5 ms·

Yes, I want to find a doc to prescribe me this and also understands the negatives. Why aren't there more docs doing this kind of stuff? Maybe bc it is not so si

Yes, I want to find a doc to prescribe me this and also understands the negatives. Why aren't there more docs doing this kind of stuff? Maybe bc it is not so simple?

Scoundreller 7y ago
Preventative pharmaceutical treatments are, culturally, a hard sell unless you have some documented risk factor better than "life". But if you can find a provider that specializes in "anti-aging", it might be the first thing they reach for. Just don't buy into too much of what they say :) I would say anti-cholesterol medications were vastly marketed/sold and prescribed to those likely to only benefit a bit. The "Number Needed To Treat" (NNT) was over 100 for most populations prescribed it. But at $1/day and several pharma companies manufacturing their versions, there was a lot of profit from influencing. But metformin is cheaper than cheap, so that won't happen. Mass vaccinations were (mostly) an easy sell when they prevented debilitating diseases that harm children (e.g. polio), but remain harder sells when the benefits are primarily for the old/already ill (e.g. flu vaccines).
- benj111 7y ago
  Except in countries with socialised healthcare.
  - Scoundreller 7y ago
    Even they will develop criteria for when they pay for an intervention or not. Unfortunately, low-value but worthwhile endeavours often go unfunded or underpromoted because the infrastructure makes it too expensive. Metformin is cheap and large tracts of the population may benefit from taking it proactively, but once you factor in the cost of MD visits for otherwise healthy people, the public benefit can swing into the negatives.
- toast0 7y ago
  The childhood mass vaccinations are individually and collectively effective with few doses and target epidemic diseases, some of which lead to a lifetime of diminished capacity. The flu vaccine targets a potentially epidemic disease, which can be lethal, but doesn't often leave you with lifetime effects otherwise. Additionally, the vaccine has varied effectiveness from year to year, requires an annual dose. Annecdotally, I know if I get the flue vaccine, I'm going to feel shitty for a couple days; but I don't know that I've ever had the flu -- most of the seasonal illness I've had doesn't seem to match, and of course, you wouldn't know unless you were tested, and no doctor wants you to come in to get tested if you're doing OK at home.
  - NotSammyHagar 7y ago
    i get the flu vaccine every year, and I got this year's shot 3 days ago. I had a sore arm for a couple of hours (from getting a shot in a muscle i think) that night and it was gone by morning.
  - Scoundreller 7y ago
    You might be one of the 75% that don't have symptoms: https://www.nhs.uk/news/medical-practice/three-quarters-of-people-with-flu-have-no-symptoms/ https://www.nhs.uk/news/medical-practice/three-quarters-of-p...
ollysb 7y ago
The side effects can be pretty nasty. I took it for 6 months and the stomach pain and diarrhoea never went away. Berberine however acts on the same pathways as metformin and doesn’t cause the side effects. As a bonus you don’t need a prescription to take it.
- Scoundreller 7y ago
  > stomach pain and diarrhoea never went away I always wondered if that's what caused the weight loss: destabilization of the digestive system, so you grow to fear overeating/eating crap. Dunno how one can say they work on the same pathways: we're not really sure how metformin does its thing.
  - copperx 7y ago
    Not necessarily as you describe it, but weight loss might be the result of the microbiota changes induced by metformin. I never felt digestive issues when taking metformin, only a feeling of having less energy.
- synt4x1k0 7y ago
  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5867333/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5867333/
throwaway5752 7y ago
Black boxed. Lactic acidosis.
- NotSammyHagar 7y ago
  Please elaborate on both sentences, I don't understand.
  - Scoundreller 7y ago
    See my above post. There was fear that metformin causes lactic acidosis because its predecessor compound did. But the evidence doesn't support that. Black box warning: Some drug regulators put alerts in a black box on their packaging. Unfortunately, these same regulators don't revisit these warnings, leading to 'alert fatigue'. And with non-metformin therapies being far more profitable, the push to get rid of that unnecessary warning isn't there.
- Scoundreller 7y ago
  > Lactic acidosis. That's debunked hysteria leftover from its predecessor compound. We've been giving metformin long enough to see that it isn't causing lactic acidosis. > Pooled data from 347 comparative trials and cohort studies revealed no cases of fatal or nonfatal lactic acidosis in 70,490 patient-years of metformin use or in 55,451 patients-years in the non-metformin group. > There was no difference in lactate levels, either as mean treatment levels or as a net change from baseline, for metformin compared to non-metformin therapies. https://www.ncbi.nlm.nih.gov/pubmed/20393934 https://www.ncbi.nlm.nih.gov/pubmed/20393934 In other words, you may find a few case reports of patients taking metformin having LA, but that's because you can have LA without metformin.

