The protocol for the chelation of mercury and heavy metals, according to Dr. Andrew Cutler Ph.D., P.E, can seem overwhelming to learn at first. On this page, we have tried to simplify this learning process in as concise a manner as possible. Before beginning the chelation for mercury, it is strongly advised that you follow these guidelines:

1. Find Support & Learn

a) Join one or more of the support groups below;

The value of such support groups cannot be underestimated. Many questions will come up along the way, and there are many good people out there waiting to offer help;

• Join the ACC Discussion Forum, which adheres strictly to Dr Andy Cutler’s protocol.
• Facebook Group: Andy Cutler Chelation : Safe Mercury and Heavy Metal Detox 

b) Listen to these interviews with Dr Andy Cutler

They provide an extremely helpful and easy introduction to Andy’s protocol, and a great primer for his books. Listen to them in the car, out on a walk, or in the kitchen cooking dinner;

b) Order Dr Andy Cutler’s book Amalgam Illness: Diagnosis and Treatment

If you want to dive deeply into Dr. Cutler’s protocol, it is strongly recommended to obtain his books, at least Amalgam Illness (this can be very technical reading, but he does cover many different topics which not found anywhere else). It is of vital importance to have this book available to refer to while you are chelating.

c) Read this article, and the general guidelines for oral chelation before you start.

2. MOST IMPORTANT! Remove Any Mercury Amalgams!

Ensure your mercury amalgams have been safely removed. You cannot take any chelating substance while you still have mercury amalgams in your mouth, or have exposure to any other source of mercury.

You can only begin the oral chelation protocol, if you do not have any mercury amalgams left in your mouth.

3) Most importantly:

• Never, ever take any chelator in any form if you have any mercury still inside your mouth! Many doctors/dentists will still advise this prior to amalgam removal. Ignore such recommendations.
• Never perform IV chelation or challenge tests.
• Do not use chlorella or cilantro/coriander for chelation purposes.

A proper basic supplementation program should always be started first, including essentials minerals (magnesium, zinc, calcium), vitamins (B, C and E), essential fatty acids (omega 3), and other targeted support.

	Abbreviated terms for:
Hg	Mercury
ALA	Alpha Lipoic Acid, also known as Lipoic acid
DMSA	Dimercaptosuccinic Acid
DMPS	DimercaptoPropane Sulfonic Acid
EDTA	ethylenediamine tetraacetic acid

3. What is oral chelation?

Oral chelation is the process whereby chelating agents are ingested, in order to bind strongly or ”chelate’ metals within the body, using chemical bonds, thus rendering the metallic ion much less chemically active and allowing for harmless excretion, through your urine (pee) or faeces (poop).

Under normal healthy circumstances our body will use its glutathione reserves to detoxify and remove small amounts of mercury found naturally. However, when the body becomes over-burdened, this natural process of mercury excretion no longer works effectively creating a toxic burden and interfering with your physiology.

Mercury is cumulative over life and does not leave the body easily on it’s own, especially the tissues of the brain. Thus oral chelation becomes a vital process in removing problematic metals that are accumulating in the body.

Chelated metals are primarily excreted through the kidneys (pee), and/or gastro-intestinal tract via the biliary network (bile from the liver) and then the stool (poop).

Mercury is the most important metal to chelate due to its extreme toxicity, coupled with its widespread use. Chelation is thus used for mercury toxicity, but has important value in the removal of most other metals accumulated through daily living, and more importantly through indiscriminate use of metals in dentistry.

True chelators are identified by the presence of two thiol groups.

Many health practitioners incorrectly advise chlorella, cysteine, NAC and glutathione for chelation, which are not true chelators in the chemical sense, as they do not contain two or more binding groups (dithiol groups). Instead, they contain only one thiol group making them ineffectual chelators, with the capacity to simply move metals around, and cause more problems. These compounds can make matters worse by redistributing stored metals i.e.  mobilizing them from their storage sites, but failing to bind and excrete them. This is like stirring up a hornets nest.

The Cutler protocol of oral chelation

Dr Andy Cutler is a well known authority on mercury toxicity and advises oral chelation for mercury removal. He is a PhD biochemist who experienced mercury poisoning and consequently examined how to safely remove the mercury, by dosing oral chelators frequently according to their pharmaceutical half-life.

The Cutler protocol thus involves giving low doses of chelator(s) frequently, meaning according to its half-life, over an average period of 3 days & nights, to help the body safely excrete mercury and/or other metals. When given in this way, blood levels of the chelator are kept at a low and stable level, thus allowing for a net movement of metals out of the body. That means every 3 hours for ALA, every 4 hours for DMSA and every 8 hours for DMPS.

Each chelating agent has an affinity for a different set of metals and there is value in knowing what specific metals are high, so that appropriate chelators can be chosen. This can be accomplished by certain testing procedures, but the accuracy of many of them is questionable. Precise testing for mercury, in specific, is impossible due to the uncanny ability of mercury to bind tightly and hide within the tissues of the human body. The safest and most informative test to do is the ‘Hair Elements Test’ by DDI.

Hair testing

Dr Cutler encourages hair testing to asses heavy metal toxicity. The hair test also gives you other important information too, but just like other ‘mercury’ tests, it is not always 100% conclusive.

