Vit B12 Deficiency, Homocysteine, & Methylmalonic Acid

Worried about vitamin B12 deficiency?
Never thought about it? Maybe you should worry a little bit, especially if you’re
older than age 60 or 65, especially if you’ve taken metformin. There’s several
other risk factors as well. I’ll ask your doctor about it. But if your doctor says,
“Oh, that’s not a problem,” or “You don’t really see that these days,” be concerned.
Tell him to look it up in the New England Journal of Medicine or I’ve got
a series of videos on vitamin B12 deficiency. And here’s another thing, it’s
easy to get a vitamin B12 test from the lab, and it’s inexpensive. But it also
doesn’t tell you anything. That’s a trap that doctors and patients fall into. Here’s what to do. There are a couple of
things to look at. The first one is methylmalonic acid. Test
for methylmalonic acid to show a deficiency in vitamin B12. In the
diagram on the bottom of this image, you see what’s going on.
Vitamin B12 or cobalamin is turned into adenosyl cobalamin. Cobalamin is a major component needed to transfer a
methylmalonyl CoA into succinyl CoA. So if you don’t have adequate vitamin
B12, what happens is methylmalonic acid builds up. Think about that. Now, that’s an
expensive test, and do I go straight there? No, I actually don’t go there very
often. I go there if there is significant risk factor. One of the tip-offs, though,
is increased homocysteine. As you see, homocysteine has a very similar
issue. Methylcobalamin is needed to change homocysteine into methionine. So
homocysteine is inexpensive, and we see a lot of people with elevated levels. When
we see that, those are a couple of things that we think about. Either that are just
going ahead and methylating. Methylating – what I mean by that?
Do I supplement? Yes, I do. Up until recently, I supplemented with… you can
find on Amazon… Thorne MethylGuard. It’s a methylated vitamin B complex. I’ve recently gotten access to a new
proprietary product. It’s a combination of AREDS. Which are the AREDS? it’s
age-related eye disease supplement. It helps decrease risk for vision loss as
we get older, and it’s got a higher methylfolate level so it has a rare
combination of AREDS plus methylation supplements. Thank you for your interest.
This is Ford Brewer. I started off my career is an ER doc, and that can be frustrating
because most of the things bringing patients into the ER can and should be
prevented, like heart attack and stroke. So I went to Johns Hopkins for training
in prevention, did well, ended up running the program,
trained dozens of docs there and have trained hundreds and even over a
thousand doctors since then in preventing disease. What’s even more
important is I’ve helped thousands of patients prevent heart attack and stroke
rather than waiting for the devastation and hoping for a cure.

4 thoughts on “Vit B12 Deficiency, Homocysteine, & Methylmalonic Acid

  1. Would it be too corny to say I'm grateful for Docs like Dr Brewer …on Thanksgiving weekend?
    Love the new format and also kinda miss seeing the margin notes, hi-lites, and mark-ups on the pages of studies he used to swing in front of the camera.
    2:03 < I'm glad for CLS's CLIA system. Bur should I be more cautious and wait for, or focus on, FDA approved tests rather than LDT's?
    I get; ferritin, GGT, a1-c, LDL-P and hsCRP, +the usual… but I get pro tips like this and add new ones regularly too.

  2. There's a lot of controversy on the most absorbable form of B12. I've taken shots and I've taken cyanocobalamin and methylcobalamin. Methylcobalamin seems to shoot my blood pressure up for some strange reason cyanocobalamin doesn't

  3. Yes, anyone taking metaformin should be thinking about their B12 status. A easy cheap hack is to include nutritional yeast in meals- especially if you are taking a low dose of metaformin for longevity. I personally like to use it as breading on fish and as a salad topping or with psyllium husk as a pizza dough

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