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Metformin is a medication used to manage blood sugar levels, but it can have side effects and interactions with certain foods and medications. It works by lowering blood sugar levels and increasing insulin sensitivity. Some side effects of metformin include headaches and a rare condition called lactic acidosis. The risk of side effects can be higher for people with liver or kidney disease. Alcohol consumption and grapefruit consumption can also increase the risk of side effects. It is important to be cautious and talk to your doctor about any concerns or questions you have about taking metformin. What to avoid when taking metformin? We're going to talk about drug and food interactions too. So you thought metformin was easy? Not so easy. We'll talk about it. It's been a life changer for many people when it comes to managing their blood sugar levels. However, a big however, for some, it is a medication they absolutely dread. I get this all the time every day, Doc, I hate this metformin, I hate this metformin. I get it. Well, that's why it's important to be aware of any medication and food interactions that could potentially affect its effectiveness and maybe even make it more harmful for you. In today's video, I will be diving into the incredible world of metformin. It's complicated. We don't even know how it works yet. But we're going to be discussing some of the interactions you need to keep in mind if you are taking metformin. Whether you are a fan of metformin or not, there is no denying the importance of understanding how to use it effectively and when not to use it, right? Now sit back and relax, no rush, nothing quick is good for you. So let's learn something new together without rushing this. It's not going to be too long, I promise. As I said, many of you have heard and had doubts about metformin, but it's okay, you're not alone. So many people. Don't worry, I'm here to clear up some of these cloudy thoughts. You might also have heard about berberine or dehydroberberine, which what we have in our superberberine at sugarmd.com, it's an actual alternative to metformin, which we'll talk about. It's not technically FDA approved, people who uses natural alternative, they found that to be effective and there are studies, not for FDA approval, but we know that they have a lot less side effects. So for those who may have had trouble with even berberine sometimes, right, you can also consider dehydroberberine, which is what is in superberberine. Now some people just want to take berberine because they're used to it, for which we also have that standalone product on our website right now. But if you are looking for a natural option, both berberine and dehydroberberine will be great options for you. Let's talk about metformin, how it works to begin with. Now by employing multiple mechanisms that we are not even sure of, metformin actually does wonders for a lot of people in lowering their blood sugars, especially in the beginning. First it puts the brake on gluconeogenesis in the liver, which is a fancy term for the production of new glucose from other nutrients in your liver, and then your liver dumps it eventually to your blood, next thing you know you wake up with a high blood sugar. Additionally metformin hinders the glucose uptake from the gastrointestinal system, which berberine kind of does the same thing, while amplifying insulin sensitivity, which is a nice, we can call it a triple treat, right? Now, like I said, berberine and dehydroberberine does similar things, however, like any other medication, metformin is a synthetic drug, is not without its fair share of side effects. One potential drawback is the risk of hypoglycemia, which is low blood sugar, which occurs when the blood sugar levels plummet, and you feel like shaking, sweating, you feel like the world is ending, not a good feeling. So this is relatively rare, but metformin is essential to recognize these signs which I just described. But wait, by the way, I know how it feels. Some of you may have seen the other videos where I literally injected myself 30 units of insulin to bottom myself out, to feel how it feels to be down to 30 blood sugar. Well, I didn't go down to 30, I was down to 50, but I felt it, dude, it was not fun. So when somebody comes to me and says, I have no idea, doc, I'm like, oh yeah, I do. So I actually even try medications on myself. Why? Think I'm a junkie? No, I try them to see the side effects, to see how my patients feel, because I want to be empathetic, sympathetic, right? But let's go back to metformin. It has some bothersome side effects. Some people may have headaches, they may not even know it's from metformin. In rare cases, there is a serious condition called lactic acidosis. That's where the blood becomes too acidic. Ooh, nobody wants that. Now it is crucial to be vigilant and aware of these possibilities. Hold on, you're not done yet. There are also some foods and medications that will interact with metformin, amplifying the chances of these side effects. Now, people always ask me, does berberine have any interactions or dehydroberberine have any interactions? Well, these are natural things. They're considered foods, right? Can there be interactions with medications? Maybe, but they're not