atara
Bluelighter
Mirtazapine is also a 5-HT2C antagonist, FWIW.
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H&R Moderators: streaM Freak
Diet Metformin the poor-mans wegovy for weight loss?
- Thread starter sHR00m
- Start date
Greetings.
I found an article from 2026 about counter strategies regarding weight gain caused by mirtazapine.
First line treatment is in fact - yep - metformin. There are alternatives listed too though.
GLP-1 agonists are actually mentioned as having no evidence of helping under these circumstances.
Hope that might help you.
So I had a wild ride with my medical situation and deep seek and came to a lot of interesting conclusions.
As I said I am prediabetic because of the Olanzapine. Since I am on keto and metformin elevated resting blood sugar is kinda concerning because both should help controlling that value. I ended up remembering what someone prediabetic on /r/keto once said. That he needed not just to restrict carbs but also protein to keep his blood sugar in check. I therefore lowered my protein intake to 90g per day and voila, blood sugar under 100 mg/DL all day like it's supposed to.
I then proceeded to buy a go keto blood ketone meter which I'm using alongside my blood sugar measurement device. The ketone meter is fire. It even measures glucose as well with the right strips. Anyway both values together can reliably tell if I'm actually in ketosis or not and oh boy am I glad I bought it. I ate a larger bowl of sauce bolognese and when I measured 2 hours later I had fully dropped out of ketosis. This was totally unexpected because protein and carbs checked out. As it turned out my liver got so affected by olanzapine that it very quickly turns protein into glucose due to an overactive process called gluconeogenesis. Great. Normally this process is on demand and doesn't just fire when you eat more protein.
I therefore ended up splitting my protein into 3x30g. 2 of which are shakes I drink in the morning and evening. The protein source is caseine which has a slow absorption and doesn't cause spikes. I further added some olive oil to it and a decent amount of fibers, both further slowing down absorption. These shakes seem to be virtually neutral to my blood sugar. Also I have since ordered MCT oil to replace the olive oil because MCT can be readily metabolized into ketones, supporting my ketosis.
The next thing I found out was that collagen was potentially beneficial during weight loss (mostly helping elasticity of the shrinking skin but also supposedly improving resting blood sugar). So I substituted some protein in my shake with 10g of collagen (which is a protein as well). Imagine my surprise when I measured the worst blood sugar spike in weeks a few hours afterwards (108 mg/dl. Collagen gets readily absorbed and my liver immediately turned it into glucose, kicking me out of ketosis. Ok. I guess no collagen for me then. I also picked up cycling 5x a week and resistance training 3 times a week to work against my insulin resistance. I did the full program that day and still had this ugly spike.
Then I learned from a study that dosing metformin a certain way (notably early in the morning and essentially right before bed) helps keeping it working round the clock. If you are dosing it in the morning/midday/evening like I used to, there is a dosing gap at night which is why the fasting blood sugar can be elevated in the morning. I took 1 gram in the morning, half a gram at lunch and half a gram in the evening. I'm therefore gonna switch that around and take 0.5 in the morning, 0.5 at lunch and 1 gram at night. This should further help maintaining a stable blood sugar level. I should know if that improves things in one or two days.
I think I optimized what I could. Now it's time to wait if I am able to reliably stay in ketosis with this regimen or if my body just keeps randomly spiking my blood sugar, kicking me out occasionally.
My rapid weight loss slowed down considerably lately. I got insane weight gain when I violated my keto regimen and pigged out on a lot of carbs for a few days. This resulted in a 10kg increase which took me about a month to lose it again. I then hovered around 95 for a while until I finally ended up at 94.5. Me being on a 35% caloric deficit should break through any plateau but this time it's really slow. I wouldn't be surprised if the rapid weight gain was an after effect from my initial weight gain caused by the olanzapine. It's like my body has a memory effect. "95kg is where you were before olanzapine. You shall go no farther. Also if you binge, insta weight gain back where it belongs (back to 125kg)." To be clear: This is NOT a normal effect during ketogenic diet. You might gain a few kilos on a cheat day or two but certainly not 10. I also very much doubt it's the metformin's fault. All it does is dampening hunger.
It am curious if metformin loses efficiency after a while though. GLP-1 agonists lose their effect after about a year - you got that much time to get your eating habits in order or you will likely gain a considerable amount back once it stops working. I don't think I am at that point with metformin (yet) since I have no issue sticking to my caloric deficit. If metformin doesn't have this issue, this might make it superior to GLP-1 agonists in that regard. Since I'm in month 10 (or 11?) I should find out soon enough.
