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Assalamu alaikum it’s muhammad muslin today i will discuss on effect of metformin on vitamin b12 okay so let’s start with this so according to research we have found that the metformin can decrease the vitamin b12 level in your blood so today we will try to discuss how does the metformin decrease this vitamin b12 level okay so according to research if the metformin
Doses is equal or more than the 1500 milligram per day then it can significantly decrease your vitamin b12 level in your blood or serum okay so according to our result that we have found that uh metformin can decrease the vitamin b12 level in 22 percent of patients those who have been taking metformin for the diabetes mellitus or pcos syndrome etc okay so today we
Will try to explain the underlying pathophysiology but before that i want to discuss briefly about the mood of action of metformin so all of us know about that but i will try to discuss it briefly okay so we know that the metformin metformin can act in multiple pathway so the important pathway is the metformin stimulates or activate the ampk that means adenosine
Monophosphate activated kinase enzyme and the amtk enzyme inhibits the gluconeogenesis so if the ampk inhibits the gluconeogenesis so we can easily predict that the blood glucose level will be decreased so that means there is happening ampk decrease the blood glucose level and metformin stimulate the mpk that means through this metformin the function of ampk will
Be enhanced that’s why gluconeogenesis process will be decreased more and more that’s why that glucose level will be fall down okay so by this pathway metformin mainly controls our blood glucose level moreover there are some other pathways that has been detected through the research and we know that uh these pathways are the metformin can also increases the
Senses insulin sensitivity that’s why insulin can act more uh more actively and more faster so uh moreover uh the metformin increases the fatty acid oxidations and it decreases the intestinal glucose absorption let’s start so before that uh i have to discuss briefly about uh that how does the vitamin b12 absorbs in our uh ilia terminal part of ileum so we know
That the vitamin b12 is mainly found in animal source so the vitamin b12 this vitamin is bound with protein diet okay mainly so uh here the vitamin b12 is indicated as cvl that means cobalamin so you can see here that the global cobalamin is bound with the protein content so whenever this protein bound with covalent is reached into your stomach the hydrochloric
Acid and pepsin secreted from your gastric glands uh they will digest and detox the cobalamin from the protein so here you can see that cobalamin is detached from the protein now cobalamin is free but the global amine cannot survive for a long time in this highly acidic uh atmosphere that’s why the urban are binder protein a glycoprotein this r binder protein
Try to protect the cobalamin so urban our binder protein will bind with this cobalamin here you can see the cobalamin is bound with r binder so uh this complex uh this cobalamin and our binder complex now reaches into the deudonym here we know that uh in judean and pancreatic juice releases so the pancreatic enzyme we digest this our vendor protein we know that
The pancreas releases the proteolytic enzyme that’s why the kobala means now again free in the deodorant so the cobalamin is a vip person and this knowledge try to travel through a mercedes or bmw car the bmw mercedes car for this cobalamin vitamins is intrinsic factor of castle which is secreted from the gastric gland we know that the parietal cell produces this
Inclusive factor so here the intrinsic factor will combine with this cobalamin so here you can see this is the intrinsic factor and cobalamin complex so this complex will uh travel down towards the your ileum terminal part of irium so here you can see that there is an anterocity so this anterocyte is located on the terminal part of alien now intrinsic factor and
Covalent complex is your lumen in in irium okay so in the enterocyte of terminal part of ileum there are receptor for this complex this covalent intrinsic factor complex okay now we will show you that receptor okay so this large cell is a enterocyte you can see here and this is a receptor which will facilitates the absorption of vitamin b12 and this receptor is
Known as cubeline receptor so the tubulin receptor is located on the luminal side of the enterocytes of ileum remember this cubeline receptor is only located on the anterocytes of terminal ileum that’s why the vitamin b12 is mainly absorbed at terminal area okay so between visual and intrinsic factor complex is uh now closer to this receptor and so this receptor
Will bind with this complex but very interesting things that for this bondage for this bondage between this complex and this tubulin receptor one ions is mandatory and that ion is the calcium ions okay so calcium ion facilitates this bondage and without calcium iron this binding cannot happen strongly and adequately so now what happened that in case of metformin
In case of metformin suppose the patient has already taken uh the midform in drug so the metformin ultimately reaches uh through the circulation into the anterocyte so here you can see uh the metformin is a become protonated within the anterocyte so the protonated metformin is positively charged so here you can see here you can see some positive charge inner
Side of the enterocyte remember this is the uh this is the enterocyte this is the enterocyte enterocyte okay so here you can see uh some positive charge this is the positive starch this positive charge actually is protonated metformin metformin so that means you can understand that metformin produces positive charges inside the anterocyte okay that’s why the
Calcium ion which is located outside of the enterocyte here the calcium ion so the calcium ion cannot bind appropriately with this location due to these uh forces these electric forces of metformin okay so as the calcium can bind with the cubilin receptor so it cannot facilitate the bondage between intrinsic factor and vitamin b12 complex and cubeline receptor
That’s why the vitamin b12 intrinsic factor complex cannot bind with this cubiline receptor due to due to failure of the calcium ion bind with the cubeline receptor okay so by this mechanism metformin can prevent your absorption of vitamin b12 in your terminal ileum okay so this is really a proof that if we take the metformin more than 1500 milligram per day and
The duration of taking metformin is more prolonged then there is evidence-based research that um vitamin b12 level can be increased in your blood so i can show you the statistics uh so here you can see the daily doses of metformin uh when we increase the doses of metformin uh the vitamin b12 living in your blood begins to fall okay it is it begins to form okay
So i have tried my best to explain the matter briefly and the easiest way so thank you everyone if you like my lectures then please like share and subscribe my channel and keep me in your prayer love is assalamualaikum
Transcribed from video
Metformin can cause vit B12 deficiency || English version By Dr.Muhammad Mosleh Uddin
