Chelation Therapy for GDD. Review of Effects and New Insights
Questions about different effects come up frequently from individuals. Hence it is worth repeating the account and adding new insights.
Redistribution vs Re-equilibration
Redistribution is the effect that occurs when a poor chelator for Gd is used, the poorer the chelator, the more redistribution. This effect is explained on the pure in vitro lab science of stability constant (thermodynamic stability) the more stable, the less redistribution. Stability: DTPA>>>EDTA>>DMSA, DMPS. The effects of redistribution are very early, so instantaneous to within 1 day onset. What does this mean: Gd is picked up by the chelator, and a lot of the Gd is re-released back into the body before it can be eliminated by the kidneys. So Gd can be picked up and then redeposited in the brain, for example. Redistribution is never a good thing. Redistribution can also be always avoided by using the strongest chelator available. Currently the strongest chelator is DTPA, but yes stronger chelators exist. DTPA though is vastly superior to the others. One common mistake I see done is individuals who have Gd and lead in them (everyone has lead in the USA... unfortunately), the treating practitioner gives them DMSA for the lead and DTPA for the Gd... All chelators move all metals, it is a matter of degree. So DMSA will move Gd, but the majority then is redistributed. DTPA happens to be also the most superior chelator for lead as well. So only DTPA with immune dampening used for Gd and lead. Always, no exception.
Re-equilibration, also known scientifically as Le Chatelier's principle, is the phenomenon that everything strives to achieve equilibration. So in chelating with DTPA for Gd, most of the Gd removed comes from skin, lesser amounts from other organs (but including some removed from bone). So after the chelation session the skin reservoir is depleted. With time then, to re-equilibrate, Gd moves from the other reservoirs (eg: bone) to skin. Ofcourse all along with that movement some of the Gd is also excreted by the kidneys. This is observed clinically by late recurrence of symptoms. At 3 weeks plus. To mitigate this, the chelation intervals can be set when symptoms recur - so if they recur in force at 4 weeks, then a 3 week chelation cycle is ideal This is a common situation observed amongst sufferers, hence why we often use 3 weeks as the chelation interval.
Flare occurs because immune cells react to the movement of Gd, both at the tissue level and the vascular system level. So deposition causes symptoms (all sufferers know this because this is the basis of GDD) but removal/dislodgment of Gd also causes these symptoms (positive treatment-related Flare). One has to keep in mind, GDD is a bad symptom complex, because it is from deposition and hence Gd staying in the body, Flare is a 'good' symptom complex, because it reflects that Gd is being removed, so total body Gd content is less (extremely good).
Controlling the Flare is essential... Flare is the dreaded phenomenon that keeps sufferers away from getting chelated. Flare however can be controlled with immune dampening strategies. These strategies are actually essential for a number of sufferers: recent development of GDD and long duration severe GDD, but extremely important for everyone. They control the Flare, but also mitigate immunological memory:: so the immune system learns to forget to react to Gd - important because some Gd will always be left in the body.
Can Flare and redistribution be distinguished? Probably not on a symptom basis or timeline basis. Flare is from the removal of Gd, but redistribution is the re-deposition of Gd to another location. So Flare is relatively speaking a 'good' pain (because Gd is being removed) and redistribution is a 'bad' pain (because Gd is not being removed just shuffled around like an ugly musical chairs game). The difference is clearly known on the basis of science: redistribution occurs when a poor chelator has been used, and Flare when a good chelator is used. Ofcourse the bad chelator will also cause the good pain of Flare, because bad chelators also remove Gd.
One of my favorite patients and who is now a colleague has used the analogy for Flare as follows: GDD is like having a splinter in your foot, if you leave it there, bandage it up, pad it, take pain killlers, the pain will diminish.. But the splinter will always be there causing some pain and inflammation, and eventually in many it will become infected and you can lose your foot, and possibly die. Removing the splinter will hurt (the analogy to the Flare) but this is the only way to get truly better. Immune dampening treatment is like then using topical lidocaine to lessen the pain. I have expanded this description: GDD is like rolling down a hill cover in a multitude of cacti with small needles, so when you stop you are covered by 1,000+ small painful needles. Chelation is removing all these needles, this will hurt but is necessary (hurts going in, hurts also coming out). Chelating without immune dampening is like the scene in 40 yr old virgin, where the lead character gets his chest hair removed by waxing, hurts like hell and leaves skin red and bleeding. The immune dampening component of treatment is then like first putting on a lidocaine lotion to reduce the pain of removal and a steroid cream afterwards to decrease the inflammation, swelling and redness.
Nuances are unfortunately almost always present. As the list of nuances is extremely extensive, I will treat only a few major ones here.
My theory is that GDD is essentially a T-cell dysregulation disease, that can precede or follow, other T-cell dysregulation conditions. So treatment, and preferably somewhat concurrent treatment of the other T-cell dysregulation conditions is important. Chronic Lyme disease is a relatively common preceding condition, as are various chronic viral conditions like Epstein Barr virus.
