*Note: underlined text are source links*  
Last year I became severely Gd toxic from Dotarem, but was fortunate to be greatly helped by a chelator/antioxidant with many names: NBMI, Irminix, Emeramide, OSR (emeramed.com).  As more Gd toxic individuals try NBMI, I have been hearing some first and secondhand accounts of side effects.  I am also hearing a lot of doubt about NBMI's effectiveness for Gd.  I thought I'd share some of my own experience and thoughts on the matter, but first let me preface by saying I am not giving any medical advice, and all assumptions and opinions expressed are purely my own.  I encourage everyone to come to their own conclusions after doing their own research, starting with Dr. Boyd Haley's many presentations and interviews posted on YouTube.  Although his presentations go into greater detail, this 2019 interview provides a great summary, so for ease of reference, I have used it as the source, with one exception, of the video minutes cited below. 

Side Effects

NBMI's only contraindication is for people with sulfur issues or a molybdenum deficiency (this 2018 interview at min 1:55 is the exception mentioned above).  Supplementing with molybdenum might help.

NBMI is most effective at 200 to 300 mg daily (min 8:12).  I'm under 100 lbs and I've had no issues on the 300 mg daily dose.  I did regress however on the few occasions that I lowered the dose.  So I'm not surprised that those I hear having side effects are taking super tiny amounts in comparison to what's recommended, and some are also pulsing the dose.  Since NBMI is sulfur-based and toxic metals have an affinity for sulfur (min 6:47), the following is my personal guess as to what's happening:  The inadequate amount of NBMI molecules being put into circulation are attracting out toxic metals, but without enough of a dose to actually bind them all, plus bind all the free radicals produced, leading to symptoms of redistribution and increased oxidative stress.  This should not occur at adequate doses because NBMI actually neutralizes Hg's toxic effects while still in the body (min 3:20), and I believe it does the same with Gd, or else I would also be having side effects.

Another guess is that NBMI is getting blamed for side effects from something else being done or taken.  When I started feeling a lot better, I began adding in various supplements and reacted to several of them.  For example, I had a setback a couple months ago when I unwisely tried supplementing with iron due to an ongoing deficiency (made no worse by NBMI).  I then learned that free iron is actually what produces the hydroxy free radicals that damage tissue (min 4:35).  Plus I found several Gd studies explaining that "metals such as iron are capable of inducing the dissociation of gadolinium from its chelate (transmetallation)."

Finally, it may not even be side effects from NBMI or anything else, but only more symptoms due to Gd toxicity.  The week before starting NBMI, I had for the first time terrible constricting pain across my rib cage making it difficult to even breathe.  I was later told that it was from severe edema, which I actually had visible signs of since the Gd injection.  So the point is, if I had started NBMI a week earlier, I probably would have been convinced that I was having a bad reaction to it and would have stopped taking it.  I shudder to think where I'd be right now if that had happened. 

Efficacy

NBMI uses flexible arms to bind heavy metals more effectively than other chelators (min 26:11).  It's a potent antioxidant (28:10) that can actually enter the cells (min 29:40).  It stops toxicity, which prevents further tissue damage, but doesn't repair the damage that's already occurred (min 31:24). 

Shortly after Dotarem, I was completely housebound with a long list of widespread debilitating pains and other symptoms.  I had started noticing some improvement in just over 2 weeks of NBMI use, then slow, sometimes backstepping, progress over several months.  I am now very relieved to be functional again, living with occasional pain in localized areas, plus some residual Gd damage that I'm still working on.  (*Tip: if you think Gd has caused nerve damage to your ears, at your own discretion, try applying progesterone cream around them.)  

While dosage, along with toxicity level and duration, determine how fast NBMI will work (min 8:12), I think in the case of Gd there are more factors at play.   This could include the stability of the contrast agent, as well as Gd's affinity for bone.  If Gd is continuously being freed in order to maintain equilibrium (see this 2009 paper, section "The kinetics of ML complex dissociation"), then both the agent itself and bone turnover could be continuous sources of toxicity.  Thus, a more long-term need for NBMI.  At my current point in recovery, I think I'm still waiting for:

• Gd to finish being released from any Dotarem that's remained intact.  This 2020 study shows Dotarem intact in rat brains 5 months post injection, which would explain why some of my head pains resurfaced for a while after supplementing with transmetallation-inducing iron.  As the pains lessened and then stopped, I assumed it was due to NBMI binding all the Gd I had freed.
• Gd to finish being released from bone.  I still get bone pain about monthly, but less severe each time as the burden lessens, and never lasting very long, again I assume because NBMI is there to bind it. 

For those of you that want more concrete proof of NBMI's Gd binding ability, fecal tests will monitor progress because the compound is excreted in feces (min 3:45).  The only labs I'm aware of that will add Gd to their toxic metals fecal test are Micro Trace Minerals in Germany or Doctor's Data in the U.S.  Whichever you choose, be sure to use the same lab for all followup tests so the results will be comparable.  If using Doctor's Data, a doctor's order is required unless you go through a third party site like DirectLabs.

I unfortunately did not have my first test done until a month after starting NBMI, and then my second test was at 3 months.  Even so, the level more than doubled from 0.019 mg/kg dry wt to 0.041 mg/kg dry wt.  (*Note: the results are not reported as mcg like with urine tests).  My third test was at 7 months, and the level significantly dropped to 0.004 mg/kg dry wt.  Considering Gd is normally excreted by not just the kidneys, but the liver as well (see this 2018 study, section "Gd in Excreta"), one could say my test results may just be showing the natural pattern of excretion.  Except all the other toxic metals that were tested also rose and then dropped along with Gd, other than a few that just dropped, including Hg, which is now at an undetectable level.

