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S2E7: B12 and MTHFR

If you’re following along with what we’re doing, last week you added in B vitamins as a group. Typically this goes well for MTHFR folks because other B vitamins help the methylation pathway to turn, but don’t push it too quickly with methyl groups. There is one exception to this, and that is vitamin B 12 – specifically the methylcobalamin form of B12. We’ll talk about that in a minute.

First – let’s check in with where we are in the process. If you haven’t added any B12 yet, then this week we’re going to add it. If you have added B12 then let’s learn a little more about the form that you’re taking and continue to symptom track so we know how your body is responding. Let’s dive into the forms of B12 that are available and what the differences are between them.

If you started with the Seeking health B complex or vitamins then you don’t have to worry about this – they’re designed for MTHFR folks and so don’t have anything methylated in them. If you weren’t able to get those specific products then I want you to go right now to wherever you keep your vitamins and check the label.

The B12 will be called *something*-cobalamin. Cobalamin is the actual vitamin and the *something* is whatever it is bonded to. Just like folate has to be methylated to become its active form, B12 does as well so methylcobalamin is the most biologically active form of B12. It’s also the hardest one for MTHFR folks to tolerate.

This is where your symptom tracking comes in. Now, you wouldn’t be the first person to give me a withering look when I mention symptom tracking for the 800th time. I get it. Everyone is tired of hearing about it. But the problem is, that humans are used to living with symptoms that change on a daily basis and unless you’re paying attention, a lot of these symptoms get dismissed as “normal.” So, it can be “normal” to have intrusive thoughts one day and not other days for no reason you can put your finger on. It can also be normal for one day to be more down or more up than others. Symptoms, especially when they’re minor, changeable, or transient, just get ignored or shuffled off to the side.

This is a great strategy to help you function as a human, but it isn’t so helpful if we’re actually trying to evaluate health changes that you’re making. So if you’ve just added a multivitamin with methylB12 and suddenly you’re having heart palpitations 50% more than you usually do, that is something we need to know. Hence, the symptom tracking. I will step down from my soap box now, and carry on with the discussion on B12.

The Best B12 for MTHFR Mutants

Vitamin B12 comes in a number of different forms. The most common and widely available is cyanocobalamin. It’s the least expensive form and generally does a fine job for most people. The cyano-prefix is actually short for cyanide, which tends to make people jumpy, but the dose of actual cyanide you get from cyanocobalamin is so negligible as to be a non-issue. Lots of people get nervous about it, but personally I’m not so concerned. It isn’t necessarily the best B12 on the market, but it will do the job. The cyano- group does have to be detoxified, so it does add a small burden that way. This is also the form most commonly found in injectable B12, which is a great option if your absorption is poor or if you have a profound deficiency.

Strangely, different people respond very differently to the forms of B12 and we don’t really have enough research to understand why, so B12 is one of those vitamins that I suggest doing a bit of your own human guinea pigging with (if guinea pigging is an actual thing). As your health journey progresses, it can be helpful to try the different forms separately and see how your body responds. Personally, I don’t do well with the methyl form at all, but respond wonderfully to the hydroxy form of B12. I notice a positive difference with it, where the methyl form just makes me jittery and irritable.

If you do notice any strange symptoms coming up this week and you did start a B12 last week, then check your form. The methyl form is known for giving people anxious, restless, wound-up energy that doesn’t feel good, intrusive thoughts, anxious thoughts, heart palpitations, and it can even be bad enough to push panic attacks or interfere with sleep.

B 12 and MTHFR can be complex. Methyl-B12 is the most active form, but methylcobalamin or methylB12 can cause anxiety, jitteriness, heart palpitations or intrusive thoughts.

I don’t want to villainize methylcobalamin. It is already methylated, which is a big help for those of us who methylate poorly and can take a burden off of our systems. It doesn’t need to be detoxified and it’s already biologically active. It is the most effective form of B12 for things like nerve health and if you tolerate it, then it’s probably the best form for you.

The hydroxo- form of vitamin B12 still has to be methylated to become biologically active, but it has the advantage of being almost like a sustained release vitamin B12, and so can be extremely helpful if your energy tends to suffer high peaks and low valleys – this one can help to even things out a bit. It’s not as easy to find as some of the other forms, but it can make getting your B12 far easier to bear.

The adenosyl-form of vitamin B12 is actually unique in that this is the form your body puts into storage, which makes it quite different from the other forms. Typically, excess B12 that you take as a supplement just washes out, but the adenosyl- form might actually go into storage. There is some very compelling informtion showing that this form might actually be the best for chronic fatigue , which is now being called myalgic enciphalomyelitis, or ME/CFS.

Research hasn’t kept pace with what people are doing clinically, and so the research on chronic fatigue shows great improvement for some people with B12 and folate supplementation, but doesn’t yet get into the nitty gritty between different forms of B12 or different forms of folate. In fact, all of the research I have seen is done using the cyanocobalamin form of B12, and plain old folic acid. Many chronic fatigue specialists, patients, and community forums indicate that the adenosylcobalamin form of B12 has the most profound effect for them.

B12 and MTHFR can be complicated.  For ME/CFS, or chronic fatigue with MTHFR the adenosylcobalamin form of B12 can be the best, although the research isn't there yet.

If you have noticed an issue with your B12, switching to a hydroxy or adenosyl form might be easier to bear. They metabolize more slowly and so you aren’t faced with the overwhelming rush of energy. We also talked about the different forms of B12 in Season 1, episode 44 so if this episode isn’t enough, check out that one as well.

Again, this is a personal response situation, so if you’ve been taking one form and either don’t notice improvement or have side effects then try switching to a different form and see how you do. We humans are unpredictable creatures and if I’ve learned anything from MTHFR, it’s that the sum total of a human is so much more than their genes, lab tests, and stressors. We are unpredictable creatures and there are no two of us alike.

I am happy to say that the Patreon page is up and running, even if it is in its baby beginnings. If you feel like you’re learning something here and want more of the podcasts – please become a patron of the show on Patreon. It will help get great information to you and to other MTHFR folks as well. Plus, there are some patron perks. Visit Patreon.com/thwt Thanks for listening!

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2 Comments

  1. Lindsay Todd Lindsay Todd

    Help! I’m having a reaction to my methylcobalamin that I started three days ago. Red face, sore to touch , jittery, anxious.
    I’m allergic to cobalt and I’ve learned that there are cobalt atoms in B12.

    Should I try another form ? Or go straight to folate ?

    I’ve been great on Seeking Health B Minus for the last week.
    Not sure what to do ?
    Kind regards,
    Lindsay

    • Hi Lindsay,
      Great question! Methylcobalamin can make anybody feel jittery and anxious and it is more likely to be the methyl group (in my opinion) than the cobalt. I’d wait until your symptoms calm down (and if they’re not calming down then make an appointment with your doctor or go to urgent care). Once things are back to baseline I think you could cautiously try a different form of B12. There is a cobalt atom in it, but B12 is also essential for life, so unless it’s an anaphylactic allergy (like full on ER visit, epi-pen type allergy) then I think your body probably has a tolerance for the low levels. If it is a full on epi-pen type allergy then please work with a specialist to determine how to get around that because B12 is vital. So outside of the full anaphylaxis, I would try a different form of B12 before giving up on it entirely. The hydroxy form is reasonably easy to find and metabolizes much more slowly so you don’t get so jittery and anxious. Also, make sure you’re starting with a low dose. If a different form also doesn’t work out, then talk with your doctor about it and for now skip to a low dose methylfolate until your doctor can help you figure out how to effectively get the B12 in. I hope this helps and let me know how it all goes!

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