Metformin - yes or no?

(icky) #1

I’ve struggled with my blood sugar for a long time and been insulin resistant for a few years.

Going into menopause, I’ve also gained weight for the first time in my life and no amount of Keto/ fasting/ whatever is shifting it.

Went to the Dr’s yesterday and my regular Dr was on holidays and the replacement was very annoying and useless.

I got sent on my way with a 3 month prescription of Metformin. She called it a “miracle drug” and said it’s “great for everything” and “it’s better than Ozempic”.

It was weird… It sounded like an advert for Metformin, to me.

I’m completely confused, unsure and in two minds as to whether to take it or not… Or whether to try it for a while…?

Anyone got any helpful pro/ contra thoughts about Metformin, to help me make a decision?

(icky) #2

So I spent some time reading up on it this morning… And I’m not convinced… Not convinced at all…

I think I’m just going to put it in the cupboard and mull on it for a few weeks… Maybe something that will convince me one way or the other will crop up…

I’ve asked for them to do another insulin resistance test in August, to see whether Keto has had any effect on that…

(Bob M) #3

How do they check for insulin resistance? HOMA-IR?

Some people believe metformin is some type of fountain of youth. It’s also commonly prescribed if you have PCOS or blood sugar issues. The problem with prescribing it for this is that you’re not treating the disease, just the symptoms.

I know people on here have taken metformin.

As for menopause, try changing things up. My wife tried Maria Emmerich’s PSMF diet and got to her lightest weight in a long time. It’s a low calorie, high protein diet with some days of very low calorie (the so-called protein sparing modified fast, PSMF, days).

(icky) #4

This particular doctor tests for insulin resistance by making you come in without having had breakfast and then you get given this huuuge, very sugary drink and then they take blood every 15 minutes for like an hour or an hour and a half… Measuring both your blood sugar and how much insulin your body produces… By looking at those two curves, that’s how they determine whether there’s an insulin resistance…

Not sure how other doctors do it… I’m only familiar with this test because I did it there about a year and a half ago, I think…

(Joey) #5

'Twas that indeed.

Miracle drugs are usually miraculous for the manufacturer.

Let’s stipulate that - having taken the glucose tolerance test as described - that you are indeed insulin resistant. So are hundreds of millions of others, most of whom were not born that way but developed it through decades of S.A.D. eating.

It will take a long while to slowly reverse your metabolic resistance to your body’s insulin. Please be patient. It is all about restricting those carbohydrates in your eating.

Fat + protein = essential nutrition (dietary components humans cannot produce on our own).

Carbohydrates = entirely unessential. The human body needs “0” mg of carbs, and can naturally produce whatever glucose is truly needed by the body from the two above.

(Geoffrey) #6

My opinion is a firm no. I see no reason to take any drug when your issues can be fixed or controlled by diet, nutrition and a little discipline.
Drugs, for the most part, are for the ignorant and the weak minded.


There’s nothing wrong with Metformin, at this point there’s as many taking it by choice and for the longevity side than they are blood sugar management, but that said, many also get near the same results with Berberine, and then there’s the better version of it, Dihydroberberine.

Well, that’s a blatant lie, Semaglutide is literally near a miracle drug. It’s immediate Insulin sensitivity, helps appetite, and you get awesome blood sugar very quickly with it. I’ve taken a ton of both, and while there’s even better than Semaglutide, those are even more pricey. If I had to rely on a prescription for it, I’d never take it. Don’t know how people swing those prices, unless you’re actually diabetic and insurance pays for it. Then there’s the argument for people who are just against all Pharma, which is stupid, but there’s plenty. Since Semaglutide is just a Peptide, that excuse goes out the window. Still people choice to hate anything they want, but then they need a real reason again.

If you take Metformin and don’t like it, stop taking it. Not like you’re going to spontaneously combust or anything.


