A Comprehensive Review of Heavy Metal Detoxification and Clinical Pearls from 30 Years of Medical Practice
Heavy Metals appear in the mammalian system because they have become part of our environment. We are in a constant exchange with our environment which is goverened by the laws of osmosis. If mercury is in the fish we eat, over time we have mercury in our system. We cannot keep our system pristine and clean, because we are seperated from our toxic environment only by semi-permeable membranes: skin and mucosal surfaces. Maintaining relative cleanliness requires a number of inherent detox systems to work overtime against the osmotic pressure of the incoming toxins. As the toxixity of our environment increases so does the osmotic pressure, pushing the often man- made poisons into our body.
Toxins almost never come alone. They come in synergistically acting package-deals. Mercury alone is toxic. Together with zinc it is many times more toxic, add in a little copper and silver, as in dental amalgam fillings and the detrimental effect to the body increases manyfold. Together with mercaptan and thioether (dental toxins) the toxic amalgam effects grow exponentially. Add in a little PCB and dioxin, as in fish, and the illness causing effect of the methyl mercury in fish increases manyfold. Toxicology is to a large degree the study of synergistic effects. In synergy 1 plus 1 = 100. Heavy metals are primarily neurotoxins There is a synergistic effect between all neurotoxins which is responsible for the illness producing effect.
Making the neurotoxin elimination a major part of my practice has been an amazing experience. Many illnesses considered intractable respond when the related issues are successfully resolved.
What are Neurotoxins?
Neurotoxins are substances attracted to the mammalian nervous system. They are absorbed by nerve endings and travel inside the neuron to the cell body. On their way they distrupt vital functions of the nerve cell, such as axonal transport of nutrients, mitochondrial respiration and proper DNAtranscription. The body is constantly trying to eliminate neurotoxins via the available exit routes: the liver, kidney, skin and exhaled air. Detox mechanisms include acetylation, sulfation, glucuronidation, oxidation and others. The liver is most important in these processes. Here most elimination products are expelled with the bile into the small intestine and should leave the body via the digestive tract. However, because of the lipophilic/neurotropic nature of the neurotoxins, most are reabsorbed by the abundant nerve endings of the enteric nervous system (ENS) in the intestinal wall. The ENS has more neurons than the spinal chord. From the moment of mucosal uptake the toxins can potentially take 4 different paths:
1. neuronal uptake and via axonal transport to the spinal chord (sympathetic neurons) or brainstem (parasympathetics) – from here back to the brain.
2. Venous uptake and via the portal vein back to the liver
3. Lymphatic uptake and via the thoracic duct to the subclavian vein
4. Uptake by bowel bacteria and tissues of the intestinal tract
Here is an incomplete list of common neurotoxins in order of importance:
mercury, lead, cadmium, iron, manganese and aluminum (are the most common).
Common Sources: metallic mercury vapor escapes from dental amalgam fillings (they contain about 50 % mercury, the rest is zinc, silver copper, tin and trace metals). Cadmium: car fumes, cigarette smoke , pigment in oil paint Lead: outasing from-paint, residues in earth and food chain from time when lead was used in gasoline, contaminated drinking water Aluminum: cookware, drinking water
such as tetanus toxin, botulinum toxin (botox), ascaridin (from intestinal parasites), unspecified toxins from streptococci, staphylococci, lyme disease, clamydia, tuberculosis, fungal toxins and toxins produced by viruses. Biotoxins are minute molecules (200-1000 kilodaltons) containing nitrogen and sulfur. They belong to a group of chemical messengers which microorganisms use to control the host´s immune system, host behaviour and the host´s eating habits.
(iii) Xenobiotics (man-made environmental toxins):
such as dioxin, formaldehyde, insecticides, wood preservatives, PCBs etc.
(iv) Food Preservatives, excitotoxins and cosmetics:
aspartame (diet sweeteners), MSG, many spices, food colourings, fluoride, methyl-and propyl -paraben, etc.
Heavy Metal Toxicity
Metals can exist in the body with different kinds of chemical bonds and as different molecules. Mercury appears to be the king-pin in the cascade of events in which metals become pathogenic. Mercury can be present as metallic mercury (HgO), as mercury salt (e.g. mercury chloride – HG+), or as methyl mercury (HG++). Methyl mercury is 50 times more toxic than metallic mercury. Methyl-Hg is so firmly bound to the body that it has to be first reduced to HG+ before it can be removed from the cell. This is achieved with reducing agents („antioxidants“) e.g. intravenous vitamin C and reduced glutathione. To remove Hg-Salts or metallic Hg from the outside of the cell, other agents are useful Mercury belongs to a group of metals that oxidize in the presence of sulfur and form compounds with sulfur (sulfhydryl affinitive metals). Methyl mercury is already oxidized to its maximum and bound firmly to sulfur in the different proteins of the body. The following metals belong to the sulfhydryl affinitive group and respond to similar detoxification methods: Copper, arsenic, cadmium, lead, mercury. Aluminum and iron for example would not respond a sulfur compound. Some detox agents have multiple mechanisms by which they bind to metals. The algal organism chlorella has over 20 known such mechanisms.
Other metals oxidize with oxygen. Iron turns to rust when oxidized. Rust is nontoxic to the body, whereas iron is. Iron overdose responds to a chemical called desferoximin (desferal). Aluminum responds to the same detoxification agent. A recent Japanese study showed that Chinese parsley, cilantro, is a powerful elimination agent for aluminum stored in bone and the brain.
· Some metals are extremely toxic, even in the most minute dose, whereas others have very low toxicity, even in high doses. However, dependent on the dose, all metals can become toxic to the body. Iron can cause severe oxidative damage, copper may compromise liver function and visual acuity, selenium and arsenic have been known to be used to murder people and so on.
· Most metals serve a functional role in the body. For example, selenium is needed in the enzyme that restores oxidized glutathione back to its functional form as reduced glutathione. Another important function of selenium is its role as a powerful antioxidant in preventing cancer.
· Some metals have a narrow physiological range. That means the difference between a therapeutic dose and toxic overdose is very small. Selenium is an example of this. Magnesium on the other hand has a wide physiological range and thus is more difficult to overdose.
· Some metals have no physiological function. Mercury, lead, aluminum are in this group. Even the smallest amounts have negative physiological-effects.
· biochemical individuality: some people may react more or less than others to the presence of heavy metals in the tissues. Some people may develop a severe chronic illness after exposure of a few molecules of mercury, whereas others may be more resistant to it. Genetic deficiencies in the enzymes responsible for the formation of the metallothioneins and glutathione production and reduction are examples.
Possible side-effects during heavy metal detox:
Every patient can be affected by metals in two ways:
1.Through their non-specific toxic effects
2. Through the system´s allergic reactions to the neurotoxins
Often these two distinctive types of symptoms cannot be easily distinguished. During a detox program, the patient may also temporarily become allergic to the various substances that help to carry out the toxins. This is based on a physiological mechanism called „operant conditioning“. Every time the detoxifying substance is given, mercury emerges from its hiding places into the more superficial tissues of the body, where mercury can now be detected by the immune system. The immune system however is fooled into thinking that the detoxifying substance itself is the enemy. The immune system now starts to react to the detoxifying substance as if it was the mercury itself. This reaction typically resolves spontaneously after six weeks of not using the detox agent in question. This type of conditioned reflex can also be easily treated with simple techniques e.g. NAET, PK (APN), or by giving the detox substance in a homeopathic dilution for a few days. Often the basal membranes in the kidney will swell as a sign of the allergic reaction, causing low back pain, anuria or inability to concentrate urine. Neuraltherapy or microcurrent stimulation of the kidneys quickly resolves the issue. Muscle aches indicate the redistribution of toxins into the connective tissue and an insufficient program. Depression, headaches, trigeminal neuralgia, seizures, increased pain levels indicate redistribution of metals into the CNS and an inappropriate detox program. Eye problems and tinnitus that occurs during detox indicates redistribution of metals into these organs and requires selective mobilization from these locations before the program is continued. I use a specific type of microcurrent for this purpose
Some recently published findings related to the metal issue:
Iron/mangnese: A recent paper on Parkinsons disease (Neurology June 10, 2003;60:1761-1766)revealed that just by eating iron and manganese containing foods such as spinach or taking supplements containing Mn or Fe -the risk of developing PD increased almost 2 fold. This demonstrates that even dietary supplements or organically grown foods are amongst the possilbe culprits in metal toxixity.
There are two major sources:
1. mercury escaped from dental amalgam fillings is converted by oral and intestinal bacteria to methylmercury, which then is bound firmly to proteins and other molecules. Methyl mercury crosses the blodd brain barrier and the placental barrier leading to massive prenatal exposure. Earlier studies determined that over 90% of the common body burdon of Hg is from dental fillings. Recent studies show that eating fish is starting to compete with amalgam fillings for the leading position as a risk factor.
A recent study (JAMA, April 2, 2003;289(13):1667-1674) revealed the following It is estimated that nearly 60,000 children each year are born at risk for neurological problems due to methylmercury exposure in the womb.
One in 12 U.S. women of childbearing age have potentially hazardous levels of mercury in their blood as a result of consuming fish, according to government scientists.
The U.S.FDA recommends that pregnant women and those who may become pregnant avoid eating shark, swordfish, king mackerel, and tile fish known to contain elevated levels of methylmercury, an organic form of mercury. Nearly all fish contain some amount of methylmercury. Mercury accumulates in the system, so larger, longer-lived fish like shark or swordfish contain the highest amounts of mercury and pose the largest threat if eaten regularly.
The National Center for Policy Research for Women & Families published in May 2003, that the following fish are lowest in methyl mercury:
· Catfish (farmed,· Blue Crab (mid-Atlantic), Croaker, Fish Sticks, Flounder (summer)
· Haddoc, Trout (farmed), Shrimp
The FDA also recommends these fish as safe to eat:haddock, tilapia, wild alaskan salmon,and sole
A recent quote from Boyd Haley, PhD: „our latest research clearly points to the ethylmercury exposure as being causal in autism. The tremendous enhancement of thimerosal toxicity by testosterone and the reduction of toxicity by estrogen explains the fact that 4 boys to 1 girl getting the disease and the fact that the bulk of severe autistics are boys. Most importantly, this autistic situation clearly shows that exposure to levels of mercury that many "experts" considered safe was capable of causing an epidemic of a neurological disease“.
Other authors have tried to specify typical symptoms for each metal. Because of the synergistic effects and simultaneous occurence of several toxins at the same time. The best source of literature on the effects of specific metals on the ystem are the old homeopathic textbooks „materia medica“ (Kent, Boericke)
I prefer to look at a client in a systemic way, not focussing on single issues . A manganese typical symptom (ie violent behaviour) may be a lot more worrysome in a given patient then their particular mercury related symptom (ie insomnia). However, the practical focus of detox should be almost always on the mercury first. If mercury is adressed appropriately, the manganese often leaves the body as a side effect of mercury detox. The opposite is not true.
Any illness can be caused by, or contributed to, or exagerated by neurotoxins. Here is a short list:
· neurological problems: Fatigue, depression, insomnia, memory loss, blunting of the senses, chronic intractable pain (migraine, sciatica, CTS etc.), burning pain, paresthesia, strange intracranial sensations and sounds, numbness. Autism. Seizure disorder. Hyperactivity syndromes. Premature ejaculation and inorgasmia
· emotional problems: inappropriate fits of anger and rage, timidness, passivity, bipolar disorder, frequent infatuation, addictions, depression, dark mood, obsession, psychotic behaviour, deviant behaviour, psychic attacks, inability to connect with god, etc.
