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Metformin And B12 Guidelines

Metformin In The Treatment Of Adults With Type 2 Diabetes Mellitus

Metformin In The Treatment Of Adults With Type 2 Diabetes Mellitus

INTRODUCTION Two classes of oral hypoglycemic drugs directly improve insulin action: biguanides (only metformin is currently available) and thiazolidinediones (TZDs). In the absence of contraindications, metformin is considered the first choice for oral treatment of type 2 diabetes (table 1). A 2006 consensus statement from the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD), updated regularly, proposed that metformin therapy (in the absence of contraindications) be initiated, concurrent with lifestyle intervention, at the time of diabetes diagnosis [1-3]. The pharmacology, efficacy, and side effects of metformin for the treatment of diabetes will be reviewed here. A general discussion of initial treatment of type 2 diabetes and the role of metformin in the prevention of diabetes, in the treatment of polycystic ovary syndrome, and in gestational diabetes are reviewed separately. Continue reading >>

Long Term Treatment With Metformin In Patients With Type 2 Diabetes And Risk Of Vitamin B-12 Deficiency: Randomised Placebo Controlled Trial

Long Term Treatment With Metformin In Patients With Type 2 Diabetes And Risk Of Vitamin B-12 Deficiency: Randomised Placebo Controlled Trial

Long term treatment with metformin in patients with type 2 diabetes and risk of vitamin B-12 deficiency: randomised placebo controlled trial Long term treatment with metformin in patients with type 2 diabetes and risk of vitamin B-12 deficiency: randomised placebo controlled trial BMJ 2010; 340 doi: (Published 20 May 2010) Cite this as: BMJ 2010;340:c2181 Philippe Lehert, professor of statistics 4 , Michiel G Wulffel, general practitioner 2 3 , Jan van der Kolk, biochemical engineer 5 , Joop Verburg, chief laboratory attendant 5 , Ab J M Donker, professor of internal medicine 7 , Coen D A Stehouwer, professor and chair 8 1Department of Ophthalmology, Academic Medical Center, Amsterdam, Netherlands 2Bethesda Diabetes Research Centre, Bethesda General Hospital, Hoogeveen, Netherlands 3Department of Internal Medicine, Bethesda General Hospital, Hoogeveen, Netherlands 4Department of Statistics, Faculty of Economics, Facults Universitaires Catholiques de Mons, Louvain Academy, Mons, Belgium 5Clinical Laboratory, Bethesda General Hospital, Hoogeveen, Netherlands 6Clinical Research and Development, Merck Netherlands, Amsterdam, Netherlands 7Department of Internal Medicine, Free University Medical Center, Amsterdam, Netherlands 8Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, Netherlands Correspondence to: C D A Stehouwer cda.stehouwer{at}mumc.nl Objectives To study the effects of metformin on the incidence of vitamin B-12 deficiency (<150 pmol/l), low concentrations of vitamin B-12 (150-220 pmol/l), and folate and homocysteine concentrations in patients with type 2 diabetes receiving treatment with insulin. Design Multicentre randomised placebo controlled trial. Setting Outpatient clinics of three non-academic hospitals in the Netherlands. P Continue reading >>

Long-term Metformin Use And Vitamin B12 Deficiency In The Diabetes Prevention Program Outcomes Study

Long-term Metformin Use And Vitamin B12 Deficiency In The Diabetes Prevention Program Outcomes Study

