B-12 - The Hidden Story

[SaraM]

Hi Freddd, if my intercellular B12 and folic acid are in the normal range, does it mean I do not have methylation problem?

 

[Freddd]

Rich's simplified 5 article used to say glutathione might be useful, haven't heard him comment on it recently. I'm guessing you are correct, but my CFS docs standard is to test glutathione, inject weekly for 6 weeks and then test again. I can stop it if necessary, but is 2 weeks enough time to stop before starting ActiveB12? Note that I'm also waiting on the methylation panel results from Vitamin Diagnostics.


The neurological formula has 5mg of potassium. So I'd be getting 1/3 of that when I'm up to 2 tables a day. Is that enough? If not I have another potassium supplement.



I'm getting 5000 IU of A, 1000 IU of D separately. And then a little of the others (except omega3) in the neurological formula.

Hi Dmholmes,


Rich's simplified 5 article used to say glutathione might be useful, haven't heard him comment on it recently.

On that other thread on methylation, unless he it was a different thread, he said he doesn't suggest it. Also, on a website with a significant amount of his writing posted I reaqd where he said that about 1/3 of people have difficulty with it. I gues I have just identified which third quite possibly.

I can stop it if necessary, but is 2 weeks enough time to stop before starting ActiveB12

Glutathione has a short serum halflife. You can take active b12s immediately and it's impeding effects wear off quickly if only taken occasionally.

The neurological formula has 5mg of potassium. So I'd be getting 1/3 of that when I'm up to 2 tables a day. Is that enough? If not I have another potassium supplement.

5mg of potassium is nothing. 99mg is 3% of the MDR. I have taken anywhere between 2 and 6 tablets of 99mg/day. At 6/day my potassium has finally come up from under 4 to 4.2 on tests.

2000mg of Omega3 is good for neurological healing. The Zinc is necessary, more than minimum. I found 65mg to work far better than 15mg. Magnesium/calcium is required, 10,000 units of A (fish oil) is probably best, 3000-5000 units of D in the current style is probably a good idea. 400 iu of E in a Gamma 8 factor complex formula is probably best. Jarrow B-right has multiple coenzyme b factors. methylfolate is essential though you might wait to add that until after you are stabilized on BOTH active b12s. SAM-e and l-carnitine (fumarate or acetyl by individual test) and a few other things can help tremendously. But wait on these until stable on the basics plus both actiuve b12s.

 

[Freddd]

Hi Freddd, if my intercellular B12 and folic acid are in the normal range, does it mean I do not have methylation problem?

Hi SaraM,

I have no idea what it may mean in relation to methylation problems. In terms of adequacy of active folate and active methylb12 and adenosylb12 the tests are useless. You may have symptoms galore that will respond to those items and the tests are completely non-predictive of that.

 

[winston]

B12

Hi Fredd, I swallowed the pill. I started this morning taking Jarow B-Right. I am OK. I am not usually this paranoid but I had a bad experience into the second year of this illness I was seeing a CFS Specialist in LA and after testing I needed to be treated for parasites. He used an antibiotic not listed in the PDR. I sufferred through weeks of taking it to get rid of those dam parasites and ended up in the hospital with drug-enduced hepatitis. I was on a lot of prescription drugs, sleep drugs, anxiety drugs, depression drugs and still was sick. This last 18 months I got off all those drugs the only thing I take today is my Synthroid and Cytomel for my thyroid. Right now I am trying to stay ahead of the darkness. I know I am going to be OK. Thank you so much for being here.

Lena

 

[dmholmes]

On that other thread on methylation, unless he it was a different thread, he said he doesn't suggest it. Also, on a website with a significant amount of his writing posted I reaqd where he said that about 1/3 of people have difficulty with it. I gues I have just identified which third quite possibly.

"Adding glutathione support will help some people, as will adding molybdenum."

Just for reference. From this article. It's a couple of years old, so probably doesn't apply.

Thanks,
David

 

[Freddd]

"Adding glutathione support will help some people, as will adding molybdenum."

Just for reference. From this article. It's a couple of years old, so probably doesn't apply.

Thanks,
David

Hi David,

Yes, I too read all the articles praising glutathione to the heavens as the greatest thing since sliced bread for CFS/FMS. That's why I tried it. That's why others at another location tried it with me. We keep trying to find the last factors for improvment. However, as noticed after the fact, after it was a disaster for every one of us, was that all the praises being sung were by people on inactive cobalamins or practitioners using inmactive cobalamins. In digging deeper, the only people having a reversal were those who had substantial improvment on active b12s that they would not have had on inactive b12s. Nobody else had the improvements to lose and so didn't notice any effect like that.

