Andy protocol vs DAN: the difference (long)

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Since a couple people have asked, this is a nice description of the

difference and was posted on the autism treatment board some time ago.

The " Andy protocol " is known for shorter dosing cycles and fewer

side-effects. [Please contact Dr. Cutler directly if you would like

to post or use this elsewhere.] .

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This is an explanation of the differences by Hall Cutler,

PhD, PE, author of Amalgam Illness Diagnosis and Treatment: A book

on how to cure mercury poisoning by Hall Cutler, PhD, PE

www.noamalgam.com

It explains why the DAN! and " Andy " protocols are so different

in their use of chelators and sulfury things (though they are quite

similar in most other areas).

Please note from the post below, and many prior posts by others, it

is not proper to say there IS a " DAN! chelation protocol " since it

seems to be a point of pride that every single DAN! doctor just HAS

to do something different with the chelating agents to put his mark

on the protocol. This is not at all the same as the " Andy chelation

protocol " which is extremely well defined, and what parts are or

aren't optional are clearly spelled out. Note: the first part is in

answer to a parents questions and are denoted by >>

>> Hi, My DAN doctor, who we have been with for four years,

Andy:

In all honesty, the fact that you still need a DAN! doctor after 4

years is troubling. You should have seen excellent or dramatic

improvements in this time if any of the treatments were on target.

" Dramatic " means things like he didn't used to talk at all and now

he speaks in complete and gramatically correct sentences.

>> and he has given me a chelation protocol for my son which is very

different from the one you recommend. Since I have been reading your

posts with great interest and admiration I would like your opinion

before I decide what to do. My son is 11 (100lbs) and tested

extremely high in mercury, silver, nickel and aluminum.

Andy:

The way you put this sounds like it was a challenged urine test,

which has precisely no meaning and no diagnostic utility. A proper

test is a hair element profile from Doctor's Data or Trace Elements

(the current TEI report is in effect the same, though you have to

stare at it for a while and think about it if you are used to DDI

reports).

Also, does your son have amalgam fillings in place? He can't chelate

with them in. They must be removed first.

>>> Our doctor suggests a 12-week cycle of:

>>ALA 100mg 3 times a day every day

Andy:

If the only thing I succeeed in doing is convincing you not to do

this, it will be worthwhile.

One of the great advantages of having years of experience with what

happens to adults when they chelate this way and that is that I have

a zillion first hand reports of what almost any protocol you can

imagine feels like from the inside, and what it does to people who

can report how they feel accurately. By selectively concentrating

mercury into the brain instead of causing its excretion, improper

use of ALA dramatically increases both neurological and psychiatric

problems.

>> DMSA 500mg 3 times a day for 3 days, then 11 days off, then

repeat this is to be combined with a specially compounded mercury

detox combo of C,E,B6,Taurine, zinc, selenium, melatonin

Andy:

This is not a mercury detox combo. I have no idea why anyone would

call it that. Also I have no idea why it would be " specially

compounded, " as you can easily get whatever combination of those

things you want in standard OTC products which are commercially

available from many sources.

Your kid needs to take appopriate supplements whether or not you

chelate him. Chelation doesn't change this.

>> Our doctor says he has NOT seen very impressive results with

this chelation protocol alone,

Andy:

Unsurprising. I am surprised that he considers it on average to help

the patients, rather than hurt them. You might try a proper

chelation protocol instead on which most people report somewhere

between noticeable and dramatic progress. Please see the polls

section and the love letters file (if you aren't using the web

interface for the listserver, you go to

and

click the hotlinks on the left for " Polls " and " Files " and see what

is there) for typical reports of progress.

I have a suggestion. He says give your kid 1,500 mg of DMSA a day on

cycle, and 300 mg ALA every day. Why not just use MY protocol once

or twice and see what happens? Then you can decide whether to try

his, and can compare them. Use perhaps 50 mg DMSA and 25 mg ALA

every 3 hours during the day (and 4 at night to sleep a little more)

for 3 days. This is 350-400 mg of DMSA and 175-200 mg of ALA. Both

MUCH less than Dr. DAN! Protocol prescribes.

>> but adding IV glutathione once a week has been very impressive.

>> What do you think?

Andy:

I am having a hard time biting my tongue. I have had a number of

" alternative " doctors call ME up and ask what the (@#* & $*( is going

on with some of their colleagues saying intravenous glutathione

makes EVERYONE SO MUCH BETTER but when THEY use it on THEIR

patients, half get a lot worse. This is confirmed by repeated

private reports - and a few on list - by parents who made the

mistake of letting their doctor do this to their kid. The worsenings

are usually long term or permanent, too. What is actually happening

is many doctors are not all that perceptive about the effectiveness

of their therapies (the standard 36 hour shifts with 12 hour rest

periods most of them worked in residencies during training are one

of the more well accepted ways to brainwash people and are

considered serious offenses against the laws of war when committed

in POW camps. After these experiences they are not always that good

at noticing things clinically that disagree with what authority

figures told them).

