The increasing prevalence of obesity and its association with chronic diseases such as cardiovascular diseases, diabetes, and cancer highlight the urgent need for effective treatment strategies. Obesity and overweight is a major health problem world-wide. While our understanding of the causes, mechanisms, and treatments for obesity has grown significantly in the last half-century, effective methods for both treating and preventing obesity remain elusive. Acarbose, typically used as an anti-diabetic drug, has emerged as a potential aid in weight loss, particularly in individuals with high carbohydrate intake. This article explores the efficacy, mechanisms, and considerations surrounding acarbose use for weight management.
Understanding Obesity and Its Implications
Nowadays, more than 1.4 billion adults, 20 and older, were overweight. Of these over 200 million men and nearly 300 million women were obese. Based on the World Health Organization reports, obesity is increasing more rapidly in developing countries than developed countries. Obesity is a common problem of industrial societies and developing countries. Obesity also is an important risk factor for cardiovascular diseases, diabetes type 2 (DM II), osteoarthritis, hyperlipidemia, apnea, and etc.
Studies show that the prevalence of obesity has being elevated in Iran in the recent years due to increasing urbanization. In controlling weight gain, diet is an important factor. Considering the high prevalence of overweight and obesity in society and the importance of this as one of the major risk factors for chronic diseases such as severe cardiovascular diseases, diabetes and cancer, the requirement for therapy is obvious. Variety of treatments for obesity and overweight has been suggested.
What is Acarbose?
Acarbose is an anti-diabetic drug primarily used in the treatment of type 2 diabetes (DM II). Acarbose is an alpha-glucosidase inhibitor agent which has little systemic absorption (less than 2%). It functions by inhibiting α-glucosidase activity in the small intestine and pancreas, leading to reduced glucose release from disaccharides and oligosaccharides. Acarbose blocks enzymes that break down complex carbs, reducing glucose absorption and post-meal spikes. These mechanisms help control blood glucose levels after meals. Beyond its use in diabetes management, acarbose has been investigated for its potential role in weight loss. Acarbose is a non-expensive and reachable drug. A targeted approach to better blood sugar control and healthy aging-slowing carbohydrate absorption to reduce spikes and support overall metabolic balance.
How Acarbose Aids Weight Loss
Acarbose has been known as an overweight medication in some studies with mechanisms including appetite reduction and fat or calorie malnutrition especially in long time use. Acarbose helps you lose weight by blocking carbs from being digested. Most weight loss medications work on the brain to help you lose weight. In contrast, Acarbose works on the intestines to help you lose weight. Several mechanisms contribute to acarbose's potential weight loss effects:
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- Reduced Post-Meal Glucose Spikes: By slowing carbohydrate digestion, acarbose blunts post-meal glucose spikes. This prevents excessive insulin release and reduces the formation of reactive oxygen species (ROS), protecting blood vessels and organs from damage that accelerates aging. It slows carbohydrate digestion to blunt post-meal surges that fuel oxidative stress, fat storage, and accelerated aging.
- Appetite Regulation: Acarbose boosts natural GLP-1 production to improve insulin sensitivity and appetite control while supporting fat loss and glucose balance. Acarbose naturally raises GLP-1 levels, improving insulin sensitivity, supporting weight management, and protecting heart, liver, and brain health.
- Gut Microbiome Modulation: Because more resistant starch reaches the colon, acarbose shifts the gut microbiota toward species that produce short-chain fatty acids (SCFAs). SCFAs reduce inflammation, improve metabolic function, and support a healthier gut barrier, all of which are linked to longevity.
- Calorie Restriction Mimicry: By reducing carbohydrate availability, Acarbose acts as a calorie restriction mimetic-impacting IGF-1, insulin signaling, and mitochondrial health.
Clinical Evidence for Acarbose and Weight Loss
There is controversy about the effect of acarbose on weight loss in different societies with different diet. In this study, the effect of this drug was investigated on the Iranians patients as a society with the high carbohydrate utilization in the meals. As shown in the results, the patients treated with acarbose have a higher rate of weight loss after 2 months. Several clinical trials have explored the impact of acarbose on weight loss, with varying results.
One double-blind randomized controlled clinical trial was performed on 66 patients with the body mass index (BMI) between 25 and 35 kg/m2. Patients were divided in treatment and control groups using the randomization. The treatment group took 100 mg acarbose 3 times a day for 20 weeks in combination with the low calorie diet and exercise. Control group was given placebo, low calorie diet, and exercise. BMI was measured after 20 weeks. Patients in acarbose and placebo group had a non significant difference in BMI at baseline. Reducing in weight was considered in every month in both groups, but this reduction was higher in the treatment group. At the 5th month, the difference of BMI in the treatment group was significantly lower than the placebo group (2.31 ± 0.6 vs. As shown in the results, the patients treated with acarbose have a higher rate of weight loss after 2 months. In that double-blind controlled clinical trial, patients with a BMI between 32 and 38 kg/m2 were treated with the low calorie diet for 10-16 weeks and then 26 weeks with acarbose.
