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This week's topic: Impact of Lead on Health
Are you well-versed in the health effects of lead?
- In which common diagnoses might it be good to evaluate for acute and chronic lead toxicity?
- Where is most lead stored in the body?
- What are the top 3 most common sources of lead in the U.S.?
- Is there a chelation agent that is better for removing lead from the brain?
Read the email for answers to these questions (and learn more)!
Overview of today's email:
- Lead and health
- Practical clinical tips on chelation
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1. Lead and health
Some key things to know about lead:
- Half life in blood and soft tissues = 35 days
- Half life in bone = 8-40 years
- Lead binds to RBCs after entering the body, and over 90% of absorbed lead is stored in bone
- The 3 primary sources of exposure in the U.S. are from water (lead service lines in municipal water that use chloramine in place of chlorine), cigarette smoke, and lead-containing paint (on dishes and fine dust from aged lead paint in homes)
- Other sources of lead = hot sauce imported from Mexico, bone broth, Ayurvedic and Chinese medicines, PVC containing products (e.g. artificial Christmas trees), and costume jewelry
Beyond known exposure, consider evaluating lead burden in those with the following symptoms and conditions:
- Cognitive decline (in children and adults)
- Inattentive and hyperactive ADHD
- Parkinson's Disease
- Depression
- Panic disorders
- Hypertension (lead inactivates nitric oxide)
- Renal disease (common finding in occupational exposure to lead)
- Male infertility
- Obstructive lung disease
- Patients with persistently high ALT or GGT
- Neuropathy
- Anemia
- Children with ODD (oppositional defiant disorder) or CD (conduct disorder)
In any post-menopausal woman with or without osteoporosis, it may be important to monitor lead levels (since osteoporosis is a common reason for increased lead levels in blood and urine).
Testing discussed in the previous email!
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3. Practical Clinical Tips on Chelation
Calcium EDTA and DMSA are the two primary chelating agents used to mobilize lead from the body.
Calcium EDTA
- Primarily mobilizes lead from trabecular bone
- 75% of CaEDTA is excreted via urine within 2.5 hours of IV administration
- Main drawback of CaEDTA = redistribution of lead from other tissues to the brain (most studies show EDTA cannot cross the BBB); for this reason, it may be best to administer a short course of DMSA after CaEDTA
- General cadence of treatments = 1-2 IVs per week
DMSA
- Primarily mobilizes lead from soft tissues (kidneys in particular, but it can also cross the BBB and chelate lead from the brain)
- Half life = 3 hours
- Enhances elimination of essential minerals and nutrients (especially zinc), so always replete minerals after use
- Best to co-administer this with NAC or taurine for enhanced secretion
- There is no standard dosing protocol for DMSA treatment, but the one I've mostly used is the 3 days on, 11 days off approach (using 30mg/kg divided into 3 daily doses, but daily dose should never exceed 2 grams)
For best practice: Do a provoked urine test with the identical therapeutic agent and dose used for treatment (EDTA vs DMSA) after 5 treatment cycles.
For more details on chelation and a review on what the literature says about phytonutrients used in lead removal (and protection from lead), subscribe to my Substack (just $8 a month)!
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I hope this was clinically useful!
These emails take a lot of time to create (and I don't receive a lot of feedback on whether they are useful to those that receive them), so I've moved to Substack for an extended version of these at a low monthly cost (available within 24 hours of releasing this email).
Why Substack? It has the benefits of being able to comment and ask questions about the posts, you're not bombarded with ads, I'm using the platform as a "micro-mentorship", and it's low cost!
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Thank you for believing in this work — and in me.
Meg
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