Metformin Contraindications Gfr

Share on facebook

In Brief: New Recommendations For Use Of Metformin In Renal Impairment

The FDA has required labeling changes that replace serum creatinine (SCr) with estimated glomerular filtration rate (eGFR) as the parameter used to determine the appropriateness of treatment with the biguanide metformin (Glucophage, and others) in patients with renal impairment. These changes will allow more patients with mild to moderate renal impairment to receive metformin, which is generally the first drug prescribed for treatment of type 2 diabetes. Metformin was previously contraindicated in women with a SCr level ≥1.4 mg/dL and in men with a SCr level ≥1.5 mg/dL, but use of SCr as a surrogate indicator tends to underestimate renal function in certain populations (e.g., younger patients, men, black patients, patients with greater muscle mass). The calculation of eGFR takes into account age, race, and sex, as well as SCr level, providing a more accurate assessment of kidney function. A literature review summarized in an FDA Drug Safety Communication concluded that, based on eGFR, metformin is safe to use in patients with mild renal impairment and in some patients with moderate renal impairment.1 The eGFR should be calculated before patients begin treatment with metformin a Continue reading >>

Share on facebook

Popular Questions

  1. bri888

    How I Lost My Lower Belly Fat

    Almost 6 months into my fitness routine, I was down to around 12% body fat and I was starting to plateau. The daily workout of weights and HIIT was taking a huge toll on me and there was still some belly fat sitting on my lower belly.
    To top it off the, the huge caloric deficits and lack of carbs were making me downright cranky. After reading a lot of posts in the forums, I thought all I had to do to lose it was create a caloric deficit and keep the workouts intense. After a month of going through the same thing over and over again, I took a step back and looked at what I was doing wrong.
    If you’ve ever wondered why you’re stuck at a certain weight at 12% fat with no change after walking 50 flights of stairs, doing Insanity and keeping a caloric deficit, this article will probably help you.
    After doing that bit of research here’s what I realized: One you get to 10-12% body fat, your body starts to fight back. At this point, the hormones that help you lose weight will drop and the hormones that hinder fat loss starts working against you.
    Here’s a breakdown and summary of all the hormones and what they do:
    Leptin is widely known as the “anti-starvation hormone. Leptin controls a number of metabolic processes in your body that lead to fat loss.
    It comes from the greek word “Leptos”, which means “thin.” Ironically leptin comes from your fat cells and the less fat you have the less leptin you produce.
    That’s not the worst part of it though. Having a caloric deficit for a few days will drop your leptin levels even lower and the bigger the deficit, the faster it drops.
    Leptin also plays a role in the production of fat burning Thyroid Hormones, T3 & T4. When your leptin levels drop, those hormone levels drop. And the metabolic processes that lead to fat loss slows down.
    Insulin is a hormone that is produced in the pancreas. It plays a role in the uptake of the nutrients into the cells in your liver, muscles and fat. It slows down the rate of fat loss by slowing down the mobilization of the fatty acids after they are released from the fat cells. What dictates how quickly fat is mobilized is a hormone called HSL (hormone sensitive lipase). And Insulin is the main hormone that deactivates HSL.
    Please do note that there is a ton of research on the internet regarding insulin and obesity but for this article, I’m trying to keep it short and related to the main topic of getting rid of the last few pounds of belly fat.
    Ghrelin is also known as the hunger hormone. Your body secretes this hormone when it feels that it’s time to get fed. The operative word there is “feels” because ghrelin is a trainable hormone. You can train your body to stop feeling hungry all the time.
    If you’ve ever wondered why you have a tendency to snack when you’re having 5 meals a day, this is the main reason why. Having 5 meals a day trains your body to expect a meal every 2 hours!
    This is also the main reason why you have so many proponents of interminent fasting as a tool that you can use for weight loss. Having fewer meals in a day trains your body not to secrete ghrelin.
    Just keep in mind that all you need to do is hit your target number of calories, macronutrients and fiber when you have your meals. Meal frequency is irrelevant unless you’re a diabetic. Or you feel that having more meals just works better for you.
    Cortisol is also known as the stress hormone because it is activated when your body goes through emotional or physical stress.
    This is the main reason why you shouldn’t train at high intensities and work volume and have huge caloric deficits. At that point, you can pretty much guarantee that your cortisol levels will go through the roof. And high levels of cortisol are usually associated with belly-fat storage. Now you know why that belly fat isn’t going away any time soon and why you’re feeling so cranky after workouts.
    It also plays a role in providing amino acids to the liver when protein levels are low. This makes cortisol a muscle-wasting hormone.
    Here are some of the steps that I took to get these hormones to stop working against me:
