I'll write a lot more later. I really appreciated yours and Mari's posts. I have trouble sleeping last night again. rats. I have pernicious anemia ....vitamin 12 deficiency and I take metformin for diabetes two....I started taking the calcium but i just realized i am only taking 600 and should take two capsules which i will start today


I’m not aware of any particular campaign on the part of Bristol Myers to inform physicians on the potential risk of B12 deficiency with metformin use. However, there is mention of this risk in the package insert for Glucophage/Glucophage XR, and it’s recommended in the PI that those at risk for deficiency be screened at 2-3 year intervals. Apparently testing for methylmalonic acid (MMA)over blood B12 levels is recommended by some, but it’s use is still somewhat controversial in the medical community. One theory is that metformin may interfere with B12 absorption; however, it appears that supplementation with 1000-1200 mg of calcium can limit this interference with B12 absorption. As I mentioned in my posting, it’s important for anyone taking metformin, particularly long-term, to talk to his or her healthcare provider about the potential risk for B12 deficiency and the steps one can take to prevent this from happening.

Hey, thanks for all the info in this thread !!

Bobby, I too think the walking is awesome, and, I think it can only be good for you... You know, the excercise, the sun light... Good !

About your heart exam, I'm praying everything will be alright... Try not to stress and don't be scared.


Take care !!

hi bobby,
2 things come to mind.
you may know this but it is better to seperate your calcium into 2 doses 12 hours apart if you can manage that, half the day you are not eating or trying to sleep so your body needs it most during those times. I have two forms of calcium, pills and chews depending on my mood.
There is a test that can determine quickly if you have any plaque build up in you coranary arteries. it is called a calcium heart screen. it costs $100 and takes 5 minutes to run it is like a little cat scan of your heart. totally noninvasive. only one hospital in my town had the right equipment to take the test but it was worth every penny for peace of mind.
I think many of us would be friends in real life if we could...I would love to come visit you some day....
(((HUGS))))
bizi

Dear Bobby,

thanks for the extended information re: the actual amounts of Ca and the specific relationship to metformin i.e. B12 malabsorption. i am a bit concerned because the information regarding supplementation is not very multifaceted in a nutritional sense... this is a complex issue.

first, Vitamin D. i'll bet the studies on supplementing with calcium to increase B12 absorption were done on people who were NOT taking extra vitamin D. and most people are way low - even the standard requirements are too low, according to the newer information in the vid Mrs D posted for us some time ago. You ARE taking vitamin D, recently increased to 8000mg. this alone will increase your calcium levels! which by extension should promote the b12 absorption ... (possibly without need for extra calcium.)

taking extra calcium does not imply it should not be balanced with magnesium. taking 1200 mg extra calcium would probably be best if 600 mg Magnesium went with it. if you stick with the 600 mg Calcium daily, that still requires an added 300 mg magnesium, to maintain a 2:1 ratio.

- How much extra magnesium are you taking?

- Do your calcium tabs have any Mg or other nutrients incorporated?

There are the nutritional unknowns, in this too. your diet could be more deficient in one or in the other. And the supplementation needs to reflect that.

Excess (unbalanced) calcium can be detrimental... can cause other problems like kidney stones for instance. Also, if the magnesium was helping you sleep, adding 600mg of calcium might have thrown off the balance... and put you back where you started.

All of this is why i suggested testing the mineral levels.

As for the frequency, the reason i suggested 3 months is only because it takes that long for the plasma levels of vit D dose to stabilize when one changes the dosage. so if you test your minerals now, because you just upped your vit D, they should be tested again in about 3 months. after that less frequently is probably adequate unless you change your supplements.

i hope this helps. talking to doctors... i'd recommend enlisting the help of a nutritionist rather than a GP for this.

i really see a rather limited of mindset in the recommendation to supplement with calcium to offset metformin issues. it seems likely the real point is to increase calcium levels... and as it is, even with the metformin, yours may now be adequate due to your vitamin D supplementation.



~ waves ~

Dear Bobby,
You already know so I am posting for others.
If one does take calcium, it is better absorbed if one takes vitamin C (or fruit) with it.
Iron supplements interfere with Calcium -- best to take them at different times.
http://www.niams.nih.gov/Health_Info...lcium_supp.asp

Lots of people are taking this med for blood sugar control (brand names Glucophage, Glucophage XR, Fortamet, Riomet, Glumetza, and others).
I wonder how many doctors are testing for B12.


