Providing resources and ideas for therapies and medical developments for Parkinson's disease:
Mercury is toxic to the human body and specifically to motor neurons which when disabled or killed off by mercury, is a possible causative factor for Parkinson's disease. Mercury and many other heavy metals (lead, chromium, ...) are bio-accumulative, meaning that they make their way into the body but the body can not easily dispose of it, thus accumulating over time. The primary human target areas susceptible to mercury are the brain and nervous system, the kidneys, and the cardiovascular system.Mercury can enter the body in many forms:
The most common toxic form being Methyl-mercury which is readily absorbed into the body through the gastrointestinal tract and has entered the aquatic food chain thanks to the output from coal burning plants making its way into the oceans. Mercury has been shown to be a neurotoxin and to cause a large influx of calcium ions into the neuron cell thus inhibiting dopaminergic neurotransmission and causes the physiological characteristics of Parkinson's disease (tremors, insomnia, muscle atrophy, muscle twitching, memory loss and degraded cognitive function) and even to neuron cell death.Sources of mercury include:
The link between mercury and ill health including Parkinson's traits is clear and established.
How Mercury Causes Brain Neuron Damage - University of Calgary
Amalgam dental fillings are composed of about 55% elemental mercury, 44% silver and 1% of trace metals like zinc, copper and tin, which together bond and form a solid metal material used to repair dental cavities. The United States Food and Drug Administration (FDA) still views the use of mercury amalgam fillings as safe and the American Dental Association (ADA) still regard mercury amalgam fillings as safe but research has shown otherwise. The Environmental Protection Agency (EPA) declared in 1988 that scrap dental amalgam material was a hazardous waste and OSHA has mandates on how to handle amalgam fillings. The act of chewing and brushing release Mercury. Acids found in foods and drinks (especially if they are hot) can cause the release of Mercury from the amalgam.
Amalgam dental fillings can be removed and replaced with composite or ceramic material. The tooth can also be given a crown or a root canal performed to replace the tooth with a prosthetic. Amalgam replacement must be done wisely as it has the potential to generate mercury vapor and fine particles which can be ingested, resulting is an even higher dose of Mercury poisoning. It is essential to have a mercury safe dentist who follows specific safety protocols when removing the fillings.
Mercury: The poison in your teeth: Amalgam stimulated with a tooth brush (Dr. Tom McGuire DDS)
The International Academy of Oral Medicine and Toxicology (IAOMT) has developed the Safe Mercury Amalgam Removal Technique (SMART) protocol recommendations. The IAOMT website also has a searchable worldwide dentist database or check out Dr. McGuire's database for a dentist with skills to meet the IAOMT protocol for removing amalgam fillings.Safe protocols for amalgam removal include:
IAOMT Safe Mercury Amalgam Removal Technique (SMART) protocol
Amalgam fillings can be replaced with porcelain inlays or onlays bonded to the tooth.
Be sure to use one of the newer bonding agents which do not contain Bisphenol A (BPA) which is a bio-accumulative, xenoestrogen endocrine disrupting chemical which has estrogen hormone like properties.
This is also true in choosing composite filling materials.
Choose materials which are BPA-free.
Also be sure to reduce your BPA exposure by choosing glass over canned food products and don't microwave polycarbonate plastic (marked with a number 7 recycling code) food containers.
Dental materials testing panel: Clifford Consulting and Research (get tested for BPA and other dental materials)
The goal of removing mercury amalgam dental fillings is to remove a source of mercury which will constantly release low doses into your body. Another reason is that it is a prerequisite for a mercury detoxification process known as chelation therapy which is used to remove mercury from one's brain and body tissue.
According to the ACC mercury detox protocol, any remaining bit of amalgam remaining in the tooth near the tooth root might induce the need for a root canal as chelation agents will be drawn up through the root of the tooth in an attempt to bind with the mercury. A grey stain remaining on the inside of a filling is more likely to be silver oxide and not mercury. A visible white spot revealed on an x-ray is problematic and an indication that a speck of mercury amalgam is remaining in the tooth.
Binders such as activated charcoal can be taken 20 to 30 minutes before the amalgam removal procedure starts for the purpose of attaching to any mercury particles that may be ingested. For more on binders, see below.
Removing dental mercury amalgam using the SMART protocol (dental dam, respiration and evacuation equipment, protective garments, etc) Dr McBride DDS
For more details and photos see the IAOMT SMART protocol for mercury amalgam removal.Dental organizations dedicated to mercury free dentistry and safe amalgam removal:
Mercury accumulates in body tissue and organs and generally can not be removed mechanically. Be very skeptical of those offering a vitamin cleanse to remove mercury as there is no evidence that it will be effective. The act of using a mercury binding molecule to attach itself and engulf mercury atoms in a way that it is viewed by the body as organic waste that can be expelled by the body's regular organs, the liver (including bile and GI tract) and kidneys, is known as a chelation therapy. The goal of the chelator is to bind to the toxic metal to make it non-toxic, water soluble and easily excretable by the body. Mercury is known to to have a very high affinity to sulfhydryl (SH) groups. This affinity is exploited to attach to mercury and remove it.
The chelating agents possess ligand (molecule that binds to a central metal atom by donation of one or more of its' electron pairs) that form bonds with the metal to be removed. The chelating agent forms a stable complex with the toxic metal to shield human tissue from the metal ion, thereby reducing the local toxicity. The resulting molecule can then be mobilized and excreted in urine and feces.
