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Foods To Avoid While Taking Metformin

By Dr. Vishesh Bharucha +2 more

Introduction

Did you know that some foods can mess with your medicines? This can happen even with everyday foods like grapefruit or coffee. It is important to avoid such food-drug interactions to prevent any adverse events and maintain the effectiveness of the medicine1.  

In this article, we’ll discuss about the food interactions which can occur with the drug, metformin. Metformin is a common medicine prescribed for the management of Type 2 Diabetes. We’ll talk about Metformin’s intricate relationship with foods, when to take it, and more2.   

foods to avoid while taking metformin

Did you know? 

  • Metformin has been shown to improve ovulation rates in women with polycystic ovary syndrome, especially when combined with letrozole. Source: pmc.ncbi.nlm.nih.gov 
  • Metformin may have protective effects against pancreatic cancer compared to other diabetes medications. Source: pmc.ncbi.nlm.nih.gov 
  • Metformin has been shown to be as safe and effective as insulin for the treatment of gestational diabetes. Source: pubmed.ncbi.nlm.nih.gov

Understanding Metformin

Metformin is a drug that helps bring down your blood sugar levels. It is mainly used to manage Type 2 diabetes3

Dosage and Usage

Metformin is available in different doses and forms. These include tablets, oral solutions, and even extended-release tablets. Your doctor will prescribe the right form and dosage based on your health condition and lifestyle. 

Storage and Precautions

Mostly, Metformin is stored at room temperature. It should be placed away from moisture or heat. Also, keep it out of reach of children. 

Mechanism of Action of Metformin

How Does Metformin Function?

Metformin mainly works by reducing glucose production by the liver. By doing so, it helps lower overall blood sugar levels. It also improves the body’s response to insulin and helps cells use insulin better, making it easier for them to take in glucose from the blood4,5. If you have type 2 diabetes, your healthcare provider may prescribe Metformin. 

Interaction with Different Foods

Certain food items and alcohol can affect Metformin’s effects6,7. We will discuss this in detail in the coming sections. 

In my experience, I have observed that use of metformin might lead to vitamin B12 deficiency. It is important to be aware of the potential risk and consider regular monitoring of your vitamin B12 levels, as well as discussing the need for supplementation with your healthcare provider13.

Dr. Siddharth Gupta, BAMS, MD (Ayu)

The Metformin and Food Dilemma

Food choices play a big role in managing type 2 diabetes. While they don’t directly counteract Metformin’s actions, overeating or bad food choices can increase its efforts to control blood sugar. 

1. Foods to Avoid While Taking Metformin

carbohydrate

Certain foods can get in the way of Metformin. These are processed carbohydrates, saturated fats, trans fats, and too much sodium. While not opposing Metformin directly, they can spike up your glucose and insulin levels. 

Detailed list of Foods to Avoid  

  • Refined/processed carbohydrates: Stuff like white bread, white rice, candy, soda, white pasta, white rice 
  • Saturated fats: Things like red meat, butter, cheese 
  • Trans fats: Baked goods from stores, fast food 
  • Excessive sodium: Pre-packaged snacks, canned soups, fast food 
  • Sugar-sweetened soda, chips, crackers, ice cream, cakes, chocolates 

Saturated fats can also make you more insulin resistant, which can make weight loss and blood sugar management more difficult. Fatty foods can delay gastric emptying and contribute to, prolonged postprandial hyperglycaemia (high blood sugar levels after food), which can be problematic over the long term. Sodium does not directly affect blood glucose or Metformin, but it increases cardiovascular risk and blood pressure, which are comorbid concerns in diabetes8. Also, some studies6 have found that a high-fat, high-calorie diet can slow the absorption of metformin. 

So, although these foods don’t directly interfere with Metformin’s pharmacologic action, they can oppose its intended effect by raising blood glucose levels, adding to Metformin’s workload. 

