Provocative Heavy Metal Test
Provocative Heavy Metal: Testing
The increase in environmental toxins in our world seems to be a big driver of the rise in ADs.108 In 1997, it was estimated that 9 million people in the U.S. had an AD. Now, it is estimated that 50 million people have an AD.1109 Nearly 80% are women.110 Rates are rising in Europe, Scandinavia, and elsewhere just as fast.111 Rheumatoid arthritis was almost totally unheard of in Japan until only a few years ago and now it is becoming common.112113
Water-soluble toxins are not as big a problem as fat-soluble toxins in general. Water-soluble toxins are relatively easily cleared from the body. Fat-soluble toxins are stored in fat and are leached out slowly into our system, driving chronic disease including pain and the disruption of the immune system. Our brains are 60% fat.114 Our brains tend to accumulate these fat-soluble toxins. So, often, people w'ith any AD also have memory and concentration issues and co-morbid depression, anxiety, irritability, and many others. Lead is a huge problem when it comes to chronic disease. Recently, a review article suggested that a large percentage of all heart attacks in the U.S. were due to lead toxicity.115 Lead is so toxic to the cardiovascular system and the body as a whole, that even amounts we typically would not think were significant will have a profoundly negative impact.116
Approximately 94% of lead is sequestered in our bones and teeth.117 So, when menopause or andropause start to cause loss of bone density, the sequestered lead starts to flood into our system, disrupting many organ systems including negatively impacting the immune system and nervous system. Blood testing tends to greatly underestimate the toxic load someone is carrying.118 If lead can be found in significant levels in serum, you know someone is carrying a very high lead load. Thus, we can test negative for lead or other toxins in the blood and still have a big toxic load in fat and bone stores throughout the body.
Provocative heavy metal tests use a chelating agent to pull these toxins from the fat stores and get them into the urine to be tested. A common chelating agent is DMSA at a dose of 1000 mg 1 hour after the first morning urine. After taking the chelating agent, urine collection is started for a set number of hours and can be done up to 24 hours, but I usually find 6 hours is sufficient to find what you are looking for."8-121
Typically, provocative heavy metal testing isn’t done right away as part of the initial set of labs. Usually, it is run a few months after blood, saliva, and stool. The reason? The levels of “good” metals in the initial blood work need to be reviewed prior to running the heavy metal test. As we mobilize large amounts of “bad” metals and get them into the urine to be tested, we are doing the same with “good” metals. If someone is low in RBC magnesium, for example, and the provocative heavy metal test is done, they could conceivably get so magnesium-depleted that they could experience heart palpitations and arrhythmias.122 RBC magnesium is one of the initial blood tests run for a variety of reasons, one being this issue. If RBC magnesium is below the range or at the very low end of the reference range, we should supplement with magnesium for 2 months and then retest levels to see if they are more mid-range.
Heavy Metal: Assessment
Some people advocate doing a non-provocative heavy metal test first. A provocative heavy metal test is one that uses an oral chelating agent to mobilize toxins from fat stores into urine for testing. A non-provocative test is one that looks at levels in the urine without having used a chelating agent first. Typically, lead and mercury are not excreted through the kidneys, and they need to be bound by the chelating agent and “dragged” out of the body through the kidneys (Figure 6.Ю).123
Heavy Metal: Treatment
Some environmental toxins are so toxic to human beings that even small amounts are problematic.115*"6 Lead is one of them. But there is also mercury, cadmium, nickel, arsenic, and cesium to name a few. The ability to detoxify suffers right along with all of the other important bodily processes when the central mechanisms are off: not enough В vitamins to run detoxification pathways, the inability to activate/methylate the В vitamins, a lack of optimal liver function, a lack of glutathione to keep mitochondria clear of toxins and making ATP, and a lack of gut function as well.
In one respect, it is not so much whether someone avoid environmental toxins as much as whether they get rid of them faster than they are coming in. Our world is so full of environmental toxins, starting in the womb during gestation.69 When it comes to pain and toxicity, I am usually thinking of neurogenic pain and pain related to mitochondrial dysfunction. But toxicity can really impact any pain process, and formal detoxification needs to occur.
Some people are so full of toxins and so sensitive to their effects, they could feel quite poorly during the days of detoxification. In this case, consider decreasing the daily dose for the same number of days, or maybe only doing 1 or 2 days of detoxification and increasing the dose and number of days as time goes on, with the goal of 3 days on and 4-11 days off; using a multimineral supplement on the “off” days. Maybe consider adding a high-quality fiber supplement to bind up the toxins after they are dumped into the gut, protecting the body until they can be cleared. Retesting can be done after 4-6 months.
It is very important that a person has bowel movements at least daily before starting the formal detoxification. If bowel movements are occurring less often, the mobilized toxins will be dumped into the gut but then reabsorbed back into the system.
