Avoid this deficiency — especially if you take metformin

If you have type 2 diabetes and are searching for natural solutions to manage your blood sugar, you might be surprised to know that many naturopathic doctors will recommend a diabetes drug.

Sure, there are many non-drug approaches at your disposal. However, one drug stands out amongst the rest due to its time-tested efficacy and surprisingly low level of adverse side effects.

The drug is metformin, which is derived from the botanical, French lilac (also known as goat’s rue). It’s been off-patent (generic) for years, so it’s not expensive. But just like any drug, metformin needs to be used with close medical supervision — especially when it comes to the management of your vitamin B12 levels.

The harmful effects of this key deficiency

Vitamin B12 is essential for cell metabolism and formation of red blood cells. It also helps keep the protective sheaths around your nerves healthy, which in turn promotes proper nerve function and prevents shingles and peripheral neuropathy.

B12 deficiency also causes anemia, so it’s especially important to keep levels of the vitamin up as you navigate your senior years.

And this can be a bit of a challenge since, unfortunately, your B12 levels drop as you age. Not to mention the fact that (as I alluded to earlier) metformin can also deplete your B12.

At the Society for Endocrinology annual conference last November, researchers presented a study where vitamin B12 levels were measured in 150 volunteers who had all taken metformin for about six years. Their average age was 63.

Results showed that one in 10 participants had B12 deficiency.

To be honest, I would have suspected a slightly higher level of deficiency. Nevertheless, the researchers suggest that doctors check each patient’s B12 levels before beginning metformin, then recheck levels on a regular basis.

There are no current guidelines for testing B12, so many doctors are unaware that this issue needs to be addressed. Likewise, many doctors are also unlikely to recommend taking a daily B12 supplement — a safe, inexpensive, and proactive solution to this common deficiency.

Solving the B12 dilemma

As I mentioned earlier, many naturopathic physicians often recommend metformin — a strong indication of its efficacy and safety.

One of the foremost doctors who recommends metformin is Dr. Marc Micozzi.

In his Integrative Protocol for Defeating Diabetes, Dr. Micozzi offers two rules of thumb regarding metformin and vitamin B12.

“When taking metformin,” he says, “also take a daily B vitamin supplement. Research shows that prolonged use of metformin can cause a deficiency of B12.”

Dr. Micozzi recommends a B complex that contains the following:

  • 100 mg of B1 (as thiamine)
  • 100 mg of B2 (as riboflavin)
  • 100 mg of B3 (as niacinamide)
  • 100 mg of B5 (as pantethene)
  • 100 mg of B6 (as pyridoxine)
  • 1,000 micrograms (mcg) of B12 (as cyanocobalamine)
  • 400 mcg of folic acid

And if your vitamin B12 levels are still deficient after supplementation, not to worry. Dr. Micozzi says, “If you are unable to absorb sufficient B12 from a supplement, B12 injections may be administered by your doctor.”

An ounce of precaution

Dr. Micozzi cautions to stay away from any of the new diabetes medications on the market. The vast majority are no more effective than the older, time-tested drugs.

In addition, most of them have poorer safety profiles than drugs like metformin. Plus, newer drugs haven’t been around long enough for all adverse side effects to be accounted for.

Dr. Micozzi’s advice? Stick with metformin.

Dr. Micozzi does warn that in some patients, metformin prompts gastrointestinal upset. But as he notes, all eight vitamins in the B complex are also important for digestive health. B2, for instance, aids digestion by maintaining the mucosal lining of the digestive tract, and B3 helps prevent deficiencies that prompt vomiting and diarrhea.

And Dr. Micozzi adds two more caveats:

  • Metformin can interact poorly with certain blood pressure medications. Discuss this issue with your doctor if you’re taking a drug for hypertension.
  • Don’t eat grapefruit when taking metformin. As we’ve seen with many other drugs, grapefruit can interfere with metformin’s effectiveness.

Dr. Micozzi discuses metformin use at length, along with many other safe, simple ways to effectively (and naturally) manage your blood sugar in Dr. Micozzi’s Integrative Protocol for Defeating Diabetes. To learn more about this protocol or to enroll today, click here.


Metformin and B12 Deficiency: A Bigger Problem Than We Thought
December 18, 2018