Pernicious Anaemia Society
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Results MMA & Homocysteine


At last results are in and I would welcome your opinions, please. I feel these are not sufficiently, if at all, indicative of B12 issue and suggest my GP will not want to initiate any treatment, to be honest.

Results -

Oct 2016

Serum Vit B12 – 165 ng/L [197.0 - 771.0]

Serum folate level - >20 (4.6 – 18.7) ng/ml

March 2017

Serum Vit B12 level 215 ng/L [197.0 - 771.0]

Serum folate level 18.7 ug/L (<3 ug/L suggestive of folate deficiency)

HOMOCYSTEINE 14.6 umol/L [0.0 - 16.0]

MMA (METHYL MALONIC ACID) 0.16 umol/l (0-0.28)

Plasma MMA values of less than 0.29umol/L are

considered not indicative of B12 deficiency

I am also hypothyroid, prescribed Levothyroxine for many years and, therefore, wonder if my symptoms may be more Thyroid related, but involving a B12 issue, appreciating these are all interlinked.

Rather than duplicate posting and repeating myself, here is the link to the HU ThyroidUK post, if interested

Many thanks for any thoughts

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Your raised Homocysteine level suggests B12 deficiency - in my non medical opinion. I have read that a level of single figures is preferred and that around 6 is considered optimal.

Often raised in us Hypo folk as we are also low in other vitals - including B12 and VitD. My Hcy levels reduced once the thyroid was well treated. I am T3 only .....


I agree with Marz, your Homocysteine is too high. irrespective of anything else - it is too high. It is a marker for vit B12 deficiency. B12 when active, converts Homocysteine back into Methionine. If you have a high homocysteine level 10 or over, this functional pathway is not working efficiently. Take a look at this article. You need to be proactive and bring your homocysteine down also check out the Food for the Brain website - I will post the link below


Food for the Brain link too - quoting studies - to help you with your GP. But basically you will have to manage this yourself as GP's / consultants don't have or have very little nutritional training. Lots of info on this site


Your homocysteine is within the normal range.

All normal ranges are based on looking at the values for large numbers of people and all of them suffer from the fact that they are generalised pictures and there will always be problems applying the general to particular individuals.

I don't know what the standard deviations are for the homocysteine test - which would give a measure as to how likely it is that someone falling into the normal range is actually B12 deficient is very small - unlike the situation with the serum B12 test - hence its use as a test for clarifying in the case of ambiguous results.

That doesn't mean that it isn't impossible that - just that it is very unlikely that you are B12 deficient based on the homocysteine result above.

Marz and LynneG please note.

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Thanks, @Marz, @LynneG, @Eoaz and Gambit62

I appreciate your thoughts. It's a shame these results don't really clarify my B12 status and, being within range, my GP will not be keen to instigate treatment.

I think what I will likely do is to get some B12 sub-lingual or lozenge to try for a time. It would be interesting to see if my symptoms, particularly of fatigue, improved or not. I can't see there any harm in trying this.

Can anyone recommend a sublingual product that is known to be reliable and effective, easily available in UK, please?

Many thanks



Hi, Sorry I have just seen your post JMN2017, I personally do not rely on blood markers being OK if fall within normal range. Just one example Thyroid Stimulating Thyroid Hormone (TSH) I don't think you will find many in the Thyroid group on HU who feel GPs act when they should. Purely because the range is way too broad. I have quite a few blood tests with having an autoimmune disease (RA) I try to keep it under control with nutrition and will not take the proffered NHS drugs. So I have to research a lot.

Most blood markers that I have ever looked at and monitor for my own situation rarely mean things are fine and dandy if fall within normal range.

Learning from Functional Doctors (look for the root cause of a condition) I recognise that usually optimum for monitoring good health is not the same as falling within range.

For instance with RA: Fibrinogen levels in blood are an issue and a reason why anyone with RA or an inflammatory condition are at a high risk of heart disease and stroke. Blood fibrinogen levels to be normal and healthy should be low or at max low to mid range. If mid to high or high end of the normal range - you are at risk.

