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Amalgam Illness: Diagnosis & Treatment

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Oral mercury chelation: general guidelines

Dr Andy Cutler's books can be ordered here

Dr Andy Cutler’s books can be ordered here

How to start you oral chelation in a nutshell, when following Andy Cutler’s chelation principles:

The starting dose of 12.5mg has become the norm, as based on experience and suggestions from the Frequent Dose Chelation Yahoo group, which adheres strictly to Andy Cutler’s principles.

  • You can start Round 1 of chelation with 12.5mg of DMSA. Take 12.5mg every 4 hours, including waking up at night!!!! If you miss a dose by an hour stop the round and wait three days before you start again. Your blood levels of your chelator will have dropped too much with the late dose inducing a lot of redistribution of mercury. If there are any side-effects monitor these and if too intense, stop, wait a few days and start on a lower dose, such as 10mg or 6mg. Alternatively, if you have strong side-effects (overt fatigue being the most common), you can increase the frequency of dosing, for example, taking a dose every 3 hours. Some people metabolize chelators more quickly and need to do it in this way. Make sure that you are familiar with adrenal and thyroid issues that often present themselves early on in chelation. It is best to have addressed these by starting appropriate support before you begin chelation. A ’round’ is “three days ON chelators” and “three days OFF chelators”, and later on you can increase the number of ON days once you have gained experience and are comfortable with the process. A common chelating schedule for DMSA is 7am – 11am – 3pm – 7pm -11pm and 3am.
  • If no side-effects, or mild manageable side-effects occur, wait three days before you start Round 2 DMSA at 12.5mg.
  • If no side-effects, or mild manageable side-effects occur then do another Round 3 DMSA at 12.5mg.
  • At this point you can continue for several more rounds of DMSA alone at the current dose and thereafter increase the dosage SLOWLY. It is best to do 3-4 rounds at a particular dose before increasing it. The increase in dosage must be not more than 50% of the current dose. For example don’t double the dosage, as the jump from 12.5mg to 25mg is often too much. This slow route is strongly encouraged before adding ALA. DMSA will reduce your body burden of mercury before you start taking mercury out the brain and internal organs with ALA. This is often the best path to follow and many people need to lower the body burden with DMSA for many months (especially when very toxic) before adding ALA. Remember, ALA can only be taken three months after mercury amalgams have been removed, or some other mercury exposure has passed. In that case continue with DMSA alone until three months have passed.
  • When you are ready to increase the dose of DMSA, raise it to 17.5mg for Round 4 and see how you do on this higher dose. It is recommended to do another 3-4 rounds at this dose of DMSA, if it does not give you side-effects.. If you don’t do well on the higher dose simply find the lower dose that works for you and ‘stick to it’ for longer periods.
  • Once you have done 3-4 rounds of DMSA at 25mg, and have none or few side-effects, consider adding ALA 12.5mg with each dose of DMSA. At this point change your chelating schedule to take both the DMSA and ALA every 3 hours on the hour, including waking up at night. You can stretch it to every 4 hours ONLY at night if it helps you get a little more sleep, but go back to every 3 hours during the day. If you miss a dose by an hour,as usual, stop the round and wait three days to start again. Monitor side effects especially closely after adding ALA, if un-manageable stop the round and reduce dosage. If you have especially bad side effects you may need to do more rounds of DMSA alone to remove some of the mercury pulled out of your cells by ALA. When using ALA and DMSA together you can begin DMSA alone for the first day or first few doses, before adding the ALA for 3 full days. At the end of the round of three days of ALA continue DMSA alone. This has the effect of reducing the side-effects from ALA. When ALA is added some mercury toxic people will struggle, as this is when mercury begins to be moved from inside your brain and internal organs. ALA usually gives more side effects the day after stopping the round. You may need to chelate for a lot longer on DMSA alone, or reduce the dosage of ALA – even as low as 3mg. This is very important..
  • Continue with 25mg DMSA and 12.5mg ALA for 3-4 rounds or longer. Then increase the DMSA or the ALA You must only increase one chelator at a time, so you know which one is causing problems if they occur. For example increase to 30mg DMSA and 12.5mg ALA, OR increase to 25mg DMSA and 17.5mg ALA.
  • Generally it is best to continue using the safe dosages for some time before increasing. When you find the one that is manageable stick there for a long time. If problems occur then go back to the previous manageable dose and stick there for a few more rounds. You should feel somewhat better on round. If you don’t you should lower the dose.
  • You can eventually increase the number of days ON if side effects are stabile, especially if you do well while chelating. This is only advised once you have become somewhat experienced with the oral chelation protocol and only when using DMSA or DMPS on its own. ALA should generally not be taken for longer than 3 days. It is then okay to chelate for longer periods with DMSA or DMPS if your body can keep up with the detox effects and interruption of sleep, then have the same time for rest periods. Usually no more that 2 weeks is recommended, but most can’t go for too long anyway because of lack of sleep due to the interruption of it. If you a lot feel better during the rounds you can extend it for a few more days and see how you do. Longer rounds excrete more mercury and cause less redistribution. Longer rounds are advised only for those that actually do better while chelating – for those that have significant side effects while on round, you will need to take as much time OFF as ON. If you feel a lot better while chelating with the DMSA during that extended time and need to stop because of lack of sleep etc, then you should take the same amount of time off before starting again. Most can’t do it for extra long periods. This is especially true when you add ALA and are dosing every 3 hours or more often. But with DMPS which is taken every 8 hours (due to its longer half-life) people can chelate longer or even continuously as you don’t have to wake up to take doses in the middle of the night. ALA causes less copper to be released during rounds causing problems in the long-term (especially for copper toxic people) so the off-days are very important for most to allow balance to return to your system.
  • Oral chelation must continue for another 6 months to a year AFTER you think you’re well. Some people have to chelate for 3 years. As Andy says, “Chelate, chelate and chelate some more.” You will know your mercury has been removed when you can take high doses of the chelators (e.g. 200mg) with no side-effects. Then it is advised to wait a few months, and start another round at a lower dose, just to make sure.
  • REMEMBER: Increasing the dosage too fast is one of the most common ways people get in trouble with this protocol. Chelation is a slow process, it does not help to push it faster than your body can cope.

