Basis for and Nutritional Replacement Therapy€¦ · Trace Minerals Intern./Blaurock-Busch...

14/08/2012 Trace Minerals Intern./Blaurock-Busch 1

Biomonitoring of Metal Intoxication

Basis for

successful Detoxification

and Nutritional Replacement Therapy


What we need to know about

metal testing

Each test reflects a specific biochemical pathway

No test tells all No test is ‘the best’


I. Blood Mineral Analysis

Blood is transport medium for nutrient and toxic metals to and from cells

Blood values reflect mineral concentration in circulating blood stream

Note - use metal-free vacutainers


1. Intake and Circulation

Every element has its own unique distribution in body fluids, tissues and organs

Concentrations fluctuate throughout the day in body fluids, and over longer periods in solid body tissues

Acute exposures have different effects than exposures over longer periods


Specifics of Blood Minerals Analysis

Allows detection of immediate and acute Toxic Metal exposure within maximal 72hrs after exposure.

Thereafter, metals have been deposited in target storage tissue or have been elimated


What type of blood for mineral analysis?

Whole blood reflects extra- and intracellular levels

95% of cadmium is bound to erythrocytes- thus whole blood analysis recommended

For heavy metal evaluation use special, metal-free tubes


Sikorski R, Paszkowski T, Slawinski P, Szkoda J, Zmudzki J, Skawinski S.

The intrapartum content of toxic metals in maternal blood and umbilical cord

blood.PMID: 2806969 [PubMed - indexed for MEDLINE]

Cadmium and mercury levels measured on both sides of placenta did not differ significantly while lead levels in maternal blood were significantly higher than its cord blood values. In all three metals studied, the concentrations in maternal blood strongly correlated with the corresponding cord blood values. A significant, positive correlation was established between the parity of the examined women and the umbilical cord blood contents of lead and mercury. The obtained results support the opinion that human placenta does not form an effective barrier to toxic metal intake by the fetus.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&itool=pubmed_Abstract&term=%22Sikorski+R%22%5BAuthor%5D

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&itool=pubmed_Abstract&term=%22Paszkowski+T%22%5BAuthor%5D

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&itool=pubmed_Abstract&term=%22Slawinski+P%22%5BAuthor%5D

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&itool=pubmed_Abstract&term=%22Szkoda+J%22%5BAuthor%5D

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&itool=pubmed_Abstract&term=%22Zmudzki+J%22%5BAuthor%5D

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&itool=pubmed_Abstract&term=%22Skawinski+S%22%5BAuthor%5D


Cd und Hg in Blut und Urin deutscher Kinder 1990-1992 Quelle: Schulz,Becker. Bundesumweltamt

Parameter Deutschland West Ost

N GM N GM N GM

Cadmium in blood (µg/l) 713 0.14 512 0.13 201 0.17 ***

Cadmium in urine (µg/l) 732 0.09 525 0.077 208 0.12 ***

Mercury in blood (µg/l) 712 0.33 509 0.26 202 0.59 ***

Mercury in urine (µg/l) 732 0.54 525 0.43 208 0.99 ***

Mercury in urine (µg/g Crea) 731 0.39 524 0.31 208 0.69 ***

N= Testpersonen GM = Geometric mean

*** statistisch signifikanter Unterschied (P 0.001)


Blood evaluation Rumanian school children 95percentile 3µg/l CDC Ref.Range <1µg/l


Hongkong children: average level 14µg/l


II: Urine Metal Analysis (UMA)

• Assessment of renal clearance of essential and toxic elements

• Monitors chelation efficacy (not all chelated patients are able (genetically or otherwise) to detoxify

• Allows physician to ‚individualize‘ chelation therapy

• Provides ‚proof‘ of treatment progress


TMI Logic for Reference Ranges

TMI Baseline urine evaluation of 120healthy people plus <300 patients with no signs of metal toxicity

Present evaluation in progreess at TMI:

typical mean value for each chelating agent


Sampling before Provocation

Collect 10ml of first morning urine. Best to urinate directly in cup or tube to prevent contamination


Post Urine collection

Patient must empty bladder before start of treatment

After treatment has started, collect for 2 to 6 hr – depending on chelating agent used

Fluid intake (2-3 cups) should be constant

Food intake: best to stay fasting

Do not take supplements or algae during chelation


Lead and Arsenic in Algae products


Evaluation of mean Urine creatinine (g/L)

in pre and post urines of children and adults

# of tested persons:

Baseline urines:

N = 977 adults

N = 355 children

Post urines:

N = 4018 adults

N = 101 children 0

0.2

0.4

0.6

0.8

1

1.2

pre post

children <12

adults


Limitations of 24-hr urine collection

Main problem:

Patient compliance

Factors influencing urine excretion results

Food and drink (coffee, tea)

Smoking or smoke exposure

Medication

Cosmetics


III. Hair Mineral Analysis

Internationally researched at recognized universities and institutions

Largely Misunderstood

Often Misrepresented

Instruments do not know how to

differentiate between specimen.


