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A report from the Framingham Offspring Study of 2,999 adults found the following average daily B12 intakes, including fortified foods and supplements (Tucker, 2000): Age 26-49: 8.9 g Age 50-64: 8.7 g Age 65-83: 8.5 g A 2015-2016 National Health and Nutrition Examination Survey of over 4,500 adults 60 years and older found the following average daily B12 intakes (USDA NHANES, 2019): Male non-supplement users (68% of men): 4.5 g Male supplement users: 5.3 g from food plus 326 g from supplements Female non-supplement users (63% of women): 3.6 g Female supplement users: 3.8 g from food plus 520 g from supplements European Food Safety Authoritys Recommendations In 2015, the EFSA released recommendations for B12 intake across Europe

Heres how they work together: Folates role: Dietary folate converts to 5-MTHF (active folate) via the MTHFR enzyme 5-MTHF donates a methyl group to homocysteine This requires B12 as a cofactor for the enzyme methionine synthase The result: homocysteine converts to methionine B12s role: B12 (as methylcobalamin) acts as a cofactor for methionine synthase It helps transfer the methyl group from 5-MTHF to homocysteine Without adequate B12, folate gets trapped and cant donate its methyl group This is called the methyl trap What happens when one is deficient: Low B12 with adequate folate: Folate cant function properly (methyl trap) Homocysteine rises despite good folate levels Methylation slows down Can mask B12 deficiency symptoms initially Low folate with adequate B12: Not enough methyl groups available for donation Homocysteine rises Methylation impaired DNA synthesis affected Both low: Severe methylation impairment Very high homocysteine Anemia (megaloblastic) Neurological damage risk Why MTHFR mutations affect this partnership: With MTHFR mutations: Your body cant efficiently convert folate to 5-MTHF This creates a bottleneck in the methylation cycle Even with adequate B12, you dont have enough active folate to work with it Result: elevated homocysteine, poor methylation The solution: Bypass the MTHFR bottleneck by taking pre-methylated folate (5-MTHF) that doesnt require conversion

If several of these sound like you, it may be time to explore b12 injections for tiredness and weakness with a trained pharmacist

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