I am aware of a couple Gd toxic individuals that haven't used NBMI, but have higher fecal Gd levels than my highest result.  While Gd brands, quantity of Gd injections, and dosages could account for some of it, I think it also has to do with the fact that NBMI doesn't affect the body's natural rate of excretion (min 3:45).  So when the fecal levels rise as NBMI binds retained toxic metals, then drop as the burden lessens, the amount and speed of this trajectory depends to some extent on individual liver clearance rates. Some people's livers detox more efficiently than others, and my liver is not one of them, having had liver and digestive issues since well before Gd.  Yet I still tolerated NBMI without any side effects.  Moreover, I believe the trajectory of my fecal results, combined with major symptom improvement, show that NBMI is a very viable treatment for Gd toxicity.

According to EmeraMed's video FAQs, NBMI should be more readily available sometime later this year. 

Background:

• 3 MRIs with Gadavist within 8 days in early 2017. [eGFR 119 pre injections ]
• 1 MRI with Gadavist in April of 2018 [eGFR 115 pre injection]
• Terrible reaction to Zn-DTPA IV chelation, winter 2018 [eGFR dropped to 91]
• Started NBMI in February 2019 [eGFR back up to 119 as of Jan. 2020]

Summary:
I conducted 2 nail tests over the one year of taking NBMI. It took approximately 6 months to collect the required sample size for each test. The 1st test showed 15 metals elevated & out of range. The 2nd test only 1 metal remained high. Gadolinium had been reduced by 72%.

*The results are not indicative of total body burden or how much remains but, to me, they clearly show that NBMI is an incredible chelating agent. If NBMI did not directly lower all the previously elevated toxic metals, I believe it at least helped my body get to a place where it was able to help itself. I'll take the reduction however it happened. The fact that reductions happened across the board, with all but 1 metal remaining out of range (although it was also reduced  by 66%), tells me this wasn't just normal “washing out” over time.

Crucial Considerations When Using NBMI:

• Monitor Molybdenum (Mo) Status & Other Nutrients.
  • NBMI is sulfur based & Mo is CRITICAL in sulfur metabolism. I learned this the hard way, despite multiple sources stating the importance of Mo & knowing my Mo levels were on the low end. More info can be found in this thread.
  • Really high or low molybdenum can cause problems.  After all, it is a metal & can be toxic in excess as well.
    
  • Heavy metals can interfere with Vitamin D production, magnesium absorption, & cause other nutrient disturbances.

• Dose Amount & Consistency.
  • The most effective dose, based on studies I found, is 300mg/daily. 300mg/daily is the amount I chose to take (100 mg with each meal). I started by taking it sublingually then switched to putting it in a gelatin capsule with saturated phosphatidylcholine. I did this hoping the saturated PC might possibly help get some of the NBMI into the bones. I have no idea if this worked but I continued taking it this way.
  • I tried multiple times to try to stretch out my supply by lowering the dose only to have Gd symptoms pop right back up.
  • There are people taking tiny doses, or randomly starting & stopping, then complaining of side effects or no effect. I feel a lot of confusion & poor results could be cleared up if people would invest a few hours trying to understand the basics of this compound (there are many great presentations on YouTube ).
  • Consistency: see “The Times I Felt Worse” below
• Patience & Flexibility.
  • I would say all chelation is complicated & Gd toxicity seems especially tricky. If you have Gd toxicity and are looking for a quick & easy solution, I'm afraid you're likely to be disappointed no matter what you try.
  • I experienced steady progress with NBMI. I had been living with 24hrs of torture level pain after the Gd injection in April 2018. NBMI took the edge off within a month. Energy levels slowly built back up. I had worked up to being able to walk 6 miles until December (see below) . Before NBMI, being able to walk to the mailbox was considered a “good” day. 

The times I felt worse during this year:

• When I ran out of NBMI my Gd symptoms were quick to show up again. I realized managing Gd toxicity is a bit like managing pain; it's best to stay on top of it. If I ran out, it took some time to get back up to the comfort level I had previously reached.
• Gd symptoms, unrelated to premenstrual pain, would show up to some degree around that time of the month. The best I can conclude is this is due to higher bone turn-over (therefore Gd being released from the bone) during the follicular phase?
• This past December my muscles starting cramping & feeling week/sour after the smallest amount of use. My energy levels tanked. Through testing & trouble shooting I concluded this was due to a Molybdenum deficiency (I was also Vitamin D, Iodine, & Magnesium deficient. Although Mg was high in the 1st test, the interpretation said this was actually a sign of deficiency. I started supplementing with topical Mg dissolved in DMSO- more sulfur! ). I had been running on Mo fumes & hit empty while still consuming high amounts of sulfur based foods & products, not good.

How I Feel Now:

• Hopeful. I know this Gd exorcism isn't quite over but I'm so incredibly thankful for the divine interventions that have got me to this point. Just look at the numbers below :-D

Why I think there is more work to be done: 

1. Gd deposition occurs at a higher rate in the bone, which is not easily accessed by drugs.
2. Macrocyclic contrast agents deposit both free & bound Gd. I'm not sure how & when Gd, that is bound to other molecules, is released & able to be chelated.
   
3. I still get pain in my hips (tops of femurs?) when I stand or walk too much. There are a few studies that show Gadavist seems to preferentially deposit in this area.(My upper thighs are also where the largest NSF like "cobblestoning" depressions occurred.)