Disturbing news (to me) about Metformin

Type 2
81

Hi Craig,

Agree that our health is in our own hands & certainly knowledge is power. Authority should always be questioned & alternatives sought. Any info presented should be viewed through a critical lens.

Disturbing that the author of the article you linked states:

“The deaths that occurred were under an experimental diabetic treatment approach — lowering blood sugar to an A1C of less than 6 percent -– which is very aggressive in my opinion. I am sure Jay’s doctor is only using the standard regimen on him. The aggressive treatment might have taxed the trial’s subjects too much. Imagine taking four shots of insulin and three pills and checking their blood-sugar levels four times a day! Too much stress kills, remember? How much more in patients who were very vulnerable?”

Lowering A1c below 6 is too aggressive–oh, please. Taking four shots a day, three pills & testing BG 4x a day is too stressful–gimme a break. I take 5-7 injections daily, thyroid meds twice daily & supplements & test 8-10 times a day. While it’s no day at the beach, that’s pro forma for many Type 1s (or at least the ones who are diligent about control). Realize he’s talking about Type 2s, but what an attitude. Is it better for people not to control high BG because it’s less “stressful” not to?

I’ve read a lot of criticism of the ACCORD study & it was flawed.

From Jenny’s site:

The people in the ACCORD study where there was a SMALL number more deaths than the control were middle aged overweight Type 2s who were diagnosed with heart disease before the study started.

They were given some mixture of sulfa drugs, Avandia, and Actos, all known to worsen heart disease, along with metformin, Byetta (so new its effects are unknown), and huge doses of basal insulin. Told to eat a VERY high carb diet and nagged on a schedule by registered dietitians to be sure they were getting their 300 grams of carb a day. (300 carbs a day!)

A Giant Step Backwards: Misinterpreting ACCORD Harms People with Diabetes
The fallout from the ACCORD study continues, and it is going to cause a lot of unnecessary kidney failure and neuropathy.

If you’ll remember, ACCORD was the study where they took people who had diabetes and preexisting heart disease , put them on every drug possible, including Avandia, Actos, Byetta and Insulin, encouraged them to eat a high carb/low fat diet and discovered that there were a very small number of so-called “excess deaths” in the group who achieved blood sugars nearer 6.5% compared to those who aimed for the old 7.0% ADA target.

The take home message from this for doctors was that lowering the A1c kills people with diabetes.

A second study, ADVANCE, which involved a lot more people with diabetes and lasted longer–a study which did NOT use Avandia, Actos, or Byetta found NO such excess deaths in the group that lowered their A1c. Not only that, but the group in the ADVANCE study that achieved the 6.5% A1cs had 21% less kidney disease–a major finding given how many type 2s end up on dialysis.

Clearly the problem illuminated in ACCORD was not that lowering A1c kills people with diabetes but that the combination of drugs given to people with diabetes to lower their blood sugar along with the high carbohydrate diet was not safe for people with preexisting heart disease.

The lack of excess deaths and the decrease in kidney disease found in the ADVANCE study should have in itself been reason to advise lowering the blood sugar targets for all people with diabetes using a protocol similar to that used in ADVANCE–which was one that did not use the newer, possibly more dangerous diabetes drugs. Ideally more scientific effort would now be put into analyzing the differences between the two studies to determine why ACCORD showed those excess cardiac deaths and the larger, longer ADVANCE study did not.

My guess is that the ACCORD population was sicker to start with–i.e. their diabetes was of much longer standing at the time the study began, that their diets were probably higher in carbs, trans fat, and junk food (ACCORD was an American study while ADVANCE was not), and that the addition of Avandia and Actos to their protocols–both known to be cardiotoxic–was probably more significant than the drug company funded researchers revealed.

Whatever the explanation, if your doctor tells you to RAISE your A1c to “be safe”–which I am hearing from my correspondents is becoming horrifyingly common-- remind him or her that:

  1. There is NO study about the safety of lowering A1c using a low carb diet rather than using dangerous drugs like Actos and Avandia with the high carb/low fat diet that was used in ACCORD. All early indications from small studies are that lowering blood sugar by lowering carb intake improves all cardiovascular markers and does not worsen heart disease.

  2. ADVANCE showed decisively that lowering A1c prevents kidney disease.

  3. ADVANCE lasted longer and involved more people with diabetes than ACCORD and found NO increase in cardiac deaths.

82

It’s interesting reading your posts. The main thing I get from them are you think all type 2 diabetics are like you and will get the same results if they do the same things as you. I guess that’s a normal thing for most people because most people think one dimensionally and forget about everything that they haven’t experienced directly themselves or doesn’t directly effect them. Can’t fault you for that, it’s how most people think. Unfortunately there is a lot more out there It’s also pretty obvious that you don’t understand genetics either. What about all the countries out there who have a completely different diet to the standard US one where diabetes is still increasing? Why do healthy people who eat right and exercise get type 2? Contrary to your statements, there has never been any study that has proved that poor diet, lack of exercise or being overweight causes diabetes. Everything to do with those factors are speculation. There are plenty of people who are at weight, eat well and exercise who get diabetes and there are also plenty of people who have crappy diet, don’t exercise and are obese who don’t get diabetes. i would like to know where you got the data that the vast majority of type 2 cases are because of an unhealthy lifestyle because I have never come over anything like that before that actually has data to back it up.