· mental problems: memory loss, thinking disorder, messy syndrome (cluttering), loss of intelligence, AD, premature aging
· GI problems: candida, food allergy, leaky gut syndrome, parasites, inflammatory bowel disease
· Orthopedic problems: joint arthritis, persisiting musculo-skeletal pain, fibromyalgia, TMD, recurrent osteopathic lesions
· Immunological disorders (autoimmune diseases, hypothyroid disorders, MS, ALS, Sjogen´s Syndrome, CFIDS, MCS etc.)
· Cardiovascular disorders ( vascular disease, arrythmias, angina, increased heartbeat)
· Cancer –mercury, arsenic, copper etc. can be a trigger
· ENT disorders: chronic sinusitis, tinnitus, glandular swelling,
· Eye problems: macular degeneration (dry and wet), optic neuritis, iritis, deteriorating eye sight, etc.)
· Internal medicine problems: kidney disease, hypertension, hypercholesterinemia, syndrome X
· OB/gyn: difficulties of pregnancy, impotence, uterine fibroids, infertility, etc.
· History of Exposure: (Did you ever have any amalgam fillings? How much fish do you eat and what kind? A tick bite? etc)
· Symptoms: (How is your short term memory? Do you have areas of numbness, strange sensations,etc)- A complete neurotoxin questionaire is available from AANT@425 462 1777
· Laboratory Testing:
direct tests for metals: hair, stool, serum, whole blood, urine analysis, breath analysis
· xenobiotics: fatty tissue biopsy, urine, breath analysis
· Indirect tests: cholesterol (increased while body is dealing with Hg), increased insulin sensitivity, creatinine clearance, serum mineral levels (distorted, while Hg is an unresolved issue), Apolipoprotein E 2/4 , urine dip stick test: low specific gravity (reflects inability of kidneys to concentrate urine), persistently low urine ph (metals only go into solution in acidic environments - which supports detoxing), urine porphyrins
· Autonomic Response Testing: (Dr. Dietrich Klinghardt M.D., Ph.D.)
· BioEnergetic Testing (EAV, kinesiology etc.)
· Response to Therapeutic Trial
· Functional Acuity Contrast Test (measure of Retinal Blood Flow)
· Non-specific neurological tests: upper motor neuron signs (clonus, Babinski, hyperreflexia), abnormal nerve conduction studies, EMG etc . non-specific MRI/CT findings: brain atrophy as in AD, demyelination
· Several „challenge tests“ are used today. They generally involve measuring the urine metal content, then administering an oral or iv. mobilizing agent and re-mesuring the metal content in the urine after a few hours. Most well known is the DMPS challenge test: However, there is agreement amongst most researchers, that the urine Hg content does not reflect total body burdon – only the currently mobilizable portion of Hg in the endothelium and kidneys. If nothing comes out, there can still be detrimental but non-responsive amounts of Hg in the CNS, connective tissue and elsewhere.
· I have developed a simple approach that works well. I use autonomic response testing (muscle biofeedback) to determine what metal is stored where and what detox agents would be most suitable for this individual. I obtain a hair sample and have it analyzed. It may or may not show any toxic metals. Metals reach the root of the hair via the blood stream. Hair only can show those metals, that have been in the blood in the last 6 weeks. That means, hair only reflects acute toxicity or recently mobilized metals but not the true body burdon. Then we embark on the detox and mobilizing program. In 6 weeks another hair samle is send to the lab and analyzed. If for example manganese is now high, mercury starting to rise (mostly it is methyl Hg, that is reflected in hair), aluminum is at the same value as before, it means, that this program is starting to mobilize Mn ad Hg, but not Al. Through minor adjustments and following the client closely, we observe as the levels in the hair may rise for months or years before returning to low or absent levels. That is the end point. At that time biochemical challenges with Ca EDTA, DMPS or DMSA can be valuabe to see if there are still hidden pockets of metals somewhere in the system that have been ovrlooked with the other methods. In general, the hair-mineral analysis is often overinterpreted. Hair minerals are a reflection of the toxic-metal induced distortion in mineral metabolism.
Why would we want to treat anyone at all? Is it really needed? Can the body not eliminate these toxins naturally on its own?
First we need to consider a multitude of risk factors, which influence later decisions:
Here is a short list of independent risk factors which can either cause accumulation of metals in an otherwise healthy body - or slow down, or inhibit the bodys own elimination processes.
· Genetics – Several genes are involved in coding for the production of inherent detox mechanisms. Example: ApoE being the major repair protein in neuronal damage and responsible for removing mercury from the intracellular environment. There are 4 different subtypes, one of them making the individual prone to accumulating Hg: (Danik, M. and Poirier, J. Apolipoprotein E and lipid mobilizatin in neuronal membrane remodeling and its relevance to Alzheimer's disease. In: Brain Lipids and Disorders in Biological Psychiatry, edited by Skinner, E.R.Amsterdam:Elsevier Science, 2002,p.53-66.)Also well known and studied are the individual genetic differences in glutathione availability. Several companies in the Integrative Medicine Field are offering genetic testing today. So far my clinical results were not impressive when I based my detox program on genetic testing only.
· prior illnesses (i.e. kidney infections, hepatitis, tonsillitis etc.)
· surgical operations (scars often restrict the detoxifying abilities of whole body sections, such as the tonsillectomy scar with it´s effect on the superior cervical ganglion - restricting lymph drainage and blood flow from the entire cranium)
· medication or ´recreational´ drug use (overwhelming the innate detox mechanisms)
· emotional trauma, especially in early childhood. This issue is huge and almost never appropriately adressed
· social status (poor people may still drink contaminated water)
· high carbohydrate intake combined with protein malnutrition (especially in vegetarians)
· use of homeopathic mercury (may redistribute Hg into deeper tissues)
· food allergies (may block the kidneys, colon etc.)
· the patients electromagnetic environment (mobile phone use, home close to power lines etc. Omura showed that heavy metals in the brain act as micro antennae concentrating damaging electro smog in the brain)
· compromise of head/neck lymphatic drainage (sinusitis, tonsil ectomy scars, poor dental occusion)
· number of dental amalgam fillings over the patients life-time, number of the patients mothers amalgam fillings
There are many considerations in choosing detox agents. After choosing the appropriate agent for the individual client and particular metal and exact chemical form of it, we have to consider the body compartment where the metal is stored. For example, the algae chlorella is ideal for removing virtually all toxic metals from the gut but has too little effect on mercury stored in the brain. Intravenous glutathione may reach the intracellular environment, even in the brain, but is fairly ineffective in removing mercury from the gut. Each agent has a primary place of action, which determines when, how much and for how long it is used. Agents that have multiple effects on compounds of different metals in the various body compartments are the basis for our detox program. Most specific agents are used for special situations only.
High protein, mineral, fatty acid and fluid intake
· proteins provide the important precursors to the endogenous metal detox and shuttle agents, such as coeruloplasmin, metallothioneine, glutathione and others. The branched-chain amino acids in cow and goat whey have valuable independent detox effects. Amino acid supplements, especially with a concentrate of brached chain amino acids are valuable.
· Metals attach themselves only in places that are programmed for attachment of metal ions. Mineral deficiency provides the opportunity for toxic metals to attach themselves to vacant binding sites. A healthy mineral base is a prerequisite for all metal detox attempts (selenium, zinc, manganese, germanium, molybdenum etc.). Substituting minerals can detoxify the body by itself. Just as important are electrolytes (sodium, potassium, calcium, magnesium), which help to transport toxic waste across the extracellular space towards the lymphatic and venous vessels.
· Lipids (made from fatty acids) make up 60-80 % of the central nervous system and need to be constantly replenished. Deficiency makes the nervous system vulnerabe to the fat soluble metals, such as metallic mercury constantly escaping as odorless and invisible vapour from the dental amalgam fillings.
· Without enough fluid intake the kidneys may become contaminated with metals. The basal membranes swell up and the kidneys can no longer efficiently filtrate toxins. Adding a balanced electrolyte solution in small amounts to water helps to restore intra-and extracellular fluid balance
· DMSA . Developed in China in the late 50s. Action via sulfhydryl group. Needs to be given every 4 hours around the clock to prevent redistribution of Hg and lead into the CNS. Approved for use in lead toxixcity. Causes major brain fog, memory problems during detox, depression and in children sometimes seizure disorders due to redistribution of metals. Indiscriminate use in the US. Common dose: 50-100 mg q4h – 3 days on, 11 days off for 3-12 months
· DMPS: developed in Russia as further development of BAL. Available both injectable and oral. The oral form is the most effective oral chelator commercially available. 1 tabl TID. Common dosage: 3 days on, 11 days off. The injectable form can be used to mobilize Hg and lead from hard to reach places, such as the autonomic ganglia, joints and trigger points. The iv injection works primarily on the endothelium (several hundred square meters) and the kidneys. Common dosage: 3 mg/kg body weight once/month. The iv form should never be used unless the patient is „covered“ with intestinal binding agents such as chlorella, cholestyramine, apple pectin or chitosan.
· Desferal: good subcutaneous detox agent for aluminum and iron. More severe possible anaphylactic reactions then with other common detox agents. Research by Canadian-German researcher Kruck showed good results with AD patients. Dosage: 1 vial/week s.c – 3 weeks on, 3 weeks off
· Ca EDTA: most information available at www.gordonresearch.com. Given as 1 minute push 5-10 ml once/week. Originally developped to remove s calcium deposits, recently found to also be effective for mercury and other metals including aluminum. Side effects are so far underreported and can be serious –mostly due to redistribution. The more conventional use of sodium EDTA over a 2 hr period was used to increase nitric oxide in the arteries causing vasodilation and increased perfusion of diseased heart muscle.
· Intravenous Vitamin C. Recent book by Tom Levy, MD. Detoxes mercury, lead and aluminum mostly over the colon which is desirable. I use 37.5 gms with 500 ml distilled water and 10 ml ca gluconate over 1 hr. Can be used daily. Once a week is common, especially during amalgam removal. Irritating to veins. Causes hypoglycemia. No serious side effects. Safe to use for most dentists.Oral vitamin C works less effectively. Must be given to bowel tolerance.
Natural Oral Agents
Cilantro (chinese parsley)
This kitchen herb is capable of mobilizing mercury, cadmium, lead and aluminum in both bones and the central nervous system. It is probably the only effective agent in mobilizing mercury stored in the inracellular space (attached to mitochondria, tubulin, liposomes etc) and in the nucleus of the cell (reversing DNA damage of mercury). Because cilantro mobilizes more toxins then it can carry out of the body, it may flood the connective tissue (where the nerves reside) with metals, that were previously stored in safer hiding places. This process is called re-toxification. It can easily be avoided by simultaneously giving an intestinal toxin-absorbing agent. A recent animal study demonstrated rapid removal of aluminum and lead from the brain and skeleton superior to any known other detox agent. Even while the animal was continuously poisoned with aluminum, the bone content of aluminum continued to drop during the observation period significantly.
Dosage and application of cilantro tincture: give 2 drops 2 times /day in hot water in the beginning, taken just before a meal or 30 minutes after taking chlorella (cilantro causes the gallbadder to dump bile - containing the excreted neurotoxins - into the small intestine. The bile-release occurs naturally as we are eating and is much enhanced by cilantro. If no chlorella is taken, most neurotoxins are reabsorbed on the way down the small intestine by the abundant nerve endings of the enteric nervous system). Gradually increase dose to 10 drops 3 times/day for full benefit. During the initial phase of the detox cilantro should be given 1 week on, 2 –3 weeks off. Fresh organic Cilantro works best (as much as person can compress in one hand), when given in hot Miso soup. Miso contains synergistically acting amino acids.
Other ways of taking cilantro: rub 5 drops twice/day into ankles for mobilization of metals in all organs, joints and structures below the diaphragm, and into the wrists for organs, joints and structures above the diaphragm. The wrists have dense autonomic innervation (axonal uptake of cilantro) and are crossed by the main lymphatic channels (lymphatic uptake).
