 Hey guys, this is Dr. Ahmed Ergen. Today, I'm going to talk to you about something you keep asking about, metformin side effects. Now, we're not gonna just tell you about what the side effects of metformin are, but also I'm going to talk to you about how to take it correctly. Now, a lot of people don't take metformin correctly. That's why they get into problems. Now, how to prevent side effects? Again, it's preventable. Again, a lot of people don't know how to do it. Even doctors don't know what to prescribe when it comes to metformin to prevent side effects. Now, difference between regular metformin and extenant release metformin. There's a huge difference between the two, and I'll go over that in this video. Metformin recall. A lot of people heard about this. A lot of people are concerned about this metformin recall. They're concerned about if the metformin causes cancer, etc, which we will go over and cover that today. And then we are going to talk about, finally, about the use of metformin in PCOS and pre-diabetes, which I've been getting a lot of questions from you guys. Let's get started. All right, so metformin side effects. What are they? Of course, the most common one that everybody... I wouldn't say everybody, but a lot of people to complain about is diarrhea. Gastrointestinal side effects. Stomach side effects. Some people may have gas. Some people may have diarrhea, abdominal pain, all sorts of problems. Now, those are the common problems with metformin. What other things can you expect from metformin? Now, I mean, like any other drug, you think it's an allergic reaction to metformin. You can develop a rash to metformin. Some people even get a chest pain from metformin. Now, chest pain is something that I don't really like and it doesn't really happen common. I've heard a couple times in so many years of it happens, and we don't know why it happens, but I'm like, yeah, well, you got chest pain. I don't think that's a good idea to continue. Not that it has any heart problems associated with it, but if you are having a weird side effect, I would not just continue with it. All right, guys, let's go. Let's go over the side effects now. Now, metformin has a lot of side effects. Now, the most common side effects are gastrointestinal, okay? So I'll go over them in detail, but if you want to summarize, let's start with the gastrointestinal side effects, which are stomach and intestinal side effects. So you may have diarrhea, you may have loose stools, you may have you know, abdominal pain, bloating and gassiness and all sorts of crazy side effects with metformin. The good thing is the side effects tend to disappear, and I'll tell you of how to remedy all these problems. One of the most forgotten side effects is B12 deficiency. Again, metformin may prevent the absorption of B12 in the intestinal system, and ironically, B12 deficiency can cause neuropathy and diabetes can cause neuropathy. So you don't want to miss B12 deficiency, especially after a prolonged use of metformin. Now, what about other side effects? Sometimes cardiovascular side effects, such as palpitations, chest pain can happen, flushing can happen, and we don't really like those side effects, especially if somebody is coming to me with palpitations or chest pain as a side effect. I'm like, ah, maybe metformin is not for you. Respiratory side effects, some people complain about shortness of breath. Now, general side effects, some people will have like tiredness. Some people will be like weak and they will have muscle pains, you know, and that they may not know what's going on, because they may not attribute those side effects to metformin, but it does happen. Dermatological side effects, such as skin manifestations, sometimes skin eruptions can happen, reds can happen with metformin. But these are typically the most common neurological side effects. We can think of like a dizziness or headaches can happen with metformin as well. So again, there's a lot of side effects. Now, these side effects that I'm talking about, other than the gastrointestinal side effects are like maybe 5% or less. Now, a lot of people tend to think that if that's a side effect, I'm going to have it. But I think you should think positive, you know, don't think that you're going to have a side effect. Now, think about the law of attraction. Law of attraction says, think positive, you will attract positive things. If you say that I'm going to take metformin and I will feel great, more than likely you will feel great on it, because sometimes our body and the nature around us creates what we are thinking. So you create your own world. So think like that. Of course, sometimes side effects are inevitable. So if you're taking metformin and next thing you know you're having diarrhea, you know that's the side effect of metformin. But if you're a little bit tired, I wouldn't just jump on and say, oh, metformin causes unless your tiredness is out of proportion, that's something that you don't normally feel. And you stop the metformin and suddenly it goes away, then, you know, then you know what it is. But I would not necessarily throw a medication right away. And since most side effects tend to disappear in time, especially the gastrointestinal side effects. Now, the good thing about metformin, the gastrointestinal side effects can be prevented quite