ExtraDAN: Dr. Amy Holmes - talks 1 and 2 (long)

[Guest guest]

Dr. Amy Holmes - talks 1 and 2

(former oncologist – mom of autistic child)

[Dr. Holmes had one talk during the parents session and one during

the general session which were similar. The slides in the general

session were the same as the previous one. I have combined the

information from both below, plus a little further explanation from

her site because it explains parts better than I could. .

kjorn@...]

Slide 1. Heavy Metal Toxicity is AS – Mercury Toxicity

Slide 2. Nationwide Statistics (US)

School Year 97-98 vs. 98-99

Children ages 6 – 21

Category Percent Increase

All disabilities 2.6%

Specific learning disabilities 2.3%

Speech impairments 1.0%

Severe emotional disturbance 1.9%

AUTISM 26%

Slide 3. Current Autism Incidence Rate

1 in 250 kids have AS

1 out of 150 boys AS

Slide 4. Better Diagnosis? Probably not

Notes: Is this increase due to better diagnostic tools or doctors

diagnosing autism better? Very doubtful. The is a behavioral

diagnosis, and the definition has not changed. It is not very

believable that doctors were so incompetent until 10-12 years ago

that they could not diagnose very well and then all of a sudden they

became much more capable.

Slide 5. Causes of the Autism Epidemic – (can't refute the fact that

it is an epidemic)

- genetics plus

- environmental factors

Slide 6. Autism: A Novel Form of Mercury Poisoning

Bernard, Enayati, Binstock, Roger, Redwood

Medical Hypothesis 2001

Available on ARI Website:

http://www.autism.com/ari

Notes: the current paper on this is located at the above url. The

symptoms are very similar.

Slide 7. Autism = Mercury Poisoning (at least in many cases)

Slides 8-10. Sources of Mercury Exposure

- Water - ionized (Hg++), poorly absorbed

- Fish/seafood - methylmercury

- Dental amalgams - vapor (Hg-0m mercury)

- Contact lens solution - thimerosal*

- RhoGam injections - Rh-negative moms

- Some childhood vaccines – thimerol: only some vaccines contain

this, not all

Vaccines that contain mercury now are the DPT, Hib routine use since

late 1980s

The Hep B has been mandatory in infants since 1991 – why this is,

cannot understand. Unless mom has had hep B there is not way the

fetus can get it until he turns into an idiot teenager and does dumb

things (sex for AIDS, hep B, etc). The Hep B is the only one given

within a day of birth. There is no point in this. Mother may receive

RhoGam injection during pregnancy and this can be problematic –

currenctly the RhoGam from Bayer is the safe one.

Slide 11. Infant Mercury Exposure Via Vaccination (US), CBER, 1999*

By age 6 months, a fully vaccinated infant has received:

-3 DPT 75 mcg mercury

-3 Hib 75 mcg

-3 Hep B 37.5 mcg

TOTAL 187.5 mcg mercury

*FDA Center for Biologics Evaluation and Research

Slide 12. An exposure of 187.5 mcg mercury in 6 months exceeds the

EPA safe limit. This is what a fully immunized body gets.

Slide 13. graphic slide showing the sharp increase in autism rates

correlates with the increase in vaccinations for infants escalating

from 1989 through the 1990s. CA is the only state that has mandatory

reported autism and PDD. This may be why the numbers are so high for

CA, the other states may not be reporting all cases as promptly.

Slide 14. Historical Precedent Exists for mass poisoning of infants.

Text: Those who do not remember the past are condemned to repeat it.

Notes: There is a historic precedent of mass poisoning of infants

involving mercury.

Slide 15. Pink Disease

-Common in children in 1890-1950s

-Pink cheeks and nose, painful pink hands

-Mystery solved 1945

---Calomel teething powders – has mercury

-Delayed onset

-Only 1 affected for every 500 exposed

Notes: Pink disease was common in the early part of the last century.

The symptoms were very common to autism and had delayed onset. It was

discovered that calomel teething powders contained mercury. This

powder was to put on infants' gums to numb the pain of teething. Once

the teething powder was eliminated, Pink Disease went away.

Slide 16. Pink Disease

-Apathy

-Lost play

-Sound/light sensitivity

-Aversion to touch

-Head-banging

-Insomnia

-Repetitive rocking

-Repetitive hand-rubbing

-Poor muscle tone

-Seizures

-Infections

Notes: These are the common symptoms of Pink Disease. Sound familiar?!

