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When the conversion of propionyl-CoA to succinyl-CoA in the mitochondria fails due to Vitamin B 12 deficiency, elevated blood levels of methylmalonic acid (MMA) occur

Incidentally, the healthy reference range is 191-663 pg/ml and correlates closely with oral cobalamin intake, which is why the vitamin B12 blood level alone is not an adequate parameter to diagnose a deficiency (Herrmann and Obeid, 2014)

It activates AMPK an enzyme that senses the bodys energy state and improves how glucose gets used in muscle cells

B12 & Omeprazole Omeprazole is a proton pump inhibitor that works similar to the H2 blockers listed above