“Mercury poisoning is difficult to determine because mercury hides. Thus trying to figure out whether someone has mercury poisoning is not an easy, direct thing to do, though many doctors will tell you it is.  One cannot simply test someone’s hair, or blood, or urine, or faeces, and measure how much mercury is there, and go by that. Why not? The body’s tissues are selective about how long they keep mercury inside themselves. Mercury will stay in some body tissues (such as the brain and liver) which are very attracted to it, for a long time. Other tissues (such as blood), will clear out the mercury pretty quickly. Blood will keep mercury for a few months, while the brain keeps it for a lifetime.Other tissues are in between.At first (soon after exposure), mercury is present in hair and blood. This means that soon after someone is poisoned, their blood and hair will probably show high levels of mercury. But later, in most cases, the mercury is “hidden” deep within the body and it is no longer present in the blood or hair or urine or faeces. However, it is still present in other areas (such as the brain) and is still doing damage there. For people who have been exposed to mercury through vaccines (thimerosal) or through amalgam (dental fillings), the exposure is usually too far in the past and/or too slow and chronic for mercury to show up in hair or blood or urine or faeces.IMPORTANT:A PERSON WHO IS MERCURY TOXIC will often have a NORMAL reading for mercury on tests of hair or blood or urine or faeces. You cannot go by that. The most recent edition of many medical textbooks tell physicians that mercury poisoning cannot be ruled out based on the urine or blood level of mercury. This is also true for hair levels of mercury. Only about 1 poisoned person in 10 shows up with a high level of mercury on these tests. The other 9 poisoned people have normal readings for mercury.If the reading for mercury is HIGH (red) on a hair test, this probably indicates the person has mercury poisoning. On the other hand, if the reading for mercury is normal (or even very low), this indicates nothing one way or another about whether the person has mercury poisoning. Mercury can still be present in the brain and organs, doing lots of damage there, and — NOT be present in the hair. THIS IS VERY COMMON”. [Source: Moria]

Deranged mineral transport in a hair test

Thus, hair elements test will not always show high levels of mercury, especially for exposures a long time ago. It can however give you an accurate idea about the state of your ‘mineral transport system‘, as taught by Dr Andy Cutler’s ‘counting rules’, which can then be applied to the hair test result, in order to indirectly determine if you have mercury toxicity.

Mercury is the only metal known to cause widespread deranged mineral transport. The mineral transport system is thus almost always defective in mercury toxicity, affecting how you transport and make use of your minerals. Dr Andy Cutler advises you to follow his ‘counting rules’ to assess your mineral transport system on the hair test. Please obtain his Hair testing book for more information.

“If you want to use “the counting rules” then you need to get a HAIR ELEMENTS TEST, run through DOCTOR’S DATA INC. DO NOT get their “hair toxic exposure” test — it does not include the essential elements. The essential elements are essential if you want to use the counting rules“.

Order a hair elements test from Holistic Health here…

Consistent with Dr Cutler’s advice, we advise you to send away for the DDI hair test’to maintain consistency in lab assessment. Since hair doesn’t deteriorate, it doesn’t need to be refrigerated or sent via express, but can be posted by registered letter.

Hair elements tests give you other important information besides indicating ‘deranged mineral transport‘. It can give you indication of how well your metabolism functions. It is very helpful at assessing adrenal and thyroid function, was well as sugar/carbohydrate handling ability. These patterns appear in the hair, long before blood tests can pick them up, making hair testing a very valuable screening tool. See some examples on our Hair testing page.

1) The DMPS Challenge test: WARNING: Do not do challenge tests!

Many health practitioners offer provoked or challenge tests to supposedly measure heavy metal levels in the body via urine. This is very dangerous to mercury toxic people and should be avoided at all costs.

The most common suggestion is the DMPS challenge test, whereby a largeamount of DMPS is delivered via a single-dose IV injection (Intra-Venous). This causes the body to mobilize a lot of mercury (and other metals), that was previously bound safely within storage sites in the tissues. Mercury is drawn out of the tissues like a sponge and dumped into the blood stream. If your body is unable to deal with this unexpected toxic load, long-term consequences can follow. Many people have had terrible adverse effects and others have experienced permanent damage from these tests. Dr Andy Cutler advises strongly against this test and encourages hair elements testing instead.

For more information of the dangers of the challenge test visit: DMPS BackfireandDr Cranton’s website.

DMPS has been recognized to have excellent use in cases of acute metal toxicity, but when used as a ‘challenge test’ the results do not yield a lot of valuable information and even if you do decide to do a ‘challenge test’ after reading this, the overall test results cannot be considered as meaningful, since mercury is mobilized and ‘redistributed’ throughout the body in indiscriminate patterns, making scientific comparisons impossible. DMPS does not cross the blood-brain barrier or cell membranes, so it yields NO information about levels in the brain, organs and cells.

Challenge tests are thus strongly discouraged as the results are not informative anyway. The readings will come from mobilizing mercury which is not released in any consistent manner. Each test result can vary in the extreme, even with the same person, skewing information.

2) The EDTA challenge test. WARNING! Do not do!

EDTA challenge tests for mercury toxic people are also not informative for the same reasons as the DMPS challenge test mentioned above. EDTA is extensively used as an IV chelator, but EDTA will not chelate mercury to any great degree and instead has a strong affinity for lead and cadmium. DMSA chelates lead better than EDTA, and if you are mercury toxic, then IV EDTA can make you much worse.