M.

Dear Bobby,

I wish you felt better about your tdoc. Do you have a social worker?
Maybe you can find activities that will bring you to other people.
Have you considered something like that?
M.

are you sure that extra vitamin d would be an adequate substitute for all that calcium. I think now a lot of doctors are aware of people's deficiency in vitamin d and having their clients take supplements. I don't know if there is a raise in pernicious anemia since metformin has been on the market.It is alll so confusing
Love
Bobby
I just ordered 1200 miligrams of magenium. last nite i didn't sleep

Dear Bobby,

sorry if my post was a mess.

Sure? no. there is no way i can calculate to what degree the vit d increases your level. but also when one takes heavy supplementation, the body tends to absorb it less. also Ca supplements are less absorbed if not combined with Mg, Vit D (which you take plenty of) also C and E and b complex are important for utilization. so the reason for those figures - the 1000-1200 is possibly they are bombarding the body due to inefficient absorption. and a recommendation to take such a mineral in isolation just doesn't make sense because it doesn't work in isolation.

the vitamin D however is a big factor, and in the amount you take it i am sure it raises levels a good bit. how much i really can't say. that's why it would be good to have your levels checked. do you perhaps have an old lab that has that data on it, to compare with?

yes but typical supplementation is not at 8000 IU... some "high dose" supps are at 1000 IU... also Vit D is not mentioned with that recommendation to pump up the calcium when taking glucophage which makes me think the people studied were NOT on Vit D supps or it would be mentioned... vit D was probably not even taken into consideration. some docs still consider 200 IU as supplementation ... you are taking FORTY TIMES that! (old RDA was 200... i think the RDA has been upped but not past 1000 that i know of)

that is an interesting question. i don't know either.

Oh dear. I hope increasing the Mg helps with that.

A bit of concern here, because 1200mg would quite skew the Ca:Mg ratio (1:1 if you are taking 1200mg Ca). Since you weren't sleeping you might need some extra Mg - more than a 1:2 ratio, but... these are some heavy dosages... i would go up slowly perhaps...

How much were you already taking for sleep? (before starting the calcium)

and yes, i agree with you it is like a cat chasing its tail isn't it. this goes up so that goes up but if you add the other thing then the first goes down and ...

I am sorry you have to deal with all of this. Have you been to a nutritionist before... can you get a referal if not?

love

~ waves ~

i found the site of the National Institute of Health, Office of Dietary Supplements...

here is the table showing the current Reference Intake (replaces the old "RDA") for Vitamin D:

http://ods.od.nih.gov/factsheets/vitamind.asp#h2

for your age group, Bobby, it would be 400 IU... nowhere near what you are taking... the newer research on the benefits of higher vitamin D serum levels have not yet been integrated - still considered new/experimental studies.

Also, fyi...

Vitamin and Mineral Supplements - Fact Sheets

~ waves ~

Here is the journal you already read perhaps about the interaction of Metaformin / B12 / Calcium.
I does not mention Vit D. That would be helpful.
(Sorry that I am talking to myself. I am trying to figure this out.)
=-=-=-=-=-=-=-=-
http://care.diabetesjournals.org/con.../1227.abstract
I am looking for something about how much calcium to take if you are supplementing with vit D and I can't find anything. But what Waves says makes sense to me -- that you do not need as much Calcium if you are taking Vit D. If I find such an article, I'll get back to you.

http://www.vivo.colostate.edu/hbooks.../vitamind.html
I think many docs are not interested in working this out for us.
Perhaps a nutritionist might be able to help. I've never been to a nutritionist for myself but I went to a session with a friend andt the nutritionist was wrong about carbs for diabetics (still giving the old gov recommendations that were wrong according to LOTS of published materials)
A pharmacist might be a good at this. --especially since you are dealing with the metaformin/ B 12/ calcium question.


M.

=-=-=

I started a study a diabetes when I got engaged at 19 to a man with diabetes 1. After that other people came into my life who had diabetes and I kept learning about it for a while. I've taken a break from the study of diabetes but I remember some of what I was reading over those years.