I'll try and slog through the 14 pages, but for now a couple of questions:
I'm attempting to follow
@Freddd 's protocol, based on sheclimber's notes and the list of symptoms posted in a few places. I'm currently using Metafolin tucked into my lower lip.
There is an instruction to take potassium away from folate by about 45 minutes - why, please? I would like to understand whether taking folate sublingually would change the need to space these two out.
Presumably the aim is to avoid hypokalemia symptoms - once the potassium dose is established as sufficient to reduce the symptoms, should that dosage then be taken
before supplements the following day?
Thanks in advance!
Hi Tima,
Here is an up to date copy of the most recent versions of important items.
REFEEDING SYNDROME - A PROTOTYPE pragmatically based guide to survival and effective healing. USE AT YOUR OWN RISK.
Version 1.1, 11/05/2018
I and some thousands of others have healed ourselves to various extents with this and perhaps other variations of B12/folate treatments. I can't speak for any doctors or their patients
Let's look at the nature of the problem. in 1948 Cyanocobalamin won the Nobel Prize as B12 In 1959 x-ray crystallography proved that the vast majority of cobalamins in beef liver extract (like the human body) was MeCbl and AdoCbl (Methylcobalamin and Adenosylcobalamin), the two immediately active forms of b12 in mammals and that the cyanocobalamin was generated by a lab mistake from those two active cobalamins. CyCbl is an inactive post waste production cleanup (Cyanide) form of cobalamin that is favored for excretion.
However, a small percentage of people were able to convert enough CyCbl to MeCbl-AdoCbl fast enough to feel a surge of energy from the cobalamin. The AMA declared all effects felt quickly were clearly placebo, said they would take actions to prevent doctors from giving people B12 because they claimed effectiveness from it. Those people who felt effects also sometimes had low potassium (hypokalemia) symptoms because of red blood cell production increase. These are people who were actually having healing going on for the only recognized b12 deficiency symptom, large red blood cells, and they would be denied B12 because of dangerous side effects.
By 1959 CyCbl was well established in research and the medical establishment. The tests that had to validate the genuine shortage of B12 (pernicious anemia basically) became the basis of giving B12, not effectiveness.
During the last 15 years that MeCbl and AdoCbl have been available many doctors have been floundering around because the research hasn't been done and some of them with considerable effectiveness, and they get in trouble for instance ,in the UK, which uses HyCbl as it's official defined B12.
All of the "standards of care" call for CyCbl and folic acid in the USA. So despite what my medical records say, that I have to have 3 x 10mg MeCbl injections daily and 24mg of Metafolin, the standards of care say nothing about that. So I could be given CyCbl and folic acid, putting me into severe deficiency starting in hours and possibly killing me with complete safety for the doctors becasue they are treating me according to the standards of care whereas they could get sued for giving me what I need in MeCbl, AdoCbl, Metafolin and L-carnitine fumarate. The "official" treatment for me is HyCbl (doesn't work for 1/3 of people like me as opposed to CyCbl with 0 to minus 100% effectiveness., folic acid (partially active for up to 50-70% or so of people but also having up minus 100% effectiveness and l-acetyl carnitine (ALCAR). This combo is the official treatment for my diagnosis and it works poorly to not at all for such people. This combination would put me into methyltrap and demyelination (like Sub Acute Combined Degeneration and MS for example) starting within 2 weeks.
I have cured myself of most all the symptoms of FMS, CFS, ME, congestive heart failure and many neurological symptoms are in remission. I had a couple of dozen other diagnoses during the decades, 100% of them useless for treatment and in retrospect of knowing what healed me, 100% wrong. Of the 100+ physicians I sought answers and treatment from during the decades, 100% of them were wrong. 100% of the treatments didn't work or were worse than nothing.
Severe b12 deficiencies, the first ones they are usually willing to diagnose, are the cause of excess homocysteine and excess Methyl Malonic Acid to be generated causing multi system/organ breakdowns of all kinds and death. By the time these are diagnosed the body is damaged and in failure mode.
I only look at symptoms as most of these diagnoses around these answers revolve around CyCbl (HyCbl) and folic acid or lots of drugs and don't work. Folic acid, CyCbl and HyCbl are 1/100 to 1/10,000 of the effectiveness of MeCbl, AdoCbl and l=methylfolate.
The following list is composed of my experiences, some symptoms I didn't have but were relieved for others and an initial international list of symptoms that responded to b12 treatment. I had over 200 symptoms myself.
Avoid glutathione, NAC, whey, Folic acid, folinic acid, HyCbl, CyCbl. They all have the ability to produce paradoxical folate deficiency or partial methylation block or healing by internal triage level or methyltrap and some other variations on ATP and methylation deficiencies.
This list has appeared in various forms on various threads
Active B12 Protocol Basics at Phoenix Rising some years ago.
SYMPTOMS LIST 01/03/2014 V 1.0
Copyright 2014, Frederick D. Davis, aka Fred Davis, aka Freddd, aka Davis Software Development, copied from original manuscript.
In this post this is a list of symptoms that are mine, and others experience of these nutritional items in relieving their symptoms, and in a very few instances reflect research and successful practice, such as p5p for Hcy and Liver extract studies of several disorders in old journals. In some instances the same symptoms might have different combinations of nutrients. However, I have used no quotes from any source. This list of symptoms is derived from the an N=1000 questionnaire development. These are the symptoms that responded to the nutrients as listed. I did the 1000 symptoms histories myself. These are the some of the results from my 30,000 + hours of work for my
These symptoms responded almost entirely or entirely with
basics 5 star MeCbl – methylcobalamin – Methylb12 - Mb12 - Mecobl . Many started improving in hours. Others took 9 months to correct.
morning joint stiffness and pain
paleness
acid reflux
nausea
daily vomiting
standing with eyes closed, lose balance
hands feel gloved with loss of sensitivity - glove anesthesia
feet feel socked by loss of sensitivity - stocking anesthesia
glove and stocking anesthesia
neuropathic bladder
unable to release bladder, mild to severe
unable to fully empty the bladder
fecal incontinence - occasionally to frequently
diminished hearing - gradual onset or present for life, sudden return possible
tinnitus - ringing in ears
always feeling cold
intolerance to loud sounds
intolerance to multiple sounds
sleep disorders
non restorative sleep
Night terrors
Prolonged hypnagogic or hypnopompic states transitioning to/from sleep
Sleep paralysis
alteration of touch all over body, normal touch can be unpleasant and painful
alterations and loss of taste
taste hallucinations
smell hallucinations
sound hallucinations
visual hallucinations
alterations and loss of smell
loss of smell and taste of strawberries specifically
loss or alteration of smell and taste of potato chips specifically
roughening and increased raspiness of voice, mb12 can smooth it in mid word
blurring of vision - can be sudden onset and sudden return
Visual impairment can be seen; ophthalmological exam may show bilateral visual loss
optic atrophy
centrocecal scotomata
hypersensitivity/intolerance to bright light
intolerance to loud sounds
intolerance to multiple sounds
burning muscle pain
diminished hearing - gradual onset or present for life, sudden return possible
tinnitus - ringing in ears
sore burning tongue
This is a list of symptoms that are mine, and others experience of these nutritional items in relieving their symptoms, and in a very few instances reflect research and successful practice, such as p5p for Hcy and Liver extract studies of several disorders in old journals. In some instances the same symptoms might have different combinations of nutrients.
These symptoms responded strongly first to 5 star MeCbl and then Metafolin with basics. Many started improving in hours. Some took 7 years to correct.
Bursitis
stomach not emptying
frequent vomiting
acid regurgitation
dyspepsia
flatulence
altered bowel habits
abdominal pain
loss of appetite for meat, fish, eggs, dairy, the only b12 containing foods
nutrient specific anorexia
intermittent constipation
intermittent diarrhea
irritable bowel syndrome
sores, ulcers and lesions along entire GI tract or any part
anorexia
Bulimia
Hypersensitivity to touch
Hypersensitivity to odors
Hypersensitivity to tastes
Hypersensitivity to clothing texture
Hypersensitivity to body malfunctions, symptoms
Hypersensitivity to sounds and noises
Hypersensitivity to light and visual stimuli
Hypersensitivity to blood sugar changes
Hypersensitivity to internal metabolic changes
Hypersensitivity to temperature changes
burning bladder (no UTI)
painful urgency (no UTI)
burning urethra (no UTI)
Low blood serum level - below 550pg/ml, Japanese Standard
elevated MCH (Mean Corpuscular Hemoglobin)
elevated LDH
big fat red cells (when said this way usually with happy or healthy modifying it completely misinterpreting results of MCV
platelet dysfunction, low count
white cell changes, low count
hyper segmented neutrophils
headaches
inflamed epithelial tissues - mucous membranes, skin, GI, vaginal, lungs
inflamed endothelial tissues - lining of veins and arteries
mucous becomes thick, jellied and sticky
asthma
chronic cough that mimics asthma but isn't
chronic sinus congestion
dermatitis herpetiformis, chronic intensely burning itching rash
frequent infected follicles or acne type lesions all over body
chronic infections, many varieties possible
Seborrhic dermatitis
dandruff
eczema
dermatitis
skin on face, hands, feet, turns brown or yellow if anemia occurs
poor hair condition
thin nails
transverse ridges on nails, can happen as healing starts
mouth sensitive to hot and cold
sore burning tongue
beef-red tongue, possibly smoother than normal
sore mouth, no infection or apparant reason
teeth sensitive to hot and cold
canker sores
with p5p added
Elevated blood serum Hcy, borderline or higher
These symptoms responded relatively partially first to 5 star MeCbl and then very strongly to Metafolin with basics. Many started improving in hours. Some took 7 years to correct.
splits/sores at corners of mouth -angular cheilitis
impaired white blood cell response
poor resistance to infections
easy bruising
pronounced anemia
macrocytic anemia
megablastic anemia
pernicious anemia
decreased blood clotting
MCV > 93 first warning,
MCV > 97 alert
MCV > 100 outright macrocytosis
MCV > 105 urgently needs treatment, severe problem
Plus Vitamin E
Child with neural tube defects
mother of child with neural tube defect
These symptoms responded not at all first to 5 star and then very strongly to Metafolin with basics. Many started improving in hours. Some took 7 years to correct.
lack of dreaming
MCV > 100 outright macrocytosis
macrocytic anemia
metallic taste in mouth
Widespread body & muscle pain responding to NSAID
Joint pain responding to NSAIDS
splits/sores at corners of mouth -angular cheilitis
Sexual related symptoms, both men and women – These responded with the most response to lesser responses in order to MeCbl, Metafolin (l-methylfolate), AdoCbl, L-carnitine fumarate
reduced libido - loss of sexual desire
loss of orgasmic intensity
unsatisfying orgasms
inability to orgasm
loss and/or change of genital sensations
burning genital skin sensation
unable to feel aroused
numb genital skin
low sex hormones
MEN
In order of response – MeCbl, AdoCbl
low testosterone men
In order of response – MeCbl, Metafolin, AdoCbl, L-carnitine fumarate
erectile dysfunction men
In order of response – MeCbl, Metafolin, AdoCbl
low sperm count
poor sperm motility
Poor sperm quality
no sperm
WOMEN
In order of response – MeCbl, AdoCbl
low testosterone
low estrogen
In order of response – MeCbl, Metafolin, AdoCbl, L-carnitine fumarate
post partum depression
post partum psychosis
In order of response – MeCbl, Metafolin, AdoCbl
Frequent miscarriage
In order of response – MeCbl, Metafolin
False positive pap smears, defective cells
menstrual symptoms
These symptoms are what responded very well to CNS penetrating doses of MeCbl either as 50mg sublingual single 4-5 hour dose or 4 x 7.5mg or 3 x 10mg or for some 2 x 15mg subcutaneous MeCbl injections. Metafolin in some way enhances retention of AdoCbl and MeCbl with excretion visibly decreased. A sublingual dose of 1-2 tablets each hour added for 12 hours appears to generate substantial CNS penetration as well.
