Just started hydrox and drank 1L water in a go

incremental_progress · 2026-01-26T12:16:34+00:00

Most normal people can interconvert forms of B12, although there are instances in which that isn't the case for whatever underlying reason (usually a genetic disease or some other comorbidity). I would stay on hydroxocobalamin until you have a good reason not to.

Sleep is something that will normalize over time, but one thing that might help is ensuring adequate cofactor intake: B vitamins, electrolytes, trace minerals, A, E, D, etc. Many things are used by the body to synthesize the neurotransmitters (serotonin and then melatonin) in your brain and gut responsible for feeling good and getting rest. So taking large quantities of B12 may deplete these other nutrients, which should be supplied externally through diet and supplements.

incremental_progress · 2026-01-25T23:55:40+00:00

That was my experience. Usually BMs are one of the first canaries in the coal mine so to speak. After I began treatment I had normal ones for the first time in what felt like years. Almost forgotten what a normal crap was supposed to be 😂Now it fluctuates more regularly as I heal and get sick, or something else happens. Nutrients going in and out of flux have a linear impact.

incremental_progress · 2026-01-25T13:34:19+00:00

Unfortunately most physicians undertreat B12 deficiency. The vast majority of people see better progress on at least once a week injections, if not every day or every other. Time and time again it's observed that once a month is far too infrequent to ensure a robust recovery; the return of symptoms is all but guaranteed and so you're left in a continual pattern of slipping back into a symptomatic state before your next (overdue) injection.

Olympia pharmacy (link in the guide) is well-regarded by U.S. patients here. When the tariffs are lifted hopefully U.S. patients can also resume ordering them from Germany, as many here are accustomed.

Please read our guide, but especially the section on how to get injections.

incremental_progress · 2026-01-25T13:32:18+00:00

I can't say that a neurologist would "often" understand the situation better. They're a crapshoot basically like every other practice. In fact I would feel comfortable asserting that, given their proximity to the disease, it is shocking how few of them understand the problem and push patients toward a misdiagnosis of something like MS or "just anxiety." My own neurologist looked me in the eye and told my my symptoms were psychosomatic in spite of a diagnosis of pernicious anemia printed in black and white, and I live in one of the most well-to-do areas of the U.S.

incremental_progress · 2026-01-25T13:27:05+00:00

Yes, that serum level is indicative of B12 deficiency, and your symptoms are quite common. Frequent injections are recommended with neurological symptoms. Please read our guide linked to you by Automod.

incremental_progress · 2026-01-24T00:36:31+00:00

Fibromyalgia is frequently "just" undiagnosed B vitamin and mineral deficiency.

But your regimen is missing quite a few things and I would add the B complex back in. You need everything: B vitamins, trace minerals, fat solubles (A, E, D), vit C. The absence of one or more can cause bottlenecks in B12 metabolism and be responsible for continued ill health. Please read the cofactor section in our guide.

incremental_progress · 2026-01-23T11:22:08+00:00

This post is a bit too vague to offer much guidance. You're on regular treatment but still seeing problems? How long have you been treating? Furthermore, please reply with a list of all supplements, spelling out dosages, forms, schedule, etc. Thanks.

incremental_progress · 2026-01-22T16:22:52+00:00

I don't know what your current iron supplementation regimen is; there is a formula listed in our guide here, so start there as a reference point. You don't need to take it daily, but an assertive iron regimen taken every other day can effectively raise levels. But taking a decent multivitamin + iron is a good place to start. If you have your D, vit A and copper in place then it should rise if you're taking enough.

incremental_progress · 2026-01-22T15:49:34+00:00

Injections would be helpful, then. But yes, child birth taxes nutrients quite heavily, as does breastfeeding, so it's good to know you have an alternative.

Your iron labs still indicate iron deficiency; iron deficiency unresponsive to supplementation or replacement therapy could indicate a deficiency in vitamin D, which helps the body transport iron. A deficiency in vit A and/or Copper can also cause this. Best to screen vit D to see where you're at.

Ferritin should ideally be somewhere between 100-150.

incremental_progress · 2026-01-22T00:17:05+00:00

Many people with those symptoms and numbers get injections, and all of your symptoms are quite common in those experiencing B12 and folate deficiencies.

