Cutler protocol

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Andy Cutler's protocol is explained in his book Amalgam Illness,

Moria has a web page explaining the dosages and timings of the chelating agents (ALA, DMSA, DMPS) here:

Basically, ALA must be taken no less often than every 3 hours, around the clock. Every 4 hours for DMSA and 8 hours for DMPS. If taking ALA+DMSA or ALA+DMPS, the dosing must be every 3 hours.

The ALA and DMSA dose should start from 1/8 or 1/4 mg per lb body weight, and adjusted upwards in ensuing rounds as tolerated. The same starting doses apply if taking ALA with DMSA. For DMPS, start from 1/4 mg per lb body weight. If taking ALA with DMPS, halve the starting dose of DMPS.

Taking it less often means running a higher risk of regression or damage. Taking large single doses or once a day doses can result in permanent neurological and other damage. Challenge tests are an example of this kind of usage. See Testing for mercury for some reports. See the sections below for an understanding of why dosage and timing are so important for safe chelation.

All sources of mercury in the body must be removed first, including amalgams under crowns, or permanent and irreversible damage can occur. See How people get poisoned#Toxicity exacerbated by chelating while having mercury fillings for reports of damage from chelating with amalgams.

See comments on other protocols also.

Testing for Mercury

Challenge tests

Movement of mercury in the body

See for the most complete explanation of: where organic mercury ends up when injected by vaccination, how mercury is affected by chelators, how DMSA and ALA work differently and what is meant or not meant by equilibrium.

See #Stall period and #The 3 month rule also.

  • A selection of papers on the half life of various species of mercury and its neurological impacts. Also commentary by Cutler on erroneus analysis of data by some authors -
  • - Cutler writes that re-absorption of mercury from bile recycling (hepatic recycling) is not clinically significant: "The absorption of inorganic mercury from the intestinal tract is 10% or less. The form excreted in bile is inorganic. Recycling is at most 10%. This is not clinically significant."
  • - "All chelators grab and drop mercury more rapidly than they are excreted, so the fact that they bind tightly to it (equilibrium) in no way means they don't rattle it around the body (kinetics)." He goes on to say how DMSA or DMPS with ALA may slightly accelerate excretion from the brain compared to ALA alone.
  • Mercury accumulates in the brain with or without deranged mineral transport. With deranged mineral transport, there will also be accumulation in organs such as the liver, intestines, thyroid, heart and adrenals -

Organic and inorganic mercury

  • - Cutler explains why it is inaccurate to say organic mercury is tremendously more toxic than inorganic mercury. Also explains why thimerosal is so harmful to infants, and though organic mercury is not harmful to kidneys unlike inorganic mercury, it is more harmful to the brain. See also vaccinations.
  • Organic mercury known to affect calcium channels, and Cutler theorizes that organic mercury in the presence of deranged mineral transport is taken up by the brain more readily -
  • Organic mercury has a greater chance of being deposited in hair than inorganic mercury, so people who eat a lot of fish can have high hair mercury yet not be very sick, and those who have elevated hair mercury without any source of organic mercury tend to be very sick -

Brain clearance of mercury

Only ALA will chelate mercury from the brain. DMSA and DMPS do not cross the blood brain barrier because they are not fat soluble nor have a transport protein.

See ALA also for information relating to chelating mercury from the brain.

  • - Cutler outlining how the brain has a higher affinity for mercury than blood. Taking ALA and waiting longer than 3 hours will result in the net brain absorption of the mobilized mercury after the ALA half life.
  • - Cutler explains that equilibrium and blood brain barrier permeability determine whether net mercury moves in or out of the brain. ALA binds free mercury on both sides of the blood brain barrier, and makes the barrier more permeable for the equlibrium of free mercury concentrations. This is why he believes brain clearance is faster when ALA is combined with DMSA or DMPS, see
  • - Cutler says it is possible that Parkinson's is caused by mercury alone, other metals, or other metals with mercury. He cites a case where the person with Parkinson's was bismuth-toxic and made worse by improper amalgam removal.
  • - Cutler gives a simplified description: Rate of mercury from brain is proportional to the concentration of ALA in the brain times the amount of free unbound mercury in the brain. Rate of mercury to the brain is proportional to the concentration of ALA in the body times the amount of free unbound mercury in the body. Together these dictate the net movement of mercury between the body and the brain, but at any moment in time, there is mercury moving both ways.
  • - Using DMSA or DMPS with ALA usually reduces side effects (compared to ALA alone) because it reduces the amount of mercury traffic accross the blood brain barrier.

Yeast and mercury

For more information on treating yeast, see Yeast overgrowth.

  • "Since mammals don't methylate mercury AT ALL, and intestinal yeast does not do so to a clinically siginificant extent, you need to chelate and also don't have to consider the methylmercury/ALA issue." -

The liver and mercury

See Liver support also.

