From the Desk of Dr. Z: AgelessRx Co-founder and Chief Medical Officer, Dr. Sajad Zalzala offers his insightful perspective on topics related to longevity. With a wealth of experience and a deep-seated passion for disease prevention and extending healthy lifespans, Dr. Z is dedicated to sharing his knowledge on the secrets to longevity. Today, he shares his knowledge on how to get the best results with Metformin and exercise.
Here’s what we’ll cover in this blog:
- Whether Metformin limits muscle mass
- How Metformin affects exercise
- When pausing Metformin is appropriate
Are you concerned taking Metformin could impair your exercise progress? If so, you’re not alone. Until recently, research suggested Metformin may hinder some of the beneficial effects of endurance, resistance, or combined exercise training. However, a study published in October 2020 found that Metformin increased gene expression of aging relevant pathways, which didn’t activate in people who just exercised and did not take Metformin—suggesting exercising plus Metformin is healthier from an aging perspective than exercising alone.
With more and more research surrounding Metformin and exercise becoming available, I routinely field questions from patients about the topic. To help further explain the effects of Metformin on exercise, I’ve listed the most common questions and answers below.
Does Metformin Limit Muscle Mass?
Metformin users certainly still gain muscle mass, but not as much as the non-Metformin users. I have a couple theories as to why:
- Muscles “bulk up” due to the damage done during exercise. Additionally, Metformin potentially makes the muscle cells more potentially efficient and, therefore, does not sustain as much damage.
- Metformin may have slight mTOR inhibition, as well as mimics calorie restriction, and, therefore, the muscles may favor repair over growth.
I do not believe that this is unique to diabetic patients. Non-diabetic patients taking Metformin may also experience diminishing gains. The two most recent studies that support these findings claim participants were non-diabetics.
A 2010 study suggested that Metformin (at higher doses than prescribed at AgelessRx) may reduce some of the benefits of exercise. This is because Metformin may reduce oxidative stress; this same stress helps improve aerobic function.
It’s not clear if lower doses or skipping doses can help reduce this, however, it is our general recommendation at AgelessRx that hardcore athletes who do engage in more strenuous exercise all the time might want to skip Metformin altogether until more research is conducted.
If you are just trying to gain muscle mass and strength simply to be healthier, then taking Metformin does not seem to be an issue. If you are looking to “bulk up” for a competition or to reach specific performance goals, such as a marathon or bodybuilding competition, then I would recommend you skip Metformin until after your competition or until you’ve met your goals. Typically, I encourage patients to skip Metformin if they are training for a major event, such as a marathon, bodybuilding competition, triathlete, iron man, etc.
Should I Switch to IR Metformin?
Whether you take intermittent release (IR) or extended release (ER) Metformin, you may still experience trouble bulking up. I generally recommend ER Metformin to help avoid potential gastrointestinal side effects. That’s why one of the biggest experts on Metformin, Dr. Nir Barzilai, is using (ER) Metformin for the TAME trial.
At AgelessRx, we primarily prescribe ER Metformin for two reasons:
- It’s easier to take (once daily versus twice a day)
- It’s easier on the stomach (far lower discontinuation rate due to diarrhea/cramps)
One could argue that you get higher peak Metformin levels with IR over ER, but we don’t know if that translates to better longevity results (or worse!).
In my medical opinion, I think the only reason I would possibly recommend IR over ER is for people who want it “out of their system” in time for heavy physical activity—but, even then, I think the effects of Metformin might stick around well after the medication is out of the system.
Should I continue to take Metformin as prescribed if I do choose to skip a dose or go off of it for some time?
If you skip a dose here and there, I don’t see any reason why you could not resume your dose, as directed.
If you skip Metformin for an extended period of time, such as months, I usually recommend a ramp-up period over 10 to 14 days to lessen any gastrointestinal side effects you may experience.
Until next time!
Dr. Z
Note: The above statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.