Tuesday, February 26, 2013

Get the Lead Out

A 40-year-old man came to my office and complained of loss of appetite, weight loss, abdominal pain, nausea, vomiting, diarrhea and headaches for more than two years. He had been evaluated by a several physicians and treated with Nexium. His symptoms didn’t improve.

He thought he was being poisoned by additives to gasoline from a leaking underground gas tank next to his gunsmith shop. And he probably was.

But the real problem was his occupational exposure to lead, a toxic metal. He had been a gunsmith for more than 20 years. He had used gloves sometimes and respirators sometimes. But not enough.

His blood lead level (BLL) was 7 mcg/dl. This is below the CDC’s old cutoff of 10 and far below OSHA’s cutoff of 40-60 for treatment of occupational lead exposure. Physicians have been trained to go strictly by these numbers. Recently the CDC lowered the blood lead level cut off to 5, especially for children. Most doctors wouldn’t be concerned about a level of 7 in an adult.

Blood levels do not reflect total body stores. Neither a spot level, a 24-hour urine level or hair samples tell the whole story. All of these reflect recent exposure.

And the patient had all the most common symptoms of lead intoxication.  So I ordered another test.  This was a provoked toxic metal urine test, the “Gold Standard” for environmental physicians. This test is the closest we can get to an assessment of the total body load of toxic metals.

I obtained a sample of urine from the patient before giving him two different medications intravenously.  Both medications were chelators which bind toxic metals in the blood and in between cells in the body.  These medications create a complex with these toxic metals and then the entire complex is eliminated in the urine. After we gave him the chelators he collected his urine for 6 hours. Samples of both the pre and post provocation urines were sent to the laboratory for analysis.  His lead increased from 15 in the “pre” urine to 330 mcg/gm creatinine in the post urine. 

The “pre” test revealed moderately high levels of lead in his baseline urine. However, the post provocation levels of lead went up dramatically from his baseline. The baseline level reflected how much lead he had been exposed to recently. This would be similar to a 24-hour urine collection for lead, mercury or arsenic. Unfortunately, it cannot reflect total body stores.

Even this provoked urine test doesn’t completely reflect total body stores, but it’s the best we have unless we are willing to biopsy and analyze the toxic metals in different organs in each person. An Italian study published in Journal of the American College of Cardiology in 1999 did just that. Patients with idiopathic dilated cardiomyopathy (IDCM) –congestive heart failure of unknown origin- had biopsies taken of their heart muscle. Testing revealed that these patients had 22,000 times the mercury concentration and 12,000 times the antimony concentration of biopsy samples from normal control hearts. So, these toxic metals go into the body are distributed by the blood and settle into various tissues. Blood tests or a 24 hour urine cannot reflect total body stores.

The half-life of lead in the blood is 25 days. This means half of a given dose of lead disappears from the blood in 25 days. Some of it is excreted by the kidneys and in the stool and some of it is distributed into the bones and soft tissues.  The half-life of lead in bone is 20 years.

This is one of the more striking tests that I have done.  And, many people have a significant increase in numerous toxic metals when they do a provoked urine toxic metal test.

Conventional doctors may say that this test is invalid and the fact that so many people have a positive provoked urine test means that it’s not specific enough.

Environmentally trained physicians believe that small amounts of toxic metals accumulate in one's body over a lifetime. We get exposed to toxic metals on the job, like my patient. At home, in our yards, the streets, everywhere. And, with the industrialization of our world, the amounts of toxic metals have increased significantly. The CDC, in the NHANES studies, and the Environmental Working Group have documented numerous metals and other toxins in amniotic fluid before birth, cord blood at birth, and in the blood and urine of infants, children and adults.

Toxic metals include the three toxic heavy metals: lead, mercury and cadmium. Other toxic metals include aluminum, tin, and thallium. Metalloids like arsenic and antimony. And, transition metals like iron and nickel. Many of the other transition metals are key nutritional minerals like zinc, chromium, copper, manganese and cobalt. We test for 20 metals that are known to damage humans and cause illness.

There is a lot we do not know about chronic metal overload and its resulting toxicity.  However, we do know that toxic metals do the following:
  • They bind to and poison enzymes displacing our own nutritional minerals like magnesium, manganese, molybdenum, zinc and copper.
  • They interfere with energy production in our mitochondria.
  • They trigger autoimmunity by binding to enzymes, receptors and proteins making the body’s own tissues appear foreign to itself.
  • They deplete our antioxidants.  Especially vitamin C and glutathione.
  • They inhibit the activity of vitamin B1 (thiamine) and B 6 (pyridoxine).
  • Mercury and lead toxins cross the placental barrier.
  • They damage brain tissue and peripheral nerves.
  • They interfere with detoxification.  This means that when we are exposed to other chemicals in the environment like PCBs, pesticides, dioxin, and other persistent organic pollutants (POPS), our ability to eliminate these from our body is slowed down.
  • About 80% of our body’s energy is devoted to absorbing nutrients from food, detoxing and eliminating waste. Toxic metals interfere with all of these processes.
  • Toxic metals act like free radicals damaging DNA, cell walls, and cellular structures.