I attempted to find even a single article praising glutathione for it's effectiveness in a program based on active b12s. I could not find a single one.

Also as far as I can tell, the socalled "methylation block" can't exist if a person is taking methylb12 and methylfolate to begin with. I believe it is the state that I had been calling "methylator exhaustion". It is a product of inactive cobalamins and folic acid. This is just based on my experience you understand in myself and walking some hundreds of people through this process.

 

[dmholmes]

Freddd, what have you seen with brain fog and anxiety with your active b12 experience? Those are worse than fatigue for me.

Thanks,
David

 

[Freddd]

Freddd, what have you seen with brain fog and anxiety with your active b12 experience? Those are worse than fatigue for me.

Thanks,
David

Hi David,

I didn't really experience anxiety myself. I experienced almost everything else but not anxiety. Brainfog is something else again. I sufferred that for decades. I have characterized myself as Rip Van Winkle, waking up from 20 years of brainfog. So much of the period from 39 until a few years ago is just lost in the fog. My exwife brought by some photographs we had taken at Monteray Bay. I had forgotten all about that and didn't recognize it. I don't know how much of that is the brainfog itself and the problem of state associated memory. I'll explain

The brainfog cleared in stages. Each time it clears it feels like "that's it". It is hard to tell relative degrees until another one clears. I used to be a decent tournament bridge player. I don't even remember a lot of the conventions any more and haven't played in 16 years. I could learn again and it would come back I'm sure but I would have to reconnect it. The brainfog did not fluctuate much, either while in it or after recovering. When changes happened they were very rapid.

Nutritional items made a huge difference in brainfog. I'll list everything that made a difference for me to illustrate, plus through in a few more that other people have found to be eye openers.

1. Sublingual doses of 5 star methylb12, 1mg to 25mg per day - the first layer of brainfog burned off in the light of the very first dose in a matter of the first hour. As I increased the dose more an more clarity was achieved for the first few months.
2. Sublingual doses of adenosylb12, 3mg-15mg per day. The major effect was the very first dose as mitochondria started funtioning better and supplying energy. Within the stated range more made little difference. Some people find adjusting balance between adb12 and mb12 makes a large difference. Clarity was maintained since then.
3. SAM-e, again an eyeopener with the first dose that was sustained with additional doses, at first 400mg/day was needed, as I've healed and reached a new balance, 200mg has been all that makes a difference. Clarity was maintained since then.
4. L-carnitine fumarate (but NOT acetyl), first 250mg was an eyeopener, slight improvment at 500mg daily. Increased energy tremendously and funtion of Adnosylb12 in mitochondria. After the b12s were in place this made the largest difference other than mb12 itself. Alpha Lipoic Acid assists this function. Intensity lasted 5 months. Clarity was maintained since then.
5. Zinc - Increase from 15mg/day to 65mg/day had to be done in 4 step titration it was so intense, but intensity was shortlived. Clarity was maintained since then.
6. B-Right b-complex going from once per day to twice a day. Did get rid of a 24 hour cycle in all sorts of things from pain to some variations in clarity. Also skin cleared up of infected follicules and other problems and heart palpitations went away.
7. Methylb12 50mg sublingual single dose or 7.5mg mb12 sc injection. Another increment of clarity. Increases neurological funtioning. Hypothesis is that it enters the cerebral spinal fluid by diffusion overcoming the barrier that causes lower CSF cobalamin levels in CFS/FMS.
8. Adenosylb12 51mg single dose. Increases neurological funtioning by entering neurological mitochondria and increasing energy production in neurons. Hypothesis is that it enters the cerebral spinal fluid by diffusion overcoming the barrier that causes lower CSF cobalamin levels in CFS/FMS.
9. Methylfolate - many report that this is the key to "turning on the methylb12", especially if taken before SAM-e. Adds to mental clarity.
10. Magnesium - this is an important substrate for active b12 functioning. This has "turned on" methylb12 for some people including banishing brain fog.
11. Vitamin D at about the 3000 IU range. For some people this is the key to turning on methylb12 and mental clarity.
12. D-ribose, makes a small difference in energy for me but for some people makes it all work and banishes brainfog.