2. Foods to Consider While Taking Metformin

fresh fruit and vegetables

Some foods can make it hard for Metformin to work. Yet, some others support Metformin’s actions. These are complex carbohydrates, healthy fats, fibre, lean proteins, and select fruits and vegetables9

Detailed List of Beneficial Foods 

  • Complex carbohydrates: Things like whole grains, fruits, and vegetables. 
  • Healthy fats: Fish, nuts, avocados, and olive oil. 
  • Fibre-filled foods: Whole grains and veggies. 
  • Lean proteins: Turkey, chicken, fish, and tofu. 
  • Vegetables: Non-starchy veggies like broccoli, cabbage, greens. 
  • Low-carb fruits: Berries are lower in carbs but high in fibre. 

Consuming these foods along with Metformin can support your blood sugar balance. Plus, it can help keep your weight in check. But please note that not all fruits are low glycaemic. Portion control and glycaemic index should be considered especially if you are diabetic. Your doctor can guide you best on what type of foods you can eat based on your blood sugar control. 

Based on my experience, I have found that metformin typically does not cause low blood sugar (hypoglycaemia) when taken alone. However, it is important to be cautious when combining metformin with other diabetes medications like insulin or gliclazide, as these combinations may increase the risk of hypoglycaemia13.

Dr Rajeev Singh,BAMS

Metformin and Specific Food Interactions

Food choices matter a lot in diabetes, especially if they interact with drugs like Metformin. Here are some specific food items that can affect metformin. 

1. Metformin and Grapefruit Interactions

Grapefruits are beneficial but found to interact with many drugs including Metformin. An old study on non-diabetic rats showed grapefruit juice might trigger a potentially fatal condition called lactic acidosis when mixed with Metformin10. Lactic acidosis is a rare but serious side effect of metformin, typically in patients with renal impairment or other risk factors. 

Grapefruit inhibits CYP3A4 enzymes, affecting drugs metabolized by this pathway (e.g., statins, calcium channel blockers). However, Metformin is not significantly metabolised by CYP enzymes, including CYP3A4. So, this seems to be an overemphasised claim. Yet, we don’t have any human case studies indicating a similar reaction with Metformin and grapefruit so far. More research is needed here. 

2. Metformin and Alcohol/Food Pairings

Alcohol consumption may also interact with Metformin’s action. Taking alcohol and Metformin together may cause lactic acidosis, a rare but serious condition7. Still, this could happen only if you drink alcohol heavily and regularly. It can also swing your blood glucose levels both ways – high (hyperglycaemia) and low (hypoglycaemia). Moderate drinking usually isn’t problematic unless you have kidney or liver issues. (Note that moderation as per guidelines is termed as no more than one drink per day, for women, and for men, a moderate amount is no more than two drinks per day.) 

Drinking alcohol regularly can also exacerbate kidney and liver issues, so talk with your doctor if you suffer from non-alcoholic liver disease or kidney disease before consuming alcohol with Metformin.  

How To Take Metformin?

Wondering how to take metformin the right way? Let’s see how and when to take Metformin for best results. 

Best Time to Take Metformin

When taking Metformin, timing is important for minimizing side effects (like GI upset) and optimizing blood glucose control. Normally, immediate-release tabs are taken twice a day while extended-release tabs are taken once daily. Keeping to this schedule helps manage diabetes effectively. 

Should Metformin Be Taken with Food?

Taking Metformin with meals can cut down its side effects like gas, bloating, nausea, and diarrhoea. Extended-release Metformin is usually taken with the evening meal to reduce gastrointestinal side effects and enhance overnight control. 

Side Effects of Metformin

Metformin, a widely prescribed medication for managing Type 2 diabetes, offers significant benefits, but users should be aware of potential side effects. Commonly reported metformin side effects include gastrointestinal symptoms like nausea, diarrhoea, and abdominal discomfort, although these often subside with continued use.  

1. Gastrointestinal Symptoms

  • Nausea, diarrhoea, and abdominal discomfort are common initial side effects11

Continued use often leads to a gradual diminishment of these symptoms. 

