GDD, revisiting Flare, Gd removal, combining chelators, and other issues.

It is often useful to revisit important concepts, and also with some modernization/ improvement of the writing. This is a short review on Flare, Gd removal, DTPA and other chelators.

The presence of post treatment Flare reflects the amount of Gd in motion in the body following chelation, which is dampened by concurrent use of steroids. Flare only occurs in individuals with GDD or other heavy metals where chelation removes the offending metal. Flares arise early, from primary removal of Gd (within days) and late (generally > 3 weeks) with remobilizing of Gd from bone back to soft tissues (le Chatelier's principle) So if there is no Flare from a treatment this generally means not that much Gd is in motion and hence removed. Flare is the simple phenomenon of the immune system reacting to the movement of Gd. The problem with chelators with lower stability constant for Gd (EDTA and DMSA) is that redistribution (Gd being picked up in tissues and immediately dropped back off) is high in occurrence. So Gd can be picked up in the skin and dropped back into the brain for example. I focus on knowing the stability constant of the agent to the particular metal to determine if it should be used as a chelator.

The use of combining chelating agents is however an interesting concept. In the instance where one chelator may be very effective for some metals DTPA (for Gd and lead) but not so effective for others (variable with mercury) that another chelator with higher removal for that other metal, which usually means higher stability constant (possibly DMSA for mercury). So I am researching the concept of combining chelators for this reason.

I consider stopping chelation when 24 hr urine measures are between 3 and 5 mcg (low yellow range) on urine reports and the patient reports symptom improval of atleast 80% from GDD since the start of disease. Stopping I usually describe as beginning with pausing, in order to make sure re-equilibration Flare does not get out of hand. Pausing for 3 months for example. If it does get out of hand (too severe - too much back to how GDD was to begin with) then treatment is immediate return to chelation, as it was too early to stop. It is impossible to remove Gd or anything else to 0, one stops chelation when the threshold of metal left behind is sufficiently low that the individual is either near cured (optimal) or feels they can manage with the symptoms that are left (this usually reflects they feel they cannot afford more chelation).

DTPA lowers total Gd body level (this is the important consideration - the total amount) better than any other available chelator. Agents with higher stability constant for Gd (such as HOPO) may be better.

Richard Semelka, MD