The Toxic Patient

by Dr. Walter Crinnion ND | Follow on Twitter

Dr. Crinnion gives us the down low on assessing, testing and treating environmental toxicities.

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WE ARE LIVING IN A WORLD LOADED WITH TOXICANTS, these small daily exposures build up in our bodies and cause adverse health problems.

This is the realm of Environmental Medicine (EM).

Toxicologists and occupational medicine physicians are fully trained to identify a person who has been acutely poisoned by a toxicant. They are not trained to identify or treat someone who has become ill over time from small daily exposures (all far below the level that would be considered potentially threatening) to environmental toxicants in their air, food and water.

This is the void into which environmental medical physicians step. Those of us in this field recognize that the total body burden of environmental toxicants (also called xenobiotics) can and often do lead to chronic health complaints that typically improve when the total toxic load is reduced.

Rarely will an environmentally ill person have a positive lab finding that will document an acute poisoning episode of a single toxicant.

Instead of utilizing toxicological endpoints (laboratory measurements) to determine acute toxicity EM physicians look for the classic presentation of environmental illness that match to the exposure history of the patient.

Laboratory measurements can also be done to confirm toxicant presence, and organic system damage. EM physicians take into account several impacts when determining if toxicants are a causative factor (or an obstacle to cure) in a persons’ chronic health problems. For example:

  • genetics
  • diet
  • nutrient levels
  • a host of stressors
  • in addition to the current and past exposure histories

Nature cure as the best treatment for the modern-day epidemic of environment burden.

“Is this patient toxic?”

This is a question that should NEVER be asked as all the persons coming in to see you have a body burden of toxins.

According to one recent study, the average number of toxins found per person was 91[1]. The CDC has also picked up the challenging question of how many toxins are in us. They have already published four reports and will continue to publish their research[2].

Instead of asking if the client is toxic, the 2 questions that should be asked are:

  1. Is their toxic burden a causative factor in their illness?
  2.  Is their toxic burden an obstacle to cure?

The tough part is attempting to accurately answer those two questions and then to design an appropriate program to reduce their toxic load.

Assessing toxic burden

In determining whether the toxic burden in your clients’ body must be dealt with in order for them to get better requires, in part, an understanding of what organs and systems are effected by the common toxins.

It also requires that one be able to recognize the common signs and symptoms of toxin buildup. Recognition of these signposts greatly assists the clinician in designing the most efficacious treatment program. In addition to recognizing toxicities telltale signs in a good history and physical exam one should also be aware of laboratory markers that would reflect toxin load.

There are a limited number of tests that would be of benefit in establishing that a certain patient would benefit from cleansing protocols.

  • Serum and adipose samples can both be used to measure chlorinated compounds and solvents.
  • Urinary measurements can be taken for heavy metals, organophosphate pesticide metabolites and phthalates.
  • Fecal measurements for toxic metals is also available and is a great method for testing pediatric clients.

Finding the source

The documentation of xenobiotic presence in an individuals’ serum, adipose, stool or urine can be highly assistive in formulating an effective therapeutic protocol.

This initial testing provides several indications:

  1. a basis on which to initiate treatment
  2. a baseline to refer back to in order to help judge your progress
  3. clear motivation for the client to follow your recommendations (depending upon how well the practitioner presents this information)
  4. an indication as to possible sources of toxin exposure

The importance of finding the source of toxin exposure in an individual cannot be overemphasized.

For many persons, the identification and elimination of the source comprises the majority of necessary treatment. Other individuals will need more help in order to reduce the total toxic burden.

Finding the source of exposure typically includes:

  • taking a detailed environmental history (past and present) of the person
  • checking out all the towns they have resided in
  • and possibly doing some home air testing

Finding exposure sources in the towns they have lived in can be accomplished with the help of two websites:

  1. www.scorecard.org (just put in the zip codes and you get a listing of local polluters and pollutants)
  2. www.atsdr.cdc.gov/hazdat.html

If the exposure is ongoing, it is imperative that the source be removed before jumping into cleansing.

If the source continues, the person will continue to be ill even with the best depuration program!

Once the exposure has been identified and dealt with the depuration program can be safely started. This program is again based on the type of xenobiotics that appear to be the causative agents in the clients’ illness. Heavy metals will often be dealt with differently from lipophylic xenobiotics as they can be easily and directly chelated, while the lipophylic chemicals cannot.

