Hair Test Interpretation: Finding Hidden Toxicities
by Andrew Hall Cutler, PhD, PE
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Mercury poisoning is the most common heavy metal problem. It is also difficult to diagnose because the exact problems it causes vary so much from person to person. There is also some confusion in the health care community as to how to interpret clinical laboratory test results. There is intense controversy because the major cause of mercury poisoning today is health care and many doctors understandably find this very upsetting. Given these factors I am including a separate fairly long section on mercury. Additional descriptions can be found on pages 25-29 of Amalgam Illness: Diagnosis and Treatment or in the medical literature1.
Reviewing some of the key factors noted in standard medical texts is a good place to start. Medical textbooks are conservative in the material they present. Controversy regarding the nature of mercury poisoning or the lack of utility of certain tests to detect it may be due to the emotionally charged nature of this subject, not to medical or scientific questions.
Erethism is generally mentioned as the most common and important finding in mercury poisoning.
Clinical Toxicology, Ford, first edition, 2001: "Erethism is a constellation of signs and symptoms, including shyness, emotional lability, nervousness, insomnia, memory problems, and inability to concentrate. "
Merritt's Textbook of Neurology, ninth edition 1995: "the psychological changes which include timidity, seclusiveness and irritability have been referred to as ˜erethism."�
Textbook of Medicine, Cecil, seventh edition 1948: "Erethismus mercurialis, a peculiar psychic disturbance characterized by ready excitability and a strange shyness in the presence of strangers, a symptom of great interest and importance; insomnia; headache; vertigo; mental depression and dullness; and, rarely, hallucinations."�
Erethism is the constellation of personality changes that appear early on in mercury poisoning, often before other symptoms are present.
Textbook of Clinical Neurology, Goetz, first edition, 1999: "Personality changes can develop before neurological signs appear. So-called "mercurial neurasthenia" may develop for weeks or months before the patient seeks treatment. This syndrome consists of extreme fatigue, hyperirritability, insomnia, pathological shyness, and depression."�
I have included a description of mercury poisoning from an older textbook written in the days when occupational poisoning was common and doctors had to rely on clinical skills rather than lab tests to make good diagnoses.
Textbook of Medicine, Cecil, seventh edition 1948: "Tremors of the orbit, lips, tongue, fingers and limbs. These are usually moderately fine at first, but at intervals become a coarse and jerking. They may become very severe and in rare instances involve contractions of the limbs of such violence as to require restraint. The tremor is intentional and subsides during rest. Under observation it may increase and diminish, rhythmically recurring. When it is marked, the patient may require assistance in eating and in other activities. Weakness of both the flexor and extensor muscles of the hand and forearm has been reported, but marked paresis is rarely, if indeed ever, caused by mercury. Polyneuritis is said to result occasionally from exposure to mercury. No ataxia occurs and reflexes are not notably affected."�
Modern medical textbooks also make it clear that mercury from "silver2"� fillings is a potential hazard to both dental patients and the people who work in the dentist"™s office.
Harrison"™s textbook of internal medicine, 14th edition 1998: "Low-level exposure from dental amalgams may also be associated with adverse immunologic reactions."�
Cecil Textbook of Medicine, 21st edition, 2000, "10% of dental offices have excessive mercury vapor levels; and accidental spillage can lead to mercury poisoning."�
Textbooks and journal articles cover some of the basic biochemical phenomena underlying mercury"™s ability to affect the body in a wide variety of ways.
Textbook of Clinical Neurology, Goetz, first edition, 1999 lists the following in a table on the effects of different heavy metals under mercury: "Alters cell membranes; causes combination of: metabolic disturbance, disturbance of Ca+2 homeostasis, oxidative injury, aberrant protein phosphorylation."�
In the journal Endocrinology, volume 89, number 6, pages 1489-98 (1971) an article entitled Effect of Mercury on Response of Isolated Fat Cells to Insulin and Lipolytic Hormones by Jack M. George shows how mercury has physiological effects that can cause exactly the constellation of problems seen in type 2 non insulin dependent diabetes "“ elevated blood sugar, insulin resistance and weight gain.
One very important question is whether you have to continue to worry about mercury if a doctor has told you that you definitely don"™t have a problem with it, or that you have something else. Standard medical textbooks make it clear that mercury poisoning is hard to diagnose and easy to mistake for something else.
Cecil Textbook of Medicine, 21st edition, 2000: "With mild exposure, the manifestations are likely to be subtle and diagnosis is difficult. Insomnia, nervousness, mild tremor, impaired judgment and coordination, decreased mental efficiency, emotional lability, headache, fatigue, loss of sexual drive, and depression are early manifestations and are often mistakenly ascribed to psychogenic causes."� In a separate section, Cecil also says "Chronic metal intoxication may also produce a dementing syndrome."�
Clinical Management of Poisoning and Drug Overdose, third edition, 1998, Haddad, Shannon and Winchester, eds. "Chronic mercurialism may be misdiagnosed as Parkinsonism, depression or Alzheimer"™s disease."�
Merritt"™s Textbook of Neurology, 9th edition, 1995: "Because of the prominent motor manifestations, confusion with ALS3 can occur."�
Because mercury poisoning is hard to diagnose, many doctors may order blood or urine tests for mercury. Textbooks point out that this is not helpful.