  • Mercury can cause lower bile flow in some people. People with lower bile flow (for any reason) are more likely to become mercury toxic as 72% of inorganic and all organic mercury is excreted through bile -
  • Low cholesterol can be caused by heavy metals, and can reduce the rate of excretion of heavy metals. Since NADH is needed for cholesterol synthesis, look into what else depends on NADH or try NADH -
  • Hepatitis causes problems with secreting bile so toxins including mercury are not excreted as well as they would otherwise be. It also causes problems digesting fats. -
  • If there is low bile flow with elevated hair copper, something else is usually responsible for it. When there is a mercury problem in addition to this, more often than not there is something else causing all this. In this specific example, he thinks the elevated lead may be the underlying cause. - (See also #Treating copper and #Treating lead)

Starting chelation

Refer to the Amalgam Illness book. The main guideline is to wait 3 months after amalgams are removed before starting with ALA or 4 days for DMSA or DMPS.

See #Treating copper for treating elevated copper.

See Chelation symptoms also.

  • Cutler says eating fish does not count as a recent, acute exposure to organic mercury. In other words eating fish is not like removing amalgams. See the above section on mercury metabolism for more information on organic mercury -
  • Cutler says once the natural mercury detox process starts, urinary mercury goes down, up and down. It doesn't matter what the source is, and some people's detox process runs slower than the six months mentioned in Amalgam Illness (page 52) -

Safety of chelation

  • There is a lot of useless information about chelation on the web. If they focus on the agent and not how to use it, or don't talk about dosage or the importance of dosage timing, it is safe to ignore it. Example given is Ray Peat's opinions on chelation. Aspirin, tylenol, testosterone and estrogen are far more toxic than EDTA, DMPS or DMSA -

The 3 month rule

In Amalgam Illness, Cutler explains that if you are chelating after amalgams are removed, you should wait 3 months before using ALA (4 days for DMSA or DMPS). The reason for this is to allow the mercury in the blood to be excreted first. ALA slightly increases the permeability of the blood brain barrier to mercury, and using it right after acute exposure may cause some mercury to be deposited in the brain as the mercury concentrations move toward equilibrium. This equilibrium process is slow and ALA accelerates it.

See #Movement of mercury in the body and #Stall period also.

  • - Cutler explains that the potential increase of mercury in the brain from using ALA before three months may cause temporary worsening, is more of a concern for amalgam poisoned adults, and is reversible with chelation.
  • - Cutler says start ALA after three months or when the dump starts. He is referring to the excretion of mercury bound to organs which happens after blood mercury has been excreted.

When you are not sure if there is a mercury problem

See Testing for mercury#Hair Tests for more information on hair tests.

  • - Hair test for 11 year old male did not meet counting rules but also supplementing. Cutler says never to stop needed supplements unless you can't do anything without the result. Suggests a trial round with DMSA and another with ALA or combined DMSA and ALA.
  • - Hair test for 13 year old non-verbal male meets counting rules, did one round of ALA with no improvement but tolerated ALA well and behavior was slightly different on round. This person asks if its too early to give up. Cutler says try three months of chelation first.
  • - 7 year old male not improving after 3 rounds of DMSA chelation. Unknown hair test. Cutler suggests using ALA and says if there is no improvement and hair test does not meet counting rules, look into other problems besides heavy metals. - Original poster after 7 months says there is still no improvement. Did not try ALA or talk about hair test result as Cutler originally suggested. Cutler says if the kid is not responding to chelation, then do something else.
  • - Normal hair test, mother considers her 4 year old son to be NT only if on GFCF Diet, a late talker and has an older PDD-NOS brother. Did one round of ALA without problems. Cutler suggests another round or two of ALA and if there are no improvements or side effects, to look into other issues besides heavy metals.

Length of rounds

See also the section on #Treating copper if you have elevated copper.

  • - Cutler explains the breaks between rounds are to prevent the build up of copper and zinc levels in the body. Copper builds up faster than zinc, and is more toxic. Hence use zinc supplementation (zinc with meals) to control copper absorption on and off a round.
  • - One day rounds are not recommended due to psychiatric symptoms in some adults. This does not happen with three day rounds. Cutler says two or one day rounds may be feasible for children at the beginning.
  • - Cutler explains that he is less concerned with the length of the breaks than at the time he wrote Amalgam Illness. In addition to the buildup of zinc and copper, the break is needed because of increasing side effects with longer rounds. Some people who feel better on the round have tried continuous chelation without breaks.
  • - Cutler says his recommendation against continuous chelation was based on conservative assumptions, and subsequent experience has shown that people who feel better on a round can chelate for long periods of time. Also says this applies only to ALA. Feels DMSA and DMPS should not be done continuously unless there is a strong reason to.
  • - Cutler on estimates of zinc and copper accumulation while on a round: "One round = 3 days = 7% increase in copper at worst, and 2% increase in zinc at worst. In practice it is less than that."
  • - Cutler states that while most people can tolerate week long rounds of DMSA or DMPS, and ALA has the most side effects, do at least 3 days on a round, and "Longer rounds are suggested if they are convenient and you tolerate them OK."