|Chelation Agent||FDA Approved||Description||Toxicity (LD50) mmol/kg (lower=more toxic)|
|DMSA||yes||Dimercapto Succinic Acid (DMSA) C4H6O4S2 is considered safer and less toxic than DMPS. Goes by the trade name "Chemet" but also called "Succimer". DMSA does not enters the cells but relies on glutathione to push toxins out where DMSA is waiting to bind to them. DMSA is typically given for 3 days followed by 11 "off" days. The body needs the "off" days to remake glutathione. The dosage is based on body weight. Chelates lead and mercury (favors organic ethyl-mercury). DMSA targets "extracellular" mercury, the mercury found outside the cell walls in body tissue. Digestible and does not result in a significant loss of essential metals like zinc, iron, calcium and magnesium. Concurrent use with EDTA is not recommended. Excretion pathway: kidneys (thus drink a lot of water to flush the resulting DMSA-Mercury compound). Half life: 4 hrs.||13.58|
|DMPS||no||2,3-Dimercapto-1-Propane Sulfonic Acid (DMPS) is used when all other detoxification methods have been exhausted. Goes by the trade name "Dimaval". Fast acting. May be over effective on first use. Not to be used when dental amalgam fillings are still resident as saliva delivery of the chelating agent will bind to the mercury and can result in acute mercury poisoning. DMPS favors inorganic mercury. DMPS targets "extracellular" mercury, the mercury found outside the cell walls in body tissue. Avoid DMPS "challenge tests" as it creates a toxic mercury load. DMPS is legal in Germany but not FDA approved for the USA. Also a strong chelator of copper. Excretion pathway: kidneys (thus drink a lot of water to flush the resulting DMPS-Mercury compound). Half life: 8 hrs||5.22|
|EDTA||yes||Ethylene Diamine Tetra-Acetic acid (EDTA) amino acid was used in the National Institute of Health (NIH) TACT trial. Considered safe by the FDA although it can be toxic to the kidneys. Kidney function should be monitored. Has the added benefit of clearing plaques in blood vessels. EDTA was first used in the 1950's as a treatment for heavy metal (lead, mercury, copper, iron, calcium, chromium, cobalt, cadmium, magnesium, vanadium, zinc, ...) poisoning. Best used for detoxification treatment of cadmium and lead. Avoid "challenge tests" as it creates a toxic load. According to Dr. Andy Cutler PhD it can form a dangerous compound when it binds with mercury. There are two versions, NaCaEDTA and NaEDTA of which NaEDTA easily binds with calcium and should not be used on children. Typically administered intravenously and not intramuscular.||10|
|ALA||no||Alpha Lipoic Acid (ALA) C8H14O2S2 is the only one of the common chelator agents which crosses the blood-brain-barrier and is used after chelation with other agents or in combination with other chelation agents.
ALA targets "intracellular" mercury, the mercury found inside the cell walls on both sides of the blood-brain-barrier (BBB).
Must wait three months after amalgam removal before starting chelation with ALA.
Excretion pathway: liver.
Half life: 3 hrs
|Glutathione||Glutathione (GSH) is available as a neuro-protective supplement which is hard for the body to absorb and thus is more effective if given intravenously but is still ineffective due to a short half life of less than 20 minutes (ref).
It has been found to be far more effective to let the body produce GSH by consumption of its precursors: N-AcetylCysteine (NAC) Glycine and Glutamate.
Glutathione is typically generated by cells in the body as a natural detoxifying agent.
Glutathione is often not considered a true chelation agent because they do not contain two or more binding groups (dithiol groups).
ACC protocol considers Glutathione IV a dangerous option as it will redistribute mercury causing more damage rather than remove the mercury from the body.
Excretion pathway: liver.
Also see Precursors to Glutathione
|Dimercaprol||yes||Dimercaprol (also called British Anti-Lewisite or BAL) is used to tread lead, mercury, bismuth, silver, nickel and arsenic poisoning. High doses can cause coma and seizures. Not to be used to chelate iron or cadmium because the resulting complex is toxic.||1.1|
|DPA||yes||Penicillamine (DPA) sometimes used to treat bismuth, copper, lead, mercury, and nickel toxicity. Primary adverse effect is an allergic reaction in people who are also allergic to penicillin. Tends to redistribute mercury with adverse reactions. |
Also see: The enigma of parkinsonism in chronic borderline mercury intoxication, resolved by challenge with penicillamine
The d-penicillamine (dimethyl cysteine or (2S)-2-amino-3-methyl-3-sulfanylbutanoic acid) variant, also known as Cuprimine, is an oral chelator which is less toxic and preferred over the l-penicillamine variant.
|DFO||yes||Deferoxamine (DFO) mesylate is a chelator used to treat iron and aluminum (AL) toxicity. Primarily used for AL-related diseases in renal patients.|
Also see: Chelation in Metal Intoxication (2010) covers chelation agents, combinations of agents, pros, cons, limitations, etc
Chelation therapy must be avoided prior, during and immediately after amalgam replacement. Do not consider chelation prior to dental amalgam removal as the chelation agent may be delivered by one's saliva to the mouth and dissolve the mercury in the amalgam resulting in acute mercury poisoning. Also note that dental amalgam replacement can temporarily elevate mercury in the body. Thus it is considered unwise to undergo chelation for four days to a week after amalgam replacement when using DMSA or DMPS or for three months after amalgam replacement when using ALA. One should find an IAOMT SMART certified dentist who has the safety gear to keep both the patient and dentist safe from mercury vapors generated during the amalgam removal process.
All effective chelation protocols will call for the replacement of beneficial vitamins and minerals, which are also removed by the chelation agents.
The removal of mercury amalgam dental fillings with modern methods is a no-brainer as they can be safely removed without exposing the patient to harm. Chelation on the other hand does not have a clear and defined exit path for the mercury being removed and thus can impose harm on a patient. The mercury being removed from the body by chelation is often buried deep within tissues spread out among organs, fat and brain matter and the journey it takes to exit the body often includes being relocated after being dropped by the chelator compound and traveling through healthy tissue causing new mercury toxicity damage. Chelation can present its own hazards. If chelation is causing pain, severe anxieties or depression, brain fog, head aches or discomfort, stop chelating as the dosage is too high! Chelation does not benefit the patient who is tough or is content with suffering as it may be doing damage. Go slow with light doses. If the patient body burden of mercury is high, start light and be safe. The discussion of chelation therapies below is not an endorsement of chelation or of any one chelation protocol. When one begins chelation therapy, they are starting at the highest level of mercury burden in the body and thus should start with the lowest dosage of chelator and stay at a low dosage for many rounds. Dangers of chelation are discussed in detail below.
The dithiol (two thiol organosulfur compounds of S-H, Sulfer-Hydrogen) group of chelators (DMSA, DMPS, ALA, etc) work as chelation agents because they have two sulfur atoms available to bind with mercury (and drop a bond eg to Hydrogen), to form two bonds with the mercury atom. Once the bonds with the mercury atom have been made, the mercury should no longer cause harm to the body and will expose an organic shell which the body can expel.
DMSA: is a dithiol chelator which bonds to mercury and exits the body mostly via the kidneys and urine with small amounts (<1%) excreted by the liver, GI tract and feces. DMSA can not cross the blood-brain barrier but can rid the body of mercury and lower blood level concentrations of mercury. The resulting DMSA-Mercury compound is excreted by the kindneys as urine, thus DMSA chelation must be accompanied with drinking a lot of water in order to purge mercury. The result of not consuming enough water will be to retain mercury and to allow it the opportunity to be redistributed.
Ratio DMSA:Hg shown is 1:1. Other ratios have been found (eg 2:2) but they are not typically long lived.
For other configurations see Mercury binding to the chelation therapy agents DMSA and DMPS and the rational design of custom chelators for mercury (PDF)
ALA: Similarly Alpha Lipoic Acid (ALA) has two sulfur atoms which can bind to mercury.
ALA can cross the blood-brain barrier to draw mercury from the brain (ref).
The natural flow will be from brain (area of high concentration) to the body (where the body concentration of mercury was lowered prior by chelation with DMSA).
Chelation of mercury (Hg) using Alpha Lipoic Acid (ALA) C8H14O2S2
ALA chelated mercury is typically excreted by liver in bile.
Many medical practitioners will want to perform a "challenge test", also known as a "provocation test" or "mobilization test", as a way to measure the level of mercury in the body and monitor chelation progress. Blood tests are transitory and only measure mercury at a given moment in time. This is also true for urine tests. A hair test will measure mercury over a longer but still short period of time. These tests ignore the reality that mercury is not typically mobile and has taken up residence in organs or fat in the body. The challenge test uses a fixed but large dosage of a chelator to dislodge mercury from the body for measurement with a blood, hair or urine test.
The ACC chelation protocol recommends against this practice as it does not follow their protocol of multiple doses spaced at the half life of the chelation agent so that mercury if dislodged from a chelator, can be picked up by the next round. The American College of Medical Toxicology (ACMT) published a position statement also recommending against the use of this test (ref) as not "accurate or reliable" and is "of no benefit to patient outcome, may actually prove harmful".
The ER guide "Goldfrank's Toxicologies Emergencies" notes that the "provocation test" "tends to increase urinary elimination of mercury, regardless of exposure history and baseline excretion" and states that it is of "dubious value".Also see:
Measuring one's level of mercury toxicity is difficult as where the mercury ends up determines its harm to one's body.
It is also hard to quantify the level of mercury in one's body.
Blood tests can accurately measure the level of mercury in the blood, but the measurement has no relevance to the amount of mercury already absorbed by body tissue nor can it predict how much of the mercury in the blood will be expelled or absorbed.
It will merely be a measurement of mercury in the bloodstream and can be a point-in-time indicator of the health of one's current diet or environment.
Blood test limits are usually acceptible if less than 10 micro-grams/Liter.
A low measurement of mercury in the blood is often mistaken for a low body burden of mercury.
This is also true for urine tests as they have the same limitations as blood tests.
Hair tests do have the advantage of a measurement over a greater duration of time but otherwise have the same limitations.
One can get tested for mercury levels in the blood, hair, urine and feces.
List of testing companies
Tri-Test: All mercury is not equal. Elemental inorganic mercury is far less toxic than organic methyl mercury.
This distinction is found in the Quicksilver Scientific mercury "Tri-Test" which measures mercury in the blood, urine and hair and distinguishes the difference in measurements for elemental inorganic mercury (Hg2) and methyl-mercury (MeHg).
Most traditional tests report "total" mercury rather than individual organic/inorganic mercury levels.
The "Tri-Test" results will also show a plot of urine vs blood levels to show how effective one's body is at expelling mercury.
Also see Quicksilver Metals Testing
Tri-Test results show the contribution of organic methylated mercury (MeHg) and inorganic mercury (Hgll). This also guides one's choice in chelators as DMSA favors the former while DMPS favors the latter. Clearly in this example, MeHg comprises the bulk of the total mercury burden. The total burden (HgT) is also plotted.
Quicksilver mercury Tri-test: includes two blood vials and urine vial, instructions and mail pouches
OligoScan: The OligoScan is a toxic metals scan which unlike the blood test is imprecise in its measurement of mercury but it can actually measure the mercury burden in tissue which makes the measurement much more relevant.
It uses light spectroscopy (spectrophotometry) to measure the levels directly in the tissue being scanned (typically the hand).
Also see OligoScan
Example OligoScan Heavy Metal Test Report. Note that the result values are not of standard units like micro-grams per liter so comparisons with blood tests are futile. Additional OligoScan tests can be merged into comparison reports to track progress.
OligoScan scans four points on the hand.
Operated by Ananda Integrative Medicine
The following is a table of chelation agent vendors.
|Living Supplements||0.25, 1, 3, 4, 6.25, 12.5, 20, 25, 50, 100 mg||0.25, 1, 2.5, 5, 10, 15, 25 mg||0.25, 0.5, 1, 3, 5, 6.25, 12.5, 18.75, 25, 33, 50, 75, 100 mg||no||DMSA and DMPS capsules includes 50 mg vitamin C unless otherwise noted. They also have an ALA/DMSA/vitamin C combo capsule (12.5 or 25 mg of both ALA and DMSA). Shipped from UK. Located in South Africa (may have to inform your credit card company to turn off fraud blocking for a purchase)|
|MandiMart UK||yes||no||yes||no||UK reseller of Living Supplements DMSA and ALA.|
|Quicksilver Scientific||no||no||no||48 mg||Detox bundle called "Push - Catch" which includes a proprietary mix of ingredients ("Liver Sauce" includes RLA) and GI binders.|
|Dr. McGuire's dental wellness website||no||no||150 mg||no||They also have vitamins and supplements for detox: Selenium, free form amino acids, vitamin C, multi-vitamin, multi-mineral|
|Everything Spectrum||no||no||5, 12, 25 mg||no||They also have "Essential 4" vitamins (C:750mg,E:400IU,Mg:300mg,Zi 30mg), adrenal cortex (250 mg) and enzyme supplements|
|Vital Supplements llc||no||no||3, 6.25, 12.5, 18.75, 25, 100 mg||no||They specialize in ALA supplements|
|Stop Aging Now (Vitamin Research Products)||no||no||100 mg||no||Sold as a capsule which bundles ALA with B12, DHA, curcumin and bacopa extract and is sold as "Brain Energizer Complex"|
|Thorne Labs||no||no||300 mg||100 mg||They also have a heavy metal detox bundle|
|Woodland Hills Pharmacy||custom orders. 12.5 - 500 mg||no||yes||no||Compounding pharmacy fills to order for specified dose and quantity. Can combine DMSA with ALA. Prescription required.|
|CareFirstRx||custom orders. Any mg||no||no||no||Compounding pharmacy fills to order for specified dose and quantity. Prescription required.|
|DMSA Chelation||100 mg||no||no||no||DMSA only|
|DMSA Synergy||100 mg||no||no||no||DMSA capsules also contain 200 mg vitamin C and 50 mg Glycine|
|NewRootsHerbal||no||no||125, 250 mg||no||ALA only|
|NutraBio||no||no||300 mg||no||ALA only|
|Vibrant Life||no||no||100 mg||no||Also available: Liposomal EDTA with R-Lipoic Acid and Glutathione/EDTA combination|
Note that DMSA and ALA are often sold in doses of 100mg or more. This is a high dosage and not recommended for initial rounds or ever. Dosages of this magnitude could have very harmful consequences.
One can also do an internet search for local "compounding pharmacies" in your area who can generate the dosage and quantities of a chelation agent custom made for you. Another alternative is to buy chelation compounds in bulk and make your own capsules. Customization allows mixing DMSA with ALA and essential 4 core vitamins all in one simple capsule at your own preferred dosage.Bulk powder:
The ACC protocol addresses the chelation of mercury and the removal from tissue, organs and from the brain. The details of the ACC protocol are covered in the book "The Mercury Detoxification Manual", a recommended read for those considering mercury chelatio0n. The ACC protocol can be performed by one's self or by a medical professional. This protocol involves the use of the chelation agents DMSA or DMPS and ALA taken orally in a given dosage and schedule. The scheduled times are during a full 24 hour day and not just a day time schedule. The schedule is dependent on the half life of the chelation agents to maintain an active level of continuous chelation and mercury removal and missing a dose by an hour or more will require a round to be stopped. The ACC protocol takes a commitment and discipline.
Stage 1 - Body: The protocol begins with a general removal of mercury from the body in at least 3 or 4 rounds (one round = three 24 hour "on" days separated by a four to eleven day "off" period) using DMSA. The schedule for each round is 25 mg as stated on page 65 of the manual or 12.5 mg as stated on the ACC website (editor's note: these are conflicting but high dosages. After a round, patients often recommend a light start at 1 mg or 3 mg) DMSA every 4 hours (for example: 7am, 11am, 3pm, 7pm, 11pm and 3am) for three days. The dosage can be adjusted higher or lower depending on tolerance. Start with very low dosages so as to not stir up and redistribute mercury. Jumping to much higher dosages by more than 50% are NOT encouraged. Tolerated low dosages are best. Fatigue is the most common side effect. Repeat the 3 or 4 rounds at higher dosages until you are using a 25 mg dosage with few side effects. The dosage should remain steady for the 3 or 4 rounds before an increase is introduced. These initial rounds will lower your body burden of mercury. The protocol recommends that the patient "Keep the dose low and go slow". While the duration is not specifically stated, it may take many months to achieve your goals.
Stage 2 - Body and Brain: Once you have reached the 25 mg dosage of DMSA, one can then take 12.5 mg ALA and 25mg DMSA every 3 hours for three days "on" followed by a four to eleven day "off" period of no chelation agents. DMSA is used in stage 1 to reduce your body burden of mercury before you start taking mercury out the brain and internal organs with ALA in stage 2. If the ALA is not tolerated well, drop the dosage to as low as 3mg. The protocol details schedule changes to accommodate ALA intolerance and getting back on schedule. Note that ALA should not be taken for more than 3 consecutive days. The protocol (30mg DMSA and 12.5mg ALA, or 25mg DMSA and 17.5mg ALA - ref: ACC website) is followed until the target dosage of DMSA and ALA are reached (200 mg ALA/dose for 6 months - ref: ACC website and Detox Manual pg 71).
The body does not store or release mercury in a consistent fashion, which affects chelation. This manifests itself as inconsistent results and problems round to round. For this reason it is important to find a low and tolerable dosage to repeat for a long duration rather than constantly trying to raise the dosage to optimize progress.
Reintroduction of essential minerals (magnesium: 100-200 mg with meals, zinc: 50 mg/day), vitamins (C and E), essential fatty acids (omega 3) and Adrenal Cortical Extract (ACE) supplement is required to counter the adverse effects of chelation. The ACC protocol has a schedule and dosage for supplements. One performs a urine or hair sample test for mercury to monitor dropping levels (hopefully). The chelation regiment is repeated until the mercury drops below an acceptably low level. Note that this is purely an indication of mercury levels as true levels in organs and the brain can not be tested. The ACC chelation protocol can last 1 to 3 years.Also see:
Authors: Dr. Andrew Hall Cutler PhD, PE and Rebecca Rust Lee
The PushCatch protocol is for addressing mercury detoxification and uses a combination of R-Lipoic Acid (RLA: nature's version of ALA) chelation, glutathione production and the enzymes that work with it. Dr. Shade feels that reliance on glutathione avoids the half life problem of pharmaceutical chelators as the body regulates the levels in the bloodstream which never go to zero. The focus of this protocol is on liver detoxification and balancing inflammatory pathways. The PushCatch protocol includes a multitude of botanicals (myrrh, dandelion, gentian, goldenrod), liver treatments (nano milk thistle, DIM, quercetin, luteolin, r-lipoic acid), binders (activated charcoal, bentonite clay, chitosan, IMD) and GI lining stabilizers (Fibregum Bio, acacia gum and BiAloe). Dr. Shade's position is that RLA is an NRF-2 (Nuclear factor erythroid-related factor 2, cellular detox gene) upregulator (rather than a chelator) which makes the body produce more glutathione which leads the body to detox in a “natural” way. Dr. Shade also sees RLA as an AMPK (promotes ketosis: cardio and metabolic health) upregulator as well as a PGC-1-alpha (mitochondria biogenesis) upregulator. This protocol encourages the liver to metabolize toxins to dump them with bile into the GI tract where the toxins cling to binders so that they will be evacuated and not re-absorbed.Liver Sauce ingredients: (push)
Quicksilver: "Push-Catch" detox
This author wrote his book to de-mystify the process of mercury detoxification. He supports the body's ability to remove mercury in a process that is based on the premise of starting low and go slow. The book is for those who are about to have their dental amalgam fillings removed and want to follow-up and remove the accumulated mercury from their body. It covers all of the nutrients, vitamins, and minerals needed for your body to manufacture enough antioxidants, and other substances, necessary to rebuild and maintain its defense system against the continuous onslaught of mercury, toxins, oxidation, and toxic metals. The book also covers supplements that aren’t considered vitamins or minerals but are essential to overall health and provide the nutritional support for a mercury detoxification program. It dedicates a chapter to monitoring your progress, chelators and oral health.
