Testing & Treatment (#5 in Heavy Metal Series)

(audio transcript below)

Welcome to AIM For Health: Root-Cause Conversations with Dr. James Biddle. All content from the conversations in this podcast are created and published for informational purposes only. This is not intended to be a substitute for professional medical advice and should not be relied on for personal medical decisions. Always seek the guidance of your doctor with any questions you have regarding a medical condition.

Welcome back!  We are doing a podcast called “Ask Dr. Jim Bob”.  I am James Robert Biddle, MD.  I am a board-certified internist running Asheville Integrative Medicine for the last 23 years and with me to help me out is our new-patient coordinator Joy.

Hello – Hey Dr. Jim Bob, hey everyone!

We are continuing to talk about heavy metal toxicity.

Yes we are.

And what is on our agenda today?

Well, just to recap in case anyone is just joining us now for the first time – we have already talked about what metals and minerals are, the ways in which some of them benefit us, and we spent the past episode or two talking about heavy metals and the ways they can harm our health.

Right.

So now that we have all that background information, today we are going to talk about how do we test for these metals and then if we find them, how do we get them out of our bodies?

Good.  And I will mention today is September 10th of 2020.

So the first test we do for just about anyone who is becoming a new practice member with us is a hair analysis.  So Dr. Biddle – what is a hair analysis? And why do we do it?

A hair analysis is the test to most likely get me called a quack.

Why’s that?

Because conventional doctors don’t understand it and don’t believe it, and with some good reason.  But I would like to point out that the medical board of North Carolina will use a hair analysis on doctor’s to see if they have been abusing drugs.  So obviously the medical profession does believe in hair analysis for measuring substances – right?

Right.

So, basically we cut your hair – we take the inch closest to the scalp, and we can see all kinds of things about this.

What do we see?

You can even use toenails and fingernails.  For example, I believe they used toenails from the body of Napoleon Bonaparte to show that he was poisoned with arsenic.

Really?!

Yes.  So we can see both nutritional minerals like calcium, magnesium, zinc, boron, molybdenum – all those different things in the hair, and we can see heavy metals like lead, mercury, cadmium, aluminum, arsenic, and all the rest of them.  What is wonderful about a hair analysis is you get a whole bunch of data points for around $100.00-150.00.

Right.  Currently running about $115.00?

$115.00 is what we are charging for a hair analysis.  We can get all these data points.  However, the hair analysis is not for the amateur to interpret because you can have some problems with a hair analysis.

Like what?

You can have the lack of excretion –

Poor excretors.

Poor excretors or time passage.  So for example, I didn’t have my first hair analysis until 15 years after I was a house painter and got toxic in lead, and so only a tiny bit of lead showed in my hair 15 years later because it is all stored in my bones.

I see.

And we will talk more about the chelation challenge; we saw a lot more come out in my urine.   The next is you can have poor excretors, so people have got chemical sensitivities and low molybdenum, and they are not really able to put the metals out into their hair, so we won’t see them in the hair.

I fell into that category. 

Right.

Which at first, I looked at the hair analysis and it was like “Oh, sweet! I don’t have any metals at all!” Except – we needed to do more testing. 

Right.  So you can’t believe a negative hair analysis on heavy metals.  If you see heavy metals, then you have to see – do you have external contamination?  So for example, we see aluminum on the hair because there is – if you are using a shampoo and conditioner that is not organic, then it almost always has aluminum in it.  And we can’t tell from the hair – is that aluminium on your hair or in your hair coming from your antiperspirant and through your body.

Right.

So then we have to confirm that with another test.  We often see uranium high in the hair analysis because well water in granite mountains like here breaks down into uranium, so all the water has uranium here.  And it is not radioactive uranium.

Right – we talked about that last time.

We talked about that.  But it does show on the hair, so now we don’t know if it is actually on the hair or in the body.  And then you can also have some displacement.  So for example, we often see very high zinc in a hair analysis, but in fact mercury and cadmium both sit right below zinc on the periodic table of elements, so they tend to kick the zinc out into the hair, which is what showed in my hair analysis.

Mine had the same thing.

And then it actually means you are low in zinc because you are having wasting of zinc from your body and you need to supplement with zinc, usually for at least 2 years to build it back up again.  And then for my hair analysis, I started off with very high zinc and then when I took zinc for 2 years and took out the heavy metals, my zinc returned to normal.  So you can have a paradoxical elevation.  And then there are some things that are just not worth at all looking at in the hair, but it shows up in the hair analysis –

Like what?

