A Case of Statin-Induced Myopathy
Help! My Wife Doesn't Know My Weight Loss Secret. And She Can Never Find Out.
Dear Prudence is Slate's advice column. Submit questions here.
Dear Prudence,
I don't know how to tell my wife that I've started taking Ozempic. I am diabetic. For several years, I have worn a continuous glucose monitor and taken metformin. Unfortunately, the metformin gives me awful "gastrointestinal distress," so I can't take the full dose I actually need. My blood sugar is OK, but it could be better. Recently, my doctor recommended trying Ozempic instead (it is covered by my insurance with a normal co-pay). After two months, the Ozempic is working great. It does have its own weird side effects, but I'm no longer afraid to venture more than 50 feet from a bathroom. I haven't lost any weight, but my blood sugar numbers have already improved dramatically. I haven't had a high blood sugar alert from my glucose monitor in weeks. My problem is telling my wife.
She is very firmly (and loudly) against Ozempic. She doesn't really say she thinks Ozempic is "cheating" at weight loss—she is more upset about so many people taking drugs that may have serious side effects in order to conform to problematic ideas about weight and health. I think she has a point! But she has been so outspoken on the subject that I feel like she would see my prescription as a rebuke. I don't want to fight about this. It's not really up for discussion anyway. If I tell her, I can only see two outcomes: Either there would be pointless conflict over a medical decision I've already made or she would feel like I was criticizing her and keep her real opinion quiet. Neither of those is a fight I want to pick. So I guess my question is: Do I actually need to tell her?
—Stealth Semaglutide
Dear Stealth Semaglutide,
Try this: "Can we talk about something? My doctor switched me to Ozempic to help with diabetes and it's been working, without all the gastrointestinal issues I had with my previous medication. But I've been afraid to tell you because I know how you feel about people taking drugs that may have serious side effects in order to conform to problematic ideas about weight and health. I'm obviously not taking it for that reason but I was still nervous about your judgment." She'll very likely say, "Of course I wouldn't judge you for that!"
But if she gives you a hard time or appears to be silently seething, please remember that being on the wrong side of her opinion on this issue doesn't mean you've done wrong. And in fact, I'd have some concerns about any partner who wouldn't want me to do something that made me feel better—whether that feeling came from losing a few pounds, or finding a way to be more than 50 feet away from a bathroom without anxiety.
That said, your wife's critique of Ozempic users has at its core a desire for people to be OK—to be at peace in their bodies and not feel pressure to risk side effects to obtain society's approval. She wants people to take care of their health in ways that work for them and aren't driven by outside pressure or judgment. I'm hopeful that she'll apply that same lens to your situation and celebrate that you're thriving rather than sacrificing your health to align with her opinions.
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Dear Prudence,
I have four children, two boys and two girls. My sons are married; my daughters are not. Since I have retired, I have frequently taken trips with my daughters. They are easy traveling companions; my sons' wives are not. They are lovely women, but their temperaments are not comfortable to be around in small, shared spaces. One is unable to plan anything with anyone else in mind (she got airline tickets that were slightly cheaper but at an airport 50 miles away instead of the one right by my house—and expected me to drive at midnight to pick them up).
The other has zero filter. She dives right into subjects that she has been asked to avoid and gets offended when she offends someone (she and my daughters are completely opposite on the political spectrum so that is the topic she picks at most). I would rather have my fingernails ripped out than imagine being trapped in the car with all four of them on a road trip to the Grand Canyon. My sons have mentioned time and again that their wives want to be included and are hurt that I haven't offered. I have tried to sidestep the issue by saying how much I want to see them on the annual family vacation but it is just easier to coordinate with their sisters since they live nearby. It isn't working. I don't want to hurt anyone's feelings here. Help!
—Daughter Trips
Dear Daughter Trips,
If your daughters-in-law aren't close enough to you to say to you directly, "I would love to come on one of the girls' trips sometime," they're not close enough to be invited. Plus, the fact that the requests are coming through your sons makes me question whether there's much truth to the story that these women are actually desperate to tag along. Until they say it to your face, I wouldn't worry about it.
If they do confront you, you can say, "This is a special tradition I do with my daughters and it's not meant to exclude anyone. Plus experience traveling has taught me that it's best to keep groups very small and manageable." Then add, "If you'd like to plan something with just the three of us, let me know!" and hope they don't take you up on the offer (trust me, they won't).
Get Even More Advice From the Dear Prudence Podcast
Dear Prudence,
Last year, my sister emailed me a $50 gift card attached to an e-card for my birthday. I haven't participated in gift-giving for decades, and she knows this and hasn't sent me anything in the past. Our parents recently passed away (I was an end-of-life caretaker for both) and I think she wants to stay close. I didn't open it for a while but when I saw the e-card in my inbox I said, "Thanks." She told me to enjoy the gift, to which I responded that I don't do gifts. She said that she does. When I finally opened it and realized there was a cash gift card attached, I forwarded it to my daughter with an explanation (she knows my sister irritates me). For my sister's birthday, I passive-aggressively sent her a $75 gift card.
