Importance of vitamin B12:
Vitamin B12 is a water-soluble vitamin that may be found naturally in some foods, added to others, and purchased as a dietary supplement or prescribed medicine. Vitamin B12 is necessary for the proper growth, myelination, and function of the central nervous system, as well as the generation of healthy red blood cells and DNA synthesis.
Food-bound vitamin B12 must be released before it can be absorbed. The process begins when food is combined with saliva in the mouth. The liberated vitamin B12 binds to haptocorrin, which is a salivary cobalamin-binding protein. The activities of hydrochloric acid and gastric protease in the stomach releases more vitamin B12 from its dietary matrix, where it binds to haptocorrin. Digestive enzymes in the duodenum break down haptocorrin to release vitamin B12, which then mixes with intrinsic factor, a transport and delivery protein generated by the stomach’s parietal cells. By receptor-mediated endocytosis, the resultant complex is absorbed in the distal ileum.
Vitamin B12 deficiency:
Vitamin B12 deficiency occurs when there is difficulty in absorption of vitamin B12 from the food consumed. Megaloblastic anaemia (characterized by large, abnormally nucleated red blood cells) as well as low counts of white and red blood cells, platelets, or a combination of these; glossitis of the tongue; fatigue; palpitations; pale skin; dementia; weight loss; depression in some cases; memory loss; mood changes, and infertility are all consequences of vitamin B12 deficiency. Numbness and tingling in the hands and feet, as well as neurological abnormalities, can also develop. As these neurological symptoms can develop without anaemia, it’s critical to get a diagnosis and treatment as soon as possible to avoid permanent damage.
Metformin and Vitamin B12 deficiency:
Metformin is a drug used in diabetes and prediabetes conditions. It is recommended for the first line treatment of type 2 diabetes and is associated with vitamin B12 deficiency, which increases the risk of peripheral neuropathy.
Since metformin is being discovered, the mechanism of its action is not known. The modification of the cell’s energy metabolism is assumed to be at the heart of metformin’s mechanism of action. In the liver and muscle cells, excess glucose is generally converted to glycogen for storage. Metformin is thought to reduce blood sugar by suppressing hepatic gluconeogenesis (the production of glucose in the liver) and blocking the action of glucagon, a hormone that signals the liver and muscle cells to convert stored glycogen into glucose for release into the bloodstream.
Along with reduction in glucose levels, it serves its side-effects as well. Metformin treatment for a long time has been shown to diminish vitamin B12 and folate absorption in the intestine. One research found a highly significant inverse relationship between metformin dose and duration and lower blood vitamin B12 levels, with 33 percent of study participants impacted. 5 Megaloblastic anaemia is characterized by the production of larger-than-normal red blood cells (macrocytosis), as well as immature nuclei as a result of a defect in DNA synthesis. This will be visible on a complete blood count (FBC) test, which will show a greater than usual mean cell volume (MCV) number, albeit this value may be within the normal range if the patient is not iron deficient.
What causes deficiency of vitamin B12?
Initially, it was considered that a change in bile acid metabolism, along with bacterial overgrowth in the small intestine or a deficiency in intrinsic factor secretion, may be the reason. All the above are needed for B12 absorption which are negated by consumption of metformin.
According to more recent hypotheses, calcium is required for absorption of the B12 intrinsic factor complex via cell membrane receptors in the ileum, and metformin inhibits this calcium-dependent membrane activity. As a result of the interference, B12 absorption is affected, and B12 levels are reduced.
Who is at risk of developing vitamin B12 deficiency?
1. Many senior citizens
2. People whose stomachs don’t produce enough hydrochloric acid or intrinsic factor
3. Pernicious anaemia patients
4. People who have had stomach or intestinal surgery of some kind
5. People who suffer from digestive issues like celiac disease or Crohn’s disease
6. Vegetarians and vegans are people who consume a plant-based diet.
Treatment of vitamin B12 deficiency:
There are several ways to address a vitamin B12 shortage. Vitamin B12 injections, given every other day at first and subsequently once a month, or high-dose B12 tablets are usually used to address a more significant deficit. A conventional multivitamin, an oral supplement, or a nasal spray can be used to correct mild deficits.
Consume vitamin B12-rich meals. If you consume a vegetarian or vegan diet, try to include vitamin B12-fortified items in your diet or take a multivitamin.
Further, at every stage it is important to consult with experts and doctors for proper guidance. If any symptoms are noticed, connect with a health expert and take preventive measures to avoid future complications.
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