Amy Nett: Next question from Nick about heavy metals. Nick says, “Can you touch on the pros and cons of using Quicksilver versus Doctor’s Data when it comes to heavy metals testing? I read that you avoid provoked urine tests because of potential effects. I’ve noticed a trend in new patients who have had the provoked urine test through Doctor’s Data.” Yes. I wonder how you’re seeing that if you’re seeing are our tests specifically their order, but you’re absolutely spot on. I have recently changed my approach. Nick says, “I have a current patient who was a welder/ironworker. After contracting a virus, it spread to his brain. He suffered facial paralysis and other odd neurological symptoms. He’s doing better now but never investigated heavy metals/compromised immune system. He’s still having some residual sensory issues.”
Great question. Heavy metals testing, I think, is still pretty nuanced, and I used to start almost universally with the Quicksilver nonprovoked. Sorry let me back up a little bit just in case any of you aren’t as familiar with the Quicksilver versus Doctor’s Data. Quicksilver does a nonprovoked urine heavy metals test. Doctor’s Data we often do provoked heavy metals testing most often using glycine and amino acid that supports detoxification and also DMSA, a prescription chelating medication that’s a urine test. The difference is nonprovoked testing, I’m not doing anything to support detoxification and simply grabbing a urine sample and then saying, “Okay, what level of heavy metals am I seeing within the urine?” What’s being excreted? Depending on the individual’s ability to detoxify their overall toxic burden level, that may or may not be representative of the toxic burden that is effectively “hiding” within the cells. Sometimes it’s really just the tip of the iceberg, and a provoked heavy metals test what you’re doing is you’re in some ways bypassing the patient’s current detoxification capacity, and you’re saying, “Well, I really need to see what toxic burden is inside the cells and so I’m going to give them a chelating agent to sort of flush out the kidneys.” A little more brute force in terms of pulling out some of the heavy metals, but I think, again, you’re not dependent on the patient’s detoxification capacity because a lot of people we’re seeing and a lot of people who do have impaired detox, we’re not going to get a good representation on a nonprovoked heavy metals test.
I would say the pros of using the Quicksilver and as from now on I’m just going say Quicksilver and that’s shorthand for nonprovoked, and when I say Doctor’s Data that’s shorthand for DMSA provoked heavy metals test. The benefit of using a Quicksilver heavy metals profile is it’s relatively easy. The patient doesn’t have to prep. You’re simply getting a blood sample and seeing what’s there. The downside of it is you might be missing some toxins that are inside the cells because this person has a depressed capacity or decreased ability to detoxify.
The advantage of using the Doctor’s Data heavy metals test is that you have a better chance of seeing what’s actually inside the cells because you’re pulling that out effectively with the DMSA. The downside is if somebody is sensitive and you give them a chelating agent and they have a bunch of heavy metals that you don’t know about, you’re potentially pulling a lot of heavy metals out of the cells into the bloodstream, into the organs of excretion. You’re potentially going to see a strong detox reaction, which might feel a little bit like a flu which might give patients a little bit of neurologic symptoms, brain fog, headaches. Patients can feel a little off-kilter from doing this.
Nick, you’re absolutely right. I have recently transition to starting a lot more with the DMSA provoked heavy metals test, but this is a conversation I have with, I think, I hope, every patient, and I tell them the pros and cons. I have some patients who are sensitive, and normally I will also say, “Look, if we run the Quicksilver blood metals panel and it’s completely normal, I’m probably still going to ask you to run a DMSA provoked heavy metals test because you still might have heavy metals hiding in your cells, but at least I will know from that Quicksilver test that you don’t have a huge burden of heavy metals.” It’s hard to say they could still have a lot in their cells, but at least we’ve done some screening. One other consideration that I should mention and I’m not as sold on this one, but some people say that the nonprovoked heavy metals will show you the acute exposure, so the heavy metals you’ve been exposed to within, let’s say, the past two weeks, whereas the Doctor’s Data provoked heavy metals test is going to show you chronic exposures or prior, like, accumulated exposure so that’s something else to think about. But again, I think even with chronic exposures, people might be moving these heavy metals out of the cells. Coming back to the discussion I have with patients, so we’ll tell them, “If you feel more comfortable. Let’s start with the Quicksilver panel, but again, we still may do the Doctor’s Data.” It’s about $250 to $300 to do that Quicksilver blood metals panel, and we still might be doing the Doctor’s Data test anyway. Having that discussion with patients, some of my patients do still say, “I really don’t want to risk having a detox reaction.” I just feel more comfortable starting with an nonprovoked test because if there is a high heavy metal on that nonprovoked test, it gives us a treatment target. We can start detoxification. The vast majority of my patients though do say, “Let’s just go with this DMSA provoked heavy metals test.” I just tell people you know schedule it at a time where you don’t have any commitments later that day, you don’t have any obligations later that day, maybe you’ll have someone else around home just in case you don’t feel well, and 90 percent of my patients come back and say, ”Gosh, why did you scare me like that. It was fine. I didn’t even notice anything.” But I do have 10 percent of people who come back and say, “I just didn’t feel that well” or “I had a headache” or “brain fog” or whatever it is. I think if people know why they don’t feel well and they have an explanation and kind of expect to not feel well it’s fine. They sometimes say, “Oh okay, I’m just detoxing because I’m not feeling that well.” Then, the next day they might feel even a little bit better because they just cleared out some of the heavy metals.
It’s a good discussion to have, so I think for this patient that you’re mentioning, he’s doing better but having some residual sensory issues. Yes, this is just the discussion, so if he feels comfortable with the DMSA, I think for the most part it’s safe. The only thing is I do always check kidney function first. You want to make sure the patient has good renal function. I personally do not use DMSA in compromised kidney function, again, risk-benefit analysis and to me that’s just not worth it. Hopefully that gives you a little more background, and you’re right. I have changed my thinking/comfort level on using the DMSA provoked testing them. Now I’m seeing a lot of patients who have had normal Quicksilver blood metals panel and then sort of circle back to heavy metals. We run the DMSA provocation, and I’m pretty surprised that what comes back. I’m not happy at this point stopping after a nonprovoked test. Great question and probably ongoing, so we can check back in a year and see if I’ve changed again, but that’s where I’m at right now with heavy metals testing.