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Methylmalonic Acid testing

Messages
54
Location
Montreal, Canada
Is this supposed to be done on blood or urine for the best indication of B12 deficiency?
Mine was done on blood , and was OK, but now I keep seeing references to urine MMA.
 

Xara

Senior Member
Messages
135
Location
The Netherlands
Is this supposed to be done on blood or urine for the best indication of B12 deficiency?
Mine was done on blood , and was OK, but now I keep seeing references to urine MMA.

Hi Branston,
Here’s what I know:
Urine MMA, is better, i.e. more reliable, although not everybody seems to agree. In spite of being more reliable uMMA occasionally gives a false-negative result.
MMA and uMMA can show but not rule out a shortage of adenoB12 in tissue.
Hope this helps.
 
Messages
54
Location
Montreal, Canada
Thank you Xara. My Blood MMA was normal..... but I have high MCV (107) low platelets and RBC. I also have MTHFR gene C677T +/+. Trying to figure out whether Folate or B12 is the real problem.
 

Xara

Senior Member
Messages
135
Location
The Netherlands
Hi Branston,
My blood MMA was normal too, my serum B12 was too low (119) and I am C677T heterozygote (+/-). MCV was normal.
Trying to figure out whether Folate or B12 is the real problem.
Depends on your complaints (symptoms). It might be something else, it might be both, so folate AND B12 - not folate or B12.
In case you still think about folate OR B12:
If you ask me, you could try B12, depending on your symptoms. (Please, do not take cyanoB12.) But when thinking about folate: in case of a B12 deficiency/insufficiency I would definitely not take methylfolate/folic acid without taking B12. And start with B12 FIRST, then introduce folates - not the other way round.
You'll find in this section of Phoenixrising lots of info, but have you seen the site of dr Ben Lynch (mthfr.net) too? And have you seen the thread about the B12 documentary?:
http://forums.phoenixrising.me/index.php?threads/b12-documentary.21478/
Good luck.
 

Freddd

Senior Member
Messages
5,184
Location
Salt Lake City
Thank you Xara. My Blood MMA was normal..... but I have high MCV (107) low platelets and RBC. I also have MTHFR gene C677T +/+. Trying to figure out whether Folate or B12 is the real problem.

Hi Branston.

High MMA indicates that a that you have too many unworking mitochondria breaking partway through the process of making ATP. High MCV at 107 is genuonely serious. It is caused most directly by low L-methylfolate and low MeCbl and possibly low p5p.

If I were in your shows, I would start titrating AdoCbl and MeCbl and L-methylfolate until methylation startup occurs, then balaqnce out the resulting induced deficiencvies which are most often potassium and L-methylfolate but could be any number of cofactors. If you get to a reasonable amount of all three items and no startup then other items need to be tried. My ex-wife called me yesterday and said "Your going to laugh. I have low b12 with high MCV with macrocytic anemia." She came over and started with three 1000mcg MeCbl, about the same in AdoCbl, 1600mcg of methylfolate and some l-carnitine. She had startup in 2 hours and said that was the best she felt in 6 months. She also had edema, asthma, brand new allergic responses and all that it was clearly both l-methylfolate and MeCbl. The doc prescribed folic acid and CyCbl which while over the counter lets her buy them sales tax free here.

As fixing those problems requires at least MeCbl and l-methylfolate and will likely require ATP support as well and will almost certainly cause low potassium you should be prepared. If you have chronic anxiety and panic and such, avoid carnitine (LCF) until you get other things going.

Fixing these problems how ever you do it is at your own risk as well as ignoring them is at your own far more severe risk. The best results are likey to be obtaind with the active cobalamins and l-methylfolate. Anything else has a much more substantial chance of failing. Both B12 and folate would normally be given for this. You are seriously deficient to have MCV = 107. Fixing it is urgent. Each day you delay there could be more neurological damage. Thios has clrarly been going on for some time. It can't happen overnight.
 
Messages
54
Location
Montreal, Canada
Hi Branston.

