ErlandFR: I tried metformin, it made me terribly sick. I stuck it out
for 3 weeks without getting used to it, so I dropped it. Do you have advice on
how to tolerate metformin? Yeah. The bottom line is there are some people
but it's less than 1% of the gene pool. They do have a genetic predisposition
where they cannot tolerate metformin and usually that's due to gastrointestinal
problems. For up to 20% of us, when we first start metformin, we can get a
little bit of gas, mostly a little bit gas, sometimes a little bit of diarrhea.
Usually, when somebody in that 20%, what we'll have them do is split the
pill back off and take like instead of 500, 250 or even less per day for a few
weeks. Usually, the vast majority of that 20%
can get used to it. One of the things that we found is that metformin actually
changes the gut biome. There are gut biomes that are more
associated with insulin resistance and diabetes. They have to do with fewer
variety of different species of bacteria, and they got some other things. And
metformin tends to change the gut biome from more of a prediabetic type of mix
of bacteria to more of a non-prediabetic mix. So that appears to be
one of the mechanisms for getting used to metformin. As I said earlier, though,
Erland, some people just don't get used to it. Now, I've got several patients who
said, yeah, I still want to take it, and I can tolerate these lower levels. And they
just continue to pill split. And there will be a lot of people that will debate
with me over this. Come in, I'm getting ready to make as well. But again,
take it in context, and we can debate that at some point too. Most people think
you have to take metformin every day. I do tend to take metformin most days.
I take 500 twice a day. I've got significant insulin resistance. But
especially for those of us with less insulin resistance, again, you don't have
to take metformin every day. If you go back to David Sinclair and his comments
about taking that formula when he was taking it,
he agreed that he intended to take metformin vacations, and it sounded like
at least once a week. He would go a day or two without taking metformin.
There's nothing like a community we saw that in the Louisville event. People got
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