Rather, it is advised to follow the oral chelation program as recommended by Andy Cutler to bring your mercury levels down safely first, thereafter IV EDTA can be considered if relavent, but can be used orally also for greater safety. EDTA was previously promoted as being good for removing calcium plaques in blood vessels. It is now suggested that it does not remove calcium plaques, but instead removes metals from the vessel lining (epithelial) receptor sites, thereby freeing up receptor sites to receive more nitric oxide, which was previously blocked by metals.

3) The 24 hour fractionated urine porphyrin tests

This can safely be used to gather information on mercury toxicity. Elevated urine coproporphyrin is suggestive of mercury poisoning (or another toxin), or possibly even a genetic disorder. Finding elevated uroporphyrin also indicates toxicity rather than genetics. The urine must be collected in a very specific way and handled in a very specific manner for accurate results (see pg.182 Amalgam Illness diagnosis and treatment). You cannot be certain that the labs will take the proper testing precautions e.g. keeping the sample on ice at all times, never exposing it to light and never shaking it. This is what makes a hair elements test much safer for diagnosis.

THE CHELATION PROCEDURE – AFTER DENTAL REVISION

There are two types of chelation, oral chelation and intravenous (IV) chelation.

• Oral chelation is much, much safer for mercury. It is also much less expensive and can be done by yourself, or monitored by a health practitioner informed of Dr Andy Cutler’s protocol.
• IV chelation can only be performed by a medical practitioner and is dangerous and not advised.

The safest approach is to bring your mercury levels down slowly and safely with the Cutler protocol.

DR ANDY CUTLER’S ORAL CHELATION PROTOCOL

Dr Andy Cutler developed this chelation protocol based on the pharmacological properties of chelators, using them according to their half-life, in order to keep blood levels of the chelators stable, without gross fluctuation. If you don’t keep blood levels stable you will induce more ‘redistribution’ of mercury and cause more damage. Dr Cutler’s oral chelation program is designed specifically for mercury, but his book describes how you can deal with other metals, should they be present.

Chelators MUST be used correctly in accordance with their pharmacological half-life in order to be safe and effective. During the Cutler protocol, chelation is done in rounds, an average round consisting of three days chelating, and three days rest. This allows for safe mobilization and chelation of mercury and a time for your detoxification channels to ‘catch-up’ during rest days. You start with very low doses and build up SLOWLY!

Again, you cannot chelate metals OUT that you are still being exposed to! For that reason it is essential that you complete the dental revision first. We suggest you consider the full dental clean-up as described by Dr Clark and Dr Huggins which ensures that you remove ALL metals from your mouth first. You never know what is hiding underneath a metal crown until you remove it. X-rays cannot penetrate metal crowns and many people have mercury amalgams there. If you chelate with ANY mercury amalgam still in your mouth, you will make matters much worse. This is a common occurance.

So what chelating agents should we be using to chelate?

DMSA, DMPS and ALA are the chelating agents that will chelate mercury properly, and should be used according to Dr Andy Cutler’s chelation protocol.

Once all mercury amalgams have been safely removed, you can start:DMSA or DMPS at least 4 days after the last amalgam is removed.Wait 3 months before adding ALA.

DMSA and DMPS reduce the body-burden of mercury and are used soon after removal. ALA cleans the brain (and organs) by crossing the Blood Brain Barrier (BBB). ALA can get mercury ‘in and out’ of the brain, so dosing indiscriminately and not according to the half-life can carry mercury into the brain. During the mercury amalgam removal process, a lot of mercury is released into the system and it is best to wait three months and lower the mercury in the body with DMSA or DMPS before adding the ALA, to prevent released mercury from moving into the brain with ALA (this presumably happens if there is a higher concentration in the blood).

ALA and DMSA are thought to exert a synergistic effect and should be used together. DMSA also reduces side-effects of ALA.

Oral chelation needs to be done correctly with low dosages taken on scheduleto avoid problems. Typically, oral chelation can take between one and five years to complete depending on how toxic you are and how well you excrete metals.
Follow Andy Cutler’s protocols and build-up doses slowly. DO NOT follow the advice on the bottles of many supplements for chelation, as you can get into trouble if you use compounds incorrectly and bounce your blood levels around. Keep the dose low and go slow.
Slow equals fast with chelation. Take your time. Letting your ‘ego’ force things along will only cause trouble as you begin moving the metals out faster than you can cope. Some supplements, such as chlorella, will only mobilize it rather than bind strongly to it and pull it out the body. If you only mobilize mercury, but fail to pull it out of the body, you can get very sick. Most of the deleterious effects of mercury happen when it is being mobilized without it being properly bound.

TYPES OF CHELATORS

ALA and DMSA are used most commonly to chelate mercury with Dr Andy Cutler’s protocol. Other chelators may be better with other metals, but not when the focus is on mercury. Again, a lot of people, including your dentist, may assume that all the mercury amalgam is out of your mouth, only to find an amalgam hidden under a metal crown when removed at a later stage, or in an ‘appecectomy’ of a root canal tooth. You will feel a lot worse if you attempt to chelate with ANY amalgam still in your mouth. This includes doing ill advised challenge tests with mercury still in, that your doctor may attempt on you. Chelators must NEVER be taken with mercury still in the mouth, and check your supplements to make sure ALA is not in them. ALA has extraordinary anti-oxidant, energy and blood sugar regulating properties…..however it is also the most important chelator.

