Diet Metformin the poor-mans wegovy for weight loss?

[sHR00m]

With metformin, prevention of weight gain is best instead of waiting until the patient gains significant weight. Paliperidone in all forms is pretty bad for that. But not all doctors tell their patients about that when prescribing these meds like invega, risperidone, olanzapine which pretty much start raising your blood sugar &insulin upon the first dose. Physicians are supposed to get informed consent when offering high risk drugs to their patients.

Anyways, don't rely on metformin by itself. It should be combined with dietary changes and some time in the gym if possible. I also stayed in ketosis a year straight to help speed things up. I was on metformin then as well but the weightloss was drastic and my psychiatrist cut me off.

Thanks for your input. Paliperidone in itself did not lead to significant weight gain but like I said losing weight was pretty much impossible. I kinda doubt metformin would help much unless the problem is appetite related. On olanzapine on the other hand I can lose weight with metformin and it indeed numbs the terrible munchies it gives so I am quite happy with that. The other big risk factor is smoking weed but I restricted that to the evening, which seems to work. I am now also doing ketogenic diet on top of that because I am getting really worried about the risk factors for diabetes. I agree that its not optimal not to maintain weight from the start but the weight gain happened very rapidly until I found this study and cleared it with my doc. I got a blood sugar meter and I tested for 120 which I suppose is within the norm but in deep ketosis I hope more for a figure of around 70. Fingers crossed.

 

[oxyloxy]

As a patient relying on antipsychotics, notably olanzapine I experienced extreme weight gain in a short amount of time. To combat that my psych recommended wegovy injections, which is technically an anti-diabetic drug that is also approved for weight-loss. This however is not covered by insurance and would cost me up to 300 Euros a month. After some research I came across a meta-study about metformin (also an anti-diabetic drug) being successfully used to combat (and reverse) weight gain caused by antipsychotics. Another study I came across mentioned success in weight-loss for knee ostheoarthritis patients. So it appears to work for weight loss also in other circumstances than just antipsychotics.

I tested metformin for roughly 2 months now and I can report a massive shift in my eating habits. I have a lot less appetite during the day, which makes dieting possible for me again. So far I constantly lost about 4 kg in 2 weeks. Why am I not counting the initial 6 weeks? Because there is a drawback to metformin. It can cause digestion problems (your food goes basically out like it goes in). That's obviously not sustainable (and is in fact a serious side effect if persisting) but I managed to get around those issues.

First, you should not drink alcohol when using metformin. Personally I have no issues drinking an occasional beer or two but I avoid getting shitfaced as excessive (or too frequent) alcohol consumption could technically cause lactic acidosis.

Second, (very important) you should dose your metformin right after a meal in order to avoid said digestion problems. Since I am sticking to that I had no digestion issues at all.
Thankfully the second study also provided some dosing guidelines. There they started with a low dose of 500mg metformin per day and slowly increased the dose up to 2 grams daily over a time-frame of 6 weeks.

I didn't follow this dosage regimen but it seems to make sense. I started with 1 gram, which led to digestive issues. Then I tried half a gram per day, also causing said issues. I was already half ready to ditch this stuff after a month but then I started only taking it after a meal and within maybe 2 weeks I went successfully from 0.5 - 1.5 grams a day. I would start with 0.5 gram after a meal and once that worked without issues I would take another 0.5 gram dose after a second meal, upping the dose to 1 gram per day. Now after some weeks I am taking 1 gram in the morning and half a gram in the evening which is working nicely for weight loss so far. Note that I still could go higher on the dose according to the second study. This might be nice in case metformin loses efficiency after initial weight loss (which often happens when dieting). If this happens to me I can still move up to 2 grams per day.

It took me roughly 6 weeks to dial it in properly (just like the second study states) but I ramped up the dose largely within the last 2 weeks after being on 0.5 gram the initial weeks, so maybe 6 weeks aren't necessary. If you encounter digestive issues, I suggest you slow down your dosing regime. Also I would initially stick to 0.5 gram per meal. These days I tolerate 1 gram doses easily even after a relatively small meal. Like a sandwich or something.