Like sodium and potassium, and germanium.  There are a number of things I wish they would take off the hair analysis form.  But, having said all that, it is still a very useful test and if you know what you are doing in interpreting it, you can gain a lot of information on the cheap.

Now, question.  If someone is a poor excretor of heavy metals in their hair, does that mean they will also be a poor excretor of the good minerals we want to see in their hair, where they are at with that?

No.  In the hair analysis the reference range, you know heavy metals should all be very very low, right?  So the reference range starts at 1N and then it goes up from some threshold.  Desired is 0, right?  But then there is a threshold of how high it can be before you are too high.  Whereas nutrient minerals start in the middle – you want them all in the middle of the reference range, and they can go either high or low.  So nutrient minerals are much more predictable in that way.  But we will see people with diffuse deficiency patterns.

Ok – say that again?

Diffuse deficiency patterns.

And what does that mean?

Nutrient minerals – it means almost all the nutrients of minerals are low in their hair.  And that almost universally means they either have a really lousy diet for decades, or they are low in stomach acid.  So when people come in and they have been on like PPI stomach acid blockers for 20 years, they are going to have a complete lack of minerals in their hair, because their whole body is deficient, which is why they get osteoporosis and dementia and kidney failure, and all the other things that have been associated with acid blocking medicines.

Wow!  I never would have thought you could see all that just through your hair!

You can see all that.  And if they are not on acid blockers, then we know they have a problem in their stomach.

Absorbing.

Absorbing.  And they either have H. pylori in their stomach lining, which is the bug that causes ulcers but can also cause low stomach acid in the long run, or they have autoimmune gastritis, which is an autoimmune attack on your stomach lining.

Ok – well those are good things to be aware of.  Now, regardless of how the hair analysis comes back, we often want to investigate further, to make sure we have the most accurate picture.  So what is next in the step of testing for metals?

Right.  So I want to review the way conventional medicine defines heavy metal toxicity, and we talked about this before, is an elevated blood level or an elevated 24-hour urine without provocation, you have not taken any medicine or anything like that, you just take a random 24-hour urine collection.  And if those are high then you have a diagnosis of heavy metal toxicity.  All the tests we do do not define heavy metal toxicity, they only show us that you have an elevated body burden which is not a diagnosis under conventional medicine, because conventional medicine just ignores this issue.  So, with a chelation challenge what we do is give you something that binds heavy metals and then collect your urine and see what comes out.

So kind of like shaking the bucket.

Yes, you shake the bucket.  And you can do this many many ways.  I started off in practice 23 years ago giving a 24-hour urine collection, but found compliance was really challenging.  So then we went to a 12-hour urine collection, but then I saw data that showed that 90% of the metals are out within 6 hours.  So now we do a 6-hour urine collection and compliance is much easier that way.

It is a lot easier to commit to 6 hours than 12 or 24.

Right.  And then we can use an oral agent to challenge with, and I don’t like to do that because what I have discovered is I don’t know how much of that oral agent you are going to absorb versus somebody else.  So I give you an oral chelating agent – you may absorb 10%, whereas I might absorb 50%.

Oh, OK.

So I don’t really know what I am challenging you with.

Right – it’s not consistent from person to person.

Yes.  So we can do that, but what I prefer to do is use an IV challenge, and that way I know exactly what is going in, it is 100% absorbed, there is no variability, and we can reproduce it from time to time.

And if we are doing the IV chelation challenge, what does one expect?  That is a big question we get a lot of times from our new clients, is what am I going to feel?  What should I expect?  Is this going to knock me out for the day or will I just go about my business?

Right.  And we will come back and talk about what we challenge with, but the challenge with challenges is are they challenging?  We are challenging your system to pull the metals out.  And if you are a healthy, a relatively healthy robust person, that is fine.  I feel great when I take chelating agents.  I feel better, I feel sharper, my vision clears up, I can think better – all those things.  But, if you are a fragile, and usually in one of two ways – either you are emotionally fragile and tend towards a lot of anxiety and depression, or if you are chemically fragile meaning that you have chemical sensitivities and it is hard for you to be exposed to perfume or detergent smells, or things like that – you get symptoms, brain fog, migraines, stuff like that.

Right.

You are going to feel lousy with chelating agents.  And I learned this the hard way.  You know, they call this a medical practice –

Right, we are practicing.

We practice all the time, and we try to get better all the time.  But I had one dear woman who is still a patient 20 years later and still working out her mercury toxicity, but she is a redhead and she was emotionally fragile, and I gave her a full chelation challenge and she was suicidally depressed for 3 days afterwards.

Oh, that’s terrible!

And I have seen other people who can feel really bad, so we try to be very picky and cautious about who we challenge.

