A review published in ACS Pharmacology & Translational Science explored the potential role of first-line type 2 diabetes medication – metformin – in the treatment of ME/CFS and long COVID. Whilst, no diabetic medication is currently approved for these conditions, there has been sustained interest in their effects.
The review, with lead author Dr David Fineberg (general practitioner and PhD candidate at the University of Melbourne), highlights several mechanisms by which metformin may benefit patients, including –
- mTOR signaling and energy metabolism: Metformin may influence mTOR signaling (a crucial pathway involved in functions such as cell growth and interpreting nutrient levels) improving energy metabolism in ME/CFS and long COVID, thereby alleviating symptoms.
- Immune/anti-inflammatory and systemic effects: “Beyond the impact on cellular metabolism, metformin has shown to have anti-inflammatory, vascular, gastrointestinal, neuroprotective and epigenetic effects” – processes implicated to varying degrees in ME/CFS and long COVID. Furthermore, “The immunological response to metformin normalizes inflammatory cytokines.”
- Sphingolipid regulation: Sphingolipids have been implicated in ME/CFS and long COVID. Metformin influences sphingolipid production and sequestration (storage), as well as other related processes. This opens the door for a potential therapeutic mechanism.
- Oxidative stress reduction: By reducing reactive oxygen species, metformin may lessen cellular stress, a contributor to ME/CFS symptoms.
The review notes that whilst metformin has numerous benefits, it carries risks. In 2016, the FDA issued a black box warning for life-threatening lactic acidosis. Common, dose-dependent side effects include diarrhea, nausea, and abdominal pain “in 20% of cases.”
The review concludes, “Metformin acting at a biochemical level has multiple targets with which to leverage against symptoms of ME/CFS.” It is an ” intriguing multiaction drug that may play a significant role in treating ME/CFS and [long COVID]. Although more research is needed to refine dosing and delivery methods, the accumulating evidence suggests it could soon be integrated into clinical practice.”
Disclaimer: This article is not a recommendation, rather just a report. Please discuss with your doctor if you are considering starting any new medication or if you are experiencing side effects or worsening symptoms.