Find a new doctor, Glucose Tolerance Tests are an outdated and incredibly and unreliable way to test that. The fact you’re Keto makes it (almost) a guaranteed fail on your part, does your doc know you eat keto, and even better, grasp why that test is even (more) useless because of that?

LP-IR is the correct way, unless you started to re-sensitize yourself to carbs ahead of time, you’re just going to fail a GTT miserably, and if you didn’t… then you’re pretty insulin sensitive! Because you should!

(Bob M) #9

She’s getting a Kraft test, which is by far the best test:


The LPIR is correlation, not causation. My LPIR is always bad because my HDL are always pegged to the right:

No idea how I can change those. Been that way for years, and I’m on my 11th year of keto. Have a zero score on CAC and fine Kraft test results. And my pattern is A.

LPIR is based on less than 5,000 people, yet being applied to millions:

(Bob M) #10

My results for the Kraft test:

Hmm…that was a while ago. I’d try to get another one done, but that was when I had this woman as my doctor:

Now that she’s no longer here, I have to pull teeth just to get fasting insulin taken. So, I usually pay for this stuff myself, and no one offers the Kraft test where I am.

(icky) #11

I think I’m getting something halfway between an oral glucose tolerance test (OGTT) and a Kraft-Test.

They measure both blood glucose and insulin levels, but only over 1.5 hours, not over 5 hours like in the Kraft-Test.

What is a LP-IR test and how would I ask my doctor to do it? (I’m in Europe, so I need to work out what it is in English, then look for the right translation and convey that to my Dr, so I can’t just walk in and literally say “Please do an LP-IR” cos then he’ll just look at me confused…)

(icky) #12

I was reading up on how Metformin actually “works” and one of the 3 modes of action seems to be that it actually affects what’s happening in the mitochondria:

“Metformin non-competitively inhibits the redox shuttle enzyme mitochondrial glycerophosphate dehydrogenase (mGPD), resulting in an altered hepatocellular redox state, reduced conversion of lactate and glycerol to glucose, and decreased hepatic gluconeogenesis.”

(Source: )

“The molecular mechanism of metformin is not completely understood. Multiple potential mechanisms of action have been proposed: inhibition of the mitochondrial respiratory chain, activation of [AMP-activated protein kinase], inhibition of glucagon-induced elevation of [cyclic adenosine monophosphate] with reduced activation of [protein kinase A], complex IV–mediated inhibition of the GPD2 variant of mitochondrial [glycerol-3-phosphate dehydrogenase] (thereby reducing glycerol-derived hepatic gluconeogenesis), and an effect on [gut microbiota]”

(Source: )

I dunno, but it messing around with my mitochondria sounds kind of scary to me… Or is what it’s doing on a mitochondrial level a good thing…? (Any ideas @PaulL ?)

(KM) #13

I guess the question would be, are these reductions which result in the return of mitochondria to a normal baseline (in which case what’s driving that divergence in the first place), or are they reductions that inhibit mitochondrial function below the normal baseline (in which case why is this helpful because I agree it doesn’t sound like a good idea, and is it healthy?)

(icky) #14

Yeah, I don’t know… But given scientists don’t seem to really understand the mode of action of Metformin, I’m not sure I want to be putting something in my body that “somehow” does something weird to my mitochondria… Given that mitochondria are about as essential as it gets, in terms of life…

(B Creighton) #15

There are many supplements which “mess around with mitochondria.” Anything improving mitochondrial function is generally good. I know some ot the longevity “athletes” use metformin, and they have no sugar issues. I echo Ifod here: " many also get near the same results with Berberine, and then there’s the better version of it, Dihydroberberine."

In your shoes I would try berberine first, since I too am reluctant to take any prescription drugs. Seems like I recently heard a negative with prolonged use of metformin, but otherwise seems a reasonably safe and effective drug.

