(Excerpt from Dental Mercury Detox by Sam Ziff, Michael Ziff, D.D.S., Mats Hanson, Ph.D.)
A question we are frequently asked concerns supplementation programs prior to, as well as after amalgam replacement. To help your body in detoxifying or reducing any existing body burden of mercury and to also assist you in coping with any additional exposure that might result from amalgam removal, the following regimen provides the nutrients that, based on the scientific literature, may be of help.  This should not be confused with the "self-testing" program previously outlined which was designed to determine if mercury was involved in the etiology of any symptoms you might have had.

SPECIAL NOTE: The following list comprises all of the nutrients that the scientific literature has indicated may be of benefit during your dental program.  It does not necessarily mean that you should take all of them as part of your own individual program.  The ones deemed absolutely essential have been marked with a solid box. Furthermore, if you have been on a supplementation program you may be able to find specific formulas that provide a great many of the nutrients in a single capsule or capulet requiring you only to take as many as needed to achieve the desired amounts of each nutrient.

Should be started as soon as possible, preferably one month, but no later than two weeks prior to first amalgam replacement.

1.  Glutathione: One 50 milligram capsule or tablet, three times a day taken on an empty stomach.  CAUTION:
Individuals with insulin deficiency should not take Glutathione.

2. Methionine: One 200-500 milligram tablet two-three times a day on the same schedule indicated for glutathione. The desired intake is 1000 mg/day.  As with all new supplements added to your program, it is prudent to start out taking only one tablet a day for the first three or four days to insure that you are not having any reaction.  If no problems are experienced then add the second and third tablets.  The importance of adding methionine to your detoxification program is explained nicely by Dr's. Braverman and Pfeiffer in the following statement:
'Glutathione contains cysteine, glycine and glutamic acid, but of these, only cysteine ever seems to be in short supply.. .The liver apparently manufactures glutathione whenever extra cysteine is available.  Blood glutathione levels change in direct proportion to the amount of cysteine in the diet. "(10) Methionine levels are a major determinant in the liver's concentration of sulphur-containing compounds, such as glutathione and cysteine.(32)  As methionine is the precursor for the manufacture of cysteine in the body, extra supplementation of this critical amino acid should increase available cysteine.

3. N-Acetyl-L-Cysteine (NAC). NAC forms L-cysteine, cystine, L-methionine, glutathione (GSH), and mixed di-sulfides. This compound (used by the medical profession to treat acetaminophen overdose) has the ability of being able to stimulate your own body to produce large amounts of cysteine and glutathione, thus greatly augmenting plasma and red blood cell content of both cysteine and glutathione.(l0) In experiments where animals were exposed to mercury vapor, NAC treatment increased survival time and decreased mercury levels in blood, lung and kidney.(12, 13)

 4. Methylsulfonylmethane MSM®. We have added this product because it provides a bioavailable dietary source of sulfur.  MSM, which contains other ingredients besides sulfur, can exert a direct beneficial effect in ameliorating a variety of allergic responses and pain associated with systemic inflammatory disorders.(14) Although at this time we have no published research outlining its use in mercury toxicity, there is a wealth of data demonstrating the essentialness of sulfur in the formation of disulfide bonds and the proper conformation of body proteins. This in turn provides the biochemical basis for its inclusion in this protocol. Another very important rationale for its inclusion in our detoxification protocol is that Fredrik Berglund, M.D. in Sweden has been using elemental sulfur in treating amalgam bearers after exchange of their mercury-containing fillings.  It is our understanding that positive results are being achieved especially for problems associated with gastrointestinal functions and the eyes.  It is possible that as more experience is obtained in the use of MSM  in the treatment of mercury toxicity, it may assume a primary role in mercury detoxification.  The recommended maintenance dose of MSM is 500-2000 mg per day.

5.  Silymarin (Milk Thistle):  One 100 mg tablet or capsule three times per day with meals.  Silymarin will provide support and protection against liver toxins which can cause free-radical-mediated oxidative damage. Silymarin is many times more potent in antioxidant activity than vitamin
E. In addition it will increase liver production of glutathione and protect red blood cell membranes against lipid peroxidation and hemolysis.

6.  Vitamin B6 (Pyridoxine): One 50 milligram tablet per day with breakfast. B6 is needed in the metabolic process that converts methionine to cysteine and then into glutathione.  NOTE: Clinical experience has demonstrated that vitamin B6 is capable of reducing and controlling the swelling and pain associated with the routine tissue and bone trauma resulting from normal dental operative procedures. Typical dosages used to assist in the reduction of post-operative swelling have been 100 to 200 milligrams one hour prior to dental work, and an additional 100 to 200 milligrams after you get home from the dental office. This can be followed the next day with 200-300 milligrams more if the swelling has persisted.
Do not use the dosages indicated for more than 3-4 days. Supplementation at high doses for any prolonged period should only be done under your physician's supervision.

7.  Vitamin C: One 500 milligram tablet with each meal. It should be noted that most vitamin C products are derived from corn.  If you have known allergies to corn, there are products available made out of Sago Palm. [NOTE:
Clinical experience has shown that in some individuals, vitamin C can affect the way they respond to dental anesthesia. In some, the anesthetizing effects are dissipated more quickly than desired, while in others the dentist is unable to anesthetize the work area at all. Therefore, as a general guideline, do not take any vitamin C for 12 hours before your scheduled dental appointment.]

8.  Zinc: One 15-30 milligram tablet after supper.

9.  Magnesium: Two or more tablets or capsules per day providing a total of 200 milligrams of elemental magnesium, taken after supper or at bed time. Please read the label.  Labels on minerals will usually state the total number of milligrams of the mineral it takes to provide the elemental dosage.

10.  Vitamin B1: One 50 milligram tablet with each meal. On the day of your dental appointment you may wish to increase your dosage of vitamin B1 to 200-500 milligrams one hour before your dental appointment.  Research has shown that vitamin B1 is capable of reducing pain that may be associated with routine dental operative procedures.(33) Increased dosages may be used the following day to assist in controlling residual pain.  Although we have not seen any research specifically applied to the use of vitamin B1 for reduction of mercury body burden, there is a study demonstrating that 2000 milligrams per day was very effective in reducing the body burden of lead.  Lead, as you know, has many of the same biochemical pathways as mercury.(34)  As with any supplement or medication, do not stay on high intakes for any extended period without consultation with your physician.

11.  Add Vitamin E.  If you have previously taken vitamin E and experienced no blood pressure changes, then you can supplement with 100-400 IU capsules. The desired dosage should be 800-1200 IU per day.  If you have previously experienced any adverse blood pressure reaction with vitamin E, then you should start with the lowest potency available and take no more than 50-100 IU per day for the first 30 days.  Discontinue taking vitamin B if at any time you experience an adverse reaction or increase in blood pressure. For those individuals who are very allergic, care should be exercised with regard to the derivative source of the vitamin B; for example, the soya bean is a common source of vitamin B because of the availability of the raw material, wheat is the next most important source, etc. Insure that you get a product to which you are not allergic. Products of oxidation such as lipid peroxides, which can be caused by mercury, are converted to harmless products by vitamin E and glutathione peroxidase (a selenium containing enzyme derived from glutathione and selenium).  Wheat germ oil, sunflower seeds, safflower oil, almonds, sesame oil, peanut oil, corn oil, wheat germ, peanuts, olive oil, soybean oil and peanut butter are food sources of vitamin B in descending order of highest occurrence.(35)

12.  Selenium: One 50 microgram tablet (or liquid equivalent of sodium selenite).  Vitamin C precipitates selenium, making it unavailable for absorption.  The two supplements should be taken at least two hours apart from each other.  As stated earlier, some individuals may react adversely to selenium, so caution should be exercised. (Note: Some manufacturers now provide products combining both selenium and vitamin B).

13.  Acidophilus capsules, powder, or liquid:
Acidophilus, or yogurt with live acidophilus culture, taken regularly will help restore the microflora of the intestine which can be adversely affected by the presence of mercury in any form.  Aside from the mercury related aspects, acidophilus has been shown to: "reduce bad breath by replacing organisms responsible for unpleasant odors with neutral organisms; reduce flatulence (intestinal gas) by breaking down sugars (including lactose) that promote and are consumed by methane-producing bacteria; regulate cholesterol by promoting normal absorption of dietary fats, facilitate the elimination of unwanted cholesterol before it is absorbed; and provide adaptogenic control (normalization) of constipation and diarrhea. "(36) Please read the product information to determine when you should take the particular supplement you are purchasing.

The above comprises the primary nutrients that have been scientifically shown to assist in the elimination of mercury from the body or to afford some degree of protection from mercury induced damage.  In addition, the following products have all been shown to be of benefit and their addition to any program is at the reader's option:

14. B Complex: Should provide at least 15-25 milligrams of each of the various B vitamins.  Take the number of tablets indicated to provide the desired amounts.  [NOTE; A word of caution concerning those individuals taking large amounts or injections of vitamin B12.  There is limited scientific information indicating that vitamin B12 can methylate mercury.  Consequently, during the entire amalgam replacement process, every effort should be made to eliminate excess B12 intake.  If you must receive B12 injections, request your physician to use hydroxocobalamin.]

