Best Form of B12

Which B12 form is best for you (based on your genetics)?

One of the most common nutrients to consider when supplementing the methylation cycle is the proper form of B12. There are 3 different types of B12 that are considered extremely beneficial to the body (hydroxocobalamin, methylcobalamin & adenosylcobalamin). Many automatically think that if you have an MTHFR defect, then you need the form of B12 called methylcobalamin, but that is simply NOT true. It is important to realize that the MTHFR status does not determine the type of B12 that’s best for you, instead it’s the status of genes like COMT, MTR, MTRR as well as VDR Taq. It is true that methylfolate and methylcobalamin work together synergistically along the methylation cycle pathway, but that doesn’t necessarily mean that if you tolerate methylfolate well you’ll also need, want or tolerate methylcobalamin well (even if that’s what most doctors, nutritionists, etc. are currently saying right now).

It seems there may be a general lack of education available to most doctors about the different forms of B12 and what those forms are as well as how they get converted within the body and what each is most beneficial for (not to mention which set of genes or genetic mutations could benefit most from which B12 type). So do your homework when it comes to B12 to see which you may tolerate the best.

The most common form of B12 that you’ll find everywhere is cyanocobalamin and it is not very active or beneficial to the body because the absorption rate is fairly low and it has some cyanide content. It doesn’t absorb well because the body has to convert it first into hydroxocobalamin, and from there the hydroxocobalamin has to be converted into both adenosylcobalamin and methylcobalamin. But if the body has genetic mutations then these conversions don’t happen well at all and the effect is that the body cannot absorb or use of the nutrient very well.

What is the best way to take B12 – pill, shot, sublingual?

It’s also a well-known fact that B12 does not absorb well through the gut, so taking B12 via sublingual or mouth absorption is the best (holding it under the tongue or between the gums and cheek is most common). Consider some form of liquid or tablet/lozenge that can be sucked on or dissolved in the mouth. Holding the B12 in your mouth for at least 90 seconds is good and the longer you can leave it in your mouth, the better for sublingual absorption (as opposed to gut absorption).

Note: Different manufacturers use different terms for tablets that are meant to dissolve sublingually in the mouth, but “sublingual” is considered a pharmaceutical term by the FDA, so dietary supplements are moving away from using that term. However, it doesn’t really matter what term or form you use (chewable tablet, lozenge, sublingual tablet, liquid, etc.) for maximum absorption the main idea is to hold it in your mouth for 90 seconds or more, if you can (if you forget, don’t worry, since you’re taking the active form, your body will still get some benefit even if you swallow it whole). Another way to absorb B12 is muscularly through shots, however, the research tells us that sublingual (or mouth) absorption is equally as effective as muscular absorption … though shots may cost significantly more money. Also, be aware with shots (many doctors still give cyanocobalamin shots) that though you may need higher doses of active B12(s) (like myself), you may not do well when given higher doses of cyanocobalamin in a shot because your body may not be able to do the conversions and you could have negative side effects.

What does it mean if your B12 blood serum level comes back high?

The most important thing to realize is that blood tests for B12 are highly inaccurate at detecting actual cellular levels of B12 (meaning the B12 that’s available for the cells to use). Studies have shown that people can have high or normal B12 levels in the blood and actually show virtually no B12 in the spinal fluid, meaning the B12 is not being transported from the blood stream into the cells where it should be absorbed and used.

What can you do if you have high B12 blood test results?

Dr. Amy Yasko and Nutritionist Cynthia Smith, both suggests you can consider taking low dose lithium orotate (Cynthia Smith suggests approximately 4.6 mg pulsed a couple times a week before adding the B12 form in that’s most likely best for you).

Since I personally have a number of mutations in all of the B12 absorption genes (COMT, MTR, MTRR, VDR Taq), I actually need all 3 types of B12, but not everyone does. If you have your 23andme genetic test results, you can use those to help guide you as you try the specific B12 forms to see how they do for you. You’ll notice below that, according to Dr. Amy Yasko, the most well tolerated active form of B12 for folks seems to be hydroxocobalamin. Every single one of the genetic combinations she lists below should be able to tolerate B12 in the form of hydroxocobalamin (and this is why our methylation protocol suggests hydroxocobalamin as the B12 form to begin with):

Folks with multiple COMT mutations tend to do very well with hydroxocobalamin (it helps mop up excess peroxynitrites which can cause problems)
Folks with MTR & MTRR mutations may do well with methylcobalamin & adenosylcobalamin supplementation
And Dr. Amy Yasko talks about folks with a particular mutation status for COMT & VDR Taq as best needing the below forms of B12:

COMT V158M	VDR Taq	B12 Types That Should Be Tolerated
– –	+ + (TT)	All 3 types of B12
- -	+ - (Tt)	All 3 types of B12 with less Methylcobalamin
- -	- -(tt)	Hydroxocobalamin and Adenosylcobalamin
+ –	+ +	All 3 types of B12 with less Methylcobalamin
+ –	+ -	Hydroxocobalamin and Adenosylcobalamin
+ –	- -	Hydroxocobalamin and Adenosylcobalamin
+ +	+ +	Hydroxocobalamin and Adenosylcobalamin
+ +	+ -	Hydroxocobalamin and Adenosylcobalamin
+ +	- -	Mostly Hydroxocobalamin