Diet Metformin the poor-mans wegovy for weight loss?

[sHR00m]

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.

 

[Katanya]

I am on Metformin as well as I have weight gain from Invega!

I have been spotty with taking it but when I take it consistently I notice a difference in my eating habits!

I am hoping going off Invega helps!

 

[sHR00m]

I am on Metformin as well as I have weight gain from Invega!

I have been spotty with taking it but when I take it consistently I notice a difference in my eating habits!

I am hoping going off Invega helps!

Sorry I only saw this now. Invega can be rough. I hope it doesn't affect you badly otherwise.
How is weight-loss working out on your end? I was at 112 kg from 122 already but went back up to 120. I am now on 2 g metformin and considerably restricted my calories. I am back on 117 now and hopeful to get back to 112kg. I think this recent setback was not metformin's fault but more the olanzapine. If you are not careful with what you eat, the weight just shoots up in no time.

 

[Conky]

Try one of the newer antipsychotics with less weight gain risk. Like ziprasidone or asenapine. Olanzapine is trash and metformin by itself won't totally reverse the huge weight gain.

 

[Katanya]

Sorry I only saw this now. Invega can be rough. I hope it doesn't affect you badly otherwise.
How is weight-loss working out on your end? I was at 112 kg from 122 already but went back up to 120. I am now on 2 g metformin and considerably restricted my calories. I am back on 117 now and hopeful to get back to 112kg. I think this recent setback was not metformin's fault but more the olanzapine. If you are not careful with what you eat, the weight just shoots up in no time.

I actually had to get on WeGovy and I have started losing weight on it!

 

[sHR00m]

Try one of the newer antipsychotics with less weight gain risk. Like ziprasidone or asenapine. Olanzapine is trash and metformin by itself won't totally reverse the huge weight gain.

I have tried a number of antipsychotics and this one seems ok regarding side effects except the weight gain (partially) caused by munchies. Metformin successfully combats munchies in my case which makes it easier to lose weight as long as I restrict my calories. Some of those medications I tried caused damage so I am not keen to continue switching antipsychotics.

I actually had to get on WeGovy and I have started losing weight on it!

With invega munchies were not a problem in my case but even at a diet of 600 calories per day I didnt lose weight so it doesn't seem surprising that you had to switch to wegovy. Glad it works. I looked into wegovy and mounjaro as well but so far i can't justify "wasting" 300 euros per month on a weight-loss medication if metformin exists.

 

[4DQSAR]

If you read the history of the biguanide class of medications, you quickly discover that metformin was 'the least worst' of those that even got a GSL and I'm sure many more never even got that far.

It's cheap, it's activity is well understood by clinicians but with ALL medications, a clinician will consider the outcomes and when used to treat what is a serious disorder, the best outomes result from prescribing.

But for weight loss. Is the risk/benefit the same - especially if other intervetions using no medications are available.

 

[Conky]

I have tried a number of antipsychotics and this one seems ok regarding side effects except the weight gain (partially) caused by munchies. Metformin successfully combats munchies in my case which makes it easier to lose weight as long as I restrict my calories. Some of those medications I tried caused damage so I am not keen to continue switching antipsychotics.

Fair enough. Although I don't know what you mean by 'damage' from those other meds. All I know is that olanzapine induced weight gain is a form of damage along with other metabolic problems that are not visible like body fat is. I was on it 10mg and gained 90lbs in a year or so. So yeah, not my favorite medication.

 

[4DQSAR]

Fair enough. Although I don't know what you mean by 'damage' from those other meds. All I know is that olanzapine induced weight gain is a form of damage along with other metabolic problems that are not visible like body fat is. I was on it 10mg and gained 90lbs in a year or so. So yeah, not my favorite medication.

Well - I have to say that the class of clinician who usually prescribe neuroleptics can be terrible at not seeing physical health as being connected to mental health.

So abosolutely do ask because it is VERY common that people on such meds put on weight and that damages their phyical health... and the physical health is somehow demoted. I find it a serious flaw in current practice.

 

[sHR00m]

Fair enough. Although I don't know what you mean by 'damage' from those other meds. All I know is that olanzapine induced weight gain is a form of damage along with other metabolic problems that are not visible like body fat is. I was on it 10mg and gained 90lbs in a year or so. So yeah, not my favorite medication.

Regarding damage: Apathy, anhedonia (invega) and a reduced ability to feel recreational drugs, notably kratom became very dull which was my drug of choice back then also because it was therapeutic. I later switched to amisulprid for a short amount of time and this changed something in me. My ability to feel kratom is now gone and so is it with most other drugs even alcohol. I'd call that damage and it makes me doing stronger drugs than I'd like in order to feel something. This switch was years ago and I wasn't even on amisulpride for long because I couldn't tolerate some side effects. There are worse things in the world but nobody ever warned me that this might happen should I take (or change my) antipsychotics. Maybe reduced effects of certain drugs as long as the med is in my system, sure but this?