High MMA indicates that a that you have too many unworking mitochondria breaking partway through the process of making ATP. High MCV at 107 is genuonely serious. It is caused most directly by low L-methylfolate and low MeCbl and possibly low p5p.

If I were in your shows, I would start titrating AdoCbl and MeCbl and L-methylfolate until methylation startup occurs, then balaqnce out the resulting induced deficiencvies which are most often potassium and L-methylfolate but could be any number of cofactors. If you get to a reasonable amount of all three items and no startup then other items need to be tried. My ex-wife called me yesterday and said "Your going to laugh. I have low b12 with high MCV with macrocytic anemia." She came over and started with three 1000mcg MeCbl, about the same in AdoCbl, 1600mcg of methylfolate and some l-carnitine. She had startup in 2 hours and said that was the best she felt in 6 months. She also had edema, asthma, brand new allergic responses and all that it was clearly both l-methylfolate and MeCbl. The doc prescribed folic acid and CyCbl which while over the counter lets her buy them sales tax free here.

As fixing those problems requires at least MeCbl and l-methylfolate and will likely require ATP support as well and will almost certainly cause low potassium you should be prepared. If you have chronic anxiety and panic and such, avoid carnitine (LCF) until you get other things going.

Fixing these problems how ever you do it is at your own risk as well as ignoring them is at your own far more severe risk. The best results are likey to be obtaind with the active cobalamins and l-methylfolate. Anything else has a much more substantial chance of failing. Both B12 and folate would normally be given for this. You are seriously deficient to have MCV = 107. Fixing it is urgent. Each day you delay there could be more neurological damage. Thios has clrarly been going on for some time. It can't happen overnight.


Thank you Freddd. My MCV always ran at around 100.... I had a diagnosis of CFS, and knew that I had low intracellular B12 and Glutathione 10 years ago, but never knew why. Now i understand that it is because I have MTHFR C677T +/+ and MTRR +/+, plus a few others.

5 Years ago I was diagnosed with Hemochromatosis and had a series of Phlebotomies to reduce my iron stores. At the end of de-ironing the MCV is supposed to fall by about 5%, and that is what happened initially, coming down to 96, but then gradually started to creep up again. Obviously the repeat Phlebotomies added to the B12 and Folate deficiencies.

I also have Chronic Chlamydia Pneumonia Infection. The CPn is an intracellular bacteria which interferes with ATP and causes Secondary Porphyria and antibodies that cross react with B12, causing B12 depletion. Also, i have been taking N-Acetyl cysteine ( to kill the Elementary Body phase of the CPn ) 2400mg for 18 months, and I have discovered that this can cause useful mB12 to be converted to Glutathionylcobolamin, and be excreted.... causing B12 depletion.

10 months ago I got the Methylation Panel from Vitamin Diagnostics done, and also the Yasko gene test.
Based on these results, and after talking with Rich, I started the Simplified methylation protocol, but because of VERY strong metallic taste had to keep the doses quite low to start with. I was taking Folapro, AdB12, HB12 and a bit of mB12

After 6 months, my MCV was still 107, and i had come across Freddd's argument that some people need much higher doses. I discovered that Dr Charles Stratton ( CPn expert ) tells his patients they may need 30mg mB12 a day !!
So I have quit taking the N-Acetyl cysteine. Have doubled the 5MTHF to 800mcg twice a day, with food. Am also taking AdB12 2,000 mcg and around 20-30mg of Methyl B12.

I don't know what to do to support ATP..... i don't understand what you mean by that. I don't have chronic anxiety.... do I need to start L-carnitine?

Potassium i was taking 99mg twice a day..... have increased that to 3x99mg twice a day. have no idea if that is the right amount.
 

Freddd

Senior Member
Messages
5,184
Location
Salt Lake City
Hi Branston,

I'll address the potassium first. If that goes low and you start having nausea, and itching andheart palpitations, and weakness and muscle spasms pop you out of bed in the middle of the night you will KNOW that you have low potassium. Often it comes on hard and makes you feel sick. The more subtle onset is a tougher call but not likely to need much. If healing turns on potassium often goes low on day 3 or so. Try 3 or 4 tablets with a large glass of water. If that releives a lot of the discomforts, then you have nailed it. Then you may want to try increasing the frequency of doses. That is to say 2 tablets 5 times a day is much more effective than 10 tablets once a day or 5 tablets twice a day. Smaller doses tend to be less irritating of the stomach.

