Metformin: The Good, the Bad, and What You Should Know

Here is the traditional party line for Metformin according to doctors and big pharma you may have heard a million times before: 

If you or someone you care about is managing type 2 diabetes, chances are you’ve come across metformin. It’s often the first medication doctors prescribe because it’s effective, affordable, and has a track record of helping many people. But like any medication, it’s not without its downsides. 

Interesting.

Early on, after my diagnosis a few decades ago in the 1990s, Metformin was the new magic bullet on the block.  It was all anyone talked about or prescribed for the longest time.  I started on it right away and it turned out I am one of the small percent of people that get horribly sick on it.  Trust me, if you are one of US, you can lose a lot of weight on it, because you feel too sick to eat.  

The other surprise for me was one of the scariest 2 hours of my life.  I had a shoulder injury that required an MRI scan that used contrast media.  I did as my doctor told me and made sure everyone knew I was diabetic and was taking Metformin.  I did my part, got loaded up with “contrast”, which was a dye needed to make my pictures, and was just lying back waiting for my turn when I heard my doctor running down the hall, screaming about the chart. (never a good thing).   She grabbed it off my bed, pointed at a red circled METFORMIN, turned on the tech, threw the chart at him, and hissed, “You might have just killed this guy.”

Seemed like a good time to sit up to me.  She got herself calmed just enough to talk and said, “I don’t know how to tell you this but this specific contrast can interact with Metformin with fatal results.  There’s nothing that can be done to fix it, but there is a chance you will survive without side effects.  I’ll stay right here in case it goes badly.  No one should be alone for this.”

Apparently, there are three things: one she did know how to say it, two I was one of the lucky ones that did live, and that was damned scary.  

One wonders why I don’t trust medicine now.

Anyway, to be fair, here are a bunch of “facts from the Internet”

The Positives: Why Metformin Is So Popular

First off, let’s talk about why metformin is such a common choice:

1. It Helps Lower Blood Sugar: Metformin works by improving your body’s sensitivity to insulin, which helps lower your blood sugar levels. For many people, it’s effective enough on its own, especially when combined with a healthy diet and regular exercise.
2. Weight-Friendly: Unlike some diabetes medications that can lead to weight gain, metformin is generally weight-neutral or might even help with a bit of weight loss. That’s a big plus when weight management is part of your health goals.
3. Heart Health Benefits: Some studies suggest that metformin may offer protective benefits for your heart. Since people with diabetes are at a higher risk for heart disease, this is a noteworthy advantage.
4. Low Risk of Low Blood Sugar: When taken by itself, metformin doesn’t usually cause hypoglycemia (low blood sugar), so you don’t have to worry as much about sudden drops in your sugar levels.

The Downsides: What to Know Before You Start

Now, let’s get into the not-so-great aspects of metformin:

1. Digestive Upset: This is probably the most common complaint. Many people experience stomach discomfort like nausea, diarrhea, gas, or bloating when they first start taking metformin. It can be unpleasant, but these symptoms often improve after a few weeks. Starting with a low dose and taking it with meals can help ease these issues.
2. Vitamin B12 Deficiency: Over time, metformin can reduce the absorption of vitamin B12, which is important for nerve function and making red blood cells. A deficiency might lead to symptoms like fatigue, weakness, or numbness and tingling in your hands and feet. It’s a good idea to have your B12 levels checked periodically if you’re on metformin long-term.
3. Risk of Lactic Acidosis: This is a rare but serious side effect where lactic acid builds up in the bloodstream. It’s more likely to occur in people with kidney problems or other conditions like severe dehydration or heart failure. Symptoms include muscle pain, trouble breathing, stomach pain, dizziness, or feeling cold. If you experience these, seek medical help immediately.
4. Interactions with Other Conditions: Metformin isn’t suitable for everyone. If you have liver or kidney issues, or if you drink alcohol excessively, metformin might not be the best choice. Always discuss your full medical history with your doctor.
5. Possible Decrease in Effectiveness Over Time: For some, metformin might become less effective after several years. If that happens, your doctor might recommend adding another medication to your treatment plan.

What You Can Expect with Metformin Treatment

Here’s what the treatment process typically looks like:

• Starting Slow: Doctors usually start you on a low dose to minimize side effects, especially digestive ones. Taking it with meals can also help.
• Adjusting the Dose: Your doctor may gradually increase your dose to find the most effective amount with the least side effects.
• Different Formulations: If regular metformin is hard on your stomach, there’s an extended-release version that might be gentler on your digestive system.