going to be dramatic. If it was a dramatic side effect, that would have been known by now, because they have been studied. However, since they're not drugs, you're not going to see on the drug label what interactions could be. However, from my experience and from the people who use berberine or dehydroberberine, we don't see major problems with the use of these supplements. Now, before we proceed into these side effects and other things, let's talk about some also patient characteristics that can heighten the risk of experiencing side effects. Some people are just fine with metformin, like, I have no problem. Some people are like, I hate this drug. Now, especially if you have liver disease, kidney disease, which, by the way, most of you have kidney disease without knowing. If you have protein in your kidney, in your urine, that is a sign that you have kidney disease. A doctor may say, I know you're fine. No, you're not fine. You're spilling protein. It's like saying, oh yeah, your car is leaking some oil, but you know what? You're fine. You go to a mechanic and they say your engine is leaking fluids and oils, and they say you're fine. Fire the mechanic, all right? But if you have the kidney disease, make sure you find out if you do have it or not. If you have a heart disease, again, most of you know it by the time you have heart failure. Well, you don't want to know when your engine totally fails or seizes, right? You want to know something way ahead of time to make sure you don't succumb to death from it. Now, you better know if you have heart disease, liver disease, or kidney disease. Now, if you have all these problems, or even allergen metformin in some cases, you have to exercise excessive caution. There's nothing wrong with being excessive when it comes to caution. Now, these individuals, for example, with those problems, they have increased vulnerability to lactic acidosis, which can kill you. Now, it is crucial to identify these patient-specific factors, but that's your doctor's job. But you know, doctors may be busy, they may not pay attention sometimes, they're human beings, right? So just be easy on them. You have to also be your own lawyer, attorney in this case, right? But you have to tell your doctor, hey, what do you think about this? If your doctor is a little convinced that you're okay, you're okay, right? So sometimes patients will tell me, oh, I have read this online. I'm like, I know you read it, but I'm telling you, you're okay. So you have to have trust and faith in your doctor as well. So don't be one of those who Mr. Who knows or Mrs. Who knows everything, but it's good to know what's going on in your body. Anyway, so there's more to discover. Did you know that there are additional factors that can either increase or decrease the likelihood of metformin side effects? Well, let's dig around and explore more. So dietary choices, right? It is crucial to be aware of the potential risks associated with metformin side effects. One common risk factor is, I know, I hear you from here, alcohol. No, no, no, no, no. Particularly excessive drinking. Excessive alcohol intake can significantly increase the risk of lactic acidosis, which again, I just told you that can kill you. Additionally, alcohol can also raise the chances of experiencing hypoglycemia, a condition characterized by low blood sugar levels. Doesn't sound good, does it? For individuals taking metformin, it is advisable to avoid or at least limit alcohol consumption. One or two drinks tops. It's important to note that excessive alcohol intake can also contribute to liver disease, which can then further escalate the risk of lactic acidosis. Too much alcohol can even kill your pancreas totally, which is a condition called chronic pancreatitis, which when you have diabetes due to chronic pancreatitis, is even harder to treat than regular type 2 diabetes, even worse than type 1. Now another point worth mentioning is simultaneous occurrence of alcohol consumption and intense exercise. So I don't know who does that. There's some crazy people out there, but this combination will definitely increase your risk of hypoglycemia. If you're going having fun drinking, you know, 3, 4, 5, 6 beers or some, uh, whatever, vodka, and then you're on the boat and you're having fun, next thing you know, your blood sugar is down to 20 and then you're drowning. Not a good idea, right? So let's move on. Grapefruit consumption. It is essential to be cautious. Grapefruit or grapefruit juice have been known to interact with various medications, potentially increasing the risk of side effects. Why? Because grapefruit is a fruit, but guess what? What it does, and we know this, it's not a medication, but we all know this, that it will affect the enzymes in your liver that clear the medications. So if you cannot clear the medications, those medications will be more harmful to you. Not everything, but some of the medications. So although the evidence, I would say, is not great, but as I said, there are a lot of studies saying grapefruit consumption may lead to increased accumulation of metformin. Now, do you have to have grapefruit? Just go for the orange, for example. It looks similar. I mean, it doesn't taste similar, but it's kind of close, right? But you have to be careful about the grapefruit. If