Cilantro tea: use 10 to 20 drops in cup of hot water. Sip slowly. Clears the brain quickly of many neurotoxins. Good for headaches and other acute syptoms (joint pains, angina, headache): rub 10 –15 drops into painful area. Often achieves almost instant pain relief.
Both C.pyreneidosa (better absorption of toxins, but harder to digest) and C.vulgaris (higher CGF content – see below, easier to digest, less metal absorbing capability) are available. Chlorella has multiple health inducing effects:
· Antiviral (especially effective against the cytomegaly virus from the herpes family)
· Toxin binding (mucopolysaccharide membrane)
all known toxic metals, environmental toxins such as dioxin and others
· Repairs and activates the bodys detoxification functions:
· Dramatically increases reduced glutathion,
· Sporopollein is as effective as cholestyramin in binding neurotoxins and more effective in binding toxic metals then any other natural substance found.
· Various peptides restore coeruloplasmin and metallothioneine,
· Lipids (12.4 %) alpha-and gamma-linoleic acid help to balance the increased intake of fish oil during our detox program and are necessary for a multitude of functions, including formation of ther peroxisomes.
· Methyl-coblolamine is food for the nervous system, restores damaged neurons and has ist own detoxifying efect.
· Chlorella growth factor helps the body detoxify itself in a yet not understood profound way. It appears that over millions of years chlorella has developed specific detoxifying proteins and peptides for every existing toxic metal.
· The porphyrins in chlorophyl have their own strong metal binding effect. Chlorophyll also activates the PPAR-receptor on the nucleus of the cell which is responsible for the transcription of Dna and coding the formation of the peroxisomes (see fish oil), opening of the cell wall (unknown mechanism) which is necessary for all detox procedures, normalizes insulin resistance and much more. Medical drugs that activate the PPAR receptor (such as pioglitazone) have been effective in the treatment of breast and prostate cancer.
· Super nutrient: 50-60% aminoacid content, ideal nutrient for vegetarians, methylcobolamin - the most easily absorbed and utilized form of B12, B6, minerals, chlorophyll, beta carotene etc.
· Immune system strengthening
· Restores bowel flora
· Digestive aid (bulking agent)
· Alkalinizing agent (important for patients with malignancies)
Dosage: start with 1 gram (=4 tabl) 3-4 times/day. This is the standard maintainance dosage for grown ups for the 6-24 months of active detox. During the more active phase of the detox (every 2-4 weeks for 1 week), whenever cilantro is given, the dose can be increased to 3 grams 3-4 times per day (1 week on, 2-4 weeks back down to the maintainance dosage). Take 30 minutes before the main meals and at bedtime. This way chlorella is exactly in that portion of the small intestine where the bile squirts into the gut at the beginning of the meal, carrying with it toxic metals and other toxic waste. These are bound by the chlorella cell wall and carried out via the digestive tract. When amalgam fillings are removed, the higher dose should be given for 2 days before and 2-5 days after the procedure (the more fillings are removed, the longer the higher dose should be given). No cilantro should be given around the time of dental work. During this time we do not want to moblize deeply stored metals in addition to the expected new exposure. If you take Vitamin C during your detox program, take it as far away from Chlorella as possible (best after meals).
Side effects: most side effects reflect the toxic effect of the mobilized metals which are shuttled through the organism. This problem is instantly avoided by significantly increasing the chlorella dosage, not by reducing it, which would worsen the problem (small chlorella doses mobilize more metals then are bound in the gut, large chlorella doses bind more toxins then are mobilized). Some people have problems digesting the cell membrane of chlorella. The enzyme cellulase resolves this problem. Cellulase is available in many health food stores in digestive enzyme products. Taking chlorella together with food also helps in some cases, even though it is less effective that way. C.vulgaris has a thinner cell wall and is better toerated by people with digestive problems.
Chlorella growth factor
This is a heat extract from chlorella that concentrates certain peptides, proteins and other ingredients. The research on CGF shows that children develop no tooth decay and their dentition (maxillary-facial development) is near perfect. There are less illnesses and children grow earlier to a larger size with higher I.Q and are socially more skilled. There are case reports of patients with dramatic tumor remissions after taking CGF in higher amounts. In our experience, CGF makes the detox experience for the patient much easier, shorter and more effective.
Recommended dosage: 1 cap. CGF for each 20 tabl.chlorella
NDF and PCA
Both are extracts from Chlorella and Cilantro and very effective in detoxing. They are well tolerated, but very expensive
Garlic (allium sativum) and wild garlic (allium ursinum)
Garlic has been shown to protect the white and red blood cells from oxidative damage, caused by metals in the blood stream - on their way out – and also has ist own valid detoxification functions. Garlic contains numerous sulphur components, including the most valuable sulph-hydryl groups which oxidize mercury, cadmium and lead and make these metals water soluble. This makes it easy for the organism to excrete these subastances. Garlic also contains alliin whis is enzymatically transformed into allicin, natures most potent antimicrobial agent. Metal toxic patients almost always suffer from secondary infections, which are often responsible for part of the symptoms. Garlic also contains the most important mineral which protects from mercury toxicity, bio active selenium. Most selemium products are poorly absorbable and do not reach those body compartments in need for it. Garlic selenium is the most beneficial natural bioavailable source. Garlic is also protectice for against heart disease and cancer.
The half life of allicin (after crushing garlic) is less then 14 days. Most commercial garlic products have no allicin releasing potential left. This distinguishes freeze dried garlic from all other products. Bear garlic tincture is excellent for use in detox, but less effective as antimicrobial agent.
Dosage: 1-3 capsules freeze dried garlic after each meal. Start with 1 capsule after the main meal per day, slowly increase to the higher dosage. Initially the patient may experience die-off reactions (from killing pathogenic fungal or bacterial organisms). Use 5-10 drops bear-garlic on food at least 3 times per day.
It is clear that the high consumption of fish oil protects the client from the damage caused by the amalgam fillings. The same is true for the high intake of selenium.
The fatty acid complexes EPA and DHA in fish oil make the red and white blood cells more flexible thus improving the microcirculation of the brain, heart and other tissues. All detoxification functions depend on optimal oxygen delivery and blood flow. EPA and DHA protect the brain from viral infections and are needed for the development of intelligence and eye-sight. They also induce the formation of peroxisomes and helps protect them. The most vital cell organelle for detoxification is the peroxisome. These small structures are also responsible for the specific job each cell has: in the pineal gland the melatonin is produced in the peroxisome, in the neurons dopamine and norepinephrine, etc. It is here, where mercury and other toxic metal attach and disable the cell from doing its work. Other researchers have focussed on the mitochondria and other cellorganelles, which in our experience are damaged much later. The cell is constantly trying to make new peroxisomes to replace the damaged ones– for that task it needs an abundance of fatty acids, especially EPA and DHA. Until recently it was believed, that the body can manufacture ist own EPA/DHA from other Omega 3 fatty acids such as fish oil. Today we know, that this process is slow and cannot keep up with the enormous demand for EPA/DHA our systems have in todays toxic environment. Fish oil is now considered an essential nutrient, even for vegetarians. Recent research also revealed, that the transformation humans underwent when apes became intelligent and turned into humans happened only in coastal regions, where the apes started to consume large amounts of fish.
The fatty acids in fish oil are very sensitive to exposure to electromagnetic fields, temperature, light and various aspects of handling and processing. Trans fatty acids, long chain fatty acids, renegade fats and other oxydation products and contaminants are frequently found in most commercial products. Ideally, fish oil should be kept in an uninterrupted cooling chain until it ends up in the patients fridge. The fish-source should be mercury and contaminant free, which is becoming harder and harder. Fish oil should tast slightly fishy but not too much. If there is no fish taste, too much processing and manipulation has destroyed the vitality of the oil. If it tastes too fishy, oxydation products are present. There are 5 commercially available grades of fish oil. Grade I is the best.
Dosage: 1 capsule Omega 3 taken 4 times/day during the active phase of treatment, 1 caps. twice/day for maintainance
Best if taken together with chlorella
. Recently a fatty acid receptor has been discovered on the tongue, joining the other more known taste receptors. If the capsules are chewed or a liquid oil is taken, the stomach and pancreas start to prepare the digestive tract in exactly the right way to prepare for maximum absorption. To treat bipolar depression, post partum depression and other forms of mental disease, 2000 mg of EPA are needed/day (David Horrobin). For the modulation of malignancies, 120 mg of EPA 4 times/day are needed. The calculations can easily be done with the information given on the label.
Balanced electolyte solution (Selectrolyte)
The autonomic nervous system in most toxic patients is dysfunctional. Electric messages in the organism are not received, are misunderstood or misinterpreted. Toxins cannot be shuttled through the extracellular space. Increased intake of natural ocean salt (celtic sea salt) – and avoidance of regular table salt - has been found to be very effective in resolving some of these problems. Most effective is a solution pioneered by the American chemist Ketkovsky. He created the formula for the most effective electrolyte replacement, which was further improved by Morin Labs, and is now called „selectrolyte“.
Dosage: 1 tsp in a cup of good water 1-3 times/day During times of greater stress the dosage can be temporarily increased to 1 tbsp 3 times/day
Mobilized metals and toxins tend to get stuck in the connective tissue and lymph channels. They can no longer be reached by biochemical agents. A mechanical approach is needed. Dr.Vodder´s MLD approach is very good. We are using a superb group of microcurrent instruments developed by a Japanese researcher. The results are often astounding. The device can also be applied transcranially to mobilize metals from the brain with ease and with no side effects, when the patient is simultaneously on a good detox program. I call this process electromobilization.
Photomobilization: I found that the release of metals from the CNS can be rapidly achieved with the use of narrow band polarized lightstimulation of the eyes. Each metal can be defined by it´s spectral emissions when it is heated up ( Fraunhofer lines). When light of the exact same frequency is beamed into the eye (using a special instrument) the release of this exact metal from the intracellular environment into the blood stream is triggered.
Peer reviewed literature shows that sweatting during sauna therapy eliminates high levels of toxic metals, organic compounds, dioxin, and other toxins. Sauna therapy is ideal to mobilize toxins from its hiding places. However, during a sauna, toxic metals can also be displaced from one body compartment into another. This means mercury can be shifted from the connective tissue into the brain. This untoward effect is completely prevented when the patient is on chlorella, cilantro and garlic. The addition of ozone can be used to deliver an effective anti-microorganism hit while in the sauna. The moment mercury and other metals are removed from the body, microorganisms start to grow. We use a ozone steam cabinet which allows us to combine the effects of hyperthermia and ozone therapy in a very safe and comfortable way.
Colong hydrotherapy removes not only fecal matter from the bowel but also sludge and debris that has attached itself to the wall of the colon. It has been shown that these residues can be years even decades old and often leaked out toxic doses of many different chemicals during those years of residue collection. During a metal detoxification program, many toxins appear on the bowel surface and shifted from bowel surface into the fecal matter. However, since many of the toxins are neurotoxins, and the colon is lined with nerve endings, many of the mobilized toxins are reabsorbed into the body on the way down. To intercept these toxins while in the colon, colon hydrotherapy is the ideal method.
Recommended use: 1-2 colonics per week during active phase of detox.
Acupuncture and Neural therapy:
Both are closely related techniques that balance the autonomic nervous system (ANS). Compartmentalized metals are often trapped because of specific dysfunctions of the ANS. Both can be resolved with either technique.
To facilitate in the detoxification process, exercise is absolutely needed. Many patients with chronic disease are unable to engage in vigorous exercise e.g. jogging. We help our clients to find the right level of exercise appropriate to their level of illness. Without exercise, mobilized toxins accumulate in the connective tissue, kidneys, lungs and skin and can cause a new set of symptoms and perpetuate the patient’s illness. A good exercise program should include 3 components: a) muscle strength training b) aerobic training c) stretching.
