Hello. This is Ford brewer. I'm doing a series on metformin . why? metformin has
become very popular over the past few years . it's by far the number one
recommended drug for the first level of diabetes it's the number one recommended
drug by the American College of Endocrinologists and the American
Diabetic Association but that's not why I'm doing a series on it I use it a lot
because of insulin resistance pre-diabetes you have to remember my my
population heart attack and stroke prevention two-thirds of three-quarters
of the heart attacks and strokes that are occurring in my population and in
this country overall are occurring because of insulin resistance and even
full-blown diabetes if you remember the the concept that over half of us get
insulin resistance during our 50s then you start realizing how prevalent it is
then you realize that not only do most insulin resistant folks not realize that
even a third of full-blown diabetics don't realize it when you start looking
at what I'm dealing with what I'm looking for cleaning this plaque out of
arteries and slowing down this inflammation of plaque and realizing
that three-quarters of that plaque is being caused by having blood sugar
levels that are too high then again you start realizing the importance of
medications like metformin metformin is actually this this video however is on
weight loss and metformin my patients will routinely come in
with an OGTT, oral glucose tolerance test of 150 or higher and evidence that they've
had that for decades and yet no notice of that by their docs I understand why
and we can talk about that in other videos
but a blood look level of 140 glucose has been shown clearly to cause damage
to eyes tendons pancreas kidneys and arteries as we just as demonstrated well
so again that's why you begin to see the importance of a medication like
metformin very common and the usual first
recommendation that we have is to change lifestyle to improve diet and exercise
but when you read books like why we get fat and what to do about it
other a blood sugar 101 some of these books show some clear evidence that of a
concept that we don't get fat because we eat too much we eat too much because our
metabolism our genetics and our age are making us fat it may sound like an
excuse but just read up on it study it before you argue that so again quite
often we'll always start with lifestyle but quite often these patients need
metformin sometimes pioglitazone is an option when they go on metformin they
routinely lose weight why glucose metabolism is a very complicated thing
glucose first in terms of what we're looking for it starts in the GI tract
it's absorbed it goes into the blood goes to the liver is released and then
you've got glucose in the blood trying to get inside the cell it goes through
the cell membrane and this is either in the liver or them
so then it gets inside the cell once it gets inside the cell that's transported
to the mitochondria what is the mitochondria the mitochondria is the
powerhouse of the cell and it's got a lot of things going on in it but it
makes the majority of our energy it starts burning glucose in a process
called glycolysis now there are things like the enzymes like AMPK which are
critical to the multiple processes in this area metformin results in
improvement and amplification of ampk ampk and other metabolic activities down
these pathways and Cascades seem to get old and rusty as we get older and
metformin tends to amp these activities back up so we start burning fat instead
of storing it we start taking sugar out of the blood we start recycling cellular
wastes to burn them it's a process called Altaf AG again multiple areas
along these steps of glucose metabolism are improved by metformin now having
said all of that there's evidence that the biggest impact from from metformin
is just stopping the the - what we call gluconeogenesis dumping of glucose
back into the bloodstream by the liver we'll talk about that later too but
again it's clear glue on metformin can talk and cause weight loss even in non
diabetic patients now having said that consider the fact that insulin
resistance or pre-diabetes is so grossly under diagnosed in this
country it sort of fogs the term when you say metformin results in weight loss
for non diabetics the resultant weight loss for folks even without glucose
metabolism problems some of the most challenging patients of polycystic ovary
disease now many of those do have glucose metabolism problems patients on
psychiatric medications there have been studies with middle-aged
females that did not have known glucose metabolism problems again time and time
and time again metformin did result in improved weight loss improved metabolism
of glucose now we're going to have it again a series of videos on metformin
this one was on weight loss we'll also talk about a neurologic function and
performance dementia senile dementia is being called by many people type 3
diabetes it seems to be very much related to impaired glucose metabolism
metformin has been shown to help metformin has been approved for research
in anti-aging by the FDA - a researcher up at Einstein College in New York
Einstein Medical School a fellow named Barzilai so we'll be looking at
anti-aging neurologic performance in this video we looked at weight loss
cardiovascular performance of prevention and of course in insulin resistance
in us baby boomers but there's even one other thing prevention of cancer so a
lot of things going on with metformin we'll have a series on that thank you
for your attention