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Pernicious Anaemia Society
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Can't tolerate Methylcobalamin, should I not take Methylfolate??


So I was diagnosed B12 deficient two months ago, I had the loading doses and now self inject Hydroxcobalamin every 3 days. I had tried Methylcobalamin sublinguals and patches and did not have a good reaction to either! I had major anxiety from both so now I just stick to Hydrox.

I have low folate (not low enough for prescription folic acid but still on the lower end). I want to supplement and keep reading about how it is NOT good to supplement with synthetic folic acid & I should be taking methyfolate instead, but I'm just wondering if this is a good idea considering my reaction to methylcobalamin?

I have done a 23andme test but the results are going to take atleast another 4-8 weeks :(

Thank you

5 Replies

There's little point in choosing methyl folate over folic acid unless you have problems with methylation, which is fairly uncommon. However, you may prefer to take methyl folate, just in case.

I doubt that a sensitivity to methylcobalamin would mean that there would be a problem with methyl folate.


I have been using folic acid with good results. It's cheap and easy to find. You could try it and see if it works for you and then adjust if you feel you need to.

(I am now trialling some methylfolate as I'm having trouble metabolising the B12 I'm taking but that may be due to other cofactor problems).

I'd recommend you take a good multivitamin and mineral supplement and make sure you get enough of the specific cofactors, especially potassium, magnesium and iron too.


Hi sami0x,,

You don't say why you or the doctors think you are b12d but if you Google "Folate rich vegetables" you'll get lists like this:-

Spinach, turnip greens, bok choy, parsley, and romaine lettuce are all rated by our system as excellent sources of folate. Other vegetables can be strong sources as well, and we see asparagus, cauliflower, broccoli and beets join the excellent group. We also see a number of the legumes do very well for this nutrient.

B12 can only be sourced naturally by eating meat, fish & poultry including eggs so unless you are vegan, vegetarian or medically or "mechanically" unable to absorb it through your stomach perhaps increasing these foods will help. (I understand caviar is wonderfully high in b12).

I am not a medical person and there are others on here that will give you more qualified advice.

I wish you well for the future


The EFSA have published quite a detailed report on recommended upper daily limits - which includes folate.


I think there have been some updates but they haven't affected the actual guidance.

The main reason for setting an upper limit for folic acid is the effect that high levels of folate have in counteracting macrocytosis - one of the results of B12 deficiency but not necessarily one of the first to materialise. Personally I think this isn't entirely thought through as it perpetuates the reliance upon macrocytosis as a way of diagnosing a B12 deficiency and is an excuse for GPs not being aware of the full breadth of symptoms and looking for all of them ...

Methylated forms of folic acid get a lot of hype. In theory they require less processing by the body but as fbirder says this is only really a factor if there are genetic factors going on that affect the bodies ability to methylate folic acid. The exact nature of the problem depends on which gene sequences are affected, and for some combinations artificial methylated forms of folate can actually cause problems rather than solving them.

If I was you I'd try folic acid and see how you get on eg try 400mcg and see how that goes - then you can try increasing it if you feel you need to.

1 like

You need folates to use up the b12 . Forget the folic acid and try methylfolates . You could go au naturelle and eat raw cabbage and kale , almonds , walnuts , watercress for your folate requirement .


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