Hompes MethodPractitioner Training Level II

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Lesson Fourteen

Testing Heavy Metal Burden

Heavy Metal Testing - Introduction

• Once heavy metals are in the body, they tend to be sequestered away in tissue storage sites such as the brain, nervous system, kidneys, liver, bone and gut. As such they may not appear in blood, urine, feces, hair and other tissues.

Heavy Metal Testing - Introduction

• Thus the accurate assessment of body burden is nigh on impossible. Even a combination of all the possible heavy metal tests can only provide an estimate of a person’s total burden. But this doesn’t mean the testing isn’t useful.

Heavy Metal Testing - Introduction

• Further confounding factors relate to the ability of different tissue samples to accurately reflect levels of individual heavy metals – hair may be good for arsenic analysis, but not for other metals. A tissue sample may only reflect one form a single heavy metal. For example, hair seems to be quite useful for detecting methyl mercury, but not elemental mercury. Interpretation is key.

Heavy Metal Testing - Introduction

• In the Metametrix Lab Evaluations book, several tests are promoted – urine, blood, porphyrins, hair, all of which you can access through Metametrix. They’re great tests, but the information is biased because the

book is written on behalf of the lab selling the tests.

Heavy Metal Testing - Introduction

• Dr. Lawrence Wilson, MD is highly biased in favour of using hair mineral analysis. He provides arguments against the use of blood and urine testing in his book, Nutrition Balancing and Hair Mineral Analysis.

Heavy Metal Testing - Introduction

• Dr. Andrew Cutler, PhD contends that you can get a very good idea about mercury toxicity (and other heavy metals) by piecing together an accurate, life long health history and “exposure” timeline. He asserts that no lab test is truly diagnostic (correct) and that challenge tests – discussed in this lesson –are dangerous (also correct).

Heavy Metal Testing - Introduction

• Cutler has a 58-question assessment in his book relating to specific symptoms and indirect markers from complete blood count panels (e.g. anaemiamarkers, immune markers, cholesterol) and certain hormones such as DHEA).

Heavy Metal Testing - Introduction

• Hal Huggins discusses the use of many different tests in his work, along with their relative merits and pitfalls. I’ve provided links to some of his work in this lesson’s resources section.

Heavy Metal Testing - Introduction

• Dr. Walter J. Crinnion is in favour of using urine testing (both with and without a provocation/challenge using a chelating agent, as well as employing a urine porphyrins test. We’ll discuss these during the course of the lesson.

Heavy Metal Testing - Introduction

• Dr. Klinghardt employs all manner of testing in his practice, some of it being non-lab based. He uses autonomic response testing (his own system) combined with patient history, hair and blood testing. We’ll discuss his approach a little more in the lessons on detoxification.

Heavy Metal Testing - Introduction

• The goal of this lesson is to expose you to all the main testing options and help you understand their pros and cons so you can effectively communicate with your clients and patients. We conclude with a suggested testing regimen based on your legal status (licensed vs. unlicensed).

Heavy Metal Testing - Introduction

“Laboratory evaluations provide both direct concentration information and functional markers for

assessing element status. Elements can be measured in whole blood, red blood cells, challenged or

unchallenged urine, or hair.”

Metametrix Lab Eval Manual, p.139.

Heavy Metal Testing - Introduction

“Single specimen profiles can reveal potential weaknesses and exposures, but testing of multiple

specimen types is the preferred evaluation for reaching firm clinical conclusions. Each element has unique physiological properties, so the most sensitive and

specific tests for evaluating a patient vary according to the element of focused therapy.”

Metametrix Lab Eval Manual, p.139.

Heavy Metal Testing - Introduction

• Let’s take a look at the main tests that check heavy metal levels per se. In other words, tests that look for a metal and quantify its presence in a specific tissue sample.

Testing for Aluminium

• Serum, erythrocyte, and plasma aluminum levels appear to correlate. Serum aluminum levels above 5 μmol/L (135 μg/L) are predictive of aluminum toxicity. Testing for anemia is indicated in patients with high blood levels of aluminum. High hair aluminum has been shown in aluminum toxicity and therefore, a high value in hair likely reflects a regular source of exposure and should be eliminated.

Testing for Aluminium

• Urinary aluminum can provide information about aluminum intake and has been used to monitor human exposed to dangerous amounts of aluminum. Because aluminum is ubiquitous in the environment, contamination of a patient’s specimen with aluminum is possible when collection containers are opened in living and work environments.

