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Serum MMA may also be elevated in thyroid disease, bacterial overgrowth in the small intestine, pregnancy, or a rare genetic disorder in infants called methylmalonic acidemia

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However, two other forms hydroxocobalamin and cyanocobalamin become biologically active after they are converted to methylcobalamin or 5-deoxy adenosylcobalamin, said Dr Aravinda G M, consultant, internal medicine, Manipal Hospital, Jayanagar, Bangalore

Their ALS progressed slower, and these patients survived much longer than an untreated group

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