(Bacon is a many-splendoured thing) #16

That’s a classic oral glucose tolerance test (OGGT). The one caveat is that if you’ve been ketogenic for any length of time, your pancreas will have dispensed with the supply of ready-made insulin needed for the first-phase response. This makes ketonians appear insulin-resistant, even though they are not. You can restore that first-phase insulin secretion by eating carbs for a couple of days to cause the pancreas to build up a store of ready-made insulin again.

Metformin is probably safe to take. Dr. Phinney says it has almost no side effects, so he keeps patients on it far longer than they stay on anything else. However, I have been reading lately that metformin can damage mitochondrial function, and damaged mitochondria are the very definition of metabolic dysfunction. If the prescription is ony for three months, you can safely take it. Just be sure to prepare for the next OGGT by eating carbs for a couple of days before. With normal people, this is not necessary, because they all eat enough carbohydrate. It’s only we ketonians who need to think about this.

(icky) #17

Thanks @PaulL

I think I’ll skip the Metformin then… I’m not anti-meds or anti-pharma… I think helpful meds are great… But Metformin doesn’t pass my risk/benefit analysis… for my particular situation… Maybe at some point, if I’m more desperate and its mode of action is better understood, I’ll revisit that decision, but for now I’m leaving it sitting in the cupboard…

Thank you for the info about the OGGT test too! I certainly can’t be bothered carbing up to make the test work… I’ll just trust that Keto is pushing things in the right direction and leave it at that.

Is there an alternative “test” regarding insulin resistance that Ketonians can do that doesn’t require carbing up?

(Bacon is a many-splendoured thing) #18

That seems like a wise decision. Your doctor was probably misunderstanding the results and over-reacted.

That’s a good question. One such test is your HOMA-IR score, which requires knowing fasting insulin and fasting glucose. It’s a pretty useful value. Another indicator is the ratio of your trigylerides to HDL. If it’s under 1.5 in American measurements or under 4.5 in non-American measurements, then you can be pretty sure that you are insulin-sensitive Those are standard lipid measures, so you can do the division yourself.

(Joey) #19

It’s a Pharma miracle! :+1:

Possible side effects include nausea, diarrhea, vomiting, constipation, abdominal pain, headache, fatigue, indigestion/heartburn, dizziness, abdominal distension, belching, hypoglycemia (low blood glucose) in people with type 2 diabetes, flatulence, gastroenteritis, and gastroesophageal reflux disease (GERD).[15] It can also cause pancreatitis, gastroparesis, and bowel obstruction.[35]

The US FDA label for semaglutide contains a boxed warning for thyroid C-cell tumors in rodents.[13][14][15][25] It is unknown whether semaglutide causes thyroid C-cell tumors, including medullary thyroid carcinoma, in humans.[13][14][15][25][36]


Which is meaningless, all drugs have laundry lists of ridiculous sides that typically don’t happen. Most people don’t have any of them, and since doc’s have wised up and many don’t follow the Diabetes dosing schedule for people that want it for fat loss, far fewer people have them. Even with the GI issues which are the most common, for the majority they subside.

In the meantime, there has never been a drug (really not a drug) that has had the ability to make people insulin sensitive and pull fat off people like this ever! The results aren’t debatable. So far the only “negatives” are the make believe ones from diet pill companies and big sugar trying to make people afraid with terms like “Ozempic face”. Too bad the Vegans already found that starvation does that, so don’t starve yourself and it’s good. That, and the small minority that it doesn’t seem to get along with, yet every account I’ve read in forums all came from people following the Diabetes dose schedule, which is a steep jump, unneeded, and wastes a lot of money if you’re paying the correct price for it, which I luckily don’t.

C’mon now, if ANYBODY can see through FUD from a Rodent study, it’s a Keto’r. Especially from a Peptide that stimulates and endogenous hormone while still leaving your body mostly behind the wheel on it.

Also, isn’t the FDA the same people that said we’re all gonna die from clogged arteries from the fat :face_with_raised_eyebrow::face_with_raised_eyebrow::face_with_raised_eyebrow:

Ahahahaha, sorry, you know you walked into that one :+1: