B12 for probably non-ME/CFS symptoms

[garyfritz]

Continuing to read and study... I have MTHFR +/+ and COMT H62H & V185M +/- and I've been taking methylB12 for about 10 months.

At http://www.mthfrsupport.com/mthfr-facts/ it says: High levels of L-methylfolate can put a burden on people with COMT V158M and H62H expressing who have a hard time breaking down epinephrine... Methylcobalamin is the most active form of B12 and the one that most doctors that know about methylation and MTHFR prescribe but it is not a good idea for people with COMT V158M and H62H expressing. Individuals with these COMT genes usually need to do hydroxy and/or adenosyl B12. Methylcobalamin can do more oxidative damage to people with COMT expressing.

Questions:

* I don't show the anxiety &etc problems it mentions, so maybe that's not a problem for me? Should I replace my methylB12 with adenosyl or hydroxy to avoid problems with COMT?

* That page also says your doctor may want to test folic acid / folate / etc levels to determine what you need. Am I muddying the info my MD will get by taking methylB12 / folate / etc? (My MD is out of the country and I won't be able to see her for a month.)

* I started methylB12 last year (Readisorb 500-1000 mcg at bedtime) and within a few weeks I noticed dramatic improvements of my sleep patterns & RLS. After 6 months it started losing effectiveness. I started ramping up my dosage based on knowledge here, and currently I'm taking about 4 * Jarrow 5mg spaced through the day, mostly in the afternoon/evening. That seems to be working, for now. But it only lasts for a few hours. Sometimes I wake in the night with twitches/agitation and I need some of the Readisorb spray to get to sleep. By morning my twitches/RLS start coming back. I added folate (Solgar metafolin 400mcg) 1x/day last week, no improvement so far. The B12 feels like a "band-aid" solution and my body keeps getting resistant to the methylB12. I don't feel any fundamental changes -- it doesn't feel like my body is switching on a new process. What does it take to kick-start the methylation?

 

[sueami]

I don't think it could hurt you to try adenosylcobalamin, and it's a recommended form of b12 in Freddd's protocol because it goes into the mitochondria, so it's having a different effect than mb12. It's also called dibencozide and I believe the current recommended brand is anabol naturals dibencoplex. I ordered mine from Iherb.com in 10,000mcg tabs. I've worked up from a quarter to a half a tab in the mornings.

I am hetero for both COMTs too. I'm about to start MB12 shots. I hope that is not going to create a problem for me.

I'm confused by the quote you excerpted, because it starts by saying high levels of L-methylfolate are bad for us COMTers. That's the Solgar metafolin. (I wonder if that's why my doc wanted me to drop the 4mg I was taking back down to 400mcg.) That's a separate issue from MB12, and I wonder whether this is where folinic acid gets recommended instead of L-methylfolate

According to Freddd's experimentation, four things are needed to kickstart methylation -- mb12, adb12, methylfolate and L carnitine fumarate. I believe he recommends titrating up on the MB12 and methylfolate first, until you start seeing results, then add in adb12, then after that stabilizes add it Lcarnitine. Since you are relatively healthy, you ought to be able to experiment with raising folate levels next (seems like you are getting mb12 in spades already). Check out the High Dose Methylation thread to see how rapidly people have titrated up.

 

[sueami]

http://forums.phoenixrising.me/index.php?threads/sulfur-and-methylation.19372/page-2

There's some interesting discussion on this page about hetero COMTage.

Given that you are not experiencing anxiety, you might not need to worry about it at all.

From Triffid:

Yes P5P is the cofactor for CBS. It helps a large percentage of people with CBS defects.
Don't worry about COMT +/- ... I said elsewhere that's like winning the lottery. It is tied
to intelligence and also stability, whereas COMT +/+ is tied to intelligence and instability
(moodiness, bipolar, etc). People take COMT inhibitors to achieve what you have going naturally.

and from dbkita:


Agreed unless your body makes excess NE due to immune dysregulation then defects in comt swarm your cns with norepinephrine.
So why is stimulating CBS enzyme with p5p to drain more homocysteine down the transsulfuration pathway? I ask only because Yasko suggests limiting b6 for cbs patients and I am still trying to figure out the best amount of p5p for me to take.

 

[garyfritz]

According to Freddd's experimentation, four things are needed to kickstart methylation -- mb12, adb12, methylfolate and L carnitine fumarate. I believe he recommends titrating up on the MB12 and methylfolate first, until you start seeing results, then add in adb12, then after that stabilizes add it Lcarnitine. Since you are relatively healthy, you ought to be able to experiment with raising folate levels next (seems like you are getting mb12 in spades already).

Yeah, I don't think I should increase mb12 any more. (But I sure hope the 20 mg/day keeps the sleep issues under control.)

I'm at 400mcg/day metafolin, and I could go up a bit on that.

I need to get some adenosylB12 ordered -- can't find any of it locally. I'll get that and start ramping up on adenosyl and LCF. Better get some niacin too but that's easy to find.

EDIT: iherb order:
* Source Naturals Dibencozide (adB12), 8.6 mg
* Doctor's Best LCF 855 mg
* Douglas Labs B-complex without folic/folinic acid
* NOW Foods Gamma E complex

I'll start taking 1x/day of each when they arrive.

 

[sueami]

I wouldn't start both the adb12 and the LCF at the same time. If either of them bother you, you won't know which it is. Save the LCF until you're certain how you are reacting or not to Adenosyl.
That E complex looks interesting. What are you adding that to improve?

Oh, and technically, you should probably start the b complex first for a few days, make sure you don't react to anything in that. then add in the ADb12, then the LCF. THat's per Freddd's protocol.

 

[garyfritz]

I've been taking a MegaFood B Complex for the past week -- it was about the only B complex at Whole Foods that didn't have folic acid. When the iherb order gets in, I'll transition to the Douglas Labs B-complex, then add in the adb & LCF as you suggest. Thanks Sue!

The E-complex -- I don't have a specific target for that, any more than I did the B-complex. Freddd lists it as one of the "essentials" in his Basics post.

 

[garyfritz]

Interesting: I mentioned I have a bit of ADD. I also have COMT V158M. Turns out homozygous V/Vs have less dopamine and score better on attention tests. Heteros degrade dopamine slower, have more dopamine in circulation, and score worse. (But amphetamines increase dopamine, and improve attention??)

http://www.ncbi.nlm.nih.gov/pubmed/15654584

Dopamine may also be implicated in RLS -- but RLS is associated with lower dopamine levels, not higher. NIH says there's no link between COMT V158M and RLS.

http://www.ncbi.nlm.nih.gov/pubmed/20184941

 

[garyfritz]

OK, my iherb order is in.

I've been taking 20+ mg of methylB12, mostly in the afternoon/evening.
For the last few weeks I've been taking 400 mcg Solgar methylfolate,
and for a week I've been taking the MegaFood B complex.

I'm going to switch over to the Douglas Labs B-Complex.
That includes 400 mcg metafolin so I'll drop the Solgar.
After a few days to see how that lands, I'll start taking Source Naturals dibencozide, probably 1x/day 8.6mg per Fredd's protocol? (Zone 2B)
After maybe a week of that, I'll add 1x/day 855mg cap of LCF.
Somewhere in there I'll start taking the E-complex.

Does that sound sensible? I'm totally guessing on dosages.

I feel like my B12 benefits are slipping away, in spite of ramping up the dosage. For 6 months I got great sleep and RLS relief on 500-1000mcg of Readisorb. Then that started not working as well in March. I've been boosting the dosage but it still only seems to last a few hours. I take 15mg of methylB12 in the 4-6 hours before bed, yet I still often wake in the middle of the night, and by 5am I'm wired and jumpy with RLS. (Which never used to happen.) Should adding the dibencozide (adenosylB12) finally kickstart the methylation process so I don't have to keep shoveling in B12 all afternoon?

I feel like I'm bailing out the boat but the water's coming in faster than I can scoop. I need to shift to a different model, fixing the holes instead of scooping out water, and I'm hoping a rebooted methylation system can do that.

 

[ahmo]

@garyfritz Is this accurate?

I've been taking 20+ mg of methylB12, mostly in the afternoon/evening.
For the last few weeks I've been taking 400 mcg Solgar methylfolate,
and for a week I've been taking the MegaFood B complex.

You need to increase your Mfolate. The B12/Mfolate ratio is pretty far off. I don't usually like to say you must, but it seems to me that's the case here. I haven't gone back thru the thread, is there a reason you've > B12 so much w/o > folate?

 

[garyfritz]

Uh, because I'm clueless??

I haven't found any clear description of what I SHOULD be doing, so I'm guessing. I was losing effectiveness with the B12 so I started boosting it. I read here that higher doses of methylB12 were OK, and I didn't really see anything about the mfolate more specific than you "should have some." I got the impression 800mcg was a lot.

So what IS a good B12/mfolate ratio? Should I boost the mfolate or cut back on the B12?

 

[ahmo]

OK. Here's my abbreviated version of Freddd's Protocol. It's a work-in-progress, taking me longer than I'd anticipated. You can add Mfolate by about 200mcg every day or 2. Especially since you've already got so much B12 to cover it. You'll likely need more potassium as you increase it. Symptoms of low K+ include breathlessness, restlessness, heart palpitations.

Sorry, I've gone past my computer time, can't offer much more in this moment.



“Deadlock Quartet”:
Methylfolate
MethylB12
AdenoB12 (Dibencozide); AKA AdoB12, adenosylcobalamin, dibencozide
L-Carnitine Fumarate


1) L-methylfolate, 200mcg 4 times a day, total 800mcg; Taken away from Potassium.

30-60 minutes after Mfolate:

2) Methyl B12 1mg + Adeno B12 a crumb from 10mg tablet, in pouch of gum line, so dissolves slowly over 1+hour

3) Potassium: Start-up and each dosage increase will usually lead to symptoms including nausea, itching, heart palpitations, weakness, muscle spasms or cramps. Typically these symptoms will occur by the 3rd day after starting folate/B12. Try approx 300 mg K+ every 2 hours until deficiency symptoms relieved. You will likely need at least this much the following day. Symptoms may shift within hours.

High doses of B1,2,3 can make this need for Potassium insatiable. 25mg or less of B complex/day, in a divided dose, is preferable.

4) About Day 4, add L-Carnitine Fumarate (for a smaller number of people, Acetyl-L Carnitine is effective)
Dr’s Best 855mg capsule yields 500mg carnitine. 1 capsule/day.

If you have anxiety and tend to over emphasize fears then you might consider microtitrating with the Jarrow Liquid carnitine (freebase). With that you might start at 150mcg a day whereas with the LCF maybe 64mg to start with (1/8 capsule)

http://forums.phoenixrising.me/index.php?threads/active-b12-protocol-basics.10138/page-8#post-413853
ratios, once again.....the ratios between MeCbl/AdCbl/MeFolate + cofactors are of course individual and must be determined by trial and error, right? However, what are the recommended ratios to start out with?

Freddd: There are no fixed ratios.

With 1mg of AdoCbl and 1mg of MeCbl each held for 1-2 hours against oral mucosa, one could end up with 200-400 mcg or more absorbed. This is enough to turn on all layers of healing except CNS for many of us. A start of methylfolate of 800mcg or less will usually produce a burst of healing on a couple of layers that then demands more folate than the body has easily available and so shorts other layers to supply the ones that are healing causing paradoxical folate insufficiency. So one titrates methylfolate until the insufficiency symptoms go away. This is usually between 1600mcg and 20-30mg depending upon how one reacts to other folates and B1, b2, b3.

While this is happening there is also usually a need for potassium of which needs to be titrated to the level of no symptoms. This usually happens in the range of 1200-3000mg daily in 4-6 divided doses. Again, this is dependent upon how fast cells are being formed and if too much b1, b2, and/or b3 can also be insatiable.

It is via systematic titration, finding peak effectiveness and staying there, not trial and error.

....

With the MeCbl I would experiment. You might find you get deeper penetration and better results by taking one dose of 5mg whereas someone else may get better results by taking 1 mg 5 times a day.

Most do best with methylfolate several times a day because of it's relatively short halflife. It needs to be taken at different times form the potassium. So again, folate with 1 tablet each 4 hours might work better than 5 at once in the morning. Like potassium, I have gone into folate insufficiency 6 hours after a barely adequate dose. Take the folate first and wait for 45 minutes for potassium.

