Acarbose May Help Us Eat More Carbs!


There's a drug that is more commonly used outside of the US called acarbose that may help us to eat more carbohydrates without a dangerous spike in blood sugar. It doesn't have risks of hypoglycemia either and may be a useful weight management tool along with a diet low in simple carbohydrates. This seems especially relevant now as it looks more and more like difficulties in processing carbohydrates for energy may be at the heart of MECFS fatigue symptoms.

I just started using acarbose, 100 mg with meals, and am hopeful that it will help mitigate the extreme high blood sugar numbers I see after eating, well, basically anything.

Here is more info:

How Acarbose Works
Acarbose, works by blocking alpha-glucosidase, the enzyme that chops up starches and complex sugars into their component glucose molecules. This results in starches and complex sugars passing largely undigested through the stomach and portions the small intestine rather than entering the bloodstream as glucose soon after eating.
However, Acarbose is not that mythical substance so beloved by health scammers the "starch blocker." That is because the starches and sugars whose digestion is temporarily blocked by Acarbose do, eventually, get broken down as they pass through the intestine where they are digested by the bacteria that live in the gut. So the glucose contained in these foods does, eventually reach the bloodstream. However, because the process is slowed down, that glucose reaches it in dribs and drabs rather than in one big blood-sugar-spiking dump.
How Much Improvement Does Acarbose Make in Blood Sugar?

The Prescribing Information provided by Bayer, the manufacturer of Precose, reports that in clinical trials Precose lowered the post-meal blood sugar numbers by 25 mg/dl to 83 mg/dl (1.4 to 4.6 mmol/L)depending on dosage. However, at the commonly prescribed dose, the change was a drop of 46 mg/dl (2.6 mmol/L). The same prescribing information insert also reports that in another study, subjects taking 100 mg of Precose over four months experienced an average drop in one-hour-post-meal numbers of 42.6 mg/dl (2.4 mmol/L).

Unfortunately, none of these studies reported the amount of carbohydrate that patients ate when they achieved these improvements. The baseline one-hour-post-meal blood sugar listed in the study cited by the manufacturer was 299.1 mg/dl, so even with the Precose, study subjects were running blood sugars that were dangerously high and it is likely that they were eating 60 to 100 grams per meal.

Adding Precose to Metformin only achieved an additional 31 mg/dl drop from a 283 mg/dl baseline post-meal blood sugar. However, unlike the case with Metformin, Precose appears to be equally effective for people who maintain healtly low blood sugar levels. Years ago when I was using it along with a low carb diet, I found that taking Precose allowed me to add an additional 15 to 20 grams of carbohydrate to my meal without seeing a dangerous spike.

Animal studies conducted throughout the 1990s suggested that even though this reduction in blood sugar was modest, Acarbose also decreased protein glycation and appeared to delay or prevent heart attacks and the other diabetic complications caused by elevated blood sugars.

Effects of the alpha-glucosidase inhibitor acarbose on the development of long-term complications in diabetic animals: pathophysioloical and therapeutic implications. Creutzfeldt W. Diabetes Metab Res rev. 1999 15(4):289-96
Does Acarbose Prevent the Development of Diabetes?

To see if Acarbose could be used to prevent the progression of impaired glucose tolerance to daibetes the multiple-research centers participating in the STOP-NIDDM Trial administered 100 mg of Acarbose three times a day to 714 subjects while giving another 715 subjects a placebo. At the end of three years the study a smaller percentage of the group taking Acarbose had developed diabetes than of the controls. This the researchers concluded meant that Acarbose could significantly decrease the progress of IGT to diabetes.

STOP-NIDDM Trial Research Group. Acarbose for prevention of type 2 diabetes mellitus: the STOP-NIDDM randomised trial. Chiasson JL, Josse RG, Gomis R, Hanefeld M, Karasik A, Laakso M;Lancet. 2002 Jun 15;359(9323):2072-7.

In addition, they appeared to have half as great a risk of cardiovascular events (heart attack, death, heart failure, stroke or peripheral vascular disease) as controls. They also had less new cass of hypertension.

STOP-NIDDM Trial Research Group. Acarbose treatment and the risk of cardiovascular disease and hypertension in patients with impaired glucose tolerance: the STOP-NIDDM trial. Chiasson JL, Josse RG, Gomis R, Hanefeld M, Karasik A, Laakso M; JAMA. 2003 Jul 23;290(4):486-94.

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