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I am a 35 year old male, Severe sleep apnea a ahi of 34.

Have had brainfog, anxiety and depression. poor memory, fatigue, mental fatigue issues since i was 14

I decided to get my b12 checked with come back as 224 pg/ml, i do have b12 symptoms some on and off, like tingling in hands and feet, and i suspect my mental symptoms could also be related.

I tried methy B12 suglingual 1000mcg stuff a few years ago, im sure i had symptoms like anxiety and felt very space and out of it, and headaches

Im taking hydroxy b12/adenosyl b12, 2000mcg, and ive experiencing the same symptoms.

Im having a folate blood test monday.

I take 5000 ui of vitamin D being the only supplement apart from b12.

My meythlation profile below. Im not sure how to interpret this.

COMT V158Mrs4680AG +/-
COMT H62Hrs4633CT +/-
COMT P199Prs769224GG -/-
VDR Bsmrs1544410TT+/+
VDR Taqrs731236GG -/-
MAO-A R297Rrs6323TT +/+
ACAT1-02rs3741049GG -/-
MTHFR C677Trs1801133GG -/-
MTHFR 03 P39Prs2066470GG -/-
MTHFR A1298Crs1801131TT-/-
MTR A2756Grs1805087AG +/-
MTRR A66Grs1801394AG +/-
MTRR H595Yrs10380CC -/-
MTRR K350Ars162036AA -/-
MTRR A664Ars1802059AG +/-
BHMT-02rs567754CT +/-
BHMT-08rs651852CT +/-
AHCY-01rs819147TT -/-
AHCY-19rs819171TT -/-
CBS C699Trs234706AG +/-
CBS A360Ars1801181AG +/-
 
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I also forgot to mention I get problems with palpitations and a tight chest when trying B12 why? Is this start up symptoms or something else going on?
 

LINE

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B12 can be stimulating. If you lean on one B vitamin, then other B vitamins may be suppressed (example B6). Any tests on your electrolytes (palpitations), magnesium?
 
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No tests on anything else. I have been taking electrolytes in my water, and was taking magnesium glycinate 400mg at bed time. Stop a week ago
 

drmullin30

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@DmxDex wow where to start. You have numerous metabolically active SNPS some of them identical to mine and if you are like me, your methylation is going to be in very bad shape because of them.

I've been doing methylation protocols for almost ten years so hopefully this will help you.

One thing you might consider getting tested is your homocysteine as this may give you an indication of where your methylation is at. Mine used to be crazy high I was a heart attach waiting to happen. Another good indicator to get tested is methylmalonic acid as this will give you an idea of your b12 status.

I think the reason you're reacting to the b12 like you are is some start-up but also due to the first SNP COMT V158Mrs4680AG +/- I have this one and others on my COMT gene and this will make you sensitive to methyl groups and b12 and you may overproduce or have problems eliminating adrenaline when adding methyl groups so low and slow is the way to go for you. When I first started taking methyl b12 all hell broke lose but this is a good sign usually means your methylation is working better than it ever has in your life and the result is neurological healing (not fun as it will cause anxiety and moods) and detox (also not fun).

Unfortunately the COMT SNP is a treatment conflict with your MTR and MTRR SNPS which for me means I need need to take methylcoblamin b12 in relatively high doses to overcome methylation block but due to your COMT sensitivity, like me you may experience some anxiety at the beginning and whenever you increase dose. Now that I'm on the advanced methylation protocol I don't have any of these issues any more as my cycle is flowing relatively smoothly.

You also have another treatment conflict to the MTR and MTRR SNPS due to your CBS SNPS which if you are like me at the beginning, will make you overproduce toxic sulfites when you're methylation kicks in. These SNPS also made me sensitive to Sulphur in the beginning and can cause problems with mercury and toxic metals as well as sulfation in general which is an important liver detoxification pathway. This is another reason why low and slow should be your mantra.

