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B-12 - The Hidden Story

Learner1

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@Belgiangirl I am so sorry for all you have been through. However, a few points:

1) Serum B12 will be high of you gave been supplementing. The test is useless. You need to have a methylmalonic acid test to assess Your true B vitamin status.

2) Hydroxocobalamin does not provide methyl groups. It is not the best type of B12 to be supplementing with. Nor is cyanocobalamin. Most of us need metbylcobalamin. And some need adenosylcobalamin. I take a combo of MB12, HB12, and AB12.

3) Randomly supplementing without having adequate lab testing is a recipe for disaster. A Genova Diagnostics NurrEval test is availabke in Europe and it would be extremely useful to untangle the mess you are in. There are many other nutrients that work with B12 and other B vitamins and its likely you have some serious imbalances given your story.

4) Finding a competent doctor who understands nutrient testing and supplementation would be extremely useful. O am not understanding who prescribed your injections and infusions, but it is highly unusual that a doctor would prescribe the without adequate testing. A functional medicine doctor who looks at the body as a system of systems might be very useful.

5) Vitamin therapies can be veru powerful. I get a nutrient infusuon every 7-10 days and am on a comprehensive oral supplement program. This has helped me lose my brain fog, helped me gain energy, and imprive do I can exercise some and work part time. But I do trsting every 9 months zand work with doctors who have expertise, and don't randomly self administer stuff.

6) It might be the case that you have other problems. Many of is have active viral or bacterial infections, autoimmunity and/it or immunodeficiency, POTS, mast cell activation, and other comorbidities. Medications for these other conditions can make a huge diffetence.

There are many resources here. I hope you csn find some better answers and some better help so you can stsrt to feel better.
 

Sparrowhawk

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Great guidance, above, well said.

One question on what you wrote here:
@Belgiangirl
5) Vitamin therapies can be very powerful. I get a nutrient infusion every 7-10 days and am on a comprehensive oral supplement program. This has helped me lose my brain fog, helped me gain energy, and improve do I can exercise some and work part time. But I do testing every 9 months and work with doctors who have expertise, and don't randomly self administer stuff.
Is this a standardized infusion IV, or do your providers customize it for you each time? I'm curious which vitamins can be infused vs. which can't. For instance I have yet to find a Vit E pill that I tolerate without headaches. Thanks for any additional information on how this is done.

I have been addressing individual vitamin deficiencies via testing blood levels with a Dr. and individual (mostly liquid) supplementation (plus the now famous Australian Methyl B-12 oils). But I still need to find a way to get in Vit B2, Vit A, Vit E which are all low. Also, due to dry eye, I no longer tolerate the Sodium Ascorbate form of Vit C, so am looking into ascrobic acid liposomal solutions.
 

BeADocToGoTo1

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Is this a standardized infusion IV, or do your providers customize it for you each time? I'm curious which vitamins can be infused vs. which can't. For instance I have yet to find a Vit E pill that I tolerate without headaches. Thanks for any additional information on how this is done.

I have been addressing individual vitamin deficiencies via testing blood levels with a Dr. and individual (mostly liquid) supplementation (plus the now famous Australian Methyl B-12 oils). But I still need to find a way to get in Vit B2, Vit A, Vit E which are all low. Also, due to dry eye, I no longer tolerate the Sodium Ascorbate form of Vit C, so am looking into ascrobic acid liposomal solutions.
Fat soluble vitamins are generally not put in an IV, and these included A,D,E,K. CoQ10, though not technically a vitamin, is another fat soluble component to check your levels for.

Have you tried cod liver oil for an easy, healthy, way of getting Vit A, D, E? Usually comes in a glass bottle and you can take a teaspoon or tablespoon worth to get a nice dosage. Getting your vitamin C boosts through food instead might be something to consider e.g. kiwi, brocolli, acerola cherries, rose hips, peppers, etc.

I agree with the others that testing properly is important. Many doctors do not do the metabolic urine tests like the Genova FMV or an intracellular test like Spectracell, or stool tests to check for malabsorption issues. Standard blood tests will not help much with things like magnesium, vitamin K or CoQ10 levels to name a few.

It is important to understand and test for reasons why you may be deficient and rule out things like any causes of malabsorption such as SIBO, Candida overgrowth, IBS, Chrohn's, gluten sensitivity, exocrine pancreatic insufficiency, etc.

Specifically for B12, I also went overboard on injections at one point and it took many months for it to get back in range. I read somewhere that potassium and niacin help, but for me it just took time for the stores in the liver to be utilized.

