Chelation

Chelation Therapy
 

Chelation Therapy

How do you safely get rid of heavy metals and toxins in the body? Is fish safe to consume? What is the best chelating agent, and how can one minimize chelation therapy side effects? This information is the summary of tens of thousands of dollars in independent testing and experimentation to answer these questions. Here is an outline of the content for those who want to skip around:
 

Background – Where did we get these heavy metals and what’s the big deal?

Heavy Metal Testing

When is the Body Ready for Chelation Therapy?

Components of a Successful Chelation Program

Chelating Agent Trials – What Worked & What Didn’t

Is Heavy Metal Excretion Urinary or Fecal?

Metals Passed Down at Birth – Quantified

Our Chelation Therapy Treatment Plan

Tips for Debugging Chelation Therapy Side Effects

How long will chelation therapy take?

FAQ

References

 

Background – Where did we get these heavy metals and what’s the big deal?

Our whole family has toxic levels of heavy metals, especially lead and mercury. We’re not unusual – almost everyone is heavy metal toxic these days. Why? We now have several generations of metals and toxins passed down to us at birth from our ancestors. We also accumulate additional metals and toxins living our everyday lives. Our ancestors got the metals from amalgam fillings, breathing toxic air, consuming toxic products, and touching toxins in the environment. Today, metals and toxins are everywhere – in the air, our food, our water, our homes. Trying to find the exact source of toxins these days can often prove futile. Here is a decent list of sources of heavy metals and some of their effects on the body.

 

Science has shown that mothers pass about 2/3 of their toxic burden to their first born child (and our family’s experimental data is consistent with this). Yup, that’s right, having a child is one of the best ways to chelate! This child accumulates even more toxins in their lifetime and passes them down to their children. Furthermore, the volume of toxins in our environment has drastically increased over the years. As a result, I theorize that human toxic burden increases with every generation.

 

What’s the big deal about toxins and metals? Unfortunately, our bodies aren’t able to excrete all of the toxins and metals that we are exposed to these days. Some get stored in the body; some constantly circulate around the body. These toxins and metals create the perfect environment for all sorts of infections – viral, bacterial and parasitic. These chronic infections can lead to all kinds of other problems and symptoms. Dr. Simon Yu MD in this article says, “The medical conditions associated with heavy metals are too vast to mention. Whether young or old, heavy metals create an oxidative stress and inflammatory response which affects your psycho-neuro-immuno-endocrine systems and contributes to medical conditions from Autism in children to cancer and Alzheimer’s in adults.”

 

Our family’s levels of metals were compounded by the fact that we are both electrical engineers who spent countless hours in the lab soldering with leaded solder. I cringe when I think back to the months I spent in the lab at MIT with rows and rows of solder stations without ventilation. When I think about the fact that I gave 2/3 of those accumulated metals to my oldest child, I am sick to my stomach.

 

I embarked on a mission to figure out how to get rid of the heavy metals (chelate) our whole family. What is the best chelation therapy protocol? The four MDs I consulted who practice chelation all gave me different answers. They didn’t agree on how long it would take, what chelating agent to use, or what supports might be needed to avoid chelation therapy side effects. Each one had a different protocol, and claimed that the protocols from the others wouldn’t work. What was true and what wasn’t? As usual, I spent tens of thousands of dollars and years of my life experimenting on myself and my family. Some practitioners who have seen my results say that I should publish them. For what? I want our investment to help people, not be locked away with copyrights in some journal somewhere.

 

 

Heavy Metal Testing

Heavy metal testing is not straightforward. The best way to test the body’s total ‘burden’ of metals and toxins is through autopsy. This gives a direct measure of the amount stored in the bones and the amount circulating in the blood. Other measurement methods are really indirect.
 

The truth is, we don’t fully understand where or how the body stores, let alone excretes toxins and heavy metals. My opinion? I think the body is good at hiding metals and toxins in our bones, especially the ones passed down from our mothers. Recent exposures I tend to think of as being stored in fat, hair, and nails. There is a diffusion gradient effect – the more we have stored, the more we have circulating. The metals stored in bones and fat can be pulled out if there is a large discrepancy in the concentrations in the rest of the body. The metals and toxins then ‘diffuse’ or spread out so the concentration is equalized. When on a chelation program, my theory is that primarily toxins and metals that are already circulating are pulled out. This creates a gradient that brings more metals and toxins from storage into circulation.

 

Here is a summary of the heavy metal testing methods currently available, and my thoughts about them:

 

