Metformin and Keto?

(LeaV) #1

I was diagnosed diabetic earlier this year, and was put on Metformin every other day. My doctor says I’m the weird “grey area” between being pre-diabetic and fully diabetic. They think I can reverse the diabetes with adequate diet changes and exercise. My question is, is the ketogenic diet safe to do while on Metformin? I’m worried about my levels ending up too low, the last time I made a drastic/sudden change in my diet I almost passed out about 6 hours in. So, has anyone here had success with this? If so how did you manage the diet changes? Is there a way to work yourself into the keto diet? Please and thank you :slight_smile:

(Polly) #2

Welcome to the forum.

As a medicated diabetic/ almost diabetic person you should be making dietary changes with medical supervision. Your doctor is obviously encouraging you to make some changes for the sake of your health, surely they are the best person to advise you on this.

I have no personal experience of diabetes, but have heard that people are able to reduce their metformin dose.

(Hyperbole- best thing in the universe!) #3

I’ve heard many people say they stay on metformin while keto, but any medication you need to watch carefully. Especially if you are taking insulin, you need to communicate well with your doctor.

I wish you well on your keto journey!

(Michael - When reality fails to meet expectations, the problem is not reality.) #4

(bulkbiker) #5

I had a really bad reaction to metformin so gave it up after 3 weeks of hell and with a combination of Intermittent fasting and ultra low carb eating put T2 into remission. Metformin doesn’t do a great deal anyway so there shouldn’t be a problem with you stopping it.

Your body, your choice.


Yup! From the sounds of it you don’t need the metformin at all though. Many automatically give the non-answer of “Talk to your doc”, if you’re eating keto and that happened than you clearly don’t need the metformin. You know who knows WAY more about your body than your doctor? YOUR BODY! Couple things though, were you checking your sugars? Many times when they’re high all the time simply going “normal” will give you hypoglycemic symptoms even though you’re fine so it (could) be that. On the metformin as a whole, there’s a lot of BENEFITS to it as well, when you’re used to it. So you don’t necessarily have to rule it out (and you may not want to). However, if you feel like you’re going to pass out, you need to back off a little, at least for now.

(bulkbiker) #7

Maybe “alleged benefits”?
I’ve never come across a definitive study unless you have.

(Ron) #8

I am t2d and took metformin for 6 months after going keto. I never had any problems other than (as you say) my blood pressure got pretty low and when I stood up I would get dizzy. I controlled it by just standing a little slower. The blood pressure was never so low as to be dangerous but I think as an overweight diabetic, my body was used to operating at such a higher blood pressure level. In time this got better and as my A1c started to come down I dropped the metformin all together at about the 4 month mark. This is just my experience so please take it at that level in your decision. Good luck and if I can help feel free to ask. :ok_hand:

(Give me bacon, or give me death.) #9

Dr. Stephen Phinney, a nutrition researcher who is now the chief medical officer of Virta Health, says that he quite often leaves patients on metformin, because it is safe and can have beneficial effects even when the patient has been on keto long enough to have all other diabetes drugs discontinued. Your doctor may need to adjust the dosage, however.

It is not actually a non-answer, the reason being that most of us on these forums are not physicians and are therefore not qualified to offer treatment advice; and even if we were physicians, it would be both unethical and illegal to offer treatment to a patient we have not seen in person. Everyone’s individual case is different, and even though I can speak with authority about my own experience, I cannot be sure that someone else’s experience will be congruent with mine. It is safe to advise someone that their medications may well need adjusting after they embark on a ketogenic diet; it is the height of irresponsibility to advise someone to adjust their own dosage when they don’t know what they are doing.

(Troy) #10

Not sure if this is helpful to some?