DMSA 

– you can start this, four days after mercury amalgam removal.

DMSA chelates specifically lead and mercury.

It is a man-made substance and was introduced initially to chelate lead for children.

DMSA doesn’t cross the blood brain barrier to any clinical degree and only chelates extracellular mercury. DMSA has a half-life of four hours. DMSA is used early in treatment to lower the blood/body levels before adding ALA, due to ALA’s ability to go into and out of the brain. For this reason ALA should NOT be added too early.

Many need to start with very small dosages of DMSA for long periods to test tolerance and reduce the body burden before increasing the dosage or using ALA (this can be done for as long as a year for some mercury-toxic people that cannot tolerate ALA early, or at all). It is generally recommended to do several rounds (at least three or four) on DMSA at low dosages before changing dosage or adding ALA. Each component is changed separately so you know which (dose or substance) is causing resultant side-effects/problems. If you use both chelators simultaneously and have problems you won’t know which one is causing them. DMSA is not a sulphur-based drug. The molecule is based on succinic acid. DMSA is a synthetic (man-made) compound, while ALA is a naturally occurring compound. Both release and bind toxins which means you should make certain you are taking sufficient antioxidants to support the detoxification process. Consult a medical practitioner aware of the Cutler approach if possible.

DMSA has the effect of reducing the side effects when used in conjunction with ALA, especially for those with a supposed lower body burden and higher brain burden. DMSA can help reduce symptoms after recent amalgam removal. DMSA, or any chelator, can exacerbate existing symptoms, so it is advised that oral chelation is begun with low doses and close attention paid to symptoms. Start with doses of 12.5mg and increase slowly over a number of rounds. Some people believe they have an allergy to the DMSA compound itself, but it is actually the incorrect dosage or timing of dose that is causing problems. If you are having side-effects with 12.5mg you can lower the dose further to 5mg. It is of course possible, that you cannot tolerate DMSA no matter what the dose.
DMSA is excreted through the kidneys which means this pathway of elimination must be flowing well.
Purchasing DMSA. DMSA can be obtained in smaller dosages from here.

ALA

ALPHA LIPOIC ACID (Also known as LIPOIC ACID or THIOCTIC ACID)

ALA chelates specifically mercury and arsenic.

ALA is the most important ingredient in oral chelation. ALA chelates both intracellular and extracellular mercury (and arsenic) – in the brain and in the body – making it essential to successful detox, while DMSA and DMPS are optional components to help reduce side-effects and open up an accessory route of elimination via the urine.

ALA is a disulfide. It is water and fat soluble which makes it able to pass the Blood Brain Barrier (BBB) and is thus able to clear mercury from the brain and inside the organs. You can successfully clear mercury with ALA alone. ALA is essential to detox, while DMSA/DMPS is not. ALA has a half-life of three hours.

Start ALA at low doses of 12.5mg to ensure few or no adverse effects, and add it after many rounds of DMSA alone. ALA can increase side effects in a mercury toxic person and you may need to reduce the dose to 6.25mg if that is the case. It is important not to rush this process. Although the goal is to eventually get to higher doses as stated in AI (100-200mg ALA per dose), that is very high dose and can cause bad or intolerable side effects in some, so work up SLOWLY. It can take some people years to get to this point. Starting low and working up is the safest way to proceed to avoid exacerbating symptoms. The higher dosage seems to make a more dramatic difference ultimately, but it takes a long time to get there safely.

ALA is not always as easy to tolerate as DMSA for some, as you are mobilizing mercury from the brain and inside the cells. So it is difficult to ‘expect’ a symptom-free round with it, and especially the day after the round has finished. Usually side-effects are worse when coming off of an ALA-round when the mercury is redistributing. The most common side-effect is fatigue. If the side effects are too harsh lower the dosage before proceeding with your next round.

If you have removed your mercury amalgams a long time ago, use DMSA on its own for a few months before adding ALA. In this way you can know which supplement is causing a problem if it occurs.

The brain will not detox mercury on its own and only over a lifetime would it be able to eliminate it to a small degree. Only ALA is able to allow mercury to be excreted from the brain. People with significant brain mercury will not be able to improve unless they use enough ALA for a long enough time. Those that improve greatly on DMSA alone, do not usually have as much brain toxicity. ALA is excreted mainly through the biliary system (bile ducts) from the liver and into the gastro-intestinal tract and also through the kidneys. This means these pathways of elimination should be flowing well to assist detoxification.
ALA is available from most health shops in far too high a dosage without appropriate warnings or directions of usage. Do not use R-ALA.
Purchasing ALA: ALA can be obtained small dosages here.

DMPS

DMPS is used for mercury, but will also chelate arsenic.

It chelates extracellular mercury or body burden. It is taken according to its half-life every six to eight hours in Dr Culter’s protocol.

DMPS, is a powerful chelator especially beneficial during times of acute toxicity. It is a synthetic compound. Taken without caution and in high dosages, as with challenge tests, it can cause too much mercury to be pushed into the kidney and liver (especially if these organs are not working well), and can possibly damage them. You should not take DMPS, or any chelator, intravenously. Taken orally however, in accordance with Andy Cutler’s protocol, it can prove very beneficial, especially for those that do not tolerate DMSA or ALA well.

