If You Take Metformin
For patients taking metformin, its actually critical that you supplement with B12. Research in 2019 found that patients taking metformin are developing a B12 deficiency.
Theyre also found that B12 deficiency can lead to nerve damage that is misdiagnosed as complications from high blood sugars when its actually related to long-term metformin use and low B12 levels.
Review Of Studies Examining How Metformin Affects The Status Of Specific Micronutrients And The Microbiome
Vitamin B1 acts as a coenzyme in neurotransmission and low levels of this nutrient may have a role in the development of certain diabetic complications.31 Phenformin has been reported to exhibit anti-thiamine activity in animals,3234 and as a result, it has been suggested that a possible anti-thiamine effect of metformin might contribute to some cases of metformin-associated lactic acidosis, a rare condition, but one that has been shown to have a mortality rate of 1825%.3537 It has been proposed that metformin and phenformin inhibit thiamine absorption through inhibition of the human thiamine transporter in the small intestine,38 a finding recently confirmed to be clinically relevant,39 particularly in at-risk populations. In patients with T2DM, plasma thiamine concentrations have been demonstrated to be reduced.40,41 The magnitude of these reductions can be as large as 76% and 75%, respectively, compared to levels in healthy volunteers with renal clearance of thiamine increased 16-fold in T2DM patients.40,41 Low thiamine concentrations have been correlated to higher concentrations of soluble vascular adhesion molecule-1 , a surrogate marker of potential vascular disease in some, but not all studies.40,41
Box 1 Suggested Mechanisms That Result in Metformin-Induced Deficiency of Vitamin B12 in Patients with T2DM
When Is B12 Considered To Be High Dose
A vitamin B12 dose of 1000 µg or more is considered high. This corresponds to over 40 000% of the daily requirement of 2.5 µg officially recommended by the Institute of Medicine , which initially appears to be an enormous overdose.
However, this impression is put into perspective if you consider the actual intake: from the 1000 µg, only a maximum of 12 µg is actually absorbed by the body with a single oral dose only 480% of the daily requirement .
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B12 For Memory And Mood
Its commonly thought that taking vitamin B12 can boost your memory and mood. However, theres not a lot of evidence to support this theory.
Animal studies suggest that vitamin B12 deficiency has been associated with memory impairment. Yet, theres currently no evidence that B12 supplements improve memory in humans who arent deficient .
In a large review, vitamin B12 supplements had no effect on depressive symptoms in the short term but may help prevent relapse over the long term (
There are no specific dosage recommendations for B12 supplements for mental performance or mood.
Optimal dosing of vitamin B12 varies by age, lifestyle, and dietary needs. The general recommendation for adults is 2.4 mcg. Older adults, as well as pregnant and breastfeeding women, require higher doses.
Vitamin B1 Or Thiamine
When taken in its fat soluble form benfotiamine, helps prevent circulatory issues in diabetics protects nerves, eyes and limbs.
Things to bear in mind A combination of Vitamins B6, B9 and B12, when given to patients with diabetic nephropathy , was found to worsen the condition in one study. Researchers felt that the possible reason for this could be the excessive excretion of magnesium due to this combination of vitamins B. It would be advisable for anyone considering a Vitamin B Complex to also include a Magnesium supplement. If you have kidney disease as well as diabetes, it would be best to involve your medical practitioner.
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Is It Safe To Take Supplements If You Have Diabetes
You will find supplements for anything and everything these days. Even when you do not suffer from an ailment, supplements are suggested to keep you healthy and ailment-free. According to CDC, use of supplements is common among US adult population over 50% adults used supplements during 2003-2006, with multivitamins/multiminerals being the most commonly used.
So when you are a diabetic, especially if you have prediabetes and type-2 diabetes, you may find yourself confronting a large number of options for supplements that claim to support, reduce and even cure your diabetes. Diabetes is quite a frustrating disorder and you may find yourself tempted to try out these supplements one after another. But is it really safe to take supplements when you are a diabetic? Let us find out. But before that you need to understand what exactly supplements are.