Diet and exercise are the building blocks for a treatment plan. I will never argue with that but there is only a finite amount of things that they can do. you should also not focus everything on blood sugar because diabetes is about way more than just that. I would also advocate questioning your doctor and knowing what’s going on. If I don’t have 10-15 things to discuss with my doctor at an appointment, be it stem cells, new tests, new research, genetics, the way certain drugs work, etc, then I don’t feel like I am using the appointment to it’s best. The more doctors I talk to the more different opinions and knowledge bases I get.

I take the ACCORD study with a grain of salt. The parameters were ludicrous to start with and the study was basically a big waste of time and unrealistic in real life. I also take the Avandia research with caution because again, the studies the warnings are based on were small individually and the people who originally came up with the criticism actually had nothing to do with any of the original studies but just studied them. The original meta-data study has been said to provide “weak evidence for adverse cardiovascular effects.” It has also been said that the person who was chiefly involved in the study was more politically motivated than patient motivated. With their recent actions on the political front you can see why that was said.

I wouldn’t say you are lucky to be managing your diabetes with diet and exercise. They are tools just like drugs, supplements and insulin.

83

Those early in kidney complications may be interested in this method of postponing them:

http://news.bbc.co.uk/2/hi/health/7796073.stm

Those interested in dietary methods for controlling diabetes may be interested in this collection of advice from the alt.support.diabetes newsgroup:

http://alt-support-diabetes.org/new.php

For many of the people with type 2 who have been able to stick with it long enough, their A1C is now below 6.0%. Seems harder to start than the usual low-fat diet for the first one to three months, then it helps control your appetite enough to make it easier. Somewhat slower at helping to control both your weight and your cholesterol levels. I haven’t been keeping up with how well it works for controlling type 1 and the less common types.

I’ve also seen reports of research indicating that a variant of the usual low-fat diet, with extra fiber and more care in balancing the different types of fat, works better than the usual low-fat diet; didn’t save a link to it, though. Haven’t seen any research reports on whether this variant of the low-fat diet has been compared to any of the low-carb-diets already shown to be more effective than the usual low-fat diet. There is a definite shortage of research reports on comparing low-fat diets for controlling type 2 to low-carb diets for controlling type 2, and also lasting long enough to show the slower effects of the low-carb diets, such as their effect on mortality.

The research reports I’ve seen so far on transfats say that one type, a natural type found in diary products (CLA?) is safe, but most of the types produced by partial hydrogenation of vegetable oils or by overheating vegetable oils, aren’t.

84

Also, your liver can convert any excess carbs into saturated fats. It can convert protein into glucose if your brain needs more glucose, although slowly enough that this is seldom a problem for those with type 2. Reports on whether it can also convert the glycerol portion of fats into glucose don’t seem to agree enough to be trusted yet, but it’s a possibility to consider.

http://www.answers.com/topic/gluconeogenesis

85

A number of people with type 2 have combined this dietary approach with medicines and exercise and been able to get their A1C low enough that they need to stop taking some of the medicines. It appears that around half of those who can stick with it long enough get their A1C below 6.0%, even with a starting point higher than yours. It’s harder to stick to for the first 1 to 3 months, but then an appetite reducing effect kicks in.

http://alt-support-diabetes.org/new.php

There’s a shortage of research of whether it’s safe to use this approach much more than just long enough to reduce your weight, though. There is, however, some research indicating that reducing your A1C that much with just medicines is not safe enough for those who already have heart problems.

I haven’t seen much on whether it’s equally effective for those with types of diabetes other than type 2.

86

If you’re able to do suitable web searches, you may want to look for information on whether the spice turmeric is also worth trying - probably about as much of it as in a typical diet in India. I’ve seen some claims that it is, but I don’t remember seeing any scientific reports to back that up. If you find any scientific reports on whether it has even been tested, could you let me know where to find them? Less technical rewrites are useful to some people if there are scientific reports to back them up, but I’m trying to find scientific reports to pass on to groups closer to researchers who prefer the scientific reports.

You may want to try a similar search for research papers mentioning both methylcobalamin and diabetes; I’ve seen similar claims for it, but haven’t found time to do such a search yet. Methylcobalamin is one of the forms of vitamin B12 and is the form normally used for vitamin B12 supplements in Japan. In the US, the cyanocobalamin form is normally used instead, often abbreviated to just cobalamin.