Heavy metal chelation

While I do not always test my clients for the presence of chemical xenobiotics, I typically do measure heavy metals in all of the clients in whom I suspect toxicity as a factor in their illness.

When these compounds are found I then begin them on a protocol to mobilize the heavy metals utilizing either

  1. 2,3-dimercaptopropane sulfonic acid (DMPS) or
  2. dimercaptosuccinic acid (DMSA)

Both of these compounds have extensive research in the literature showing both their safety and efficacy in clearing mercury, lead and other heavy metals from animals and humans[3] [4] [5]. DMSA is available from pharmacies under the name Chemet and Succimer as well as other sources. DMPS is available from compounding pharmacists in both oral and IV forms.

DMSA is given in a body weight dose of 30 mg/kg, and has been shown to be safe in that dose for children (including infants) who have been poisoned with both mercury and lead[6] [7].  Using the published body-weight dose of DMSA the two protocols that seem to be most commonly used are:

  1. 3 days of DMSA followed by 11 days without or
  2. 5 days of DMSA followed by 9 days without

In my practice we would do a repeat urinalysis at the beginning of every 5th round (at week 10, 20, 30, etc.) to monitor the clients’ progress.

Over the years we found that most of our clients did 20 or 25 rounds before stopping.

On the days they were not taking DMSA we supplemented with low levels minerals to replete any possible micromineral loss from the DMSA [8]:

  • zinc
  • copper
  • molybdenum
  • manganese

We also found that we had to give fairly high levels of magnesium, often accompanied by mag sulf shots in order to keep the clients from experiencing magnesium depletion. While magnesium does not appear on the affinity list for either DMSA or DMPS it appears to be mobilized from the body with any cleansing process.

Clearing lipophilic xenobiotics

While the clearance of heavy metals through chelation is fairly straightforward, the mobilization of lipophilic compounds is not.

The body burden studies previously mentioned along with numerous smaller studies worldwide have alerted us to the presence of chlorinated pesticides and PCBs in everyone.

“The majority of the compounds found in everyone are lipophilic rather than water-soluble”. <– Tweet this

Lipophilic substances have no efficient means of exit from the body as the bowels are designed to retain all fat-soluble substances. In order to help these compounds leave the body the use of saunas have been employed with documented success[9] [10] [11] [12].

Sauna therapy allows the xenobiotics stored in the subcutaneous fat pads to be released through the skin, while those in deeper fat stores are released into the circulation. The compounds in the subcutaneous fat pads include both the items absorbed through the skin[13] and some compounds from the circulation (primarily medications).

Numerous compounds have been documented to exit the body via the skin including necessary minerals[14], [15]:

  • zinc
  • copper
  • iron
  • manganese

And the heavy metals:

  • lead (13) [16]
  • cadmium [17]
  • mercury [18]
  • various medications

Clinical experience with numerous patients undergoing thermal chamber depuration has provided many undisputable olfactory encounters with chemical compounds being released in the sweat.

Two patients undergoing thermal chamber depuration experienced disinitegration of clothing that was worn in the chambers. There are two published accounts of thermal chamber depuration being successfully used in the treatment of chemically sensitive persons [19] [20] which include the reduction of serum hydrocarbon levels.

The fat-soluble compounds released into the circulation do not exit the body as easily.

These compounds then are subject to the same pathways of phase one, two and three that had previously been unable to successfully clear them from the body. It is important then to attempt to increase the excretion of fat-soluble items from the bowels when sauna depuration is used. When proper nutrition and other physical therapy modalities are included with thermal chambers results such as those with chemically sensitive persons (19,20) are often found.

The author successfully utilized retrograde colonic irrigations to assist the clearance of the xenobiotics that had been dumped into the bile after the sauna sessions[21].

Those compounds that are moved out through the skin are often grossly detectable by smell and their damaging effect to articles of clothing. Utilizing this protocol the author has noted dramatic improvements in numerous chronic illness states. By reducing the body burden on the client (through avoidance of the source, chelation and mobilization of lipophilic substances) the self-healing nature of the body can work unfettered.

