Diabetes India
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Is there any replacement to metformin to get around B12 issue with it?

I have been on metformin for about 11 to 12 years. Recently, my B12 readings are less than normal. Read metformin causes B12 deficiency. For the last few years, I have been taking meformin 250mg 3 times a day right after meal. My latest Hba1c is 5.02. Average glucose (MBG i think) is 97. FBS is 97. Please suggest if there is anything that I can use to replace metformin fully or partially.

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Dear Anand,

To fulfil the Vitamin B12 requirement, you can take one tablet of Neurobion Forte daily after meal.

Take care and stay healthy!

Best regards,

Kunwar Singh

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Have you discussed the issue with your doctor about the B12 and possible change of medications?

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Take Neurobion forte as suggested by close2health or take becadexamine capsule which is a multivitamin.

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take chicken liver. It has lot of B12

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Most answers are, what kind of foods or supplements got B12. But I am looking for answer to "Is there any replacement for metformin that does not affect B12 absorption by the body"

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You could buy B12 supplement and make sure it is methylcobalamin and not the plain cyancobalamin (less bioavailable and so a waste of money). A retail name for the former is Mecobalamin. To buy, go here ---- > my.iherb.com/search?kw=meth...

** Vitamin C (ascorbic acid) supplements. Taking vitamin B-12 with vitamin C might reduce the available amount of vitamin B-12 in your body. To avoid this interaction, take vitamin C two or more hours after taking a vitamin B-12 supplement.**

Two possible/potential replacements for metformin:

[1] Berberine and [2] Black cumin seed oil (Nigella sativa).

Do not confuse Nigella sativa (Kalonji) with Centratherum anthelminticum (called Kalijiri in India) even though both are [confusingly] called by the same English name of 'black cumin'.

Worse, there's another botanical entity called 'kala jeera' (Bunium bulbocastanum) which is not the same entity as either kalijiri or kalonji.

Incidentally, kalijiri is also said to be effective for diabetes.

** Article on sorting out the various names of black cumin, black seed, kala jeera, kalijiri:

----- > lazygardens.blogspot.my/201...

For Nigella sativa / kalonji, here's a customer's review at iherb.com :

Multi-use - Posted by iHerb Customer on December 1 2016 | Verified Purchase

"Helped to lower my husband's blood sugar even without metformin. Currently hovering at 7.7 to 8 (normal is 6 and below) without restricting his diet to greens so not bad. Maybe after a month of taking these, it will lower some more (hope to God). Btw, this makes the skin really soft when applied topically."

Source: my.iherb.com/r/Amazing-Herb...

Dr. Frank Shallenberger: On Berberine replacing Metformin:

faim.org/can-this-herb-comp...

Nigella sativa / Kalonji:

google.com.my/search?hl=en&...

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Thanks @coffeeday for the input. Good to hear from you again after the jyotish episdode!!

Could you specify the dosage for the 3 months you suggested?

B12 is not just for addressing peripheral neuropathy. Other potential symptoms that can show up:

** fatigue, muscle weakness, intestinal problems, nerve damage and mood disturbances/swings, mental fogginess, memory problems, feelings of apathy and lack of motivation, etc (www.mayoclinic.org)

If left untreated: depression, sleep problems, dementia, Alzheimer’s disease, cardiovascular disease, anemia, cancer, multiple sclerosis, and irreversible brain damage (www.mercola.com)

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I did NOT know- we can refer to other sites - drmercola.com - I get emails- dont read all the times

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So how much Nigella in your one tsp of raw honey? You didn't specify the amount of the former. I assume this Nigella dosage that you'll now specify is for the 3 mth period. The one you are now consuming is the maintenance dosage I guess and it may not be the same as the one for tackling neuropathy initially.

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Thanks for the detailed info. I do not have much luck with honey... it rapidly spikes BS in my case but I've come across a few reports that certain types can actually help diabetics. There is one called Tualang honey which I intend to get and try out - it's locally harvested from trees that grow up to 150 feet. Harvesting it is a dangerous occupation because the bees are particularly fierce and protective of their hives. Not surprisingly, the price of a bottle of 650-750 g [raw, unprocessed TH] can fetch a market price of US30 and above. I'm still puzzling out what raw honey does for you - bringing down the glucose level? What are nutritional benefits you've experienced from it?

I've never come across Nigella in powder form. It's either in the original seed form or as oil, either in small bottles or encapsulated. I've taken the later religiously for months but did not see any changes to the body. So is the powder form more effective than the oil extract? Anyway I went out to get the seeds this afternoon and intend to combine it with black cumin and a host of other antidiabetic stuff (amla powder, fenugreek powder, turmeric, ghee) as recommended by Dr Pankaj Naram to see if the concoction will work or not.

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amazon.in/Berries-Nuts-Nige...

=> is that the same are you talking about. Can I buy and start eating regularly?

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The price at Amazon is twice the price I paid. Wow.

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Fried or roasted? I think you said fried earlier.

[1] Did you use any oil to fry or roast the seeds?

[2] How long do you have to fry or roast the seeds?

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I think what you meant is 'toasting' in a frying pan. Frying implies the addition of oil/fat. Thanks again for the input.

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Thanks for the detailed info. The most expensive honey we get from locally harvested honey is is the kelulut variety derived from the stingless/Trigona bees. The prohibitive prices put it out of reach for most people. I'll get the Tualang one tomorrow at the mall. You can get some info on the Tualang honey (Madu Tualang as it is called) here:

google.com.my/search?hl=en&...

I found that the price of the common Madu Tualang at eBay is inflated by 4x !! And some posted there are actually fakes. It is unsafe to buy those not certified by the government. There was one which appeared to stabilize and even lowered the BS a little. I can't remember the exact name but it is a Bulgaria import. Most from Europe carry a EU label of a leaf outlined with white stars shown at this website: bulgarianhoney.com.my/conte...

Research study on Kelulut honey:

"This research is the first to report data on phenolic profile and total antioxidant capacity of Kelulut honey. Our data suggest that Kelulut honey has prominent medical properties and could be exploited as a natural nutraceutical to treat free radical associated diseases." sciencedirect.com/science/a...

Madu Tualang in the news: foxnews.com/health/2016/07/...

Here is an interesting research study on lab rats using Madu Tualang at :

mdpi.com/1422-0067/11/5/205...

"This study shows that oxidative stress is still evident in the pancreas of diabetic rats administered the two most commonly prescribed antidiabetic drugs, glibenclamide and metformin. The administration of these two drugs in combination with tualang honey inhibited lipid peroxidation and attenuated the altered activities of antioxidant enzymes. In other words, based on our data, it can be said that tualang honey provides additional antioxidant effect to glibenclamide and metformin. Thus, the additional antioxidant protection exhibited by a combination of glibenclamide, metformin and tualang honey can be ascribed to tualang honey. This protection on pancreas against oxidative stress might also partially have contributed to the hypoglycemic effect of tualang honey in diabetic rats. This study establishes a basis for the need of antioxidant therapy in combination with hypoglycemic drugs in the management of diabetes mellitus."

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I normally take a BS reading a day after ingesting the experimental product. I can't wait to get a non-invasive, continuous monitoring BG system. There are at least two (one is called Libre) on the market but they originate from Britain/US and the prices are still very prohibitive. There a few waiting in the winds and will make it to the market pretty soon.

Videos on Libre on Youtube:

youtube.com/results?search_...

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There is also the DEXCOM CGM system. Go to: healthunlocked.com/user/act... for the postings on the DEXCOM.

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Yes, Dexcom has been around for a long time and they have taken a lot of trouble to tweak it to cutting edge quality. But it is less invasive than Dexcom and Medtronic; all of them use a "needle" but the skin depth penetrated differs.

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Oops, what I meant was a week later, not the next day. Sorry! I only take a reading the next day when I do the one-day liquid fast. But lately, I decided to also include a reading before the fast too, just to see the extent of the BS fall.

Re the reduction of pharma drugs - I kicked out Clamide and and reduced Met. by one third a while ago. Since then my BS has been kind of messed up and does not show signs of improvement. So I have to be very careful. Until a definite and large BS fall obtains, I feel it is unwise and unsafe to reduce the current dosage any further.

Well I will add (tualang) honey and kalonji as per your recipe to the arsenal and see how the BS battle will turn out :) Phew, what a life!

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You might want to consider adding (organic) Blackstrap molasses and/or colloidal minerals to your regimen... they are a rich source of minerals, I gather.

As for astro stuff, I did download the latest Junior Jyotish and Jyotish Hora programs resp. but have yet to unpack them. These latest (?) editions are said to contain different Ayanamsa options - the Raman one being one of them.

Yes, jyotish is such an advanced science that one would have to spend a lot of time studying and getting trained under experts. The Tamil community here has been asking the local university to include it in their degree programs, interestingly enough. One of my favorite jyotish sites is

barbarapijan.com/bpa/bAstrH...

B. P. Lama writes well and scores high on perspicacity. If you haven't come across her, dig in at her website. You won't be disappointed.

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In my opinion, long term solution would be to come off medicines altogether. Looking at your blood sugar numbers, it seems very much possible. Please review your diet. If you follow low carb diet, you may be able to gradually reduce the doses of medicine and finally come off medicines altogether.

Regarding alternative medicines, you should consult your Doctor. We are not trained to prescribe any medicines.

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Thanks. I understand very well the forum is for sharing the experiences. Since the forum is full of diabetics, just to check if someone came across similar experience and using some replacement and getting good result. We definitely go to doctor and take his advise and prescription before starting to use anyone's advise/experience. My purpose of question is only for knowledge and experience sharing.

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Thanks, yvjanard. I appreciate your point.

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Yes, this is quite a common problem. No real replacement drug for Metformin. It is an excellent drug, with lil side effects relatively, even in the long run. B12 def, caused by malabsorption due to met can be easily rectified. Take b complex on empty stomach in the morning. Replacent to met with a drug? Not really.

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This input is from my wife.

Her sister switched over from Metformin to DAONIL 5mg 3 times a day.

Seems like that works. She is a 73 years old.

And very less side effects.

She said its a very in-expensive tablet available in any pharmacy.

Please do NOT come back to me for any questions sir.

I do NOT use this (although I am 29 year old diabetically).

Just my wife's opinion.

Best way to go would be

"Cut down the intake for a day to 40% of your current consumption. Avoid any food that has CARB in it.

If you feel tired, have some protein supplement.

As far B12, there are plenty of natural supplements as well any pharmacy guy will guide you with."

After a few days, check your Fasting regularly to see if there are any positive response.

I am just a tiny member like any one else and NOT a DOCTOR (or qualified) at all to provide any definitive procedures.

I only give my friendly suggestions for better.

Listen to some good songs / music that you like for 2 hours.

Sleep more hours (may be for 9 hours without thinking about any worries) for good.

Good luck.

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Yes, Daonil, now I remember. Sufonylurea category drug. Good info for the questioner, am not the one, but useful info. I think Daonil works on some patients well, I tried it long time back, Glibenclamide is the drug, did not work for me, but may work for others, and this side effect of lack of b 12 does not arise I reckon. It basically increases the secretion of insulin from the pancreas, but doesn't affect the receptors, which is the main problem in type 2 diab. Met works best on receptors. Glibenclamide is often given as conjunct to met, a combo works well for some patients.

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Daonil, glibenclamide + most, if not all, sulphonylureas increase the risk of cardiac events, esp hard attacks (sigh!!). This is becomingly evident from recent medical research while met is not without its attendant adverse side effects too. Looks like we can't have a clean and pure win when it comes to pharma drugs.

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My Dr has cut my Metformin because it isn't good for your kidneys. It increases creatinine levels

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For regular patients, long term usage is fine with kidneys. When a patient has an existing ailment of the kidney or weak kidneys, then yes. Met is one of the safest drugs relatively.

