Metformin In Muscle: Common Diabetes Medication Restores Diabetics' Ability To Burn Fat

Almost every type 2 diabetic is told to lose weight. If you can just shed that belly fat, the doctor says, your blood sugars will normalize and you might not even need your medications.

The Diabetic Weight Loss Dilemma

It is also true that almost every type 2 diabetic struggles to lose weight. That's because insulin does more than just move sugar out of the bloodstream. It also locks fatty acids inside fat cells. Interventions to lower diabetic blood sugar levels usually involve increasing insulin levels, and when insulin levels are high, the activity of an enzyme called hormone-sensitive lipase is low. Without the hormone, fat in the form of triglycerides cannot be broken down into the diglycerides and free fatty acids that can escape the fat cell, circulate through the bloodstream, and feed the muscles that burn them during prolonged physical activity. With the higher insulin levels needed to lower sugars, physical activity drives the appetite for more sugar, leaving fat stores untouched but setting up the hard working diabetic for blame despite his or her best efforts.

What Metformin Does for Fat Burning in Muscle (or Doesn't)

For diabetics to lose weight, they need to burn fat. Unfortunately, to burn fat they need lower insulin levels, which would lead to higher blood sugar levels. Metformin is not the complete answer to this dilemma, although it goes a long way toward resolving it.

Some muscles mostly burn fatty acids. Other muscles burn a more balanced mixture of sugar and fatty acids. Studies of muscle cells show that metformin doesn't really have a big effect on the way the slow-moving, predominantly fat-burning muscles burn fat for fuel. However, it greatly increases the rate at which faster-twitching muscles burn fat during exercise even when insulin levels are high. This means that exercise begins to result in actual fat burning with this small change in the way muscles make energy. The skeletal muscles diabetics use during exercise do more fat burning when metformin is part of the treatment plan.

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This doesn't mean that metformin does all the work. It's still necessary to adhere to diet so the body does not release as much insulin (if you have type 2 diabetes) or you don't need as much injected insulin (if you have type 1 diabetes, LADA, or you are in the later stages of type 2 diabetes). This allows hormone-sensitive lipase to work inside fat cells to release fatty acids into the bloodstream to circulate to your muscles where they are burned. You also have actually to exercise so your muscles need the fatty acids that your adherence to portion control allows your fat cells finally to release.

You won't just work out only to have increased appetite and wind up gaining more weight when you exercise regularly, as millions of diabetics do.

Nutritional Fine Tuning That Helps Diabetics Burn Fat

Many fans of natural medicine protest that metformin, despite its being inexpensive (as little as $4 a month even in the United States), available nearly everywhere, and well understood, "causes" nutritional deficiencies. The truth is, for metformin to work well for you, you do need to take some similarly inexpensive, widely available, and well understood nutritional supplements. That isn't because metformin sucks nutrients out of your system. That's because the process of burning fat requires more of certain antioxidants and vitamins. When you succeed with diet, exercise, and metformin, you need more of these nutrients to continue the process of losing weight.

The key supplements are:

• Lipoic acid,
• L-carnitine, and
• The often-overlooked B vitamin biotin.

As most diabetics know, lipoic acid, usually taken in the form alpha-lipoic acid, reduces the rate at which hemoglobin combines with glucose in the bloodstream to form glycated hemoglobin, or HbA1C. Alpha-lipoic acid isn't actually the best form of lipoic acid for diabetes. Alpha-lipoic acid is a mixture of two isomers, only one of which, R-lipoic acid, is readily available to the body. The body can sort the R-lipoic acid out of alpha-lipoic acid, however, so about 50 per cent of the relatively inexpensive alpha-lipoic acid does a diabetic good.

L-carnitine is better known by body builders. There's a growing body of evidence, however, that up to 2,000 mg of L-carnitine a day might protect diabetic brain tissue. It was brain researchers who discovered the application of the combination of these two supplements in burning fat.

In a Chinese study of diabetic fat burning, researchers took fat cells from lab rats and cultivated them under "test tube" conditions to see how they would react to lipoic acid and L-carnitine used singly and together. Fat cells didn't respond very much to either lipoic acid or L-carnitine used without the other. When the fat cells were exposed to a combination of R-lipoic acid and L-carnitine, however, some astonishing things happened:

• The mitochondria, or energy makers of the cell, began to activate their DNA so they could grow.
• Larger mitochondria took up more oxygen so they could in turn
• Burn more glucose and fatty acids.

And the combination of antioxidants had another interesting effect. Like the well-known TZDs, they increased the activity of PPAR-gamma. They stimulated the fat cells' ability to clear glucose and fatty acids out of the bloodstream (or, in this case, the cell culture medium). What was remarkable was the fact that these fat cells not only could take up more glucose and fatty acids, they burned them instead of stored them. This experiment seems to suggest that possibly diabetics, in particular, could benefit from lower blood sugars (as they already do with high levels of lipoic acid supplementation) as well as increased metabolism and lower weight, if lipoic acid and L-carnitine are taken together.

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If you decide to give this supplement combination a try, remember that lipoic acid depletes biotin. Be sure to take 125 micrograms of biotin for every 200 mg of lipoic acid. Also, be sure to tell your doctor you're taking the supplements. While R-lipoic acid protects you against some of the effects of high blood sugars, notably in the nerves and heart, it also masks long-term high blood sugars as measured by HbA1C.