Vit B12 Anaemia

Hi @ali2
Whether it be due to metformin, Ranitadine or any other medications I take, yes, I have B12 Deficiency
Is there something you'd like to ask?

Hi,

I don't have personal experience of this, but you may find these links interesting

http://care.diabetesjournals.org/content/35/2/327

https://www.bmj.com/content/340/bmj.c2181

https://www.sciencedirect.com/science/article/pii/S2352385917302657

My personal view is that anyone taking metformin would be sensible to take sublingual B12 supplements too (these are tables that dissolve under the tongue rather than in the stomach, and the B12 is absorbed by the lining of the mouth, rather than in the digestive tract). Also they should be asking their doc for regular B12 tests to see if they develop deficiency over time.

At diagnosis over 4 years ago my Vit B12 level was 425ng/L. Initially, on 2000mg Metformin it plummeted rapidly to 131ng/L. A normal range is 197-771. I inquired about supplementation at the surgery and got nowhere. Since then I have used B12 spray which absorbs more efficiently through the lining of the mouth than tablets that need to be swallowed and my last level was 260ng/L. I have to ask for monitoring each year. I'm hoping that this may improve now that I'm down to 500mg Metformin. I hope this helps.

ali2 said:

Thank you i have been told to an injection avery 3 months with no monitoring of the level, but i wondered if changing from metformin would help my levels but dn is reluctant to do this as i have good blood sugar control.

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Hi @ali2
Assuming you are in UK, you should have 6 injections over a 2 week period, ie Mon, Weds, Fri for 2 weeks (total 6) and then every 12 weeks. If you have neuropathy, or anything symptoms related with nerve system, memory, pins & needles, numbness, then you should have the injections alternate days (ie M-W-F) until there is no further improvement. That's basically the NICE guidelines.

The nurse is quite right in that, once having Vit B12, there is no point in monitoring the level unless, maybe, if you don't start feeling the benefit of the injections after a while. The reason being, B12 is water-soluble so you will wee any excess out and B12 is not toxic. Also, after injections, your level will be too high to measure - which is quite normal and acceptable.

Have you had Folate levels checked too? I'ts important to have good level of Folate, in particular, as it works with B12.

Unfortunately, HCPs very often don't appreciate this condition and under-treat, which is not good.

I'd like to PM you with some further info, if you don't mind.

I was at 159 and exhausted with brain fog and lots of aches etc 3 months ago. Many countries have a much higher minimum than the nhs’ 160. My gp refused any treatment. I researched and bought methylcoalamin b12 as it’s the best absorbed type. Cyanocoalamin is pretty much useless though cheaper. I just had bloods done having only really taken them for the first two months and not much this last month. Now at 818 and feeling much better. Well worth the money. For the record much cheaper in the USA and postage didn’t take long via amazon.

I had b12 anemia, think it caused a small stroke as b12 deficiency was not discovered until tests in hospital discover it.

Im 58, T2 was diagnosed July 2017, was taking 2000mg metformin, stroke was Oct 1 2017

Also now have some nerve damage on left hand only, some theoropy has helped with finger dexterity, but still have stiffness

ali2 said:

Hi I am a first time user, does anyone have experience of vitb12 deficiency anaemia caused by taking metformin.?

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Yes it is a known side effect of long term Metformin use. You may need to consider a B12 supplement, but not a general Vit B one since these usually omit B12. It is also exacerbated by diets that omit the fortified cereals such as breads and flour that by law has to have vitamins added. and these are products that we as diabetics tend to avoid. Most GP's now include a check on B12 in the annual blood tests/ review - mine does.

http://care.diabetesjournals.org/content/35/2/327
https://www.bmj.com/content/340/bmj.c2181

ali2 said:

Hi I am a first time user, does anyone have experience of vitb12 deficiency anaemia caused by taking metformin.?

Click to expand...

Yep. Took a few years but I got buzzing with n hands, numbness and tingling in extremities. Changed GP and one B12 injection and it disappeared. I now have B12 injection every three or four months.

Oldvatr said:

Yes it is a known side effect of long term Metformin use. You may need to consider a B12 supplement, but not a general Vit B one since these usually omit B12. It is also exacerbated by diets that omit the fortified cereals such as breads and flour that by law has to have vitamins added. and these are products that we as diabetics tend to avoid. Most GP's now include a check on B12 in the annual blood tests/ review - mine does.

http://care.diabetesjournals.org/content/35/2/327
https://www.bmj.com/content/340/bmj.c2181

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Not sure how true and haven’t tried it, but my gp said oral was not much use because Metformin just strips the b12 out.

Roseanne01 said:

Not sure how true and haven’t tried it, but my gp said oral was not much use because Metformin just strips the b12 out.

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In the trial I linked to, they measured a 19% reduction, so not a complete strip. Also given the apparent fact that the deficiency takes prolonged use to build up to being a problem, then the effect is fairly gradual over a long term. Certainly if you have been diagnosed with iron deficiency anemia, then an injection is a quick fix. My GP increased my iron and folate intake to let my levels come back more gently.

There are diets discussed on the forum here that exacerbate the risk of deficiency. For iron to be absorbed from food, we need to have edible iron, folate, and Vit C all present at the same meal for best absorption. This is especially true for iron supplement pills to work too and many GP's (mine included) do not mention this when prescribing iron.

Not all forms of iron can be digested, so for example, spinach is full of iron, is a green veg, but is apparently not compatible with our metbolism, so actually does not work at all for us. Similarly 6" nails is not a solution either.

Folate can be difficult to source naturally too. Some diets for T2D especially cut out fruit, so vit C intake can be low. Other diets reduce or cut out animal products, so do not provide either folate or B12 in any significant amounts.

This is why by law most commercial cereals, breads, pastas, flours all have added vitamins, but again some diabetic diets reduce or eliminate these products.

Oral b12 does work if you take the right one. See my comments above.

It is not a done deal. I have been using 2000 mg Metformin a day for over 10 years now, and my B12 levels have been fine. I did get iron deficiency, but iron + folate tabs oral meds have bought that into range again. But I am a red meat eater, so that is a good source of edible B12 and B6 as well as iron.