To Metformin or not to Metformin?
5 months on a low carb high fat diet and most of my issues have resolved but not completely (12 years of chronic fatigue, so come a long way). I've consistently been in ketosis, <50 g carbs, but now considering increasing between 50-100 g. I have a lot of joint pain and don't feel like I'm recovering as well from workouts, or in general, as the first few months on this diet. It feels like I've taken a step backwards towards fatigue and non-recovery. Perhaps I'm bonking, low on glycogen, and protein is being diverted from tissue repair to gluconeogenisis, or even some catabolism. I'm adding back some fat lbs. I exercise moderate to intense 5x/week, short workouts, sprints and weights, plus 1-2 short easy walks. Recovery with a low carb diet points to issues with diabetes, pre-diabetes, or metabolic syndrome. It appears we are all a little diabetic or heading in that direction with the standard high carb diet. Since diabetic issues produce damaging elevated glucose, how does one manage the reduction of blood glucose along with finding the carbohydrate intake sweet spot? My fasting blood glucose is currently in the 120 range, so pre-diabetes. I'm considering metformin to reduce glucose but it feels counterproductive to be taking metformin while adding back some carbs. Will the glucose reducing benefits of metformin interfere with glycogen storage? Any comments, tips, ideas?
If you thing you are diabetic or pre-diabetic, go see your MD and get tested. The A1C test is still the best diabetes indicator. I'd stay away from starting a drug regimen for Metformin unless your doc pegs you as diabetic. If you are pre-diabetic, I'd keep working on it with diet/exercise.
So, are you still looking at losing weight or are you where you want to be?
I'd honestly add back in some carbs to see where that gets you. Some people here have reported doing damage by being in ketosis for long periods, some people manage it just fine.
You'll just have to see what works best for you.
Also, your not over exercising are you? Are you resting enough to recover?
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Before jumping on the metformin boat consider myo-inositol supplementation. It has many of the same benefits of metformin and none of the nasty side effects.
Your raise a couple of issues. I see that you're in Canada--can you get Metformin OTC? Here in the U.S., it's Rx only, so you'd have to consult a doctor about all this.
I agree that any concern about fasting BG should be checked with an A1C. Keep in mind that those of us in ketosis will have higher than normal fasting BG (similar to the Dawn phenomenon that diabetics experience), so it's possible that your fasting number is an illusion. My doctor knows I eat low carb, so he always orders an A1C in addition to the standard fasting BG.
If it turns out that you actually DO have high BG (from an A1C) AND you have been in ketosis, make sure your doctor knows about this WOE. I say that because my first endo had me take a Glucose Tolerance Test (the gold standard for diabetic diagnosis) because she said that my low-carb eating could 'mask' diabetes. Mine turned out fine, but my point is that low carb should be suppressing your BG, so the situation may be more serious than the numbers show right now.
In your situation, I'd get checked. Undiagnosed diabetes can cause severe fatigue.
My A1C is 5.7, so also borderline prediabetes, taken before I was in ketosis. These last few weeks my FBG averages 120 while in ketosis. My Dr prescribed metformin at my request but admits knowing nothing about prediabetes, so no real support there. I find better information/support in the ancestral health community and PubMed vs GPs around here. 12 years and no diagnosis will erode one's confidence in the medical system. Symptom relief from the LCHF diet is a clear sign. And I've read a lot of comments about going too extreme into ketosis, or too long, and the benefits of adding back some carbs. Perhaps that's an appropriate rebalancing of the pendulum. Feedback was very helpful. Thank you all. Good post on Robb Wolfs site below. I also heard the author on a podcast. Sounds like the secret is to add back carbs slowly. I also read green coffee beans are good for glucose blunting. Will proceed half steam ahead. Wish me luck.
good,The A1C test is still the best diabetes indicator. I'd stay away from starting a drug regimen for Metformin unless your doc pegs you as diabetic. If you are pre-diabetic, I'd keep working on it with diet/exercise. thanks
My A1c is 5.7 and fasting glucose is 120, so I'd say that makes me pre diabetic. Cutting carbs, adding healthy fats, exercising with intensity, are all supposed to improve insulin sensitivity, which I assume will display as lower FBG and A1c (notwithstanding dawn phenomenon). FBG I can test at home, A1c requires a Drs visit and last attempt they didn't do it, not sure why, medical system protocol BS I assume. So if LCHF diet plus exercise improved 12 yrs of negative symptoms almost over night (ok, so resolved 60% in 3 weeks, 80% 6 weeks), then insulin resistance is a reasonable conclusion, or carb intolerance, or both. It sounds to me like the trick is to lower glucose which will lower insulin, increase insulin sensitivity, while maintaining enough dietary carbohydrates to replenish glycogen stores and allow for exercise and lifestyle routines. Dietary protein is important for muscle and tissue repair, especially if you exercise, or the body will breakdown current muscle for repair and the effects are net negative. Robust levels and quality of fat is important for a zillion reasons. Somewhere there is a sweet spot for each individual. I think it's time for another experiment. I'll try some low dose metformin and green coffee bean extract before bed to see if there's a FBG lowering effect, and a positive effect on my non restorative sleep and lingering occasional fatigue issues, while maintaining the LCHF diet and exercise ensuring adequate rest, and adding back a few carbs to the tune of 75 to 100 g total carbs per day. I can't see any one of these interfering with the other(s). If the overall effect is positive or negative, I can drop the metformin later and determine it's influence. Right or wrong, it's a plan...
Last edited by Gregmh; 06-15-2014 at 04:27 AM.
I have higher FBG when lowcarbing too.
I am trying to get to 100-150
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