Are both folapro and B12 meant to be under the tounge? And how long should they normally be there? I have just bought the supplements...
FolaPro can just be taken orally. It is absorbed well by the gut. B12 should be taken sublingually in order to get enough into the blood. The normal absorption process in the gut, involving haptocorrin and intrinsic factor, is limited in the amount it will absorb. It works fine in a normal, healthy person, but in ME/CFS, more B12 is needed to overcome the functional deficiency that is caused by glutathione depletion.
If, in addition, a person has an inborn error of metabolism in their B12 processing enzymes, such as Freddd appears to have, then even more B12 is needed, and it must be the coenzyme forms methyl B12 and adenosyl B12, as Freddd recommends. We don't yet know what fraction of those who have ME/CFS also have such an inborn error of metabolism. The clinical study that Dr. Nathan and I performed suggests that most do not have this issue, but Freddd's experience suggests that it may still be present in quite a few people.
I still suggest trying hydroxocobalamin as the B12 form first. If this hasn't produced benefit in 3 months, then I would suggest doing some testing to find out why, or doing a trial of Freddd's protocol. I would suggest starting at lower dosages than he recommends at first, if you do this, in order to lower the likelihood of a severe drop in potassium in the blood, which can be hazardous, and also to allow glutathione to come up, as we showed in our clinical study will occur if the methylation cycle is not overdriven.
I realize that Freddd may have different views on this, but I think it is wise to proceed cautiously, because large dosages of methyl B12 together with 5L-methylfolate will take control away from the cells. I have seen a few cases now in which testing has shown that this can overdrive the methylation cycle to the detriment of building glutathione, which is necessary to correct many of the symptoms of ME/CFS.
I suspect that the rapid rise in folates in the cells with this high-dose protocol also gives rise to rapid proliferation of cells, leading to a high demand for potassium. Since it has been shown that whole-body potassium is low in ME/CFS, a large potassium demand can lower the blood level of potassium, and this can have serious detrimental consequences.
I realize that if a person has an inborn error of metabolism in the B12 processing enzymes, as Freddd appears to have, there is no other choice but to use methyl B12 and adenosyl B12, together with L5-methylfolate. In that case, I still think it is a good idea to start at lower dosages at first, to see how it goes. As Freddd has repeatedly pointed out, it is hazardous to drive potassium too low.