Sunday, January 20, 2019

Metformin (10) Macavity


Macavity, Macavity, there's no one like Macavity,
He's broken every human law, he breaks the law of gravity.
His powers of levitation would make a fakir stare,
And when you reach the scene of crime - 
Macavity's not there!
You may seek him in the basement, you may look up in the air
But I tell you once and once again, - Macavity's not there!

I think people might have noticed over the years that I'm not a great fan of metformin acting clinically by blockade of complex I. Particularly over the last few months I have waded deep through layers of references looking at the morass of "paradoxes" about metformin. In particular that 250micromolar in your plasma will kill you but 4000 micromolar can be justified in cell culture because meformin "accumulates in the mitochondria" at up to 1000 times the level in the blood/cytoplasm, which is a deeply held belief structure on which an unimaginable amount of grant funding hangs. Does metformin cumulate in mitochondria?

It doesn't. I really enjoyed this review from last year. Talk about reinforcement of confirmation bias:

Metformin-Induced Mitochondrial Complex I Inhibition: Facts, Uncertainties, and Consequences

But when you have spent years slogging through papers thinking: That's crap! it comes as a huge relief to find that it's not just you who thinks this, no matter how politely the reaction is phrased.

So. Is metformin research all garbage? No, of course not. Anything involving a live animal on oral doses which do not cause death by lactic acidosis is worth thinking about. Any parallel cell culture research in the same paper using a 4millimolar concentration can be junked. In vivo effects are real, at real dose rates. Cell culture at 1000 times overdose is fiction.

Just to summarise my own speculations:

Under fasting the component of insulin signalling facilitated by the glycerophosphate shuttle can be replaced by saturated fatty acid oxidation via electron transporting flavoprotein dehydrogenase. This maintains insulin signalling at the "cost" of increased fat oxidation. Hence the weight loss.

In the peak absorptive period after a carbohydrate based meal the normal development of insulin-induced insulin resistance is blunted and glucose oxidation continues for longer than without the metformin. If you are eating the absolute crap suggested by any cardiologist or diabetologist this might be of some benefit. If you are already LC the increased fasting fatty acid oxidation is probably where the benefits accrue from.

Cancer benefits are likely to be real, off "target" and secondary to reduced insulin exposure.


Edit: These people seem to be looking at the real world too. Worth spending some time on this

Low metformin causes a more oxidized mitochondrial NADH/NAD redox state in hepatocytes and inhibits gluconeogenesis by a redox-independent mechanism


Adam said...

I hate to ask a simple question but - let’s say I eat a LCHF Hyperlipid/Optimal style diet. With occasional lapses. Should I consider taking metformin?

Peter said...

Hi Adam,

I don't, ItsTheWoo does. Woo is very insightful. Metformin is probably fine if you don't develop lactic acidosis or B12 deficiency....


karl said...

I have a hunch that Metformin is harder to tolerate if one is eating LC than on the standard junk food diet. Just an informal hunch - but LC people I've talked to seemed to have more gas problems than the mainstream.

Never underestimate how many different effects a drug might have. The list of drugs that once were thought to be perfectly safe - but turned out otherwise is rather long.

T2D is rather easily treated if one is willing to do LC and do the right kind of physical exercise. Remember - The business of modern medicine is mostly the selling of false hopes.
These hopes are often based on false and ungrounded narratives that make up the maze we call medicine - and often that narrative is based on the rather silly idea that some pill can fix everything with out some cost or risk.

Peter said...


Interesting. I guess the bacterial population of the GI tract is very different between LC and CIAB eaters....


altavista said...

Is there anything fat is not good at? :) WTF of the day via StanH

JM said...

I took Metformin for a month or two, while on a low-carb, ketogenic diet. It was a positively awful experience. I felt severe nausea and had plenty of gas. There's a reason that the people taking it call it "Metfartin".

I am convinced that the main benefit it confers is severe loss of appetite from the nausea. Any benefits derive from the resulting reduced food intake.

Kajus said...