2. Rare but Serious Side Effects

  • Lactic acidosis (though rare and primarily occurs in patients with renal insufficiency, severe liver disease, heart failure, or dehydration) requires attention as it can be life-threatening11.
  • Vigilant monitoring and communication with healthcare providers are essential. 

3. Gender-Specific Considerations

Metformin Side Effects in Females:

  • Metformin can impact hormonal levels in women with polycystic ovary syndrome (PCOS) by reducing insulin resistance and androgen levels. 
  • Caution is warranted in specific cases like PCOS or infertility treatment 

Metformin Side Effects in Males: 

  • Similar gastrointestinal symptoms, with potential effects on male reproductive hormones. 
  • Personalized guidance necessary for those with hormonal concerns. 
  • Timely Reporting and Adjustment: 

When to Consult Medical Providers

If your health changes or you spot signs like muscle pain, feeling tired, abdominal complaints, uneven heartbeats, or problems in breathing, get immediate medical help. These could be early signs of lactic acidosis. It’s a serious but rare side effect of Metformin. 

Foods to Avoid When Taking Metformin for PCOS

When taking metformin for PCOS, it’s advisable to be mindful of certain foods. Limiting high-carbohydrate and sugary foods can enhance its effectiveness. Avoid excessive alcohol consumption and consider reducing intake of processed foods. Incorporating a balanced diet with whole grains, fruits, and vegetables is beneficial. Consulting with a healthcare professional for personalized dietary recommendations is essential for optimal PCOS management with metformin. 

Metformin’s Impact on Weight

Another interesting aspect of Metformin is its effect on body weight. Over time, people using Metformin have reported a slight weight loss. But remember, this isn’t guaranteed for all users. 

Researchers have noticed a link between Metformin and weight loss, which might be due to reduced hunger cues12. However, metformin’s weight loss effect is thought to be multifactorial, including improved insulin sensitivity, decreased hepatic glucose production, possible mild appetite suppression, and effects on gut hormones like GLP-1. But keep in mind, weight management isn’t only about medicine. It’s also about eating healthy and exercising regularly. 

The Role of Metformin in Long-term Weight Loss

Long-term weight loss linked with Metformin varies from person to person and may not be as much as you’d want. An average drop of around six pounds after a year of treatment is seen. To kickstart and keep up the weight loss, diet tweaks and exercise are crucial elements as well. 

Is Metformin Recommended for People without Diabetes?

Simply put, no. Metformin is specially made for patients with Type 2 diabetes. Though it has shown results in helping non-diabetic obese patients lose weight, this is an ‘off-label’ use and not approved by the FDA for non-diabetics. However, metformin is sometimes used off-label in PCOS and prediabetes with some evidence of benefit. 

Conclusion

Dealing with food-drug interactions can be hard. However, understanding your body’s specific reactions can help keep good health and make your medication work best. 

In short, matching wise food habits with Metformin can boost its effects in controlling Type 2 diabetes while making the wrong choices can increase its workload. Often, it’s about learning the potential interactions and making small food swaps in our daily meals. If you have diabetes, it’s best to discuss with your doctor and design the best diet plan that is suitable for your condition and does not impact your medications. 

Moreover, simple things like watching your salt intake, staying hydrated, and exercising regularly can have a beneficial impact on your overall health. Remember, tiny tweaks in your diet and lifestyle can yield big health gains over time! 

Frequently Asked Questions (FAQs)

Can Metformin be taken with coffee? 

As of now, there’s not enough proof to say coffee messes up Metformin. But remember, too much of caffeinated drinks might cause hydration issues. So, drink moderately. 

What should I watch out for when taking Metformin?  

Metformin may cause nausea, and if you also take insulin, Metformin can cause low blood sugar levels. This can be dangerous if you’re unable to keep liquids down, so call your doctor immediately if this is the case and you’re having trouble treating low blood sugars. 

Can I take Metformin if I am breastfeeding? 

