I appear to have a type of "methylmalonic acidemia" which I find is much improved when I take adenosylcobalamin but not so improved with methylcobalamin.
Of course, in these genetic diseases it's hard to know which specific pathways are disrupted and, unfortunately, this means one cannot always assume normal metabolic processes are taking place. I believe in normal metabolism adenosylcobalamin and methylcobalamin can be converted into the other. Do you know if this conversion is normally for very minor amounts? I am trying to understand my strong metabolic preference for adenosylcobalamin.
Methylmalonic acidemia can result from inherited genetic defects which affect one of the several enzymes involved in processing of B12 within the cell, or simply from B12 deficiency with no inherent problem with these enzymes. The former situation usually results in much more serious problems, though there are degrees of severity even with these inborn errors of metabolism, depending how badly the relevant enzyme is affected by the genetic mutation.
Methylmalonic acid (MMA) accumulates when the enzyme methylmalonyl CoA mutase (MCM, encoded by the gene
MUT), which uses adenosylB12 as cofactor, is not functioning well. This enzyme catalyses the transformation of methylmalonyl CoA to succinyl CoA, which in turn feeds into the Kreb's cycle. Methylmalonyl CoA is formed from the breakdown of odd chain fatty acids and some amino acids, which produces MMA, combined with CoA.
When the enzyme is not functioning well and so succinyl CoA is not being formed at a normal rate, increased amounts of the substrate MMA appear in the urine.
Since no other metabolic pathway produces MMA, measurement of this metabolite in either serum or urine is also used as a functional test of B12 deficiency.
Specific genetic testing would be needed to determine if a genetic mutation were responsible for the accumulation.
In the post immediately before yours, I gave a link to a detailed post explaining the complexity of intracellular processing of B12 and the different enzymes involved.
I also indicated that according to what is known about this processing, the form of B12 taken shouldn't matter, yet in practice, the form taken has been found to make a difference, at least for the large amounts used in treating children with genetic defects in B12 metabolism.
This suggests alternative pathways for processing B12 which are not understood.
In your own case, you appear to respond better to the adenosyl form. As far as I am aware, the reason for this different response is unknown.
If this form helps you, keep taking it.