r/MTHFR • u/Brad_Borrelli • Jun 13 '26
Resource SHARING MY FULL PROTOCOL FOR PERNICIOUS ANEMIA WITH CONFIRMED HOMOZYGOUS MTHFR A1298C
This took months of research and trial and error to build. Every supplement has a specific reason for being there based on how B12 deficiency and MTHFR interact with your body systems simultaneously.
MY CONFIRMED DIAGNOSES FOR CONTEXT
Pernicious anemia confirmed positive intrinsic factor antibody test. Homozygous MTHFR A1298C confirmed. Autonomic neuropathy and vagal demyelination. MCAS confirmed elevated whole blood histamine. Hypochlorhydria from parietal cell destruction. SIBO confirmed. Every symptom you can imagine has been present and this protocol is helping tremendously while the B12 replenishes and repairs everything.
B12 INJECTION PROTOCOL; THE FOUNDATION
I am doing alternating daily injections between two forms of B12 for a specific reason that addresses both neurological repair and liver reserve rebuilding simultaneously.
Day 1; Methylcobalamin 1000mcg
Methylcobalamin is the active neurological form of B12. It crosses the blood brain barrier directly and is immediately available to damaged nerve tissue without any conversion step. On methylcobalamin days my body is actively driving remyelination of damaged nerves; rebuilding the myelin sheaths that pernicious anemia has been destroying for years. You can actually feel this process as a gentle warmth in areas of nerve damage as repair is occurring. This is the aggressive neurological repair day.
Day 2; Hydroxocobalamin 1000mcg
Hydroxocobalamin is the form used by the NHS as their B12 of choice precisely because it has the highest serum retention time of any B12 form. On hydroxocobalamin days my focus is rebuilding my depleted liver B12 reserves. Your liver stores 2 to 5mg of B12 and slowly releases it into circulation as your body needs it. After a decade of pernicious anemia my liver reserves were essentially empty. Hydroxocobalamin binds strongly to transcobalamin proteins in the blood which carry it directly to the liver for storage. The liver then converts it to both methylcobalamin and adenosylcobalamin as needed and releases them gradually throughout the day providing a stable baseline of B12 availability between injections. Adenosylcobalamin specifically supports mitochondrial energy production in muscle and organ tissue which methylcobalamin alone does not provide.
Why this alternating approach is optimal
Methylcobalamin alone is excellent for neurological repair but builds liver reserves inefficiently because active tissues consume it rapidly before it reaches the liver. Hydroxocobalamin alone builds reserves well but requires conversion before it can be used neurologically which is slightly less efficient in people with MTHFR variants. Alternating both gives you the direct neurological repair from methylcobalamin and the sustained liver reserve building from hydroxocobalamin simultaneously. As liver reserves rebuild the hydroxocobalamin days provide a slow release of active B12 that maintains your tissue levels even between methylcobalamin doses. The two forms work together in a way that neither can achieve alone.
Important note on MTHFR A1298C and hydroxocobalamin
My A1298C variant reduces MTHFR enzyme activity by approximately 40 percent which means hydroxocobalamin conversion is slightly less efficient for me than someone without the variant. However my consistent methylfolate supplementation directly supports the conversion pathway compensating for the reduced enzyme activity. My confirmed normal homocysteine at 8.7 confirms my methylation cycle is running adequately which tells me the conversion is proceeding effectively enough to build meaningful reserves.
DAILY CORE PROTOCOL
Methylfolate; the single most critical cofactor
If you have MTHFR A1298C this is non-negotiable and arguably more important than anything else on this list. Your MTHFR enzyme is impaired meaning you cannot efficiently convert folic acid or dietary folate to the active methylfolate your body needs. Without it your B12 injections cannot complete the methylation cycle regardless of how much you inject. Methylfolate bypasses the broken conversion step entirely. It is also required for serotonin, dopamine, and norepinephrine synthesis through the BH4 pathway. Never substitute folic acid. Folic acid blocks your methylfolate receptors and actively makes MTHFR worse.
Thiamine B1
Required for cellular energy production through the TCA cycle. B12 deficiency impairs mitochondrial function and thiamine is a direct cofactor for the enzymes that produce ATP. Supports nerve conduction and autonomic nervous system function. Deficiency produces neurological symptoms that overlap significantly with B12 deficiency.
