Vitamin B12 Deficiency. PPIs and Metformin.

[Sid Bonkers]

Some months ago I had a routine annual blood test and all was fine except my Vitamin B12 was rather low I think from memory it was 116 pg/mL when the (range is 180 - 1100) I had recently stopped taking metformin as well as fairly regular Omeprazole use and my doctor requested another blood test in a couple of months and this was done a few weeks back and my levels had dropped further to 108 pg/mL, I was asked to make another appointment with my GP following the result and that happened last Tuesday.

We discussed oral and injected Vitamin B12 and it was decided to try the oral approach first as its the cheapest option! And I shall have another blood test after I have finished the course of vitamin pills to see what effect the oral route has had.

I am posting this as I had previously thought that you could only be deficient in Vitamin b12 if you were also anaemic which is easily diagnosed by a low red blood count but this is not always the case, both Metformin and Omeprazole taken long term can interfere with the Vit B12 balance and as I had been using both these drugs the Metformin for my T2 diabetes and the Omeprazole for taking with Ibuprofen for breakthrough arthritic pain control and have been taking both regularly for over 7 years now.

So just be aware that long term use of both or either of these drugs can cause a stand alone drop in Vitamin B12 levels so if you have been using either drug regularly for more than 4 or 5 years you might like to mention this to your GP at your next visit.

 

[Freema]

yes and thats a bad sideeffect .. good luck with your vitamin-B12 intake hope you can still uptake them orally.. but otherwise the injections are a good safe option , the liver can keep vitamin B12 enough for 4-5 years so an injection every second month is a good other way to get them..

it is one of the vitamins you don´t have to get every day...but only once in a while in adequate amount

 

[catherinecherub]

There is an article dated 2013 when the evidence was brought to light.
http://www.pulsetoday.co.uk/clinica...h-acid-suppressing-drugs/20005335.fullarticle

 

[Sid Bonkers]

Cheers @catherinecherub and thanks for the link, i did know about the metformin risk but hadnt realised that proton pump inhibitors (PPI's = Omeprazole etc) were implicated, or maybe I had just forgotten or not connected the information, its amazing how something focuses the mind when it becomes personal

It seems that I am now between a rock and a hard place as I dont like taking too many paracetamol as they can adversely affect the liver and now I am not keen on taking the omeprazole which was helping to protect my stomach against the ibuprofen!!

Still, I guess there are much worse problems I could have and the slow release Transtek patches have been a real game changer for me so I guess ill just have to accept some breakthrough pain.

 

[LucySW]

PPIs also deplete magnesium levels and that can be important. Google for sources but it seems uncontested. So supplement magnesium as well.

My spouse decided to wean himself off PPIs after ten years. He googled and found a careful Swede who phased use progressively down over six months, and did it. Clear now.

BTW PPIs do cardiovascular damage too. They suppress nitric oxide levels and so partly disable the body's anti-clotting mechanisms. So good to get off them if you judge you can. See https://drmalcolmkendrick.org/2016/09/21/what-causes-heart-disease-part-xxi/.

 

[dawnmc]

Mad isn't it, take a pill to counteract the other pill. I'm on antihistamines to counteract the itching Metformin gives me.

 

[zand]

Mad isn't it, take a pill to counteract the other pill. I'm on antihistamines to counteract the itching Metformin gives me.

Oh does it help? I'll try that. Thanks.

 

[Indy51]

@dawnmc @zand - I'd be very nervous about doing this without having your liver function tested first - itching can be a symptom of liver damage and I believe metformin may also have issues in that regard. Pretty worrying if you're taking OTC meds without having other causes ruled out

 

[zand]

Sid, some on this forum have found that adding extra fat as well as low carbing has helped to ease arthritic pain and stiffness. I understand that up until now you have had no need to try this and that you successfully low carb by having small portions. Since you say you are now in between a rock and a hard place would it not be worth a try? What has worked for you in the past is no longer working as well as it once did and as Lucy SW says some of these painkillers can do harm to the cardiovascular system. I agree with her that magnesium deficiency is a potential problem as I am convinced that was what caused my heart to go out of sinus rhythm and into AF for years at a time. I have since stopped many of the drugs I was taking and supplement with magnesium and my heart now stays in sinus rhythm.

