4 Forms of Vitamin B12 – Which one to take?


Know the difference between cyanocobalamin, methylcobalamin, adenosylcobalamin, and hydroxocobalamin?




Find out who would benefit from each type of B12 and which one should be thrown away!

Do you know which form of B12 is best to take? Find out! @drbenlynch


Full Transcript:

Hey, Dr. Ben Lynch here. Four types of B12. You’re confused. Yes. I know. Let’s clarify that confusion right now, shall we? Let’s start with the easy one, cyanocobalamin, garbage can. That simple. Cyanocobalamin is a synthetic form of B12 that you don’t want to be using in your patients. It’s cheap and it’s utilized but its demanding process to convert cyano into methylcobalamin and into ethylcobalamin. So, why take a nutrient that your patient has transformed using other nutrients in order to make it bioavailable and effective? Let’s not do that, right? Cyanocobalamin, garbage can. Stop using it.

Now, methylcobalamin, the kingpin. A lot of people are deficient in methylcobalamin. Why? Antacids. A lot of people are taking antacids. A lot of people are also vegetarians or vegans and they’re not eating the red meat. Methylcobalamin requires very good absorption and digestive system function, right? So , patients who have poor digestion or they’re taking antacids or both, and not eating red meat, or even eating red meat could be deficient in B12. So, you check serum cobalamin, it looks fine. That doesn’t tell you anything. Serum cobalamin is not a good marker. Look at MCV, MCH. MCV and MCH is elevated or borderline high, then you know that they’re B12 or folate deficient or both. Okay, methylcobalamin is very important. It’s ready. It’s ready to work. Methylcobalamin supports methylation, but it needs methylfolate in order to work. So methylfolate and methylcobalamin are in tandem to support methylation. That’s where I’ll stop on methylcobalamin.

Now, methylcobalamin needs also to be carried and it needs to be carried by transcobalamine. There are genetic issues that take your transcobalamin and help carry your methylcobalamin. Glutathione is needed to help that binding be stronger. So if your patient is glutathione deficient, and you’re giving methylcobalamin, and they’re still not getting a good effect, maybe they’re deficient in glutathione. So, support your glutathione levels.

Now, adenosylcobalamin, what’s that? Adenosylcobalamin is the fuel B12. It’s the kick starter. So if you give adenosylcobalamin to a patient who is tired and fatigued or who has exercise induced fatigue that’s too quick, it just doesn’t seem right to you that they run a quarter of a mile and they’re just hurting? Maybe they have a genetic defect or some enzymatic co-factor problem that converts methylcobalamin to adenosylcobalamin. That conversion occurs in the mitochondria, because adenosylcobalamin is a mitochondrial form of B12. So, check for it. And you can check to see if adenosylcobalamin levels are okay. How? You check urinary methylmonic acid which you know about. Oh, that’s what that’s checking. Yes, if you’re low on adenosylcobalamin, the patients’ methylmonic acid levels will be high or pushing high.

Hydroxocobalamin is the third one. It’s a third active form. And hydroxocobalamin is very useful to lower nitric oxide levels. Now another cardiologist thinks, whoa, whoa, nitric oxide is really useful. It is, in the right amounts. Too much causes radical issues in your patient, reactive oxygen species. So, we want to make sure that the nitric oxide levels are where they need to be. And you also need to also support them with glutathione and supraoxide dismutase as well. So, if you give hydroxocobalamin to lower the nitric oxide and your patient does better, that’s a sign that their nitric oxide levels are elevated and you typically see elevated nitric oxide in patients with chronic disease especially autoimmune disease or fibromyalgia or chronic fatigue. These things are known to drop nitric oxide levels and improve. The research is out there. So, those are three four types that you want to be focusing again. Again, cyano garbage can, methylcobalamin supports methylation, adenosylcobalamin supports energy, and hydroxocobalamin supports the reduction of nitric oxide and optimizes the levels. Thank you. I hope that’s useful for you.

Whoa! Wait, wait, wait. Sorry, I forgot about this. SHEICON2015, if you heard about it, you just enjoyed this video. I hope you’re excited about it. This information is very clinically relevant to you and your patients. SHEICON2015 is an upcoming conference in October that you can’t miss. There’s 400 like-minded people like me, like yourself, that want to know more about how to optimize the health of your patients. You got four days of it. You got 400 doctors who are wanting to get more information on this and do what they need to do and transform medicine and transform the health of your patient and transform your practice. SHEICON2015. You can do it. Learn more at SeekingHealth.org. Thank you.

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Comments 30

  1. This is terrific. Thank you very much for explaining all of this. People wonder why I never suggest cyanocobalamin, now I will simply tell them that cyano is Latin for “garbage.” Great stuff, Dr. Lynch.

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      1. I would add that Hydroxocobalamin should probably be used in those that are homozygous for CBS SNP as that would help with the excess methyl groups (SAME) when homocysteine is low? Correct me if I am wrong, but using Methyl-C in this case would probably not be as beneficial until the CBS issues are resolved?