If you know what your kid's plasma cysteine is you can decide if it

is worthwhile to increase his thiol (sulfur) intake, but there is no

reason to use glutathione IV - if he needs more appropriate use of

oral agents is much more effective and long lasting than the

injection.

Also, I am curious what rationale he uses for wanting to chelate

your kid if he thinks the IV glutathione is what helps and the

chelation isn't very helpful? This makes no sense at all.

BTW, if your doc can't tell you what your son's plasma cysteine is

and proposes to shoot him up with glutathione I really would like to

spend some time trying to convince you to go elsewhere. This is THE

most basic measurement of " sulfur " metabolism, is inexpensive and

easy to do, and is part of a test most DAN! doctors typically order

the rest of (the Great Smokies Lab comprehensive detoxification

profile - almost all DAN! doc's order either that or the regular

detox profile which is very similar but doesn't have cysteine).

First, in discussing the DAN! protocol I do have to note that it

started with a few of the early DAN! doctors following the protocol

as laid out in my book Amalgam Illness: Diagnosis and Treatment.

They got excellent results with this. However, they also spent a lot

of time arguing with parents about the need to get up at night

because the doc's weren't all that convinced it was necessary (for

the most part they had not chelated people before or had used

protocols that don't require the patient to get up).

Based on the excellent response achived early on with this every 3-4

hour low dose protocol, DAN! decided to use a DMSA and ALA protocol.

However, based on the fact that nobody at the relevant meeting

understood any pharmacokinetics so they weren't able to figure out

why 3-4 hour dosing was a crucial part of the protocol, they decided

it would make no difference to dose every 8 hours so they

arbitrarily changed the protocol. They also arbitrarily decided that

since one textbook talks about using 10 mg/kg of DMSA every 8 hours

and they didn't understand why there was any reason to use less,

they would also arbitrarily change the dosage because more must be

better, and using a higher dose must speed things up a lot.

So the existing DAN! protocol was made up by a room full of doctors

who had never used it clinically and didn't understand what the

important differences were between it and the protoccol they had

heard was successful. Basically, they were arrogant enough in their

ignorance to believe that their (lack of) understanding was adequate

to change the protocol willy-nilly and still have it work fine

without even doing a trial of the new protocol on people, or

animals, before endorsing it.

This is the same combination of arrogance and ignorance that leads

most current pediatricians to continue injecting children with the

thimerosal preserved vaccines they have in the stockroom rather than

take the economic loss of throwing them away, because the doc's

don't see how the thimerosal could hurt the kids and are certain

they know everything important there is to know about the subject.

This unfortunately is part of the medical culture and is not unique

to the mainstream or alternative medicine communities.

So, after that DAN! meeting, a new, randomly modified and untested

protocol was emitted. As is easily verified in the polls section of

this list and in its archives, what actually happened is that a lot

of kids who had been getting better on the every 4 hour protocol

were switcched to the every 8 hour protocol and started to get worse

again. Once the parents realized that the doc's had gone off the

deep end and switched back to the 3-4 hour protocol, their kids

resumed improving. While informal, this is a " controlled crossover

study, " which is among the most powerful evidence doctors claim to

believe in. It provided conclusive proof that the lower dose 3-4

hour protocol is dramatically superior to the DAN! 8 hour, high dose

protocol. Like the mainstream, however, DAN! has ignored those

results that don't agree with its position.

In fact, when using the 3-4 hour protocol, the early DAN! doctors

were reporting dramatic, rapid improvements in their patients. Since

switching to the 8 hour protocol they are reporting rough going,

some improvement in perhaps 60% of patients, and are getting really

interested in using other interventions (like MT promoter) in place

of chelation.

I believe that the reports of the DAN! doctors actually are correct.

Dramatic progress in most cases on 3-4 hour chelation, rough going

with modest progress on 8 hour chelation. I believe these are in

fact the rule. They are consistent with reports on this list, with

what I have heard from many adults, with what one would expect from

basic pharmacologic and pharmacokinetic considerations, and with how

things felt when I was very toxic and chelated a few different

random ways at first before I figured out what I was doing.

The difference in administration frequency between the DAN! protocol

(every 8-12 hours for ALA, every 8 for DMSA) and the " Andy " protocol

(every 4 hours or more often for DMSA, every 3 hours or more often

for ALA with occasional 4 hour use) are pretty straightforward to

explain. First, chelating agents serve two functions. They mobilize

toxic metals. They also bind toxic metals. They do NOT " hold on

tight " and do NOT bind irreversibly. They pick up and drop the

metals often. Thus, you need to maintain a rough balance between

mobilization and binding so that the chelators grab most of the free

toxic metals rather than letting them grab back on to the body. In

order to do this, you need to keep the blood level of chelating

agents reasonably constant. This is done by giving them roughly a

half life apart, so that blood levels don't fluctuate by more than a

factor of 2. The half life of DMSA (directly measured in human

children) is 2.5 to 3.5 hours. The kinetics of ALA are much more

complicated but are adequately described as a half life of 1.5 to

2.5 hours. The peaks get smeared out over a 2 hour period due to it

taking about 2 hours for the stuff to slowly be absorbed when it is

given by mouth. EXACTLY how long you can wait between doses varies

from individual to individual and I have determined my numbers based

on the experience of a lot of people who have done it this way. They

are theoretically sound and empirically verified. While I can't

really tell you exactly why ALA is best every 3 hours or whether

DMSA could be stretched to 5 and still be OK, I can tell you with

great certainty that 8 hours is way beyond the bounds of reason.