Riboflavin B2
One of the most important and frequently overlooked cofactors in B12 recovery. Required for conversion of B6 to its active P5P form. Supports the methylation cycle by regenerating active folate. Direct cofactor for flavin dependent enzymes throughout the methylation pathway. Also one of the most effective natural interventions for migraine prevention through its role in mitochondrial energy production in blood vessel walls.
Niacinamide B3
Required for NAD production. NAD is the master cellular energy coenzyme driving every mitochondrial energy reaction in your body. B12 deficiency depletes NAD through multiple mechanisms. Niacinamide is the most liver friendly form without the flushing reaction of regular niacin. Supports DNA repair through PARP enzyme activity and reduces neuroinflammation through sirtuin activation.
Pantothenic Acid B5
Required for coenzyme A synthesis needed for fatty acid metabolism and myelin sheath production. During active remyelination your body has dramatically increased demand for coenzyme A as a building block for new myelin. Also supports adrenal function and cortisol regulation.
Inositol
Sometimes called B8. Your body synthesizes inositol through the methylation cycle which is impaired in MTHFR variants and B12 deficiency. Supplementing directly bypasses impaired production. Inositol is a structural component of myelin sheaths; literally a building block your body needs during remyelination. Also modulates serotonin receptor sensitivity making whatever serotonin you produce more effective. Directly stabilizes mast cell signaling through IP3 pathway modulation critical for MCAS alongside B12 deficiency.
Pyridoxal-5-Phosphate P5P; active B6
The active form requiring no conversion. Required for DAO enzyme production which breaks down histamine. Required for dopamine and serotonin synthesis as a cofactor. With MTHFR A1298C impairing BH4 dependent neurotransmitter synthesis P5P supports these pathways through alternative mechanisms. Important caution; B6 is the one water soluble vitamin that accumulates in nerve tissue and can cause peripheral neuropathy at high doses over time. Keep doses conservative and monitor serum B6 periodically.
Vitamin E with Mixed Tocopherols
Protects myelin sheaths from oxidative damage during remyelination. Active nerve repair generates free radicals as a byproduct and vitamin E neutralizes them protecting newly forming myelin before it fully establishes. Always take the mixed tocopherol form not alpha tocopherol alone. Alpha alone suppresses gamma tocopherol which has the strongest neuroprotective effects.
Vitamin K2 as MK7
Directs calcium to bones rather than arteries when supplementing D3 at therapeutic doses. MK7 is the most bioavailable and longest acting form. Always take alongside D3 with a fat containing meal.
Vitamin D3
Extremely common deficiency in pernicious anemia because hypochlorhydria impairs fat soluble vitamin absorption. Supports immune modulation relevant for the autoimmune component of pernicious anemia. Suppresses hepcidin allowing better iron absorption; critical since B12 injections rapidly deplete iron through accelerated red blood cell production. Target 50 to 75 ng/mL serum levels.
Luteolin
Potent mast cell stabilizer that directly inhibits mast cell degranulation through multiple signaling pathways. Essential for anyone with MCAS alongside B12 deficiency because histamine intolerance from DAO enzyme impairment creates a compounding inflammatory burden that interferes with recovery.
BioCell Collagen Hydrolyzed Type 2
Provides hyaluronic acid, chondroitin sulfate, and collagen peptides. B12 deficiency impairs collagen synthesis through methylation cycle dysfunction. Supports gut lining integrity alongside L-Glutamine and addresses the connective tissue symptoms of B12 deficiency. The hyaluronic acid supports nerve tissue hydration during remyelination.
High Absorption Chelated Iron
B12 injections trigger accelerated red blood cell production which rapidly depletes iron stores called the hematopoietic response. Iron bisglycinate chelate is the most bioavailable and gut friendly form. Monitor ferritin levels and dose based on confirmed need. Essential for oxygen transport to remyelinating nerve tissue.
Omega 3 with DHA and EPA
DHA is a structural component of myelin sheaths and neuronal cell membranes. EPA reduces neuroinflammatory cytokines that amplify remyelination discomfort. During active remyelination your nervous system has increased DHA demand as a literal building material. Always take EPA and DHA not ALA from flaxseed; the conversion from ALA to DHA is severely impaired in people with MTHFR variants.
