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Old 03-27-2013, 07:59 PM   #1
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Metmorfin and a Keto diet?

Hi all, new here and I just wanted to ask if anyone here take Metmorfin for either Insulin Resistance or Diabetes type 2 and have a Keto diet (30g or less of carbs) and have no complications?

I recently started doing this, one doctor said it was ok, the other said to stop completely and because of the Metformin I could suffer metabolic acidosis. Which to be honest, I trust this guy all the time, but at this moment I don't think I could he didn't explain it to me any further.

So I was wondering if you guys have any information on the effects of Metformin and Keto. As well as what your doctors have said, being mine negated each other.
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Old 03-27-2013, 08:08 PM   #2
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Sounds like another doctor who doesn't know the difference between ketosis and diabetic ketoacidosis to me... I almost took Metformin, but declined treatment with it so I can't be 100% that this is the reason he was concerned. Maybe someone with more knowledge than me can chime in, but as far as I know there shouldn't be a concern there! I know plenty of diabetics who have benefited from this WOE
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Old 03-27-2013, 08:26 PM   #3
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Originally Posted by raindroproses View Post
Sounds like another doctor who doesn't know the difference between ketosis and diabetic ketoacidosis to me... I almost took Metformin, but declined treatment with it so I can't be 100% that this is the reason he was concerned. Maybe someone with more knowledge than me can chime in, but as far as I know there shouldn't be a concern there! I know plenty of diabetics who have benefited from this WOE
Yeah, I think this doctor is old school. I take 500mg twice a day of Metformin for Insulin Resistance. Or in another words, onset diabetes type 2. I think I may stop taking this medicine if I can't do a keto diet only because I believe this diet may help me more then a pill.

I would love some more input from people whom take Metformin and have Insulin Resistance/Diabetes type 2.
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Old 03-27-2013, 08:32 PM   #4
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I take Metformin and I'm VLC (below 30 grams net) with NO problems. I like to say that Metformin keeps me honest on low carb, because when I eat too many carbs I get immediate "retribution" in the form of severe GI distress from the metformin.

Metformin is an insulin sensitizing drug. It does NOT lower blood glucose directly, it helps your cells be more sensitive to insulin so that the insulin your body makes can control your blood sugar. It's very UNCOMMON to experience hypoglycemia from Metformin, and there's NO risk of ketoacidosis because your body is still making insulin if Metformin is going to work. I was put on both a VLC diet and Metformin by a wonderful, highly knowledgeable endocrinologist. When I was younger it worked great to treat my PCOS and insulin resistance. Now that I'm older and more insulin resistant, it's not working quite as well.

Metformin is one of the oldest and best studied oral diabetes drugs. It has an excellent track record and many health benefits besides just improving insulin sensitivity, Jenny Ruhl's blog, Diabetes 101, has an extensive list of peer reviewed articles about the benefits of Metformin.

If you're new to Met, here's a couple of suggestions to help you adjust to the medication:
1. Start at the lowest dose, once a day and SLOWLY (over the course of several days or weeks) increase the dose to the prescribed amount and frequency.
2. ALWAYS take Met with food. Some people find that they have to take it in the middle of the meal because if they take it at the start of the meal they'll experience GI problems (the most common side effect is explosive diarrhea and cramping,--really severe, really sudden, really liquid, high volume--not fun, but short lived).
3. If you experience nausea, diziness, too much GI distress, you should ask for extended release tablets, they cause fewer side effects.
4. Keep up on your fluid intake while taking met, especially if you have the side effects.

The side effects usually don't happen until you've been taking it for a few days at least. And they don't last more than a few days, with occasional bouts if you're eating weird stuff.

I know the side effects sound horrible, but they don't last forever, and Met does help to suppress appetite and help your body use the insulin you produce. Combined with low carbing, it's a really effective treatment.
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Old 03-27-2013, 08:38 PM   #5
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Originally Posted by Janknitz View Post
I take Metformin and I'm VLC (below 30 grams net) with NO problems. I like to say that Metformin keeps me honest on low carb, because when I eat too many carbs I get immediate "retribution" in the form of severe GI distress from the metformin.

Metformin is an insulin sensitizing drug. It does NOT lower blood glucose directly, it helps your cells be more sensitive to insulin so that the insulin your body makes can control your blood sugar. It's very UNCOMMON to experience hypoglycemia from Metformin, and there's NO risk of ketoacidosis because your body is still making insulin if Metformin is going to work. I was put on both a VLC diet and Metformin by a wonderful, highly knowledgeable endocrinologist. When I was younger it worked great to treat my PCOS and insulin resistance. Now that I'm older and more insulin resistant, it's not working quite as well.

Metformin is one of the oldest and best studied oral diabetes drugs. It has an excellent track record and many health benefits besides just improving insulin sensitivity, Jenny Ruhl's blog, Diabetes 101, has an extensive list of peer reviewed articles about the benefits of Metformin.

If you're new to Met, here's a couple of suggestions to help you adjust to the medication:
1. Start at the lowest dose, once a day and SLOWLY (over the course of several days or weeks) increase the dose to the prescribed amount and frequency.
2. ALWAYS take Met with food. Some people find that they have to take it in the middle of the meal because if they take it at the start of the meal they'll experience GI problems (the most common side effect is explosive diarrhea and cramping,--really severe, really sudden, really liquid, high volume--not fun, but short lived).
3. If you experience nausea, diziness, too much GI distress, you should ask for extended release tablets, they cause fewer side effects.
4. Keep up on your fluid intake while taking met, especially if you have the side effects.

