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Effects of Metformin and Aerobic Exercise

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  • Effects of Metformin and Aerobic Exercise

    I ran across this interesting article that seems to support a negative Metformin effect on cardiorespiratory fitness when added to aerobic exercise. The study group was heavily weighted with women and the insulin sensitivity data with metformin showed significantly different results in the metformin group- some improved and others did not. Comments?
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  • #2
    This is one of two studies (the other being on muscle building) which I highlighted in earlier posts that shows a negative effect from metformin usage. Along with the 2019 Banting Award lecture that I recently posted under fatmax's Metformin topic, together those give a good understanding of how metformin affects different areas of the body and interesting pleiotrophic effects like reduction in several types of cancer. I used to take metformin every day for pre-diabetes, but I started to back away a bit given these two studies as I try to exercise vigorously three times weekly. I take metformin on the other days when I am just walking for exercise. I have started a weekly dose of pioglitazone as TZDs are one class of drugs which helps with insulin resistance.
    Last edited by Tom; 02-02-2020, 11:22 PM.

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    • #3
      I’ve not taken as many “metformin vacations”. But I do a lot of intense HIIT and resistance training. (6minute/mile hill intervals). Maybe I should slow down on the Metformin and see what that does .

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      • #4
        I just heard an interesting STEM-Talk podcast with Adam Konopka who was one of the authors of the Cell paper. He basically said that people who were less fit gained the most from a combination of exercise and metformin, and the most fit people generally did not get much improvement with some decline possible. He also comments on timing of metformin usage when exercising. In any case he says exercise, exercise and more exercise is the key to healthy aging (along with diet, etc. obviously). He wants to see some human study using rapamycin, and that would be most interesting. Are you giving rapamycin prescriptions out yet? That would be interesting. As things are now, I may need to get an extra kidney installed so that I qualify
        https://www.ihmc.us/stemtalk/episode-102/
        Last edited by Tom; 02-03-2020, 03:22 AM.

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        • #5
          Originally posted by Tom View Post
          This is one of two studies (the other being on muscle building) which I highlighted in earlier posts that shows a negative effect from metformin usage. Along with the 2019 Banting Award lecture that I recently posted under fatmax's Metformin topic, together those give a good understanding of how metformin affects different areas of the body and interesting pleiotrophic effects like reduction in several types of cancer. I used to take metformin every day for pre-diabetes, but I started to back away a bit given these two studies as I try to exercise vigorously three times weekly. I take metformin on the other days when I am just walking for exercise. I have started a weekly dose of pioglitazone as TZDs are one class of drugs which helps with insulin resistance.
          How's your water retention on the once a week pioglitazone? Any change in BP or weight?

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          • Tom
            Tom commented
            Editing a comment
            I have only been taking pioglitazone for four weeks now, and I don't think that my water retention has changed much. Nothing significant for blood pressure, but my weight is up two lbs. That may well be due to the fact that I have been exercising lately with a focus on building muscle mass and mitochondria usage (Zone 2 exercise mentioned in recent posts). Only time will tell I guess on whether I do start to put on weight, but if that happens I then throttle back on carbs a bit and my weight drops. In the last year I wasn't sure that I could do more than a three day water fast at my long stabilized weight of 150 lbs. as I didn't seem to have much in the way of extra fat to burn. To my understanding pioglitazone pushes more triglycerides into subcutaneous fat as the mechanism to improve insulin sensitivity. If I do build up some fat, then I will go for one four or five day fast yearly.
            Last edited by Tom; 02-06-2020, 02:22 AM.

        • #6
          Below is Rhonda Patrick's thoughts on the issue of metformin inhibiting the exercise adaptive response and muscle building. If a person is young and healthy (without significant insulin resistance), there doesn't seem to be a lot to gain in the short-term from taking metformin if that person is also exercising vigorously. However, it becomes a little more murky for older people who have some risk factors but still try to exercise vigorously. I personally am still continuing to take metformin on the days when I am not exercising vigorously because I am older and have higher risk factors. RIsk analysis is important on so many things that have known benefits along with side effects.
          https://onlinelibrary.wiley.com/doi/...111/acel.13039

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          • #7
            These are very interesting papers. They present another side of the debate for “preventive” metformin as seen in the TAME study. As I continue to study this issue, I am coming to a similar conclusion (as Dr Patrick).
            Nobody can say for sure. But I also suspect both sides of this debate may be right - depending on the situation. How can that be? I suspect that the benefit/risk ratio increases as the level of IR climbs - and the exercise intensity drops. In other words, I think it makes more sense for sedentary and older people with more serious IR.

            Again, I don’t think anyone can confirm at this point. So I educate my patients about both sides of the debate and seek patient guidance on their preferences in this choice.

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            • #8
              My stance is once I'm down to 170 I'll drop from 500mg TID a day to 250TID then a month or so after nine. I'm 41 and was only ever prediabetic.

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