The BMHT SNPS also impact methylation but through a different pathway. For these SNPS I used TMG and phosphatidylcholine to help the cycle in this area. However, now that I'm on the advanced protocol my body doesn't need the TMG any more. TMG is a pretty heavy methyl donor so again with the COMT SNP I had to be careful

Luckily, you don't have many issues around folate as your MTHFR is OK so you may not need to supplement with folate but you're having a test so you'll know soon. My MTHFR gene is complete mess almost entirely ++ so I take 45 mg per day of methyl folate which is a huge dose but I've learned is absolutely necessary for healing and function for me.

Here are my standard reference websites for methylation which will inform you about your SNPS etc.:
http://heartfixer.com/AMRI-Nutrigenomics.htm
https://www.b12-vitamin.com/methylation/

I've also attached a book that helped me a great deal although some members don't agree with Yasko I found her explanations of the SNPS to be very helpful.

I hope this helps and good health!
 

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@DmxDex wow where to start. You have numerous metabolically active SNPS some of them identical to mine and if you are like me, your methylation is going to be in very bad shape because of them.

I've been doing methylation protocols for almost ten years so hopefully this will help you.

One thing you might consider getting tested is your homocysteine as this may give you an indication of where your methylation is at. Mine used to be crazy high I was a heart attach waiting to happen. Another good indicator to get tested is methylmalonic acid as this will give you an idea of your b12 status.

I think the reason you're reacting to the b12 like you are is some start-up but also due to the first SNP COMT V158Mrs4680AG +/- I have this one and others on my COMT gene and this will make you sensitive to methyl groups and b12 and you may overproduce or have problems eliminating adrenaline when adding methyl groups so low and slow is the way to go for you. When I first started taking methyl b12 all hell broke lose but this is a good sign usually means your methylation is working better than it ever has in your life and the result is neurological healing (not fun as it will cause anxiety and moods) and detox (also not fun).

Unfortunately the COMT SNP is a treatment conflict with your MTR and MTRR SNPS which for me means I need need to take methylcoblamin b12 in relatively high doses to overcome methylation block but due to your COMT sensitivity, like me you may experience some anxiety at the beginning and whenever you increase dose. Now that I'm on the advanced methylation protocol I don't have any of these issues any more as my cycle is flowing relatively smoothly.

You also have another treatment conflict to the MTR and MTRR SNPS due to your CBS SNPS which if you are like me at the beginning, will make you overproduce toxic sulfites when you're methylation kicks in. These SNPS also made me sensitive to Sulphur in the beginning and can cause problems with mercury and toxic metals as well as sulfation in general which is an important liver detoxification pathway. This is another reason why low and slow should be your mantra.

The BMHT SNPS also impact methylation but through a different pathway. For these SNPS I used TMG and phosphatidylcholine to help the cycle in this area. However, now that I'm on the advanced protocol my body doesn't need the TMG any more. TMG is a pretty heavy methyl donor so again with the COMT SNP I had to be careful

Luckily, you don't have many issues around folate as your MTHFR is OK so you may not need to supplement with folate but you're having a test so you'll know soon. My MTHFR gene is complete mess almost entirely ++ so I take 45 mg per day of methyl folate which is a huge dose but I've learned is absolutely necessary for healing and function for me.

Here are my standard reference websites for methylation which will inform you about your SNPS etc.:
http://heartfixer.com/AMRI-Nutrigenomics.htm
https://www.b12-vitamin.com/methylation/

I've also attached a book that helped me a great deal although some members don't agree with Yasko I found her explanations of the SNPS to be very helpful.

I hope this helps and good health!
O wow.

So it sounds like start symptoms? What about the palpitations and shortness of breath, may be anxiety, but I can't always tell. Should I just switch to sublingual methyl B12 or stick to hydroxy/adenosyl pills? I will take a look at the info
 

Mary

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I also forgot to mention I get problems with palpitations and a tight chest when trying B12 why? Is this start up symptoms or something else going on?
You might need more potassium. It's very common for potassium levels to drop when starting B12 and/or folate, due to refeeding syndrome. As one's body starts to use the B12 and/or folate, cells will start to divide more rapidly and do what they're supposed to do, which uses more potassium, and this can cause a functional potassium deficiency. Here are some common symptoms of low potassium, including palpitations: 8 Signs and Symptoms of Potassium Deficiency (Hypokalemia) (healthline.com) My worst symptom was severe fatigue, but many people get palpitations and cardiac symptoms. Also I'd get twitching or spasms in my feet and calves.