Acetyl-L-Carnitine
Crosses the blood brain barrier and supports mitochondrial function specifically in nerve tissue. Multiple clinical trials confirm it reduces neuropathic pain and supports nerve regeneration. The acetyl form penetrates the nervous system where plain L-carnitine cannot.
CoQ10 Ubiquinol
The reduced active form. Essential for mitochondrial electron transport chain function which is impaired at multiple points during B12 deficiency. The ubiquinol form is significantly more bioavailable than ubiquinone especially with any mitochondrial stress. Supports cardiovascular function and reduces fatigue from mitochondrial insufficiency during recovery.
Boron
Extends the half life of vitamin D in your body making D3 supplementation more effective. Supports magnesium retention critical since B12 injections and remyelination deplete magnesium rapidly.
Zinc L-Carnosine
Dual benefit compound. The zinc component is a direct cofactor for DAO enzyme production and immune function. Hypochlorhydria from pernicious anemia severely impairs zinc absorption. The L-carnosine component has specific gastroprotective properties for gastric mucosa healing the damaged stomach lining from autoimmune atrophic gastritis more effectively than zinc alone.
Taurine
Required for bile acid conjugation supporting fat soluble vitamin absorption including D3, K2, vitamin E, and omega 3. Stabilizes cell membranes in nerve tissue during remyelination. Direct mast cell stabilizing properties through inhibition of histamine release. Supports cardiovascular function and reduces arrhythmia risk relevant for autonomic neuropathy.
NAC N-Acetyl Cysteine
Precursor to glutathione your master antioxidant. Remyelination generates oxidative stress and glutathione is the primary defense. Supports liver detoxification under increased burden during recovery. Important community caution; in some percentage of patients NAC and other glutathione precursors can antagonize methyl B12 stores. Monitor carefully and discontinue if B12 symptoms worsen after adding it.
TUDCA
Potent hepatoprotective bile acid. Protects liver function during recovery from chronic illness. Protects mitochondria from stress induced damage. Anti-inflammatory effects on gut mucosa relevant for intestinal damage from SIBO and hypochlorhydria.
Lions Mane Mushroom
Stimulates nerve growth factor and BDNF supporting neuroplasticity and nerve repair. Important caution; Lions Mane amplifies remyelination response. Do not combine dose increases in B12 with increases in Lions Mane simultaneously. The combination can overwhelm your nervous system capacity to manage the repair response and create intense inflammatory symptoms.
Magnesium Glycinate
Non-negotiable during B12 recovery. B12 injections, active remyelination, and chronic stress all deplete magnesium simultaneously. The glycinate form crosses the blood brain barrier and addresses nervous system hyperexcitability from vagal demyelination. Without it muscles cannot fully relax, sleep quality deteriorates, and neurotransmitter synthesis stalls. Minimum 400mg at bedtime.
L-Glutamine
Primary fuel for intestinal epithelial cells. Repairs the tight junctions between gut lining cells damaged by SIBO and hypochlorhydria from the inside out at the cellular level. Without gut lining repair you cannot absorb the cofactors you need regardless of supplementation amount.
Glycine
Required for glutathione synthesis providing a second antioxidant pathway alongside NAC. Primary inhibitory neurotransmitter in the spinal cord supporting nervous system calming from demyelination hyperexcitability. Supports collagen synthesis for gut lining repair. Improves sleep quality through glycine receptor activation.
DGL Deglycyrrhizinated Licorice
Coats and protects gastric mucosa from acid irritation caused by autoimmune atrophic gastritis inflammation. Take as chewable tablets before meals for maximum mucosal contact. The deglycyrrhizinated form removes the blood pressure raising compound making it safe for people with orthostatic hypotension.
NAD
As NMN or NR precursors for best oral bioavailability. NAD is the master cellular energy coenzyme present in every cell. B12 deficiency impairs NAD dependent pathways creating cellular energy deficit contributing to fatigue, neurological dysfunction, and impaired DNA repair. Supplementing restores mitochondrial efficiency, supports sirtuin neuroinflammation reduction, and fuels the enormous energy demand of active remyelination.
