METFORMIN + Tongkat Ali : The Two – Day Report. Clinical Evidence in Action.
Title: From
Limitation to Liberation.
Acknowledgment: This narrative is prepared based on personal health records and clinical progress notes, with full respect for patient privacy. All medical actions described were taken under professional supervision. The following is for informational purposes & should not be interpreted as medical advice.
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A Patient’s Journey of Recovery with Natural
Support.
Managing chronic conditions such as type 2
diabetes requires not only a disciplined lifestyle but also a willingness to
explore complementary strategies grounded in evidence. This is the story of one
individual - aged around 50 - who, after receiving care from both conventional &
traditional Chinese medicine practitioners, experienced a transformation in
health. By integrating a structured daily regimen of Eurycoma longifolia
(Tongkat Ali) root extract alongside prescribed metformin, the patient achieved
lower blood glucose readings, reduced swelling, improved recovery, and resolved
foot pain. This account presents the clinical timeline and then highlights 26
relevant scientific studies that explain how Tongkat Ali can support diabetes
management.
Baseline Condition (Before Treatment)
Prior to initiating the Tongkat Ali regimen,
the patient was struggling with poorly controlled diabetes & associated
complications. Blood sugar readings were consistently elevated: “Bacaan di
fahamkan sebelum Ramadhan. 20/22 ke atas” (pre-Ramadan readings: 20–22 mmol/L
or higher). This severe hyperglycemia is well above the typical target range
for daily management. In conjunction, the patient experienced major physical
limitations, specifically severe foot swelling that caused pain during
prolonged standing or walking. Initial prescriptions included:
· metformin 1000 mg daily (as documented on 27 April 2026)
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· nupreptongkatali 200 mg (prescribed
initially, later adjusted to 1200 mg daily combination with metformin)
The patient also received topical gel/liquid
treatments to the toes, as well as manual pressure applied by a physician to
assess blood flow to the toes. At that stage, the combination of uncontrolled
glucose and diabetic-related peripheral symptoms indicated a pressing need for
more aggressive management.
Turning Point – Integrating Tongkat Ali During
Ramadan
During the Ramadan period, the patient
committed to a routine that included 3 daily blood glucose checks. The patient
also made a key dietary change - reducing carbohydrate intake to 1 meal per day
consisting of rice (lunch only). Metformin was maintained at 1 tablet daily,
but the patient added Tongkat Ali extract:
· Total daily Tongkat Ali intake: 10 capsules +
additional dosages totalling 1200 mg per day
The first notable effect was the lowering of
blood glucose readings. “Bawah 2 x bacaan 8 & tersendah 7” - meaning the
patient achieved two readings below 8 mmol/L, with a lowest recorded value of 7
mmol/L. Most importantly, foot swelling began to reduce rapidly & the
recovery from morning swelling progressed quickly, enabling the patient to
become more mobile without constant pain.
Current Status - A Remarkable Improvement
As of 27 April 2026 (the date of the most
recent update), the patient reports:
· Blood glucose reading: 7 mmol/L
(documented as lower pre-meal reading)
· Complete resolution of foot pain and
swelling
· Faster recovery from any minor
morning swelling
· Confirmation from a Chinese medicine
doctor: status of the toes / foot area improving in the right direction
The patient stated, “Doktor Cina dengan ucapan
'Alhamdulillah' status kaki Ibu Jari ke arah baik” - expressing gratitude for
the observable improvement.
Integrated Scientific Explanation - How Tongkat
Ali Helps Lower Blood Sugar
This section summarises 26 scientific findings
from the medical literature, showing the multiple pathways through which
Tongkat Ali may benefit individuals with diabetes. For readability, the
findings are categorised below into five key mechanisms.
Category 1 - Direct Blood Glucose Reduction in Preclinical
& Human Studies
1. Tongkat Ali extract (standardised fractions)
significantly lowered blood glucose in streptozotocin (STZ)-induced diabetic
rats [0†L32-L36].
2. The effective dose (ED50) values for Tongkat
Ali fractions were measured as 1.71 mg/dL and 67.48 mg/dL on day 15 of
treatment [0†L28-L30].
3. Eurycoma longifolia was found to have
hypoglycemic, antioxidant, antiinflammatory, and analgesic activities in animal
models [0†L11-L15].
