For many with PCOS, insulin resistance is a core challenge. It means your body’s cells are “resistant” to the signal of the hormone insulin, leading to high insulin levels in the blood. This hyperinsulinemia is what drives androgen production, disrupts ovulation, and makes weight management so challenging.
To address this root cause, insulin-sensitising medications like metformin are commonly prescribed. They work to lower insulin levels and improve the body’s response to it.
However, there is a critical, and often unmentioned, side effect of these medications that can undermine their very purpose.
Let’s talk about inflammation. We know that chronic, low-grade inflammation is a significant problem in PCOS. It’s not just about symptoms like pain or fatigue; this inflammation actively worsens insulin resistance and increases the risk for long-term conditions like heart disease and diabetes. A key marker of this dangerous inflammation is elevated homocysteine.
Now, here is the crucial connection that is often overlooked.
While insulin-sensitising medications work to lower insulin levels, studies, including one by Pongchaidecha et al., show that they can significantly deplete levels of Vitamin B12 and folate. They found “there was a significant depletion of levels of serum Vitamin B12 among patients who had been on long-term metformin treatment.”
Why does this matter?
Because your body needs B12 and folate to break down and clear out homocysteine. When these vital B vitamins are depleted, homocysteine levels rise, fueling the very inflammation that causes insulin resistance and increases cardiovascular risk in the first place.
This creates a vicious cycle.
You take a medication to improve insulin sensitivity → The medication depletes B12/folate → B12/folate deficiency causes homocysteine to rise → Elevated homocysteine increases inflammation → Increased inflammation worsens insulin resistance.
The medication is fighting the fire of insulin resistance on one front, while potentially fanning the flames of inflammation on another. This is the critical information many are not told, and it highlights why monitoring B-vitamin levels and addressing this nutritional deficiency is non-negotiable for anyone on long-term insulin-sensitising medication.
Many taking these medications complain of side effects such as stomach issues. We know that Vitamin B12 deficiency can cause this complaint. There are many signs and symptoms of a Vitamin B12 deficiency, including:
Signs and Symptoms of Vitamin B12 Deficiency
A deficiency of vitamin B12 can lead to vitamin B12 deficiency anemia. A mild deficiency may cause only mild, if any, symptoms. But as the anemia worsens, it may cause symptoms such as:
- weakness, tiredness or light-headedness
- rapid heartbeat and breathing
- pale skin
- sore tongue
- easy bruising or bleeding, including bleeding gums
- stomach upset and weight loss
- diarrhea or constipation
If the deficiency is not corrected?
It can damage the nerve cells. If this happens, vitamin B12 deficiency effects may include:
- “tingling or numbness in fingers and toes
- difficulty walking
- mood changes or depression
- memory loss, disorientation, and dementia”
How can you increase the B vitamins in your Diet?
This list will help:
- Vitamin B1 (thiamine): sunflower seeds, sesame seeds (tahini), oatmeal, pork, cashews, peanuts, mustard powder.
- Vitamin B2 (riboflavin): organic liver (beef, chicken, lamb, veal), organic kidney (beef, lamb, veal), almonds, egg yolk, chilli, mussels, oysters, anchovies, broccoli (raw), parsley.
- Vitamin B3 (niacin): rice bran, rice flour, red meats, organic kidney (beef, lamb, veal, pork), organic liver (veal, lamb, beef, chicken, emu, salmon, sardines, anchovy, tuna, white fish, chilli, passionfruit, sesame, sunflower seeds.
- Vitamin B5 (pantothenic acid): organic liver (lamb, chicken), rice bran, egg yolk, mutton, pork, cashews, coconut (dried), crab, salmon, mushrooms (stir-fried).
- Vitamin B6 (pyridoxine): kangaroo, chicken, turkey (lean), mutton, veal, salmon, silverbeet, eggplant (aubergine), sunflower seeds, pistachio nuts.
- Vitamin B12 (cyanocobalamin): organic liver (chicken), sardines, mussels, oysters, rabbit, eggs (duck & chicken), scallops, mullet, snapper, beef, veal, lamb, turkey.
If you are taking insulin-sensitising medications, I strongly recommend you increase your vitamin B intake through the food you eat and in a high-quality B-complex supplement. This will not only help you to reduce your risk of heart disease and stroke, but it may also help to reduce any medication-related stomach problems.
From PCOS to perfect health, with love,
Dr. Rebecca Harwin
The PCOS Expert
Chiropractor & Bestselling Author of
Conquer Your PCOS Naturally
www.ConquerYourPCOSNaturally.com
P.S. When selecting a supplement, choose a reputable brand for quality assurance. Practitioner brands are usually the best.
P.P.S. Discover how to improve your insulin sensitivity naturally.
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