In this case scenario, we discuss the “double trouble” of using PPIs and metformin and their effects on vitamin B12.
Mrs. J is a 68-year-old woman with type 2 diabetes and gastroesophageal reflux disease (GERD). She has been taking metformin 1,000 mg twice daily for the past six years and omeprazole 20 mg daily for the past four years. She presents to her primary care provider with complaints of increasing fatigue, occasional dizziness, numbness and tingling in her hands and feet, and difficulty walking up stairs. She also reports mild forgetfulness over the past few months.
On physical examination, she appears pale, has mild distal paresthesias in both lower extremities, and a slightly unsteady gait. Vital signs are within normal limits, but laboratory studies reveal a hemoglobin of 10.8 g/dL, mean corpuscular volume (MCV) of 108 fL (macrocytic), and low serum vitamin B12 at 160 pg/mL. Folate levels are normal.
The primary care provider recognizes the patient is at risk for B12 deficiency due to her long-term use of both metformin, which can impair B12 absorption in the ileum, and omeprazole, which reduces stomach acid necessary for B12 release from dietary proteins (excellent board exam nugget).
She is started on oral vitamin B12 supplementation at 1,000 mcg daily, and her medications are reviewed. The provider discusses the risks and benefits of continuing long-term PPI therapy, emphasizing lifestyle modifications for GERD and considering step-down therapy if appropriate. The patient is educated on monitoring for neurological symptoms, adherence to supplementation, and the importance of follow-up labs to ensure her B12 levels normalize.
Over the next several months, Mrs. J’s fatigue improves, her gait steadies, and her neuropathic symptoms gradually lessen. Follow-up labs show normalization of her B12 levels, highlighting the importance of recognizing medication-related nutrient deficiencies in patients on long-term therapy.
If you are looking for more information on omeprazole, vitamin B12, and metformin, be sure to check out these podcast episodes:
Why PPL and Metaformin never defined here?
What are PPIs, I take a 1000 mg a day 500 morning 500 night of metformin
PPI’s are Proton Pump Inhibitors, like Omeprazole.
Ppi is a protein inhibitor.eg omneprazole.it keeps acid down in stomach to avoid reflux
Thank You for The Information. It has given me some (Clarity) . I willnot be taking Metformin ever again
YESS THIS IS WHY I TOLD MY DOCTOR TO TAKE ME OFF THAT NOW MY A1C IS DOWN FROM 20 TO 5.5 GOOD DIET EXERCISE GS IS AT 120 114 118 ALWAYS
I would not stop Metformin. It is an important drug to combat high blood sugar in diabetes. Left untreated is far worse then having to take B12 supplements. Speak to your doctor
When omrprazole was added as the third of these for me .to take. I took for five days and woke up one day and could not walk. By evening I was walking again when I was in ER. Adding that medication was the only change I had made in any aspect of my life and I have not taken it since. In my medical records I list it as a medication I am allergic to and I have not taken anything in its place. This happened over 6 years ago
Ppls is short for the plural form of people.
Lolol!
Wanna join.
Wanna join for health reasons
PPI stands for Proton Pump Inhibitor. These medications are prescribed for acid reflux as they prevent production of acids which aggravate the mucous lining of the esophagus and stomach. Examples are Omeprazole, and Pantoprazole
Wow i didnt know tht i have acid reflux bad
I been taken metformin, 1,000mgs a day for yrs also I have acid reflux, barracks. I take pantoprazole 40 mg a day. I can’t live without taking it..
Proton pump inhibitors. If it ends in zole (generic nane) it’s a PPI.USRD FOR GASTRIC reflux.. prilosec protonix, nexus. To name some brand names
I also have problems with walking..I was nausea for 3 weeks. I no longer take B12 and my nausea is gone!
You must be your own advocate.
I believe in second opinions…
T.edwards
82 yr.
