Well Woman Podcast - Is Metformin Good or Bad?

Metformin has been controversial or even rubbished in some quarters. 

Here I give extensive details regarding why some regard it as unsuitable but why there is overwhelming evidence that it gives many benefits  that extend to 

- anti-aging

- prevention of cancer, dementia, heart disease, macular degeneration, kidney disease etc

- great for the skin, and also reducing skin cancer.

- helpful in Polycystic Ovarian Syndrome, osteoarthritis, 

- prevention and management of pre diabetes and diabetes 

I literally have dozens of references because of my research in metformin over the years and for my best selling book - Well Woman - link below for book 

https://www.google.com/search?client=safari&rls=en&q=buy+well+woman+book&ie=UTF-8&oe=UTF-8

International 

https://www.amazon.com.au/Well-Woman-Prescription-Lifelong-Health-ebook/dp/B0DXMSV4VL

The ebook is also available 

drfrances.co.nz

Transcript

SPEAKER_00 0:03

Hello everyone and welcome to the Well Woman Podcast with me, Dr. Francis Pitsilis. This podcast is for education and does not replace personalized medical advice. Today I'd like to talk to you about metformin, which is a medicine used for diabetes. And I've been using it for a long time, and quite a few years ago, I realized its general benefits, its anti-aging benefits, its um anti-cancer benefits, its benefits in losing weight, and its benefits in extending life. Now I've been prompted to make this video because I've had so many patients come back to me and say, my pharmacist asked me if I was a diabetic because they saw they were on metformin for prevention. I've been told to come off it because I don't need it by various doctors. So metformin is actually a medicine that is often first line for diabetes, but it's really not a drug. It's flowers, it's it's it's French lilacs, and in the past was used in folk medicine. It was introduced for diabetes by the FDA in the USA in 1994, and it's known to help diabetes and obesity and help with weight loss. So when researchers looked into diabetes and saw patients that were on metformin and had diabetes, they noticed that they had less heart disease, less cancer, and did a lot better. So, thus, I've got dozens of scientific papers describing all of this. Now, where does it become controversial? Well, the other thing that I've noticed is that some of my patients have asked me why metformin is being rubbished on the internet. And I can't tell you why, but I know that there are alternative medicines to help with weight loss, but I cannot understand why it would really be rubbished. The controversy may well be in relation to its potential side effects, which include abdominal upset, diarrhea, and nausea. Now, my own experience of that is that when I give people 250 or 500 milligrams in the evening for its general benefits, I generally don't get these side effects. When I give people diabetic doses, which is 500 to 1000 milligrams twice a day, now that can cause problems. So we have to manage that. It can upset your kidneys, your heart, or be associated with infection. There is a limitation to its use if you've got very, very sluggish kidneys and the glomerular filtration rate, we call it, of less than 30 is what you need to be aware of. And it can lower vitamin B12, but we can manage that. And metformin is very useful for its non-diabetic benefits. It's been studied for anti-aging, weight loss, and its effect on preventing and treating cancer, as well as benefits for inflammation, the brain, and the heart. Now, if you don't want to waste any time, I will just list all the benefits before I go into detail. Lowers blood sugar, lowers insulin, helps you lose weight, reduces appetite, improves insulin sensitivity of the tissues, reduces heart attack and stroke, protects your eyes and reduces age-related macular degeneration, protects the kidneys, protects the nerves, may reduce inflammation and cholesterol. And there are many cancers that it can improve or help or prevent. It can help with Alzheimer's disease and even depression. So the underlying themes for all of these conditions are the inflammation and the messengers that are produced by this inflammation by the visceral fat, the abdominal fat. So, what's one of the first things that metformin is used for that's non-diabetic? Well, polycystic ovarian syndrome. These are women who can have polycystic ovaries, have irregular periods, and have fertility issues with it. Along with that, they can gain weight and some of them have excessive hairiness and acne. Now, metformin has been known to bring back and correct the menstrual cycle. It helps with the weight loss and it helps with the whole condition. When I test people, this is a separate issue, I find that when I'm looking for a pre-diabetic state, I favor using the fasting insulin test rather than just fasting glucose or hemoglobin A1C. The fasting insulin test is more sensitive. So then I start people on metformin and it helps them lose weight. Cardiovascular disease. If you're 40 and you have diabetes, you already have a 4.8-fold increase of developing heart failure later in life. But also we know that if you have heart failure, it increases the risk of diabetes. Now the heart gets its energy, most of it, from fatty acid