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Absorption of the medication itself is not affected by gallbladder absence

Metformin is associated with higher relative abundance of mucin-degrading Akkermansia muciniphila and several short-chain fatty acid-producing microbiota in the gut

Rather than acting in isolation, it operates within a complex microbial network that regulates barrier integrity, mucosal turnover, and hostmicrobe communication

Reduction in Systemic Inflammation Chronic inflammation, reflected by elevated CRP and TNF-, interferes with reproductive hormone signaling

doi:10.1038/cdd.2009.107, PMID: 19662025 Balaban RS, Nemoto S, Finkel T (2005) Mitochondria, oxidants, and aging