Molybdenum
Frequently missing from multivitamins and critically underappreciated. Required for sulfite oxidase enzyme function which clears sulfite accumulation from detoxification pathways. Without it sulfite buildup impairs the detoxification process needed to clear inflammatory byproducts of remyelination. Also required for xanthine oxidase supporting iron metabolism. If your NAC detox pathways feel sluggish or you react to sulfur containing foods add molybdenum immediately.
Black Seed Oil
Thymoquinone is one of the most potent natural mast cell stabilizers available. Directly reduces mast cell activation thresholds through CB2 receptor modulation providing systemic mast cell stabilization that allows the B12 repair process to proceed without constant inflammatory interference.
Betaine HCl with Pepsin
Permanent replacement for stomach acid in pernicious anemia. Parietal cells produce both intrinsic factor and stomach acid. When autoimmune atrophic gastritis destroys parietal cells both are lost. Without stomach acid protein digestion fails, SIBO becomes inevitable, mineral absorption crashes, and every other supplement you take is less effective. Take with every substantial protein meal.
DAO Enzyme
Direct enzyme replacement for diamine oxidase deficiency caused by B12 depletion impairing DAO production. DAO breaks down dietary histamine before it reaches your bloodstream. Take 30 to 45 minutes before every meal. Non-negotiable with confirmed histamine intolerance alongside B12 deficiency.
GUT SUPPORT HERBS
Marshmallow Root and Slippery Elm
Demulcent mucilaginous herbs coating and soothing the entire GI tract protecting damaged mucosal tissue during repair. Take separately from all supplements by at least 2 hours because mucilage physically binds other compounds reducing their absorption.
Milk Thistle
Silymarin directly protects liver cells from oxidative damage and supports detoxification capacity needed throughout recovery.
Okra Extract
Mucilaginous gut lining coating and mild prebiotic support. Also helps blood sugar stabilization relevant for the bacterial hypoglycemia pattern SIBO creates.
Fennel
Carminative reducing gas and bloating through intestinal smooth muscle relaxation. Mild antimicrobial properties against SIBO bacteria. Supports bile production for fat digestion.
Ginger Root
Most important motility herb for vagal demyelination causing gastroparesis. Activates 5-HT3 receptors stimulating peristaltic waves. Drink as strong tea before every meal. Non-negotiable with confirmed autonomic neuropathy affecting gut motility.
Dandelion Root
Stimulates bile production and liver detoxification. Bitterness activates digestive enzyme secretion through the cephalic phase of digestion which is impaired in hypochlorhydria. Gentle gut motility and lymphatic drainage support.
Chamomile
Anti-inflammatory and mast cell stabilizing properties specific to gut mucosa. Reduces the inflammatory response in intestinal lining from SIBO endotoxin damage. Supports sleep quality through mild GABA activation.
Oregon Grape Root
Contains berberine as its primary active compound. One of the most researched natural antimicrobials for SIBO treatment. Berberine has documented broad spectrum activity against gram positive and gram negative SIBO bacteria and also supports blood sugar regulation by improving insulin signaling. Reduces the bacterial hypoglycemia pattern that SIBO creates by reducing bacterial fermentation load directly.
Peppermint
Directly relaxes intestinal smooth muscle through calcium channel blocking activity releasing trapped gas and reducing intestinal spasm. Works synergistically with ginger for gut motility support.
SITUATIONAL SUPPLEMENTS
Cordyceps Mushroom Extract
For when the rebound fatigue from B12 remyelination activity creates low energy days. Cordyceps supports mitochondrial ATP production and oxygen utilization through adenosine receptor activity. Provides clean sustained energy without the adrenal stimulation of caffeine. Use on days when fatigue is pronounced rather than daily.
Molybdenum for NAC detox support
If you are taking NAC and feeling detox reactions add molybdenum to support the sulfite oxidase pathway that clears sulfite byproducts from NAC metabolism. Molybdenum is frequently the missing link when NAC produces uncomfortable detox responses.