Recommendations: 20 minutes twice a day is the minimum requirement during the active detox phase
When metals are mobilized a certain portion travels through the kidneys. The kidneys may react with swelling of the basal membranes and decrease in filtration rate. To prevent damage to the kidneys the patient has to drink increasing amounts of water (with selectrolyte solution). The kidny has a filtrating surface equal to a ping-pong table, the gut that of a soccer field. The nephrons - like brain cells - live long and cannot be replaced once damaged. The gut membranes are renewed every 3 days. It is foolsih to push toxic metals through the kidneys and wise, to push them out through the gut. Chlorella pulls toxic metals through the mucosal surface of the intestines from the blood and protects the kidneys.
Additional recommended supplement: Renelix 15 drops three times a day
When metals are moved out of the body through the feces, the bowel flora is damaged. During the active phase of the detox, chlorella works as an excellent pre-probiotic: It selectively feeds the good bowel flora. In addition, we recommend taking HLC (Acidophilus/Bifidus) two capsules with each meal.
There is a strange but largely overlooked association of metal toxicity and psychological issues.
I found that often when the client has a breakthrough in psychotherapy her/his symptoms become temporarily worse. This is often falsely believed to be a healing crisis (immune system acivation). In this situation the client´s urine will often show high levels of toxic metals with out a provocative agent being used. The psychological intervention has led to a release of deeply stored toxins. I developed a targeted rapid approach to resolve related psychological issues called „applied psychoneurobiology or APN“, which is a form of muscle biofeedback assisted counseling.
The Klinghardt Axiom and the Triad of Detoxification:
By experience I found the following to be true: each unresolved psycho-emotional conflict or each unresolved past trauma causes the body to lose the ability to successfully recognize and excrete toxic substances. Also each entanglement or limiting connection with another family member, unhealed relationships and unhealthy, non-life affirmative attitudes limit the organisms ability to detoxify itself. In fact, the type of retained metal or other toxin and the body compartment, where it is stored, can be predicted with a high degree of certainty by knowing what type of unresolved psycho- emotional conflict is present in a client and at what age the associated event occurred.
For each unresolved psychological issue there is an equal amount of toxins stored in the body.
When the patient starts to effectively detoxify on the physical level, repressed emotional material moves from the unconscious to the more superficial subconscious part of the brain. Instead of feeling better from the lessened toxin burden, the patient will often start to experience unpleasant inner states of being, e.g. tension, anxiety, sadness or anger. This is commonly mistaken as a side-effect of the medications used for detoxification or as an unspecified “detox reaction”. When this emotional material is not dealt with, the body stops releasing further toxins - the tension or discrepancy between the unresolved psycho-emotional material and the already released physical toxins is too large. Both are out of balance – the toxin container is less full then the container with the unresolved emotions. Unless appropriate psychological intervention is chosen as the next step in treatment, detoxification cannot progress.
Things are further complicated by the increased activity of microorganisms such as fungi and molds, bacteria, viruses, prions and different species of mycoplasma during a detox program. Insecticides, herbicides, wood preservatives, mercury, and other toxins are used by us with a single purpose – to stop the growth of microorganisms and other unwanted pests in the outside world (farm fields, materials and furniture made from wood, to preserve food, etc.). When these toxic agents have entered our inner environment (via the food chain, air, water, skin contact or amalgam fillings) they have the same effect in us. They stop the growth of microorganisms – at a price: they also harm the cells of our body. As the patient is detoxifying from these agents, microorganisms may grow out of control, since the growth of the microbes is no longer inhibited by the poison. Paradoxically, it is the toxin induced impairment of our immune system that enables the microorganisms to enter our system in the first place. Once established, they are hard to conquer and removing the causative toxin is no longer enough. The organism needs help with the elimination of the infectious agents.
The flare-up of previously hidden infections occurs regularly during mercury detoxification. Historically, this fact is well known: mercury was used quite effectively for treatment of the bacterial spirochete causing syphilis. Some people died from side effects of the treatment, but many people lived after eradication of the infection. The reverse happens, when we withdraw mercury from the body: spirochetes, streptococci and other microorganisms present in many hiding places (such as the red blood cells, the jaw bone, inside the lateral canals of a root filled tooth, inside the calculus of a bone spur, in the soft tissues of a whip-lash injured neck, in the gray matter of the brain etc.) may start to grow and extend their hold on us. Microorganisms use their respective neurotoxins to gradually achieve control over our immune system, our behavior, our thinking, and every aspect of our biochemistry. It is the microbial neurotoxins that are responsible for many, if not most poison related symptoms, not the poisons themselves.
For each equivalent of stored toxins there is an equal amount of pathogenic microorganisms in the body (Milieu theory of Bechamp)
Patients who are infected with Borrelia burgdorferi, the spirochete which causes Lyme disease, often are unaware of their illness. They may have some joint pains or fatigue, but nothing that alarms them. However, frequently they start to become more symptomatic during or after a successful mercury detoxification program: they may experience MS-like symptoms such as muscle weakness, increased levels of pain, numbness, fatigue or mental decline. The same is true for infections with mycoplasma, streptococci, tuberculosis and others. Therefore, it is important to anticipate the temporarily enhanced growth of microorganisms during a successful detox program. There is a latent period in which the microorganisms are already recovered, but the host’s immune system is not. During this time the practitioner has to prescribe appropriate antifungal, antibacterial, antiviral, and antimycoplasma medications. I prefer natural solutions which are often sufficient - or even better in the long run then medical drugs - such as freeze dried garlic, bee propolis, colloidal gold and microbial inhibition microcurrent frequencies.
The immunesystem in a client with unresolved psychoemotional material and compartmentalized toxins is unable to recognize and eliminate the microorganisms present in the toxic areas of the body. Those areas serve as hiding and breeding places for these organisms. Unfortunately they have been termed “stealth organisms”, implying that they behave in secret unpredictable ways, that they have learned to evade a perfectly evolved and functional immune sytem. There is a fear, that they are slowly gaining control over us and that there is really nothing we can do about it. We can, if we understand the triad of detoxification.
The Detoxification Axiom:
For each unresolved psycho-emotional conflict or trauma there is an equivalent of stored toxins and an equivalent of pathogenic microorganisms. To successfully detoxify the body the three issues have to be addressed simultaneously.
The triad of detoxification:
· Detoxification of the physical body
· Treatment of latent microorganisms and parasites
· Treatment of unresolved psycho-emotional issues
Detoxing the patient from heavy metals can be an elegant smooth experience or rollercoaster ride. The problems that occur can always be resolved with the use of autonomic response testing (ART). Without the use of ART and addressing the psychological issues (with APN), embarking on a heavy metal detox program can be unsatisfying, incomplete, sometimes dangerous and may not lead to resolution of the underlying medical condition. We recommend that each patient undergoing a metal detox program stays under the supervision of an experienced and qualified practitioner. There are many more ways to approach metal detox. However, many roads I have witnessed also did not lead to complete resolution of the underlying problem and are shortsighted. The practitioner should avoid short term interventions for long term issues and should not underestimate the depth and magnitude of the underlying problem.
and recommended reading about mercury from dental fillings and related issues.
The references for chlorella, CGF, Fish oil, cilantro, garlic, ART, APN and others can be obtained from the American Academy of Neural Therapy: firstname.lastname@example.org and at www.neuraltherapy.com
1 Carlson, J., Larsen, J.T., and Edlund, M.-B.: Peptostreptococcus micros has a uniquely high capacity to form hydrogen sulfide from glutathione. Oral Microbiol. Immunol., 8: 42-45, 1993
2 Debelian, G.J., Olsen, I., and Tronstad, L.: Systemic diseases caused by oral microorganisms. Endod. Dent. Traumatol., 10: 57-65, 1994
3 De Boever, E.H., De Uzeda, M., and Loesche, W.J.: Relationship between volatile sulfur compounds, BANA-hydrolyzing bacteria and gingival health in patients with and without complaints of moral malodour. J. Clin. Dent., 4: 114-119, 1994
4 Duhr, E.F., Pendergrass, J.C., Slevin, J.T., and Haley, B.E.: HgEDTA complex inhibits GTP interactions with the E-site of the brain ß-tubulin. Toxicol. Appl. Pharmacol., 122: 273-280, 1993
5 Giuliana, G., Ammatuna, P., Pizzo, G., Capone, F., and D’Angelo, M.: Occurrence of invading bacteria in radicular dentin of periodontally diseased teeth: microbiological findings. J. Clin. Periodonto., 24: 478-485, 1997
6 Granlundt-Edstedt, M., Johannson, E., Claesson, R., and Carlsson, J.: Effect of anaerobiosis and sulfide on killing of bacteria by polymorphonuclear leukocytes. J. Periodont. Res., 8: 346-353, 1993
7 Hannah, R.S., Hayden, L.J., and Roth, S.H.: Hydrogen sulfide exposure alters the amino acid content in developing rat CNS. Neurosci. Lett., 99: 323-327, 1989
8 Johnson, P.W., Yaegaki, K., and Tonzetich, J.: Effect of volatile thiol compounds on protein metabolism by human gingival fibroblasts. J. Periodont. Res., 27: 553-561, 1992
9 Khatoon, S., Campbell, S.R., Haley, B.E., and Slevin, J.T.: Aberrant guanosine triphosphate-ß-tubulin interaction in Alzheimer’s disease. Ann. Neurol., 26: 210-215, 1989
10 Kilburn, K.H., and Warshaw, R.H.: Hydrogen sulfide and reduced-sulphur gases adversely affect neurophysiological functions. Toxicol. Ind. Health, 11: 185-197, 1995
11 Kombian, S.B., Reiffenstein, R.J, and Colmers, W.F.: The actions of hydrogen sulfide on dorsal raphe serotonergic neurons in vitro. J. Neurophysiol. 81-96, 1993
12 Larsen, J.T., Claesson, R., Edlund, M.-B. and Carlsson, J.:Competition for peptides and amino acids among periodontal bacteria. J. Periodont. Res.,30: 390-395, 1995