I hope this info might be useful to some peeps out there since metformin for weight-loss seems still relatively unknown. Take care and keep in mind, what works for one person doesn't have to work for another. If you keep having digestive issues no matter what this might be an indication for lactic acidosis and you should stop. Ideally you coordinate all these steps with your physician (you can print out the studies and show them to your doc).

Here is an overview of metformin regarding drug interactions and potential side effects.

Thank you for the information. I take metformin 500 mg 2x daily for a condition that is not diabetes. Did your doctor up you to that dose or did you just up yourself? I’ve been taking metformin for several years and haven’t noticed any weight loss. I don’t have much of an appetite, but the problem with that is that by eating much less, your body is always clinging to calories. The key to losing weight I have found, is actually eating more frequently but much smaller portions. I am miserable at my current weight and like I said I’ve taken metformin for several years. But I also just take it twice per day. I haven’t paid attention to when I’m taking it, although almost always in the morning I take it on an empty stomach and yes, I do experience the digestive issues

 

[4DQSAR]

I think I may have made this observation earlier in the thread but psychiatrists are just about the least holistic specialist clinicians out there.

I shared a home with a guy who had been prescribed haloperidol for decades and he was displaying ever worstening extrapyramidal side-effects. So I just suggested he mentioned the fact to his psychiatrist and ask if options existed. No more. I didn't say he should demand a change - just that it was worth asking.

So he was swapped onto quetiapine.

Within a year the guy went from being as thin as a chip to roughly spherical. I felt really bad for having put the idea into his head. Because AFAIK he developed diabetes and then just disappeared. I mean, we had both moved on but I would see him every few months around town... now I don't.

I'm not inherently against the use of metformin, only the fact that 'indication creep' avoids the huge amount of testing required for an entirely new medication. With something as serious as type 2 diabetes, the best outcomes will usually involved the prescribing of a drug. But AFAIK lactic acidosis is rare but extremely serious side-effect metformin can cause (and other serious side effects also occur). It's worth noting that every other biguanide-class medication for type 2 diabetes has been taken off the market due to toxicity. But the point is, the outcomes are on average still far better than NOT providing medication.

I would suggest that if someone is already prescribed an antipsychotic it's accepted that weight gain is common, the patient should be told. Assuming that a patient sees their psychiatrist every six months, it's not a case of weighing someone, it SHOULD be obvious.

I think he was prescribed quetiapine.

But the last few times I saw him, he was eating junk food. I mean he didn't stop eating to talk. It seemed like all he did was eat.

So maybe the prescribing of metformin to patients prescribed certain antipsychotics WOULD result in better outcomes than those given the antipsychotic alone? I honestly don't know. But to essentialy watch someone eating themselves to death is every bit as upsetting as seeing someone you know consuming alcohol or drugs to the extreme where you know it will kill them.

 

[sHR00m]

I think I may have made this observation earlier in the thread but psychiatrists are just about the least holistic specialist clinicians out there.

I shared a home with a guy who had been prescribed haloperidol for decades and he was displaying ever worstening extrapyramidal side-effects. So I just suggested he mentioned the fact to his psychiatrist and ask if options existed. No more. I didn't say he should demand a change - just that it was worth asking.

So he was swapped onto quetiapine.

Within a year the guy went from being as thin as a chip to roughly spherical. I felt really bad for having put the idea into his head. Because AFAIK he developed diabetes and then just disappeared. I mean, we had both moved on but I would see him every few months around town... now I don't.

I'm not inherently against the use of metformin, only the fact that 'indication creep' avoids the huge amount of testing required for an entirely new medication. With something as serious as type 2 diabetes, the best outcomes will usually involved the prescribing of a drug. But AFAIK lactic acidosis is rare but extremely serious side-effect metformin can cause (and other serious side effects also occur). It's worth noting that every other biguanide-class medication for type 2 diabetes has been taken off the market due to toxicity. But the point is, the outcomes are on average still far better than NOT providing medication.

