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  #1   ^
Old Mon, Feb-07-11, 10:57
Nancy LC's Avatar
Nancy LC Nancy LC is offline
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Plan: Paleo 99.5%
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Default Metformin and B12 deficiency

Just read this this morning:
Annual Vitamin B12 Supplementation may become Mandatory with Long-Term Metformin Use

Apparently Metformin causes your B12 stores to go low. I don't know if doctors test it routinely or not -- probably not knowing how horrible doctors are about such things. But I'd take a B12 supplement if you're on Metformin (sublingual methylcobalamin is best) because B12 deficiency is vicious and irreversible.

Quote:
Chronic metformin use results in vitamin B12 deficiency in 30% of patients. Exhaustion of vitamin B12 stores usually occurs after twelve to fifteen years of absolute vitamin B12 deficiency. Metformin has been available in the United States for approximately fifteen years. Vitamin B12 deficiency, which may present without anemia and as a peripheral neuropathy, is often misdiagnosed as diabetic neuropathy, although the clinical findings are usually different. Failure to diagnose the cause of the neuropathy will result in progression of central and/or peripheral neuronal damage which can be arrested but not reversed with vitamin B12 replacement. To my knowledge, this is the first report of metformin-induced vitamin B12 deficiency causing neuropathy.
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  #2   ^
Old Fri, Mar-25-11, 14:33
deb34's Avatar
deb34 deb34 is offline
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Plan: CAD/OMAD
Stats: 231.6/226.5/199 Female 66 inches
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Quote:
B12 deficiency is vicious and irreversible.

if you already have B12 deficiency, what's the point of taking B12(sublingual methylcobalamin) if the deficiency is irreversible? Sounds like a waste of money to me....

I've been taking Metformin for over a decade and it's very possible I'm B12 deficient already.
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  #3   ^
Old Fri, Mar-25-11, 15:41
Hutchinson's Avatar
Hutchinson Hutchinson is offline
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Posts: 2,886
 
Plan: Dr Dahlqvist's
Stats: 205/152/160 Male 69
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Quote:
Originally Posted by deb34
if you already have B12 deficiency, what's the point of taking B12(sublingual methylcobalamin) if the deficiency is irreversible? Sounds like a waste of money to me....

I've been taking Metformin for over a decade and it's very possible I'm B12 deficient already.
They don't say that deficiency is irreversible but the progression of central and/or peripheral neuronal damage caused by deficiency status.

The sooner you correct deficiency status the less central /peripheral neuronal damage will progress.

B12 methylcobalamin can also be bought in a spray form the sublingual or spray forms of methylcobalamin are the best, better in fact (more effective) than shots that some people have from the doctor.
The reason for the spray/sublingual is to allow some of the B12 to be absorbed directly through the tissues in the oral cavity rather than pass through the digestive system where they may be degraded. You may find you have B12, folate, B6 in your mulitvitamin but generally speaking the forms in multi's are the cheaper forms that are least well absorbed and require activation (further processing steps) before your body can use them. It may be the case that your body manages to convert from inactive to active form without problems but for others it's better safe than sorry, the least steps required the less chance of things not working.

Those who are concerned about the prospect of Alzheimer's/dementia and who are striving to keep homo-cysteine levels low may also want to consider activated folate and the activated form of B6

Long term treatment with metformin in patients with type 2 diabetes and risk of vitamin B-12 deficiency

The examples of active forms of B vits I've provided come from IHERB because they offer cheapest shipping to UK (you may find same examples cheaper else I haven't checked shipping to where you live) Code ~~~~~~ saves Iherb Newbies $5.

Last edited by Hutchinson : Fri, Mar-25-11 at 15:48.
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  #4   ^
Old Fri, Mar-25-11, 15:44
Nancy LC's Avatar
Nancy LC Nancy LC is offline
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Plan: Paleo 99.5%
Stats: 210/170/160 Female 67.5"
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Default

Quote:
Originally Posted by deb34
if you already have B12 deficiency, what's the point of taking B12(sublingual methylcobalamin) if the deficiency is irreversible? Sounds like a waste of money to me....

I've been taking Metformin for over a decade and it's very possible I'm B12 deficient already.