oxidation, so dealing with fatty acid, and from using glucose. Now a failing heart has a deficiency of its energy supply, which usually comes from the mitochondria, which are these energy factories in the cells. And these mitochondria use the fatty acid and the glucose to make ATP, which is the energy molecule that the cells use. Now, researchers have suggested that metformin could enhance the mitochondrial action to give energy to the cells through a mechanism called AMPK. But when I learned that, I found that the researchers were still looking at it. However, let's talk about AMPK. AMPK stands for activated protein kinase, and this is a key regulator of various pathways involved in glucose, lipids, and energy metabolism. And this mechanism is the first and most studied mechanism through which metformin gives its actions. And many studies have demonstrated that AMPK is also involved in a number of other pathways that help the person, which are too detailed to mention here. So through AMPK, metformin can suppress inflammatory responses in the body along with these other messengers. And researchers have found that when they have a patient with diabetes type 2 and heart failure, that giving them metformin caused a reduction in mortality. Now there are other mechanisms through which metformin protects the heart and atherosclerosis. And most of these studies are randomized control trials, which are the gold standard in science. And these improvements include it reduces platelet aggregation and blood viscosity, so this reduces blood clots. It reduces markers, indicators of oxidative stress throughout the body in type 2 diabetes patients, and it reduces oxidation of advanced glycation end products. Now advanced glycation end products are the result of sugars in the body going off, if you like. And this is also caused by AMPK. So AMPK reduces advanced glycation end products. Now let's move to brain cells. Can metformin help prevent brain cell degeneration? Well, at the moment, there has been some research on mice that are able to get through the maze better than the other mice when they've been given metformin. At the moment, researchers can't say anything about humans, and so we're waiting for more research. But I'd like to share a case with you where I think this was illustrated. A patient of mine, who's 90, developed mild dementia, and because her family doctor said to her, You're no longer diabetic, so you don't need to take metformin. She came off the metformin, but her dementia worsened. So her daughter put her back on the metformin and her dementia improved again. So I think that's a practical example of where metformin can be potentially protective of Alzheimer's disease. Now there's been a lot of research on the benefits of metformin for cancer prevention and treatment. As it is, when you're a diabetic, because you can get more inflamed, and a lot of diabetics have got pot tummies and visceral fat, all of that increases their risk of cancer as it is. So what researchers have observed is that these patients' survival were much better if they were diagnosed with cancer. So researchers have looked further into this with animal studies and then later human studies. So here are some statistics. Of 8,000 diabetics treated with metformin, there was a 54 to 72% lower incidence of all cancers compared with the general population. And these patients had a higher survival rate, especially if they'd been on the metformin longer. So here's another piece of information. In a breast cancer study, those that were taking metformin who were having chemotherapy responded better. 24% had a complete response to those who didn't take metformin, which was 8%. And 16% of non-diabetics who were given metformin along with their chemotherapy experienced a remission. So everything improved with the chemotherapy, whether they were a diabetic or not, taking metformin. So I'm going to now tell you which cancers there's research for for metformin. Breast cancer, including HER2, breast cancer, bowel cancer, pancreas cancer, prostate cancer, melanoma, endometrial cancer, which is the cancer of the lining of the uterus, ovarian cancer, gastric cancer, kidney cancer in those with type 2 diabetes, and hematological malignancies, blood cancer. There has been early research so far, but in the last few years I've noticed there's been an absurgence of blood and lymphoma cancers. And every time I've researched it for each patient, I've found that metformin has been found to be helpful. So along with this, they're still looking, the researchers, at chemotherapy with metformin. And they've also found that non-diabetic patients have been found to benefit from metformin. So how does metformin do this for cancer? One of the things it does is that it blocks an enzyme called aromatase. Aromatase is in all people and it converts testosterone to estrogen in men and women. So this process is particularly important in breast and prostate cancer. Metformin also suppresses a specific cancer-causing protein called HER2. The other name for it is human epidermal growth factor II, and that increases breast cancer risk. Now, another mechanism is that cancer cells love sugar and they need energy to grow. So metformin reduces glucose and insulin and cuts off the cancer's blood