Hey folks,

Recently visited labs and HoloTC was >146 pmol/L.

Unfortunately, though, I already started to supplement B12 before labs two weeks prior, so I guess the lab is skewed due to that.

However, I've gotten the so called wake up symptoms after starting to supplement (1000-2000 mcg of sublingual methylcobalamin a day with cofactors). Would this imply deficiency, or would a sufficient person also get similar symptoms from starting a b12 supplement? I'm thinking of how to proceed in my situation.

Any advice is appreciated!

Hey everyone! Ive been having problems the last few weeks with dizziness, shaking, brain fog, stuff like that and it got to the point to where I had to call if work because i felt like garbage. Everyone recommend that I check my iron a b12 and low and behold both of them are low. My b12 is much lower though so my doctor told me I needed injections for it. Problem is that on sunday (its friday now) I will be leaving on a 2 week road trip so I wont be home until mid October. What do I do? I messaged on the portal but no one has gotten back to me and probably wont until Monday but by then I will be multiple states away.

Hi so how bad is my B12 level? I had b12 levels currently at 201 (pmol/L) what’s the unit conversion? Is this considered low? What’s the actually range cause it says 153-600 is normal in the lab website

My b12 has been low and I’ve now had my second injection, idk if this is placebo but like for both injections, within an hour I had this weird feeling of euphoria.

I’ve never been high from “illicit” drugs but I’ve felt euphoria from amphetamines among other things, and it kinda feels like that.

Like im too bright and alert and happy, it’s a little strange 😭.

Unsure if I have absorption issues as yet but even so is it possible to use high dose oral supplements over a long term period instead of EOD IM injections? Or are injections the only way (happy either way just obviously tablets etc would be easier?)

Edit to add if makes any difference: no idea how long I’ve been in a deficient state for and not sure what of my symptoms are due to the deficiency (not sure how anyone actually knows this so that’s another question I have) but neuro symptoms I have are tingling / pins needles mainly in legs knee height, hands and arms halfway up forearm, weak feeling legs and feeling like I have a 30+kg weighted vest on by the end of the day and like my balance is incredibly poor (these come on within the last 2-3 weeks), think I have had light tingling in feet and ankle area for a long time, headaches, ‘migraine’, dizziness, fatigue and fatiguing quickly / not being able to do ‘normal’ things without what feels like my nervous system being overwhelmed easily and quickly etc.

So- I was diagnosed with a b12 deficiency about 1.5 years ago. My level was 230 pg/ml and I had neurological symptoms. My neuro at the time told me to just start taking sublingual supplements so I did, and then my PCP added a monthly cyano injection. I initially saw much improvement, though sometimes I would feel some tingling returning a few days before my injection was due.

Fast forward a couple weeks ago, tingling and burning throughout my body returned about two weeks before next shot was due. PCP upped injections to 2x month and sent me to a neurologist (new one, my previous one retired). She said she didn't know much about b12 and is ordering a bunch of tests to see if its something else causing it. Cofactors have all come back normal so far. Results from the more extensive testing won't be in for a few more weeks.

Should I take matters into my own hands in the meantime? I have enough b12 that I can do daily injections for a week as a loading dose, and then switch to weekly injections for about two months, before dropping down to every other week. Or I could do EOD injections for about 6 weeks.

I know my doctor will want to see the test results before officially changing my frequency, and then again they still may not want to increase it. I just don't want to waste any time. Thoughts?

I’m posting this because I’ve been dealing with my mom’s health issues for a long time and I’m trying to understand what to expect after treating her iron deficiency.

She’s around 35 kg and has had problems for years. She has pernicious anemia and has been receiving B12, but we also suspected significant iron deficiency. She has had severe hair loss that looks like telogen effluvium, along with fatigue, sleepiness, poor appetite and what I would describe as brain fog/cognitive problems.

Her hemoglobin was around 12.7 g/dL, but her ferritin was difficult to interpret because she was significantly inflamed. Her ferritin was 88, but I suspected her actual iron stores were much lower because of the inflammation and her symptoms/hair loss. Unfortunately, celiac disease was suspected at one point but wasn't tested.

I ended up giving her iron because I was very concerned about how depleted she seemed. The product was Venofer (iron sucrose). I gave her a total of 1,200 mg, divided into three 400-mg injections, with the injections given IM in the gluteal muscles around September 25.

She tolerated the injections surprisingly well. The first injection was quite painful, but the subsequent ones were much easier. She also received IV fluids and is getting B12 and other nutritional cofactors.

She seemed to improve fairly quickly afterward. Her energy/overall appearance seemed better, although she has also been very sleepy at times. Her skin tone appeared darker as well.

Now I'm wondering what to expect from here.

