Chelation challenge testing: not scientific, not beneficial, may be harmful

13 Aug

Who knows about the toxic effects of mercury? Toxicologists. The premier toxicology group in the U.S, the American College of Medical Toxicologists, represents the doctors who test and treat people suffering from real heavy metal poisoning.

By contrast, many doctors have added chelation to their treatment options due to the false theory that autism is caused by heavy metal poisoning (specifically, mercury). These alternative-medicine practitioners usually depend on non-standard test to “prove” heavy metal poisoning. The favorite seems to be the “challenge” chelation test. In this test, a chelator is given to a person before a urine test. Chelators are chemicals which bind to metals in the body and allow them to be excreted more easily. Thus, if you give a chelator to a person, you expect their urine to show higher levels of heavy metals.

This has been discussed on this blog and elsewhere for a long time.

And now the American College of Medical Toxicologists has come out with an official position statement.

The practice is not scientific. There are no reference values for post-challenge urine metal testing. There is no correlation between actual metal exposure and post-challenge test results.

It is, therefore, the position of the American College of Medical Toxicology that post-challenge urinary metal testing has not been scientifically validated, has no demonstrated benefit, and may be harmful when applied in the assessment and treatment of patients in whom there is concern for metal poisoning.

It’s time for post challenge urine testing to end. It is time for chelation as a “treatment” for autism to end. It is time for those who promoted the “autism is mercury poisoning” theory to step forward and admit their mistakes.

23 Responses to “Chelation challenge testing: not scientific, not beneficial, may be harmful”

  1. Synesthesia August 13, 2009 at 21:33 #

    If Mercury caused autism, wouldn’t there have been a lot of autistic people in Mozart’s era because they used mercury as a medicine back then and possibly before hand?

    I get annoyed at autism being called mercury poisoning because it doesn’t sound accurate at all.

  2. Sullivan August 13, 2009 at 22:23 #

    Synesthesia,

    there probably were a lot of autistic people in Mozart’s era…but that is another story.

    I have never fully understood the rationale beyhind “autism is just like mercury poisoning from non ethyl-mercury compounds” combined with “autism only came about when ethyl-mercury compounds were invented”.

  3. RJ August 13, 2009 at 22:43 #

    I’ve never heard of a doctor misdiagnosing acrodynia for autism. Ever.

    But wait, didn’t you know. Now, it’s aluminum. It’s the new mercury.

  4. Sullivan August 13, 2009 at 22:53 #

    RJ,

    Very true. Real toxicologists make it very clear that there isn’t a similiarity between autism and mercury poisoning.

  5. Anthony's Dad August 15, 2009 at 00:20 #

    Wonder what Thoughtful House et al think about this statement… Nah, not really. Already know.

    • Sullivan August 15, 2009 at 03:57 #

      Anthony’s Dad,

      Too bad there isn’t a ThoughfulHouse press release. On second thought, we don’t need more strange interpretations from them.

  6. David N. Brown August 15, 2009 at 06:59 #

    According to quackwatch.com, the FDA warned that chelation was being used as a form of fraud way back in 1989. I suspect that quite a few advertising chelation for autism are cons who started using it for other conditions. Something which should be clear from the Nadama/Kerry case is that, regardless of chelation’s merits, many people who perform it aren’t qualified to do so. Personally, I think chelation is worth considering for “general health” use, but it’s certainly not a cure for autism (and wouldn’t be even if autism WAS an effect of mercury poisoning). Having it used inappropriately, while the technology may still need refining, by people who can’t even do it well can only set back valid development and applications of chelation.
    Something else I’ve commented on: Age of Autism is funded by Lee Silsby, which sells chelation agents as an autism treatment.

  7. Petra August 19, 2009 at 23:13 #

    How do you get from:
    “post-challenge urinary metal testing has not been scientifically validated”

    to:
    “It is time for chelation as a “treatment” for autism to end.”

    Because this test is worthless, chelation doesn’t help?

  8. Sullivan August 19, 2009 at 23:50 #

    Petra,

    autism is not mercury poisoning. It just isn’t. There is a lot of discussion on this blog (and others) discussing this.

    The fact that the ACMT has come out denouncing the challenge test is just the latest in a long history of exposing the problems with chelation.

    Because the test is worthless, it is clear that autistic children are not suffering from mercury poisoning. It is also clear that the chelationist doctors are willing to create false tests to convince their patients (and perhaps themselves) that autism is mercury poisoning. That, to me, says a lot about the chelationist doctors.

    How does chelation help if the problem isn’t mercury poisoning?

  9. Sullivan August 20, 2009 at 00:16 #

    Petra,

    did you read the statement by the ACMT? They describe some of the potential dangers.