Tom is also the author of "The Poison in Your Teeth" and "Healthy Teeth - Healthy Body".Also see:
Author: Dr. Tom McGuire DDS
This is the toxicology textbook you will find in most hospital Emergency Rooms and poison centers. The book follows the FDA advisement that dental amalgam exposure is safe and does not lead to poisoning. It does give an exemption for rare cases of immunologic hypersensitivity.
The book does cover mercury chelation with Dimercaprol (BAL) and Succimer (DMSA) and advises for acute and chronic poisoning.
Dimercaprol (BAL): administer for 10 days in decreasing dosages of 5 mg/kg/dose every 4 hrs for 48 hrs, then 2.5 mg every 6 hrs for 48 hrs followed by 12 hr dosages for a week. This regiment was derived from their chelation of lead protocol and is for acute inorganic mercury poisoning. The book noted that BAL should not be used for organic mercury poisoning as it is more likely to do harm by mobilizing mercury to the brain.
Succimer (DMSA): 10 mg/kg orally 3 times a day for 5 days, then twice a day for 14 days if the GI tract is clear. The book recommends Succimer for those who are not acutely ill or who have been chronically poisoned by inorganic mercury. When chelating methy-lmercury (organic mercury), DMSA is credited with a decrease in brain and body mercury which is in contrast with ACC which limits recognized effectivity to reducing body burden only. Note that this guide recommends an extremely high chelator dosage when scaled for body weight, much higher that other protocols like ACC. High initial doses present their own dangers and should be viewed with caution.
The book acknowledges the use of DMPS and D-Penicillamine but states that BAL and DMSA are the treatments of choice and that DMSA is preferred for those who are not acutely ill.
Authors" Nelson, Hoffman, et al 2019
Other protocols exist but seem incomplete.
Trial to Assess Chelation Therapy (TACT) was a chelation study sponsored by the US National Institutes of Health (NIH) using disodium ETDTA as the chelation agent to test the safety and efficacy of chelation therapy. Primarily the study determined that it benefited those with coronary heart disease with an 18% reduced risk of a cardiac event and that vitamin and mineral supplements had little effect on the outcome. There were two studies performed, TACT and TACT2. The TACT study found EDTA (NaEDTA specifically) to be a safe chelation agent for adults. The TACT study did not address mercury or Parkinson's disease.Also see:
The various chelation therapy protocols are often in conflict and do not define a consensus leading to patient confusion on such an important issue. Sorry. The patient must educate themselves and chose a path. Local holistic practitioners are often not of much help either as it is easy to educate oneself to a level that only stumps the practitioner when approached with in depth questions. Choose a practitioner who is familiar with the various protocols and not just with the directions on the side of the chelation agent container.
|Chealation Agent or Supplement||Dr Cutler (ACC)||Dr Shade||Dr McGuire||Notes|
|Cilantro||never||not mentioned||light dose with DMSA||Half life unknown. Dosage unknown.|
|Chlorella||never||not mentioned||yes||ACC warns that it may cause mercury redistribution|
|Dandelion||no, hard on the liver||yes||??||Contains luteolin, a flavonoid known to inhibit inflammation|
|DMSA||yes||not mentioned||yes, but optional||ACC protocol has dosage taken at half life to always have chelation agent available to pick up droped mercury. Other protocols don't cover this condition.|
|EDTA||for lead, not for mercury||not mentioned||yes|
|ALA||yes||use RLA||yes||ALA passes Blood-Brain-Barrier (BBB) to detox brain|
|RLA||never, makes you ill. Use ALA||yes||yes|
|Glutathione||never, too weak. More likely to move rather than cleanse mercury.||yes, nature's way||yes||Gets digested so it is often given intravenously (IV). ACC seriously warns against it.|
|Glycine||yes||??||yes||Increases bile flow.|
|Milk Thistle (Sylmarin)||yes||yes||yes with meals||Supports liver|
|Activated Charcoal||only during amalgam removal||yes. Part of the UltraBinder "catch" in the protocol||yes||Prevent mercury re-absorption by binding to excrement|
The ACC protocol is suspicious of weak chelators as they may bind to a mercury atom but then not maintain a hold to it in a strong enough bond to journey from the source to excretion from the body. The ACC protocol assumes that weak chelators will not maintain the bond to the mercury atom and will distribute and release mercury to other parts of the body where it may cause even more harm. All protocols use ALA or RLA to remove mercury from the brain where mercury is causing damage and characteristics of Parkinson's disease.
There is a huge gap in the opinion about chelating with the presence of mercury amalgam fillings. ACC protocol forbids it as they believe that chelators will remove mercury from the fillings and poison your body. The ACC protocol is cautious and does not allow for the use of DMSA until amalgams are removed and forbids the use of ALA until three months after they are removed. The ACC protocol fears that since ALA can cross the "Blood-Brain-Barrier" (BBB), it might pick up mercury atoms in the body and deliver them to the brain. ACC believes in detoxifying the body first and then the brain, all after amalgams have been removed. The Dr Tom McGuire believes in the use RLA/ALA chelators before amalgam fillings are removed to lower the mercury burden as soon as possible. He does hold off on the use of DMSA until after amalgams are removed. Dr Chris Shade does not discuss the topic.
The various protocols have not undergone FDA review, scientific tests or revision to optimize and improve the protocols. Each of the protocols has their pros and cons. If you are lucky enough to find a doctor knowledgeable in mercury detox you will find a full spectrum of treatment offerings from those who merely read the chelator carton directions to those who follow an existing protocol to those customize their own protocols. Dr Chris Shade can be found on video acknowledging that his "push-catch" protocol can be implemented concurrently with Dr Andy Cutler's ACC protocol. This has its merits as the "push-catch" "liver sauce" has many anti-inflammatory ingredients which will help counter the inflammation experienced from chelation agents used in the ACC protocol. This website does not endorse chelation or any particular chelation therapy, nor with any particular experimentation of therapies.