15. Activated charcoal, taken immediately (15 minutes) before drilling/chunking out amalgam, will bind any swallowed mercury and also prevent enterohepatic recirculation of the metal (excretion with the bile and reabsorption further down the intestines).  Take a second dose immediately after treatment.  There is some evidence that NAC and methionine will adsorb to charcoal, reducing their availability.  Therefore, charcoal should not be routinely used in your detoxification program other than during dental appointments, where the increased potential of mercury exposure exists.

16. Garlic products contain high levels of sulfur and some contain selenium.  Research has shown that garlic protects against many harmful conditions including mercury poisoning. Most preparations on the market today are odor free.

17. Bromelain:  Bromelain is a powerful proteolytic enzyme derived from pineapple.  Clinical evidence indicates it can help reduce swelling and inflammation. (37)  If you are going to use it to help minimize any swelling or inflammation that may result from dental operative procedures, a couple of days before your dental appointment take 500 mg of bromelain twice daily. Take between meals with a full glass of water.

SPECIAL NOTE: As indicated earlier under the supplementation section, the ideal situation is to be under the care and supervision of a qualified physician or health professional.  In this regard, unless your physician has specifically prescribed iron and copper supplements for you, please refrain from taking any supplement that contains iron and copper.  If you are starting on your own program and have not been taking vitamin supplements, it is important that you phase slowly into the program, giving your body a chance to adjust and balance to the changes.

If, after amalgam replacement, you are not experiencing any problems, no change in supplementation is required. However, you should be aware that it is not unusual to experience an exacerbation of existing symptoms or to develop flu-like symptoms for two or three days following an amalgam replacement appointment. Consequently, if after a week there has been a worsening of any existing symptoms or you experience new symptoms, you can make the following changes to the program. If you have experienced new symptoms not present prior to supplementation, they may be caused by either the supplement itself or the particular brand you are taking.  (Most manufacturers use different types of fillers to meet existing tablet-size requirements) If you do feel it is the supplements, then stop taking everything and start retaking them one at a time for two or three day periods in an attempt to isolate the particular offender.  If, however, the supplements have been well tolerated and the reaction has occurred only after amalgam replacement, try the following steps.  If, after increasing dosages as indicated you experience an exacerbation of any symptomatology, stop taking all supplements and seek professional assistance.

1. Increase the glutathione to two capsules three times per day for a total of 6 capsules or 300 milligrams.

2. Increase vitamin C to 1,000 milligrams with each meal and 1 ,000 milligrams 1 hour after supper.

3. Add pantothenic acid. One 100 milligram tablet with breakfast and supper.

4. Add an amino acid complex. Mercury has the ability to deplete or impair utilization of several amino acids. Clinical experience of some physicians indicates that the addition of an amino acid complex has supplied the proper balance in intractable cases.  Take one hour before meals or at bedtime.

Preferably, detoxification should be started one month, but no less than two weeks before scheduled amalgam removal/replacement and continued throughout the treatment plan.  After completion of your dental treatment plan, continue on the detoxification protocols for an additional 30-60 days. You will be the best judge, based on how you are feeling, as to when to reduce, modify, or stop the supplements.

As stated elsewhere in this book, detoxification is more than just taking supplements.  Dietary and lifestyle modifications are an essential adjunct to supplementation. In this regard, please pay special attention to the information contained in Appendix B, which explains the benefits of a high-fibre diet as an integral part of your detoxification process. Additionally you should give up chewing gum until all the mercury amalgam fillings have been replaced.  If possible, weekly sweat therapy should be instituted at the same time as supplementation.  Sweat therapy does not mandate steam baths or saunas.  Any exercise or activity that causes sweating serves the desired purpose of inducing the excretion of toxins and heavy metals through the skin. Regardless of the modality used, the objective should be to participate in the sweat generating activity for at least 30 minutes per session.
NOTE: Pregnant women and individuals with high blood pressure or heart disease should obtain approval from their physician before initiating sweat therapy.

The last point we would like to make concerns the proper protocols for the removal of mercury amalgam dental fillings. Try to locate a dentist who knows about protecting his patients from mercury and does not place mercury fillings, (mercury-free). Some people react to the levels of mercury vapor at the dentist's office.

