What is Metformin for?
Metformin, also known as Glucophage, is an oral medication used to treat Type 2 Diabetes, Insulin Resistance and PCOS. Insulin Resistance is the precursor to Type 2 Diabetes and a common symptom of PCOS (and/or may be a causal factor – the jury is still out on that one). Because Insulin Resistance is such a big part of PCOS, certainly in my experience, using Metformin to treat Insulin Resistance has become a common form of treatment for PCOS more generally.
What exactly is Insulin Resistance?
In optimal health, the way our bodies should work is that the liver produces glucose during fasting to keep our blood sugar at a healthy level and make sure cells are well-supplied with energy. After we eat, the pancreas releases insulin, the hormone responsible for making sure that when the food we eat is converted into glucose, that glucose is then properly absorbed and used as energy. Once insulin is released, the liver should turn down or turn off its glucose production, however in people with Type 2 Diabetes, the liver fails to recognise insulin and continues to make glucose. The condition, known as Insulin Resistance, “is caused by a glitch in the communication between liver and pancreas” as Diabetes In Control explains.
How does Metformin work?
Metformin works by increasing the body’s sensitivity to insulin, so the pancreas doesn’t have to work so hard and blood sugar is stabilised. There is a lack of clarity in the literature around exactly how Metformin does this. One source advises that Metformin “bypasses the stumbling block in communication and works directly in the liver cells” by mimicking the protein that tells the liver it’s time to stop releasing glucose. Netdoctor, however has quite a different interpretation for how it works:
“Firstly, it reduces the amount of sugar produced by cells in the liver. Secondly, it increases the sensitivity of muscle cells to insulin. This enables the cells to remove sugar from the blood more effectively. Finally, it also delays absorption of sugar from the intestines into the bloodstream after eating”
Sources do generally agree however that “it is used when diet and exercise [alone] have failed to control blood sugar levels”, and/or is best used in conjunction with diet and exercise or other ‘diabetic’ medications.
How does Metformin help with PCOS?
Insulin Resistance is one of the main protagonists of PCOS. Some of the symptoms associated with PCOS are actually caused by Insulin Resistance – darkening of the skin (acanthosis nigricans) for example. High insulin levels are also responsible for causing the ovaries to produce excess testosterone which in turn leads to excess body hair and weight gain. So using Metformin to treat the Insulin Resistance that many PCOS sufferers experience can cause other PCOS-related symptoms to improve, including of course reducing weight gain and improving fertility.
There is no doubt that Metformin has been revolutionary for some PCOS sufferers, with many stories on PCOS forums demonstrating how improved blood sugar has led to altered hormone levels and ultimately to improved fertility, which for many women is the main objective for getting their PCOS under control.
Side effects of Metformin
Metformin is not without its side effects however. Commonly reported side effects of Metformin include lactic acidosis, diarrhea, nausea, vomiting and flatulence.
Doctors will generally advise that the best way to take Metformin to minimise these symptoms is to always take it with meals and to slowly increase the dose overtime to the level required to be effective so the body adjusts to the side effects. Sometimes though, the side effects can be so severe, as was the case with me, that we can’t adjust and need to look instead for alternatives that might do the job.
Alternatives to Metformin
There are a number of other pharmaceutical interventions that can be prescribed to help control blood glucose levels for Insulin Resistance, Type 2 Diabetes and PCOS. They all work in slightly different ways, and crucially they are all reported to have a similar set of possible side effects to Metformin. Four of the most common pharmaceutical alternatives are:
- Sulfonylureas. Stimulates the pancreas to produce more insulin (which strikes me as a bandaid approach considering lack of insulin sensitivity is the problem for insulin resistant people, not lack of insulin per se). Common side effects include hypoglycaemia (low blood sugar), hunger and weight gain.
- Meglitinides. These work the same way as Sulfonylureas by increasing insulin production in the pancreas. Common side effects listed include low blood sugar and joint pain (charming!)
- Thiazolidinediones. These work similarly to Metformin in that they reduce the glucose produced by the liver while increasing receptivity to insulin in muscle and fat. Common side effects include weight gain, fluid retention, cold/flu symptoms, headaches and joint pain.
- Alpha glucosidase inhibitors. These slow the digestion of complex carbohydrates and thus lower the blood sugar response to these foods to help keep blood sugar in check. Common side effects include flatulence, bloating, stomach pain and diarrhea.
Every source I’ve read that explains the above medication notes that they are often prescribed in combination with each other, as well as with diet and exercise. It has been reported that in some studies, diet and exercise alone have been as effective PCOS treatment options as a pharmaceutical intervention, if not more so. While not underestimating the serious health implications of conditions like Type 2 Diabetes, Insulin Resistance and PCOS, lifestyle change, in combination with natural alternatives to Metformin and other pharmaceuticals will improve symptoms as well as overall quality of life.