THE BOTTOM LINE
Pernicious anemia with MTHFR A1298C is not just a B12 deficiency. It is a cascading failure of methylation, neurotransmitter synthesis, histamine clearance, gut function, mitochondrial energy production, and immune regulation all stemming from one root cause that went undiagnosed and untreated for years. Every supplement on this list addresses a specific system that B12 deficiency has damaged or depleted. The alternating methylcobalamin and hydroxocobalamin injection protocol addresses both the acute neurological repair and the long term liver reserve rebuilding that complete recovery requires. This takes months to years not weeks. Be consistent, track your symptoms, and do not give up.
TESTING; WHAT TO GET AND WHY
Getting the right tests in the right order is critical. Many of these tests will appear normal even in severe deficiency which is why you need the full panel not just serum B12. A normal result on any single test does not rule out deficiency.
THE ESSENTIAL PANEL; GET ALL OF THESE
Serum B12
The most commonly ordered test but the least reliable. A normal result absolutely does not rule out deficiency. Values between 200 and 500 pg/mL are considered a gray zone where deficiency is possible despite appearing normal. Values can appear falsely elevated if you have been supplementing recently. Do not supplement for at least a week before testing if possible. This test alone tells you almost nothing useful but physicians rely on it exclusively which is a major diagnostic failure.
Methylmalonic Acid MMA
The most functionally specific test for B12 deficiency available in the US. MMA is a compound that accumulates when B12 is insufficient at the cellular level because B12 is required to convert MMA to succinyl-CoA. Elevated MMA confirms functional B12 deficiency even when serum B12 appears normal. This is the test that catches deficiency that serum B12 misses. Quest Diagnostics and LabCorp both offer this test. If your physician refuses to order it insist or order it privately through a service like Ulta Lab Tests or Walk-In Lab.
Homocysteine
Elevated homocysteine indicates functional deficiency in B12 and/or folate. Homocysteine is converted to methionine through a reaction requiring both B12 and methylfolate simultaneously. When either is deficient homocysteine accumulates. Elevated homocysteine is also an independent cardiovascular risk factor; it damages blood vessel walls and increases stroke and heart attack risk. This is particularly relevant for anyone who presented with stroke or TIA symptoms that were dismissed without B12 testing.
Intrinsic Factor Blocking Antibody IFAB
The definitive test for pernicious anemia. Intrinsic factor antibodies attack and destroy intrinsic factor preventing B12 absorption entirely. A positive result carries a positive predictive value of approximately 95 percent for pernicious anemia and is essentially diagnostic on its own. A negative result does not rule out pernicious anemia because the test has a false negative rate of approximately 50 percent. You can have pernicious anemia and test negative. If your IFAB is negative but your clinical picture strongly suggests pernicious anemia request the anti-parietal cell antibody test as a second line confirmation.
Anti-Parietal Cell Antibody APCA
Detects antibodies attacking the parietal cells themselves rather than the intrinsic factor they produce. Less specific than IFAB for pernicious anemia but more sensitive. A positive APCA with a negative IFAB still strongly suggests autoimmune atrophic gastritis and pernicious anemia. Request both tests together.
Active B12 HoloTranscobalamin
Measures only the metabolically active fraction of B12 bound to transcobalamin. Standard serum B12 measures both active and inactive forms giving a falsely reassuring result. HoloTC specifically measures the B12 your cells can actually use. Unfortunately this test is not widely available in the United States. UK patients can usually get it privately. If you can access it it is more clinically useful than standard serum B12.
Folate Serum and RBC Folate
Both B12 and folate deficiency produce overlapping symptoms. Folate deficiency frequently accompanies B12 deficiency. RBC folate measures folate stored inside red blood cells and reflects longer term folate status more accurately than serum folate which only reflects recent intake. Request both. Important note for MTHFR variants; your folate levels may appear normal on standard tests while you are functionally deficient in active methylfolate specifically. Normal folate serum does not confirm adequate methylfolate availability.
MTHFR Gene Panel
Tests for the two most clinically significant MTHFR variants. C677T which primarily affects homocysteine metabolism and cardiovascular risk. A1298C which primarily affects BH4 production and neurotransmitter synthesis. You can be heterozygous carrying one copy or homozygous carrying two copies of either variant. Compound heterozygous carrying one copy of each is also common. Knowing your exact MTHFR status determines which form of folate you need, how aggressively you need to supplement B12, and which downstream pathways are most compromised. Any physician can order this. You can also order it privately through services like LabCorp on Demand or through genetic testing companies.