Dr. Chris Shade's YouTube video where he mentions that some practitioners overlay DMSA chelation on top of his push-catch protocol (see video 38:38 - 39:37 minutes)
Video: Dr. Christopher Shade Interview on Heavy Metal Detoxification
The pharmaceutical chelators (ETDA, DMSA, DMPS, etc) are powerful heavy metal detox agents but, if misused, can have high risks of generating more damage than if never applied. Some "over the counter" supplements can act as chelators and while they have a less powerful effect, they are not immune from hazard.
There are many sauna based heavy metal detoxification facilities and one has to be skeptical of many claims but research does support claims that sweating deserves consideration for mercury and toxic element detoxification. Sweating can also be acheived by endurance exercise which has been shown to be more effective than intensive exercise. One must take care not to get dehydrated or salt, potassium and electrolyte depleted as this can be hard on the kidneys.
The human body has mechanisms to chelate mercury naturally, but it's not very effective at handling a high toxic burden. The body protects itself with the sulfer-hydrogen (SH) compounds Metallothionein and Glutathione.
Metallothionein (MT) is cysteine-rich and found intracellularly and can bind both essential and non-essential heavy metals.
Glutathione (GSH: γ-glutamyl-cysteinyl-glycine) is a natural anti-oxidant found in plants and animals. It too has a cysteine thiol group (SH) group which acts as an electron donor when binding to heavy metals (Cu, Hg, Cd, and Pb). Glutathione is poorly absorbed by the body and thus does not work well as an oral supplement. Precursors to GSH (NAC, glycine and glutamine) can be taken as supplements to suport the generation on GSH by the body. The ACC protocol recommends against the use of the GSH pathway while the Dr. Chris Shade protocol and some research has been in favor.
Neither are strong chelators as they form weak bonds comapared to pharmacutical chelators (eg DMSA, DMPS, ...). The half life of mercury when relying on natural, unassisted chelation, can be decades.Also see:
Chelation therapies can remove the intended "bad" heavy metals like mercury but it will also deplete the human body of essential minerals and metals. It is essential that these be reintroduced to the body as they are essential for mental health and system regulation. It may even take longer to reintroduce the required nutrients than to remove them. Thus if done improperly, chelation can result in gradual system decline and deleterious effects.
The dosage and rate of intake of chelation agents is also important. Too much and the body may experience the toxic effects of the mercury separated from body tissue. Dosage timing is also important as chelation agents are bonding with the mercury, but stopping at the wrong time may just dislodge the mercury without excreting it, causing the mercury to potentially relocate. One study found that chelation elevated mercury in the circulatory system which in turn elevated mercury levels in motor neuron axons across the neuromuscular junction.
Intravenous chelation therapies can result in a burning sensation at the site of injection. Aggressive use if chelation agents can induce vomiting, headaches, nausea, low blood sugar symptoms and blood pressure changes.
Challenge tests with a high single dosage of a chelation agent are sometimes given by clinicians to show that they can remove mercury by showing an increase of mercury in a urine test. This is often not safe as it can result in adverse effects and a spike in mercury in the system which gets relocated rather than removed.
Chelation therapy has risks including anxiety, psychosis, brain damage and death. This is most often accomplished by doseages which are too high. This webiste does not endorse any specific product, service, or treatment.Also see:
Chelation therapy will grab mercury from your body, bind to it so that the resulting molecule can be evacuated by the kidneys and liver. There is the danger that when evacuated by the liver through the bile duct into the Gastrointestinal (GI) tract, that mercury can be re-absorbed in the small intestine and colon. The GI tract is about 26 feet long and giver mercury a chance to be re-absorbed into the body. To mitigate this effect, binders are often taken to absorb and attach to toxins to help the GI tract fully expel them. Binders can also be taken at the time of amalgam removal in case any is ingested. Note that if a binder is taken at the same time as a chelator or supplement, the binder may remove that too. Binders should be taken on an empty stomach, between meals or in a fasted state.
Binders include activated charcoal, bentonite clay, zeolite (aluminosilicate) and chitosan as well as combinations of the aforementioned substances. Activated charcoal tends to remain in the GI tract as is true of large particles of zeolite. Small "nano" particles of zeolite on the other hand will pass into the bloodstream and travel through the body and act like a chelator and will posess the same mercury redistribution pitfalls as a chelator.Also see:
Quicksilver Scientific: Ultra Binder
If one has a glutathione transferase (GST) polymorphisms, they may have a decrease in the body's ability to clear heavy metals like mercury. Patients with GST enzyme abnormalities may want to consider receiving glutathione to expedite excretion of chelated metal. Patients with the GST polymorphisms also tend to excrete mercury later in their course of treatment than other heavy metals. This can produce early false negatives for mercury, due to preferential excretion of lead and other metals.
See our page on genetic links and look at SNPs rs3957357 and rs1695.Also see:
While DMSA and ALA may not directly remove lighter nutrient minerals, those high in mercury often experience low levels of magnesium and zinc. The ACC protocol suggests the following four "core" supplements while chelating:
|Vitamin C (buffered)||1000 - 2000 mg 3X or 4X/day
250 - 500 mg/chelator dose
|90 mg||The buffered variety is easier on the stomach and helps avoid heartburn.|
Dr. McGuire: 1000 mg 3X/day
Warning: doses of greater than 2000 mg/day may lead to kidney stones and severe diarrhea (WebMD)
|Vitamin E||1,000 IU/day||15 mg
|Note that too much vitamin E can accumulate in body fat, cause blood thinning and bleading.
Vitamin E is an antioxidant which protexts cells from the damaging effects of free radicals.
Vitamin E refers to a group of eight compounds: alpha-tocopherol, beta-tocopherol, gamma-tocopherol, delta-tocopherol, alpha-tocotrienol, beta-tocotrienol, gamma-tocotrienol and delta-tocotrienol of which there are synthetic and natural formulations.
Gamma-tocopherol is the most prevalent form of vitamin E and is found in plant seeds, vegetable oils and nuts (pecans, almonds, sunflower seeds, walnuts).
Gamma-tocopherol has anti-inflammatory effects and is linked to a reduction in cancer and cardiovascular disease risk.
Warning: high doses can be associated with increased concentration of creatine in the urine (creatinuria) and increased risk of bleeding.
|Magnesium-L-Thorate||100 - 200 mg 3X or 4X/day||420 mg||For more information see magnesium supplements
Warning: doses greater than 350 mg/day may lead to irregular heartbeat, low blood pressure, confusion, and may build up in the body causing coma and death (WebMD)
|Zinc||50 mg/day||11 mg||Considered an essential mineral which can not be fabricated by the human body. Supplementation of zinc often results in copper deficiency as the two compete for absorption. Zinc supplementation may require copper supplementation (zinc/copper supplement ratio: 15/1).
