Metformin - The Case of Exaggerating Both Benefits and Harms 196,787 views Jul 14, 2015

Metformin - The Case of Exaggerating Both Benefits and Harms 196,787 viewsJul 14, 2015 1.7K DISLIKE SHARE DOWNLOAD CLIP SAVE James McCormack 5.21K subscribers This is a talk I gave May 24th 2015 at the BCCFP Family Medicine Conference. I discuss all the evidence I could find around the benefits and harms of metformin. Metformin is considered the gold standard medication for type 2 diabetes and for many years I said as much. However if one looks in detail at the evidence one quickly finds that while it does lower glucose, the evidence that it reduces the risk for cardiovascular disease and other outcomes is pretty minimal at best. Fortunately the risk that it causes serious side effects like lactic acidosis is also probably close to, if not zero, if not taken in overdose. If you think I have misrepresented the best available evidence or if I missed evidence please let me know. I have no personal issues with metformin or even other treatments for type 2 diabetes, I just want people to be aware of the best available evidence when they make decisions. 310 Comments rongmaw lin Add a comment... M. Sue Gettman M. Sue Gettman 2 years ago I took Metformin for 14 years. The effects at the beginning were very good but as time went on it did not work as well. What worked for me was fasting 36 hours 3 times a week and eat the ketogenic way when I ate. Reversed Type 2 in 3 months. Off of Metformin within one month and off blood pressure meds also. Here it is 6 months later blood sugar is STILL under control and blood pressure is excellent. I maintain by eating low carb, exercising, weight training and fasting dinner to dinner or OMAD (one meal a day) a couple times a week. I eat no processed food, no sugar, no grains. I do eat all kinds of meat, tons of salad with hot bacon grease dressing (love it) and vegetables. I love meat so much I could be a carnivore, I love vegetables so much I could be a vegetarian so....I HAVE THE BEST OF BOTH WORLDS! 136 Candy White Candy White 3 years ago I have PCOs so I was put on this medication about twenty years ago and I started having periods, the cysts went away and i lost a huge bunch of weight!! For me this has been a great medication. I love my metformin. In the beginning, it gave me nausea and diarrhea but once I got over those side effect my health improved so much. I hope OB gyn Doctor’s are prescribing this to their patients. 14 jimcampbell47 jimcampbell47 2 years ago My Dr. kept increasing my Metformin dosage until I was taking 2000 mg a day and 10mg. of glypicde. It was discovered that I had a heart murmur I've always had a strong heart. I was referred to a heart surgeon. He said that without having a heart valve replacement I would live a year and a half. I had the procedure last week and now feeling much better. I went off Metformin and am now taking Berberine. I'm trying to find an attorney to sue Merck. 12 Mark McConnell Mark McConnell 6 years ago Wonderfully clear and stated with great humility and appreciation for "the unknown". I wonder about a meta-analysis of metformin when there is, as you say, only one RCT of metformin (UKPDS 34). Is the meta-analysis better than the one trial on which it is based? That asked, you remind me of Huxley who said we must "sit down before a "fact" as a little child". Encouraging us to be very careful not to be entrenched in dogmatism. 8 The Center for Unhindered Living The Center for Unhindered Living 1 year ago It’s all well and good to say the risk is so small that it’s insignificant, unless you are one of the ones effected. I had stage three chronic kidney disease and was never told about the possibility of side effects of metformin. Consequently I ended up with pancreatitis, sepsis and kidney failure and nearly died. I had no risk factors for pancreatitis other than metformin use. cloudthunder1 cloudthunder1 4 years ago (edited) I would love the link to the ten year study in the UK. HOW many people did the study start with and who was kicked off of the study? I'll google the study. My mom has developed Pulmanary Fibrosis since given Metformin. After two years on Metformin, her Dr. suggested vit. B12 supplimentation. Way late in my opinion. 'I just know ' that metformin has been bad for my 86 year old mother. 8 Hevo Foro Hevo Foro 2 years ago Excellent discussion. I would be interested in your analysis of statins as I believe they are vastly over prescribed and thus not helpful to many and harmful to some, many? Who knows? Too, there are striking flaws in the hypothesis that underlies the very use of statins. 10 Patrick Foley Patrick Foley 2 years ago I found I exercised less on metformin because I was worried about shitting my pants at an inopportune moment. 