I have found some studies on pub med that question that ALA should be used without dmsa. Cutler disagrees and his rational is in biochem speak so it is hard for the layman to form an intelligent opinion. Below is a pretty good read on ALA with the last few paragraphs expressing concern the it could mobilize by not eliminate mercury without dsma. Dmsa is cheap - so why not use it with ala. I just added ala to my dmsa rounds and am experiencing a burst of energy after the last round. I have my fingers crossed.