Cecil Textbook of Medicine, 21st edition, 2000, "Because of the body"™s metabolism of mercury, blood and urine levels may be unreliable."�
Textbooks are also clear on the fact that some children are very sensitive to mercury and become poisoned at low levels that don"™t bother others.
Clinical Toxicology, Ford, first edition, 2001: "Acrodynia ... Although it is most often postulated that the etiology of this syndrome is an idiosyncratic hypersensitivity reaction to mercury because of the lack of correlation with mercury levels, many of the symptoms resemble recognized mercury poisoning."�
With medical textbooks saying that mercury poisoning is difficult to diagnose and can cause a wide variety of problems, a thorough description of it is necessary.
Mercury"™s effects on thought and emotion cause the most troubling symptoms.
Mercury poisoning changes people"™s emotional responses to things. Irritability, argumentativeness, avoidant behavior, anxiety, shyness, being easily embarrassed, and a desire to avoid strangers lead to social withdrawal and makes it difficult for them to relate to others. The victim generally feel that their behavior patterns are appropriate even when this is clearly not so.
The argumentativeness may reach the point where it is impossible to hold a job or maintain most social relationships.
Fatigue, lassitude and depression further limit social interaction. The depression brings feelings of futility, hopelessness, discouragement, and impending doom. Minor problems become overwhelming and insurmountable, while these emotional changes themselves are frightening.
Feelings of enjoyment and happiness become less and less common. There is no motivation for important tasks, fun activities, or day to day routine.
Intelligence gradually deteriorates. Previously bright persons become dull and slow thinking. They suffer from a progressive decline specifically affecting short term memory as well as the faculties for logical reasoning. Thus their ability to do things like balance the checkbook, do math, or play chess suffers. Thoughts become heavy, repetitive and pedantic. Creative thinking becomes progressively more difficult. Verbal expression suffers from an inability to select the right words to convey their meaning.
"Brain fog"� sets in with a poor ability to concentrate and pay attention.
Men frequently become quietly depressive and withdrawn while women more often become anxious, shy, fearful and high strung.
Symptoms come and go over a period of months or years. Life seems to progress in fits and starts, with periods of productivity and social enjoyment coming less and less often as poisoning progresses.
In severe cases, mercury poisoning can cause psychosis. Psychosis interferes with a person"™s thinking, emotions, memory, communication, behavior and interpretation of reality. When sufficiently impaired in all these areas that they can not meet the ordinary demands of life, a person is psychotic.
Psychotic people often have very disorganized behavior which may be childlike or infantile, an inappropriate mood for the situation they are in, poor ability to control their impulses, speak in an incoherent jumble of words, and may have delusions and hallucinations (usually without an understanding of the fact that these are not real). Thought processes are often quite disrupted, with the psychotic person"™s train of thought seeming perfectly logical to them but being at best very loosely connected as far as anyone else is concerned.
Mercury can impair the brain"™s electrical regulation and cause epilepsy (either grand mal or petit mal varieties). Poor electrical regulation that is not bad enough to cause epileptic seizures can cause impulsivity and sudden strong emotions not rationally related to what is going on. It can also cause sudden confusion or disorientation or loss of train of thought.
Mercury affects the senses. The most well known effect is numbness in the hands, feet, and around the mouth (the medical term for this is stocking and gloves parasthesia). There can be a generalized reduction in sensitivity to touch and pain which is often more pronounced in children.
The sense of smell becomes less acute. While the ability to perceive sound is not reduced the person loses the ability to pick meaningful sounds out of background. For example, they are not able to understand speech directed at them at a party, or if music is playing.
The ability to focus the eyes and to control the iris progressively deteriorates, as does convergence - the ability to bring both eyes to bear on nearby objects so as to see one object with depth perception rather than to have double vision. People with convergence problems have difficulty keeping their place while reading and find reading for long periods quite tiring.
Color vision may also become less acute and colors do not appear as bright.
Mercury poisoned children typically have learning or developmental disabilities and trouble relating to peers. The poor visual convergence and accommodation due to mercury poisoning is a common cause of dyslexia and reading difficulties.
Children who are poisoned in infancy or before birth may have hyperextensible joints, hypermobile hips, and may lay in crib with their feet up by their head.
Early physical symptoms include dizziness, tinnitus (ringing in the ears), insomnia and daytime drowsiness. The biological clock runs slow. The poisoned person"™s body wants to wake up late and stay up late. It takes them a long time to "get going"� in the morning.
There may be a tendency towards diarrhea - often alternating with constipation, cold hands and feet, a tendency towards sweating (some people have the opposite symptom and do not sweat at all, which is more common in women), flushing or reddening of the skin - particularly on the face and neck. Some people blush frequently, but others do not blush at all.. Digestive disturbances are also common.