Long-term Metformin Use and Vitamin B12 Deficiency in the Diabetes Prevention Program Outcomes Study Vanita R. Aroda , Sharon L. Edelstein , Ronald B. Goldberg , William C. Knowler , Santica M. Marcovina , Trevor J. Orchard , George A. Bray , David S. Schade , Marinella G. Temprosa , Neil H. White , Jill P. Crandall , and the Diabetes Prevention Program Research Group MedStar Health Research Institute (V.R.A.), Hyattsville, Maryland 20782; George Washington University (S.L.E., M.G.T.), Rockville, MD 20852; University of Miami (R.B.G.), Miami, Florida 33146; National Institute of Diabetes and Digestive and Kidney Diseases (W.C.K.), Phoenix, Arizona 85014; University of Washington (S.M.M.), Seattle, Washington 98185; University of Pittsburgh (T.J.O.), Pittsburgh, Pennsylvania 15260; Pennington Biomedical Research Institute (G.A.B.), Baton Rouge, Louisiana 70808; University of New Mexico (D.S.S.), Albuquerque, New Mexico 87131; Washington University School of Medicine (N.H.W.), St. Louis, Missouri 63110; and Albert Einstein College of Medicine (J.P.C.), Bronx, New York 10461 Address all correspondence and requests for reprints to: Jill Crandall, MD, Diabetes Prevention Program Coordinating Center, The Biostatistics Center, The George Washington University, 6110 Executive Boulevard, Suite 750, Rockville, MD 20852. E-mail: [email protected] . Received 2015 Oct 22; Accepted 2016 Feb 17. Copyright 2016 by the Endocrine Society This article has been cited by other articles in PMC. Vitamin B12 deficiency may occur with metformin treatment, but few studies have assessed risk with long-term use. To assess the risk of B12 deficiency with metformin use in the Diabetes Prevention Program (DPP)/DPP Outcomes Study (DPPOS). Secondary analysis from the DPP/DPPOS. Participants were ass Continue reading >>

Metformin And Vitamin B12

Metformin And Vitamin B12

Diabetes Forum The Global Diabetes Community This site uses cookies. By continuing to use this site, you are agreeing to our use of cookies. Learn More. Get the Diabetes Forum App for your phone - available on iOS and Android . Find support, ask questions and share your experiences. Join the community I just wanted to let you know, because your doctor probably wont tell you that the use of Metformin PREVENTS the absorption of Vitamin B12. I was shocked to find this out, as my doctor never told me. I took Metformin for 2 years and now I have symptoms of B12 deficiency, confirmed after blood tests. Consider taking a B12 supplement if you take this drug. And if you require evidence, check out any web site or Google Metfomin and Vitamin B12. I am disgusted that my doctor never told me this, because if I can find this out, so can he. I will be posting separately about my symptoms. I just wanted to let you know, because your doctor probably wont tell you that the use of Metformin PREVENTS the absorption of Vitamin B12. I was shocked to find this out, as my doctor never told me. I took Metformin for 2 years and now I have symptoms of B12 deficiency, confirmed after blood tests. Consider taking a B12 supplement if you take this drug. And if you require evidence, check out any web site or Google Metfomin and Vitamin B12. I am disgusted that my doctor never told me this, because if I can find this out, so can he. I will be posting separately about my symptoms. Hello @maverickuk It does mention this in the possible side effects section of the drug information that comes with the box. The DN did say there were possible side affects and that I had to tell them if any became a problem, but no the B12 deficiency was not specifically mentioned. I looked on the internet and read up on Continue reading >>

Easd: Metformin-induced B12 Deficiency Linked To Diabetic Neuropathy

Easd: Metformin-induced B12 Deficiency Linked To Diabetic Neuropathy

EASD: Metformin-induced B12 deficiency linked to diabetic neuropathy Key clinical point: Metformin has an overall detrimental effect on neuropathy mediated by its effect on MMA, a specific biomarker of B12 deficiency. Major finding: Metformin use was associated with a significant (P = .001) 0.04 micromol/L increase in MMA over the course of the study when compared with placebo. Data source: A prospective, randomized controlled trial of 390 insulin-treated patients with type 2 diabetes who were randomized to metformin or placebo for 4.3 years. Disclosures: Dr. Out reported that he had no disclosures. The HOME study was supported by Takeda, Lifescan, Merck Sharpe & Dohme, and Novo Nordisk. STOCKHOLM Clinicians might want to consider more routinely monitoring levels of vitamin B12 in their diabetic patients who are using metformin, according to new data from the HOME (Hyperinsulinaemia: the Outcome of Its Metabolic Effects) randomized controlled trial, which showed that B12 depletion was linked to neurotoxicity. The new study findings, presented at the annual meeting of the European Association for the Study of Diabetes, showed that metformin increased levels of serum methylmalonic acid (MMA), the gold standard biomarker of tissue B12 deficiency, and that this in turn was linked to neuropathy measured using a validated score. We earlier showed that metformin causes B12 deficiency (<150 pmol/L) with a number needed to harm of 14 after 4.3 years, said study investigator Dr. Mattijs Out of Bethesda Diabetes Research Center in Hoogeveen, the Netherlands, referring to the original results of the trial ( BMJ. 2010;340:c2181 ). Today I showed you that metformin increases MMA, dose dependently and progressively over time, he added. Metformin has two opposite effects on neuropathy Continue reading >>

