Weight management can be broken down into these three basic elements.  These are hunger, satiety, and the caloric content of your food. 

Let’s talk about hunger.  When your stomach is empty it releases Ghrelin (Growth Hormone Releasing Initiator).  As a matter of fact, the part of the stomach that produces Ghrelin is surgically removed during a gastric sleeve.  Ghrelin gets into the brain and generates the FEED signal, one of the four “F”s that control behavior (FIGHT, FLIGHT , FEED, and ...).   The “FEED” response gets your intestines ready to digest food, and you release human growth hormone (HGH) in large quantity.  The HGH stimulates your metabolism, motivates hunting and mixes with Insulin to make fat cells grow, insuring there is plenty of space to store the calories you find. 

Now let’s talk about satiety.  When fat cells get full, they produce Leptin, the satiety hormone. Leptin counters Ghrelin, the “Feed” signal, and makes you feel satisfied. 

Finally, let’s talk about the caloric content of your food. The caloric content of the food you eat determines how much Leptin gets into the brain.  The higher the caloric content, the less Leptin gets into your brain.  High starch and sugar foods have the most caloric content and effectively block Leptin.  Ghrelin then shoots directly into your brain every time your stomach is empty, and you just keep on eating – “Bet you can’t eat just one!”  This sets HGH and Insulin into action and you make fat cells divide like crazy. 

Metformin is a medicine that helps you use Insulin more effectively so you don’t need as much Insulin for the same caloric intake.  It prevents you from forming new fat cells, calorie for calorie, because less Insulin is produced and Human Growth Hormone cannot make new fat cells without Insulin.

If your body mass index is more than 30 you may benefit from controlling Insulin release with Metformin.

To Safely Use Metformin

The dose of Metformin should be slowly increased and your progress should be monitored.  Periodic testing for kidney and liver functions should be performed. You should not use Metformin if you are allergic to it or already taking Glucophage (another name for Metformin). 

You should not start Metformin for weight control if you are using Insulin.

A serious but rare condition associated with the use of Metformin is lactic acidosis.  Lactic acidosis occurs once in every 16,600 patient-years and may be fatal if untreated.  To put this in perspective, fatalities related to NSAID/aspirin use are 20 times higher, occurring once in every 820 patient-years.  Also, lactic acidosis most often occurs in patients with serious health conditions. These conditions are related to reduced oxygen intake.  These conditions include heat stroke, dehydration, severe systemic infection, recent heart attack, cardiac failure, lung disease, surgery and alcoholism.

You should not take Metformin if you have or kidney impairment (serum creatinine >1.3 mg/dL), liver disease or a history of heart disease.  This could increase the risk for lactic acidosis.

Metformin should be stopped for 48 hours prior to surgery or X-Ray procedures requiring intravenous dye, and not restarted until a normal fluid intake resumes. 

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