However, an investigation on 2002 in Taiwan and several Asian countries showed the acarbose has higher effect on reducing Hemoglobin A1c and post-prandial glucose in DM II patients than sulfonylurease. Furthermore, acarbose was shown to be well-tolerated and safe but did not significantly lower the BMI than other treatment. In that study, the DM II patients did not get low calorie diet in contrast to the present study in non-diabetic patients with low calorie diet. Although, their diet was very different and low calorie diet was not administered for the subjects.
Another double-blind randomized clinical trial registered in the Iranian Registry of Clinical Trials with the code IRCT20130924014752N5. The research population included all the patients with MetS referred to Isfahan Endocrine and Metabolism Research Center between August 2016 and August 2017. Among them, 84 patients with MetS based on American Heart Association criteria[14] and endocrinologist's opinions were selected using nonrandom convenience sampling method. The patients were evaluated regarding the height and weight and after calculating BMI (BMI = weight/height2, weight [kg] and height [cm]) and the cases with BMI greater than or equal to 30 kg/m2 were included.
In the present study, from 32 patients in acarbose group, there were 25 (78.1%) females and 7 (21.9%) males with the mean age of 41.25 ± 7.71 years; and from 42 patients in the control group, 29 (69%) individuals were female and 13 (31.0%) were male with the mean age of 38.92 ± 9.05 years. After the intervention, despite a significant decrease in both groups (P-value < 0.05), CRP level in acarbose group with the mean of 0.43 ± 0.26 was significantly lower than the control group with the mean of 0.93 ± 0.38 (P-value < 0.001). Additionally, the mean reduction in IMT and EFT levels in the acarbose group was significantly higher than the control group (IMT: −0.24 ± 0.39 vs −0.01 ± 0.06; P value = 0.001 and EFT: −0.89 ± 0.83 vs −0.43 ± 0.64; P value = 0.046).
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A study conducted by Nakhaee et al. demonstrated that diabetic patients who received acarbose for 3 months followed a low-calorie diet and performed consistent physical exercises had greater weight loss compared to control group. Various studies suggested that acarbose induces weight loss in obese subjects. A study by Zhang et al. revealed that acarbose consumption reduces body weight and waist and hip circumferences in diabetic patients.
Mixed Results and Considerations
However, some studies reported non-significant weight loss using this drug in non-Asians. In another trial by Rachmani et al., acarbose was not shown to significantly decrease weight than placebo. Although, their diet was very different and low calorie diet was not administered for the subjects. In other words, this medication alone, without low-calorie diet and exercise, did not result in weight loss in Asian people.
The reasons for these contradicting results maybe sex or ethnic differences or having other diseases such as diabetes or hypertension. First, the sample size was too small to compare the sex difference in acarbose induced weight loss. Further studies with large enough sample sizes and controlling potential confounding variables such as age and sex are needed for a more generalized conclusion.
Additional Benefits of Acarbose
Beyond weight loss, acarbose offers several additional health benefits:
- Improved Metabolic Parameters: Post-intervention mean of weight (mean difference: −2.5 ± 0.89) and abdominal obesity (mean difference: −2.2 ± 0.64) in acarbose group were significantly decreased (P value < 0.001). High-density lipoprotein (HDL) level in acarbose group was significantly higher than control group (44.7 ± 7.6 vs 41.1 ± 6.4; P value = 0.043), while the other metabolic parameters were not significantly different between the two groups (P value > 0.05).
- Reduced Inflammation: Acarbose decreases pro-inflammatory cytokines and downregulates NF-κB activity. By curbing low-grade systemic inflammation - a driver of cardiovascular disease, neurodegeneration, and tissue aging - it helps preserve organ function. After the intervention, the mean CRP, IMT, and EFT levels in the acarbose group were significantly lower than the control group (P-value < 0.05).
- Cardiovascular Protection: Some studies have demonstrated that acarbose can reduce blood pressure, lipid, body weight, inflammatory markers, and cardiovascular adverse events.
Dosage and Administration
Treatment group was given acarbose pills (100 mg) and other group took lactose contained placebo (100 mg). Patients were asked to take medicines in the first 2 weeks with 1½ of a tablet daily and from 3rd week with 3 tablets daily (to reduce gastrointestinal side-effects). They were asked to take the pills at the beginning of a meal. Acarbose is most effective when taken before meals containing complex carbohydrates. Take with the first bite of a carb-rich meal. Tablets can be swallowed or chewed. Your clinician will guide specific timing and dose.
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For patients in the acarbose group, treatment was initiated with 25 mg/day acarbose in the first week; and if the dosage was safe and well-tolerated, it was increased by 25 mg/day every week to a maximum dose of 100 mg/day within a month. The dosage was increased up to the maximum dose of 300 mg/day for 3 months and maintained for the second 3 months (a total of 6 months). Response to treatment was considered if at least 5% of weight loss was achieved during the 6-month follow-up period, but if the patients had serious complications, they were excluded from the study.
Side Effects and Precautions
If patients avoid carbs they rarely ever have side effects. If the prescribed diet is not observed, gastrointestinal symptoms are the most common side effects of Acarbose. The most common reason for not continuing study intervention was the occurrence of side-effects. The side-effects were abdominal pain, diarrhea, and flatulence. No severe side-effects such as hepatitis or thrombocytopenia were seen. Temporary GI symptoms like bloating, gas, or mild cramping. These often improve with continued use and proper dose titration.