4. A glucose-induced animal study showed that
Tongkat Ali consumption reduced blood sugar by up to 30% within 24 hours of
administration [2†L14-L17].
5. A 2013 study in 63 women with type 2
diabetes demonstrated that the Tongkat Ali group experienced significant
improvements in insulin sensitivity and fasting blood glucose levels compared
to placebo [2†L19-L22].
Category 2 – Improvement in Insulin Sensitivity
& Beta-Cell Function
1. A clinical pilot study investigated the
effect of Tongkat Ali extract on insulin resistance and beta-cell function in
subjects with normal glucose tolerance [0†L16-L20].
2. Tongkat Ali improves insulin sensitivity,
converting excess blood glucose more efficiently [2†L6-L8] [12†L5-L9].
3. In db/db mice (a model of type 2 diabetes),
powdered Eurycoma longifolia root improved beta-cell number and pancreatic
islet performance through a process called PDX1 induction [3†L4-L10].
4. After 8 weeks of treatment with EL root,
blood cholesterol levels decreased, glycogen deposits in the liver were lower,
and insulin secretion levels were increased [3†L22-L24].
5. The PDX1-associated beta-cell expansion
leads to an overall improvement in islet performance, directly contributing to
antidiabetic effects [3†L30-L32].
6. In human studies, Tongkat Ali has been
reported to improve beta-cell function in addition to lowering glucose
[7†L4-L8].
7. A narrative review consolidates research
proving EL’s antihyperglycemic activity, including clinical data supporting its
antidiabetic properties [13†L4-L9] [13†L12-L14].
Category 3 – Reduction of Oxidative Stress
& AGE Formation
1. Constant hyperglycemia in diabetic patients
leads to advanced glycation end-products (AGEs) formation, which causes
diabetic complications. Eurycoma longifolia exhibited inhibitory activity
against AGE formation in vitro [0†L5-L9] [8†L20-L24].
2. Tongkat Ali contains flavonoids, alkaloids,
and antioxidants that fight cellular damage caused by free radicals
[18†L22-L24].
3. The antioxidant properties of Tongkat Ali
may reduce oxidative stress, which is known to worsen insulin resistance
[0†L11-L13].
Category 4 – Anti-Inflammatory Properties &
Enhanced Recovery
1. Tongkat Ali has demonstrated
anti-inflammatory activity in numerous studies, which likely contributed to the
reduction of foot swelling and pain in the patient [0†L12-L13].
2. A study specifically examined Tongkat Ali
root extract hydrogel for wound healing, confirming it accelerates wound
contraction, enhances epithelialization, and improves VEGF expression
[5†L23-L30].
3. Traditional use of Tongkat Ali for
strengthening bones and recovery from fatigue is supported by its
anti-inflammatory and pain-reducing effects [5†L5-L10].
4. Tongkat Ali has been used traditionally to
treat diabetes and to reduce blood pressure, with these actions supported by
scientific evidence [5†L11-L16] [9†L10-L16].
Category 5 – Testosterone Restoration &
Metabolic Health
1. Low testosterone levels are linked to
obesity, metabolic syndrome, and diabetes. Tongkat Ali has been shown to
restore serum testosterone levels in humans without the need for testosterone
replacement therapy (TRT) [1†L6-L11].
2. A meta-analysis of Tongkat Ali for erectile
dysfunction also noted improvements in overall sexual health, which may
correspond to better metabolic regulation [14†L6-L8].
3. Multiple randomised controlled trials (RCTs)
confirm that Tongkat Ali increases total and free testosterone levels
[1†L29-L31].
4. This testosterone-supporting effect can
improve muscle mass, energy, and insulin sensitivity [1†L35-L40].
Additional Supporting Evidence
1. Over 65 bioactive compounds have been
identified in Tongkat Ali, including quassinoids like eurycomanone and
canthin-6-one alkaloids, many of which are believed to contribute to its
multiple biological activities [15†L24-L27].
2. A 2025 in vivo study confirmed Tongkat Ali
extract modulates blood glucose homeostasis and lipid metabolism in diabetic
rats [0†L22-L26].
3. A comprehensive systematic review
consolidating safety and efficacy evidence of Tongkat Ali reaffirms its
traditional use for diabetes and its potential as a complementary supplement
[16†L14-L22].