Slide 17. Sources and Forms of Brain Mercury

diagram showing sources of mercury entering the body (vapor from

teeth, vaccines, fish)

Notes: Mercury can move into the brain regardless of the source. Once

it is converted to Hg++, it will not leave and it very difficult to

remove.

Slides 18-19. Mercury likes to attach to sulfhydryl groups in

proteins. When it binds to two sites, we call this " tighly-bound "

mercury.

Slide 20. Proteins Bound to Mercury

- can be enzymes or structural proteins

- both are inhibited when bound to mercury

- loss of enzyme function

- loss of structural integrity

Notes: Whatever type of proteins they are, when mercury binds to them

it inhibits their activity. These can be enzymes or structural

proteins.

Slide 21. Slide showing loss of enzyme activity when mercury was added

Slides 22-24. Slides showing loss of protein activity when different

vaccines were tested. Showed that enzyme activity was greatly

decreased with the addition of thimerosal.

Notes: A person may have cravings for salty and vinegar/sour foods

because these are two of the pathways out of 5 that are not inhibited

by heavy metals.

Slide 25. Conclusions

-Thimerosal inhibits both tubulin and actin viability, plus the

activity of several other enzymes, at concentrations similar to

observed with mercury.

-Vaccines containing thimerosal are solutions of extreme toxicity.

This toxicity is most likely due to the synergistic effects of the

other chemicals in the vaccine mixture.

Slide 26. Conclusions

-Thimerosal is the major toxic component of most vaccines.

-Thimerosal is a more potent inhibitor of many metabolic enzymes than

is mercuric chloride.

-Due to synergistic toxicity, thimerosal exposure through vaccines

with aluminum should be considered quite capable of causing severe

neurological and systemic damage.

Slide 27. Why only some children?

- Most get about the same mercury exposure

- Only 1 out of 250 are autistic

- Why?

Notes: So what does this affect only some children…why are not all

children who receive these vaccines affected?

Slide 28. The Answer: Genetics!

Slide 29. Predisposing Factors Under Investigation

-metallothionein

-apolipoprotein E

Notes: There is some genetic factor which makes some children more

susceptible to begin with. These are two of the factors currently

under investigation.

Slides 30-31. Metallothionein Functions

-Sequesters metals

-Regulates copper-zinc balance

-Larger detox role (quenches nitric oxide)

-Familial variability

-Induced by zinc

Notes: These are the main functions of Metallothionein in the body.

It needs zinc to function most of the time. Reference: Dr.

Walsh

Slide 32. Metallothionien Dysfunction

-Abnormal copper:zinc ratio

-Impaired detoxification of heavy metals

-Impaired neuronal development

-Immature GI tract

Notes: These are common results of MT dysfunction.

Slide 33. Copper:Zinc Ratios

-Normal – 0.7 to 1

-ADD 1.2

-ADHD 1.4

-Autism 1.7 or greater

Note: These are the ratios of copper:zinc found by Dr. Walsh. The

highest ever seen was 4.0

Slide 34. Role of vaccinations

-MMR

-Which vaccines and when?

Notes: Which vaccines may be contributing to the problems? Is timing

an issue?

Slide 35. MMR

-Regressive autism reported after MMR

-Linked with various bowel symptoms

-Endoscopy – ileal lymphonoldular hyperplasia (autistic enterocolitis)

-Vaccine-strain measles virus demonstrated in intestinal lymph nodes

Notes: These things are found happening after MMR.

Slides 36-37. MMR and Mercury Toxicity

-Mercury is known to impair cell-mediated immunity

-Unable to clear viral infections

-Persistent measles infection

-Leaky gut

-Final insult in some children?

Notes: Something in the MMR is directly impacting brain enzymes but

right now we don't know what it is.

Slide 38. Reasonable Vaccine Recommendations

Notes: What is a reasonable vaccine schedule? The current one is not

reasonable.

-All vaccines thimerosal free

-Hib

-DtaP – the one by -Kline-Beachum is the only safe one to be

giving when child starts walking outside

-measles monovalent – a very serious disease - when the child is 2

years

-Mumps monovalent (?) - mumps in childhood is nothing, disease is

more tolerable and you get life long immunity. If a boy gets this

after puberty, there is a 50% chance of being sterile.

-rubella monovalent (?) - for boys no, for girl when young

-Others? No reason for hepatitis before puberty - personal opinion

Slide 39. Testing for Mercury Toxicity

-not straightforward

-clears quickly from biological samples – blood clear 4-6 months

after exposure

-must test for known effects on certain processes

Notes: Testing for mercury toxicity is not straightforward because it

clears quickly from blood and urine samples. So we need to run a test

for something that we know that mercury affects.

Slide 40. Lab tests for Mercury toxicity – in handout.

-Urine organic acid tests

-Fractionated urine porphyrins – currently no commercial labs runs

this test

-Immune system tests

-Specific esoteric tests

Note – The hair test is a good screen for other heavy metals, just

not mercury.

Slide 41. Urine Organic Acid and Amino Acid Tests

-Indications of mitochondrial dysfunction

---uncoupling of oxidative phosphorylation: elevated fatty acid

metabolites, elevated lactate, elevated hydroxymethylglutarate

---multiple partial blocks in Krebs cycle

-Elevated 3-methyl histidine

-Elevated sarcosine

Slide 42. Fractionated Urine Porphyrins

no commercial labs runs this test

-elevated coproporphyrin

-elevated precoproporphyrin

[i don't know what this was in reference to]

Slide 43. Immune System Tests

-Elevated total IgE (over 300)

-Low CD8+ T cells

-Low NK cells

-anti-MBP antibodies

-anti-NAFP antibodies

-high CD3+CD26+ cells (?)

Slide 44. Esoteric Blood Test

-Low superoxide dismutase

-Low reduced glutathione

-Low glutathione peroxidase

-Elevated lipid peroxides

-Elevated platelet serotonin

Slide 45. Esoteric Urine Tests

Elevated pyroglutamate - glutathione depletion

Elevated vanilmandelate - epinephrine, norepinephrine breakdown

Elevated homovanillate - dopamine breakdown

Notes: She looks for glutathione depletion and evidence of sulfate-

wasting in urine.

Slide 46. Evidence of Sulfate-Wasting in Urine

Low plasma sulfate with normal urinary sulfate to creatinine ratio.

Slide 47. Lab Abnormalities NOT Found Unless Exposure was Recent

- high blood mercury

- high hair mercury

- high packed RBC mercury

- high urine mercury

Notes: Tests are VERY different from lead. Abnormal mercury will be

found if the exposure was very recent, otherwise mercury content will

not show up. The hair, blood and urine clear very quickly. The liver,

kidney, lining of the gut, and non central nervous system organs

clear more slowly – several years. Mercury in the brain clears very

slowly with a half-life estimated to be 20 years (so it is there to

stay, unless you go get it).

Slide 48. Mercury Kinetics (after end of exposure)

-blood, hair rapidly cleared – 4 to 6 months

-non-CNS organs clear more slowly – several years

-brain mercury very slowly removed – half-life about 20 years

Slide 49. Mercury Removal

-Stop big sources of mercury exposure

-Clear out body mercury (this may be unnecessary with small amounts)

-Clear out tightly-bound mercury, including mercury in brain

-Appropriate nutritional support: determined by testing, particular

attention to antioxidants

Slide 50. Stop Exposure to Mercury

-Remove all amalgam fillings

-Stop fish/seafood intake

-Use only thimerosal-free vaccines

-Watch for other thimerosal exposure

Slide 51. Step 1

Clear out any loose Mercury

- use DMSA alone

*This step may not be necessary

Notes: DMSA does not cross the blood-brain barrier, therefore the

only mercury (or any other metals) pulled out with DMSA (with or

without glycine) are coming only from non-brain organs. While it is

very interesting to see how much mercury our children have managed to

store in liver, kidney, intestines, and so forth, the amounts removed

will have little impact on the child's brain functioning. For this

reason, we do not really care how much mercury or other metals come

out of non-brain locations. The only issue while using DMSA alone is

that the non-brain mercury is gone BEFORE adding lipoic acid. All we

want is a " clean " body before adding lipoic acid because we do not

want to give lipoic acid any chance to move body (non-brain) mercury

up into the brain.

Slide 52. Step 1

-DMSA – max dose 10mg/kg three times a day for 3 days, off 11 days,

repeat

-Add glycine to each dose of DMSA

-Test urine mercury after 2 to 5 rounds

Notes: Testing During Step 1 (DMSA alone):

DMSA almost exclusively dumps metals into urine. We have a few

choices about testing urine to determine when all or most non-brain

mercury has been removed:

Option 1. Test urine on every cycle - this option is strictly for

those who are REALLY curious about what metals are contained in the

child, but not in brain, and are also extremely rich. The cost of

this option excludes most of us parents.

Option 2. Do four 2-week cycles of DMSA (3 days on/11 days off OR 7

days on/7

days off). Then test urine on the 5th 2-week cycle, on either Day 2

or Day 3 of the cycle. If the amount of mercury excreted on the 5th

cycle is very low, then we know the body (not brain) is " clean " , and

then we can add lipoic acid with complete safety. This option is the

most popular among parents.

Option 3. Do at least eight (preferably ten or twelve) 2-week cycles

of DMSA (with or without glycine). This option is reserved only for

those children who are very uncooperative with urine collections.

After eight 2-week cycles, 95% of all children have excreted

virtually all non-brain mercury. After twelve 2-week cycles, 99%

have " clean " bodies.

The urine test to check for excreted metals is the Urine Toxic

Elements test done by Doctor's Data Lab [call Trudy at 225 767-7433].

They would like at least a 6-hour collection, but a longer collection

is even better. The bladder is a great storage place for urine, so

first morning urine is at least a 6-hour collection, probably longer.

For those not-yet potty-trained, urine collection bags are the best

option.

Note regarding other metals besides mercury: DMSA will pull out most

heavy metals, some better than others. If the child shows a large

amount of some metals like lead or tin, it is very advisable to

continue on DMSA alone (with or without glycine) until these metals

are no longer being excreted in huge quantities. And we may

accelerate the schedule from 3 days on/11 days off to something like

5 days on/ 9 days off or even 7 days on/7 days off. The reason for

this is that these other metals (lead and tin most notably) really

slow down Step 2 to the extent that they may even double the time

required in this later step. The quicker we can get rid of

these " other " metals, the faster Step 2 will go.

Slides 53-54. Showed 2 slides showing test results of patient where

metal is coming out.

Slide 55. Step 2

-DMSA + lipoic acid (LA)

-Add glycine to each dose (she said this is optional, that often she

forgets this entirely)

-DMSA:LA ratio from 2:1 to 6:1

-Test stool mercury every 4 to 6 months: hair test may be better for

some (child must be chelating consistently for at least 2 months

prior to hair specimen collection)

Notes: Sustained " regressions " once Lipoic Acid is Added is almost

ALWAYS due to overgrowth of some unfriendly organism in colon – as

body dumps mercury and it is going out the body, it encourages the

growth of the bad flora. Any other cause(s) extremely rare.

Testing During Step 2 (DMSA plus lipoic acid)

While DMSA causes mainly urinary excretion of metals, lipoic acid

excretes metals into bile - bile goes into stool. So lipoic acid does

most of its metal excretion via stool. Once we add lipoic acid, we

usually do not see any mercury come out in urine, except in some very

young children (4 or less) unless we happen to get lucky (urine

become " hit-or-miss " detecting metals once lipoic acid is added).

The best test for mercury excretion on Step 2 (DMSA plus lipoic acid)

is the Fecal Metals test also done by Doctor's Data Lab. The

procedure is to collect stool on Day 4 or Day 5 that would be the 1st

or 2nd day after a 3-day cycle of DMSA plus lipoic acid). While the

stool test is the best test for metal excretion on Step 2, there are

(or can be) a few problems:

1. Child does not " go " on either of the preferred days.

2. Child flushes the specimen down the toilet.

3. Child's stool transit time is so different from average that even

though you collect on one of the " preferred " days, that day was not

the " preferred " day for your child - the mercury came out either a

couple days earlier or a week later, and we missed it totally. To

complicate matters even further, it is impossible to tell what your

child's stool transit time actually is, even if they appear to

be " regular " .

4. Lipoic acid is so involved with another metal (especially antimony

and arsenic) that it latched on to these metals, ignoring mercury at

least on this cycle. Remember, there is always competition for

binding sites on both DMSA and lipoic acid between the metals, and

there is also a " pecking order " of metal preference for both of these

substances, for instance, lipoic acid prefers arsenic over mercury,

so if there is a lot of arsenic around, mercury will be ignored. See

note below about lipoic acid and other metals.