Testing for Arsenic

• Urinary arsenic is most commonly measured to screen for arsenic exposure. Urine reflects arsenic exposure in the few days prior to specimen collection. To eliminate the contribution of seafood to total arsenic levels, avoid seafood 72 hours before testing.

Testing for Arsenic

• Hair, nail and urinary arsenic levels have been shown to be comparable. Hair or nail arsenic represents several months of exposure prior to taking the specimen. Hair arsenic greater than 1 μg/g dry weight has been taken to indicate excessive exposure.

Testing for Arsenic

• Since elevated arsenic in the serum drops within 6 to 10 hours, serum is not the best specimen for determining chronic arsenic exposure. Whole blood is suitable for identifying acute exposure to arsenic, and high levels should be addressed immediately. When arsenic toxicity is suspected, arsenic levels in drinking water should be measured.

Testing for Cadmium

• Whole blood cadmium is indicative of recent exposure, and is therefore not reflective of total-body burden. Normal concentration of whole blood cadmium is up to 1 μg/L for non- smokers, and up to 4 μg/L for smokers.

Testing for Cadmium

• Urinary cadmium may be reflective of total-body burden, although recent exposure will increase levels. Monitoring urinary output of cadmium is an excellent means of assessing exposure. Daily output of cadmium of 2 to 4 μg per 24- hour urine indicates toxicity (approximately 1–3 μg/g creatinine).

Testing for Cadmium

• High hair cadmium is an indication of increased body burden. Elevated hair cadmium has been demonstrated in smokers. When a combination of high cadmium and low zinc is found, potential toxic effects may result because zinc competes for some protein binding sites that are sensitive to cadmium.

Testing for Lead

• Hair lead is a sensitive measure of lead exposure. For those in apparent steady-state lead balance, hair levels were well correlated with blood lead. Normally, hair lead content is < 5 μg/g. Lead levels > 25 μg/g indicate severe lead exposure. Some hair darkening products contain lead acetate and may elevate lead levels in hair.

Testing for Lead

• Whole blood lead is defined by the CDC as the preferred test for detecting lead exposure. Some have proposed to lower reference values for whole blood lead.

Testing for Lead

• Urinary lead concentrations increase with lead poisoning, although urinary elimination of lead is a process that occurs for many days after a single exposure.

Testing for Mercury

• Blood mercury has revealed low level chronic and acute exposure from work environments. The quantity of mercury assayed in blood and hair, but not urine, correlates with the severity of toxicity symptoms.

Testing for Mercury

• Hair has been a frequently used specimen by CDC and the Environmental Protection Agency (EPA) for accurately assessing mercury exposure in selected populations. Levels of mercury greater than 1 μg/g indicate mercury toxicity. A positive correlation of blood pressure with levels of hair mercury has been seen.

Testing for Mercury

• The level of mercury in urine is a reliable way to assess exposure to inorganic mercury. Daily urinary levels greater than 50 μg indicate a Hg2+ overload.

Constructing a Testing Regimen

• Let’s put this all together. In an ideal world, to quantify heavy metal burden you’d want to test:

– Baseline hair

– Baseline blood

– Baseline urine (6-8 or 24 hour collection)

– Challenged urine

• Where you take a chelating agent and measure urinary metal output over 6-8 or 24 hours).

Constructing a Testing Regimen

• A hair test is a simple and non-invasive way to assess not only toxic elements / heavy metals, but also nutrient element levels and certain ratios. Hair analysis is covered in more detail later in the programme. If heavy metal levels are low or absent in the test, it doesn’t mean the metals are not present, which can be confusing for clients and patients.

Constructing a Testing Regimen

• A blood test requires a full blood draw. The laboratory can assess for toxic elements only, nutrient elements only, or both. According to most of the literature I’ve read, the blood test will typically reveal recent exposure rather than body burden. This is helpful for identifying exposure sources and helping clients and patients reduce their exposures.

Constructing a Testing Regimen

• An unprovoked urine test simply means that you collect urine for 6-8 or 24 hours in a large container, shake it up (make sure the lid is on tight!) then pipette a small sample into a vial for analysis.

Constructing a Testing Regimen

• A provocation, or challenge urine test, is done in exactly the same way as the previous urine test, except that a chelating (“claw”) agent is taken at specific points in time to claw onto heavy metals and pull them out of storage so they are excreted in the urine.