  • Hair Test – Hair tests measure of the amount of metals the body is storing in the hair. I consider it more of a measure of exposure from the last 3-6 months. I don’t think it is a measure of the body’s total burden. For example, after our family stopped eating fish, our hair mercury levels dropped x3.75 (see chart below). I prefer the ARL hair analysis because they do not wash the hair and their accompanying interpretation is decent. I generally interpret mineral ratio imbalances as having one of four root causes: a parasitic infestation, gastrointestinal (GI) dysbiosis (aka leaky gut), a poor diet, or another chronic infection. In our case, we still had mineral imbalances after we cleaned up our GI dysbiosis and diet. Sure enough, we all had large parasite infestations. Stay tuned for info about how our mineral imbalances shift after clearing up parasites.
  • Urine Toxic Metals Test –This urine test by itself without a chelating agent is a measure of recent exposure plus what the body is able to excrete on it’s own of the total body burden. The end result is mostly a measure of recent exposure because our bodies chelate stored body burden very slowly on their own. Dr. Natasha Campbell-McBride claims that the body will chelate itself on the GAPS diet, but I haven’t found this to be true. If clinical symptoms or detoxification or drainage problems exist, this may not be a good measure of recent exposure to metals. Common symptoms of detox/drainage problems include skin issues, autism, brain fog, leaky gut, and inflammation. These need to be resolved first before the Urine Toxic Metals Test can be considered a decent measure of recent exposure.
  • Urine Toxic Metals Challenge Test – Commonly practitioners recommend a ‘Challenge Test’ as part of heavy metals testing. This involves orally taking a chelating agent and then measuring levels in the urine. The most common chelating agent used for challenge testing is probably DMSA, at a dose of 30mg per kg of body weight. The theory is that the chelating agent pulls out metals that are in proportion to the body’s stored burden of metals. I generally go along with this theory. Still, I think autopsy is best, but I’m not ready to die for the sake of science! All of our Urine Toxic Metals tests were done through Doctor’s Data. Unfortunately Doctor’s Data customer service is horrible, both with patients and doctors. In hindsight, I wish we had used Great Plains Laboratories. At the time of writing, it seems like more practitioners are set up to work with Doctor’s Data than they are with Great Plains. Note that I would not do any challenge testing without removing amalgam fillings first. It is possible that the chelating agent can pull metals out of the fillings and into the body. If the body is not ready for chelation, this is likely not a good measure of stored body burden.
  • Fecal Metals – This test by itself without a chelating agent is also a measure of recent exposure plus what the body is able to excrete of it’s total burden. The end result is mostly a measure of recent exposure because our bodies excrete body burden very slowly on their own. Again, if symptoms of detox/drainage problems exist, this is likely not a good measure of recent exposure.
  • Fecal Metals Challenge Test – Practitioners prescribing chelation therapy have varying views on how the chelating agent pulls out the metals. Most of them seem to think that metals are excreted primarily through the urine. Generally I think they underestimate the amount that comes out in the stool. I am of the opinion that a Urine Metals Challenge test shouldn’t be done without simultaneously doing a Fecal Metals Challenge test. I would not do any challenge testing without removing amalgam fillings first. All of our fecal results are from Doctors Data, and if I could do it again I would’ve used Great Plains Laboratories. If the body is not ready for chelation, this is likely not a good measure of stored body burden.
  • Quicksilver Labs Testing – Quicksilver offers a Mercury-only test that uses a combination of blood, urine, and hair. This might be useful to narrow down the exact source of mercury exposure. I already stated, however, that I almost think this is futile because mercury is everywhere in our environment and many of us had mercury passed to us at birth. The exception to this is if you’re still eating seafood or still have amalgam fillings. Another method of testing for different forms of mercury is to use ZYTO. These scans can show the form of mercury that is stressing the body, and they are cheaper and easier than Quicksilver. As for the page linked at the top of this section, there are a couple of flaws in their logic. First, they did challenge tests without comparing to ‘baseline’ or what the body is naturally excreting. The chelating agent used may not be effective or in a high enough dose. More importantly, the patient used as a sample does not pass the criteria in “When is the Body Ready for Chelation?”

We have done all of the above heavy metal tests, except for Quicksilver, many times over many years. I used to not be a fan of Challenge Testing because it seemed unlikely that the chelating agent would pull out metals in proportion to the body’s burden. However, after doing Challenge Tests, I’ve realized that a lot more metals come out with a chelating agent than without one. It seems to be the best benchmark we have at this time, short of autopsy.

 

In summary, Hair Testing and Urine/Fecal baseline testing is the best measure we have of current exposure to metals. To debug current exposure problems, we use hair testing, mainly because it is naturally averaged over many months. We then brainstorm and experiment with ideas of where this exposure might be coming from. Chelating agent challenge testing is the best measure we currently have for total stored body burden. I use this to evaluate the effectiveness of various chelating agents.

 

Below is a summary of our family’s hair test results. I have only listed the metals of concern that were outside the reference level. All results are in parts per million [ppm], or milligrams per 1000 grams of hair. All results are from the same lab, ARL. Note that we were all detoxing and draining well at the time of these tests, and our bodies were ready for chelation therapy.

 

Numbers in parts per million [ppm]MercuryLeadAluminumArsenicCadmium
Youngest Child – initially, still eating fish*3.221.5318.90.120.12
Youngest Child – 1.5 years after stopped eating fish, no other change0.730.4522.60.170.06
Oldest Child – initially, still eating fish3.01.7320.80.060.10
Oldest Child – 1.5 years after stopped eating fish, no other change0.810.5816.30.120.07
Me – year 2001, eating fish2.303.006.000.030.16
Me – year 2014, stopped eating fish in 20120.760.3819.80.140.04
Husband** – year 2014, stopped eating fish in 20120.990.214.80.150.01

* The fish was always wild caught, mostly wild salmon and wild sole. Occasionally wild shrimp or wild squid were eaten. Approximate frequency of fish meals was 2-3x/week.

** No data available from when he was still eating fish

 

There were no other significant lifestyle changes during the pre- and post- fish data. We ate the same food from the same organic vendors, lived in the same house, and our general health status stayed constant.

 

Here is the same data again in graphical format:

 
Hair5
 
A couple of interesting observations from the above data:

 

  • On average, the level of mercury that our bodies stored in our hair decreased by a factor of 3.75 after we stopped eating fish. The fish was always wild caught, mostly wild salmon and wild sole. Occasionally wild shrimp or wild squid were eaten. Approximate frequency of fish meals was 2-3x/week. A thoughtful friend also did some of her own hair test experiments. I have not verified her results, but she claims no increase in mercury levels eating 1 tin of Wild Planet White Anchovies 3x/week.
  • On average, the level of lead that our bodies stored in our hair decreased by a factor of 4.75 after we stopped eating fish. This is interesting because we normally don’t think of fish as having lead.
  • The level of aluminum that my body stored in my hair increased by a factor of 3.3 from 2001 to 2014. I theorize that this is due to increased levels of aluminum in our environment (chemtrails).
  • My husband has 4x lower aluminum stored in hair than the rest of the family, despite living in the same house and eating the same diet. Years of observation indicate that the husband is the best detoxer in the family and is the least effected by infections in the family. I theorize that he has the same Aluminum exposure as the rest of us. His body is able to excrete more and store less. One practitioner theorizes that this is because he is Type O blood and the rest of the family is type A+. Type Os tends to be secretors, Type A+ tends to struggle with detox, according to this practitioner. I have no idea if this is the reason or not.
  • To first order, the levels of metals in our hair is pretty much the same for all the members of our family at the same point in time. This corroborates the theory that testing hair is an indicator of ‘current’ exposure, rather than a measure of total body burden.

 

 

When is the Body Ready for Chelation Therapy?