90 libs is really bad I agree but everyone is different. After RLS with quetiapine and apathy, anhedonia and the other shit olanzapine seems not too bad to me weight gain aside.

 

[sHR00m]

If you read the history of the biguanide class of medications, you quickly discover that metformin was 'the least worst' of those that even got a GSL and I'm sure many more never even got that far.

It's cheap, it's activity is well understood by clinicians but with ALL medications, a clinician will consider the outcomes and when used to treat what is a serious disorder, the best outomes result from prescribing.

But for weight loss. Is the risk/benefit the same - especially if other intervetions using no medications are available.

Well obesity is a common and huge health hazard which elevates your risk factors for a number of diseases, diabetes among them. Certain antipsychotics too elevate the risk to develop diabetes. Diabetes is less treatable than HIV and in itself is a huge risk factor leading to all kinds of other health issues. I think that might have been part of the risk/outcomes calculation of my psych. Since metformin is a first line treatment med for prediabedics it seems people other than diabetics are taking this med on a daily basis. I would say the risks are known by now. It helps preventing diabetes and along with a diet change you can lose weight in the process as well. There are like a dozen studies by now about metformin and weight-loss but it seems that the more elegant way is to put people on metformin early on when uncontrollable weight-gain starts instead of waiting until you gained 90 lbs.

I agree in an ideal world we would not need off-label medications to treat a condition but metformin is far from unique in that regard. And its not an easy choice for everyone. Wegovy and mounjaro are drugs that only the rich can afford especially in the states.

 

[4DQSAR]

@sHR00m - I'm not disagreeing with you - I'm simply suggesting that metformin can have knock-on effects on any future medication a clinician may prescribe which is why I recommended asking, If something goes wrong and a clinician does not know the patent is consuming a biguanide, it could go badly wrong.

I'm concerned how pharmacutical companies are now ALL attempting to get there diabetes medications repurposed as weight loss medications. Don't think it's just the biguanide class. My fear is they WILL be when for most people, changes in lifestyle and diet are practical alternatives. Often clinicans don't even mention the option because patient complience to all drugs is only something like 51% (scary low figure) and for options that require self-reporting, possibly even lower.

Now how neuroleptics cause diabetes - again, a simple blood test would spot this before it becomes an issue. But as I mentioned, the clinicians who usually prescribe neuroleptics really seem to do a terrible job in considering the physical health of their patients. I mean scarily so in some cases. It's a case where patients need to be the 'canary in the coal mine' and make complaints. How else would other clinicians know?

 

[Smyth2]

Phenylbiguanide is a 5-HT3 agonist used to study the role of 5-HT3 receptors in the CNS. It has been found to trigger dopamine release in the NAc of rats.
Phenylbiguanide is used to make amanozine.

Higgins GA, Joharchi N, Sellers EM. Behavioral effects of the 5-hydroxytryptamine3 receptor agonists 1-phenylbiguanide and m-chlorophenylbiguanide in rats. J Pharmacol Exp Ther. 1993;264(3):1440-9.
Chen, Jianping; van Praag, Herman M.; Gardner, Eliot L. (1991). "Activation of 5-HT3 receptor by 1-phenylbiguanide increases dopamine release in the rat nucleus accumbens". Brain Research. 543 (2): 354–357. doi:10.1016/0006-8993(91)90050-6.

 

[4DQSAR]

Phenylbiguanide is a 5-HT3 agonist used to study the role of 5-HT3 receptors in the CNS. It has been found to trigger dopamine release in the NAc of rats.
Phenylbiguanide is used to make amanozine.

Higgins GA, Joharchi N, Sellers EM. Behavioral effects of the 5-hydroxytryptamine3 receptor agonists 1-phenylbiguanide and m-chlorophenylbiguanide in rats. J Pharmacol Exp Ther. 1993;264(3):1440-9.
Chen, Jianping; van Praag, Herman M.; Gardner, Eliot L. (1991). "Activation of 5-HT3 receptor by 1-phenylbiguanide increases dopamine release in the rat nucleus accumbens". Brain Research. 543 (2): 354–357. doi:10.1016/0006-8993(91)90050-6.

In rats - which we have discussed before, does not automatically mean the same is true in man. At least have the decency to state 'in animal models' for people who may not have access to the papers.

 

[sHR00m]

@sHR00m - I'm not disagreeing with you - I'm simply suggesting that metformin can have knock-on effects on any future medication a clinician may prescribe which is why I recommended asking, If something goes wrong and a clinician does not know the patent is consuming a biguanide, it could go badly wrong.