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  2. If I’m MTRR ++ and one other MTRR +-, I know I need Methly-B12. Would Hydroxy-B12 not be good for me, or would it just not get used? I’ve read that Hydroxy B12 helps to detox cyanide. Would that function still work if I’m MTRR ++? I used to get B Shots before I knew I was MTRR++ so I was getting a lot of Cyanocobalamin, and my blood B12 levels were high, yet tests show I had a HIGH need for B12.

    I’m also NOS ++. So, would Hydroxocobalamin be bad for me if it were to lower my already low Nitric Oxide levels? And if I’m MTRR++, then maybe Hydroxocobalamin wouldn’t do much for me? Altough it seems to kinda help when I take your Hydroxocobalamin sublingual, at least it doesn’t seem to make things worse.

    You mention that Glutathione helps with methylcobalamin? I’m CBS++ but don’t have signs that it’s a problem. Normal Ammonia and Sulfur, etc… But a test I had showed I have a HIGH need for B12 and Glutathione. Both help me feel good.

    Being MTRR++ sounds like I might need both Methylcobalamin and Adenosylcobalamin, but I tried Adenosylcobalamin one time and it seemed too stimulating. Due to my methlyation illness I ended up with Adrenal Fatigue and I think the Adenosylcobalamin might make it worse? My adrenals are much better now a days but still healing. I haven’t tried Adenosylcobalamin in a while.


  3. Hello Dr. Lynch,

    I just found all my answers here which I am looking for until 4.5 years. Thank you so much for your all hard work and fun videos:)

    My son has a low glutathione levels and I couldn’t figure out what we can do. He needs 600mg glutathione daily. Oral glutathione is not works, skin creams not enough dose for us and I do not want to try IV glutathione because he is just 5 years old. We have been doing MB12 shots (methylcobalamin form) and we haven’t seen really good results. We saw some mild improvements like increasing energy, happiness and awareness.

    We are living with Autism (mild form) and our biggest problem is speech. My son is gifted about Math and he loves to talk. But talking like 1,5 years old (like mom come, I go school) Also, he doesn’t have MTHFR mutation.

    You are talking about, if person has a glutathione deficiency, methylcobalamin supplementation not works. We need your recommendations about glutathione supplementation. Which way is the best for increase glutathione levels?(oral, IV, cream, inhalation) How we can get appointment from you?

    Thank you…

    1. I didn’t find out about all this until I was in my sixties. So I have the advantage of being an adult aspie and a genius who had to do my own diagnoses and treatment plan. What I found was that I started having neuro/speech problems when these things got much worse. I found the main problem to be histamine intolerance, followed by oxalate intolerance. The histamine improved with diet but apparently the oxalate problems have been lifelong. Epson salts did not help as I can’t yet handle the sulfur. Instead I use marine magnesium, superior to regular magnesium. I have had nearly lifelong muscle spasms in my neck so severe that they pull my back out. This helps a lot but I still have problems. Recently I read that if you have an oxalate issue that you have a gall bladder problem. I do have a gb issue but it is not operable. It’s caused a pancreas problem so I’m taking straight bile and pancreas supplements from cows, plus several B6 and calcium whenever I ingest any minute oxalates and milk thistle SEED (I buy the seeds in bulk and grind them up with a coffee grinder) for the liver. Also you want to reverse the underlying gut damage from the food intolerances which can be quite the chore. I still am struggling but with lesser and lesser issues all the time and considering that I was developing what looked a lot like the dementia that killed my mom and that is all reversing, I can’t complain too much. These things are complex but keep working on it. I have yet to stop finding stuff and it’s been years. Also be sure to take probiotics not high in histamines (bifido infantis) to begin with. There’s supposed to be a probiotic that has anti oxalate properties, looking to try and find that next. Lastly if I have language issues it is ALWAYS due to something I ate and every single issue corresponds with gut problems. I hope this helps.

  4. Thank you for the usefull information. I never knew that untill now.
    I should specify: I am not a doctor; I am just an ovo-vegan (or is it ovo-vegetarian? – I’m not sure cause I’m not an native English speaker) who tries to take care of her health.
    I have a problem, though – and maybe you can clear this for me: You see, in Romania, there are no other supliments (as far asa I checked) than cyanocobalamin. In that situation, I cannot go to my doctor and ask for a prescription for B12 and get methylcobalamin, for instance. A friend guided me to an online site – but now, after reading your article, I am a little confused and not sure: how do I know which of the 3 “good” B12 forms should I purchase? I mean: should I start with methylcobalamin and, if that doesn’t work try adenosylcobalamin? Or (if it doesn’t work) should I try first methylcobalamin + glutathione ? And what about hydroxocobalamin? Should I take it ocasionally?
    So … my question actually is: how should a vegan proceed, if they do not have an informed physician they can appeal to?
    Thank you and God bless you!