Common sources of lead are ceramic pottery, lipstick, tobacco, house paint in older homes, coal fired power plants, motor vehicle exhaust residual in soils and streets, soldering, lead plumbing in older homes and water systems, and pesticides just to name a few.

Cadmium is found in cigarettes, conventionally grown spinach, batteries and downwind from battery factories, paints, soldering, black rubber tires, super phosphate fertilizers and pesticides among others.

Mercury is found in fatty large fish like albacore tuna, swordfish, red snapper, sea bass and many others. And, in coal-fired power plants, silver amalgam fillings, immunizations in the form of thimerosal, fungicides, and UV light bulbs.

Arsenic is in old pressure treated wood, fungicides, water, herbicides, fertilizers, paints, wood preservatives, automobile exhaust and others.

This is not a complete list. It’s a small sampling to demonstrate how pervasive our exposure to toxic metals may be.

This is why environmental doctors test for toxic metals when they see patients complaining of a long list of symptoms or illnesses. Unfortunately, we live in a polluted world. The food we eat, the water we drink, and the products we use every day have toxic metals in them.  Most Americans’ bodies contain toxic metals — along with other toxins like pesticides, solvents, PCBs and dioxins.

Physicians trained in environmental medicine suspect this toxic overload contributes to increased cardiovascular disease including high blood pressure, heart attacks, angina, strokes and congestive heart failure, cancer, autoimmune diseases, and neurodegenerative disorders like Alzheimer’s, Multiple Sclerosis and Parkinson’s disease.

While each of the toxic metals has a slightly different effect, they may also cause or contribute to asthma, allergies and chronic lung disease. Some individuals may experience psychiatric illnesses, reproductive system diseases in men and women, kidney and liver damage, and skin disorders.

Many people get better when they receive chelation therapy for toxic metal overload.

If someone feels great, do they need to be tested?  That depends on the patient’s family history, history of exposures and attitude toward prevention versus treatment of illness. An ounce of prevention is worth a pound of cure. If we wait until we notice symptoms, it may be too late for a satisfactory cure.

Parkinson’s disease is a good example: Generally, by the time this disease is diagnosed, about 90% of the affected part of the brain has already has been damaged. Treatment is possible and can be very rewarding. And, treatment will be more intense, more expensive and more extended.

Chelation has been around for a long time. Mother Nature has used chelation since before we were humans. Chlorophyll and hemoglobin are the EXACT same molecules except that manganese is chelated in the center of chlorophyll and iron is chelated in the center of hemoglobin. Chelation has been used for many years in ER’s or by toxicologists to treat people who have been recently exposed to high levels of toxic metals. For example, when a firefighter is acutely exposed to toxic metals, or a child is acutely poisoned with lead or overdoses of iron, the conventional medical community employs chelation to treat these severe recent toxic exposures.

Environmental physicians differ with conventional doctors on this point: If chelation is effectively used for recent poisoning episodes, why not use it for toxic metals that have accumulated over many years? If one has angina, high blood pressure and high cholesterol, why not test for heavy metals and if found in significant amounts, treat the cause of the problem. Many patients are able to reduce the number of medications that they take when they remove toxic metals with chelation.

Anti-aging doctors go one step further. If one feels fine and has a strong family history of atherosclerotic cardiovascular disease and a personal history of smoking or exposure to passive smoke, they test for toxic metals and if found, treat the findings early before illness is fully established.

There are four frequently used chelators, based on the lab test results:

1. Calcium EDTA is a synthetic amino acid. It is characterized by the FDA as GRAS (Generally Recognized as Safe). It was first approved for treatment of lead toxicity by the FDA in 1953. It is widely used in the food industry as a preservative, so we probably eat a little bit each day.

2. Disodium EDTA. Another version of the same synthetic amino acid that has the added benefit of stimulating bone growth and enhances reversal of osteoporosis. This chelation drug is widely used to treat cardiovascular disease. It has been used since the 1950s for this indication.

Both of these versions of EDTA remove lead, cadmium, tin, arsenic, nickel, aluminum, and some other toxic metals through the kidneys. These two drugs often deplete our body’s supply of zinc, manganese, iron, and B6. Therefore, patients supplement their intake of these while doing chelation. If one gets “low” on these nutrients, the most common complaint is fatigue.

3. DMPS. (2, 3-dimercapto-1-propane sulfonic acid). DMPS is not approved by the FDA but is allowed into the country as a bulk agent that can be prepared for use by a compounding pharmacy. Physicians can prescribe it. It is given intravenously or as an intramuscular shot. This drug chelates inorganic and organic mercury, lead, arsenic, cadmium, silver, nickel, antimony, bismuth, platinum, tin and other toxic metals. It may increase our body’s need for molybdenum, selenium, magnesium, zinc, and copper.