Practitioners disagree about when to chelate as part of a treatment program. For example, some chelate autistic children, saying that chelation will help their autism. I don’t buy this, and I think they are confusing the need for detoxification and drainage with chelation. If one is trying to heal from any kind of symptoms or condition (Lyme, parasites, adrenal exhaustion, autism, etc), when is the right time to chelate? Earlier in the healing program or later?
Here is a list of where one needs to be before starting a chelation therapy program:

 

  1. Amalgam Fillings – These need to be removed. There is a risk that chelating agents will pull metals out of amalgam fillings and into the body. Get rid of all amalgam fillings first.
  2. Symptoms – All symptoms should be resolved before starting chelation. What symptoms? Any symptoms. Examples include, but are not limited to: skin issues, fatigue, allergies, autism, gastrointestinal issues. Debug and eliminate symptoms first. If the body is already struggling, chelation therapy will only stress it further. Depending on the particular case, the detoxification and drainage sections below might be helpful. We also take a break from chelation if we are having any procedures, like frenectomies and dental work.
  3. Diet – Chelation is hard on the body. The diet must promote a healthy gastrointestinal tract, the immune system, and the detoxification pathways. The diet should be tight to avoid chelation therapy side effects and Herxheimer reactions. Details on the recommended diet can be found in the best diet for health section.
  4. Gut & Methylation – The gut should be healed and the body should be methylating. I would check the gut with a Doctor’s Data stool test before starting chelation therapy. If there is any kind of MTHFR mutation or history of methylation issues, I would check-in on methylation supplements one more time before starting chelation. Details about getting methylation jump started are in the MTHFR treatment section.
  5. Liver Preparation – I would do a few gallbladder-liver flushes before starting chelation. More details about these can be found in the gallbladder liver flush section. I would also prepare the liver by doing a few weeks of Klinghardt’s Liver Massage.
  6. Drainage– Get on a few drainage remedies before even starting chelation. I would also go to ZYTO for an energetic drainage treatment.
  7. Minerals– Chelating agents can pull out essential body minerals as well as toxins and heavy metals. Mineral deficiencies should be identified and corrected before starting chelation. We have used ZYTO, and Hair Mineral Testing. I prefer the ZYTO route because of the additional benefits listed in #8 below. ZYTO can also be used to test more frequently, because one doesn’t have to wait for hair to grow. We have found results between Hair Mineral Testing and ZYTO to be consistent.
  8. ZYTO– I would try to get in at least one ZYTO session before starting chelation. ZYTO can quickly double-check a few things: Methylation, Gut health, Drainage Remedies, Binders, and Mineral Deficiencies. Plus, the energetic treatments for Methylation and Drainage can be really effective themselves.
  9. Removing the source of heavy metals – I think it is useful to look over this list of sources of heavy metals and try to eliminate as many as possible. This is somewhat futile because, as you can see, these toxins are almost everywhere these days! Our major changes based on this list were all cast iron or stainless steel cookware, no deodorants, Aluminum-free baking soda toothpaste, non-toxic soaps and washing detergents, no paints, chemicals or pesticides, no food out of aluminum cans, and stay away from car exhaust.

All items on the list are necessary, and I would not start chelation therapy until a check mark can be put next to each of the above items. Chelation is hard on the body, and pulling more metals from storage into circulation will likely exacerbate any symptoms or issues that are already present. Figure out the above issues first. It’s probably obvious by now that I think chelation therapy belongs closer to the end of a healing program.
 
 

Components of a Successful Chelation Program

Now that we know we’re toxic, how do we get rid of the toxins? How do we get rid of the toxins safely and while still living our normal lives? How can we minimize chelation therapy side effects? These answers again vary widely from practitioner to practitioner. There is no consensus. This is because we don’t really fully understand how the body excretes metals and toxins. The best I can do is share my opinions based on discussions with 4 MD chelation practitioners, our experiments, and our five years spent doing chelation therapy.

 

First off, the components of a successful chelation program are: Detoxification, Drainage, Chelating Agent, Gastrointestinal Health (Gut), and Methylation. Below is a pie chart of their relative importance, in my experience:

 
Chelation-Therapy-Components
 

The most important pieces to successful chelation therapy have nothing to do with the chelating agent itself. Detoxification and Drainage have to do with the body’s ability to excrete the metals and toxins that are being pulled out. Gut and Methylation refer to the need to monitor gastrointestinal function and methylation constantly during chelation therapy. These are both essential to immune health. A healthy immune system deals with viral and bacterial flare-ups as the metals and toxins are excreted. In practice, this has to do with minimizing chelation therapy side effects. The next sections go into detail about each of the components of a successful chelation program.

 

Detoxification (40%)

Detoxification and drainage are the most important components of a chelation program. These two help ensure that toxins and metals leave our bodies instead of building up. If they do build up, chelation therapy side effects will often arise. This is called a ‘Herxheimer reaction” or “Herx”. A few of the common symptoms of Herx are autism, brain fog, fatigue, inflammation, and skin issues.

 

Detoxification refers to treatments and supplements that help pull circulating toxins out of our bodies. Detoxification doesn’t necessarily mean that our bodies will effectively excrete, we also need drainage pathways open (more on that in the drainage section).

 

The most common thing to flare-up in our family when we have lots of metals circulating is strep, presenting as a sore throat. I think for most people it’s yeast and associated symptoms. Our family doesn’t eat sugar so we see strep before yeast. A healthy immune system along with detoxification and drainage help our bodies resolve the strep or any other chelation therapy side effects.

 

So how do we make sure our bodies can detoxify effectively? The detoxification help that we need often changes over time while chelating. This is true even if we don’t change our chelating agent. Why? Who knows. Stress in our lives, changes in methylation, where the metals are being pulled from in the body, what exact toxins or metals being pulled. The bottom line is that it’s very important to keep monitoring and optimizing detoxification support during chelation.

 
Chelation Detoxification
 
We have (once again!) spent a small fortune and a long time testing various detoxification supplements and treatments. These are the ones we have found most useful, in rank order from most to least helpful:

 

