Can Metformin help me lose weight?

[Paul]

Hi everyone,

My name is Paul. I am a 48 year old male, 120kg (264 pounds) HIV+ since 2003. HIV is fine and undetectable. My endocrine system is another thing altogether.

My current regimen is as follows:

2ml depo testosterone weekly
1 x 25mg Aromasin every 6 days. (used to be every 3 days but due to cost changed to every 6 days)

I have started this month to also take Acetyl L Carniine, Zinc + Copper, Vitamin E, Vitamin D & Co-Q10 as suggested on this site and Magnesium. I also take 150mg Aspirin daily to keep my blood thin. I have been on this TRT for the last 2 years. Got my blood tests back and will give you the results which concern me.

Test	Result	Reference	Units
Haemoglobin	21.3	14.3 - 18.3	g/dl
Red Cell Count	6.47	4.89 - 6.11	10[SUP]12[/SUP]/l
Haematocrit	59.8	43.0 - 55.0	%
MCH	32.9	27.0 - 32.0	pg
Immature Granulocytes	0.70
Urate	0.46	0.21 - 0.43	mmol/l
Homocysteine	27	< 15	umoll
TSH (Roche)	3.58	0.27 - 4.20	mIU/l
Prolactin	7	4 - 15	ug/l
DHEAS	6.2	1.9 - 13.4	umol/l
Total Testosterone	29.1	8.0 - 27.1	nmol/l
SHBG (Roche)	28.6	11.4 - 52.3	nmol/l
Free Testosterone Calculated	728	180 - 536	pmol/l
Oestradiol	103	< 208	pmol/l
FSH	0.6	1.2 - 15.8	IU/l
LH	< 0.1	1.3 - 9.6	IU/l
PSA	1.66	0.0 - 4.0	ng/ml

My GP said I need to have blood removed at a hospital because of my high Haematocrit which I understand. Can't donate because of my HIV.

He also says I have gout because if my high Urate.

Homocysteine is also a concern and very high.

Prolactin is high.

My Total T and Free T is also high.

I'm not sure about my Oestradial if that is too high.

I will need to reduce my weekly T dosage. maybe to 1.5ml every 10 days instead of 2ml every 7 days ?

FSH & LH suppressed because of my TRT ?

PSA seems OK.

Any advice from the experts here would be much appreciated. I will be going to an endocrinologist with these result soon as well.

Many thanks,

Paul.

 

[Nelson Vergel]

Paul

Yes, you have to give blood. Since HIV+ people cannot donate, your doctor has to write an order for a therapeutic phlebotomy. You may need to give 1 unit 1 month apart and then every 3-4 months (have him measure your ferritin blood levels to make sure they do not extract too much blood. Low ferritin can make you tired).http://www.thebodypro.com/content/64756/testosterone-replacement-therapy-and-polycythemia.html

When you say 2 mls of testosterone per week, do you mean 200 mg or 400 mg (It depends on the strength and country)?

Do not waste your time or money measuring LH and FSH since you are on testosterone and your HPT axis is shut down.

Aromasin can increase liver enzymes and decrease HDL. What are these values?

Your estradiol is 29 pg/mL. Not high at all. Do you know if it was tested using ultrasensitive assay?

You say your weight is 264 Lbs. How tall are you? Are you overweight or a bodybuilder? What is your blood pressure like at that T dose?

 

[Paul]

Hi Nelson,

Thank you for your quick reply. To answer your questions :

Depo-Testosterone is 100mg/ml. I get a 10ml vial an get 5 injections out of it so I take 200mg per week. I tried 100mg per week (1ml) but I found it was not enough.

Last time I had my LDL tested was in the beginning of November last year. Results were:

Cholesterol Total 5.3 2.8 - 4.9 mmol/l
Triglycerides 1.3 0.5 - 1.6 mmol/l
HDL 1.3 1.0 - 1.6 mmol/l
LDL 3.8 1.6 - 2.9 mmol/l

We only had 1 estradiol test available. I asked my GP to indicate it to be ultrasensitive but I am not sure if the lab actually did it or not.

I am overweight. I am 6 feet (1.82m).

My blood pressure is too high for my liking as well. Last time I checked it was around 130/97

There was one other test I did last November which concerns me as well. It was a fasting glucose test.

Glucose Fasting 4.5 3.9 - 6.0 mmol/l
Insulin Fasting 19.4 0.2 - 9.4 mIU/l
Homa Index 3.88 0.8 - 2.0

I'm very concerned about my Insulin.

Many thanks,

Paul.

 

[Vettester Chris]

Paul, welcome to EM. Thanks for joining.

If possible, we need to look a lot deeper on the thyroid. It's impossible to really make any comments with the TSH-Only lab, but even that lab at 3.58 mIU has me suspicious on your thyroid productivity. See about getting Free T4, Free T3, Reverse T3 & Antibodies (TPO, TgAb).

 

[Paul]

Hi Chris,

Thanks for the reply. I will pop in to my GP on Thursday to have them done. When I ordered the thyroid test last week I thought that they would do all that automatically but it seems that you have to specify it. I will let you know as soon as I have the results.

Kind regards,

Paul.

 

[Gene Devine]

Hi Chris,

Thanks for the reply. I will pop in to my GP on Thursday to have them done. When I ordered the thyroid test last week I thought that they would do all that automatically but it seems that you have to specify it. I will let you know as soon as I have the results.

Kind regards,

Paul.

Most GP's are not trained well in how to evaluate Thyroid health and will go simply by reference ranges...which we all know here is not right.

High TSH like yours is suspect like Chris noted.

The labs he listed are spot on to give you a good assessment as to what is going on.

Make sure to insist on these labs as you may get some push back when the GP says "but your TSH is in range"...and that isn't right.

 

[Paul]

Hi Gene,

Thanks for the advice. I have my GP "well trained" He is used to me coming in with research and medical information. He said to me a while back I probably know more about HIV than he does and now he wants to know if I'm studying endocrinology.

I'm only going to him to get the tests done but will be visiting an endocrinologist with my results. I have discovered over the years that I need to take control of my own health and that's why I bought both of Nelson's books and subscribe to sites that are up to date with the latest research.

My last endocrinologist did all the tests, called himself Dr. Testosterone, eventually diagnosed me with leaky gut syndrome and wanted me to do a quick IV cure that would instantly cure all my issues. When he mentioned that my testosterone was high, which it wasn't according to Nelson's books, and he was just rushing me and charging me an arm and a leg, I never went back.

I am now going to a new endocrinologist who was educated in France (I live in Johannesburg, South Africa) and will see what he has to say.

I'll post my T3, T4 etc. results as soon as I get them.

 

[Nelson Vergel]

Paul

Wow..I want that IV cure!

By the way, you definitely have insulin resistance. You have high fasting insulin and high HOMA score. This problem is more common in HIV+ people than HIV-. Insulin resistance can cause (and/or be the cause) of obesity. Ways to decrease insulin resistance is exercising 30 min a day or 1 hour 3-4 times a week, increasing fiber intake, decreasing simple carbs, switching HIV medication regimens away from protease inhibitors (many docs are switching people to integrase inhibitor-based regimens), losing weight, and taking medications like Metformin (glucophage).

I talk about ways to improve insulin resistance in this article: http://www.positivelyaware.com/2012/12_01/hiv_wellness_series.shtml

I assume you have undetectable HIV and a good CD4 cell level. Correct me if I am wrong.

Metformin has shown promise in decreasing fat and lipids in people with HIV, so discuss with your doctor. http://jama.jamanetwork.com/article.aspx?articleid=192922

Some anti-aging physicians think Metformin is a true anti-aging medication: http://www.huddlebuy.co.uk/articles/Neil-Palmer-SEO-Webinar-IM3

The good thing is that your lipids are not bad. I assume you do not take statins.

Please let us know more pieces of the puzzle!

 

[Paul]

Hi Nelson,

My HIV regimen is Viramune and Truvada (Tencitab is the generic form from Aspen who also make Truvada). Take it in the morning. My last blood test were fine. CD4 611, CD4% 30 and undetectable <40 copies according to their undetectable levels. Same for my wife.

The new endocrinologist I am seeing wants me to start monitoring my glucose level with a glucometer. When I 1st spoke to him a few weeks back he was also surprised that no-one had put me on Metformin yet so that is a positive sign from his side.

I have changed my diet. Less bread and more cruciferous vegetables. Has done wonders for my bowel movements. Using coconut oil now to cook as well. trying to cut out as much as possible sugary foods as well as artificial sweeteners. Trying to stick to slightly flavoured water.

No I don't take statins.

I'll post my Thyroid result next week when I get them.

many thanks for the links.

 

[Nelson Vergel]

Paul

Good to know about your immune system and no statins. Your medication regimen is actually one of the most metabolic friendly ones out there, so good for you. I think with hormone balance, Metformin, a good diet and exercise you will be in shape soon as those pounds start shedding off (which will also normalize your glucose, blood pressure and insulin resistance).

