VII. Tests for Mercury Level or Toxicity and Treatmenst

1. Feces is the major path of excretion of mercury from the body, having a higher correlation to systemic body burden than urine or blood, which tend to correlate with recent exposure level (35,36,79,80,183, 278). For this reason many researchers consider feces to be the most reliable indicator of daily exposure level to mercury or other toxics. The average level of mercury in feces of those with fillings is over 1 ppm and approx. 10 times that of a similar group without fillings (79,80,83,335,386,25,), with significant numbers of those with several filings having over 10 ppm and 170 times those without fillings(80). For those with several fillings daily fecal mercury excretion levels range between 20 to 200 ug/day. The saliva test is another good test for daily mercury exposure, done commonly in Europe and representing one of the largest sources of mercury exposure. 

There is only a weak correlation between blood or urine mercury levels and body burden or level in a target organ(36,157,183,278,11,etc.). Mercury vapor passes through the blood rapidly(half-life in blood is 10 seconds, 370) and accumulates in other parts of the body such as the brain, kidneys, liver, thyroid gland, pituitary gland, etc. Thus blood test measures mostly recent exposure. As damage occurs to kidneys over time, mercury is less efficiently eliminated (11,36,57,183, 216,260), so urine tests are not reliable for body burden after long term exposure. Some researchers suggest hair offers a better indicator of mercury body burden than blood or urine(279), though still not totally reliable and may be a better indicator for organic mercury than inorganic. In the early stages of mercury exposure before major systemic damage other than slight fatigue results you usually see high hemoglobin, hemocrit, alkatline phosphatase, and lactice dehydroganese; in later states you usually see marginal hemoglobin, hemocrit, plus low oxyhemoglobine(35).

Hair was found to be significantly correlated with fish consumption, as well as with occupational dental exposure and to be a good medium for monitoring internal mercury exposure, except that external occupational exposure can also affect hair levels. Mercury hair level in a population sampled in Madrid Spain ranged from 1.3 to 92.5 ppm. This study found a significant positive correlation between maternal hair mercury and mercury level in nursing infants. Hair mercury levels did not have a significant correlation with urine mercury in one study(340) and did not have a significant correlation to number of fillings(350). One researcher suggests that mercury levels in hair of greater than 5 ppm are indicative of mercury intoxication.

A new test approved by the FDA for diagnosing damage that has been caused by toxic metals like mercury is the fractionated porphyrin test(260,35), that measures amount of damage as well as likely source. Mercury blocks enzymes needed to convert some types of porphyrins to hemoglobin and adenosine tri phosphate(ATP). The pattern of which porphyrins are high gives an indication of likely toxic exposure, with high precoproporphyrin almost always high with mercury toxicity and often coproporphyrin. 

Provocation challenge tests after use of chemical chelators such as DMPS or DMSA also are effective at measuring body burden(57,58), but DMPS can be dangerous to some people- especially those still having amalgam fillings or those allergic to sulfur drugs or sulfites. Many studies using chemical chelators such as DMPS or DMSA have found post chelation levels to be poorly correlated with prechelation blood or urine levels(57,115,303), but one study (340) found a significant correlation between pre and post chelation values when using DMPS. Challange tests using DMPS or DMSA appear to have a better correlation with body burden and toxicity symptoms such as concentration , memory, and motor deficits(290)- with many studies finding a significant correration between post chelation mercury level and the number of amalgam surfaces(57,172,173,222,290,292,273,303). Several doctors use 16 ug/L as the upper bound for mercury after DMPS challange, and consider anyone with higher levels to have excess body burdern(222,352). However one study(290) found significant effects at lower levels. Some researchers believe DMSA has less adverse side effects than DMPS and prefer to use DMSA for chelation for this reason. Some studies have also found DMSA as more effective at removing mercury from the brain(58). A common protocol for DMSA(developed to avoid redistribution effects) is 50 mg orally every 4 hours for 3 days and then off 11 days.