13 Loomer, P.M., Sigusch, B., Sukhu, B., Ellen, R.P. and Tenenbaum, H.C.: Direct effects of metabolic products and sonicated extracts of Porphyromonas gingivalis 2561 on osteogenesis in vitro. Infect. Immun., 62: 1289-1297, 1994
14 Nair, P.N:R., Sjogren, U., Krey, G., Kahnberg, K.-E., Sundqvist, G.: Intraradicular bacteria and fungi in root-filled, asymptomatic human teeth with therapy-resistant periapical lesions: a long-term light and electron microscopic follow-up study. J. Endodon., 16: 580-588, 1990
15 Pendergrass, J.C., Haley, B.E., Vimy, M.J., Winfield, S.A., and Lorscheider, F.L.: Mercury vapor inhalation inhibits binding of GTP to tubulin in rat brain: similarity to a molecular lesion in Alzheimer diseased brain. Neurotoxicology, 18: 315-324, 1996
16 Pendergrass, J.C., Haley, B.E.: Inhibition of brain tubulin-guanosine 5’-triphosphate interactions by mercury: Similarity to Observations in Alzheimer’s diseased brain. Metal ions in biological systems: mercury and its effects on environment and biology (Sigel, H. and Sigel, A., eds) Marcel Dekker, Inc., New York, pp461-478, 1996
17 Pendergrass, J.C., Haley, B.E.: Mercury-EDTA complex specifically blocks brain ß-tubulin interactions: similarity to observations in Alzheimer’s disease. Status quo and perspectives of amalgam and other dental materials (Friberg L.T. and Schrauzer G.N., eds) Georg Thieme Verlag, Stuttgart, pp98-105, 1995
18 Persson, S.: Hydrogen sulfide and methyl mercaptan in periodontal pockets. Oral Microbiol. Immunol., 7: 378-379, 1992
19 Persson, S., Claesson, R., Carlsson, J.: Chemotaxis and degranulation of polymorphonuclear leukocytes in the presence of sulfide. Oral Microbiol. Immunol., 8: 46-49, 1993
20 Ratcliff, P.: Local predisposing events leading to gingivitis and periodontitis. J. Periodont., 66: 749-750, 1995
21 Reiffenstein, R.J., Hulbert, W.C., and Roth, S.H.: Toxicology of hydrogen sulfide. Annu. Rev. Pharmacol. Toxicol. 109-134, 1992
22 Roth, S.H., Skrajny, B., and Reiffenstein, R.J.: Alterations of the morphology and neurochemistry of the developing mammalian nervous system by hydrogen sulfide. Clin. Exptl. Pharmacol. Physiol., 22: 379-380, 1995
23 Skrajny, B., Reiffenstein, R.J. Sainsbury, R.S., and Roth, S.H.: Effects of repeated exposures of hydrogen sulphide on rat hippocampal EEG. Toxicol. Lett., 84: 43-53, 1996
24 Warenycia, M.W., Goodwin, L.R., Benishin, C.G., Reiffenstein, R.J., et al.: Acute hydrogen sulfide poisoning. Biochem. Pharmacol., 38: 973-981, 1989
25 Safavi, K.E., Rossomando, E.F.: Tumor necrosis factor identified in periapical tissue exudates of teeth with apical periodontitis. J. of Endodontitis, 17(1): 12ff, 1990
26 Maiorino, R.M., et al.:Sodium 2,3-dimercaptopropane-1-sulfonate challenge test for mercury in humans. III. Urinary mercury after exposure to mercurous chloride. J. Pharmacol. Exp. Ther., 277(2): 938-44, 1996
27 Keith, R.L., et al.: Utilization of renal slices to evaluate the efficacy of chelating agents for removing mercury from the kidney. Toxicology, 116(1-3): 67-75, 1997
28 Aposhian, M.M., et al.: Sodium 2,3-dimercapto-1-propanesulfonate (DMPS) treatment does not redistribute lead or mercuri to the brain of rat. Toxicology, 109(1): 49-55, 1996
29 Aposhian, H.V., et al.: Urinary mercury after administration of 2,3-dimercaptopropane-1-sulfonic acid: correlation with dental amalgam score. FASEB J., 6(7): 2472-6, 1992
30 Aposhian, H.V., et al.: Human studies with the chelating agents, DMPS and DMSA. J. Toxicol. Clin. Toxicol., 30(4): 505-28, 1992
31 Hermann, M., Schweinsberg, F.: Biomonitoring for the evaluation of a mercury burden from amalgam fillings. Mercury determination in urine before and after oral doses of 2,3-dimercapto-1-propanesulfonic acid (DMPS) and in hair. Abteilung Allgemeine Hygiene und Umwelthygiene, Universität Tübingen, Zentralbl-Hyg-Umweltmed., 194(3): 271-91, 1993
32 Zander, D., et al.: The mercury exposure of the population. III. Mercury mobilisation by DMPS (Dimaval) in subjects with and without amalgam fillings. Medizinisches Institut für Umwelthygiene, Heinrich Heine-Universität Düsseldorf
33 Molin, M., et al.; Mobilized mercury in subjects with varying exposure to elemental mercury vapour. Int. Arch. Occup. Environ. Health, 63(3): 187-92, 1991
34 Maiorino, R.M., et al.: Determination and metabolism of dithiol chelating agents. XII Metabolism and pharmakinetics of sodium 2,3-dimercapto-1-sulfonate in humans. J. Pharmacol. Exp. Ther., 259(2): 808-14, 1991
35 Gerhard, I., et al.: Diagnosis of heavy metal loading by the oral DMPS and chewing gum tests. Clin. Lab., 38: 404-11,
36 Gonzales-Ramirez, D., et al.: Urinary mercury, porphyrins and neurobehavioral changes in dental workers in Monterrey, Mexico. J. Pharmacol. Exp. Therap., 272: 264-274, 1995
37 Godfrey, M. and Campbell N.: Confirmation of mercury retention and toxicity using (DMPS). J. Advance Med., 7(1): 19-30, 1994
38 WHO Criteria 118, 1991
39 Konetzka, W.: Microbiology of metal transformation, microorganisms and minerals, 317-342, 1977
40 Lexmond, T.-M., et al.: On the methylation of inorganic mercury and the decomposition of organo-mercury compounds – A review. Neth. J. Aci., 24: 79-97, 1976
41 Compeau, G. and Bartha, R.: Methylation and demethylation of mercury under controlled redox, pH and salinity conditions. Appl. & Environ. Microbio. Vol. 48, No. 6, 1203-1207, 1984
42 Edwards, T.: Biosyntheses and degradation of methyl mercury in human faeces. Nature, Vol. 253, 462-464, 1975
43 Blum, J. and Bartha, R.: Effect of salinity on Methylation of mercury. Bulletin Environ. Contam. Toxicol., 25: 404-408, 1980
44 Bertilson, L. and Neujahr, H.Y.: Methylation of mercury compounds by methylcobalamin. Biochemistry, Vol. 10, No. 14, 2805-2828, 1971
45 Imura, N., et al.: Chemical Methylation of inorganic mercury with methylcobalamin, a vitamin B-12 analog. Science, Vol. 172, 1248-1249, 1971
46 Jernelov, A. and Martin, A.: Ecological implications of methal metabolism by microorganisms. Annual Review of Microbiology, 61-77, 1975
47 Lander, L.: Biochemical model for the biological Methylation of mercury suggested from Methylation studies in vivo with Neurospora crassa. Nature, Vol. 230, 452-454, 1971
48 Wataha et al.: Dental Materials. 10(5): pp2988-303, 1994
49 Hamdy, M.K., and Noyes, O.R.: Formation of methyl mercury by bacteria. Appl. Microbiol., Vol. 30, No. 3, 424-432, 1975
50 Brunker, R.L. and Bott, T.L.: Reduction of mercury to the elemental state by a yeast. Appl. Microbiol., Vol 27, No. 5, 870-73, 1974
51 Holm, H.W. and Cox, M.F.: Transformation of elemental mercury by bacteria. Appl. Microbiol., Vol. 29, No. 4, 491&494, 1975
52 Pan Hou, H.S. and Imura, N.: Involvement of mercury Methylation in Microbial mercury detoxification. Arch. Microbiol., 131: 176-177, 1982
53 Bisogni, J.J. and Lawrence, A.W.: Kinetics of mercury Methylation in aerobic and anaerobic aquatic environments. J. Water Pollut. Control Fed., 47: 135-152, 1975
54 Report on the international committee on MAC values on mercury (1969)
55 USEPA document on mercury 1973 & 1984
56 US NIOSH document on mercury 1973
57 Wieliczka, D.M. et al.: Equilibrium vapor pressure of mercury from dental amalgam in vitro. Dent. Mater., 12(3): 179-184, 1996
58 Bjorkman, L. and Lind, B.: Factors influencing mercury evaporation from dental amalgam fillings. Scand. J. Dent. Res., 100(6) 354-60, 1992
59 Lussi, A.: Mercury release from amalgam into saliva: An in-vitro study. Schweiz. Monatsschr. Zahnmed. 103(6): 722-6, 1993
60 Olson, S. and Bergman, M.: Daily dose calculations from measurements of intra-oral mercury vapor. J. Dent. Res., 71(2): 414—23, 1992
61 Vimy, M.J. and Lorscheider, F.L.: Dental amalgam mercury daily dose estimated from intra-oral vapor measurements: A predictor of mercury accumulation in human tissues. The Journal of trace elements in exderimental medicine, 3(1): 11-123, 1990
62 Emler and Cardone: An assessment of mercury in mouth air. Oral Roberts University, March 1985
63 Vimy, M.J. and Lorscheider, F.L.: Serial measurements of intra-oral air mercury: estimation of daily dose from dental amalgam. J. Dent. Res.,64(8): 1072-5, 1985
64 Abraham, J. et al.: The effect of dental amalgam restorations on blood mercury levels. J. Dent. Res., 63(1): 71 & 73, 1984
65 Ott, K. et al.: Mercury burden due to amalgam fillings. Dtsch. Zahnärztl. Zeitung, 39(9): 199-205, 1984
66 Svare, C.W. et al.: The effects of dental amalgam on mercury levels in expired air. J. Dent. Res.,60(9): 1668-1671, 1981
67 Stortebecker, P.: Mercury poisoning from dental amalgam
68 Schubert, J.: Combined effects in toxicology – A rapid systematic testing procedure cadmium, mercury and lead. J. Toxic. Envir. Health, 4: 763-776, 1978
69 Fedin, B.: Swed. Dent. J. 3: 8-15, 1988
70 Pendergrass, et al.: Neurotoxicology. 18(2): 315-324, 1997
71 Hanson, M.: J. Orthomol. Psychatry, Vol 12, No. 3, 1983
72 Vimy, M.J. and Lorscheider, F.L.J.: Dent. Res., 64: 1069-71, 1985
73 Berglund, A. et al.: Determination of the rate of release of intra-oral mercury vapor from amalgam. J. Dent. Res., 67: 1235-242, 1988
74 Grandjean, P. et al.: Cognitive deficit in 7-year-old children with prenatal exposure to methylmercury. Neurotoxicol. Teratol., 19(6): 417-28, 1997
75 Marlowe et al.: Low mercury levels and childhood intelligence. J. of orthomol. Medicine, Vol 1, No. 1, 1986
76 Reinhardt, J.W.: Side-effects: mercury contribution to body burden from dental amalgam. Adv. Dent. Res. 6:110-3, 1992
77 Vanherle, G.: Dental care using silver amalgam. Verh. K. Acad. Belg., 58(5): 587-634, 1996
78 Danscher, G. et al.: Traces of mercury in organs from primates with amalgam fillings. Department of Neurobiol. Univers. Of Aarhus, Denmark, Exp-Mol-Pathol., 52(3):219-9, 1990
79 Weiner, J.A. et al.: Does mercury from amalgam restorations constitute a health hazard? AU: AD: National Board of occupat. Safety and Health, Solna, Sweden, Sci-Total-Environ. 99(1-2): 1-22, 1990
80 Drasch, G. et al.: Eur. J. Pediatr., 153(8): 607-10, 1994
81 Arvidson, B.: Inorganic mercury is transported from muscular nerve terminals to spinal and brainstem motoneurons. Muscle Nerve, 15(10): 1089-1094, 1992
82 Retrograde axonal transport of mercury in primary sensory neurons innervating the tooth pulp in the rat. Neurosci. Lett. 115(1): 29-32, 1990
83 Aschner: Effects of systemic methyl mercury-adulerated water consumption on fast axonal transport in the rat visual system. Acta Pharmacol. Toxicol. (Copenh.), 59(5): 349-55, 1986
84 Lorscheider, F.L. et al.: FASEB J. 9(4): A-3845. FASEB Annual Meeting, Atlanta, Georgia, 10th March 1995
85 Szucs, A. et al.: Effects of inorganic mercury and methymercury on the ionic currents of cultured rat hippocampal neurons. Cell. Mol. Neurobiol., 17(3): 273-88, 1997
86 Goering et al.: Fundam. Appl. Toxicol., 19: 319-329, 1992
87 Pendergrass, J.C. et al.: Mercury Vapor inhalation inhibits binding of GTP to tubulin in rat brain: Similarity to a molecular lesion in Alzheimer diseased brain. Neurotoxicology, in press, 1997
88 Haley, B.E. et al.: FASEB J. 9(4): A-3845. FASEB Annual Meeting, Atlanta, Georgia, 10th March 1995
89 Duhr, E. et al.: Federations of American Societies for experimental biology (FASEB). 75th Annual Meeting, Atlanta, Georgia. 21.-25 April 1991. Abstract 493. Hg2+ induces GTP-tubulin interactions in rat brain similar to those observed in Alzheimer’s disease.