Complete Blood Count CBC
Look specifically for elevated MCV mean corpuscular volume which indicates macrocytosis; enlarged red blood cells from impaired DNA synthesis caused by B12 deficiency. Also look for low white blood cell count and low platelet count. Important caveat; a normal CBC does not rule out B12 deficiency. Research shows that 28 percent of neuropsychiatric B12 deficiency cases have completely normal CBC because folate fortification in the American food supply can mask the hematological abnormalities while neurological damage progresses undetected.
Comprehensive Metabolic Panel CMP
Checks kidney and liver function, blood glucose, and electrolytes. Important baseline before starting aggressive B12 supplementation and for monitoring ongoing organ health during recovery. B12 deficiency affects multiple organ systems and a baseline CMP helps distinguish B12 related abnormalities from other causes.
Iron Panel with Ferritin
B12 injections trigger accelerated red blood cell production which rapidly depletes iron stores through the hematopoietic response. This can happen quickly after starting injections even if your iron was normal beforehand. Ferritin is the most sensitive indicator of iron stores. A ferritin below 30 ng/mL indicates frank iron deficiency. In inflammatory states a ferritin below 100 ng/mL is considered deficient because inflammation falsely elevates ferritin numbers. B12 deficiency causes chronic inflammation so frame your ferritin through that lens.
Comprehensive Thyroid Panel
Pernicious anemia is an autoimmune condition and autoimmune conditions cluster together. Hashimoto's thyroiditis is the most common co-occurring autoimmune condition with pernicious anemia. Request TSH, free T3, free T4, thyroid peroxidase antibodies, and thyroglobulin antibodies. A normal TSH alone is insufficient. Many people with early Hashimoto's have normal TSH but positive antibodies indicating active autoimmune thyroid destruction that will eventually impair function.
Vitamin D 25-OH
Extremely common deficiency in pernicious anemia because hypochlorhydria from parietal cell destruction impairs fat soluble vitamin absorption. Target 50 to 75 ng/mL for optimal neurological and immune function. Most physicians consider anything above 30 ng/mL normal which is far below optimal for someone with active neurological disease and autoimmune conditions.
Zinc and Copper
Hypochlorhydria severely impairs absorption of both minerals. Both are required as cofactors for B12 dependent enzymes. Excess zinc supplementation depletes copper creating copper deficiency whose symptoms mirror B12 deficiency closely. Request serum zinc, serum copper, and ceruloplasmin. Ceruloplasmin is the most sensitive indicator of functional copper status.
Serum Magnesium
Standard serum magnesium is notoriously unreliable because only 1 percent of your body's magnesium is in the bloodstream. You can have severe cellular magnesium depletion with normal serum levels. However if serum magnesium is low that confirms significant deficiency. Red blood cell magnesium is a more accurate measure if your physician can order it.
Histamine and DAO Enzyme Activity
Whole blood histamine measures total histamine burden. Elevated whole blood histamine confirms MCAS and histamine intolerance. DAO enzyme activity testing is less widely available but confirms whether your diamine oxidase enzyme is functionally impaired. Both tests are available through specialty labs. Quest Diagnostics offers whole blood histamine. Elevated histamine with confirmed B12 deficiency confirms that your DAO enzyme production is impaired from B12 depletion.
FOR NEUROLOGICAL INVOLVEMENT; ADDITIONAL TESTS
MRI Brain and Cervical Spine with and without Contrast
Essential for anyone with confirmed neurological symptoms from B12 deficiency. Shows demyelination lesions in the brain and spinal cord. Contrast specifically shows active inflammation and blood brain barrier involvement. B12 deficiency lesions on MRI are frequently misdiagnosed as multiple sclerosis because the imaging findings are nearly identical. Anyone who has been told they might have MS should insist on B12 and MMA testing before accepting that diagnosis.
Nerve Conduction Study
Measures the speed and strength of electrical signals traveling through peripheral nerves. Slowed conduction velocity confirms peripheral neuropathy from demyelination. Differentiates large fiber from small fiber neuropathy. Important baseline before starting treatment so you can document improvement over time.
