Methylmalonic acid (MMA) is a substance produced in very small amounts and is necessary for human metabolism and energy production. In one step of metabolism, vitamin B12 promotes the conversion of methylmalonyl CoA (a form of MMA) to succinyl Coenzyme A. If there is not enough B12 available, then the MMA concentration begins to rise, resulting in an increase of MMA in the blood and urine. The measurement of elevated amounts of methylmalonic acid in the blood or urine serves as a sensitive and early indicator of vitamin B12 deficiency.
If elevated, it reflects insufficient Vitamin B12.
Common symptoms if low B12:
- Fatigue,
- poor memory,
- brain fog,
- unsteady gait,
- numbness, tingling,
- and depression
Medications that interfere with or decrease B12:
- H2 Blockers and PPIs for acid
- Metformin/Glucophage
- Birth Control Pills
- Hydrocortisone and Ciprofloxacin
Treatment considerations:
- Increase B12 foods / B12 supplementation
- Consider H.Pylori/SIBO/GUT testing
- Consider serum Intrinsic Factor or Parietal Cell Antibody testing
- Consider Biotin testing (actually causes blunted MMA but B12 symptoms)
References:
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