I had not lost any weight in about a year despite diet, exercise, and metformin. I was always hungry - caused, I think, by too much insulin. Now I know why. If this was in Dr B's first book I missed it:

"When blood sugars are much higher than the targets that I set, both metformin and the thiazolidinediones can cause the pancreas to increase insulin production in response to glucose. Because of the lower blood sugars that we see, this effect becomes insignificant."

I believe that this was not insignificant for me because my BG would go up about thirty points after my breakfast of boiled egg and bacon. Breakfast was also when I took my morning dose of metformin I started taking lower dose ALA and EPO a couple of weeks ago. I backed off the EPO because of rosacea but have since increased it as well as taking about 1500 mg ALA a day. My blood sugar has dropped, I'm no longer hungry, and, since, increasing the dose - I"VE LOST ABOUT 3 or 4 POUNDS!!!!! It may be 3 or 4 pounds of water but at this point I''ll take whatever I can get.
I read somewhere that ALA starts working about 30 minutes after you take it. I think it is kicking in, acting like insulin, dropping my BG before my body makes its own insulin - without the bad effects of insulin.
I hope this is really what is working for me. Many of you know how frustrating it is to be hungry all the time, eat very little food, and still not be able to drop a pound. I'm keeping my fingers crossed!