Metformin vs "All Natural Supplements" for Type 2 Diabetes

Goat’s Rue or French Lilac

I recently wrote a post pointing out the reason the metformin should be the first medication used if you have type 2 diabetes. A reader asked a great question. “How can sugar be controlled using readily available all natural substances like vitamins and supplements.” I am an internal medicine physician and I get questions like this all the time. “Why should I take a medicine when I can control my pressure, sugar, and cholesterol using natural supplements and vitamins.”

That is a very important question and it applies to other "all natural substances" compared to prescribed medications for type 2 diabetes, high blood pressure, and high cholesterol. Humans have used natural products containing metformin for hundreds of years to control sugar levels.

While metformin is indeed derived from natural compounds found in Goat's Rue or French Lilac, it is a specific, purified chemical entity with well-defined properties and a specific chemical structure. The "biguanide produced by Goat's Rue or French Lilac" refers to a mixture of naturally occurring compounds not just pure metformin.

It is also important to note that we don’t treat type 2 diabetes merely to lower the blood sugar. High blood sugar does not kill or maim you. It is diabetes complications that kill or maim you. Scientific research has proven that metformin lowers heart attack by 39% and all other diabetes complications by 32%. Metformin continued to reduce heart attack risk by a third ten years later. When metformin is part of an integrated protocol for type 2 diabetes it reduces heart attack risk four fold. There is no comparable data for treatment with supplements and vitamins.

Here's a breakdown of the key differences:

1. Chemical Specificity and Purity:

Metformin: Is a single, well-defined chemical compound (dimethylbiguanide hydrochloride). Its production involves a specific chemical synthesis process to yield a pure substance with a consistent molecular structure and dosage.  

Goat's Rue contains a variety of molecules similar to metformin. While these compounds have blood glucose-lowering effects, they are not a single entity like metformin. The concentration and composition of these compounds can vary depending on the plant's growing conditions, harvest time, and preparation method.

2. Dosage and Standardization:

Metformin: As a pharmaceutical drug, metformin has precisely controlled dosages in tablet or liquid form. This ensures patients receive a consistent and predictable amount of the active compound. You get the same dose every time.

Goat's Rue Preparations: Herbal preparations of Goat's Rue (teas, extracts, supplements) will have varying and often unstandardized concentrations of the active compounds. It's difficult to determine the exact amount of glucose-lowering substances a person is consuming, leading to inconsistent effects and potential safety concerns.

3. Safety and Efficacy:

Metformin: Has undergone extensive scientific research and clinical trials to establish its efficacy in treating type 2 diabetes and its safety profile. Dosage guidelines and potential side effects are well-documented.  

Goat's Rue: While traditional use suggests blood glucose-lowering properties, there is less rigorous scientific evidence to support its efficacy and safety compared to pure metformin. The other compounds present in the plant extract might have different pharmacological effects or potential toxicities that are not fully understood. Historically, some early biguanide derivatives from Goat's Rue were found to be too toxic for widespread use.

4. Regulatory Oversight:

Metformin: As a pharmaceutical drug, metformin is subject to strict regulatory oversight by health authorities (like the FDA in the United States). This ensures quality control, manufacturing standards, and proper labeling.  

Goat's Rue Preparations: Herbal supplements containing Goat's Rue are generally not subject to the same level of scrutiny as pharmaceutical drugs. Quality and purity can vary significantly between different products and manufacturers.

5. Historical Context:

Metformin's Development: Metformin was specifically synthesized and isolated based on the observation that compounds like metformin in Goat's Rue had glucose-lowering effects. Researchers aimed to find a safer and more effective specific compound.  

Early Biguanides: Early attempts to use crude extracts or other biguanide derivatives from Goat's Rue were often limited by toxicity. Metformin was found to have a better safety profile than some of its predecessors like phenformin and buformin, which were eventually withdrawn from the market in many countries due to the risk of lactic acidosis.

In summary: Metformin is a purified and well-characterized drug that was developed based on the glucose-lowering properties observed in Goat's Rue. It has proven safety and efficacy. However, the plant contains a mixture of compounds, and using unstandardized preparations of Goat's Rue is different from taking precisely dosed and regulated metformin. While the historical link is important, they are not interchangeable in terms of predictable therapeutic effect and safety. The metformin story is important because the same argument can be applied to other “natural products” used to treat high blood pressure, high cholesterol, heart attack and other cardiovascular diseases.