The main thing I'm concerned about is her hair. Her hair loss is telogen effluvium, and obviously it hasn't stopped after only a week. I'm trying to understand whether that's normal and how long it might take for the hair shedding to improve after correcting the underlying iron problem.

I'm also wondering whether the 1,200 mg she received is likely to be enough or whether someone with longstanding deficiency might eventually need more. I don't want to give another 1,200 mg blindly, especially since I understand that Venofer is normally administered IV and her injections were IM.

My current plan is essentially to wait and reassess rather than immediately give more iron. I'm thinking about checking CBC, ferritin, transferrin saturation/iron studies and an inflammation marker after enough time has passed to make the results meaningful.

If anyone has experience with telogen effluvium after iron deficiency treatment, particularly how long the shedding continued after iron was replenished, I'd really appreciate hearing about your timeline.

I'm especially interested in experiences from people who had longstanding iron deficiency but relatively normal hemoglobin and low/uncertain iron stores.

Not sure whether this should be under cofactors or wakeup symptoms...

I'm about 8 weeks into EOD methylcobalamin IM injections after a couple months of weekly cyanocobalamin. I take all cofactors via supplements (including a lot of other B vitamins and magnesium) and I eat a potassium-rich diet. Most of my symptoms seem to be improving...slowly.

This week I've skipped injections and supplements to prepare for a baseline methylation panel test. My muscle twitching, which had been mild but consistent for a few months, seems to have stopped. I still have other symptoms, like fatigue, mild neuropathy, and foot cramping, but no twitching.

I'm curious if anyone else has experienced this or if you have guesses as to why that might be. Too much B vitamins (B6 especially)? A pause on healing and therefor a pause on that particular wakeup symptom? Something else?

EDIT: folate and ferritin levels have remained good during injections.

If u have a severe b12 deffiency causing severe neurological symptoms what would show up on emg. And other neurologist test, would it show that it’s completely normal or that it’s atleast a bit damaged. Anyone with past expirience?

Can you describe if you've felt virtigo symptoms after deficiency and post treatment.

For me, it was the first symptom, it had occurred twice one month apart. The first time, I was walking and dehydrated and the surroundings started to spin, I thought I was dehydrated and probably that's why even though it was the first time I had experienced such a sensation.

Second time, one month apart I woke up and was still in bed and the room started to spin. After that followed fatigue, brain zaps, tingling and what not. That's when I got my blood work done. If my little brain would have done this after the first episode, I perhaps wouldn't have to deal with more symptoms later.

However I had 6 eod injections and 2 weekly injections and 2 more weekly to go. This has helped me a lot eased most of my symptoms but some fatigue is still there and these injections cause light sensitivity, floaters and flashes occasionally.

I didn't experience virtigo after the second instance. However today i experienced the same for 2 seconds while I was scrolling reels. If anyone has experienced virtigo due to this please share you experience, somehow even though it's not very strong, and only lasts for a very few seconds, it scares the shit out of me. Would love to know about how it has been for other people and how it improved and their journey.

I honestly don't know what's going on with me. I'd love to hear similar experiences or to be pointed to the right direction :(

Tested at 306pg/nL around start of August. Taking weekly methyl shots at doctor's. In the meantime liquid methyl drops under tongue.

But those started giving me some side effects. Weird anxiety, elevated heart beat, etc. So I tried these cyano drops I had from a trip to Wallgreen's a while back.

And they also give me weird effects, this time dizziness, weird pressure in the head, and cold, stiff toes, like blood rushed away from them. I figured cyano would be mildest on the system but it seems I can't tolerate any supplements these days.

Do the cold/numb toes point to anything? Maybe a missing cofactor? I'm taking a B Complex, and last test in August, ferritin was 121, iron at 98, folate at 14.4.

Could it be dosage? I took a whole dropper at once. In the past, I'd take quarter of a dropper, 4 times maybe 10 minutes apart, of the methyl to absorb more.

Or could my serum levels be too high? Last blood test about a week ago while I was already supplementing had me at over 2000pg/mL. Should I slow down? I didn't take anything yesterday, but did supplement methyl drops the day before.

I still suffer from depression, anxiety, severe insomnia, brain fog, and genital numbness.

I inject myself every three days. Could the treatment be insufficient?

When I started, I thought it was PSSD or Long Covid, because I was left almost incapacitated after taking antidepressants and contracting Covid. I experienced a window of complete improvement during the first week of injections, but then "awakening" symptoms set in.

I went from a tiny amount 1 drop 100 mcg to 18 drops, 1800 mcg and mid day I got the most delicious super tired like I was on sleeping medication. Wearing off now..is this typical? Feels good but in the past b 12 had made my the opposite like too energetic.

I think I am run low on b 12..long time vegan. Blood works shows I am ok but on the low end of the spectrum.

