Toxic metals challenge test from Doctors Data

Here are the results of my toxic metals urine test (and hair test here) which involved a challenge agent and six-hour timed urine collection (please excuse the typos introduced by OCR):

Barium High

Barium (Ba) has not been established to be an essential element. Elevated levels of Ba often are observed after exposure to Ba (a contrast agent) during diagnostic medical tests (e,g, “barium swallow”, “upper GI series”, “barium enema”, etc.). Elevated levels of Ba may interfere with calcium metabolism and potassium retention. Acutely high intake of soluble Ba-salts (nitrates, sulfides. chlorides) can be toxic. Chronic exposure to Ba may be manifested by muscular and myocardial stimulation, tingling In the extremities, and loss of tendon reflexes. Due to its high density, Ba is utilized to absorb radiation and is utilized in concrete shields around nuclear reactors and in plaster used to line x-ray rooms. Peanuts/peanut butter are very high in Ba so urine Ba may be elevated shortly after consumption of these foods; toxic effects would not be anticipated under such conditions,

The main use of Sa in medicine is as a contrast medium. Long-term retention of Ba can occur – granuloma of the traverse colon has been reported after diagnostic use of Ba­ sulfate, Crystalline Ba-titanate is a ceramic compound which is used in capacitors and transducers. Ba is also used to produce pigments in paints and decorative glass.  Soluble Ba compounds are highly toxic and may be used as lnsecticides. Ba-aluminates are utilized for water purification, acceleration of concrete solidification, production of synthetic zeolites, and in the paper and enamel industries.

Although Ba is poorly absorbed orally «5%)  it can be very high in peanuts and peanut butter (about 3,000 nanograms/gram), frozen and fast foods such as burgers, fries, and hot dogs (400-500 nanograms/gram). It is noteworthy that Ba intake is much higher in children than adults (Health Canada 2005).

Ba levels (and the levels of 16 other elements) in water can be assessed with water testing as provided by DDI. A possible confirmatory test for excessive Sa retention is measurernent of blood electrolytes as hypokalemia may be associated with excessive Ba in the body.  Hair elements analysis may provide further evidence of exosure to Ba.

LEAD HIGH

This individual’s  urine lead (Pb) is higher than  expected  which  means that Pb exposure is higher than that of the general  popu’atlon, A percentage  of assimilated  Pb is excreted  in urine. Therefore  the urine Pb level reflects  recent or ongoing  exposure  to Pb and the degree of excretion  or endogenous  detoxification   processes.

Sources  of Pb  include:  old lead-based  paints, batteries,  industrial  smelting  and alloying, some types of solders,  Ayurvedic  herbs, some toys  and products  from China  and Mexico, glazes  on(foreign)  ceramics,  leaded  (anti-knock  compound)  fuels,  bullets and fishing  sinkers, artist paints with Pb pigments,  and leaded joints  in municipal  water  systems,  Most Pb contamination   occurs  via oral ingestion  of contaminated   food or water or by children  mouthing  or eating  Pb-containing  substances.  The degree  of absorption  of oral Pb depends  upon stomach contents  (empty stomach  increases  uptake)  and upon the essential  element  intake and Pb status.  Deficiency  of zinc, calcium  or iron increases  Pb uptake.  Transdermal  exposure  is significant for Pb acetate (hair blackening  products).  Inhalation  has decreased  significantly  with almost  universal  use of non-leaded  automobile  fuel.