Despite the above listed problems with the stool test, for about 80%

of the children so far, the stool test has been excellent - a large

amount of mercury is detected in stool, and everyone is happy (there

is nothing better than seeing a huge " dump " of mercury coming out in

stool!!). For the children for whom the stool test is not the best

test (at least one of the above reasons), a reasonable but not very

satisfying compromise is serial hair tests. The hair test will give

us a rough indication of how much mercury is being mobilized, and

will usually give us a good indication when to stop treatment. It is

a compromise at best because:

1. We have already " flushed " the body with DMSA (with or without

glycine) already, so the only mercury that is reflected in hair is a

tiny amount mobilized from brain each cycle.

2. We are using an on/off schedule with DMSA plus lipoic acid. The

only times metals are actually being pulled are on the " on " days.

Nothing is being pulled out on the " off " days. Hair represents an

average of both on and off days, so the amount shown in hair is much

less than is being mobilized " on cycle " . For this reason, hair always

gives what appear to be very tiny quantities of all metals - and this

is very unsatisfying for all involved (no immediate gratification!).

But, if your child is one of the unlucky 20% who have no success for

whatever reason with the stool test, we have no other choice but to

use the hair test. There is one very important thing regarding the

hair test (if we have to use it) - the child must be chelating

consistently for at least 2 months prior to collection of the hair

sample, or else the amounts of metals reflected in the hair will be

even

lower than expected false low results. Whatever test you choose for

your child on Step 2,

testing every 4 to 6 months is probably best, unless you are

extremely curious (and very rich!).

To obtain either the Fecal Metals or hair test kits, call Trudy (225

767-7433) and tell her which kit you want or she will mail it to you.

Note regarding lipoic acid and other metals: Lipoic acid does cross

the blood-brain barrier and will latch on to whatever heavy metals

are in the brain and bring them out. It will either (usually) dump

these metals directly into stool via bile or pass them on to DMSA, in

which case they will be excreted via urine.

Lipoic acid has a " pecking order " of metal preference. While it does

latch on to mercury quite well, there are at least two other metals

it prefers over mercury - arsenic and antimony. In fact, the best-

known chelator of arsenic is lipoic acid. If there is a lot of

arsenic or antimony (or some other metal lipoic acid likes a lot),

lipoic acid will preferentially chelate this metal first. Eventually,

once the more-preferred metals are gone, mercury will be picked by

lipoic acid. Regardless, getting rid of these other metals is very

desirable. Do not be surprised if you see a huge amount of arsenic

coming out on the first few Fecal Metal tests.

Slide 56. Showed test results after DMSA+LA with metals coming out.

Slide 57. Common Side Effects

-Worse behavior initially

-Diarrhea

-Headache

-Fatigue

-Overgrowth of intestinal yeast and Clostridium with lipoic acid

(this can occur as the metals pass through the gut, you may need to

stop chelating and treat the gut bug problem)

Slide 58. Worse Behavior

Whatever the child does that REALLY bugs the parent will get worse.

It may include stimming, aggressions, hyperactivity. You should

expect this to be worse on the " on " cycles and get better on

the " off " cycles. If you see any sustained " regression " on DMSA alone

and it is not related to an/off cycles, this is usually related to

mineral deficiencies being " unmasked. " You need to call the treating

physician at this point.

Slide 59. Uncommon Side Effects

-Abnormal blood counts

-Mineral problems

-Seizures?

-MUST monitor with routine tests!!!

Slides 60-63. tables showing fecal test results removal of metals. In

particular there was no fecal mercury on DMSA or LA alone. The

combination of the two resulted in a lot of mercury being withdrawn.

Slide 64. Excretion of Mercury Using DMSA/LA

- Once no more mercury is excreted in urine on DMSA alone, adding

lipoic acid causes fecal excretion of mercury

- Neither DMSA alone nor lipoic acid alone results in any fecal

excretion of mercury

- Lipoic acid seems to " need " DMSA, perhaps for activation into the

dihydro-form

Slide 65. Age Effect on Mercury Excretion

Table with results of fecal mercury from DMSA+LA showing much mercury

removed from a 2 yr old, less removed from an 8 yr old, and hardly

any being removed from a 17 yr old

Notes: She said she thinks it is always good to try, but they are not

seeing much metal removal from teens and they are not sure why.