  5. My son have high rates of B12 in the blood (and very low rates of lithium as well), and his physician, through genetic exams (23andme), has contraindicated methyl but prescribed the adenosyl form. Is that the right way to perform ?

  6. I am B12 deficient. I was given hydroxocobalamin in injection form to take. I had some really bad adverse effects from it. For four months, everything tasted like it was laced with salt. I didn’t know what the cause was in the beginning, and my doctors were treating me for throat infections. This messed me up mentally as nothing was tasting right.

    Can you recommend what I could use where I won’t have the adverse effect please?

  7. Where’s the research that shows the different forms of B12? Many people have questioned why cyano is bad and why they should supplement with other forms.

  8. My son has high homocysteine and cysteine levels and he has low threonine (he has autism) with the following genetic snps. What B12 should I use and should I give him 5mthf along with it? Very confused. Thanks for your help.

  9. I’m a pernicious anemia and graves patient and I had to fight to get methyl b12 from my doc. Finally found it on my own and also figured out I needed glutathione. I’m now studying Integrative Medicine due to my own journey with autoimmune.

  10. I was looking for info on dibencozide.

    It may be worth noting (from wikipedia):
    “Adenosylcobalamin […] is also known as cobamamide and dibencozide”

  11. My daughter has been taking B12 methylcobalamin, 1000 mcg about 1 or 2 daily.

    After taking the 23andme, we found she has both (COMT V158M and COMT H62H) homozygous ++, and (VDR Taq) heterozygous +/-, which seems to indicate B12 (Hydroxy B12 and Adenosyl B12).

    For the B12 methyl form, the tests indicate that my daughter (autoimmune hypothyroidism is under control) has MTHFR (C677T and A1298C ) and MTRR (A66G and A664A) heterozygous +/-.

    My question is should we try to alternate now, say the hydroxy and adenosyl B12 combination? This is perplexing issue and feel that perhaps even alternating by say “every other day switching forms”.

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      Dawn –

      One does not use supplements based on SNPs – that is misinformation. You use what is best for the person. If your daughter is doing well – that’s great. Leave it as is.

      I highly recommend you consider http://www.strategene.org and running her raw data through there. Then join our Facebook group. There you will get terrific support and learn a TON.

  12. My husband has Parkinson’s Disease and has difficulty walking but no hand tremors, which form of B12 should he take? We are using Methylcobalamin at this time. Thank you.

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  13. I take a b complex that has cyanocobalamin. Is this form actually BAD for me, or is it just ineffective? I’m just learning now about these four different forms, and haven’t yet searched for a b complex with the methyl- or adenosyl- form. If I can’t find an appropriate complex, would it be okay to take an additional supplement of the methylcobalamin or adenosylcobalamin? Or should I truly just throw away the B complex formula that contains cyanocobalamin? I’ve always wondered why I feel no energetic difference when I forget to take my B complex…

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      I believe cyanocobalamin is not a wise choice. Is it BAD? I am not sure – I have not studied it – but it certainly does not make any biochemical sense why anyone would want to ingest cyanide in any amount and then have the body transform it to something useful. I formulated a B Complex with methylcobalamin and adenosylcobalamin – it’s called B Complex Plus You will likely feel more energetic from this product compared to your other one. I use it only on days where I am ‘dragging’ or tired a bit.

      Most days I actually start my mornings with a smoothie using Optimal Prenatal Protein Powder – which has a solid amount of complete nutrition.

  14. There was a question about MTHFR mutations above, but no reply. Will a Methylcobalamin B12 shot be okay for someone with these MTHFR mutations?
    If I were to get that shot would I need to add extra methylfolate to be beneficial? You mention “Methylcobalamin supports methylation, but it needs methylfolate in order to work. So methylfolate and methylcobalamin are in tandem to support methylation.”
    Thank you!!

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      Hi Julie –

      If you have adequate methylfolate levels (by eating leafy green vegetables, taking some methylfolate in a multivitamin or other product), then taking methylcobalamin in isolation is ok. The body stores folate too – but it gets used up. Now if you get sunburned, stressed out, sick or not sleeping well, you’ll be using up more methylfolate to compensate and thus will likely need more.

  15. For someone with MTHFR C677T, diagnosed with (pots, lyme, fibromyalgia, chronic fatigue, Chlamydia-pneumonia)


    can one take all three or one then the other building up to all three, or using only one

  16. Hi. Looking for some information regarding my 82 year old mother in law. She has been diagnosed with cerebral atrophy and suffers from feeling “dizzy”. She is now suffering with short term memory loss and anxiety. I read that b12 supplements would be helpful. Which forms would be best for her. Sadly nhs offer no advice re supplements. Thank you

  17. Do you recommend b12 shots, i was at 220, nervous, so tired, not sleeping, started the shots, am uo to 610, sleeping better, but my legs still feel like jelly, nervous a little, how high do the numbers need to be

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