If you’re using metformin you need to take B-12

by Dr. Alan Kadish NMD

As many of my patients know I use metformin for a number of disorders, in addition to high blood sugars and diabetes. There is enough supportive literature to suggest other health benefits, including increased longevity, decreased cardiovascular risk, some decreases in cancer expression both in GI and breast tissue and it even helps in viral hepatitis c. This is one of the safest and cost effective available.

One of the issues with taking any medication is the potential interaction with our nutrients. In this study they addressed people on long term use, both at 3.2, 5 and 13 years. The indications are strong and suggest that the use of B-12 supplementation and testing is in order for all patients using metformin.

One of the misconceptions of B-12 testing is the use of a blood test for this nutrient…..but it does not work ! Many years ago researches noted that they would treat someone who appeared to be potentially B-12 deficient and sure enough even though their blood levels suggested they were normal, they felt much better. From this observation tissues samples were taken and indeed the blood test for B-12 does not reflect what’s happening in the tissues. The correct test reflects the actual tissue effect of B-12 and is known as the methyl malonic acid test. There are also tests that expose your cells to various levels of many nutrients that can direct us specifically to proper supplementation. Why fool around when you can test, not guess ?

One additional complication when choosing the correct form of B-12 is that some patient’s do not easily absorb B-12 supplements. Currently we have 3 forms of  B-12….methyl, hydroxyl and cyano and hang in there….they come in 5 formats. You can swallow a pill or capsule, place it in your nose, under your tongue or inject into your muscle or subcutaneously.

Proper selection is essential and can truly have you feeling much better. Most patients will notice better mental clarity and some increased energy.

At the Center have used all of the forms of B-12 for over 30 years and are consistently surprised at the number of patients who benefit and how often they were told they were fine.

Time for a check up on B-12 and more ? Call us at the Center of Health and let’s really get you feeling well. 541.773.3191

Vitamin B12 deficiency seen with long-term metformin use

Aroda VR, et al. J Clin Endocrinol Metab. 2016;doi:10.1210/jc.2015-3754.

February 24, 2016

Biochemical vitamin B12 deficiency and anemia were associated with long-term use of metformin, according to findings from the Diabetes Prevention Program Outcomes Study.

Jill P. Crandall, MD, professor of clinical medicine at Albert Einstein College of Medicine in Bronx, New York, and colleagues evaluated data from the Diabetes Prevention Program (DPP) and Diabetes Prevention Program Outcomes Study (DPPOS) on 1,073 people assigned metformin and 1,082 assigned placebo for 3.2 years to determine the effect of long-term metformin on vitamin B12 levels. Participants assigned to metformin received open-label metformin for an additional 9 years. B12 levels were evaluated at 5 years (n = 857, placebo; n = 858, metformin) and 13 years (n = 756, placebo; n = 764, metformin).

Compared with placebo, the metformin group had a 10% lower mean B12 level (P = .02) and higher borderline-low vitamin B12 level (P < .01) at 5 years. Vitamin B12 deficiency was most prevalent among the metformin group and increased over time. Thirty-eight percent of the placebo group and 45% of the metformin group that were B12 deficient at 5 years remained deficient at 13 years. An increased risk for B12 deficiency was linked to years of metformin use (OR for B12 deficiency/year metformin use = 1.13; 95% CI, 1.06-1.2). The metformin group had a higher prevalence of anemia, which did not differ by B12 status. Among the metformin group, those with low B12 levels had a higher prevalence of neuropathy compared with those with normal or borderline levels (P = .03).

“Given that metformin is widely recommended as a first-line agent for the treatment of type 2 diabetes, the growing population of individuals who receive metformin for other indications (including high risk of diabetes, gestational diabetes, polycystic ovary syndrome), and the chronic nature of treatment of these conditions, understanding the potential adverse consequences of metformin treatment is essential,” the researchers wrote. “Long-term follow-up data from DPP/DPPOS support the evidence that metformin is associated with vitamin B12 deficiency, and routine measurement of vitamin B12 for metformin-treated individuals should be considered.” – by Amber Cox

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Dr. Kadish is an unusual physician often referred to as a "doctor detective". His expertise is the evaluation and treatment of complex disorders, typically after other physicians have been stumped, is renowned. He provides care for all family members and has additional training in autistic spectrum disorders and chronic complex diseases.