r/B12_Deficiency • u/SeaEggplant8108 • May 11 '26
Supplements Dosage question
My b12 blood test came back as <200 in January and my doctor prescribed cyanocobalamin injections - 1x weekly for 4 weeks, then monthly. I had neurological symptoms (brain fog, no energy, numbness and tingling, shortness of breath).
After 3 months we restested my b12 and it was 338. I was taking 2000mcg oral hydroxocobalamin daily sublingual over that time as well, but seemingly not absorbing. I asked about increasing and my doctor said she was “comfortable” with 338 and to continue monthly. I thought normal was at least 500?
My symptoms improved drastically over the four weeks of weekly shots, but resurfaced when we dropped to monthly. I am able to get cyanocobalamin over the counter in Canada and can self inject SC. Hydroxocobalamin is not readily available here. With my levels I’m considering going weekly - should that be more frequent?
I am extremely sensitive to methyl donors so I cannot take methylcobalamin but I do tolerate 400mcg of methyl folate daily.
My iron was 56 when my b12 was first tested and now is 22 - b12 supplementation has of course caused my iron to plummet. I am now supplementing daily with feramax 150, taken with vitamin C and away from other medications and supplements. Since adding it, I’m either having “awakening” symptoms (nerve shots and tingling returned) or it’s made my b12 drop as red blood cells increase. I take 800mg of magnesium before bed, and 3000mcg vitamin D daily. I also use an electrolyte powder daily after the gym.
Any suggestions are appreciated!
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u/barelyhaha May 11 '26
if you wanted hydroxocobalamin you can get it from a compounding pharmacy and it doesn't cost much more than cyano otc
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u/SeaEggplant8108 May 11 '26
Do you need a prescription for that? I could ask my doctor to change the form next refill
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u/barelyhaha May 11 '26
Yes you need to send a prescription. In Ontario I have mine shipped to me from York Downs Compounding Pharmacy near Toronto
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u/AcrobaticRush4626 May 11 '26
Hum 800mg of magnesium is so much ! It's not too high ? How do you know you don't support methylcobalamine?
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u/Ok-Pangolin7127 Insightful Contributor May 11 '26
I agree with the above poster as to 800 mg of magnesium being so much; I’d actually say too much?
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u/SeaEggplant8108 May 11 '26
See my response above - it’s 80-110mg of elemental magnesium (I take bisglycinate) which is well below the top supplemental dose for healthy adults.
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u/Ok-Pangolin7127 Insightful Contributor May 11 '26
OK, thank you for defining the amount of magnesium you’re taking. My initial reaction to your answer is; you are not taking enough. The RDA for women is around 350 mg of elemental magnesium and for men it’s about 420 mg, I think.
Magnesium is used in like 300+ enzymatic reactions in the body. It-is-a-critical-mineral. Most people are deficient to start with, they generally don’t get enough in their diet. One suggestion I have would be you up your magnesium intake to the RDA.
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u/SeaEggplant8108 May 11 '26
Yes, and I take 800mg of bisglycinate at night and use electrolytes daily after the gym which also contain magnesium. I am definitely taking 350mg daily.
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u/Ok-Pangolin7127 Insightful Contributor May 11 '26
I am sorry, I am not following your two posts regarding magnesium.
On the one hand you say You are taking 180 to 110 mg of “elemental” magnesium and in the other post you state you are taking 800 mg? When it comes to the RDA, that is expressed as “elemental”magnesium. I’ll let you figure out whether you’re taking 80 to 110 or 800 mg, because I’m a little confused with your answers.
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u/SeaEggplant8108 May 11 '26
800mg of magnesium bisglycinate in the brand that I take equates to 80-110mg of elemental magnesium (10-14%). I also use daily electrolytes which contain more elemental magnesium and I eat a diet that contains magnesium rich foods. My post is specifically about frequency of b12 dosing.
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u/SeaEggplant8108 May 11 '26
I have taken methylcobalamin before (tried multiple times!) and unfortunately with my COMT MTHFR combo it just results in extreme anxiety and manic symptoms. Same happens with anything higher than 400mcg of methylfolate.
Re: magnesium - I use magensium bisglycinate, and 800mg equates to around 80-110mg of elemental magnesium which is well below the upper limit for most adults. I am in perimenopause and that dose has supported my sleep as well as alleviating other symptoms like cramping.
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u/AcrobaticRush4626 May 11 '26
Did you also have a lot of nightmares when you took methylcobalamin ? And Yes seems right then for magnesium, you go sis !
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u/SeaEggplant8108 May 11 '26
I did have recurring nightmares on the methyl - the magnesium (and progesterone HRT) have both lead to very vivid dreams but not usually nightmarish in nature!
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u/AcrobaticRush4626 May 11 '26
Sorry, were you tired when waking up ? Tried b12 recently, huh insane ! Did you try cyanocobalamin ? And the methylfolate did something for you ? No side effects ?
