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This week's topic: Tips for Testing Heavy Metals
Diving into environmental medicine today, and discussing heavy metal testing!
Overview of today's email:
- Brief review of heavy metals
- Practical clinical tips for testing
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1. Overview of heavy metals
Heavy metals are naturally occurring elements that are high density ("heavy"), and can be essential or toxic. Examples of "essential" heavy metals include zinc, copper, and manganese. Toxic heavy metals include mercury, cadmium, and arsenic.
As with anything, dose matters (even essential heavy metals can be toxic in high doses)!
The diagnosis of heavy metal toxicity is challenging, but requires 3 primary factors:
- Known personal (and I would add ancestral) exposure
- Signs and symptoms are aligned with the element in question
- Abnormal levels on testing
Heavy metal toxicity should always be on a differential diagnosis if any of the following are present (source):
- Renal disease of unexplained origin
- Bilateral peripheral neuropathy
- Acute changes in mental function
- Acute inflammation of the nasal or laryngeal epithelium
- A history of elemental (chronic or acute) exposure
Beyond the above, I would also consider testing for heavy metals in someone who is 6+ months out from trying to conceive (heavy metals can cross the placenta), and someone with a strong family history of neurodegenerative or cardiovascular diseases.
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2. Practical Clinical Tips
The most important point I emphasize to patients is that we will always be exposed to some degree of heavy metals, and if a treatment plan is needed, the goal is to reduce (NOT eliminate) the load! I've worked with a handful of patients who were receiving IV chelation from other practitioners, and had been receiving the treatments for years (trying to get the labs levels to zero).
I go over all the testing options I consider in the paid version of Substack and in the FMC mentorship, but initial testing should ALWAYS start with:
- Blood testing (including CBC, kidney and liver function testing)
- Unprovoked urine testing (and use the NHANES criteria to determine if levels are over the 75th percentile, which suggests acute exposure; I use a table that Dr. Paul Anderson put together for one of his webinars, and you can get some of this information from the book noted below)
These rule out acute or ongoing exposure (and we NEVER want to use chelators in acute exposure!).
For more detailed review of testing and treatment, consider the Clinical Environmental Medicine textbook (written by Walter Crinnion and Joseph Pizzorno). Dr. Paul Anderson also has a few short courses on this topic.
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Did you know I launched a mentorship this year? And now it has two tiers! One that includes mentor calls/webinars, and one with platform access only! In this (intentionally) small collaborative community, I aim to get to know each member and their unique challenges as we navigate the nuances of real-world functional medicine. Click on one of the buttons below to learn more about the options at FMC and/or apply!
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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!
Every time one of you chooses to support me financially, it tells me my effort and words matter. It’s validation. It’s fuel.
Thank you for believing in this work — and in me.
Meg
Additional resources that may be helpful:
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