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Metformin, one of the most popular drugs to treat type 2 diabetes, interferes with uptake of vitamin B12, which can in turn lead to some neuronal dysfunction resulting in cognitive dysfunction.
Because of the malabsorption problem caused by metformin, patients taking the drug may not be able to get enough B12 from a balanced diet alone and may need supplemental B12.
Physicians should carefully monitor B12 levels in patients taking metformin, particularly those who have been taking the drug for more than 3 years or those who already suffer from some sort of cognitive impairment. Although the editors of BipolarNews.org have made every effort to report accurate information, much of the work referenced here is in abstract or pre-publication form, and may not have received proper review by the scientific community at this time. Currently, there exists much information, as well as mis-information, about interactions between certain herbs & nutrients and drugs. In general, if a drug affects the digestive system, such as acid inhibiting medications, it may have the potential to alter nutrient absorption.
Each of the three interactions we will describe exemplifies a different type of interaction.
In Part I we defined some common types of interactions that can occur between drugs and natural health products (NHPs). Another study found that taking metformin 850mg over 4 years resulted in a 19% decrease in vitamin B12 levels compared to patients taking placebo.(4) This is an important impact because vitamin B12 is needed to metabolize a substance called homocysteine.
Metformin appears to inhibit uptake of vitamin B12 by interfering with the receptor responsible for absorption in the terminal end of the small intestine, called the ileum.(7) Dr.
As the name suggests, SSRIs act by increasing levels of the neurotransmitter, serotonin, inside brain cells (neurons).
There have been documented cases of serotonin syndrome in individuals using SSRIs in combination with other drugs affecting serotonin as well as St.
In preceding sections we discussed interactions involving nutrient depletion (vitamin B12) as well as additive combinations (St. Of prime importance when considering this drug is recognizing the fact that the range of target blood levels for warfarin is very narrow. Cranberry juice is a food as well as an herbal medicine most commonly used for treatment and prevention of urinary tract infections.
Three human trials have reported that consumption of 240mL cranberry juice per day for up to two weeks failed to affect blood clotting time called INR, or warfarin blood levels.(5,6,7) However, one study found that consumption of cranberry juice for two weeks increased a measure of INR (clotting time) by up to 30% after a single dose of warfarin (8).
In conclusion, although cranberry juice or extract is extremely useful for fighting urinary tract infections, individuals who are on warfarin should be cautious about using it.
Will new diagnostic criteria for diabetes mellitus change phenotype of patients with diabetes? A popular diabetes drug has been shown in a new study to increase the risk for vitamin B12 deficiency and anemia when taken over several years.
Metformin (generic name: glucophage) is a drug prescribed to people with Type 2 diabetes to help control the amount of sugar (glucose) in the blood by reducing how much glucose is absorbed from food and produced by the liver.
Crandall added that some people also take the drug to prevent diabetes, and to treat polycystic ovarian syndrome (PCOS), one of the most common causes of female infertility. For the study, Crandall and her team looked at data from the Diabetes Prevention Program and the Diabetes Prevention Program Outcomes Study, which followed individuals at high risk for Type 2 diabetes for more than a decade. At the start of the study, more than 3,000 participants age 25 years and older had high blood sugar. Average B12 levels were higher at the 13-year-point than at 5 years, but B12 deficiency was also found to be more common in both the metformin and the placebo groups.
Julie Fidler is a freelance writer, legal blogger, and the author of Adventures in Holy Matrimony: For Better or the Absolute Worst. Get the latest key natural health information from NaturalSociety with our daily newsletter, and receive three free health guides and one full length E-book! Several studies have sought to clarify this link, which may affect up to 30% of patients taking the drug.
Those who follow a vegetarian diet, have had bowel surgery, have certain complications with the stomach, or who take other medications that depress stomach acid may be at special risk.
Some of the most common questions we receive as naturopathic doctors (ND) pertain to this area. For the purposes of this article, we will discuss three types: first, a drug can deplete levels of a certain nutrient.

