B12, MMA, Lithium Orotate
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Dr. Woeller,
Here is my BIG quandary and I hope you can shed some light on this and help!
I have more and more adults showing high blood levels of B12, well over the reference range (1500 and above). MMA is usually low normal, sometimes closer to mid-range. I’ve been taught that this means B12 is not getting into the cells and so it is floating around in the blood…and that Lithium Orotate (LO) can help drive B12 into the cells, provided you can get the lithium levels up. Those that do agree to do hair analysis show low lithium levels. Start on 5 mg of LO and and go higher if B12 levels do not decrease and MMA increase. I’ve been told a safe upper limit of LO is 20 mg. daily. I’ve also recommended bidfido probiotic since it can help with B12 absorption.
The problem is, I’m not seeing any significant changes in B12 levels or MMA status.
I am also aware that a person can have multiple SNPs that can factor in such has MTRR, TCN2, FUT2, CBS, etc..
Since I am not an MD, I cannot do B12 injections and it is very difficult to find a doctor willing to go this route…because the doctors comment that having a high blood B12 level is not a problem and to simply stop taking so much B12 or B Complex supplements even when patient is not taking a significant amount or any at all!
So, I’m wondering:
1. Would B12 injections make any difference for these types of patients?
2. What do you consider a safe upper limit of lithium orotate to recommend and just how effective is it in helping with B12 status?
3. Is it dangerous to have all the extra B12 floating in the blood if it never comes down to normal range?
4. Is there any advice you can give me that I can do with/for my patients (within the scope of my practice being a registered, licensed RDN) when dealing with these areas mentioned here?TIA,
KimKim,
1 – B12 injection are just going to make the serum levels go higher.
2 – LO can be effective. I usually stick with 10mg to 20mg daily, but often with the kids I am using 1 to 5mg as liquid lithium (ionic).
3 – The main thing about too much vitamin B12 is masking a folate deficiency. There is some discussion about Polycythemia as well, but I have never seen this in all my years of giving B12 injections in many cases for years.
4- You are correct about the B12 being high in the serum not dictating what is happening at the cellular level. The analogy would be high blood sugar in a diabetic, but cellular levels of glucose can be compromised. SpectraCell does have an intracellular vitamin test – http://www.integrativepsychiatry.net/intracellular_vitamin_analysis_spectracell.html
5 – is the MMA you are analyzing in the blood? Here is a good description of a high and low MMA, in associated with homocysteine analysis – https://labtestsonline.org/understanding/analytes/mma/tab/test. It is most concerning when MMA is high.
6 – BTW – what I have learned regarding Methyl-B12 is we are not using it because of a deficiency per se, but instead a biochemical dependency on its presence to aide in methylation.Sincerely,
Dr. Woeller
Thank you, Dr. Woeller, for your answers and the references. I am aware of Spectracell tests and most likely should push to have vitamin analysis done for these particular adult patients. Money is always a factor as you well know.
The MMA test results I see are blood levels. To date, I have not had a patient with elevated MMA or Polycythemia. The labtestonline reference states “If both MMA and homocysteine levels are normal, then it is unlikely that there is a B12 deficiency.” I failed to mention anything about HCY levels, but that quote is typically what I see, although some have low normal MMA with normal HCY. So to me the relationship of MMA and HCY with the High B12 levels means it is not getting into the cell and they would be functionally deficient, yet conventional doctors do not see it that way. They actually want patient to stop taking B12 or B Complex.
So it sounds like I need to bump up LO above 10 mg with the adults and go from there. I do have a few patients already on 15 mg. and still don’t show a decrease in high B12 levels. Is this a reflection of their very low Lithium levels as well that need repleted or is something else going on??
– Do you think once the Lithium levels are improved I could see the B12 levels come down?
– What length of time would you recommend between raising LO to then retest B12 levels?
– Any idea what else could be going on that prevents B12 from getting into their cells
– Is there anything else that I could be doing to help these patients get B12 into the cells? I’m referring to patients that have already cleaned up their diet, healed dybiosis…the whole integrative/functional medical nutrition therapy approach has already been applied.
– Am I correct in implying from your answer that it is not harmful if B12 levels are very high in the blood and remain high as long as some of it is actually aiding methylation?I wish I didn’t have so many questions for you, but this whole situation with high B12 levels is frustrating me and I so much want to be able to help these types of patients.
Kim
Kim,
I am not sure how high you would need to push Lithium Orotate levels to get B12 in the serum to a normal level since there may be other factors involved. What I would go on too is the clinical effects of taking the B12 and not make the sole decision based on the serum blood lab. B12 is water soluble so there is minimal chance of causing any problems. These scenarios are an opportunity to learn some new things with your patients by running periodic labs and tracking results. Here are some suggestions:-perform homocysteine, MMA and serum B12 every 90 days. Add in a CBC for good measure just to document that Polycythemia is very rare.
-It is being assumed that B12 in the cell is deficient because the serum level is high. It actually may not be. This is where looking at intracellular B12 would be needed.
-I have not seen problems with methylation support with B12 causing cellular issues as we have discussed before. One thing to keep in mind are the SNPs that come with genomic testing. This is another level of assessment that could be done, and in fact if you took that on as a course of study could set you apart from others in becoming a DNA Methylation Panel specialist!Does this help?
Dr. WoellerYes, Dr. Woeller, you have been very helpful. Thank you for your suggestions and helping me sort this out as well as giving me a plan of attack.
Two days ago, I opened an account with HDRI. Now I hope to begin using their Methylation Pathway Panel when needed; it will be very helpful.
I have delved into genomics, epigenetics and nutrigenomics; mostly self-study of Yasko, Lynch, Van Konynenburg, Heartfixer and a few others work….which can lead to a little confusion from all the various sources as far as treatment routes. I would like to find a more extensive, formal program on DNA, Methylation and Treatment. Are there any formal programs you would recommend?
Kim,
I think I remember you mentioning this before.Good news about HDRI. It is an interesting test, and when you start looking at the various markers prior information from sources like Yasko, Pangborn (Autism: Effective Biomedical Therapies) and others starts to make more sense.
I don’t know of any formal training program. I would think, if there are any, they still would come with some conflicting information based on the practitioners experience compared to the other practitioners, i.e. Yasko. Much of it comes down to have a solid foundation in the information and then seeing how things play out clinically in your own practice. The methylation discussion to me is similar to whole bio-identical hormone testing and therapy field. Everyone has an opinion, but no one knows all the nuances about everything, and each person (patient) responds slightly different. Therefore, the SNPs are a guide for potential intervention and potential problems, but ultimately the person’s body is still the best test. What I don’t like to see if paralysis by over-analysis.
Dr. Woeller
Agree with the paralysis by over-analysis…I’ve certainly let that get me stuck at times. I was able to snag a Used copy of Pangborn’s book, eager to read when it arrives.
I am seeing more patients who want to know their Genome and methylation profile, so I know with time and practice with interpreting panels and tests, I’ll become more proficient. I do find the whole area of study fascinating!
Thanks again,
Kim
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