  1. Diet – A nutrient dense diet is essential to the body’s ability to function and detoxify effectively. Water is also very important for excretion. Adults drink 3 Liters per day while chelating, and children drink 1.5 Liters per day. More details, tips, tricks, and recipes can be found in the section Best Diet for Health.
  2. Enemas – The enema is the fastest thing we’ve found to relieve symptom flare-ups. Even a water or drug store Fleet enema can really help. We often put whatever remedy is testing well in our enema. Enema testing is an example video that demonstrates how we test what goes into our enemas. Things that typically go into our enema might be Minerals (#3 below), Binders (#5 below), or Drainage.
  3. Minerals – Chelating agents have been known to pull out our body’s minerals as well as toxins. We don’t know much about what essential minerals various chelating agents tend to pull. Practitioners seem to agree on the need for mineral supplementation while chelating. We take 2-4grams of magnesium per day; it varies based on our testing. We also take 2g Vitamin C per day. We also always take one or more of the following: Multi-Mins, Biomins (formerly Citramins), Biomins II, or Fulvic-Humic. These we take on the weekends only, when we’re not taking a chelating agent.
  4. Sweat – The skin is our largest organ, and sweating is a great way to release toxins. We go into an IR Sauna twice per week for 30 minutes at 120F. We go from the sauna straight to a cold shower to close our pores so the toxins aren’t re-absorbed. Then we scrub our skin with soap and water. I haven’t observed much difference in results between the IR sauna and a traditional sauna. Our oldest child completely lost her ability to sweat from years of chronic Lyme, so we had to slowly ramp up her time in the Sauna. Raw Hypothalamus Concentrate from Bio Design also helped her start sweating again (we had to get this through a practitioner).
  5. Binders –Binders are supplements that ‘bind’ to circulating toxins, making them supposedly easier to excrete. We are constantly re-testing and adjusting our binding supplements. Below is an example video that shows how we test. If unfamiliar with the general technique, check out the Intro Video first.

    Another way to test binders is with ZYTO. These are faster and easier than testing by hand, but cost money. They also don’t indicate the dosage, so we still have to test by hand for dosing. The ones that consistently test best for us in rank order are:

    • Toxinabsorbmax (discontinued, a major bummer!!)
    • Activated Charcoal
    • DE – We found that animal grade from the pet store tests best on us, better than the other various forms of silica made for humans.
    • E3 Live (Yes, we found that E3 acts as a decent binder in addition to it’s action as a chelating agent. E3 Live tests well for us as a binder especially while on oral DMSA.)
    • Chlorella
    • Zeolite
  6. Skin Brushing – Skin brushing helps move the lymphatic system. We found this treatment less useful after we started the Sauna. I’m guessing going from hot to cold in the Sauna actually pumps the lymph so much that skin brushing no longer makes a difference. If no sauna is available, then skin brushing might be higher on this list. This video gives a decent explanation.
  7. Glutathione – Glutathione is known to aid liver detox. It doesn’t often test well on us, but when it does, it is usually pretty helpful. Our favorite is Redisorb Liposomal, and we’ve only been able to buy it through a practitioner.

If any chelation therapy side effects appear, we take a break from the chelating agent until we can resolve the symptoms. It’s important to let the body excrete what is already circulating before pulling out more. This usually takes quite a bit of debugging effort and time, especially in the beginning. After a while, I tended to get the hang of what additional therapies or binders each person typically needed.

 

Drainage (40%)

Most chelation practitioners don’t understand the concept of drainage, let alone how to fix it. This is a real tragedy. Drainage refers to opening excretory pathways in the body. These pathways are at the physical and energetic levels. These may already be open for some people, but they often aren’t, especially for people with methylation mutations and A+ blood type (don’t ask me why the blood type, it’s a wives tale of sorts). The most prominent drainage pathways that we struggle with as we chelate are liver and kidneys. Acupuncturists might think of the liver or kidney meridians. The idea with drainage is that we want our bodies to have a clear path to excretion for the toxins. On the other hand, detoxification refers to methods used to actively pull the toxins out of our bodies. If drainage pathways aren’t open, the detoxification won’t work. Both of these are essential for effective chelation therapy.

 

Symptoms of blocked drainage pathways are pretty indistinguishable from symptoms of detoxification failures: skin issues, Herx, brain fog, autism, fatigue, inflammation. We test both for detoxification solutions and drainage solutions when chelation therapy side effects arise.

 

Typically drainage remedies are homeopathic or herbal. We’ve also had ZYTO drainage treatments and those can work as well. We’ve spent thousands of dollars trying different drainage remedies. Different brands. Different lines from those brands. Different formulations. Herbal. Homeopathic. The most effective drainage products we’ve found, in rank order from most helpful to least helpful are as follows (remember, I don’t get any $$ from referral links or product endorsements):

 
Chelation Therapy Drainage
 

  1. Professional Formulas Liquescence Remedies – The problem with these is that there are a lot of different ones to test. The one needed will often change every 2-4 weeks. We have tested them all over many years both at home and with ZYTO. If I were to only buy a few of them, our most frequented ones are: Kidney, Liver, Skin, Brain, Stomach, Lymph, Gallbladder. Although these are our most frequented, when we really need Pancreas or Brain, for example, then we really need them. The bottles will last for a long time. Dosage is 5-10 drops 2x/day either rubbed into the arm or taken orally. If just starting on these Remedies, I would ramp up the number of drops starting with one. Note that I used the TerrainMax remedies, but these are no longer available. You might still be able to get some from Dr. Hale at acudocpb@gmail.com. I have my fingers crossed that the Liquescence remedies will operate in the same way as the TerrainMax remedies.
  2. Energetix Remedies – Again, there are a lot of these to choose from. Our most frequented are Adrenopath, Lymph Tone I, Lymph Tone II, Lymph Tone III, Bacteria Chord. Dosage and instructions are the same as the Terrain Remedies above.
  3. ZYTO drainage treatment – These biocommunication devices and energetic treatments can really help with drainage pathways. We may not fully understand them, but they can work. We also use ZYTO to determine which of all of the other drainage remedies to take. We have them all in our database, and ZYTO will rank them for us. This ranking is consistent with our home testing, and yields great results. After a biocommunication session, I usually spend about 45 minutes per person ‘digesting’ the information. This includes updating drainage remedies. Typically we take the top three drainage remedies recommended by ZYTO at all times.
  4. Neem – We are on Neem about 50% of the time while chelating. Theraneem usually tests the best on us.
  5. Liver Chi – Initially while ramping up on chelation, we didn’t do much Liver Chi. Once we started increasing the chelating agent, we found Liver Chi pretty helpful.
  6. Cranial structural issues – Our cranium is a 22-piece puzzle. If the bones in the head are in an improper position, it can create pressure on the spinal cord and central nervous system. This can compromise our body’s ability to detoxify and drain toxins. I would also check oral function on our ability to drain and detoxify. For more details, please see Cranial Structural Issues. As a general rule, I recommend at least 1 osteopath visit before chelating.
  7. Pekana Remedies – Similar instructions to #1, Itires, Renelix and Toxex. These can only be purchased from a practitioner, as far as I know.
  8. Futureplex Line – Similar instructions to #1, Lmph-Max and Kdn-Max. It looks like these products are on their way to discontinuation, so not sure if you will be able to find them at the current time.
  9. Nutramedix Line – Parsley and Pinella from Nutramedix often test well on us while chelating.
  10. Gallbladder ND – More often used in the beginnings of chelation.