Slides 66-67. Early Results

Amount of improvement from kids chelating based on 152 children –

DMSA + LA 6 months

Ages 1-5 (66 kids) 36 marked improvement, 39 moderate, 15

slight, 9 none

Ages 6-12 (55 kids) 15 marked improvement, 35 moderate, 36 slight,

15 none

Ages 13-17 (24 kids) 0 marked improvement, 17 moderate, 54 slight,

29none

Ages 18+ ( 7 kids) 0 marked improvement, 14 moderate, 14

slight, 71 none

Notes: This shows that the younger the child the better the results.

Slide 68. Rapid Responders

(based on very early observations)

- younger children

- those with history of normal development followed by regression

(this is true for all age groups)

Notes: She stressed that this is what they see now but it is subject

to change at any moment because they are so early into the process

and there is a lot more to learn. Maybe there is some little key they

haven't found yet for the older kids so don't lose hope.

Slide 69. Pleasant Surprises with Removal of Mercury

-CNS autoantibodies have disappeared

-Symptoms and laboratory evidence of IgE-mediated allergies have

disappeared.

Notes: These are things they see regularly but were surprised to find

with chelation. The central nervous system AA disappeared and some

allergies left.

Slide 70. Effects on Other Areas (Totally Unknown)

- Chronic viral infections

Maybe we shall see

-Gluten/casein-free diet

-Gut bugs

Notes: They do not know how chelation will affect these areas in

general, although any particular inidividual may see positive

results. Gluten/casein diet…if it is working just stay with it…it is

too early to say conclusively about the effects of continuing it or

discontinuing it.

Slide 71. Conclusions

-Autism may represent fetal/infantile mercury toxicity in susceptible

individuals

-Chronic viral infections may be due to inhibition of cell-mediated

immunity

Slide 72. Conclustions

-Significant improvements have occurred with mercury and other heavy

metal removal (based on the early data)

-Rapidity/duration of treatment seem to be dependent on age and

developmental history

-Ultimate outcome is unknown but looks promising.

Notes: This is VERY early data, too early to make many conclusions,

but it looks like a very promising approach. It appears to be working

well in many children. The age and developmental history are very

important. We are actively looking at several new related areas.

Additional information from Dr. Holmes' site:

Safety Testing

These tests do not show anything regarding how much mercury is being

removed. They are strictly safety tests to make absolutely sure that

DMSA (with or without lipoic acid) is not adversely affecting your

child. They are absolutely required and are of utmost importance.

Every 2 to 3 months:

1. CBC with differential counts (blood counts)

2. Liver function tests (hepatic panel)

3. Chem 7 (serum electrolytes plus creatinine)

Every 6 months:

RBC Essential Elements (intracellular trace minerals)

We used to check serum copper and plasma zinc every 2 to 3 months

(along with the first 3 tests listed), but these two tests have

presented some major problems because of the way our bodies excrete

heavy metals with the aid of DMSA with or without lipoic acid. There

is a step in heavy metal excretion that involves intracellular

transport of the heavy metal inside red blood cells - this is

necessary, and without this step, the metal would never be excreted.

Unfortunately, while inside the red blood cell, the heavy metal

displaces certain trace minerals (zinc is the most popular to be

displaced) outside the cell into the serum/plasma. This results in

high plasma zinc readings, leading us to erroneously conclude that we

are giving the child too much zinc. The place zinc is used (as a

component of many enzymes) is inside the cell, not in the plasma. So

what is important is the intracellular concentration of zinc, not the

plasma zinc level. And the same is true for all of the other trace

minerals, including copper.

The RBC Essential Elements test is run by only a handful of labs - we

greatly prefer MetaMetrix because of the quality of the test and it

is also not terribly expensive like some other labs. This is a blood

test and the blood for this test can be drawn at the same time as the

every 2 to 3 month tests by the same lab that does these other tests

for you (any local lab), but the lab must send the specimen to

MetaMetrix properly processed. It makes it much easier for whatever

local lab you choose and for you to bring the RBC Essential Elements

kit with you to the lab with your child, so there is no confusion on

the lab's part about what needs to be done. When it is time to have

this test done on your child (every 6 months), please call Trudy (225

767-7433) and tell her you want the RBC Essential Elements test kit -

I will also send you a prescription that you take with the kit to the

lab of your choice requesting this test be drawn and mailed.

