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Can Metformin lower Vitamin B12 Levels?

Question: Can Metformin lower vitamin b12 levels?


Metformin is a mainstay in diabetes therapy and probably the most widely prescribed first line diabetes treatment. It may also be prescribed for people with “prediabetes” (diagnosed when blood sugar levels are above the normal range but have not reached the cutoff for diabetes) or for women with polycystic ovary syndrome.

However, yes, long-term therapy with metformin can impair absorption of vitamin B12. Some studies suggest that 10 to 30% of people taking metformin have reduced vitamin B12 absorption. One recent randomized placebo-controlled trial was done in people with type 2 diabetes treated with metformin for over 4 years. The metformin-takers had 19% lower vitamin B12 levels and 7.2% higher risk of vitamin B12 deficiency compared to placebo.

Vitamin B12 is a water-soluble vitamin found naturally in foods such as meat, poultry, eggs, milk, and milk products. It is also available as a dietary supplement or prescription medication and comes in several forms containing the mineral cobalt. Collectively, these ore called “cobalamins”. Methylcobalamin and 5-deoxyadenosylcobalamin are the active forms of vitamin B12 in humans.

Vitamin B12 is required for the body to make red blood cells and DNA, as well as, for proper brain and nerve function. Signs of vitamin B12 deficiency may include anemia, fatigue, weakness, constipation, appetite loss and weight loss. Other symptoms of lack of vitamin B12 may point to nerve dysfunction such as difficulty maintaining balance, depression, confusion, dementia, poor memory, and soreness of the mouth or tongue.

Other people are also at risk of having vitamin B12 deficiency. Individuals, particularly, the elderly, may be afflicted by conditions that cause vitamin B12 molabsor ption such as atrophic gastritis (wherein stomach acid secretion is impaired” or pernicious anemia (wherein intrinsic factor is missing). Lack of vitamin B12 may also be seen in strict vegetarians, people with stomach and small intestine disorders (e.g., celiac disease and Crohnis disease), or people who hove had gut surgery.

Some experts believe vitamin B12 levels need to be checked yearly in those on long-term metformin therapy, while others think screening would be too costly with benefits still to be proven. And still others deem it more cost-effective to just give a yearly vitamin B12 injection. In any case, if you hove been taking metformin for a long time or are on the verge of doing so, discuss with your doc if a vitamin B12 supplement may be right for you.

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