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Metformin

 I walk an interesting medical line....One foot in traditional medicine( Acute care) and one if Functional medicine(Chronic and preventive care). I have been asked by patients to try metformin for longevity and cancer related issues.  This is an interesting question, and here are my thoughts.


Emergency medicine perspective (1):

Toxicology 101
 What is metformin? It is a diabetic medicine that essentially decreases glucose uptake in the GI tract. This has the effect of increasing anaerobic metabolism and therefore lactate.....Oh my I think I am losing you, and perhaps me with this. 

 Most of the time lactate is cleared by the liver quite easily. However, the effects of metformin also block two enzymes needed to convert pyruvate to glucose or ATP production in the Krebs cycle.....This can cause an even larger build-up of lactate in certain situations. This is mostly a problem during overdose, sepsis(infection), dehydration, kidney insufficiency, liver disease etc. 

 Lactic acidosis can be a serious life-threatening condition and needs to be treated appropriately and aggressively in this setting. 

 Functional medicine perspective:

Biochemistry 101

 Metformin simplistically lowers blood glucose levels, which are known to increase an inflammatory molecule called insulin like growth factor. In diabetics with cancers, there is an improvement in cancer remissions when patients are compliant with metformin. The anti-inflammatory benefits of this medication may also positively impact longevity.

 From my limited research with cancer, metformin is valuable in patients with coexisting diabetes, but not so much in those without type 2 diabetes. 

Is there an alternative solution?

 One suggestion by DiNicolantonio et al. (2), is the combination of berberine with astaxanthin. 

 Berberine is an herbal supplement that has a similar mechanism of action as metformin, blocking AMP kinase and lowering blood sugars.  Unlike metformin, it is not associated with Lactic
 Acidosis and has minimal gastrointestinal effects. 

  Astaxanthin is natural carotenoid with a similar mechanism of action to fibrates (lipid lowering medications).  Both Astaxanthin and Fibrates are PPAR gama agonists.  Fibrates are used to treat cholesterol and metabolic syndrome. 

 According to the article published in BJM (2), Berberine, when combined with 8 mg per day of Astaxanthin, has been suggested to improve mitochondrial biogenesis, promote longevity, lower triglycerides, blood sugar levels and even LDL levels.  

 For those who do not tolerate statins, combining this with a red yeast rice extract was proposed as a tolerable alternative. 

 If you are looking at the benefits of metformin, I encourage you to read the articles below.  All medications and herbal supplements have effects.  It is important to be educated on the risks and benefits of all treatment options, and then weigh your decisions with your medical providers. 

 
 This post is for informational purposes only and is not intended as medical advice or to diagnose, treat or cure any medical condition.  Always discuss these and any medication or supplement regimens you are considering with your healthcare provider.

 Be wise and be well!

 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3576503/

 (1) Gussow, Emergency Medicine News, Brace yourself for Metformin- Associated Lactic Acidosis. Sept 2019, Vol41, No9 Page 8.

 (2) 0805604001568399023.jpghttps://openheart.bmj.com/conte…/openhrt/6/2/e000977.full.pd

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