What is the best test for B12 status?

[Patrick H]

I'm reading about paradoxical deficiency and MMA and OAT. What would be the best test or tests to determine true B12 status?

 

[Methyl90]

I firmly believe in the MMA test because the serum test (at least in my case) indicated really high values (a sign, however, that it is not absorbed at an intracellular level).

In the absence of MMA, consider elevated serum values as a sign of 100% deficiency.

 

[2manyhobbies]

I've read, Sherry Rogers I think, that the MMA test is pretty much the gold standard for B12 sufficiency.

 

[SlamDancin]

@Methyl90 I have high serum b12. Not sure about MMA. If it’s not being absorbed intracellularly than supplementation shouldn’t make a difference right?

 

[Patrick H]

Ok thanks for the answers. @Methyl90 would urine MMA be superior?

 

[Methyl90]

@Methyl90 I have high serum b12. Not sure about MMA. If it’s not being absorbed intracellularly than supplementation shouldn’t make a difference right?

Take a hair mineral test and look for lithium ... it's critical for B12 absorption.

 

[Methyl90]

Ok thanks for the answers. @Methyl90 would urine MMA be superior?

I've never done this in urine but if you get the chance you can do both.

 

[SlamDancin]

Take a hair mineral test and look for lithium ... it's critical for B12 absorption.

Thanks I just started taking Lithium Orotate not too long ago actually

 

[Shanti1]

Urinary MMA or serum MMA can pick up on a deficiency much earlier than serum B12. Additionally, a while back I got to view a series of tests where individuals had elevated serum B12 while the MMA indicated B12 deficiency. Here is an example:

Note: High MMA indicates B12 deficiency, The MMA-Normalized is the marker to pay attention to.

Although creatinine was low in the labs above, the chem screen showed normal kidney function.

What is interesting is that I had visibility to follow up in 3 of these cases and the addition of adenosylcobalamin normalized the MMA. These individuals were only taking high doses of methylcobalamin.

You can see in the image below that adenosylcobalamin is responsible for lowering MMA. Theoretically, any form of B12 you take should be able to convert intracellularly to other forms, however, case reports on this forum and in the 3 individuals mentioned above indicate some individuals may need to supplement with adenosyl.

 

[Shanti1]

Here is one of the 3 cases (posted with permission) demonstrating a need to take adenosylcobalamin in addition to methyl to control MMA

Labs are from a vegan male:
For the labs below, he was taking 500mcg cyanocobalmin every 10 days, MMA shows B12 deficiency, serum B12 is normal.

It was suggested he take 1000mcg of Methylcobalamin daily
Labs 1 year later while still on methycobalamin:

It was suggested he add adenosylcobalamin to the methylcobalamin (amount was not specified)
Labs one year later show MMA was normalized on both methyl and adenosyl (serum B12 not measured)

 

[Methyl90]

@Shanti1 Currently I fully agree on the use of Adenosylcobalamin for lowering MMA. This is what I learned from following and applying User Fred's Tips.

 

[Patrick H]

I've never done this in urine but if you get the chance you can do both.

Ok thank you

@Shanti1 Very helpful info, thank you