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Treatment Of Gadolinium Toxicity (and Other Heavy Metals). The 11 Commandments in 2023.

At the start of 2023, it is worthwhile to go over the critical aspects of treatment of Gadolinium toxicity (GDD) and by extension all other heavy metal toxicities (Deposition Diseases).

1, Do not receive additional exposure to the metal causing toxicity. This is the principal treatment. For Gadolinium: no more GBCA injections, for other metals: remove yourself from exposure (eg: no more eating Kale if you have elevated Thallium).

2. If you are significantly sick from the metal, the primary treatment is to remove as much of the metal as reasonable. Chelation is the best method for this. Stability constant is the best metric available for the determination of what chelator is optimal.

3. Use a chelating agent with the highest stability constant for the metal in question. For Gadolinium and Lead it is iv DTPA presently. In the future this may be HOPO.

4. The chelation process should follow (at least to start) the pathway that the metal has been administered. The deposition of the heavy metal leaves mud tracks along the route of its administration. For Gadolinium, as it has been administered intravenously, so chelation intravenously makes sense. An inhaled toxic metal, eg: Plutonium, aerosolized agent should also be used. An orally ingested heavy metal, additional oral chelation makes sense.

5. The rate of administration, if known, of the toxic metal should be somewhat matched by the chelator. Bolus administration of DTPA preferred over drip for Gadolinium toxicity treatment. Almost all GBCAs are administered by rapid iv push at 2ml / sec, so the mud tracks of Gd are deep in the interstitial tissue. GBCAs are administered this way to get maximal enhancement of organs and disease processes like tumors. To capture these deep interstitial mud tracks of Gd, relatively rapid administration of chelator is needed to flush it out- hence bolus administration.

6. If the person has a metal deposition disease state, they will experience a Flare reaction to metal removal with an effective chelator. Always experience: Metal Removal Flare (0-2 days start time after administering chelator) and Metal Re-equilibration Flare (generally start 2-3 weeks after administering chelator). If a poor chelator is used then Re-distribution Flare will also occur (0-2 days start time after administering chelator). When possible always avoid using a poor chelator because Re-Distribution Flare is always bad and achieves no useful information. No Flare = either no Deposition Disease state or ineffective chelator, or both.

7. Metal Removal Flare and Re-equilibration Flare are the most important pieces of information to confirm a Deposition Disease state is present.

8. Flare reactions should always be controlled for atleast the first 5, and perhaps all, chelations. The Flare is most analogous to an acute hypersensitivity reaction, so we always use a combination of an Acute Hypersensitivity Reaction regimen and a steroid taper.

9. Do not chelate too little, do not chelate too much. Individuals who received 1-2 GBCA injections likely require a minimum of 5 chelation, 3-5 GBCA injections likely require at least 10, and > 5 at least 15. The body has an amazing capacity to heal itself.. so let it. Unfortunately Gd and many other heavy metals are stored by host defensive measures. All metal removals involve initial removal and then subsequent re-equilibration. For Gd and Lead, the initial removals are from circulating white blood cells, skin and soft organs (eg: brain), and the repository for the re-equilibration is bone. To reduce substantially the total body burden of Gd and Lead, a minimum of 3 chelations is needed to get sufficient metal removed from bone (through primary removal and re-equilibration). To a greater or lesser extent this same distribution is present for other heavy metals. I aim to pause at chelation when the individual feels approximately 80% back to their normal status. I also use postchelation 24 hr urine Gd amount: when it drops into the low/ mid yellow range (3-5 mcg/24hr) it informs that the bone repository of Gd (and Lead) are now also being drained considerably.. Chelations should be spaced 1-4 weeks apart, one has to pay attention when the re-equilibration Flare starts up in severity to guide the intervals.

10. Concurrent management of health is always crucial- this can be termed Detoxification. Favor a diet containing healthy natural whole foods. Pay close attention to what your body is telling you about diet, supplements, sauna, HBOT, etc. Tumeric (also as Curcumin and nanocurcumin), Chlorella, and Spirulina appear to be effective natural anti-inflammatory supplements. Be cautious. Everything in moderation. Generally try to add 1 new element at a time.

11. Caveat Emptor. Be wary of false prophets. Be wary of individuals on the internet. Simply saying you are an expert, does not an expert make. The best objective guidance is number of peer-reviewed articles written - but specifically in high impact factor journals (and not open access journals). Writing blogs, such as this one, on its own does not make a person an expert.

Richard Semelka, MD

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