Metformin & keto... can I do both?

(Nina S. ) #1

Hello, I started a slight keto diet on July 30th (I say slight because I started eating between 30-60g per day of carbs- a significant reduction compared to the hundreds of grams of carbs I would normally consume per meal) and I did that for 2 weeks and lost 16lbs. On 8/20/18 I got serious and changed my numbers to 20g of carbs per day. I felt sick on days 2 and 3 but completely better by day 5. I tested for ketones at home that week and was between 1.5 and 4 mmol/L up until 4 days ago.

4 days ago my Endo decided to put me back on Metformin for PCOS (Polycystic Ovarian Syndrome). I’ve been on Metformin for 4 days now and surprisingly it hasn’t made me sick with nausea and diarrhea as is has in the past (when I was eating crazy large amounts of carbs) but when I tested my ketone levels this morning I was at 8 mmol/L. Should I be worried??

From what I’ve read, Metformin desensitizes you and makes you more sensitive to insulin but, I’ve also read that eating a low carb diet will make you produce less insulin so I am confused because I am on a medication that makes me more sensitive to insulin but I also on a low carb diet which makes me produce less insulin?

Can I be on Metformin and still stick to under 20g of carbs or should I slightly increase my carb intake to get my ketone levels back down to optimal ketosis levels??? I don’t feel sick or anything just worried that my ketone levels are so high and I’m not sure why.They weren’t as high prior to me starting the Metformin and I’m wondering if it has anything to do with it. I also haven’t lost any more weight but I haven’t gained either.

Please help!

#2

Metformin & keto… can I do both?

I hope someone can help you here

#3

I remember another thread where one person lowered their dose after starting keto and one stopped taking it completely.

https://www.ketogenicforums.com/t/cutting-back-on-my-metformin/54675/2

#4

It’s my understanding that the Metformin is to help you reduce blood sugar. Keep testing your blood sugar, and make notes for your next doctor checkup. If you’re keeping a log of what you are eating, it’s not a bad idea to bring that too.

Since you have changed your way of eating pretty recently, your body is still changing. This way of eating will help the PCOS–when I did low carb I ended up pregnant when my body finally got healthy. Watch your blood sugar and contact your doctor if you think it is going too low.

When you have ketones it is just showing the concentration. You are either producing ketones or not. If you drink more water it will show less ketones because you are releasing them in urine and also diluting the concentration in your blood. Having ketones is good! Whatever your carb goal is, just stick with it unless you have a reason not to. I suspect the days of you being on Metformin are limited. But that is between you and your doctor. Keep doing what you’re doing!

(Diane) #5

I’m 53 and was diagnosed with PCOS 14 years ago. I have more recently had some serious health issues which have kept me from being able to work for the past year and a half. I was never diagnosed with type 2 diabetes, though once or twice my HbA1c crept up into pre-diabetic levels and she advised me make dietary improvements. I started eating ketogenically in September 2017. I’ve lost 86 pounds over the past 11 months (still maybe another 114 to go), and seen tremendous improvement is some of my other symptoms (mental clarity and depression) with others continuing to slowly improve over time.

I took metformin for many years (for PCOS NOT diabetes), and often had issues with nausea and lightheadedness even though I always dosed with food. I stopped (without consulting my primary care provider) after several months of eating ketogenically. I was trying to eliminate extra prescriptions and see if this helped to ameliorate some of my other health issues/symptoms.

She has encouraged me to restart my prescription, even though my blood sugars are fine (mid 80’s to low 90’s upon awakening) and my HbA1c is also good (5.3). My understanding is that the metformin bonds to extra testosterone (one of the issues with some PCOS patients). But the main reason she wants me to continue taking metformin is to improve my insulin resistance, which has improved significantly with the Keto diet, but is still quite high. She says (that for me), there is no reason for me not to restart, even though I continue to eat very low carb and have good glucose control.

After further discussion with my PCP and because my weight loss had stalled significantly (at least in part due to my continued high insulin resistance- in my opinion and hers), I am going to take the lowest dose available with meals, starting with 500 mg extended release, once a day. I’m not going to take it while I am doing extended fasting since I wouldn’t be able to take it with a meal.

Barring any weird symptoms, I’m going to try this for 4 to 6 weeks and see what happens with my insulin resistance (she is happy to order lab tests for me) and weight loss.

Hope this helps as you gather information.

Continued good fortune on your journey!

(Thurston ) #6

I’ve taken Metformin since March and started Keto at the same time due to a Type 2 diagnosis. No issues

(Nina S. ) #7

@grinch734 thanks for the link!

(Nina S. ) #8

@DiMo thanks for all the helpful information. I’m 37 and was diagnosed 19 years ago. It’s progressed over the years and cursed me with weight gain. I’m not diabetic or pre-diabetic and the Metformin is strictly for the PCOS. I decided to stop taking it for 2 weeks to see if I have a change in ketone levels. If I don’t and they still remain so high then I think I will need to readjust my numbers and get back on the Metformin. I guess I will have to continue to play around until I figure out what works best.

(Nina S. ) #9

@DAB lucky you! Are you in ketosis?

(Drew Schmidt) #10

A little late to the thread - but - I’m Type 2 diagnosed 12 years ago. Currently taking 1000 MG of Metformin twice a day. After 4 months of Keto A1C was 5.9 so Dr. lowered me to 500mg twice a day. I think at this point I could probably drop all of the Metform. I haven’t seen my blood sugars go to low. Usually in the 90’s in the morning. Yet I certainly get the dawn effect. It’s not unusually to see 105-110 in the morning and if I test another hour in I’ll be lower. It’s not unusual for me to be in the 80’s at bedtime and in the 90’s when I wake up.

(Thurston ) #11

I am in ketosis according to my $5.00 breathalyzer.

(Karen Thompson) #12

Did your ketone levels or weight change? I’ve been Keto for a couple of years and am about to start metformin for pre-diabetes (HgbA1C of 6.5). I’m curious to see how it affects ketones and weight!

(Thurston ) #13

@Karen_T My A1C was 6.2. Started Metformin then Keto and walking. Lost weight, got the A1C to 5.5 in 3 months and have been maintaining there for about 9 months. The holidays were a bit trying but with longer days and sunshine it’s easier to stay on track.

Good Luck, Metformin and Keto are your friends when starting this journey.

#14

Richard is taking Metformin I believe?

Have you listened to the podcasts?

(Peter - Don't Fear the Fat ) #15

Bumping this thread because I’ve met someone starting Keto, I’m not sure what to tell them about their Metformin dose.
I did say consult with your doctor but not sure how that might go

(Doug) #16

I do both and have never had any problems. Metformin doesn’t tend to make blood sugar go “too low” so it’s not like one necessarily has to cut or eliminate the dose when eating ketogenically - at the very least it would be an individual deal. I agree that the doctor should be consulted.

(Peter - Don't Fear the Fat ) #17

Ah thanks Doug, that’s what concerned me.

#18

I’ll second @OldDoug, not going to make you go too low, I switched to Berberine after I learned that Metformin can screw up teeth, but it definitely helps and isn’t going to make you too low, even with higher doses. Metformin plus Keto is just going to speed up the repair process.

(Peter - Don't Fear the Fat ) #19

All this is great news. Certainly helps introduction to a low carb/zero carb life. So liaising with your doctor not that crucial?

#20

Given they already have the Metformin, I wouldn’t.