Warning: high doses of 100mg/day or more for 10 or more years doubles the risk of developing prostate cancer. Doses of 10,000 mg or more can be fatal (WebMD
The Everything Spectrum "four core" ESential 4 vitamins for chelation replentishment:
|Supplement||ACC Dose||DV||Description and Dose|
|Omega 3||15 ml fish oil/day
45 ml flax oil/day
|Helps with focus, concentration and mood.|
Dr. McGuire: 1000 mg 3X/day
Warning: doses of over 3,000 mg may increase the risk of bleeding
|Adrenal Cortex (not Adrenal Medulla)||50-250 mg 3X/day||Only needed to counter low adrenal function. See "Monitoring Your Body" in the next section.
Warning: IV injections are not considered safe. Side effects include alergic reactions, irritability and insomnia. May lower immune resistance. May have a debilitating effect on your hormonal system.
|Vitamin A||25,000 IU/day||5000 IU||Helps with immunity. Too much vitamin A can be toxic to the liver and kidneys and cause headaches and rashes.
Warning: doses greater than 10,000 (3,000 mcg) per day are generally seen as unsafe and hard on the liver. High levels of vitamin A are associated with a higher risk of osteoporosis and hip fracture (WebMD)
|Molybdenum||500 - 1000 mcg/day||45 mcg||Helps prevent copper absorption. Important when taking ALA as ALA reduces copper excretion in the bile.
Warning: doses should not exceed 2,000 mcg/day. High doses may result in Gout
|phosphatidylcholine (lecithin)||1000 - 2000 mg/meal||Liver: Increases bile flow, help disolve cholesterol.|
Brain: help with poor concentration and attention deficit, depression
|Milk Thistle (Silymarin)||up to 750mg/day with meals||Liver: Helps with liver function by promoting glutathione production. Recommended by ACC, Dr. McGuire and Dr. Shade protocols.|
Dr. McGuire: 100 mg 3X/day
Warning: may have estrogenic effects. May also cause an allergic reaction (anaphylaxis) (Mayo clinic)
|Glycine||1000 - 3000 mg/day with meal||Liver: Helps increase bile flow. Precursor to Glutathione.|
Dr. McGuire: 825 mg/day
|taurine||500 - 1000 mg/day with meal||Liver: Helps increase bile flow|
Brain: helps with anxiety.
Warning: may make bipolar disorder worse (WebMD)
|l-tyrosine||1000 - 3000 mg/day||Brain: help with poor concentration and attention deficit, anxiety, depression|
|B12||1 - 12 mg/day||6 mcg||Brain: help with poor concentration and attention deficit, depression.
Warning: not to be used without professional medical supervision by those who have Leber disease, megaloblastic anemia, polycythemia vera, an alergy to cobalt or cobalamin or by those who have recently received a coronary stent (WebMD)
|melatonin||3 - 50 mg||Insomnia: take one dose one hour before bed time. Available in time-release formulas. Only take if you have trouble getting to sleep.
Warning: Melatonin can make depression, diabetes, blood pressure and seizure disorders worse. May also interfere with immunosuppressive therapies (WebMD)
Dr. Tom McGuire Recommended Brain Supplements:
|Brain Supplement||McGuire Dose||Description and Dose|
|500 mg 1X - 2X/day||Helps with anxiety and depression. Protective antioxidant. Improves neuronal metabolism. Stimulative effect may affect sleep if taken in the evening. Take with plenty of water.
Found in beef, chicken and dairy.
Warning: may cause diarrhea, nausea, stomach pain, vomiting, headaches, insomnia, higher blood pressure and psychosis in people with bipolar disorder. May adversely interact with drugs and supplements. (WebMD)
|25 - 50 mg/morning||Essential for nurturing growth and function of neuron dendrites. Helps with mood, energy, cognitive function, memory and sleep. Dr. McGuire recommends health professional supervision.
Warning: possible side effects include hair loss, increase in testosterone, high blood pressure, fatigue, head ache, irregular heartbeat, insomnia, increase in LDL cholesterol (WebMD)
|150 mg 2X/day||A component of Omega 3 fatty acids supplement. Supports nerve cell membranes and brain health. Regulates calcium in the brain.
Warning: may increase sensitivity to aspirin, increase risk of bruising and bleeding, lower blood pressure, increase blood sugar in people with type 2 diabetes (WebMD)
|Ginkgo Biloba||120 mg 2X/day||Leaf extract helps with blood flow and slows blood clotting. Seed and plant extract are likely unsafe, poisonous and could cause seizures and death.
Warning: Not recommended for those taking monoamine oxidase inhibitors (a type of antidepressant), those who have a blood clotting disorder or are pregnant. Side effects include stomach upset, headache, dizziness, constipation, forceful heartbeat, and allergic skin reactions. Should not be taken by those who experience seizures, bleeding disorders, diabetes and might cause severe anemia in people have G6PD enzyme deficiency. (WebMD)
Nicotinamide Adenine Dinucleotide
|2.5 mg/day increasing to 5 mg
Anxiety becomes a problem > 10 mg
|Boosting NADH in the brain will boost the production of neurotransmitters. NADH is synthesized from niacin and helps transform tyrosine into dopamine. Helps with Parkinson's disabilities.|
Found in meat, fish and poultry.
Warning: should not be used over the long term (longer than 12 weeks) or at doses over 10 mg/day (WebMD)
|100 mg/day||Helps with memory, learning and cognitive factors. PS is important for the healthy function of neurons and other brain cells.
Warning: should not be used over the long term (longer than 3 months) or at doses over 300 mg/day (WebMD)
|250 - 400 mg/day||Helps brain and nervous system with toxic protection.|
|200 mg/day increasing to 400mg||Helps with mood. Natural anti-depressant. Don't take within 4 hrs of sleep. Take on an empty stomach and with plenty of water.
Warning: SAMe might make Parkinson's symptoms worse. Also linked to making bipolar disorder and Lesch-Nyhan syndrome, worse (WebMD)
Dr. McGuire's guide has detailed information on brain supplements and a tolerance testing regiment.
The body is use to obtaining nutrients with food and thus it is most natural to the body to take supplements with meals. Consumption of water is also very important as it helps flush waste and toxins from cells, helps eliminate toxins from the bloodstream and supports kidney and liver function.
