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The paradoxical B12 deficiency might have a relation with the inactive form being supplemented. If one supplements cyanocobalamin, and one expects the body to convert it to methylcobalamin, and if this conversion doesn't happen for whatever reason, and if the measured form includes the inactive form, then "paradoxical B12 deficiency" can be observed.

There is a more insidious form of it whereby the active form doesn't enter the brain. Symptoms are: difficulty speaking, tremors and ataxia. This can be tested by CSF (cerebrospinal fluid) testing. This assumes that the active form is supplemented and it is present in blood. It can be remedied by a course of corticosteroid pills, followed by megadosing B12 orally daily. Refer to PMID 38924428.

I take a triple active form of it which is methyl+hydroxy+adenosyl, covering all bases, but a total of just 500 mcg per day, above which it harms my sleep.

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Would you mind sharing a brand or a link? I have had grey hair since I was in my 20s and struggle with energy. I have been taking nature made multi vitamin for a vitamin b deficiency that was high enough to cause craggy edges on my tongue, caused by the stomach acid suppressant I was prescribed. I would like to compare.

https://www.amazon.com/gp/aw/d/B09G6ZDCDP

Use it with a 2-way or 3-way pill splitter, just once piece per day.

For acid, use famotidine to the extent possible, in as low a dose as does the job. For overnight suppression, however, omeprazole is useful.

Thanks!

> The paradoxical B12 deficiency might have a relation with the inactive form being supplemented.

Yup, not everyone can convert cyanocobalamin or hydroxocobalamin to adenosyl-/methylcobalamin. Especially in severe cases, anecdotally I’ve seen people not make progress with the standard cyanocobalamin injections, but then make huge progress with methylcobalamin injections. Unfortunately, methylcobalamin is often not preferred in injectable form due to very quick degradation into hydroxocobalamin upon exposure to light.

Taking methylcobalamin B12 supplements essentially fixed my memory problems. Early on I tried out the cyanocobalamin type and got absolutely nothing from it.

If I stop taking the supplements for a few weeks, the memory problems come back. If I start again, a week later my memory is excellent. It’s well worth the minor effort.

What kind of memory problems, could you expand? I wonder if I fall on this bucket. I had graying hairs as soon as I finished high school (~19). One of my major problems with studying was an inability to retain stuff in university, which is weird because through middle school a single read was sufficient for me to retain stuff.

Mostly noun recall. I can mentally picture and describe thing or person X, but when I'm having the problem it could possibly take me 30 minutes to figure out the name of X without looking it up.

When I don't sleep enough I definitely have that, but it's not a thing that occurrs otherwise. Thank you!

Subligual methylcobalamin works just as well as the shots and you can buy it anywhere.

Also, get a Methylmalonic Acid Test with you B12 levels. An MMA test is more useful because it is an enz=yme which uses B12, so when the active form of B12 is low, so will MMA in most cases.

> Subligual methylcobalamin works just as well as the shots

It does not. The cobalamin molecules are quite large and don’t penetrate the sublingual mucosa very well. On top of that, the proteins in saliva that bind to B12s will cause any bound B12 to not absorb sublingually, instead having to wait to make it through the digestive system for intestinal uptake.

Sublingual is still certainly a better option than oral pills, but the injections are preferable in severe cases for a reason.

> The cobalamin molecules are quite large and don’t penetrate the sublingual mucosa very well.

Absolute nonsense.

Did you even bother to look for one paper on the subject? Here are a few:

https://www.scielo.org.mx/scielo.php?pid=S0034-8376202000060...

https://pubmed.ncbi.nlm.nih.gov/34871525/

https://www.proquest.com/openview/e9a25963dbc92150e420a3a847...

Ok, so assuming you don’t want to have your CSF tested, is there any risk of harm to supplementing with the active form?

There's no risk in non-smokers if you stick to a sane dose. Megadosing it can harm sleep and severely increase blood pressure and heart rate, although these gradually reverse upon cessation. This can take time to manifest. It is why I limit the dose to 500 mcg per day. Older people, such as those over 70, can need more and tolerate more, even 5 mg per day, due to deteriorated absorption.

Also, don't forget the other B vitamins. In truth I take them all.

> Megadosing it can harm sleep and severely increase blood pressure and heart rate

https://www.researchgate.net/profile/Osama-Arafat/publicatio...

> METHYLCOBALAMIN HAS AN EFFECT ON HYPOTHALAMIC–HYPOPHYSEAL– ADRENAL AXIS

In rats, but may apply to humans too.

> There's no risk in non-smokers if you stick to a sane dose.

Also, B12 is water soluble, which generally means that your body is pretty good at flushing out any excess it can't use, making it difficult to overdose on. (Compared to fat-soluble substances.)

A little extra B12 is easily flushed out, but when it's a lot, meaning several milligrams per day for many days, it can quickly and suddenly cause very elevated blood pressure and heart rate, e.g. 160 for both SBP and HR. This effect is easy to undo using a good beta blocker, e.g. atenolol, but if one doesn't, then an emergency hospital visit is required. The point is that despite being water soluble, this adverse effect does happen.

Even at just one milligram per day, it can significantly harm sleep.

It has a high circulating half life of six days, which implies that it can really build up if repeatedly megadosed in this period.

Does it help you with grey hair ?

No, it's useless to me in this regard, although it could help someone who is efficient. I think my issue may have more to do with copper.

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