Further to your kind reply (for which, many thanks Freddd), I've spent some time reading through various threads, and my understanding is much better; nevertheless I've a number of further questions (not to mention sub-questions!). I want to get it all reasonably straight in my head before I embark on taking Anna through it, so as to improve the chances of success while minimizing the downside suffering...
Q1 You say, on Day 1 to take 1x EnzyTherB12Infusion. But only 1 (x 1mg)? Previously with Jarrow, the recommendation was 1 (x 5mg), so why not 5 (x 1mg) EnzyTher now?
Q2 Re Dibencoplex, you say to take and 1/10-1/2. Within that wide range, what does one's choice depend on? What’s best to try? ¼?
Q3 If successful startup on Day1, do we continue on Days 2, 3 and beyond, on the same minimal dosages as day1? Or step up the dosages? And if so, which ones and how much?
Q4 If no startup on minimal dosages, do we try again on increased dosages? Or switch to trying to start up with LCF?
Q5 You say “If you don't get startup with the first 3, then titrate the LCF” – do you mean omit the B12s and folate for now, and try to start up on LCF alone? If so then presumably bring back in the B12s and folate once successfully started up on LCF?
Q6 Re LCF, is it 855mg 1xdaily? Single or split doses? (Short half-life?)
Q7 Re potassium, there’s talk of 1-3g per day? Am I right in thinking the symptoms of excessive K are similar to the symptoms of insufficiency? Can we pre-empt deficiency by going straight to 2g or 3g from day 1? And please confirm we're talking about elemental K, so 2g equates to 12g potassium gluconate or 4g potassium chloride? (Which form is preferable?)
Q8 Should we take a multi-min/ multi-vit supplement (i.e. in addition to the fish oils, lecithin, B-Complex, the Gamma-E, the ascorbic acid powder and calcium and magnesium citrate tabs/powders)? If so, which one? Or if the only additional things we need are zinc, selenium (and inositol?), why not just take additional supplements for these, rather than a multi? Is it still advisable to avoid copper and iron?
Q9 How much calcium and magnesium?
Q10 What times of day should things be taken? Which things need to be separate from which other things? Which are better taken together? Which should be taken with food?
Q11 You talk about B3 turning down your methylation. Why/when would you want to do this? When you’re feeling too wired to sleep?
Q12 Are crashes inevitable or can they be avoided?
Thanks in anticipation!
Q1 You say, on Day 1 to take 1x EnzyTherB12Infusion. But only 1 (x 1mg)? Previously with Jarrow, the recommendation was 1 (x 5mg), so why not 5 (x 1mg) EnzyTher now?
There were a number of considerations. The N=1000 questionnaire development study and follow-up I did showed that nobody could tell the difference by effect until they had reached the limit of saturation with a 1mg dose. Then in discussion with Rich, he agreed that 1mg of MeCbl would be a reasonable dose that wouldn’t “force” anything in his opinion. We were working out a progression from the SMP to active b12/folate protocol that we both could agree with if the SMP didn’t produce satisfactory results in 3 months.
Another consideration was that the idea of 1mg was less scary than the idea of 5mg. Also, we were trying to control the entry level cost. We agreed that being able to afford to buy an initial set of supplements and getting started was more important than a higher dose, especially since it would not make a noticeable difference for some months at least. At that time, the relationship, or lack thereof, of MeCbl dose to Methylfolate dose and/or potassium dose was not clear. Rich did not consider shortening the saturation period important or maybe even possible. I thought that coming up with a transition plan far more important than any specific dose that wouldn’t make any significant difference for more or less months. There was no discussion at all for a transition from the Active B12/folate Protocol to the SMP
Q2 Re Dibencoplex, you say to take and 1/10-1/2. Within that wide range, what does one's choice depend on? What’s best to try? ¼?
AdoCbl is very different in startup effects from MeCbl. Generally a single dose for the body and a larger single dose for the CNS later takes care of initial startup and regular doses maintain it. Again, the smaller the dose, the more affordable and the less intimidating it was. The dosage effect is very non-linear just as MeCbl. A person with anxiety would take a small dose requiring several for saturation at all levels, slowing down startup, a person without anxiety could take the larger and be done with AdoCbl startup in typically a single dose.
Q3 If successful startup on Day1, do we continue on Days 2, 3 and beyond, on the same minimal dosages as day1? Or step up the dosages? And if so, which ones and how much?
I wouldn’t be too hasty. For many, startup occurred on the 2, 3rd or 4th day on the same dose. Don’t forget, the Methylfolate is part of this initial process. I started with 400mcg. I had so little and no assurance of any more for 2 years. Many coming from the SMP would be taking 200mcg. Again, that was fine too as both 200mcg and 400mcg would start methylation but not be enough to continue healing so both would provide donuthole paradoxical folate deficiency to serve as a startup flag and a place to start titrating from, and again small enough not to be intimidating. Methylation startup and ATP startup are very intimidating for those who are anxious. This anxiety appears to be direct evidence of damage in the limbic system. These amounts are fully adequate for startup unless something else is deadlocking.