    1.) What to do with your caloric deficits
    At this point in your fat loss training, you’re probably wondering why you’re not seeing results. You’re probably saying to yourself “WTF is going on? I’m tracking my calories, keeping a huge deficit and I’m doing more work adding some 1-2 miles to my normal distance”
    What most beginners do is take the idea of having a caloric deficit to the extreme.
    If a little deficit is good for them, then having huge caloric deficits is going to get them rock hard abs right? Wrong! Always, remember that you’re eating not just to lose fat but to fuel your workouts as well.
    Keep your caloric deficits low!
    Trust me on this: your body will fight like hell to keep those last few pounds of belly fat hanging around if you keep it up.
    And it won’t matter how big your caloric deficit is right now, you will burn out because your body always wins. ..unless you can somehow trick it into producing more hormones that are necessary for fat loss. Now that requires discipline to keep your caloric deficits low so your leptin levels don’t crash and you won’t have to work against your body when trying to lose fat.
    Some personal trainers refer to it as having a high g-flux. A high g-flux simply means eating more to fuel a training that has a higher work volume and intensity.
    One more thing, people at 12% body fat tend to eat too little and by the time they get to 10-12% body fat there’s really no more calories you can cut from.
    2.) What To Do With Your Cheat Meals/Re-feeds
    One of the ways you can stop your plateau when trying to lose fat is to plan and execute your cheat meals or re-feeds. Write it down along with your workout schedule and meal plans. Figure out and list down how many calories it would take for you to be happy with your food. This is the fun part of planning your meals! Now I know some people are probably asking themselves why. Why do you need to do this at all? After all it’s your “cheat day” right?
    Well let me ask you, if you wanted to have a dream vacation in Rome a few weeks from now, you’d probably plan for it right? That way, you know exactly where to go and make the most out of your trip. You won’t have to worry about all of the details of your trip and how you’ll go about them when you get there.
    Well it’s the same thing with your cheat day. Planning for it helps you make the most of it by having the foods that you really love and cutting off the “bad” foods that you don’t really want.
    You’ll also get rid of that nagging feeling that you went just a little overboard on your cheat day.
    It helps you enjoy the experience of having that scoop of ice cream or that slice of cake without worrying about the horrors that it can do to your progress.
    Having a cheat day is not just something that can help you psychologically but it’s crucial in restoring the hormones necessary for fat loss such as leptin.
    About the worst thing that you can do on your cheat days is to get worried about going overboard with your caloric intake because you didn’t figure out the macronutrients and total number of calories in your food.
    One last note on this one, eat till you’re happy but don’t gorge yourself like you’ve been starved to death for a year.
    3.) Cyclical Carb Fasting
    I also kept my carbohydrates pretty low through cyclical carbohydrate fasting. I usually skipped carbohydrates when having lunch simply because I wanted a lower carb intake for the day. I also loaded on carbs on my cheat days, which were right before my strength/power training days.
    Some people believe that consuming carbohydrates at night will hinder fat loss. For them, the carbohydrates consumed at night can’t be burned off by our bodies and so they end up being stored as fat.
    I used to think this was true until I looked at some of the research ( Alan Aragon’s website provides excellent information regarding this topic). It turns out that there is no shred of evidence that having carbs at night will hinder fat loss. Our bodies are so much more complicated than that.
    I’ve always suspected the lack of carbs as the reason for not being able to sleep well at night so I started experimenting with having high GI carbs at night. And guess what, I ended up having a more restful sleep and I wasn’t as cranky in the morning. This leads us to…
    4.) Why Sleep Is So Important Have you ever noticed what happens to you when you lack sleep? You tend to snack a lot and that’s not just because you’ve been awake for more hours.
    Some friend or relative walks in the room offering a snack and all you could think to yourself is: “Dammit! Stop trying to tempt me!”
    And for some weird reason, you end up eating it anyway and feeling guilty about it minutes later. An article from the American Journal of Human Biology found a direct link between lack of sleep and higher levels of Ghrelin. If you’ve ever wondered why you tend to snack a lot when you lack sleep, you can blame it on this hormone.
    Lack of sleep also leads to a rise in cortisol levels, which is assosciated with belly-fat storage as mentioned. Cortisol also activates the reward centers in your brain that make you crave junk food. In my case, I try to get some shuteye earlier in the evening to get my 7-8 hours of sleep. If I can’t get any sleep within the next 15 minutes, I usually do something boring like read a Twilight book. I try to make sure there are no bright lights around.
    5.) Is Low-Medium Intensity Cardio Useless?
