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Biguanides and Nutrient Deficiencies: Managing Diabetes While Maintaining Optimal Health

Biguanides and Nutrient Deficiencies: Managing Diabetes While Maintaining Optimal Health

With over 11% of the population of the United States having diabetes, its impact on American health is significant. According to the American Diabetes Association, out of this 11%, 90-95% have type 2 diabetes.

What is Diabetes?

Let's briefly touch on the two different types of diabetes. Both are chronic diseases that cannot be cured, affecting how your body regulates blood sugar (glucose). While glucose is an essential fuel for your body's cells, it needs insulin to be able to enter the cells. You can view insulin as the key to your cell.

In type 1, the immune system attacks the pancreas's beta cells responsible for insulin production, leaving your body unable to produce insulin. This is like not having a key to your cells. Patients with type 1 diabetes have to inject themselves with insulin.

In type 2, the pancreas produces less insulin than usual, and your body builds insulin resistance. In the later stages of the disease, your body often doesn't make enough insulin anymore. So, in this case, you have a key that is not working properly and can break.

What are Biguanides?  

Biguanides, primarily Metformin, have established their significance in the battle against diabetes. With the high share of type 2 diabetes, the use of biguanides is substantial. Metformin, in particular, has become the first-line medication for treating type 2 diabetes, given its efficacy in improving glycemic control and safety profile.

So, what are biguanides? Biguanides are organic compounds that prevent the production of glucose in the liver. Reducing the amount of sugar absorbed by the intestines during digestion, they help your body manage lower insulin levels.

Common pharmaceutical brands and names of biguanides primarily include Metformin, which is also known under the brand names Glucophage, Glucophage XR, Glumetza, Fortamet, and Riomet. These medications are broadly similar in their effects but may differ regarding extended-release versus immediate-release properties and cost.

Side Effects of Biguanides

However, like many medications, long-term use of biguanides can lead to certain nutrient deficiencies. This article delves into these deficiencies, their potential consequences, and how to manage them effectively.

The long-term use of biguanides can affect specific nutrients, primarily vitamin B12 and Folic Acid. Although only some people on biguanide therapy will develop these deficiencies, it's essential to be aware of the potential risks.

Vitamin B12 Deficiency

Biguanides, particularly Metformin, have been shown in several studies to reduce Vitamin B12 levels in the body. A meta-analysis published in the BMJ in 2010 found that Metformin treatment leads to a statistically significant reduction in vitamin B12 levels, which might increase the risk of Vitamin B12 deficiency. This deficiency can cause anemia, nerve damage, and fatigue.

Solution: Regular monitoring of vitamin B12 levels is recommended for patients on Metformin, especially those on high doses or those on the drug for an extended period. Supplementation can effectively replenish Vitamin B12 levels and should be considered in patients showing deficiency symptoms. 

Folic Acid Deficiency

Some studies have suggested a potential link between biguanide use and reduced Folic Acid levels. A study in the Journal of Endocrinological Investigation (2009) showed decreased serum Folic Acid in patients treated with Metformin. Folic Acid deficiency can lead to anemia and high levels of homocysteine, which might increase cardiovascular risk.

Solution: Monitoring of Folic Acid levels and potential supplementation may be beneficial for those using biguanides long-term, particularly if they show signs of deficiency.

Importance of Testing and Supplementation

As not everybody on a biguanide regimen will experience these deficiencies, it is essential to do regular tests for potential deficiencies, as not all symptoms are indicative. Many supplements counter these deficiencies and allow patients to lead a balanced life.


In conclusion, biguanides, particularly Metformin, are vital in managing type 2 diabetes. However, their long-term use can lead to nutrient deficiencies, namely Vitamin B12 and Folic Acid. By staying informed about these potential deficiencies and addressing them promptly through regular testing and potential supplementation, patients on biguanides can continue to live a healthy, balanced life. Always remember that any medication or supplementation should be under the guidance of a healthcare provider to ensure its safety and effectiveness.

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