These are some other tests to consider for possible B12 deficiency causes:

  • Antiparietal Cell Antibody (APCA)
  • Methylmalonic Acid (MMA)
  • Intrinsic Factor Antibody (IFA)
 

Learner1

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I have done both Spectracell and the NutrEval on the same day and though they were in agreement, the differences were concerning. Spectracell is limited - it is looking at feeding nutrients to WBCs which is not really useful. Chris Masterjohn has done a scathing analysis of it. You also cant see entire pathways and relationships between them as you can with the NutrEval.

Great guidance, above, well said.

One question on what you wrote here:

Is this a standardized infusion IV, or do your providers customize it for you each time? I'm curious which vitamins can be infused vs. which can't. For instance I have yet to find a Vit E pill that I tolerate without headaches. Thanks for any additional information on how this is done.
My "recipe" is customized for me, based on my labs and my treatment goals and what is known about the synergy of cofactors to make the key ingredients work. It's the same basic recipe each time, adjusted occasionally based on how my symptoms or needs changed. I also have had an extr

I do a NutrEval every 9-12 months and if we are suspicious in between due to any symptoms, we spot check homocysteine, RBC folate and minerals or run an amino acid panel through a major US lab in between.

The ingredients are typically some combination of:
  • B vitamins - individually dosed
  • Minerals - magnesium, calcium, zinc, selenium, molybdenum
  • MIC - methionine, inositol choline
  • Lysine
  • Glutathione
  • Vitamin C
  • NAD+
  • Phosphatidyl choline
Not all are compatible in the same IV bag, so 2-3 bags are given in sequence. Similarity must be taken into consideration as well.
I have been addressing individual vitamin deficiencies via testing blood levels with a Dr. and individual (mostly liquid) supplementation (plus the now famous Australian Methyl B-12 oils). But I still need to find a way to get in Vit B2, Vit A, Vit E which are all low. Also, due to dry eye, I no longer tolerate the Sodium Ascorbate form of Vit C, so am looking into ascrobic acid liposomal solutions.
I take Thorne R5P for B2, a sublingual drop formulation for vitamin A, and both mixed tocopherols and tocotrienols for vitamin E. I am allergic to corn, so I take 9mg of a corn free vitamin C daily, in 3 divided doses.

If your digestive sysyem is great, you may be absorbing everything. If you are well and eat a fantastic diet, you may not need supplementation. But, if you are ill with toxic and infectious exposures, it's wise to consider various routes of administration and the dosing you can actually get out of each. I looked into the B12 oils and decided that MB12 injections 3x a week was more effective at getting the high dose I needed, while sublingual versions have been helpful for other nutrients.

But it's important to have a well thought out comprehensive plan, and do labs to ensure you're on course. It's also good to be observant of symptoms - fatigue, irritability, depression, headache, smelling of sulfur, etc. that can clue you in to needing to adjust your protocol. Small tweaks of one or more nutrients can make a huge difference.
 

Sparrowhawk

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Many thanks for both the responses. Very helpful, informative and much appreciated!
I have MCAS and only able to eat about 8 foods at this point, so food-based C and similar are not in the cards for now.
If you have specific brands/products to recommend for these I'm all ears "I take Thorne R5P for B2, a sublingual drop formulation for vitamin A, and both mixed tocopherols and tocotrienols for vitamin E "

Best,
Peter
 

Learner1

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Many thanks for both the responses. Very helpful, informative and much appreciated!
I have MCAS and only able to eat about 8 foods at this point, so food-based C and similar are not in the cards for now.
If you have specific brands/products to recommend for these I'm all ears "I take Thorne R5P for B2, a sublingual drop formulation for vitamin A, and both mixed tocopherols and tocotrienols for vitamin E"
I usually take Thorne Research products when I can as they are good about allergens. Oddly, Allergy Research is more problematic - they have an allergy line of products but the rest may contain allergens. I havectajen their Cassava based C, but all their other Cs are corn ferived (as is most ascorbic acid).

I have MCAS as well. I take cromolyn sodium, ketotifen, ranitidine and injectible benadryl, which have calmed my gut down.. My doctor has his most severe patients on imatinib, which I don't need. My naturopathic doctor has me on lots of B5 and C to keep acetyl Via moving, fkush8ng out MCAS products, and optimizing methylation (5-MTHF, B12, B6, B2, B1, magnesium, and molybdenum) is very helpful too.