—–

Dr. Crinnion has been providing training for other healthcare professionals in the field of environmental medicine since 1999. His 6-month training includes home study with instructional DVDs and then gathering for 3 weekend meetings to learn to apply that information to real patient cases from their own practices.

His book: Clean, Green and Lean provides an excellent and easy-to-follow stepwise progression through the home and diet to allow anyone to dramatically reduce their daily exposures to environmental toxicants. The book also covers the steps needed to begin reducing the total load of toxicants in the body as well.

References:


[1] http://www.ewg.org/reports/bodyburden/es.php

[2] http://www.cdc.gov/exposurereport/

[3] Graziano, JH. Role of 2,3-dimercaptosuccinic acid in the treatment of heavy metal poisoning. Med Toxicol  1986;1:155-162.

[4] Aposhian HV. DMSA and DMPS – water soluble antidotes for heavy metal poisoning. Ann Rev. Pharmacol Toxicol 1983;23:193-215.

[5] Aposhian HV, Maiorino RM, Rivera M, et al. Human studies with the chelating agents DMPS and DMSA. Clin Toxicol 1992;30(4):505-528.

[6] Forman J, Moline J, Cernichiari E, et al. A cluster of pediatric metallic mercury exposure cases treated with meso-2,3-dimercaptosuccinic acid (DMSA). Environ Health Perspect 2000;108(6):575-577.

[7] Chisolm J. Safety and efficacy of meso-2,3-dimercaptosuccinic acid (DMSA) in children with elevated blood lead concentrations. Clin Toxicol 2000;38(4):365-375.

[8] Quig D. Personal communication

[9] Schnare D, Ben M, Shields M. body burden reductions of PCBs, PBBs and chlorinated pesticides in human subjects. Ambio 1984;13(5-6):377-380.

[10] Root D, Lionelli G. Excretion of a lipophilic toxicant through the sebaceous glands: a case report. J. Toxicol – Cut Ocular Toxicol 1987;6(1):13-17.

[11] Tretjak Z, Shields M, Beckmann S. PCB reduction and clinical improvement by detoxification: and unexploited approach. Hum Exp Toxicol 1990;9:235-244.

[12] Krop J. Chemical sensitivity after intoxication at work with solvents: response to sauna therapy. J Alt Comp Med 1998;4(1):77-86.

[13] Lilley SG, Florence TM, Stauber JL. The use of sweat to monitor lead absorption through the skin. Sci Total Environ 1988;76(2-3):267-78.

[14] Cohn JR, Emmett EA. The excretion of trace metals in human sweat. Ann Clin Lab Sci 1978;8(4):270-5.

[15] Omokhodion FO, Howard JM. Trace elements in the sweat of acclimatized persons. Clin Chim Acta 1994; 231(1):23-8.

[16] Omokhodion FO, Corckford GW. Lead in sweat and its relationship to salivary and urinary levels in normal healthy subjects. Sci Total Environ 1991;103(2-3):113-22.

[17] Stauber JL, Florence TM. A comparative study of copper, lead, cadmium and zinc in human sweat and blood. Sco Total Environ 1988;74:235-47.

[18] Sunderman FW. Clinical response to therapeutic agents in poisoning from mercury vapors. Ann Clin Lab Sci 1978;8(4):259-69.

[19] Krop J. Chemical Sensitivity after intoxication at work with solvents: response to sauna therapy. J Altern Complement Med 1998;4(1):77-86.

[20] Rea WJ, Pan Y, Johnson AR, Ross GH, Suyama H, Fenyves EJ. Reduction of chemical sensitivity by means of heat depuration, physical therapy and nutritional supplementation in a controlled environment. J Nutr Environ Med 1996;6:141-8.

[21] Crinnion WJ. Results of a decade of naturopathic treatment for environmental illnesses: A review of clinical records. J Naturo Med;7(2) 21-27

About the Author
Dr. Walter Crinnion ND

Dr. Crinnion is the environmental medicine expert. As a prolific speaker, practitioner, and author of Clean, Green and Lean and The Prediabetic Detox, Walter has been critical in building awareness about the impact that the environment has on the body and mind. His online monthly subscription podcast, cleverly called “Crinnion Opinion” keeps you up-to-date on environmental health news, while his course Training in Environmental Medicine for Doctors is an extensive 23 hour program.