We realize this is very inconvenient, but is unfortunately very

necessary for complete safety during treatment.

1. Expect your child's behavior to get worse during the first few

cycles of both DMSA alone and DMSA/ALA. This is an effect of moving

metals around and out of the body and is expected to occur.

2. Other common side effects of DMSA include diarrhea in 15%, some

nausea, very stinky gas, and possibly breaking out in a fine red

bumpy rash that may or may not itch (this is called a mercury rash

and is not dangerous - if it itches, use Benadryl cream or oral

Benadryl). Side effects of lipoic acid include light sensitivity and

the development of red rings around the eyes - looks like raccoon

eyes, except red not black. Lipoic acid also causes euphoria in some -

child will like it, you will not!

3. Uncommon side effects include a drop in blood counts and a

temporary increase in liver enzymes. This is why we test blood

counts, liver and electrolytes/kidney every 2 to 3 months while on

DMSA with or with out lipoic acid.

4. There is a theoretical possibility that by removing mercury from

the brain, the membrane potentials of the brain cells may change

enough to induce seizure activity. So far, with hundreds of children

under treatment, including many with seizure disorders, this has not

been a problem. Chances are, if we were able to remove every molecule

of mercury all at once, induction of seizures would occur, but since

we are only able to remove a tiny amount each cycle, that is probably

why we have had no problem with seizures at all.

5. Take all of the supplements listed in your child's support

protocol every day. The only exception to this rule is that if your

child is taking oral glutathione, do not give this on the days he/she

is on DMSA.

6. Encourage your child to drink a lot of fluids on the days on DMSA

and DMSA/ALA. Three to four 8-ounce glasses of fluids per day should

be more than enough.

7. It is very important to avoid known sources of mercury both during

chelation and after it is over. These include:

a. Thimerosal-containing vaccines*

b. Fish and seafood**

c. Amalgam (metal) fillings. If your child ever needs to have

fillings put in his/her teeth, ask the dentist to use white composite

material instead. If your child already has amalgam ( " silver " )

fillings in his teeth, these MUST be replaced with either white

composite fillings or stainless steel caps PRIOR to beginning DMSA.

For future reference, stainless steel caps are fine and braces are

fine - anything that does not contain mercury is fine.

7. Urine and stool will smell like sulfur on DMSA. This is normal.

*Every commonly given vaccine has at least one brand that is

thimerosal-free. By 2002, all US vaccines will be thimerosal-free

(according to the FDA and CDC).

**To be on the completely safe side, most parents have made a new

rule of the house - no fish, no seafood. If your child needs to have

a note for the school cafeteria stating " no fish/no seafood " , I will

be more than happy to write one for you.

Do not expect to see any behavioral improvements on Step 1. If any

occur, they are most likely due to the elimination of heavy metals

other than mercury. Do not expect to see any improvements from the

elimination of mercury until 2 to 3 months into Step 2 of the

chelation protocol. Usually, younger children respond faster than

older children, but this is not always the case. The timing of the

response is dependent on many factors including exactly how fast the

mercury is being removed from the brain, how fast any damage that is

being repaired is actually being repaired, and so forth. There is a

lot of individual variation in rapidity of response.

Most Common Order of Improvements - usually starts 2 to 4 months into

Step 2 (DMSA + LA):

1. eye contact

2. interaction with significant others

3. receptive language

4. expressive language

5. pronunciation - improvements in apraxia/dyspraxia

6. stimming/ stereotypical behaviors

7. other problem behaviors

None of these happen overnight, but you should notice slow steady

improvements, usually in the order listed over several months,

depending on the child's initial level of functioning and his

individual response to treatment.

Problems Encountered in Step 1 (DMSA alone with or without glycine)

It is extremely common to see regressions in behavior, learning,

attention, and so forth around the days on DMSA - this is normal and

is expected to occur. If you notice a continued regression in

anything that is not related to the DMSA cycles in timing (like is

happening all the time), then that is not normal. Invariably,

problems like this encountered on DMSA alone are related to either

minerals (usually magnesium deficiciency) or taurine deficiency or

something similar. If this occurs with your child, do the following:

1. Call us and tell us exactly what is happening

2. If he/she is already on a multimineral supplement, increase

the dose. If he/she is not, get him/her on one ASAP, add additional

magnesium, either via magnesium sulfate cream or oral magnesium

glycinate. Same with Taurine.

