Narrator:
0:00
Welcome to the MedEvidence podcast. This episode is a rebroadcast from a live MedEvidence presentation, Dr. Bartilucci. Does Metformin cause weight gain? If so, why prescribe it?
Dr. Darlene Bartilucci:
0:16
Metformin is a drug that has been used for a number of years to treat diabetes, and as we have used this drug over the years, we've learned that it has many uses. Initially, the drug was designed to help the body utilize sugar more efficiently by transporting the sugar from the bloodstream into the cells muscle cells to be used as energy. And what we have learned over the years with regards to what diabetes does in the body is that it actually raises insulin levels and you get into a state where your body is resistant to insulin. Perhaps some of you have heard the phrase insulin resistance. What happens when the body produces too much insulin is that it can't utilize it all, and Metformin is a drug that helps the body to utilize the insulin more efficiently.
Narrator:
1:11
How is obesity linked to diabetes? Does it alter insulin levels?
Dr. Darlene Bartilucci:
1:15
Obesity and diabetes can go hand in hand, but they don't always. Obesity creates a change in the body that affects the metabolism. In many ways. It does affect insulin levels, because the extra weight creates that insulin resistance that we spoke of earlier. When you reach a certain weight, your body doesn't know what to do with the insulin and your brain is perceiving that there isn't enough sugar in circulation, so it tells the pancreas to produce more insulin, therefore increasing the insulin levels. Now, when insulin is in circulation, you're again, like I said, your brain is starving for energy and therefore it makes you hungry. Because your brain isn't getting enough energy, because it doesn't know how to process the insulin which is bringing sugar to the brain, and so it's sending a message to the pancreas I need more insulin, and the insulin is what causes you to want to eat excess carbs, essentially. And the more carbs you eat, the heavier you get, and the heavier you get, the more resistant to the insulin that you become, and that's the vicious circle that occurs.
Narrator:
2:31
What is an ideal weight loss rate? Would it be one pound a week or three pounds a week? Is a slower rate better?
Dr. Darlene Bartilucci:
2:38
That's another good question. Yes, often people will ask that you know how quickly can I lose? You know can I get to the weight that I'm looking to achieve? And the slower weight loss is better because that's going to be permanent weight loss. When folks lose weight too quickly, the body doesn't have time to assimilate to that new weight and unfortunately people will gain all of their weight back plus a certain percentage. It's usually between 16 and 20% of the weight that they will plus in addition to what they lost. So, yes, I would recommend losing weight slower and ideally about one to two pounds a week is where the studies have shown that individuals have been able to sustain the weight loss.
Narrator:
3:24
T I've heard that if you exercise regularly, it offsets the extra weight. Is this true?
Dr. Darlene Bartilucci:
3:36
That's something that we would all like to believe is true, but not necessarily, because it really depends on how much exercise you're doing, how many calories you're burning versus how many calories you are consuming and, like I mentioned in the talk, ideally what happens. In order to lose weight, we have to put ourselves into a caloric deficit. That's how weight loss is achieved. We consume fewer calories than we are burning calories, so you can exercise regularly and it will help. It can potentially offset some weight gain, but if you're consuming the same amount of calories that you are burning off, then your weight is going to remain neutral.
Narrator:
4:16
Dr.. Bartilucci Bartolucci, what about the relationship between the stress hormone, cortisol, and weight gain? What are your recommendations?
Dr. Darlene Bartilucci:
4:24
Well, cortisol, like I mentioned in the talk, is your stress hormone, and by that I mean it is a hormone that is secreted when the body perceives stress, and it could be good stress or bad stress. I think most people associate it with the fight or flight response, as I mentioned in the talk. What happens when cortisol is produced in excess in the body? It layers the body in fat because it does not perceive what the stress presented is a good stress or bad stress. It just knows that there is a stress, and the idea being that your brain doesn't know if it's going to be able to find food, and so what it does is it layers you in fat because it can live off of the fat. So that's why so many individuals are, you know, asking about cortisol levels and how do I reduce my cortisol level?
Dr. Darlene Bartilucci:
5:13
And ultimately, it has to do with the amount of stress in your life and, like I said, it could be good stress or bad stress. I also mentioned earlier that oftentimes, when individuals pursue a certain diet, it's stressful to them because it's so opposite of what they're used to doing that it creates more stress. That's why it's really important to try to find a diet that works for you that doesn't create more stress, because, in an effort to try to engage in a weight loss diet that you think might work for you, it's creating more stress, elevating cortisol. Then you're really not going to be losing weight successfully.
Narrator:
5:50
I've been on Weight Watchers since 1975, up and down like a yo-yo. How do I keep the weight off permanently?
Dr. Darlene Bartilucci:
5:57
That's a great question, and I tell you that is something that many of my patients struggle with. Sustainability has always been an issue when it comes to weight loss, because what often happens is that individuals will decide that they want to lose weight for various reasons. Either they have a cruise that they're want to be you know that's upcoming or they have a wedding that they're going to be attending, and so what happens is is people will lose weight to a target number, and when they get to that target number, then they essentially stop doing what they were doing to get them to that number. And so when we talk about sustainability, the idea is lifestyle changes. Ultimately, that's what it boils down to. It's not about reaching a target number. It's about changing your lifestyle in a way that you can live with. That will help you sustain the weight loss that you have achieved or that you are looking for.
Narrator:
6:58
What are your thoughts on the value of intermittent fasting?
Dr. Darlene Bartilucci:
7:01
Well, that's a hot topic right now, for sure, and it's really a lecture in and of itself. But basically the theory is that our bodies can go without eating for a certain period of time and be okay. What's happened as we have evolved as a society and become more technologically advanced is that information has become available to us pretty much around the clock. So whereas back in the 50s the television would go off at midnight, people would go to bed, or 11 o'clock people would go to bed, they wake up the next day and they would start their lives again. And so there was this period of time where people weren't eating overnight, and so it could be between eight and midnight, whereas now people are up until late in the evening, sometimes one or two o'clock, and oftentimes what happens is it throws people into another eating cycle, and so they're eating way into the wee hours of the evening, and then they're not giving their body that break. So it's a little more complicated than I think what is put out there.
Dr. Darlene Bartilucci:
8:08
There was an article in the New England Journal that talked about intermittent fasting, and it gave several suggestions I would suggest. You know, perhaps maybe we can put a link in the talk to that. But basically it talks about the benefits of intermittent fasting, and intermittent fasting doesn't necessarily have to be a daily occurrence. There was one portion of the article mentioned that you could eat regularly five days a week and then two days a week you can restrict your calories to five to 600 calories per day, and that too would be considered intermittent fasting. So it's not necessarily what all of the Hollywood you know dietitians are saying is that you have to eat, you know, six hours a day and then you're fasting for 18 hours a day. You have to find something that works for you.
Narrator:
8:56
Thanks for joining the MedEvidence podcast. To learn more, head over to MedEvidence. com or subscribe to our podcast on your favorite podcast platform.