Glutathione precursors were the ONLY thing that for me increased brainfog and started bringing it back. It caused mood changes, loss of clarity, personality changes and resumption of neurological deterioration.
It's these many varied experiences that keeps me coming back to the importance of taking the basics like A,D,E,C,mag, zinc, cal etc as well as the absolutely necessary items; adb12, mb12, methylfolate, B-Right, Potassium, Omega3 oils and the critical coffactors like SAM-e, l-carnitine, etc.

I suspect that anxiety is caused by a different area of the brain being afflicted than I had. I only had some of the neuropsyc changes, as do most people. Outright psychosis is pretty rare these days. Paranoia however seems pretty common, especially in the long term takes of cyanocobalamin.

Good luck.

 

[dmholmes]

1. Discontinue SAM-e, methylfolate, TMG, L-carnitine, for 2 weeks in an attempt to cool down the methylation and enhancement of mitochondrial function. Also discontinue any glutathione and/or glutathione promoting precursors including un-denatured whey, glutamine, NAC, etc

Freddd, would the 17mg of TMG in 2 tablets of HH neuro formula be a problem?

Thanks,
David

 

[Freddd]

Freddd, would the 17mg of TMG in 2 tablets of HH neuro formula be a problem?

Thanks,
David

Hi David,

I wouldn't think so as it is so minimal.

 

[winston]

B12

Hi Fredd, I don't know if it was a placebo affect or a fluke but I felt noticeable better by Saturday and today. I started the B-Right on Thursday, I was less fatigued and not as toxic feeling. Though brainfog and dizziness are still my constant companions. Today I took the B-Right after breakfast and than one after lunch, it did make me feel jittery the rest of this day. Is there any benefit in taking one or two a day? I will do this for one more week than I will start the Country Life adenosylb12. Again thank you for helping me with this treatment. I am encouraged.

Lena

 

[mmorrison101]

Methylation block & the methylation cycle

Dear Freddd,

You have delved deeply into the mysteries of vitamin B-12! At some point I will come back and re-read this thread a few times when I have less brain fog, and maybe some of it will stick. <smile>

This quote of yours caught my eye:

Also as far as I can tell, the socalled "methylation block" can't exist if a person is taking methylb12 and methylfolate to begin with. I believe it is the state that I had been calling "methylator exhaustion". It is a product of inactive cobalamins and folic acid. This is just based on my experience you understand in myself and walking some hundreds of people through this process.

I've been on the Yasko protocol for a couple years, and I can offer a little more information about the term "methylation block". The methylation cycle is a pathway that consists of a series of related biochemical reactions. Imagine a road that loops around, crosses 1/2 dozen bridges, and then arrives back where it started. If any one of those 6 bridges are out, then your progress around the road is impeded. Similarly, the body's methylation cycle can be impaired by blocks or glitches in more than one place. Vitamin B12 and folic acid help repair some of these "breaks" in the cycle, but certain mutations affect the body's supply of other chemicals in addition to B12. As examples, here are some things I've gleaned from my own genetic report: An MTR mutation increases the activity of an enzyme that uses up B12, and so uses it up at a faster rate. MTRR mutations affect the enzyme called methionine synthase reductase, which helps recycle B12 in the body. These 2 mutations would be directly helped by additional B12. Some other mutations that come into play are MaoA, which breaks down serotonin, ACE, which causes increases in aldosterone levels, and NOS, which plays a role in ammonia detoxification. So... I've had the Yasko genetics testing done, and know that I have about a dozen of the mutations she looks at. I know I need B12, but I also need certain other supplements to repair the other damaged "bridges" in my biochemistry. In my case, B12/folic acid alone probably wouldn't do the trick.

Of course, that's an overly-simple description of something that's actually very complicated. I guess what I was trying to get at was that there are multiple places where the cycle can break down, and the cause of an impaired methylation cycle may be at bridge #1, bridge #4, any of the other bridges, or at more than one bridge. The result is the same in each case--the methylation cycle slows down. However, the specific cause may be different, and a remedy that works for one person (fixing bridge #1) may not work for another (maybe for them bridge #4 is out).

I don't want to minimize the work you've done researching B12 deficiencies! I think this is an area that is vastly understudied, and you're contributing a LOT with what you're doing. I just want to humbly suggest that it may not be the *only* remedy, even if the common symptom is an impaired methylation cycle.

Okay, I'm totally out of brain now. Rich or someone else who knows more biochemistry than me could go farther into details, but maybe I managed to get the basic idea out there.

Thanks for the all the work you do helping people,
zenmom

 

[Freddd]

Hi Fredd, I don't know if it was a placebo affect or a fluke but I felt noticeable better by Saturday and today. I started the B-Right on Thursday, I was less fatigued and not as toxic feeling. Though brainfog and dizziness are still my constant companions. Today I took the B-Right after breakfast and than one after lunch, it did make me feel jittery the rest of this day. Is there any benefit in taking one or two a day? I will do this for one more week than I will start the Country Life adenosylb12. Again thank you for helping me with this treatment. I am encouraged.

Lena

Hi Lena,

For years, I took b-complex once a day. I experimented in taking it in the morning or the evening or midday, based on a variety of people's theories about which is better. At some point a pattern appeared. One piece of the pattern was a daily 24 hour pain cycle. It turned out to reach a maximum, quite reliably, 24 hours after the previous b-complex dose. It of course only became apparant, as morning or evening pain peaks are quite common, when I looked at my charting of such and noted that it followed when I took the b-complex including mid-day. When I tried twice a day, with breakfast and dinner, the pain peak disappeared. Not only that, but my skin problems finished clearing up and my heartbeat irregularities, palpitations, went away. When I went back to once a day, they returned. As the b-vitamins are all water soluable and many have a short serum halflife it appears I was taking one step forward and one back each day hindering my epithelial healing, maintaining the heartbeat irrgularities and causing a 24 hour pain cycle. Less obviously my IBS cleared up the rest of the way and my allergies faded even more, all epithelial tissue inflammation functions, at least in part. The b-complex in general has beneficial effects from maintaining a more even serum level. B-Right also has specifically, a small amount of methylb12, 250 mcgs. Taken orally 250mgs can be absorbed at 1% for those with IF problems and somewhat more, up to about 5-10mcg per dose for those with a fully funtioning absorbtion and transport system. This makes a small start at bringing methylb12 up to a fully functional level.

The "jittery" feeling is a relative thing. A person without any b12 deficiency symptoms at all would generally not feel a thing regardless of the amount of methylb12 and/or adenosylb12 taken. A person who is terribly down with a severely depressed nervous system or mitochondria system will tend to feel any increase towards normal as "jittery". It's a relative thing. If a person is operating for years at 0.1% capacity and it goes up to 1% capacity that is felt as a huge change as 3+ doublings. If a person goes up from 50% to 100% that is hardly more than barely noticable at one doubling. This is how our sensory system works, the result being we can see by starlight as well as sunlight and everywhere in between. However when we walk out of a dark room into bright sulight we can't keep our eyes open at first as the light intensity is overwhelming but becomes normal pretty quickly. "Jittery" is the same sort of thing, an artifact of change from a very low state to a slightly brighter state.

 

[Freddd]

Dear Freddd,

You have delved deeply into the mysteries of vitamin B-12! At some point I will come back and re-read this thread a few times when I have less brain fog, and maybe some of it will stick. <smile>

This quote of yours caught my eye:



I've been on the Yasko protocol for a couple years, and I can offer a little more information about the term "methylation block". The methylation cycle is a pathway that consists of a series of related biochemical reactions. Imagine a road that loops around, crosses 1/2 dozen bridges, and then arrives back where it started. If any one of those 6 bridges are out, then your progress around the road is impeded. Similarly, the body's methylation cycle can be impaired by blocks or glitches in more than one place. Vitamin B12 and folic acid help repair some of these "breaks" in the cycle, but certain mutations affect the body's supply of other chemicals in addition to B12. As examples, here are some things I've gleaned from my own genetic report: An MTR mutation increases the activity of an enzyme that uses up B12, and so uses it up at a faster rate. MTRR mutations affect the enzyme called methionine synthase reductase, which helps recycle B12 in the body. These 2 mutations would be directly helped by additional B12. Some other mutations that come into play are MaoA, which breaks down serotonin, ACE, which causes increases in aldosterone levels, and NOS, which plays a role in ammonia detoxification. So... I've had the Yasko genetics testing done, and know that I have about a dozen of the mutations she looks at. I know I need B12, but I also need certain other supplements to repair the other damaged "bridges" in my biochemistry. In my case, B12/folic acid alone probably wouldn't do the trick.

