On Metformin? Take B12 and Folic Acid

I know quite a few of you who have been offered Metformin for diabetes and PCOS (Polycystic Ovary Syndrome).

But, if you are on it, did you know that it is quite likely that you will become folic acid and B12 deficient if you are on the drug for more than a year?

Most people think that aside from possible gastrointestinal upset, there are no side effects from taking metformin, and thus you can take it for a very long time. Recent evidence is showing that the longer you take metformin, the more likely it is that you will develop a vitamin B12 deficiency.

The Hospital de Clínicas de Porto Alegre in Brazil found that one of every three diabetics taking metformin for at least one year had indications of a possible vitamin B12 deficiency.

Long-term use of metformin also causes a decrease in folic acid (a B vitamin), and an increase in homocysteine, which in an undesirable metabolic substance if there is too much of it. [Ed’s note: it is one of the main indicators of cardiovascular risk]. Source: PCOS enews, May 12

You can read more about this in the links below: Nervo M et al, Vitamin B12 in metformin-treated diabetic patients: a cross-sectional study in Brazil, Am J Clin Nutr. 2011 Mar;93(3):652-62

de Jager et al, Long term treatment with metformin in patients with type 2 diabetes and risk of vitamin B-12 deficiency: randomised placebo controlled trial, BMJ. 2010 May 20;340:c2181

So, two things occur.

The first is to make sure you look after your B12 and folate levels (incidentally, the homocysteine usually rises because of a deficiency of these two crucial B vitamins). A good multi with plenty of B12 and folate is a must. It’s probably easier to take a good multi and then add an extra B Complex.

Second, is there a good natural alternative to metformin?

Well, we do know that a healthy diet and lifestyle can change insulin patterns as much as metformin. But, of course, it is not as easy as taking a pill so many people prefer the drug, despite its side effects.

NAC a Natural Alternative to Metformin

NAC, N-acetyl-cysteine, an amino acid has been shown to be a good natural alternative. Erciyes University in Turkey has reported that NAC was equally effective as metformin for reducing the symptoms of PCOS. 

In this study, 100 women with PCOS were evaluated for six months. One group took 500 mg Metformin 3 times a day. The other group took 600 mg of NAC 3 times a day. And guess what? The researchers reported that there was almost no difference between NAC and metformin. Both groups of women had improvement in testosterone reduction, improvement of hirsutism, insulin normalization, and normalization of cycles. Source PCOS enews.

Note the normalisation of insulin there – just what diabetics as well as PCOS sufferers need, so NAC and changing your diet and lifestyle has to be worth a try before resorting to a drug that depletes you in such important nutrients.

4 Replies to “On Metformin? Take B12 and Folic Acid”

  1. Since many people have the MTHRF mutation (apparently about 40% of people have a mutation), shouldn’t these people use a bioactive form of folate instead of folic acid?

    In fact, shouldn’t you also be using methyl B12 and B6 as well? These active forms rely less on your possibly defective metabolic machinery.

  2. hello micki thank you for you article on metformin/ I have type 2 diabetes . I want to try the nac that you mention ? is there side effects to it . as metformin reacks havoc on my stomach thank yo Paul

    1. Hi Paul, you would need to take advice from a health professional as I don’t know what you are on or your case etc. I’ve never known anyone have a problem with it myself. Generally, this is the official line:

      “N-acetyl cysteine is LIKELY SAFE for most adults, when used as a prescription medication. It can cause nausea, vomiting, and diarrhea or constipation. Rarely, it can cause rashes, fever, headache, drowsiness, low blood pressure, and liver problems.”

      Re med contraindications I think they are likely around ACE inhibitors and platelet drugs as it can affect blood clotting. This is a good make and they are usually helpful with questions so maybe talk to them too: http://naturaldispensary.co.uk/products/NAC_600mg_60_s-7335-0.html or I can always do a mini report for you to check your meds specifically. https://purehealthshop.ecwid.com/#!/Mini-Advice-Report/p/51698028/category=12778026

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