health education | wellness

Category: Endocrine

  • Is Metformin Good or Bad?

    Is Metformin Good or Bad?

    Metformin is one of the most commonly prescribed drugs in the United States. Doctors prescribe it for many different conditions including diabetes, pre-diabetes and polycystic ovary syndrome. Up to one-third of adults over the age of 50 are now taking this medication. There are plenty of benefits as well as potential side effects. In this article, we are going to discuss the benefits and risks with this drug and answer the question, Is metformin is good or bad?

    Here’s what you need to know.

    An overview

    This is one of the most interesting drugs available today. It is not just for treating diabetes, it has been shown in studies to be cardioprotective and beneficial in the presence of stable congestive heart failure. It also has the potential to become a potent anti-cancer treatment that can be used to both prevent and treat cancer. 

    Marketed under the brand name “Glucophage,” Metformin is the first-line treatment for type 2 diabetes, particularly in obese patients. It is also employed in the treatment of Polycystic Ovarian Syndrome. This medication aids in the control of blood sugar levels in people with type 2 diabetes. It does so in many ways, including:

    • Reducing the amount of sugar absorbed by your body from food 
    • Lowering the amount of sugar produced by your liver
    • Increasing your body’s response to the insulin that it naturally produces

    The Origin of Metformin

    The Origin of Metformin

    French lilac (Galega officinalis) was used by healers in medieval Europe to treat a variety of symptoms, including some that could have been caused by type 2 diabetes. By the 17th century, doctors were recognizing diabetes and treating it with plant extracts. 

    It was first synthesized in the 1920s using compounds derived from French lilac. In rabbits, the drug was found to lower blood sugar levels. Glucophage is a brand name that means “glucose eater”. It took until 1994 for the FDA to approve its use in the treatment of type 2 diabetes in the United States. It may now be the most widely used diabetes medication on the planet.

    The Good and the Bad (side effects) of Metformin

    The Good 

    Metformin aids in the regulation of blood sugar levels. It is the first-line treatment for type 2 diabetes in patients aged 10 and above. Controlling high blood sugar levels can help prevent kidney damage, blindness, nerve problems, limb loss, and sexual function issues. Diabetes control may also reduce your risk of having a heart attack or stroke. This medication can help to reduce these side effects of diabetes. Metformin works by restoring your body’s proper response to the insulin it produces naturally. It also reduces the amount of sugar produced by your liver and absorbed by your stomach/intestines. 

    Metformin lowers blood sugar levels by improving your body’s insulin response. It is typically prescribed for diabetes when diet and exercise alone have failed to control blood sugar levels. Because of insulin resistance, the liver believes there isn’t enough glucose in the cells and produces glucose to compensate. Metformin stops the liver from making glucose. It can also improve the way the muscles use insulin. This is referred to as increasing insulin sensitivity. Metformin (at full dose) can reduce A1C levels by up to 2% over a three-month period by combining these two actions.

    Is metformin good or bad? – It is one of the first line drugs for treating type 2 diabetes.

    It has other positive effects in the body and has been shown to improve total cholesterol and LDL cholesterol  numbers. The drug usually causes weight loss in overweight individuals. 

    Clinical trials have found that metformin can help with a variety of cancers. It prevents the growth of tumor cells, survival, and metastasis while also altering the tumor microenvironment to suppress cancer development. 

    It also has piqued some interest as an anti-aging drug and remains one of the least expensive prescription drugs on the market. 

    The Bad (Side Effects)

    While Metformin is a good drug, it is not without fault. Just like most drugs, it also has side effects. It is well-known for causing stomach discomfort, diarrhea, nausea, and bloating in some patients. Most often, these side effects tend to resolve after a few weeks.  Is metformin good or bad? – There are a few more serious concerns with this drug.

    Lactic acidosis

    Lactic acidosis is a rare but serious condition that can occur when taking metformin. Lactic acidosis symptoms include muscle pain and cramping, fast and shallow breathing, stomach pain, and unusual sleepiness. 

    Lactic acidosis due to metformin is linked to kidney dysfunction. Individuals taking metformin should have their kidney function (also known as serum creatinine) tested at least once a year to ensure that metformin is still the right medication. Metformin is not advised if your kidney function has deteriorated to a certain level. This is also why this medication should not be taken on the same day as or within 48 hours of a contrast dye imaging study.

    Vitamin B12 deficiency

    The exact mechanism by which metformin reduces B12 levels is unknown, but there is an increased risk of B12 deficiency in those who have been taking a high dose of metformin for several years. A lack of B12 causes neurological symptoms such as numbness and tingling. The tricky part here is that diabetes can cause these symptoms. B12 levels are easy to check on laboratory testing. It’s usually safe to take an over-the-counter B12 supplement even if you don’t have a lab value to prove you’re deficient. If you’ve been taking this drug for three years or more, ask your doctor what he or she thinks about adding B12 to your medication regimen.