Now please note that everyone is different. Everyone is a unique

individual. This is just as true biochemically as socially. Thus

while there is perfect certainty that the above applies to any large

group of people, and is best for most people in that group, any

given individual may need to do it differently and in any large

group there will be a few who do better on something other than

the " one size fits all " average protocol. This leads to the

following conditions which I believe any responsible person would

adhere to:

1. Try the " best " approach on everyone, no matter what. Just try it.

2. If some particular person repeatedly does poorly on the " best "

approach and well on something else, respect their individual needs

and do what works for them.

Please also note something else covered under " everyone is

different. " Not all autistic children have mercury (or a related

heavy metal) as the root cause of their condition. Good diagnosis is

needed. Any doctor who chelates ALL of the children who come in the

door isn't doing it right. The first step is make some attempt to

figure out WHAT is wrong, and direct treatment at that. If treatment

is not leading to the expected progress, go back to the diagnostic

step. A diagnosis is only an opinion as to what is going on.

Opinions can be wrong.

As to dosing differences between the " Andy " and DAN! protocols, the

important factor is that increasing the dose increases side effects

rapidly, but does not increase metal removal much. Doubling the

amount of DMSA or ALA in a dose more than doubles side effects.

However, it speeds up metal removal by less than 33%. Once you are

using enough chelator to get some response and have some side

effects there really is no reason to push things. You can double

your dose and go from noticeable side effects to a horrendous,

intolerable experience and make it so you can get through a given

amount of metal in 3 months instead of 4. Also, as the side effects

increase, your ability to chelate frequently will decrease so

sticking to a lower dose and doing it routinely every weekend or

every other weekend will in practice get your kid cleared of metal

faster than using a very high dose and spending weeks or months

putting your kid back together after each cycle. This is clearest in

the discussions regarding all the yeast problems kids have with

chelation that are in the archives.

Summarizing the dosage and administration differences:

8 vs 3-4 hour dosing. Why dose more often? It is necessary for most

children if they are going to get better. This is supported by the

fact that DAN! doctors were reporting dramatic progress when doing

it this way and no longer are now that they use 8 hour dosing.

1500 mg/day versus 350 mg/day. Why use more DMSA/ALA? There is no

real need to use a lot, since it makes the kid dramatically more

uncomfortable without really speeding things up much.

Let me work the arithmetic on this one and you will quickly see what

I mean about dosing. The relevant formulae are in the appendix to my

book Amalgam Illness: Diagnosis and Treatment (described at

www.noamalgam.com).

Each 500 mg dose of DMSA removes (500/50)^0.409 = 2.56 times as much

metal as each 50 mg dose.

3 500 mg doses daily remove 7.69 units of metal.

7 50 mg doses daily remove 7.00 units of metal.

The difference in metal removed by DMSA between the DAN! high dose

protocol and the Andy low dose protocol is 10% in this case. If you

use 100 mg DMSA every 4 hours versus 500 mg every 8 hours the lower

dose protocol actually removes 21% MORE metal than the higher dose

protocol.

Similarly for lipoic acid, the arithmetic is:

Three 100 mg doses remove 5.29 units of metal, while seven 25 mg

doses remove 7.00 units of metal. Again, the " lower dose " protocol

actually removes more metal in a 24 hour period.

The really important thing to keep in mind is some further human

biochemistry as far as heavy metals are concerned. That is, why is

it such a bad idea to let the metals bounce around by just giving

chelator randomly? Don't the metals come out eventually no matter

how you do it?

The real issue is that the metals do NOT sit where they are until

they come out. Chelators ccan move them all over the body. The most

damaging place they can be is in the brain, and the next most

damaging is in the liver. A lot of the metal that is sitting quietly

in a muscle, bone, kidney, or ligament and not really causing much

damage there can be moved INTO the brain and liver if it gets

stirred up and there isn't chelator around to keep it company until

it is excreted. So improper chelation with too long an interval

between doses actually can make people MORE poisoned by INCREASING

the amount of toxic metal in the brain and liver even though the

total amount in their body does decline. This has been observed

innumerable times with adults for many years, and DAN! has now

experimentally demonstrated that it works just the same way in

children. With proper chelation everything gets BETTER from the

start. With improper chelation some things get WORSE. Then it takes

LONGER for those to get better than if proper chelation had been

used all along.

I hope this rather long post clarifies the differences between the

DAN! and Andy chelation approaches, and explains why I think it is

important to do it one way instead of another.

What I hope you will consider the " take home lesson " here is to just

try it both ways a couple of times if you are considering the DAN!

protocol or if your doctor insists.