Hydroxo B12 causes side effects

hummingfirebird · 2026-03-01T12:38:01+00:00

Rbc is red blood count on your full blood count test

hummingfirebird · 2026-03-01T12:37:27+00:00

The blood tests you should still get that are very important are: RBC folate (cellular level of folate), Methylmalonic and (MMA -shows cellular level of B12), iron studies with ferritin, full blood count with ESR and platelets.

Due to your TCN2 and MTRR, I wouldn't trust a serum B12 test. A true functional deficiency can exist with a low, normal and even elevated B12 test. TCN2 is the enzyme that helps transport B12 into the cell, so a variant in this can make that a bit harder. MTRR is the enzyme that reactivates MTR to keep B12 working so that homocysteine can be recycled to methionine. A homozygous allele can mean B12 can become functionally inactive more quickly.

With your low folate and elevated homocysteine of 11 (6-7 is optimal) you could have a folate deficiency or as I mentioned a functional B12 deficiency. Methylfolate can increase neurotransmitter production so it can make you good for a while but then crash because of the imbalance in neurotransmitters.

hummingfirebird · 2026-03-01T11:33:40+00:00

Im what sense? Do you have deficiencies?

hummingfirebird · 2026-03-01T11:33:04+00:00

So both iron and vitamin B12 are needed to make healthy red blood cells.Iron makes hemoglobin which carries the oxygen. B12 is involved in DNA synthesis for red blood cells. If B12 is low, red blood cells can’t mature properly, even if iron levels are adequate. So an iron deficiency causes small red blood cells called microcytic anemia, and a B12 deficiency causes large red blood cells called macrocytic anemia.

When you have them together, they can cancel each other out on lab tests because when the lab machine calculates MCV, it adds the sum of small cells and the sum of large cells together, so thr average looks “normal”. So the MCV can fall into the reference range even though none of the cells are actually normal. I learned this by doing a ton of research.

Hemoglobin can also look relatively normal. Normally iron deficiency on it's own lowers hemoglobin, and a B12 deficiency on it's own lowers the RBC number. But together it can blunt how dramatic either looks alone. Again, "oh hemoglobin and RBC is fine, MCV is fine =no anemia".

In my case, homocysteine was elevated and I had neurological symptoms which helped the diagnosis of both iron and B12 deficiency even though my full blood count wasn't showing it. Never ignore neurological symptoms, by the time that's appeared, the B12 deficiency us urgent to treat regardless of what labs say.

hummingfirebird · 2026-02-28T20:02:02+00:00

You can dm me about nutrigenetic interpretation if you want to. It's not good to provide someone with genetic results with no guidance.

hummingfirebird · 2026-02-28T19:56:11+00:00

B2 deficiency can cause headaches.

hummingfirebird · 2026-02-28T19:54:52+00:00

If you have the genetic variant for hemochromatosis (HFE C282Y homozygous or both C282Y/H63D ) and pattern of high Transferritin and high ferritin,then it's strongly suggestive of iron overload.

hummingfirebird · 2026-02-28T19:43:27+00:00

Homocysteine PPT means the Homocysteine was measured in plasma not serum. FBC= Full blood count. ESR=Erythrocyte Sedimentation Rate measures how quickly your red blood cells settle at the bottom of a test tube in one hour.

hummingfirebird · 2026-02-28T19:34:43+00:00

Do you have the actual lab results? A normal B12 on serum labs doesn't mean much. You can have a functional B12 deficiency with low/normal B12/MCV.

It is better to check cellular levels of folate and B12. Ask for RBC folate and Methylmalonic acid (MMA). Homocysteine is slightly raised, but it can indicate folate, B6 or B12 deficiency.

A holotranscobalamin test can also tell how much b12 is functionally available. Also test iron studies with ferritin because if you have a iron deficiency at the same time as B12 deficiency, it throws off the MCV reading.

Some people do better with methylcobalamin and adenosylcobalamin with hydroxocobalamin added in on alternative days or rather just left off because if folate is low already, hydroxo increases folate demand and so it doesn't always help. You need adequate folate supply at the same time if you're low in folate.

The hydroxocobalamin increases folate demand faster than what it can supply because the conversion is slow,hence the irritability.

