. This can make you feel very tired, breathless, and faint, so your doctor may check the vitamin B12 level in your blood. If your vitamin B12 levels become too low, vitamin B12 supplements might be of help.
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