    Life extension?

    There was mention of taking metformin for life extension. This does have serious concerns. There has not been detailed research to support this claim. Moreover, some researchers have shown that metformin started later if life shortened one’s life span.

    Is metformin good or bad? – There is not enough evidence to support taking metformin solely for life extension.

    Will metformin aid in weight loss?

    The majority of metformin users have type 2 diabetes and need to lose weight, but it should not be used solely for weight loss. Maintaining a healthy diet and regular exercise is the best way for anyone to lose weight. 

    Metformin use has been linked to weight loss in studies, but results vary. In some studies, patients lost 4 to 6.5 pounds (lbs.), whereas in others, they lost only about 2 lbs. Weight loss, even if only slight, appears to be the norm, in contrast to the weight gain that frequently occurs with insulin or sulfonylurea treatment. 

    In general, while it is a useful drug for controlling blood sugar in diabetes, weight loss due to metformin is unlikely to be sufficient. For type 2 diabetes weight control, individuals should follow a healthy diet and engage in regular exercise.

    In conclusion – Is metformin good or bad?

    Metformin is a widely used clinical drug that provides numerous benefits via various signaling pathways. The most notable property of metformin is its ability to prevent hyperglycemia. While it has many other benefits, this drug is not without risk and should be used under the direction of a physician. Metformin also should not be used for “off-label” uses such as life extension. As long as people are cautious about side effects and complications, it can be a powerful treatment for diabetes.  

    References:

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5552828/

    https://care.diabetesjournals.org/content/37/7/1786

    https://www.metabolismjournal.com/article/S0026-0495(15)00306-6/fulltext

    https://pubmed.ncbi.nlm.nih.gov/15189360/

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4772077/

    https://www.everydayhealth.com/type-2-diabetes/metformin-health-benefits-why-they-likely-go-beyond-type-2-diabetes/

  • Signs of Thyroid Disease

    Signs of Thyroid Disease

    The Thyroid – Your Master Gland of Metabolism

    The thyroid is a butterfly-shaped gland located at the base of your neck, and it represents the master gland of your metabolism. It produces an important body chemical known as the thyroid hormone. This hormone regulates many bodily functions, including temperature maintenance, the body’s systemic metabolism and importantly, your heartbeat.

    When your thyroid doesn’t function properly, every aspect of your health is affected. Overproduction or underproduction of the thyroid hormone may lead to thyroid disease that can cause weight gain or loss, lack of energy and depression.

    Undiagnosed thyroid problems can increase the risks of obesity, depression, anxiety, heart disease, hair loss, infertility, sexual dysfunction, and many other conditions. To be more aware if you have a problem with your thyroid, it is best to know the common signs of thyroid disease.

    Common Signs of Thyroid Malfunction

    As we mentioned, the thyroid can either have an overproduction or underproduction of the hormone. The most common signs of thyroid disease are:

    • Fatigue

    Feeling tired all the time, even after having a 10-hour sleep, and having little to no energy during your regular waking hours, are issues often associated with many different conditions. However, this can be strongly related with hypothyroidism. Hypothyroidism is a disorder that is caused by reduced thyroid hormone production in the body. If you feel exhausted far too often than usual, this may be a sign that your thyroid is underactive. Fatigue is the number one symptom of thyroid disease.

    • Depression and Anxiety

    Low thyroid levels are typically associated with depression. Conversely, feelings of anxiety or panic attacks can be linked to excessively high thyroid levels in the body. If you suffer from depression, and you don’t respond to antidepressants, then there is a high probability you have undiagnosed thyroid hormone imbalance.

    • Fertility Problems and Menstrual Irregularities

    Painful and long menstrual periods, with heavier flow than usual, can be closely associated to a thyroid function disorder – hypothyroidism. On the other hand, infrequent and lighter menstrual flow is often a sign of its counterpart – hyperthyroidism. In hyperthyroidism, your menstrual period may become shorter, farther apart and very light. It is best therefore to observe your menstrual flow consistency (heavy or light), its monthly frequency (shorter or longer periods) and any atypical sensations you may experience.

    • Fuzzy Brain

    Cognitive functions can also be affected by the presence of a thyroid disease. Too much thyroid hormone production can cause difficulties in every day concentration, while too little of it may cause frequent forgetfulness and general brain fog. Brain fogginess is a summation of the feelings of confusion, lack of focus and lack of mental clarity; hence, you may experience difficulty and frustration going through your everyday tasks.

