Overview
Metformin, a commonly prescribed medication for managing blood sugar in Type 2 diabetes, plays a crucial role in preventing complications like kidney damage and nerve issues. However, it often causes digestive side effects, with diarrhea affecting around 53% of immediate-release users and 10% of extended-release users. This occurs due to changes in stomach bacteria and increased intestinal fluid secretion. Typically, this side effect lasts about four days initially but can vary. Adjusting dosages, using extended-release formulations, or taking metformin with meals can help mitigate these issues. Always consult a healthcare provider for persistent symptoms or side effects.
Why does Metformin cause diarrhea?
Metformin can cause diarrhea due to its significant impact on the gastrointestinal system. This medication alters stomach bacteria and increases intestinal fluid secretion, speeding up food processing and leading to loose stools or diarrhea, commonly known as metformin-induced diarrhea.
Diarrhea can occur when metformin dosage is increased too quickly or when taken in high doses. The exact mechanism is unclear, but researchers suggest several factors:
- Gut microbiome changes: Metformin alters the balance of gut bacteria.
- Increased bile acid: Higher bile acid concentration in the intestines.
- Glucagon-like peptide 1 (GLP-1): Increased GLP-1 concentration.
- Serotonin activity: Elevated serotonin activity in the intestines.
- Histamine disruption: Interruption of histamine breakdown.
- Increased intestinal glucose: Higher glucose levels in the intestines.
The osmotic effect caused by increased bile acids and glucose draws more water into the intestines, leading to diarrhea. Additionally, metformin can increase substances like GLP-1, serotonin, and histamine, all linked to gastrointestinal symptoms. Studies have also shown that metformin changes the gut microbiome, which can contribute to diarrhea.
For most, diarrhea occurs soon after starting metformin but can also begin after a few weeks or any time during treatment.
How long does Metformin give you diarrhea?
Metformin-induced diarrhea is most common during the first few weeks of taking the medication. While these initial weeks can be challenging, with about 5% of people discontinuing metformin due to gastrointestinal side effects, symptoms typically improve over time. If diarrhea persists or becomes particularly bothersome, consulting a healthcare provider is essential. They can discuss strategies to prevent and manage diarrhea, including potential dose adjustments to help your body adapt comfortably.
How can you treat or manage Metformin’s diarrhea?
Managing metformin-induced diarrhea involves several strategies, including dosage adjustments and formulation changes. Metformin is available in immediate-release (IR) and extended-release (ER) forms. The IR form often causes diarrhea, while the ER form releases the active ingredient more slowly, reducing gut irritation.
To decrease gastrointestinal side effects, healthcare providers may:
- Start with a low dose: Begin with a low dose and gradually increase it.
- Take Metformin with meals: This can help reduce digestive discomfort.
- Prescribe extended-release Metformin: Taken less frequently, it minimizes side effects.
If you accidentally missed the Metformin dose, avoid double the dose yourself. Skip the missed dose and take the next coming dose with a meal. If your diarrhea persists while taking it with a meal, consult your healthcare provider for the best alternative medication, says Dr. Richard Honekar.
To address short-term side effects and find comfort while your body adjusts to the medication, consider these tips:
- Stay Hydrated: Diarrhea can deplete fluids, so drink plenty of water to avoid worsening symptoms.
- Eat the BRAT Diet: Bananas, rice, applesauce, and toast can reduce gastrointestinal strain. Ensure you also eat protein and follow other dietary guidelines for diabetes.
- Increase Fiber Intake: Sometimes, diarrhea is triggered by a lack of fiber. Incorporate high-fiber foods like whole grains, fruits, and vegetables into your diet to help control blood glucose and support weight loss.
- If diarrhea is severe, your healthcare provider may recommend anti-diarrheal medication to manage symptoms.
- Temporarily Stopping Metformin: To see if the diarrhea resolves before resuming treatment.
Always inform your healthcare provider and consult them for personalized guidance and adjustments.
What foods to avoid with Metformin diarrhea?
Certain foods can exacerbate diarrhea and other side effects when taking metformin. To minimize these issues, avoid the following:
- High-fat, sugary, or fried foods: These foods often contain trans fats and added sodium, which can worsen gastrointestinal discomfort.
- High-sodium foods: Canned soups, salty snacks, and processed meats can increase the risk of hypertension and exacerbate diarrhea. Aim to limit sodium intake to 2,300 mg per day or less.
- Sugar substitutes: Artificial sweeteners and sugar alcohols can have a laxative effect, especially in large amounts.
- Dairy products: Many people find dairy difficult to digest, even if not lactose intolerant.
- Alcohol: Alcohol can worsen metformin’s side effects, including diarrhea, and increase the risk of lactic acidosis.
- Simple or refined carbs: Foods like white bread, white rice, white pasta, candy, soda, desserts, and snack foods can spike blood sugar levels, making it harder for metformin to work effectively.
- Saturated Fats: Found in red meat and full-fat dairy products, these can increase inflammation and the risk of cardiovascular disease. Opt for low-fat dairy options instead.
To manage metformin’s side effects effectively, it is beneficial to consult a healthcare provider for personalized dietary advice and dosage adjustments.
What are other side effects of Metformin?
Some of the other side effects of metformin include :
- Nausea
- Vomiting
- Abdominal discomfort
- Metallic taste in the mouth
- Headache
- Dizziness
- Fatigue or weakness
- Muscle pain
Starting this medication may initially bring about some of these symptoms. Allowing your body time to adapt can ease this adjustment period.
Why does metformin make your poop smell so bad?
Foul-smelling stools can occasionally occur as a side effect of metformin. Metformin can alter your gut microbiome, the unique blend of bacteria, viruses, and fungi that help with digestion and overall health. This shift can lead to stomach problems, including changes in stool odor.
Additionally, metformin affects how the liver produces glucose, producing lactic acid, an intestinal irritant. It can also increase substances like glucagon-like peptide 1 (GLP-1), serotonin, and histamine, which are linked to gastrointestinal symptoms. These changes can result in foul-smelling stools. If this side effect persists or becomes bothersome, consult your healthcare provider.
When to consult a doctor
Metformin is an antidiabetic medication that is prescribed widely by healthcare providers for effective treatment of type 2 diabetes. Like every medication, taking this medication can lead to side effects, including diarrhea, nausea, and vomiting. Taking this medication with or after meals is recommended to avoid gut problems.
Get the consultation and treatment plan for Metformin diarrhea by connecting with your doctors online and taking the personalized dose/dosage regimen.
FAQs about Metformin diarrhea
Diarrhea from metformin can sometimes lead to temporary weight loss due to fluid loss and decreased absorption of nutrients during bouts of diarrhea. However, this weight loss is usually not significant or sustained in the long term.
Yes, metformin-induced diarrhea often subsides on its own. Approximately 30% to 40% of patients experience diarrhea, vomiting, or general gastrointestinal discomfort when starting metformin. Most symptoms diminish within a few weeks but may reoccur if the dosage increases.