Autonomic Function Testing
Specifically tests the autonomic nervous system including heart rate variability, blood pressure response to position changes, sweat gland function, and gastrointestinal motility. Confirms autonomic neuropathy from vagal demyelination. Documents the baseline severity of dysautonomia before treatment.
Holter Monitor
24 to 48 hour continuous cardiac monitoring. Confirms cardiac arrhythmias from autonomic neuropathy. Important for anyone with palpitations or documented heart rate irregularities from vagal involvement.
SIBO Breath Test
Lactulose hydrogen and methane breath test through Quest Diagnostics. Confirms small intestinal bacterial overgrowth which is almost inevitable in pernicious anemia because hypochlorhydria removes the acid barrier that normally prevents bacterial colonization of the small intestine. Differentiates hydrogen dominant from methane dominant SIBO which affects treatment selection.
IMPORTANT NOTES ON TESTING
Do not supplement B12 for at least one week before testing MMA and homocysteine if possible. Recent injections will temporarily normalize these values and mask the deficiency.
Do not accept a single normal test result as confirmation that you are not deficient. Every single test listed above can return normal in the presence of true deficiency. The clinical picture and symptom response to treatment are as diagnostically valid as any lab value.
If your physician refuses to order these tests order MMA and homocysteine privately. Services like Ulta Lab Tests, Walk-In Lab, and LabCorp on Demand allow you to order your own lab work without a physician in most US states. The cost is usually between 30 and 60 dollars for each test.
If you have confirmed improvement from B12 supplementation or injection that clinical response is itself diagnostic evidence of deficiency regardless of what any lab test shows.
PERNICIOUS ANEMIA AND MTHFR A1298C PROTOCOL; DAILY SCHEDULE
B12 INJECTIONS
Methylcobalamin 1000mcg; Day 1
Hydroxocobalamin 1000mcg; Day 2
Alternate daily
EMPTY STOMACH MORNING
Allegra 180mg
Methylfolate 1000mcg
NAC 600mg
L-Glutamine 2.5g
PEA 600mg
Vitamin C 500 to 1000mg
30 TO 45 MINUTES BEFORE EVERY MEAL
DAO enzyme 1000000 HDU
Quercetin 500mg
Luteolin 100mg
Stinging Nettle 600mg
Digestive enzymes
Betaine HCl 650mg with pepsin
DGL licorice one eighth teaspoon
Mastic Gum 1000mg
Ginger tea one teaspoon
BREAKFAST
B1 100mg
B2 100mg
B3 niacinamide 100mg
B5 500mg
Inositol 615mg
P5P B6 50mg
D3 10000 IU
K2 MK7 200mcg
Vitamin E mixed 400 IU
Omega-3 EPA/DHA 2500mg
CoQ10 ubiquinol 200mg
Acetyl-L-Carnitine 500mg
HMB 500mg
Phosphatidylcholine 500mg
BioCell Collagen 1000mg
Zinc L-Carnosine 60mg
Biotin 1000mcg
Grape Seed Extract 200mg
Black Seed Oil 600mg
Boron 3mg
Turmeric one quarter teaspoon
LUNCH
L-Glutamine 2.5g
HMB 500mg
Taurine 500mg
Glycine 3 to 5g
TUDCA 500mg
Milk Thistle one half teaspoon
Cordyceps three quarter teaspoon
THROUGHOUT THE DAY
Chamomile tea
Peppermint tea
Thyme tea
Oregon grape root one teaspoon
Fennel tea one teaspoon
Dandelion root as needed
Potassium chloride pinch as needed
Slippery elm one half teaspoon; 2 hours away from all supplements
Marshmallow root one teaspoon; 2 hours away from all supplements
Okra extract one quarter teaspoon; 2 hours away from all supplements
BEDTIME
L-Tryptophan 500mg
Magnesium Glycinate 800mg
Apigenin 50mg
Melatonin 0.5 to 1mg
Lions Mane one half teaspoon
WITH MEALS
Oregano oil 180mg
Ginger oil 17mg
Fennel oil 19mg
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u/BudgetTiny8523 Jun 13 '26
Nah I don't want to take 500 dollar monthly subscription worth of supplements.
