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Four Pillars of Chelation. This is Important. July 2023

With roughly 5 years of experience with chelation and having written all the peer-reviewed literature to date on Gadolinium chelation these are what I describe as the 4 essential pillars of chelation:

The four most critical aspects regarding chelation are:

1. removing enough Gd with the best available chelator( based on stability constant) to patient tolerance per each session,

2. controlling removal Flare (0-2 day post chelation, early Flare) with steroids and antihistamines,

3. performing enough chelation sessions that re-equilibration Flare (late onset, > 7-10 days post chelation, generally plateauing at 5 weeks) is minimal and tolerable..

4. spacing chelation sessions from 1-4 weeks to experience some, but not too much, re-equilibration Flare, based on individuals perception of severity of late onset Flare.


  1. 1 dose Multihance, realistically at least 5 two-day chelations (10 one-day chelations)

  2. 5 Gadavist injections, realistically 10 two-day chelations would be necessary, and more likely at least 15.

The individual's perception of their 'stable' status, of being back to 80% of themselves is the most useful guide. I also pay attention to post chelation 24 hr Gd in urine at 3-5 mcg/ 24 hrs.

I do hear from some of my fellow members in GadTTRAC and random other close contacts that chelation with DTPA has 'failed someone'. My response is two-fold: either i) I did not do the chelation, or ii) if I did the chelation, either the individual, for a number of reasons, and some may be legitimate, did not follow through with the above 4 pillars, or rarely due to me chelating early in the evolution of chelation, and therefore me not recognizing the critical nature of the 4 pillars.

Somewhere in the 1-5 % range there may be a pre-existing Tcell dysregulation that does not respond to chelation, and may be worsened by it. But essentially the above 4 pillars is as effective and reliable as any medical management for any disease process.

Any future chelation, with better chelators (based on stability constant) or that are oral (with at least equivalent stability constant) will also have to pay attention to the 4 pillars. If a chelation technique does not experience the above mentioned Flares it is because it is not doing very much or you don't have GDD.

Richard Semelka, MD

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