http://forums.phoenixrising.me/index.php?threads/how-to-titrate-to-get-out-of-donut-hole- insufficiency.22614/page-2#post-345537
Following the newer version of the titration pattern then the steps look like this.
1 - Titrate AdoCbl/MeCbl combo to approximately 100mcg absorbed where healing can “turn on” with 200-800mcg of l-methylfolate. 200mcg will not be enough and will immediately (3 days) give “detox” symptoms composed of low potassium and donut hole folate insufficiency. If startup does not occur by the time one gets to 1000mcg combined absorbed cobalamins, titrate LCF
2- Identify low potassium symptoms and titrate potassium.
3 - Identify donut hole folate insufficiency and titrate with 4x-8x dose size of l-methylfolate several times a day until those symptoms are strongly diminishing.
4 - titrate AdoCbl and MeCbl to perhaps a nominal sublingual dose of 1000mcg each, watching for low potassium, donut hole folate insufficiency and identify any other new symptoms, and what isn’t being taken care of
5 - Finish titrating LCF to 500-1000mg for now, then identify what isn’t healing or not enough. Try SAM-e, TMG, D- ribose, Vit D, Zinc, B-vits and various things as needed to improve performance. It isn’t a try 1 thing and then another. It is add SAM-e and then TMG and various other things. It is usually combinations that yield results. SAM-e need titration over several months. LCF could take six months to titrate up to the 500mg dose and try 1000mg to see if it makes a difference. Don’t rush things. Think things through. Look at the symptoms and effective supplements for them to get ideas. Most people will fall into one of several groups. Almost everybody here has appears to have complicating factors and more severe things going on, with me it is SACD which is basically long term damage from prolonged deficiency. Hormones get all messed up and will often change during these titrations.. There isn’t a system of the body that is immune to damage from these deficiencies. As there are at least 600 reactions affected by the methylation and ATP the variations are huge in number.
6 - Titrate MeCbl separately until it makes no difference.
7 - Adjust potassium and l-methylfolate as needed by response to symptoms 8 - Titrate AdoCbl separately until maximum amount that makes a difference.
8 - Titrate AdoCbl separately until maximum amount that makes a difference.
9 - Adjust LCF
10 - Adjust various factors.