Yes, I want to find a doc to prescribe me this and also understands the negatives. Why aren't there more docs doing this kind of stuff? Maybe bc it is not so simple?

Scoundreller 7y ago

Preventative pharmaceutical treatments are, culturally, a hard sell unless you have some documented risk factor better than "life". But if you can find a provider that specializes in "anti-aging", it might be the first thing they reach for. Just don't buy into too much of what they say :) I would say anti-cholesterol medications were vastly marketed/sold and prescribed to those likely to only benefit a bit. The "Number Needed To Treat" (NNT) was over 100 for most populations prescribed it. But at $1/day and several pharma companies manufacturing their versions, there was a lot of profit from influencing. But metformin is cheaper than cheap, so that won't happen. Mass vaccinations were (mostly) an easy sell when they prevented debilitating diseases that harm children (e.g. polio), but remain harder sells when the benefits are primarily for the old/already ill (e.g. flu vaccines).

benj111 7y ago
Except in countries with socialised healthcare.
- Scoundreller 7y ago
  Even they will develop criteria for when they pay for an intervention or not. Unfortunately, low-value but worthwhile endeavours often go unfunded or underpromoted because the infrastructure makes it too expensive. Metformin is cheap and large tracts of the population may benefit from taking it proactively, but once you factor in the cost of MD visits for otherwise healthy people, the public benefit can swing into the negatives.
toast0 7y ago
The childhood mass vaccinations are individually and collectively effective with few doses and target epidemic diseases, some of which lead to a lifetime of diminished capacity. The flu vaccine targets a potentially epidemic disease, which can be lethal, but doesn't often leave you with lifetime effects otherwise. Additionally, the vaccine has varied effectiveness from year to year, requires an annual dose. Annecdotally, I know if I get the flue vaccine, I'm going to feel shitty for a couple days; but I don't know that I've ever had the flu -- most of the seasonal illness I've had doesn't seem to match, and of course, you wouldn't know unless you were tested, and no doctor wants you to come in to get tested if you're doing OK at home.
- NotSammyHagar 7y ago
  i get the flu vaccine every year, and I got this year's shot 3 days ago. I had a sore arm for a couple of hours (from getting a shot in a muscle i think) that night and it was gone by morning.
- Scoundreller 7y ago
  You might be one of the 75% that don't have symptoms: https://www.nhs.uk/news/medical-practice/three-quarters-of-people-with-flu-have-no-symptoms/ https://www.nhs.uk/news/medical-practice/three-quarters-of-p...

ollysb 7y ago

The side effects can be pretty nasty. I took it for 6 months and the stomach pain and diarrhoea never went away. Berberine however acts on the same pathways as metformin and doesn’t cause the side effects. As a bonus you don’t need a prescription to take it.

Scoundreller 7y ago
> stomach pain and diarrhoea never went away I always wondered if that's what caused the weight loss: destabilization of the digestive system, so you grow to fear overeating/eating crap. Dunno how one can say they work on the same pathways: we're not really sure how metformin does its thing.
- copperx 7y ago
  Not necessarily as you describe it, but weight loss might be the result of the microbiota changes induced by metformin. I never felt digestive issues when taking metformin, only a feeling of having less energy.
synt4x1k0 7y ago
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5867333/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5867333/

throwaway5752 7y ago

Black boxed. Lactic acidosis.

NotSammyHagar 7y ago
Please elaborate on both sentences, I don't understand.
- Scoundreller 7y ago
  See my above post. There was fear that metformin causes lactic acidosis because its predecessor compound did. But the evidence doesn't support that. Black box warning: Some drug regulators put alerts in a black box on their packaging. Unfortunately, these same regulators don't revisit these warnings, leading to 'alert fatigue'. And with non-metformin therapies being far more profitable, the push to get rid of that unnecessary warning isn't there.
Scoundreller 7y ago
> Lactic acidosis. That's debunked hysteria leftover from its predecessor compound. We've been giving metformin long enough to see that it isn't causing lactic acidosis. > Pooled data from 347 comparative trials and cohort studies revealed no cases of fatal or nonfatal lactic acidosis in 70,490 patient-years of metformin use or in 55,451 patients-years in the non-metformin group. > There was no difference in lactate levels, either as mean treatment levels or as a net change from baseline, for metformin compared to non-metformin therapies. https://www.ncbi.nlm.nih.gov/pubmed/20393934 https://www.ncbi.nlm.nih.gov/pubmed/20393934 In other words, you may find a few case reports of patients taking metformin having LA, but that's because you can have LA without metformin.