Hi all,

I first posted here maybe about a year ago (don't recall for sure)... Anyway, I've now been sick for 14 months with a myriad of symptoms. Have been seen in all the major Boston hospitals by 35+ specialists...etc. etc. Wont go in to full story or all the testing and results on this post, but in regards to B12, I do have many of the symptoms of B12 deficiency and it was raised a while back in my intro thread.

However when tested serum levels are always mid-range (usually around 500), MMA is always low but homocysteine is always slightly raised (around 15 range 0-12). MTFHR I am only 1298AC the heterozygous, NO 677. With these findings and my symptoms/lack of firm diagnosis I was able to get my doc to order some other related labs. Here were the results of those:

ANA: Neg

Gastric Paritel Cell Ab: Neg

Fasting Gastrin: 15 pg/mL Range: <101

RBC, HGB, HCT: always just at lowest level of "normal" or just below

B12: 514 Range: 180-914 pg/mL

B12 Binding Capacity: 480 'LOW' Range: 650-1340 pg/mL

My question is, what do these indicate? Given the IF, fasting gastrin and gastric parietal ab's, PA is all but ruled out. However, the low b12 binding test results, if I understand things correctly, suggests that while I may be getting B12 from my diet, my body is not utilizing properly? with that said, I wonder why my MMA level is always fine?

The ordering doc was doing it as more of a favor and has no idea what to make of the results.... he has offered to provide b12 injections to see if they help with any of my symptoms.

This explains some:
http://mthfr.net/what-is-mthfr/2011/11/04/

I think you need methyl forms of both folate and B12.
That would be Metafolin (methylfolate) and methylcobalamin.

I cannot find an answer online regarding low binding capacity (transcobalamin) levels. This is a relatively new concept and is a new test in US.

One site I looked at suggested using hydroxocobalamin instead of cyano or methyl, as injections. If you go the injection route, you could try that. The suggestion is to flood the serum and bypass the transcobalamin deficiency... Perhaps the injections often (not once a month) would have an effect.
There is another B12 called adenosylB12... you could try that orally. Take on an empty stomach;
This is one affordable source:
http://www.vitacost.com/nutricology-...Fe8WMgod4U8AUA
Unless your injections are frequent, I think daily oral would be a better route.

Once you get your B12 treated you can do the folic acid as methylfolate. It appears you have some mutation there that hinders methylation. So regular folic acid would not be fruitful for you.(it is not active and requires methylation to work).

Hey Mrs. D,

Thanks for the reply....

Adding the oral methyl or adeno versions is easy enough...the injections I've been offered are the normal cyno b12. Not really sure what to go with...wish I could find moe info on how to interpret that b12 binding test...my doc ordered through Quest.

if I am correct, i.e., the binding test results mean that although I am ingesting B12, not much of it is being bound and used properly, I am wondering how one would overcome this issue...its would appear, even if I added the oral versions you mentioned, they still wouldn't be bound and utilized? or maybe its just means I need to get my levels super high, so that even though only a small % is being bound, it still equates to a normal total amount of B12 being used.

In regards to adding the methyl folate, I understand it is important to correct the B12 issue prior, but in my case, where there isn't an actual low level of serum b12, how do I know when it is corrected and to add the folate? my folate levels have always been in the normal range.

The gist I saw was that when the binding capacity is low, then the idea is to flood the serum with B12, so that it won't need a carrier anymore. Transcobalamin really has limits in how much it can carry. It is designed to only move 2-4mcg a day, which is our typical RDA.

So the thought is you MIGHT bypass it by having much higher levels. Say over 1000 or even maybe higher.

It would be a waste to get cyano injections IMO, if you are having a impaired methylation status as your test reflects.
You can ask for the hydroxocobalamin type, which the doctor can order, or have methylcobalamin injections compounded for you.
The B12 does not stay around more than 3 days from the shots, so there may be ups and downs in symptoms. This is why oral can be better...some every day mimics how the body receives it from food. You'd have to do high dose orally to get those high levels...close to 5mg a day I would think.

Another thing to look at is the MCV...that would be reported on your CBC results. The MCV will be higher when B12 is not around to help with red cell formation. The cells become larger and that is reflected in the MCV value.

If the MMA is low but homocysteine high, that reflects either, the folate is not methylated and active, a deficiency in glycine which provides the methyl group in the first place, or inactive B6 chemistry. (you would need the special B6 called P5P for that). Methylcobalamin + methylfolate + P5P are the cofactors to convert homocysteine to SAM which then carries that methyl group around the body to the various systems that need it.