I'm guessing I probably meant some of the symptoms. Death, for instance, is hard to reverse!

Quote:
Failure to diagnose the cause of the neuropathy will result in progression of central and/or peripheral neuronal damage which can be arrested but not reversed with vitamin B12 replacement.
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  #5   ^
Old Fri, Mar-25-11, 17:36
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kwikdriver kwikdriver is offline
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Plan: No grains, no sugar.
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If you're doing low carb and, therefore, eating lots of meat and dairy, you should be getting plenty of B12 (and the rest of the B vitamins). If, on the other hand, you're eating lots of "heart healthy whole grains" and avoiding meat and "artery clogging dairy," then you might be in trouble. Guess which diet the ADA has been recommending for years.
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  #6   ^
Old Sat, Mar-26-11, 03:53
Hutchinson's Avatar
Hutchinson Hutchinson is offline
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Plan: Dr Dahlqvist's
Stats: 205/152/160 Male 69
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Progress: 118%
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Quote:
Originally Posted by kwikdriver
If you're doing low carb and, therefore, eating lots of meat and dairy, you should be getting plenty of B12 (and the rest of the B vitamins). If, on the other hand, you're eating lots of "heart healthy whole grains" and avoiding meat and "artery clogging dairy," then you might be in trouble. Guess which diet the ADA has been recommending for years.
Absolutely true, it's vegetarians and vegans that are MOST vulnerable to B12 deficiency.
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  #7   ^
Old Sat, Mar-26-11, 06:45
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Robin120 Robin120 is offline
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Thanks for posting Nancy- I'm pescatarian AND take metformin- will ask Dr to check my levels next visit.
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  #8   ^
Old Sat, Mar-26-11, 09:15
Nancy LC's Avatar
Nancy LC Nancy LC is offline
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Posts: 45,309
 
Plan: Paleo 99.5%
Stats: 210/170/160 Female 67.5"
BF:
Progress: 80%
Location: San Diego, CA
Default

Quote:
Originally Posted by kwikdriver
If you're doing low carb and, therefore, eating lots of meat and dairy, you should be getting plenty of B12 (and the rest of the B vitamins). If, on the other hand, you're eating lots of "heart healthy whole grains" and avoiding meat and "artery clogging dairy," then you might be in trouble. Guess which diet the ADA has been recommending for years.

Not always true, unfortunately. Some people are lacking the ability to get B12 from their food. That's why B12 pills are best when used sublingually, then it bypasses the digestive system and is absorbed into your blood directly through the capillaries in your mouth.

Also, realize that being low but in-range for B12 might not be a good thing. I've met people who had issues until they raised their level to quite high. It won't hurt to take B12, you just excrete what you don't need.
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  #9   ^
Old Sat, Mar-26-11, 16:40
amandawald amandawald is offline
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Plan: GF mod carb/Schwarzbein
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Just subscribing, this is one of my other pet subjects (besides magnesium)...

I'll be back later... (You have been warned!!!)

amanda

PS

Nancy, I think it is great you posted this!!!
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  #10   ^
Old Sat, Mar-26-11, 16:42
amandawald amandawald is offline
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Plan: GF mod carb/Schwarzbein
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Default

Quote:
Originally Posted by deb34
if you already have B12 deficiency, what's the point of taking B12(sublingual methylcobalamin) if the deficiency is irreversible? Sounds like a waste of money to me....

I've been taking Metformin for over a decade and it's very possible I'm B12 deficient already.


You probably are, but a lot of the symptoms of B12 deficiency are reversible, as I can personally testify, having used sublingual methylcobalamin with great success.