If you’re on a vegetarian diet, you may also want to do a web search for just which forms of vitamin B12 are found in your favorite source of vitamin B12. I’ve seem rumors that some of the claimed natural sources, especially sea vegetables, provide chemicals that are close enough to trigger the usual tests for vitamin B12 content, but not close enough for humans to actually convert them to either of the two active forms of vitamin B12. The various useful forms at least have cobalamin as part of their technical names; however, a number of humans have been found who either have problems absorbing any of these forms from their diets, or have problems converting some of these forms to one of both of the two active forms.

87

I’m not willing to put much trust in such stories gathered by a group with a financial interest in the sales of various things Dr. McDougall recommends. Too many similar groups have started making up stories when they could not find enough favorable stories.

How many scentific reports have you been able to find on tests of how effective what he recommends is, but done by researchers with no financial interest in his sales success, and distributed by channels without the opportunity to simply throw out any unfavorable reports?

88

Could you send me a list of any web sites you have found claiming this, especially scientific reports, so that I can pass these on to a group that is doing computer processing related to the relation of genetics and diabetes? I’m hoping that they will pass along at least some of them to the actual researchers.

In the meantime, you may be interested in this group developing software that looks useful for investigating the amyloids that eventually kill the beta cells responsible for producing insulin in the pancreas for those with type 2 diabetes. Their software is far enough along that they let the public provide any idle time on their computers to run parts of it on, currently mainly to help Alzheimer’s researchers.

http://boinc.bakerlab.org/rosetta/

I have one of their programs running in the background on the same computer I’m typing this on, and my other computer is currently waiting for a sufficiently reliable internet connection that it can continue participating as well.

89

wow! I thought I was the only one with all these problems, like hair loss. I took myself off of statin drugs because I could actually feel the bad effects I had with them and could place these effects to the statin drugs. I also cannot lose weight, I have carb cravings, fatigue, conjestive heart failure and generally feel really tired and worn out. Now I am starting to believe it could be the metformin. I have made an appointment with an alternitive medicine,antiaging M.D. who I believe can put my body back on tract. I had been doing good for a while. I was loosing weight off of metformin and high blood meds, when I decided to do a full body flush. I went 14 days without eating and screwed myself up totally, seems you also need to do enemas with these flushes, which I didn’t know. So I lost all ground, starting over from scratch. I only eat organic, whole milk and milk products and grass fed beef, also free roaming chicken and organic eggs, no white four or any processed foods. no gmo’s or fruitos corn syrup. I do agree weight loss is the answer, but hard to obtain when on metformin. I am glad I am not alone and others agree w/me on how bad the drug co.'s are and I also think alot of Dr.'s and nothing more than drug pushers. they give you a drug it has side effects so they give a drug or two for that and those have side effects and on, and on, and on. We have to take charge and make ourselves well, thank God for the internet and you guys.

90

Here’s the most successful way I’ve found for controlling type 2:

Somewhat hard to start properly, but after 1-3 months your carb cravings and excess appetite go away.

A little difficult to use with a vegan diet and still get enough vitamin B12; I suspect that this may be true with an organic diet as well.

For congestive heart failure, which I have, I’ve found that lying with your feet raised above your heart works well. If you can afford it, a laptop that sits on your stomach allows you to stay connected to the internet.

91

Seems that the way for inserting hyperlinks at least needs better instructions. Here are the same links, not formatted as hyperlinks:

http://alt-support-diabetes.org/new.php

http://www.vrg.org/nutrition/b12.htm

92

Craig, I’ve used Metformin now for almost a year, and the ONLY thing that it has done for me, is exactly what we wanted it to do, that was to lower my BS. I wanted to blame my weight gain on it, but then looked back at my food diary, and realized, that I had to take on that responsibility. I am a skeptic like yourself. I question everything my doc says, and follow very little of it, unless it proves to be right in a month of doing it…I have to say, this was a right call. Even though the first time if scared me to death, reading some of the information on it. I admire you for taking your own way, and going natural with your diabetes.
I am sick and tired of docs telling me to do one thing, and then change again in a month. I want consistency, but then I had to tell them that, and of course argue a little, and then get what I want anyway. So good luck to you.

93

Good supplement list, thank you! Can you tell me if you are taking any diabetes medication? Do you take B12 and Vitamin D?

94

No medication, but plenty of walking and healthy (low carb, high nutrient) foods. Yes… both B12 and D (along with a coral calcium supp.)

95

@Barbie1 - do you cut or split your Metformin pill?

96

If the Metformin pill is extended release you can’t cut or split it. For this reason I take Diaformin which can be cut in half or crushed, but is not an extended release Metformin pill.

97

Do you cut or crush it to help you adjust to the symptoms or is it a matter of dosage, that is you don’t need as much as provided in the one pill?