Lead accumulates  in extensively  in bone and can inhibit formation  of heme and hemoglobin  in erythroid  precursor  cells, Bone Pb is released  to soft tissues  with bone remodeling  that can be accelerated  with growth,  menopausal  hormonal  changes,  osteoporosis,   or skeletal  injury,  Low levels of Pb may cause  impaired  vitamin  D metabolism,  decreased  nerve conduction.and developmental   problems  for children  including:  decreased  IQ, hearing  impairment,  delayed  growth, behavior  disorders,  and decreased  glomerular  function.  Transplacental  transfer  of Pb to the fetus can occur at very low Pb concentrations in the body. At relatively  low levels,  Pb can participate  in synergistic  toxicity  with other toxic elements  (e,g, cadmium,  mercury),

Excessive  Pb exposure  can be assessed  by comparing  urine Pb levels  before  and after provocation   with Ca~EDTA (iv) or oral DMSA.  Urine Pb is higher post-provocation   to some extent  in almost everyone,   Whole  blood analysis  reflects  only recent ongoing  exposure  and does  not correlate well with total body retention  of Pb, However,  elevated  blood Pb is the standard  of care for diagnosis of Pb poisoning  (toxicity).

BIBLIOGRAPHY   FOR LEAD

1. ATSOR  Toxicological   Profile for Lead (2007 update) www.atsdr,cdc.gov/toxprofile
2. Centers  for Disease  Control  and Prevention,  Third National  Report on Human  Exposure  to
Environmental   Ohemicals, Atlanta,  GA: CDC; 2005.
http://www.cdc.gov/exposurereporVreport.htm        [Accessed  02/01/2009)
3. Lead Tech  ’92, “Proceedings   and Papers from the Lead Tech ’92: Solutions  for a Nation at Risk” Conference,   Sept 30-0ct 2,1992. Bethesda,  MD, lAO Publicatlons,  4520 East-West  Highway.  Ste 610,
Bethe$d~,  MD. 20814.
4. “Preventing   Lead Poisoning  in Young  Children”,  US Centers  for Disease  Control.  Atlanta,  GA, Oct.  1991
Statement.  US Dept. of Health and Human  Services.
5, Carson  B,L. et al. Toxicology  and Biological  Monitoring  of Metals in Humans,  Lewis Publishers,  Inc”
Chelsea,  MI, p, 128-135,  1986.
6. Tsalev D,L. et al. Atomic  Absorption  Spectrometry   in Occupational  and Environmental   Health Practice
VOl 1, CRG Press,  Boca Raton,  Fl1983.
7. Piomelli  S. et al. “Management   of Childhood  Lead Poisoning”,  J. Pediatr  105 (1990) p, 523-32.
8. Shubert  J. et at. “Combined  Effects in Toxicology•   a Rapid
Systematic  Testing  Procedure:  Cadmium,  Mercury  and LeadH     –   J. Toxicology  and Environmental   Health,
4:763-776,1978.
9. Mayo Clinic.  Mayo Medical  Laboratories.  http://www.mayomedicallaboratories.comftest-catalog/
clinical+and+lnterpretive/60246      [Accessed  10/25/2011]
10. Saper RB et al. “lead,   mercury  and arsenic  in U.S. and Indian manufactured   ayrevedic  medicines sold via the internet.”   JAM A (2008)  300(8):  915-23.

NICKEL  HIGH

This individual’s  urine nickel  (Ni) is elevated  which mayor  may not be of significance.  Urinary excretion  of nickel bound to cysteine  or other thiol compounds  (such as glutathione)  or to amino acids (histidine,  aspartic  acid, arginine)  is the predominant  mode of excretion.  With the exception of specific  occupational  exposures,   most absorbed  Ni comes from food or drink, and intakes  can vary by factors  exceeding   100 depending  upon geographical  location,  diet, and water  supply. Depending  upon chemical  form and physiological  factors,  from  1 to 10% of dietary  Ni may be absorbed  from the gastrointestinal  tract.  Urine Ni only reflects  recent exposure  to Ni and May vary widely  from day to day.

Sources  of nickel are numerous  and include the following.

