Of all the heavy metals, mercury is the most toxic to the human body. Mercury (Hg), also known as “quicksilver,” comes in three forms – metallic, inorganic and organic. Metallic Hg (Hg0) can be oxidized into inorganic Hg as Hg1+ or Hg2+, or it can be methylated into organic Hg by the bacteria found in the mouth or gut of the exposed patient.
Mercury has been shown to cross the blood brain barrier and disrupt microtubule metabolism and nerve conduction, to bind to the sulfhydryl proteins of the cardiac muscles and cause cardiac arrest, to cause kidney damage resulting in porphyrinuria, to depress the activity of humoral and cell-mediated immunity lowering the resistance to infections or causing allergies and autoimmune conditions, to greatly increase free radical production resulting in chromosomal and cellular damage, to concentrate in bone marrow disrupting normal blood formation, and to accumulate in glandular tissues causing hormonal imbalances. Furthermore, the amount of Hg exposure in mothers has been correlated with the amounts found in their breast milk and in their fetuses.
Worldwide, the burning of fossil fuels can release 12,000 tons of Hg annually into the atmosphere. To date, 95% of the estimated 200,000 tons of Hg emitted into the atmosphere since 1890 is currently in terrestrial soil stocks of part of the oceanic sink. The concern here is the recycling and re-emission into our air, water and food supplies since elemental Hg can neither be lost nor destroyed. In Grassy Narrows, Ontario – a paper plant dumped tons of Hg into the river system for decades poisoning Ojibwa residents who fed on the toxic fish where 70 to 80% of the native adult population experienced symptoms of mercury toxicity. This is because Hg in the rivers bioaccumulates and biomagnifies from the lower tropic level of the food chain (algae, detritus, and macrophytes) to the smaller fish and eventually making their way to the larger fish, and finally to the Ojibwan fish consumers.
Since Hg is so poisonous, limits of Hg exposure have been established by various health agencies in North America. The EPA drinking water limit for Hg is set at 2 parts per billion and for rivers and lakes at 144 parts per trillion. The FDA seafood limit is set at 1 part per million (ppm), whereas Health Canada is set at 0.5 ppm. The FDA also limits the amount of Hg in grain at 1ppm. And OSHA workplace limit is set at 0.01mg/m3 for MeHg and 0.05 mg/m3 for Hg vapor for 8-hour shifts and 40-hour work weeks. Recognizing that Hg accumulates in our bodies, the recent trend has been for these agencies to lower their limits to Hg exposure. In 2001, the EPA lowered its reference dose of Hg from 0.5 to 0.1 ug/kg/day. In 1999, the ATSDR (Agency for Toxic Substances and Disease Registry) lowered its maximum daily load from 0.5 to 0.3 ug/kg/day. In 2003, the WHO lowered the weekly tolerable intake of Hg from 3.3 ug/kg/week to 1.6 ug/kg/week.
North American dentists place about one million Hg fillings into patients’ mouths every day. In 2000, an estimated 600,000 pounds of Hg was used by dentists, and to date an estimated 557 tons of Hg are stored in the teeth of North American dental patients. Currently the NIH does not support research on MeHg from dental sources, they are only interested in the fish industry and are leaving the dental industry alone. Yet the ADA’s mercury handling procedures recommends training and care in handling amalgams and amalgam contaminated instruments. The EPA has declared dental amalgam scrap as a hazardous waste since 1988. WHO studies show that a single amalgam can release 3 to 17 μg of Hg per day – that is about six times higher than Hg derived from the fish and the environment.
The symptoms of Hg toxicity are insidious and overlap with the symptoms of many diseases. Mercury poisoning is the greatest masquerader of our time. Dentists and MDs are not in a position to see the cause and effect relationship of mercury fillings or toxic fish and the development of illnesses years later. So it is up to NDs to properly assess and treat these toxic individuals. Far too many times I have seen patients who have gone to alternative practitioners who use chelating therapies at the first chance they get. Invariably, patients who are environmentally sensitive or have poor eliminatory capacity needlessly suffer at the hands of these practitioners.
