Guest Post by Felice L. Gersh, MD
Metformin is the number one drug for use in diabetics and pre-diabetics, and has become a mainstay in the treatment of women with PCOS. The mechanism of Metformin as an anti-diabetic drug was truly not understood during its long tenure of use in diabetics, but has finally become more comprehended in the past few years. Simultaneously, its potential adverse effects are now finally becoming acknowledged.
How Metformin Works:
It’s now believed that Metformin works through a variety of mechanisms. One of the newest ones brought into the limelight has been its role in altering the gut microbiome– the incredible new world we are just beginning to understand. The gut microbiome has been found to be critical to insulin/glucose regulation. Low grade generalized inflammation in fat tissues or in the liver is an important etiologic factor in insulin resistance, a condition common to PCOS women. The wrong intestinal bacteria are a major source of systemic LPS, inflammatory particles derived from the “wrong” bacteria, which can cause inflammation both within the bowel itself, in the liver, in fat tissue, and across the entire body. With the wrong bacteria present in the gut, the protective mucous coating of the inside lining of the gut, produced by a species of bacteria call Akkermansia, is absent, and the LPS can cause damage to the lining cells of the gut, and of the body as a whole. Certain cells in the gut walls, called Paneth cells, produce antimicrobial peptides and greatly shape the gut microbial world. Metformin appears to increase the abundance of Akkermansia bacteria, thereby promoting the protective mucous coating and supporting the function of the important Paneth cells.
Metformin also appears to work by creating low grade damage to mitochondria, the energy producing factories of cells. By creating this mild damage, the pathways for fat burning and cellular rejuvenation are stimulated, which can lead to more effective glucose regulation.
The Problems with Metformin:
If one were to just read the paragraphs above, one would believe that Metformin is a wonder drug. Though it can have its place, it never cures insulin resistance or diabetes, doesn’t seem to improve fertility success or ovulation, and doesn’t give meaningful weight loss. As well, when compared directly with a lifestyle and exercise regimen, lifestyle wins and Metformin loses. Of course studies such as that one are rare.
In terms of facilitating success with IVF, when directly compared with Berberine, Berberine won! Berberine, an alkaloid plant extract, yielded more successful IVF babies than did Metformin, when used with women with PCOS. And no studies can be found comparing Metformin with Resveratrol or Myo Inositol, yet we know they are wonderfully helpful to reverse metabolic dysfunction.
And other negative issues exist with Metformin, most notably the fact that many users suffer greatly with nausea and gastrointestinal symptoms stemming from its use. Metformin is also widely known as a drug which depletes the body of Vitamin B12, and other nutrients. B12 has taken center stage, and rightly so, as a shortage of B12 is associated with nerve pain, known as neuropathy, cognitive dysfunction, and anemias. B12 is also critical for many of the detoxification pathways and for DNA stability.
Shockingly, it is now well recognized that Metformin is an endocrine disruptor. That means that it is a chemical – a man-made drug – which acts as an abnormal hormone-like substance, creating different and unexpected symptoms and effects. In fact, Metformin can be excreted unchanged, will travel through the water treatment plant, and be released unchanged into rivers. Metformin can actually end up in our drinking water. It also ends up in lakes and rivers, where it acts as a chemical hormone imitator. It has been absolutely proven to alter the genitalia of fish and render the fish nearly sterile. I greatly fear what impact it has within young female bodies and in the bodies of fetuses and nursing babies. Drugs known to be an endocrine disruptor should never be recommended to the young and unborn, in my opinion.
The Last Word:
In summary, Metformin can have some beneficial impacts on the regulation of glucose, and some new data suggests it may have cancer fighting benefits, but it’s also known that various nutraceuticals can likely work as well or better than Metformin, without the untoward side-effects, and that lifestyle changes can also work better. I remain very excited about ProLon, the new fasting mimicking diet, developed at the Longevity Center at USC. It can create wonderful metabolic effects which can help restore metabolic functions in women with PCOS, and do it naturally, without the collateral damage which accompany all pharmaceuticals.
If you wish to try an alternative approach to the treatment of PCOS, avoiding Metformin, consider an integrative approach, incorporating lifestyle, ProLon, and nutraceutical therapies, and work with PCOS Diva and myself. You can take control of your life!
Note From Amy: Please do not stop taking Metformin or any other medication without consulting your physician.
Dr. Felice Gersh is one of only a small number of fellowship trained integrative gynecologists in the nation. She blends the best of the world of natural and holistic medicine with state of the art functional and allopathic medical treatment. Because of her extensive knowledge of the complex inter-relationships of the body’s organs, she recognizes the need to investigate all aspects of health, always working to re-establish a healthy gastrointestinal tract, adequate sleep, good mood, great nutrition, high energy, and balanced hormones.
Expert in all areas of women’s health, and particularly of gynecological and reproductive matters, Dr. Gersh deals in an integrative manner with such uniquely female issues as polycystic ovary disease (PCOS).
She is currently writing a book on Polycystic Ovary Syndrome and writing a chapter on the same topic for a medical textbook.
You may contact Dr. Gersh at:
Integrative Medical Group of Irvine, 4968 Booth Circle, Suite 101, Irvine, California 92604