An easy thing to try to see if your potassium is low is to drink 2 or 3 glasses of low-sodium V-8 or vegetable juice, which is high in potassium. If the problem is low potassium, very often people start to feel better a few hours after drinking this. And then they can decide if they want to take a potassium supplement or keep getting what they need from food. If someone does decide to take a potassium supplement, it's important to take it in divided doses - not to take a high dose all at once.

No tests on anything else. I have been taking electrolytes in my water, and was taking magnesium glycinate 400mg at bed time. Stop a week ago
You stopped your electrolytes a week ago? That might not be a good idea, especially if you need them. I started taking potassium 11 years ago when I added methylfolate to my supplements, and I still take extra potassium (1000 mg. in DIVIDED DOSES - not all at once) - I still need it. I titrated up over a couple of days to see what I needed to make my symptoms (horrible fatigue) go away.

This post explains why people with ME/CFS can have low intracellular potassium despite normal blood levels: Why is potassium supplementation needed in methylation treatmt? | Phoenix Rising ME/CFS Forums

Also, it might be helpful to do some reading about refeeding syndrome: Refeeding syndrome: what it is, and how to prevent and treat it (nih.gov)
Refeeding syndrome can be defined as the potentially fatal shifts in fluids and electrolytes that may occur in malnourished patients receiving artificial refeeding (whether enterally or parenterally5). These shifts result from hormonal and metabolic changes and may cause serious clinical complications. The hallmark biochemical feature of refeeding syndrome is hypophosphataemia. However, the syndrome is complex and may also feature abnormal sodium and fluid balance; changes in glucose, protein, and fat metabolism; thiamine deficiency; hypokalaemia; and hypomagnesaemia

 

drmullin30

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You might need more potassium.
Great post Mary and everything you said is very important. I forgot to mention that once the methylation starts going refeeding syndrome can kick in and cause all kinds of deficiencies with potassium often the one that shows up first. Also copper deficiency can look very similar to potassium deficiency.

Since doing methylation protocols I've had occasional deep deficiencies producing overt symptoms in all of the following minerals and electrolyte:
- Potassium
- Calcium
- Magnesium
- Copper
- Molybdenum
- Manganese
- Sodium
- Chloride
- sulfate
- iron
- Boron

I also have struggled with heart palpitations for many years. Deficiencies in copper, calcium potassium and magnesium have all caused palpitations for me. One thing that really put this to bed was when I started a low oxalate diet and added lithium to my regimen. Lithium helps to balance the electrolytes and copper and oxalates will cause palpitations in those who are sensitive so I don't have palpitations nearly as often since implementing those two strategies.

This website gives great details on deficiency and toxicity symptoms for most nutrients:
https://acu-cell.com/index.html
 
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I have just got some magnesium malate. Magnesium glycin makes me more spaced and fatigued the next day. Where can I get 1000mg of potassium from? I though you could only take a small apart per day? Thank you for all the suggestions. Should I go onto methyl B12? Start at 500mcg and work up?
 

LINE

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Should I take a b complex along side my B12 I'm taking?
You could try, I use individual B vitamins such as B2 and B6 (which are quite helpful for me) and sometimes use a general b complex. The trick to the game is to observe these experiments and then adjust which is a very important part.
 
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You could try, I use individual B vitamins such as B2 and B6 (which are quite helpful for me) and sometimes use a general b complex. The trick to the game is to observe these experiments and then adjust which is a very important part.
I would rather blood test the other Bs. Heard its not ideal blindly taking other Bs individually
 

Victronix

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I take the other Bs individually but in very small dosages to try to approximate what is in a typical B-multi. I can't tolerate methylfolate or B6, and those are in all the B-multis, so no choice, but it's worked for me.