CNS penetrating dose MeCbl – AdoCbl – Metafolin – Omega-3 oils
Elevated CSF Hcy
Low CSF cobalamin
limbs feel stiff
Drowsy
CNS penetrating dose MeCbl – AdoCbl
dimmed vision - usually not noticed going into it because change can be very slow or present for life
Clumsiness
CNS penetrating dose MeCbl – AdoCbl - Metafolin
Slow to adapt to night vision
CNS penetrating dose MeCbl – AdoCbl – Metafolin – LCF
Difficulty in word finding
CNS penetrating dose MeCbl – AdoCbl – Metafolin – Omega-3 oils
Brainstem or cerebellar signs or even reversible (with mb12) coma may occur
demyelinated areas on nerves
subacute combined degeneration
axonal degeneration of spinal cord
unsteadiness of gait
ataxic gait, particularly in dark
positive Romberg
positive Lhermittes
Loss of motor control over some or all of toes
Loss of motor control over part or all of feet
Loss of sense of joint position
sudden electric like shocks/pains shooting down arms, body, legs shooting down from neck movement
sudden "ice pick" pain
decreased reflexes
brisk reflexes
Foot Drop
tripping over toes
injuring toes catching top of toes on floor
general feeling of weakness
12. Next 1 year titrating Metafolin and finding all the reasons I get folate insufficiency, early partial methylation block by effect.
These symptoms are what responded very well to L-carnitine fumarate AND AdoCbl for the first two items
L-carnitine fumarate – AdoCbl – Metafolin - MeCbl
weight loss involuntary
muscular atrophy
exercise does not build muscle
L-carnitine fumarate – Metafolin – AdoCbl - MeCbl
weight gain, watery fat
edema
L-carnitine fumarate – AdoCbl – MeCbl – Metafolin
mild to extremely severe fatigue
continuous extremely severe fatigue
easy fatigability
severe abnormal muscle fatigue up to and including apparent paralysis leading to death
weakness
muscle pain especially around attachment points to bones
Eighteen severely tender muscle spots of FMS
AdoCbl – L-carnitine fumarate
exercise debilitates for up to a week, making things much worse
accumulating muscle pains following exertion
sore muscles throughout body
lack of muscle recovery after exercise
High urinary MMA
AdoCbl – L-carnitine fumarate – Metafolin
congestive heart failure
Elevated CSF MMA
Elevated uMMA
MeCbl - AdoCbl – L-carnitine fumarate – Metafolin
shortness of breath, oxygen hunger
heart palpitations
MeCbl - AdoCbl – L-carnitine fumarate
extremely sore neck muscles reversing normal curvature of neck
painfully tight, stiff muscles, especially legs and arms
frequent muscle spasms anywhere in body
weak pulse
MeCbl - AdoCbl
Confusion
Disorientation
Difficulty in word finding
MeCbl - AdoCbl - Metafolin
irritable
depression
SAD - Seasonal Affective Disorder
mental slowing
personality changes
chronic malaise
poor concentration
moodiness
tiredness
mood swings
memory loss
listlessness
impaired connection to others
mentally fuzzy, foggy, brainfog
dizziness - even unable to walk
Vertigo
MeCbl – Metafolin – AdoCbl – L-carnitine fumarate
psychosis, including many of the most florid psychoses seen in literature, megaloblastic madness
Alzheimer's
delirium
dementia
paranoia
delusions
hallucinations - multisensory
anxiety or tension
nervousness
mania
Widespread pain throughout body
A caution, those with anxiety and panic symptoms may respond with extreme moods of increased fear, anxiety, panic, anger rage, homicidal rage and profound depression, usually in repeatable sequences following LCF or ALCAR even at levels of 1mg oral. A micro titration of carnitine would be cautious. While most find the moods intolerable, certain persons have been able to tolerate these (both past) and current, to find they can fade after some months of consumption. A few people may find similar, maybe somewhat lesser, response to MeCbl or more likely AdoCbl. As these are less controllable than LCF which can be micro dosed, they should be considered first
Following are the groups of induced deficiency symptoms when starting with the Deadlock Quartet (AdoCbl, MeCbl, Metafolin, L-carnitine fumarate).
Version 2.42 11/06/2018 A work in process, incomplete, limited testing, people come in many variations, use at your own risk.
Copyright 2018, Frederick D. Davis, aka Fred Davis, aka Freddd, copied from original manuscript.
INDUCED DEFICIENCY SYMPTOMS FROM REFEEDING SYNDROME. This can follow 5 days of food deprivation, anorexia, or sort of a pinpoint starvation via vitamin or mineral or amino acid deficiencies. Whatever the “most needed” item is will often cause a strong response. The first usual notable symptoms occur on typically the third day of starting a previously insufficient nutrient with normally feeling or seeing the changes within minutes to hours. From MecBL I had over 30 symptoms respond in the first few hours with blow my socks off intensity with neurological startup and potassium deficiency on the 3rd day along with increasing folate deficiencies that took years to figure out. For instance it was noted in the 50s with injections of B12 with potassium deficiency (hypokalemia) as a side effect. It is dangerous and can be unpredictably fatal if not corrected and the cause is continued. When they say people are dying in Syria after they have been starved and given food, they are often suffering REFEEDING SYNDROME. When previous symptoms return that can also indicate a developing deficiency that started hindering cell formation.