Suggested onibasu search terms:

+from:andycutler continuous*

Dosage and timing of chelators

  • When to add ALA after starting DMSA? "There is no testing that is informative in deciding whether to introduce ALA. You just do it based on what you see going on." - In an earlier post he says introduce ALA when progress slows down (when the 3 month rule does not apply) or sooner - Some people who are very toxic or very sensitive to chelators will need to wait longer before introducing ALA or will tolerate only very small amounts of ALA.
  • The rate of mercury excretion is proportional to the increase in dosage to the power of 0.409, definitely nowhere near linear. Yet side effects increase much more quickly -
  • Chelating with too high a dose can do more harm than good. People can get very sick thinking that more aggressive chelation will result in faster progress. Use a dose that has tolerable side effects -
  • When chelators are used wrongly, they make people worse; further deranges mineral transport, concentrate more mercury in the brain (and organs), reduce immune function causing intestinal issues, etc -

Dosing more frequently than 3 or 4 hours

Forms of dosing

Experience with progress

See Progress reports for people's experiences after long term chelation using Cutler's protocol.

Note Sometimes people will experience worsening during chelation, especially of neurological symptoms, because there is a hidden source of mercury in the mouth. For examples see How people get poisoned#Toxicity exacerbated by chelating while having mercury fillings

  • - Cutler says liver will usually improve before endocrine (adrenals), except some fast phase 1 problems can take a long time to heal. Suggests a year or two for adrenals to start improving significantly.
  • Chelating with too high a dose can do more harm than good. People can get very sick thinking that more aggressive chelation will result in faster progress. Use a dose that has tolerable side effects -

Stall period

In most mercury toxic people uncomplicated by other heavy metals, there is a stall period after initial improvement when chelating according to Cutler's protocol.

Refer to page 52 of Amalgam Illness for a graph and explanation.

See #Movement of mercury in the body and #The 3 month rule also.

  • Another post on the importance of chelating through the stall period if improvements were seen at the beginning. Progress should resume 9-15 months after the the start of chelating if you keep chelating through the stall period -
  • The timing of the progress-stall-progress curve is more dependent on what the body is doing rather than chelation itself, i.e. it doesn't matter how many rounds or how often one chelates -
  • In an early post, Cutler says there is a 3 month valley between excretion peaks in adults poisoned by amalgams, and the second peak could be higher in children. Suggests a genetic dimorphism for those who excrete mercury from the body and those who retain mercury in organs - See posts relating to deranged mineral transport in #Movement of mercury in the body for more elaboration.
  • 'Everyone with mercury tox seems to go through a "two humped" excretion regardless of whether they chelate and if they do regardless of what agent they use.' -

Lack of progress

See also the section #The liver and mercury on this page.

  • - In responding to someone who has experienced worsening of some symptoms, Cutler says the odds of recovering over the long term in those who react to chelation is probably over 95% but the biggest problem is not sticking to it.
  • Cutler says if a mercury toxic person is not tolerating chelation, they need to figure out what supplements or changes are needed to tolerate it. Describes the profile of an intolerant person as "chemically sensitive allergic to everything "universal reactors" who have adrenal insufficiency and lots of psych symptoms along the lines of agitation, anxiety and depression." He also says the most toxic people and lead toxic people do not fit the profile of seeing improvements early. -,

Other issues

Conception and pregnancy

See also Poisoning in utero under How people get poisoned.

  • Better to leave fillings in than to take them out if pregnancy is planned within a year. If taking them out, it is best to wait after 18 months of chelation before conceiving -
  • Don't chelate until after birth of next child, basic tradeoff is between having a baby that is damaged (possibly irreversibly, but more often reversible with chelation) or regretting not conceiving -
  • In an early post from 2001, Cutler said wait 2 years after starting chelation to conceive, or one year if chelation is very aggressive. Note that his more recent suggestions are slightly different and more specific. -

Chelation of infants

Other chelator concerns

  • DMSA-heavy metal complexes are excreted through urine. However this does not mean the kidneys are stressed. Alkalinizing urine is only required for cadmium. It doesn't make a difference for other metals. -

See Chelation symptoms and Testing for mercury#Urine/fecal tests during chelation rounds also.

To understand why ALA must be used for chelating mercury in the brain, and why DMSA and DMPS cannot do this, see #Brain clearance of mercury.

Treating lead

In Hair Test Interpretation, Cutler wrote that lead levels can be normal if the exposure was from long ago (p.11), and "lead is not falsely elevated very often by deranged mineral transport."

  • Cutler doubts the relation between DMSA dose and lead removed is linear. The amount of DMSA used in low doses is still much larger than the total lead burden. ALA has helped the symptoms of lead-toxic animals in studies. Finally some discussion of urine porphyrins -
  • If there is low bile flow with elevated hair copper, something else is usually responsible for it. When there is a mercury problem in addition to this, more often than not there is something else causing all this. In this specific example, he thinks the elevated lead may be the underlying cause. - (See also #Treating copper and #The liver and mercury)

Treating copper

This section was moved to Copper toxicity


  • Mercury often inhibits iron absorption or retention. Some do better with iron supplementation, others do worse. Often comes up on its own if antioxidants are used properly. Hair iron does not reflect body stores. Best source is red meat juice drippings from cooking roasts -

See also

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