Last month, mainstream news outlets made a big fuss about a new study that attempted to link metformin — the first-line Type II diabetes drug — with increases in dementia risk. But, as usual, the real story is far more complicated.
Metformin is the only drug I’ve ever recommended to control blood sugar. For one, it derives originally from the ancient European folk remedy called French lilac. (In the U.S., we call it goat’s rue and the USDA classifies it as a “noxious weed.”)
Second, it effectively controls blood sugar.
Third, it has been thoroughly studied over several decades and has a long history of safe use. In fact, it is now available as an inexpensive generic.
And fourth, metformin is the only drug that reduces all the dangerous complications of Type II diabetes, such as damage to the eyes, heart, kidneys, and peripheral nerves.
But this one, lone study out of Taiwan turns up a questionable finding…and we’re supposed to throw all those established scientific findings out the window?
Well, not so fast. When I looked closely at the study design, I found many serious problems with it.
Design problems with new metformin study
The researchers for this new study examined records in the National Health Insurance database of Taiwan. They divided participants into two groups. The first group included 4,651 Type II diabetes patients who received metformin prescriptions. The second control group included 4,651 Type II diabetes patients who did not receive prescriptions for the drug.
After 12 years, researchers found higher rates of dementia (and Parkinson’s disease) in the patients given metformin prescriptions. The researchers presented these preliminary findings at an open poster session at the International Conference on Alzheimer’s and Parkinson’s Disease.
Right off the bat, I saw several problems.
First, the researchers broke down metformin users into two categories. In one group, they put everyone who had taken metformin for less than a year. Then, they lumped everyone else with over one year of use into another group.
Typically, a patient will take metformin for many years. So — for a long-term treatment of a long-term medical condition, this is an odd and unusual break-down.
The second problem area involves the nature of the disease itself, which the researchers fail to acknowledge. For example, previous research links Type II diabetes mellitus itself with an increased risk of dementia. In fact, years ago I suggested that we could consider dementia as “Type III diabetes.” And previous studies show that metformin actually reduces the risk of dementia and other neurological diseases — as would be expected and biologically plausible.
Five big questions loom in metformin study
Before we overturn the findings of all the prior studies on metformin, the new study would need to be rock solid, which it’s not. In fact, we don’t even know five important factors in the Taiwan study…
We know the Type II diabetes patients received metformin prescriptions. But we don’t know whether they actually filled their prescriptions for metformin. A critical factor, don’t you think?
Second, even if they filled the prescriptions, we don’t know whether the patients actually took metformin, as prescribed.
Third, of the patients who did take metformin, we don’t know whether they actually achieved blood sugar control.
Fourth, to reduce blood sugar and hemoglobin A1C, the long-term measure of blood sugar, doctors must prescribe the proper dosing schedule and follow a set clinical protocol — and then measure the actual outcomes in terms of controlling blood sugar (I’ll tell you more about that in an upcoming Dispatch.)
But it seems the researchers in the Taiwan study only assumed the doctors correctly prescribed metformin with the right doses etc. to their patients, and that the patients followed the protocol.
Interestingly, the researchers in the study weren’t Type II diabetes experts, so they didn’t dig into these important details. But knowing these details absolutely helps us determine whether we can trust the study’s findings.
Fifth, the researchers in the new study didn’t explain how they controlled for other factors such as diet, exercise, body weight and obesity, or weight loss. Nor did they question whether the patients who didn’t take metformin used natural approaches — such as dietary supplements and herbs — to control their blood sugar.
Certainly anyone with Type II diabetes in a medically advanced country like Taiwan (Republic of China) would be doing something for diabetes, if they have been diagnosed with the condition. And many traditional Chinese remedies effectively control blood sugar and support metabolism. In fact, they know a lot more about using natural approaches in China than we do in the U.S.
Indeed, many nutrients and herbs reduce blood sugar. But I’ve always recommended taking metformin, instead of these dietary supplements for several reasons.
For one, the National Institutes of Health (NIH) never did the studies to establish the right clinical protocols for any of the nutrients and herbs that do reduce blood sugar. And Type II diabetes is just too serious and complicated of a disease to go it alone without established protocols.
Of course, the NIH also claims (incorrectly) that there is no role for nutritional and dietary supplements in diabetes. They want us to believe that there is no role for nutrients in a metabolic/nutritional disorder. This claim is absolutely false.
In this case, I believe the diabetes patients not taking metformin did so because they were probably taking lots of other natural steps instead that protected them against both diabetes and dementia.
Ask your doctor to look at the whole picture
In my view, this kind of study wields far too much power. And it reminds me of the old saying: “one swallow doesn’t make a summer.’’ (Especially when it comes to swallowing drugs.)
In other words, one poorly designed study on metformin shouldn’t supplant all the other well-designed studies that came before it and support the drug’s use. Furthermore, doctors should always consider all the research that has been done on a drug (or a supplement).
This study will probably prompt some doctors to stop prescribing a safe, inexpensive Type II diabetes drug in favor of a new drug that is far more dangerous, far more expensive, and far more profitable for big pharma.
Thankfully, at least one doctor is having none of it.
Dr. Larry Ereshefsky told Medscape, “I don’t believe the findings based on what’s up there.” (Meaning the limited methods and data presented on the short poster, prior to full publication in the peer-reviewed medical literature. That is, if it ever gets published in peer-reviewed medical literature. I certainly would never vote for its inclusion in a journal.)
Some good news to look forward to…
For me, this study reaffirms the need to help you sort through the good and the bad research out there regarding Type II diabetes. It also concerns me that metformin depletes the all-important vitamin B12. That’s the last thing you need, although you can reverse it by taking B vitamin dietary supplements and vitamin B12 shots.
So — I have begun work on a comprehensive, natural protocol that can help you control diabetes without drugs.
In the meantime, you can learn about the many dietary and nutritional factors to prevent and reverse dementia in my Complete Alzheimer’s Cure online learning protocol.
“Metformin Use Linked to Increased Dementia, Parkinson’s Risk in Patients With Diabetes,” Medscape (www.medscape.com) 3/30/2017