The side effects usually don't happen until you've been taking it for a few days at least. And they don't last more than a few days, with occasional bouts if you're eating weird stuff.

I know the side effects sound horrible, but they don't last forever, and Met does help to suppress appetite and help your body use the insulin you produce. Combined with low carbing, it's a really effective treatment.


Thank you, I've been on Metformin since I was 17 (25 now) I know the horrors of the GI side effects. I am on my 3rd day of Keto. I am also doing 30g or less and I am having the early side effects of Metformin, stomach pain and the latter.

I figured it wasn't an issue and very safe, I wanted to get an answer like this confirm, not only from you but your doctor. I just think my doctor is a little dated quite honestly and may not know keto as well as others. Which is weird because the one that said no, is an endocrinologist and apparently highly credited in NY.

Again thank you,

Any tips while doing a seriously low carb keto?
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Old 03-27-2013, 08:38 PM   #6
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They also wanted me on Metformin due to insulin resistance (though mine was due to PCOS) but I declined treatment because the side effects outweighed the benefits for me personally.

That being said, if your doctor wants you on it right now for those reasons I would definitely heed his advice there. He would know better than anyone else what you should be taking. But you should be completely safe doing LC, which will probably eliminate your needs for the medicine at some point anyway given enough progress... I know IR can be somewhat reversed by utilizing a LC diet so that's great news. I would say your doctor just didn't know the difference between ketosis and diabetic ketoacidosis, which we see VERY often on here! They're apples and oranges and can't be compared, because they're not the same thing at all.

Next time he asks about your diet (since you know how he reacted when you mentioned a keto diet) simply tell him that you've cut out processed foods, and you no longer eat junk. Doctors LOVE hearing that
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Old 03-27-2013, 08:42 PM   #7
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Originally Posted by newjack View Post
Any tips while doing a seriously low carb keto?
Definitely check out the Nutritional Ketosis board... they'll be your friends if you're trying for ketosis Everyone is great over there, and there's lots of beginner information. They give you advice on how to calculate the right amount of protein for your weight and your goal weight to make sure you're not consuming too much. Too many grams of protein can create an insulin response in people too, especially those with insulin resistance!

My best bit of advice other than that? Definitely eat enough fat! I eat around 120 grams of fat a day give or take for my body weight. The fat is what will help keep you sated, and stop the carb cravings if you have any! Good fats are also highly ketogenic which helps you get there quicker and stay there
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Old 03-27-2013, 08:42 PM   #8
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I think Metformin is wonderful for "prediabetics" even if they low carb. Studies show the earlier you start it the more it does to help you long term.

I have taken it for decades while low carbing for years and not for years. eating low carb has nothing to do with ketoacidosis.
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Old 03-27-2013, 08:52 PM   #9
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I think he said I run the risk of being put in "metabolic" acidosis. But I was so shocked by his answer, "no", he may have very well said ketoacidosis. When I asked him I made sure I said "Is being on Metformin and doing a Ketogenic diet ok?" He knew what I was talking about. Unless, he bs'ed me like a salesmen. :P

No offense to salesmen, I was a salesmen not to long ago!

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Old 03-27-2013, 09:53 PM   #10
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Most doctors don't know squat about nutrition honestly, and it's quite common for them to assume ketogenic means you'll be forced into ketoacidosis... especially when you're diabetic or pre-diabetic, because they're already in that thinking mode. Many of them probably don't even understand what that diet even is, so they just go with what they DO know and "hey that sounds like another word I know, and ketoacidosis is bad!" Whether it's through ignorance, or just trying to save their own skins... who knows? I know if a doctor isn't a nutritionist the usual responses you get are either wrong ones or reluctant ones that amount to "no, don't do anything I don't understand!"

Most people when they get a negative response from their doctors wind up just saying they cut out junk foods and processed foods and eat more whole foods now... many doctors will just let you leave it at that, assuming your labs are okay
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Old 03-27-2013, 10:18 PM   #11
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I think he was more alarmed that I was on Metformin doing the diet. I dont know, I am going to do the diet and be cautious, make sure I have enough salt in my diet and drink plenty of water. If I feel any different after the first week of my transitional periode I will stop and carb load like crazy.

My labs have been fine, liver, thyroid, the whole nine.
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Old 03-28-2013, 03:23 AM   #12
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I think you will find that there are plenty of people here on metformin and eating a ketogenic diet with no issues whatsoever.
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Old 03-28-2013, 05:44 PM   #13
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I follow Dr. Richard Bernstein’s method and have never had a problem. I’ve been on low carb (under 30 grams and many days under 20 grams) for over 2 ˝ years. When I started I was taking 4 – 500 mg of metformin a day and that was decreased, incrementally, to where I am off it completely after 2 years.

My doctor was the one who kept decreasing my dosage. Not because it might do harm but because at this point I don’t need it. He said the only harm it was doing was giving me GI distress. I know at some point I may have to go back on it and that would be okay but as long as I stay true to this way of eating and my exercise I think I can maintain.

I know eating low carb has evened out my blood glucose numbers and I never have the terrible swings from being way too high to dangerously too low. Everyone one of us are different so we each have to find, through trial and error sometimes, what works and what doesn’t.
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Old 03-29-2013, 06:36 AM   #14
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newjack, even though you say you feel confident that you and your doctor understood each other, the fact that you posted here asking us, I think you should maybe ask your doctor to clarify? Maybe you can use some of the questions brought up here to get more clarification?
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Old 03-29-2013, 01:18 PM   #15
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Metformin was one of the few diabetes drugs that Dr.Atkins mentions in Dandr as safe to continue taking. I have no experience with it, just wanted to chime in with this tidbit.
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