Metformin, heart disease and diet

Metformin (Glucophage) is one of the most commonly prescribed medications for type II or “adult-onset” diabetes, the type of diabetes that does not usually require insulin.

A previously known – although rare – risk associated with this medication is acidosis, a potentially life-threatening condition caused by a build-up of lactic acid in blood.

A recent study (Nutr Metab Cardiovasc Dis, 2001;11:108-116) found that Metformin also raises blood levels of homocysteine, a substance that has been found to cause heart disease. Homocysteine builds up in blood when certain B vitamins are deficient and it is believed that Metformin raises homocysteine levels by blocking the absorption of vitamin B12 and folic acid, two essential nutrients.

In recent years, Metformin has also been prescribed to individuals who are considered at high risk for developing diabetes in the hope of preventing or delaying its onset. A study this year (N Engl J Med 2002;346:393-403) looked at more than 3,000 individuals, all of whom were in this high-risk category and divided them in three groups: one received Metformin, the second a placebo, and the third followed very basic diet and exercise guidelines but received no medication or placebo.

The study concluded that, although Metformin reduced the onset of diabetes by roughly 30% over the placebo group, the basic lifestyle and diet changes recommended in the study were twice as effective, reducing diabetes onset by almost 60%.

Although certain people are more susceptible to this illness because of family history, Type II diabetes is clearly caused by diet and lifestyle. I believe it can be prevented, and often reversed, when these issues are addressed and related nutritional deficiencies are corrected. Herbal products such as cinnamon, a common kitchen spice, have also been shown to help normalize blood sugar and can be helpful while the underlying causes are addressed. Research on cinnamon and diabetes can be found in the Journal of the American College of Nutrition (Aug. 2001;20(4):327-336), although there are no large scale studies due to lack of funding.

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