If she sends me another gift card, would it be rude to forward it to her daughter? I don't want to be mean but I don't want a gift either. We have a fairly large family (I'm one of five and we all have kids) and receiving gifts gives me recipient anxiety. I know this is my problem, not hers. She said she enjoys bringing people joy through gifts. But it doesn't bring me joy, it brings me stress.
—Happy Curmudgeonly
Dear Happy,
I've never heard of a passive-aggressively sent $75 gift card before, but I guess there's a first time for everything. That was the wrong move, though. You have to stay consistent with your message, and if the essence is, "I don't do gifts," you can't start giving gifts! Even if you mean it in a "Take that!" way. I'm not in favor of forwarding the card to your niece either.
Here's what you should do: Google some combination of "sponsor a family" or "adopt a family" combined with your area and find an organization that helps people who are struggling to make it, whether they're recent immigrants or have just transitioned from homelessness into their first place. Call or email the organization and find out who to contact if you have a gift card you'd like to pass on. And the next time your sister gives you one, forward it right on to them. Your message to her can be, "You know I don't feel comfortable receiving gifts, and I wish you would respect that. From now on if you send me something, I'll be handing it over to someone in need."
The other, more important part of the conversation you need to have is, "I know you are doing this because we lost our parents and you want to stay close. I have some other ideas for how that can happen." And then suggest something that doesn't take place over email, and doesn't involve the exchange of money or violating someone's clearly stated preferences.
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Benefits Of Metformin For Aging And Weight Loss
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Study: Metformin Associated With 41% Decrease In Long Covid, Here Are The Caveats
In a clinical trial, 6·3% of those who had received metformin while infected with the severe acute ... [+] respiratory syndrome coronavirus 2 (SARS-CoV-2) ended up getting diagnosed with long Covid compared to 10.4% of those who had received placebo only. (Photo by Francis Dean/Corbis via Getty Images)
Corbis via Getty ImagesDon't go "metformin" any premature conclusions about the results of this study just yet. But a clinical trial described in a June 8 publication in The Lancet Infectious Diseases found that those taking metformin when sick with Covid-19 were 41% less likely to have eventually developed long Covid than those taking only a placebo. In the trial, 6·3% of those who had received metformin ended up getting diagnosed with long Covid compared to 10.4% of those who had received placebo only. That's encouraging news because the long and short of it is that doctors currently don't have any proven treatments for long Covid at their disposal. However, there are a lot of buts, one cannot lie, about the findings from this clinical trial. So, before you "metformin" any plans to take this medication the next time you test positive for Covid-19, first take a closer look at what this study actually found.
Here's a tweet from The Lancet Infectious Diseases on the publication and the trial, which bore the name COVID-OUT:
The goal of the COVID-OUT trial was to see whether taking metformin, fluvoxamine, or ivermectin during the acute phase of a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection could somehow reduce the risk of later developing long Covid. All three medications have been around for a while to treat other unrelated conditions. Metformin is a medication that's been commonly used to treat diabetes. Fluvoxamine is a commonly-used antidepressant that showed some early promise as a treatment for Covid-19, as I've reported for Forbes back on March 8, 2021, but has yet to be established as an effective Covid-19 treatment. And of horse, you've probably heard of ivermectin. Ivermectin is a medication that's been used for years to treat parasite infections in humans, horses, cows, and other animals. There certainly isn't enough scientific evidence that it can be an effective treatment for Covid-19. That hasn't kept a number of personalities and anonymous social media accounts from continuing to make all sorts of claims about ivermectin until the cows come home.
Long Covid, otherwise known as post-COVID-19 condition, by the way, has been a growing major problem since 2020. It's where you either continue to have symptoms or develop new symptoms weeks, months, and even years after you supposedly recovered from a SARS-CoV-2. It's a major problem because chronically suffering difficulty breathing, chest pain, fevers, headaches, chronic fatigue, "brain fog," anxiety, stress, "pins and needles" sensations, sleep problems, joint pain, diarrhea, tummy pain, or other such symptoms kind of really sucks. It's a major unsolved problem because when it comes to treating long Covid doctors have been sort of throwing their hands in the air, but not in a Timbaland song type of way.
Carolyn Bramante, MD, an Assistant Professor of Medicine at the University of Minnesota Medical School and the first author of The Lancet Infectious Diseases publication called metformin "an inexpensive, safe and widely available drug," in the following tweet from the University of Minnesota Medical School:
Indeed, since metformin has been around for many years and generic versions of it are available, metformin is certainly much less expensive than a completely new medication would be. If you look at the common side effects from metformin, you'll find things like abdominal or stomach discomfort, cough, chills, decreased appetite, and diarrhea. Although no one will say, "Yay, diarrhea," these side effects don't necessarily occur and the medication seems to be in general well-tolerated.
