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The commonly used diabetes medication metformin sometimes has such an unpleasant odor that people may stop taking it, experts say.

But they recommend that people let their doctors know if the smell of this oral drug is an issue for them, because different formulations — especially the extended-relief version — tend to have a milder odor, if any at all, reports a letter in the Feb. 16 issue of the Annals of Internal Medicine.

“Metformin is an excellent drug, but the immediate-release formulation may have an odor to it. The smell is fishy or like the inside of an inner tube, and in a patient’s mind, because it smells like something that has gone bad, they may think the drug isn’t good,” explained one of the letter’s authors, J. Russell May, a clinical professor at the University of Georgia College of Pharmacy at the Medical College of Georgia.

However, May said, “some metformin products on the market are extended-release and the drug is embedded and released slow, over time. These products have much less smell, if any.”

May and his colleagues wrote the letter to the journal to raise awareness of this issue, especially because nausea is a commonly reported side effect of metformin. “Is it nausea from the medication, or is it because it smells bad?” May said.

Physicians at the Medical College of Georgia had two adult male patients with type 2 diabetes complain of the “dead fish” odor of metformin. The smell was significant enough that both of the men stopped taking the medication. One of the men switched to the extended-release version of the drug and no longer had any problems; the second man refused to try the extended-release version.

May and his colleagues searched the medical literature to see whether problems with the smell of metformin were common, but they found no reports.

Then they searched the Internet and found reports on hundreds of posts to message boards about the smell of metformin, and in an informal survey of pharmacists, several said they could easily identify metformin by its unique “old locker-room sweat sock” odor.

Bristol-Myers Squibb is one of a number of companies that manufacture metformin, and although the company won’t comment on drugs made by others, a spokesman, Ken Dominski, released this statement on metformin’s odor:

“Bristol-Myers Squibb is aware that the inherent characteristics of metformin have been associated with a mild odor upon opening of the bottle, so these type of reports are not unexpected. It’s important to note there has been no correlation between an odor and the efficacy of metformin, which has been on the market in the U.S. since 1995.”

“Patients actually put up with a lot of side effects and discomfort from medications, and most doctors would like to know that, because there are probably some underreported experiences with medications that we don’t know about, and this may be one of them,” said Dr. Elbert Huang, assistant professor of medicine at the University of Chicago. “As doctors, we can’t take every medication, so we don’t always understand what it’s like. But, one thing is clear, if we make people miserable, we’ve defeated the purpose of the medication.”

If the smell of metformin bothers you, Huang added, you shouldn’t discontinue the medication, but you should definitely let your doctor know. A different formulation may be available to you.

One easy solution May proposed is simply to hold your nose while taking the drug.

SOURCES: J. Russell May, Pharm.D., clinical professor, University of Georgia College of Pharmacy, Medical College of Georgia, Augusta, Ga.; Elbert S. Huang, M.D., M.P.H., assistant professor of medicine, University of Chicago; statement, Bristol-Myers Squibb

Despite rising rates of obesity and diabetes, a new survey has found that a majority of Americans believe their health is just fine - it’s everyone else who has the problem.

More than 50 percent of respondents said that other people’s health “was going in the wrong direction.” In contrast, only 17 percent said their own health was going in the wrong direction.

Commissioned by GE Healthcare, The Cleveland Clinic and Ochsner Health System, the survey looked at how Americans and their health-care professionals rate the country’s health. The findings, which were released Tuesday, show a big disconnect between how Americans rate their own personal health and how they rate the health of their fellow Americans. Furthermore, Americans seem to think they are in much better shape than their doctors believe they are.

“Either people are denying reality about themselves or they don’t have the correct knowledge and believe they are doing the right things,” said study author Dr. Michael Roizen, chairman of The Cleveland Clinic’s Wellness Institute. “Personally, I think there is a lot of misinformation [about healthy habits].”

On the other hand, Roizen added, many physicians may be overstating their concern about the health of the general population because they tend to see the sickest.

According to the study, which surveyed more than 2,000 people across the United States late last year:
Nearly 30 percent of the respondents gave themselves an A for managing their personal health, while 92 percent of doctors gave them a C or lower.
Nearly a third of the study respondents gave themselves an A for eating healthy. Once again, 92 percent of doctors gave them a C or lower.
About a third gave themselves an A for getting regular exercise, while 91 percent of physicians gave them a C or lower.

One disconnect is that in a land where a majority of people are overweight or obese, people tend to compare themselves favorably with their more overweight neighbors, explained Eva To, a registered dietician in White Plains, N.Y.

“Everything is relative,” she said. “In America, everything is big. But if you put them in an Asian country, they will compare themselves to someone else.”

Another problem seems to be that many respondents didn’t know their basic health numbers - blood pressure, cholesterol, glucose level and other measures. Just 24 percent knew their body-mass index; 29 percent knew their blood glucose level; 33 percent knew their daily caloric intake; and only 36 percent knew their current cholesterol levels.

And yet a majority reported that keeping those numbers in a good range was key to good health. Ninety-five percent agreed that regular checkups with their physicians were important, even though 70 percent said they had taken actions to avoid their doctors, such as hoping their health problems would go away on their own or asking a friend for medical advice instead.

“It is important that patients communicate with their personal physicians to help manage their own health,” said Dr. Scott Hayworth, president and CEO of Mount Kisco Medical Group in New York. “With this comes an obligation to be aware of how well they are following guidelines for exercise, diet and weight management.”

It’s a task that may be easier said than done, according to To.

“Americans are just not into prevention,” she said. “If they are not sick, they think they are healthy. But most of the killers are silent diseases, such as diabetes, high blood pressure and hardening of the arteries. We don’t feel it, but they are killers all the same.”

People also tend to rationalize their bad behavior by believing that the good things they do cancel out the negative. An extra slice of pizza, for example, may be justified as OK after a workout.

“People may say they eat salad for lunch, but what about the salad dressing?” said To. “They look at one element and not look at the whole picture.”

SOURCE: Michael Roizen, chairman, Cleveland Clinic’s Wellness Institute, Ohio; Scott Hayworth, M.D., president and CEO, Mount Kisco Medical Group, NY; Eva To, MS, registered dietician, White Plains, N.Y.;

Poorly fitting condoms not only boost the risk of sexually transmitted diseases, they also reduce sexual pleasure during intercourse, a new study has found.

The findings are based on a survey of 436 men, aged 18 to 67, who responded to an Internet survey after being recruited through newspaper ads and a blog on a condom sales company Web site. The survey asked the men about how a condom fit the last time they used one while having sex with a female.

Nearly 45 percent said they’d used a condom that fit poorly the last time they had sex during the previous three months. These men were more than 2.5 times more likely to say their condom broke or slipped compared to those who said their condoms fit well. And they were five times more likely to say they experienced irritation to the penis.

The men whose condoms fit poorly were also about twice as likely to say that the condoms made it difficult for them, their partners or both to reach orgasm. Not surprisingly, this made intercourse less pleasurable, the study authors noted.

And the men with poor-fitting condoms were twice as likely to say they took off the condoms before they finished having sex, the survey found.

The findings “emphasize the point that men and their female sex partners may benefit from public health efforts designed to promote the improved fit of condoms,” the researchers wrote.

The study, which surveyed men through the Web site of the Kinsey Institute for Research in Sex, Gender and Reproduction, is published online in February in the journal Sexually Transmitted Infections.