• Cigarettes  (2 to 6 mcg Ni per average  cigarette)
• Diesel  exhaust  (particulates  may contain  up to 10 mg/gram)
• Foods,  especially:  cocoa,  chocolate,  soya products,  nuts, hydrogenated   oils, and coffee
• Nickel-cadmium   batteries  (Ni-Cd)
• Nonprecious,   semiprecious  dental  materials
• Nickel-containing   prostheses
• Electroplating,   metal plated  objects,  costume jewelry
• Pigments  (usually  for ceramics  or glass)
• Catalyst  materials  (for hydrogenation   processes  in the food, petroleum  and petrochemical   industries)
• Arc welding
• Nickel refining  and metallurgical   processes

Most clinically  relevant  Ni exposures  are manifested  as dermatoses –   contact  dermatitis  and atopic dermatitis.  However,  Ni hyper-sensitizes  the immune  system  anti may cause  hyperallergenic responses  to many  different  substances,  because  Ni can displace  zinc from binding  sites on enzymes  it can affect abnormal  enzymatic  activity.  Nickel sensitivity  is observed  to be three to five times  more prevalent in females  than in males.

Other laboratory  tests or possible  clinical findings  that may be associated  with Ni exposure  are; hair elements  analysis,  presentation   of multiple  allergic  sensitivities,  dermatitis, positive  patch test for “Ni allergy”,  proteinuria,  hyperaminoaciduria  (by 24-hour  urine amino acid analysis).  Administration of EDTA or sulfhydryl  agents  (DMPS,  DMSA,  D-penicillamine)   may increase  urine Ni levels; ~I,JCh chelator-induced   elevations  mayor  may not be associated  with adverse  health effects.

BIBLIOGRAPHY   FOR NICKEL
1. Tsalev  D.L. and ZK  Zaprienov  Atomic Absorption  Spectrometry  in Occupational  and
Environmental Health Practice, CRC Press, Boca Raton FL, pp 173-78,1983.
2. Carson B.L. et al. Toxicology and Biological Monitoring of Metals in Humans, Lewis Publishers,
Chelsea MI, pp 162-67,1986.
3. Nial$QnF.H. in Modem  Nutrition  in Hoalth and Di:)¢Q~ccd. by Chila et .,1,Lea 8; rebiger,
Philadelphia, PA, pp 279-81,1994.
4. Medical and Biological Effects of Environmental   Pollutants: Nickel, Nat. Acad. Sci,
Washington DC,1975.
5. Ambient Water Quality Criteria for Nickel, US EPA NTIS, Springfield,  VA, Publ No. PB81-
117715,1980.

THALLIUM HIGH

This individual’s urine thallium (TI) is higher than expected, but associated symptoms or toxic effects mayor may not be presented. Pl’eSer’1tationof symptoms can depend upon several factors including: chemical form Of the TI mode of assimilation.  severity and duration of exposure. and organ levels of metabolites and nutrients that effect the action of TI in the body.

Thallium can be assimilated transdermally, by inhalation, or by oral ingestion. Both valence states can have harmful effects: TI+1 may displace potassium from binding sites and influences enzyme activities; TI+3 affects RNA and protein synthesis. TI is rapidly cleared from blood and is readily taken up by tissues. It can be depOSited in kidneys, pancreas, spleen, liver, lungs, muscles, neurons and the brain. Blood is not a reliable indicator of TI exposure.

Symptoms that may be associated  with excessive TI exposure are often delayed. Early signs of cnronic, low-level TI exposure and retention may include: mental confusion, fatigue, and peripheral neurological signs: parestnesias. myalgias, tremor and ataxia. After 3 to 4 weeks, diffuse hair loss with sparing of pubic and body hair and a lateral fraction of eye- brows usually occurs. Increased salivation occurs less commonly. Longer term or residual symptoms may include: alopeCia, ataxia, tremor, memory loss. weight loss. proteinuria (albuminuria),  and possibly psychoses. Ophthalmologic neuritis and strabismus may be presented.