The next step is seeing my doctor and getting a more thorough check up. Deep seek actually came up with various useful markers that really should have been checked long ago. I'm kinda pissed that my psych hasn't done that and didn't even tell me that I'm prediabetic until like half a year later. Oh well.
Alright, that's all for now. Peace out.
As I said I am prediabetic because of the Olanzapine. Since I am on keto and metformin elevated resting blood sugar is kinda concerning because both should help controlling that value. I ended up remembering what someone prediabetic on /r/keto once said. That he needed not just to restrict carbs but also protein to keep his blood sugar in check. I therefore lowered my protein intake to 90g per day and voila, blood sugar under 100 mg/DL all day like it's supposed to.
I then proceeded to buy a go keto blood ketone meter which I'm using alongside my blood sugar measurement device. The ketone meter is fire. It even measures glucose as well with the right strips. Anyway both values together can reliably tell if I'm actually in ketosis or not and oh boy am I glad I bought it. I ate a larger bowl of sauce bolognese and when I measured 2 hours later I had fully dropped out of ketosis. This was totally unexpected because protein and carbs checked out. As it turned out my liver got so affected by olanzapine that it very quickly turns protein into glucose due to an overactive process called gluconeogenesis. Great. Normally this process is on demand and doesn't just fire when you eat more protein.
I therefore ended up splitting my protein into 3x30g. 2 of which are shakes I drink in the morning and evening. The protein source is caseine which has a slow absorption and doesn't cause spikes. I further added some olive oil to it and a decent amount of fibers, both further slowing down absorption. These shakes seem to be virtually neutral to my blood sugar. Also I have since ordered MCT oil to replace the olive oil because MCT can be readily metabolized into ketones, supporting my ketosis.
The next thing I found out was that collagen was potentially beneficial during weight loss (mostly helping elasticity of the shrinking skin but also supposedly improving resting blood sugar). So I substituted some protein in my shake with 10g of collagen (which is a protein as well). Imagine my surprise when I measured the worst blood sugar spike in weeks a few hours afterwards (108 mg/dl. Collagen gets readily absorbed and my liver immediately turned it into glucose, kicking me out of ketosis. Ok. I guess no collagen for me then. I also picked up cycling 5x a week and resistance training 3 times a week to work against my insulin resistance. I did the full program that day and still had this ugly spike.
Then I learned from a study that dosing metformin a certain way (notably early in the morning and essentially right before bed) helps keeping it working round the clock. If you are dosing it in the morning/midday/evening like I used to, there is a dosing gap at night which is why the fasting blood sugar can be elevated in the morning. I took 1 gram in the morning, half a gram at lunch and half a gram in the evening. I'm therefore gonna switch that around and take 0.5 in the morning, 0.5 at lunch and 1 gram at night. This should further help maintaining a stable blood sugar level. I should know if that improves things in one or two days.
I think I optimized what I could. Now it's time to wait if I am able to reliably stay in ketosis with this regimen or if my body just keeps randomly spiking my blood sugar, kicking me out occasionally.
My rapid weight loss slowed down considerably lately. I got insane weight gain when I violated my keto regimen and pigged out on a lot of carbs for a few days. This resulted in a 10kg increase which took me about a month to lose it again. I then hovered around 95 for a while until I finally ended up at 94.5. Me being on a 35% caloric deficit should break through any plateau but this time it's really slow. I wouldn't be surprised if the rapid weight gain was an after effect from my initial weight gain caused by the olanzapine. It's like my body has a memory effect. "95kg is where you were before olanzapine. You shall go no farther. Also if you binge, insta weight gain back where it belongs (back to 125kg)." To be clear: This is NOT a normal effect during ketogenic diet. You might gain a few kilos on a cheat day or two but certainly not 10. I also very much doubt it's the metformin's fault. All it does is dampening hunger.
It am curious if metformin loses efficiency after a while though. GLP-1 agonists lose their effect after about a year - you got that much time to get your eating habits in order or you will likely gain a considerable amount back once it stops working. I don't think I am at that point with metformin (yet) since I have no issue sticking to my caloric deficit. If metformin doesn't have this issue, this might make it superior to GLP-1 agonists in that regard. Since I'm in month 10 (or 11?) I should find out soon enough.
The next step is seeing my doctor and getting a more thorough check up. Deep seek actually came up with various useful markers that really should have been checked long ago. I'm kinda pissed that my psych hasn't done that and didn't even tell me that I'm prediabetic until like half a year later. Oh well.
Alright, that's all for now. Peace out.
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