I read every label as corn, milk, and gluten and any derivative drive all my other food allergies. Glutamine and glycine heal the gut lining. I find drugs are worse than supplements for allergens and have most compounded it or havevto use injectible versions in some cases.

My MCAS symptoms have improved with all of the above. Best wishes.;)
 

Belgiangirl

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I live in Belgium and am seen as a hypochondriac whatsoever. In the past years I have had up to 5 labs. You could see climb my Vit B12 status gradually.

Indeed my ANA score is positive in 1:160, already from january I noticed now. No MD (not the one asking for the labs nor my GP) bothered to even tell me.
Same thing about the Vit B12: they could see it rise above the normal values gradually, no one mentioned it. Only the last one now it is above >2000 and the lab apparently can't measure it anymore.


No-one told me about specific testing. And what would it matter?
Means are getting scarce, we have public insurance in Belgium and I don't work, that makes me not a candidate to get all diagnostic testing available, instead of that you are being seen as a wasteproduct so no one cares.

Instead the idea is: if you test it or not, but the test result doesn't change anything - than don't test it. (Cochrane).
For high Vit B12 status there is no cure, neither for the high ANA or whatever deficiences I have like deformated red blood cells, ENA is negative so no obvious condition comes forward so nothing happens...
And I am too tired to fight and pull on MD jackets, I did so when it all started 10 years ago and i did not live far from university hospital but i am done with it. I wouldn't even know where to go. Just checked for rheumatology but all inthe neighbourhood are centred around bones and muscles, so doesn't seem adequate to me?


This IV is the first therapy I ever had for CFS. Being ill for almost 16 years now, 33 yrs of age and having a master degree and dying to have a normal life and contribute to society. I don't know what it exactly was, neither I don't know what was in the 'red injection' but my guess indeed is that it were water soluable vitamins. This is a therapy that of course you don't get paid back from public insurance (neither from a private probably) and I already take pills from +50 euros a month for not having to pee all night long so...
This IV is not standardised. I have no idea what is exactly in it but I understood it was a combination of vitamins and wouldn't harm even though my labs showed no shortages. It is 1 little bag with a yellow fluid in it coming from a bottle. A lot of tired people benefit from it. I thought indeed you just peed out what is to much (water soluable) so it would not harm.
I read here and elsewhere a lot about people having no shortages but still feeling much better with adding something.

I mean it is easy to judge but I am not a doctor and I don't know one and in Belgium you can't order test yourself nor on question and it won't really help your relationship with any doctor.
 
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Belgiangirl

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@Sparrowhawk I am sorry I can not help you out any better than this.
It is nice to know that people here are so technically schooled into this and can say from every pill which side effects it have. I also took vit E but I wouldn't be able to tell.

Yesterday I took nothing and had a good day...

But I do think these therapies are something that was hyped in the U.S.

I agree with above: if you do supplementation but still have deficiencies maybe there may be a problem with absorption? Coeliakie, chrohn, ... I don't know if you can get a doctor get you tested from this (trough taking biopsies of the intestine which is not really fun...).

Fat soluble vitamins are generally not put in an IV, and these included A,D,E,K. CoQ10, though not technically a vitamin, is another fat soluble component to check your levels for.

Have you tried cod liver oil for an easy, healthy, way of getting Vit A, D, E? Usually comes in a glass bottle and you can take a teaspoon or tablespoon worth to get a nice dosage. Getting your vitamin C boosts through food instead might be something to consider e.g. kiwi, brocolli, acerola cherries, rose hips, peppers, etc.

I agree with the others that testing properly is important. Many doctors do not do the metabolic urine tests like the Genova FMV or an intracellular test like Spectracell, or stool tests to check for malabsorption issues. Standard blood tests will not help much with things like magnesium, vitamin K or CoQ10 levels to name a few.

It is important to understand and test for reasons why you may be deficient and rule out things like any causes of malabsorption such as SIBO, Candida overgrowth, IBS, Chrohn's, gluten sensitivity, exocrine pancreatic insufficiency, etc.

Specifically for B12, I also went overboard on injections at one point and it took many months for it to get back in range. I read somewhere that potassium and niacin help, but for me it just took time for the stores in the liver to be utilized.

These are some other tests to consider for possible B12 deficiency causes:

  • Antiparietal Cell Antibody (APCA)
  • Methylmalonic Acid (MMA)
  • Intrinsic Factor Antibody (IFA)
This is interesting...