I don't like to think of anyone suffering in pain so I hope you take this post in the spirit that it's meant. I'm not interested in a debate about LCHF and I respect your feelings about it as a method to control diabetes. This is just a suggestion from me to you of something that could help you with your health now. You don't need to have pounds of butter or lard or litres of olive oil, just a little extra could help, you don't know until you try. It makes sense to me that low carbing reduces the inflammation and higher fat oils the joints better.

Best wishes anyway, whatever you decide.

 

[zand]

@dawnmc @zand - I'd be very nervous about doing this without having your liver function tested first - itching can be a symptom of liver damage and I believe metformin may also have issues in that regard. Pretty worrying if you're taking OTC meds without having other causes ruled out

Thanks, I know itching can be a sign of liver damage and if I have too many carbs it's worse, so that makes sense. I just hadn't considered that an anti-histamine would help when the itching isn't caused by an obvious allergy. I won't use them though, I have a cream which helps when it's really bad and the itching is usually a sign that my fatty liver has got a bit worse. Good advice Indy, thanks.

 

[dawnmc]

@dawnmc @zand - I'd be very nervous about doing this without having your liver function tested first - itching can be a symptom of liver damage and I believe metformin may also have issues in that regard. Pretty worrying if you're taking OTC meds without having other causes ruled out

Gp gave me them. Its the 2nd time I've been with this problem. I have had a liver scan.

 

[Indy51]

Gp gave me them. Its the 2nd time I've been with this problem. I have had a liver scan.

I'm not sure whether to be reassured by that or not if the GP didn't check your liver function

 

[dawnmc]

I'm not sure whether to be reassured by that or not if the GP didn't check your liver function

Thanks for your concern Indy, I'm not living off them, I only take them when I wake up with hives and the itching is unbearable.

 

[Sid Bonkers]

Sid, some on this forum have found that adding extra fat as well as low carbing has helped to ease arthritic pain and stiffness. I understand that up until now you have had no need to try this and that you successfully low carb by having small portions. Since you say you are now in between a rock and a hard place would it not be worth a try? What has worked for you in the past is no longer working as well as it once did and as Lucy SW says some of these painkillers can do harm to the cardiovascular system. I agree with her that magnesium deficiency is a potential problem as I am convinced that was what caused my heart to go out of sinus rhythm and into AF for years at a time. I have since stopped many of the drugs I was taking and supplement with magnesium and my heart now stays in sinus rhythm.

I don't like to think of anyone suffering in pain so I hope you take this post in the spirit that it's meant. I'm not interested in a debate about LCHF and I respect your feelings about it as a method to control diabetes. This is just a suggestion from me to you of something that could help you with your health now. You don't need to have pounds of butter or lard or litres of olive oil, just a little extra could help, you don't know until you try. It makes sense to me that low carbing reduces the inflammation and higher fat oils the joints better.

Best wishes anyway, whatever you decide.

No in my case the arthritis is spondilitis of the lower spine and the damage was done years ago and caused by trauma to the back so the lower vertebra are now knurled and misshapen and in time will fuse together as the condition moves up my spine, so no amount of fat would help it.

And as ive said many times the fact that I cut the carbs from my diet meant that i automatically increased the ratio of fat in my diet even though I didnt eat any more so i did in effect eat a lchf diet, simply put when you cut one group the other groups percentage is increased and as you know I have never believed that there is a need to increase the fat in your diet if you want to lose weight and if i ate more fat now then I would just put weight back on and become more insulin resistant again and theres no way I want that as I can pretty much eat what I want now

 

[Sid Bonkers]

PPIs also deplete magnesium levels and that can be important. Google for sources but it seems uncontested. So supplement magnesium as well.

My spouse decided to wean himself off PPIs after ten years. He googled and found a careful Swede who phased use progressively down over six months, and did it. Clear now.