    Insulin is one of the things that you have to watch out for because it impedes fat loss. At around 10-12% body fat, fat breakdown and mobilization slows down to a crawl as insulin levels starts to rise.
    Fasted cardio really helped me burn off that last bit of fat simply because of the low levels of insulin.
    At low insulin levels, fatty acids will be released from the fat cells. All I had to do was burn them off with low intensity cardio.
    After doing weights, the last thing I wanted to do was P90x or any kind of HIIT workout. Fasted steady state or slow cardio can be muscle wasting so make sure not to do too much of it. This is just one of the tools that I used to get those last bits of fat off. Please do note that you only have to use this when you’re at lower levels of body fat and not early on in your training program.
    Also remember to use this sparingly. I did a maximum of 2 of these per week and no more than 30-40 minutes. You also want to have enough protein in your diet while doing this.
    Now I know some genius on the internet decided to compare the physique of a marathoner in his prime against that of a 70-year old marathoner. The guy who made that probably had a colonoscopy on his brain. The guys, who say that cardio is useless don’t take into account that:
    *a.) Sprinters do a lot of strength training compared to marathoners. *b.) Sprinters do more drills that involve steady state cardio than High Intensity Interval Training. (I know. WTF right?) *c.) You can’t sprint every single training day.
    Now I love sprints and I believe it’s superior to steady state cardio but saying that it’s useless is just wrong. I sprint 3-4 times a week but there were days when I didn’t feel like sprinting at all. That’s when I did steady state cardio.
    6.) Watching out for fructose
    If you look at some of the old bodybuilders, they usually avoid fruit near the competition and for good reason. Having too much fructose leads to fat storage. I have a pretty conservative upper limit of around 40 grams of fructose a day. That’s equivalent to 3 apples or 5 bananas. That’s still a lot of fruit.
    Some would argue that the upper limit should be higher at around 90 to 100 grams but at that time I didn’t want to take any chances so I stuck with the 40 grams.
    7.) Watching out for what I drink
    It’s so easy to forget about your fructose and carbohydrate intake when you’re having any kind of shake or soda. What I did was avoid it altogether. I just drank plain old cold water with lemon.
    Your options aren’t limited to water and citrus fruits though. You could add a few sprigs of mint or whatever it is that’s low in calories and good enough to satisfy you.
    Social Issues:
    A lot of people want to talk about the technical issues when it comes to weight loss but they almost always skip the part that some people actually feel threatened when you lose some weight.
    While most people will try to justify and argue, I found it much better to be agreeable and find out why they think that way. You’ll soon find out that it’s more about their issues with weight loss than it is about you. Don’t be judgmental but stick to what you’ve always been doing. At the end of the day it’s your life.
    It took a couple of months to finally get rid of my belly fat. Remember that losing those last few pounds will take time so don’t believe the advertisements that claim to help you lose that belly fat in weeks. It’s more of a marathon than a quick sprint. Also, learn to listen to your body and see what works for you personally. Anyway, I hope this has been a big help to you guys. I have some more info on fat loss, but I figured this post is probably a little too long already. If you’ve got questions or anything like that, just PM me.
    I've been hearing a lot about spot-reduction on this thread. This is not some spot-reduction or any of those woo woo weird tip shortcut technique. If you're looking for that, please go buy one of those ab machines they're hawking. You won't get six pack abs but it definitely has a spot reduction feature.
    That stuff is from the 90's and should be extinct by now. I didn't know why there's still a lot of talk about spot-reduction in 2014. You still have to do the hard work of getting to lower body fat percentages until the only fat that is noticeable is on your belly, butt and upper thighs. Don't do this until you're around the range of 11-13% body fat if you're a guy and higher for women. Don't worry about the hormones too much until you get to that level of fat.
    Some guys are claiming that I've somehow violated the sacred laws of thermodynamics. I'm not a physicist but I'm guessing you're talking about caloric deficits. Please read the post again. You still need to have a caloric deficit but in lower quantities than before or you'll end up losing a lot of lean muscle mass.

  2. legopolis

    This is one of the best posts, hands down, that I have seen in this sub. There is SO MUCH GOOD WISDOM in here that I have only scratched the surface of myself through trial and error.
    Some slow carbs at night? They are my secret weapon now for good sleep when before I was terrified of them.
    Occasional fasted cardio == awesome progress.
    Refeeds and downgrading exercise to reduce cortisol and eliminate plateaus -- totally works.
    Love all of this. Everybody read it, memorize it, and upvote it.

  3. Drewdledoo

    So...to the FAQ with it, then? I vote yes.

  4. -> Continue reading
read more close

Related Articles

Popular Articles

More in ketosis