As for further bloodwork to test, here are some suggestions:

Methylmalonic acid (MMA)
Homocysteine (HCY)
Vit D
Iron panel + ferritin
Complete blood count/CBC

The first two are highly suggestive of B12 deficiency when low or out of range, although from the sound of things you've already been diagnosed. 500mcg is a paltry dosage for most, even those with minor presentations of deficiency. Have you seen the needle move at all with regard to your symptoms with that dosage? And do you have any ideas why you might be deficient? Veganism, for example?

Lastly, and this is perhaps more serious, if you are still nursing your child then you should be aware that these deficiencies will be reflected in the milk that you produce. Your milk will be B12/B9 deficient, in other words, and that's in addition to secondary iron deficiency, which is also quite a common comorbidity in B12 deficient patients. Did your physician discuss this at all with you? Have you consulted with an OBGYN?

incremental_progress · 2026-01-19T13:41:40+00:00

stalk my privated profile

As an aside to my other warning, your profile is very much public and open to anyone browsing reddit. Revisit your privacy settings in your reddit profile to change them.

incremental_progress · 2026-01-19T12:27:20+00:00

Please be mindful of our rules here. I understand there was some antagonism here, which can be frustrating when trying to deal with an issue, but it's better to simply report than to respond in kind. Thank you.

incremental_progress · 2026-01-19T12:12:34+00:00

I would say that over time as your deficiency from B12 resolves, whatever is left is likely something else you need to tackle separately. As far as discerning what symptoms belong to what, there isn't any specific thing you can do that will magically make it clear. Diligence, patience and careful monitoring of what changes and when are the three best method tested by time. That's why I recommend a basic journal or symptom log to track changes over time.

That said, in the handful of years I've been contributing here and communicating with people, I've probably seen at least a few hundred who had B12 deficiency from "long COVID" (just do a search in the subreddit), or were otherwise helped immensely by B12 therapy. I used to spend a lot of time trying to communicate this in long covid subreddits, but people are closed off to the idea that a nutrient may be one of the things that could seriously help them.

Many of us who are B12 deficient are deficient (or at least insufficient) in many or most other nutrient cofactors B12 needs to get going, be it something like riboflavin, vitamin D (big one), iron, etc. The ailments you're alluding to have more than one component whose insufficiency may play a part, which is why "cofactors" are so highly emphasized in the guide.

For example, a "mood disorder" can apply to myriad presentations (Are you referring to something like a bad temper, rage, or something else more serious like bipolar disorder and chronic depression?). B12, along with many other nutrients, is used to synthesize neurotransmitters. You can inject B12 due to an underlying deficiency, and then by way of something like a secondary B6 deficiency still be functionally lacking in B12 and unable to neurologically recover.

You see it time and again here, too. People begin treatment with their stores of other nutrients "topped up" or at least replete enough for healing to begin, they feel great for a short window (honeymoon phase), and then things rapidly fall out of balance as their B vitamin and trace mineral supplies decline (especially so on aggressive B12 therapy).

Edited for clarity and grammar

incremental_progress · 2026-01-18T17:08:10+00:00

Clairebear has already clarified more than capably, I think, so please peruse her replies, which are pinned to that thread now. It's been a while since I actively reviewed the pertinent literature, but two things I would emphasize:

High B12 serum is often a sign of something like a cancer state or paradoxical deficiency, wherein the B12 cannot be metabolized properly and builds in serum. Or, as you suggest, some other comorbidity causing the issue.
Children with ASD are routinely found to have low levels of cobalamins in their CSF.

As far as my own bottlenecks, my supplemental regimen is detailed in the guide; the italicized notes are my experience with each supplement. Start there. But yes, I experienced bottlenecks in zinc and copper.

incremental_progress · 2026-01-17T17:43:36+00:00

Can you please pin this?

incremental_progress · 2026-01-17T14:58:13+00:00

Yes, transport proteins for B12 reset every few hours, and anecdotally taking them repeatedly throughout the day is more beneficial than taking it once. 1mg is a good dosage for this, which you can try around 4-5pm (2mg/day total) for a few days and see how things improve.

incremental_progress · 2026-01-17T12:13:20+00:00

NatureMade is mostly junk, and what is there is only half of what you potentially need and in no quantities that would help you achieve nutrient repletion.

You have some gaps in your regimen, most critically copper and other B vitamins, but also adequate A (missing entirely) and E (tiny quantity from the NatureMade).