I did not, never have a defiency in vit B12.
Though like 10 years ago I had an attack of whatever disease (short breathedness, pain with every movement, ... actually not much different from what i am experiencing now) that took 4 months to heal (with extremely high fever and rash in the end). At that time, and today still, my RBC were to law and too large.
Sth that would fit apparently Vitb12 or folic acid defiency. Only it was never found.
Happily they were thorough at the time and I was put in the "digestion" part of a hospital (I had been taken in) so they also screened my intestine and stomach and even took biopsies because they thought it still could be coeliakie or some malaborsorption explaining all my symptoms (it included extrapyramidal symptoms and neurological sensations of the limbs and everywhere). Everything came back negative...

But that is what my body is like all the time: all kind of symptoms, all kind of strange blood labs. But whatever you do: the puzzle doesn't make sense and it doesn't add up to make an existing diagnosis... I think that is why doctors don't like testing me anymore because each tests only asks for more tests and at the end nothing comes out.

Because my folic acid was on the low side and I supplemented with this orally (but maybe it was also in the injection B complex) now I also do have it too much.

But I do have APCA, and the one time it was tasted I did have not enough Intrinsic factor, which make sense since I always shock doctors with how skinny I am... Of course they explain all test results because of my abnormal body weight (underweight). It only was always that way.

So never deficiency in VitB12 nor folic acid, way too much right now, but IF was too low only time it has been measured in my life and APCA were there (also only once measured but not mentioned to me, blood labs were mentioned to be normal...) same as with ANA now at 160 - this was measured before.
I obviously have POTS, but never tested (but it doesn't matter I guess since Cochrane rule nr 1 goes here too :) ).


Thank you for the tip! It is a better alternative than increasing alcohol, coffee or exercise because I can't handle any of those.
May I ask do you know how much was your vit B12 at the time (could the laboratory still measure it, since apparently they can't when it is >2000 which is mine ). It may be 5000, maybe 10 000, I have no clue but I realise it could be a lot since it already was on the upper limit before I started this therapy.... and least for me this explains why I don't get sleep anymore and feel like anxious / nervous and get all kind of strange symptoms.

Apparently to much may yield nerve damage according to the doctor - and the same symptoms as to few...


Warning: too much Vit B12 without a cause (without supplementation), as is too high levels of ferritin, is a reason to concern because it indicates very serious diseases (that's why I don't like none of the doctors including the first being from a university did not tell me my vitB12 was already off limit, though still measurable).

This implies that it may be harmful to supplement with vit B12 since this may hide disturbed processed in the body that you would like to have discovered as early as possible.
 

Belgiangirl

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But it's important to have a well thought out comprehensive plan, and do labs to ensure you're on course. It's also good to be observant of symptoms - fatigue, irritability, depression, headache, smelling of sulfur, etc. that can clue you in to needing to adjust your protocol. Small tweaks of one or more nutrients can make a huge difference.
Umpf I would love to know what it was in my case. I feel lazy, and doctors already here think of me as a hypochondriac. But I am really too tired and unfocued/ unsystematic for that I think and too inpatient.
 

Belgiangirl

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@Belgiangirl I am so sorry for all you have been through. However, a few points:

1) Serum B12 will be high of you gave been supplementing. The test is useless. You need to have a methylmalonic acid test to assess Your true B vitamin status.

2) Hydroxocobalamin does not provide methyl groups. It is not the best type of B12 to be supplementing with. Nor is cyanocobalamin. Most of us need metbylcobalamin. And some need adenosylcobalamin. I take a combo of MB12, HB12, and AB12.

3) Randomly supplementing without having adequate lab testing is a recipe for disaster. A Genova Diagnostics NurrEval test is availabke in Europe and it would be extremely useful to untangle the mess you are in. There are many other nutrients that work with B12 and other B vitamins and its likely you have some serious imbalances given your story.

4) Finding a competent doctor who understands nutrient testing and supplementation would be extremely useful. O am not understanding who prescribed your injections and infusions, but it is highly unusual that a doctor would prescribe the without adequate testing. A functional medicine doctor who looks at the body as a system of systems might be very useful.

5) Vitamin therapies can be veru powerful. I get a nutrient infusuon every 7-10 days and am on a comprehensive oral supplement program. This has helped me lose my brain fog, helped me gain energy, and imprive do I can exercise some and work part time. But I do trsting every 9 months zand work with doctors who have expertise, and don't randomly self administer stuff.