Some type or variant of the Multiple Chemical Sensitivity Syndrome (MCSS) is also very common, so added attention to various sensitivities is critical. The biggest problem is when the sensitivity is to the agents used for immune dampening. I have found in reality it is rarely the case that there is a true sensitivity to these drugs, as they are designed to control for this sensitivity, but they can occur. My first step is to decrease amount or duration of the immune dampening drugs, before trying to find substitutes. Complete avoidance of immune dampening is usually a vastly more serious downside, than the sensitivity: as not only will the Flare be more severe (even essentially uncontrollable) but also equally bad the immunological memory won't be mitigated and each chelation then serves like a mini-GBCA injection, which can perpetuate the disease to be severe GDD, without even the need for Gd to be present- essentially the same as any other severe autoimmune condition.
Sympathetic Dystrophy/ Neural tissue dystrophy represent a large and disparate group of conditions. Members of the family include : Sympathetic dystrophy, Fibromyalgia, and Complex Regional Pain Syndrome (CRPS). My theory is that these entities are closely aligned with T-cell dysregulation (as I have previously written). These also predispose to GDD once a patient starts getting imaged with MRI with GBCA - to the point that many of these neural dystrophies may have started as an independent entity unto themselves, but after investigatory MRI with GBCA, especially if it is repeated, the condition predominantly becomes GDD.
Autoimmune and autoinflammatory coexistent diseases can either precede (more common) or develop subsequent to GDD. Concurrent management of that disease then is also essential. One positive effect, but not worked out as yet, some treatments for autoimmune disease will also be effective for GDD. This will include DMARDS (immune modulators) and monoclonal antibodies (Mabs), primarily to cytokines, but to other substances is also possible in the future. This is our major focus for the research we are currently doing. One of the more common autoimmune conditions, in general but also with GDD, is autoimmune thyroiditis, which is fortunate because it is generally not so severe and can be readily managed with replacing thyroxin.
The nuances then include the full range of diet, dietary supplements, activity, sauna, hyperbaric oxygen... and many other consumables and therapies. The problem is that very few actually have solid science that is accepted by the scientific community behind them. Even things as commonplace and simple and straightforward as multivitamins. So I am often stuck with the recommendation, which I have called the Semelka trilogy: if there is science behind it, it is not too expensive, and is extremely unlikely to be harmful, then try it. The critical understanding not everything that is supposed to be 'great' works for everyone. If something seems to work keeping going, if it is making you worse, then even if all the reports are that it is wonderful, don't use it. Always be cautious : Caveat Emptor (buyer beware). Be careful combining things , especially too many things. Nothing is 100% safe.... look at GBCAs for example.
Other metal toxicities are increasingly becoming a more important category of disease in the modern age. As I have written in previous blogs a number of the newly minted diseases (Dercum's, Particle Disease, Morgellons) probably are all metal toxicities. I suspect they also have a genetic basis, as I suspect with GDD, more likely a constellation of genes than a solitary gene. This includes lead toxicity. Probably the correct terminology for all these metals is what I have developed for Gd: everyone has lead in them, hence lead storage condition if they are not sick (I presume the great majority) and if they are sick from lead it is lead deposition disease (the unfortunate children we saw on tv from Flynt Michigan with developmental delay). As with GDD, DTPA with immune dampening is vastly superior to any other treatment for lead deposition disease, and all those children and adults should be receiving exactly the approach we use for Gd. Metal toxicities and their treatment represent an entire field of medicine unto itself. Fortunately most metals are well chelated by DTPA, but the technique of DTPA and immune modulation may not be optimal for every single metal This field of medicine is still in the fetal stage. Any of these metal deposition diseases predispose to GDD, and vice versa.
Neurodegenerative/ neuroinflammatory conditions often are extensively evualated by MRI with GBCA. With a dark humor eye, high signal in the Dentate Nucleus and Globus Pallidus was originally written up in textbooks as reflecting advanced disease in Multiple Sclerosis, we now know it reflects deposition of Gd from linear GBCAs in these locations... How would I disatinguish these entities and GDD, and what symptoms are from what? GDD symptoms Flare with chelation with Ca-DTPA, symptoms from other diseases should not Flare.
Treatment response is not linear. In fact I am often surprised that individuals who I think will have a long and arduous course, turn out to respond well and quickly; and also rarely, those who should be slam dunks for quick and early and complete response , follow a longer course. The majority of this has to do with the unique immune system they have, most aspects of GDD for example are extremely similar between the vast majority, but each individual has their own unique twist. There are a thousand moving parts in t]he immune system (read 1 million) so there are a thousand subtle variations. The important recognition is treatment is not linear.