Foods That Contain B Vitamins
Foods rich in Vitamin B
The vitamin B family is present in so many foods that this cannot be an exhaustive list by any means. However, weve picked some of the foods that have a high balance of all the Vitamins B.
Beef, beef liver, oats, tuna, turkey breast, eggs, bananas , avocado, kidney beans, summer squash, spinach, kale, almonds, milk . Several of the recipes listed in our diabetes-friendly diet can give you interesting and tasty ways to incorporate these foods into your daily diet.
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Staying Healthy As The Years Go By
As we get older, we have to get more creative and involved in staying healthy. Planning regular visits to the doctor and getting blood tests can help us stay on top of vitamin deficiencies and other issues that may cause health problems. Fortunately, if you have a B12 deficiency, its relatively easy to get a diagnosis and start a treatment plan.
For other ways to stay healthy, Snug has you covered. Visit our blog for more information on how to stay active, including tips for yoga, tai chi, core exercises, and balance exercises for seniors. Youll find advice ranging from the best vitamins for seniors to tips on recovering from surgeries such as hip replacements and bunion surgery.
We also make it easy for you to stay connected in an increasingly digital world. Discover how to stay in touch with loved ones with the best cell phones for seniors, and learn how to stay connected with online forums. The Snug app is also a free and friendly way to get daily check-ins that can give you peace of mind and freedom. The app will check in with you each day. If somethings amiss, itll notify your emergency contacts.
Which Vitamin B Is Good For Diabetics
. Moreover, is vitamin B complex good for diabetics?
Vitamin B-12 is necessary for a healthy nervous system and healthy blood cells. For example, having diabetes mellitus can increase your risk of having a B-12 deficiency because it may be a side effect of metformin, a common treatment for type 2 diabetes mellitus.
One may also ask, how much vitamin b12 should a diabetic take? In the US, it is currently believed that adults with type 2 diabetes that are over 50 should take 2.4 µg of synthetic vitamin B12 daily either in supplement form or in fortified food.
Then, what vitamins should diabetics take?
Using Supplements for Diabetes Treatment
- Chromium. Chromium is an essential trace element.
- Vitamin B-1. Vitamin B-1 is also known as thiamine.
- Alpha-Lipoic Acid. Alpha-lipoic acid is a potent antioxidant.
- Bitter Melon.
Top Sources Of Dietary Vitamin B12
- Organ meats kidney, heart, giblets, brains
- All meats and poultry
Include the above foods regularly in your diet and your intake of B12 should be sufficient. If youre a vegetarian or especially a vegan, it is highly recommended you take a supplement.
There are also other food items that have been fortified with B12 such as: nutritional yeast, breakfast cereals, breads and sometimes tofu but in many cases, these are foods we would not necessarily recommend for a low carb T2 diabetic diet. Stick to the natural food sources because they are a much better option.
Just know though, if you are deficient in vitamin B12, it is very unlikely you will be able to correct the problem through food alone, but will likely need to include a supplemental form, at least for a time.
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A Potentially Dangerous Diagnosis
That diagnosis of peripheral neuropathy could be falsely attributed to the patients blood sugar management rather than to the side effects of the medication being used to treat the patients diabetes.
Current British Society of Haematology guidelines recommend that vitamin B12 levels are checked only when there is clinical suspicion of deficiency, explained Mulla. However, peripheral neuropathy is irreversible and it may be too late once symptoms have developed.
An unknowing doctor might even prescribe a higher dose of metformin to improve the patients blood sugar levels, not realizing that indeed a side effect of the drug itself is the culprit.
Ive been hearing about this since about five years ago, Dr. Caroline Messer, an endocrinologist specializing in bone loss at Lenox Hill Hospital in New York, told Healthline. But there are no guidelines established for testing for it.
Messer said the problem is that while some doctors are testing their patients vitamin B12 levels, many doctors are not because it hasnt become an official part of standardized diabetes care.