Group 1 – Hypokalemia onset. Often called “detox”. Symptoms may appear with serum potassium as high as 4.3. May become dangerous if ignored. Considered “rare” with CyCbl (Cyanocobalamin) it is very common with MeCbl (methylcobalamin) and AdoCbl (adenosylcobalamin) and less so with HyCbl (Hydroxycobalamin).
There does not appear to be a clear order of onset. The order of onset varies widely from person to person but many appear consistent for each episode for any given person. There tend to be more and more intense symptoms as it gets worse. Some people have ended up in the ER because of not recognizing the symptoms.
IBS – Steady constipation, Nausea, Vomiting, Paralyzed Ileum,
Hard knots of muscle, Sudden muscle spasms when relaxed, Sudden muscle spasms when stretching , Sudden muscle spasms when kneeling, Sudden muscle spasms when reaching , Sudden muscle spasms when turning upper body to side, Tightening of muscles, spasms and excruciating pain in neck muscles, waking up screaming in pain from muscle spasms in legs. Muscle weakness
Abnormal heart rhythms (dysrhythmias), increased pulse rate, increased blood pressure, intense sudden dizzy spells correctable potentially in minutes with water with potassium gluconate for instance.
Emotional changes and/or instability, dermal or sub-dermal Itching, and if not treated potentially paralysis and death.
Group 2a - Both hypokalemia and l-methylfolate deficiency
IBS – Diarrhea alternating with constipation, IBS – Normal alternating with constipation
Group 2b – Either or both hypokalemia and l-methylfolate deficiency
Headache, Increased malaise, Fatigue
Group 3 - Induced and/or Paradoxical Folate deficiency or insufficiency, partial methylation block to methyltrap on 1 or more internal triage levels. Frequently called “NAC DETOX” or “GLUTATHIONE DETOX”. Can be caused by folic acid, folinic acid and for some people, like me and quite a few others, excess vegetable folates. Further excess B1, B2, B3 and/or inositol can increase methylfolate deficiency symptoms. Methylfolate, MeCbl and just about anything else that starts healing can cause the folate deficiency symptoms.
These symptoms appear in 2 forms generally, the milder symptoms that start with partial methylation block and the more severe symptoms that come on as partial methylation block gets worse or very quickly with methyltrap onset.
Edema - An additional thing I would like to mention. I would never have found it without 5 years of watching the onset of paradoxical folate insufficiency and trying to catch it earlier and earlier and to figure out what was causing it and to reverse it. For me the onset order goes back to the day of onset now with edema and a sudden increase of weight. I noticed that within 2 hours of taking sufficient Metafolin I would have an increase in urine output.
Old symptoms returning in a general sense, a person may have had onset of these hundreds of time if they are on the borderline
Edema
Angular Cheilitis, Canker sores,
Skin rashes, increased acne, Increased itchy acne on scalp and face, Skin peeling around fingernails, Skin cracking and peeling at fingertips, painful cracks in the skin at the corner of fingernails at approximate right angles to nails, can take months to occur and it may be only non mood or neurological symptoms.
IBS – Diarrhea alternating with constipation, IBS – Normal alternating with constipation
Headache, Increased malaise, Fatigue
Increased hypersensitive responses, Runny nose, Increased allergies, Increased Multiple Chemical Sensitivities, Increased asthma, rapidly increasing Generalized inflammation in body, Increased Inflammation pain in muscles, Increased Inflammation pain in joints, Achy muscles, Flu like symptoms
IBS – Steady diarrhea, IBS – Diarrhea alternating with normal, Stomach ache, Uneasy digestive tract,
Coated tongue, Depression, Less sociable, Impaired planning and logic, Brain fog, Low energy, Light headedness, Sluggishness, Increase irritability, Heart palpitations,
Longer term, very serious:
Loss of reflexes, Fevers, Forgetfulness, Confusion, Difficulty walking, Behavioral disorders, Dementia, Reduced sense of taste, bleeding easily.
