Metformin

Metformin is a medicine prescribed to treat Diabetes mellitus. One of its popular brand is Glycomet. All those anti Diabetic brands that have a suffix of “Met” or “M” at the end has metformin in it such as Janumet, Galvusmet, GLP-M and so on..

It is often  prescribed from the Day One when a person is pronounced Diabetic. A person who is suffering from DM for 20 years is likely to have consumed this drug every day for 20 years which adds up to 10 kilo of metformin. No wonder it has its own side effect.

One of the little known side effect of long term metformin use is lowering of Vitamin B12 level in our body. It can happen as frequently as 1 in every 10 people who take it. That is a tall count considering that India has more than 10 crore diabetic people. Most of them are on metformin. That roughly estimate that the state of B12 deficiency in India will be the 5th most populous city in India.

Vitamin B12 ( Cobalamin) is a nutrient that helps to keep the body’s nerve and blood cells healthy. It is found in foods of animal origin only. That includes milk, cheese, yoghurt, and eggs. Unfortunately, it is rarely found in plant based foods.

( Patients with frank vitamin B12 deficiency can present with symptoms of anaemia or neuropathy or both. That is a serious medical problem. This is not a forum to discuss them.)

Today we shall discuss few subtle symptoms that can occur with low Vitamin B12 levels in our body. Symptoms of Low B12  are so general in nature that often you tend to ignore them. However these disabilities are real and can be  successfully treated with very high doses of B12 supplements, provided of course it strikes our mind. Often, it does not. So the issue remains unaddressed.

Subtle symptoms of Low vitamin B12 levels.

Here are few examples.

You may be feeling very tired or weak. You have no appetite and are losing weight. There may be nausea, vomiting or diarrhoea. But are not they due to the summer heat ? They can be, who knows?

You can have a sore mouth with ulcers in tongue or numbness and tingling in your hands and feet. You can have vision problems and a yellow skin. You are already taking a multivitamin tablet for that. The problem remains unsolved though.

Often low B12 levels will make it difficult for you in remembering things. That will keep you confused. Over all you will feel depressed and irritable. Mostly you will experience a change in the way you feel, behave, speak and walk.

When you complain of so many symptoms, people will think that you have gone nuts. This time they will send you to a psychiatrist. But none of it is your fault. the culprit is one innocuous drug – Low B12 resulting from long term Metformin use.

_Mind you, some of them once set in are not reversible._

1. We have seen that strict vegetarian diets are poor sources of vitamin B12. 
2. If you’re a diabetic in addition, most likely you are also taking Metformin and a gas tablet: PPI ( Rabez or Pan). All the three culprits can join hands to reduce your B12 levels significantly. Unfortunately, when you test your B12 level, it will be still within the normal range though on the lower side. Your doctor will give you a clean chit and advise Rest and prescribe Yoga and sleeping tablets instead. That is tragic, is it not.

*How do you treat ?*

Animal food products like Red meat, fish, poultry, eggs, milk and dairy products are rich source of vitamin B12. But if you are a strict vegetarian, pints of milk may not reverse your symptoms.

So better to take some extra doses of B12 from the counter. Unfortunately both online and offline dietary supplement market is crowded with so many vitamin supplements that it will confuse you thoroughly.

*Vitamin B12 dietary supplements:

Have you ever examined the Vit B12 strength of a good vitamin preparation available on line or in a chemist’s counter. It can range from *as low as 25 mcg to as high as 1500 mcg*. Which one will do ? The standard multi vitamin multi mineral drugs contain 25-50 mcg of B12. But the print is so small and so voluminous that it will only frustrate you.

Then again you will have to choose between two types of Cobalamins ( B12)- Cyano Cobalamin and Methyl Cobalamin. They are not same. Which one will be good for you ?

*Conclusion:*

It is now mandatory that the product insert in the Metformin packet includes the statutory warning – “Metformin can cause B12 deficiency”. If you are on Metformin you must continue the low dose B12 supplement. If you have neglected and are having symptoms, better to go for the higher strength pills.

Metformin is still going to be first line drug for all diabetic patients. B12 will remain at the firing line till such time.