Functional Medicine Heavy Metal Detox Protocol: Testing, Diagnosing, and Treatment

"Mad as a hatter." But… Why was a hatter mad? Well, because the mercury compound used in making felt hats in the 18^th and 19^th centuries affected the exposed workers' health, causing them to go "mad."

But the human story of heavy metal exposure may go much further back in history. For example, the Romans discovered how to move water about in lead pipes, used lead to make their cooking pots and eating utensils, and even used lead to sweeten syrups and wine. Some theorize that the erratic behavior of Roman rulers during the decline could have been, in part, the result of lead exposure.

Despite the historical use of heavy metals in ways that clearly caused health issues, it was not always immediately identified. Though toxic metals exist throughout the natural environment at low levels, human activity remains the most common reason for heavy metal exposure at levels leading to noticeable symptoms.

One reason it is difficult to identify the symptoms of chronic exposures is that they can be quite vague, like fatigue, diffuse skin issues, difficulty concentrating, or contributing to the development of autoimmune conditions. Of course, the specific symptoms do vary depending on the metal, the individual, and the dose. But, there appear to be commonly shared mechanisms of cell damage due to excessive oxidative stress from heavy metal exposure.

Functional medicine can help test for chronic heavy metal exposure, giving practitioners and individuals a much clearer understanding of how heavy metals may be impacting their health. Practitioners can then use this information to form Heavy Metal Detox Protocols to gently and safely support the body's natural removal of these metals.

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How Does The Body Naturally Detox?

Before the Roman Empire, toxins were part of the human biological environment. From heavy metals naturally occurring in soil and water (thus in food) to bacterial and fungal toxins in the environment and foods and toxic byproducts of human metabolism made in our bodies, humans would not have survived long without the ability to both protect the body from these toxins and support their removal from the body.

How does this happen? There are a variety of ways.

If someone has a recent toxic exposure, the toxin will likely be present in the blood for a while. Certain toxins stored in fat cells may also be present in higher levels in the blood if someone is fasting and accessing fat from storage for energy.  

Toxins in the bloodstream can be exhaled through the lungs (think of when someone's breath smells of alcohol).

Toxins from the bloodstream can be sweated out through the pores (like in a sauna or while exercising)

Toxins from the bloodstream can be excreted by the kidneys and then exit the body in the urine.  

The liver can transform toxins from the bloodstream to be more easily removed from the body. Many toxins will leave the body in the stool, and some will return to the bloodstream to be removed in their converted form by the kidneys or lungs.

These processes are happening all the time, though many factors, including toxic exposures, nutritional status, and genetic differences, can affect how efficiently they occur.

What is a Heavy Metal Detox?

If the body is constantly detoxifying, why would there be such a thing as a "heavy metal detox?"

A heavy metal detox is a lifestyle program designed to enhance how the body naturally removes toxins, specifically heavy metals.

This often includes a nutritional focus on nutrients specifically involved in the detox processes (protein, sulfur) and scavenging free radicals (antioxidants, like glutathione and vitamin C). It also typically involves following an extra clean lifestyle for a time to minimize the inflow of toxins to allow the body to focus instead on toxins that may be stored in tissues (and causing problems) from past exposures.

Often also included are lifestyle practices such as sweating through exercise and sauna and sometimes stress reduction techniques. They may also involve consuming some kind of substances that bind to toxins to either help remove them from the body or prevent their reabsorption by the intestines.

What Are The Most Common Heavy Metals Exposure?

Heavy metals exposure can occur in anticipated ways, many of which are due to human activities, such as occupational exposure. Mercury is currently the second most common toxic metal exposure, following lead. Some common examples are:

• Exposure to heavy metal dusts or vapors from metalworking
• Exposure to arsenic contaminated soil working on historic apple orchards
• Firefighters — many toxic metals
• Dentists (mercury)
• Auto and heavy machinery mechanics absorb petroleum products, including associated metals, through the skin (lead, aluminum, nickel, silicon, cadmium, and arsenic)
• Working around small airplanes as avgas is still leaded
• Military or police exposure to lead from firing firearms
• Working around uranium mine tailings exposes one to thallium and uranium.
• Working with some ceramic glazes or stained glass

Exposure to Heavy Metals From Daily Activities

Exposure also occurs in common daily activities such as:

• Mercury amalgam fillings (mercury)
• Fish is the most common source of methylmercury
• The use of certain supplements contaminated with heavy metals
• Unknowingly eating food grown in soil with high heavy metal concentrations, such as chocolate that has absorbed lead and cadmium from the soil
• Drinking water contaminated with heavy metals. Arsenic is commonly present at levels exceeding EPA guidelines for drinking water through much of the Western US. Some water pipes still contain lead.
• Breathing air contaminated with heavy metals from nearby industry or coal burning (mercury)
• Using lead-containing ceramics or crystal for food or drink
• Copper and Chromium from wear of prosthetic joints, i.e., hip replacement.