High MCV, > 93, persistent and resistant to MeCbl and B6 and/P5P. The warning about too much folate causing subacute combined degeneration which kept folic acid to a max of 800 mcg for decades becasue large folate doses can lower MCV without MeCbl. There is a long history to this.
Group 4 - HyCbl onset, degraded MeCbl onset, MeCbl after photolytic breakdown onset.
Itchy bumps generally on scalp or face that develops to acne like lesions in a few days from start.
Group 5 – Copper deficiency after methylation startup has been achieved which often starts refeeding syndrome. 50mg or more of zinc has been indicated as a possible cause. 200-400 mg of zinc has been linked to copper deficiency. Excess supplemental or environmental manganese is linked to copper deficiency. Any or all symptoms can occur at “low normal range” copper tests. Well after all other observable copper deficiency symptoms showed up, a lower value as copper continued to fall, MCV suddenly went over 100 after it had fallen to
Demyelination of nerves similar to Sub Acute Combined Degeneration except that methylation and ATP startup has occurred, and copper deficiency favors damage to the upper motor neurons with perceived muscle weakness. Brittle nails. Sleep disorders. Mood (especially depression perhaps) and personality changes. Connective tissue breakdown. Spider veins. Varicose veins. Shrinking gums. Gum disease not responsive to usual measures. Unstoppable tooth decay on exposed areas without enamel. Low testosterone
Group 6 – Excess P-5-P, an active form of B6 that appears to drive hematocrit.
High hematocrit. The blood thickens and doesn’t pump as easily. Deep vein thrombosis can result. Other suspected circulatory hazards. Sometimes linked to high testosterone when lowering P-5-P might reduce it.
Group 7 – Excess B-vitamins affecting methylation
When taking the active B12/folate deadlock quartet (AdoCbl, MeCbl, Metafolin, L-methylfolate) Excess B1 - Thiamin, Excess B2 – Riboflavin, Excess B3 – Niacin and/or Excess Inositol can all produce an excess need for potassium to deal with Groups 1, 2a and 2b symptoms and/or produce an excess need for l-methylfolate to reduce groups 2a, 2b and 3 symptoms. A person might not be able to correct by taking potassium or folate and may need to reduce B1 <= 15mg/day, B2<= 10.2mg/day, B3 <=50mg, and inositol below an unknown quantity.
Group 8 – Boron insufficiency.
Arthritis swelling and pain, can be reduced by Boron
Contribution to fatigue, neurological effects
Formation of bacterial films
Runaway tooth decay,
vaginal bacterial films
Loss of calcium in bones and teeth
15 Surprising Benefits of Boron
Although all of the deficiency symptoms of boron are not fully understood, it is known that boron deficiency might result in the abnormal metabolism of calcium and magnesium. Some of the other symptoms include hyperthyroidism, sex hormone imbalance, osteoporosis, arthritis and neural malfunction.
Group 9 - Vanadium insufficiency
Deficiency of vanadium is poorly known or recognized. It affects tissue permeability like insulin.
vanadium insufficiency can cause (allow?) rising AIC
vanadium insufficiency allows the liver to make more cholesterol
Group 10 - Lithium insufficiency Non ionizing forms, small micronutrient doses
Lithium allows better permeability of B12 in nervous system membranes. Many people appear to have trouble affecting some B12 deficiency symptoms with B12 even poor sleep (B12 insufficiency sleep disorder it looks like), poor B12 absorption.
Group 11 - Iodine insufficiency, especially needed for those who don't eat iodized table salt and/or seafood.
Group 12 - L-carnitine XXXXX, That can be L-carnitine tartrate, L-C Fumarate, L-C freebase, ALCAR and others but usually works only one kind at a time.
neuromuscular pain, feeling of growing inflammation, fatigue, mood changes, sleep problems. These are quick occuring symptoms and they can sprwead to the complete 4 way deadlock over time.
It appears that for most people in this refeeding situation many may respond to only one form of l-carnitine, initially fumarate or ALCAR and sometimes also including a freebase form. However, as the deficienciencies change, the pathways appear to change and the carinitne that worked so well no longer does and the form is some entirely different one, like tartrate or some other variation. A person may need to trial half a dozen forms. A response is usually clear the first day or occasionally several days with micro doses and titration. And it can change based on what else is corrected.