Metformin And Risk For Vitamin B12 Deficiency

Metformin And Risk For Vitamin B12 Deficiency

Metformin (brand names Glucophage, Glucophage XR, Fortamet, Riomet, Glumetza, and others) is a popular and highly effective oral diabetes drug used to help manage Type 2 diabetes. This drug works by lowering the amount of glucose made by the liver and by making the body’s cells more sensitive to insulin. Metformin also has some other beneficial effects in that it may help lower blood lipid, or fat, levels (cholesterol and triglycerides) and can, in some people, promote a small amount of weight loss. Metformin can be used with other diabetes pills and with insulin. Side effects of taking metformin are relatively rare, the most common being bloating, nausea, and diarrhea, all of which are temporary. Some people shouldn’t take metformin, including people with kidney disease, liver disease, or congestive heart failure, for example, because of an increased risk of a potentially fatal condition called lactic acidosis. In recent years, there’s been some concern over the risk of vitamin B12 deficiency in people who take metformin. Vitamin B12 (also known as cyanocobalamin or cobalamin) plays many important roles in the body, such as keeping your blood cells and nervous system in tip top shape. There’s also some evidence that vitamin B12 may help prevent heart disease and possibly even Alzheimer disease (the jury is still out on this one). This vitamin is found primarily in animal foods, such as beef, seafood, eggs, and dairy products, which is why some vegetarians are at risk for a B12 deficiency. Elderly people are often at risk for deficiency as well, due to problems with absorption from the gastrointestinal tract. Symptoms of B12 deficiency include certain types of anemia, neuropathy, memory loss, confusion, and even dementia. So, why would taking metformin possibly Continue reading >>

Long Term Metformin Use Association With Vitamin B12 Deficiency And Anemia

Long Term Metformin Use Association With Vitamin B12 Deficiency And Anemia

Long Term Metformin use Association with Vitamin B12 Deficiency and Anemia Petros Thomakos1 and Kyriakoula Marinou2* 1Diabetes Center & Clinic, Hygeia Hospital, Greece Received: August 16, 2016 | Published: March 07, 2017 *Corresponding author: Kyriakoula Marinou, University School of Medicine, Greece, Email: Citation: Thomakos P, Marinou K (2017) Long Term Metformin use Association with Vitamin B12 Deficiency and Anemia. J Diabetes Metab DisordControl 4(1): 00102. DOI: 10.15406/jdmdc.2017.04.00102 EASD: European Association for the Study of Diabetes; T2DM: Type 2 Diabetes Mellitus; ADA: American Diabetes Association Since its introduction in the mid-1950s in Europe and in 1995 in USA, metformin is considered the most frequently prescribed medication for the treatment of Type 2 Diabetes Mellitus (T2DM). All guidelines, including the European Association for the Study of Diabetes (EASD) and the American Diabetes Association (ADA), focus on metformin as the first-line treatment option along with lifestyle intervention for hyperglycemic management in T2DM patients [1]. Beyond glycemic control, metformin has a beneficial effect on lipid metabolism, inflammation and oxidative stress [2,3]. Moreover, metformin can promote weight loss and has been proven to reduce the risk of myocardial infarction and all-cause mortality in overweight newly diagnosed T2DM patients [4]. Several studies have also linked metformin use with a reduced cancer risk in T2DM individuals [5,6]. It is widely approved that Metformin suppresses hepatic glucose production and improves insulin signaling mainly in muscle, hepatic and adipose tissue [7,8]. The main side effects of metformin include gastrointestinal disturbances, such as diarrhoea and vomiting [9]. Individuals with renal, hepatic insufficiency Continue reading >>

Update On Vitamin B12 Deficiency

Update On Vitamin B12 Deficiency

ROBERT C. LANGAN, MD, and KIMBERLY J. ZAWISTOSKI, DO, St. Luke's Hospital, Bethlehem, Pennsylvania Am Fam Physician.2011Jun15;83(12):1425-1430. Patient information: A handout on this topic is available at . Vitamin B12 (cobalamin) deficiency is a common cause of megaloblastic anemia, a variety of neuropsychiatric symptoms, and elevated serum homocysteine levels, especially in older persons. There are a number of risk factors for vitamin B12 deficiency, including prolonged use of metformin and proton pump inhibitors. No major medical organizations, including the U.S. Preventive Services Task Force, have published guidelines on screening asymptomatic or low-risk adults for vitamin B12 deficiency, but high-risk patients, such as those with malabsorptive disorders, may warrant screening. The initial laboratory assessment of a patient with suspected vitamin B12 deficiency should include a complete blood count and a serum vitamin B12 level. Measurements of serum vitamin B12 may not reliably detect deficiency, and measurement of serum homocysteine and/or methylmalonic acid should be used to confirm deficiency in asymptomatic high-risk patients with low normal levels of vitamin B12. Oral administration of high-dose vitamin B12 (1 to 2 mg daily) is as effective as intramuscular administration in correcting the deficiency, regardless of etiology. Because crystalline formulations are better absorbed than naturally occurring vitamin B12, patients older than 50 years and strict vegetarians should consume foods fortified with vitamin B12 and vitamin B12 supplements, rather than attempting to get vitamin B12 strictly from dietary sources. Administration of vitamin B12 to patients with elevated serum homocysteine levels has not been shown to reduce cardiovascular outcomes in high-risk Continue reading >>

Vitamin B12 Deficiency In Diabetic Subjects Taking Metformin: A Cross Sectional Study In A Lebanese Cohort

Vitamin B12 Deficiency In Diabetic Subjects Taking Metformin: A Cross Sectional Study In A Lebanese Cohort

Highlights • Thirty three percent of the patients were found to have borderline values of the serum vitamin B12 (148–220 pg/dl) while 22.5% had a clear, unambiguous deficiency (levels less than 148 pg/dl). • We found a highly significant inverse correlation between the dose and duration of metformin treatment and the serum levels of vitamin B12. • Furthermore, both borderline and low levels of vitamin B12 were associated with the presence of different neuropathies and macrocytic anemia in a dose dependent manner. • Based on our results, we strongly recommend the routine screening of T2D patients on metformin for vitamin B12 deficiency due to its high prevalence and the significant clinical effects it may result in. • Furthermore, we recommend, based on our data to start treating patients with B12 once a borderline or low level is detected. Abstract Metformin is the only biguanide derivative used to treat type 2 diabetes mellitus (T2D). Several studies documented that its use contributes to vitamin B12 deficiency in 10–30% of diabetics. The incidence of deficiency varies among populations and studies reported. There has been no reports documenting this incidence in the Middle East and Lebanon. The objectives of this study were to establish the incidence of vitamin B12 in our population, to investigate and characterize any specific associations between taking metformin and vitamin B12 deficiency to establish clear recommendations based on this data. During the first 6 months of 2015, we conducted a cross sectional study on 200 Lebanese individuals. The cohort consisted of subjects with an established diagnosis of T2D and who have been on metformin for at least three months. The patients were subjected to a questionnaire, medical record review, and vitamin B1 Continue reading >>

Vitamin B12 Monitoring May Be Lacking Among Long-term Metformin Users

Vitamin B12 Monitoring May Be Lacking Among Long-term Metformin Users

Vitamin B12 Monitoring May Be Lacking Among Long-Term Metformin Users Vitamin B12 Monitoring May Be Lacking Among Long-Term Metformin Users A 10-year study monitored long-term metformin therapy and serum B12 serum levels According to a study published in theJournal of the American Geriatrics Society, long-term metformin use is significantly associated with lower serum vitamin B12 levels, but those at risk often are not monitored for this deficiency. Researchers conducted a retrospective cohort study to evaluate the association between long-term metformin therapy and monitoring serum vitamin B12 at a single Veterans Affairs Medical Center (VAMC) from 20022012. Veterans aged 50 years with either type 2 diabetes receiving long-term metformin therapy (n=3,687) or veterans without diabetes and no metformin prescription (n=13,258) were included in the study. ACP: Updated Drug Therapy Recommendations for T2DM Long-term metformin therapy was defined as a prescription for 500mg daily for 6 consecutive months. The study showed that only 37% of older adults with diabetes receiving metformin were tested for vitamin B12 levels after long-term metformin prescription. The average B12 concentration was significantly lower in the metformin-exposed group vs. those without diabetes (439.2pg/dL vs. 522.4pg/dL;P=0.0015). Also, about 7% of patients with diabetes receiving metformin were considered vitamin B12 deficient (<170pg/dL) vs. 3% of patients without diabetes or metformin exposure (P=0.001). After adjusting for gender, race, ethnicity, body mass index, and number of years treated at the VAMC, patients using metformin were 23 times more likely not to be tested for vitamin B12 status vs. those not exposed to metformin based on their age. Since metformin is first-line therapy for treati Continue reading >>

Nice Guidelines | B12 Deficiency Blog

Nice Guidelines | B12 Deficiency Blog

Patients with a diagnosis of PA (pernicious anaemia) do not experience a more excruciating pain or a different kind of damage than someone who has a diagnosis of B12 deficiency due to another cause . Both B12 deficiency and PA cause damage tothe protective fatty coating (myelin) of the nerves. PA patients are often thought to have a worse form of the condition but this is not true. Diagnosis and treatment of B12 deficiency often proves to be a very difficult challenge for the patient but in some areas a diagnosis of PA (a positive IFAB test) can represent a golden ticket to treatment,leaving others with identical symptoms, but no confirmed diagnosis of PA, without any treatment at all. It is important to note that A negative Intrinsic Factor antibody result does not exclude the diagnosis of PA as only 60% of patients with PA will have this antibody. PA and B12 deficiency (unless it is caused purely by dietary lack) are caused due to an inability to absorb B12 from food and therefore B12 injections are required to bypass the stomach. There would be uproar if our doctors only used plaster casts for a broken arms if the cause were a skiing accident whilst treating everyone else with a broken arm with a sticking plaster. This scenario is whats happening far too regularly with B12 deficiency and thesituation is down to lack of education and correct, clear information about this condition. This condition can have a devastating effect whatever the cause. If you choose a diet which avoids animal products then you should supplement with B12 in order to access this vital nutrient. Of course vegetarians and vegans might also be at risk due to a co existing cause so it is advisable to familiarise yourself with these in case they too apply to you. Youll see there are so many more c Continue reading >>

Should Patients Taking Metformin Also Take Vitamin B12?

Should Patients Taking Metformin Also Take Vitamin B12?

Should Patients Taking Metformin Also Take Vitamin B12? Should I recommend vitamin B12 to patients taking metformin? Response from Gayle Nicholas Scott, PharmD Assistant Professor, Eastern Virginia Medical School, Norfolk, Virginia; Clinical Pharmacist, Chesapeake Regional Medical Center, Chesapeake, Virginia Metformin is a first-line type 2 diabetes treatment that effectively lowers blood glucose and has a good long-term safety record. (It has been available in the United Kingdom since 1958 and the United States since 1995).[ 1 ] Metformin also offers the important advantage over most other antihyperglycemic drugs of improved cardiovascular morbidity and mortality risk.[ 2 ] Beyond monitoring renal and hepatic function and avoiding concomitant drugs that interfere with renal tubular secretion (eg, cimetidine), metformin use has become rather mundane. A sometimes forgotten disadvantage of metformin is its effect on vitamin B12 absorption. Although the liability of metformin to lower vitamin B12 levels has been well described,[ 3 ] interest in the need for monitoring for vitamin B12 deficiency is more recent.[ 1 , 4 , 5 , 6 ] Vitamin B12 deficiency is estimated to be present in up to 30% of patients with diabetes taking metformin.[ 1 ] The risk for vitamin B12 deficiency increases with patient age and the dose and duration of metformin use.[ 5 , 7 ] Concomitant conditions such as suboptimal dietary intake, which is common among vegetarians and alcohol abusers, and malabsorption due to atrophic gastritis, pernicious anemia, chronic pancreatitis, and celiac disease may further increase risk for vitamin B12 deficiency.[ 5 ] The combination of metformin with proton pump inhibitors has been reported to have an additive effect on risk for vitamin B12 deficiency.[ 8 ] Vitamin Continue reading >>

Long-term Metformin Use Linked With Vitamin B12 Deficiency

Long-term Metformin Use Linked With Vitamin B12 Deficiency

With commentary by Jill Crandall, MD, professor of clinical medicine, Albert Einstein College of Medicine, New York. Long-term use of the popular diabetes drug metformin is linked with vitamin B12 deficiency and anemia, according to new research that solidifies some previous research. "We have essentially confirmed what many smaller studies have suggested," says Jill Crandall, MD, professor of clinical medicine at the Albert Einstein College of Medicine, the Bronx, who led the new study. "There is a small but significant risk of developing Vitamin B12 deficiency when people take metformin." The finding, she adds, ''has implications for the consequences of B12 deficiency." These can include cognitive impairment, nerve problems (neuropathy) and anemia (low red blood cell count). B12 is crucial for the proper formation of red blood cells, for neurological functioning and for making DNA. The link between taking the popular diabetes drug and deficiencies in vitamin B12 has been discussed as long ago as 1969, according to Dr. Crandall. However, few studies have looked at long term use, as her new study has done, tracking people for up to 13 years. The new study was published online Feb. 22 in the Journal of Clinical Endocrinology & Metabolism. Overview of the Metformin Study The researchers evaluated more than 2,000 men and women enrolled in the Diabetes Prevention Program and the Diabetes Prevention Program Outcomes Study. In these studies, researchers enrolled overweight people who had prediabetes (blood sugar levels higher than normal but not high enough to be termed diabetes) to see if modest weight loss or treatment with metformin could prevent or delay the onset of type 2 diabetes, then followed them to see if the effects endured. Half of the participants were given 850 Continue reading >>

Should You Take B12 Supplements If You Take Metformin?

Should You Take B12 Supplements If You Take Metformin?

Metformin is the most widely prescribed medication to treat diabetes (usually type 2 diabetes) in the world. Its effectiveness equals or exceeds many of the other oral medications available and has an excellent safety profile for most individuals. However, for the last ten to fifteen years there has been a question as to whether metformin causes B12 deficiency in those who take the drug for long periods of time. Several studies and clinical cases have noted suboptimal blood levels of B12 in those who have taken metformin for extended periods. The National Nutrition and Health Examination reviewed the blood work on 1,621 people with diabetes, more than a third of whom were taking metformin, and demonstrated a reduction in serum B12 levels in people who took metformin compared to those who did not. But just because these people taking metformin had lower levels of B12 in their bloodstream doesn’t necessarily mean the B12 that’s there isn’t getting the job done. New measurements of B12 activity have indicated that although metformin does seem to reduce blood levels of B12, this may not reduce the vitamin’s effectiveness in carrying out it its functions in the body. When B12 doesn’t work the way it’s supposed to, levels of something called total plasma homocysteine (tHcy) go up. But newer studies looking at the levels of tHcy in people who take metformin have found that they have not been elevated. According to an article published this year in Diabetes Care, “low serum B12 alone without disturbances in the metabolic markers has no diagnostic value.” From a practical standpoint, this means that if a B12 deficiency is suspected from a serum B12 test, further testing should be undertaken before assuming the patient is B12 deficient. B12 is one of the B-family Continue reading >>

Should Metformin Come With A B12 “prescription”?

Should Metformin Come With A B12 “prescription”?

Metformin is widely considered to be a first-line treatment for type 2 diabetes, and it has been prescribed to over 120 million people worldwide. It’s a safe bet that a large proportion of those people are deficient in vitamin B12, thanks to the use of this medication. While the percentages vary, studies consistently show that metformin impairs vitamin B12 absorption. In one multicenter randomized trial, metformin was associated with a 19% decrease in vitamin B12 concentration compared to placebo (de Jager J, et al. BMJ (Clinical Research Ed.) 2010; 340, c2181). In a cross-sectional cohort study, patients on long-term metformin therapy had 26.7% lower cobalamin levels, 21.6% lower holotranscobalamin and 9.7% higher homocysteine compared with people in the control group (Hermann L, et al. The British Journal of Diabetes & Vascular Disease. 2004; 4(6), 401–406). Commonly cited figures are that 10-30% of people with diabetes who take metformin will have decreased vitamin B12. This is most likely an underestimation. Given its impact on vitamin B12 absorption, it might make sense for doctors to consider pairing B12 supplements with their metformin prescriptions. Signs of Deficiency Vitamin B12 is the largest and most complex of the vitamins. It is the only one that contains a metal ion—cobalt--and the only one that requires a transporter in the small intestine. It is required for proper red blood cell formation, neurological function, and DNA synthesis. It is also a co-factor for methionine synthase and L-methylmalonyl-CoA mutase. The former is needed for the formation of S-adenosylmethionine (SAMe), a universal methyl donor for almost 100 different substrates. Symptoms of B12 deficiency include: megaloblastic anemia, fatigue, weakness, constipation, loss of appetite, Continue reading >>

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