We are typically each on 2-4 drainage remedies at all times while chelating. The ones testing the best are the ones we take. Without symptoms, we re-test and change these about once per month. At the first hint of symptoms, we immediately re-test and change remedies.

 

We either muscle test at home or use ZYTO for testing. Here is a list of videos that demonstrate how we figure out chelation therapy side effects. Check out the Intro Video first if these debugging techniques are new.

Intro Video: Overview of Debugging Methods

Debugging Skin Issues – Drainage & Detox Problem

Drainage Remedy Testing for an Enema

Sussie the Dog Drainage testing – A dog, not a person, but it shows the general idea.

 

 

Chelating Agent (7%)

Chelating agent refers to a substance that bonds to heavy metals and toxins. This helps extract the metals from our bodies. Primarily toxins and metals that are already circulating are bound and pulled out. This creates a gradient that brings more metals and toxins into circulation. The chelating agent helps accelerate our body’s excretion, with the ultimate goal of excreting all of our stored metals and toxins (wishful thinking?!?). The whole next section is devoted to our trials with chelating agents. Note that we didn’t take any chelating agents until we were ready to start chelation.

 

Chelation Therapy Side Effects: Gut & Bacterial Flare-Ups (7%)

Gastrointestinal issues tend to pop up during chelation. As metals are excreted through the digestive tract and kidneys, it can create the perfect environment for the balance of bacteria to shift. We try to stay on top of this before we end up with gastrointestinal symptoms. While chelating, we test proactively for supplements that support a healthy GI tract. The ones we most often end up on while chelating, are Grapefruit Seed Extract, Caprylic Acid, and Berberine. Check out the healing leaky gut section for more details.

 

Bacteria and viruses can also flare up, especially in the excretory organs as metals are pulled out. Our oldest child had a borderline urinary tract infection (UTI) during chelation therapy, and ended up needing UT Vibrance. My husband ended up with a nasty case of phimosis, an infection in the foreskin. He needed ozone and some anti-microbial herbs. We have learned to watch for symptoms and test often for any supplements needed to support bacterial or viral flare-ups during chelation therapy.

 

Methylation (7%)

We have noticed shifts in our methylation as we chelate. The methylation cycle is very complex. As metals are excreted, the cycle can break in a different place or become closer to breaking. Without symptoms, we check and adjust our methylation supplements about once per month. With symptoms, we check and adjust immediately. We also sometimes do ZYTO treatments for methylation. If methylation is broken, often detox and drainage pathways will break as well. So we double check those too.

 

Details about getting the body methylating can be found in the MTHFR treatment section. For the crash course, MTHFR supplements testing is an instructional video showing how we check in on methylation. Monitoring methylation is essential to minimizing chelation therapy side effects.

 

 

Chelating Agent Trials – What Worked & What Didn’t

Once we were ready for chelation therapy, the question became what chelating agent to use. We initially tried ‘natural’ oral chelators like Chlorella, Zeolite and DE, but didn’t see much movement in our hair, urine or fecal results. One practitioner said we would make progress in about 2-3 years using rounds of UNDA numbers with Pleo Chelate. We spent thousands of dollars on this plan but didn’t see much progress there either. Another practitioner suggested E3 Live, a fresh algae. Yet another suggested oral DMSA, another suggested DMPS IVs, another said no matter what we’ll never get all the metals out because they are ‘bottomless’ in our bodies these days. Friends had practitioners recommend a topical cream, like EDTA. Other practitioners say that isn’t a good idea, since the cream absorbs into the skin and then not have a clear excretion path.

 

In an attempt to figure out what was true and what wasn’t about chelation therapy, we did some of our own experimentation. Note that we were all detoxing and draining well at the time of these tests. We had no amalgam fillings. We met all the criteria in the section: When is the Body Ready for Chelation Therapy? We monitored and adjusted our detox protocol, drainage protocol, and methylation supplements so that we had no symptoms. This is EXTREMELTY IMPORTANT.

 

The following graphs summarize our chelating agent trials.

 
Chelating-Agent-Trial-UrineO
 

Chelating-Agent-Trial-FecalO

 

Chelating-Agent-Trial-UrineY
 

Chelating-Agent-Trial-FecalY
 

Chelating-Agent-Trial-UrineH
 

Chelating-Agent-Trial-FecalH

*The baseline values for these elements was <dl (below detection limit). Unfortunately Doctor’s Data is non-cooperative in supporting their doctors or patients, so they would not give us the actual detection limits for their ICP-MS machine. However, making a few calculations from the stack of results we have from them, I estimate their detection limit at 1ppb.

**Urine collected over 6 hour period after challenge test.

***E3 Live 1 or 2 Tablespoon/day put into water bottles. Water was drunk throughout the day. Test performed after 30 days on E3 Live Monday-Friday and off on Sat & Sunday. Urine was collected over a 6 hour period, starting first thing in the morning. Fecal samples were average from the first two stools of the day, after 30 days on the chelating agent.

 

My overall conclusions from our results are as follows:

 

  1. Oral DMSA is good at pulling Lead out both through the urine and fecally.
  2. E3 Live is especially good at pulling out Bismuth, Berylium and Lead fecally.
  3. DMPS IVs are good at pulling Mercury out through the urine.
  4. One practitioner claims that lead comes out first, followed by mercury. Preliminary results from the Oldest Child after ‘DMSA 62mg bid for 3 months’ seem to indicate that this might be true.

It is still a mystery why E3 Live, a fresh algae, chelates metals so much better than freeze dried chlorella. One practitioner theorizes that the E3 Live actually displaces lipids, bumping out biofilms. I have no confirmation of this theory.

 

Since E3 Live seemed like a decent ‘natural’ chelating agent, I wanted to make sure that E3 live itself wasn’t toxic. So I pulled out my wallet and sent samples to two independent labs for testing. Since these tests were expensive, I only requested tests for the metals that we were excreting in high amounts in our E3 Live urine and fecal tests. Both FAL and ABC labs used ICP-MS for testing.