I would suggest that if someone is already prescribed an antipsychotic it's accepted that weight gain is common, the patient should be told. Assuming that a patient sees their psychiatrist every six months, it's not a case of weighing someone, it SHOULD be obvious.

I think he was prescribed quetiapine.

But the last few times I saw him, he was eating junk food. I mean he didn't stop eating to talk. It seemed like all he did was eat.

So maybe the prescribing of metformin to patients prescribed certain antipsychotics WOULD result in better outcomes than those given the antipsychotic alone? I honestly don't know. But to essentialy watch someone eating themselves to death is every bit as upsetting as seeing someone you know consuming alcohol or drugs to the extreme where you know it will kill them.

That's horrible with the quetiapine. Haldol too gave me extrapyramidal side-effects and akinetone was supposed to counteract that but it didn't work. Later went on quetiapine, risperidone, paliperidone and amisulpride before settling on olanzapine. Seeing a psychiatrist only once every 6 month seems insane in itself. Seems the system really fucked up in his case sadly. On a side note I am down from 125 kg to 111 kg. BTW I fully agree its a generally well tolerated med, if used right and if alcohol is not consumed but there are rare but potentially serious side effects. Even aspirin can have serious and fatal side effects however. Thousands of people die of aspirin every year. I am not saying "get some metformin and go for it", I am merely providing studies that a psych might want to know about when weight gain becomes a possibility.

 

[4DQSAR]

Yeah - well the guy I knew had facial spasms where he would twist his mouth then open it and his tongue was twisted in just the same way. It happened every few minutes so I couldn't fathom why not clinician had noted it. I got used to it but I could see others being put off interacting him which I though would itself be bad for his mental health. Holistic.

I'm not disagreeing with your view, just making you and indeed everyone that if metformin was an entirely new medication for obesity, large studies would show outcomes.

But because metformin is a licenced medication, increasing the indications doesn't require that outcomes for the new indications to be tested as fully i.e. it's a cheap option. I don't have the data but by pure coincidence, the last example of indication creep in the UK was quetiapine. It's sole indication was to treat psychosis. But suddently it was being used to treat bipolar and unipolar depression.

BUT the same doses were (at least initially) were being prescribed. So someone with depression could find themselves prescribed 400-600mg of quetiapine per day! I only know this because I know someone who was prescribed it for depression but told their doctor that the medication meant they couldn't work. But after a year they went back to the same psychiatrist who again prescribed quetiapine BUT was at pains to point out that it would only be 25mg/day... which I think you will argee, is a HUGE difference.

Now I'm the first to admit that a single case study is weak evidence but the way it was described to me was that the psychatrist put in so much effort to make clear how much smaller the dose was. So did the psychiatrist just not know the appropriate dose? Or were they told that the dose-range for treatment of depression was the same as that for psychosis?

I think that is what concerns me. That clinicians either aren't provided with dose-ranges depening on indications OR that they were incorrectly told the dose range was the same?

BTW I should add that one HUGE positive for metformin is that it's been used for such a long time. I have been witness to multiple classes of new medication appear and then be removed from the market by the manufacturer (cheaper than ending up with a massive law suite). COX-2 inhibitors being the example I always cite but it happens more than you think. For a few years citalopram was the 'go to' antidepressant in the UK. But now it's rarely used and compared with a placebo, their isn't mush difference.

Clearly, someone putting on vast amounts of weight IS going to catch up with them and cetainly I would look at metformin. I guess I'm a bit skeptical because the history of diet drugs really isn't very good. So that's a bias within me and I suppose being aware is the first step in dealing with it.