a bit. So we're going to talk about this. This is the first topic that I want to stress about. Most people do not take metformin correctly. And the reason for that is like Dr. Prescribe, let's say a thousand milligrams twice a day, regular metformin. Oh my God. That's like a person a suicide of 100 percent. If you prescribe 100 milligram, I mean, 1000 milligram metformin twice a day, 100 percent, you will get diarrhea. The very rare people will will not have diarrhea. So the way to start this is starting very small, like 500 milligram. And then another important thing is to start with your dinner and always take it with meal. If you take an empty stomach, you're going to be in trouble. So take it with meal, start with dinner, take it for a week and see how it goes. And if everything is good, you don't feel bad, no side effects. And maybe you can start 500 milligram twice a day and again with meals. And maybe you can start with the breakfast and dinner this time. Another important thing that's forgotten all the time. Yes, I know metformin is free at Publix in the United States, but that doesn't mean that free is good for you all the time, right? So extended release formulation has four times less side effects. So when it comes to diarrhea and bloating and all that metformin extended release, which is metformin ER or XR, whatever your premises has, has much, much less gastrointestinal side effects than a regular metformin. So if you think that you want to be on metformin, you want to stay on metformin, start with extended release. I mean, you can, you can, you can, if you have the guts, you can say, oh, my guts are good. So I will just go with the regular metformin since it's free. And if I have a problem, then I'll, I'll, I'll go for extended release. Well, let me tell you guys, I didn't have that kind of time. If I was diabetic, I wouldn't just mess around with it. But if you want to save a couple of bucks, that's OK. You know, try to regular metformin, see how it goes, start with small dose and advance slowly, that will do it. Now, the maximum dose is typically around 2,000, 2,500 milligram of metformin. Not that you have to go to maximum dose every time. I would say the maximum dose is the dose that you can tolerate. So just because you want to go to 2,500 milligram, you don't want to really push it to a point where you cannot tolerate anymore. So again, to summarize, guys, start slow, start with meals, start with dinner once a day only and then advance twice a day, maybe 500 milligram twice a day and then advance to maybe a thousand milligram twice a day. Now, a quick caveat for you in the United States, again, I'm not talking about Canada. I have, you have a lot of followers from Canada and the UK and the rest of the Philippines and the rest of the world. Sometimes I get upset when I don't say anything about this. The problem is I live in the United States. I have no idea what's going on in this country. So I apologize for that. But the bottom line is metformin extended release is generic. OK, but it comes in generic only in 500 milligram in the United States. A thousand milligram is not really generic yet. Or even if it is generic, I think it's generic, but it's kind of expensive. So we end up doing like maybe prescribed 500 milligram tablets and then we sometimes tell them to take two tablets twice a day. And that's sometimes easier anyway, because metformin tablets are kind of big, you know, is a lot of people have trouble taking that down. So, I mean, you know, you can think about that as well as a clinician. You know, really, I have to think about everything. Just prescribing a medication and sending a patient home doesn't necessarily solve the problem. You need to make sure that the patient is comfortable. You need to make sure that the patient can take the medication. That's all that's that's what the doctor's ship is about. You know, that's how a doctor should treat their patients. So how to prevent side effects. Now, of course, you know, we discussed about this, you know, take it with meal, use extent release metformin. And the difference between the regular and the extent release. We already jumped to that topic as well. The extent release is much, much, much better. Now, B12 deficiency. Now, what you do with that? So basically, you just have met B12 checked maybe once a year or so, or every other year. It's not really your B12 holes are not going to drain very quickly because B12 is a stored vitamin. So I would not panic about that. Check your B12. If it is normal, you don't have to check it for another year. But B12 is very easy. You can take you can take a B12 supplement if you're deficient. If you have prognosis or anemia, you can take an injection. Now, recently, there was a metformin recall. Now, with the metformin recall, I wouldn't worry about this too much because when there's a drug recall, they're going to let your pharmacy know and pharmacy will call you. Now, metformin recall does not mean that they recalled all the metformin in the world. No, that's not true. Some metformin brands, again, there's like a God knows, 20, 30, 100 brands out there that make metformin because it's the most commonly used medication in the market right now. So some of the companies screwed up and figured that out very quickly. And they said you had to pull that drug immediately.