long use of metformin, leading to lack of folate,

[lottie@yorkshire]

Have been told I might have to come off Metformin! and use just Insulin because lack of folate, is this a thing or is it just me? this gives me concern, I will have to up my insulin!!
Quite worried,

 

[malcsleep]

I’m type two my folate and iron are very low since taking metformin I’ve been put on a tablet for each and it’s amazing how my energy has returned the gp prescription has worked wonders hope this helps

 

[HHardy39]

Metformin does cause iron and folate deficiency because it reduces absorption of these from the intestines. Folate is naturally found in leafy, dark green vegetables and beans. Iron is high in spinach, liver, red meat and beans, You could try making sure you eat these types of food regularly?

 

[AloeSvea]

@lottie@yorkshire, did the med-folk say anything to you about B12 too? Or is it 'just' B9 (folate)?

Apparently iron, B9 and B12 deficiencies go together, in that they work together when we are functioning well, nutritionally speaking. They probably suggested you supplement? In that case - it could be worth it for you to supplement for B12 too, as that is a known deficiency associated with metformin. (There is a whole thread on its association with metformin in this forum.) You could discuss with your medical team?

Taking supplements is controversial, except when there is a known deficiency, apparently. And, metformin is known to use the same pathway, as it were as the B vitamins, so our bods can get less than they normally do, when we take metformin. Suzy Cohen, this wonderful online pharmacist talks about this as medication having a "drug mugging" effect, and she definitely recommends supplementation. (She also sells them, so make of that as you will! She is a pharmacist, so....) But absolutely - discuss this more fully with your medical team. That should help with the anxiety - that, and talking to us in here for sure! I had a rapid drop in my B12 when I started taking metformin, and on reading that you can't OD on B12, I pop low-mcg wee pills like candy (I can afford the 50mcg ones! The more heavy duty ones are a bit pricey for me in my current budget.) I was getting fatigue, a known side effect of b vitamin deficiency, and I don't any more. Try supplementation, after consulting your medical team of course, and see if you feel better? Good luck!

 

[Brunneria]

Hi,

here is a link showing an overview of folate/b12 deficiency.

Vitamin B12 or folate deficiency anaemia

Read about vitamin B12 or folate deficiency anaemia, which occurs when a lack of vitamin B12 or folate causes the body to produce abnormally large red blood cells.

www.nhs.uk

the two vitamins work together, so a low level of one may be accompanied by an imbalance in the other, which results in a form of anaemia.

were you told to stop the Metformin? I would have thought that (providing you don’t have difficulties taking Metformin) that a simpler solution would be to supplement both B12 and folate.

I have to supplement high doses of both of those (and several other vits and mins) because my guts fail to absorb enough nutrition from food, no matter how nutritious it is, or how much I eat. Supplementation can be an easy, available and convenient option.

 

[LonelyFatGuy]

Hi,

here is a link showing an overview of folate/b12 deficiency.

Vitamin B12 or folate deficiency anaemia

Read about vitamin B12 or folate deficiency anaemia, which occurs when a lack of vitamin B12 or folate causes the body to produce abnormally large red blood cells.

www.nhs.uk

the two vitamins work together, so a low level of one may be accompanied by an imbalance in the other, which results in a form of anaemia.

were you told to stop the Metformin? I would have thought that (providing you don’t have difficulties taking Metformin) that a simpler solution would be to supplement both B12 and folate.

I have to supplement high doses of both of those (and several other vits and mins) because my guts fail to absorb enough nutrition from food, no matter how nutritious it is, or how much I eat. Supplementation can be an easy, available and convenient option.

Do you mean that if one is low, the other can be high...? Or if one is low then the other might also be low...? Just trying to clarify what precisely you mean by an imbalance in the other.

I don't know what my folate and iron is, but I found out a few months ago that I have high B12. (test says >150 pmol/L, so it could well be even higher than that). So now you've got me wondering if my folate and iron are low. Iron hasn't been tested in 3 years, and I've been on Metformin for at least 2 years now.

 

[Brunneria]

Do you mean that if one is low, the other can be high...? Or if one is low then the other might also be low...? Just trying to clarify what precisely you mean by an imbalance in the other.

I don't know what my folate and iron is, but I found out a few months ago that I have high B12. (test says >150 pmol/L, so it could well be even higher than that). So now you've got me wondering if my folate and iron are low. Iron hasn't been tested in 3 years, and I've been on Metformin for at least 2 years now.

You would need tests to see how it is working in your body.