What can you replace metformin with. I take 1000mg twice daily .. I take vitamin B12 and vitamin D3 daily. I also have iron deficiencies and take iron daily as well. But metformin is the only medication that keeps my diabetes under control.
Proton pump inhibitors ( omeprozal for acid reflux)
I don’t take ppis but I DO take metformin twice a day and I have all her symptoms, have for a few years. I’m not happy, my Dr doesn’t see any problem. What’s up?
Amazing, I took Metformin for years from 500mg to 1000mg. I have taken Omeprazole (GERD), and B12. PPI’s and metformin is interesting to me.
What is ppl?
My son had the same reaction.
Proton pump inhibitors
Proton pump inhibitors, like omeprazole and prevacid
what is Ppls and metformin fir type 2 diabetes
Yes thanks for the information.
What about H2 blockers .Do they would slow down the absorp6 of
Vit b12
I’m a diabetic patient on the same medicines. I got very useful information from this blog.
It’s PPi and it means proton pump inhibitor and it is a type of antacid. Metformin is a pill for high blood sugar.
Metformin is for high blood sugar not high blood pressure.
Metformin has damaged my kidneys! I’ve started B12 daily do to fatigue and have more energy. I take a protonic daily and noticed Alot of these issues,I’ve had!
You can Google it you know…
PPI is a proton pump inhibitor. It is used for acid reflux/gerd. I have taken PPI’s for many years.
Metformin is for diabetes. One of my friends used to take it but she uses Cassia cinnamon oil now.
Y husband is experiencing some medical symptoms,he take metformin and B12 everyday,now his body isn’t working on his body is doing weird things, numbness in right hand other things.O need help!
I have my meds in ties and fingers I take metformin and just started B12 & vitamin D last week. How long to see results from B22& vitamin D
I my self have megaloblastic anemia caused by deficiency of B12, also folic acid. My diagnosis was self diagnosed after years of severe illness almost to the point of dying. And being told nothing was wrong with me, even after going to ER and receiving lab’s that were a 100% diagnostic of megaloblastic anemia. It was still denied by kaiser. The attending ER doctor said he had never seen blood cells like i had, he told me that it wasn’t likely that i would be made aware of the finding so he gave me the lab results of which was denied existed. When attempting to get the full report i was blocked. I had previously requested to view my records and made an appointment to do so, but when requesting copies later after revealing the findings in ER i was denied. Going back later a clerk replied “well” there isn’t much i’m just going to let you have them, and he did. Most were gone. A few more years with kaiser and learning as i went along i changed from kaiser to another practice. My new primary said he couldn’t diagnose from old records and other doctors reports. , but noting i was becoming increasingly sicker. Finally he decided to review the records i did have. After a few more weeks he told me there is a test i like to do, and a methylmalonic acid test was done which then showed i had megaloblastic anemia. And i was started on B12 injections for a few weeks now i take one a month for life, because of the long delay i have no intrinsic factor or parietal cells and suffer from Achlorhydria. since, i have very much educated myself on medical terminology and procedure, and have diagnose at least seven more of my disorders and have learned to treat them all. The medical field is complicated for so many reasons, so knowlege is a must have.
Amen
Been on.metformin for many years now are saying it is not a good thing to do
PPI is Proton Pump Inhibitors like acid reflux medications and Metformin is used to those with type 2 diabetes. Hopefully that helps.
My hubby has peripheral neuropathy and poly myalgia rheumatica. He takes 1xprednisone daily and 2x Nurika twice a day(25mg tablet)
Can you advise
Yes this is true and happened to me as well. I am using esomeprazole from the last many years. Due to random chest pain and fatigue , I tested my HB and B12. Hb was 9.5 and B12 222 pg/ml. Now I have stopped ppI and using famotidine 40 mg daily. let’s see what happens?
I take Omeprazole and I fall down or stagger when I walk. I don’t know what to do about it.
I was given that Omeprazole and had issues like that with walking.
I stopped taking that and feel better now.
I think this is just for temporary use.
