New research suggest that specific probiotics formulated to stimulate the production of folate (also know as vitamin B9) in the colon might help alleviate metformin-associated gastrointestinal adverse effects. Gastrointestinal distress, which can manifest as stomach pain, bloating, gas, diarrhea or constipatio, is one of the most common side effects of the type 2 diabetes drug metformin. It is thought that metformin can cause gastrointestinal problems by inducing an imbalance in gut bacteria. Specifically, metformin affects or reduces the limited number of bacteria able to produce folate. At the same time, metformin tends to decrease the absorption of folic acid, which is the synthetic form of folate that can be taken via pills or supplements. Therefore, metformin has not only an inhibitory effect on the production of folate in the colon but also reduces its bioavailability from other sources. Folate deficiency has been linked to inflammatory bowel disease (IBD) and the occurence of gastrointestinal symptoms, including abdominal pain and diarrhea, especially after meals. Several probiotic strains of bacteria are able to produce folate. For example, bifidobacteria and lactobacilli-containing probiotics have

been extensively studied for their capacity to produce this vitamin. In this new scientific research proposal, a researcher from Istanbul Kemerburgaz University, in Turkey, chose to focus on a probiotic bacteria called Intestinibacter Bartlettii, whose count is significantly lowered with metformin treatment. The idea of biochemist Adbullah Olgun is to engineer this bacteria so that it is resistant to metformin and a greater folate producer by means of complex procedures and genetic manipulations. The, it could be made into a probiotic for metformin users. The prevention of stomach problems with metformin currently focuses around taking the treatment during or after a meal or using a lower dosage. Olgun suggests that taking a probiotic alongside treatment could be an alternative strategy. Helping to restore the integrity of the gut microbiota and increasing folate production could help counteract many gastrointestinal problems seen with metformin. Future research will look to elaborate on Olgun’s theory and find out which bacteria in the gut, other than Intestinibacter Bartlettii, are sensitive to metformin and design specific folate-producing probiotics with data collected from studying them.