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. However, studies have shown that Metformin passes into breast milk in very low amounts but is generally considered compatible with breastfeeding. The American Academy of Paediatrics (AAP) and other authorities regard Metformin as usually safe during lactation. However, consult a doctor who will weigh the potential benefits against the potential risks before prescribing this medication while breastfeeding. 

How soon will I be able to notice the benefits of Metformin use? 

You may notice improvement in your blood glucose control in 1 to 2 weeks, but the full effect of blood glucose control may take up to 2 to 3 months. Ask your doctor if you have any questions about this. 

What should be the ideal breakfast when on Metformin? 

Health pros suggest a low-carb, high-protein breakfast might work well with Metformin. Think eggs, lean meats, whole grains, and fresh fruits. It gives you main nutrients, lowers glycaemic spikes, and keeps you full till lunchtime. 

Why does metformin cause diarrhoea? 

Metformin-induced diarrhoea is thought to result from its impact on the gastrointestinal tract, causing increased fluid secretion and alterations in gut motility. Metformin increases intestinal glucose and bile acid concentrations, which can cause osmotic effects leading to increased fluid retention in the bowel. It may also alter gut microbiota and serotonin pathways affecting motility. Consultation with a healthcare professional is recommended for those experiencing persistent or severe diarrhoea while using metformin. 

Can metformin cause hypoglycaemia? 

Metformin typically does not cause hypoglycaemia (low blood sugar) when used as a monotherapy. However, in combination with other diabetes medications that can lower blood sugar, there may be a higher risk of hypoglycaemia. It’s essential to follow healthcare provider guidance and monitor blood sugar levels regularly. 

Can metformin be given in pregnancy? 

Metformin is occasionally prescribed during pregnancy for gestational diabetes but should only be used under the guidance of a healthcare professional. Individual health considerations and potential risks to the mother and foetus need to be carefully evaluated before making any decisions about medication during pregnancy. 

Can metformin cause kidney damage? 

While metformin is generally considered safe for the kidneys, there’s a rare risk of lactic acidosis, a serious condition. It’s crucial for individuals with kidney issues to consult with a healthcare professional to determine the appropriateness of metformin and to monitor kidney function regularly. 

Does metformin reduce insulin resistance? 

Yes, metformin is known to reduce insulin resistance, a key factor in type 2 diabetes. It improves insulin sensitivity, allowing cells to better respond to insulin and promoting better regulation of blood sugar levels. 

Is metformin habit-forming? 

No, metformin is not habit-forming. It is an oral medication commonly prescribed to manage type 2 diabetes and does not possess addictive properties. Always follow your healthcare professional’s guidance on medication use.

Can metformin reverse prediabetes? 

 
Metformin for prediabetes can be effective in slowing or preventing the progression from prediabetes to diabetes. However, individual responses vary, and it’s essential to consult with a healthcare professional for personalized advice on its use and to incorporate lifestyle changes for comprehensive prediabetes management. 

Can you stop taking metformin? 

Stopping metformin suddenly can mess with your blood sugar. Always talk to your doctor before making any changes to your medication, so they can help you do it the right way. 

Can metformin cause liver damage? 

Metformin is generally considered safe for the liver, but in rare cases, it may cause an increase in liver enzymes. Regular monitoring and consultation with a healthcare professional are recommended to ensure the medication’s safety and address any potential concerns. 

What are the signs that metformin is working? 

Signs that metformin is working include stable blood sugar levels, better insulin sensitivity, and reduced symptoms related to the medical condition. Regular check-ups with a healthcare professional help track and confirm its effectiveness for each individual. 