...
http://forums.phoenixrising.me/inde...ble-to-just-take-b12-first.22213/#post-339721
you have hopefully looked at those 6 symptoms lists, You see how there are interconnected and most of the symptoms likely respond to more than 1 nutrient. There is often kind of a 4 way round-robin roadblock starting one item at a time. My best idea of how it is best done now, after 10 years of a variety of experiences of healing everything except the worst of the neurological damage, I would start a combination of AdoCbl and Mecbl as they work synergistically together. I would suggest 200mcg doses of L-methylfolate, 4 per day, because of the short halflife. 100mcg combined absorbed AdoCbl/MeCbl plus the l-methyklfoalte will typically unblock partial methylation block and break methyltrap within hours. On the 3rd or 4th day typically a swarm of low potassium symptoms and often donut hole folate insufficiency. Those two things need to be titrated to sufficiency.

As you bring the base level up of one the other set of symptoms may become more prominent. Also, with methyltrap, the symptoms flip flop back and forth between b12 deficiency and folate deficiency symptoms in a paradoxical seeming fashion. After these stabilize, often between 1200-3000mg of potassium a day and 800 mcg and 30mg of l-methylfolate, then everything needs to be evaluated. Then the LCF titration begins as the startup subsides from the other items. Constant evaluation to consider what may be going low is needed.

Basically a person should be ready for these things before starting and be taking basic vitamins and minerals. Constant re-evaluation is needed. However, avoid the instant response of thinking in terms where the thinking has been done. Consider the symptoms, not all the intstant fear answers that result in shutting down healing whenever it pokes it's head up. This isn't whack a mole with healing startup being the mole. It's intelligent recognition of what is happening with healing as the goal. This whole healing process is like a maze. Kneejerk answers won't get you through that maze.

 

[garyfritz]

Wow, thanks @ahmo! Lots of great info there that I didn't see or didn't absorb when I read through all these threads the first time(s). Things I draw from your post:

* Fred is recommending 1mg MeB12 + 1mg AdB12 !? And I'm sucking down 4 * 5mg MeB12 with no AdB12. I ramped up my MeB12 hoping to "top up the tank" so I'd have less demand, and that isn't working. I think it's time for me to scale back on that as I add the AdB12. I'll have to break the dibencozide tablets into 8 pieces to get 1mg.

* First priority: size down MeB12, add in AdB12.

* Following freddd's link above, I found him saying here that Jarrow MeB12 "went bad" two years ago! I don't know if that was ever rectified or not, but maybe I need to ditch the Jarrow 5mg and start with something else along with the dibencozide. I wonder if "bad B12" is why I'm still seeing accelerating symptoms with 20mg/day Jarrow? (BTW I sure wish someone would go back and correct the first-post info in places like the "absolutely critical basics" list. It still recommends Jarrow 5mg.)

* If Jarrow is "bad," what MeB12 are people using? I'm tempted to go back onto the Readisorb since it did work very well for me for 6 months.

* Fred says 25mg B-complex, but the Douglas Labs B-Complex he recommends has 50mg. Cut in half I guess?

* On another topic, the heartfixer.com site is death on sulfate levels, saying it's critical to address CBS issues **BEFORE** moving on to methylation. I haven't tested my sulfate levels yet but I have CBS/BHMT variants that can cause problems.

 

[ahmo]

@garyfritz You won't need to use as much AdB12 as MB12. thanks for pointing that out to me, it gets confusing. I've been stabilized for some time w/ 20mg MB12 and 3 mg AdB12, 15mg Mfolate. I went up to 10mg AdB`12, also tried it at 5mg, body seems perfectly happy at 3mg only.

The suggested MB12 is Enzymatic Therapies for 1mg, Country Life for 5 mg.

Another piece from Freddd I just came across:

…Sometimes the balance between AdoCbl/MeCbl can make a difference. Chart it every day and see what is steady and what changes day by day and even the pattern within the day. I found this kind of diary very helpful in knowing what was going on. I could see clear changes in the right direction in a month that were not visible in day to day memory comparisons. Our memories are so frail in this and it is so easy to forget most of the changes. Looking back 11 years I have trouble now believing how sick and miserable I was, how disabled I was. I was reasonably euphoric for the first 9 months or so despite all the increased awareness of muscles and nerves damage.

Yes, use 1/2 doses of the B Comp. I settled on another one, which I also divide. I use a capsule making 'machine', fill 20 in about 20 minutes:
https://www.swansonvitamins.com/swanson-ultra-activated-b-complex-high-bioavailability-60-veg-caps

Yes, you've got CBS++, as well as NOS, so there are definitely sulfur/ammonia issues. Don't know whether you need sulfate strips to tell you this. I'm using a number of supps for this: butyrate w/ meat meals; amino acids citrulline, arginine, ornithine, lysine all help process ammonia.

