Heavy Metal Detoxification in the Treatment of ASD
Heavy Metal Detoxification can occur in many different ways. One of the most effective is the process of taking a chelating medication that has a strong binding affinity for toxic metals in the body. Once the medication is in the bloodstream, it seeks out the toxic metals and binds to them very tightly. The complex of [chelator + metal] can then be excreted by the body into the urine and stool. Chelation actually mimics the body’s own natural Phase Two detoxification pathways, where molecules (such as glutathione) are attached to toxins in order to excrete them. Chelators are much stronger than glutathione in pulling metals.
Heavy metal detoxification medication can be taken five ways – intravenous (IV), rectal suppository (PR), oral (PO), transdermal (TD), or an intramuscular (IM) “shot”.
- Intravenous heavy metal detoxification is by far the most effective, and gives the strongest “pulls” of metals, because the medication is going straight into the blood where it can go to work. IV heavy metal detoxification is also the most expensive, due to the need to use sterile solutions and have medical staff administer it.
- Rectal suppositories take some getting used to, but are usually not painful and are very effective. Inside the rectal area, there are many blood vessels. A suppository containing a chelator will melt from body heat within minutes, and the medication is absorbed into the blood. Suppositories are therefore only second to IV’s in effectiveness, are less expensive than IV’s, and can easily be done at home, sometimes while the child sleeps. It is important to explain this procedure to a child before it is done however, so that the child does not feel that they are being inappropriately invaded. A separate instruction sheet is available on how to correctly insert a suppository.
- Oral heavy metal detoxification is usually only practical for kids who can swallow pills because the medications taste really bad, but they can be mixed with flavored syrups for those who will tolerate it. However, oral heavy metal detoxification is most likely to exacerbate gut problems by increasing bad “gut bugs” such as yeast.
- Transdermal heavy metal detoxification is the most “user friendly” and is well tolerated by the gut, but is generally considered to be the weakest or least effective method. Transdermal is therefore most often used only in very young children.
- Intramuscular is generally too painful for routine use in children.
There are three prescription medications that can be used to detoxify heavy metals – DMSA, DMPS, and EDTA. Developmental Spectrums has individual informed consent forms listing potential side-effects for each medication. The appropriate consent must be read and signed before taking the medication.
DMSA is FDA approved for removing lead in children – but it also removes mercury and other toxic metals. It has been on the market in this country for many years, and was originally used to detoxify children who had eaten lead paint chips. DMSA can be used orally, transdermally, in a shot, and as a suppository, but not IV. DMSA is “off-patent” and is therefore relatively inexpensive compared to DMPS, however, it often has more gastrointestinal side-effects than DMPS. Since it is an FDA approved drug, it can often be covered by insurance – including Medical.
DMPS is not FDA approved because it is not an American drug. Its use is therefore considered “experimental” in this country, and it is usually not covered by insurance. However, there are many years of documented safe and effective use of DMPS in the rest of the world. In some countries, it is considered so safe that it is available over the counter. It is manufactured in Germany, Russia, China, and other countries. It is imported into the USA, checked for purity, and compounding pharmacies dispense it in many forms (including IV’s) based on a doctor’s prescription. DMPS is much more expensive than DMSA, but it is often better tolerated (not always), and is generally considered to be superior to DMSA in chelating mercury. It also pulls lead and other toxic metals.
EDTA is a chelator that can come in two forms – either bound to sodium or calcium. It is an FDA approved drug for lead poisoning in adults and children. It has been on the market in this country for many years, and is even used in small amounts as a food additive. EDTA is most effective if used as a rectal suppository or given IV. It is relatively ineffective if used orally or transdermally. The sodium form of EDTA is generally only used in slow, three-hour IV drips in adults who are being treated for heart disease where the goal is to pull calcium from clogged arteries in the body. Only the calcium-bound form of EDTA, or CaEDTA is used at Developmental Spectrums. CaEDTA does not pull calcium from the body, and is very good at chelating lead, cadmium and arsenic among other metals, but is not good at pulling mercury. It is still useful in autistic children, since most ASD kids have lead toxicity in addition to mercury toxicity. It is helpful to remove the lead first, since the presence of other toxic metals in the body seems to decrease the excretion of mercury.
All forms of heavy metal detoxification are given in “on/off” cycles. This is important to give the body a rest between cycles, and to allow adequate time for re-mineralization. Oral and transdermal heavy metal detoxification is usually given in an on/off schedule such as 5 days off – 2 days on, or 11 days off – 3 days on. The oral or transdermal medication is usually given three times a day on the “on” days. IV heavy metal detoxification is usually not done more than once a week, but suppositories are often done 2-3 times a week. The day after an IV, it is recommended to do a “mop-up” dose of chelator to help grab any metal that may have been “loosened” by the IV. Different methods of medication administration can be combined depending on a patient’s needs, such as IV’s every 2-4 weeks, with oral or suppository in-between.
SIDE-EFFECTS: All medical treatments have the possibility of side-effects. The most common side-effects of chelating are 1) symptoms of mineral deficiency (tiredness, increased chewing or mouthing behavior, grinding teeth, dark circles under the eyes, or crankiness), 2) symptoms of a yeast flare-up (excessive hyperness, silliness, spaciness, or stimming), or 3) symptoms of detoxification (mild fatigue or irritability for a day or two after taking a dose). Detoxification symptoms are greatest in the beginning of the process, can be minimized by adjusting the dose, and decrease as the total body toxic load decreases. Carefully supplementing minerals, monitoring mineral levels, and being vigilant for yeast greatly minimizes the other symptoms. If a yeast flare or mineral deficiency occurs, it might be necessary to take a break from chelating to fix the problem, and then resume.
Rarely, liver or kidney problems, bone marrow suppression, or a rash can occur. A rash can signal an allergy to the medication, or it may be a mild detox rash from mobilizing the metals. Extremely rare types of severe rashes called SJS or TEN can occur and can be life-threatening. These types of rashes are not unique to chelators, but are possible with almost any prescription medication and are extremely rare. Just to be safe, be sure to report any rashes to Dr. Mielke, and stop using the medication until you have discussed it with the doctor.
Rarely, the mobilization of the metals in the body can cause a temporary exacerbation of autistic-like symptoms, or even cause temporary autistic regression. If this occurs, generally lowering the dose to proceed more slowly solves the problem and the child improves. This usually only occurs in really toxic children, and is a sign of how sensitive a child is to the metals and how important it is to get them out. This is a clear example of the connection between heavy metal toxicity and autism symptoms.
If a child becomes ill for any reason, heavy metal detoxification should be temporarily discontinued until they have fully recovered. If unusual lethargy, abdominal pain, nausea, or vomiting occurs, discontinue the medication and report to Dr. Mielke. It is important to understand that overall, the vast majority of patients tolerate heavy metal detoxification with no major adverse effects.
The biggest risk of heavy metal detoxification is mineral depletion, so minerals must be supplemented carefully during the heavy metal detoxification process. Signs of low minerals can be tiredness, increased chewing or mouthing behavior, grinding teeth, dark circles under the eyes, or crankiness, among others. Usually, a patient’s mineral dose will need to be increased when heavy metal detoxification is started to make up for the minerals that will be lost. All chelators bind weakly to minerals, so some minerals are lost as the metals are being excreted – especially zinc. It used to be recommended not to take minerals within 6-12 hours of a chelation dose (pre and post) to prevent the chelator from binding to the minerals, but this sometimes resulted in mineral levels dropping too quickly. In most people, it is necessary to take minerals even on chelation days. This still works well since the medications have a much stronger binding affinity for metals than minerals, so even if the chelator does bind to a mineral first, it will drop the mineral to grab a metal if one is available.
Prior to beginning heavy metal detoxification, blood mineral levels must be checked and be adequate, and the major bodily organs must be functioning properly (based on a blood CBC and chemistry panel). Also, the child should not be dehydrated or constipated when chelating, because the metals will be exiting the body in urine and stool. If the metals sit in the gut for too long, they could be reabsorbed, and they have a longer time to cause dysbiosis (an imbalance in the gut flora). Blood tests must also be checked periodically throughout the detoxification process to ensure that the child is progressing safely. A blood test for CBC, chemistry panel, and intracellular mineral levels, and a urine toxic metal test are done every two – three months to monitor for safety and progress.
