Dr Jason Fung on T2 Diabetes and Drugs

[AloeSvea]

http://www.medscape.com/viewarticle/724468

http://care.diabetesjournals.org/content/25/12/2244

http://www.lifeextension.com/magazine/2001/9/report_metformin/Page-01

https://www.ncbi.nlm.nih.gov/pubmed/21205121/

There are more articles covering this topic in Dr Google

Alas, none of these articles and research papers say taking metformin lowers too-early-death from T2D. But it does a great job of lessening severity of 'complications'.

@Oldvatr ,Medscape won't let me read their articles - they want me to pay! Darn it. Could you post the conclusion or key statemeents of that article?

Anyway -

This from care.journals seems to be a comparison statement, ie metformin does better than sulfonylureas in combo or not (which Dr Fung also talks about in his speechs and blog rather a lot too).

From life extension magazine, they say the usual benefits of metformin (which ARE good - don't get me wrong), and this is their conclusion

And this from pubmed - "possible benefit" is NOT reduced mortality (I prefer to say too-early-death as we are all going to die, but I can be a bit... nit picky)

 

[Oldvatr]

Should the doctor warn you of the risk of getting killed in a car accident while going it to have a set of blood tests done? Where do you want the line to be drawn?

Is it not our duty to read the information leaflet that comes with all meds to find out about these small risks?

My GP uses the British National Formulary to find out which meds are contra-indicated and what warnings are in place. The BNF is often missing the latest alerts such as exist for Forxiga, for example. The pharmacist uses this same learned tome, so having found a new contraindication on some of my other meds, I have had great arguments with said pharmacist since what I was saying was not covered by the BNF, so ERGO the patient is mistaken. NOT!!!!!!!

For example, my PPI med was interfering with my diabetic meds and my iron absorbtion, This is not mentioned in the BNF but is mentioned in my iron supplement literature leaflet. So I moved my time of taking it clear of when I took my main meds, I was chastised for this since the PPI is shown as needing to be taken with meals, but it is not in the manufacturers literature, but is in the BNF,

There are so many instances where I have found the BNF to be lacking, especially where med alerts are in place from ADA or FDA in the US, but where our authorities chose to ignore these. So, every so often I run my scrip against the FDA and ADA databases just to be sure.

I knew that Actos and Avandia had a high risk of CVE long before they were banned (although in UK Actos is still prescribed provided you have not already had a CVE. My GP insisted I take Avandamet for a long time, which stopped when i had my second stroke. I cannot prove the med caused my events.

GP's do not have time to research all their info from independant sources, so they rely on the BNF being the Absolute TRUTH. My GP now respects my decisons regarding my medication, and we no longer disagree. The pharmacist is another matter.

Whilst it may be a good idea for us all to at least double check these matters for ourselves, the problem lies with the editors of the BNF, not the GP. It also lies with NICE, who do not take notice of the FDA warnings and pass them on.

 

[Oldvatr]

Alas, none of these articles and research papers say taking metformin lowers too-early-death from T2D. But it does a great job of lessening severity of 'complications'.

@Oldvatr ,Medscape won't let me read their articles - they want me to pay! Darn it. Could you post the conclusion or key statemeents of that article?

Anyway -

This from care.journals seems to be a comparison statement, ie metformin does better than sulfonylureas in combo or not (which Dr Fung also talks about in his speechs and blog rather a lot too).

View attachment 23333

From life extension magazine, they say the usual benefits of metformin (which ARE good - don't get me wrong), and this is their conclusion

View attachment 23334
And this from pubmed - "possible benefit" is NOT reduced mortality (I prefer to say too-early-death as we are all going to die, but I can be a bit... nit picky)

View attachment 23335

Extract from Medscape article
"
July 1, 2010 (Orlando, Florida) — In patients with diabetes and documented atherothrombosis, the use of metformin was associated with a significant 24% reduction in all-cause mortality after two years of follow-up, according to a subgroup analysis from a large registry study presented here at the American Diabetes Association (ADA) 2010 Scientific Sessions.

Even patients thought to have contraindications to metformin, such as those with moderate renal failure, congestive heart failure, or advanced age up to 80 years, showed benefit, said Dr Ronan Roussel (Hôpital Bichat, Paris, France).