It is important to monitor your body with frequent blood tests while chelating to make sure you are not damaging any organs. Dr. McGuire's guide recommends blood tests, fecal tests and a symptom evaluation every three months to monitor your detox program (chapter 8).
|Liver||ALT (Alanine Transaminase)||enzymes indicating damage. Heavy weight lifting can also release enzymes and elevate ALT due to muscle damage||< 41 units/L|
|Liver||AST (Aspartate Aminotransferase)||enzymes indicating damage. Heavy weight lifting can also release enzymes and elevate AST due to muscle damage||< 40 IU/L|
|Liver||GGT (gamma-glutamyl transferase)||liver and bile duct system. Less affected by heavy weight lifting than ALT and AST||0 - 30 IU/L|
|Liver||ALP (Alk Phos or Alkaline Phosphatase)||bile duct system||40 - 130 U/L|
|Liver||Albumin||generated by liver||3.5 - 5.2 g/dL|
|Liver||Bilirubin||level of Bilirubin waste processed by the liver||0.1 - 1.0 mg/dL|
|Kidney||ACR (Albumin to Creatinine Ratio)||protein should be in blood not urine!||< 1.4 mg/dL|
|Kidney||Creatinine||protein||0.67 - 1.17 mg/dL|
|Kidney||GFR (glomerular filtration rate)||calculated||90 - 137 mL/minute|
|Kidney||BUN (Blood Urea Nitrogen)||Liver releases BUN into the bloodstream, removed by the kidney and excreted in urine. If the BUN level is too high, the kidney is not functioning. A high protein diet can also elevate BUN||8 - 20 mg/dL|
|Thyroid||TSH (thyroid stimulating hormone)||Produced by the pituitary gland in your brain||0.4 - 4.0 mU/L|
|Thyroid||T3/Free T3 (triiodothyronine)||Hormone generated from T4 which regulates body temperature, heart rate and metabolism. Most of the T3 in your body is bound to protein. The T3 that isn’t bound to protein is called free T3 and circulates unbound in your blood. Total T3 is the sum of bound T3 and free T3||Total T3: 75 - 200 ng/dL|
Free T3: 0.2 - 0.5 ng/dL
|Thyroid||T4/Free T4 (Thyroxine)||Hormone generated by the thyroid which regulates body temperature, heart rate and metabolism. The T4 that isn’t bound to protein is called free T4 and circulates unbound in your blood. Total T4 is the sum of bound T4 and free T4||Total T4: 4 - 11 ng/dL|
Free T4: 0.8-1.8 ng/dL
|Adrenal gland||ACTH (Adrenocorticotropin hormone)||Generated by the pituitary gland that stimulates the adrenal glands to make cortisol.||AM: 10 - 50 pg/ml|
PM: 5 - 10 pg/ml
|Adrenal gland||DHEA-sulfate (Dehydroepiandrosterone)||3 - 5 ng/mL (women)|
7 - 10 ng/mL (men)
|Adrenal gland (cortex)||cortisol||level changes throughout the day||0.5 - 10 ng/mL|
dependent on time of day
|Adrenal gland (cortex)||ALD (aldosterone)||Sodium, potassium and chloride levels are also an indication||ng/dL|
|Blood||WBC||White blood cell count||4.0 - 10.9 10e3 cells/mcL|
|Blood||WBC: Neutrophil %||White blood cell differential: Neutrophil percentage|
Increase from baseline may indicate infection
|40 - 60 %|
|Blood||WBC: Lymphocytes %||White blood cell differential: Lymphocytes percentage|
Increase from baseline may indicate infection
|20 - 40 %|
|Blood||WBC: Monocytes %||White blood cell differential: Monocytes percentage|
Increase from baseline may indicate chronic inflammation
|2 - 8 %|
|Blood||WBC: Eosinophils %||White blood cell differential: Eosinophils percentage|
Increase from baseline may indicate an allergic reaction
|Blood||WBC: Basophils %||White blood cell differential: Basophils percentage||0.5 %|
|Blood||WBC: Neutrophil||White blood cell count: Absolute Neutrophil count (ANC)|
Discontinue chelating if ANC varies 1.5 from baseline: sign of neutropenia
|1.90 - 8.60 10e3 cells/mcL|
|Blood||WBC: Lymphocytes||White blood cell count: Absolute Lymphocytes count||0.53 - 4.40 10e3 cells/mcL|
|Blood||WBC: Monocytes||White blood cell count: Absolute Monocytes count||0.10 - 10.0 10e3 cells/mcL|
|Blood||WBC: Eosinophils||White blood cell count: Absolute Eosinophils count||0.00 - 0.87 10e3 cells/mcL|
|Blood||WBC: Basophils||White blood cell count: Absolute Basophils count||0.00 - 0.20 10e3 cells/mcL|
|Blood||RBC||Red blood cell count||3.8 - 5.2 10e6 cells/mcL|
It has been suggested in the ACC detoxification protocol that when experiencing both adrenal and thyroid problems, one should address the adrenal problems first. Adrenal support for those experiencing lethargy, can be helped by taking the supplement adrenal cortex (without adrenal medulla which contains adrenaline which can cause mood and behavior disorders).
It is important to monitor how much mercury is being removed by the chelation therapy. You have reached the successful completion of treatment when the chelator is no longer removing mercury because there is no more to remove.
The ACC protocol suggests a hair test and has published a book specifically on the topic of interpreting hair analysis results. The Detoxification Manual also covers "counting rules" to help interpret the test results and to help determine if you still have toxic levels of mercury remaining. This protocol also suggests that if you are feeling the discomfort of chelation, that mercury is still being removed from your system.
Dr. Chris Shade's Quicksilver website sells a mercury "Tri-Test" which is available to doctors and tests mercury in the urine, hair and blood to determine the body's mercury burden and its ability to eliminate it. It is a unique test that measures methyl mercury and inorganic mercury separately.
The Dr. Tom McGuire protocol uses a fecal test every three months at the end of a three day chelation period. This protocol has chosen a fecal test because 90% of the eviction of mercury is through bile and the intestine. He also does not believe in employing the hair test as he feels that it measures organic methyl mercury and will not include the elemental mercury indicative of the mercury contributed by amalgam fillings. Note that it is not safe to chelate while mercury amalgam fillings are still present in one's teeth. When the mercury level tested reaches a low steady-state measurement, you have reached completion.