 

[sHR00m]

Thank you for the information. I take metformin 500 mg 2x daily for a condition that is not diabetes. Did your doctor up you to that dose or did you just up yourself? I’ve been taking metformin for several years and haven’t noticed any weight loss. I don’t have much of an appetite, but the problem with that is that by eating much less, your body is always clinging to calories. The key to losing weight I have found, is actually eating more frequently but much smaller portions. I am miserable at my current weight and like I said I’ve taken metformin for several years. But I also just take it twice per day. I haven’t paid attention to when I’m taking it, although almost always in the morning I take it on an empty stomach and yes, I do experience the digestive issues

My doctor initially put me on half a gram of metformin twice daily but we did not specify a definitive dosage. This was just the inital trials. My 2 grams per day come from the second study I linked where it was the dosage chosen for weight loss. My psych retired by now sadly so I am not able to coordinate further actions for now. Ideally you could lose weight with an effective diet only. I lost roughly 50 kg with ketogenic diet and without any meds. It sucks that olanzapine gets in the way of that but thats just how it is. Since you are unhappy with your weight may I point you to/r/keto ? This sub saved my life. There is lots of solid info on the sidebar and once you are properly dieting the metformin might help a bit as well. There are various health risks that can be reduced with this diet. Should keto be too radical for you mediterranean diet has comparable efficiency regarding weight loss.

 

[sHR00m]

I just wanted to check in to show some results.
I have lost 21.5 kg in total thanks to ketogenic diet and metformin. It works. It just numbs the appetite and enables me to diet despite the olanzapine. I'm not experiencing any side effects either, just initial digestion problems.

 

[4DQSAR]

Can I take Metformin and Quetiapine together?

Quetiapine may reduce metformin's effectiveness, raising blood sugar levels. Learn about the risks of hyperglycaemia and how to manage your medication.

patient.info

I DO appreciate that in your case, glucose levels aren't critical.

 

[sHR00m]

Can I take Metformin and Quetiapine together?

Quetiapine may reduce metformin's effectiveness, raising blood sugar levels. Learn about the risks of hyperglycaemia and how to manage your medication.

patient.info

I DO appreciate that in your case, glucose levels aren't critical.

Well you called it. My fasting blood sugar is actually worse than when I started which really pisses me off because I've lost 27 Kg or so in the meantime but now my levels are worse which pretty much is the fault of my antipsychotics. Additionally I barely eat carbs so I'm doing all I can in order not to become a diabetic. It seems it's a race against time. I need to become not obese which would be another 20 kg or so and I ditched the olanzapine since it is a considerable risk factor for developing diabetes. My psych wants to put me on abilify instead. Not sure if that affects diabetes risk as much. My blood work is good but I developed a tendency to retain considerable amounts of water if I don't restrict my water intake which is being attributed to being pre diabetic. It seems metformin serves me two fold now. Once for weight loss and once for helping with the symptoms of pre diabetes. I guess my only option is to carry on. I'm below a 100 kg now and the goal is around 80.

 

[4DQSAR]

@sHR00m - Well, it seems that quetiapine produces hyperglycemia by antagonising H1 and 5-HT2c receptors which can impair glucose regulation.

But if prescribed AS an anipsychotic, it's almost always the case that some side effects will occur - because that class of medication is promiscuious i.e. it acts on many receptors. With this specific medication, quetiapine has very high affinity for the H1 receptor (11-19 nM) but it's the metabolite, norquetiapine that has moderate to high 5-HT2c affinity (76-107 nM).

So diet may or may not help.

Metformin IS the medication indicated in patients taking quetiepine who demonstrate hyperglycemia.

Don't forget, it doesn't really matter what you eat, sugar and fatty acids drive the ATP cycle.

Be cautious of things such as 2,4-dinitrophenol. Yes it burns fat BUT it also uncouples it from the ATP cycle so you 'burn energy' in the most literal sense - energy in the form of heat is produced. It pops up every so often within gym culture and it seems that every time at least a few badly informed and/or easily led people wind up being harmed (fatalities).

I always remind people that they are the centre of their own health. Yes, absolutely involve clinicians. If nothing else, someone asking for non-drug ways of solving a physical problem will be novel to them.

Apriprazole I don't know much about but while a common side effect of olanzapine is weight gain, it's isn't the case that a person will inevitably demonstrate that side-effect.

I spent a good few years (in the 1980s) looking at schizophrenia and the two chemical markers we knew of back then. I even became quite hopeful because Pesampator, Iclepertin and Pomaglumetad seemed to suggest that researchers had finally accepted the hypothesis that schizophrnia is actually caused by two metabolic changes that result in the same set of symptoms. But herein lies the problem. Cerebrospinal fluid samples showed up that sufferers had either increased levels of DOPAC (a dopamine metabolite) and/or reduced levels of NMDA.

