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Consistent with this, a study reported that intestinal-specific deletion of Dmt1 did not alter Mn absorption when Fe-adequate conditions (Shawki et al., 2015), highlighting a complex relationship between Fe status and Mn transport

Factors Indicating Need for Dose Escalation Increase doses when minimal subjective improvements after 3-4 weeks at current dose, IGF-1 levels show minimal or no meaningful increase from baseline after an adequate trial period (e.g., 812 weeks), good tolerance without significant side effects suggesting room for higher dosing, and treatment goals require more aggressive approach than current dose provides

References: (1) Krzysztofik M, et al

How ALA recycles glutathione N-Acetyl Cysteine (NAC) provides cysteine the rate-limiting precursor for your body's own internal glutathione synthesis