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Sunnybhai, what happens with long-term use of Met. is that the liver becomes 'resistant' to it and then begin to outsmart it. Meaning that Met. loses its power to control BS. This is happening to me. So what alternative, if any, can one replace it with??? Yay, I know you'll say berberine ... but that does not affect my BS one iota. So what then?

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Yes, that part is true. Met doesn't hv the same power as it has in the first few yrs, in some patients. Happened to me too. Generally, we increase the dosage in cases of resistance, even with insulin. It works lil better, but with drugs as you know it is not perfect. All relative. Weigh the pros and cons and decide.

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Berberine dose help- need to take for three months --before it will really show the effect - lower BS -- then continue. Also depned on what dosage you take.

*** 2008 study showed that it is as effective as Metformin and safer.

Taking 500 mg - three ( 3 ) times a day - reduced fasting sugar from 172 to 140 mg/dL and average ppb sugar declined from 266 to 210 mg/dL. ***

However, when I bought from a Vitamin Shop- and took for two week, I was feeling grumpy in stomach- so I stopped it.

each person may have different effect or side effects.

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Not just Met but all pharma drugs have side effects and worse if taken long term. Blood creatinine level can be reduced/ameliorated by taking cinnamon (cassia type) and Salvia multiorrhiza (powder form) easily purchased from TCM retail outlets.

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lchf for example, is diet prescription recommended by so many to control diabetes effectively but I doubt if any conventional doctor or nutritionist approves it.

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quite true there, not many approve of it. Surely, lchf give great results, but long term effects, we do not quite know, hence most docs do not approve. Overall, it may really be good for those on whom it works well.

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Yessssssssssssss. No conventional Doctor, Unless he is curious to new thinking and academic savvy, would agree to such kind of diet changes etc. etc. without medicines.

my experience i share here. I HATE medicines, for any health issue, unless very essential. But due to wrong food habits such as more carbs, no time maintenance or check hungry or not, are the long time, habits that crop-up into such diabetic issues. to cut the story short, I stopped Metformin, for last 4 months, and following low carb, diet. use coconut oil, lemon, water, multivitamin tabs, chicken, eggs, cabbage, carrot (limited), Tomato (limited- one or two max. per day, Or nil), my blood sugar levels are normal, and Hb1Ac is also normal. So far maintaining. incidentally all that foot tingling effect i.e. neuropathic issues are GONE.

i dare "Diabetes".

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Metformin is the safest drug of all and in reality there is no replacement for Metformin. People taking Metformin must take Vit. B12 supplement in the form of mecobalamin. I take Nurokind OD sublingual tablet where mecobalamin is 1500 mcg. Just keep it under the tongue and let it dissolve because absorption is maximum this way. Multivitamin may be taken as such but not enough to meet with Vit. B12 deficiency caused by Metformin. Take Vit. B12 supplement separately daily.

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Yes, nurokind sublingual is a good idea! You get in 500mcg dose too.

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there is a herbal replacement for Met. It is called Goat's Rue (Galéga Officinal, French lilac, French honeysuckle). The active Met. agent [guanidine] was originally synthesized from G's Rue but later replaced with Met. But I read that taking Goat's rue may not be good as the guanidine it contains may affect the liver adversely.

But then, Met. a biguanide, is itself NOT as "white" as it is painted either. This counterclaim needs to be checked out as internet trolls are everywhere injecting their venomous disinformation into unsuspecting health forums online.

Just because it is a botanical does not automatically make it safe to consume. Plants too can contain natural toxins and being organic does not exonerate potential plant toxicity, for the same reason. B. Jensen and others have argued that a full spectrum herbal (as opposed to an extract of the active ingredient) is a lot safer to consume as often nature provides the antidote to plant toxins and factoring out the undesired ingredients as in an extract is therefore unwise when compared with full-spectrum dosage.

"Galegine in goat's rue has been associated with marked reductions in blood sugar levels. Studies in the 1970s demonstrated galegine and other guanidine derivatives reduced blood sugar levels."

Adverse Reactions

"One text advises discontinuation of goat's rue preparation if symptoms such as headache, jitteriness, or weakness occur."

