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It is about giving the nutritional correction phase enough runway to actually work

10.1371/journal.pbio.2006203 PLoS Biol

However, it is worth noting that, although metformin is generally well-tolerated in the treatment of PCOS and no serious adverse events or hepatic or renal dysfunction were observed during the clinical period, the most commonly reported side effects are short-term gastrointestinal disturbancesincluding nausea, bloating, and diarrheawith roughly one quarter of adult participants experiencing these symptoms yet continuing the medication, and a small number of adolescents discontinuing treatment after gastrointestinal reactions persisted for more than two weeks

When the parasitemia reached around 2% with predominant ring stages, the cultures were subjected to two rounds of tight synchronization within a span of 3 h in the previous cycle, followed by one additional synchronization in the subsequent cycle when they are in early rings