I’ve had non specific B12 deficiency for around 2 years. 2 monthly Hydroxycobalamin injections for 10 months with daily sublingual Methylcobalamin.
Still looking for something.
Is there any point in a urine MMA test if treating with high serum B12 supplement for so long. I think the MMA test looks at cellular efficiency of active B12 irrespective of Serum levels but really don’t know if this is a false path. Is it worth doing the test, or not?
Are you supplementing with folic acid and a daily multivitamin to support the metabolism?
Yes. Daily multivitamin and mineral.
You may need up to 5 mg max of folic acid specifically to support metabolism. Take what you can tolerate and build up over a period of time.
The priority is to get B12 sorted first and then add folic acid. But the two work together. The reason for a priority is that neurological damage may continue if B12 levels are not high enough. I like mine >1500 pg/ml off the top end of the chart.
For me, I still had lots of symptoms after I was on B12 injections and it was a roller coaster ride of highs right after each injection and lows before the next injection.
That was when I was on 3x monthly hydroxo injections and I got the GP to first decrease the interval to 2x months and finally to monthly B12 injections.
I then moved from the UK to the USA and had to start on monthly cyano.
I now self inject 1ml cyano weekly and supplement with daily methyl sublinguals as well to fill in whenever I start to crash.
Now I take 6x 800 mcg (=4.8 mg) folic acid tablets that I spread 2x three times a day. This provides a more or less continuous supply.
In addition to my daily multivitamin, I also take 100 mg B1, 100 mg B6 to support nerve repair and trymethylglycine (TMG) 500 mg to support the processing off of the homocysteine via a parallel path to B12.
I just found a jar or marmite in the cupboard and started adding about 1/2 teaspoon to my breakfast gluten free bread. That is helping as well.
Green leafy vegetables and meat every day also help keep the roller coaster fairly level now.
Are you keeping a logbook of all your symptoms and food, drink and meds to help sort out what works from what doesn’t. The main issue with treating by symptoms is that you get very similar symptoms after each jab as you had before the jab. The ones, like muscle pain, soft stool, that reappear in sequence within 3 days after each B12 injection are “good” and indicate that nerve repair is occurring with a stronger signal to the brain and that metabolism in the cell is working producing extra water as a byproduct.
You will have your own unique set of symptoms and you may be able to identify a marker symptom the you can readily measure for severity and use an a leading indicator that treatment is working and progress with nerve repair is bring made. The progress however is very slow (months and years) so the logbook helps look back (for me I also have (had) short term memory loss so writing everything in the moment helped tremendously later on when I could not remember how severe my symptoms were.)
MMA is a waste product that builds up if your cells don't have enough B12 to recycle it so it can be used as a secondary measure of what is happening with B12 in your cells (active B12 is a combination that only exists in your blood).
In theory MMA should be very high if you don't have enough B12 in your cells though there is some debate as to whether this is always the case - but only a minority of voices currently expressing that doubt - suspect the reason for the doubt is that this is only one process that uses B12 so says nothing about other processes ... and your cells may prioritise the use of B12 between different processes in a different way for different individuals.
MMA can also be raised by other factors which is why the urine test is better.
Sorry - that means I can't really give you a clear answer. MMA may be effective in showing a cellular B12 deficiency in the presence of high serum B12. The purpose of the test isn't defeated by the supplementation but there is a small question mark over whether MMA being in range really does rule out a cellular deficiency in all cases.
Correct MMA test??
Missing MMA Result 
Do you need to be clear for 4 months for MMA test?
Homocysteine and MMA - an point after first injection? 
Results MMA & Homocysteine