 

E3 Live Toxicity Results

First Analytical Laboratories* [ppm]ABC Testing** [ppm]E3 Live*** [ppm]
Aluminum (Al)0.5863.927
Arsenic – Inorganic<0.42
Cadmium<0.05
Barium (Ba)0.4120.749
Lead (Pb)<0.050.032<0.06
Mercury (Hg)<0.010.011<0.05
Nickel (Ni)<0.050.062
Thallium (Tl)<0.050.001
Tungsten (W)<0.250.001
Uranium (U)<0.050.030

*First Analytical Laboratories, PO Box 110372, Research Triangle Park, NC 27709, sample manufactured 2014

** ABC Testing, 1169 Warner Ave, Tustin, CA 92780, sample manufactured 2014

*** Values reported by E3 Live themselves, ‘Certificate of Analysis’ manufactured 2011 – 610 Broad Street, Klamath Falls OR 97601

 

The question now becomes: Is the level of Aluminum in E3 Live a problem or not? If I assume we are taking 2T of E3 live per day for 5 out of 7 days per week, I get a total of 30mg of Aluminum per year using the ABC number of 3.927ppm. I compare this 30mg of Aluminum per year to an aspirin which has 10-20mg of Aluminum per pill. The aluminum amount in E3 live is equivalent to 2-3 aspirin per year.

 

Barium also seems a bit high, and in toxic amounts it can cause hypertension and effect renal function. The World Health Organization (WHO) lists as a ‘tolerable intake’ of barium of 0.02mg/kg body weight / day [1]. If I calculate the amount in E3 live at a dose of 2T/day, we get 0.022mg Barium/day from E3 Live. The WHO ‘tolerable intake’ for my 22kg child is 0.452mg Barium/day. So the lightest member of my family is still a factor of 20.5 below the ‘tolerable intake’.
 
 

Is Heavy Metal Excretion Urinary or Fecal?

A have heard varying information on how chelating agents pull metals out. One practitioner says that oral DMSA chelates primarily through the kidneys / urine. Another practitioner said that it is 80% fecally and only 20% through the urine. Each of the four MDs who practice chelation therapy had a completely different theory. There seemed to be little consensus.

 

I back-calculated from our results how much lead is excreted in the urine vs. the feces for DMSA and E3 Live. Unfortunately, I didn’t send corresponding Fecal Tests for all of our Urine Challenge Tests, but I figure some data points are better than none! My assumptions are that we excrete the same amount of lead in the urine and feces all day as we did in the tests. The amount of dry weight of stool per day was 150grams for adults, and the urine per day was 1.5Liters for adults. I scaled these numbers by body weight for children. Here are the results:

 

 Lead ChelationUrine [ug/day] (% of total)Fecal [ug/day] (% of total)
Husband – DMSA Challenge Test30 (30%)699 (70%)
Oldest Child – DMSA 62mg bid, during actual chelation protocol *0.33 (1%)23 (99%)
Oldest Child – E3 Live 1T/day**0.34 (1%)37 (99%)
Oldest Child – E3 Live 2T/day**0.31 (0.3%)98.5 (99.7%)
Youngest Child – E3 Live 1T/day***0.45 (0.6%)80.5 (99.4%)

* These tests were done during her actual chelation therapy protocol. Note that the levels of Lead were all in the ‘green’ range. This means not much was coming out.

** After 3 months on E3 Live at dose specified

*** After 9 months on E3 Live at dose specified

 

DMSA does chelate more lead fecally per day than it does through the kidneys. This is an interesting result, and contrary to what most practitioners seem to believe. E3 Live chelates lead mostly fecally. I’m wondering if our oldest child’s better tolerance of E3 Live over DMSA is both because of the lower amount chelated and because of the fact that not as much of the lead goes through the kidneys.

 

I have a bit of data for mercury:
 

 Mercury ChelationUrine [ug/day] (% of total)Fecal [ug/day] (% of total)
Husband – DMSA Challenge Test1.94 (12%)14.85 (88%)
Oldest Child – DMSA 62mg bid, during actual chelation therapy protocol*0.30 (23%)1.00 (77%)
Oldest Child – E3 Live 1T/day**0.095 (6%)1.60 (94%)
Oldest Child – E3 Live 2T/day**0.42 (7%)5.95 (93%)
Youngest Child – E3 Live 1T/day***0.17 (4%)3.75 (96%)

Finally, I include the same data for Thallium. Our family is excreting relatively large amounts of Thallium. The numbers are significantly large enough for me to have some faith in their accuracy.
 

 Thallium ChelationUrine [ug/day] (% of total)Fecal [ug/day] (% of total)
Husband – DMSA Challenge Test1.10 (7%)14.10 (93%)
Oldest Child – DMSA 62mg bid, during actual chelation protocol*0.15 (7%)1.85 (93%)
Oldest Child – E3 Live 1T/day**0.085 (5%)1.65 (95%)
Oldest Child – E3 Live 2T/day**0.20 (9%)2.10 (91%)
Youngest Child – E3 Live 1T/day***0.59 (6%)9.30 (94%)

Overall, oral chelating agents pull more out fecally than they do through the kidneys. In hindsight, I wish I had sent a fecal test on my Husband’s DMPS IV. The MD only sent out the Urine Toxic Metals. It would be interesting to see if the chelating agent entering through the blood pulls out more from the kidneys than an oral chelator.

 

 

Metals Passed Down at Birth – Quantified

I have heard that we give 2/3 (66%) of our total body burden of heavy metals to our first born child. Then we give another 1/6 (16%) to our second born child, leaving us with 1/6 (16%) [2]. I want to go a bit out on a limb here and try to back calculate if this is true or not for our results. The best test for body burden of metals is autopsy. Since I’m not dead yet, I’m using the DMSA Urine Challenge test, where the DMSA Challenge dose was scaled for our body weight. I wish I could use the DMSA fecal Challenge Test, but unfortunately I don’t have enough fecal DMSA data. Here is a comparison of our results for the metals that were above the reference level.

 

DMSA Urine Challenge Test, scaled for body weightLead [ug/g creat]

(% of total)

Mercury [ug/g creat] (% of total)Thallium [ug/g creat] (% of total)Cesium [ug/g creat] (% of total)Barium [ug/g creat] (% of total)
Mom15 (16%)2.3 (23%)1.1 (16%)14 (18%)15 (15%)
First Born61 (66%)5.1 (52%)3.3 (47%)32 (41%)24 (24%)
Second Born16 (17%)2.3(23%)2.6 (37%)32 (41%)61 (61%)

The lead and mercury I know I had before they were born. I had high levels of lead from years in the electronics lab at MIT, and mercury from fillings passed down from my mom and grandma. I also have mercury from fish consumption. Interestingly, the levels of lead and mercury come out almost exactly to the 16%, 66%, 16% ratios that would be expected. The Thallium, Cesium and Barium I am not sure if I had in high levels before the children were born or if we all acquired those later from some environmental or other exposure. These numbers don’t follow the expected ratios, so I’m guessing at least some of those metals were acquired after birth.
 