Now that I'm looking at your SNPS, you've also got ++ DAO and MAO, so there's bound to be histamine issues.
How's your diet? I'm also avoiding sulfur and histamine foods, I'm on an extremely limited diet.

MTRR reinforces the need for MB12; I don't have short statements about the rest of your's, just the ones that I share.

Heartfixer is the best shorthand version I know of to work out how to proceed. Do you have Amy Yasko's free ebook? It's the long version. And her forums can be useful, but rely pretty heavily on her protocols.

Following from @caledonia: Methylation Made Easy

https://www.youtube.com/watch?feature=player_detailpage&v=o4uqEDK6BvM

http://forums.phoenixrising.me/inde...w-to-be-safe-on-a-methylation-protocol.26711/
Roadblocks to Successful Methylation:

http://forums.phoenixrising.me/inde...to-successful-methylation-treatment-pdf.6827/

http://www.holisticheal.com/media/downloads/autism-pathways-to-recovery-book.pdf

 

[sueami]

As far as b-complexes go, one of the most recent reccs I saw from Freddd was Nature Made's list number 1338. I found it in king soopers here. He liked the particular combination of b types and dosages.

My doc thought with my MTRR snps (and you share the homozygous one), that I would need methylcobalamin and damn, was he right -- these b-12 shots I"m taking are amazing. I feel almost normal for the first time in five months. I just hope it lasts until I can get enough healing on-line to stay on an upward path.

I'm injecting 1 mg every other day right now and I can't get over how effective the shots are, compared to my taking 5mg against the cheek over the course of a day. Makes me wonder if Country Life methyl b12 has been reformulated in some way, or if I'm just not doing a good enough job of dissolving them. In any case, if you've responded well to b-12 in the past, I wouldn't necessarily back down on b-12 now, just to match ADb12 levels, or even folate levels, based on that MTRR.

I was up to 4g folate while I was taking 5g mb12 and 5g adb12 orally (which my doc said was too much folate and I now realize he was right. Stupid brain fog.)

So while it is possible to get out of balance in folate and b12, I managed to do it with too much folate and not enough methyl and I didn't realize what I was doing because I was focused too much on the paradoxical folate insufficency list of symptoms.

The dosage sounds so high on the sublingual pill but absorption must be much lower than I thought. Or perhaps my impaired methyl recycling snps (the MTRRs) make me need that much more b12 than others.

fwiw,
Sue

 

[caledonia]

I feel like my B12 benefits are slipping away, in spite of ramping up the dosage. For 6 months I got great sleep and RLS relief on 500-1000mcg of Readisorb. Then that started not working as well in March. I've been boosting the dosage but it still only seems to last a few hours. I take 15mg of methylB12 in the 4-6 hours before bed, yet I still often wake in the middle of the night, and by 5am I'm wired and jumpy with RLS. (Which never used to happen.)

It sounds like you may need to take some potassium and/or magnesium. Their deficiency symptoms are very similar. I have both of those maxed out. The need for potassium started once I got methylation going.

I'm also taking less adenosyl than methylcobalamin like @ahmo. 16mcg of methyl vs. 4 mcg of adenosyl per day.

I have many useful links in my signature, so basically just posting so you can access those easily. "Start Low and Go Slow" and "Roadblocks to Successful Methylation" are good places to start.

 

[garyfritz]

Thanks @caledonia -- I take about 500mg/day of Mg, have for many years. (I tried much higher doses about 10 yrs ago when I thought it might help my muscle twitches.)

I agree, though, I think I need more potassium. Last night during the night my calves were cramping! Maybe I'm finally getting something started here. The cramps weren't terrible, not wake-up-screaming, but between that and the RLS I didn't get much sleep. Took 400mg of potassium between 3am & 5am.

I assume you're doing 16 & 4 mg of methyl/adenosyl, not mcg?

 

[garyfritz]

@caledonia, I read your "Nutreval Interpretation Guide" and said "Waitaminnit, that looks familiar..."

I had a test from Genova Diagnostics that used that exact reporting format. It was just reporting the levels various metals and minerals, though.

It was 8 years ago, but at that time my Sulfur was right in the middle of the green range -- which seems surprising if my ++ CBS and ++ NOS3 are supposed to cause sulfur issues.