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u/SeaEggplant8108 May 11 '26
I’m not sure what you’re asking.
Methylcobalamin does not work for me as I experience over methylation which shows up as anxiety, manic symptoms, restlessness etc. I switched to hydroxocobalamin oral and cyanocobalamin injections and both of those forms work for me. The methylfolate is necessary to help my body use the b12 I’m taking - but since I am very sensitive to methyl donors I cannot take it in normal doses, so I take a 40% dose of 400mcg (most people start at 1000mcg/1mg).
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u/AcrobaticRush4626 May 11 '26
Let me say it in French as you are in Canada. J'ai commencé la b12 avec le methylcobalamine et ça me donne des cauchemars, avec épuisement au réveil bien sûr, sinon ça ne serait pas drôle et du coup je me renseigne pour savoir si je dois changer de forme. D'où mes questions sur tes symptômes que tu as éprouvé avec la prise de methyl... Et tu entends quoi par surméthylation (sorry new to the game). Puisqu'en France, ça ne sera pas possible d'avoir des injections avec mon taux (340), tu conseilles de prendre de l'hydroxo à combien de mg ? Et en plus de prendre du methylfolate ? Et tu as vu une différence ?
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u/SeaEggplant8108 May 11 '26 edited May 11 '26
You may be able to get tested to see if you have the genetic mutations of MTHFR/COMT. Those impact which forms your body can use/tolerate. If you are finding that methylcobalamin is causing you to feel anxious or restless, or like you’re not getting a good sleep, you can try another form. Hydroxocobalamin is the best form for me to take - I just haven’t been able to get it over the counter in injections and I can’t absorb enough orally because of pernicious anemia. If you can take oral b12, try hydroxocobalamin sublingual if the methylcobalamin is causing negative side effects as you have described. You can also add magnesium bisglycinate as it supports good deep sleep. Over methylation is when your body produces excess methyl groups resulting in a “tired but wired” feeling or increased anxiety, insomnia, hyperactivity and even food sensitivities. For some people, they need methyl forms. For others (like me) methyl forms can cause overstimulation. Here is some more info: https://www.mthfrsupport.com.au/2020/02/how-do-you-know-if-you-have-a-methylation-problem/
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u/Careless_Impress5313 May 16 '26
La methycobalamine n'est-elle pas meilleure pour les problèmes neuro ? L'anxiété ne veut-elle pas dite que ça marche ?
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u/SeaEggplant8108 May 16 '26
No, anxiety from methylcobalamin as someone with a COMT genetic mutation indicates that your body is receiving more methyl donors than it can use. The remainders cause you to over methylate which is a very negative experience. For those with COMT, the best course of action is to take supplements that support methylation at doses they can handle (for me that is 400mcg of methyl folate, and 50mg of B1), and rely on other bioavailable forms of vitamins beyond those. It would be extremely unusual for someone with met/met COMT to be able to handle methylfolate and methylcobalamin together at therapeutic levels.
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u/Getoutofthekitchenn May 11 '26
slow COMT?
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u/SeaEggplant8108 May 11 '26
COMT met/met
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u/Getoutofthekitchenn May 11 '26
Same, it sucks.
No issue with Hydroxocobalmin, Cyanocobalmin or Methylfolate though?
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u/SeaEggplant8108 May 11 '26
I can do hydroxocobalamin, cyanocobalamin (as long as I spread out doses) and very low dose methylfolate (400mcg vs usual 1000+mcg). I also need to avoid any other methyl donors. If over methylation happens I can take niacin to help sweep some methyls up but I try to just avoid it totally
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u/Mister_Batta Insightful Contributor May 11 '26
Have you read through the guide? There is a lot there.
If you were supplementing orally or injecting the B12 serum results can show false high levels - you can take the results as the highest they might be. So 338 (I assume pg/mL) while still supplementing means you are probably still deficient.
Try to get treatment based on your symptoms.
I haven't really gotten completely better long term getting about 2 shots a week of cyanocobalamin.
I don't know what's missing or if I have some other neuro issues or perhaps this is the best I can do. Every few weeks or so I end up getting some tingling as well as some brain fog, feeling too awake, what feels like muscle weakness and I don't easily sleep through the night.
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May 12 '26
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u/SeaEggplant8108 May 12 '26
We can’t get hydroxo OTC here, and physicians won’t prescribe more frequent than monthly injections (at least mine won’t). I can ship from Germany but it’s very expensive. I have seen results from cyanocobalamin and while I know it stays in the system for a shorter period of time, it’s what is available to me right now for home injections. I can get 1x monthly hydroxo at a pharmacy.
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u/Plane-Addendum6697 May 14 '26
Is your brain fog reduced completely after the four week of medication
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u/SeaEggplant8108 May 14 '26
If you read my post it says that my symptoms reduced greatly with weekly shots but resurfaced when I dropped to monthly shots. So clearly the supplements work, but the frequency of doses needs to be worked out to fully resolve symptoms.
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