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Dig deeper to find cause of malaise.

Dr. Julie's column in your February/March 2013 issue prompted me to write. She was reviewing the case of a woman with fatigue and achiness driven by heavy metal toxicity in addition to food sensitivities and nutritional deficiencies. I'd like to echo her sentiment for health-care practitioners to dig deeper to find the cause of their patient's malaise.

As the former GM of a functional medicine laboratory and medical center and someone who has battled chronic illness most of his adult life, I have become quite well versed in the treatment and causes of chronic illness. In fact, I donate much time, advising individuals who find me. They often need advice on where to go for treatment, what tests to ask their doctor for, or how to round out a treatment protocol. They are often failed even by alternative/integrative health-care providers either because the latter don't do their homework and stay current, or only do salivary hormone assays, standard blood chemistries, food intolerance testing, and nutritional deficiency testing and don't dig any deeper. This approach may work well for 80 of 100 patients, but the remaining 20 are not helped. As time goes on, this 80/20 situation is going to become more of a 50/50 situation as we are constantly bombarded with toxins in our air, food, water, and cosmetics.

The tests for digging deeper are available. Innovative labs such as Genova/Metametrix, Doctor's Data, Cyrex, BioHealth, Diagnos-Techs, and IGeneX give health-care practitioners amazing tools to dig deeper into their patients' health status. (Kudos to Metametrix for the Toxic Effects Core Panel; I look forward to the addition of flame retardant compounds to the panel.)

Regarding heavy metals, it is totally insufficient to look in a patient's mouth for amalgams and inquire into known heavy metal exposures. So many patients have accumulated body burdens without even knowing it: the house that they grew up in, the city asphalt playgrounds, their summer job in the factory. A provocative challenge with a chelating agent should be done for those with neurological symptoms along with their fatigue and malaise. Current/ongoing exposure can be ruled in or out with a prechallenge collection or a prechallenge blood test.

My own heavy metals timeline will shed some light on this:

* 1986: became chronically ill;

* 1987: approximately 15 dental amalgams removed;

* 1994: provocative challenge with EDTA--mercury and copper high, no discernible lead;

* 1994-1998: chelation with EDTA and later DMPS IV pushes, all heavy metals at low end of challenged reference range in late 1998;

* 2006: fatigue and neurological symptoms return, provocative challenge with DMSA shows huge lead load. Blood lead level prior to challenge very low. Throughout treatment in the 1990s, no significant lead load was ever detected;

* 2006-2010: chelation with oral DMSA, all heavy metals in low end of challenged reference range in late 2010;

* 2012: Neurological symptoms return, provocative challenge with DMSA shows lead load at 70% of 2006 (extremely high) levels.

A few things should be obvious from the above history:

1. We never know the total body burden of heavy metals or the tissue compartments where they are stored, only what came out on a particular challenge test.

2. When challenged, stored metals come out when they are ready, perhaps based on what metal it is, where they are stored, and the health of the individual being challenged. Never assume that heavy metals don't factor into an illness because they've been treated prior.

5. The exposures in this case were very old, with lead perhaps predating mercury.

As a final comment on heavy metals, I've read that even given a significant bioaccumulation of heavy metals, if a patient's porphyrin test is negative, these metals are not presently contributing to illness. I'd like to hear from clinicians regarding this. Does this seem to be true given the presentation of your patients? By not addressing identified heavy metal accumulations, are patients perhaps being set up for future illness? (As you can see from above, I've experienced three distinct heavy metals mobilizations to date).

By way of closing, I'd just like to touch on the area of chronic infections, particularly parasite infections. The question of travel outside the US just does not hold as much relevance to ruling out those infections as it used to. Food handlers in most metropolitan areas come from all parts of the world. Organic produce is grown in animal manure and may not be washed properly. Cryptosporidium parvum cannot be killed by chlorine and is in many public water supplies. This, coupled with sluggish immune function from overconsumption of sugar, chemical and heavy metal toxins and the toll that modern pharmaceutical drugs, especially antibiotics, take on the liver and microbiome, makes parasite infections very common. In fact, after the dramatic symptoms have ended (which are often mistakenly attributed to the flu), often the body adapts to the invading organism and the infection becomes chronic. Some patients harboring parasites present with fatigue and aches, absent specific GI symptoms.

Along with Dr. Julie, I encourage all health-care providers serving chronically ill patients to attend classes and seminars to stay current with the latest research and to use cutting-edge laboratory assessments to get to the root cause of your patients' malaise.

John McCarthy

Wayne, Pennsylvania
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Author:Mccarthy, John
Publication:Townsend Letter
Geographic Code:1USA
Date:Jul 1, 2013
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