I get potassium from coconut water and bananas, which is about all I need at this point, but when I was taking methylfolate I used to have to take elemental potassium (Potassium Gluconate as a powde) directly for the potassium deficiency symptoms. It was hell to manage, however, and eventually I dropped the methylfolate and then no longer had to take the potassium powder. All kinds of things could set off a potassium sink that could get really bad and I just couldn't take it anymore.

A B12 of 224 is pretty low, so you do need to take it, and the B-multis will offset the anxiety and stimulation effects significantly. I did the 500 and just worked up gradually. It would take several days or up to a week to adjust every time I increased it. Often when I would first increase it I would be overcome with anxiety, heart racing, etc., and gradually that would lessen.

Some things are very difficult to test in blood. I had an awful magnesium deficiency but it showed as normal in blood tests. I didn't know until I actually tried magnesium and finally my constant muscle pains went away. Then it took a long period of trial and error to find a magnesium mixture I could tolerate.

You don't want to start taking B12 and suddenly stop - the depression I experienced with suddenly stopping was awful. Just go slowly and gradually, whether it's up or down.

I take Enzymatic Therapy's B-12 Infusion, but there might be others that work well also, I haven't checked on that recently.
 
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Thank you for all the great advice everyone who has posted. I decided to get some Jarrows methyl B12 500mcg. I will also pick up a B12 complex. Not going to get the active form either. Not sure how I will react to folate, unless someone thinks I should just grab a activated form?
 
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I take the other Bs individually but in very small dosages to try to approximate what is in a typical B-multi. I can't tolerate methylfolate or B6, and those are in all the B-multis, so no choice, but it's worked for me.

I get potassium from coconut water and bananas, which is about all I need at this point, but when I was taking methylfolate I used to have to take elemental potassium (Potassium Gluconate as a powde) directly for the potassium deficiency symptoms. It was hell to manage, however, and eventually I dropped the methylfolate and then no longer had to take the potassium powder. All kinds of things could set off a potassium sink that could get really bad and I just couldn't take it anymore.

A B12 of 224 is pretty low, so you do need to take it, and the B-multis will offset the anxiety and stimulation effects significantly. I did the 500 and just worked up gradually. It would take several days or up to a week to adjust every time I increased it. Often when I would first increase it I would be overcome with anxiety, heart racing, etc., and gradually that would lessen.

Some things are very difficult to test in blood. I had an awful magnesium deficiency but it showed as normal in blood tests. I didn't know until I actually tried magnesium and finally my constant muscle pains went away. Then it took a long period of trial and error to find a magnesium mixture I could tolerate.

You don't want to start taking B12 and suddenly stop - the depression I experienced with suddenly stopping was awful. Just go slowly and gradually, whether it's up or down.

I take Enzymatic Therapy's B-12 Infusion, but there might be others that work well also, I haven't checked on that recently.
Im also taking magnesium Malate, i just started, citrate causing too much gastro issues, and magnesium glycinate, makes me feel terrible, worsens my fog
 

Victronix

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The inactive (synthetic) form of folate, folic acid, will actually block the active form, so you might not want to take that. But it's up to you. That's also the case for inactive B12, to some extent.

Great that Jarrow makes a 500 mcg now, I hadn't seen that.

What I did with mfolate was get capsules and open them up and use tiny tiny amounts - someone pointed out that even an amount the size of the head of a pin would cause them to react - and that way be able to control the outcome. Otherwise my response was too huge.
 
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The inactive (synthetic) form of folate, folic acid, will actually block the active form, so you might not want to take that. But it's up to you. That's also the case for inactive B12, to some extent.

Great that Jarrow makes a 500 mcg now, I hadn't seen that.

What I did with mfolate was get capsules and open them up and use tiny tiny amounts - someone pointed out that even an amount the size of the head of a pin would cause them to react - and that way be able to control the outcome. Otherwise my response was too huge.
I need to do my folate test first. It may come back fine. I don't have the certain mutation that causes issues with folate, so I may be fine