“Brain Fog” & Heavy Metals – A Case Study

I have had the privilege to work with and had Dr Walter Crinnion, ND as a mentor from 1996-2002.   His area of speciality included Environmental Medicine; working with people with environmental allergies; chemical exposures and sensitivities to solvents; heavy metals (HM) or pesticides and patients with unknown causalities to their chronic symptoms.  

This intro leads me to KM, a 53 year old female coming in for non-specific memory issues, decreased cognitive function or brain fog for years.  As a pharmacist, she was required to be both  detail -oriented while  retaining extensive amounts of  drug info.  Brain fog was NOT a symptom she could have in her occupation. KM also complained of chronic skin issues of which her GP and dermatologist never diagnosed but prescribed various forms and concentrations of steroid topicals.  She denies any sleep or GI concerns, has good family and social support, enjoys her job, and no other significant symptoms.

KM consulted a neurologist but scans and tests were inconclusive. We dug a little deeper with her family and childhood history, past travels and hobbies when she recalled spending 4 consecutive childhood summers, 8+ in total, with her grandparents in New Jersey.  Her grandfather operated a gun shooting club and it was her job to collect the used bullets at the end of the day.  He would then ‘remelt’ the lead bullets and repack the cartridges to resell to his clients.  Not only were they exposed to lead off-gassing from the melting process, but also solvents (to clean the copper and brass casing),as well as airborne and physical contact with gunpowder while breathing the indoor air around the shooting range.

We discussed HM toxicity and ran a provocative urine toxic metal (UTM) challenge test using DMSA (Dimercaptosuccinic acid) with Doctor’s Data Lab in Illinois.  A one-time, 2000mg dose followed by a 6-hr fasting urine collection was completed to assess HM in the urine.  HM toxicity can down-regulate certain P450 pathways that help with solvent and pesticide detoxification.  In other words, HM can prevent the liver from reducing other toxins from the body.  Metals like mercury not only utilize glutathione reserves but can also reduce production of new and recycling of oxidized glutathione, so reducing metal toxicity is a good place to start. 

UTM looks at excreted levels of 20 different metals, of which 16 were positive, including very elevated lead, mercury, cadmium and nickel.  The results are presented on a bar graph showing a green column indicating ‘within reference’ (misleading because there is no normal amount of intracellular HM), and a yellow and red column indicating ‘outside reference’.  These four metals were in the red and an additional five others in the yellow.  Note: UTM does NOT show total body load, just the excreted amount in the urine.

After reviewing the results, we discussed continuing with DMSA chelation at 30mg/kg body weight per day in three divided doses.  EDTA and DMPS were also considered since lead and mercury were the predominant metals, however  we stayed with oral DMSA since there were so many other metals present.  Compounded DMSA 650mg capsules were used tid x 5 days and then 9 days off for a total of a 2-week round.  10 rounds or 20 weeks was prescribed.  High mineral supplements were limited during the 5 DMSA days to reduce the chelation of the beneficial minerals, but replenished during the 9 off days.  Liver, adrenal and kidney supportive supplements were also prescribed during this 20-week protocol.  Two weeks after the last round, KM retested a DMSA provocated UTM to reassess metal excretion.

KM reported subtle improvements in perceived mental function and clarity by the 4-5th round.  Towards the 9-10th round, she received unsolicited positive feedback from her family; was less forgetful and able to recall minute details of ‘non-work’ events. Furthermore, her speech was more fluid and shedidn’t have to concentrate on which words to use.

Retested UTM indicators showed 12 metals; 4 previous red metals had downgraded to 3 yellows (Pb, Hg and Ni) and a green on the bar code. Her skin felt itchy, dry and a little bumpy on the arms and legs, however this time a visible rash did not reappear.

We discussed continuing this protocol another 8 rounds and followed by a reassessment.  Dr Crinnion believed if 7 or more metals were present, regardless of where it fell on the color codes – in the big picture, they were toxic.  UTM only shows what was excreted, there’s no way of knowing what was still in the body causing continued metabolic and/or physiological imbalance and dysfunction.  KM was optimistic, relieved and extremely happy with her progress in spite of what her medical friends previously advised.