[Postscript: I wrote this article 3-years ago. In 2018 I went back on Metformin as the science continued to stack up on the long term health benefits – especially for someone like me with a genetic predisposition to prostate cancer and type II diabetes, and that’s leaving aside the other benefits like anti-aging and fast-mimicking. And I found that after a month of going back on it I no longer had any side effects as noted in the original article. I’m taking the lowest dose possible – 500mg a day and at 0.80 cents a month it’s a bargain. As they say on the ads – “talk to your doctor to see if Metformin is right for you”.]
The following is the original article published in 2017. The science is still valid today:
I admit it: I took metformin for a week, the leading prescribed drug for treatment of type 2 diabetes (59.2 million units prescribed) in the United States alone and taken by 80 million people around the world. This medication has been around for more than half a century and is often touted as a wonder drug for individuals with type 2 diabetes as well as for those living with other health challenges.
My reasons for taking metformin were highly personal: I have a genetic predisposition for both prostate cancer and type 2 diabetes (I’m not diabetic but I swing in and out of pre-diabetes based on my daily blood sugar readings), and I’m getting older (who isn’t!). I did copious amounts of research and it seemed on all three counts (prostate cancer prevention, managing type 2 diabetes (increasing insulin sensitivity), and anti-aging), it truly was a wonder drug. Oh, and I had also read that pretty much every billionaire in Silicon Valley was on it – mainly for it’s purported life extension benefits (as it can mimic the effect of calorie restriction – see more below).
Before I went on it I wanted to get some key blood indicators taken, specifically:
So I did that.
The plan was to have these indicators measured before taking metformin and then again, one month later. I really wasn’t looking at metformin as a drug – I was looking at it more as a “superfood”. Could it really have all these purported benefits with no real side effects? Why wouldn’t I take it? After all, I don’t take any other drugs so I had no real risk of the “cocktail effect” whereby it could have possibly interacted with other medications.
However I quickly changed my mind for the reasons set out below, but I wanted to first share with you some of the benefits and advantages of using metformin and then also point out how you, too, can potentially abandon this drug and follow a more natural route if you are struggling with similar health issues that I am.
What is metformin?
Metformin is an oral medication in the drug class biguanides that is prescribed alone or in combination with other medications, including insulin, to treat type 2 diabetes. It is available as a generic and also under the brand names Fortamel, Glucophage, Glumetza, and Riomet. Nearly a dozen combination drugs (containing both metformin and one other medication) also are available by prescription.
How does metformin work for type 2 diabetes?
Metformin is designed to help control the amount of glucose (sugar) in your blood by reducing the amount of sugar you absorb from your food and the amount of glucose made by your liver. Metformin also increases your body’s response to insulin, a natural substance that controls the amount of glucose in the blood. People who have type 1 diabetes, however, do not produce insulin and therefore should not use metformin.
People with type 2 diabetes are prone to developing serious complications, such as kidney problems, nerve damage (diabetic neuropathy), heart disease, vision challenges, sexual dysfunction, and stroke. Use of metformin, along with lifestyle changes (e.g., diet, exercise, not smoking) and routine monitoring of blood sugar can help prevent these life-threatening issues.
What are the health benefits of metformin?
I’ve already mentioned that metformin can be effective in controlling blood glucose levels. The Diabetes Prevention Program Research Group conducted a randomized clinical trial among adults at high risk for type 2 diabetes. The authors examined the impact of either lifestyle intervention or treatment with metformin on the prevention or delay of diabetes onset. Lifestyle changes (low-fat, low-calorie diet plus 150 minutes of moderate exercise weekly) resulted in a 58 percent reduction in the development of type 2 diabetes, while use of metformin alone reduced diabetes incidence by 31 percent – which is pretty good but nowhere near the benefits from just making lifestyle changes!
The kicker here though is that the benefits of taking metformin and making the lifestyle adjustments were not cumulative, so making the lifestyle adjustments alone should be the first priority.
But metformin can do more for your health. Take prostate cancer, for example. A recent study found that metformin could be a useful complementary treatment, especially in men using androgen deprivation therapy (ADT). Metformin appears to work directly on the prostate tumor as well as helping to lower insulin levels throughout the body.
More generally, metformin can suppress tumor growth, enhance the activity of anticancer medications, and improve immunity. This latter benefit is associated with the ability of metformin to lower blood sugar by improving insulin receptor sensitivity. The drug can reduce the fuel supply for bacteria, viruses, and fungi, which tends to reduce one’s susceptibility to infections.