 

Also: Andy Cutler has this to say about the chelation of heavy metals:
‘Generally, heavy metal detoxification involves an exponential decay in symptoms. For example, half the problems might be resolved in the first 6 months, half the remaining problems (a quarter of the original ones) resolved in the next 6 months, etc. Mercury is the exception to this, with a few months of improvement, several months of worsening, and then slow improvement over many more months.’

(Hair Test  Interpretation: Finding Hidden Toxicities, pg. 237)

 

Important: If you miss a dose or are later by one hour stop the round!!!!! THIS IS VERY IMPORTANT.


When should I increase the dosage? When you are not having any side effects at all at the dosage you are at and have done a few rounds at that ‘comfortable’ dose. It is a good idea to remain on that ‘comfortable’ dosage for a long time. Chelation should be pleasant and if it becomes difficult you are probably pushing too fast and should lower the dose. Many people find a dosage that they actually feel better on (no side-effects) and stay on it for many, many rounds before increasing the dose.
Repeat oral chelating rounds until you feel better. It can take 1-3 years (and longer for some who are         very poisoned). Give each round a number so you know how many rounds you have done. Increasing dosage to tolerance and using the same dose for many rounds until side effects have diminished, or have subsided at that dosage, before increasing the dosage is the safest way to chelate. The body does not release mercury consistently when you chelate which is why you can get different problems with different rounds, and yet another reason why challenge tests are not informative. All progress achieved with oral chelation should be PERMANENT. If ‘scary stuff’ starts to happen, stop the ALA immediately and wait at least several days before trying it again at a lower dose.

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These guidelines are taken from here thanks to Moria and Andy
Mercury Detox: Information, Tools, and Resources….  here…
IN GENERAL:
ALL methods of chelation and ALL chelation agents have some risk
Pay attention to your kid or yourself and what is happening. Your actual results take precedence over anyone’s theories of what could happen or should happen.
If something has bad results STOP IT
Do NOT try to chelate mercury if your child or yourself has/have any amalgam dental fillings present.
Which chelation agent(s) to use:
This is a somewhat complex topic, and there is not an obvious one-size-fits-all answer. As an intro though, Andy does say the following things:
DMSA alone followed by DMSA + ALA is a reasonable option.
So is DMPS alone followed by DMPS + ALA.
ALA is the only one of the common chelator agents which crosses the blood-brain-barrier, so you need to use ALA at some point in order to clear mercury from the brain.
ALA has specific risks because it crosses the blood-brain-barrier. It is riskier if used soon after mercury exposure (such as soon after amalgam replacement). This should be considered in deciding when to use ALA.
ALA tends to lessen copper excretion — so people taking ALA may have their copper levels increase. This can be a problem for people who already have high copper (which is toxic). This should be considered in deciding when to use ALA.
DMSA is stressful to the liver. ALA is helpful to the liver.
ALA is sulfury. (This is “good” for some and “bad” for others. If you are a “high sulphur” person, you may need to limit the ALA dose amount and/or limit sulphur foods carefully while chelating with ALA.)
[added note: see Sulfur food list]
Dose frequency: NB stick to the schedule strictly by setting an alarm each time!
DMSA: every 4 hours,including at night
ALA: every 3 hours, including at night. (You can stretch it to every 4 hours at night if it helps you get a little more sleep, but go back to every 3 hours during the day.)
DMSA + ALA (together): same as ALA, every 3 hours, including at night. (You can stretch it to every 4 hours at night if it helps you get a little more sleep, but go back to every 3 hours during the day.)
DMPS: every 8 hours
DMPS + ALA (together): same as ALA, every 3 hours, including at night. (You can stretch it to every 4 hours at night if it helps you get a little more sleep, but go back to every 3 hours during the day.). Use 1/2 as much DMPS per dose.
It is generally okay to take a dose SOONER, if this is more convenient. For instance, it is fine to take the next dose of ALA after 2.5 hours rather than 3. If you do this, be sure to adjust the time of the next following dose so that it is taken within 3 hours. (Don’t accidentally leave it till 3.5 hours later because of the “early” dose). All dose guidelines are about the LONGEST you can go between doses. Shorter is okay.
Dosage: (based on weight)
DMSA (alone or in combination with ALA): 1/8 to 1/2 mg of DMSA per pound (1 pound = 0.45 kg) of body weight, per dose
ALA (alone or in combination with DMSA): 1/8 to 1/2 mg of ALA per pound (1 pound = 0.45 kg) of body weight, per dose
DMPS (alone): 1/4 to 1 mg of DMPS per pound of body weight, per dose (every 8 hours)
DMPS (with ALA, given twice as often as when used alone): use 1/2 the amount stated above (which is 1/8 to 1/2 mg per pound of body weight, per dose, every 3-4 hours)

(added note: These have changed somewhat in practice and you should start at 12.5mg and build up to avoid any bad reactions)
Ratio of DMSA to ALA (if using both):
A 1:1 ratio seems to work fine. A ratio between 1:2 and 2:1 is best.
Length of cycles:
at least a few days on. Three days on or more is recommended. 2.6 days on is acceptable. (3 entire daytimes and the 2 nights in between = 2.6 days.) (Also, Friday after school until Monday morning = 2.6 days.) Less is getting “iffy”.
at least as many days off as you had on
There is not an obvious one-size-fits-all answer. The following are all reasonable options: 3 days on, 4 days off. OR 3 days on 11 days off . Many other options are also reasonable.
How long to wait after amalgam replacement before chelating:
for DMSA: at least 4 days
for ALA: at least 3 months. ALA has specific risks because it crosses the blood-brain-barrier. It is riskier if used soon after mercury exposure (such as soon after amalgam replacement). This should be considered in deciding when to use ALA.