 

[Nelson Vergel]

More good news on Metformin:

Metformin aids in the stabilization of metastatic prostate cancer
Higher dose metformin associated with improved survival among colorectal cancer patients

 

[Nelson Vergel]

Metformin plays role in reducing MI, heart failure risk



“We don't know how metformin works, but I would speculate that suppression of appetite and promotion of weight loss may play a role,” John M. Miles, MD,professor of medicine at the University of Kansas in Kansas City, said during a presentation at the AACE 24th Annual Scientific & Clinical Congress.

According to Miles, metformin's role in reducing MI was established in the original United Kingdom Prospective Diabetes Study, which found a nearly one-third reduction in MI in patients assigned metformin compared with a nonsignificant reduction among those assigned insulin plus a sulfonylurea.

In the 20-year follow-up study, the two groups saw a nearly identical effect on HbA1c, but the insulin plus sulfonylurea group showed a 15% reduction in MI while the metformin group had a “statinesque” 39% event reduction, Miles said.

“What was dramatically different [between the study groups] was body weight, which was greater than control in the sulfonylurea-insulin group, but not greater than control in the metformin group,” Miles said. “Modest intentional weight loss of just a few pounds is associated with longer life in people with type 2 diabetes.”

Miles cited studies showing an association between metformin use and lower risk for heart failure as well. In contrast, other studies suggested an increased risk for heart failure and elevated blood pressure with insulin use.

“If your patient gains 7 kg or 8 kg, should you be surprised that their BP might go up?” he asked.

Miles also said metformin use could safely be expanded to patients with stage 3 kidney disease. Evidence of the drug's safety in patients with estimated glomerular filtration rates between 30 mL/min/1.73 m2 and 59 mL/min/1.73 m2 comes primarily from retrospective and observational studies, according to Miles. At least one of these showed lower rates of infection, acidosis and all-cause mortality among patients assigned metformin than compared with those not assigned metformin, he said.
In addition, many patients with stage 3 kidney disease are already assigned metformin because their creatinine levels are not in the range that would disqualify them from receiving the medication, according to Miles.

“I would argue that metformin is substantially safe in patients with CKD stage 3, but we need a way to prescribe it with confidence. &#8230; We need more pharmacokinetic data in patients with eGFRs between 30 [mL/min/1.73 m2] and 59 [mL/min/1.73 m2],” Miles said. “One of the intriguing possibilities &#8230; is that metformin is not only clearly safe in patients with heart failure, but may actually benefit heart failure. We don't know why, but maybe a reduction in sympathetic activity is a factor.” &#8211; by Jill Rollet

Reference:
Miles JM. Oral presentation SGS3. Presented at: AACE 24th Annual Scientific & Clinical Congress; May 13-17, 2015; Nashville, T

http://www.healio.com/endocrinology..._medium=email&utm_campaign=endocrinology+news

 

[Juan Valdez]

What's the ideal way (assuming there's an ideal way) to take Metformin for weight loss? I've posted my weight, height, and blood numbers in other posts. I'm now taking 1000 mg 2 x day. I've been told to take it on an empty stomach first thing in the am and before bed. I'm assuming that's because it causes appetite suppression. I've also read people take it with each meal. I find if I take it first thing in the am, I have no desire to eat at all, but then later in the day, I get overly hungry as my body tries to catch up. I know I should be eating a large breakfast, a decent size lunch and a small dinner. Any thoughts on how best to do it while trying to lose a lot of weight?

 

[Vince]

What's the ideal way (assuming there's an ideal way) to take Metformin for weight loss? I've posted my weight, height, and blood numbers in other posts. I'm now taking 1000 mg 2 x day. I've been told to take it on an empty stomach first thing in the am and before bed. I'm assuming that's because it causes appetite suppression. I've also read people take it with each meal. I find if I take it first thing in the am, I have no desire to eat at all, but then later in the day, I get overly hungry as my body tries to catch up. I know I should be eating a large breakfast, a decent size lunch and a small dinner. Any thoughts on how best to do it while trying to lose a lot of weight?

I take 750 mg of metformin twice a day and was told to take it after a meal, but was also told I could take it all at once and it was not necessary to split the dose.

 

[Tommy Wall]

I been taking 2x500mg for years and regret to say that I haven´t lost one gram so far. I believe it has a lots of other benefits if one is pre or diabetic but for loosing weight "nope".

 

[Juan Valdez]

Does it make sense to take Metformin 3 x's a day? I have a prescription for 500 mg. I have been taking 1000 in the evening and 1000 in the morning for my cardio days and 500 mg on the days I do weights. I've been told that taking Metformin the night before and in the morning before cardio is the best way to lose weight in a low insulin, fasted state.

I'm wondering if I should just take 500 mg morning, noon, and night? Any thoughts or does it not matter.

 

[Vince]

I believe the best time to take Metformin is after your evening meal, but I take metformin twice a day. I guess it's best not to overthink it.