The results are from the Reduction of Atherothrombosis for Continued Health (REACH) registry, a worldwide registry designed to determine which patients are at high risk for cardiovascular disease from a population of more than 67 000 patients from 5473 sites in 44 countries.
"

 

[Oldvatr]

Extract from Medscape article
"
July 1, 2010 (Orlando, Florida) — In patients with diabetes and documented atherothrombosis, the use of metformin was associated with a significant 24% reduction in all-cause mortality after two years of follow-up, according to a subgroup analysis from a large registry study presented here at the American Diabetes Association (ADA) 2010 Scientific Sessions.

Even patients thought to have contraindications to metformin, such as those with moderate renal failure, congestive heart failure, or advanced age up to 80 years, showed benefit, said Dr Ronan Roussel (Hôpital Bichat, Paris, France).

The results are from the Reduction of Atherothrombosis for Continued Health (REACH) registry, a worldwide registry designed to determine which patients are at high risk for cardiovascular disease from a population of more than 67 000 patients from 5473 sites in 44 countries.
"

@AloeSvea I re-read your posting, and you seem to be seeking assurance of a reduction of death due to T2D presumably on its own. Now experience seems to show that it is the complications such as CVE and CHF that are the main causes of premature death, with liver or kidney failure as a close second, and not high bgl levels. So I re-iterate, that the studies show reductions of all cause mortality, and there seems to be no specific studies on death by sugar alone.

 

[AloeSvea]

Hey, but I DID find this on Dr Fung's Intensive Dietary Management. Yay for metformin!

 

[AloeSvea]

@AloeSvea I re-read your posting, and you seem to be seeking assurance of a reduction of death due to T2D presumably on its own. Now experience seems to show that it is the complications such as CVE and CHF that are the main causes of premature death, with liver or kidney failure as a close second, and not high bgl levels. So I re-iterate, that the studies show reductions of all cause mortality, and there seems to be no specific studies on death by sugar alone.

Not seeking assurances! (I have gone drug free all the way.) (And actually, I personally have accepted the 10 years off my lifespan otherwise. I am VERY happy to have that 10 years off thing proved wrong.) Just reading closely to see if they say taking such and such a drug reduces your chance of dying too early from T2D. Just a reading matter.

 

[bulkbiker]

Not seeking assurances! (I have gone drug free all the way.) (And actually, I personally have accepted the 10 years off my lifespan otherwise. I am VERY happy to have that 10 years off thing proved wrong.) Just reading closely to see if they say taking such and such a drug reduces your chance of dying too early from T2D. Just a reading matter.

I think that the problem with all the studies is that they look at Type 2's who eat either an Eatwell plate or standard western diet and take medication. So no-one knows really whether eating LCHF with good sugar control is going to do anything to our lifespan. I would guess that we'll be with the regular population but depending on how much damage has been done before diagnosis we may have a slightly shorter span. One thing we all know is life is terminal...

 

[Art Of Flowers]

Hey, but I DID find this on Dr Fung's Intensive Dietary Management. Yay for metformin!

View attachment 23336

Metformin reduces A1C from 8% to 7.4% which is the equivalent to a blood glucose drop from 10 to 9. This is way higher than the results through LCHF diet and intermediate fasting where blood sugars in the range 5-7 are achievable within a few months.

I suspect there are two factors at work here. One is disease caused by high blood sugars and the other is disease related to being obese. Obesity seems to be a higher risk than elevated blood sugars. It appears that Metformin is better for all cause mortality than insulin and SUs because it allows type 2 patients to better control their weight, despite being less effective in lowering blood sugars. High insulin can cause increased obesity as insulin turns glucose in the blood to fat.

A LCHF diet allows the body to burn off fat using ketosis. This can be accelerated by intermittent fasting. The result is lower blood sugars and less obesity which reduces both risk factors and should dramatically improve life expectancy for type 2 suffers. If people really want to increase their life expectancy, then they should consider the benefits of intermittent fasting. See ..

 

[ringi]

I expect the main factor with Metformin is disease related to raised levels of Insulin, as Metformin reduces how much Insulin (make in our bodies or injected) is needed to control BG for any given carb intake.

(Easting low carbs also reduce insulin levels, so does intermittent fasting.)

The research is starting to show that in Insulin Resistance Type 2 (Unlike Type1) BG levels are not a good predicted of life time outcomes. Some drugs that lower BG levels but have now been shown to increase lifetime risks have been taken off the market. For a long time drugs have been developed to make doctors feel better about the numbers on their computers, with no benefit to long term health – this is starting to change.