    So, when there is no reason to believe chelation will work, and there is potential risk, the risk/benefit ration is infinite.

  10. passionlessDrone August 20, 2009 at 00:38 #

    Hi Sullivan –

    Because the test is worthless, it is clear that autistic children are not suffering from mercury poisoning.

    You are drawing unjustified conclusions here. All this tells us is that testing via challenge isn’t useful for diagnosing mercury ‘poisoning’.

    Furthermore, the idea that you have to suffer ‘mercury poisoning’, whatever that is, for there to be physiological or neurological impacts is difficult to defend. All we need to do is take a look at the decreasing amounts of ‘acceptable’ levels of lead in the past few decades to see that ‘acceptable’ in large part depends on how subtly we can look for differences.

    In any case, we have many studies telling us that metal metabolism and/or detoxification capabilities are abnormal in the autism population. We have the infamous Ip debacle, a study from Kuwait showing abnormal excretion patterns, several genetic and clincial analysis indicating risk or protection factors associated with glutathione production, and differential zinc to copper ratios. There are probably others if I felt like looking them up.

    A study came out this week regarding metal excretion in autism:

    Chromium, Cadmium, and Lead Levels in Urine of Children with Autism and Typically Developing Controls

    Unsurprizingly, significant differences were found. I haven’t read this paper yet, so I don’t know if mercury was also tested for, and found to be consistent. Has anyone else read it?

    Causation can’t be assigned, and chelation might not be the right answer; but the ‘autism isn’t mercury poisoning’ argument is a strawman, almost as utility free as the ‘autism is mercury poisoning’ argument.

    – pD

    • Sullivan August 20, 2009 at 00:55 #

      You are drawing unjustified conclusions here. All this tells us is that testing via challenge isn’t useful for diagnosing mercury ‘poisoning’.

      Yes. And if this was the only post I had ever made on the subject, this would be a valid criticism. But, I have discussed this many times, as has Kev, as has AutismStreet, as has Neurodiversity.com, as has the cryptically named “Not Mercury” blog…

      Autism is not mercury poisoning. Experts in mercury poisoning say so. Experts in autism say so. A group of doctors who listen to PR people and business people say otherwise.

      Autism is not mercury poisoning. Not a straw man. Take it up with Mark Blaxill, David Kirby and the rest of the people who are responsible for a decade of kids being subjected to needless chelation.

  11. Sullivan August 20, 2009 at 01:03 #

    pD–

    what did you get for “related articles” when you went to pubmed for that article?

    I got this as the top related article:

    http://www.ncbi.nlm.nih.gov/pubmed/17503250?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=1&log$=relatedarticles&logdbfrom=pubmed

    24-hour provoked urine excretion test for heavy metals in children with autism and typically developing controls, a pilot study.

    Here’s the conclusion:

    CONCLUSION: In the absence a proven novel mode of heavy metal toxicity, the proportion of autistic participants in this study whose DMSA provoked excretion results demonstrate an excess chelatable body burden of As, Cd, Pb, or Hg is zero. The confidence interval for this proportion is 0-22%.

    I guess I am left wondering why you used the word “unsurprisingly”. Sounds like you read the Turkey study with a bit of a bias.

  12. David N. Brown August 20, 2009 at 06:42 #

    Something I have noticed is that people advocating chelation for autism have apparently cited opposite results- high or low levels of mercury in urine or hair- as “proof” of the same conclusion- that autistics somehow metabolize mercury abnormally. In my view, the default conclusion to make is no difference at all.
    I have seriously considered the possibility that autistics (or an unusual proportion thereof) are unusually vulnerable to mercury. If it were true, it need not be regarded as anything more than a comorbid allergy or metabolic disorder. But without solid proof of a difference, there’s no point in speculating.
    Also, as I mentioned earlier, I think chelation has some potential value for “general health”. Its best application would be in areas with elevated environmental mercury, to prevent it from accumulating above a harmful level in the individuals’ tissue. I have also entertained the pipe dream of using it on animals. But the use of chelation on the autistic by therapists who may be dangerously underqualified (eg. Roy Kerry) can only delay more reasonable uses.

  13. daedalus2u August 20, 2009 at 15:26 #

    pD, chromium is an essential nutrient. Usually less than 1% of dietary chromium is excreted in the urine. 97%+ is excreted in the feces. The toxic form of chromium is hexavalent chromium (Cr VI) which is highly soluble and goes right into cells where it is reduced to trivalent chromium (Cr III) which is highly insoluble. Trivalent chromium oxide is still used as the green pigment in green soap.