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Side effects
Side effects can increase and decrease during the round and can be worse on some rounds than others. Side effects starting hours later are usually a sign of Mercury (Hg) being mobilised, while immediate side effects are usually a sensitivity to the drug/supplement. Always begin with low doses of 12.5mg of ALA, DMSA or DMPS to test sensitivity to the compounds, and thereafter build up. If you are in a hurry, it is going to cause chelation to take far longer in the end (due to needing to stop and recover from damage along the way). Slow equals fast in chelation. Complications often show up with the second or third round. So take it easy! Side effects do not always show up right away and they can occasionally hit you ‘like a freight train’ all of a sudden if you are using too high of a dosage or increasing too fast. Being in a hurry is not safe and you need to think about possible consequences if you make yourself worse. We all want to get well as fast as possible but chelating can be dangerous at high doses and cause lots of bad side effects if you push too hard or too fast.
Symptoms with chelation usually confirm mercury toxicity even if tests for mercury don’t show it. When you can take high doses of safe chelators like ALA (1200mg. over a day) without symptoms for while it crudely implies a lack of mercury toxicity. If you have progressively bad side effects even with low doses make doubly sure you have not got a piece of amalgam still inside your mouth.


Is it safe to assume that when you are having a lot of symptoms during a round that you are losing a lot of mercury?

Moving a lot of mercury around and if the symptoms are not tolerable it means that the dose is too high. Take chelation seriously, stick to the program and build up slowly. There is a danger of doing damage when moving mercury around. It can cause long term damage and side effects if you are too arrogant with your approach. If you push it too hard and your body can’t handle it you may create problems. Some people only begin to have problems when they add ALA and start moving mercury from inside the brain and organs. If this occurs lower your ALA dose (some people go as low as 3mg. and stay on this for as long as a year), or continue to chelate with DMSA/DMPS for a longer time before you add the ALA in again. ALA is essential for the mercury detox, and if you have adverse reactions to it lower your dose significantly until you find a dose you can tolerate. No, it only means you are

Food tips while chelating

Sulphur (sulfur) foods

Some mercury poisoned people will not do well with sulphur foods (please follow this link to properly understand) , these are foods with high free-thiol content, not simply a high sulfur content, as can be found on many website lists. We calll them high sulphur foods to simplify. Foods such as like dairy, eggs, garlic, cabbage, broccoli, cauliflower, etc. can cause a lot of problems and may need to be avoided while chelating. Dairy is a very common sulphur food with free thiols. See the sulphur food list for more information and search for sulphur metabolism charts, to understand its conversion. Mercury often interferes with the metabolism of sulphur foods.


Usually it is people that test high in plasma cysteine that cannot tolerate sulfur foods and supplements high in sulphur. People with low plasma cysteine feel better if they eat foods high in sulphur. You would need to test your plasma cysteine levels to know this. See Andy’s comments on thiols, sulfur and cysteine.
Sulphur based nutrients, such as garlic, or medicines with only a single thiol (sulphur) group (the ones that grab onto metals) will make the mercury in the body bounce around faster, making it come out a “little” faster, but it may also create some damage during the processes, which is why some mercury toxic people don’t do well on it. Everywhere it bounces more cellular damage (oxidative damage) is caused which eventually leads to more symptoms. A single sulfur group (thiol) can’t hold on the mercury tightly enough to remove it from the body. Chelators have TWO or more sulfur groups (di-thiol groups) close together in the same molecule (e.g. DMSA, DMPS and ALA) that bind the mercury much more tightly, hang on to it better, and can eventually carry it out of the body.

 

Sulphites (sulfites) and Molybdenum

Part of sulphur metabolism produces poisonous sulphites [R-SO3] further down the chain. Sulphites are also found in many foods e.g. white wine. These must quickly be converted to non-toxic sulphates [R-SO4] by the liver. This process uses an enzyme called sulphite oxidase (SO) which requires molybdenum in its core. Often mercury substitutes itself for molybdenum rendering the enzyme useless. This is why molybdenum is one the important minerals to take while chelating, especially those with high copper as molybdenum reduces copper absorption. ALA tends to increase copper retention and molybdenum will help a lot when ALA is being used.
Many soils are deficient in certain minerals (e.g. South Africa soils are low in molybdenum, along with zinc, germanium, magnesium and selenium).

Other food tips

Avoid beer or wine because of the reactions many mercury toxic people have to them and because they encourage candida yeast infections – particularly while one is chelating. Chelation itself encourages yeast due to the direct effects of  moving of metals. DMSA on it’s own may aggravate yeast in some people, so if you have such an issue you will still need to control the candida while chelating.