BTW PPIs do cardiovascular damage too. They suppress nitric oxide levels and so partly disable the body's anti-clotting mechanisms. So good to get off them if you judge you can. See https://drmalcolmkendrick.org/2016/09/21/what-causes-heart-disease-part-xxi/.

Interesting link Lucy, thanks i didnt know that.

 

[zand]

No in my case the arthritis is spondilitis of the lower spine and the damage was done years ago and caused by trauma to the back so the lower vertebra are now knurled and misshapen and in time will fuse together as the condition moves up my spine, so no amount of fat would help it.

And as ive said many times the fact that I cut the carbs from my diet meant that i automatically increased the ratio of fat in my diet even though I didnt eat any more so i did in effect eat a lchf diet, simply put when you cut one group the other groups percentage is increased and as you know I have never believed that there is a need to increase the fat in your diet if you want to lose weight and if i ate more fat now then I would just put weight back on and become more insulin resistant again and theres no way I want that as I can pretty much eat what I want now

Sorry, I hadn't realised it was spondylitis. My friend has this too, though not as badly as you yet. Her's was due to trauma too. Have you tried physio and/or chiropractor? My friend has been much more mobile since having both of these treatments 3 or 4 years ago, and the pain is less now, though of course this isn't a cure.

 

[Sid Bonkers]

Sorry, I hadn't realised it was spondylitis. My friend has this too, though not as badly as you yet. Her's was due to trauma too. Have you tried physio and/or chiropractor? My friend has been much more mobile since having both of these treatments 3 or 4 years ago, and the pain is less now, though of course this isn't a cure.

Yes I had a year of physio several years ago and it just made it worse, then got sent on a back rehab course why all they did was tell us that pain isnt real its just nerves telling your brain that there is pain but there isnt really, really helpful like that makes the pain any easier to deal with *shakes head & rolls eyes*.They did also teach us meditation techniques which did actually help but its finding the time to employ them...

After the back pain rehab it was off to the pain clinic where I tried all sorts of pain killers from co-codamol, amitriptyline through to gabapentin and pregabalin and none of them helped much and some caused other problems like no feeling below the waist! That was either the pregabalin or the gabapentin, cant remember which but I stopped taking it PDQ

Finally prescribed DF118 codeine which helped but only if I took it religiously which I never did and then my GP suggested I tried Bu-Trans patches and they were a game changer for me, been on them several years now and have increased the dosage several times now on Transtek 35 micrograms / hour and have been taking paracetamol and or ibuprofen (with omeprazole on the side) for breakthrough pain, last winter I was probably taking them every day so thats when I believe that I probably first became deficient in vit b12, I was also taking 2 x 500mg metformin a day then too so the combo of met and the omeprazole did its work

But like I said there are worse problems to have and lots of folk much worse off then me and at least the T2 isnt a problem for me at present so Im grateful for that

 

[zand]

Yes I had a year of physio several years ago and it just made it worse, then got sent on a back rehab course why all they did was tell us that pain isnt real its just nerves telling your brain that there is pain but there isnt really, really helpful like that makes the pain any easier to deal with *shakes head & rolls eyes*.They did also teach us meditation techniques which did actually help but its finding the time to employ them...

After the back pain rehab it was off to the pain clinic where I tried all sorts of pain killers from co-codamol, amitriptyline through to gabapentin and pregabalin and none of them helped much and some caused other problems like no feeling below the waist! That was either the pregabalin or the gabapentin, cant remember which but I stopped taking it PDQ

Finally prescribed DF118 codeine which helped but only if I took it religiously which I never did and then my GP suggested I tried Bu-Trans patches and they were a game changer for me, been on them several years now and have increased the dosage several times now on Transtek 35 micrograms / hour and have been taking paracetamol and or ibuprofen (with omeprazole on the side) for breakthrough pain, last winter I was probably taking them every day so thats when I believe that I probably first became deficient in vit b12, I was also taking 2 x 500mg metformin a day then too so the combo of met and the omeprazole did its work

But like I said there are worse problems to have and lots of folk much worse off then me and at least the T2 isnt a problem for me at present so Im grateful for that

Thanks, now I understand. I was going to 'like' your post, but that doesn't seem appropriate.