Your NALFD Medication: Do You Know the Side Effects? Case Study: Metformin


If you’ve been diagnosed with NAFLD (non-alcoholic fatty liver disease), it’s likely your doctor has recommended diet and lifestyle changes along with watchful waiting and follow-up tests in a certain amount of weeks or months.

This is especially true if you are in the beginning stages of NAFLD, which are more easily managed via weight loss and exercise and do not generally require medication.

But the reality is that often, other conditions do exist along with NAFLD. Generally, these run along the lines of insulin and/or weight issues. When a condition – for example, metabolic syndrome/insulin resistance, or developing diabetes – is discovered along with NAFLD, even if that condition is mild, more and more doctors are seeking treatments for the concurrent issue in order to hopefully alleviate or at least stall the progression of NAFLD.

But could the treatment hurt more than the cure, as the old saying goes? Here is, currently, one of the most commonly prescribed medications off-label to help treat NAFLD, and the side effects that may accompany it. (Please note that we neither endorse nor seek to discredit this particular medication: the commentary below is for illustration purposes only. The following information is not inclusive. Please speak to your doctor directly for facts on taking Metformin and potential benefits or side effects.)


Metformin (most common marketing name: Glucophage) is one of the most frequently prescribed pharmaceutical treatments for Type II diabetes, a condition found in in a percentage of NAFLD patients.

A statistically significant number of Type II diabetes patients are also overweight (as are a percentage of NAFLD patients). There is some evidence that this medication may help stabilize weight or even be accompanied by weight loss, and though this is not a claim made by doctors or the producer of Metformin in an official way (correlation/causation has not been established), observation of the apparent phenomenon is one reason physicians may be willing to attempt this line of treatment off-label for NAFLD sufferers.

Metformin has a very positive history of helping Type II diabetic individuals and women with polycystic ovarian syndrome (PCOS), but is contraindicated (recommended against) in cases of kidney disease, lung disease, and severe liver disease. (Stage I NAFLD is not generally considered, by itself, to be a severe form of liver disease but rather, a preliminary one.) If your doctor is suggesting Metformin, don’t discount it, but do be aware of the risk of side effects.

These may include:

  • nausea
  • vomiting
  • stomach pain
  • diarrhea
  • loss of appetite
  • a metallic taste in the mouth

These are generally not life-threatening effects, but can be uncomfortable, can impact one’s quality of life if they are frequent, and may result in a degree of damage if they persist. Also, if you are underweight or have absorption issues, a loss of appetite and diarrhea could make these issues worse. Tell your doctor if you experience any of the above.

Very rare side effects of Metformin may include:

  • Elevated levels of lactic acid in the blood (lactic acidosis)
  • Decreased absorption of vitamin B12 during long-term use
  • Skin reactions such as rash, itching or flushing

The first two will only be detectable by symptoms and medical testing; for any skin reaction, IMMEDIATELY contact your physician or go to the nearest emergency room or Urgent Care. You may  be experiencing an allergic reaction to the medication.

Is Metformin “The Bad Guy”?

First, the above information is not intended to refute any advice or instruction given by your physician. If you are under the care of your doctor, DO NOT stop any current medication, alter the amount or timing of your medications, or begin any medicine, including over-the-counter preparations, without consulting your doctor first.

In many cases and for many patients, Metformin can be beneficial for their Type II diabetes condition. So we’re not advising you to skip this or another medication which could, even if indirectly, help you to get healthier.

Rather, the above illustration is made to point out that a drug is a drug is a drug, as the saying goes (in a slightly modified way for our purposes here), and both sides of the coin should be considered before deciding upon any pharmaceutical or surgical course of treatment.

Whatever treatment you and your physician choose, make sure to implement all lifestyle changes your doctor recommends. In the final analysis, to date, only a reduction of overall bodyfat has been directly implicated in improving NAFLD in a statistical portion of sufferers. Once you have that in place, follow your doctor’s instructions and be sure to ask questions, report any side effects, and follow up with all testing in a timely fashion so you can make the most of your treatment – and your health.





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