Metformin - A potential gamechanger in Long Covid

There seems to be a strong association between individuals at risk of Long Covid symptoms and gut dysbiosis. The exact mechanisms are not completely clear, but focusing on strengthening the gut microbiome makes a lot of sense.

Metformin is a medication used to treat type 2 diabetes, a condition in which the body is unable to properly use insulin to regulate blood sugar levels. It works by reducing the amount of glucose produced by the liver and increasing the body's sensitivity to insulin, allowing for better control of blood sugar levels.

Metformin is known to concentrate in the gut after oral administration, particularly in the upper small intestine. This is because metformin is poorly absorbed into the bloodstream, and instead remains in the gastrointestinal tract where it exerts its glucose-lowering effects.

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Metformin seems to increase the levels of Akkermansia Muciniphila, a bacteria that has mucin degrading properties and protects intestinal cells.

Ke, Haoran, et al. "Metformin exerts anti-inflammatory and mucus barrier protective effects by enriching akkermansia muciniphila in mice with ulcerative colitis." Frontiers in Pharmacology 12 (2021): 726707.

Aggarwal, Vidushi, Sushant Sunder, and Smita Rastogi Verma. "Disease-associated dysbiosis and potential therapeutic role of Akkermansia muciniphila, a mucus degrading bacteria of gut microbiome." Folia Microbiologica 67.6 (2022): 811-824.

These impacts on bacteria could help explain some of the observed benefit in long Covid research.

David Boulware, MD MPH @boulware_dr

As the cost of metformin is $1, there is no big pharma pushing this med. Most impressive is the 42% reduction in #LongCovid diagnoses shown in a randomized, double-blind trial.

Important to note that this is not a treatment for long Covid, but certainly a part of the broad strategy to resolve associated gut dysbiosis.