Of course, that's an overly-simple description of something that's actually very complicated. I guess what I was trying to get at was that there are multiple places where the cycle can break down, and the cause of an impaired methylation cycle may be at bridge #1, bridge #4, any of the other bridges, or at more than one bridge. The result is the same in each case--the methylation cycle slows down. However, the specific cause may be different, and a remedy that works for one person (fixing bridge #1) may not work for another (maybe for them bridge #4 is out).

I don't want to minimize the work you've done researching B12 deficiencies! I think this is an area that is vastly understudied, and you're contributing a LOT with what you're doing. I just want to humbly suggest that it may not be the *only* remedy, even if the common symptom is an impaired methylation cycle.

Okay, I'm totally out of brain now. Rich or someone else who knows more biochemistry than me could go farther into details, but maybe I managed to get the basic idea out there.

Thanks for the all the work you do helping people,
zenmom

Hi Zenmom,

Thankyou for some details. I was over simplifying, guilty as charged. I myself needed quite a few more items to correct things more or less completely. The complication of these multi segmented chains of reactions having so many places they can break down causing the whole process to come to a grinding halt is why I advocate elliminating as many assumptions about things working fully and correctly as possible and using the active factors such as methylb12, adenosylb12, methylfolate, p-5-p, pantethine and so on instead of the inactive factors that count on all steps of multiple complicated chains to work correctly such as hydroxycobalamin, folic acid, cyanocoblamin, pyridoxine, pantethenic acid or calcium pantethenate, etc. As each chain of assumptions is elliminated a larger percentage of people have stronger, more rapid and more complete positive responses and healing. Impaired methylation is just one part of the problem and may be a result of other problems as well as a primary problem itself and perhaps a combination of several causes.

Just today for instance, I identified another reaction chain negatively impacted by the taking of glutathione precursors in a trial earlier this year. Unrecognized amongst all the induced methylb12 deficiency symptoms were some induced methylfolate deficiency symtoms. I had a sizable reaction to increasing my methylfolate from 800mcg/day to 2400mcg twice a day whereas before the glutathione precursors that amount did nothing at all not done by 800mcg/day. Further the sores ever present at the corners of my mouth for decades, only disappearing several years ago when I started methylfolate had crept back unnoticed compared to other much more prominent symptoms until pointed out to me. Sure enough I responded to methylfolate as one deficient in it. More SAM-e on the other hand had made no difference as I had already tried that. Now I'm anxious to see what else besides fatigue, brainfog, mood change and the corner of mouth sores (angular cheilitis) which is folate deficiency specific respond to the increased methylfolate before I decrease it to maintenance levels where ever that is now. The body is a complicated system.

 

[dmholmes]

Freddd, I've been doing well with the adb12 for 4 days, once a day. Added B-Right yesterday. I saw 1g and 5g Jarrow mb12 at Whole Foods. Would starting with the 1g be of any benefit for the overly cautious ones like me?

 

[Freddd]

Freddd, I've been doing well with the adb12 for 4 days, once a day. Added B-Right yesterday. I saw 1g and 5g Jarrow mb12 at Whole Foods. Would starting with the 1g be of any benefit for the overly cautious ones like me?

Hi David,

I saw 1g and 5g Jarrow mb12

I suspect that what you actually saw were Jarrow 1mg and 5mg as they don't make a 1 gram and 5 gram tablets. The 1 g would be the size of 1000mg C tablets and a 5 mg would be a huge horsepill 5 times as large.

If you buy the 5mg and split it in quarters it is usually less expensive than the 1mg tablet and allows you to titrate right on up with fewer tablets. However 1 mg is perfectly satisfactory. It's the first 1mg in a sublingual dose that makes almost all of the perceived differences. Some people find one 5mg to be more effective and some find three or four 1mg tablets spread across the day to be more effective. Buy both and do a comparison and then let us know what you found by way of effects. The only time the 5mg is essential is when trying the 50mg dose. I was hypersensitive to begin with and found comparisons very easy to do for that reason. If you are hypersensitive and would like to do some brand effectiveness comparisons let me know and I can suggest a brand that needs some comparisons made as some remarks lead me to believe it may be a 4 or 5 star brand. I would like very much to be able to expand the list of 5 star brands as it would make it easier for people to locate some locally.

