Gd is always on the move in your body, and naturally, especially if kidneys are normal, it is being eliminated. At some point beginning at about 3 months post-GBCA injection, the bulk has stationed mainly in bones, then skin, then in lesser concentration in other organs, such as brain, liver, etc. Movement continues, but to a much lesser degree. I believe the bone and skin deposition is the survival technique of the immune system/body to keep a great number of toxins away from vital organs (at least in mass). When we chelate, we are removing primarily from more accessible organs, and then lesser (but still occurring) amounts from other organs. So skin and white cells (mainly resting in the spleen) are the most accessible, marching down through brain... ending up with some coming from bone. DTPA holds onto Gd much better than all other available chelators (to refresh your memory from my blogs - measured as stability constant or thermodynamic stability/kinetic stability) and the stability of Gd to DTPA is 300,000 times greater than Gd to EDTA.. yes I wrote 300,000.
There is le Chatelier's principle that describes that everything strives for equilibrium, so all repositories of Gd are in equilibrium with each other, so if we remove Gd from the skin, Gd from, for example, the bone, will gradually move from bone to skin (and all the other organs: brain to skin, liver to skin, etc). So this redistribution phenomenon can elicit pain and other symptoms, because your immune system is reacting to the motion of Gd, even if it is good motion (like Gd moving from tissues through vascular system to kidneys for elimination, that we are doing with DTPA).
I use the timing of patient's symptoms to guide when chelation session should occur. When symptoms come on late, such as 5-6 weeks since last chelation, this likely reflects the pain of motion from re-equilibration, and if it is very severe it tells us the intervals between chelation are too long. Remember as well though, that I use 20 chelations as a relative stopping point, so this applies to chelations 2-19). Every 3 weeks seems to be a good number for most people to minimize this late le Chatelier's principle - based pain.
I generally don't do weekly chelation, often the most important reason is that since patients travel from a distance, weekly is not practical for them. But the other reasons are since Flare usually lasts for 1 week, weekly chelation then creates a constant state of Flare. This can be controlled by constant relatively high dose steroids - but I prefer to avoid this. The other reason I shy from weekly is to avoid the possibility of creating a constant low level of native metals, like Mg, Mn, Cu. Chelation with Ca-DTPA also removes these metals (Zn-DTPA does not - reflecting relative stability of the cation to the chelator). Remarkably though, self-regulation and return to normal in healthy people on healthy diets, this return to normal levels usually occurs within 3 days - so concern of this happening with weekly chelation really is more theoretical than real for not decreasing normal native metal levels in the body. But in people who do not get severe Flares, they may do very well with weekly sessions, weekly has the advantage of pulling out more Gd in a shorter period of time, so rather than a treatment period of 9 months to 1 year, the period can be 3-4 months.
Circling back to the above and to re-iterate another point I have written about. All chelators remove Gd from tissues: so EDTA, DMSA, DMPS, but the major problem is that most of the Gd will not be attached tightly to these weaker chelators, which means it will be picked up somewhere, like the skin, then dropped back off in the body, where it can go somewhere else, like the brain. That is why I never, ever (add in 10 more evers) recommend these chelators, especially when the practitioner makes the miscalculation that they should use DMSA (even in addition to DTPA). because the patient has lead in addition to Gd, and DMSA is recommended for lead. But the DMSA not only picks up lead, but also Gd, and actually redistributing a fair amount of both, even the lead. DTPA also is the optimal available chelator for lead.
So to summarize the answer to your question:
1. Late onset symptoms. Getting symptoms, even new symptoms late after chelation is likely a reflection of ongoing le Chatelier's principle, and likely reflects that the interval between sessions is too long. le Chatelier pain may be due to continued removal from the site of deposition, by the forces of re-equilibration, or from re-equilibration of Gd to new sites. The latter being undesirable, hence the value of going to a shorter interval between chelations. Late onset symptoms may also reflect that the immune reaction has become independent from the presence of Gd and then becomes essentially a pure autoimmune disease. This is why I always (add 10 always) recommend controlling the Flare reaction, and also the importance of pauses, and careful thinking about treatment beyond 20 chelations. I have a blog about that as well. Beyond 20 chelations, the Flare reaction continued restimulation of the immune reaction may outweigh the value of continued Gd removal.
2. Early onset symptoms. the Flare, almost purely reflect the host immune system reacting to the movement/removal from tissue, and this reaction can also occur in sites where a sufferer did not have symptoms before, for example left 4th rib, sternum. The Gd was always there deposited, but the present removal was the first time that it appeared symptomatic to the person. So early pain, the Flare, is fundamentally good pain, but in the great majority of people it is essential to control the severity of the host reaction, with Frame drugs. If a poor chelator is used, early onset pain may also reflect the pain of redistribution to new sites, which occurs likely in much greater amount than the new site redistribution from le Chatelier pain. This should always be avoided, because it can be avoided. Flare may be less with poor chelators, but not for any good reason, only because less Gd is mobilized hence less Flare. But this is a poor strategy for managing Flare, the best is to manage with Frame drugs, and second best either just Zn-DTPA or lower volume chelator, the first manages Flare and a large amount of Gd is removed, the basis for the other two strategies is less Gd is removed, which for most people is not a desirable thing (Zn-DTPA alone also though removes less native metals which is however in general a good thing). We can use the current discussions about COVID for example- it is essential that there is host immune reaction to COVID, but if it is too much reaction, it creates the cytokine storm, which for COVID, and many other circumstances, this storm can be lethal (interesting, although horrific, the cytokine storm from unmanaged Flare from DTPA chelation does not appear to be lethal). I liken this to the Goldilocks principle of Dr Semelka's treatments: not too little, not too much, just right.
Richard Semelka MD Consulting
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