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sregan, yes, I ramped up as fast as I could. I followed Freddd's protocol as best I could, informed by all the other research I was also doing. But none of that at first. All I had going in was a prescription for Deplin-15.
Answering your questions about what I did when, my ramp-up and symptoms, what I did to improve things as I went, the mistakes I made, the conclusions I drew, and all of what I'm taking now is a really REALLY long post. So -- as long as this one is, it's is a summary.
The problem with discussing ratios of active B12 (only MeCbl & AdoCbl, to be clear) to L-MTHF is that MeCbl has a challenging absorption profile, so you can (as I did) take 20mg in oral mucosa (inside of lip, not tongue) and only get a fraction (10-25%) -- assuming the brand is good. If it's not good, you can get NOTHING. (Methylcobalimin is tricky stuff to work with -- it deteriorates very fast in light -- so it's entirely possible to get tabs that have no potency at all, and I have experienced those.) For MeCbl, I've used sublingual tabs of various brands, injections (SC & IM), nasal spray, and am now experimenting with inhaling (vaping) MeCbl. (Very exciting possibility.) My ratio did NOT stay the same, and I'm still trying to get my MeCbl up higher. (This is definitely an adventure.)
My primary advice on supplementation: the Deadlock Quartet and potassium. (But as freddd says, anything can block you if you don't have enough of it.)
My approach was to dive in at the deep end, partly because I was desperate, and partly because I was already in the deep end what with only taking 15mg L-MTHF, which dragged me through lots of interesting hells before I found the protocol. (There are many ways up this mountain.)
This is a summary of my ramp up of the Deadlock Quartet. I looked for Freddd-recommended brands whenever possible (see Guide in sig.)
Jul-20-14: L-MTHF 15mg (Deplin-15); in 4 doses/day
Aug-10-14: MeCbl & AdoCbl, ramping up to 10mg/day each within days
Aug-20-14: L-Carnatine Fumerate (LCF); my ramp up to 800mg/day took two months -- my stomach just wouldn't take it. I did finger-touch to mouth multiple times across the day to ramp up. Tried ALCAR for two days and it didn't work; went back to LCF.
Co-factors, most of them within the first three week, ramping up slowly, esp with C, Calc/magn/zinc tab & Potassium:
B-complex 2x (low niacin & no folic acid)
Calc/magn/zinc: 2 tabs daily total 1gm/600/10
C (500mg-1gm)
O3FA (~2gm);
E+D+A
Potassium Gluconate & Citrate as needed; more Gluconate over time, now exclusively: total 3-5gms/day, away from L-MTHF
For sleep, some combination of tryptophan, melitonin, gaba, valarian root extract, ashwaganda
Disclaimer: I post here with this level of transparency to help others on the path who might benefit from my experiences, but my knowledge of the biochemistry of methylation has a long ways to go and many people here know things I don't. My protocol seems to be working for me, for now, but it may not work for you; there are great variences between people's needs and reactions to methylation work, due to genetics, history, age, damage, illness, and any number of other factors medical science has yet to put its grubby little fingers on. I know at least one person with similar methylation genetics to mine who has completely different symptoms. My advice: keep a log, review it often, and have courage; some of us here are healing dramatically from this work, and you might, too. To say "your mileage may vary" is an understatement, and this is one of the reasons I opted to follow Freddd's protocol, because it is more about results than theories that don't explain everyone. Methylation theory is only about 10 years old - a split second for medical science and research -- so most doctors don't know much about it, and even methylation experts disagree. I do not have all the answers, and advise you take with a grain of salt the advice of anyone who tells you they do. On the plus side, *all* the doctors I have talked to assure me that methylation work and the supplements involved are pretty safe and it's hard to go far wrong. That doesn't mean you won't have rocky reactions -- I sure did. For me getting better was the most important thing and I was willing to go through whatever it took to get there. Was I scared? Oh, very. Am I glad I took the risk? Oh, very.