Problems Encountered in Step 2 (DMSA plus Lipoic Acid)

If the regressions in behavior, etc are only occurring around

the " on " days, then this is normal and expected to occur. But, if

there is EVER a continued regression (or even a plateau in progress)

at any time during Step 2, the major cause (so far, at least 95% of

kids) is overgrowth of some unfriendly bug in the gut that is

producing toxins that influence behavior, learning, attention, stools

and even sleeping. The reason is simple - lipoic acid ends up dumping

mercury into stool (this is obviously good because it is on its way

out of the body). But, while mercury is in the intestines, it impedes

intestinal defenses allowing all sorts of unfriendly toxin-producing

bugs to overgrow, even in children who never had any bad bug problems

in the intestines before.

If at any time during Step 2 (DMSA plus lipoic acid), you notice a

continued regression unrelated to on/off cycles or even a plateau in

progress, we MUST check for bugs SAP. This entails both:

1. Stool micro (alone or with parasitology if we even remotely

suspect parasites in your child)

2. Either urine organic acid test (if your insurance paid at least

50% of the cost of this test before) or just the dysbiosis section of

this test (if the insurance did not pay at least 50% of the OAT

above - no insurance will pay for just a section of the test). Call

Trudy (225 767-7433) immediately and tell her which tests you want to

run. She will send them to you ASAP.

These two tests together will give us a complete " bug picture " . The

stool culture will only grow out aerobic (will grow in the presence

of oxygen) organisms, and the urine test will check markers put out

by anaerobic organisms (cannot grow on culture). Almost invariably,

this has been THE major reason for any regression or plateau on Step

2. Once the bugs have been eradicated, the progress resumes, and

everyone (child, parent, doctor) is much better.

Of course, if any problem arises during the course of treatment in

any area, please E-mail us or call Trudy. We may not be able to fix

everything, but if we don't know about what is going on, we can't

help much at all!

If possible, to help us keep track of progress and any problems

encountered, once every 3 to 6 months, please send (mail, fax, E-

mail, etc) us the following info:

1. Repeat ATEC reports (can fill out online on ARI web site) -

we want results

2. The ARI's Mercury Detoxification Progress tracking sheet

(also online at ARI)

3. Any re-evaluations you have done through county early

intervention/pupil appraisal teams, or even private developmental

psychologists/pediatricians, speech therapists, and other people like

this.

4. A list of exactly what medications and supplements he/she is

currently on with dosages.

This will help us help you take the best care of your child, and will

also aid the ARI/DAN group in assessing treatments. Also, anything

else new that you want to try let us know, especially if it works!

If your child demonstrates any signs of central nervous system

(brain) mercury toxicity, then eventually, we will end up adding

lipoic acid to get rid of mercury and other divalent metals in the

brain. Lipoic acid mostly dumps mercury into stool (via bile). That

is good because it will be leaving the body, but while mercury is in

the intestines, it impedes normal intestinal defenses, and this can

allow all sorts of unfriendly organisms to overgrow, especially some

yeast and Clostridia. One can usually tell if this has occurred

because usually it is manifested by some continued regression or a

plateau in progress. But, there are some children who show no obvious

behavioral signs of a bad gut bug overgrowth problem at all (like my

son). If we start Step 2 of mercury removal (DMSA plus lipoic acid)

and all is getting better for a while, then you start noticing a

continued regression in behavior, learning, attention, stools or

sleeping behavior, that is our clue that we need to check for bad

bugs ASAP. Once the offending organisms are eliminated, then progress

(behavioral, learning, attention, etc) resumes. If your child is one

like mine who demonstrates no obvious regressions with even the

world's worst gut bugs growing wild, then we may have to resort to

checking for bugs periodically just to be on the safe side. One thing

is definitely known about some of these bugs - they " mask " progress

very well, and may lead us to believe that the treatment isn't

helping when it actually is. The strange part about many of these

children who end up growing all sorts of unfriendly bugs on lipoic

were the same children who had no gut bug problems at all when we

started DMSA/LA. The only good part of this whole scenario is that at

least it tells you beyond any doubt that you are dumping organic

mercury from the brain into the gut!