Possible Side Effects and How to Handle Them

Let’s delve a bit deeper into the side effects and what you can do:

1. Digestive Issues: If you’re dealing with nausea or diarrhea, give your body some time to adjust. Eating smaller, more frequent meals and avoiding high-fiber foods initially might help. If symptoms persist, talk to your doctor—there might be alternative options.
2. Metallic Taste: Some people notice a strange metallic taste when they start metformin. It’s harmless but can be annoying. Chewing sugar-free gum or mints might help mask the taste until it fades.
3. Feeling Tired or Weak: If you start feeling unusually fatigued, it could be a sign of vitamin B12 deficiency or, in rare cases, lactic acidosis. Don’t hesitate to reach out to your healthcare provider if you notice this.
4. Skin Reactions: Though less common, some people might experience skin rashes. If this happens, let your doctor know.

Medication Interactions to Be Aware Of

Metformin can interact with other medications, so it’s important to keep your doctor informed about everything you’re taking:

• Other Diabetes Medications: Combining metformin with other blood sugar-lowering drugs can increase the risk of hypoglycemia. Your doctor will guide you on how to monitor your blood sugar levels closely.
• Blood Pressure or Heart Medications: Some of these can affect how metformin works or increase side effects.
• Alcohol: Drinking alcohol can increase the risk of lactic acidosis. It’s best to limit or avoid alcohol while taking metformin.

How Long Will You Be on Metformin?

Metformin is often a long-term medication. As long as it’s working well and you’re not experiencing significant side effects, you might be on it indefinitely. However, diabetes can change over time, so your treatment plan might need adjustments. Regular check-ins with your doctor will help keep your management on track.

Recent Research on Metformin’s Risks

While metformin has been a staple in diabetes treatment for decades, it’s important to stay informed about recent research regarding its potential risks:

1. Concerns About NDMA Contamination: In recent years, some batches of metformin were found to contain N-Nitrosodimethylamine (NDMA), a substance classified as a probable human carcinogen. The FDA conducted investigations and recalled affected batches in 2020. Current supplies are monitored to ensure they meet safety standards. If you’re concerned, talk to your pharmacist or doctor about the source of your medication.
2. Lactic Acidosis Risk Reevaluated: Earlier beliefs held that metformin significantly increased the risk of lactic acidosis. However, more recent studies have shown that when used appropriately, the risk is much lower than previously thought. A comprehensive review published in the Journal of the American Medical Association found no cases of lactic acidosis in over 70,000 metformin users, suggesting that the risk is rare.
3. Impact on Kidney Function: Historically, metformin was not recommended for people with reduced kidney function. Updated guidelines now allow for metformin use in patients with mild to moderate kidney issues, but at adjusted doses. Regular monitoring of kidney function is essential to ensure safety.
4. Vitamin B12 Deficiency Awareness: A study in the British Medical Journal highlighted the link between long-term metformin use and vitamin B12 deficiency. The research suggests that healthcare providers should periodically check B12 levels in patients taking metformin for extended periods.
5. Gastrointestinal Side Effects and Quality of Life: Research published in Diabetes Therapy indicates that gastrointestinal side effects can significantly impact the quality of life for some patients, leading to non-adherence. Extended-release formulations or dose adjustments can help mitigate these effects.
6. Potential Cognitive Effects: Some studies have explored a possible connection between metformin use and cognitive function. While results are mixed, it’s an area of ongoing research. If you have concerns about memory or cognitive changes, discuss them with your doctor.

Wrapping It Up

So, what should we think?  I remember after my Dad’s first heart attack in 1976, They told him to zero salt.  He did just that and was miserable.  His doctor said no salt and Dad took it “to heart”. For years he ate a salt-free diet.  Then one day medicine decided that No Salt was wrong, just slightly lower salt was fine.  His popcorn was fun again.  Years later he got to a point where he had much more salt,  He lived to be 96.  

How does that relate to Metformin?  It made me sick and the doc had to sit a death watch with me.  So, honestly, I don’t trust it.  And  I don’t trust when doctors change their opinions.  I mean I just started learning about insulin, insulin resistance, and all of the other potential cures for diabetes.  Yet my last doctor said it would never be cured.

Oh well

The talking heads in a doctor’s jacket still say:

Remember, managing diabetes is a personal journey, and what works for one person might not be the best for another. Your doctor is there to help tailor a plan that fits your needs, lifestyle, and health goals. With the right support and information, you can navigate the ups and downs of treatment and live a healthy, fulfilling life.

As for me, I’m doing my own research and writing books that might help you like they are helping me. And I’m still taking the die out of diabetes!

Required Disclaimer Below.

Disclaimer: This post is for informational purposes only and should not replace professional medical advice. Always consult your healthcare provider for personalized guidance on medication and treatment options.