90 Pamphlett, R. and Waley, P.: Motor neurons uptake of low dose inorganic mercury. J. Neurol. Sci., 135(1): 63-7, 1996
91 Oskarsson, A., et al.: Total and inorganic mercury in breast milk in relation to fish consumption and amalgam in lactating women. Arch. Environ. Health, 51(3): 234-41, 1996
92 Amin.Zaki, L., et al.: Methyl mercury poisoning in the Iraqi suckling infant: A longitudinal study over five years. J. Appl. Toxicol., 1(4): 2104, 1981
93 Redhe, O.: Pleva recovery from amyotrophic lateral sclerosis and from allergy after removal of dental amalgam fillings. J. Int. J. Risk Safety Medicine, 4: 229-236, 1994
94 Enwonwu, C.O.: Potential health hazard of the use of mercury in dentistry: Critical review of the literature. Environ. Res., 42: 257-274, 1987
95 Guinta, F. et al.: Severe acute poisoning from the ingestion of a permanent ware solution of mercuric chloride. Hum. Toxicol., 2: 243-246, 1983
96 Rosenmann, K.D., et al.: Sensitive indicators of inorganic mercury toxicity. Arch. Environ. Health, 41: 208-215, 1986
97 Desi, I., et al.: Effect of subchronic mercury exposure on electrocorticogram of rats. Neurotoxicology. 17(3-4): 719, 23, 1996
98 Angotzi, G., et al.: Impairment of nervous system in workers exposed to inorganic mercury. Toxicol. Eur. Res., 3(6): 275-8, 1981
99 Marriott, J.B., Quasim: Anti-phospholipid antibodies in the mercuric chloride treated brown Norway rat. J. Autoimmun., 4:457:67, 1994
100 Shapiro, et al. and Ship II, et al.: Reported the relation between cumulative exposure to mercury and chronic health impairment
101 Cutright, D.E., et al.: Systemic mercury levels caused by inhaling mist during high-speed amalgam grinding. J. Oral Med., 28, 100, 1973
102 Cross et al.: Blood of dentists. Lancet, 312, 1978
103 Ngim, C.H., et al.: Chronic neurobehavioral effects of elemental mercury in dentists. British Journal of Industrial Medicine, 49: 782-790, 1992
104 Foo, S.C., et al.: Neurobehavioral effects in occupational chemical exposure. Environ. Res., 60(2): 267-73, 1993
105 Uzzell, B.P., et al.: Chronic low-level mercury exposure and neuropsychological functioning. J. Clin. Exp. Neuropsych., 8(5): 581-593, 1986
106 Shapiro, I.M. et al.: Neurophysiological and neuropsychological function in mercury exposed dentists. Lancet, 1(8282): 1147-1150, 1982
107 Echeverria, D. et al.: Behavioral effects of low-level exposure to Hg among dentists. Neurotoxicology and Teratology, 17(2): 161-168, 1995
108 Ritchie, K.A. et al.: Psychomotor testing of dentists with chronic low-level mercury exposure. J. Dent. Res., 74(S1): 420, A-160
109 Drasch et al.: Trace elements in medicine and biology. 9(2):82-7, 1995#
110 Hahn, L.J., et al.: FASEB J., 4(14): 3256-60, 1990
111 Vimy, M.J., et al.: Am. J. Physiol., 258(Pt. 2): R939-45, 1990
112 Vimy et al.: Mercury from maternal “silver” tooth fillings in sheep and human breast milk. Biological Trace Element Research, V56, pp143, 1997
113 Wenstrup, D., et al.: Trace element imbalances in isolated subcellular fractions of Alzheimer’s disease brains. Department of Chemistry, University of Kentucky, Lexington. Brain Res., 533:1, 125-31, 1990
114 Nylander, M., et al.: Mercury concentrations in the human brain and kidneys in relation to exposure from dental amalgam fillings. Swe. Dent. J., 11:5, 179-87, 1987
115 Friberg, L. et al.: Kvicksilver I centrala nervsystemet I relation till amalgamfyllningar (Mercury in the central nervous system in relation to dental amalgam). Lakartidningen, 83:519-22, 1986
116 Eggelston, D.W., et al.: Correlation of dental amalgam with mercury in brain tissue. J. Pros. Dent., 58: 704-7, 1987
117 Schiele et al. in 1984
118 Nylander, M., et al.: Mercury concentration in the human brain and kidneys in relation to exposure from dental amalgam fillings. Swed. Dent. J., 11(5): 179-87, 1987
119 Weiner, J.A. and Nylander, M.: The relationship between mercury concentration in human organs and different predictor variables. National Board of Occup. Safety and health, Solna, Sweden. Sci-Total-Environ., 138(1-3): 101-15, 1993
120 Drasch, G., et al.: Silver concentrations in human tissues, their dependence on dental amalgam and other factors. Trace Elements in Medicine and Biology, 9(2): 82-7, 1995
121 Smith, D.H.: Science, 156, 1114, 1967
122 Duhr, E. et al.: Hg2+ induces GTP-tubulin interactions in rat brain similar to those observed in Alzheimer’s disease. FASEB, 75th Annual Meeting, Atlanta, Georgia, 21.25 April 1991, Abstract 493
123 Pendergrass, J. et al.: The deleterious effects of low micromolar mercury on important brain and cerebrospinal fluid protein. American Association of pharmaceutical scientists, Annual Meeting, 5-9 November, 1995, Miami
124 Pendergrass, J.C. et al.: Mercury vapor inhalation inhibits binding of tubulin in rat brain: Similarity to a molecular lesion in Alzheimer disease d brain. Neurotoxicology, In Press June-July 1997
125 Lorscheider, F.L., et al.: Toxicity of ionic mercury and elemental mercury vapour on brain neuronal protein metabolism. 1994
126 Summers, A.O. et al.: Mercury released from dental “silver” fillings provokes an increase in mercury- and antibiotic-resistant bacteria in oral and intestinal floras of primates. Antimicrob. Agents Chemother. 37(4): 825-34, 1993
127 Edlund, C. et al.: Resistance of the normal human microflora. Mercury and antimicrobials after exposure to mercury from dental amalgam fillings. Clin. Inf. Dis. 22(6): 944-950, June 1996
128 Liebert, C.A. et al.: The impact of mercury released from dental “silver” fillings on antibiotic resistances in the primate oral and intestinal bacterial flora. Met. Ions. Biol. Syst., 34:441-60, 1997
129 Catsakis, L.H., Sulica, V.I.: Allergy to silver amalgams. Oral Surg. Oral Med. Oral Pathol., 46(3): 371-5, 1978
130 Stejskal, V.D.M., et al.: The lymphocyte transformation test for diagnosis of drug-induced occupational allergy., Journal of Allergy and Clinical Immunology 77, 411-426
131 Stejskal, V.D.M. et al.: Lymphocyte transformation test for diagnosis of isohia-zolinone allergy in man., J. of Investigative Derma-tology 94, 798-902
132 Stejskal, V.D.M. et al.: Allergy to drugs and other chemicals diagnosed by the presence of specific memory cells in human blood. In realm of tolerance. Edited by P. Ivanyi. Pp. 213-224. Springer-Verlag, Berlin
133 Wilhelm-M, Dunninger, P. et al.: Effects of amalgam on cells of the immune system. Einfluss von Amalgam auf Zellen des Immunsystems. Med. Poliklinik der Universität Würzburg, Dtsch. Zahnärztl. Z., 46(8): 544-7, 1991
134 Adverse immunological effects and autoimmunity induced by dental amalgam and alloy in mice. Hultmann: FASEB J, 8(14): 1183-90, 1994
135 Hultman: Murine mercury-induced immune-complex disease: effect of cyclophosphamide treatment and importance of T-cells., Br. J. Exp. Pathol., 70(3): 227-36, 1989
136 Hultman: Murine susceptibility to mercury. II. Autoantibody profiles and renal immune deposits in hybrid backcross and H-2d congenic mice. Clin. Immunol. Immunolpathol. 68(1): 9-20, 1993
137 Enestrom, S., Hultman, P.: Does amalgam affect the immune system? A controversial issue.; Int. Arch. Allergy Immunol., 106(3): 180-203, 1995
138 Warfvinge, G., Larsson, A.: Contact stomatitis to mercury associated with spontaneous mononuclear cell infiltrates in brown Norway (BN) rats with HgCl2-induced autoimmunity. J. Oral Pathol. Med. 23(10): 441-5, 1994
139 Kosuda, L.L.; et al.: Mercury-induced renal autoimmunity in BNàLEW. 1N chimeric rats., Cell. Immunol. 155(1): 77-94, 1994
140 Sato, K., et al.: An Epidemiological study of mercury sensitization. Allergology International, 46:201-6, 1997
141 Summers, A.O., Sugarman, L.I.; J. Bacteriol. 119, 242, 1974
142 Katsunuma Exercise-induced anaphylaxis: improvement after removal of amalgam in dental caries., Ann. Allergy, 64(5): 472-5, 1990
143 Caron, G.A., et al.: Lympho-cyte transformation induced by inorganic and organic mercury., International Archives of Allergy 37, 76 87
144 Bolewska, J., et al.: Oral mucosal lesions related to silver amalgam restorations., Department of Oral Medicine and Oral Surgery, University Hospital, Copenhagen, DK, Oral-Surg. Oral-Med.Oral-Pathol., 70(1): 55-8, 1990
145 Finne, K. et al.: Oral lichen planus and contact allergy to mercury. International Journal of Oral Surgery 11, 236-239
146 Laine, J., et al.: Resolution of oral lichenoid lesions after replacement of amalgam restoration in patients allergic to mercury compounds. Br. J. Dermatol., 126(1). 10-5, 1992
147 Stejskal, V.D.M., et al.: Mercury-specific lymphocytes: an indication of mercury allergy in man. J. Clin. Immunol., 16(1): 31-40, 1996
148 Henriksson, E., et al.: Healing of lichenoid reactions following removal of amalgam. A clinical follow-up. J. Clin. Periodontol., 22(4): 287-94, 1995
149 Smart, E.R., et al.: Resolution of lichen planus following removal of amalgam restorations in patients with proven allergy to mercury salts: a pilot study. Br. Dent. J., 178(3): 108-12, 1995
150 Mobacken, H. et al.: Material. Cont. Derm., 10: 11-15, 1984
151 Macleod, R.I. et al.: J. Dent. Res., Divisional Abstracts, page 738, Abstract # 410, 1993
152 Schrallhammer-Benkler, K., et al.: Acta derm. Venerol (Stockh)71(4): 294-6, 1992
153 Ahlrot-Westerlund, B.: Mercury in cerebrospinal fluid in multiple sclerosis. Swed. J. Biol. Med., 1:6, 1989
154 Stejskal, V.D.M. et al.: J. of Clin. Immun. Vol 16, No. 1, pp. 31-40, 1996
155 Siblerud, R.L.: A comparison of mental health of multiple sclerosis patients with silver/mercury dental fillings and those with fillings removed. Psychol. Rep., 70:3 Pt 2, 1139-51, 1992
156 Ingalls, T.H.: Epidemiology, etiology, and prevention of multiple sclerosis. Hypothesis and fact. Am. J. Forensic Med. Pathol., 4:1, 55-61, 1983
157 Siblerud, R.L., Kienholz, E.: Evidence that mercury from silver amalgam fillings may be an etiological factor in multiple sclerosis. Sci. Total Environ., 142(3): 191-205, 1994
158 Craelius, W.: Comparative Epidemiology of multiple sclerosis and dental caries. J. Epidemiology and Community Health, 32, 155-165, 1978