In my office, patients on metformin who are B12 deficient isnt something we see often. Its rare here, but this study says 10 percent of all patients taking metformin are deficient, and thats not a small amount, she said.
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Metformin Induced Vitamin B12 Deficiency Among Patients With T2dm
In the absence of contraindications like renal and hepatic dysfunction, recent guidelines advocate for the use of metformin as the first line glucose lowering agent concurrently with life style modification approaches . Despite its very superior glycemic lowering effect, metformin has for long been shown to decrease vitamin B12 levels. In one early randomised controlled trial by DeFronzo et al., metformin decreased the serum vitamin B12 levels by 22% and 29% compared to placebo and glyburide respectively . This side effect of metformin has been demonstrated again in several ensuing cross sectional studies , case reports and randomised controlled trials .
The risk of developing metformin associated vitamin B12 deficiency is greatly influenced by increasing age, metformin dose and duration of use . In a nested case control study performed among 155 adult Chinese DM patients on metformin and 310 controls, every 1 g/day increase in the metformin dose conferred an odds ratio of 2.9 for developing vitamin B12 deficiency. Among patients using metformin for 3 years, the adjusted odds ratio was 2.4 compared with those who had received metformin for 3 years .
Histamine H Receptor Antagonist /proton Pump Inhibitor Induced Vitamin B12 Depletion
Literature suggests that drugs which suppress stomach acid production such as PPIs159163 and HRAs164167 interfere with vitamin B12 absorption, by reducing dietary B12 release from food proteins. A 5389% reduction in protein-bound B12 absorption was noted following HRA treatment,159,162 with ranitidine specifically reported to induce decreases in B12 status.168171 Similarly, there have been other reports of an inverse correlation between vitamin B12 levels and duration of PPI therapy.172175 The enzyme cytochrome P450 2C19 , catalyses the metabolism of PPIs and a polymorphism of this enzyme has been demonstrated to influence levels of vitamin B12 in patients using these medications.173 Hence, those who poorly metabolize PPIs are likely to exhibit increased suppression of acid production and thus more interference with absorption of vitamin B12. Alternatively, patients who have enhanced PPI metabolism are likely to experience diminished acid suppression with a lower interference with absorption of B12.
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Recommended Vitamin B12 Dosage For Seniors
The proper vitamin B12 dosage for seniors depends on if they have underlying health conditions and how severe their deficiency is. In some cases, doctors may recommend high doses more than 1,000 micrograms per day. A recent study found that for seniors, a daily dose of 500 micrograms was efficient in reversing the signs of B12 deficiency.
In general, experts recommend 2.5 micrograms of vitamin B12 per day for people over the age of 14. You can get these amounts from taking dietary supplements like multivitamins, B12 supplementation including sublingual tablets, or by eating certain foods rich in vitamin B12.
There is no one recommended vitamin B12 dosage for seniors. Rather, the right daily intake will largely depend on your specific situation. Make an appointment to talk with your doctor about the best treatment plan for you.
Physiological Roles Of Vitamin B12
Vitamin B12 exerts its physiological effects through mediating two principal enzymatic pathways i.e. the methylation process of homocysteine to methionine and the conversion of methylmalonyl coenzyme A to succinyl-CoA. Vitamin B12 as a co-factor facilitates the methylation of homocysteine to methionine which is later activated into S-adenosyl-methionine that donates its methyl group to methyl acceptors such as myelin, neurotransmitters and membrane phospholipids.
Metabolically significant vitamin B12 deficiency hence will result in disruption of the methylation process and accumulation of intracellular and serum homocysteine. Hyperhomocysteinemia has been shown to have potentially toxic effects on neurones and the vascular endothelium. This reaction is also essential in the conversion of dietary folate to its active metabolic form, tetrahydrofolate. In another essential enzymatic pathway, vitamin B12 as a co-factor mediates the conversion of methylmalonyl coenzyme A to succinyl-CoA. In the presence of vitamin B12 deficiency, this conversion pathway is diminished and an increase in the serum methylmalonic acid ensues. This is followed by defective fatty acid synthesis of the neuronal membranes . Vitamin B12 is also essential in the synthesis of monoamines or neurotransmitters like serotonin and dopamine . This synthesis is impaired with vitamin B12 deficiency.
