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Pernicious Anaemia Society
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Synthetic vs. natural B 12

Hello Community,

I found out my B level was low last week, during m annual check up I requested my B level to be done AND it's a good thing I asked because my level is quite low. For so many years I've had fatigue, dizziness when standing, exhaustion from simple activities,. I've also had bells Palsey and recovered completely after about 7 months, although when im in the cold that side of my face does get slightly numb.

Now that I know my B's are low I was told to take supplements, however after reading there is a synthetic supplement called cyanocobalamin and the natural methylcobalamin,,I want to make sure not to do any more damage by taking synthetic version.

Does anyone have advice regarding the synthetic vs natural? I've got an appointment with PC next week and will see what she says.. pretty sure they will suggest there is no difference between synthetic and natural.



19 Replies

The methylcobalamin you can buy is just as synthetic as the cyanocobalamin.

If taking them orally there's very unlikely to be any difference.


would the patch make any difference?

I'm new to this and just doing research now.

Thank you for your help :)


Hi zuli

A few questions so people here can help.

Are you in the UK.

Can you post your B12 and folate results with ranges - eg vit B12 111< (180 - 1000ugs)

Have you any neurological symptoms as this makes a difference to the treatment needed.


Hello beginner1,

I live in Maryland, USA.

My B12 is 294 (standard range should be 243 - 894 pg/dL)

My Folate is 16.85 (standard is 4.20 - 19.90 ng/mL)

Iron 74 ug, & Lyme test was negative

Hope this helps, besides the dizzy spells and weakness, I do sometimes mixup my vocabulary words, I'm in University and have a lot of reading to do, I find myself forgetting what Ive Just read, lol maybe that from have too many books to read. Hopefully once I start the vitamins these symptoms may subside.

Thanks again! :)

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The 'experts' will be along to give you their advice (I'm not one of them.) There are several people who come from the USA too who will know the protocols.

Good luck and give my love to Maryland - I lived there for six years, Silver Spring near DC.


zuli, there is a lot of hype about how wonderful methylcobalamin is because it is more natural - as fbirder says it is actually just as synthetic as cyanocobalamin in terms of creating the tablets etc.

The 'claim' to be natural comes from the fact that there are two forms of B12 that are actually used by processes that go on in your cells and keep you healthy - methylcobalamin and adenosylcobalamin, so the assertion is that your body needs to do less processing if you take methyl rather than cyano but actually the processes that allow you to extract the B12 and use it in cells are a lot more complicated than that simple assumption - there's a lot of binding with other proteins and breaking bonds going on in cells to actually build the methylcobalamin and the adenosylcobalamin in individual cells so the assu timption that methyl must be best because it is the form used in the cell isn't correct.

There have also been some genetic variants that have been identified that mean that some people can actually be unable to convert methyl to adenosyl meaning that just taking methyl would leave them without the adenosyl form so those processes won't work. The same isn't true if the form taken is cyanocobalamin/hydroxocobalamin.

There is only one condition that would contra-indicate the use of cyanocobalamin - lebers - which is a particular genetic sensitivity to the cyano/cyanide element of cyanocobalamin*. This condition is very rare and mainly affects males.

*this element of the cyanocobalamin molecule is very tightly bound to cobalamin and quite difficult to break - it is also a very small element of the B12 molecule so doesn't pose a toxicity risk.

Whilst high dose oral can be effective for some people who have B12 absorption problems it doesn't work for everyone. Injections will be a much more effective way of raising levels initially and oral may then be a good and effective way of keeping the raised.

Basically, form of delivery of B12 that is effective and the type of B12 that works best for an individual varies a lot. The only way to be sure what is going to work for you is generally trial and error - try a regime and see if it works - if it doesn't then try something else until you find something that works.

Having said that though recovering from an initial deficiency is also something that varies from person to person - dependent on what systems have been most effected by the deficiency - if you had macrocytic (larger rounder red blood cells) that will take a few months to clear - other symptoms may be much quicker - others may take much longer.


Hi Administrator,

I really could use your help . This post was very helpful but I'm missing some keynote information . Is there a resource where I can read more and understand the absorption differences? Currently I take methylcobalamin shots I ordered from the Uk that I don't feel a thing. Do you have any other resources where I can get a more appropriate form for absorption like the cyanocobalamin/hydroxocobalamin? Also, I'd like help with clearing my macrocystic cells.

Thank you !



not sure where you are based - B12 is generally defined as a vitamin and often isn't a controlled substance - just that injectable forms often get caught up in regulations surrounding injectable medications.

Suggest you look back through other posts for info on sourcing non-injectable B12 - try using the search feature - which is at the top on the right hand side if you are using a browser- not sure where it will be if you are using a phone.

Your body will just clear macrocytic anaemia over a period of months - new red blood cells will be healthy but they only replace old ones as they wear out - red blood cells live for around 4 months. This may mean that you need both folate and B12 if the anaemia was caused by both - or only folate if the anaemia is caused by folate alone.


Thanks. What test do I do to find out of its more folate or b12? My doc just saw all this on a basic CBC. I understand you have to not b supplementing for a long while to test b12 accurately. Is there any alternative to this testing-wise ?

I've used a Jarrow product called B-Right & it really was effective for me taking 1mg dose daily but gave me serious niacin flush, so had to discontinue . I now am on the search for another noninjectable .

But b12 is a controlled substance in that it's not a whole food nor full spectrum vitamin, but I see what you are saying with injectable meds.

I guess I forgot to mention I do have a hydroxicobalamin I did try that was injectable and it did nothing. Could be my folate level is off. ? I'd like to test this in some way to know for sure .

Thanks again.



MMA test would show if you don't have enough B12 at cell level.

B12 symptoms tend to develop very slowly - folate comes on much more quickly.

real issue is whether you have an absorption problem and if so what that is.

Not aware of any conclusive tests


Thank you kindly!


Hello Gambit62,

I'll try the patch and see how that works, Thank you for the insight!! :)

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Zulu there is a difference but I suggest you go on line and read about it as I am not certain where you live and there are differences in recommendations from country to country.here in the US cyanocobalomine is prescribed the other is considered more potent but I don,t know wether UK use it in preference. The first contains a microscopic amount of cyanide hence the name.as some of us have been on it for decades it is negligible.


Zuli lives in Maryland USA.


beginner1, I live in North Potomac, about 25 min. Northwest of where you lived. I'm glad you have fond memories of my state .what a small world it is..


We had a wonderful time there, travelled across country via places like Yellowstone to California twice. I still have friends there that I Skype.

PS. Just across Georgia Avenue! My son used to live in Olney not far away either.

PPS. Silly me - I mean Rockville Pike it's 2.45 am here and I should be asleep.


UK uses hydroxocobalamin as does most of europe.


The B12 I bought over the counter in Germany was cyanocobalamin. I just asked for B12 ampoules and that's what they sold me.


Pingo , Germany has one of the largest chemical industries in the world and probably makes most of the worlds B12 of whatever form - they make cyano and they make hydroxo and they sell both - pharmacies provide both - it isn't a prescription only medication in germany. cyano is a little cheaper than hydroxo (it's slightly easier to make) so that was probably why the type offered was cyano.

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