Metformin killing people
Yep. That’s why I took myself off it years ago. I was infertile without it, so I’m thankful for the assist in pregnancy. But I’d advise anyone to not take it or at least not long term. The diarrhea from Met. isn’t worth it anyway
PPI’s a group of medication classes that treats acid reflux commonly known as heart burn. PPI stands for proton pump inhibitors. This name refers to the way how these medications prevent or minimize the amount of acid levels naturally released in our stomach. Some of these drugs within a class are Omeprazole(Prilosec), Pantoprazole( Protonix), Esomeprazole(Zantac))
PPIs are medication for GERD. Metformin is a very common medication for type 2 diabetes.
I am grateful to have read the blog very informative an I look forward to reading and learning more
What about centrum silver for men and metformin?
Should a person who is taking metformin be taking other vitamins?
I realize all the these questions should be addressed to a primary care doctor.
How often do you feel that blood levels should be taken?
I just wanted your take on this subject.
I ha d a lot of issues and here’s just one more for me to add to the list. No wonder a doctor once said to me ” I am such a high risk I was doomed at birth”
Exactly my situation as in this writing. Diagnosis with B12 deficiency.
Great to see these symptoms were mine as well. I have since quit taking metformin and have improved on these symptoms..
Metformen is very bad for you can cause kidney problems and other problem
She should not use Omeprazole tablets, diabetic patients generally develop Neuropathy in the Foot and hand foot soles burning, numbness in the feet, due to poor circulation of blood to the Lower Extremities developing burning sensation in the feet for which Nervpace is prescribed by Endocrinologist, besides she can use Ayurvedic supplements for GERD 1. Indukantha Grutham of Variars Pharmacy, Kotakkal, 2 spoons in the morning along with Dhatri Loha tablets 1 in the morning, she can use it in the evening as per her GERD position, this is the good remedy Prescribed top Ayurvedic Specialist, my son with Peptic ulcer was cleared on usage of the medicines cited above for One year he was normal now.
Good suggestions
She needs to switch to Jardiance. Get her off of those two meds!
Anyone taking any of those or even just one, needs to STOP IMMEDIATELY and have their Physician switch them to Jardiance!
Your so quick to switch to Jardiance a new drug hasn’t been around long.u don’t know the consequences down the road. Metformin has been around a long time. It is considered a safe medicine
Metformin is for high blood sugar not high blood pressure.
Is it recommended to take metformin and jardiance together in the management of A1C?
I have been on metformin for over 5 years until recently when Jardiance was added.
My fear now is deficiency affecting anemia. What next?
I was on jardiance, but got off that as well. That is another form of metformin. I was now put on Xigduo Xr 2.5-1000 mg tablets and my Ac1 is at 6.5. She also has me taking insulin shot at 6 units a day which I think is all too much.
Is it possible to be on jardiance and metaformin
Meta form taste terrible and I am keeping a headache . Just one week of it. She also gave jardiance. She stared I have diabetes and liver disease.
She told me I was stubborn. Now iam looking for information on everything .
Any help is for my research
Thank You in advance.
You should have your doctor check your blood to see if you’re becoming anemic.
I am on both of them
I thought jardiance was another form of metforim.
Why is everyone taking B12?
If you have fatigue you should ask for a cbc blood test to inquire why you got the fatigue?
I read so much of ppl get so many more pills added, don’t they realize the combination could add side effects?
Get off Of Metformin! It causes other problems. Try Ceylon Cinnamon and natural supplements if possible. Pro and Prebiotics will help . Andrew Lessman has wonderful supplements and vitamins all natural !!!
We only need to take Berberine and Chronium…NO DRUGS FROM A DOCTOR. MY MOM DIED WITH KIDNEY DISEASE FROM METFORMIN.. My A1c 5.9. NO LONGER TAKE NASTY METFORMIN.
I am complications I was walking before taking these medications but I am dizzy , have problem walking, my. Blood. Is super. High. All. The. Time.
