One of the most misunderstood results I see in autistic and PANS/PANDAS children is a high serum B12. When B12 is high in the blood, I want to know why it isn't getting into the cell. Because B12 has one of the longest journeys of any nutrient. It needs stomach acid to free it from food, intrinsic factor to grab onto it, and a healthy ileum to absorb it. Then it has to get inside the cell. And this is where lithium gets really interesting - it's so often low in the kids we see, and it's been linked with B12 transport and uptake. Once it’s in, B2 has to be converted into FAD and FMN - without these, B12 metabolism will not work properly. And what makes it even more convoluted is that without good thyroid function, that B2 step gets disrupted- this is why Greg Russell-Jones’ work on iodine and selenium is so interesting. Add inflammation, which can push up the proteins that carry B12 in the blood, and you can see how the serum number can go up without reflecting usable B12 in the cell. This is why I also look at MMA. It goes up when the B12-dependent conversion of methylmalonyl-CoA isn’t working properly, and you can measure it in both blood and urine. This does NOT mean these children never need B12, but if the problem is somewhere along that pathway, more B12 won’t necessarily fix it. #B12 #PANS #PANDAS #Autism