4. DMSA. (2,3-dimercapto-succinic acid /Captomer /Chemet/succimer), is an oral prescription drug. It was approved for treatment of lead poisoning in children in the 1950s. The Physician’s Desk Reference lists it as a potential treatment for mercury and arsenic toxicity. It chelates lead, organic and inorganic mercury, arsenic, cadmium, antimony, silver, tin, thallium, bismuth, nickel and platinum. It is frequently used in children as well as adults. It is eliminated through the bowels and kidneys. It may increase the need for copper, molybdenum, selenium, and magnesium. It also increases the need for cysteine, an amino acid found in whey protein, or NAC (N-acetyl-cysteine).
Physicians who perform chelation should be trained by and follow the current recommendations of the American Board of Clinical Metal Toxicology and/or the American College for the Advancement of Medicine.

While one will hear occasional scary stories about chelation, there have been very few major problems. The CDC reported in MMWR in March 2006 that they found (only) three deaths due to chelation from 2003-2005. Remember that over 100,000 people receive chelation annually.

Most people tolerate chelation without any difficulty. During the IV infusion, some people feel pain at the IV site; some have a change in blood pressure or blood sugar, and rarely an allergic reaction to one of the drugs may develop. During the 24 hours following a chelation treatment, some patients may feel empty headed, have a headache or have trouble concentrating. Some patients experience nausea.

Most of these symptoms resolve fairly quickly. However, there are rare individuals who are very sensitive to the chelation process and can have more severe side effects over the short term. If this happens, we adjust the doses of the chelators during the next round of chelation in order to avoid a recurrence of these symptoms. Very few patients are unable to continue with chelation due to side effects.

The most common side effects over weeks of therapy are fatigue and muscle cramping. This is due to depletion of Vitamin B6, zinc and magnesium.

There are additional lifestyle changes that people must make. The most important is to stop smoking.  There are so many toxic metals in a cigarette that it is impossible to get ahead if one does not stop smoking.

The other lifestyle change is to avoid re-exposure to the toxic metals.  General recommendations include:
  • Use a water filter at home and an air filter if indicated.
  • Drink bottled water if necessary.
  • Eat organic foods whenever possible.  Go to www.EWG.org for a list of the dirtiest and cleanest produce with respect to pesticides.
  • Eat range raised or organic meats and organic dairy products.
  • Reduce fish intake and only use molecularly distilled fish oil supplements.
  • Use safe pest management and natural lawn care products instead of toxic pesticides around the house.
  •  Replace old and avoid adding new silver amalgam dental fillings. Have this done by a dentist who is trained to remove fillings safely and who can coordinate follow-up care with your physician.
  • Avoid immunizations that contain thimerosal.
  • Avoid exposure to toxins in the workplace, sports, home and hobbies.

There are a few people who should not take chelation. Women who are pregnant; instead, it's important for “mothers to be” to make certain that they are toxin free before getting pregnant.  Anyone with poor nutrition; an allergy to DMPS, DMSA, or EDTA; unhealthy bowels; dehydration; constipation; and certain kinds of kidney disease. People with these problems need to get healthier before proceeding with chelation.

There are alternatives to chelation. One alternative is take oral supplements that enhance the natural elimination process. Chelorex is an all natural oral chelator. Homeopathy, colonics, and sauna are other alternative cleansing procedures. Traditional allopathic medical treatment may include medications, bypass surgery, and stenting.

Supplements are an important part of chelation. A good multiple vitamin, magnesium, sulfur in the form of food and/or supplements, and vitamin C are the minimum. Some of these replace nutrients that may be lost during chelation. Or, they protect the body from the toxic metals as they move from being deep inside your cells and are mobilized by the chelators to move through the blood stream and out of your body. There are also supplements we use to enhance chelation.

Methionine helps the body release cadmium and glycine helps the body release aluminum. We usually recommend fiber to enhance elimination of the toxic metals from our body. On days when one is not chelating, patients take extra essential minerals to replenish those that the chelators may have pulled out of our bodies.

Back to the patient, he is slowly improving with occasional recurrence of his symptoms when he gets re-exposed or doesn’t take his supplements. He changed jobs and had someone else clean up the building that he was working in. This may sound drastic, but he could not continue his occupation. He now teaches gunsmithing instead of doing it himself. His second test 6 months later shows a drop in lead to 90 from 330. He continues treatment. The results of his follow-up test are in the last column of the chart.

For more information about illnesses caused by lead, as well as treatments for toxic metal overload, please attend a free talk at Vaughan Integrative Medicine on Wednesday, March 20, at 6:00pm. Please call 336-808-3627, x10, or e-mail amie@vaughanintegrative.com for reservations since seating is limited. 

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