Most people do fine without DMPS, using DMSA and ALA only. However if you have a problem with DMSA, then use oral DMPS at frequent low dosages and then later add ALA. DMPS requires a script from an appropriate doctor in some countries. It can be purchased online here…

Other compounds that can chelate or move metals around, BUT SHOULD NOT BE USED:
CILANTRO – Coriander/Dhania – although this is a natural chelator known to cross the blood-brain barrier, its half-life and method of action are unknown at present. Therefore, you are advised to steer clear of methods advising its use until its safety has been properly evaluated.

CHLORELLA – is not a chelator as it contains only onethiol group (sulfhydryl group). It can pick up mercury and move it around, but it does not strictly chelate it and hold onto it. This can cause a lot of oxidative damage as mercury ‘bounces around’. Chelators are dithiols(they contain two sulfhydryl groups) and hold on to mercury tightly and safely. Beware of protocols using chlorella for chelation.

Oral mercury chelation: general guidelines

How to start you oral chelation in a nutshell, when following Andy Cutler’s chelation principles:

The starting dose of 12.5mg has become the norm, as based on experience and suggestions from the Frequent Dose Chelation Yahoo group, which adheres strictly to Andy Cutler’s principles. Generally one starts with either DMSA or DMPS four days after the last mercury amalgam is removed, and adds ALA three months later. For mercury only ALA is really needed, however DMSA and DMPS help alleviate side-effects for some, making chelating a easier process. DMSA is needed for lead.

• Round 1 of chelation with 12.5mg of DMSA. Take 12.5mg every 4 hours, including waking up at night!!!! If you miss a dose by an hour stop the round and wait three days before you start again. Your blood levels of your chelator will have dropped too much with the late dose inducing a lot of redistribution of mercury. If there are any side-effects monitor these and if too intense, stop, wait a few days and start on a lower dose, such as 10mg or 6mg. Alternatively, if you have strong side-effects (overt fatigue being the most common), you can increase the frequency of dosing, for example, taking a dose every 3 hours. Some people metabolize chelators more quickly and need to do it in this way. Make sure that you are familiar with adrenal and thyroid issues that often present themselves early on in chelation. It is best to have addressed these by starting appropriate support before you begin chelation. A ’round’ is “three days ON chelators” and “three days OFF chelators”, and later on you can increase the number of ON days once you have gained experience and are comfortable with the process.A common chelating schedule for DMSA is 7am – 11am – 3pm – 7pm -11pm and 3am.
• If no side-effects, or mild manageable side-effects occur, wait three days before you start Round 2 DMSA at 12.5mg.
• If no side-effects, or mild manageable side-effects occur then do another Round 3 DMSA at 12.5mg.
• At this point you can continue for several more rounds of DMSA alone at the current dose and thereafter increase the dosage SLOWLY. It is best to do 3-4 rounds at a particular dose before increasing it. The increase in dosage must be not more than 50% of the current dose. For example don’t double the dosage, as the jump from 12.5mg to 25mg is often too much. This slow route is strongly encouraged before adding ALA. DMSA will reduce your body burden of mercury before you start taking mercury out the brain and internal organs with ALA. This is often the best path to follow and many people need to lower the body burden with DMSA for many months (especially when very toxic) before adding ALA. Remember, ALA can only be taken three months after mercury amalgams have been removed, or some other mercury exposure has passed. In that case continue with DMSA alone until three months have passed.
• When you are ready to increase the dose of DMSA, raise it to 17.5mg for Round 4 and see how you do on this higher dose. It is recommended to do another 3-4 rounds at this dose of DMSA, if it does not give you side-effects.. If you don’t do well on the higher dose simply find the lower dose that works for you and ‘stick to it’ for longer periods.
• Once you have done 3-4 rounds of DMSA at 25mg, and have none or few side-effects, consider adding ALA12.5mg with each dose of DMSA. At this point change your chelating schedule to take both the DMSA and ALA every 3 hours on the hour, including waking up at night. You can stretch it to every 4 hours ONLY at night if it helps you get a little more sleep, but go back to every 3 hours during the day. If you miss a dose by an hour,as usual, stop the round and wait three days to start again. Monitor side effects especially closely after adding ALA, if un-manageable stop the round and reduce dosage. If you have especially bad side effects you may need to do more rounds of DMSA alone to remove some of the mercury pulled out of your cells by ALA. When using ALA and DMSA together you can begin DMSA alone for the first day or first few doses, before adding the ALA for 3 full days. At the end of the round of three days of ALA continue DMSA alone. This has the effect of reducing the side-effects from ALA. When ALA is added some mercury toxic people will struggle, as this is when mercury begins to be moved from inside your brain and internal organs. ALA usually gives more side effects the day after stopping the round. You may need to chelate for a lot longer on DMSA alone, or reduce the dosage of ALA – even as low as 3mg. This is very important.
• Continue with 25mg DMSA and12.5mg ALA for 3-4 rounds or longer. Then increase the DMSA or the ALA You must only increase one chelator at a time, so you know which one is causing problems if they occur. For example increase to 30mg DMSA and 12.5mg ALA, OR increase to 25mg DMSA and 17.5mg ALA.
• Generally it is best to continue using the safe dosages for some time before increasing. When you find the one that is manageable stick there for a long time. If problems occur then go back to the previous manageable dose and stick there for a few more rounds. You should feel somewhat better on round. If you don’t you should lower the dose.
• You can eventually increase the number of days ON if side effects are stabile, especially if you do well while chelating. This is only advised once you have become somewhat experienced with the oral chelation protocol and only when using DMSA or DMPS on its own. ALA should generally not be taken for longer than 3 days. It is then okay to chelate for longer periods with DMSA or DMPS if your body can keep up with the detox effects and interruption of sleep, then have the same time for rest periods. Usually no more that 2 weeks is recommended, but most can’t go for too long anyway because of lack of sleep due to the interruption of it. If you a lot feel better during the rounds you can extend it for a few more days and see how you do. Longer rounds excrete more mercury and cause less redistribution. Longer rounds are advised only for those that actually do better while chelating – for those that have significant side effects while on round, you will need to take as much time OFF as ON. If you feel a lot better while chelating with the DMSA during that extended time and need to stop because of lack of sleep etc, then you should take the same amount of time off before starting again. Most can’t do it for extra long periods. This is especially true when you add ALA and are dosing every 3 hours or more often. But with DMPS which is taken every 8 hours (due to its longer half-life) people can chelate longer or even continuously as you don’t have to wake up to take doses in the middle of the night. ALA causes less copper to be released during rounds causing problems in the long-term (especially for copper toxic people) so the off-days are very important for most to allow balance to return to your system.
• Ideally, oral chelation must continue for another 6 months to a year AFTER you think you’re well.
  Some people have to chelate for 3 years, and as Andy says, “Chelate, chelate and chelate some more.”
  You can keep slowly increasing the dosage of ALA over time, and you will know when you are done, 
  when you can take 200mg of ALA per dose, for 6-months without symptoms, and also without seeing further improvement.REMEMBER: Increasing the dosage too fast is one of the most common ways people get in trouble with this protocol. 
  Chelation is a slow process, it does not help to push it faster than your body can cope.