Metformin can also help with weight loss. This benefit comes in handy not only among men who are struggling with type 2 diabetes but those who simply need to drop some excess weight. Results of the BIGPRO 1 trial showed that use of metformin was associated with a decline in bad cholesterol (low-density lipoprotein, LDL) concentration when compared with placebo and a decrease in damage to artery linings, a characteristic that contributes to the complications associated with type 2 diabetes (i.e., damage to the eyes, kidneys, and nerves). Other benefits of metformin include a decline in total cholesterol, free fatty acids, and tissue plasminogen activator antigen, all of which are associated with cardiovascular complications.
Metformin and life extension
Some research has even suggested metformin may help extend lifespan. The potential life-extension benefit goes something like this: metformin inhibits a complex called mammalian target of rapamycin (mTOR), which regulates the production of protein, boosts energy production, and creates waste. Metformin can help keep mTOR levels from being elevated too much or too often (situations associated with inflammation and cancer growth), which in turn can contribute to longevity.
What are the side effects of metformin?
Side effects associated with starting use of metformin can include nausea, vomiting, bloating, diarrhea, and stomach pain. These side effects typically fade as individuals become accustomed to the drug. Metformin should not be taken if you have a history of liver or kidney disease or of congestive heart failure. Anyone with a history of alcohol abuse also should avoid taking metformin because serious lactic acidosis may develop.
People with diabetes are encouraged to exercise regularly, yet use of metformin may interfere with this activity. A study published in Diabetes Care reported that “metformin has the potential to lower some patients’ selected exercise intensity” and also tends to increase heart rate.
The combination of using metformin and exercising may also result in another complication. Use of metformin reduces levels of blood glucose, but exercise can increase levels of the hormone glucagon, which deals with low blood sugar. The combination of metformin and exercise can result in significantly elevated concentrations of glucagon as the body attempts to compensate for the impact of metformin. One result is a less than effective result at lowering the glycemic response after eating than is possible by taking metformin alone.
In addition, the results of at least one small study suggest that use of metformin may lower sex drive and testosterone levels. Given the intense interest among men in their testosterone levels and the desire to boost them, these side effects are not welcome as well.
A total of 64 men with type 2 diabetes were evaluated: 30 who were taking metformin and 34 taking sulfonylurea. Twenty-seven nondiabetic men served as controls. Use of metformin was associated with a significant reduction in testosterone levels, libido, and low testosterone-induced erectile dysfunction, while use of sulfonylurea was associated with a significant elevation in all three factors.
Continued use of metformin also is associated with a reduction in vitamin B12 absorption. Since absorption of this nutrient declines with age, the addition of metformin to the picture can make it worse. A decline in B12 concentrations can cause an elevation in homocysteine levels (which is a risk factor for cardiovascular disease, especially among people with type 2 diabetes), and this decrease in B12 values can grow over time. Low concentrations of B12 are associated with changes in mental function, neuropathy, and anemia.
What side effects did I personally experience from metformin?
Ok, so you know the TV ads for drugs right – 5 seconds on the actual drug and 5 minutes on the side effects. I get it, drugs have side effects and they spend all that time telling you what they are for one reason, to avoid legal liability. It’s a fact – as long as they TELL YOU you can die from taking a drug you can’t sue them if you die – that’s America for you!
Some of the known side effects of metformin are above – but for me, one week on the drug was enough – notwithstanding all the purported health benefits. Here’s what I personally experienced:
- A 5lb weight loss in a week that was unexplained by any other reason;
- Constant nausea and lightheadedness;
- Massive fatigue and low energy – basically resulting in me being unable to finish basic workouts;
- Muscle weakness – I was lifting only ~75% of my normal weights and they were even feeling heavy;
- Low motivation and increased anxiety;
- Sleepiness by 8pm – normally I don’t feel like going to bed until after 10.30pm;
- Lack of breath – just climbing stairs had me puffing;
- Heart palpitations; and
- Constant dry mouth.
If it had just been one or two of the above I may have sucked it up, but all of them together felt like a sledgehammer – especially when I was in the middle of training for some pretty intense Spartan and other obstacle course races. All of my training partners were looking at me wondering what the heck was wrong with me!
So I quit – and doubled down on natural therapies.
How to reduce blood sugar naturally
Although metformin may be an effective way to reduce blood sugar, there are plenty of natural ways to achieve the same goal, and without the side effects. And the studies show that making lifestyle interventions are even more effective than taking the drug (see above). For me, I’ve always manically exercised and had a similar obsession with my nutrition. So I’m just doubling down on those key factors despite my genetics working against me. I’m also adopting a bunch of other strategies to help keep my blood sugar under control going forward. Here are some suggestions you may also want to try:
Reduce your alcohol intake. Reducing alcohol helps the liver better metabolize sugars and keep blood glucose at a healthier level. Basically, loading up the liver with too many tasks means it has to prioritize as it can’t do everything at once – and metabolizing alcohol usually takes precedence leading to increased insulin and glucose levels.