 

Our Chelation Therapy Treatment Plan

The main components of successful chelation therapy are Detoxification and Drainage. Before starting a chelating agent, I made doubly-sure we had no symptoms of drainage or detox problems. THIS IS VERY IMPORTANT! We also went to ZYTO to make sure our detox pathways looked OK there too. See “When is the Body Ready for Chelation Therapy?” for more details.

 

What are my opinions about the chelating agent? Overall it seemed like E3 live and DMSA were good choices for pulling out large quantities of lead and mercury. The question now becomes, which one is tolerated well with the least side effects on our daily life? For that experiment, our oldest child was the best judge. She has 3x more lead than anyone else in the family, has had Lyme disease the longest, and generally has more trouble detoxing and excreting than the rest of the family. She tried a 62mg of DMSA 2x/day with along with some drainage remedies and detox supplements. These were apparently not enough. She became fully autistic by day 4 of this protocol, including night terrors. It took me about 2 days of heavy doses of binders (mostly activated charcoal) to get her out of this autistic state.

 

While on her initial E3 Live 1T/day and 2T/day trials for 30 days, we noticed a bit of irritability, but once we figured out new drainage remedies, the irritability disappeared. She also sometimes had skin ‘bumps’ with E3 Live, but adjusting drainage remedies has always made them disappear.

 

Our chelation therapy treatment plan is as follows:

Detoxification

Diet – We are really strict about our diet while chelating. More details, recipes, tips and tricks can be found in the best diet for health section.
Enemas – 2x/week, try to hold 500mL for 20 minutes. We put the detox or drainage remedies testing best into the enema.
Minerals – Taken on Sat & Sun (when chelating agent isn’t being taken). Favorite minerals: Citramins, Citramins II, MultiMins, Fulvic Humic.
IR Sauna – 2x/week for 30 minutes at 120F. Note that I haven’t observed much difference in results between the IR sauna and a traditional sauna.
Binders – We are almost always on some kind of binder to help with detox. Typically only one binder is needed per person at a given point in time. The best binder and/or dosage often changes for that person over time. We retest this about once per month without symptoms. Sooner with symptoms. Our favorites are: DE, Zeolite, Activated Charcoal, Chlorella, E3 Live (yes, we found that E3 acts as a decent binder even when on DMSA). Here is an instructional video that demonstrates how we test.
Skin Brushing – We try to do this about once per week, but I don’t get too worried if we forget. I think this is more important if one isn’t doing the sauna.

Drainage

We are always on the 2-4 drainage remedies that test the best while chelating. Always. We usually re-test the remedy every 4 weeks, as our bodies shift and get stuck in a new place. If any symptoms start to appear, we immediately test for new drainage remedies.
ZYTO – Without symptoms, we re-check drainage pathways and get treatments on ZYTO about once every 2 months. If symptoms appear, we do this immediately.

Chelating Agent

1T E3 Live in our water bottles per day, M-F. Switch chelating to DMSA 32mg 2x/day after about 6months. Move up to 64mg bid after about 2 weeks. Move up to 125mg bid after another 3 months. Slowly ramp up DMSA, not forgetting to check Detox and Drainage along the way. We found ZYTO quite useful in indicating when we were ready to move up the dose of the chelating agent. Interestingly, every time ZYTO said more chelating agent was testing beneficial and we increased the dose, things went beautifully. We were surprised to see larger doses of DMSA testing well on ZYTO, but they eventually were!

Methylation

We have noticed shifts in our methylation during chelation therapy. We are constantly adjusting our methylation supplements. This instructional video shows how we check in on methylation. If methylation is broken, often detox and drainage pathways will break.

Gastrointestinal Issues

While chelating, we test proactively for supplements that support a healthy gut. Our favorites, and the ones we most often end up on during chelation therapy, are Grapefruit Seed Extract, Caprylic Acid, Berberine, and UT Vibrance.

Check-In

Here is an example video showing how we check-in every few months to see if our body is ready to move on to a different chelating agent, higher dose, different binders, new drainage remedies, different methylation supplements, etc. We also use ZYTO once per month so we don’t have to always test every remedy by hand (gets difficult for 4 people and 100s of remedies around our home). ZYTO was helpful in determining when to increase the dose of the chelating agent.

 

 

After about 6 months on E3 Live, we were able to switch the oldest child to a low dose DMSA. We started with 32mg twice per day, and found she needed more binders, mostly Activated Charcoal. Two weeks later we moved her up to 64mg twice per day. At this point, she needed even more Activated Charcoal and UT Vibrance. The UT Vibrance is typically used for urinary tract infections (UTIs). Dysbiotic bacteria in the urinary tract were probably flaring up as the concentration of toxins and metals in her urine increased. Three months later, ZYTO said she was ready for more. We moved up the chelating agent to 125mg twice per day.

 

Why could she now tolerate DMSA without going autistic, but couldn’t tolerate it previously? My theory is that the E3 live pulled out some metals and toxins while allowing us to dial in her detox and drainage pathways. The combination of the decreased load of toxins/metals AND the more open pathways allowed her to tolerate the DMSA.

 

The youngest child and husband were able to tolerate oral DMSA without side effects. However, they also had lower concentrations of metals, and generally have an easier time detoxing and draining. A successful chelation therapy protocol may not always look the same. All of us have different levels of metals to start with, different immune systems, etc. My hope is to have given enough details, ideas, and skills so one can figure out a successful chelation therapy treatment plan without side effects.
 
 

Tips for Debugging Chelation Therapy Side Effects

Symptoms caused by chelation therapy can be almost anything. The most common in our experience are headaches, fatigue, autism/behavioral issues, brain fog, and skin issues. In our experience, frequent home testing is the only thing that has been able to debug and resolve chelation therapy side effects. Brainstorm. Test. Repeat. In case you haven’t checked out the video examples already, here is one.