17 Marira Marira 4 years ago How fascinating - I often wonder why my liver adjust my blood sugar up overnight, or if I am ill - bodies are so well designed that it seems to me that we may need that glucose to fight infection - as in "starve a fever, feed a cold" yes I would be so glad if there could be a study of risks associated with glucose, and levels occurring at different ages and groups. Thank you Kentucky Ranger Kentucky Ranger 5 years ago After 3 years of taking Janumet, 2 heart attacks and suffering horrible diarrhea, and neuropathy in the hands and feet, I stopped. One week later, the diarrhea and neuropathy are receding. Oh yea, and I don't poop the bed anymore... 31 Bobby Ocampo Bobby Ocampo 3 months ago (edited) When my HBA1C is 10.2, I stopped all meds, started low carb diet (keto) and reduced HBA1C to 6.1% in 6 months almost without exercise. My next test will be this March now with 1 hour exercise everyday still low carb diet. 1 James McCormack James McCormack 2 years ago Boy - given this video was posted over 4 years ago it is odd that I'm all of a sudden getting all these "interesting" comments. All I tried to do was to present the best available evidence, at the time, around metformin use and some of the general issues around the evidence for other diabetes treatments and diabetes guidelines. Can't really respond to these comments because none of the commenters have said specifically what (and why with opposing evidence) I presented is wrong or misleading. Happy to comment on evidence discussions if any commenters wish to be specific and clear (with evidence) about their concerns with my talk - other than it's too fast etc - because that's just me😀. Also if you think I'm part of white coat, drug company, drug cartel - you haven't looked at what I have done over my 30 year academic career. 14 Muralikrishnan Iyer Muralikrishnan Iyer 2 years ago (edited) 7 years ago in Toronto, when I was.just.getting diabetic, doctor prescribed Metformin & just taking 1/2 tablet, went to Mall And had LOW SUGAR & COLLAPSED. I DISCONTINUED, BUT WHY THIS HAPPENED, WHY I WAS unable to process this dose when the doctor said he prescribes to even pregnant women. I stuffed my mouth with a sweet puff bought just then and became alright 2 James McCormack James McCormack 4 years ago The decision to take or stop any medication should be a shared one between you and your health care providers. This video was just meant to lay out the evidence about the benefits and harms of metformin. Evidence should inform all healthcare decisions. 4 Ryan Smith Ryan Smith 2 years ago Diabetes medicine ruined my life. Now I can't stay awake, or eat. Don't take the poison. Eat better and move your butt. 22 Ben Nguyen Ben Nguyen 2 years ago (edited) Isn't A1c considered to be extremely unreliable, due to the differences in RBC turnover? Irl Hirsch has a good video on the subject! Would have liked to have heard more about the metformin's mechanism of action.. which seems to be the suppression of hepatic glucose output (HGO)? Also, It will be 5 years since this talk was given, any update as to either the benefits of taking Metformin (1g/day) or potential risks found? What about SGLT2 inhibitors or allopurinol? The latter is also said to help with high blood pressure to bric uric acid down to below 5mg/dL. PAULA O PAULA O 1 year ago Far as I know. Metformin, will store sugar in the liver and time release it into the blood stream, when needed. So not a lot of sugar is being released at one time. 1 MIKE CEBU MIKE CEBU 2 years ago 68 yo,5 years on metformin 500mg bid, resveratrol 440mg 2x a day, melatonin 3mg before sleep, a multivit, vit e, a prostrate vitamin, niacinamide, a veggie pill with broccoli, and blood sugar normal it got even better as did most labs but only triglycerides remain high, but added olive oil daily to see if helps ...no difference in feelings but dreams began possible again on the melatonin.We shall see. I have no disorder at all and have a 4 year old daughter hehee. 2 Mary VDW Mary VDW 2 years ago Thank you so much for this information!! 1 Lorraine Green Lorraine Green 1 year ago (edited) I took Metformin for years..then I was having problems after a procedure and my Lactic Acid was at a critical level..from Metformin. I have been off of it now for about 3 weeks..never taking it again. Had to be admitted to the hospital for 4 days and I also have kidney disease..my BUN and Creatinine were off the chart too. Patrick Foley Patrick Foley 2 years ago My doctor put me on 2000 mg metformin to start with.I always found the dose to be impractical. I have to eat four meals a day to take the meds.I much prefer fasting. I eat 1 or 2 meals a day and tend to tolerate maximum 1000mg per day.P.S. I've never had an abnormal blood sugar reading in my life whether on metformin or off of it So what gives? Em H Em H 2 years ago Walking just 10 minutes after a meal , works better than Metformin. 