Say Goodbye to Metformin Diarrhea: Tips and Tricks for Effective Relief

May 21, 2024

Metformin is used to treat type 2 diabetes and prediabetes and is used off-label for many reasons, including weight loss, antiaging, and treating polycystic ovary syndrome. It has a very good safety profile and reduces blood sugar levels. However, one of its most common side effects is diarrhea.

How does metformin work?

Metformin does not work in the same way as insulin. It lowers glucose production in the liver, decreases glucose absorption from the intestines, and increases insulin sensitivity.1 Unlike other diabetes medications, metformin does not cause hypoglycemia (low blood sugar). Metformin takes a few days to start working.

What is diarrhea?

Diarrhea is having loose or watery stools at least three or more times per day.

After you chew and swallow food, it passes through the esophagus to the stomach, where the digestive process begins. Stomach muscles contract and mechanically begin to break down food. Gastric enzymes and hydrochloric begin chemical digestion. Food continues to be digested in the small intestine.

After food is digested, carbohydrates, proteins, and fats are absorbed through the intestinal walls into the bloodstream. This process occurs in the small intestine. Much of the water and fluids used for digestion are reabsorbed in the large intestine. If the intestinal contents move through the intestines too quickly, there is not enough time to absorb all the liquids, and you get loose, watery stools or diarrhea.

Wooden diarrhea figure with intestines

Why do people with diabetes get diarrhea?

Almost 75% of people with diabetes report having diarrhea, and metformin can worsen it. High blood sugar can damage the lining of blood vessels, reducing blood supply to nerves and causing damage. While diabetic neuropathy is more common in the legs and feet, it can occur in the gastrointestinal tract.

Nerve damage in the stomach and intestines can cause:

  • Esophageal dysmotility: difficulty swallowing
  • Gastroparesis: difficulty emptying your stomach
  • Intestinal dysmotility: diarrhea, cramping, and fecal incontinence

If you take metformin to treat type 2 diabetes, diarrhea may result from diabetes and be made worse by taking metformin resulting in metformin diarrhea. However, diarrhea associated with diabetes is much more common in type 1 diabetes than in type 2.3

Why do I keep having diarrhea with metformin?

Diarrhea is a known side effect of metformin. About 25% of people have gastrointestinal side effects when they take metformin. About 5% of people are unable to take metformin at all.4

Metformin acts in the gut, in addition to the liver. Changes in gut motility can be a result of the following:5

  • Increased intestinal glucose uptake: can cause shifts in water movement across the intestinal lining
  • Increased lactate production: can irritate the lining of the gut and cause diarrhea
  • Increased GLP-1 concentrations: can slow stomach emptying and change gut motility
  • Increased bile acid pool: can irritate the lining of the gut and activate bile acid receptors
  • Altered microbiome: can change the proportions of bacteria in the gut

Why metformin causes diarrhea is unclear. But it is likely due to drug accumulation in the gut. Some people find that the delayed release form of metformin causes fewer side effects than the immediate release.6 Talk to your doctor to see if changing to an extended or delayed release metformin may help your symptoms.

How long does metformin diarrhea last?

Some people have problems with loose stool the entire time they take metformin, while others only have it for the first few days.

Blue intestines clay model metformin diarrhea

Is it OK to take anti-diarrhea medicine with metformin?

Talk to your doctor before taking any medications to verify that there are no known side effects associated with them that may be worse due to your health conditions or that they do not adversely interact with any medications you are taking.

Imodium and other anti-diarrheal medications are intended for short-term use. Your doctor may suggest trying an anti-diarrheal medication when first taking metformin. If you continue to have diarrhea, talk to your doctor about a long-term plan to control your diarrhea, such as:6

  • Taking metformin with meals
  • Changing or decreasing your metformin dosage
  • Changing to an extended-release or delayed-release form of metformin
  • Avoiding spicy foods, caffeine, and dairy products
  • Avoiding artificial sweeteners
  • Slowly increasing fiber in your diet
  • Drinking plenty of fluids to stay hydrated
Say Goodbye to Metformin Diarrhea: Tips and Tricks for Effective Relief

If your diarrhea persists, talk to your doctor to see whether medication changes are appropriate. Call your doctor if you have vomiting, nausea, abdominal or rectal pain, bloody or tarry stools, or stool that contains pus.

Metformin, like all medications, has side effects, which can vary between users. Your symptoms may also improve after your body adapts to metformin use. If you have questions about metformin or are interested in getting metformin for weight loss, talk to an Invigor Medical specialist today.

Frequently Asked Questions

How do I stop metformin diarrhea?

To alleviate metformin diarrhea, it’s advisable to consult a healthcare professional. They may recommend adjusting the dosage, taking the medication with food, or switching to an extended-release formulation. Increasing fluid intake and consuming a bland diet may also help relieve symptoms.

What foods cause metformin diarrhea?

Certain foods, particularly those high in fiber or sugar alcohols, can exacerbate diarrhea in individuals taking metformin. Foods such as beans, broccoli, cabbage, and high-sugar items may contribute to gastrointestinal discomfort. Maintaining a balanced diet and monitoring the body’s response to different foods can help manage metformin diarrhea.

How to lose weight fast on metformin?

Losing weight while taking metformin requires a multifaceted approach that includes a balanced diet, regular exercise, and consistent medication management. It’s essential to work with a healthcare provider to develop a personalized plan that considers individual health goals and medical needs.

What are the signs that metformin is working?

Signs that metformin is effectively managing blood sugar levels may include stabilized glucose readings, reduced symptoms of hyperglycemia (such as excessive thirst or frequent urination), and improved hemoglobin A1c levels. Regular monitoring of blood sugar levels and ongoing communication with a healthcare provider are crucial to assess the medication’s effectiveness.

Author: Leann Poston, M.D.
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Sources

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  • Foss, M.T. and Clement, K.D. (2001), Metformin as a Cause of Late-Onset Chronic Diarrhea. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 21: 1422-1424. 
  • Dujic T, Zhou K, Donnelly LA, Tavendale R, Palmer CN, Pearson ER (2015) Association of organic cation transporter 1 with intolerance to metformin in type 2 diabetes: a GoDARTS study. Diabetes 64:1786–1793
  • McCreight, L.J., Bailey, C.J. & Pearson, E.R. Metformin and the gastrointestinal tract. Diabetologia 59, 426–435 (2016).
  • Tarry-Adkins, J.L., Grant, I.D., Ozanne, S.E. et al. Efficacy and Side Effect Profile of Different Formulations of Metformin: A Systematic Review and Meta-Analysis. Diabetes Ther 12, 1901–1914 (2021).
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