Everything else was in the green too, except borderline-high Gadolinium (!?) and copper, and low Manganese. Calcium/Magnesium/Potassium were on the low end of green. Who knows how valid it is 8 years later, though...

 

[garyfritz]

Another piece from Freddd I just came across:

…Sometimes the balance between AdoCbl/MeCbl can make a difference. Chart it every day and see what is steady and what changes day by day

@ahmo, chart WHAT? The ratio you're taking? Some measure of something else?

Now that I'm looking at your SNPS, you've also got ++ DAO and MAO, so there's bound to be histamine issues.
How's your diet? I'm also avoiding sulfur and histamine foods, I'm on an extremely limited diet.

My diet is pretty healthy, very very little junk food or processed foods. I'm making a half-hearted attempt at moving toward a paleo/primal diet -- I've cut way down on the cereals and grains and I eat more meat than I used to. Meat is supposed to be high-sulfur but this page says the sulfur in meat stays bound up in methionine and doesn't cause much trouble. I eat less dairy than I used to, but a fair amount of yoghurt and occasional cheese.

I'm not 100% sure but I think eating a lot of eggs (like 2-3 a day for 4-5 days in a row) was aggravating my sleep issues so I've cut back on eggs. Not 100%, I don't avoid things with egg in them, but I don't fix omelets for breakfast 2-3x/week any more.

@sueami, glad to hear those B12 injections are working for you. (Do you do the whole thing of wrapping the bottle & syringe in foil to block all light?) I'd like to think I could avoid shots, but I may get there yet. I did so well for so long on Readisorb, I'm hoping I can get back to that state. I suspect Readisorb works better than the sublingual tablets, and it's faster. When I wake in the middle of the night with my nerves/muscles going bonkers, I can take a shot or two (500-1000 mcg) of Readisorb and feel my body relax within a few minutes. Unfortunately I'm about out, my MD's office is out, and I'm about to leave town for a week. I might pick up one of the sublingual drops products from Whole Foods to tide me over.

I'm not crazy about sucking on these acidic tablets for hours a day, and taking a shot of slightly sweet/acidic Readisorb in the middle of the night. That can't be good for your teeth. Hopefully I won't have to keep doing that forever?

 

[whodathunkit]

@garyfritz: "charting" means track how much you take of each type of B12 each day, every day, when you take it, and precisely how it makes you feel (good, or if bad, what symptoms are manifested). If you do this for a period of time you will begin to see a pattern emerge and will thus be able to hone in on what works for you. The period of time it takes to see a pattern will depend upon your physiology, your problems, and how good your charting is.

This is also called journaling and is frequently used in medicine and psychiatry to help patients become more self-aware of what's going on with themselves. It's a good idea for anyone trying to figure out what their problems are and how best to fix them. You can do this for all supplements, not just the B12's. Or even with other issues like anxiety or addiction, to figure out what your "triggers" are.

Journaling can be a lot of work.

But it sounds like you're not in the simple solutions category you hoped you were in when you started mB12. So now you just have to decide how much time and energy you can devote to getting better, and what you're willing to try to get there.

Shots are not bad. I was fairly intensely afraid of needles before I started using my beloved crack injectable methylcobalamin. I hated getting shots at the doctor's office. Now I'm like "Meh, whatever" about shots. It's just no big deal.

If you use the little insulin syringes with the little tiny thin needles, you can't even feel them most of the time. If you do feel it, it's a little tiny pinprick and that's it. Nothing a man (or woman) can't handle.

Not all B12's are created equal. If your Readisorb is a physician quality product you may find a big difference between it and the drops you buy at Whole Foods. Just saying, don't be surprised if you have to shop around for products that are effective for you.

HTH.

 

[sueami]

I baaarely can feel the insulin syringes I use. I was squeamish at the start of these too.

I should start journaling too. Now that brain fog and energy has improved, it seems a doable proposition.

Gary, if you want to do a one-time sulfate test, I bought the strips that I found online via Caledonia's sig. I'm not going to do anything about sulfate right now, because I'm focused on some other interventions first, so I could lend you the bottle (the label to read the strips is on the outside of the little can of strips, so you need the whole thing to get a proper reading). I could either mail it to you or we could do a hand-off somewhere in town. It would save you 40 bucks if you're not sure you need them.