Also: Andy Cutler has this to say about the chelation of heavy metals:

‘Generally, heavy metal detoxification involves an exponential decay in symptoms. For example, half the problems might be resolved in the first 6 months, half the remaining problems (a quarter of the original ones) resolved in the next 6 months, etc. Mercury is the exception to this, with a few months of improvement, several months of worsening, and then slow improvement over many more months.’ (Hair Test  Interpretation: Finding Hidden Toxicities, pg. 237)

Important: If you miss a dose or are later by one hour stop the round!!!!! THIS IS VERY IMPORTANT.

When should I increase the dosage?

When you are not having any side effects at all at the dosage you are at and have done a few rounds at that ‘comfortable’ dose. It is a good idea to remain on that ‘comfortable’ dosage for a long time. Chelation should be pleasant and if it becomes difficult you are probably pushing too fast and should lower the dose. Many people find a dosage that they actually feel better on (no side-effects) and stay on it for many, many rounds before increasing the dose.

Repeat oral chelating rounds until you feel better. It can take 1-3 years (and longer for some who are         very poisoned). Give each round a number so you know how many rounds you have done. Increasing dosage to tolerance and using the same dose for many rounds until side effects have diminished, or have subsided at that dosage, before increasing the dosage is the safest way to chelate. The body does not release mercury consistently when you chelate which is why you can get different problems with different rounds, and yet another reason why challenge tests are not informative. All progress achieved with oral chelation should be PERMANENT. If ‘scary stuff’ starts to happen, stop the ALA immediately and wait at least several days before trying it again at a lower dose.

These guidelines are taken from here thanks to Moria and Andy Mercury Detox: Information, Tools, and Resources….  here… IN GENERAL: ALL methods of chelation and ALL chelation agents have some risk Pay attention to your kid or yourself and what is happening. Your actual results take precedence over anyone’s theories of what could happen or should happen. If something has bad results STOP IT Do NOT try to chelate mercury if your child or yourself has/have any amalgam dental fillings present. Which chelation agent(s) to use: This is a somewhat complex topic, and there is not an obvious one-size-fits-all answer. As an intro though, Andy does say the following things: DMSA alonefollowed by DMSA + ALA is a reasonable option. So is DMPS alone followed by DMPS + ALA. ALA is the only one of the common chelator agents which crosses the blood-brain-barrier, so you need to use ALA at some point in order to clear mercury from the brain. ALA has specific risks because it crosses the blood-brain-barrier. It is riskier if used soon after mercury exposure (such as soon after amalgam replacement). This should be considered in deciding when to use ALA. ALA tends to lessen copper excretion — so people taking ALA may have their copper levels increase. This can be a problem for people who already have high copper (which is toxic). This should be considered in deciding when to use ALA. DMSA is stressful to the liver. ALA is helpful to the liver. ALA is sulfury. (This is “good” for some and “bad” for others. If you are a “high sulphur” person, you may need to limit the ALA dose amount and/or limit sulphur foods carefully while chelating with ALA.) [added note: see Sulfur food list]  Dose frequency: NB stick to the schedule strictly by setting an alarm each time! DMSA: every 4 hours,including at night ALA: every 3 hours, including at night. (You can stretch it to every 4 hours at night if it helps you get a little more sleep, but go back to every 3 hours during the day.) DMSA + ALA (together): same as ALA, every 3 hours, including at night. (You can stretch it to every 4 hours at night if it helps you get a little more sleep, but go back to every 3 hours during the day.) DMPS: every 8 hours DMPS + ALA (together): same as ALA, every 3 hours, including at night. (You can stretch it to every 4 hours at night if it helps you get a little more sleep, but go back to every 3 hours during the day.). Use 1/2 as much DMPS per dose. It is generally okay to take a dose SOONER, if this is more convenient. For instance, it is fine to take the next dose of ALA after 2.5 hours rather than 3. If you do this, be sure to adjust the time of the next following dose so that it is taken within 3 hours. (Don’t accidentally leave it till 3.5 hours later because of the “early” dose). All dose guidelines are about the LONGEST you can go between doses. Shorter is okay. Length of cycles: at least a few days on. Three days on or more is recommended. 2.6 days on is acceptable. (3 entire daytimes and the 2 nights in between = 2.6 days.) (Also, Friday after school until Monday morning = 2.6 days.) Less is getting “iffy”. at least as many days off as you had on There is not an obvious one-size-fits-all answer. The following are all reasonable options: 3 days on, 4 days off. OR 3 days on 11 days off . Many other options are also reasonable. How long to wait after amalgam replacement before chelating: for DMSA: at least 4 days for ALA: at least 3 months. ALA has specific risks because it crosses the blood-brain-barrier. It is riskier if used soon after mercury exposure (such as soon after amalgam replacement). This should be considered in deciding when to use ALA. ………………….