    • Weight changes

    Too much thyroid hormone can make you feel hungry all the time. This condition may cause you to have unpredicted blasts of increased appetite; and even if you keep on eating to satisfy your hunger pangs, it won’t result to gaining weight. This increase in appetite leading to increased food intake, but not gaining weight, is a sign of hyperthyroidism. On the other hand, hypothyroidism can result in the difficulty of losing weight amidst your efforts of taking in low-fat and low-calorie diet. No matter how strict you follow your diet plan, you are still unable to lose a single pound.

    • Constipation or Diarrhea

    Long-term constipation is often a sign of low thyroid levels. Under normal conditions, the body needs the thyroid hormone for the digestive muscles to contract and move. This action allows for the normal excretory processes in the digestive tract to happen. When thyroid hormone level is low, this causes the muscles of the digestive tract to be sluggish or slow in action. In the long run, this causes constipation as our body’s wastes are not released timely and correctly.

    Irritable bowel syndrome or diarrhea, on the other hand, can be linked with too much thyroid production. Over activity of the digestive tract muscles, due to the increased levels of the hormone causes the small and large intestines to over react and thereby cause excessive release of body waste.

    • Dry Skin and Hair Loss

    Hair and skin are very sensitive to thyroid level changes. Hair loss is often linked with the thyroid disease. Hair texture becomes coarse and dry when thyroid levels drop too low; that is why hair falls and breaks easily. Similarly, when your skin is dry and itchy, this can be a symptom of hypothyroidism. This is because low levels of the thyroid hormone slows down your metabolism and changes your skin texture and appearance. It can reduce sweating that can lead to making the skin dry quickly and become flaky. Additionally, nails may also become brittle too.

    • Muscle weakness and pain

    If you feel aches in your muscles and joints, followed by unexplained weakness in arms and legs, this could be a sign of thyroid disease.

    • Problems with Cholesterol

    High cholesterol in the blood, which doesn’t respond to any diet, medications or exercise, is a very common sign of low thyroid levels. On the contrary, low cholesterol levels may be linked to high thyroid hormone production.

    Health Insight

    Being more aware of the effects of thyroid hormone imbalance helps us to think back and look closer as to how often or not, these symptoms have shown itself to us in our daily lives. Most often, these symptoms may have been existing, yet are ignored for the longest time. Only when we can no longer tolerate the effects of these imbalances do we give it a check or give it time to really know what lies behind.  Thyroid conditions effect women more the men.

    Since correct diagnosis is essential, of whether hypothyroidism or hyperthyroidism is present, it is still best to reach out and talk to the right health care provider who can give you the correct initial assessment of your symptoms. It is important to know that thyroid conditions effect women more the men.

    Thyroid conditions also need laboratory testing for a diagnosis.

    Once that is established, the correct evaluative tests, the right clinical interpretation of the results along with the appropriate medical intervention, if need be, can be implemented. As a general rule however, it is still best to take action now through meaningful lifestyle changes, in order to prevent health complications and to get used to these adjustment so that in the long run, living a healthy lifestyle become effortless.

    References:

    Office on Women’s health, U.S. Department of Health and Human Services
http://womenshealth.gov/publications/our-publications/fact-sheet/thyroid-disease.html

    Genesys Medical Institute 
http://www.genesysinstitute.com/thyroid-trouble-the-tell-tale-signs/

    JAMA. 2004 Jan 14;291(2):228-38.
    Subclinical thyroid disease: scientific review and guidelines for diagnosis and management.
    Surks MI1, Ortiz E, Daniels GH, Sawin CT, Col NF, Cobin RH, Franklyn JA, Hershman JM, Burman KD, Denke MA, Gorman C, Cooper RS, Weissman NJ.

    Climacteric. 2013 Oct;16(5):555-60. doi: 10.3109/13697137.2012.717995. Epub 2012 Oct 1.
    Comparison of the symptoms of menopause and symptoms of thyroid disease in Japanese women aged 35-59 years.Oi N1, Ohi K.

    Br Med Bull. 2011;99:39-51. doi: 10.1093/bmb/ldr030.
    The epidemiology of thyroid disease.
    Vanderpump MP1.

  • Thyroid disease in women

    Thyroid disease in women

    Types of Thyroid Disease in Women

    Women are far more likely to have problems with the thyroid than men. Studies have shown that one in eight women tend to develop thyroid disease during her lifetime. Sometimes, menopause symptoms can be mistaken for thyroid problems, but thyroid disease is more likely to develop after menopause.

    The most common thyroid diseases are:
    •    Thyroiditis and Postpartum Thyroiditis
    •    Goiter or Thyroid Enlargement
    •    Thyroid Nodules
    •    Cancer of the Thyroid
    •    Hypothyroidism
    •    Hyperthyroidism

    We have already established the definition and the effects of hypothyroidism and hyperthyroidism in previous articles.
    Let’s briefly describe the above conditions: Thyroiditis is the inflammation of the thyroid gland. This inflammation may be caused by several factors that includes autoimmune diseases, infection and certain medications. Postpartum thyroiditis is a type of thyroiditis that develops during pregnancy or after childbirth. It is thought to occur from an underlying autoimmune condition that gets triggered during pregnancy. Thyroid nodules are the abnormal growth of cells that forms into a lump in the thyroid gland. Generally this lump is non-cancerous or benign.  Sometimes however, nodules can be malignant and thus become a sign of thyroid cancer. Goiter, on the other hand, is general enlargement of the thyroid gland. It can be associated with either hypothyroidism or hyperthyroidism.

