I'm not aware of the mechanisms leading to lactic acidosis, does it affect basal lactate levels? What does happen if your body needs to use anaerobic glycolysis for its energy needs (e.g. 400m sprint or other such activity)? Will metformin impair performance or could it even be dangerous?
What about sudden kidney or liver failure? Could it kill you because of your metformin intake, while someone not taking metformin would easily survive on dialysis/transplants?
This study, looking at metformin and exercise in healthy males suggests that it does not affect lactate production during strenuous activity - so it may be safe for that.
On the other hand, here are a few case reports of lactate acidosis in people taking metformin who did not have renal failure or other pathologies [
1,
2,
3,
4]. Ironically, lactate acidoses induces renal failure later down the road too.
Looking at this another way,
here's a study that shows an increase of lactate in patients given metformin, but it wasn't significant. On the other hand,
in a perfused rat liver, a closed system, metformin significantly increased lactate, according to its mechanism of stimulating flux of glucose to lactate, preventing lactate turn over back into glucose (gluconeogenesis), and blocking liver uptake of lactate, all of which can increase lactate levels in cells and serum. Apparently, generally the body can deal with this fine, which means metformin is generally safe, even under conditions of exercise. These cases and its mechanism of action, are interesting though, and something to keep in mind; after all, the life span increasing ability has only been seen with hypertension mice and female transgenic HER-2/neu mice, which may mean it's a good drug candidate for the treatment of such. However, both types of mice did not live as long as, or only matched, the normal life span of wild type laboratory mice, even with metformin (half the life span of a normal mouse for the HER-2/neu mice with metformin, and about the same life span of a normal mouse for the SHR mice with metformin).
Edited by Michael, 19 July 2012 - 11:52 AM.