I would get a blood test pretty damn quick and take it from there. If you are taking a drug like this, it should be easy for you to DEMAND that you get B12 paid for!!!

amanda
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  #11   ^
Old Sun, Mar-27-11, 03:07
Hutchinson's Avatar
Hutchinson Hutchinson is offline
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Posts: 2,886
 
Plan: Dr Dahlqvist's
Stats: 205/152/160 Male 69
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Progress: 118%
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Quote:
Originally Posted by amandawald
I would get a blood test pretty damn quick and take it from there. If you are taking a drug like this, it should be easy for you to DEMAND that you get B12 paid for!!! amanda
However, if you cannot afford to pay for a B12 test or persuade your health professionals to do one, then it's no big deal using a Methylcobalamin B12 spray or sublingual.
If you start using B12 and find you've a lot more energy suddenly then you can be pretty sure your deficient and need to continue.
If you don't notice any difference and are consuming High B12 food sources then you could just take it a few times each week as insurance.
If I was on Metformin though I'd supplement with B12 irrespective of test or other food sources. In the same way I think everyone taking a statin should simultaneously also take CoQ10. I don't understand why this isn't the law. What about the principle "First do no harm"?
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  #12   ^
Old Tue, Mar-29-11, 10:47
deb34's Avatar
deb34 deb34 is offline
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Plan: CAD/OMAD
Stats: 231.6/226.5/199 Female 66 inches
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Quote:
Originally Posted by Nancy LC
I'm guessing I probably meant some of the symptoms. Death, for instance, is hard to reverse!


ok, thanks I understand now. I'll look into some of the active B forms as PCOS I think has some link to an inability to absorb or use the B vitamins. I don't know this positively, but it can't hurt to up the B's.

Quote:
If I was on Metformin though I'd supplement with B12 irrespective of test or other food sources. In the same way I think everyone taking a statin should simultaneously also take CoQ10. I don't understand why this isn't the law. What about the principle "First do no harm"?


Thanks for this, I agree 100%! I'm pretty cheesed off about my dad taking Liptor w/o being informed it drains CoQ10....he's supplementing now and doing a bit better I think, but I'm not convinced he needs Lipitor at all.
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  #13   ^
Old Tue, Mar-29-11, 12:26
amandawald amandawald is offline
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Plan: GF mod carb/Schwarzbein
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Location: Brit in Germany
Default B12 made me feel like a new woman!!!

Quote:
Originally Posted by deb34
ok, thanks I understand now. I'll look into some of the active B forms as PCOS I think has some link to an inability to absorb or use the B vitamins. I don't know this positively, but it can't hurt to up the B's.

Thanks for this, I agree 100%! I'm pretty cheesed off about my dad taking Liptor w/o being informed it drains CoQ10....he's supplementing now and doing a bit better I think, but I'm not convinced he needs Lipitor at all.


Hi Deb,

My Dad went off the statins he had been prescribed after I got him to look at this book:

http://www.amazon.com/Great-Cholest...01420970&sr=1-1

Maybe you could get it for your Dad???

On the B- vitamins:

If you are interested in taking the B vitamins and you have a B12 deficiency, you really need to take B12 separately from your B-complex. The body can apparently use excess B6 to make up for a lack of B12. This is what had probably happened in my case as I had been taking a B-50 complex, but no extra B12, hence my B12 levels appeared to be "normal", although I had plenty of B12 anaemia symptoms. Nearly of them went away within a few weeks of taking this:

http://www.iherb.com/Source-Natural...blets/1466?at=0

I was so desperate to get some B12 after I saw the doc (who said my levels were "normal" and couldn't explain my symptoms, despite the abnormal size of my red blood cells: he could only see the "normal level"...), that I got these via a German online retailer for mucho bucks - GRRRR. But they're much cheaper at iherb.com...

Anyway, they worked a treat and within a few weeks I felt like a new woman!!! Really and truly. I initially took two a day (one in the a.m., one in the early afternoon), dissolving them as slowly as possible under my tongue, changing the position of the tablet now and then (this is apparently necessary to ensure maximum absorption).

I then panicked a little when I read about potassium being needed, too, and yet again bought some over-priced supplements here in Germany. I would have preferred to have gotten this:

http://www.iherb.com/Nature-s-Way-P...sules/2000?at=0

If you have been suffering from B12 anaemia (which was what I had, i.e. not enough and too large red blood cells), then when your levels go up, your body starts making new red blood cells at a faster rate than normal, for which it uses potassium, amongst other things. This is why it is also necessary to initially supplement with potassium as well, or have your potassium levels checked and supplement if they are going down.