Jardiance does have some side effects that people should note as well before changing to that, and in some countries its still a very new drug
I’m on Jardiance along with Metformin. Jardiance helps to take the extra sugar out of my system.
I used jardiance for a few weeks and had to stop taking it because I had a constant yeast infection.
I do take Metformin 1.000 a day,and B12 daily
I’m taking daily
Famotidine 40mg
Amlodipine 5mg
Hydrochlorothiazide 25mg
Metoprolol 25mg ×2
Rosuvastatin 10mg
I went to see a Neurologist and she diagnosed me after an MRG, with peripheral idiopathic neuropathy.
Except for the bottom of my feet feeling strange ,somewhat numb.
However l can barely walk.
Me too
Metformin is a drug used for long for diabetes, the side effects are very minimal, a combination with other drugs gives good control of blood sugar. Acid reflux is a common disease which can be controlled with life style modifications rather than using medication, proper exercises and timely food with regular intervals and reduce stress by practicing yoga or meditation will definitely give good results
Yes very informative I take both medication and I have been feeling more tired lately and mild forgetfulness
What about if it. Is allergic to Jardiance??
What about if person Is allergic to Jardiance??
One of Jardiance side effects is UTI’s. My doctor switched me to that medication because I can’t swallow a large pill like Xigduo. I had to stop taking Jardiance because it caused me severe UTI’s.
Since then, I am any longer taking both of those meds. My A1C went up a little so I’m trying to find ways to control my sugar.
Someone mentioned Casia Cinnamon oil. I will look that up and see if I can help.
I thinking about going to dermatology to see what I’m allergic too. I’m 70 and all is new to me
I too .
I take Metforimin 500/ day and have just switched back to Mounjaro from Ozempic 2 mg actually made me throw up and I was always nauseous and constipated. I had no side effects with Mounjaro, and I thought performing was a great anti aging drug! Now it’s the devil- why?
I take Metforimin 500/ day and have just switched back to Mounjaro from Ozempic 2 mg actually made me throw up and I was always nauseous and constipated. I had no side effects with Mounjaro, and I thought Metformin was a great anti aging drug! Now it’s the devil- why?
That’s why I stopped taking this poison
Which one do you think is poison?
So what are you taking know then since you stop taken this poison
Very informative.
If ppi is taken to lessen risk of bleeding due to clopidogrel 75 daily along with Metformin, should it be stopped?
At 40mg of PPI (Pantoprazole) for treating GERD for a hiatal hernia, I ended up with small, non-cancerous growths in my stomach and low levels of several vitamins. I’m also now on supplementation for B12 and a reduced 20mg level of Pantoprazole, plus added vitamin D, vit C, and magnesium. I was still having lethargy and focus issues, and additional testing showed that I also needed iron and then Coenzyme Q10 was added. THE PPI CAN CAUSE SIMILAR VITAMIN ABSORPTION ISSUES FOR EVERYBODY.
All of the additional items are taken at very specific times of day to prevent absorption or interaction issues. I feel better now, but I’m trying to determine how on earth I can reliably modify my diet enough to stop taking the PPI. As confounding factors, I’m also on Amlodipine blood pressure med and Levothyroxine thyroid meds. I have a gluten issue that makes dietary changes difficult.
I am fit, my heart CT, A1C, BP, Cholesterol, etc are all in range, but I’m still a bit low on energy. It’ll be interesting to see how this pans out.
I am type2 I take metformin 2x a day. I have GERD currently on my last month of Voqueza and it has helped. My B12 levels are elevated (liver damage?) but my main issue is Nocturnal leg cramps and cramps all over my ribs and stomach during the day. I wonder if this combination is causing me more pain than help. No one seems concerned about the neuropathy or the cramping. Very frustrating. This article is the first I’ve seen about this correlation.
Could you tell me more about different times needed to prevent interactions/abortions? I take many of them pills and my Dr says ok to take all at once.
Thank you I take ppi’s and it has affected my legs alot.