 How do I know when I am done?

Ideally, oral chelation must continue for another 6 months to a year AFTER you think you’re well.
Some people have to chelate for 3 years, and as Andy says, “Chelate, chelate and chelate some more.”

You can keep slowly increasing the dosage of ALA over time, and you will know when you are done,
when you can take 200mg of ALA per dose, for 6-months without symptoms, and also without seeing further improvement.

REMEMBER: Increasing the dosage too fast is one of the most common ways people get in trouble with this protocol.
Chelation is a slow process, it does not help to push it faster than your body can cope.

Many people feel well enough to stop before reaching this point, however that is the way you will know for sure.

Side effects
Side effects can increase and decrease during the round and can be worse on some rounds than others. Side effects starting hours later are usuallya sign of Mercury (Hg) being mobilised, while immediate side effects are usually a sensitivity to the drug/supplement. Always begin with low doses of 12.5mg of ALA, DMSA or DMPS to test sensitivity to the compounds, and thereafter build up. If you are in a hurry, it is going to cause chelation to take far longer in the end (due to needing to stop and recover from damage along the way). Slow equals fast in chelation. Complications often show up with the second or third round. So take it easy! Side effects do not always show up right away and they can occasionally hit you ‘like a freight train’ all of a sudden if you are using too high of a dosage or increasing too fast. Being in a hurry is not safe and you need to think about possible consequences if you make yourself worse. We all want to get well as fast as possible but chelating can be dangerous at high doses and cause lots of bad side effects if you push too hard or too fast.
Symptoms with chelation usually confirm mercury toxicity even if tests for mercury don’t show it. When you can take high doses of safe chelators like ALA (1200mg. over a day) without symptoms for while it crudelyimplies a lack of mercury toxicity. If you have progressively bad side effects even with low doses make doubly sure you have not got a piece of amalgam still inside your mouth.

Is it safe to assume that when you are having a lot of symptoms during a round that you are losing a lot of mercury?

Moving a lot of mercury around and if the symptoms are not tolerable it means that the dose is too high. Take chelation seriously, stick to the program and build up slowly. There is a danger of doing damage when moving mercury around. It can cause long term damage and side effects if you are too arrogant with your approach. If you push it too hard and your body can’t handle it you may create problems. Some people only begin to have problems when they add ALA and start moving mercury from inside the brain and organs. If this occurs lower your ALA dose (some people go as low as 3mg. and stay on this for as long as a year), or continue to chelate with DMSA/DMPS for a longer time before you add the ALA in again. ALA is essential for the mercury detox, and if you have adverse reactions to it lower your dose significantly until you find a dose you can tolerate.

Food tips while chelating:

Sulphur (sulfur) foods

Some mercury poisoned people will not do well with sulphur foods (please follow this link to properly understand), these are foods with high free-thiol content, not simply a high sulfur content, as can be found on many website lists. We calll them high sulphur foods to simplify. Foods such as like dairy, eggs, garlic, cabbage, broccoli, cauliflower, etc. can cause a lot of problems and may need to be avoided while chelating. Dairy is a very common sulphur food with free thiols. See the sulphur food list for more information and sulphur metabolism to understand its conversion. Mercury often interferes with the metabolism of sulphur foods.
Usually it is people that test high in plasma cysteine that cannot tolerate sulfur foods and supplements high in sulphur. People with low plasma cysteine feel better if they eat foods high in sulphur. You would need to test your plasma cysteine levels to know this. See Andy’s comments on thiols, sulfur and cysteine.
Sulphur based nutrients, such as garlic, or medicines with only a single thiol (sulphur) group (the ones that grab onto metals) will make the mercury in the body bounce around faster, making it come out a “little” faster, but it may also create some damage during the processes, which is why some mercury toxic people don’t do well on it. Everywhere it bounces more cellular damage (oxidative damage) is caused which eventually leads to more symptoms. A single sulfur group (thiol) can’t hold on the mercury tightly enough to remove it from the body. Chelators have TWO or more sulfur groups (di-thiol groups) close together in the same molecule (e.g. DMSA, DMPS and ALA) that bind the mercury much more tightly, hang on to it better, and can eventually carry it out of the body.