 

[Robkww]

I think that the problem with all the studies is that they look at Type 2's who eat either an Eatwell plate or standard western diet and take medication. So no-one knows really whether eating LCHF with good sugar control is going to do anything to our lifespan. I would guess that we'll be with the regular population but depending on how much damage has been done before diagnosis we may have a slightly shorter span. One thing we all know is life is terminal...

What! Terminal! .....Blast....

 

[ringi]

Studies to be useful to GPs have to look at the results of GP actions, e.g. if a GP gives half the people a bit of paper with the name of a drug on, and the other half a booklet on LCHF would will be the result? (It is not valid to just include people who do what the booklet says, likewise you can't exclude people who don't take the tablet for some reasons.)

 

[CherryAA]

Hey, but I DID find this on Dr Fung's Intensive Dietary Management. Yay for metformin!

View attachment 23336

My own hba1C reduced from 10.3% to 5.5% using LCHF.. I haven't read anything that actually states that metformin is " good for you " in preference to not taking it in those circumstances . For it to be so, then there must be an action that metformin does other than actually reducing Hba1C and insulin resistance- to a GREATER extent than simply not eating carbs does.

If anyone does have a reference for that I would be very interested to see it.

meanwhile Dr Fung has now posted another article explaining which diabetes drugs do " work" . In all instances that seems to be by driving out sugars from the body , or not allowing carbs in.

https://medium.com/@drjasonfung/medications-that-actually-help-with-type-2-diabetes-98839b815dde

Interesting stuff.

 

[Oldvatr]

My own hba1C reduced from 10.3% to 5.5% using LCHF.. I haven't read anything that actually states that metformin is " good for you " in preference to not taking it in those circumstances . For it to be so, then there must be an action that metformin does other than actually reducing Hba1C and insulin resistance- to a GREATER extent than simply not eating carbs does.

If anyone does have a reference for that I would be very interested to see it.

meanwhile Dr Fung has now posted another article explaining which diabetes drugs do " work" . In all instances that seems to be by driving out sugars from the body , or not allowing carbs in.

https://medium.com/@drjasonfung/medications-that-actually-help-with-type-2-diabetes-98839b815dde

Interesting stuff.

Seems sensible, makes sense to me,

 

[ringi]

My own hba1C reduced from 10.3% to 5.5% using LCHF.. I haven't read anything that actually states that metformin is " good for you " in preference to not taking it in those circumstances .

Remember that protein also results in a increase in insulin, and it is the insulin level that results on a lot of the hart/stroke risks. So if metformin reduces this, it could still be of benefit on LCHF.

It is a real shame the NHS does not test for fasting insulin levels as part of the normal diabetes review blood tests. Therefore no one has the data to track the effect of insulin resistance etc.

As no one makes much money from selling metformin, there is no funding to do large scale trails to find out if it would benefit people with insulin resistance who have not yet become diabetic.

 

[dbr10]

I know my doctor does the Kidney function blood test every year anyway and they show no issue, hence I don't think there is a real risk to my Kidney from Metformin. But I think everyone on Metformin should have a full set of bloods done each year.

I think they've decided now that there is little risk to kidney function unless you have CKD when the metformin can't be got rid of.

 

[JohnEGreen]

I have lowered kidney function but as I have said before my GP informed me that metformin is a risk at the higher doses but at 500mg a day that risk if very low.

 

[AloeSvea]

My own hba1C reduced from 10.3% to 5.5% using LCHF.. I haven't read anything that actually states that metformin is " good for you " in preference to not taking it in those circumstances . For it to be so, then there must be an action that metformin does other than actually reducing Hba1C and insulin resistance- to a GREATER extent than simply not eating carbs does.

If anyone does have a reference for that I would be very interested to see it.

meanwhile Dr Fung has now posted another article explaining which diabetes drugs do " work" . In all instances that seems to be by driving out sugars from the body , or not allowing carbs in.

https://medium.com/@drjasonfung/medications-that-actually-help-with-type-2-diabetes-98839b815dde

Interesting stuff.

Yes I too lowered my BG levels hugely by changing diet only, and upping activity. (From 93 at diagnosis to 40-45 range.) (You folks that use that percentage thing - argh! 10 point something to 5.8-6.3.) I didn't know about LCHF until I had been going moderate to low carb for eight months or so, and then, yes, I have never looked back since, due to really liking this way of eating.

