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Not sure I agree

Oldvatr

Expert
Messages
8,453
Type of diabetes
Type 2
Treatment type
Tablets (oral)
This presentation by Ben Bikman was informative

But there are a couple of things I do not agree with.

Firstly Bikman covers medications and their effect on insulin Resistance. When discussing Metformin, Bikman spends a moment or three to demonise Metformin as poisoning muscle cells but no mention of its relationship to IR, Now for a start one of the acredited effects of Metformin is reduction of IR, albeit the contribution is small. The only other diabetes drug that also acts to reduce IR is Actos, which he omits to mention. Actos is still prescribed in the UK.

Now when it comes to the poisoning allegations, Bikman points the finger at Metformin. Now muscle wastage is a known and documented side effect of diabetes and affects both T1D and T2D alike. Some, but not all, T1D get prescribed Metformin. so it is possible that general muscle wastage could be due to the med, but there has not been any study that has established a link. The generally accepted theory for it is muscle scavenging by gluconeogenesis, which has been studied in great detail and is one of the reasons why LCHF has increased fat.

The other evidence I have seen in my research is that Metformin is actually being used to delay the onset of Motor Neurone Disease (MND) and it seems to help preserve muscle mass.

There is another study that shows age related differences. Older patients are being given Metformin while recovering from surgery and trauma, because it protects against inactivity wastage. So bedbound patients seem to benefit and recover more spedily from prolonged bed rest. Another study was done specifically on bedrest patients and confirmed this benefit not just in elderly but general patients..

So it seems possible that younger athletically fit people may lose muscle tissue and notice it but I would hesitate to declare it as an effect for all.

The other gripe I have with the Bikman treatise on IR and hyperinsulinemia is that he does not mention fasting as a valid tool in the armoury. also he does not consider the effects of OMAD and 2MAD in reducing IR, but he does include snacking between meals. a glaring omission IMO.

So I have to take Bickman with a pinch of salt. I felt there was a certain bias in the presentation he gave, and although it fits my echo chamber, I come away from it saying Yeah But....

This is not the first or only time I have had this effect from one of his videos. Maybe his books are better.
 
Interesting,

because along with some of the very dodgy “advice” I’ve seen given to non D bodybuilders regarding insulin use..
Metformin is also suggested as muscle mass aid? (On these I’ll advised topics.)
 
Jaylee said:
Interesting,

because along with some of the very dodgy “advice” I’ve seen given to non D bodybuilders regarding insulin use..
Metformin is also suggested as muscle mass aid? (On these I’ll advised topics.)
Click to expand...
looking at other reseach into MND it seems that Metformin does not act to preserve muscle mass, but it reduces the associated toxic proteins casued by the disease. and which congregate in the brain. so it is not protecting against muscle scavenging as I had first interpreted in an article. apologies for misinformation.. I had read proteins, and assumed muscle protein, but it is blood borne protein they were talking about.
 
OK. finally identified the poison that Bikman is talking about. It is Lactate, which is a known bi product of gluconeogenesis. Metformin does increase the level of lactate, but it only becomes a problem where the kidneys are failing since lactate is normally excreted in urine. So I do accept what Bikman was saying, but I am surprised he dwelt on it so heavily. Lacticacidosis is rare. and does not appear to be related to hyperinsulinemia or IR so he seems to be off topic here.
 
Other causes of lactic acidosis other than Metformin are
AIDS, alcoholism, cancer, cirrhosis, cyanide toxicity, kidney failure, respiritory failure (especially pneumonia), and sepsis infection.

So, a collecion of unwanted bed fellows. But one must assume that being on ,Metformin increases the risk of one of these killing you. Moral - don't drink alcohol when taking Metformin.

Note: fasting acidosis and starvation acidosis are classed as different forms from the above, although they too increase lactic acid levels, but also have high ketone levels so are more similar to DKA.
 
I thought that lactate was also a by product of strenuous exercise?
 