Right.  Not everyone is going to be an appropriate choice for this test.

Not everyone is going to be an appropriate choice.

Whereas some of us, we know we will be OK and even if we feel lousy for a little bit, we just kind of bear it and get through the test.

Right.  Now fortunately in my almost 25 years of using these agents, I have never seen anybody actually damaged with them.  It is all just “Oh, I feel lousy for a number of days or weeks, and then I am OK”.

Right.  I only felt lousy for a few hours. 

For a few hours.  And that is more classic.  So the agents that we use for a chelation challenge; one is calcium-EDTA and EDTA is ethylene diamine tetra acetic acid.  It is a classic chelator for lead, but does not bind mercury very well.  It binds a lot of the other heavy metals, and the calcium form of that is just a 5-minute push on the IV.

So you are not sitting there for hours with the IV dripping into the arm, into the vein.  It really is just a push.

Right.  That long chelation is the magnesium-EDTA which is used to flatten the plaque in the arteries for people with vascular disease like heart disease.

Flatten the plaque?

It flattens the plaque.  That is how it works is that is makes vulnerable fluffy plaque which might rupture and cause a heart attack and clot, into stable plaque which is flatter and by making it flatter it opens up the artery some.  So we are not going to talk a whole lot about chelation and heart disease, but that is the –

That’s a whole other podcast!

That’s a whole other podcast.

We are going to get there though.

Right.  But that is 1 ½ to 3 hours for that IV, but the calcium-EDTA is better at binding the heavy metals because it is going in fast and gets a higher peak in the blood stream, so that is what we use for testing the heavy metals and for treating them.  Then the second agent we use is called DMPS and that is specifically used to bind the mercury because the EDTA does not bind the mercury very well.  The DMPS is in a funny regulatory position and that is not actually FDA approved, but it is FDA available because it has been studied, it has been recognized as generally safe, and it is available through compounding pharmacies.  We thought we almost lost it this last year, but we are still able to get it.  We may lose it in the future at some point.  And then the other thing we can use for challenges is DMSA and DMSA binds all the metals, but it is not used by IV, it is only orally.  So when I do need to give an oral chelation challenge, either because somebody has lousy veins, or they live at a long distance away, and can’t get here in person for the IV, then we will use oral DMSA for that.  But in my experience, DMSA is the harshest of the chelators and has the most side effects.  It causes the most brain fog and such of any of the chelators, and the DMPS and EDTA combination is actually much better tolerated by more people.

Which is great.  We want it to be tolerable.

Right.  So then they collect, you empty your bladder before the IV, then after the IV you get a jug, and any urine you make over the next 6 hours goes in the jug, and then you shake it up and pour off a test tube and mail it directly to the lab.  You don’t bring it back to us.

No, we give you a kit and everything with all the packaging and the stickers that you need.  So they will pick it up at your home, and then 2-3 weeks later we find out.

We know exactly how much came out, which correlates pretty well most likely to what your body burden is.  Your total lifetime accumulation.  And, to talk about myself with that – my hair only showed a little bit of lead but a lot of mercury, whereas my urine showed a little bit of mercury but a lot of lead.  What that meant is that my lead was an old but large exposure, from being a house painter, and my mercury was a more recent ongoing exposure because I had 12 amalgam fillings and used to eat tuna fish, but I was doing a pretty good job of excreting it along the way and taking care of it, whereas the lead was all hidden in my bones.  But after a few years of detoxification, I repeated my chelation challenge and they are both down to almost normal.

Now you were saying that certain chelators bind better to certain metals.  If someone like you shows that they have lead and mercury, and we talked in the last podcast about both of those extensively, which one do you go after first?  Or does it matter?

Well, it depends on who the person is and what they tolerate.  For myself, partly because I have the clinic and I have the IVs available, I used everything.  I used IV EDTA, I used IV DMPS, I used oral DMSA.  If people are very fragile, we don’t use the oral DMSA, but if they are pretty robust, we do.  One of the challenges with a practice like this is most of people we see are a bit fragile, so we are always trying to be careful with them.

Absolutely.

Perfectly healthy people do not usually go invest in seeing a doctor.  Although we really appreciate the people who do, because people do come in here and say “Hey, I want to age gracefully”.

Exactly, an ounce of prevention.

So, I used it all, but it is really very individualized, and besides those three we also have other chelators which we will talk about, for treatment.

Sure.  Now if we find that someone for whatever reason might be too fragile to do that chelation challenge, what option is left to them other than the hair analysis?