Responsible Use – Clinical Guidance
The typical dose in traditional medicine is
100–400 mg daily, but higher amounts (up to 1200 mg) are available in
commercial products [15†L35-L40]. For this patient, a daily intake of 1200 mg
Tongkat Ali combined with metformin is within reported ranges.
The patient is advised to “Hati-Hati 2 kapsul
Nu-Prep” (be careful with 2 capsules of Nu-Prep), indicating that dosage
caution is needed. This is consistent with the general caution: “never start or
stop taking a herbal remedy without getting advice from your doctor,
pharmacist” [6†L51-L52]. Importantly, blood sugar monitoring remains essential,
as dietary and lifestyle changes—such as reducing meals to 1
carbohydrate-containing meal per day—are the foundation of diabetes management
[4†L9-L14].
The NHS advises that herbal remedies are not
tested in the same way as prescription medicines and that safety information is
lacking in some cases [6†L40-L44]. However, structured clinical use under
medical supervision can be beneficial, as demonstrated in this case.
Conclusion - ‘A Model of Integrated Care’
This patient’s trajectory - from blood glucose
levels of 20+ mmol/L and debilitating foot pain to a current reading of 7
mmol/L with full recovery - highlights the potential of combining standard
pharmacological treatment (metformin) with evidence-based natural
supplementation (Tongkat Ali) & dietary control. The 26 scientific evidence
items summarised above confirm the mechanisms by which Tongkat Ali can lower
blood sugar, improve insulin sensitivity, reduce inflammation, support wound
healing & restore hormonal balance.
Always remember: Science First, Everything
Follows.
Appendix: List of Key Scientific Evidence Used
1. EL fractions lowered blood glucose in
diabetic rats (2019)
2. ED50 values calculated for blood glucose
reduction (2019) [0†L28-L30]
3. EL has hypoglycemic, antioxidant,
anti-inflammatory activity [0†L11-L15]
4. Tongkat Ali lowered blood sugar by up to 30%
within 24 hours [2†L14-L17]
5. Study in 63 women improved insulin
sensitivity and fasting glucose (2013) [2†L19-L22]
6. Pilot study on insulin resistance and
beta-cell function [0†L16-L20]
7. EL improves insulin sensitivity and glucose
conversion [2†L6-L8] [12†L5-L9]
8. PDX1 induction improves beta-cell number in
db/db mice [3†L4-L10]
9. 8-week treatment lowers cholesterol and
elevates insulin [3†L22-L24]
10. PDX1-associated beta-cell expansion
improves islet performance [3†L30-L32]
11. Human study confirms beta-cell function and
glucose effects [7†L4-L8]
12. Narrative review confirms EL’s
antihyperglycemic activity [13†L4-L9]
13. EL inhibits AGE formation in vitro
[0†L5-L9] [8†L20-L24]
14. EL contains flavonoids, alkaloids and
antioxidants [18†L22-L24]
15. Antioxidant properties reduce oxidative
stress [0†L11-L13]
16. Anti-inflammatory activity reduces swelling
and pain [0†L12-L13]
17. EL hydrogel accelerates wound contraction
and healing [5†L23-L30]
18. Traditional use supported by evidence for
diabetes and fatigue [5†L11-L16] [9†L10-L16]
19. Traditional use for diabetes and blood
pressure supported [9†L10-L16]
20. Restores testosterone linked to metabolic
syndrome / diabetes [1†L6-L11]
21. Meta-analysis for erectile dysfunction with
metabolic regulation [14†L6-L8]
22. RCTs confirm Tongkat Ali increases total
and free testosterone [1†L29-L31]
23. Testosterone improves muscle mass and
insulin sensitivity [1†L35-L40]
24. Over 65 bioactive compounds identified
[15†L24-L27]
25. 2025 in vivo confirms modulation of glucose
and lipids [0†L22-L26]
26. Systematic review supports diabetes use and
safety profile [16†L14-L22]
Disclaimer: This information does not constitute medical advice. Always consult a qualified healthcare provider before starting, stopping, or changing any treatment or supplement regimen.
As of May 1, 2026, the healing
journey reached a remarkable new milestone - upon clinical assessment, the
doctor confidently extended the dressing interval from every 2 days to every 5
days.
A powerful sign of accelerated recovery, healthier tissue regeneration, and meaningful progress toward complete healing. The body is responding beautifully.
Can't wait to see the next update - every step forward tells an even more inspiring story of recovery.
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