I'm concerned how pharmacutical companies are now ALL attempting to get there diabetes medications repurposed as weight loss medications. Don't think it's just the biguanide class. My fear is they WILL be when for most people, changes in lifestyle and diet are practical alternatives. Often clinicans don't even mention the option because patient complience to all drugs is only something like 51% (scary low figure) and for options that require self-reporting, possibly even lower.

Now how neuroleptics cause diabetes - again, a simple blood test would spot this before it becomes an issue. But as I mentioned, the clinicians who usually prescribe neuroleptics really seem to do a terrible job in considering the physical health of their patients. I mean scarily so in some cases. It's a case where patients need to be the 'canary in the coal mine' and make complaints. How else would other clinicians know?

I find current developments kinda exciting. Lets face it. Obesity is the most common eating disorder and its becoming more and more widespread. Having an injection or a pill that not only makes you lose more weight but also rejuvenates your cardio-vascular system (like wegovy seems to do) seems pretty awesome. BTW I expect a person to undergo a proper diet change along with a related change in medication. I doubt metformin is a wonder drug in that regard btw. For that its just too tricky to take enough of the drug without digestive issues and/or over eating, though I had some good success so far. I kinda ruined earlier progress with weed consumption and resulting munchies sadly.

 

[4DQSAR]

I find current developments kinda exciting. Lets face it. Obesity is the most common eating disorder and its becoming more and more widespread. Having an injection or a pill that not only makes you lose more weight but also rejuvenates your cardio-vascular system (like wegovy seems to do) seems pretty awesome. BTW I expect a person to undergo a proper diet change along with a related change in medication. I doubt metformin is a wonder drug in that regard btw. For that its just too tricky to take enough of the drug without digestive issues and/or over eating, though I had some good success so far. I kinda ruined earlier progress with weed consumption and resulting munchies sadly.

I just know the history of diet drugs and let's just say that so far, it hasn't been an unmitigated success.

What concerns me is that unlike a totally new medication, getting the indications for the same medicine changed is not subject to the same scrutiny. Indication creep has worked out badly in the past.

I'm not saying 'no', I'm saying that pharmacutical companies are just about as unethical as you can get and avoid jail time.

 

[Conky]

Regarding damage: Apathy, anhedonia (invega) and a reduced ability to feel recreational drugs, notably kratom became very dull which was my drug of choice back then also because it was therapeutic. I later switched to amisulprid for a short amount of time and this changed something in me. My ability to feel kratom is now gone and so is it with most other drugs even alcohol. I'd call that damage and it makes me doing stronger drugs than I'd like in order to feel something. This switch was years ago and I wasn't even on amisulpride for long because I couldn't tolerate some side effects. There are worse things in the world but nobody ever warned me that this might happen should I take (or change my) antipsychotics. Maybe reduced effects of certain drugs as long as the med is in my system, sure but this?

90 libs is really bad I agree but everyone is different. After RLS with quetiapine and apathy, anhedonia and the other shit olanzapine seems not too bad to me weight gain aside.

I was on haloperidol for a few years. I know all about the apathy, anhedonia, and reduced ability to feel certain other drugs classes such as amphetamine, methylphenidate, cathinones, psychedelics, and opioids to a much lesser extent(You still feel morphine but it's not as rewarding).

Alcohol is a powerful CNS depressant, if you are taking big shots of whisky one after the other you will certainly feel it (at least until you backout)
Same with benzos, GHB/GBL, and other more obscure GABA drugs. But alcohol is best example because it's way more reliable and consistent compared to drugs obtained on the grey and black markets. Kratom included. So I don't really believe you can't feel alcohol's intoxicating effects.

Oh and I'm also currently on metformin 1500mg. The effect is modest and so I used/use other "tools" to reverse the weight gain 100%. In fact, I'm now trying prevent weight loss.

 

[AlphaMethylPhenyl]

I don't know much other than that metformin is supposed to be really heathy, other than being used to reverse weight gain while on antipsychotics. Ozempic is also used, I think it's older, I don't know the insurance situation with it.

 

[Katanya]

I don't know much other than that metformin is supposed to be really heathy, other than being used to reverse weight gain while on antipsychotics. Ozempic is also used, I think it's older, I don't know the insurance situation with it.

Is it used after the person is off the antipsychotic that caused weight gain?

I was on metformin while I was on Invega Trinza (the injection) and it didn’t do anything.

 

[Conky]

Is it used after the person is off the antipsychotic that caused weight gain?

I was on metformin while I was on Invega Trinza (the injection) and it didn’t do anything.

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.