6) It might be the case that you have other problems. Many of is have active viral or bacterial infections, autoimmunity and/it or immunodeficiency, POTS, mast cell activation, and other comorbidities. Medications for these other conditions can make a huge diffetence.

There are many resources here. I hope you csn find some better answers and some better help so you can stsrt to feel better.
Thank you for your time.

Unfortunately I don't know what you mean with your 1 st and 2nd point.

I do have other problems indeed and I wouldn't know where to find a doctor who could do this for me. It's not so easy here. We have a public health system and don't work with private insurances, so the quality is not like sky rocketing.

5 Indeed after the first times I had this IV infusions I felt an incredible difference too and actually could do things... Though it is not sth I would be able to pay ever week or forthnight and that was also not the intention of the doctor. It should be more like a boost that could get many patients back on track. I
 

BeADocToGoTo1

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@Belgiangirl

Sounds very tough. High ANA could be an autoimmune issue. Have you been checked for thyroid issues including Hashimoto's, or autoimmune atrophic gastritis, or pernicious anemia, lupus, celiacs, Sjogrens, arthritis?

My B12 was too high to measure (>2000) for about 4-5 months, and it was caused by too much supplementation through pills and IV. It can be in fortified food, multi-vitamin pills, IV treatments, so as with any supplementation you will have to add them all up. Sorry if I missed if you mentioned this, but if you did not have a B12 or folate deficiency, is there a reason you were supplementing them?

There are private labs you can use for testing, but sadly they are not cheap. Genova Diagnostics comes to mind who do have a lab in the UK. There might be doctors in Belgium who work with Genova and have the kits for the tests.

Have you ruled out any autoimmune reactions due to food and drink sensitivities?

Have you done an honest and hard look at all your food and drinks as many problems start there, but do not show up much later, until years of insults. Some can be genetics, where you are sensitive or allergic to certain compounds and food elements. Autoimmune reactions and systemic inflammation can be caused in many different levels of intensity, with some symptoms just ignored as not important, even though they are a signal from the body.

What about toxin exposures to chemicals and heavy metals?

A less salient question, but an important one (don't have to answer of course, or you can pm me, but just think about it). How is the quality of your stool? Do you have to go more than 2-3x per day? Is it more yellow, more soft, extra smelly and particularly important, does it stick to the bowl? All of these are other important symptons of malabsorption and exocrine pancreatic insufficiency (EPI). Most doctors do not know how to recognize the symptoms, nor test for it properly.
 

pamojja

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1) Serum B12 will be high of you gave been supplementing. The test is useless. You need to have a methylmalonic acid test to assess Your true B vitamin status.

2) Hydroxocobalamin does not provide methyl groups. It is not the best type of B12 to be supplementing with. Nor is cyanocobalamin. Most of us need metbylcobalamin. And some need adenosylcobalamin. I take a combo of MB12, HB12, and AB12.
Unfortunately I don't know what you mean with your 1 st and 2nd point.
When supplementing with vitamin B12, the more so with injections (I never did), it is perfectly normal to have serum levels of <2000, which I have already for many years without any negative symptoms. A methylmalonic acid test either in serum or urine is more sensitive and could give a more accurate picture if your body is able to metabolize the B12 (otherwise without metabolizing, as high it may go in serum, you're still actually short of it). A simpler homocysteine test could indicate there is shortage of B12, B9, B6, B2 or choline too.

The second point means we all have different bio-chemical individuality. A certain form might not get metabolized in one, but works perfectly in an other. I wouldn't show in a B12 serum test, since it would only show its accumulating, but not if it is metabolized. There are 3 major kinds of B12 to try: cyanocobalamin, methylcobalamin and adenosylcobalamin. Which is the one you used mainly?


PS: In my own case I just did my first methylmalonic acid test paid out of own my pocket (~EUR 35,-), and it showed just about sufficient B12, despite sky high serum B12 for many years. Homocysteine still borderline high indicates something still needs higher doses.
 
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xrayspex

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Great guidance, above, well said.
I have been addressing individual vitamin deficiencies via testing blood levels with a Dr. and individual (mostly liquid) supplementation (plus the now famous Australian Methyl B-12 oils). But I still need to find a way to get in Vit B2, Vit A, Vit E which are all low. Also, due to dry eye, I no longer tolerate the Sodium Ascorbate form of Vit C, so am looking into ascrobic acid liposomal solutions.
hi could you please give a link to the australian b oils?