A “challenge test” is when a dose of a chelating medication is given to the patient and then urine and/or stool is collected to measure the output of metals excreted. A challenge test usually involves starting with an empty bladder, taking the chelation challenge dose, collecting urine for the next 6 -12 hours, and then sending a sample to a lab to assess the metal output. Sometimes the “challenge” dose of chelator will be double the usual dose to see a more obvious result. Other times the collection is done after the usual dose, to see what is coming out routinely. It is not necessary to do a challenge test after each dose. This test only measures what is being excreted at that time, and is not a quantitative measure of total body stores of metal. Porphyrin testing is more useful for indicating how much mercury may be stored in the body. However, a challenge test can provide a useful record of the metal excretion, and can give an idea of when we are “done”. Sometimes the initial tests look like there is little metal coming out, and some people wrongly conclude that there is not an excessive amount of metal in their child’s body. It is not uncommon for a person to chelate for months before mercury is accessed and begins to be excreted. Other people will show a big “dump” of mercury immediately. Heavy metal detoxification results, like everything else, are very individual. If no metals are being excreted with a certain chelator or with a certain method, often we will change medications, routes of administration, or doses to achieve adequate metal excretion. Remember, the child will not improve to their full potential unless the toxic metal is coming out.
People often wonder when to stop chelating. There is no definitive marker on when to stop chelating, but when the child has plateaued in their progress, or no further metals are coming out, or the child has fully recovered, then it is time to stop. However, even after metals stop coming out, it is often a good idea to take a break from chelating for several months to allow metals in the body that are in deep storage to redistribute from “hard to grab” locations to “easier to grab” locations, and then re-do a challenge test. Often a whole new batch of metals shows up.
It is important to remember that there is no “safe” amount of mercury or lead, and the presence of more than one toxic metal synergistically and exponentially increases the toxicity. Sensitivity to heavy metals varies hugely between individuals. Because of genetic differences between people, a given amount of mercury may not cause any discernible symptoms in one person, but the same amount could cause major health problems in another person. Children on the spectrum are extremely sensitive to mercury and other toxic metals, and are often glutathione deficient. Also, estrogen protects against mercury toxicity, while testosterone enhances mercury toxicity, contributing to the 4:1 ratio of affected boys to girls.
Heavy metal detoxification often needs to be done for a minimum of six months – two years or more, depending on the child. Younger children seem to get better results from chelating, and when begun early enough and done in combination with all the other major Defeat Autism Now!-based treatments, can result in dramatic improvements in some children. With older children, more aggressive methods of chelation (such as IV) may be necessary to achieve significant metal output, and heavy metal detoxification results may be less impressive, but are not zero. It may be that in older children the brain damage from toxic exposure is more permanent. But any aged person, including adults, can functionally improve and will be healthier from removing toxic metals from their body.
It is important to remember that mercury and other toxins can and do kill some brain cells (neurons), and it is not possible to predict in advance how many neurons in a child are already dead and gone, and how many are still alive but toxic. The neurons that are still alive are potentially recoverable, but a dead neuron will remain dead no matter how much heavy metal detoxification or other treatment is done. The best hope for that type of brain injury may be future stem cell infusions.
There are other ways to detoxify metals as well. Adding nutrient supplements- such as vitamins and minerals – improves the body’s own natural ability to detoxify. Giving glutathione, either transdermally, in an IV, suppository, or in oral lipoceutical form, helps the body detoxify.
Many people have had success with the FAR-IR sauna. Since the body naturally excretes metals through urine, stool, hair, skin, nails, and SWEAT – the sauna uses a natural pathway to excrete metals. Chemical toxins are also removed this way, so there is a double bonus from sauna therapy. The FAR-infra red sauna induces sweating at a much lower temperature than traditional saunas, and is safe for use with children. Protocols vary, but often start at 100 – 120 degrees F, for 10-30 minutes a day. All sweat should be toweled off, and afterwards take a shower. This can be done every day, depending on an individual’s tolerance. Minerals are lost through the sweat as well, so must be supplemented as in heavy metal detoxification. These saunas can be purchased for home use, generally costing around $2000 -$3000. Some children like it, but some don’t like getting hot and sweaty. I recommend that patients try it out at a center before purchasing their own unit.
Others are using clay baths to remove metals. The purity of the clay is very important here, because we wouldn’t want to soak a child in more metals! Some are using ionic foot baths, but I can’t vouch for their usefulness, and they are expensive. Others are using chlorella, an algae, but again the purity of the product is hard to certify. Algae grow in water, and all major bodies of water on earth now have toxic metals in them. There are many other “natural” products out there that are available without a prescription that claim to work, but they do not have a proven track record of efficacy, and some of them don’t even bind to mercury in a test tube! Natural is not always better.
Although not every patient will improve from chelating, overall, chelating and/or detoxifying protocols in combination with full Defeat Autism Now!-based treatment can cause real improvement in many patients on the autistic spectrum.