Animal data

"Goat's rue increases breast milk production. Reports of the lactogenic effects of the plant exist. Goat's rue given to cows would increase milk secretion from 35% to 50%. Goat's rue is recommended in veterinary medicine to stimulate milk secretion."

Source: drugs.com/npp/goat-s-rue.html

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yes, that was interesting and true too. Sythesized drugs almost always come with side effects. We just hv to check the pros and cons of it. Met is a great drug, that is the bottom line for diabetics.

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Just to play safe, I'd make it a point to invoke a prayer/blessing on all the medicine prior to ingestion. As one spiritual teacher once said, if you offer it to Divinity s/he will take care of all the negative stuff and adverse events that can happen.

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Yes, invoking and praying is always good. Looks like your more into natural lifestyle and spirit. Good.

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Also vegetarians are usually deficient of b12. Sl form is recommended and that too once a day only.

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i dont think metformin has any connection for low vit.B12.

For Vit.B12,Cap. Diavit found good for me.consult your doctor for same.

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It surely has!! It causes malabsorption of b12 leading to deficiency in the long term usage of met.

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Metformin would increase vit B12 deficiency. Need supplements, if one is using Metformin. Telling from own experience and literature study (i am not Doctor)

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Chronic metformin use results in vitamin B12 deficiency in 30% of patients. ... Vitamin B12 deficiency, which may present without anemia and as a peripheral neuropathy, is often misdiagnosed as diabetic neuropathy, although the clinical findings are usually different.

Vitamin B12 is necessary for a healthy nervous system and healthy blood cells. ... Another medication that may interfere with B12 absorption is metformin, a common type 2 diabetes treatment. Simply having diabetes may make you more prone to B12 deficiency.

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Yes, I think it is reported in abt 30% of patients, not all suffer from it.

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Not only Met., but also Vit C - both can interfere with absorption of B12:

"Vitamin C and B-12 also interact in your digestive tract, and for this reason, you should not take vitamin C and B-12 together... If you take supplemental vitamin C, be aware of the interaction between your supplement and vitamin B-12. Vitamin C supplements can break down vitamin B-12 in your digestive tract, according to MedLinePlus. As a result, consuming supplements at the same time as meals that contain vitamin B-12 reduces B-12 absorption. Make sure you wait at least 2 hours after a meal before taking your vitamin C supplements."

Source: healthyeating.sfgate.com/vi...

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My latest Hba1c is 5.02.Average glucose (MBG i think) is 97. FBS is 97. If it is true fantastic reading.

Non diabetic numbers. Basic doubt -- Is he diabetic ?

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Very good question and observation. Have been diabetic for the last 12 years. Adding to it, my lipids are consistently high. Cholesterol is 200+ and triglicerides are 200+ always HDL this time is 33. And these lipids are same for many many years. Last couple of times HDL was around 40+. Usually it used to be always less around 30. This time, I am also happy to see good readings. Usually Hba1c used to between 5.5 and 7. The comprehensive health check is done Strand Life Sciences labs via 1mglabs and done locally in Bangalore without transporting to another city unlike thyrocare etc. I am on medication (3 times metformin250, and some for BP and thyroid). Somehow, my observation is, whenever I take more fatty foods regularly, my lipids become much higher. Apart from these, early morning 2hours yoga, 1 hour walk, and 30min walk after dinner, dinner by 7PM, sleep by 9PM, wakeup by 4AM, and take food ontime and regularly have been taking aloevera, jeera, tulsi. Now I reduced metformin dose to two tabs of 250mg a day for observation.

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All allopathic medicines have side effects. so finding a new drug means you are bringing other side effects. So best alternative would be the exercise. Start doing some aerobics like jogging, cycling or swimming for at least half an hour .Take herbs as suggested by coffeeday and haldin21 along with healthy diet. Reduce allopathic medicines gradually so you won't need any b12 supplement from outside.

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generally the tests done of medicines are short term. it won't tell what would happens say 10 years after. besides Vitamin B12 Malabsorption there are many other side effects of the metformin given in the following link:

livestrong.com/article/1831...

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