In Part 1 of our Back to Basics blog series, we discussed the causes and consequences of heavy metals toxicity. Here, in Part 2, we will cover the basics of metals testing and why our Mercury Tri-Test and Blood Metals panels are superior to traditional "challenge testing" for ascertaining your body burden of heavy metals and guiding the implementation of a successful detoxification strategy.
Mercury Distribution in the Body
In Back to Basics: Metals Toxicity, you learned that there are four primary forms of mercury to which we are exposed in our environment – elemental, inorganic, methyl-, and ethylmercury. Once inside the body, these forms of mercury redistribute into various tissues and body fluids.
Blood contains methylmercury and inorganic mercury, but its methylmercury content far outweighs its inorganic mercury content.1 Hair contains over 95 percent methylmercury because it binds tightly to the sulfhydryl groups of keratin, thus becoming integrated into the hair.2 Urine harbors over 95 percent inorganic mercury and can be compared to the blood inorganic mercury level, producing a ratio indicative of the excretion efficiency for inorganic mercury. A hair: blood ratio can also be calculated to give an excretion index for methylmercury.
Problems with Metals Challenge Test
Historically, a “challenge test” was used to assess a patient’s heavy metal body burden. This test involves administration of a synthetic chelating agent, such as DMPS, and subsequent collection of urine over the following 24 hours. Advocates of the test state that the amount of heavy metals measured in the collected urine reveals one’s body burden of metals. At first glance, this reasoning seems perfectly rational. However, emerging evidence indicates that the challenge test is not scientifically validated for the assessment of chronic heavy metals exposure and may cause harm to the patient by redistributing metals to sensitive tissues and organs.3,4
According to the American College of Medical Toxicology, heavy metals challenge testing is appropriate only when there has been a known significant exposure to a toxic metal with symptoms consistent with exposure or as part of biomonitoring for occupational exposure to heavy metals. Challenge testing is not appropriate for assessing chronic exposure and body burden for several reasons:
- Challenge testing does not differentiate between methylmercury and inorganic mercury and thus does not allow the clinician to distinguish the source of a patient's mercury exposure.
- Challenge testing only detects transient peaks of mercury in the blood. It is not sensitive enough to detect ambient levels of the metal. The detected level may also be skewed in people with renal insufficiency because the test dumps a large amount of mercury into the urine.
- There is no standardization of challenge conditions for the challenge test, leading to wildly different results from one patient to the next.
The Mercury Tri-Test
Due to the problems posed by toxic metals challenge testing, there has long been a need in the medical community for an innovative, scientifically-validated test for assessing mercury body burden.
Quicksilver Scientific has fulfilled this need with our ground-breaking Mercury Tri-Test. Our Tri-Test uses a patented mercury analysis technique to separate the biologically relevant forms of mercury - methyl and inorganic mercury – from hair, urine, and blood samples. We are the only clinical lab in the world that offers mercury speciation analysis.
Our Tri-Test offers multiple benefits over challenge testing:
- The test’s high sensitivity allows for the detection of ambient levels of mercury, unlike challenge tests that only detect transient peaks in mercury.
- The test’s propriety mercury speciation technology gives patients and practitioners an understanding of the source of mercury exposure. The methylmercury level reflects mercury exposure from fish consumption while the inorganic mercury level reflects exposure from dental amalgams, airborne exposure from coal-fired power plants and other industrial sources, and demethylation from ingested fish.
- The test provides a measure of the magnitude of mercury exposure.
- The test provides information on the individual’s ability to excrete each form of mercury.
Together, these features make our Mercury Tri-Test™ superior to heavy metal challenge tests without putting the body at risk for heavy metal redistribution or essential metals depletion.
Blood Metals Panel
In addition to our Mercury Tri-Test, we offer a Blood Metals Panel that screens for a broad range of potentially toxic and nutrient metals using state-of-the-art inductively coupled plasma/mass spectroscopy, including:
The Blood Metals Panel can be used alone or in combination with the Mercury Tri-Test. Importantly, the Blood Metals Panel also looks at metals ratios, such as the zinc-copper ratio, which have significant implications for our health.
Interpreting Mercury Tri-Test Results
When interpreting the Mercury Tri-Test, there are six types of results. Each type reflects a type of exposure and level of efficiency of excretion.
Type 1: Normal or no issue results
This result is seen in people who either don’t have much mercury exposure or have very efficient excretion pathways that consistently keep their levels low.