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How To Diagnose A Vitamin B12 Deficiency
The best way to see if you have a vitamin B12 deficiency is to visit your healthcare provider and take a blood test. On the day of your visit, your doctor will ask you about your medical history and draw blood to determine your B12 levels in blood serum. This blood test will analyze serum levels and can also help determine if you have any other vitamin deficiencies.
Your doctor may also order a methylmalonic acid test to confirm the results of the blood test. In certain cases, your doctor may recommend a bone marrow biopsy to determine the source of the deficiency.
Often, seniors will experience both vitamin B12 and folate deficiencies at the same time. Thats because both of these nutrients play a key role in blood cell production and can be inhibited by medical conditions. If your doctor determines you have a deficiency, they may recommend you get vitamin B12 injections or take vitamin B12 supplements.
You can take oral vitamin B12 supplements, or the doctor may recommend certain foods that contain large amounts of B12. Some individuals will only need to take these supplements for a short period while others, particularly those with anemia, may need to take them long-term.
Where Will I Go For My Patient Support Needs
- The ADA blog features real, user-submitted stories of how people manage their diabetes, and is broken into categories .
- For those with type 2 diabetes, the ADAs free, online Living With Type 2 Diabetes program will continue. You are encouraged to register for this program and take small steps to big changes.
- The ADA offers Healthy Living information and resources for all people with diabetes and their loved ones at diabetes.org/healthy-living. Be sure to sign up for timely information on topics you care about, from the latest medical breakthroughs, treatments and lifestyle tips to diabetes-friendly recipes for people living with diabetes and their families, at diabetes.org/healthylivingnews.
- For those who have questions about diabetes management, the ADAs free Ask the Experts series provides a community where people can learn about specific topics, ask their questions, and receive answers from diabetes experts, live. Learn more at diabetes.org/experts.
- As always, the ADAs Center For Information is here for you at 1-800-DIABETES .
- We are grateful to our community members who have come to share their experiences and learn from one another, and we look forward to continuing that tradition in the Collab community and through our partners at BT1 and around the diabetes community. We encourage you to remain involved!
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Vitamin B12 For Diabetes Patients Treated With Metformin
Department of Nutrition Science, East Carolina University, USA
*Corresponding author: Roman Pawlak, PhD, Department of Nutrition Science, East Carolina University, Greenville, USA, Tel: 252-744-1013, E-mail:
Received: March 24, 2017 | Accepted: May 13, 2017 | Published: May 15, 2017
Citation: Pawlak R Vitamin B12 for Diabetes Patients Treated with Metformin. J Fam Med Dis Prev 3:057. doi.org/10.23937/2469-5793/1510057
Vitamin B12 And Neuropathy
I went to my Neurologist and saw the nurse, because my neurologist had to cancel all her appointments. The nurse went thru all my blood work, and said my B12 is way too low for someone with Neuropathy. She repeated that B12 test, and again it is low. Because it is in a low, but normal range, 2 neurologists, 2 pain specialists, and 1 primary care physician of mine, did not catch that it was low. Only this nurse did, and now I need a week of daily Vitamin B12 shots, and then weekly, for a month. If you have neuropathy, B12 level should be at least at 400. Mine is at 185. I am praying Vitamin B12 helps. I really know nothing about Vitamin B12. Just found out mine is way too low for neuropathy. These doctors need to read the actual numbers, not just the highlights of what blood work is out of range. Maybe this could have been caught 2 years ago. I dont know if Vitamin B12 will help, but I am giving it a try. We all go thru so much. Lori Renee
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