methymalonic acid test???

Just found out my B12 is low, 350, my dr. suggested a methylmalonic acid test. What is it and why am I having it? Her nurse called me so I didn't get a chance to ask questions. Rhonda

Hi Rhonda. I know about this only because of what I do at work. Methylmalonic acid levels will be elevated if you truly have a vitamin B 12 deficiency. They might want to be sure the low B12 levels are not from lab error. Normal values are 0.08 - 0.56. Good luck. By the way, I'm going for lab work tomorrow because I'm having Vitamin D problems. Wilma

What she said.  MMA lets you know if you are using your B12 that your body has.  I also believe that a nutritional homocysteine level (another blood test) can also help decipher B12 usage by the body. That being said... lab normals for B12 often go down into the 200s, I believe.  The levels are based on when cardiac issues begin and unfortunately not when neurological issues do.  People can have neurological issues like neuropathy (pain, tingling in toes, fingers) at levels that labs deem to be "normal" in the high 200s-300s.  The World Health Organization (WHO) recently updated their minimum standard for B12 level to 460, I believe.  The U.S. hasn't caught up with this.  I know of some long term post-ops that ended up with neurological damage due to their B12 level so please do what needs to be done to get that up. My husband and I both have taken sublingual B12 (which doesn't seem to work for everyone) and have done well.  Our levels are above the normal range to which our doctor says "Your B12 is high.  We like it high."  Excess will wash out of your body since the B vitamins are water soluable. Good luck to you! Kathy

Kathy, I read the caption to this post and clicked it hoping that you had answered as you are so educated in this area. I think of you DAILY.  Please shoot me a PM and let me know how you are doing, OK? Hugs and love, Vanessa

Hi. Rhonda! While I am not familiar with this particular test, if your doctor suggests that you have it, do it. I had a B12 level of 424 which is "normal" but was suffering from SEVERE ANEMIA and now deal with what appears is going to be permanent neurological damage.  PLEASE, PLEASE, PLEASE, follow your doctors orders and research B12 levels -- Pernicious anemia, etc.  I have information on my profile if that will help you as I have experienced problems.  I do support the more agressive B12 replacement treatment from personal experience and I truly recommend that a treatment plan developed specifically for YOU as you are the only "you" in the entire world. If I can help you further, feel free to PM me and I will help in any way that I am able.

Thank you so much for your response. I went this morning and had blood drawn. My B12 I had checked last week and the Dr. said it was at 350 which is on the low range of normal. That is why she wanted to do this other test. She said it will check several areas as well as anemia. My Dr. has never dealt with a gastric bypass patient and makes no bones about it that she does not advocate ANY weight loss surgery, so sometimes she makes me a little nervous.  I know I should probably seek out a new physician, but we live in a small town and the choices are few.  Again, thank you. Rhonda

As others have mentioned "we" should have higher numbers.  My surgeon wants me over 1000 and this is what I hear most from my WLS friends as well!  It took a very aggressive treatment to get me up to 870 and I've to continue to be very agressive.   I believe that I used up stores faster b/c I went 7+ month with chronic abdominal pain and wasn't able to eat.  I did take my vitamins but admit that I did suffer from -- "No one is listening to me, why bother" a few times and then I'd wake up.  I finally got treated by going back home to my original WLS who did exploratory surgery.  I had an internal hernia and adhesions.  A few months later, I had two bowel obstructions -- so I went approximately 14 months without really eating (as it was painful).  ANYWAY, that's how I think I got low with no stores so quickly.   Another possibility for me and others is that it could be on the lower range prior to WLS from a deficiency in our diets -- I was always dieting = starving myself to lose weight. I'm glad you had your blood work done.  I'm very interested in these things so I'd love for you to keep me posted on your health!

For your doc, let's unconfuse her a little.  Why do ALL WLS ppl need to supplement B12?  The way that B12 normally works is that you eat your B12 source, then it goes into the stomach and martes with its specific digestive component called, forgettably, "intrinsic factor" or" IF".   Then together, they are ready for absoption and they go together into the duodenum where B12 can be absorbed.  In normies, some ppl do not make the IF (broken) and certain tests can confirm that.  That doesn't apply here.  In ppl over 50, IF decreases, so often us oldies would have to supplement ANYWAY.  When the IF cannot be reached, the B12 has to get in OTHER than swallowed.    So, via shot (the cheap way) or sublingual (the other way).  Sublinguals work for some, not others.  OK, so we're clear on the IF being the deciding factor for normies, right?     With RNY or DS, for example, the IF simply isn't available any more.  With DS, the majority of it got tossed in the bucket and with RNY, the IF maker is sealed off.  So, the point here is: THE FOOD DOESN'T GO THERE.  So, besides there not being any mating of B12 + IF, the food is not channeled into the duodenum for absorption.  The restrictive ppl will have trouble EATING enough B12 foods, even if they have robust IF going on.  All that said, the newer studies show 800 as being the BOTTOM of the B12 range with no top end at all.  My PCP knew this, but none of the surgeons seem to know it. So you could well FEEL sluggish & sorta "clunky brained" even at 400. If you want to fast forward, go to http://groups.yahoo.com/group/Graduate-OSSG , where we routinely discuss how we are holding the B12 levels up at longr & longer times post-op. I think we should test our MMA & homocysteine levels ANYWAY, at least annually since we were such high risk ppl.