Richard Maurer, ND
Last week, the most popular Medical News site ran a headline with the rhetorical question, “Should Everyone Take Metformin?” It’s remarkably audacious and offers a let’s put it in the water supply solution that rightly raises my hackles. What is this panacea metformin and why should—or shouldn’t—you take it?
The research that generated the metformin headline was another in a series showing that metformin is far superior for those with type 2 diabetes when compared to medications that raise insulin. But this study went further and compared metformin takers with a non-diabetic untreated control group—those taking metformin lived a little longer than the controls. Researchers quickly discredited the unsubstantiated finding but sensational media was less disciplined.
What is Metformin? Metformin is the generic name for the brand drug Glucophage. It is used to lower blood sugar, presumably for those who have been identified with high blood sugar—a condition called hyperglycemia or prediabetes. Type 2 diabetes is a later stage of uncorrected high blood sugar.
How Your Metabolic Economy Works: With a healthy metabolism, your body keeps just the right amount of sugar, as glucose, in your bloodstream to meet your energetic needs over the next several hours. When you eat glucose, as starchy carbohydrates or sugars, your body will have to store the glucose for later use. Eating your meal is like like earning a paycheck—you want to put the energy, or money, safely in a place that allows you to tap into it at a later time. Your paycheck will be put into a bank—you later use checks or an ATM to access the stored money. Alternately, your blood glucose will be turned into clumps, called glycogen or turned into compact and efficient adipose –yeah, that’s what we call fat in medical-speak. This stored glucose is deposited into your muscles, liver and fat cells. When you need it, this storage will be released, right?
Saves More: Here’s how metformin works. The drug greases the path so that you become a little better at storing the glucose. In the money analogy this sounds good, you’ll save more cash. But in the glucose reality, while it is true that metformin will result in lower blood glucose levels, the glucose doesn’t go away – it’s just stashed a little better. Medical speak: metformin enhances glucose uptake.
Blocks Spending: Metformin goes a step further and, like a guard, prevents you from getting to the ATM machine. Metformin throws the glucose in the tissues of your body more effectively and then locks the door so it’s harder to release the stored energy.
Save more? Spend less? This sounds great for a debt-burdened economy. But if you have high blood sugar, especially with weight gain and extra fat, you are not in debt—to the contrary you have a surplus. In this state, you need to promote saving less and spending more. An economist understands that over-saving and under-spending can be catastrophic. So too, your metabolism relies upon the ability to spend in balance with saving.
Especially for exercisers, metformin’s save more—spend less effect has problems. People taking a common dose of metformin had higher heart rates and more fatigue under exercise conditions. The drug researchers desperately blamed strenuous exercise for interfering with metformin’s action and suggested less exercise. I disagree. Exercise should not be de-emphasized—to the contrary, exercise works as well if not better than metformin to control blood sugar. And strenuous exercise in particular improves underlying insulin resistance better than metformin.
Most medical care, unfortunately, is not incentivized to promote an effective exercise or dietary cure—nor are patients always compliant with needed lifestyle changes. But with the right message, patients do better—and I think we all know that the miracle-pill is not the right message.
I am the author of The Blood Code and specialize in metabolic recovery and health—people I see with type 2 diabetes understand that they need to store less and spend more. Dietary and fitness changes are to that end. In my experience, metformin is rarely necessary to achieve normal blood sugar and healthy metabolism. But for some, metformin is a clearly a best choice to reduce complications of type 2 diabetes. For the masses, we must be free to choose. As for me, I’ll keep my water clean.
 Boulé, N. G., et al. Metformin and Exercise in Type 2 Diabetes: Examining treatment modality interactions. Diabetes Care. 2011 July; 34(7):1469–74.
 https://www.nih.gov/news/pr/aug2001/niddk-08.htm from the Diabetes Prevention Program: US National Institute of Health.
 Orchard T, et al. The effect of metformin and intensive lifestyle intervention on the metabolic syndrome: the Diabetes Prevention Program randomized trial. Ann Intern Med. 2005 Apr 19;142(8):611-9.