References

  1. Petric Z, Žuntar I, Putnik P, Bursać Kovačević D. Food-Drug Interactions with Fruit Juices. Foods. 2020 Dec 24;10(1):33. doi: 10.3390/foods10010033. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7823305 
  2. Sharpe A, Morley LC, Tang T, Norman RJ, Balen AH. Metformin for ovulation induction (excluding gonadotrophins) in women with polycystic ovary syndrome. Cochrane Database Syst Rev. 2019 Dec 17;12(12):CD013505. doi: 10.1002/14651858.CD013505. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6915832/ 
  3. Lv Z, Guo Y. Metformin and Its Benefits for Various Diseases. Front Endocrinol (Lausanne). 2020 Apr 16;11:191. doi: 10.3389/fendo.2020.00191. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC7212476/  
  4. Corcoran C, Jacobs TF. Metformin. [Updated 2023 Aug 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK518983/  
  5. Yerevanian A, Soukas AA. Metformin: Mechanisms in Human Obesity and Weight Loss. Curr Obes Rep. 2019 Jun;8(2):156-164. doi: 10.1007/s13679-019-00335-3. Available from: https://pubmed.ncbi.nlm.nih.gov/30874963/  
  6. Sun ML, Liu F, Yan P, Chen W, Wang XH. Effects of food on pharmacokinetics and safety of metformin hydrochloride tablets: A meta-analysis of pharmacokinetic, bioavailability, or bioequivalence studies. Heliyon. 2023 Jul 1;9(7):e17906. doi: 10.1016/j.heliyon.2023.e17906. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10344758/ 
  7. Yamagishi H, Sekiguchi N, Hirano A, Oshima A, Imai T. Metformin-associated Lactic Acidosis Induced by Excessive Alcohol Consumption. Intern Med. 2024 Jun 15;63(12):1745-1749. doi: 10.2169/internalmedicine.2707-23. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC11239242/  
  8. Pramono A, Fitranti DY, Nugroho KH, Sobirin MA, Syauqy A. The Association between Unhealthy Food Consumption and Impaired Glucose Metabolism among Adults with Overweight or Obesity: A Cross-Sectional Analysis of the Indonesian Population. J Obes. 2023 Mar 22;2023:2885769. doi: 10.1155/2023/2885769. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10060072/  
  9. Reynolds A, Mitri J. Dietary Advice For Individuals with Diabetes. [Updated 2024 Apr 28]. In: Feingold KR, Ahmed SF, Anawalt B, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279012/  
  10. Owira PM, Ojewole JA. Grapefruit juice improves glycemic control but exacerbates metformin-induced lactic acidosis in non-diabetic rats. Methods Find Exp Clin Pharmacol. 2009 Nov;31(9):563-70. doi: 10.1358/mf.2009.31.9.1435463. Available from: https://pubmed.ncbi.nlm.nih.gov/20094639/  
  11. Crowley MJ, Diamantidis CJ, McDuffie JR, et al. Metformin Use in Patients with Historical Contraindications or Precautions [Internet]. Washington (DC): Department of Veterans Affairs (US); 2016 Sep. APPENDIX A, FDA SAFETY ANNOUNCEMENTS FOR METFORMIN. Available from: https://www.ncbi.nlm.nih.gov/books/NBK409379/ 
  12. Lee A, Morley JE. Metformin decreases food consumption and induces weight loss in subjects with obesity with type II non-insulin-dependent diabetes. Obes Res. 1998 Jan;6(1):47-53. doi: 10.1002/j.1550-8528.1998.tb00314.x. Available from: https://pubmed.ncbi.nlm.nih.gov/9526970/
  13. NHS. Side effects of metformin. NHS Medicines A to Z: Metformin – side effects of metformin [Internet]. Last reviewed 24 March 2022 [cited 2025 Jul 2]. Available from: https://www.nhs.uk/medicines/metformin/side-effects-of-metformin/

Disclaimer: The information provided here is for educational/awareness purposes only and is not intended to be a substitute for medical treatment by a healthcare professional and should not be relied upon to diagnose or treat any medical condition. The reader should consult a registered medical practitioner to determine the appropriateness of the information and before consuming any medication. PharmEasy does not provide any guarantee or warranty (express or implied) regarding the accuracy, adequacy, completeness, legality, reliability or usefulness of the information; and disclaims any liability arising thereof. 

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