Similarly, if an herb or nutrient impacts the liver or kidneys, the primary organs of drug metabolism and elimination, it could have the potential to increase or decrease blood levels of the drug. Stay tuned for Part II, which will discuss the interaction between metformin and vitamin B12. In this section, we describe a drug-nutrient interaction between metformin and vitamin B12. Elevated homocysteine is associated with increased risk of heart disease and stroke, and this is especially relevant because patients with diabetes are already at increased risk of heart disease. Elaine Moore showing that patients on metformin are at higher risk of cognitive impairment.(6) In an interview with Medscape Medical News, Dr.
Moore suggests that patients taking metformin should have their vitamin B12 levels checked on an annual basis, and appropriate supplementation undertaken to correct deficiency.(7) Importantly, Dr. John’s wort.(2,5) There may be some instances where use of St John’s wort may be indicated, such as in patients weaning off antidepressants, however this should never be undertake unless under the advice and supervision of a healthcare provider. In this study, it appeared that the effect was greater in men with a certain genetic variation, suggesting that this may play a role in determining who might be susceptible to this type of interaction. At present the evidence is not clear, but it is possible that some may be more likely to have increased bleeding time from combining cranberry and warfarin.
Self-monitoring of blood glucose has become an important component of modern therapy for diabetes. The oral administration of amla extracts to the diabetic rats slightly improved body weight gain and also Triple therapy will include Thiazolidinedione in addition to type 1 diabetes pregnancy ultrasound insulin gestational for protocol metformin and insulin therapy.
They were randomly assigned to receive either 850 milligrams of metformin twice daily, placebo medication, or an intensive lifestyle program not including medication. These samples helped the team conclude that at year 5, average B12 levels were lower in the metformin group than the placebo group, and B12 deficiency was more common, affecting about 4% of participants on metformin, compared to 2% of those not taking the drug. We must get it from either supplements or animal sources, such as eggs, dairy products, and fortified grains. This is a very complex area, and we certainly encourage you to consult with a trained healthcare provider such as an ND if you are on any medications. This can happen through increased nutrient utilization or through impaired nutrient absorption. Vitamin B(12) deficiency associated with concomitant metformin and proton pump inhibitor use.
In vitro binding experiments with a Valerian, hops and their fixed combination extract (Ze91019) to selected central nervous system receptors.
Metformin is one of the most commonly prescribed oral medications for type II diabetes as well as for polycystic ovary syndrome (PCOS). Effect of metformin therapy on vitamin D and vitamin B levels in patients with type 2 diabetes mellitus.
Recommendations for diagnosis and management of metformin-induced vitamin B12 (Cbl) deficiency.
Long term treatment with metformin in patients with type 2 diabetes and risk of vitamin B-12 deficiency: randomised placebo controlled trial. Association of biochemical B deficiency with metformin therapy and vitamin B supplements: the National Health and Nutrition Examination Survey, 1999-2006. Increased risk of cognitive impairment in patients with diabetes is associated with metformin. John’s work is recognized as a highly effective herb for treating depression,(1) and it is thought to act in part through parallel effects on serotonin.(2,3) It is thought that combined use of these medications with St. Patients on medication should consult with a naturopathic doctor to assess whether it may be appropriate for them.
Hypericum perforatum: Pharmacokinetic, Mechanism of Action, Tolerability, and Clinical Drug-Drug Interactions. Serotonin syndrome and rhabdomyolysis induced by concomitant use of triptans, fluoxetine and hypericum.
Herb-drug interactions with St John's wort (Hypericum perforatum): an update on clinical observations. In this section, we describe a potential interaction between a common food and herb, cranberry, and warfarin, a commonly prescribed blood thinner.

This means that if blood levels fall too low, the drug will not be effective; however, if blood levels become even a little bit too high, there is risk of serious side effects.
Consult with your healthcare provider if you are unsure about the appropriateness of using any natural health product. Cranberry juice ingestion and clinical drug-drug interaction potentials; review of case studies and perspectives.
The absence of an interaction between warfarin and cranberry juice: a randomized, double-blind trial.
Pharmacodynamic interaction of warfarin with cranberry but not with garlic in healthy subjects. If you don’t test you may never know if you have elevated blood glucose values or at least not know in a timely manner to do something about Gestational diabetes. Top one half of a medium leftover baked potato (or microwave a raw one for 10-15 minutes) with low fat cheddar cheese and a spoonful of salsa. Gymnema Sylvestre is a great herb to use if you are starting any type of diet or trying Were do I get this the best Gymnema Sylvestre Supplements from I live in Dalls Tx help asap answer. Only those taking metformin were included in the new analysis, and about 50 participants were excluded who had undergone weight-loss surgery, which would affect their diabetes outcomes.
However, there are a handful of well characterized interactions between common drugs and certain natural health products (NHPs) that the safety-conscious consumer should be aware of. Finally, if the herb or nutrient is targeting the same organ or bodily function as a drug, there may be a possibility of additive effects.
John’s wort and the class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs). Stay tuned for Part IV of this series, examining the interaction between a common food & herbal medicine and warfarin. Since warfarin is a blood thinner, the risk is that blood clotting time may become too short - predisposing to clot formation and possible heart attack – or that blood clotting time may become too long – resulting in risk of bleeding and hemorrhage. In one study all 38 patients with insulin-dependent diabetes were required to lower their insulin dose to Workshops Courses and Events. Breakfast shakes: Make shakes with low-fat milk yogurt or soya bean milk which provide good quality protein and calcium for healthy bones. In this article we will discuss relevant evidence on interactions of herbs or nutrients with the drugs metformin, antidepressants, and warfarin. For instance, in someone taking medication for sleep, taking an herb that also sedates the central nervous system could result in over-sedation.
Although there are many natural agents that are very safe, it is important to be aware of those that may not be, and to seek professional advice if unsure.
By Daniel dietary menu for gestational diabetes reverse pre exercise Noesgaard in Diabetes and HIstone Deacetylase. People with low vitamin B12 levels are more likely to brain shrinkage and cognitive decline. Finally, an herb or nutrient can change the way that the body metabolizes a drug.(3) These are also known as pharmacokinetic interactions. Conversely, supplementation may be of higher importance in persons taking medications known to deplete certain nutrients.
St John’s wort may increase the action of SSRI’s leading to a complication called serotonin syndrome.
For instance, some drugs need to be activated in the body before they can have their effects.
If an herb increases enzymes responsible for this activation, it could increase blood levels of this drug, thereby increasing its effects.

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