Type 2: Load-dependent concentration, good excretion
This result is seen in people with chronic exposure to mercury, either from seafood or amalgams, who are efficiently excreting mercury through their detoxification pathways. These people generally respond very well to a mercury detoxification protocol such as our Detox Qube.
Type 3: Retention-influenced concentration, poor excretion
A high blood/urine inorganic mercury ratio: urine inorganic mercury ratio indicates retention of mercury in the body caused by impaired excretion pathways. These individuals require comprehensive gut, liver, and kidney support to facilitate excretion of the retained mercury in their bodies.
Type 4: Those missed by total Hg tests
Standard mercury tests, such as those offered by Quest and LabCorp, often produce false negatives for mercury toxicity due to their low mercury detection limit and lack of speciation analysis. People who have previously tested negative for elevated mercury on a standard test but demonstrate elevated levels with our Mercury Tri-Test fall into this category.
Type 5: Rapid demethylators
People with high demethylation activity rapidly convert methylmercury from fish into inorganic mercury, resulting in a high body burden of toxic inorganic mercury and an increased risk of neurotoxicity and hepatoxicity.
Type 6: Intracellular retention of mercury
People with poor methylation ability retain mercury intracellularly, with very little entering the blood, urine, and hair. On the Tri-Test, these people may present with very low inorganic mercury levels. Oftentimes, these people have genetic polymorphisms in MTHFR, PON1, and CBS genes that impair their endogenous mercury detoxification mechanisms and increase their susceptibility to mercury toxicity.7
A methylmercury level of 5 or above and an inorganic mercury level at 0.1 or above indicates a pressing need for mercury detoxification. High blood and low urine mercury levels reflect a disruption in the filtration pathways in the kidneys, causing retention of mercury.
Heavy Metals Toxicity is Individualized
While assessing mercury levels is highly useful for directing a successful course of treatment, a number alone cannot show the toxic response of an individual to a given level of mercury. The toxic reaction to mercury and other heavy metals is highly individualized. A level that is innocuous to one person may be highly toxic to another person due to differences in genetics and detoxification capabilities. Diagnosis of heavy metal toxicity must, therefore, use a combination of clinical symptomology and auxiliary testing to chart a safe, effective course of treatment for an individual. The International Academy of Oral Medicine and Toxicology (IAOMT) has a useful mercury toxicity symptom survey that can be combined with testing to gauge the magnitude of mercury toxicity.
Do I Need to Test Before Starting Detoxification?
While you can begin our heavy metals detoxification protocol, the Detox Qube, without testing, you will need to titrate the supplements slowly since it will be unclear what detoxification "type" you are, as discussed in the "Interpreting Your Tri-Test Results" section. That being said, we always recommend that you consult with a practitioner before using our detox protocol.
When Should You Re-Test?
Many patients wonder, when should heavy metal levels be re-tested? We recommend that you take 3-6 months to implement a detoxification protocol before re-testing. All detoxification supplements should be stopped 2 weeks before re-testing to get the most accurate heavy metal measurements.
Our Mercury Tri-Test and Blood Metals Panel offer cutting-edge testing for heavy metals toxicity, assessing both your body burden of toxic metals and your ability to eliminate them. Stay tuned for Part 3 of our Back to Basics blog series, in which we’ll discuss the best detoxification strategies for heavy metals toxicity.
- Branco V, et al. Biomarkers of mercury toxicity: Past, present and future trends. J Toxicol Environ Health B Crit Rev. 2017; 20(3): 119-154.
- Manceau A, et al. Chemical forms of mercury in human hair reveal sources of exposure. Environ Sci Technol. 2016; 50(19): 10721-10729.
- American College of Medical Toxicology. ACMT recommends against use of post-chelator challenge urinary metal testing. J Med Toxicol. 2017; 13(4): 352-354.
- Molin M, et al. Mobilized mercury in subjects with varying exposure to elemental mercury vapour. Int Arch Occup Environ Health. 1991; 63(3): 187-192.
- Flora SJ, Pachauri V. Chelation in metal intoxication. Int J Environ Res Public Health. 2010; 7(7): 2745-2788.
- Sears ME. Chelation: Harnessing and enhancing heavy metal detoxification—A review. Sci World J. 2013; 2013: 219840.
- Austin DW, et al. Genetic variation associated with hypersensitivity to mercury. Toxicol Int. 2014; 21(3): 236-241.