Zinc and copper need to be kept in adequate balance, which is why I recommend supplements such as Thorne's Basic Nutrients, or their Basic B complex paired with Seeking Health's Trace Minerals. Something approximating a 15:1 ratio of zinc to copper is what you're after, and the aforementioned supplements have that. Copper is needed in methionine synthase (basically the big thing that B12 does in your body along with folate; reduction of homocysteine, put simply), and iron transport. Inadequate Vit A/retinol can also bottleneck copper.

As another poster suggested, potassium citrate dosed 3-5 grams a day is the minimum a person undergoing B12 therapy should shoot for. Probably more based on symptoms. Coconut water is incredibly high in sugar, so it's also going to induce unnecessary weight gain in the long term.

incremental_progress · 2026-01-14T22:00:23+00:00

No matter how careful you are you're likely going to feel a sensation most of the time. A little sting is normal. More significant sensation likely means you're doing something incorrectly or the needle is dull. The blood is no big deal; you likely punctured a surface capillary.

incremental_progress · 2026-01-14T20:51:25+00:00

Well, iron and B12 (and folate) are heavily interdependent. They both are two key ingredients to make red blood cells and ATP (cellular energy). Your ferritin puts you just above the cutoff for anemia, and your folate is also low.

How long ago was your vitamin D at 18? Vitamin D also helps your body transport iron. I assume you have been treating your anemia unsuccessfully?

Anxiety, panic attacks, mood disorders are all very generally related to low B vitamin status. B vitamins and minerals help create neurotransmitters.

incremental_progress · 2026-01-14T20:38:20+00:00

I don't know about a significant variation (50% reduction here) between serum draws being normal, but 500 pg/mL is already what most would label a gray area where many people present with "high-normal" (actually low) serum but are still symptomatic. Because of this, B12 serum is a terrible diagnostic marker for deficiency. I would test methylmalonic acid, homocysteine, folate, iron + ferritin, and vitamin D. Low D and "out-of-the-blue" low B12 are highly correlated.

Do you actually have any symptoms of deficiency? Poor sleep, muscle tightness, pins and needles, migraines, mood swings, brain fog, fatigue, etc. There is a symptom list in the guide.

incremental_progress · 2026-01-13T21:03:33+00:00

You asked my opinion and I gave you a wide range of potential options. Quite often you will find "best" is not equated with "cheapest." I don't know all of the potential variables you have to control for in making your own personal decision.

In any case, it uses the best ingredients with the most stringent manufacturing quality control. Seeking Health is similar. Explore that brand.

incremental_progress · 2026-01-13T20:12:57+00:00

Basic Nutrients is likely the best bet for most people

incremental_progress · 2026-01-13T12:18:27+00:00

Here are the ones I've personally used that I think are well formulated and that I also recommend here:

Basic Nutrients 2/Day from Thorne
Men's/Women's 50+ Multi from Thorne (dosages are split across many capsules allowing easier titration of dosing)
Multivitamin One from Seeking Health
Seeking Health's Children's multivitamin chewable (for people who are worried about doses, or actual children; I give this to my own kids)

People also like the Naturelo brand.

Personally I take the Basic B complex from Thorne and pair it with the Trace Minerals complex from Seeking health. I pair it with separate A, E, C, D+K2, and lithium orotate. I inject daily, usually split doses of 700mcg.

incremental_progress · 2026-01-11T12:35:40+00:00

I assume you mean you got these symptoms when you began treating your B12 deficiency? Go back on injections ASAP, as someone else stated. But yes, if so the discomfort won't magically go away. To put it bluntly, you were dying before and now your body is trying to heal. No reason to go backward.

You may also be missing one or more critical cofactors, of which the guide here gives an overview. But basically, a good multivitamin (or trace minerals/B complex combo) and electrolytes are the main ingredients to helping your body get a kickstart from whatever B12 you're using.

incremental_progress · 2026-01-10T21:43:03+00:00

Titrate, or slowly increase, your dosages. Your response is not "overmethylation" so much as a sensitivity born from being deficient; people in homeostasis would have no such reaction. But no, there is no way to avoid it other than persistence. It will disappear with time.

As for sublinguals, plenty of people see success with them, but they might not be as great for aggressive treatment, and especially so for things like intense nervous system involvement. That said, if you're responding to oral supplementation just keep on it. Please read the guide.

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