I am debating trying b's again. a clinic just tested me and said am low in folate and b6 and methylmaronic acid. they suggested taking either pure encapsulation melt b12 and folate or thorne methyl guard plus. I couldnt remember if I had tried methyl b's before when they suggested it. well I found a 10+year old bottle of intrinsic b12 and folate in my fridge tonight and recalled I tried Rich V's thang back in like 2009 and couldnt tolerate any of it so quit after many low dose trials of individual parts of it.

so I am not sure where best place to jump back in and experiment again with Bs is. my b12 was too high a number of times in last 8 years but this spring it test high normal and since methymmaronic acid low I am probably ok with b12. but i am still not feeling inclined to supplement with it like the PA rec'd. but maybe trying folate or b-6 is ok. I do have some mthfr.
 

Sparrowhawk

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hi could you please give a link to the australian b oils?
Here you go - I first found mention of these in Phoenix Rising via the inimitable @garyfritz - I've found them very effective. Note the inventor counsels we take selenium, molybdenum and a bit of iodine to facilitate processing of the B12, and my Dr. says I should never take B12 without methylfolate, given my genetics. We're all different, and I took 7 years before I bothered to address MTHFR status and B vitamins because I found it all overwhelming and complicated. Now I'm doing fine with Methyl Pro's L-methylfolate, and the MethylB12 oil from Australia. Site is here: http://www.b12oils.com/products.htm
 

xrayspex

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Here you go - I first found mention of these in Phoenix Rising via the inimitable @garyfritz - I've found them very effective. Note the inventor counsels we take selenium, molybdenum and a bit of iodine to facilitate processing of the B12, and my Dr. says I should never take B12 without methylfolate, given my genetics. We're all different, and I took 7 years before I bothered to address MTHFR status and B vitamins because I found it all overwhelming and complicated. Now I'm doing fine with Methyl Pro's L-methylfolate, and the MethylB12 oil from Australia. Site is here: http://www.b12oils.com/products.htm
hey thanks that is helpful to hear, will check it out!
 

xrayspex

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@Sparrowhawk the person I consulted is a PA in a mainstream clinic who has taken an interest in mthfrs and complex cases and they seem to know a little but never heard of Rich V and have no where near the knowledge a lot of people on here do. I am rusty on ideas for trying to deal with methylation etc and not desperate to dive in again, just sort of went along with her on a whim and got the updated blood test. But anyway even tho my B12 wasn't low she is recommending I take B12 with folate to address the low folate . but I read that high mma could mean yr B12 is low but my mma was low so I am not sure why I should take the B12. In the past I had abnormally high B12 so I dont see why I should mess with it. Do you know any reason I couldnt just take methyl folate alone ?

and thanks for suggestion about selenium etc Rich V had rec'd I take tiny bit of molybdenum even just by itself to help with MCS and sometimes selenium too. I have those on hand in liquid. haven't tried the iodine that I recall.
 

Sparrowhawk

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We're all so different, and even the same person may react one way to supplements and a different way later. Now that I have a few things addressed (MCAS mast cell mediators, H1 blockers) I can supplement again in ways I simply could not for the previous 4-5 years. My saying is "some things work for some of the people some of the time." :)

For iodine I just apply a bit topically each day. Some folks put it in water and drink it but I don't want to further upset my gut flora by doing something like that.
 
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Three things :

1) Vitamin B6 is one of those vitamins that can cause toxicity symptoms as well as deficiency symptoms. If you have too much of it you can get neuropathy problems.

https://en.wikipedia.org/wiki/Vitamin_B6#Deficiency
https://en.wikipedia.org/wiki/Vitamin_B6#Toxicity

2) There is a relationship between vitamin B12 and potassium. You would need to do some research into it because I'm not clear what that relationship is. I supplement with B vitamins (not a high dose) and B12 (a high dose) in tablet form. I also have to supplement potassium (I don't take much, but without it I get restless legs) because it seems to get depleted when I supplement the B vitamins, particularly B12.

3) In order for the body to make use of B12 in the body you also need good levels of folate. Supplementing with folic acid is not a good idea, instead methylfolate is much better. See this link :

https://chriskresser.com/folate-vs-folic-acid/
 
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Can anyone tell me if there's a difference between oral b12 and sublingual? To be more specific, can I use the powder in an oral capsule and massage under my tongue or in my gums like mentioned in some other threads?

Only reason I ask is the only B12 sublingual I can get in my country are loaded with fillers that I react very badly too.