Rich - Are the dosages for Hydroxy b12, Methylfolate, and the Folinic Acid in the SMP starting dosages only or can / should they be increased if tolerable ? If so, how high would you recommend ?
The dosages of hydroxo B12, methylfolate and folinic acid in the SMP can be increased if tolerable. For most PWME's, I think the dosages of the folates will probably be adequate. Some people do need higher B12 dosages, depending on their genomic polymorphisms. I realize that Freddd recommends avoiding folinic acid and going to higher dosage for methylfolate. However, as I've mentioned in the past, I think his genomic polymorphisms are unusual. Folinic acid is helpful for most PWME's, and going to higher dosages of methylfolate may block the glycine N-methyltransferase reaction, raising the ratio of SAMe to SAH too much. This could raise the rates of the methyltransferase reactions, and it's not clear to me what the consequences of that could be. I do agree that making sure the cofactor nutrients are at adequate levels in the body is important.