There is no question that maintaining optimal vitamin B12 level is crucial for keeping homocysteine at an appropriate level.

Unfortunately, vitamin B12 is one of the most common nutrient deficiencies I see. In fact, I see it on a near-daily basis.

The main reason so many people are deficient of vitamin B12 is because the molecule is so large, and our ability to absorb it declines with age. Because vitamin B12 is such a large molecule, the best way to supplement is via injection. I teach many of my patients to self-inject it.

If you are going to use vitamin B12, I suggest natural forms. The hydroxocobalamin form provides the most consistent positive clinical responses. For the vast majority of people, it works better than the other natural form — methylcobalamin — even in methylation-impaired patients.

If you are going to use oral forms of hydroxocobalamin, I suggest using 1 mg (1,000 mcg) daily. If you are injecting it, I usually have my patients inject 1 mg twice per week and more during periods of illness or stress.

I do not recommend using synthetic vitamin B12, also called cyanocobalamin, in any form. There is no toxicity with vitamin B12.

More information about vitamin B12 can be found in my book, Vitamin B12 For Health.