BUT only around 10% of suffers just have increased NMDA and so even it if works for the wrong reasons, antipsychotics that act at the dopamine and serotonin receptors are still 'more effective) i.e. 90% of patients will likely see reduced symptoms. Any medication that's only going to work in 10% of cases simply isn't the most profitable option.

I think that terrible, but only quadriplegia is classed as more disabling than schizophrenia so the fact that medications aren't safe, in context still means they can obtain commercial licences.

 

[sHR00m]

So after I switched from olanzapine to abilify my resting blood sugar level was back to 89 mg/dl today after months of scratching at the diagnosis for diabetes with levels above 110. Below 100 counts as not prediabetic assuming that the levels stay below 100 in the future. There are other relevant markers but those seemed to be fine when doing blood work.

Abilify still has a diabetes risk but it's considered more "metabolically neutral" in elevating the risk as far as antipsychotics go unlike olanzapine.

Moving on to losing more weight. I'm at roughly 95 kg now and continue using metformin. Now without the olanzapine it should not be necessary anymore to take metformin for weight loss but it probably stabilizes my health. I might go off it if my blood sugar remains stable once I am not considered obese anymore.

Cheers

Edit: I tested now below 100 mg/dl 3 days in a row. The last result was 74, which is so good I hadn't had such a low value since a decade ago. 74 might appear to be too low for some but it can be perfectly fine on a ketogenic diet.

I'm relieved that my blood sugar finally responds like it should.

 

[4DQSAR]

BTW @sHR00m - it's almost 20 years later but I still feel guilty for recommending someone I knew ask their clinician if another antipsychotic might be better as they had been on haloperidol for decades and movement disorders were pretty apparent. Well, maybe I was trusted too much but this person WAS swapped to something else and they went from stick thin to morbidly obese in just a handful of years and while I used to bump into them now and then, I haven't done so for gosh, maybe a decade.

Now a random person really shouldn't alter a clinicians opinion and I was not at the medication review but honestly, either this person just had no more access to their consultant (quite likely) but honestly, even a GP should really have been watching that weight gain and possibly acting.

But the older I get, the more I believe power gradients produce terrible outcomes. If a consultant prescribes, most GPs do not feel confident in questioning that prescription BECAUSE of that power gradient.

One thing I know for sure is that in hospitals, nurses often know more than the doctor but once again, the power gradient means often they don't feel confident in questioning a diagnosis. Every clinician should feel able to ask if they have a real concern, no matter their exact role/seniority.

 

[AlphaMethylPhenyl]

Metformin is generally a very healthy medication to take, it doesn't have the side effects of Ozempic or others that work similarly--though I doubt it's as effective for weight loss.

 

[sHR00m]

So maybe the prescribing of metformin to patients prescribed certain antipsychotics WOULD result in better outcomes than those given the antipsychotic alone? I honestly don't know. But to essentialy watch someone eating themselves to death is every bit as upsetting as seeing someone you know consuming alcohol or drugs to the extreme where you know it will kill them.

Metformin used to be a second or third tier option to tread weight gain caused by antipsychotics but that paradigm has shifted in recent years. There are guidelines now recommending it for such use cases.

 

[sHR00m]

Metformin is generally a very healthy medication to take, it doesn't have the side effects of Ozempic or others that work similarly--though I doubt it's as effective for weight loss.

I can only speak for myself but I gained 30 kg extremely rapidly on olanzapine despite me living on a ketogenic diet, which is among the more effective forms of nutrition for weight management.

Thanks to Metformin (and despite continuing Olanzapine) this trend did not only stop but radically reversed itself. I lost more weight within half a year (14.2% bodyweight) than the average ozempic patient in the same time (about 10%-14% bodyweight).

Granted, unlike most ozempic patients I was already on an effective diet for weight loss, which surely contributed to the efficiency but I wouldn't say that metformin is necessarily less effective than glp-1 agonists. More research on that topic would be interesting.