More of a PSA

THIS was just newsworthy about a week ago or so
Feel free to merge elsewhere

Certain Metformin RECALLS

6-11-20 on the below


I disagree, people know that they’re not getting true medical advise from random internet people, in most cases that’s by design. It’s also not unethical nor illegal for a private person to give advise regardless of what it’s about. It’s just an opinion, and freedom of speech. As private citizens we’re bound by near nothing as far as words that come out of our mouth. If we were going to take that at face value then the forum should be shut down because we advocate a WOE that mainstream medicine says is unhealthy, will clog arteries and eventually kill them. Regardless of any advise given it’s ultimately up to the person to decide if they want to follow advise of people who they feel know better, or there Doctor who has probably let them down. I don’t agree with the nanny mentality of protecting people against themselves. I’m for people doing their own research and making educated decisions when they have the facts. For the overwhelming majority of us that have been doing this for years, that’s exactly what we’ve been doing the whole time. Pretty sure I’ve never once been mistaken for a medical professional.

(Polly) #12

For what its worth I agree with @PaulL on the issue of advising people to seek medical advice where it seems appropriate. I am not medically qualified and neither are the dudes who own this site. When I suggest people get advice from their doctor I am thinking about possible repercussions for the dudes if someone of less than sufficient intelligence acts on advice from one of us and comes to harm through it. It is only a few years since Tim Noakes was taken to a tribunal over a tweet.


That’s fine. With that mindset though make sure you also don’t recommend keto to people because the lack of carbs and all the saturated fat will be unhealthy for them. Ask the overwhelming majority of mainstream docs across the planet, they’ll agree. You see the problem with that?

Nobody’s pretending to be a doctor here. Also, Tim Noaks IS/was a professional and as such was bound by things that although weren’t fair, were real. We’re not. Some people are afraid of having an opinion, and expressing it, I’m not. We’re clearly going to disagree on that.

Also, Richard and Carl absolutely Guinea Pig’d the hell out of themselves over the years! I know you’ve heard enough of the podcasts to know that.

(Polly) #14

For sure Richard and Carl have taken responsibility for their own health(s) and done a great job of it. Many of us here have done the same for ourselves.

Advising people in a general way to give keto a try is very different from telling someone who has already told us that they are suffering from a medical condition and being treated by a physician because of it to do anything. If someone wants to talk about macros or even calories, then we are in the realm of this works for me and that works for someone else. As soon as we get into issues of metformin we are treading on dangerous ground.

(squirrel-kissing paper tamer) #15

I was diagnosed pre diabetic and given the option of diet change or Metformin. I choose keto and did it for a year. I lost weight and had a bunch of other benefits, but never got my blood sugar down. A year later I started Metformin and for the first time my blood glucose is in the 80’s on labs. I am thankful for starting it and aside from the initial GI side effects, it doesn’t cause problems. I’ve never bottomed out, felt low blood sugar or any of that. I do notice that if I eat a bunch of carbs I have increased GI upset so it also works as a deterrent :rofl:

(Bob M) #16

Have you tried some longer fasts, say 36 hour plus?

And when you say you “never got your blood sugar down”, could you be more specific? You never got your blood sugar down, when? In the morning, in the evening, anytime, etc.?

I have noticed that after 6.5 years, my morning blood sugar is slightly lower than it was about 4.5 years ago. I didn’t start taking data for a while. It’s not shocking, upper 90s instead of lower 100s, but it seems to be there. (Though since I’m using pin-prick blood sugar meters, it’s hard to tell since they have so much error.)

(squirrel-kissing paper tamer) #17

Bob, I’m also fighting the effects of steroids, but I never got it down in my labs with the doctor or my morning fasting at home blood glucose checks. I cannot do extended fasts. I eat two meals a day.

(Ellenor Bjornsdottir (spare me thy resistant starch spiel)) #18

Metformin does not directly reduce the blood sugar level. It’s not unsafe in the case of a ketogenic diet for most people. But… it could be an issue if you’re one of the people where it does directly reduce the sugar level. I’m not a doctor and this ain’t medical advice.

Were it me in that office, with the info I have now, I’d tell the Doc “let’s do both.”

Ouf. Cortical steroids (I’m assuming!) are a real bear.