Vitamin B12 deficiency due to Metformin?
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Time to read 3 min
Metformin is a commonly prescribed medication for people with type 2 diabetes and women with PCOS (polycystic ovary syndrome). Originally developed to treat diabetes, it helps lower blood sugar levels and regulate hormonal imbalances by stabilizing insulin levels in the body.
However, long-term use of metformin can also have side effects , including a possible vitamin B12 deficiency . 1٫ 2٫ ³ ٫ ⁴ ٫ ⁹
This article explains why vitamin B12 is important, how a deficiency can manifest itself, and how dietary supplements can help.
Table of contents
Metformin for PCOS and type 2 diabetes
Metformin belongs to the class of biguanides and was primarily developed to regulate blood sugar levels in type 2 diabetes . It inhibits glucose production in the liver and delays glucose absorption in the intestine, thereby lowering overall blood sugar levels.⁵
Insulin also plays a central role in PCOS , which is why metformin is often prescribed. Women with PCOS often struggle with insulin resistance, a condition in which the body's response to the hormone insulin is impaired. This can disrupt the hormonal balance and trigger symptoms such as menstrual irregularities, acne, and increased body hair.
Metformin is frequently prescribed to support blood sugar regulation and lower insulin levels. However, although it is often recommended as the "drug of choice," a growing number of studies show that taking metformin can also cause side effects – such as a possible vitamin B12 deficiency .
Vitamin B12 deficiency: A side effect of metformin
Metformin is a well-researched medication that has been prescribed for many years, but it can have some potential side effects. The most common complaints at the start of therapy are:
- Gastrointestinal problems such as nausea and bloating
- a metallic taste in the mouth
However, one point stands out particularly when taking the medication long-term:
- Metformin can impair the absorption of vitamin B12 ⁶
The exact mechanism is not yet fully understood, but it is thought that metformin interferes with the function of intrinsic factor – a protein produced in the stomach that is necessary for the absorption of vitamin B12.⁴
Such a deficiency can have serious consequences , as vitamin B12 is essential for many important processes in the body.
Why Vitamin B12 is essential
Vitamin B12 is involved in numerous key processes in the body:
- Blood formation : It supports the formation of red blood cells, which are important for the oxygen supply of all body cells.
- Nerve health : Vitamin B12 protects the nerves and enables smooth signal transmission in the nervous system. A deficiency can lead to nerve damage, often manifesting as tingling or numbness.
- Energy and metabolic processes : Vitamin B12 plays a role in energy metabolism and helps to reduce tiredness and fatigue.
What to do in case of vitamin B12 deficiency?
A vitamin B12 deficiency usually develops gradually and is often only recognized late.
The first symptoms include:
- fatigue
- paleness
- Concentration problems
- Tingling in the limbs
In the long term, however, an untreated vitamin B12 deficiency can lead to severe nerve damage that may be irreversible.
If you are taking Metformin, it is advisable to have your vitamin B12 levels checked regularly by a doctor .
A deficiency can be detected through a blood test that measures not only vitamin B12 levels but also functional markers such as methylmalonic acid (MMA) and homocysteine. These markers indicate whether a deficiency actually exists.
To prevent a deficiency , you can focus on foods rich in vitamin B12. Good sources include:
- Meat and fish (e.g., liver, salmon)
- Dairy products and eggs
Vitamin B12 as a dietary supplement
People who take the drug Metformin long-term to treat type 2 diabetes or PCOS have an increased risk of vitamin B12 deficiency.
Targeted supplementation with vitamin B12 can be useful to ensure adequate supply if a deficiency is detected or suspected.
Before taking any supplement, it is advisable to speak with a doctor to determine the appropriate dose and form and to ensure that the vitamin B12 supplement is suitable for the individual.
Metformin, frequently prescribed for type 2 diabetes and PCOS, can impair the absorption of vitamin B12 in the long term. A vitamin B12 deficiency can lead to fatigue, difficulty concentrating, and nerve damage. People taking metformin should therefore have their B12 levels checked regularly by a doctor and take a supplement if necessary.
Women with PCOS can consider inositol as a natural alternative to metformin, as it also supports insulin metabolism without affecting vitamin B12 absorption.
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