I have heard it described as a seesaw, where a pair of vitamins that work in balance, can swing one high while the other swings low - but of course that will depend on whether you have enough intake of the one swinging high…

My docs have always been stunningly unhelpful where my malabsorption/malnutrition is concerned. Unwilling to test for even b12 or Vit D, when asked.

So now I take full responsibility for the matter and pay privately for 6 monthly tests. I use Thriva, whose prices are very reasonable, but there are several other companies who provide the same service.

If you choose to simply eat more of the vitamin containing foods, you can google for lists such as ‘20 best folate foods’.

And if you want quality supplements (it is worth paying for quality), then once again, Google can tell you the most bio available forms of ea Vit, and the optimal or max appropriate dose.

 

[DiabeticBloke1]

Hi AloeSvea and Bunneria (and everyone else in this thread). AloeSvea's recent post, saying "Apparently iron, B9 and B12 deficiencies go together, in that they work together when we are functioning well", is something I hadn't known before. However I couldn't agree more with you. I had deficiencies in all three, none of which had previously been detected until I moved interstate and found a new GP and new specialists. I have numerous other complications/medical conditions, and they all interact, and any - or all - of them could be the cause of these deficiencies. However the bottom line was my lethargy and constant lack of energy. Apart from all my medications, including metformin, I had to have 2 iron transfusions, and regular supplements of B12 (weekly) and folate B9 (daily). I still have AF (atrial fibrillation), Type 2 diabetes and Advanced Heart Failure, but I also now have a lot more energy to help me better deal with these issues. Cheers, DB1.

 

[Brunneria]

Hi AloeSvea and Bunneria (and everyone else in this thread). AloeSvea's recent post, saying "Apparently iron, B9 and B12 deficiencies go together, in that they work together when we are functioning well", is something I hadn't known before. However I couldn't agree more with you. I had deficiencies in all three, none of which had previously been detected until I moved interstate and found a new GP and new specialists. I have numerous other complications/medical conditions, and they all interact, and any - or all - of them could be the cause of these deficiencies. However the bottom line was my lethargy and constant lack of energy. Apart from all my medications, including metformin, I had to have 2 iron transfusions, and regular supplements of B12 (weekly) and folate B9 (daily). I still have AF (atrial fibrillation), Type 2 diabetes and Advanced Heart Failure, but I also now have a lot more energy to help me better deal with these issues. Cheers, DB1.

I will tag in @zand because I know she has experience of AF which has responded to supplements (sorry zand, I can’t remember, was it potassium or magnesium, or something else?)

If you have a history of needing supplements of folate and B12, then maybe (like myself), you have a body that just needs supplements, and Zand’s experience may be of interest re your AF.

 

[zand]

I will tag in @zand because I know she has experience of AF which has responded to supplements (sorry zand, I can’t remember, was it potassium or magnesium, or something else?)

If you have a history of needing supplements of folate and B12, then maybe (like myself), you have a body that just needs supplements, and Zand’s experience may be of interest re your AF.

Thanks for the tag.

I'll answer the question first.

I had persistent AF for several months before having 2 cardioversions (the first didn't work). Since then I have read that AF can be caused by extremely strenuous exercise by someone who is low in magnesium. Well, in me AF started after clearing several inches of snow from our drive back in maybe 2009 ish.

I was seeing a naturopath about something else a few months later when she tested me for magnesium deficiency. She gave me a magnesium powder to mix with juice and said that it was a muscle relaxant and since the heart is also a muscle, it could help alleviate the AF.

I had a catheter ablation procedure (in 2012) which put my heart back into sinus rhythm. Since then, I have had short episodes of AF several times. I find that one dose of magnesium normally relaxes my heart enough to put it back into sinus rhythm. The only time it has needed as many as 3 doses was when my GP performed a minor skin operation for me. I asked him not to use the anaesthetic with adrenaline in, as adrenaline was likely to throw my heart out of rhythm again. He laughed and said that was unlikely and used the adrenaline one anyway...

So, yes, it's magnesium I use whenever I feel my heart rhythm isn't normal. I use it for leg cramps too. I know others use potassium for cramps, but I guess I'm not low in that.

I have been meaning to post on this thread anyway as I didn't realise that low B12 levels were also associated with AF. I have recently found out that I've had lowish B12 levels for very many years and no doctor ever told me that my levels were near deficiency levels, being at the bottom end of normal. I suffered from fatigue for years, often struggling to put one foot in front of the other.

So it's likely that B12 and magnesium deficiency caused my heart problems and my fatigue. 20 plus years of struggling when the easy answer was right there all the time. Frustrating for me. Costly for the NHS who paid for 4 procedures that may not have been necessary if I had known to self supplement.