The COVID-OUT trial was a decentralized, randomized, quadruple-blind, parallel-group, phase 3 trial. That may sound like quite a mouthful. But it all makes more sense when you look at each word individually. Decentralized meant that the trial was conducted at six different locations in the United States without one location lording over the others. Randomized meant that study participants were randomly assigned to get one of six treatment combinations as soon as they were enrolled in the trial: metformin plus ivermectin, metformin plus fluvoxamine, metformin plus placebo, ivermectin plus placebo, fluvoxamine plus placebo, or placebo plus placebo. Quadruple-blind didn't mean that everyone was wearing four blindfolds throughout the trial, which would have made it a bit difficult to conduct the trial. Rather, it meant that none of the four major groups of people involved in the study—study participants, investigators, those providing medical care to the participants, and those assessing the outcomes of the participants—knew which participants were assigned to which treatment group. This helped prevent anyone from consciously or unconsciously showing any bias for or against a particular treatment, which has been a problem for some of the ivermectin studies.
To be enrolled into the trial, all participants had to be experiencing Covid-19 symptoms for fewer than seven days and had had a clearly positive SARS-CoV-2 test within the three days prior. This had to be the first time that they were diagnosed with Covid-19. Of note, all participants had to have body mass indices of over 25 kg/m2, the threshold for being in the overweight category. Recruitment for the trial occurred from December 30, 2020, to January 28, 2022. Each participant then received one of the six treatment combinations as soon as he or she was enrolled in the trial. Then each participant was asked to complete surveys 180, 210, 240, 270, and 300 days after being enrolled in the trial. The surveys asked each participant whether they had received a diagnosis of long Covid from a health care professional.
The researchers were able to initially enroll 1431 people in the trial. However, not all of them made it through the entire trial. Of the 1431 people, 1323 eventually received one of the six combinations of treatments while 1126 ended up completing at least one survey. The ages of these 1126 participants ranged from 30 to 85 years. Around 95% (1074 of the 1126 participants) were followed for at least nine months. A little over half (56·1%) of the participants were female with 44 of them being pregnant. The median age of participants ended up being 45 years while the median body mass index BMI ended up being 29·8 kg/m2.
Many people around the world have continued to suffer Long Covid, which is when symptoms persist at ... [+] least three months beyond the initial SARS-CoV-2 infection. (Photo by Jörg Carstensen/picture alliance via Getty Images)
dpa/picture alliance via Getty ImagesParticipants started receiving treatments as soon as they were enrolled in the trial, which meant that they were still in the midst of their SARS-CoV-2 infection. Ultimately, 564 of the participants ended up receiving a two-week course of metformin that was titrated up from 500 mg to 1000 mg over the first six days, and 562 ended up receiving a matched placebo.
By Day 300 after their initial SARS-CoV-2 infection, 93 (8·3%) of 1126 participants had been diagnosed with long Covid. However, this incidence was 41% lower (6·3% vs. 10.4%) among those who had received metformin compared to those who had received just placebo (10·4%). The difference was even greater (63% lower) among those who had started taking metformin within three days of first experiencing Covid-19 symptoms.
And surprise, surprise, there was no real difference in long Covid incidence between those who had received ivermectin and those who had received placebo. Fluvoxamine didn't seem to have any overall positive effect as well.
So why might a medication that's typically used to treat diabetes help prevent long Covid? Metformin is useful against diabetes because of the following sweet effects: it can decrease the amount of glucose produced by your liver, decrease the amount glucose absorbed through your intestines, and increase the response of your body tissues to insulin. Those taking metformin also often lose weight as well.
But wait, what does that all have to do with long Covid? Well, several laboratory studies have shown that metformin may work specifically against the SARS-CoV-2. It's been found to inhibit the reproduction of the virus in cell culture and human lung tissue. Keep in mind, though, that you are more than a just bunch of cells or lung tissue. You do have feelings and other things. So just because metformin can keep the virus from reproducing in the lab doesn't meant that it will do the same in live, whole humans.
A protester holds up a placard demanding research into Long Covid-19 during the demonstration. ... [+] (Photo by Martin Pope/SOPA Images/LightRocket via Getty Images)
SOPA Images/LightRocket via Getty ImagesPlus, while promising, this clinical trial was exactly one clinical trial. You should never deem something to be an effective treatment based on just one clinical trial. That would have been like calling Los Del Rio the next Beatles right after their song Macarena ascended to number one on the Billboard charts in 1996. People aren't exactly lining up to do the Vámonos que nos vamos at weddings.
Moreover, this clinical trial did not include anyone younger than 30, with a BMI less than 25 kg/m2 or who had had COvid-19 previously. People under 30 do matter, really. So the results from this trial may not be generalizable to the rest of the population.
All in all, there needs to be more real scientific evidence before metformin can be recommended as a Covid-19 treatment. That means more studies and trials are definitely needed. Thank goodness for all the research funding that's been allocated to study Covid-19...Oh wait, that's right, a lot of the money is no longer there.
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