What kind and how are you doing the MeCbl? Not all MeCbl is created equal. The best is rare, perhaps 1 in 10 or 20 brands. Same with injectable, qualitative effects are all over the map and change from batch to batch of crystal the pharmacy starts with. Then expsoure to light can ruin it either during prep or drawing and injecting..

NAC might have been canceling out everything you were trying to do.

The L-carnitne fumarate is often most effective but a few people find ALCAR most effective. Many have found that the brands that buy the Sigma Tau carnitine from Italy (Jarrow and Drs Best at least, in the USA) are most effective. A lack of LCF can stall ATP production.

Once a person gets healing started, there are lots of clues to follow. Getting it started is difficult sometimes. Usually it is a matter of working throufgh all the things that generally might prevent healing startup. That full list is near the beginning of this thread. http://forums.phoenixrising.me/index.php?threads/the-stages-of-methylation-and-healing.21725/page-1

Do some reading. Of course everything you do or don't do is at your own risk. As the problem isn't corrected yet the right combination does not appear to have been found. It sounds like you are on the track to get things started becasue all the impediments can probably be worked through.

One thing I will say is that if you are not using the Enzymatic Therapy MeCbl, at least to get things started so you have a standard basis of comparison, you might wanrt to get some of that if you haven't been using that brand.

My ex-wife had more than a $1000 worth of tests plus a chest x-ray (new onset asthma, not unusual with onset of methylblock). The doc got it right with b12 and floate deficiencies. It's just that he prescribed folic acid and CyCbl. I know from previous testing and experiences that she has had lifelong folate problems. Her doc years ago when Metafolin was prescription only wanted her to take that but it was too expensive. Her current doc doesn't know that and of course there is no continuity of records yet. So I helped her get off to a good start.

She had a "viral" infection never identified the end of last summer, the same time I had the crash form the changed Jarrow. She has never recovered from it and been going downhill ever since. I don't know how high her MCV is yet because they called her with some urgency and said to get started immediately and the paper results would follow.

What surprised me is how hard and fast it came on from genuiely normal MCV to frank macrocytosis in 6 months and extremely low serum cobalamin. As with you first the correctable situations need correcting and later perhaps we can figure out why it happened.

Good luck and good health.
 
Messages
54
Location
Montreal, Canada
I started off using Holistic Heal ( Amy Yasko's ) adB12 and HB12 drops and the Jarrow's mB12... ... and now will order the AOR brand from Canada. Also use Metagenics Folapro.

You might want to check out Chlamydia Pneumonia infection also as an association with adult onset Asthma following a so-called "Viral" infection. The associated B12 deficiency can be quite abrupt and severe.................as i have discovered.
Check out www.cpnhelp.org
Poor Mans CPn test : http://www.davidwheldon.co.uk/NAC.html
 

Freddd

Senior Member
Messages
5,184
Location
Salt Lake City
I started off using Holistic Heal ( Amy Yasko's ) adB12 and HB12 drops and the Jarrow's mB12... ... and now will order the AOR brand from Canada. Also use Metagenics Folapro.

You might want to check out Chlamydia Pneumonia infection also as an association with adult onset Asthma following a so-called "Viral" infection. The associated B12 deficiency can be quite abrupt and severe.................as i have discovered.
Check out www.cpnhelp.org
Poor Mans CPn test : http://www.davidwheldon.co.uk/NAC.html

Hi Branston,

You might want to check out Chlamydia Pneumonia infection

Very Intersting. Thankyou. I knew this was a possiblity and I was actually diagnosed with a chlamydia sore throat and respiratory complications one time decades ago. I have also needed extended multi antibiotic treatments. It all sounds so familair. This looks like something I had at least once long ago. The doc at the time mentioned how rare it was, then at least.