As I said, nearly all of my symptoms have gone, in particular the typical anaemia symptoms, such as getting out of breath easily, not being able to walk up a slope or a flight of steps without feeling I was wearing lead boots and simply not getting enough air, feeling seriously fatigued after just an hour's hike, or feeling like I was going to pass out after I cycled up a short hill: all of this has gone!!! OK, I'm no spring chicken and you're not going to be seeing me at the next Olympics, but I can now run up four flights of steps again if I'm late for a train, cycle up hills and don't get out of breath at the slightest exertion.

The only symptom that hasn't quite cleared up is a rather odd and disturbing one as it may well be neurological (something to do with myelin sheaths and nerves???). For the last few years I have had, from time to time, these odd numb patches on my back which come and go without warning. They used to be quite large areas which simply felt numb on the very surface. Now I get occasional twinges of the same feeling, but very briefly and the "patches" are not the large areas they used to be. I can only guess that this particular piece of damage caused by lack of B12 takes longer to repair and this is why this particular symptom hasn't entirely disappeared. I am hoping it will eventually and am therefore going to carry on with 1mg of the sublingual B12 for the foreseeable future. I still have to find out for definite if I have pernicious anaemia, which I will try and get a test for when I next have blood work done.

If you get either or both of these products, feel free to use this code ~~~~~~ to get a $5 discount off your first order.

I can also recommend this book if you want to read up on B12 in more detail. Metformin is unfortunately not the only medication which can make your B12 levels drop: all the antacids/acid blockers will do the same (Prilosec and all the rest), as you need a good level of stomach acid to actually be able to absorb B12 properly.

http://www.amazon.com/Could-Be-B12-...howViewpoints=1

There is also a monster thread at "wrongdiagnosis" on B12, which Sally Pacholok started off.

Interestingly, even the Weston A Price people recommend B12 supplementation, although they are generally of the opinion that most supplements are unnecessary. There is a good article about it on their website, but it is kind of difficult to locate for some reason... If I find a link, I'll post it later in an edit.

According to Sally Pacholok, many health problems are being falsely labelled as any number of - in some cases incurable - diseases, when in fact the real reason for these health issues is "merely" B12 deficiency. I say "merely" because, if you detect the deficiency early enough, practically all the symptoms can be reversed with either sublingual methylcobalamin or injections!!!

I am so glad I didn't listen to the doctor and treated myself and got myself nearly 100% better again. It's a bit of a pain that I didn't get a prescription and get my health insurance to cover the costs, but, seeing as it is fortunately a very cheap supplement, it doesn't bother me that much. If I had listened to the doctor, goodness knows how I would feel by now!!!

Hope this helps!

amanda
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  #14   ^
Old Tue, Mar-29-11, 12:35
amandawald amandawald is offline
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Plan: GF mod carb/Schwarzbein
Stats: 160/160/160 Female 164cm
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Progress: 51%
Location: Brit in Germany
Default Just eating low-carb might not do the trick, I'm afraid...

Quote:
Originally Posted by kwikdriver
If you're doing low carb and, therefore, eating lots of meat and dairy, you should be getting plenty of B12 (and the rest of the B vitamins). If, on the other hand, you're eating lots of "heart healthy whole grains" and avoiding meat and "artery clogging dairy," then you might be in trouble. Guess which diet the ADA has been recommending for years.


I have to agree with Nancy on this one: it ain't quite that simple!!!

I first got a blood test done in late 2006: my iron was low and I had a low red blood cell count. I started low-carbing in May 2007 and began eating red meat again with a vengeance!!! I confidently expected that my blood work would reflect this when I had my next test done about a year later, but was disappointed: there was virtually no improvement!!!

What I didn't know then, but have since discovered, is that I was probably already gluten intolerant at that point, but didn't have any noticeable symptoms (they came much later) and I was therefore not absorbing the iron in the meat very well.

What's more, I have been eating plenty of B12-rich foods since May 2007, too, but this didn't affect my B12 level, either: they went down regardless, again probably due to the gluten intolerance, but possibly due to pernicious anaemia.

Low stomach acid can also complicate matters, which means that many of us older folk - after about the age of 40 your stomach acid levels decline - have steadily declining B-12 levels, too, as we age. If we aren't informed, we might just put down various deficiency symptoms to ageing and blithely accept our ailments, instead of supplementing.

amanda
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