Read more about what I have to say about Metformin alternatives right here.
Other PCOS treatment options
What does ‘lifestyle change’ mean anyway?
Without a doubt, lifestyle change is the most effective way in the longer term to improve your Insulin Resistance, and quite possibly other PCOS symptoms, and should be a goal even for people relying on pharmaceutical interventions to treat their condition. This site defines lifestyle improvement as consisting of “a diet especially designed to rebalance your hormones, increased exercise, better management of chronic stress, and getting enough sleep”.
While a diet low in carbohydrates (to avoid blood sugar spikes) and low in dairy (because it is said to cause inflammation, which in turn contributes to Insulin Resistance as well as apparently containing hormones that are damaging for PCOS-sufferers) can be particularly helpful for rebalancing hormones, just lowering your body fat percentage can also make a big difference. In my case, losing 30% of my body weight did the trick. While PCOS is such a complex condition that some symptoms may remain, an improvement in the severity of symptoms can be reasonably expected.
I’ve written at length in G.I. Gen about how I lost weight even with PCOS, so I won’t repeat myself here except to advise that the winning combination (supported by other sources on the subject) in particular for reversing Insulin Resistance seems to be:
- A low carbohydrate, high protein and high fat (calorie controlled) diet
- High intensity exercise including strength training
Why low carb? In short, carbohydrates produce the highest insulin response which can be followed by blood sugar ‘crashes’ and a diet consistently high in carbohydrates puts our bodies on an unsustainable blood sugar roller-coaster, with potentially disastrous consequences.
How does strength training help? Building lean muscle helps boost metabolism to improve fat loss. Lean muscle is attractive to look at, and is also great for other health benefits and self esteem. I’ve written further on the subject here. Strength training combined with some high intensity cardio is the best combination for achieving real results. If you can’t afford a personal trainer or a gym membership you can absolutely achieve results at home by combining a set of adjustable dumbbells:
…with a Youtube or DVD at-home exercise program, such as Jillian Michaels’ 30 Day Shred:
Natural Alternatives to Metformin
To supplement the essential lifestyle change, ‘natural’ alternatives to assist with regulating diet you might consider can include:
Chromium is a mineral that has been reported as aiding insulin sensitivity to help regulate blood glucose levels and control sugar cravings, as well as potentially to help metabolise carbohydrates, protein and fat. I personally found it very helpful for my sugar cravings. As it’s relatively inexpensive it can be a great addition to the lifestyle changes suggested above, if you’re on a mission to reduce the impact of your Insulin Resistance or PCOS.
This one from Amazon has a money back guarantee if you’re not 100% satisfied it’s had a positive impact.
Berberine is noted as “one of the few supplements in the Examine.com database with human evidence that establishes it to be as effective as pharmaceuticals”, and Authority Nutrition describe it as “one of the most powerful natural supplements on earth”. Berberine is an alkaloid extracted from plants that has been found to help lower glucose production by the liver as well as improving the function of other organs. Research has found that in 116 diabetic patients it lowered fasting blood glucose levels by as much as 20% returning them to normal range. It’s not without its own side effects however, as apparently “too much” could cause an upset stomach so should be taken under supervision by a doctor.
Lean Nutraceuticals Berberine has 5 star reviews on Amazon.
Inositol collectively refers to molecules with similar structures, however it’s actually usually used to refer to the specific product myo-inositol, which is used to treat Insulin Resistance, particularly PCOS-related, and anxiety (Source: Examine.com). It also “holds some promise” in helping to treat binge eating disorders. Examine.com cites research rating it as having “very high” success rates for treating PCOS when taken in proper dosages, although it’s difficult to find as clear an explanation of how it works as is available for chromium or berberine. As with other similar supplements it’s advised to increase the dosage slowly to minimise risk of stomach upset and diarrhea.
Recent research is suggesting that Vitamin D deficiency could be contributing to an over-production of macrophages – cells that produce chemicals called cytokines that impair insulin action in the liver and muscles. There’s nothing conclusive about this yet as best as I can tell from reading up on the subject, however it is known that Vitamin D deficiency has a range of nasty health impacts, so therefore Vitamin D supplements can have multiple uses and positive impacts.
To conclude, while Metformin and other pharmaceuticals have their place in treating Type 2 Diabetes, Insulin Resistance and PCOS, they’re best used in conjunction with lifestyle change – predominantly diet and exercise which is an essential part of any PCOS treatment program. Given the side effects of Metformin and other pharmaceuticals can be unpleasant, AND given that lifestyle change and natural alternatives can have a very positive impact, it’s worth considering natural alternatives before relying on pharmaceutical interventions.
Disclaimer: While I’ve done my best to only use quality sources for the information in this article, please note I am not a medical doctor, and you are not to take anything said here as medical advice. PCOS and any other health condition should always be treated in consultation with a health practitioner.