LittleGreyCat said:
I thought that lactate was also a by product of strenuous exercise?
Click to expand...

Biochemistry of exercise-induced metabolic acidosis - PubMed

The development of acidosis during intense exercise has traditionally been explained by the increased production of lactic acid, causing the release of a proton and the formation of the acid salt sodium lactate. On the basis of this explanation, if the rate of lactate production is high enough...
pubmed.ncbi.nlm.nih.gov
Seems not to the level of acidosis. My comment was regarding acidosis. Not sure if exercise + Metformin does, but exercise alone it seems not.
 
Playing devil's advocate.

Prof Bikman's seminar was aimed at people who don't have a science or biology degree, or anything near. The pitch of his lecture was dumbed down for the general population i.e. people like me. I've seen a video where he was talking to experts and students in his field, of course I could hardly understand his words, they went straight over my head.

He had a lot to squeeze into his hour on the spot. I too was rather disappointed he didn't expand more into the realms of fasting, but he did slightly touch on it when he mentioned that snacking keeps insulin production high. We're not meant to have nice regimented mealtimes.

As for Metformin, at the start of my T2 journey I had a decision to make, of which I was grateful I even had a choice, do I go down the drug pathway or the diet one to control my diabetes? I thought he was trying to get across that such decisions needed a balance and not one erring on what 'big pharma' thinks we should do. He's clearly not a fan of 'big pharma' from his stance on statins.

Metformin may be a wonderful drug, and can help many people in all sorts of ways, but I don't think it should be prescribed in the first instance of being diagnosed T2, and that's what I think Bikman was trying to get at in the short time he had.
 
Indeed. His comments on Metformin are out of place and off topic, and represent a bias, I am also anti Big Pharma myself. But there is a place for it, as there is a place for Metformin in the tool box we can use to control the Betes beast. Metformin is one of the safest drugs available for diabetes treatment, so demonising it as a poison is not helpful. As has been pointed out just now, exercise also produces lactate so if we say no to Metformin shouldn't we also say goodbye to exercise. I for one am already there as I have stopped both, but thats my journey.

The venue for the talk looks suspiciously like a lecture theatre, like as in University or Med school, and I suspect the audience may be fairly well clued up - they look like students, not general public. The query at the end is certainly not from a novice.

getting back to beginners meds, when I was diagnosed, the NICE guidelines started with
Step 1:= Lifestyle and diet changes
Step 2:= Metformin
Step 3:= insulin

end of. No choice. so maybe we have progressed,from that but maybe we went too heavy on the medication? Yep, and today we see weight loss miracle drugs, and drugs to make you puke but get good glucose readings on the way. We get statins that are a pain in the.proverbial but lower some marker that doctors like to keep low. When the profit from one drug alone pays off the deficit of the budget.of a whole country (Denmark) then yes, we should query whether Big Pharma is actually doing us a favour. But not in a talk about hyperinsulinemia and Insulin resistance.
 
By the way Ben Bikman's Diet Plan is being offered via Nao Medical which is a collaborative of many private health clinics. The diet plan is keto and LCHF. No surprises so far.
 

He does make a passing reference to fasting, nearish to the beginning if my memory serves me well.

I believe the use of Metformin with MND patient has shown promise with our friend the mouse, but is is still in the testing world, with the MND UK website signposting this study in the US, or 18 folks living with a specific mutation of MND. The trial duration is 24 weeks, so small and brief.
I'll be genuinely interested to hear eventually how that goes. MND is a cruel condition.

Safety and Therapeutic Potential of the FDA-approved Drug Metformin for C9orf72 ALS/FTD - Full Text View - ClinicalTrials.gov

Safety and Therapeutic Potential of the FDA-approved Drug Metformin for C9orf72 ALS/FTD - Full Text View.
classic.clinicaltrials.gov

I'm not a Bickman disciple, but I think it would be interesting to watch a few more of his videos on similar topics. He has several from 6 minutes to 1hr 45min.
 
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