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Despite adherence challenges, clinical studies report encouraging signals

Eligible studies had to report both microbiome measures (e.g., taxonomic composition) and hepatic parameters (e.g., histopathology, enzyme activity, oxidative stress markers)

Additionally, Metformin does lead to a decrease in oxidative stress (ROS production) and a decrease in DNA damage (a consequence of using a low dose of a mitochondrial poison)

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In available research it's been generally well-tolerated, but human safety data is limited and it isn't FDA-approved which is why it should be used under medical supervision, not self-sourced online