Toxic Mercury Load Case
A 45-year-old counselor presented to my office with mercury toxicity due to amalgams in approximately 20 teeth which were removed in 1995. She complained of having bad taste in the mouth, dizziness, pressure in her chest, pressure under her ribs especially the right side, nausea, extreme agitation, frequent but ineffectual urination, bloating, constipation, inability to eat solid foods (only drinks vegetable juices), feelings of panic, anxiety, depression, muscle weakness, burning tongue, headaches, difficulty concentrating, intestinal problems, tattooing of her gums from mercury, difficulty walking at times, facial immobility, dry skin, pain in the ears and eyes, feelings of pressure and swelling in her head, sinus problems, multiple chemical sensitivities, fatigue when standing, burning feet, thyroid gland often being sore and enlarged especially on the right side, inability to fall asleep and pain in her kidneys that radiates to her upper back and to her abdomen.
She was diagnosed with mercury toxicity in 2003 by IV DMPS 250 mg challenge which showed that her mercury level was at 25 ug/g of creatinine (approx. 8 times over the upper limit of 3) and that her creatinine was at 7.4 mg/dl (normal 60 -160). Her doctor administered seven DMPS treatments which caused extreme adverse reactions, especially with the skin.
Despite these setbacks, the patient was determined to find a solution and came to our office in hopes of dealing with the heavy metal issue in an appropriate manner – one that was gentle and did not cause adverse reactions. During the interview, it was discovered that during her childhood, she had the 20 amalgams in her mouth, had lived in a farming community where farmers regularly sprayed pesticides and insecticides, and that her home was situated next to a main thoroughfare where vehicles and trucks were using leaded gasoline.
Examination
The patient is a pleasant and bright woman at 5’4” and 108 lbs. Her BP was 104/60, P 60 bpm, and her TCM pulses were sinking, slow and had an empty feel. Her pulses also showed kidney yang 3-, spleen 1-, lungs 2-, kidney yin 2-, liver 1- and heart at 1-. Her tongue showed scalloping at 1+ and coating at 2+ in posterior and mid-tongue regions involving the kidney and stomach/spleen regions with deep cracks and furrows indicating B12 deficiency. Her face had a pinkish hue indicating acrodynia, but the rest of her skin was dry with a mottled grayish look.
In examining her mouth, she had dark bluish gums and there were no traces of silver amalgams as they had previously been replaced by porcelain fillings. On palpation, she showed no tenderness in her abdomen. However, on light reflex test it showed a failure of her pupils to hold constriction indicating adrenal exhaustion. As well, on examining her nails, her capillary refill test was slow at 2-, lacking moons, and had white spots, with some vertical ridging indicating poor circulation, trace mineral and B-vitamin deficiencies.
Lab Testing
Creatinine, urea, and uric acid levels were low indicating a compromised kidney function as confirmed by a positive kidney punch test to the left flank region. Her globulin and LDH levels were slightly high indicating high oxidation rates and heavy metal toxicity. Her A/G ratio was slightly low indicating liver dysfunction, oxidation and immune activation. Her hemoglobin, WBC counts were slightly low, and MCV, RDW were slightly high all pointing to B-vitamin deficiency and heavy metal toxicities. As well, her anion gap was high, turgor at 3+, and urine specific gravity at 1.005 indicating low salt status and acidity. Also, indican level showed moderate malabsorption problem which would explain her inability to eat solid foods. Plasma malondialdehyde was at 80% indicating high free radical status. Plasma antioxidant panel showed most values to be rather low. Essential and non-essential panels of amino acids also showed many values to be rather low suggesting poor protein malnutrition and/or malabsorption. The gastrointestinal panel showed markers for yeast and fungi growth in the bowel. Methylmalonate was highly elevated indicating B12 deficiency.
Her hair analysis showed abnormally high levels (greater than 68th percentile) of antimony, cadmium, and nickel and significantly high levels (greater than 95th percentile) of lead and uranium. However, mercury was normal which indicated that she had problems eliminating mercury considering her history and the IV DMPS challenge test results.