you really love that so much, maybe have a half of it and just say, I'm done. It's worth noting that the grapefruit interactions are a topic of debate. Some doctors may say, oh, don't worry about it, or whatever, but I think there's some consideration there now. You can exercise on metformin, there's nothing wrong with that. If you're consuming grapefruit alongside the metformin, nothing wrong with that, or any other medication, as long as you don't drink alcohol, or you make a cocktail from grapefruit and alcohol, and some crazy people do that. But anyway, understanding, let's do some potential interactions with metformin, and I'm going to get into this prescription medication interactions a little more now. So if you are currently taking any of these medications I'm going to talk to you about, you have to have a conversation with your doctor before making any changes. In fact, some doctors want to increase the metformin to very high doses. Like why? There's really no benefit of getting too much of a metformin, and actually, if you combine metformin and berberine, or dehydroberberine, you will have much better results than just jacking up the metformin. But don't worry, I'm here to provide you the necessary information with drug interactions. First off, let's talk about certain contrast media used in imaging modalities. So if you're going for a CT scan, for example, or there's some other imaging that use iodinated contrast media, they will interact with the metformin. That can even cause problems in renal clearance of metformin, leading to excessive concentration of metformin, which in turn will increase the risk of especially lactic acidosis. It's always wise to discuss any contrast media usage with your doctor, asking them, do you have to stop metformin, and in 99% of the cases, they will say yes, stop it a day before and start two days after a CT scan, for example. And when you go to the hospital, if they stop your metformin, and the real only reason they do that is they want to make sure that somebody orders CT and somebody forgets that the patient was taking metformin, and then there's a problem. So they don't want any problems, they're going to take the metformin off, and actually they're going to take everything off, pretty much, they're going to put you on insulin. So don't be upset, that's a typical hospital protocol, I know you don't like it, but that's what they do, for your safety. Now, some specific medications used to treat chest pain medications that can interact with metformin. I would say not every medication or chest pain medication will do that, and I'm not going to get into too nitty gritty on this, so if you are seeing a cardiologist for chest pain and they are giving you medications, ask them if there is any interaction with metformin. And if you're on metformin, you will need to have some potential adjustments in some other medications. For example, if you're doing steroids, good luck, right, prednisolone, diuretics, prismite, some drugs like some hormones, testosterone, estrogen, these are actually going to make you more insulin resistant, and you may actually need more diabetic medication, more of metformin, but preferably more of something else to keep your blood sugar under control. So if you're on metformin, everything is going well, and next thing you know, your blood sugars are in the 300s, maybe you're one of those, maybe you just started taking one of those steroidal agents, it could be a testosterone, it could be a birth control pill, those are also considered steroidal agents, okay? And when you start thyroid medications, etc., if your thyroid levels change, you may have problems with your blood sugar levels. If you just started taking contraceptive drugs, it is really important that you may become fairly insulin resistant fairly quickly, so you have to watch your diet, and if you have like PCOS, for example, or some other insulin resistance syndromes, you may want to consider using metformin or berberine just to prevent the excessive insulin resistance that may happen with it. Remember, knowledge is the power. You need to be aware of potential interactions, and keeping open lines of communication with your doctor will contribute to your overall well-being, so don't be hesitant to ask your doctor if there are interactions of the new medications especially being started on you if you are already taking metformin. Well, thanks for watching. Remember to visit sugarmd.com for berberine and superberberine, and make sure that we have a new app. It's called SugarMD app. That's actually not new, but we improved it, so it's a social app now. You can post what you're eating, you can post your experience, if you don't mind posting your personal things, like Facebook for diabetics. You also can ask a diabetes coach about your diet, etc. She's going to be there for you during the weekdays, so we hired a full-time person to help you with your diet questions as well. You can also call her over the phone from our phone lines if you have any diet-related or supplement-related questions. And finally, remember to subscribe to our email list because I'm going to start sending you some pretty cool emails that tell you important information that you may not have known about diabetes before. So, I'll see you in the next video.