In my practice Vitamin B12 is the most common vitamin deficiency I see. Low stomach acid, stress, and irritation/inflammation all contribute to decreased B12 levels. You may be at greater risk of not only low levels of B12, but also Folate if you are a Type 2 Diabetic on Metformin.
A study published, in the Journal of Internal Medicine, demonstrated a 16-week use of Metformin a 14% decrease in Vitamin B12 and a 7% decrease in Folate. The individuals who took the metformin also had higher levels of homocysteine and methylmalonic acid (markers of B12 deficiency which also correlate with increased cardiovascular risk) and significantly worse scores on standardized assessments of the severity of neuropathy.
Effects of short-term treatment with metformin on serum concentrations of homocysteine, folate and vitamin B12 in type 2 diabetes mellitus: a randomized, placebo-controlled trial
M. G. Wulffelé
1, A. Kooy 1, P. Lehert 2, D. Bets 3, J. C. Ogterop 4, B. Borger van der Burg 5, A. J. M. Donker 6& C. D. A. Stehouwer 6
Both Folate and Vitamin B12 are critical nutrients for the production of cellular energy, are major co-factors in many biochemical pathways and are extremely important for neurotransmitter production and mood. Among the many side effects of B12 deficiency is peripheral neuropathy, which is also a major complication of Type 2 Diabetes.
To correct both deficiencies I recommend starting with series of inter-muscular injections of a combination of B12 and Folic acid, followed by monthly injections or a daily sub-lingual B12 tablet (a tablet that dissolves under the tongue). I prefer the methylcobalamin form of B12 and the L-methlyfoloate form of Folate as these forms are more readily used by the body. B12 is a bit of a problem nutrient as it needs a carrier called intrinsic factor, it is only absorbed if you are producing enough stomach acid, and is only absorbed in a very small portion of your small intestine, for these reasons an injection or sub-lingual tablet is preferred over a capsule that you would swallow.
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