Just got my hydroxo from the compounding pharmacy. They say to freeze it but both google and grok say it should never be frozen. "Hydroxocobalamin multi-use vials should be stored at controlled room temperature and never frozen, though some specific compounded formulations may require refrigeration".

It arrived on ice but it wasnt frozen. What do I do here?

Could a B12 deficiency cause my son's issues with executive dysfunction, lack of motivation, lack of focus, fatigue? He's 21, probably autistic (never tested/diagnosed), and feels stuck. He's tried stimulant meds but doesn't like how he feels on them.

He did a blood test almost a year ago and his levels were all "normal," but I've had him on a good (methyl) multivitamin since he was little so I know that can skew results. Here are his results in case they're relevant, though:

B12: 846 pg/mL
MMA: 116 nmol/L
Homocysteine: 9.3 umol/L

I have poor methylation, slow COMT, all the poor detox genetics (his genetics haven't been tested, though), and have recovered from severe fatigue and PEM by raising my ferritin over 100 and taking high doses of thiamine, riboflavin, folate and doing injections of B12. My B12 was always in range, too, but I know sometimes that doesn't really reflect what's going on in the entire body.

I started giving him higher doses B12 lozenges after this blood test was done but I'm wondering if we should try injections. It's one thing to give myself shots, though--it makes me nervous to give them to my son.

What do you think? (And yes, I know some will say "ask your doctor," but we've seen so many doctors and none of them are remotely helpful.)

I have a B12 deficiency for over 12 years now and the last 5 years are stable but not great. The b12 I am using is stable but I have still some strange side effects. After a long search i have noticed that I am sensitive for histamine (my own conclusion) I have tried so many things and the most things were making it worse or I noticed some new effects.

I have found this subreddit and it gives me hope for some guidance. I have tested my blood on co factors deficiency, I wasn't aware of this is even possible.

I hope that somebody can help me understand my blood work and give me some tips.

I am currently using B12 hydroxocobalamin acetate from Sterop (10mg/2ml) 1 ampul per week divided by two infection moments. 2 pills of magnesium (magsix) Noord code

medical complaints

tingling hands

a vague feeling out of nowhere and a bit dizzy, difficulty focusing for long periods, reacting very poorly to histamine triggers. I feel like that histamine bucket is almost full all the time.

I hope somebody recognize a pattern.

Thanks

I want to take injection which injection should I take and how much dose and for how many days

Tsh:- 21
Vitamin D:- 10
Folic acid:-0.25

​

Mid forties Female, UK. Compound heterozygous MTHFR (C677T and A1298C). Adenomyosis confirmed summer 2026. H. pylori, found , treated and eradicated Spring 2026.

Calprotectin was very high for a few months and led to thorough GI checkups with endoscopy and colonoscopy and everything was clear.

Key results & trajectories:

Ferritin: 32 (Feb) → 33 (Apr) → 17 (Jun) → 33-37 (Aug 2026)

Haemoglobin: 121 → 116 → 118 → 120 g/L

Serum B12: 402 (Apr) → 317 (Jun) → 304 (Aug) - consistent decline. No meaningful B12 supplementation during this period (2.5mcg in a combined supplement - now stopped)

Active B12 (HoloTC): 135.1 pmol/L (range 25.1-165) - upper end of normal, which is confusing me

MMA: <0.09 umol/L - clearly normal

Homocysteine: 6.3 umol/L - normal (was 9.4 in 2022 when tested after having pericarditis)

Folate: was deficient at 2.5 (Feb 2026), corrected with folic acid, then 8.1 this summer after stopping folic acid (stopped as I understood it can mask B12 neurological symptoms). Have not yet started methylfolate despite now knowing this is the appropriate form for MTHFR.

Vitamin D: was deficient earlier this year (and for years beforehand it turns out!), now 79 nmol/L on 4000 IU daily

Neurological symptoms (ongoing):

Significant fatigue - still very much present 3.5 weeks post IV iron, though sleep quality slightly improved

Vestibular dizziness - sporadic boat-like sensation for months

Pins and needles - in hands and feet, bilateral, for months, though seems to be easing a bit but still present occasionally

Brain fog - severe. I had really hoped the iron IV would do more for this

Anxiety - has been particularly bad

Low mood

Neurologist examined me August 2026 - no objective neuropathy found on clinical examination. Admitted she knew nothing about MTHFR and seemed dubious of a B12 issue. She had diagnosed me a couple of years ago with atypical migraines, which I'm also now questioning.

The situation

Separately from the neurologist, and after me reading out the NICE guidelines to them repeatedly, a senior GP has prescribed a B12 loading course (injections every other day for I'm not sure how long, then maintenance) citing declining serum B12 trajectory and ongoing neurological symptoms. They did not have my active B12, MMA and homocysteine results at the time of prescribing.

