Metformin Effectiveness - Diet Interactions

[TomBAvoider]

I guess it stands to reason, but it's still a bit of a jolt to fully appreciate the fact that pharmaceuticals/medication interacts with diet and can be profoundly influenced in its effectiveness to the point of total ineffectiveness. This appears to be true of metformin as well. The following study was initially in fruit flies, but then an attempt has been made to validate those findings in humans. Bottom line, it's possible that if you are on a high carb diet - or just have a lot of sugar in your diet - that your gut biome can cause metformin to become ineffective. In other words, it's possible that to obtain any benefits from metformin, your diet must have a particular profile. 

Obviously, while this particular case applies to metformin, doesn't it stand to reason that it's true for many other drugs/interventions? They may all interact with other medications, diet, lifestyle choices and genetics. So, perhaps some of the variability of outcomes might be down to these confounders. Say, if you take rapa, perhaps there are things you should/should not do to derive any benefits. Perhaps another reason to carefully evaluate the individual and their entire profile before prescribing any drug/intervention - again more toward individualized medicine.

Here's the study in question:

https://www.sciencedaily.com/releases/2019/08/190830112810.htm

"Implications for metformin treatment

"Our results shed light on how the complex network of interactions between diet, microbiota and host impacts the efficacy of drugs," says Cabreiro. "With our high-throughput screening approach we now finally have a tool at hand that allows us to tackle this complexity." The findings of this study may help to inform dietary guidelines or the development of genetically engineered bacteria that could be used to enhance the beneficial effects of metformin. They may also provide a valuable insight into the evidence that suggests that metformin-treated type-2 diabetic patients are healthier and live longer than non-diabetic individuals."

[Saul]

13 hours ago, TomBAvoider said:

"With our high-throughput screening approach we now finally have a tool at hand that allows us to tackle this complexity."

Hi Tom!

I'm very skeptical.  They're talking about an extremely complex situation.  An analogous claim, made by a physicist, would be:  "We have discovered the nature of the universe".

I believe the best technique, assuming that you are healthy, is to pursue a good diet with exercise -- and void unnecessary drugs. 

  --  Saul

[mccoy]

19 hours ago, TomBAvoider said:

They may also provide a valuable insight into the evidence that suggests that metformin-treated type-2 diabetic patients are healthier and live longer than non-diabetic individuals."

Doesn't that sound absurd? Metformin turning diabetics into longevity champions... 

[Ron Put]

5 minutes ago, mccoy said:

Doesn't that sound absurd? Metformin turning diabetics into longevity champions... 

Not really, if you read the fine print. Basically they compare subjects with Type-2 diabetes and are taking Metformin, with subjects who have the same characteristics but are not classified as diabetics and are not on medication for it. Which means that it is likely that the "control" group is comprised of people who are overweight and not necessarily healthy, and may be per-diabetic. Such "controls" are also less likely to monitor their sugar intake than those already diagnosed with diabetes. To boot, the difference in mortality seems minor.

 

20 hours ago, TomBAvoider said:

Bottom line, it's possible that if you are on a high carb diet

"High arb diet" is a meaningless term. If you are on a high fiber "high carb diet" comprised of vegetables, fruit and whole grains and legumes, your microbiome would be very healthy and you would have been excluded from the study cited above. If you are on a donuts and soda "high carb diet," then you are within the scope of the study.

As to "personalized medicine" involving individual characteristics, especially involving microbiome, we are barely beginning to grasp the complexities and anyone who claims to have cracked it should be viewed with due skepticism.

[mccoy]

8 hours ago, Ron Put said:

Not really, if you read the fine print.

OK then, if the control group is biased toward prediabetics or people not metabolically perfectly healthy....