 

Supplements to take while chelating

Review – Amalgam Illness diagnosis and treatment - by Andy Cutler, for comprehensive information on correct supplementation for mercury poisoning and chelation. The minimum basic suggested supplements and doses are listed below, and you are encouraged to research the book for details on individual situations, so you can adapt the suggestions to suit your own process.

  • VITAMIN B – 12.5mg to 25 mg four times a day totaling 60 – 100mg/day. Can split a “B-50″ or “B-100″ tablet. Important to take several times per day to keep blood levels high. Don’t take after 4pm as it can keep you awake. Other water soluble vitamins such as Vitamin C should also be taken several times
  • VITAMIN C – 4 grams or more, one with each meal and one at bedtime. Can take up to 12 grams, or up to bowel tolerance, to reduce side-effects of chelation and oxidative damage caused by mercury.
  • VITAMIN E – 1200iu. It is fat soluble and can be taken once a day. This is a VERY IMPORTANT option. Vit. E is a potent anti-oxidant and will balance out the over-oxidizing effect of moving metals, and mercury in particular. Mercury causes oxidative damage wherever it goes and Vit. E and Vit. C help to repair it.  Only buy natural Vit E. Natural Vitamin E begins with a d, as in d-alpha-tocopherol and the synthetic variant begins with a dl, as in dl-alpha-tocopherol.
  • MAGNESIUM - in absorbable forms like citrate, malate, aspartate, or amino acid chelate – 50-100mg several times a day up to 750 mg and adjust lower if diarrhoea. People with weak adrenals should not use Magnesium Oxide as it uses up stomach acid. Magnesium is one of the supplements that poisoned people need a lot of. You can also take pharmaceutical grade Epsom Salts (Magnesium Sulphate) 1/4 – 1/2 teaspoon 4 times a day (don’t take Epsom salts at the same time as Calcium supplements however as it can create an indigestible by-product)
  • ZINC – 50 to 100 mg spread out during day (especially copper toxic people). Everybody needs this.
  • FISH OILS: Pharmaceutical grade Cod Liver Oil. 1 teaspoon – 1 tablespoon/day. Take more in winter.
  • VITAMIN A – 5 RDA’s per day. Can use the mercury-free fish oils to supply this.
  • FLAX OIL - 1-3 tablespoon per day, take some fish oils also. Take with cottage cheese if you tolerate dairy. Balance with BORAGE OIL, 1 teaspoon of Borage for every tablespoon of Flax. People with allergies can do well by taking more flax
  • LIVER HERBS – milk thistle. One capsule with each meal.
  • SULPHATE (SULFATE): EPSOM SALT BATHS are excellent to provide (Magnesium) sulphate and can be done daily! Or consider (Glucosamine) Sulphate 1500mg/day
  • Consider also CHROMIUM 200mcg/meal and VINPOCETINE 5mg…… three times/day, plus:
  • MOLYBDENUM- 500 mcg………… to 1000mcg per day. This is especially important for ‘copper toxic’ people as molybdenum (along with zinc) prevents copper absorption. It is also important to use when using ALA as ALA reduces copper excretion in the bile. (Many South Africans are low in this according to recent hair tests).
  • COENZYME Q10 400mg……/day; INOSITOL 2-12g/day; LYSINE 2g/day;        ARGININE 6g/day, ACETYL-L-CARNITINE 1-2g/day.

Other supplements to consider are:

  • KIDNEY HERBS – ginger and parsley in boiling water is great to help flush the kidneys. Sip throughout the day.
  • MELATONIN – if you have trouble getting to sleep. Not otherwise
  • ACTIVATED CHARCOAL is ONLY used at the time of amalgam removal, as it only helps with current ingestion of toxins and should not to be taken regularly.
  • SAUNAS are one of the quickest ways to bring the body burden of mercury down after stopping exposure. Build-up carefully and keep hydrated with electrolytes drinks. Avoid ‘Far Infra-Red’ saunas.
  • An ALKALINE URINE is important for some metals and a pH of 8 or more is desired, especially when chelating cadmium. According to Andy Cutler “The thiol based chelators will drop off some of the metals in the kidneys if the urine is too acidic”. You can test your morning pH. There is a recipe to increase your pH here…