Dozens of research articles produce findings that adequate B12 levels is critical to central nervous system function. It’s often deficient when digestive infections and dysbiosis is present, needed for folate metabolism (methylation), production of energy, cognition, optimal brain function and so much more. I’ve blogged about several of them and you’ll find a few key pieces with links below. It’s critical that B12 deficiency is identified and it’s equally critical that the correct lab test is ordered. Many pediatricians and neurologists do not know what the correct lab is!
Chronic anti-epilepsy drugs may impair folate absorption and gastrointestinal transport by altering gastrointestinal pH . The association between vitamin D, AEDs, and poor bone health in individuals with epilepsy was first recognized in 1979 . Linnebank et al.  recommends that patients treated with AEDs should have their serum levels of folate and vitamin B12 closely monitored, or should receive prophylactic vitamin supplementation while receiving AED therapy.
The researchers recommend that any child with neuroregression, seizures and movement disorders (I would suggest further myoclonic seizures, tics, etc) should be explored for a vitamin B12 deficiency.
What is the most accurate test for B12 levels? Not “B12”! But rather methylmalonic acid. This can be tested through urine or blood. B12 in its different forms can also be made in the digestive system. A B12 level tests all various forms of B12 not specifically what is usable by the body. This is a false reading and can be misinterpreted by medical professionals. This is a serious mistake. An article written “All B12 levels are not created equally” reinforces that:
the Vitamin B12 Test is rarely abnormal except in cases of SEVERE deficiency. In more subtle cases, or in someone who only RECENTLY became vitamin B12 deficient, it will be normal! And in cases of about 33% of the population with the MTHFR Gene mutation, the Vitamin B12 Level can even be HIGH in the presence of a serious vitamin B12 deficiency. How confusing is that when you can be deficient in Vitamin B12 with a low, normal, or high Vitamin B12 level!
Methylmalonic acid is the waste product that builds up in the blood when B12 cannot convert into succinic acid. It begins to build up 10 days after a B12 deficiency begins. For this reason it is the best means to identify levels, specifically the usable form of B12. It can be measured in both blood and/or urine.
Here is added research about the benefits of testing methylmalonic acid:
- “If serum MMA… levels are elevated, a therapeutic trial of vitamin replacement therapy may be undertaken.”(1)
- “MMA, being more specific, is preferable for assessment of cobalamin status.”(2)
- “we found that a urine MMA Test… was a simple, rapid, convenient, specific and sensitive method for the diagnosis of cobalamin deficiency.”(3)
- “MMA levels are a good indication of cobalamin distribution and function… With rapid, reliable quantitation…, urinary MMA can now be a useful clinical test.”(4)
In my profession, I’ve seen elevated levels of B12 (blood) but yet deficient methylmalonic levels (Urine). These finding would warrant high doses of methylcobalamin (B12) and in some case hydroxycobalamin.
Bringing much light,