    Thyroid Hormone Imbalance and Reproductive Health

    When the thyroid gland is enlarged, it affects the production of the thyroid hormone in the body. The levels can either become too high (hyperthyroidism) or too low (hypothyroidism). As already discussed, imbalance of the thyroid hormone level affects major bodily functions that can disturb both your physical and mental health.
    Since the thyroid hormone is very important for a number of metabolic processes, a malfunctioning thyroid can cause several potentially dangerous problems specifically in women. These problems include:

    Menstrual Problems
    An unbalanced thyroid hormone production can result in light, heavy, painful or irregular periods. It can also make your period stop for more than several months. This is a condition called amenorrhea.

    Problems Getting Pregnant
    Thyroid disorders can cause many reproductive problems in women. Scientific studies have established link between hypothyroidism or hyperthyroidism, and infertility.  These thyroid diseases can affect the ovulatory cycle of women.
    The two main hormones that affect ovulation are LH (luteinizing hormone) and FSH (follicle stimulating hormone). However, when either hypothyroidism or hyperthyroidism is present in the body, the misbalanced thyroid hormone level can alter the balance of FSH and LH.
    Hypothyroidism may also cause your body to produce more prolactin. Prolactin is another hormone that tells your body to make milk. Too much prolactin can also prevent ovulation.

    Problems during Pregnancy
    Two pregnancy-related hormones cause increased thyroid levels in the body. These hormones are hCG (human chorionic gonadotropin) and estrogen. hCG is made by the placenta and acts very similar to the function of the hormone TSH (thyroid-stimulating hormone).
    TSH, made by the pituitary gland in the brain, is the hormone responsible for stimulating the thyroid gland to produce the thyroid hormone. Increased TSH therefore stimulates extra thyroid production.

    Similarly, the presence of increased estrogen in the body (due to pregnancy), produces higher levels of a certain protein that transports the thyroid hormone into the blood. This protein is better known as thyroxin-binding globulin, or thyroid-binding globulin due to its binding capacity.

    Although these hormone changes are completely normal, they can sometimes make it difficult to interpret thyroid function tests during pregnancy.  These tests are important for the pregnant women because the level of thyroid hormone in the mother’s body affects the growth of the fetus.

    Regular thyroid hormone production is vital for the normal development of the fetal brain and nervous system. During the first trimester, the mother’s thyroid hormone acts as the unborn baby’s source of thyroid hormone.  This happens because the baby’s thyroid gland doesn’t begin to function on its own, until the fetus is 12 weeks old.

    It is normal for thyroid levels to elevate slightly and for the thyroid gland to slightly enlarge during a healthy pregnancy. However, when the thyroid is significantly enlarged, this can be a sign of thyroid disease and it is essential to be evaluated. Due to higher levels of thyroid hormone in the blood, along with increased thyroid size, fatigue, and many other symptoms typical of pregnancy, thyroid problems can be difficult to diagnose during pregnancy.

    Medical Insight

    Being aware of the above conditions helps to avoid possible complications.   The presence of certain predisposing factors like family history or past medical history of thyroid disease, should make you more vigilant to look out for the mentioned symptoms. It is never too late to take care of yourself. Seek the help of your health care provider so that you may understand what has gone wrong, what needs to be avoided and what you can do to correct the situation.

    References:

    National Institute of Diabetes and Digestive and Kidney Diseases, U.S. Department of Health and Human Services 
http://www.niddk.nih.gov/health-information/healthtopics/endocrine/pregnancy-and-thyroid-disease/Pages/fact-sheet.aspx

    U.S. National Library of Medicine 
http://www.nlm.nih.gov/medlineplus/thyroiddiseases.html#cat7
    Office on Women’s Health, U.S. Department of Health and Human Services
http://womenshealth.gov/publications/our-publications/fact-sheet/thyroid-disease.html

    Climacteric. 2013 Oct; 16(5):555-60. doi: 10.3109/13697137.2012.717995. Epub 2012 Oct 1.
    Comparison of the symptoms of menopause and symptoms of thyroid disease in Japanese women aged 35-59 years. Oi N1, Ohi K.

    Br Med Bull. 2011;99:39-51. doi: 10.1093/bmb/ldr030.
    The epidemiology of thyroid disease.
    Vanderpump MP1.