Choose methylcobalamin if: You have confirmed MTHFR mutations Elevated homocysteine levels Neurological or mood symptoms You tolerate methylated supplements well Choose hydroxocobalamin if: Sensitive to methyl-B12 (anxiety, insomnia) Histamine intolerance or MCAS Need gentle, balanced B12 support Want detoxification benefits Choose adenosylcobalamin if: Chronic fatigue is your primary concern Mitochondrial dysfunction Want to combine with methyl-B12 for comprehensive support Consider combination formulas: Many practitioners recommend combining forms: Methyl-B12 + Adeno-B12 (methylation + energy) Hydroxy-B12 + Adeno-B12 (gentle + energy) All three forms for comprehensive support The bottom line: For MTHFR mutations, methylcobalamin is typically most effective for supporting methylation and lowering homocysteine
The Journal of neuropsychiatry and clinical neurosciences, 24(1), 5-15
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Then, we'll review your medical history, looking at things like your diet (especially if you're vegan or vegetarian), your age, any stomach or gut conditions, past surgeries, and even the medicines you take, like metformin or proton pump inhibitors, which can sometimes affect B12 levels