159 Huysmans, M.C. et al.: Fatigue behavior of direct post-and-core-restored premolars. J. Dent. Res., 71(5): 1145-50, 1992
160 Huysmans, M.C., et al.: Finite element analysts of quasistatic and fatigue failure of post and cores [published erratum appears in J.Dent. Res., 21(3):190] J. Dent., 21(1): 57-64, 1993
161 Siblerud, R.L.: The relationship between mercury from dental amalgam and the cardiovascular system. Sci. Total Environ., 99(1-2): 23-35, 1990
162 Ronnback, L., Hansson, E.: Chronic encephalopaties induced by mercury or lead: aspects of underlying cellular and molecular mechanisms. Br. J. Ind. Med., 49: 233-240, 1992
163 McNerney, R.T., McNerney J.J.: Mercury contamination in the dental office. A review. NYS Dental J., pp 457-458, 1979
164 Sandborgh Englund, G., et al.: DMSA administration to patients with alleged mercury poisoning from dental amalgams: a placebo-controlled study. J. Dent. Res., 73(3): 620-8, 1994
165 Weaver, T., et al.: An amalgam tattoo causing local and systemic disease? Oral Surg Oral Med Oral Pathol, 63(1): 137-40, 1987
166 Siblerud, R.L., et al.: Psychometric evidence that mercury from silver amalgam fillings may be an etiological factor in depression, excessive anger and anxiety. Psychol. Rep., 74(1): 67-80, 1994
167 Michel, E., et al.: An epidemiologic study of the relation between symptoms of fatigue, dental amalgam and other factors. Department of occupational medicine, University Hospital, Uppsala, Sweden, Sew-Dent-J., 13(1-2): 33-8, 1989
168 Florentine, M.J., Sanfilippo, D.J., II. Elemental mercury poisoning clinical pharmacy. 10: 213-21, 1991
169 Benton, D., et al.: The impact of selenium supplementation on mood. Biological Psychiatry, 9(11): 1092-1098, 1991
170 Bloch, P., Shapiro I.M.: Summary of the international conference on mercury hazards in dental practice. JADA, 104: 489-90, 1982
171 Silverstein: Modulation of heart muscle mitochondrial malate dehydrogenase activity. I. Activation and inhibition by p-mercuribenzoate. Biochemistry, 9(2): 274-82, 1970
172 Differential effects of mercurial reagents on membrane thiols and on the permeability of the heart mitochondrion. Biochemistry, 9(4): 714-24, 1970
173 Manoukian, S.V., Wenger, N.K.: Mercury in the heart. Am. J. Cardiol., 67(4): 317-8, 1991
174 Shimojo, N., Arai, Y.: Effects of exercise training on the distribution of metallic mercury in mice. Hum Exp Toxicol., 13(8): 524-528, 1994
175 Magos, L., et al.: The effects of dose of elemental mercury and first-pass circulation time on exhalation and organ distribution of inorganic mercury in rats. Biochem Biophys Acta. 25; 991(1):85-9, 1989
176 Lindh, U., et al.: New Aspects of Murine Coxsackie B3 Myocarditis – Focus on Heavy Metals. Ilback, NG; Eur Heart J., 16(Suppl 0):20-4, 1995
177 Omura, Y., Shimotsnura, Y., Fukuoka, A., Fukuoka, H., Nomoto, T.: Significant mercury deposits in internal organs following the removal of dental amalgam, and development of pre-cancer on the gingiva and the sides of the tongue and their represented organs as a result of inadvertent exposure to strong curing light (used to solidify synthetic dental filling material) and effective treatment: A clinical case report, along with organ representation areas for each tooth. Acupunct Electrother Res., 21(2):133-60, 1996
178 Foster, H.D.: Landscapes of Longevity: The Calcium-Selenium Mercury connection in cancer and heart disease. Med Hypotheses, 48(4): 355-60, 1997
179 Chavez, E. and Holguin, J.A.: Mitochondrial calcium release as induced by Hg2+. J. Biol. Chem., 263(8):3582-3587, 1988
180 Chen, C.W. and Preston, R.L.: Effect of mercury on taurine transport by the red blood cells of the murine polychate, Glycera dibranciata. Bull Environ. Contam. Toxicol., 39(2): 202-208, 1987
181 Mehra, M. and Kanwar, K.C.: Clearance of parenterally administered 203 Hg from the mouse tissues. J. Environ. Pathol. Toxicol. Oncol., 5(4-5): 127-30, 1984
182 Brake, J., et al.: Mercury induced cardiovascular abnormalities in the chicken. Arch. Environ. Contam. Toxicol., 6(2-3): 269-77, 1977
183 Mechanisms in cardiovascular regulation following chronic exposure of male rats to inorganic mercury. Toxicol. Appl. Pharmacol., 69(3):442-50, 1983
184 Klein, C.L., et al.: Increased adhesion and activation of polymorphonuclear neutropohil granulocytes to endothelial cells under heavy metal exposure in vitro. Pathobiology, 62(2): 90-98, 1994
185 Ringstad, I. & Fonnebo, V.: The tromso heart study: serum in a low-risk population for cardiovascular disease and cancer and matched controls. Ann. Clin. Res., 19:351-54, 1987
186 Wojciechowski, J. and Kowalski, W.: Cardiac and aortic lesions in chronic experimental poisoning with mercury vapors. Pol. Med. Sci. Hist. Bull., 15(2): 255-60, 1996
187 Schottel, J., et al.: Nature, 251, 335, 1974
188 Marcusson, J.A.: Psychological and somatic subjective symptoms as a result of dermatological patch testing with metallic mercury and phenyl mercuric acetate. Toxicol. Lett., 84(2): 113-22, 1996
189 Lamperti, A. and Printz, R.: Localization, accumulation and toxic effects of mercuric chloride on the reproductive axis of the female hamster. 11; 180-86, 1974
190 Lamperti, A. and Niewenhuis, T.: The effects of mercury on the structure and function of the hypothalamo-pituitary axis in the hamster. Cell. Tissue Res., 170; 315-324, 1976
191 Mikhailova, L., et al.: The influence of occupational factors on diseases of the female reproductive organs. Pediatr. Akush. Ginecol., 33; 56-58, 1971
192 Panova, Z. and Dimitrov, G.: Ovarian function in women with occupational exposure to metallic mercury. Akush. Ginekol., 13; 29-34, 1974
193 Goncharuk, G.: Problems relating to the occupational hygiene for women employed in mercury production. Gig. Tr. Prof. Zabol., 5; 17-20, 1977
194 Barlow, S. and Sullivan, F.: “Mercury and its compounds (inorganic)”, in Barlow, S. and Sullivan, F. Editors, Reproductive hazards of industrial chemicals: an evaluation of animal and human data, New York and London: Academic Press
195 DeRosis, F. et al.: Female reproductive health in two lamp factories: effects of exposure to inorganic mercury vapor and stress factors. Br. J. Ind. Med., 42; 488-494, 1985
196 Sikorski, R. et al.: Women in dental surgeries: Reproductive hazards in occupational exposure to metallic mercury. Int. Arch. Occup. Environ. Health, 59; 551-7, 1987
197 Iwasaki, A. and Gagnon, C.: Formation of reactive oxygen species in spermatozoa of infertile patients. Fertil Steril, 57(2): 409-16, 1992
198 Aitken, R. et al.: Use of xanthine oxidase free radical generating system to investigate the cytotoxic effects of reactive oxygen species on human spermatozoa. J. Reprod. Fertil., 97(2): 441-50, 1993
199 Webb, J.: Enzyme and metabolic inhibitor, Volume 4, Academic Press, 727-1070, 1966
200 Hirota, Y. et al.: Inhibitory effect of methyl mercury on the activity of glutathione peroxidase. Toxicol. Appl. Pharmacol., 53; 174-6, 1980
201 Holmstrup, P.: Oral mucosa and skin reaction related to amalgam. Adv. Dent. Res., 6:120-4, 1992
202 Bradberry, S.M., et al.: Elemental mercury-induced skin granuloma: a case report and review of the literature. J. Toxicol. Clin. Toxicol., 34(2): 209-16, 1996
203 Hamdy, M.K. and Noyes, O.R.: Formation of methyl mercury by bacteria. Applied Microbiology, Vol 30, No. 3, 424-432, 1975
204 Langworth, S., et al.: Minor effects of low exposure to inorganic mercury on the human immune system. Sacnd. J. Work. Environ. Health, 19(6): 405-13, 1993
205 Sasaki, G., et al.: Three cases of linear lichen planus caused by dental metal compounds. Dermatol., 23:12 890-2, 1996
206 Bass, M.H.: Idiosyncrasy to metallic mercury, with special reference to amalgam fillings in the teeth. J. Pediat., 23: 215-8, 1943
207 Cooper, R.L., et al.: Effects of metal cations on pitiuary hormone secretion in vitro. J. Biochem. Toxicol., 2: 241-9, 1987
208 Gerhard, I. & Runnebaum, B.: Fertility disorders may result from heavy metal and pesticide contamination which limits effectiveness of hormone therapy. Zentralblatt für Gynäkologie, 14: 593-602, 1992
209 Summers, A.O.and Lewis, E.: J. Bacterial., 113, 1070, 1973
210 Bakir, F. et al.: Clinical and epidemiological aspects of methyl mercury poisoning. Postgrad. Med. J., 56(651):1-10, 1980
211 Murai, Y., Shiraishi, S., Yamashita, Y., Ohnishi, A., Arimura, K.: Neurophysiological effects of methyl mercury on the nervous system. Electroencephalogr. Clin. Neurophysiol. Suppl., 36: 682-7, 1982
212 Brunker, R.L. and Bott, T.L.: Reduction of mercury to the elemental state by a yeast. Appl. Microbiology, Vol. 27, No. 5, 870-3, 1974
213 Martinez Vazquez, C. et al.: Evoked potentials and psychometric tests in the diagnosis of subclinical neurological damage in a group of workers exposed to low concentrations of mercury vapor (see comments). An. Med. Interna., 13(5): 211-6, 1996
214 Pan Hou, H.S. and Imura, N.: Involvement of mercury Methylation in microbial mercury detoxification. Arch. Microbiol., 131: 176-177, 1982
215 Bisogni, J.J. and Lawrence, A.W.: Kinetics of mercury Methylation in aerobic and anaerobic aquatic environments. J. Water Pollut. Control. Fed., 47: 135-152, 1975
216 Hua, M.S. et al.: Chronic elemental mercury intoxication: Neuropsychological follow-up case study. Brain Inj., 10(5): 377-84, 1996
217 Snapp, K. et al.: Contribution of dental amalgam to blood mercury levels. J. Dent. Res., Special Issue March 1986, Abstract fl. 276, 65; 311
218 Nilsson, B. and Nilsson, B.: Mercury in blood and urine in dental personnel. Swed. Dent. J., 2: 280, 1987
219 Gowdy, J.M., and Demers, F.X.: Whole blood mercury levels in mental hospital patients. Am. J. Psychiat., 135: 115, 1978
220 Richter-Snapp, K. et al.: The contribution of dental amalgam to mercury in blood. J. Dent. Res., 68: 314, Abstract 1059, 1989 (Dows Inst. For Dent. Res., University of Iowa)
221 Magos, L.: Mercury-blood interaction and mercury uptake by the brain after vapor exposure. Environ. Res., 1: 323-37, 1967