One downside is however metformin's intestinal issues if you don't slowly up the dose over weeks/a month+ depending on the dosage. Jabs don't seem to have that issue.

 

[4DQSAR]

Metformin used to be a second or third tier option to tread weight gain caused by antipsychotics but that paradigm has shifted in recent years. There are guidelines now recommending it for such use cases.

Don't forget, antipsychoics are generally accepted even though they produce severe side-effects on the basis that schizophrania is such a serious illness that they still pass that risk/beneft calculation.

The history of the biguanide class is quite interesting. Several related (and supposidly superior) medications were licenced and withdrawn due to ketoacidosis. Typical that the prototype proved to be the only safe one. I suspect the only class that would really concern me is the thiazolidinediones. It's a grim NHS joke that they are well known to increase the risk of heart-attack yet for some reason are still being prescribed...

 

[Flynnal]

It's a grim NHS joke that they are well known to increase the risk of heart-attack yet for some reason are still being prescribed...

What is so tragic about this is that isn't the entire point of weight control and diabetes control all about reducing complications such as cardiovascular disease? One would assume it is counterproductive to take these medications if they are going to increase the risk of terrible outcomes, like heart attacks, when the goal of achieving a healthy weight is to reduce these exact risks.

 

[4DQSAR]

What is so tragic about this is that isn't the entire point of weight control and diabetes control all about reducing complications such as cardiovascular disease? One would assume it is counterproductive to take these medications if they are going to increase the risk of terrible outcomes, like heart attacks, when the goal of achieving a healthy weight is to reduce these exact risks.

That's the thing. While it's no longer prescribed to new patients (since 2010), it isn't the case that every patient already on that medication has been contacted by their GPs, a consultation undertaken and an alternative prescribed.

It's an odd position. I suspect it was overwhelmingly prescribed to elderly patients where age rather than BMI was the most significant causal factor in their diabetes.

It isn't unique either. Barbiturates are still in the BNF because it proved more hazardous to detoxify a patient who may have been prescibed them for decades than to just keep on prescribing. Chlormethiazole is another one. I was told by an eldery former pill-head that a special ward was opened at Addenbrooke's (considered one of the best hospitals in the UK) just to treat people dependent on chlormethiazole and after a year it was recognized that just like barbs, the detoxification was just too hazardous.

Now we have an eldery generation who have been prescribed a benzodiazepine hypnotic fore decades and once again, it's considered the lesser evil to just keep on prescribing.

I have no doubt that there will be an admittedly smaller but still significant number of people who were prescribed Z-drugs before the risks were understood and I bet you £1 that we will see just the same thing...

Then in the last decade the same with pregabalin. Teens who are on daily-pickup and have been for years.

It's almost as if there is a pattern we just haven't spotted...

 

[atara]

Metformin is generally a very healthy medication to take, it doesn't have the side effects of Ozempic or others that work similarly--though I doubt it's as effective for weight loss.

There are two different goals here: weight loss by itself and addressing weight gain from medication. But weight gain caused by medication is likely to be due to some kind of biochemical disruption that could be addressed directly, whereas weight gain without a known cause is usually blamed on a lifetime of problematic environmental factors.

In principle, a drug that could cause weight loss in anyone ought to be dangerous: if I lost fifty pounds I'd be dead, but if a much fatter person lost fifty pounds it might improve their life. How does the drug know the difference? But a drug that only blocks weight gain from other drugs might be safer. If a healthy person took it, the effects should be less.

Since it's metformin, we can be specific. Metformin affects the central melanocortin system, inhibiting the release of adrenocorticotropic hormone (ACTH). The infamous 5-HT2C receptor also has appetite-suppressant effects because it activates the central melanocortin system, releasing alpha-melanocyte stimulating hormone (alpha-MSH). Alpha-MSH and ACTH compete for the same receptors (particularly a receptor called M3). But most cases of obesity unrelated to serotonin antagonist medications are probably not caused by defects in the central melanocortin system or ACTH dysregulation.