Dear Reader,
“Are you in any pain right now?
“Oh, yes. It feels like there’s lightning shooting through my hands and feet.”
“Huh? What’s going on with your extremities?”
“Eh, I am not really sure — my doctor says its neuropathy. I think it’s just a part of having diabetes.”
This is a conversation I once had while doing a patient assessment. I will never forget how she described her pain.
I could almost see little lightning bolts flashing through her fingers and toes as she described the ever-present buzzing and electric feelings in her extremities.
At the time, I was working at an inpatient mental health unit, but since some anti-psychotic medications increase the risk of diabetes, many of the patients I saw were diabetic.1
It was all too common to hear them complain of numbness, shooting and stabbing pains, tingling in their hands and feet, loss of balance and reflexes, and even extreme skin sensitivity — all symptoms of neuropathy.
Some patients even had to rely on wheelchairs to get around during especially painful bouts.
It was difficult to watch this seemingly matter-of-fact situation.
But as it turns out, suffering from neuropathy may not be a consequence of just diabetes.
This painful and debilitating condition maybe be due to a side effect of a diabetic medication — vitamin B-12 deficiency.
And not just any diabetic medication, the most prescribed diabetic medication: metformin. 2
In fact, a study found 40 percent of metformin users to be B-12 deficient. And of those metformin users, three-quarters experienced neuropathy .3
Plus, 22 percent of diabetics are already B-12 deficient, regardless of their medication regimes, making the metformin related B12 deficiency statistics even more significant.4
So that leaves us with the ultimate question: What came first, the pain or the pill?
Unfortunately, the answer is not clear.
But what is clear — if you are diabetic or diabetic and taking metformin, chances are you have a B-12 deficit.
And as I’ll explain in a minute, even if you’re not diabetic or taking metformin, you could still have a B-12 deficiency.
The good news is B-12 deficiency is easy to diagnose and inexpensive to treat.
And boosting your B-12 level may relieve symptoms of neuropathy, regardless of its source.
We will get deeper into the steps you can take to increase your B-12 levels in a bit.
First, let’s take a closer look at metformin, B-12, and neuropathy.
Understanding the Lightning
A study published in BMJ reveals that long- term use of metformin can cause patients to experience an increasing deficiency of vitamin B-12 over the time of use.
The researchers reported: “Metformin is considered a cornerstone in the treatment of diabetes and is the most frequently prescribed first-line therapy for individuals with Type 2 diabetes,” and went on to say, “Metformin does… induce vitamin B-12 malabsorption, which may increase the risk of developing vitamin B-12 deficiency — a clinically important and treatable condition.”5
Vitamin B-12 is vital to nerve health and function. When the body is experiencing malabsorption of this key vitamin, it creates a deficit.
When the body lacks B-12, it can cause damage to the protective myelin sheaths surrounding your nerves. Once compromised, the myelin sheaths can no longer shield your nerves, which may result in nerve and spinal cord damage and alter your nerve functions.
Altered nerve functions can cause nerves to fire slower or incorrectly. This means the body and brain may not receive the right messages.
In the case of neuropathy, these mixed and missing messages cause the lightning-like pain and buzzing feelings in the hands and feet, just like my former patients experienced.
When B-12 is adequate, it can help to ensure nerve protection and may reduce symptoms.
Unfortunately, nerve damage caused by diabetes can feel very similar to nerve damage caused by low B-12, therefore making it very difficult to tell the difference between the two.
The best way to know if B-12 is causing your neuropathy (or any other health issues, as B-12 affects many organs) is to get your B-12 level checked with a simple blood test.
If you are taking metformin or are diabetic, your doctor should include regular B-12 tests as part of your care plan. If it’s been a while since your last test, request one.
In fact, anyone over age 40 should have their B-12 levels checked on a regular basis. As you get older, your stomach acid levels decline and stomach acid is crucial for absorbing B-12. Up to 40% of all adults are deficient in B-12, and this can lead to nerve pain in everyone, not just diabetics.
And the best news is vitamin B-12 deficiency is preventable and easily reversible through diet and supplementation.
Though, B12 levels are scant or even non-existent in most fruits and vegetables while red meat, eggs, poultry, fish and dairy are good sources of B12. However, these sources may not be enough to stave off deficiency. Taking a B12 supplement is the best way to increase your levels. The Institute of Medicine actually recommends all adults get extra B-12 from supplements or fortified foods, since many people have trouble absorbing enough from food alone.
Here are some tips to get you started:
- Methylcobalamin: When looking for a supplement, make sure it contains methylcobalamin as the active ingredient and not cyanocobalamin. Methycobalamin is the natural and bioavailable form of B12. This mean sit is in the form the body is able to use. Cyanocobalamin is the synthetic form and the body has to first convert it to the methyl form in order to put it to use.
- Sublingual absorption: Sublingual, or under-the-tongue, ingestion of B-12 has the best absorption rate. In fact, absorption through the sublingual route is three–10 times greater than the oral route. Make sure the supplement you choose is dissolvable under the tongue. A quick way to figure this out is to look at the directions. They should say something like “place under tongue until dissolved and then swallow”
- Dosage amounts: While you can find a B-12 in many doses, research indicates 500 µg is the sweet spot for optimal results. A study has found 500 µg daily dosages to provide maximum reduction in biological markers of B-12 deficiency.7
If you have anything to say about metformin, neuropathy, or B-12, please share! nmoore@lfb.org
Live well,
Natalie Moore
Managing editor, Living Well Daily
P.S. If you are a Natural Health Solutions member and want more information on diabetes, check out this report from our Chief Health Officer Brad Lemley.
P.P.S Next week, Living Well Daily will be exploring a farmer-friendly and fun way to explore new produce while getting your vitamins and nutrients. Stay tuned!
Sources
[1] Homocysteine, Cortisol, Diabetes Mellitus, and Psychopathology
[2] Medications for Type 2 Diabetes
[3] Metformin causes vitamin B12 deficiency
[4] Diabetes and B12: What You Need to Know
