Methylmalonic Acid Test (uMMA) (A B12 Status Marker)

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Turnaround Time: 2-4 weeks
Test Type: Kit Based - Urine


Methylmalonic Acid Test (uMMA)
(A B12 Status Marker)

The Vitamin B12 test measures a substance called methylmalonic acid (MMA) in the urine, which is a specific indicator of low B12 status. The more MMA you have, the more likely you are to be low in this critical nutrient.

Do you know your number?


Your Vitamin B12 test results are reported in specific units. The units are mmol MMA/mol creatinine (cr). Optimal vitamin B12 status is indicated when the result is below 2.0 mmol MMA/mol cr. A result above 3.8 mmol/mol cr means B12 status is very low and should be confirmed with further testing.

Vitamin B12 is a crucial nutrient responsible for many functions. Optimal B12 levels have been linked to benefits for:

  • Cells
  • Heart
  • Nerves
  • Pregnancy
  • Brain

Why Test Your Vitamin B12 Level?

Vitamin B12 is rich in many animal products, so vegans and vegetarians are at risk of having low B12 in their body unless they take a supplement. But most people are not vegetarians and eat enough B12 food sources to meet their needs. However, not everyone is able to absorb it.

Many different conditions, from autoimmune diseases to gut complications, can interrupt B12 absorption. Common medications like proton-pump inhibitors and metformin can also make B12 absorption more difficult. So, often dietary intake is NOT the reason someone has a functional B12 deficiency, which makes testing even more important.

It has been estimated that vitamin B12 deficiency is present in about 20% of the elderly population. Nearly 40% of 3000 subjects in the Framingham Offspring study, were found to be B12 deficient.

Why Do We Test B12 in Urine?

A substantial amount of B12 is stored in the liver and recycled by the body, potentially masking B12 deficiency for up to 10 years! Because of this, B12 levels in the blood don’t always respond quickly to a decrease in B12 absorption. MMA levels in blood and urine respond to functional B12 deficiency at the cellular level early on, so a nutritional solution can help avoid the worst symptoms related to B12 deficiency, such as brain fog and nerve damage.


Measuring MMA levels in the urine (and correcting for creatinine levels) helps reduce the chance that kidney issues are falsely increasing levels, which is not the case for blood MMA levels. This makes it easier to detect when it is even slightly elevated and a more sensitive test. It also doesn’t degrade for several weeks, so your sample will reach the lab in good time to be tested accurately.

Why is Vitamin B12 so Important?

The B vitamins are known for being important co-factors in energy production in our cells. Vitamin B12 is no different, but it is also involved in the pathway that creates and repairs DNA.

B12 deficiency can cause fatigue and low energy, anemia, and brain and spinal cord problems. This can lead to difficulty with balance and walking and can be irreversible if not recognized early and treated with B12.

B12 deficiency is strongly associated with cognitive impairment and the development of dementia and Alzheimer’s Disease. These conditions can respond well to B12 supplementation if detected early.

Who is at Risk of a Vitamin B12 Deficiency?

  • Vegans and vegetarians are especially vulnerable to B12 deficiency because it is mainly found naturally in animal foods.
  • Pregnant women need more B12 to support their baby’s development.
  • Forty percent of people who take metformin for diabetes have B12 deficiency. This aggravates the neuropathy that is common in diabetes and can lead to serious problems.
  • People taking antacids or proton pump inhibitors (PPIs) for heartburn can also have B12 deficiency.
  • People who have had bariatric or other intestinal surgeries are more likely to have issues absorbing B12
  • Autoimmune diseases can also destroy the parietal cells in the stomach that make intrinsic factor (IF) causing a disease called “pernicious anemia”.
  • Elderly people can have a digestive system that doesn’t break down food as well, which can also contribute to a B12 deficiency.

Collection Details:

Collection Instructions:

Collect Sample: Follow the simple kit instructions to collect your sample from the comfort of home. Once you collect your sample, mail it back to our lab with the pre-paid envelope.