Take apple cider vinegar before meals. Before each meal, stir one to two tablespoons of apple cider vinegar (ACV) into a glass of water and down it. The acidic acid in vinegar disrupts the enzymes that digest starch in carbs, which means the starch is not digested (and converted to sugar) and blood glucose (sugar) levels are kept low. A recent study in Diabetes Research and Clinical Practice reported that consuming vinegar before a meal can reduce post-meal glucose and insulin levels. You can also get ACV in a drink which is a bit more diluted but also easier to stomach.
Try bitter melon supplement: Use of bitter melon (Momordica charantia) supplements, which contain the natural antidiabetic compounds charantin, polypeptide-p, and vicine, is a real plus in keeping type 2 diabetes at bay. Bitter melon helps control blood sugar levels as well as regulates blood pressure.
Add curcumin/turmeric to everything possible. Use of curcumin/turmeric in food and/or as supplements can improve lipid (cholesterol, triglyceride) levels in individuals and reduce the risk of cardiovascular events. The results of a recent international study reported that the presence of curcuminoids (bioactive ingredients in curcumin/turmeric) can reduce bad cholesterol levels and “contribute to a reduced risk of cardiovascular events” in individuals with types 2 diabetes and poor lipid control.
Furthermore, recent literature review published in the International Journal of Endocrinology and Metabolism titled, “Anti-Hyperglycemic Effect and Insulin Sensitizing Effects of Turmeric and Its Principle Constituent Curcumin,” adds support to the notion that the ancient Indian spice turmeric may provide an ideal drug alternative to treating and perhaps even preventing type 2 diabetes including:
- Reduction in liver glucose production
- Reduction in liver glycogen production
- Stimulation of increased glucose uptake
- Stimulating insulin secretion from pancreatic tissues
- Improvement in pancreatic cell function,
- Increasing insulin receptor β and reduction of insulin resistance
Other human clinical research conducted on diabetic and pre-diabetic patients revealed that curcumin had the following beneficial effects:
- Glucose lowering effect
- Improved beta cell function
- Improved fatty acid oxidation and utilization
One of these studies is especially worth highlighting, as it found a turmeric extract was highly effective in preventing the development of diabetes within pre-diabetic subjects. The study published in 2012, in the American Diabetic Association’s own journal, Diabetes Care, and titled, “Curcumin extract for the prevention of type 2 diabetes,” found that the administration of six capsules containing 250 mg of curcumin daily for 9 months was 100% effective at preventing the development of type 2 diabetes in prediabetics. That’s a big call but even if it’s 25% effective then it seems worthwhile, given all the other positive health benefits of curcumin/turmeric.
Modify your diet. Choose foods that are natural to minimally processed (and organic whenever possible), with an emphasis on healthy fats (e.g., extra virgin olive oil, coconut oil, avocados, nuts), primarily plant-based proteins with whole grains, and some low-fat dairy. Added sugars, simple carbs, and processed foods should be totally avoided if possible. There’s a lot of information online on eating to reduce blood sugar so search around. A lot has also been written lately about the benefits of a ketogenic diet for reducing blood sugar and treating type 2 diabetes. I tend to follow a mainly Mediterranean diet which is about 70% ketogenic.
Exercise, exercise, exercise. Daily physical exercise is a given, including a combination of HIIT (high-intensity interval training), and strength training. Strength (resistance) training, for example, has been shown to reduce the risk of developing type 2 diabetes to various degrees, depending on how much you do. A Harvard School of Public Health study found that pumping iron for 60 minutes per week can reduce diabetes risk by 12 percent, and it also improves insulin sensitivity. It makes sense that the more muscle you have the more room there is to store underutilized glucose. Cardio training also increases insulin sensitivity when done on a consistent basis. Try and walk or do some light exercise after meals as that helps to even out the blood sugar spikes. Having a high fiber carbohydrate snack before bed can also help even out nighttime blood sugar spikes. Try some unsweetened muesli and almonds or baked beans on toast – those seem to work for me.
Try green coffee bean extract. Use of this supplement has been shown to help manage diabetes by reducing the accumulation of body fat and thus fight obesity. Research done in India on normal-weight participants with normal blood glucose (or blood sugar) levels also found that various doses of supplements containing green coffee extract all lowered blood sugar, with higher doses associated with larger drops. Here’s the one I take.