Sulphites (sulfites) and Molybdenum

Part of sulphur metabolism produces poisonous sulphites [R-SO3] further down the chain. Sulphites are also found in many foods e.g. white wine. These must quickly be converted to non-toxic sulphates [R-SO4] by the liver. This process uses an enzyme called sulphite oxidase(SO) which requires molybdenum in its core. Often mercury substitutes itself for molybdenum rendering the enzyme useless. This is why molybdenum is one the important minerals to take while chelating, especially those with high copper as molybdenum reduces copper absorption. ALA tends to increase copper retention and molybdenum will help a lot when ALA is being used.
Many soils are deficient in certain minerals (e.g. South Africa soils are low in molybdenum, along with zinc, germanium, magnesium and selenium).

Other food tips

Avoid beer or wine because of the reactions many mercury toxic people have to them and because they encourage candida yeast infections – particularly while one is chelating. Chelation itself encourages yeast due to the direct effects of  moving of metals. DMSA on it’s own may aggravate yeast in some people, so if you have such an issue you will still need to control the candida while chelating.

Supplements to take while chelating:

Review – Amalgam Illness diagnosis and treatment – by Andy Cutler, for comprehensive information on correct supplementation for mercury poisoning and chelation. The minimum basic suggested supplements and doses are listed below, and you are encouraged to research the book for details on individual situations, so you can adapt the suggestions to suit your own process.

• VITAMIN B– 12.5mg to 25 mg four times a day totaling 60 – 100mg/day. Can split a “B-50? or “B-100? tablet. Important to take several times per day to keep blood levels high. Don’t take after 4pm as it can keep you awake. Other water soluble vitamins such as Vitamin C should also be taken several times
• VITAMIN C– 4 grams or more, one with each meal and one at bedtime. Can take up to 12 grams, or up to bowel tolerance, to reduce side-effects of chelation and oxidative damage caused by mercury.
• VITAMIN E– 1200iu. It is fat soluble and can be taken once a day. This is a VERY IMPORTANT option. Vit. E is a potent anti-oxidant and will balance out the over-oxidizing effect of moving metals, and mercury in particular. Mercury causes oxidative damage wherever it goes and Vit. E and Vit. C help to repair it.  Only buy natural Vit E. Natural Vitamin E begins with a d, as in d-alpha-tocopheroland the synthetic variant begins with a dl, as in dl-alpha-tocopherol.
• MAGNESIUM – in absorbable forms like citrate, malate, aspartate, or amino acid chelate – 50-100mg several times a day up to 750 mg and adjust lower if diarrhoea. People with weak adrenals should not use Magnesium Oxide as it uses up stomach acid. Magnesium is one of the supplements that poisoned people need a lot of. You can also take pharmaceutical grade Epsom Salts (Magnesium Sulphate) 1/4 – 1/2 teaspoon 4 times a day (don’t take Epsom salts at the same time as Calcium supplements however as it can create an indigestible by-product)
• ZINC– 50 to 100 mg spread out during day (especially copper toxic people). Everybody needs this.
• FISH OILS: Pharmaceutical grade Cod Liver Oil. 1 teaspoon – 1 tablespoon/day. Take more in winter.
• VITAMIN A– 5 RDA’s per day. Can use the mercury-free fish oils to supply this.
• FLAX OIL – 1-3 tablespoon per day, take some fish oils also. Take with cottage cheese if you tolerate dairy. Balance with BORAGE OIL,1 teaspoon of Borage for every tablespoon of Flax. People with allergies can do well by taking more flax
• LIVER HERBS– milk thistle. One capsule with each meal.
• SULPHATE (SULFATE): EPSOM SALT BATHS are excellent to provide (Magnesium) sulphate and can be done daily! Or consider (Glucosamine) Sulphate 1500mg/day
• Consider also CHROMIUM 200mcg/meal and VINPOCETINE 5mg…… three times/day, plus:
• MOLYBDENUM- 500 mcg………… to 1000mcg per day. This is especially important for ‘copper toxic’ people as molybdenum (along with zinc) prevents copper absorption. It is also important to use when using ALA as ALA reduces copper excretion in the bile. (Many South Africans are low in this according to recent hair tests).
• COENZYME Q10400mg……/day; INOSITOL2-12g/day; LYSINE2g/day; ARGININE6g/day, ACETYL-L-CARNITINE 1-2g/day.

Other supplements to consider are:

• KIDNEY HERBS – ginger and parsley in boiling water is great to help flush the kidneys. Sip throughout the day.
• MELATONIN – if you have trouble getting to sleep. Not otherwise
• ACTIVATED CHARCOAL is ONLY used at the time of amalgam removal, as it only helps with current ingestion of toxins and should not to be taken regularly.
• SAUNASare one of the quickest ways to bring the body burden of mercury down after stopping exposure. Build-up carefully and keep hydrated with electrolytes drinks. Avoid ‘Far Infra-Red’ saunas.
• An ALKALINE URINE is important for some metals and a pH of 8 or more is desired, especially when chelating cadmium. According to Andy Cutler “The thiol based chelators will drop off some of the metals in the kidneys if the urine is too acidic”. You can test your morning pH. There is a recipe to increase your pH here…

SOURCE: https://www.livingnetwork.co.za/chelationnetwork/chelation-the-andy-cutler-protocol/