Mitigating the side effects of Metformin

When I first started taking Metformin I had a lot of stomach upset and later acid reflux, and it took me a while to figure out what to do to mitigate the symptoms.  As instructed by my endocrinologist I ramped up slowly. Started with two a day, then three then four. He prescribed 500 mg Extended Release (ER) tablets because they are easier on the stomach. So I started with 1000 mg ER per day and ramped up to 2000 mg ER (this is the therapeutic dose for PCOS.)  I remember going to three tablets a day and taking them every eight hours, I could feel them wear off and would watch the clock until it was time to take the next dose! I felt like an addict, but they helped tremendously. Recently I got a bottle of Metformin from the pharmacy and noticed that they did not give me huge bouts of diarrhea and almost no stomach aches. Looked at the bottle, it said Amneal Pharmaceuticals. Now I have it listed at the pharmacy that I can only take Amneal. Since it is generic I don't pay anything extra.

I started to lose inches, more than I lost weight and began to look like I remembered myself from years ago. I felt good. My bad moods slowly slipped away. I used to be just fine then in a second I would be screaming at anyone near me. It was awful and the Meformin corrected that. All during this time I was having diarrhea on and off from the Metformin. Yes, I took it with food and no I didn't break or chew the tablets. When I went to the pharmacy for antibiotics the pharmacist told me to take the pills at least an hour before going to bed, otherwise they would sit in my stomach all night. AHA! I realized that is what I was doing with the Metfomin, then taking the morning dose on top of that then running to the bathroom. So I started to take the nighttime dose earlier. Often I would remember just before going to bed, I found that two pills was too much for overnight but I could take one and not have much in the way of side effects (I talked to my endocrinologist about this, your should too) and then take the full dose the next day.  It makes it harder to keep the weight off if I do this all the time but is easier on my stomach.

Another side effect of Metformin is acid reflux, I called it in and was told to take an acid blocker (it tells your body to make less acid) so I scooted over to the pharmacy and asked for it. There, it was explained to me that this was an everyday medicine used to prevent your body from making acid, not a "take if you have symptoms" medicine. We need the acid in our stomach to break down the food we eat. I ended up with the one you take only if you have symptoms. When I was talking with a friend about this, she suggested I think about why there would be an abundance of acid. It made me think, and I remembered that I had learned about digestion (from a book by Adelle Davis, nutritionist in the 50's) and that I could help my body digest the food by taking an enzyme pill (I like Trader Joes Papaya enzymes) and by taking a pro-biotic (make sure it comes refrigerated) so I did. In addition, I cut back on things that cause acid reflux like caffeine, acidic foods and fatty foods (you can find a full list on www.medlineplus.gov.) With these changes my acid reflux went away. I could sleep peacefully again.

Metformin blocks the absorption of B vitamins, this can make you tired. So to combat this I take a B-Complex, when you are low in one B vitamin you can easily be low in others because they all work together (that is why they are called a complex) I started with Trader Joe's B-100 and my urine was always dark yellow. B vitamins are water soluble and the extra is excreted in the urine. So I switched to the B-50, which I still take today, sometimes my urine is dark and other times not. You can also take Nutritional yeast (it is an acquired taste, but I love it now!) as it is full of B vitamins.

A friend of mine who is a nurse and took Metformin explained  that eating a large amount of sugar with the pills will cause diarrhea too. I probably did that in the beginning unknowingly, now I don't. 

One small change that helped me a lot was to have a bit of food about half an hour before my morning or evening  pills, something on the order of toast with butter (plain toast will shoot your blood sugar up quickly, the fat slows it down) or an apple with a bit of cheese. When that is in my gut digesting I take my meds with my morning/evening  meal.