Right.  We didn’t used to have an option, but I discovered a guy, when I was in charge of the education for ACAM about 14-15 years ago, I invited this gentleman who had spent 30 years at the University of Washington in Seattle studying porphyrins and how they relate to heavy metals.  Porphyrins are the recycling products of your red blood cells.  So your red blood cells get recycled every 3 months.  Your spleen filters out the old ones and then sends the parts to the liver which puts them through what is called a porphyrin pathway which is a series about like 9 different molecules that they go through, and then they get sent back to your bone marrow to make new red blood cells.   I love biology!

So it really is a recycling program – I didn’t know that!

It’s a recycling program.  And it turns out that the different heavy metals will block certain enzymes in that pathway to cause characteristic elevations of certain components in that pathway that can tell us without doing a chelation challenge whether you are being poisoned at the cellular level by different heavy metals.  So we do a urine porphyrin test.  This guy after 30 years – conventional medicine completely ignored him – so I invited him to a conference in Las Vegas in about 2006 I believe it was, and from that conference then porphyrins got adopted in the alternative medical community as a way to get an idea – you can’t diagnose heavy metals, but you can get an idea that somebody has a heavy metal issue.

More definitive so then if they were a poor excretor and we didn’t really get a clear picture out of their hair analysis?

Right.  And then we don’t have to put them through a chelation challenge to get started, and it will tell us – is it most likely lead? Is it most likely mercury? Is it most likely arsenic? Is it something else?  And then we can work on them for a while, usually a year to 2 years, sometimes 3 years, and then after detoxifying what shows up, then they are usually not so fragile and then we can do a chelation challenge on them and then they will usually tolerate that and then we can get a more empiric solid measurement of what the heavy metals are left in their body at that point in time.

I see.  So just to make sure we are all clear – with the porphyrins test it is unprovoked, in that we are not giving them any chelating agents at all prior to the urine collection.

Right.  It is unprovoked, but then the results are more qualitative, not quantitative.  So it says yes, you have a problem, and the problem is with lead.  But it does not tell you what your lead level is in your body whereas then in the urine it will tell you – OK, on a scale of 0-4 – when I did my test the scale was up to 5 and my level of lead was 85 in the urine.

Wow!  That’s pretty high!

That’s pretty high.  I have only found 5 people worse than me in the last 23 years.  One of them had a bullet lodged in his spine, one of them owned a tire balancing shop with the lead weights, one of them owned a shooting range with all the lead, and one was a painter like I was, and the 5th woman I don’t know where she got hers, but some way or another she got lead toxicity.

So in terms of testing, we are looking at either a hair analysis, a chelation challenge, or porphyrins test. And then once we have –

And usually it is a hair analysis, and then either a porphyrin test or a chelation challenge.  Because the other tests don’t tell us anything about your nutritional status of minerals.  So the hair analysis is unique in that we get a very inexpensive look at your zinc, copper, molybdenum, chromium, vanadium, selenium – all those different minerals, and if you are starting off deficient in any of those, then chelation is going to be much harder on you because the chelating agents are not so specific.  They do have an affinity order.

What’s an affinity order?

Well affinity order says which metal does it bind best?  It will grab that first and then, which metal does it bind second best, and then third best, and then fourth best?  So for example, EDTA starts with the lead and then goes down the line.  DMPS starts with mercury, lead, silver, cadmium, nickel, arsenic, antimony, bismuth, chromium, cobalt, molybdenum, copper, then on down the line.  DMSA starts with lead, then cadmium, then mercury.  So they have a little bit different order.  So based on what your metal is, it helps us pick which chelating agent to treat you with.

I see.  Along with testing our own bodies, you mentioned well water earlier also.  We also have the option to test our water to see what we are drinking and constantly putting into our bodies.

Right, so we can find out Is your water a source of the toxicity?

Yes.

And we usually assume that if you are on city water it is not likely to be, unless it is in the pipes going to your house itself.  But if you are on well water, you can definitely have contamination from industrial exposures.  Another thing – back to the nutrients.  If you are starting off for example very low in selenium and then we start to chelate you and make you even worse low in selenium, then you could feel worse, that is one of the reasons to feel worse.  And so the hair analysis tells us that we need to be supplementing selenium in-between doses of the chelating agents, or whatever mineral you are low in.

That way we are not depleting what you need and you are already low on.

Right.  And then we will repeat your hair analysis every year, 1 ½ to 2 years then to make sure we are on the right tract.

Got it.  All right.

All right.  Maybe that is a good place to have a pause.

Yes.

And then we are going to come back and do a part 2 of this particular episode and talk more about the treatment.

Yes.  Ongoing treatment. 

Ongoing treatment.

 

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