Methylmalonic Acid Test

[LynneG]

Can anyone tell me whether the MMA test can be obtained through the NHS?

I saw a GP yesterday (I am still dizzy following falling backwards again a week ago)

I am going for my blood test on Thursday to see if my folate level has improved after taking a folate /B12 supplement for 4 months on instruction of GP as had tested deficient for folate previously. My B12 serum level had shown 600

As going for blood test , I asked if MMA could be added. He said he hadn't heard of and had never ordered before. I had explained what it was and why I would appreciate having the test. Pressing a few keyboard keys , he said, no I am sorry. I didn't really get an answer when I asked 'Is it not available on the NHS?

A friend of mine got the same answer/response when she asked her GP for a homocysteine test, which I know is available on the NHS as I have. Kind of makes me not trust their information.

[helvella]

I suggest you check your local pathology lab.

Many have Laboratory Handbooks (or similar), often available online, which list the tests they do. They often provide extra information such as preparation, restrictions on availability, etc.

Failing that, ring them up or email them. If necessary, and I hope it won't be, you could put in a Freedom Of Information request.

[LynneG in reply to helvella]

Thank you so much for the advice

[Sleepybunny]

Hi,

Short answer - yes in some cases (from personal experience).

It's possible that rules for having MMA tests vary between different ICBs (Integrated Care Boards) and Health Boards in UK.

Searching online for "NHS MMA test" and"name of your ICB/Health Board MMA test" should show some links.

It's likely that you would need to be referred to a specialist who could then possibly order a MMA test

When to refer B12 deficient patients to neurologist/haematologist/gastro-enterologist

(Scroll down page to section on referrals)

cks.nice.org.uk/topics/anae...

Might also be worth being referred to a rheumatologist and endocrinologist.

Private tests

It is possible to get a private MMA test in UK but there can be a problem getting NHS doctors to accept results of private tests. Results of MMA tests may be affected by recent supplementation of B12.

"I asked if MMA could be added. He said he hadn't heard of and had never ordered before. I had explained what it was and why I would appreciate having the test."

Links about MMA

labtestsonline.org.uk/tests...

stichtingb12tekort.nl/engli...

"I am still dizzy following falling backwards again a week ago"

Have you been referred to a neurologist?

Both B12 deficiency and folate deficiency can lead to proprioception problems.

Proprioception is awareness of where the body is in space.

NICE guidance Suspected Neurological Condition

nice.org.uk/guidance/ng127

NICE when to refer B12 deficient or folate deficient patient to neurologist/haematologist/gastro-enterologist

cks.nice.org.uk/topics/anae...

Unhappy with treatment?

How to write letters to GP about B12 deficiency

b12deficiency.info/b12-writ...

Link to thread about Patient Safety, has useful links for those in UK having difficult health experiences with B12 deficiency.

healthunlocked.com/pasoc/po...

I'm not medically trained.

Lots more useful info in pinned post "Various PA/B12D resources".

Pinned posts are on right hand side of screen if on computer. may need to scroll up or down to find them.

[LynneG in reply to Sleepybunny]

Wow, thank you so much Sleepybunny

[LynneG in reply to Sleepybunny]

GP has referred me for Ear/Brain MRI and referral to Vestibular Clinic

[Nackapan in reply to LynneG]

I had that .The vestibular physiotherapy was very good.

Pressure in ears measured.

Tinnitus management offered but by thrn was doing coping techniques by then.

Had two brain MRI scans s year apart.

Didn't need a MMA test but neurologist could order for you.

[LynneG in reply to Nackapan]

Thank you Nackapan. I just can't understand how I can have a coping technique for falling backwards. I am feeling fine , no warning and suddenly swing my arms in a circular motion (not purposely) while staggering backwards on my heels for an inch or so and then hit the ground. All over in 2 seconds. Did you fall backwards?

My MRI referred by the GP , so don't have a neurology referral

Does the Vestibular Clinic look into B12 /Folate as a possible cause ?

Sorry for all the questions

[grumpyold]

I had my MMA tested as part of Medichecks Pernicious Anaemia blood test.

I have had my suspicions that I might be B12 deficient, so I got this private blood test rather then fanny about begging for tests from my useless GP. With this test you cannot have the finger prick test you do at home. I opted for the nurse to visit me at my house. Not that much dearer than going to a clinic/hospital and so much less hassle. It wasn't cheap, but "I'm worth it" and saves being fobbed off by NHS.

Maybe have a look at Medichecks website?

[LynneG in reply to grumpyold]

Thank You, I have used Medichecks years ago in the past. Good to know they do it. I was reading about the MMA test and it seems need to not have supplemented Folate or B12 for 6 months (may have been up to 12 months - I have read so much in the last few days

[grumpyold in reply to LynneG]

Yes, there is so much to learn/read isn't there.The thought of having to stop my folate and B12 supplements for so long in order to get an accurate reading fills me with dread though. I have just started sub lingual B12 drops in order to bypass stomach and possible mal absorption issues.

[LynneG in reply to grumpyold]

Hi grumpyold,

Totally agree, the thought of stopping is awful. Since my folate deficiency result in April I have been concentrating on getting my folate up, obviously with watching my diet which I do anyway but also supplementing. The supplement also highlights improvement of homocysteine as my homocysteine level had shot up with the folate deficiency - so need to take. But it has 1000mcg of B12 , not sublingual like I normally take as couldn't find a sublingual folate. I normally take a methyl + adenosyl B12 5000 mcg sublingual from Amrita .co .uk every third day but haven't while taking this current supplement. Had blood test yesterday so waiting to get results. I feel confident in the sublingual to raise B12 levels

[Cherylclaire Forum Support in reply to LynneG]

Generally, if B12 replete -once loading dose of 6 B12 injections completed if found to be B12 deficient, for example - MMA should also have rapidly dropped into "normal" range.

If a patient is still deteriorating, and has been unresponsive to the loading dose, an MMA test with a high result would be a very good indication that there is a functional problem in the expected link between the injected B12 and the MMA - so insufficient amounts would be transported to cell/tissue level. Serum test would show high B12 and MMA in this case, while still symptomatic of B12 deficiency.

There would be other conditions to rule out which could raise MMA:

Renal problems - which could be eliminated as cause by a blood test.

Small intestine bacterial overgrowth (SIBO) can later be ruled out as a potential cause for raised MMA by fasting breath test.

I had my first MMA test requested by a GP who suspected functional B12 deficiency, and this was confirmed by the testing laboratory. It took a third request after two refusals to get this test at primary care level. Local hospitals do not always have this facility.

I later had four MMA tests from haematology consultants.

Later still, I had a final 6th test from DNA specialists in hereditary diseases.

These were all under NHS care.