Hair sample preparation –

Key to reliable results


Hair is Body Tissue

Hair follicle receives nutrients and toxins from circulating blood

What has been stored will remain ‚locked‘ in this inert tissue and thus hair can be stored indefinitely. In fact, hair has been used as an ideal forensic tissue for decades


Hair mineral analysis provides a record of past exposure or nutritional inadequacies reflecting the specific growth period (i.e. Hair growth is 1mm/day or 3cm/months. If taken close to scalp now, we evaluate the mineral exposure of last month)


Al -Aluminum MTM Study 1997-98 N=10000 random collection

0-6 7-

1415-

2122-

3031-

4041-

5051

and

up

Germany

United States

Brazil

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

% o

f p

ati

en

ts s

ho

win

g h

igh

va

lue

s

Germany

United States

Brazil


Mercury Distribution in Body Tissues

0

0,5

1

1,5

2

2,5

3

3,5

4

4,5

Bon

e

Brain

Skin

Hair

Mus

cle

Hea

rt

Colon

Live

r

Kidne

ys

Source: Thomas L. Labor & Diagnose, Med.Verlag pg 430

mc

g/k

g

Mercury


Physiological Distribution of Lead in Human Tissue

0

10

20

30

40

Bon

e

Brain

Skin

Hair

Mus

cle

Heart

Colon

Live

r

Kidne

ys

Source: Thomas L., Labor & Diagnose, Med.Verlag

Marburg

mcg/k

g

Lead


Pb - Lead - Chumbo - Blei

0-6 7-14 15-21 22-30 31-40 41-50 51 and up

Germany

United States

Brazil

0

1

2

3

4

5

6

7

8

9

Av

era

ge

Le

ve

l (p

pm

)

Germany

United States

Brazil


Case of Oliver Sch.


What about problem patients?

Consideration:

Reduce toxic exposure (lifestyle changes etc)

Evaluate nutritional status (and supplement accordingly)

Evaluate toxic status (hair analysis)

Change chelating agent or combine chelating agents


Enzyme systems needed for

detoxification

Glutathione –S-TransferaseM1 (GSTM1)

Glutathione –S-Transferase T1 (GSTT1)

Glutathione –S-Transferase P1 (GSTP1)

Superoxide dismutase 2 (SODs)

Manganese and/or Copper-dependant for functioning


GSTM1 deletion genotype-

common in Asians

Groups such as Pacific Islanders and Malaysians have a reported frequency of no enzyme activity of 62%-100% .

Other Asian populations have high-reported frequencies of the deletion genotype ranging from 48%-50% for Japanese and 35%-63% for Chinese.

A population-based study conducted among Chinese reported a frequency of 51% for the GSTM1 deletion genotype.

Two Korean case-control studies found frequencies of 53% and 56% for the GSTM1 deletion genotype


Genetic testing

once in a lifetime


Why testing?

Individuals with homozygous deletions of either the GSTM1 or the GSTT1 locus have no enzymatic functional activity of the respective enzyme.

This population has to be made aware of lifestyle risks

Chelation treatment is more often needed then by those who do have proper enzyme function

Greater nutritional support is needed


Presence of GSTM1 0/0 Polymorphisms at

certain diseases


Summary:

Diagnostic Screening for difficult cases

1. Metal screening -hair and/or blood

2. Detoxification treatment with chelator of choice, depending on metal exposure

including pre and post urine

3. If insignificant metal excretion, resume treatment

using different chelating agent and/or use combination of chelating agents. Record doses used. and repeat post urine (pre not necessary)

4. Consider genetic test panel GSTM1, GSTT1, GSTP1 and SODs


Thank you!

Basis for and Nutritional Replacement Therapy€¦ · Trace Minerals Intern./Blaurock-Busch...

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Transcript of Basis for and Nutritional Replacement Therapy€¦ · Trace Minerals Intern./Blaurock-Busch...