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I learned so much for my patients actually one of my patients a couple of years ago taught me about the concern for vitamin b12 with metformin more and more people are using metformin as i’ve mentioned several times there studies like the tame study team would actually do something similar to putting metformin in the water for folks over 60 65 years old the cdc is
Pretty clear that about one out of thirteen people that need metformin are actually taking it so as you if you’re considering that form and one thing to remember is that there has been some association of decreased vitamin b-12 with metformin and i’m going to cover that briefly in this article this is an article in diabetes care it was a couple of years ago 2012
Association of biochemical b12 deficiency with metformin therapy and vitamin b12 supplementation so here’s a couple of key points here biochemical the reality is as they saw in this study you can get some apparently significant decrease in vitamin b12 but still not have any symptoms and though anemia and no neuropathy no depression none of the other symptoms associated
With vitamin b12 deficiency now when you say significant that’s one of the the questions well if it doesn’t cause any symptoms and it’s not causing any harm how significant is it that’s a good question the other thing is the point about vitamin b12 supplementation one of the things they found was that the typical supplementation especially the multivitamins don’t
Really have enough to impact this biochemical level of decreased vitamin b12 so real quick how did the study work they took adults 60 years and older with or without type-2 diabetes now with diabetes was sixteen hundred and twenty-one and time and with type-2 diabetes was six thousand eight hundred and sixty-seven this was from the in haines study national health and
Nutrition examination study so basically that’s a study that’s been going on for decades if the whole idea is to look at our popular american population and see what’s the typical nutritional and health status it over samples minorities over samples folks 60 65 and older what they did with this study after they look they do get blood samples with a lot of these the
Folks in this study and what they did was basically look at serum serum b12 count concentrations they labeled less than or equal to 148 as borderline deficiency in 148 to 221 as excuse me the opposite less than or equal to 148 is deficiency in 148 to to 221 as borderline i think i’ve covered most of the issues in here yep well a couple of their comments regarding
Deficiencies their point was in see they’re saying the same thing that all of us are saying is we get older we tend to have higher prevalence of type 2 diabetes they’re listing it as 20% over 20% at age 65 that’s a very very low number and again what kills you with diabetes is the cardiovascular disease not the sugar and the cardiovascular disease occurs during
Those 1 to 10 20 years prior to a diagnosis of diabetes that you have pre-diabetes so that’s the time when you should be focusing on your diet your lifestyle and even taking metformin so again this 20% is a way low underestimate now they did go on to say that they saw deficiency and 6% and mild biochemical deficiency in 20% so now here’s one of the the if you look
For standards on what to do on that the us preventive services task forces and other government agencies really don’t have any yet why is that it gets back to the issue of they’re trying to figure out is it significant or not so if you have a concern about it sure go ahead and and monitor that actually there is one other point there studies that have been done
To look at how long does it take after starting metformin to start having some of this problem and it looks like about four years so if you started metformin over the past few years and you’re curious or concerned about this you can get serum vitamin b12 level now what to do about it again taking normal supplements may not be very helpful taking specific vitamin
B12 supplements appears to be more helpful and for sure vitamin b12 injections just a figure out of this study the the black bars are folks that had diabetes and metformin these folks had diabetes no metformin and these folks had no diabetes the point was it’s clearly and this is this side of the graph is mild vitamin b12 deficiency this side of the graph is the
Serious or the higher about chemical we say i said serious but again we’re still not seeing a lot of biological significance other than just the monitoring value itself so again what to do as i mentioned you could ignore it a lot of people are doing it a lot of the standards committees are ignoring the whole thing because they’re not seeing significant disease
With it yet or you could go ahead and monitor and treat and you can give supplements thank you for your interest
Transcribed from video
Metformin & Vit B12 deficiency 2018- It's real. – FORD BREWER MD MPH By Ford Brewer MD MPH