Genetics Role in Metabolizing Heavy Metals

Genetic differences in metabolism, especially in glutathione-related genes, may lead to different rates of naturally detoxing certain metals, such that different individuals develop symptoms at different levels of exposure.

Combinations of heavy metals may be far more toxic to cells than individual metals.

The risk for toxicity is also higher if certain micronutrient deficiencies are present.

Heavy Metal Exposure Symptoms

Symptoms reflect the mechanisms by which toxic metals cause injury but can be particularly vague at non-emergency levels. Generally, a major component of cell damage from metals is mostly via the creation of reactive oxygen species (ROS) and depletion of glutathione, which leads to a situation in which the body's antioxidant protection systems are overwhelmed. This can also lead to DNA damage and cascading inflammation and cell damage.

The symptoms of heavy metal exposure will vary depending on the metal exposed to and the amount and duration of exposure. Broadly speaking, there are acute and chronic exposures.

Acute heavy metal exposure is a medical emergency. If you are experiencing symptoms and have a known exposure, please contact poison control or go to the Emergency Room.

Symptoms of acute heavy metal exposure may include:

• Chills/Feeling cold
• Diarrhea
• Abdominal pain
• Nausea/Vomiting
• Dehydration
• Numbness in hands or feet
• Weakness

Symptoms or illnesses as a result of cumulative and chronic heavy metal exposure may include:  

• Alzheimer's disease — mercury, aluminum
• Parkinson’s disease — population studies show an association with exposure to metals, including mercury, lead, manganese, copper, iron, aluminum, bismuth, thallium, and zinc
• Sympathetic dominance — chronic fight or flight state, poor stress response
• Cadmium and chromium are associated with early pregnancy loss.
• Heart attacks
• Chronic fatigue
• Autoimmune diseases and allergy
• Brain Fog
• Depression and anxiety
• Digestive issues from an affected gut microbiome

Functional Medicine Labs For Heavy Metal Exposure

Generally, most people will be exposed to heavy metals. But, some will eliminate them more effectively than others, and some may have higher exposures than is realized. Testing may be helpful initially to suggest that heavy metal exposure is a concern. It may also be particularly useful in following progress during a detoxification program, as in that case, some of the challenges in testing are eliminated.

Urine metals are a common test for evaluating heavy metal exposure beyond a concern for acute exposure (which usually would look at blood metals). It is beneficial to test urine both before and after chelation provocation as the tests provide different information. The pre-provocation test is more likely to pick up current exposures, and the post-provocation test is more likely to pick up total body burden (some of the metals stored in tissues). Post-provocation tests may be done at a variety of intervals, but often at 6 or 24 hours after taking the chelating agent.

Knowing the relative levels of different metals in each test (also considering the chelation agent used for the test) can help to decide which chelation agent if any, may be most effective.

The Tri-Test includes hair and blood tests in addition to the urine test. This test can give insight into the source of mercury, particularly distinguishing between organic and inorganic forms, which commonly come from fish consumption and mercury amalgam fillings, respectively. This can also provide insight into how effectively the body is getting rid of the metals we are all inevitably exposed to.

In addition to looking at metals specifically, Oxidative stress and Glutathione (via an Organic Acids test) testing can provide useful insight into how well the body may be dealing with exposures.

As some micronutrient deficiencies are associated with more severe consequences of heavy metal exposure, a micronutrient panel may make sense as well in some cases to direct nutritional therapy.

Additional standard tests that would be performed in case of suspected heavy metal exposure would include:

• CBC, since heavy metals are associated with altered white blood cell and eosinophil counts
• Comprehensive metabolic panel (CMP), giving insight into kidney and liver function
• Urine test to look for protein as an indicator of kidney injury

Six-month follow-up intervals would be a reasonable starting point for functional medicine tests.