There are special techniques utilized by your dentist to remove mercury amalgam fillings. If done properly, there is minimum exposure to increased levels of mercury vapor caused by the removal procedure.  However, we feel it important that you should be aware of certain aspects related to removing mercury from the oral environment:

1. The office and operatory should be well-ventilated.

2. The dentist should have an assistant present to assist in minimizing their exposure, and yours, to any mercury vapor. The correct protocol requires the use of high volumes of cold water both from the drill and separate irrigation by the assistant, who should also be simultaneously using high volume suction evacuation of the vapor and particles resulting from the removal procedure. The requirement for copious amounts of cold water during amalgam removal is well documented and cannot be overly emphasized.(38) Even dentists who are not mercury-free should know this. Failure of a dentist to be aware of this should be considered a sign of a lack of knowledge on the subject. Sadly, some dentists still drill out old amalgam with very little or even no water spray. Should you encounter a dentist who is unaware or inattentive to this, you would be well advised to seek treatment elsewhere.

3. It is the volatility of mercury that necessitates all the precautions and correct techniques. Mercury vapor pressure doubles with every ten degree centigrade rise in temperature. One acceptable procedure that minimizes extensive grinding (which generates great temperature increases) involves sectioning the amalgam into chunks versus just grinding it out.
4. In some dental offices the dentist may ask you to breathe through a nose piece that will permit you to draw air from another area of the operatory or office. If the dentist has nitrous oxide/oxygen available and you have elected to use it, this will accomplish the same thing.

5. The use of the rubber dam during the amalgam removal procedure is still controversial at this time. Some believe it to be essential, while others maintain that it results in amalgam particles and mercury vapor being trapped under the dam during the entire procedure. These latter contend that careful attention to removal and evacuation results in lower mercury exposure to the patient.

6. Clean UPTM is a recently developed new type of oral aspirator/evacuator product from Sweden that is now available in the United States. The Clean Up device fits over the tooth being worked and applies a constant suction to the immediate work area, thereby greatly reducing extra-oral aerosol spray and possible infectious particulate. Clean UPTM is available in the United States and Canada from Future Dentistry, Inc.

7. During the procedure, the dentist and his assistant are at greater risk to mercury vapor exposure than the patient. To protect themselves, they will be putting on special mercury trapping masks and rubber gloves to protect them during repeated removal operations.

8. Don't be in a hurry. Current information indicates that it is better to replace only a few amalgams at a time, with several weeks in between appointments.

 Unless your physician or dentist has deemed it absolutely essential and critical to a diagnosis, do not permit x-rays of any kind to be taken during pregnancy. If dental x-rays are deemed essential, do not permit them to be taken unless a lead apron of suitable size is utilized to cover the area from the chin down over the abdomen. There is substantial scientific documentation demonstrating the toxic maternal and fetal effects from extremely low-dose radiation.(39,40)

 One question related to amalgam replacement that we get a great number of calls on deals with a protocol called "sequential removal." Sequential removal requires the dentist to measure and chart the electrical current of each filling
and to remove/and or replace the amalgam fillings based or the charted information, starting with the highest negative readings first.  There is no scientific data to support the use of sequential removal. Additionally, there is absolutely no scientific data to support the statements being made by the proponents of sequential removal that "if your dentist doesn't use sequential removal it will cause the mercury to be locked into the tissues." It has been well established scientifically that precise measurement of these electrical currents or comparison of the electrical currents emanating from various amalgams is not possible.  Amalgam is an unstable material to start with and measurements are of specific points on the filling, not the entire filling. Therefore, they cannot be compared to each other.

The simple truth is that most dentists around the world are replacing amalgam fillings with nonmetallic fillings by quadrant, usually starting with the quadrant that has the largest fillings, thus removing the largest source of mercury first.  The results achieved with removal by sequential removal cannot be distinguished from those achieved with quadrant removal.  Therefore, if your dentist has the equipment and wants to replace your amalgam fillings sequentially, there is no problem in allowing it. Just bear in mind that it is not a prerequisite for successful amalgam filling replacement.

One other aspect of the oral electrical phenomenon deals with having a gold crown, inlay or onlay that is making contact with an amalgam filling.  This condition causes an increased release of mercury vapor and accelerated corrosion of the amalgam filling. Gold can be affected in a negative way since it absorbs mercury vapor.  Therefore, if this condition exists in your mouth, the dentist may want to correct it first by replacing amalgam fillings in contact with gold.

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