I chose not to take medications, mainly so I can see how my body is responding to the diet and exercise, and leaving the way clear to experiment with different inputs and outputs, as it were. And I am not inclined towards medication use when the non-medication looks as good or better for me. (or ever really, I must be honest.) So, yes, I agree with you wholeheartedly.

But, for those who want the immediate benefit of - it's switching off the liver 'on' switch isn't it? That metformin does. For producing/secreting our body's own glucose? Metformin clearly seems to be a good choice, with a long track record of safety.

My understanding is that is a definite treating the symptom method though - not the liver actually getting better, operating normally. And the reason for taking it (thinking of Jenny Ruhl's extensive discussion of the matter) is to lessen the severity or occurrence of those dreaded 'complications'. I know Ruhl is convinced that it is worth it. Or she was when I was reading her a lot a couple of years ago.

I have always been curious at the amount of non-diabetics I meet or know and love in my life, who believe that taking this medication is THE treatment for insulin resistant T2D - NOT diet and exercise. When I say - quite a few - I mean quite a few folks! (Oh yeah - including many doctors and specialists lol.) "My friend, she just takes a pill" (which I am assuming is metformin) "and she eats whatever she wants. I don't think there is any problem." "They can treat that with a pill now, can't they?" (Oh - dear old Dad!) They then look at me like I am a quack or very eccentric for all these food restrictions (which is how they see it - I don't! Unless it's Christmas.) - especially when all I need to do is pop a pill and it's all good! Grrrrrrrr.

I do like Dr Fung's way of talking about this - that it makes the most sense to treat a dietary disease with diet - which does say rather often, even when he is really interested in a good safe medication that gets rid of excess glucose in the body, as well as the blood (which is when it will save lives big time).

As far as I know, when I was researching this topic back in 2014 and 2015, the research seemed to indicate that nothing compares with lowering carbs (ie 'diet') and upping the exercise (the latter if you have that kind of body type). And now intermittent fasting is added to that list. In terms of improved health and lessened mortality outcomes. But that may have changed now? I don't know.

 

[CherryAA]

Yes I too lowered my BG levels hugely by changing diet only, and upping activity. (From 93 at diagnosis to 40-45 range.) (You folks that use that percentage thing - argh! 10 point something to 5.8-6.3.) I didn't know about LCHF until I had been going moderate to low carb for eight months or so, and then, yes, I have never looked back since, due to really liking this way of eating.

I chose not to take medications, mainly so I can see how my body is responding to the diet and exercise, and leaving the way clear to experiment with different inputs and outputs, as it were. And I am not inclined towards medication use when the non-medication looks as good or better for me. (or ever really, I must be honest.) So, yes, I agree with you wholeheartedly.

But, for those who want the immediate benefit of - it's switching off the liver 'on' switch isn't it? That metformin does. For producing/secreting our body's own glucose? Metformin clearly seems to be a good choice, with a long track record of safety.

My understanding is that is a definite treating the symptom method though - not the liver actually getting better, operating normally. And the reason for taking it (thinking of Jenny Ruhl's extensive discussion of the matter) is to lessen the severity or occurrence of those dreaded 'complications'. I know Ruhl is convinced that it is worth it. Or she was when I was reading her a lot a couple of years ago.

I have always been curious at the amount of non-diabetics I meet or know and love in my life, who believe that taking this medication is THE treatment for insulin resistant T2D - NOT diet and exercise. When I say - quite a few - I mean quite a few folks! (Oh yeah - including many doctors and specialists lol.) "My friend, she just takes a pill" (which I am assuming is metformin) "and she eats whatever she wants. I don't think there is any problem." "They can treat that with a pill now, can't they?" (Oh - dear old Dad!) They then look at me like I am a quack or very eccentric for all these food restrictions (which is how they see it - I don't! Unless it's Christmas.) - especially when all I need to do is pop a pill and it's all good! Grrrrrrrr.

I do like Dr Fung's way of talking about this - that it makes the most sense to treat a dietary disease with diet - which does say rather often, even when he is really interested in a good safe medication that gets rid of excess glucose in the body, as well as the blood (which is when it will save lives big time).

As far as I know, when I was researching this topic back in 2014 and 2015, the research seemed to indicate that nothing compares with lowering carbs (ie 'diet') and upping the exercise (the latter if you have that kind of body type). And now intermittent fasting is added to that list. In terms of improved health and lessened mortality outcomes. But that may have changed now? I don't know.