On further inquiry, it was discovered that she had been drinking well water. After testing, it showed some uranium which would explain for high uranium levels in her hair test. The lab did not perform tests for other heavy metals and it had been recommended that the patient get more thorough tests for other heavy metals including cadmium, lead, mercury and nickel.
Treatment
Her treatment commenced with a restricted diet of vegetable juice of greens, beets, and some non-citrus fruits. She was told to drink bottled spring water instead of the well water and drink an electrolyte solution of sea salt, lemon and water while she is using the sauna. Her husband was able to build her an infra-red sauna complete with ventilation and she has been able to use it for 15 min to 3 hours per day. She takes a probiotic product for her dysbiosis, buffered C to bowel tolerance, electrolyte formula to alkalize, melatonin for sleep, amino acid formula, multi-minerals, fish oils (without contaminants of course), mixed tocopherols, pantothenic acid, germanium, boron, Siberian ginseng and niacin prior to sauna therapy.
Follow-Up
After following the program for one month, the patient has seen an overall 10% improvement. She was able to sit in the sauna for about 2 hours per day and states that she can taste the heavy metals in her mouth which goes to her sinuses leading to headaches. She takes charcoal while in the sauna in order to eliminate the headaches. She tried using niacin but found that it just increased her nausea and headaches and she was not able to sweat as much. Niacin is a vasodilator and her symptoms indicate mobilization of heavy metals even though her eliminatory capacity is not quite where it should be. I will ask her to reintroduce niacin at a later time. Her digestion had improved significantly and she was able to incorporate some solid foods including rice, kamut biscuits, fruits, carrots, celery and potatoes. In April, 2005 she went to see a biological dentist and discovered that a cavitation in the lower jaw had never healed after an old molar had been extracted in the past. This invariably caused the infection to travel to her sinuses and cause ongoing headaches and continue to challenge her immune system. Since then, she has been using LED lights to stimulate circulation in order to clear the infection.
It has been almost a year since instituting this program and overall her symptoms have improved by about 25%. She is sleeping better, has more energy and is able to work full days. Sauna therapy has been crucial in her recovery and she is using it 3.5 hours every day. She finds that she has to do her therapy every day as the heavy metals have been mobilizing from her tissues and if she were to go on vacation for a couple of days, her symptoms would be unbearable due to the need for elimination. She is no longer on any supplements and is only using Valerian herb for sleep and Cascara for bowel regularity. She recognizes that when she is “dumping” heavy metals, her urination and bowel movements would cause burning sensations. As well, during sauna therapy, she would continue to taste the metals in her mouth, her skin would erupt into fever blisters and eczematous lesions and her kidneys would spasm…all of these are good signs and she celebrates in the knowledge that she is getting better as the toxins are being eliminated. She is able to eat solid foods now and is no longer as sensitive to her environment (used to have to lie down if exposed to various scents).
This patient’s prognosis is good. We anticipate that in another year we may be able to implement more supplements such as Zn to upregulate metallothionein response in her kidneys, various antioxidants and other nutrients to improve glutathione production in her liver and maybe even use alpha lipoic acid to chelate for the heavy metals.
Conclusion
We don’t know why it is that some individuals are more sensitive and reactive to heavy metals than others. But while we’re waiting to find the mechanism, it would be prudent to adhere to the wisdom of our naturopathic principles of: (1) Do no harm; (2) treat the individual; and (3) treat the cause. Do a thorough interview especially around the history of exposure. Obviously, take steps to avoid further exposure if the patient has not already done so. Use a biological dentist trained in the proper removal of amalgams when referring. Do a complete physical exam, urine tests, chem. screen and CBC. Use less invasive heavy metal assessments, include IV vitamin C challenge which will not cause reactions for those who are hypersensitive. Finally, use therapies that are suited to the patient’s detoxification and eliminatory capacities and when in doubt use the most gentle methods in order tease the metals out the body – do not use a bulldozer when a small chisel will do the same trick!