15 bbaker904 Baker bbaker904 Baker 1 year ago weather you like metformin or not a new use for it is showing promise. This happened to me. I was diagnosed with Acute Myeloid Leukemia. History I had ulcerative colitis for 15 years and had a proctocoloectomy. The steroids I took for the UC caused my blood sugar to go high. I was put on metformin to lower my blood sugar as I weaned off steroids. When my AML hit I had been off metformin for 4 months with a normal AIC and I lost 75 pounds. I had one of the worst types of AML according to my doctor. My main mutation in my stem cells was trisomy 8 with EGR1 and 2Q deletion.I was given weeks to live. My first chemo was Vyxeos for a 3-5 treatment. After 21 days the next biopsy showed little change in my AML. The chemo caused my blood sugar to spike and I averaged 350 to 450 every day. They were going to give me insulin but I refused. My type of diabetes is from pancreatic damage from a benign tumor removal. Pancreatogenic type 3c is what I have and I can go hypoglycemic fast if given insulin. I got my Endo involved and she put me back on metformin at 500mg twice daily. At the same time they started my next 7 day chemo of Vidaza and venetoclax. Within weeks color returned to my skin and the talk of me dying went away. When I got my next 21 day biopsy all the doctors on the floor of the cancer center came into my room. They were baffled with the results. Not only was I in remission they genetic tests showed no mutations. They couldn't explain this. I was discharged a few weeks later as my numbers increased to safe levels. I wasn't given a script for metformin and I couldn't reach my endo thanks to the covid. I had an old bottle so I self medicated. Before takin it on my own I looked up the drug to see if it interfered with the chemo. I was shocked finding metformin can kill cancer cells. When searching metformin and blood cancer metformin killed mutated blast cells by reducing the glucose they need to divide. Metformin can get into the mitochondria of mutated stem cells causing the ADP production to stop making the cell go into self destruct. I showed this info to my endocrinologist and she agreed to let me stay on metformin long term at the 1,000 mg a day. I have had 6 blood draws over the past 8 weeks and all are clear of blast and immature cells. I am not saying I am cured. But doctors now agree that the metformin combined with my chemo wiped out 99.9% of my leukemia. I am still getting consolidation chemo to kill any remaining mutated cells. Metformin may be the only reason I am still alive. 3 Juliany Nascimento Silva Juliany Nascimento Silva 6 years ago Loved the last slide! Couldn't stop reading :p Thank you for sharing this 5 KnowBull Hockey KnowBull Hockey 3 years ago I've been "pre" diabetic for twenty years and was told to take metformin many times but I refused. I am not a diabetic today! I saved myself 20 years of who knows what damage metformin would have caused. BIG PHARM IS WRECKLESS AND GREEDY 7 Brian Brian 2 years ago I have found that for diabetes 2 the core factor to control is daily caloric intake. Keep it down to what you are burning off, or a bit less if you are wanting to lose weight, and eventually your body will stop making its own glucose. That's it. Just control your weight and caloric intake. 1 Fabienne Haichour Fabienne Haichour 2 years ago Playback speed .75x is perfect. I am in no hurry! Thanks for sharing your time, 🙏 2 Luckydog Sanctuary Luckydog Sanctuary 4 years ago You left out two key phrases regarding lactic acidosis in metformin-treated patients "not different from those... treated with other agents" and "compared to other anti-hyperglycemic treatments" why? Why aren't you comparing those on metformin to the general population? 3 Yolanda Helfrich Yolanda Helfrich 2 years ago This talk was immensely helpful to me. I was still diagnosed with diabetes, type 2 in the year 2000. I took Metforman and then another med was added when the diabetes seem to be progressing. I stopped taking all meds about a year and a half ago when I was having more negative side effects from the meds then any good. I do intermittent fasting, have drastically changed my eating habits and take very specific supplements to protect my organs from the effects of high glucose. The high sugars are still a concern but my sugars are more stable and I feel so much better. 6 Prashant Katti Prashant Katti 8 months ago Stopped after a month for t2d, feels poisoning and weird. KukaMalia Broussard KukaMalia Broussard 3 years ago I was diagnosed with Type 2 Diabetes. Immediately I was placed on Metformin. My body rejected it. I started to get tired. So Docs put me on Glyceride. Finally I found out I was allergic to Shellfish and anything with an outer hard skin (higjly allergic to Cockroaches, Shrimp, Lobster, Crabs, dry grass, etc.) I asked my doctor, my stomach is churning, what is in Metformin? Is there shellfish in the white powder? Answer: I dont know what's in Metformin. I asked the Pharmacy. Answer: I dont know. Great so the Doctor and the Pharmasist did not know if Shellfish was in Metformin. Nobody could answer my questions. So I took a Medication Holiday, and I'm still on the Holiday. I've curbed the sugars and the starches, increased my activity and got active. I put my health issues on Holiday too, and I'm working on my feet. I'm not going to let any moss grow under my feet. Death will get swollowed up in Victory. #StayActive #StayInformed #AskQuestions 9 Ideoform Sun Ideoform Sun 2 years ago What is Metformin made of? How is it made? Where is it made? What are the inactive ingredients? How was it discovered? How does it work? 6 Manny Radzky Manny Radzky 3 years ago Why not eat less carbs, do keto and intermittent fasting to actually REVERSE diabetes and not need metformin. 