 

What are ideas of things to test and try if symptoms appear after starting chelation? Without knowing the exact symptom, here is a list, in rank order, of where I would start looking:
 

  1. Lifestyle- check & correct any diet, sleep, stress issues
  2. Drainage remedies
  3. Detoxification binders
  4. Enema – Put the detox binders testing best in the enema. Often we can get quick symptom resolution with enemas.
  5. Sauna
  6. Skin brushing or trampoline jumping

If the symptom is a skin issue, then I would consider rubbing drainage remedies and binders that test well on the skin twice a day. If it is more of an autism or behavioral issue, then I would go straight for the enema.
 
 

How Long Will Chelation Therapy Take?

I have asked four MDs with decades of experience in chelation therapy how long it will take to get rid of toxic levels of metals. I received four different answers, everything from a few months to never (yes, one practitioner told me that we’d never be done!). So who knows. The average answer was around 2-3 years. Stay tuned as I update our progress. I take data about every 6 months.

 

 

FAQ

Q: Is wild fish safe to consume?
 
A: Unfortunately we have no idea what toxins are in the fish that we buy, wild or farmed. Our hair mercury level dropped by a factor of about 4 after we stopped eating wild fish. Our hair lead level dropped about a factor of 5. We mostly ate sole and salmon. Furthermore, we had a practitioner tell us that we were the only people not testing positive for radioactive Strontium after Fukushima. We are her only patients who don’t eat fish. For us, it’s not worth the risk.

 

Q: I just don’t feel well when I’m chelating. Any ideas?
 
A: I would check drainage and detox remedies first. Ideas include: Activated Charcoal, DE, Zeolite, Liquescence Remedies, and Pekana’s Itires, Renelex and Toxex. The next place I would look would be methylation. We found that chelation therapy often pushed our methylation out of whack. Ideas for checking in on methylation can be found in the MTHFR treatment section.

 

Q: How do I use E3 Live? It can only be kept fresh in the refrigerator for 1 week, but I don’t use up the whole bottle in one week.
 
A: Thaw the E3 Live, and pour 1T amounts into an ice cube tray. Put the ice cube tray in the freezer to re-freeze. Then pop out the 1T cubes and put in a bag in the freezer. We put the 1T cubes in our water bottles in the mornings and drink it throughout the day.

 

Q: Can I do chelation therapy while taking other medications?
 
A: It depends on what the other medications are. Unfortunately chelating agents tax the liver and / or kidneys. The ‘other medications’ probably also tax the liver and kidneys, so it may not good to do chelation at the same time. Sauna sessions and sweating, however, use the skin as the primary organ of excretion. Here is an example video showing how we test medications and supplements. I would test the chelating agent together with any other medications being taken.

 

Q: What do you think about topical chelating agents and EDTA cream?
 
A: My theory is that oral is better. My reasoning? I can understand a clear path to fecal or urine excretion for metals extracted from an oral chelating agent. Oral chelators go through the digestive tract, so first I would imagine they extract metals and chemicals primarily from the digestive tract. These, it would seem, since already extracted into the digestive tract, keep going in the excretory direction! I theorize that there is a gradient effect, so as metals and toxins are pulled out in the digestive tract, more disperse from other parts of the body. Some of the oral chelating agent is likely also absorbed into the blood stream. Any blood-circulating chelator with toxins is eventually filtered out in the kidneys and excreted. Note the test results in this document somewhat support that theory – we are seeing good chelation both fecally and through the urine. If a chelating agent is absorbed through the skin and extracts metals or chemicals, how do they excrete out of the body? The only way I can rationalize is back through the skin if they are not already stuck too far away from the pores. This would require the person to sweat the bound metals out through the skin. If they embed deeply enough, there’s a chance that they will be excreted via blood in the lymph & capillaries. However, lymph and capillaries are physically small pathways without a lot of movement. In this case, they can theoretically congest the lymphatic system, or get stuck away from areas of large blood flow. Skin brushing or moderate exercise might help.

 
Q: What about Andy Cutler’s chelation protocol? Have you tried it or do you have thoughts on it?
 
A: I asked the 4 chelation practicing MDs that we visited this exact question. None of them practice or recommend Cutler chelation. Why not? I got various answers. Some said there wasn’t enough drainage / detox understanding in his protocol. Some said the science doesn’t back up his protocol or claims. Some said waking kids up does more harm than good. Others said Andy and his protocol are closed minded. Here are my comments: Let’s be honest – there’s a lot we don’t know about chelation, let alone how the body works. I’m a curious scientist, and I don’t like the attitude of my way is the only / best way. Heck, I’ve made a lot of mistakes in our quest for health, but at least I’m willing to admit them and hopefully others can learn from them. Specifically about his protocol, I actually think the body needs time to detox/drain what the DMSA has bound. I think of ‘breaks’ in chelation not as redistribution, but as time to detox, drain, and deeply-stored metals to redistribute further towards the surface for excretion. I agree with the sleep comment. I have yet to see any hard data showing the Cutler method works for people better than any other method. If someone has some, please send it to me.

 
Q: What do you think about ionic foot baths for removing toxic metals?
 
A: We have never personally tried them. However, I note this study “Objective Assessment of an Ionic Footbath (IonCleanse): Testing Its Ability to Remove Potentially Toxic Elements from the Body,” which looks pretty thorough.
 

Q: What about ALA removing Mercury from the brain? I don’t see anything on your site about this.
 
A: We have tried ALA in various formats. Unfortunately I don’t have enough independent data to publish it in the above charts. (Too many variables were changing. We were trying chlorella without enough break time in between for me to stand behind the ALA data.) Additionally, I have yet to see hard data that ALA chelates mercury from the brain better than anything else. Our observation was that ALA didn’t make a difference in excretion or in symptoms. Again, there are many Cutler-followers out there claiming with authority that this is true. I’m not closed minded about it, but my experience and data doesn’t support it. I would love to see someone scientific minded pull out their pocketbook and present independent hard data about this. All of that said, we do occasionally take a round of ALA for liver detox reasons. We have found it’s pretty good in this category.
 

 

References

[1] Choudhury, Harlal and Richard Cary, “Barium and Barium Compounds,” WHO Geneva 2001.
[2] I heard this from a talk given by an MD. Unfortunately I can’t find a written reference from this source. I did find this reference, which points in the same direction but does not explicitly give the 2/3 and 1/6 numbers: Chen, et al. “Placental transfer and concentrations of cadmium, mercury, lead, and selenium in mothers, newborns, and young children” Journal of Exposure Science and Environmental Epidemiology (2014) 24, 537–544.
 

 




 

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Last Updated: Mar 23, 2023 @ 3:46 pm

 

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