Based on your symptoms and blood test results, starting a vitamin B12 supplement is a reasonable consideration since your vitamin B12 levels are on the low side. Here’s a breakdown of the main types of B12 supplements and their benefits:

Types of Vitamin B12

1. Methylcobalamin and Hydroxocobalamin: These are two popular forms of vitamin B12 used in supplements. Methylcobalamin is often recommended because it’s one of the active forms that the body can use directly. Hydroxocobalamin, on the other hand, is a form that is naturally occurring in foods and is often used in medical supplements due to its longer stay in the body¹.

2. Cyanocobalamin: This synthetic form is commonly used in supplements and tends to be well-absorbed, but it needs to be converted into an active form by the body².

Benefits of Vitamin B12

Vitamin B12 is essential for maintaining nerve health, supporting the formation of red blood cells, and facilitating DNA synthesis³. It's also been suggested that supplementation with B12 can help alleviate symptoms like fatigue, weakness, and neurological issues, which match some of your symptoms³.

Vitamin B12 and Acne

Some reports suggest that high doses of vitamin B6 and B12 can potentially trigger acne in susceptible individuals⁴. However, this effect can vary greatly from person to person. It might be beneficial to start with a moderate dose of B12 and monitor your skin condition⁴.

Vitamin B12 Complex with Folate

Combining vitamin B12 with folate (B9) can be beneficial, especially if your folate levels are low or borderline insufficient, as they work synergistically in the body⁵. Folate deficiency can also contribute to health issues and combining supplements can help in addressing potential concurrent deficiencies⁵.

Given your current folate level of 3.2 µg/L, which might be considered on the lower side of the normal range, taking a B12 complex with folate might be advantageous⁵.

Recommendations

• Form: Starting with methylcobalamin or hydroxocobalamin is often recommended for better absorption¹².
• Combination: Consider a B-complex that includes folate, especially since it can enhance the functional use of B12 in the body³⁵.
• Monitoring: Since B12 can sometimes cause acne, consider starting at a lower dose and gradually increasing, while monitoring your skin's response.⁴

It would be best to discuss this with a healthcare provider to determine the appropriate dosage and combination based on your medical history and current health status.

Footnotes

1. Vitamin B12 in Foods, Food Supplements, and Medicines—A Review of Its Role and Properties with a Focus on Its Stability, PMC. ↩ ↩²

2. Efficacy of supplementation with methylcobalamin and cyancobalamin in maintaining the level of serum holotranscobalamin, PMC. ↩ ↩²

3. Vitamin B12: MedlinePlus Medical Encyclopedia, MedlinePlus. ↩ ↩² ↩³

4. Acne related to dietary supplements - PubMed, PubMed. ↩ ↩² ↩³

5. Folate and vitamin B12: function and importance in cognitive development - PubMed, [PubMed](https://pubmed.nc ↩ ↩² ↩³ ↩⁴