222 American Dental Assoc. Workshop: Biocompatibility of metals in dentistry (NIDR). A recommended standard for occupational exposure to inorganic mercury. NTIS No. PB- 222 223, 1973
223 Grandjean, P., et al.: Neurotoxicol. Teratol., 19(6): 417-28, 1997
224 Heintze, U. et al.: Methylation of mercury from dental amalgam and mercuric chloride by oral streptococci. Scand. J. Dent. Res., 91:2, pp 150-52, 1983
225 Rowland, A.S., et al.: The effect of occupational exposure to mercury vapor on the fertility of female dental assistants. Occup. Environ. Med., 51(1): 28-34, 1994
226 Mandel, I: JADA Vol. 122, 1991
227 Gordon, H.P. and Cordon, L.D.: Reduction in mercury vapour levels in Seattle dental offices. J. Dent. Res., Abstract 1092 57A:347, 1981
228 Akesson, et al.: Archives of environmental health, v62, n2, p102(8), 1991
229 Cross, J.D., et al.: Letter, Lancet, 2: 8084 pp312-13, 1978
230 Danielsson, B.R., et al.: Behavioral effects of prenatal metallic mercury exposure in rats. Neurotoxicol. Teratol., 15(6): 391-396, 1993
231 Nylander: Mercury in pituitary glands of dentists. Lancet, 1(8478): 442, 1986
232 Akesson, I., et al.: Neuropathy in female dental personnel exposed to high frequency vibrations. Occup. Environ. Med., 52(2): 116-23, 1995
233 Skare: Mercury exposure of different origins among dentists and dental nurses. Scand. J. Work Environ. Health, 16(5): 340-7, 1990
234 Wood, R.W., et al.: Hand tremor induced by industrial exposure to inorganic mercury. Arch. Environ. Health, 26: 249-52, 1973
235 Mantyla, D.G. and Wright, O.D.: Mercury toxicity in the dental office: a neglected problem. JADA, 92: 1189-94, 1976
236 Fredriksson, A. et al.: Prenatal Coexposure to metallic mercury vapour and methyl mercury produce interactive behavioral changes in adult rats. Neurotoxicol. Teratol., 18(2): 129-34, 1996
237 Oskarsson, A., et al.: Exposure to toxic elements via breast milk. Analyst, 120(3): 765-70, 1995
238 Shapiro, I.M., et al.: Neurophysiological and neuropsychological function in mercury-exposed dentists. Lancet, 8282: 1147-50, 1982
239 Ship, I.I. and Shapiro, I.M.: Mercury poisoning in dental practice. Compendium Continuing Education. 4: 107-110, 1983
240 Miller, J.M., et al.: Subclinical psychomotor and neuromuscular changes in workers exposed to inorganic mercury. A. Indus. Hyg. Assoc. J., 36: 725-33, 1975
241 Lyer, K., et al.: Mercury poisoning in a dentist. Arch. Neurol., 33:788-90, 1976
242 Merfield, D.P., et al.: Mercury intoxication in a dental surgery following unreported spillage. Bril. Dent. J., 141: 179-86, 1976
243 Barber, T.E.: Inorganic mercury intoxication reminiscent of amyotrophic lateral sclerosis. J. Occupat. Med., 20: 667-9, 1978
244 Smith, Jr. D.L.: Mental effects of mercury poisoning. South Med. J., 71: 904-5, 1978
245 Langolf, G.D., et al.: Evaluation of workers exposed to elemental mercury using quantitative tests of tremor and neuromuscular functions. Am. Ind. Hyg. Assoc., 39(12): 976-84, 1978
246 Zweben, L.L.: Mercury poisoning: A case history. J. New Jersey Dent. Assoc., 10-1, 1978
247 Albers, J.W. et al.: Asymptomatic sensorimotor polyneuropathy in workers exposed to elemental mercury. Neurology, 32: 1168-74, 1982
248 Adams, C.R., et al.: Mercury intoxication simulating amyotrophic lateral sclerosis. J. Amer. Med. Assoc., 250:642-3, 1983
249 Cook, T.A. and Yates, P.O.: Fatal mercury intoxication in dental surgery assistant. Br. Dent. J., 127: 553-5, 1969
250 Ritchie, K.A. et al.: Psychomotor testing of dentists with chronic low-level mercury exposure. J. Dent. Res., 74(S1): 420, A-160
251 Schumann, K.: The toxicological estimation of the heavy metal content (Cd, Hg, Pb) in food for infants and small children. Z. Ernährungswiss., 29(1): 54-73, 1990
252 Vimy et al.: Maternal-fetal distribution of mercury released from dental amalgam fillings. Am. J. Physiol., 258 R939-R945, 1990
253 Vimy et al.: Mercury from maternal “silver” tooth fillings in sheep and human breast milk. Biological Trace Element Research, V56, pp143, 1997
254 Warfinge, K., et al.: Development of prenatal exposure to mercury vapor. Neurotoxicology, 15(4), 1994
255 Cutright, D.E., et al.: Systemic mercury levels caused by inhaling mist during high-speed amalgam grinding. J. Oral Med., 28, 100, 1973
256 EPA Mercury Health Effects update. Health Issue Assessment. EOA-600/8-84f. USEPA, 1984
257 Goyer, R.A.: Toxic effects of metals. Cassarett and Doull’s toxicology – The basic science of poisons, ed3, New York, MacMillan, Publ. Co, pp582-609, 1986
258 Kuhnert, P. et al.: Comparison of mercury levels in maternal blood fetal chord and placental tissue. Am. J. Obstet and Gynecol., 139: 209-12, 1981
259 Kuntz, W.D.: Maternal and chord blood mercury background levels; Longitudinal surveillance. Am. J. Obstet and Gynecol., 143: 440-443, 1982
260 Brodsky, J.B.: Occupational exposure to mercury in dentistry and pregnancy outcome. JADA 111(11): 779-80, 1985
261 Yoshida, M., et al.: Milk transfer and tissue uptake of mercury in suckling offspring after exposure of lactating maternal guinea pigs to inorganic or methyl mercury. Arch. Toxicol., 68(3): 174-8, 1994
262 Ellender, G., et al.: Toxic effects of dental amalgam implants. Optical, histological and histochemical observations. Aust. Dent. J., 23:5 pp395-99, 1978
263 Fisher, D., et al.: A 4 year follow-up study of alveolar bone height influenced by 2 dissimilar class 2 amalgam restorations.
264 Freden, H., et al.: Mercury content in gingival tissues adjacent to amalgam fillings. Odont. Rev., 25: 207-210, 1974
265 Koivumaa, K.K. and Makila, E.: The effect of galvanism on accumulation of bacterial plaque invivo. Suom Hammaslaak Toim., 66: 367-371, 1970
266 Lindquist & Mornstad: Effects of removing amalgam fillings from patients with diseases affecting the immune system. Medical Science Research., 24, 1996
267 Bratel, J., et al.: Effect of replacement of dental amalgam on oral lichenoid reactions. J. Dent., 24(1-2): 41-45, 1996
268 Ibbotson, S.H., et al.: The relevance and effect of amalgam replacement in subjects with oral lichenoid reactions. Br. J. Dermatol., 134(3): 420-3, 1996
269 James, J., et al.: Oral lichenoid reactions related to mercury sensitivity. Br. J. Oral Maxillofac. Surg., 25(6): 474-480, 1987
270 Jameson, M.W. et al.: Mucosal reactions to amalgam restorations. J. Oral Rehabil., 17(4): 293-301, 1990
271 Koch, P. and Bahmer, F.A.: Oral lichenoid lesions, Hg hypersensitivity and combined hypersensitivity to mercury and other metals. Contact Dermatitis, 33(5): 323-328, 1995
272 Lind, P.O., et al.: Electrogalvanically-induced contact allergy of the oral mucosa. Report of a case. Int. J. Oral Surg., 13(4):339-345, 1984
273 Lind, P.O., et al.: Amalgam-related oral lichenoid reaction. Scand. J. Dent. Res., 94(5): 448-451, 1986
274 Pang, B.K. and Freeman, S.: Oral lichenoid lesions caused by allergy to mercury in amalgam fillings. Contact Dermatitis, 33(6): 423-427, 1995
275 Skoglund, A. and Egelrud, T.: Hypersensitivity reactions to dental materials in patients with lichenoid oral mucosal lesions and in patients with burning mouth syndrome. Scand. J. Dent. Res., 99(4): 320-8, 1991
276 Fox, J.G. and Jones, J.M.: Occupational stress in dental practice. B.D.J., 123:10 pp 465-473, 1967
277 Iyer, K., et al.: Mercury poisoning in a dentist. Arch. Neurol., 33: pp788-90, 1976
278 Ship, I.I. and Shapiro, I.M.: Preventing mercury poisoning in dental practice. The J. of the Houston District Dental Society, pp18-20, 1983
279 Simpson, R., et al.: Suicide statistics of dentists in Iowa 1968-1980. JADA 107, 441-3, 1983
280 Fox, C.H., et al.: Periodontal disease among New England elders. Journal of Periodontology, Vol 65, No. 7, pg. 676-684, 1994
281 Mattila, K.J. et al.: Association between dental health and acute myocardial infarction. British Medical J., Vol. 298, pg 779-782, 1989
282 DeStefano, F.D., et al.: Dental disease and risk of coronary heart disease and mortality. Br. Med. J., Vol. 306, 688-691, 1993
283 Joshipura, K.J. et al.: Poor oral health and coronary heart disease. Journal of dental Research, Vol. 75, No. 9, 1631-1636, 1996
284 Beck, J.D.: Periodontal disease and cardiovascular disease. Presented at the symposium: The relation of periodontal infection to systemic diseases. Bufallo N.Y., May 20, 1995
285 Offenbacher, S., et al.: Periodontal infection as a possible risk factor for preterm low birth weight. J. Periodontology, 1996
286 Pendergrass and Haley: Mercury and its effects on environment and biology in metal ions in biological systems. V 34, 461-478, 1997, Marcel Dekker, Inc. NY, NY
287 Brun, R.: Epidemiology of contact dermatitis in Geneva. Contact dermatitis, 1: 214-7, 1975
288 Djerassi, E. and Berova, N.: The possibilities of allergic reactions from silver amalgam restorations. Int. Dent. J., 19:4, 481-88, 1969
289 Miller, E.G., et al.: Prevalence of mercury hypersensitivity in dental students. J. Dent. Res., 64:338 Special issue abstracts # 1472, 1985
290 Nebenfuher, L., et al.: Mercury allergy in Budapest. Contact Dermatitis, 10(2): 121-122, 1983
291 Rudner, et al.: Epidemiology of contact dermatitis in North America. Arch. Derm., 108(4): 537-40, 1973, 1996
292 White, R. and Brandt, R.: Development of mercury hypersensitivity among dental students. JADA, 92: 1204-1207, 1976
293 Ahlbom, A. et al.: Dentists, Nurses and Brain Tumors: 4th International Symposium Epidemiology Occupational Health, Como, Italy, 10-12 September 1985 (Abstracts)
294 Arrhenius, E.: Methyl mercury in fish – a toxicologic-epidemiologic evaluation. Nord Hygien. Tidskr., suppl 4, pp166, 1971
295 Kuntz, W.D., et al.: Maternal and chord blood background mercury levels: A longitudinal surveillance. Am. J. Obstet. Gynecol., pp440-443, 1982
296 Mansour, M., et al.: Maternal-fetal transfer of organic mercury via placenta and milk. Env. Res., 6: pp 479-484, 1973
297 Nixon, G.S., et al.: Pregnancy outcome in female dentists. B.D.J. 146, pp 39-42, 1979
Pitkin, R.M. et al.: Mercury in human maternal and cord blood, placenta and milk. Proceedings of the society for experimental biology and medicine, 151 pp565-567,