Early following treatment this lack of linearity is especially striking. At the first stage what I pay attention to is how much Gd is being removed (comparing pre- to post Ca-DTPA 24 hr urine Gd measurements) which lets me know how much Gd above baseline is being removed. There are nuances to urine Gd as well, which is a separate upcoming blog. If a lot of Gd is coming out (40 x + above baseline) my first thought: great this is fabulous, but second thoughts are Flare will be stronger and symptoms from re-equilibration stronger (because more Gd movement from re-equilibration will occur). But no matter what the Flare or re-equilibration symptom severity are - this is 100% the right course to follow- but we have to maintain or ratchet up the immune dampening (if we can) or the subject must understand, everything is fabulous but treatment symptoms, especially early on will be strong. We have to get the 1,000 cactus needles out. Also it can be disturbing that new pains occur following chelation that they did not have before. The typical example, the right 9th rib hurt with GDD development, and now with chelation the left 11th rib hurts. There are two components to the explanation: i) the new bone pain may have been overshadowed at disease onset because of all the other pains, and ii) following deposition the immune cells have aligned themselves such that more cytokines are released at sites which were previously relatively quiescent.
In a recent blog I described that many things behave in a quantum physics way: meaning both as particulate matter and as energy wave forms. There is a sinusoidal rhythm to essentially everything in life, but they do not follow a simple one regular sinusoidal pattern. Diurnal rhythms, menstrual cycle rhythms, barometric pressure rhythms, temperature rhythms, sunlight rhythms, MRI itself is based upon the Free Induction Decay (FID): decreasing wave rhythm; and simple Gd retention in GSC probably a similar FID rhythm, like a T2 or T2* relaxation pattern. But they don't act as just one sinusoidal rhythm, we experience them as a complex composite of all those rhythms and wave forms, all with vary lengths, periodicities, and amplitudes, and all changing. So it is not a simple solitary ring-down pattern of throwing a stone into a still pond. It is best thought of using this analogy, yes there is the stone, but then there are leaves, and different leaves with different patterns, seeds dropping, birds landing, fish swimming, wind, and wind of varying strength and pattern> So maybe 1,000 different components to our ring down which then form a composite complex wave form (also incidentally complex wave forms in MRI are employed to create rf energy and gradient energy- but with 1,000 + variables in GDD, instead of maybe 10 commonly used in MRI).
So response to treatment also is not a linear simple solitary sinusoidal wave, but a complex multicomponent wave form that varies as well over time, and response may be best thought of as an oscillation of symptoms with a trend-line of improvement.
So the sufferer has to understand and expect that treatment response is an oscillation of symptoms. Do I know all the components of the oscillation in any individual . No I don't, but importantly I know they are there. It is critical though not to be overwhelmed by the fundamental complexity of all this. What to do then? I simplify it. The critical simplification is to look at the trend line of the oscillations, and especially that after the first chelation, even the first three chelations, the amplitude of oscillations can be dramatic. What is most encouraging is if some symptoms greatly decrease at 1 week after chelation in the early stages of chelation therapy. That informs me that those symptoms can be improved and hopefully cured. It is not rare that those improvements will diminish in week 3.4 following early chelation sessions, because they may lack durability. They lack durability is because of the intrinsic broad amplitude of the oscillations in early treatments, and the shifting of Gd in reservoirs based on le Chatelier. The durability develops in subsequent chelations. The trend-line then for improvement often looks like an old long hand-saw leaning handle down against a workbench: it is leaning strongly upward, but some of the teeth are missing, there are some areas of deep gouging from trying to cut steel, some areas of rusting.... but the saw is pointing up, analogizing getting healthier.
So points to emphasize. One chelation session is essentially never enough. It may only be enough in individuals with essentially highly spontaneously resolved GDD, and the one chelation, gave the immune system a little nudge by resulting in somewhat less Gd in the system. Generally speaking. the extreme minimum of chelations is 3, and probably the realistic minimum is 5.
As stated in prior blogs, pauses are useful, I use round numbers of 5, 10, 15 in general, but any stoppage number is fine - this isn't magical, Pause to see if the immune system can take over on its own - that is essentially ignore the Gd that is left.
It is important to recognize re-equilibration symptoms and use them to guide treatment intervals.
I have introduced the term oscillation of symptoms, this explains, some symptoms may get worse transiently, some new ones develop, this arises from the complex interplay of Gd removal, Gd re-equilibration, and the immune cell reactions at the time these are occurring (also the immune cells follow their own rhythm: the path of complex oscillation and variation).
It is important to keep calm. Calmness is important in all aspects of life as a baseline. There are brief times of not being calm that are essential. For example: if you have GDD and your physician wants you to undergo another GBCA injection to figure out what is going. The first approach is to be calm in saying no, but this may have to escalate to a more non-calm state to get the point across.. unfortunately.
Richard Semelka, MD