I did enjoy this blog post.
Have you ever had rib pain? I remember when I was having problems taking ppis metformin I was having horrible rib pain and I looked it up and there was a lawsuit against Zantac which is similar to a PPI and there were people complaining of horrible rib cage pain just curious if anyone else has had real pain from taking ppis or similar products with metformin
I have rub pain and black out and I take metformin
My mom was 63 and took metformin for years and complained a lot about the tingly sensation in her limbs and pins and needles in her feet and weak feeling very bad headaches and suddenly when no one expected one morning in 2022 she passed suddenly. God rest her soul love ya mom!
Amazing, I have been taking same amount of metformin, acid reflux for quite awhile and need B12 shots. So glad I found this article. Am going to show this to my PCP.
The Senior pharmacist in one of Durbans leading pharmacy in
South Africa said you can’t talk 1000mcg of B12 & i said you can .
She warned of serious side effects
I was allways very tired & fatigued
Lots of headaches.
The moment i started taking 200mcg of B12 IMMEDIATELY i started felling better but the cost of 200mcg of vitamin B12 is very expensive but the benefits outweights the cost
I am on metformin 500mg per day but I substitute on alternate days with Himalayan Organics – Diabetes Support 2 capsules. Works fine. Also support with controlled diet and exercise.
I dont take metformin but have been taking Nexium for 20+ years. I have serious memory issues, balance issues as well. I take B12 1000 mcg daily hmmmm
Which one do you think is poison?
This is very educational. It helps to aid problem solving. Metformin and PPI helps those patients taking these meds. Thanks. I will share this article with a friend.
So what are you taking know then since you stop taken this poison
Started metphormine in conjuction with keto diet along with d, b12, multi, and c with zinc. Walked 30 mintes after dinner
Did not eat or drink after 7 p.m. and nothing before 9 a.m. after 6 weeks of this information stopped metphormine keeping all the rest practices vits, diet, walk. I lost 100 lbs in 12 month.
Very useful information
Very interesting article. My husband takes metformin, omeprazale n jardiance. His doc just keeps adding meds. He see’s a new doc in March. I kept telling him he needs to switch. I’m hoping new doc will take him off some of his meds.
I have been talking metformin 100mg twice daily. My both legs have become weak, numb feet and cold besides painful.
I live in Mauritius.
I take metforman.so its ok if i take B12
Have your docror check kidney function if taking PPIa long term.
My bloodwork recently showed high-levels of B12+ folate as
>2000. I had just taken a B12 shot. I also take Metformin 24hr release tablet now. I no longer take Metformin 2x daily.
I have not been feeling like myself for the last 2-3 days.
Interesting I’ve been having a lot of these same issues and I to be 12 and folic acid and omeprozel for gerd- I have had 4 Mri’s In last 3 months to see if it had anything to do with my brain or spine- I’m wondering if there’s anyway you can be related to these 2 medications the dizziness the blacking out and just feeling like crap! However I took jardiance and almost died from the horrid side effects! Is there REALLY and answer to all of this anyway?
Im on Metformin 1000mg 2 times daily, glimepiride 4 mg 2x a day, januvia 100mg 1 a day they put me on ozempic to, and i stopped it. I take 40mg omeprazole daily since I underwent breast cancer treatment chemo. They tell me i need to keep taking omeprazole? Dont know who to trust and who to believe? What do you all think?
Im on Metformin 1000mg 2 times daily, glimepiride 4 mg 2x a day, januvia 100mg 1 a day they put me on ozempic to, and i stopped it. I take 40mg omeprazole daily since I underwent breast cancer treatment chemo. They tell me i need to keep taking omeprazole? Dont know who to trust and who to believe? What do you all think? I was never told anything about b12 just so happens i decided to take b12 on my own and have been for at least 4 years
Hello. to all of you. Been reading your posts. Many of you are on Omeprazole, which can be a concern for long term use. Calcium from food or supplement requires some acid to allow for absorption. Diminished calcium absorption will contribute to osteopenia, the predecessor of osteoporosis, an increased risk of fracture. As for you having had breast cancer, radiation treatment will leech calcium out of your bones. Again creating risk for osteopenia/osteoporosis & fracture risk. Talk with your PCP about alternative GERD nonPPI treatment, calcium supplementation & a bone density exam for evaluation of your bones.