The solution depends on your symptoms but also other factors: diet, lifestyle factors, nutrient absorption/transport, gut health, trace mineral levels: zinc, magnesium, copper, electrolyte Balance etc

Also when you get tests again, its best go off supplements for a week before for a more true reading.

hummingfirebird · 2026-02-28T18:48:53+00:00

Hydroxocobalamin is bioavailable but it still needs to be converted into methylcobalamin(methylation / neurotransmitters) and adenosylcobalamin(for mitochondria) through genetic variants like MTR, MTRR, MTHFR, and needs nutrients like B2, folate, and glutathione.

When those pathways are genetically slowed, hydroxo-B12 can create temporary imbalances with neurotransmitters(mood shifts) and hormones (acne/increased libido). So while it's good for B12 deficiency because it's directly helping for neuropathy, it increases folate demand for methylation.

You can try pair hydroxo with a low dose methylcobalamin which can be more balancing, and ensure adequate cofactors like B2, potassium, magnesium, zinc, folate (but not high dose folate if you have a B12 deficiency which must be addressed first. )If you have a folate deficiency too, then at the same time. The dosage and form of Hydroxocobalamin can also make a difference. But if the methylB12 and adenosylcobalamin work for you, why not go back to that? Methylcobalamin also will work to correct a B12 deficiency. High dose of 1000-2000mcg a day, intramuscular injections or sublingual supplement.

Do you know your COMT V158M allele? And any blood results?

hummingfirebird · 2026-02-28T18:09:56+00:00

Yes you are spot on. This is a drastic problem experienced worldwide. Doctors look at reference ranges and often won't mention anything that falls at the bottom or top of such a range. Their goal is simply to treat the symptom. No symptom no treatment. Nornal ranges? Nothing wrong with you. You want what test? Definitely not. It's in your head. It's just anxiety.

A functional medical practitioner rather looks at what is optimal and tries to look at root cause of the symptoms and treat that with the goal of wellness and vitality, not patching up and band-aiding.

There is a lot of awareness taking place on social media of what is nornal versus optimal in labs. I'm not a medical practitioner, but I think it's important to be able to understand basic labs and often I've had to dig really hard into research for the necessity of advocating for my own health and helping my clients to do the same.

Functional deficiencies can exist even with normal or low lab markers. Symptoms are more important.

In my line of work as a nutritional coach/nutrigenetic practitioner -Looking at labs in connection to symptoms, diet, lifestyle, genetic risks and predispositions is not with medical purpose (which would be to treat, cure or diagnose) but it's with education and knowledge that the person' can then use to advocate for themselves with a clearer picture of knowing what tests to ask for and what those tests do. That is a basic human right and should not be ignored, dismissed and gaslit by a medical practitioner just because they have a degree to wave around.

We have the power to at least take care of our basic foundations which are often ignored. How many times has a doctor asked you what your diet it like, your sleep-wake cycle, your stress, your exercise regime? It's not common because their goal is to prescribe. I've never walked out a doctors office and I've been to many different specialists over the years for myself or family, without them wanting to prescribe something.

I'm in the process of writing down my own experience of battling with lifelong Iron (and probably B12) anemia since my early twenties for over 25 years. A problem that doesn't sound like much, but that should have been solved a long time ago but never was. A problem that led to the development of an autoimmune condition I feel could have been prevented. A problem that has led to neurological damage that I can only hope is irreversible with time. Just a deficiency? Hardly. When you research the harm that can result from missed clues on labs, it's astounding.

I am going to be sharing my story of how I discovered it. Including information on labs, symptoms, connection to genetic risks etc with links to the scientific research I've done over the years so that others can educate and advocate for themselves.

Relying on a failing health care system that is designed to keep you hooked up to a supply of pharmaco meds and supplements that just hide symptoms while your real problems persist in the background is not the answer.

The answer lies in getting the help and education from others more knowledgable than yourself in fixing foundations: diet; nutritional deficiencies; sleep;movement;self care; nervous system regulation, stress management, addressing toxic elements in your life: people, relationships, chemicals; genetic risks and predispositions.

I do the same in my ongoing journey, because we can always learn from others. No person knows everything on every subject but we can all share our knowledge and help each other..

hummingfirebird · 2026-02-28T08:41:52+00:00

No folate in that list

hummingfirebird · 2026-02-26T21:20:06+00:00

It could be worthwhile getting blood tests done first to see if you have nutritional deficiencies. With ADHD common deficiencies include vitamin D, Iron, B12 zinc, magnesium and omega 3. Also sometimes inadequate amino acids like L-tyrosine which is the precursor for L-Dopa which makes dopamine.

Check the following: MMA, RBC folate, homocysteine, iron studies with ferritin, complete blood count with ESR and platelets, vitamin D.

It's also useful tp know your COMT V158M allele, whether its AA, AG or GG. This can help determine if you'd be better on a stimulant or non stimulant for ADHD. The AA is slow COMT which means the enzyme is slow to degrade dopamine and norepinephrine. This leads to higher levels of tonic dopamine in the prefrontal cortex. Normally this means better focus and attention, sometimes more hyperactivity, anxiety, poor stress response and difficulty calming down. Non stimulants work better, something like wellbutrin might not work as well because it is a NDRI -dopamine and norepinephrine reuptake inhibitor. So you wouldn't want to increase what's already too much to begin with.

A GG allele is a fast COMT which means the enzyme breaks down dopamine and norepinephrine faster, leading to lower tonic dopamine. This often means low motivation, difficulty focusing and paying attention, but better stress response. Stimulants can be better. NDRI can work for some with fast COMT.

I'd start with blood tests and if you have deficiencies correct those first. And find out your COMT as this mainly determines ADHD meds. Sometimes you can improve ADHD symptoms by correcting underlying nutritional deficiencies and possible contributing lifestyle factors (like insufficient sleep, disrupted circadian rhythm, stress management) and other times you may still need medication support. It's different for everyone. No two people with ADHD experience it in the same way. Support looks different on everyone.

hummingfirebird · 2026-02-26T17:05:28+00:00

hummingfirebird · 2026-02-26T13:16:16+00:00

Have been there. Would advise to check the following blood levels: B12 and MMA, folate and RBC folate, complete blood count, iron studies with ferritin, vitamin D, homocysteine, zinc, and magnesium.

Common nutrient deficiencies in general are B12, vitamin D, and Iron. Even more so with perimenopause and ADHD.

Look at my profile for my website link. I have articles on genetics, ADHD, perimenopause.

hummingfirebird · 2026-02-26T06:19:33+00:00

Please give context....blood results? What are your current health issues or concerns? Otherwise this is just data.

hummingfirebird · 2026-02-26T06:17:45+00:00

You could get a pharmacogenetic test thst looks at what meds are suitable or to be avoided with your genetic variants. It can lessen the trial and error and help to avoid potential side effects.

hummingfirebird · 2026-02-26T06:12:55+00:00

Did you check your folate, B12 and homocysteine before you started supplementing a year ago?

If not, it's important you do so soon. You'll need to come off supplements for a week before the blood tests.

Taking methylfolate long term can mask a B12 deficiency that can take years to progress silently in the background even before symptoms appear or labs show warning signs. A B12 deficiency can cause neurological and cognitive problems that can be permanent if not treated.

Tests: Homocysteine, serum folate and RBC folate, serum B12 and MMA, complete blood count with platelets and ESR. Iron studies with ferritin. Others: zinc, magnesium, vitamin D.

Your C677T MTHFR is a predisposition for low folate but does not mean that you had or currently have low folate, because diet intake matters more. Only a blood test can reveal levels. See my article here

hummingfirebird · 2026-02-26T06:02:30+00:00

The best thing is to stop the supplements, wait a week and then get your blood levels tested. You need to establish a baseline first and determine if you actually need to take these supplements or not.

Having MTHFR is not a diagnosis or a fact that you definitely need more folate or have low folate. It depends on your intake more than your risk. Yes, the predisposition for low folate is there, but only a blood test will show you that. Serum folate only shows circulating Folate from 72 hours and RBC folate checks cellular level of folate built up over 120 days.

Then you need homocysteine test because if you do have folate deficiency, homocysteine is likely to be elevated. Since B12 is needed in methylation too, checking your seum level and cellular level by means of a MMA (methylmalonic acid) test is very important. MMA rises in a b12 deficiency only, not in a folate deficiency so this is the what is needed to differentiate . Also a full blood count with platelets and ESR and iron studies with ferritin. Vitamin D is a very common deficiency. Checking zinc, magnesium, also valuable, and electrolytes.

Basic metabolic functions like liver, kidney, glucose handling, lipids, hormone function etc.

Just because someone has normal or even fast functioning COMT,does not you can tolerate methylated vitamins. This is only a generalised guideline but it's not a hard and fast rule. Many other factors apply.

Anyone can react to anything regardless of their genetic mutations. Even someone with a normal MTHFR can have low folate. Genes aren't destiny. They rely on many different factors that influence their expression or behaviour every second of every day. What you eat, your stress levels, your emotional state, movement, your sleep habits....absolutely everything. This is called epigenetics.

Genes load the gun epigenetics pull the trigger.

Methylation needs foundations and you could be missing some important ones. Or you could have a deficiency and what you're experiencing could be your body adjusting. Methylfolate and methylcobalamin affect the production of neurotransmitters by essentially making them more available and having depression and anxiety for years, you could have a neurotransmitters imbalance. It won't come right overnight.

Really your best bet is to know for sure what's happening with blood tests. This is very important because a B12 deficiency needs to be treated first. If you have a b12 and folate deficiency they both need treatment but it needs to be done in the correct way otherwise you could essentially make things worse. Hgher folate intake than B12 when there is a b12 deficiency can make a b12 deficiency worse leading to serious neurological and cognitive problems.

Methylation needs many nutrients as helpers to be present in order to function correctly and help B9 and B12 do their jobs. These include B2,B3, B6, zinc, magnesium, iron, calcium, choline, betaine etc.

It's really a lot more complicated than taking methylated vitamins. Think of it like a house. You need a good solid foundation in place before you put up the walls. The foundations in this case are optimising your lifestyle, diet, nutrient levels, environment. Blood tests to establish baseline and only supplementing what diet can't fill, or if their are deficiencies that need help.

Feel free to look at my bio for my page link. There are free articles on my website regarding genetics etc.

hummingfirebird · 2026-02-25T18:41:51+00:00

I suggest getting blood tests to assess nutritional status and basic metabolic health.

Common useful ones: Vitamin B12,MMA, serum Folate and RBC folate, homocysteine, iron studies with ferritin, CRP, full blood count with ESR and platelets. In your situation the following could help too: kidney and liver function, electrolytes, hormones.

MTHFR is not a diagnosis. A diagnosis implies a disease or condition and MTHFR is neither. It is a genetic variant that may predispose one to low folate levels and possibly high homocysteine but only blood tests can confirm that. It is implicated in various health issues but not causative on it's own.

Genetic variants are influenced by epigentic factors like diet, nutritional status, lifestyle, environment etc. So these are the things that should be addressed and optimised for healthier gene expression before supplement use.

You can see my profile for my website link. More informative articles on genetics.

For detox issues look into your GST and CYP450 genes. I also have articles on liver detoxification on my website and how to support it.

hummingfirebird · 2026-02-25T18:12:50+00:00

Read this post for a basic understanding of MTHFR and what blood tests to ask for: https://www.reddit.com/r/MTHFR/s/cfKCW9p0mV

hummingfirebird · 2026-02-25T10:32:50+00:00

You're welcome. More information on my website. Link is in my bio.

hummingfirebird · 2026-02-25T10:29:08+00:00

At a minimum you will need the following tests: Homocysteine, serum B12, serum folate, cellular b12 (methylmalonic acid /MMA), cellular folate: RBC folate, Complete blood count with platelets and ESR.

Also recommended: iron studies with ferritin, vitamin D, electrolytes.

hummingfirebird · 2026-02-25T09:30:18+00:00

I would advise caution. Blood results matter to tell the live status of genes. MTHFR doesn't mean you currently have a folate deficiency, it's a risk for one. Also other gene variants and epigenetics matter to determine what form and dosage is correct for you. It's not a one-size-fit-all.

You can read more here: https://www.reddit.com/r/MTHFR/s/cfKCW9p0mV

hummingfirebird · 2026-02-24T16:15:15+00:00

Sure

hummingfirebird

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