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Functional Medicine Heavy Metal Detox Protocol

A combination of using a chelation agent specific to the metal and antioxidants is a common approach with good evidence of benefit to address the foundational issues present with heavy metal exposure.  

Specific antioxidants, such as glutathione and ALA, can help prevent oxidative damage from mercury exposure and support the body's natural elimination of heavy metals.

One mercury elimination protocol with oral chelating agents (DMPS, DMSA), vitamin C, and glutathione showed a 69% reduction in provoked mercury levels.

Using chelation agents or intentionally mobilizing heavy metals is not a great do-it-yourself project, as there are risks involved. One major risk is the redistribution of toxic metals to the brain. Another is the depletion of other essential minerals.

Nutrition

The first principle of nutrition as it relates to exposure is to avoid adding to the problem.  

In the case of toxic metals, this means minimizing or completely avoiding seafood that contains mercury and not cooking foods, especially acidic ones, in aluminum cookware. Foods known to be prone to heavy metal contamination, such as chocolate, some supplements, and even some greens, should be checked to avoid ones grown in likely contaminated areas. Drinking water would ideally be tested and not used if found to be high in heavy metals.

Along the same lines as avoiding adding to the problem is to avoid foods to which one is allergic, simply to reduce the stress on the body while it is healing.

A caloric deficit will likely mobilize some metals, which, under the right conditions, can help them to be removed from the body. But, this should be done with care, as it is possible to re-distribute metals to other organs when mobilized, causing more problems.

A whole food, plant-based, high micronutrient diet supports the body's natural defenses against the effects of heavy metals and will generally be a solid nutritional base for maintaining health. It should be high in leafy greens (Folate helps arsenic metabolism) and brightly colored fruits and vegetables, which contain many antioxidants (like vitamin C, Vitamin E, glutathione, carotenoids, and flavonoids) that support the tissues to some degree from the damaging effects of toxic metals and may help to chelate metal ions. Adequate, clean water is also very helpful as a basic measure.

More specifically, nutrients needed to make glutathione, such as sulfur, taurine, or N-acetyl cysteine, should be incorporated. Due to the increased need for amino acids, protein should be given specific attention, and for some, might be a reason to deviate from a strictly plant-based diet and intentionally consume some high protein, clean animal products.

High-fiber foods will naturally occur in a whole food, plant-based diet, but specific addition of soluble fibers and chia or flax seeds can be helpful as well.

Supplements

Some supplements may be useful in addressing heavy metal exposure. These might include:

• Glutathione
• Chlorella to bind metals
• Probiotics can bind metals
• As a free radical scavenger, the Ayurvedic herb Tulsi supports the body against heavy metals and radiation damage to cells. It can be taken daily as tea or in capsules.
• Milk thistle supports glutathione levels and helps decrease heavy metals
• Garlic with vitamins C and E for lead exposure
• Modified citrus pectin (MCP) is a gentle chelator appropriate for children that may help lower lead levels.
• Antioxidants to support the body's defense against Reactive Oxygen Species (ROS), which form as a result of metal exposures.

Long-term exposure is not going to be cleared overnight. Generally, a good starting point is to follow a program for six months and then retest, tracking changes in the original symptoms. Some people may be done after six months, and others may benefit from continuing on a program for longer.

Lifestyle Interventions

As with diet, the first principle of lifestyle is to avoid exposure!

As the skin can be a route of elimination of toxic metals, it often makes sense to incorporate exercise and sauna therapy in order to sweat more than normal.

It would also be a good idea to decrease stress on the liver while healing from other sources, such as alcohol or Tylenol.

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Summary

So, while heavy metal exposures on some level are an inherent part of modern life, if the body falls behind pace in removing them or putting out the cellular fires they start, symptoms of many kinds can arise. Common issues that can be related to metal exposure include low energy, skin problems, sluggish thinking, anxiety or depression, and immune impacts. Chronic exposure is linked to autoimmunity, cancer, and neurodegenerative disorders.  

It is likely beneficial for everyone to incorporate some lifestyle factors supporting heavy metal detoxification. Those with more intense exposures or more advanced illnesses may benefit from working with a provider who is able to test and provide specific protocols for the individual.

Reducing heavy metal exposures and body storage levels can ultimately positively affect one's health.