Hello. to all of you. Been reading your posts. Many of you are on Omeprazole, which can be a concern for long term use. Calcium from food or supplement requires some acid to allow for absorption. Diminished calcium absorption will contribute to osteopenia, the predecessor of osteoporosis, an increased risk of fracture. As for you having had breast cancer, radiation treatment will leech calcium out of your bones. Again creating risk for osteopenia/osteoporosis & fracture risk. Talk with your PCP about alternative GERD nonPPI treatment, calcium supplementation & a bone density exam for evaluation of your bones.
AVOID Man-Made drugs they are CHEMICALS read about Elare.store and Resilia oil of Oregano softgels 85% carbacrol mix with Black Seed Oil. To GOD Be The Glory
I have taken antacids/PPI’s for acid reflux/gerd for forty years. I take 20mg of famotidine at night and 20mg of rabeprazole in the morning.
My electrolytes are always low. My magnesium, potassium, Vitamin B12 and D are always low.
PPI’s slow stomach acid production. We need stomach acid to digest our food and absorb vitamins and nutrients from it.
I take more supplements than I do prescription medications.
Thank for the Advice ..I been taking metformin tablet for diabetic type 2 i take a 500 MG tablet after breakfast and 500 MG after dinner a day …since year 2024 please Email me if you have any advie .thank
Metformin 2g daily x many years!
Omeprazole dly x many years
Vit B12 1ml monthly x many years
#Papillary Thyroid Cancer 1993. Metastised x 3
# Endocrine complications
CA because of ionizing radiation
I’m 67yrs old
My glucose level was 8 march2024
Dr put me on metformin 1000mg per day. From the 1st week I noticed that I was losing weight and hairloss .I have told the Dr about my situation She insisted that I continue with the metformin for 1 years Today 22 months later I’m off metformin have excessive muscle loss and nerve damage which is irreparable. Please advise
I’m in Glucophage 1000 mg twice a day. Will cgeck with my GP for Jardiance, not sure if available in SA.
I take these meds also how do l let my doctor see this l
I like you inf. My lab. report im low on B12 irion I take metforming for many many years 1000 xa day thankyou
All medications should improve your health and positive results should be apparent within a reasonable period. Patients should let doctors know if they desire a change in their treatment. Sometimes the body needs a change in the treatment plan not just adding more medication to the treatment plan. Always remember to advocate for yourself and research your own medication side effects.
Very interesting . I also take metformin and GERD meds and have bad rib cage pain.
I had been on omeprazole for several years myself. Just before I had a major foot surgery I had to do a blood draw. It was found that my B12 was low and my PCP said that is common with people who drink (alcohol) excessively. I don’t. I eat healthy most of the time, eat salmon, oatmeal, walnuts, berries, etc the things that have B12 so it didn’t make any sense. I was also struggling with major fatigue, balance issues and even fell down the stairs (broke my foot!). I study nutrition so I knew that it was the long term use of the PPI’s causing this.
Just before my foot surgery my GI doctor wanted to switch me to a newer medication for my acid reflux, I tried it but seemed to get a rash from it. She advised me to go back to taking the omeprazole/ pantoprazole.. So I started to wean down and now I really watch what I consume, take a more natural supplement called Reflux Gormet ($28 Amazon) and have my energy back.
Best advice: review your med with every doctor at every vist. Ask if any new med will cause an advers reaction to your body.
And you pharmacist 🙂
I inject myself with insulin in and by bloodsugar level over 6 months is 5. I injected myself with insullin 4 x pd. Can I have to use
Iminsullin