Already this year  5  reports(from India,  USA,  Germany and Australia)  of  a few cases of metformin-related lactic acidosis  (MALA)  warn about  occult metformin toxicity;   

while at least 6 studies on Medline alone  warn of  the increasing pandemic of  illness, collapse and deaths from aggressive marketed use of red bull  and other sugary “energy” drinks- especially when spiked with taurine -and  especially the chief killer alcohol.


But these MALA case reports are inevitably incomplete, and cannot claim  direct causal role of metformin in   the acute illnesses.

 In fact there is conclusive evidence that  lactic acidosis is common in any severe illness- which in turn is far more common in (pre)diabetics-  and

Prof  J D Lalau from Amiens has  pointed out for almost  20 years that  metformin in fact reduces the mortality of multifactorial lactic acidosis by up to 90%.  and as Prof  Charles  Glueck (Cholesterol Center, Cincinnati) wrote last year,  “since metformin came to the US, the number of cases of lactic acidosis  has fallen significantly, and the likelihood of lactic acidosis from  metformin is very close to zero. cjg”.       In fact, as Salpeter et al have repeatedly shown in meta-analysis,  “the upper limit for the true incidence of metformin-associated lactic acidosis was 6.3 cases per 100,000 patient-years, and the upper limit for the true incidence of lactic acidosis in the non-metformin group was 7.8 cases per 100,000 patient-years” ie as Glueck says, metformin reduces the incidence of and protects against morbidity from lactic acidosis. Thus metformin could be reducing the incidence of lactic acidosis by 20%.

Mandatory  routine low cost  N-acetyl cysteine  supplement as another antioxidant –  insulin sensitizer and  nitric oxide stabilizer  will protect not just the lungs but also against metformin-associated radio-contrast-induced nephropathy, and paracetamol/ acetaminophen toxicity. . 


By contrast with essential metformin for pandemic overweight mtabolic syndrome, there are already six  studies  on Pubmed alone in the past year on Red Bull and other sugar-loaded toxic carbonated drinks that are anything but soft, that have been associated with major collapse if not deaths, especially when spiked with alcohol. Naturally, despite the fact that such drinks are huge short- and -longterm cause of  major morbidity and death, national health regulators do nothing to stop such poisoning of youth  any more than they want to enforce preventative use of  metformin- the beverage, and disease, industries pay huge taxes and thousands of employees, whereas metformin is long out of patent.

   But  Merck’s newly patented slow-released metformin is giving metformin a much needed boost. .


Alcohol, tobacco smoking, sugar, oxygen, water, panados, aspirin, gasoline   kill every day;  so death from 100 metformin tablets  intentional overdose  is irrelevant.

If  the manufacture and sale of  alcohol, sugar, smoking tobacco , explosive weapons,  and speed-unregulated  petrol-driven private vehicles were banned, millions of innocent lives including children  would be spared monthly, and the industrialists (and the  politicians, scientists and lawyers in their pay) would  and do find other ways to make immoral megaprofits.

 In fact it is already  4 years since  Geoff Cannon  published  for the  World Health Policy Forum, New York : Why the Bush administration and the global sugar industry are determined to demolish the 2004 WHO global strategy on diet, physical activity and health.

 and Cohen from the RAND Corporation  last month reviews Neurophysiological pathways to obesity: below awareness and beyond individual control,  why  “excessive food consumption occurs in ways that defy personal insight or are below individual awareness, why the current food environment stimulates automatic reflexive responses that enhance  desire to eat and increase caloric intake, making it exceedingly difficult for individuals to resist, especially because they may not be aware of these influences , with at least  10 neurophysiological pathways that can lead people to make food choices subconsciously or, in some cases, automatically.  Given that people have limited ability to shape the food environment individually and no ability to control automatic responses to food-related cues that are unconsciously perceived, it is incumbent upon society as a whole to regulate the food environment, including the number and types of food-related cues, portion sizes, food availability, and food advertising. 

The giant metformin studies – the 20yr UKPDS, the 5yr report on thousands of  treated Canadian diabetes (Johnson 2002-2006), the USA COSMIC trial to launch metformin there,  the Chinese, USA and Indian diabetes prevention  trials all produced zero cases of MALA lactic acidosis. Appropriate metformin almost halves the all-cause deathrate in diabetics, and halves the incidence of new diabetes in the overweight  ie “prediabetics”  – without ever producing any significant adverse effects provided , like all  chronic drugs, it is started in low dose eg 125mg/day, and increased gradually to find the optimal tolerated dose that does not cause symptoms.

LIKE ALL MEDICATION, the patient is instructed to consult if any new symptoms develop, and in the meantime briefly stop the drug till new symptoms subside, then resume at half the dose if tolerated, and retitrate. 

NO GOOD STUDY HAS SHOWN ANY RISK WHATSOEVER FROM APPROPRIATELY USED METFORMIN AT ANY AGE OR IN ANY APPROPRIATELY MONITORED CHRONIC CONDITION. the  same cannot be said for modern heavily marketed  drugs (eg statins, biphosphonates, prozacs, nonsteroidal anti-inflammatories, glitazones, Cox2 inhibitors, sulphonylureas, benzodiazepines, viagras, and black cohosh ), which can and do kill unpredictably – and none of which are essential drugs except as occasional last-ditch agents, – and none of which reduce all-cause mortality and morbidity as does metformin.


As Stephen Brunton from Columbia University N Carolina  writes recently in “The Changing Shape of  type 2 diabetes: due   to increasing affluence, lifestyle changes and obesity,  diabetes type 2  is affecting younger as well as older. Improving diet and increasing physical activity are important therapeutic interventions in diabetes and associated conditions. However, many people find it difficult to maintain lifestyle changes, which is why the American Diabetes Association recommends lifestyle intervention plus metformin following initial diagnosis.  It is important that patients with diabetes receive the most effective therapy for maintaining glycemic control and that treatment is modified or augmented in those who are not achieving appropriate glycemic goals. Only by maintaining long-term, effective glycemic control can the microvascular and macrovascular comorbidities associated with diabetes be minimized.”

           Brunton’s reasoning is precisely why metformin needs to be started as soon as overweight is observed:  ie  to reduce the increasing risk of prediabetes and thus progressive tissue damage – especially in the pancreas. Teams from Chicago ( 1997) and Pisa (2002)  universities have shown that  both in rats and in human pancreas cells, Metformin has direct protective action on  pancreas  beta-cells, delaying the onset of diabetes and the loss of insulin production .

        So it is metformin, not statins or alcohol or cigarettes or sugar,  that should be sold over the counter, albeit  ALL OF THEM with appropriate black box cautions.


 See the HRT  and supplement papers  above and below , and the recommended condition-specific supplement product information.. For specialist  internist consultation on appropriate supplements including HRT for individual circumstances, email your concise health details to


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