MikronährstoffCoach®: Wechselwirkungen / mikronaehrstoffcoach.com

Active substances and pharmaceuticals concerned

Name of active substance	Trade name	Affected micronutrients
α-glucosidase inhibitors	Diastabol®, Glucobay®	Vitamin D Chrome Alpha-lipoic acid
Sulfonylureas	Amaryl®, Diamicron MR®
Biguanide	Diabetex®, Glucophage®
Glinide	Novonorm®
Glitazone/ Thaiazolidinedione	Actos®, Diabetalan®
Dipeptidyl peptidase-4 inhibitor	Galvus®, Trajenta®
SGLT-2-inhibitor	Forxiga®

Specially affected active substances and pharmaceuticals

Name of active substance	Trade name	Affected micronutrients
Metformin	Glucophage®, Diabetex®, Diabetormin	Vitamine B₁₂
Sulfonylureas	Amaryl®, Diamicron MR®, Glucobene®	Coenzyme Q10

Mechanism of interaction

Mechanism of interaction
Vitamin D	Deficiency of vitamin D can increase insulin resistance and reduce insulin secretion of beta cells in the pancreas. Vitamin D status should be checked, especially under therapy with glitazone, as the risk of bone fractures is increased.
Chromiume	The cellular insulin effect is increased by the chromium-dependent oligopeptide chromodulin.
α-lipoic acid	As coenzyme of pyruvate dehydrogenase and α-ketoglutarate dehydrogenase glucose utilisation is stimulated.
Coenzyme Q10	Sulfonylureas inhibit the coenzyme-Q10-dependent enzyme chain and thus disturb the mitochondrial energy metabolism. Hypothesis: Possible impairment of insulin secretion and an increase in cardiac side effects due to repeated oxygen deficiency of the myocardium.
Vitamin B₁₂	Free calcium ions are necessary to absorb vitamin B₁₂. Metformin lowers this and prevents the uptake of the intrinsic factor B₁₂ complex in the intestine. This inhibition leads to a vitamin B₁₂-resorption disorder.

Consequences and possible symptoms of the interaction

Negative consequences of the interaction		Possible symptoms
Vitamin D	Decrease in vitamin D levels	Fatigue, weakness, insomnia Susceptibility to infection Decrease in bone density, rickets, osteopenia; in children: Rickets with skeletal deformations, spinal deformations, delay of tooth breakthrough Calcification of the vessels of the cardiovascular system, cardiac insufficiency Increase in alkaline phosphatase in the blood, insufficient absorption of calcium and phosphate ECG changes, tetanic muscle spasms (paw position of hands and feet); in children: increased nervousness and irritability Reduced insulin secretion and increased risk for type 1 diabetes Fertility problems
Coenzyme Q10	Decrease in coenzyme Q10 levels	Fatigue, weakness Muscle weakness and pain Disorders of cardiac bioenergetics, endothelial dysfunctions Increased risk of Alzheimer's disease, tumors, Parkinson's disease Increase in laboratory parameters for nitrosative stress
Vitamin B₁₂	Decrease in vitamin B₁₂ levels	Weakness, dizziness, pale skin and mucous membranes, shortness of breath, sleep disorders Neuralgias, paresthesia, muscle paresis, memory and concentration disorders Diarrhea, mucosal atrophy, glossitis, stomatitis Anemia, maturation disorders, thrombocytopenia, leukopenia, pernicious anemia Increase in serum homocysteine level Indirect folic acid deficiency

Positive consequences of the interaction		Possible symptoms
Chrome	Improvement of glucose utilization	Blood sugar-lowering effect of oral antidiabetics, but also of insulin is increased
α-lipoic acid	Possible increase in blood sugar-lowering effect	Particularly in diabetics with polyneuropathy, oral antidiabetics and insulin have a beneficial effect.

Recommended Supplementation

Medical substance	Recommended supplementation	Dosage
Antidiabetics	Vitamin D	1000 - 4000 I.U./d p.o.
	Chrome	200-1000 µg/d p.o.
	α-lipoic acid	600-1200 mg/d p.o.
Sulfonylureas	Coenzyme – Q10	90-500 mg/d p.o.
Metformin	Vitamin b12	500-1000 µg/d p.o.

Special instructions for use

Instructions for use
Chrome	Optimal effect with magnesium, benfotiamine, vitamin C and zinc.
α-lipoic acid	In diabetic polyneuropathy also combine with benfotiamine (150–300 mg/d p.o.).
Vitamin B₁₂	A combination of vitamin B₁₂, calcium and other B vitamins should be considered - due to the poor vitamin and mineral supply in often obserevd in diabetics a multivitamin mineral may be suitable.

References

Anderson RA et al. Elevated intakes of supplemental chromium improve glucose and insulin variables in individuals with type 2 diabetes. Diabetes. 1997 Nov;46(11):1786-91.
Bell DS. Metformin-induced vitamin B12 deficiency presenting as a peripheral neuropathy. South Med J. 2010 Mar;103(3):265-7. doi: 10.1097/SMJ.0b013e3181ce0e4d.
Chiu KC Hypovitaminosis D is associated with insulin resistance and beta cell dysfunction. Am J Clin Nutr. 2004 May;79(5):820-5.
de Jager J et al. Long-term effects of metformin on endothelial function in type 2 diabetes: a randomized controlled trialJ Intern Med. 2014 Jan;275(1):59-70. doi: 10.1111/joim.12128. Epub 2013 Sep 16.
Gröber U. Mikronährstoffe. Metabolic Tuning – Prävention – Therapie. 3. Auflage, 2011
Gröber U. Arzneimittel und Mikronährstoffe. Medikationsorientierte Supplementierung. 3. Akt. und erw. Auflage, 2014
Henriksen EJ. Exercise training and the antioxidant alpha-lipoic acid in the treatment of insulin resistance and type 2 diabetes. Free Radic Biol Med. 2006 Jan 1;40(1):3-12.
Kishi T et al. Bioenergetics in clinical medicine. XI. Studies on coenzyme Q and diabetes mellitus. J Med. 1976;7(3-4):307-21.
Menon RK et al. The effects of vitamin D₂ or D₃ supplementation on glycaemic control and related metabolic parameters in people at risk of type 2 diabetes: protocol of a randomised double-blind placebo-controlled trial. BMC Public Health. 2013 Oct 23;13:999. doi: 10.1186/1471-2458-13-999.
Sahin M et al. Effects of metformin or rosiglitazone on serum concentrations of homocysteine, folate, and vitamin B12 in patients with type 2 diabetes mellitus. J Diabetes Complications. 2007 Mar-Apr;21(2):118-23.
Stargrove Mitchell Bebel, Treasure Jonathan, McKee Dwight L.: Herb, Nutrient, and Drug Interactions: Clinical Implications and Therapeutic Strategies. 2008