72 Cris Wendt Cris Wendt 2 years ago He seems to trivialize diabetes when so many people die from "complications due to diabetes". He's not clear on why that is and if these different drugs attempt to address those issues, but I do appreciate his approach that drugs are not the answer they portray to be. 1 John Smith John Smith 2 years ago (edited) I was given metformin and developed blood clots. I nearly died with a massive pulmonary embolism. That drove me to do some research and now I have followed what I found on how to reverse type 2 diabetes and I am no longer taking any medication. My Doctor was shocked because he said it was not reversible. 2 LisaP LisaP 1 year ago (edited) 11 days I stopped , headaches returned while on it , NO THANKS. I began walking 6000 steps a day and lowered my carbs and I’m making better healthy food choices and I’ve lost 17 lbs so far and it’s only been 3 Wks !!! 1 My Better Half My Better Half 2 years ago (edited) You need to petition for more podium time~ so you don't have to talk so darned fast~! 7 Pearl Salsman Pearl Salsman 2 years ago Do you have any studies showing that it will make your sugar levels go up every time I take insulin matter Foreman and the glyburide my sugar's go up there all over the place doctors don't believe me they say it's impossible and I poked and test my fingers all the time.they tell me prove it to me but they will not let me go without not taking the drugs to show them that it is doing this any suggestions that might help would be greatly thank you. 1 Steven Meadows Steven Meadows 1 year ago Thanks for posting this ! I just started Metformin, and was concerned about the possible side effects. Some say get off the drug quickly because it will surely kill you and others say it's 100 percent safe to take. It's hard to find neutral, unbiased data on the internet relating to pretty much anything. Now I have the info I need to make a decision. DR ZAHOORUL HAQ DR ZAHOORUL HAQ 2 years ago Thank you for adding to the confusion..... 😙😌 4 Dino Stas Dino Stas 2 years ago The next hype is taking Metformin to live longer and you do I talk on that topic 4 Kobus Kotze Kobus Kotze 2 years ago I think you are living on a different planet. Do you know how many limb amputations we do because of uncontrolled high blood sugar in South Africa?? In our practice the the benefits of Metformin is not a vague shadow, but a undeniable fact! It's use saves many lives in South Africa. 1 Josephine Jugo Josephine Jugo 3 years ago Why are they still in the market and doctor still prescribing it to the patients? 10 J Bird J Bird 2 years ago Listen man, you need to slow your speech down if you want to be HEARD AND UNDERSTOOD. You’re really great but slooooowwwwww dooooowwwwnnnnn... you’ll live longer! 2 Marvin Addington Marvin Addington 2 years ago If you have Diabetes lose as much Weight as possible! 11 Gaylene Morley Gaylene Morley 2 years ago I am dealing with metforman now i am ok walking talking eating sleeping joel serrahn joel serrahn 4 years ago does this mean i should stop taking my metformin? Phillip Bridge Phillip Bridge 2 years ago Perfect speed for me!!! I speak and walk fast. Life is short. 4 Nenad Cubric Nenad Cubric 3 months ago First Metformin later Insulin 100% J Bird J Bird 2 years ago (edited) Ok f-it. This is crazy fast and I don’t have time to bloody rewind and listen to over and over again and again just to get it. I have found other better, more advanced and more current STUDIES!!!!! Yes studies! Recap: I have chosen to NOT take metformin. Welcome to Berberine into my life and all is well. 2 Akshaya Sahoo Akshaya Sahoo 3 years ago 👍👍👍👍👍 Thanks ! Very nice ! Steven Miller Steven Miller 1 year ago Could you talk a little faster? I was almost able to understand you. 1 Kim Shelton Kim Shelton 1 year ago I wish they would just take these pills off the shelfs .. BOBObro kake BOBObro kake 2 years ago your not taking into account the better health we feel before we die and thats the most important and less amputation !! 4 carmela. nealon carmela. nealon 2 years ago that is true ms shirlee 1 Elipe Karunakara Vara Prasada Raorasada Rao Elipe Karunakara Vara Prasada Raorasada Rao 3 years ago Needed information for diabetics 2 David Nelson David Nelson 3 years ago Greed will destroy civilization folks. 12 Adeleni Surnameless Adeleni Surnameless 3 years ago I use Metformin. Recently diagnosed tye 2 diabetes. Don't understand a thing you are saying. My whole family on both sides are diabetic. We live forever! 5 Kim Shelton Kim Shelton 1 year ago I don't like taking them at all they hurt my tummy all the time Donald Henry Donald Henry 3 years ago Killing me softly 4 frank frank 6 years ago I know a few people that never treated their diabetes and lived long full lives an I knew lots of people that took this and other drugs and all died in their 40s and 50s. I wonder. 21 Aldi Lee Aldi Lee 1 year ago But dr. David sinclair takes metformin for longevity