Q4 If no startup on minimal dosages, do we try again on increased dosages? Or switch to trying to start up with LCF?
After 3 or 4 days without startup it’s time to add the LCF. This should be titrated, either a normal titration or a micro titration if there is anxiety.
Q5 You say “If you don't get startup with the first 3, then titrate the LCF” – do you mean omit the B12s and folate for now, and try to start up on LCF alone? If so then presumably bring back in the B12s and folate once successfully started up on LCF?
No. It is the deadlock quartet. You add an item, not subtract 3.
Q6 Re LCF, is it 855mg 1xdaily? Single or split doses? (Short half-life?
So that we can compare carnitine doses across varieties I use the “carnitine” mass of 500mg rather than the fumarate mass of 855mg. Carnitine has 3 forms we may be dealing with and 2 main alternatives so we have to be able to compare amounts across multiple forms.
IF person has anxiety do microtitration, starting at 33mcg for 3 doses a day each time on empty stomach with the Jarrow Liquid Freebase carnitine, and increase 10% a day as tolerable.
IF person doesn’t have anxiety do a regular titration starting at perhaps 20mg (approx) for 3 doses per day. The first form to try is L carnitine fumarate such as Drs. Best, Jarrow, Swanson (all Sigma Tau carnitine) or other such vitamin brand. To start with add 20mg a day, either as another dose or another dose starting with the earliest one. Fumarate will be about 90% of people, ALCAR 10%. One will typically work like gangbusters, the other won’t and a mix doesn’t work either, typically. Try the other kind after reaching 125mg daily total with no effect, starting over on amount.
Q7 Re potassium, there’s talk of 1-3g per day? Am I right in thinking the symptoms of excessive K are similar to the symptoms of insufficiency? Can we pre-empt deficiency by going straight to 2g or 3g from day 1? And please confirm we're talking about elemental K, so 2g equates to 12g potassium gluconate or 4g potassium chloride? (Which form is preferable?)
The symptoms of excessive potassium are different enough. First the spasms are like not being able relax the muscle when contracting it rather than it contracting when relaxed. Second excessive potassium doesn’t come on in response to starting methylation. This is the flag that lets one know what is happening. If started in advance how would you ever know or how much? Yes, elemental K. I like the gluconate best despite the larger amount of material. It’s easiest on my stomach. Some like citrate.
Q8 Should we take a multi-min/ multi-vit supplement (i.e. in addition to the fish oils, lecithin, B-Complex, the Gamma-E, the ascorbic acid powder and calcium and magnesium citrate tabs/powders)? If so, which one? Or if the only additional things we need are zinc, selenium (and inositol?), why not just take additional supplements for these, rather than a multi? Is it still advisable to avoid copper and iron?
A multivitamin is a difficult starting point as many of the things need increasing by separates anyway or have folic acid or CyCbl or too much B1, b2 or b3. I take a multi mineral plus additional minerals as needed. All the basic vitamins and minerals are needed. After healing is started it is much easier to adjust doses and tell what is happening. I prefer a high Gamma E like Now foods 8 factor E. Inositol is ome of those I find added laster after the basics and deadlock quartet and getting balanced. Many of these things have to be adjusted over and over as others are adjusted. I have copper in my multi mineral in a balanced amount,. Iron isn’t needed by most men and meny women. It intervfears with absorption of al sorts of things and should be isolated in a meal without E and some toher things 8 hours away from E and other sensitive vitamins. B complex needs to be taken twice a day. I take most everything but E, selenium and chromium in divided doses.
Q9 How much calcium and magnesium?
Reasonable. I take the Calcium Citrate from Costco which includes 500mg of calcium , some magnesium and an additional magnesium capsule. It also has half a dozen trace minerals.
Q10 What times of day should things be taken? Which things need to be separate from which other things? Which are better taken together? Which should be taken with food
I worked out a schedule that works for me. I eat twice a day and take all the “with food” vitamins at that time. Because I include 600mg of potassium and 6 grams of C. I take the methylfolate about 90 minutes before dinner. I take my morning 4mg of folate shortly after wakeup with SAM-e, pregnenolone, DHEA, TMG if taking it, thyroid, l-carnitine fumarate and that usually it. If I need extra potassium. I then take potassium an hour later, at least an hour before eating. Iron has to be with a meal at least 8 hours separate from vitamin E and maybe others. Then I take anoter 300mg of potassium at bedtime. I take the sublingual b12s at carious times duing gthe day and find the best kick from the moring if about 2 hours after SAM-e and carnitine, etc.
Q11 You talk about B3 turning down your methylation. Why/when would you want to do this? When you’re feeling too wired to sleep?
Actually I don’t “talk about B3 turning down your methylation”. I talk about B3 increasing the need for potassium and/or methylfolate and stopping healing. I wouldn’t want to take additional b3 as it can cause additional damage.
Q12 Are crashes inevitable or can they be avoided?
What kind of crashes? Those induced by too much b1, b2 or b3? Those caused by glutathione, whey, NAC? Those caused by folic acid or folinic acid? Those caused by over doing things?