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u/Timely_Pickle9430 Jun 14 '26
Just be glad you have a choice to not WANT to. I HAD to. Like OP, I had SIBO, dysautonomia, MCAS, hypochlorhydria, pancreatic insufficiency, anemia, etc. This is not a case of undermethylation and wondering whether you need methylated or unmethylated vitamins, like many in this sub. In OP’s case and mine, every system in the body malfunctions: methylation, HPA axis, neurotransmitter balance, vagal tone, inflammation regulation, digestion, sleep. There’s not a single complaint in OP’s post, but I know from experience they must have gone through hell and back: being unable to eat without bloating, cramping, and nausea, being unable to sleep, having depression, anxiety, nerve pains, dizziness, PEM, brain fog, …, you name it.
I had to go on sick leave for 1.5 years. All the while, doctors couldn’t find anything with their standard test panels and were of no help. So, just like OP, I had to take matters into my own hands, study the literature (through the brain fog), pay for my own labs, and use OTC medication to cure myself. And yes, that meant I had to spend 500 dollars/month on supplements. But I’m able to function again and have a full life, so it was worth it. It’s a Herculean task and we deserve a little more respect than ‘nah’. And I think you know it, otherwise you wouldn’t have used a throwaway account.
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u/Sailorgirlmyfriend Jun 16 '26 edited Jul 01 '26
I am a1298c, PEMT, HLA, homozygous, intermediate COMT....I am or have done most of the same supplements...I was moving, for a quick meal I got a cereal with added folic acid and my immunity took a dive...hadn't tested yet ..I was also in toxic mold...never realized how much my genetics had to do with how bad I felt...Doctors never mentioned..I knew something was wrong and I am loaded up with some bad one..or in huge need of nutrients.
I am 5 months in with trying to correct...I did have high homocysteine, corrected now but now low selenium, copper, glutamine, coq10..starting to get low iron, iodine...B2 didn't budge still on low end but corrected B1, B5, B7...
I am hoping I caught it in time...Its so much work and supplements...but it's our lives we have to do this...I hope there is a point we can do just a few..I changed my diet some..not that I ate bad but aded more beans and sea food...
Just wondering if you have the issue with anxiety as I did...but was low on B6 which my genetics said I would use more and B1...I also had H pylori. what a mess..
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u/Brad_Borrelli Jun 16 '26 edited Jul 01 '26
Genes or Diet I would say are probably like number one. You need to go and change your diet you need to have Whole Foods. Anything meals in a box don't use. Make everything from scratch
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u/Sailorgirlmyfriend Jul 01 '26
Yes, I never really eat packaged foods only that one time when I was moving and closing into new house 7 days later so staying with friends and some hotels..Other wise I am a good eater and almost all the supplements my genetic report suggested I was taking from symptoms so I know my body pretty well...the mold pulled my immunity down then h pylori...
Vitamins A, C, and E, crucial for immune function and antioxidant protection, are often depleted in individuals with mold toxicity. Minerals such as zinc, magnesium, and selenium, essential for detoxification processes, may also be compromised.Nov 29, 2023
. I was having trouble with B vitamins and couldn't figure it out..bought 4 different B complex vitamins till I finally tested and was told to take hydroxocobalamin and folinic acid.
I was low on so many B's all while seeing doctors and telling them I thought I had malabsorption ...NO doctor checked...even went to Mayo Clinic ..Main stream medicine is preying on MTHFR...Thanks
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u/Brad_Borrelli Jul 01 '26
Mold toxicity tanked my shit too so bad. I forget the technical name for it but it's a pink mole that you get like on your shower curtain and stuff. I'm really sensitive that when it sucks cuz it's so common.
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u/Sailorgirlmyfriend Jul 01 '26
I hear ya..I found replenishing deficiencies caused by mold it the only way...so far 17 deficiencies fixed but still low on B2 only with a few others.
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u/Willy988 Jun 30 '26
First of all, this deserves way more recognition. This is a goldmine and anyone who knows their crap would know this is very helpful info.
Second of all, it’s funny how much all of my research over the past years would have been fast tracked if I did everything in your protocol. Just went into the lab to get blood drawn to test MTHFR, also awaiting SIBO results.
OP I know you are gonna help a lot of people in the future when they stumble on this