Environmental  and occupational sources of TI include: contaminated  drinking water, airborne plumes or waste streams from lead and zinc smelting, photoelectric, electrochemical  and
electronic components (photoelectric cells, semiconductors,  infrared detectors, switches). pigments and paints, colored glass and synthetic gem manufacture,  and industrial catalysts used in some polymer chemistry processes. Thallium Is present in some”weight loss” supplements (e.g. Active 8) at undisclosed levels (“trade secret”).

Hair (pubic or scalp) element analysis may be used to test for suspected TI exposure. Although urine is the primary natural route for excretion of thallium, the biliarylfecal route also contributes. Therefore. fecal metals analysis provides a confirmatory  test for chronic ongoing exposure to TI, Clinical findings that might be associated with excessive TI are: albuminuria.
EEG with diffuse abnormalities. hypertension.  and elevated urine creatinine phosphokinase (CPK). No provocation agents are currently available to estimate TI retention by means of urinalysis.

BIBLIOGRAPHY FOR THALLIUM
1. Centers for Disease C antral and Prevention. Third National Report on Human Exposure to Environmental Chemicals. Atlanta, GA: CDC 2005. http;lIwww.cdc.gov/exposurereport.htm [Accessed 2101/2009)
2. Graef J.W. “Thallium” in Harrison’s Principles of Intemal Medicine, 13th ed., isseioacner  et al
3. Tsalav D.L. and Zaprianov Z,K, Atomic Absorption Spectrometry  in Occupational  and
Environmental Health Practice CRC Press, Boca Raton FL. pp 196-199, 1983.
4. Carson B.L et al. Toxicology and Biological Monitoring of Metals in Humans Lewis Publishers, Chelsea, MI, pp 243-254, 1987.

TUNGSTEN HIGH

The level of tungsten (W) in this urine sample is higher than expected. After exposure and absorption via inhalation. ingestion or injection, most W is rapidly eliminated via urine and feces, W has no known biological role. Long-term chronic exposures have been associated  with lung disease (pneumoconiosis  or “hard metal lung disease”) and lung cancer. Skin contact with W may produce contact eczema, pruritis. folliculitis and neurodermatitis. Tungsten has an antagonistic relationship  with molybdenum (Mo) decreasing hepatic Mo concentration and reducing the effectiveness  of sulfite and xanthine oxidases.

Tungsten is a silvery-white lustrous element usually obtained as a grey powder and is mainly utilized as tungsten carbide in metal-working,  mining and petroleum Industries. Calcium and magnesium tungstates are widely used in filaments for electric lamps, electron tubes and television tubes,  Since W has the highest melting point of all metals it is used for high-speed and hot-worked steels, Other sources include catalysts and reagents in biological analysis, fire and waterproofing materials, and industrial lubricants.

For people exposed to hard-metal dust, W levies can reach .014 jJg/g in urine. Intestinal absorption of tungsten is rapid and seemingly  significant. W is rapidly transported to the blood
and then to the kidneys for filtration and eventual excretion from the body,  In a rat study, elimination of W via feces was slower than that of urine but reached 52% after three days.  PUlmonary absorption of W-tungstic oxide has been studied in dogs, 60% of W is rapidly deposited in the respiratory  tract and 33% of that fraction reaches systemic circulation. Tungsten is also easily transferred from mother to fetus usually later in gestation.

Urinary W levels may be elevated after administration  of OMPS or DMSA; comparison of urine W before and after provocation provides and estimate of net retention of W over time.

BIBLIOGRAPHY FOR TUNGSTEN. HIGH

1. Marquet, P’I Francois, B.•Lotti, H” Turcant, A.,  Debord, J., Nedelec, G.•Lachatre,  G. Tungsten aetermination in biological fluids, hair and nails by plasma emission spectrometry in a case of severe acute intoxication in man. J ForensiC Sci 42(3):527-30, 1997.
2. Seiler, H’I Sigel, A., Sigel, H. Handbook on Metals in Clinical and Analytical Chemistry.
New York. Marcel Dekker, lnc., 1994.