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Health & Wellness
Metformin Blocks Benefits of Aerobic Exercise on Insulin Sensitivity and VO2 max
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<blockquote data-quote="dnfuss" data-source="post: 146972" data-attributes="member: 15487"><p>Let's start with the fact that the mechanisms of action of metformin are only grossly understood, more deduction from results than fully mapped-out biochemistry. When anyone, including the NIH, makes statements regarding such they must be taken as likely hypotheses rather than gospel.</p><p></p><p>But putting that aside, you can both be correct in certain aspects of your statements without the need for any ad hominem arguments.</p><p></p><p>DragonBits,</p><p>Metformin does reduce the <u>rate</u> of glucose absorption in the intestine. That is not exactly the same as <u>blocking</u> carbohydrate digestion, which is the mechanism of action of other oral agents, such as Acarbose. And even so, the effect is fairly weak. Diabetics on metformin who continue on a Standard American Diet will see at best quite modest reductions in postprandial and fasting serum glucose, and almost inevitably not down to the level of truly normal blood sugars. If a change is made to a very low-carbohydrate diet together with metformin, normal blood sugars <u>may</u> be achieved if the diabetes is mild enough.</p><p></p><p>Kudos to you for your statement to the effect that those with naturally truly normal lifetime blood sugars (my extremely rough guess would be somewhere between 40% and 65% of the adult population, but that's just pure speculation) can pretty much eat any diet and pursue any exercise plan (or none at all) with no adverse effect on blood sugars. They will never develop diabetes (or pre-diabetes). Those of us who are not as fortunate are well-advised to monitor our blood sugars and do whatever is necessary (and fasting is usually not helpful in this regard) to maintain truly normal blood sugars despite our genetic proclivity to the contrary. Even so-called pre-diabetes (i.e., mild diabetes) over the years demonstrably increases morbidity and mortality. E.g., pre-diabetics experience serious cardiovascular events at significantly higher rates than do those with truly normal blood sugars.</p><p></p><p>Tad1979,</p><p>The etiology of type 2 diabetes mellitus is quite complicated to say the least. While many, maybe the majority of, type 2 diabetics are quite insulin resistant, many are not. They may simply have, e.g., insufficient first phase insulin response. That leads to very high post-prandial blood sugars while still retaining normal or near-normal fasting glucose (this is in fact how a great many type 2 diabetics remain undiagnosed for many years). And sometimes the body tries to compensate for this with an overly-robust second-phase insulin response (which in those with truly normal blood sugars is a very mild fine-tuning of blood sugars following a robust first-phase insulin response). This is generally the pattern leading to reactive hypoglycemia. It is very commonly, although not always, associated with the early stages of diabetes. It can be controlled, like all diabetes, with the proper therapy. Begin with a low-carbohydrate diet and exercise, if insufficent add oral agents as indicated, if still insufficient add the correct regime of injected insulin.</p><p></p><p>You are quite correct that the most dramatic perceived result of metformin therapy appears to be better glucose uptake/less hepatic and muscular insulin resistance. However, I must take issue with the thought that type 2 diabetes inevitably worsens and requires ever-increasing amounts of insulin. This is only true if one follows the recommendations of the ADA, eating a high-carbohydrate diet and allowing blood sugars to remain at constantly elevated levels. And insulin, used properly, certainly does not worsen diabetes, but can actually help preserve beta cell function. Diabetics (including Type 1s) who follow the practices laid out in the last sentence of the previous paragraph and constantly maintain truly normal blood sugars can expect to live full life-spans and maintain a consistent insulin dosage through their lives (and occasionally even reduce their dosage under the right conditions).</p></blockquote><p></p>
[QUOTE="dnfuss, post: 146972, member: 15487"] Let's start with the fact that the mechanisms of action of metformin are only grossly understood, more deduction from results than fully mapped-out biochemistry. When anyone, including the NIH, makes statements regarding such they must be taken as likely hypotheses rather than gospel. But putting that aside, you can both be correct in certain aspects of your statements without the need for any ad hominem arguments. DragonBits, Metformin does reduce the [U]rate[/U] of glucose absorption in the intestine. That is not exactly the same as [U]blocking[/U] carbohydrate digestion, which is the mechanism of action of other oral agents, such as Acarbose. And even so, the effect is fairly weak. Diabetics on metformin who continue on a Standard American Diet will see at best quite modest reductions in postprandial and fasting serum glucose, and almost inevitably not down to the level of truly normal blood sugars. If a change is made to a very low-carbohydrate diet together with metformin, normal blood sugars [U]may[/U] be achieved if the diabetes is mild enough. Kudos to you for your statement to the effect that those with naturally truly normal lifetime blood sugars (my extremely rough guess would be somewhere between 40% and 65% of the adult population, but that's just pure speculation) can pretty much eat any diet and pursue any exercise plan (or none at all) with no adverse effect on blood sugars. They will never develop diabetes (or pre-diabetes). Those of us who are not as fortunate are well-advised to monitor our blood sugars and do whatever is necessary (and fasting is usually not helpful in this regard) to maintain truly normal blood sugars despite our genetic proclivity to the contrary. Even so-called pre-diabetes (i.e., mild diabetes) over the years demonstrably increases morbidity and mortality. E.g., pre-diabetics experience serious cardiovascular events at significantly higher rates than do those with truly normal blood sugars. Tad1979, The etiology of type 2 diabetes mellitus is quite complicated to say the least. While many, maybe the majority of, type 2 diabetics are quite insulin resistant, many are not. They may simply have, e.g., insufficient first phase insulin response. That leads to very high post-prandial blood sugars while still retaining normal or near-normal fasting glucose (this is in fact how a great many type 2 diabetics remain undiagnosed for many years). And sometimes the body tries to compensate for this with an overly-robust second-phase insulin response (which in those with truly normal blood sugars is a very mild fine-tuning of blood sugars following a robust first-phase insulin response). This is generally the pattern leading to reactive hypoglycemia. It is very commonly, although not always, associated with the early stages of diabetes. It can be controlled, like all diabetes, with the proper therapy. Begin with a low-carbohydrate diet and exercise, if insufficent add oral agents as indicated, if still insufficient add the correct regime of injected insulin. You are quite correct that the most dramatic perceived result of metformin therapy appears to be better glucose uptake/less hepatic and muscular insulin resistance. However, I must take issue with the thought that type 2 diabetes inevitably worsens and requires ever-increasing amounts of insulin. This is only true if one follows the recommendations of the ADA, eating a high-carbohydrate diet and allowing blood sugars to remain at constantly elevated levels. And insulin, used properly, certainly does not worsen diabetes, but can actually help preserve beta cell function. Diabetics (including Type 1s) who follow the practices laid out in the last sentence of the previous paragraph and constantly maintain truly normal blood sugars can expect to live full life-spans and maintain a consistent insulin dosage through their lives (and occasionally even reduce their dosage under the right conditions). [/QUOTE]
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Metformin Blocks Benefits of Aerobic Exercise on Insulin Sensitivity and VO2 max
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