The skin becomes dry, athlete's foot and toenail fungus progress, and the insides of the ankles, particularly behind the ankle bone and a bit above it become dry, itchy, flaky and peel. This becomes annoying enough to keep the victim up at night. There may also be hair loss. Hair may thin out or it may fall out in patches leaving bald spots.
Tremors eventually appear. There may be twitching of the eyelids. Poor coordination of the lips and tongue may render speech more difficult to understand. Handwriting deteriorates and eventually becomes illegible.
Mercury affects the blood coagulation mechanism and leads to easy bruising and bleeding in some people.
Women with mercury problems often have menstrual problems, irregularities, and may suffer from infertility.
Mercury also interferes with the brain"™s regulation of water balance and causes excessive urination.
Mercury can reduce the function of the adrenal and thyroid glands. Typically it does this enough to make the person miserable, but not enough to make laboratory tests abnormal.
Mercury poisons the immune system, making fighting off minor illnesses more difficult. Immune dysregulation can also lead to increased allergy, asthma and other respiratory complaints. It is also a common trigger for autoimmune conditions such as lupus, multiple sclerosis or rheumatoid arthritis. In physiologic terms, mercury poisoning causes an imbalance between T helper type 1 and T helper type 2 cells along with reduced activity of natural killer (NK) cells. This is the same problem that zinc deficiency causes and is most likely due to an acquired zinc deficiency caused by mercury"™s derangement of mineral transport.
Heart racing (the medical term is tachycardia) is quite common in people with mercury poisoning. The heart rate may vary dramatically over a period of a few minutes for no apparent reason. Heart pain (angina) may occur. Doctors may hear intermittent heart murmurs and may find a flattened T wave or a prolonged QT interval on an EKG.
Mercury induced derangement of mineral transport almost invariably results in reduced body zinc levels (usually reflected by high hair zinc levels), poor zinc absorption, increased loss of zinc in the stool and urine, and difficulty concentrating zinc into cells where it is needed. People with low zinc due to mercury problems typically need levels of zinc supplementation that would be excessive in normal individuals. Mercury toxic people tolerate high level zinc supplementation for prolonged periods of many years. Deranged mineral transport also typically results in a need for large amounts of magnesium and molybdenum. Sometimes manganese or selenium is also needed, sometimes excessive selenium is retained. Copper levels are usually somewhat high and copper supplementation is usually harmful.
Blood and urine porphyrins are often elevated in mercury toxic people though this test is seldom performed
It is not unusual for MCV and MCH on a blood count (CBC) to be mildly elevated (suggesting B-12/folate deficiency anemia) in people with mercury poisoning, even when they have more than adequate levels of B-12.
The liver enzymes AST and ALT (also called SGOT and SGPT) may be mildly elevated when a "chemistry panel"� test is done on someone with mercury poisoning, though this is not the rule.
Cholesterol may go up quite a bit in the earlier stages of mercury poisoning. In some people it later falls due to inhibited steroid synthesis, typically in conjuction with inability to make enough cortisol and DHEA for their body"™s needs.
Blood sugar may go up (and may be diagnosed as type 2 diabetes) due to mercury poisoning.
In chronic mercury poisoning there is seldom any evidence of the kidney problems which are present in acute poisoning.
The most common result from a person"™s doctor ordering standard tests like a CBC, chem panel, urinalysis and thyroid test on someone with a fairly serious mercury poisoning problem is that all the tests come back normal, or close enough that the doctor doesn"™t consider the results significant.
In certain circumstances mercury poisoning may be recognized in an 'acute' phase. For example, after placement of fillings which extend below the gumline, after placement or replacement of several fillings, after placement of a dissimilar metal crown or bridge over or against amalgam.. In this earlier phase there may be red blood cells in the urine, greatly elevated urinary porphyrins leading to pink - not red-tinged - urine, burning urination, as well as the above symptoms. Very high exposure levels cause nausea, loss of appetite and diarrhea. In general acute poisoning leads to much more pronounced physical symptoms and much less pronounced mental and emotional symptoms. As time progresses the mental and emotional symptoms slowly increase.
1) The review by Gerstner and Huff (Clinical Toxicology of Mercury, Journal of Toxicology and Environmental Health volume 2, pages 491-526 (1997) ) is particularly good. Also the descriptions in the 1948 and 1955 editions of Textbook of Medicine by Cecil are excellent though more modern editions have less useful descriptions. Any pre-1972 edition of Diseases of Occupations by Hunter also contains accurate and useful descriptions of what mercury poisoned people are like. For a firsthand description of mercury poisoning see http://www.stanford.edu/~bcalhoun/AStock.htm.
2) Silver amalgam fillings are 50% mercury, and approximately 30% silver plus 20% other materials. It would be more accurate to refer to them as mercury fillings.
lateral sclerosis, also known as Lou Gherig"™s disease.
In the United Kingdom it is referred to
as motor neuron disease.
Phone order to (425)
557-8299 or Download
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Phone order to (425) 557-8299 or Download fax and mail order form
Read some excerpts from the book: