Metformin and Diabetes: How to Balance Your Blood Sugar Naturally Through Food

The Global Burden of Diabetes

Diabetes is one of the most significant public health challenges of the 21st century. According to the International Diabetes Federation (IDF), approximately 537 million adults (aged 20–79) were living with diabetes in 2021, and this number is projected to rise to 643 million by 2030 (1).

Type 2 diabetes (T2D) accounts for 90–95% of all diabetes cases and is characterised by insulin resistance—a condition where the body’s cells become less responsive to insulin, leading to elevated blood glucose levels. Left unmanaged, T2D can result in severe complications, including:

• Cardiovascular disease (CVD), the leading cause of death in people with diabetes.

• Kidney disease (diabetic nephropathy).

• Nerve damage (diabetic neuropathy).

• Vision loss (diabetic retinopathy).

💡 The Economic Impact: Diabetes and its complications cost the global healthcare system an estimated $966 billion USD annually, a 316% increase over the past 15 years (1).

The Role of Metformin in Diabetes Management

Metformin, introduced in the 1950s, remains the first-line pharmacological treatment for Type 2 diabetes. It is recommended by major guidelines, including those from the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD).

How Metformin Works:

Metformin exerts its effects through multiple mechanisms:

• Inhibition of Hepatic Gluconeogenesis: Metformin reduces the liver’s production of glucose, a key driver of hyperglycemia in T2D.

• Improved Insulin Sensitivity: It enhances the uptake of glucose by peripheral tissues, such as muscle, by activating AMP-activated protein kinase (AMPK), a cellular energy regulator.

• Reduction in Intestinal Glucose Absorption: Metformin slows the absorption of glucose in the gastrointestinal tract, contributing to lower postprandial (after-meal) blood sugar levels.

💡 The Science: A 2021 meta-analysis in Diabetes Care confirmed that metformin reduces HbA1c (a marker of long-term blood sugar control) by an average of 1.5% and lowers the risk of cardiovascular events by 18% (2).

Why Nutrition Is Essential Alongside Metformin

While metformin is effective, it is not a standalone solution. Type 2 diabetes is a lifestyle-driven condition, and addressing the root causes—such as poor diet, physical inactivity, and chronic inflammation—is critical for long-term management.

Limitations of Metformin:

• Does Not Address Lifestyle Factors: Metformin cannot reverse the dietary and lifestyle patterns that contribute to insulin resistance.

• Nutrient Depletion: Long-term use of metformin has been associated with reduced absorption of vitamin B12, which can lead to neuropathy if left unaddressed.

• Gastrointestinal Side Effects: Up to 30% of patients experience nausea, diarrhea, or abdominal discomfort when starting metformin (3).

💡 The Role of Nutrition: Evidence shows that dietary interventions can significantly improve glycemic control, reduce medication dependency, and lower the risk of complications (4).

The Science of Blood Sugar Control Through Diet

1. Low-Glycemic Index (GI) Foods

The glycemic index measures how quickly a food raises blood sugar levels. Low-GI foods release glucose more slowly, preventing spikes and crashes.

Examples of Low-GI Foods:
✔️ Non-starchy vegetables (e.g., spinach, broccoli, zucchini).
✔️ Whole grains (e.g., quinoa, barley, oats).
✔️ Legumes (e.g., lentils, chickpeas, black beans).

💡 The Science: A 2020 study in The American Journal of Clinical Nutrition found that low-GI diets reduced HbA1c levels by 0.5% and improved insulin sensitivity in individuals with T2D (5).

2. High-Fibre Diets

Fibre slows the absorption of glucose, helping to stabilise blood sugar levels. It also supports gut health, which is critical for individuals on metformin.

High-Fibre Foods to Include:
✔️ Vegetables like artichokes, Brussels sprouts, and carrots.
✔️ Fruits like apples, pears, and berries (with the skin).
✔️ Seeds like chia and flaxseeds.

💡 The Science: A 2021 meta-analysis in The Lancet found that individuals consuming at least 25–30 grams of fibre per day had a 20–30% lower risk of developing diabetes-related complications (6).

3. Healthy Fats

Healthy fats improve insulin sensitivity and provide a steady source of energy without spiking blood sugar.

Sources of Healthy Fats:
✔️ Avocados.
✔️ Nuts and seeds (e.g., almonds, walnuts, sunflower seeds).
✔️ Fatty fish (e.g., salmon, mackerel, sardines).

💡 Pro Tip: Replace refined oils with extra virgin olive oil for added anti-inflammatory benefits.

4. Hydration and Blood Sugar

Dehydration can lead to higher blood sugar levels by reducing the efficiency of glucose transport in the bloodstream.

💡 Tip: Aim for at least 2 litres of water per day, and consider herbal teas like cinnamon or ginger, which may support blood sugar regulation.

5. Addressing Nutrient Deficiencies

Metformin use has been linked to reduced absorption of vitamin B12, which is essential for nerve health and energy production.

Foods Rich in B12:
✔️ Eggs.
✔️ Dairy products.
✔️ Fortified plant-based milks (for vegans).

💡 The Science: A 2021 study in Diabetes Therapy recommended regular monitoring of B12 levels in individuals on long-term metformin therapy (7).

The Evidence for Combining Nutrition and Medication

Key Research Findings:

• A 2022 review in Nutrients highlighted that combining metformin with a low-glycemic, high-fibre diet significantly improved glycemic control and reduced HbA1c levels (4).

• A 2020 study in The Lancet found that dietary fibre intake was associated with a 20–30% reduction in the risk of Type 2 diabetes complications (6).

• Research in Diabetes Therapy emphasised the importance of addressing nutrient deficiencies, particularly B12, in individuals on long-term metformin therapy (7).

Why Choose XLR8 Your Health?

At XLR8 Your Health, we specialise in applying the principles of clinical nutrition and functional medicine to help clients optimise their health. If you’re managing Type 2 diabetes with metformin, we can help you:
✔️ Personalise Your Diet: Tailor your meals to stabilise blood sugar and support metabolic health.
✔️ Address Nutrient Deficiencies: Identify and correct deficiencies caused by metformin use.
✔️ Support Gut Health: Minimise gastrointestinal side effects and optimise your microbiome.
✔️ Integrate Lifestyle Changes: Incorporate stress management, physical activity, and sleep optimisation into your plan.

💡 Ready to take control of your blood sugar and feel your best?
👉 Book a free 15-minute call with us today: xlr8yourhealth.com/contact