Constructing a Testing Regimen

“While an unprovoked 24-hour urine test for mercury can be very illuminating, a urine test following a

provocative challenge with DMSA) or DMPS can reveal even more. This can be especially revealing if the

provoked test is done following the unprovoked one. The author has found this method to be quite effective at revealing heavy metal (not just mercury) burdens in

chronically ill individuals.”

Crinnion: Alt Med Rev. Vol 5; No.3

Constructing a Testing Regimen

• The chelating agents are:

Constructing a Testing Regimen

Constructing a Testing Regimen

• DMSA and DMPS are FDA approved drugs. They’re not supplements. Thus, it’s very risky to use them for testing or detoxification unless you are a licensed practitioner.

Constructing a Testing Regimen

• Note the importance placed on making sure a client/patient is able to tolerate the chelating agent whilst at the same time ensuring he or she has adequate creatinine clearance (kidney function). If you performed a provocation/challenge test without doing this and damaged the client/patient you would be in big trouble.

Constructing a Testing Regimen

• A further test for heavy metals is the urine porphyrins test. Unlike all the previously mentioned tests, the porphyrins profile assesses toxic effects rather than seeking to detect the heavy metals per se.

Constructing a Testing Regimen

• Going back to 1993 and beyond, porphyrin testing was used by the likes of Dr. Hal Huggins, who states:

“According to research by Dr. James Woods at the University of Washington, mercury toxicity appears to

leave a specific fingerprint in the excretion of a chemical called porphyrin.”

Hal Huggins – It’s All In Your Head, 1993, pp. 93-95.

Constructing a Testing Regimen

“Porphyrins are chemicals that the body manufactures for the purpose of transporting energy for use by every

cell in the body…Porphyrins turn into more than one product depending on the body’s requirements. One key

product is haemoglobin, perhaps the best known energy unit in the body. Haemoglobin’s primary

function is to transport oxygen from the lungs to all body tissues.”

Hal Huggins – It’s All In Your Head, 1993, p.94.

Constructing a Testing Regimen

“Porphyrins are proteins involved in the formation of heme measured in urine. Heme is essential for the proper function of many proteins including oxygen

transport, energy production, and detoxification. Proper porphyrin production is essential for our body's capacity

to detoxify toxins.”

http://www.metametrix.com/test-menu/profiles/toxicants-and-detoxification/porphyrins-profile

Constructing a Testing Regimen

“Porphyrins are particularly well suited for assessing heavy metal toxicity. First, the heme pathway is a

constantly-changing pathway that is active in almost every cell of the body. Any disturbance in the pathway

tends to cause rapid and relatively large accumulations of intermediates, such as porphyrins. Second, the enzymes of the pathway are widely distributed in

human tissues, and are highly sensitive to the presence of various toxins, creating the large accumulation of

porphyrins in the pathway.”

Constructing a Testing Regimen

“The highly regulated heme pathway consists of eight enzyme-driven reactions. Reactions begin and end inside the

mitochondria, with intervening steps carried out in the cytosol. When porphyrinogens build up, they are easily oxidized to

porphyrins that appear in urine. Toxicants like heavy metals and organic xenobiotics bind to one or more enzymes to produce specific patterns of urinary porphyrin elevation. Oxidized porphyrins that accumulate in the body become

additional toxicants that cause further tissue degradation. The blockages also slow down the production of the heme-

requiring proteins listed at the upper left.”

http://www.metametrix.com/files/test-menu/misc/heme-pathway.pdf

Constructing a Testing Regimen

“Porphyrins appear elevated in urine when the cellular pathway for heme synthesis is blocked by natural or man-made toxicants or when genetic disorders that

affect the enzymes of the porphyrin pathway are present. When confounding variables are absent, the

analytes and ratios of the Metametrix Porphyrin Profile allow discrimination of certain types of toxic effects.”

http://www.metametrix.com/files/test-menu/interpretive-guides/Porphyrins-IG.pdf

Constructing a Testing Regimen

http://www.metametrix.com/files/test-menu/misc/heme-pathway.pdf

Constructing a Testing Regimen

• Porphyrin testing helps identify:

– Levels of biochemical damage caused by toxicant exposure.

– Physiologic burden of a person's level of toxins.

– Levels of porphyrin elevation correlated with levels of toxic interference.

– Toxicity of patients before and during chelation therapy.

– Toxicity of therapeutic drugs.

Constructing a Testing Regimen

http://www.metametrix.com/files/test-menu/interpretive-guides/Porphyrins-IG.pdf

Stool Test for Heavy Metals

“Analysis of elements in feces provides indirect information about the potential for toxic metal burden.

