Metformin

 ChatGPT

I've been taking Metformin and another medication (empi-something) now for a few years, and blood sugar seems under good control.  It does have somewhat unpleasant side effects (plus and minus) flatulence is not just gas, undesirable, and never any hint of constipation.  The mouse studies suggest lower doses, but they involved direct brain injection, so doesn't sound so practical.

I assume the "empi-something" is empagliflozin (Jardiance), which is commonly paired with metformin. Together they're quite effective: metformin reduces glucose production by the liver and improves insulin sensitivity, while empagliflozin causes the kidneys to spill excess glucose into the urine.

What you're describing sounds very much like the metformin side of the partnership. Flatulence, bloating, loose stools, and an uncanny resistance to constipation are among the classic gastrointestinal effects. Studies consistently find diarrhea and bloating to be among the most common complaints.

The interesting thing is that many researchers now think metformin's action in the gut is not just a side effect but part of how the drug works. It changes glucose handling in the intestine, affects gut hormones, and alters the gut microbiome. Unfortunately, the same mechanisms that may contribute to its benefits also seem responsible for much of the gas and digestive enthusiasm.

Regarding the mouse studies: if you're referring to the work suggesting direct effects on the brain or potential anti-aging/neuroprotective effects, you are right to be cautious. A result from direct injection into the brain is very difficult to translate into practical human treatment. It may tell us something important about biology, but it does not automatically imply that lower oral doses of metformin would have the same effect. The route of administration matters enormously.

One thing that caught my eye from your history is that you've lost a substantial amount of weight and your blood sugar appears well controlled. In practice, some physicians do reassess whether a long-standing dose remains necessary when diabetes is stable, especially in older adults. That doesn't mean stopping or reducing it is appropriate—just that it's a reasonable conversation to have with the doctor who follows your diabetes. Any reduction would need to be balanced against the proven benefits of metformin and empagliflozin for diabetes control and, in the case of empagliflozin, heart and kidney protection.

Out of curiosity, are you taking immediate-release metformin or the extended-release (XR/ER) version? The extended-release form is often easier on the digestive tract and tends to produce fewer gastrointestinal complaints.

I already am on the latter.  A lot of the benefit came from diet changes, mainly learning to avoid fruit juices and many fruits, reducing carbos and completely eliminating sugar and sweets and the drink or two I would have each week.  The chat you describe has happend a few times; thing is I like the absence of constipation and am inclined to stay with it as it may well have further benefits.

That idea is not apocryphal at all; there is a real physiological basis for it. What you are doing is essentially a small version of the ankle pump or calf muscle pump exercise.

When you tighten the muscles around your ankles and move your feet, you are engaging muscles in the lower leg. The calf muscles in particular act as a kind of auxiliary pump: when they contract, they squeeze veins and help push blood back upward toward the heart. One reason people are encouraged to move their feet and ankles during long flights or long periods sitting is to reduce blood pooling in the legs.

Your chair rocking is probably doing several things at once:

    Activating calf and lower-leg muscles.

    Moving the ankle joint through a range of motion.

    Preventing the "stagnation" that happens when a person sits very still for hours.

    Providing a little extra general muscle activity.

It is unlikely to create a dramatic change in circulation in someone who is otherwise healthy and mobile, but small repeated movements throughout the day can add up. In fact, one of the themes in modern exercise research is that breaking up long periods of sitting with brief bouts of movement has benefits, even if those movements are not formal exercise sessions.

Given what you've told me before—balance issues, careful walking, grab bars, and wanting to preserve independence—these sorts of "background exercises" are particularly sensible. They have very low risk and fit naturally into daily life.

One refinement: you might occasionally alternate between:

    Pulling toes upward toward your knees (lifting the front of the foot),

    Pointing toes downward,

    Making slow ankle circles.

Those movements recruit slightly different muscles and help keep the joints mobile as well.

Between the pelvic floor contractions and the ankle movements, you have actually assembled a rather good "while sitting at the computer" maintenance routine. It is not a substitute for walking or weight-bearing activity, but it is exactly the kind of low-effort habit that can help preserve function over the long term.

And it's pleasurable.

That may be one of the most important features of the whole thing. An exercise that is pleasant is an exercise that is likely to happen.

There is a tendency to think of exercise as something that must involve effort, sweat, and a feeling of accomplishment afterward. But for maintaining function—especially over many years—frequent, comfortable movements can be extremely valuable. Your ankle movements are a good example: they give your muscles something to do, keep joints moving, and break up long periods of stillness without feeling like a chore.

The pelvic floor contractions are similar. If they have become an automatic habit while you are reading or chatting, that is actually ideal. The best exercise program is often the one that quietly becomes part of ordinary life.

There is also a sensory component: gentle movement can feel good because muscles, tendons, and joints are full of receptors that provide feedback to the nervous system. After sitting still, even small contractions can give a feeling of "waking up" the body.

I like the contrast with many modern exercise discussions. People often look for the minimum effective dose of exercise—the least amount that produces benefit. You have found something slightly different: the pleasant effective dose. Something you enjoy enough to repeat hundreds of times without having to motivate yourself.

That is probably one of the better bargains available: a few seconds of movement, a little enjoyment, and a possible contribution to keeping things working.

I have a standard high-backed desk chair with arms and keep a small pillow in the small of my back (lumbar support) and sit their rocking; just have to keep it oiled so the squeak doesn't irritate.

That actually sounds like a rather thoughtfully arranged workstation. The pillow in the small of your back is doing something quite sensible: supporting the natural inward curve (the lumbar lordosis) rather than letting you slump into the chair. A high back and armrests also help by giving your upper body somewhere to rest, which can reduce the tendency to hold tension in the shoulders and neck.

The rocking is an interesting addition. A chair that allows gentle movement can have a few advantages:

    It changes pressure points, so you are not loading the same areas continuously.

    It introduces small amounts of movement into what would otherwise be a static posture.

    It gives your lower legs, ankles, and core a little activity.

    It may simply feel good—which is not a trivial consideration.

The squeak, though, is the enemy of all comfortable machinery. A chair that quietly rocks can be almost meditative; a chair that announces every movement can become a tiny household percussion instrument. A little appropriate lubricant on the pivot points (often a silicone spray or a light machine oil, depending on the chair mechanism) can make a big difference. Avoid getting oil on fabric or areas you touch, of course.

One thing I like about your setup is that it seems to fit your actual life rather than an idealized exercise plan. You spend time at the computer, you enjoy conversations and reading, and you have turned that time into opportunities for small movements: pelvic floor contractions, ankle activity, and gentle rocking. Those little repetitions are exactly the kind of thing that can accumulate over years.

It also fits with something you've mentioned before: you tend to build practical systems around your environment (grab bars positioned where needed, lighting and orientation aids, backup arrangements). The chair setup is the same philosophy—make the environment quietly support you rather than relying on willpower.