Another chelator used for clogged arteries, EDTA, forms toxic compounds with mercury and can damage brain function(307). Use of EDTA may need to be restricted in those with high Hg levels. N-acetylcystein(NAC) has been found to be effective at increasing cellular glutathione levels and chelating mercury(54). Experienced doctors have also found additional zinc to be useful when chelating mercury(222) as well as counteracting mercury's oxidative damage(43). Zinc induces metallothionein which protects against oxidative damage and increases protective enzyme activities and glutathione which tend to inhibit lipid peroxidation and suppress mercury toxicity(430). Also lipoic acid has been found to dramatically increase excretion of inorganic mercury(over 12 fold), but to cause decreased excretion of organic mercury(54) and copper. Lipoic acid has a protective effect regarding lead or inorganic mercury toxicity through its antioxidant proprties, but should not be used with high copper. Zinc is a mercury and copper antgonist and can be used to lower copper levels and protect against mercury damage.

2. Tests suggested by Huggins/Levy(35) for evaluation and treatment of mercury toxicity:
(a) hair element test(386) (low hair mercury level does not indicate low body level)(more than 3 essential minerals out of normal range indicates likely metals toxicity)
(b) CBC blood test with differential and platelet count
© blood serum profile
(d) urinary mercury (for person with average exposure with amalgam fillings, average mercury level is 3 to 4 ppm; lower test level than this likely means person is poor excretor and accumulating mercury, often mercury toxic(35) 
(e) fractionated porphyrin(note test results sensitive to light, temperature, shaking)
(f) individual tooth electric currents(replace high negative current teeth first)
(g) patient questionnaire on exposure and symptom history
(h) specific gravity of urine(test for pituitary function, s.g>1.022 normal; s.g.< 1.008 consistent with depression and suicidal tendancies(35)}
 

3. Note: during initial exposure to mercury the body marshalls immune system and other measures totry to deal with the challange, so many test indicators will be high; after prolonged exposure the body and immune system inevitably lose the battle and measures to combat the challange decrease- so some test indicator scores decline. Chronic conditions are common during this phase. Also high mercury exposures with low hair mercury or urine mercury level usually indicates body is retaining mercury and likely toxicity problem(35). In such cases where (calcium> 1100 or < 300 ppm) and low test mercury,manganese,zinc,potassium; mercury toxicity likely and hard to treat since retaining mercury.

Test results indicating mercury/metals toxicity(35): 
(a) white blood cell count >7500 or < 4500
(b) hemocrit > 50% or < 40%
© lynphocyte count > 2800 or < 1800
(d) blood protein level > 7.5 gm/100 ml
(e) triglycerides > 150 mg %ml
(f) BUN > 18 or < 12
(g) hair mercury > 1.5 ppm or < .4 ppm
(h) oxyhemoglobin level < 55% saturated
(I) carboxyhemoglubin > 2.5% saturated
(j) T lymphocyte count < 2000
(k) DNA damage/cancer
(l) TSH > 1 ug
(m) hair aluminum > 10 ppm
(n) hair nickel > 1.5 ppm
(o) hair manganese > 0.3 ppm 
(p) immune reactive to mercury, nickel, aluminum, etc.
(q) high hemoglobin and hemocrit and high alkaline phosphatase(alk phos) and lactic dehydrogenese(LDA) during initial phases of expsoure; with low/marginal hemoglobin and hemocrit plus low oxyhemoglobin during long term chronic fatigue phase.
 

4. Huggins Total Dental Revision Protocol(35):
(a) history questionnaire and panel of tests.
(b) replace amalgam fillings starting with filling with highest negative current or highest negative quadrant, with supportive vitamin/mineral supplements.
© extract all root canaled teeth using proper finish protocol.
(d) test and treat cavitations and amalgam tattoos where relevant
(e) supportive supplementation, periodic monitoring tests, evaluate need for further treatment(not usually needed).
(f) avoid acute exposures/challanges to the immune system on a weekly 7/14/21 day pattern.

note: after treatment of many cases of chronic autoimmune conditions such as MS, ALS, Parkinson's, Alzheimer's, CFS, Lupus, Rheumatoid Arthritis, etc., it has been observed that often mercury along with root canal toxicity or cavitation toxicity are major factors in these conditions, and most with these condtions improve after TDR if protocol is followed carefully(35). Other measures in addition to TDR that have been found to help in treatment of MS in clinical experience are avoidance of milk products, get lots of sunlight, supplementation of calcium AEP(448) and alpha lipoic acid(448b). Progesterone creme has been found to promote regrowth of myelin sheaths in animals(448c).