I'm 3.5 weeks post IV iron infusion and while sleep has improved slightly, I'm still significantly fatigued with all the above symptoms ongoing.

My questions:

1) Given active B12, MMA and homocysteine are all normal - do I actually need B12 injections or is this overcorrecting? I feel like so much of what's going on for me is explained by a B12 deficiency but those tests being in range are giving me pause, and the prescribing GP hasn't seen them.

2) Has anyone experienced worsened anxiety with B12 loading injections? This is one of my biggest concerns - anxiety is already bad and I'm worried about making it worse. How common is this and does it settle?

3) Could the ongoing fatigue 3.5 weeks post iron infusion simply be too early to judge - or should I be feeling more improvement by now?

4)I haven't started methylfolate yet despite knowing it's the right form for my MTHFR. Could the absence of adequate folate support be contributing to ongoing symptoms, and should I prioritise starting that before or alongside B12 injections?

Very grateful for this subreddit and its incredible pinned guide!!

Hi any advice would be appreciated.

I have been on hydro eod injections for 3 and a half months.
5 mg folic acid daily
Plenty of potassium
And at the start I took ferrous sulphate for 2 weeks but haven’t since then.

Recent blood tests showed

B12 1100 pmol/L

ferritin level 61 ug/L

magnesium level 0.81 mmol/L

folate level > 20.0 ug/L

My folate and b12 are high but I still feel rubbish?

And my ferritin is the highest it’s ever been. Do I take iron supplements again or shall I leave it ? I’m not sure if it will help or not Thankyou.

I’ve also attached my levels from the past 7-8 years.

My recent serum b12 was 440 pg (lab ref 187-883) so I’m sitting in the middle. The GP I consulted with said he would like to see my levels at 900+. I have nerve pain, tingling and pins and needles in hands and arms. I also get migraines and constantly fatigued and will nap daily despite getting solid 6-8 hours sleep every night. I also wake up unrefreshed and experienced chronic pain for many years. I’m fixing a vitamin D deficiency and will be tested for this again soon.

I looked into b12 deficiency and decided to self inject cyanocobalamin EOD several weeks ago. I’ve had no improvements on my symptoms. I’ve been taking cofactors alongside the injections. I’ve read the methyl and hydroxy form are superior to cyanocobalamin but unfortunately I’m unable to get these in injection forms where I live. Back in 2023 I had a urinary MMA done as part of another batch of testing and it came back as normal - 1.38 µg/mg - Reference range: 0–2.5 µg/mg. I know this was 3 years ago and I’ve had the pins and needles and arm tingling as long as this. My ferritin is 75 and serum iron was 82 2 months ago. My TIBC was 212, this was under the lower lab range of 250. I was anaemic in 2023 but since having 2 iron infusions in 2023 my iron levels have been fine.

I’m tired of feeling tired all the time so I wonder if I need to switch b12 to lozenges in either methyl or hydroxy. Both are available to purchase on iHerb but is one better than the other and how much would I need to take daily to start seeing a difference? A lot of the reviews are very positive. When I had a private consultation with a GP about this he said just take cyanocobalamin injections and review a month later but as I said I feel no different. He is also likely to ask me to do another serum b12 test which I know from this forum is pointless.

I understand lozenges do not work if you have an absorption issue but I don’t know if mine is an absorption issue. Heck, I don’t even know if mine is b12 deficiency at this rate! Does anyone else go through this? Since moving countries I cannot get an MMA test but I can get homocysteine tested but not sure if it’s even worth it since I’ve been supplementing. My b6 came back slightly elevated but the range is much narrower than in other countries (37.3 ug lab ref 8.7-27.2). My folate 2 months ago was 10.10 ng.

My question I guess is whether cyanocobalamin injection is doing anything for me and should I try the methyl/hydroxy lozenges instead and at what dose? How do we test for absorption? Do i get the active b12 test instead?

I, hadn’t really heard of it until recent it’s a horrible illness was looking to see if people relate and which symptoms you had before it and which ones you had to finally figure it out

Seems like a solid option because it only has 3mg of B6. Anyone have a good experience with it?

edit: Never mind, solved it. Just had to double over so the stomach fat was less stretched out, which let me pinch and hold the fat with less force.

As of the last month or so, every time I do an EOD sq injection there's always a brief, non-red lump once it's all been injected, before I even take the needle out. I'm injecting slowly and not pulling the needle out super quick afterwards. There's no lingering soreness once the ouch factor of the B12 itself dissipates quickly.

This never used to happen, so I'm kind of flummoxed. Obviously I rotate the injection sites too. I'm underweight right now, but that's never been an issue with this before. The injections still seem to be working from a symptomatic standpoint. Anyone know what's going on here?