Good luck. I considered the effects to be euphoric after 20 years in the pit rather than jittery. Beauty is in the eye of the beholder. Have good expectations of the mb12, that it will improve consciousness, sense of smell and taste, of touch, awareness in general, sex, cognitive function, energy and mood, even if by comparison it seems a bit much at first. The same effects seen through the manure colored glasses of fear seem something else entirely.

Will you describe all the effects of the adb12 for me? It will help me follow what is happening as well as helping others by knowing your experience.

 

[dmholmes]

Will you describe all the effects of the adb12 for me? It will help me follow what is happening as well as helping others by knowing your experience.

Seemingly less brain fog, more energy, and definitely more libido with the adb12. Just started a quarter of an 5mg mb12.

Thanks,
David

 

[Freddd]

Seemingly less brain fog, more energy, and definitely more libido with the adb12. Just started a quarter of an 5mg mb12.

Thanks,
David

Hi David,

Sounds like a good set of changes. Adb12 affects far fewer things than mb12. Do you have burning muscle pain, intense sore spots in the muscloes, easy spasming and things like that? My experience of the adb12 was that the increase in energy was also an increase in exercise tolerance. However, don't overdo. Don't boogy all night just becasue you feel like you have the energy. Build up slowly. Start slowly and build up. Doing to much can cause a crash. So gentle exercising, taking a walk and walking a little further each day is a great start. Then build on it as muscles recover.

 

[dmholmes]

Hi David,

Sounds like a good set of changes. Adb12 affects far fewer things than mb12. Do you have burning muscle pain, intense sore spots in the muscloes, easy spasming and things like that? My experience of the adb12 was that the increase in energy was also an increase in exercise tolerance. However, don't overdo. Don't boogy all night just becasue you feel like you have the energy. Build up slowly. Start slowly and build up. Doing to much can cause a crash. So gentle exercising, taking a walk and walking a little further each day is a great start. Then build on it as muscles recover.

I haven't had burning muscle pain. I do have one sore spot in back/shoulder muscle. Have had an issue with eye muscle spasming, but not in a while.

Up until a couple of months ago, I've been able to exercise without much fatigue afterwards. I stopped playing hockey for a bit because I was afraid it was going to make it worse. I'll try a little after a week of adb12 and see how it goes. My fatigue has historically come in acute bouts, maybe a couple of times a month I would be down for a whole day.

I haven't noticed anything tangible from the 1/4 mb12. Should I continue with 1 adb12 and 1/4 mb12 a day?

Thanks,
David

 

[Freddd]

I haven't had burning muscle pain. I do have one sore spot in back/shoulder muscle. Have had an issue with eye muscle spasming, but not in a while.

Up until a couple of months ago, I've been able to exercise without much fatigue afterwards. I stopped playing hockey for a bit because I was afraid it was going to make it worse. I'll try a little after a week of adb12 and see how it goes. My fatigue has historically come in acute bouts, maybe a couple of times a month I would be down for a whole day.

I haven't noticed anything tangible from the 1/4 mb12. Should I continue with 1 adb12 and 1/4 mb12 a day?

Thanks,
David

Hi David,

So far so good. You wanted to be cautious "any benefit for the overly cautious ones like me?" so we started cautiously. You had a significant effect from adb12 indicating that you were indeed deficienct of adb12. as That can "top off" very rapidly, the intial experience on adb12 is rarely repeatable, but the energy is maintained and adb12 becomes one of the important building blocks for building the entire structure. So now continue with the adb12 and titrate the mb12 upwards. 1/2 tablet would be good tomorrow, then 3/4s the next day and then an entire one, unless you have a large reaction at some point, at which you maintain until it smooths out. If you were going to have a large reaction form the mb12 you would have had it already most likely. Only certain functional things happen almost instantly. Other things come on far more slowly. So of the 4 active b12 deficiencies you know that you had one of them and the other 3 are as of yet unknown. As the mb12 builds up it's effects will increase. After you are comfortable, which could be quickly at 5mgs a day, adding methylfolate would be a good next step. If you are not taking all the basics like a,c,d,e,b-complex, cal,mag, zinc it best to phase these in. Any one or 5 of them may act as a key. Later, the relative amounts of mb12 and adb12 can be adjusted for your best effect. Right now it's just a matter of getting things started and through the initial stages and then the fine tuning and adjustments. After the methylfolate there are another half a dozen or so critical cofactors to be added in. If you are not taking at least a little potassium now is a good time to add that unless you have high potassium, in order to prevent potential problems.