For many toxic metals, fecal (biliary) excretion is the primary natural route of elimination from the body.

Fecal elemental analysis also provides a direct indication of dietary exposure to toxic metals. Specimen collection is convenient for the patient and only requires

a single-step procedure.”

http://www.doctorsdata.com/test_info.asp?id=147

Stool Test for Heavy Metals

“Administration of pharmaceutical metal binding agents results in excretion of toxic metals primarily

through the kidneys into the urine. In contrast, support of natural detoxification processes enhances the rate of excretion of toxic metals into the feces…Fecal specimens

can provide a valuable tool to monitor the efficacy of natural detoxification of metals in infants or patients who are on very limited and defined diets that do not

contain contaminated solid foods.”

http://www.doctorsdata.com/test_info.asp?id=147

Stool Test for Heavy Metals

“A preliminary study performed at Doctor’s Data indicates that biliary/fecal excretion of mercury and lead may be markedly enhanced following high dose intravenous administration of ascorbic acid. Other

orthomolecular or nutraceutical protocols may also enhance the fecal excretion of metals and hence

potentially decrease burden on the kidneys. Further research to identify and validate such therapies is

warranted.”

http://www.doctorsdata.com/test_info.asp?id=147

Stool Test for Heavy Metals

“The fecal metals test was not developed to replace the pre and post urinary toxic metals provocation test, but rather provides an alternative for infants, children or adults for whom urine collection is problematic, or for

individuals who do not tolerate the available pharmaceutical metal detoxification agents. Elements

are measured by ICP-MS and expressed on a dry weight basis to eliminate variability related to water content of

the specimen.”

http://www.doctorsdata.com/test_info.asp?id=147

Drinking Water Tests

• Doctor’s Data provides a drinking water test that assesses for several key contaminants. This can be very helpful when evaluating exposure sources. As well as toxic elements/heavy metals, the test looks at fluoride levels and pH.

Drinking Water Tests

http://www.doctorsdata.com/_data/pdfs/water.pdf

Drinking Water Tests

• Biolab in London also offers drinking water tests. The test includes aluminium, antimony, arsenic, beryllium, cadmium, chromium, copper, lead, lithium, manganese, nickel, selenium and uranium. It doesn’t look at fluoride or pH.

http://www.biolab.co.uk/index.php/cmsid__biolab_test/Water_-_toxic_metals

Heavy Metal Testing Quirks

“…Neither provoked nor unprovoked tests may show the whole picture of heavy metal load. In a study of 18 subjects, all of whom previously had amalgam fillings and who exhibited symptoms of mercury overload, the

four who still had amalgam fillings showed urine mercury levels within the normal range.”

Crinnion: Alt Med Rev. Vol 5; No.3

Heavy Metal Testing Quirks

“Those who had amalgam removal showed elevated urine levels. When the four had their amalgams

removed, their urine output increased to elevated levels over time. The researchers hypothesized that some

persons with amalgams exhibit a “retention toxicity.”

Crinnion: Alt Med Rev. Vol 5; No.3

Putting it All Together

“Toxic metal assessment can be done with porphyrins, hair, or whole blood. Many clinicians use a non-

provoked and a provoked urine test to assess heavy metal exposure while others select urinary porphyrins in

conjunction with a challenge urine test to screen for heavy metal exposure.”

Metametrix Nutrient & Elements Interpretive Guide

Putting it All Together

• Stool Test (DD)

Putting it All Together

• How useful is the heavy metal testing? Personally I think it’s incredibly useful. If nothing else, it can really motivate a client or patient to change. When you see some of the client reports in lesson eleven, art three, you’ll realize why this is.

Putting it All Together

• The safe option would be:

– Porphyrins

– Hair

– Whole blood

– Possibly look at drinking water

• The more risky option (legally and health-wise) would be:

– Porphyrins

– Baseline urine

– Urine challenge

– Or just the baseline and urine challenges

– Possibly look at drinking water

Putting it All Together

• Remember that each practitioner has his or her own bias when it comes to any kind of testing. Opinions vary. The most important consideration in my opinion is “first do no harm”. In my practice, I do very little heavy metal detoxification testing and work with my clients because I feel it’s somewhat beyond my legal and ethical boundary (I will likely be conducting the work in conjunction with an MD in the future).

Thank you!

• As always, thanks a million for tuning in and consuming this information. In Part Three we’ll look at some client reports from each of these specific nutrient and toxic element panels. We’ll discuss detoxification strategies in more detail during the detoxification section.