supply. Now, on top of that, calorie restriction can extend life and this can be relevant in cancer. And metformin works like calorie restriction through the stimulation of AMPK. Now that in turn causes the cancer cells to die, or it stops the cell cycle. So cancer cells have a cycle of growth and reproduction. So the AMPK that is stimulated by metformin kills cancer cells andor stops them cycling. So also the AMPK in the liver reduces production of glucose and insulin. And throughout the body, the AMPK burns fat and helps the sensitivity of cells to insulin. And as a result of that, it reduces inflammatory messengers. So inflammation is the foundation of many diseases in cancer. So by generally reducing inflammation, metformin, through its AMPK action, reduces a lot of conditions, well, through reducing inflammation, but also helps to prevent and reduce cancer. Now, still on the cancer benefits, there's an age-accelerating complex in the body called MTOR, mammalian target of rapamycin, mTOR, and that is implicated in cancer development. So because mTOR is inhibited by metformin, it also then inhibits the body receiving this abnormal messenger that can increase cancer. So in prostate cancer, metformin blocks certain pathways that can accelerate cell division in prostate cancer. And one of them is called a protein called P27. Now there are other things that also block that protein, help that protein to block cancer cell division. And those natural things are vitamin D, fish oil, and milk thistle. So now in endometrial cancer, metformin has been found to stop the cell cycle and block expression of certain messengers, which can cause unchecked cell division. Once again, this is the AMPK. In pancreatic cancer, metformin increases caspases, and these are molecules which are cell death messengers. So they cause cell death of the cancer cells. And metformin also reduces other cell damaging messengers. So there's some initial studies starting to look at the effect of metformin helping enhance the effect of radiation on lung cancer and also whether it can stop the division of hepatitis C virus. Now that's important because hepatitis C virus can cause liver cancer. Now, what else can metformin do? Well, because metformin protects organs by reducing inflammation and oxidation through its AMPK action, it can have far-reaching effects on the whole body. One example of metformin's effect on the microbiome, well, there's been a lot of interest in the microbiome in recent years, it increases good bacteria and reduces inflammatory messengers like IL6 and IL beta. And part of this is by increasing short chain fatty acids in the bowel and also by decreasing carcinogenic molecules. As well as all of this, brain, heart, cancer, metformin has an anti-aging action. And this is happening through some survival genes called sertuin one. So we know that exercise and calorie restriction stimulate CERT one or sertuin one, and metformin does this as well. And this causes reduced inflammation and it's using its AMPK mechanism again. So AMPK is amazing, it's everywhere. Now, if you're interested in anti-aging, the other supplements that can help anti-aging and support activate CERT one include resveratrol, curcumin, and melatonin. So they, along with metformin, are part of my anti-aging protocol. So another anti-aging mechanism that metformin has is by stimulating autophagy. Autophagy, Greek for self-eating. So this causes the destruction of old cells and recycling of aging cells. And it also improves mitochondrial energy production and reduces inflammation in older people. So there's a lot of benefits to metformin. So I can't see why people want to bag it. I think the benefits far outweigh the risks. And I think that if you're thinking about aging well, you know what's happening in your own history and your family's history, and you can see some things are going to come at you as you get older. It's something that you can discuss with your doctor. And hopefully your doctor will have this information or can look it up. Before I finish, it's very important that we tell you who shouldn't have metformin if you've got kidney and liver disease, alcoholic, severe heart failure, respiratory failure on certain drugs, etriconazole and gem fibrosole, a recent heart attack or stroke, type 1 diabetes, pregnant or breastfeeding. And in men in the fertile age group, it may affect sperm quality and cause birth defects. Now, the very last thing before I go is that when you're on metformin and you've got thyroid issues, it's important to remember that metformin causes your thyroid-stimulating hormone blood test to look lower and it can trick the doctor into thinking that you're okay or that you're having too much thyroid. So just remember that you can't trust the TSH when you're on metformin. So I'm going to put some references down below. Don't be surprised if you start seeing more people on metformin who are not diabetics. Doctors will start using it for its extra action. To help to prevent diabetes, cancer, and other problems. Remember that this podcast is for general education and does not replace personalized medical advice with your own healthcare professional. Thanks for coming to the Well Woman podcast. Please like, subscribe, and share, and I'll see you at the next one.