I just posted a 24 hour graph of blood sugars following a three day fast - brought on by re watching some of Dr Fung's stuff because of this thread . here :
http://www.diabetes.co.uk/forum/threads/ivor-cummins.123932/page-3#post-1516743

I'm sold !

 

[AloeSvea]

I just posted a 24 hour graph of blood sugars following a three day fast - brought on by re watching some of Dr Fung's stuff because of this thread . here :
http://www.diabetes.co.uk/forum/threads/ivor-cummins.123932/page-3#post-1516743

I'm sold !

For sure!

The joke in my household is I too can achieve normal blood glucose levels, like my healthy un BG-dysregulated loved ones. The only thing is - all I have to do is not eat! hohoho.

It IS neat to have healthy normal blood glucose readings whilst fasting, absolutely.

My trouble is my signalling must still be way off, therefore my liver and pancreas are still way off, as I pour out heaps of glucose from my liver when I am back eating, even LCHF, as demonstrated in a highish FBG, regardless of how long I can fast for. (The longest I have gone is 10 days.) (My partner begs me not to do it again.) (He also doesn't want me to low-cal again, but then that doesn't leave me much more to experiment with, lol.) Otherwise I would have been able to 'reverse' (or whatever you want to call it), and I have not been able to. I stay at a stable level of impairment. (FYI, that level of drop to impairment is still considered a success according to Prof Taylor's way of defining success, and Dr Fung gives folk like me 'special mention' too. ie can drop from fullblown T2D to 'merely' prediabetic levels. I find it hard to feel it though, although my Dr and loved ones do.)

I know Dr Fung says you just keep on going - get all that glycogen out, the fat stores off of your ailing organs out, with fasting. And I'm sure he is right! (Or - I am pretty sure he is.) Ditto Prof Taylor with the personal fat threshold. The trouble is, and anyone who has read me in here when I have been doing experiments of that nature, in my attempt to get better with T2D, is - it can be way easier said than done. For me, it's about trying to find the least painful of a bunch of painful treatment methods which all involve some level of semi-starvation. Please know - I do know that periods of semi starvation are healthy for the human/mammal bod! I really do. I just suffer. It's hard to leap up in the morning with joy when you know you have to endure being hungry. And then, as I have found, I regain any weight lost during the fasting period (or the semi starvation period on a low-cal regime.) Please note - I absolutely agree that fasting gets easier with time. Just not as easy for me as watching it was for Prof Taylor, nor Dr Fung finds his own IFing routine, alas.

It may be that I am too impatient, and want big results big time fast. And that keeping up the IFing over a much longer period of time will give that - but without being able to lose another 10kg - bigger feat still - and be able to keep it off - I can't see that IFing will get me down to non-diabetic levels.

I can understand why some folks go with the medication to have normal BG levels! Psychologically it must be very satisfying. (And health wise? If it does cut down on the severity and occurrence of complications.) I am pretty sure if I took metformin, I would really delight my Dr with normal BG levels, as I know my T2D so well. But, unlike my Dr, I know it is just dealing with the symptom - my higher BG levels - it would not indicate my body is sorting the regulation out properly itself. More is the pity. (So is my understanding at any rate.)

 

[Art Of Flowers]

Dear Art,

Glad you caught your diabetes a year ago and are able to follow and be monitored for intermittent fasting. That is not the case for all of us. And I personally am loathe to give up Metformin's anticancer properties, even though perhaps not totally proven. Also, as a normal weight person, don't know how much fasting I would be willing to ever do

Intermittent fasting can be as simple as just skipping breakfast and eating within a six hour window (18:6 fasting). Some people are TOFI - Thin Outside Fat Inside which means they have high visceral fat despite appearing to be thin. Fasting does improve health and dramatically improves life expectancy, even for people who are not overweight.

Fasting allows the body to repair itself through a process called autophagy. Experiments with mice have shown repaired brain cells from fasting and mice fed every other day lived 40% longer than those fed every day. If you google Metformin and memory loss you will see there is some evidence that Metformin can be responsible for impaired cognitive function. Metformin can also result in neuropathy via B12 deficiency. I found Metformin caused pins and needle sensations in my hands and short term memory loss. This is why I started taking Alpha Lipoic Acid. I have now stopped taking Metformin.