Why ? What's the point of having normal ranges! well yes we are all different as we know but also science and understanding moves fwd but the ranges are rarely shifted. Also different countries have different attitudes to preventative medicine and so different countries have vastly different ranges of normal.

The Japanese have a Serum B12 normal range of 500-1300. (they also have a lot less heart disease and dementia)

6 yrs ago, I had my B12 tested and my GP told me it was fine.

I research and read as said, and I read Dr Daniel Amen's book (practising psychiatrist with a functional, nutritional approach using SPECT scans of the brain) He stated with B12 you never want to be bottom of the class! Get your levels up there at the top of the range, if not you are incurring damage.

I therefore asked for a print out of blood test results. My B12 level that my GP had said was fine was 191. (range 191-650) The range within the last 6 years has moved to 197-700) When will the UK catch up with the Japanese? Goodness knows.

I spoke to retired GP Dr Chandy who runs the B12 deficiency website charity and he told me that if I had a serum level of 191 in 2011 then I would have been deficient for at least 10 years previous and that damage will have been occurring for all these years.

On this site I have been told that B12 needs to be at a minimum of 1000 before healing can start to happen. I have been supplementing and my level raised into the UK range but below the Japanese absolute minimum. But my GP wouldn't consider my B12 an issue even with awful symptoms, without me putting up a fight and a lot of info documents provided from the kind people on this site. She did eventually refer me to haematology but they rejected the referral on blood levels.

So I am on my own and supplementing with Jarrow methyl B12 5000mcg (Amazon)

as recommended by a member on here

Hope this helps :)


Good morning LynneG

Many thanks for taking the trouble to reply. Good to learn you are finding your solution.

It's ironic, isn't it, that the doctors don't like patients using internet to research their illnesses but don't have the information/education to treat us, hence we have to use what resources we can. I feel many of the medical profession don't like a patient to tell the dr what the problem is. Must be pride, or plain chauvinism that prevents them doing some research too, to my mind. Argh!!!

So, yes, I'm working on optimising all vit levels and have made another appt to see GP, in the hope he might just agree to trial me with B12 injections.

I've also recently learnt that low carb diet (I'm diabetic T2) which has helped me stabilise glucose levels and lose weight, can cause T3 to lower, therefore causing more hypothyroid / b12 def symptoms so needing to check out my plan of action ...

It's never-ending, eh? ... :)


Hi, that's interesting re hypo and low carb diet. My TSH is definitely climbing has been for a couple or more years, now is 3.53 and I have mentioned how interrelated this can be with B12. But GP obviously doesn't see as an issue either. It is as if they are programmed to not think or use any initiative in medical school. Anyone with any common sense can join up the dots.

So is the low carb (I am low carb re inflammation, autoimmune) causing insulin resistance because the pancreas has become blase about producing insulin because so few glucose spikes? Altho, I say I am low carb which I am most of the day except for fruit and veg but have jacket potatoes with eve meal and a banana for afternoon snack. So presume would be some insulin reqd/some spike?

Please let me know how you get on persuing the thyroid link:)

Did you know that GP's have training in how to deal with us? The well informed patients, they have coined a name for us 'Expert Patients' lol

Posting a link below - thought you may be interested.


Hi LynneG

Thanks for the link ;) Yes, so ironic, eh? They want us to take responsibility for our own health but, when we do, they don't like it ;)


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Remember that your body can convert protein to sugar. so if eating low carb, make sure you are getting enough saturated fat to burn for energy so you don't overload on protein. (good sat fat - coconut oil, avocados, free range eggs, grass fed butter - Beurre d Isigny Tesco or Guernsey Butter Waitrose (I have Guernsey now as really yellow a good sign grass fed) No polyunsaturated oils, bottled oils unless olive oil. Listen to You Tube lectures - Ivor Cummins - shows results of blood markers and diet. Blood markers don't lie so makes interesting listening and so helpful. Bit sciency at first but gets easier to follow. Does a great one on vit D too.

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