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aquariusgirl ,
I don't know the whys and wherefores of the chemistry, but I do know that some practitioners warn not to supplement with BH4 until you have good support for the rest of the methylation cycle. I also disagree on other points with some other things these practitioners say, but I give them credit for being right about a lot of things. This may be one - I don't know. I think you take a chance if you supplement with BH4 first. I remember reading about people 'crashing', mostly mood I think, from introducing BH4 too early. At least that was the explanation as I remember, for what it's worth.
I am doing active research on BH4, Crit, so if you can give me
more information on those who have
'crashed' that would help a lot. Especially how those symptoms changed.
One obvious warning just came to mind, if you are taking anti-depressants (such as SSRI's or Amphetamines) doses may need to be lowered when taking BH4. You would need to consider St John's Wort to be an anti-depressant in that light (it's a Mona Amine Oxidase Inhibitor).
But then that's common sense advice do not take two treatments for the same thing without knowing how they interact.
BH4 (along with Vitamin D) plays a role in the immune system as does Dopamine which they both help to produce. When the immune system wakes up it could cause a lot of flu like symptoms, albeit for good reasons. So that's one obvious issue that comes to mind.
In the context of ME it's definitely a more experimental treatment, all treatments have risks, and theoretically there seems to be a lot of positive potential.