A great deal of research has also examined the potential health benefits of standard coffee. A 2012 study in the New England Journal of Medicine suggested that death rates fell with each additional cup consumed daily. Meanwhile, a 2009 Archives of Internal Medicine review of 18 studies involving more than 457,000 people indicated that each additional daily cup of coffee was associated with a 7 percent drop in the relative risk of developing type 2 diabetes.
Experiment with intermittent fasting. I fast one day per week, which is just one technique of intermittent fasting. Fasting benefits the body in several ways, including reduced insulin resistance (which lowers the risk of developing type 2 diabetes), fights inflammation, reduces blood pressure and cholesterol levels, helps control weight, provides detox, may increase production of new nerve cells, and extends lifespan.
Take a low-dose aspirin. Consuming one 81-mg aspirin daily can disrupt the formation of blood clots and thus help ward off heart attack and stroke. Studies have also shown that aspirin helps prevent additional heart attacks and strokes in people who have already had one. And since having diabetes puts people at an increased risk of having a heart attack or stroke, the American Heart Association recommends aspirin therapy for diabetics.
So hype or wonder drug?
According to Dallas Clouatre, PhD, consultant in alternative and complementary medicine and the author of The Prostate Miracle and several other books on alternative and complementary medicine, “My thoughts on metformin are that it is interesting, but over-hyped….Downsides of metformin include reduced efficacy with advancing age, reduced efficacy with prolonged use, and GI [gastrointestinal]-tract issues in some individuals.” He goes on to say that “for me it is difficult to suggest the chronic intake of a drug that works by gumming up a natural process of the body.”
I hear what he’s saying but you can’t discount the fact that metformin is truly helping nearly 100 million people worldwide – but how many of these people would be better served by making massive and consistent lifestyle interventions – which in the case of type 2 diabetes have been shown to be significantly more effective than the drug? Probably tens of millions!
Prevention and management of type 2 diabetes can be achieved without the need for metformin. Although the drug does have some benefits, long-term use can lead to significant health issues that natural means of blood glucose management will not introduce into your life.
My decision to go on and quickly off the drug was personal, and based on my own experience and side effects. Look at all the benefits and risk factors before making up your own mind.
Al-Kuraishy HM, Al-Gareeb AI. Erectile dysfunction and low sex drive in men with type 2 DM: the potential role of diabetic pharmacotherapy. Journal of Clinical and Diagnostic Research 2016 Dec; 10(12): FC21-FC26
Boule NG et al. Metformin and exercise in type 2 diabetes. Diabetes Care 2011 Jul; 34(7): 1469-74
Charles MA, Eschwege E. Prevention of type 2 diabetes: role of metformin. Drugs 1999; 58 Suppl.1:71-73
Choi BK et al. Green coffee bean extract improves obesity by decreasing body fat in high-fat diet-induced obese mice. Asian Pacific Journal of Tropical Medicine 2016 Jul; 9(7): 635-43
de Jager J et al. Long term treatment with metformin in patients with type 2 diabetes and risk of vitamin B-12 deficiency: randomized placebo controlled trial. BMJ 2010; 340:c2181
Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. New England Journal of Medicine 2002 Feb 7; 346:393-403
Fontbonne A., Charles MA, Juhan-Vague I, et al. The effect of Metformin on the metabolic abnormalities associated with upper body fat distribution. Results of the BIGPRO 1 trial. Diabetes Care 1996; 19:920-6.
Kondo T et al. Vinegar intake reduces body weight, body fat mass, and serum triglyceride levels in obese Japanese subjects. Bioscience, Biotechnology, and Biochemistry 2009 Aug; 73(8): 1837-43
Krawinkel MB, Keding GB. Bitter gourd (Momordica charantia): a dietary approach to hyperglycemia. Nutrition Reviews 2006 Jul 1; 64(7): 331-37
Merck. The Merck Manual of Diagnosis and Therapy. Section 2. Endocrine and Metabolic Disorders. Chapter 13. Disorders of Carbohydrate Metabolism
Panahi Y et al. Curcuminoids modify lipid profile in type 2 diabetes mellitus: a randomized controlled trial. Complementary Therapies in Medicine 2017 Aug; 33:1-5
Shishehbor F et al. Vinegar consumption can attenuate postprandial glucose and insulin responses; a systematic review and meta-analysis of clinical trials. Diabetes Research and Clinical Practice 2017 May; 127:1-9
Statista. Leading prescriptions dispensed in the US diabetes market 2017
Whitburn J et al. Metformin and prostate cancer: a new role for an old drug. Current Urology Reports 2017; 18(6): 46
Wong S. Study reveals the gut’s role in effects of diabetes drug. Imperial College London 2016 Apr 6