  14. passionlessDrone August 20, 2009 at 17:32 #

    Hi Sullivan –

    I will freely and loudly proclaim that autism is not mercury poisoning, that the argument is over simplistic and lacks any empirical support. I just don’t appreciate the underlying implication that we know that metal metabolism is not a component in autism, a lot of our available evidence speaks towards the opposite.

    As towards Soden, there is a bit of irony here. Soden couldn’t detect any increases in urinary mercury excretion at all post chelation challenge. If it’s results were accurate, and my child does respond in a challenge situation with increased excretion, doesn’t this mean that the test my DAN provider gave me is actually giving me important information? Either the tests are bogus because you’ll always get an increase as a result of challenge and Soden’s results aren’t meaningful; or Soden’s results aren’t meaningful and challenge tests are useful tools because Soden showed that even normal children didn’t excrete more heavily when challenged. (?)

    In any case, Soden looks to be an instance of using measurement techniques of insufficient precision to detect anything at all.

    A review of the statistics by the DeSoto (yes, that DeSoto) claims that if you measure the number of tests provided to children with autism versus test provided to children without, there was a significant difference in the groups.

    In any case, if I had a study with fifteen kids with autism and four controls that showed the opposite, I’m sure you would jump up and down about the very small and highly skewed groups should keep us from reaching any conclusions. Who knew that sample sizes and balanced controls only matter in some instances?

    – pD

    • Sullivan August 20, 2009 at 21:30 #

      I just don’t appreciate the underlying implication that we know that metal metabolism is not a component in autism, a lot of our available evidence speaks towards the opposite.

      And I don’t appreciate the suggestion that anyone knows enough about this to promote chelation.

      Here’s a basic outline of what should happen before chelation is tried on autistic kids:

      1) obtain data that generates an hypothesis suggesting chelation may be beneficial
      2) test hypothesis against other known data
      3) propose study
      4) conduct study on safety and efficacy of chelation
      5) based on (4), consider whether hypothesis was correct and whether chelation is indicated
      6) monitor safety and efficacy

      As far as I can see, you have part of 1 and you have jumped to 5.

      Take the proposal that autistic kids (or some subset) excrete metals differently than non autistic kids.

      What does that mean? Seriously, before you know, and I mean know, what that means, you don’t move forward to treatment.

      I guess the precautionary principle is just a phrase that gets used to question the vaccine program? If autistic kids have a difference in metals excretion, that tells this reader something simple:

      Do Not Mess Around With The Metals Metabolism of Autistic Kids Without a Really Good Understanding of What You Are Doing.

      In other words, it is precisely because I believe there could be a possible difference in metals metabolism that I suggest extreme caution.

      As towards Soden, there is a bit of irony here. Soden couldn’t detect any increases in urinary mercury excretion at all post chelation challenge.

      You haven’t read the paper or the abstract lately, have you? “Three autistic subjects excreted one metal in greater quantity during the provoked excretion than baseline. ”

      Who knew that sample sizes and balanced controls only matter in some instances?

      I suggest you read the title of the study where it says “pilot study”. Somehow I thought I didn’t need to point out the limitations involved in a pilot study to you.

  15. Mike Stanton August 20, 2009 at 20:40 #

    OK pD,
    the American College of Medical Toxicologists have issued a statement that challenge or provocation testing for metals in urine has no diagnostic value whatsoever. From this it follows that treatment should not be prescribed on the basis of these tests.

    However DAN/ARI use these tests both as justification for their claims about autism and mercury poisoning and as a basis for prescribing chelation therapy. This seems to be a straightforward either/or situation to me. Either ACMT is right and DAN/ARI is wrong or vice versa.

    Whether or not there are differences in the levels of various metals in the urine of autistic people and the possible significance of this is an interesting topic. But it has no bearing on the import of the ACMT statement.

  16. passionlessDrone August 21, 2009 at 02:32 #

    Hi Sullivan –

    And I don’t appreciate the suggestion that anyone knows enough about this to promote chelation.

    Fair enough. I would always say that we have much more to learn, and indeed, you might be suprized to know that I sometimes times find myself feeling that the DAN approach is akin to feeling its way in the dark.

    1) obtain data that generates an hypothesis suggesting chelation may be beneficial
    2) test hypothesis against other known data
    3) propose study
    4) conduct study on safety and efficacy of chelation
    5) based on (4), consider whether hypothesis was correct and whether chelation is indicated
    6) monitor safety and efficacy

    Also seems fair. As far as testing against other known data; that immediately gets difficult; because we don’t know what seems to be causing such a wide range of abnormal values, where do we start insofar as what data to use as a reference? In other words, what’s our model? [genuine question]

    I believe such a study was proposed, and yanked due to safety concerns, I believe based on an animal study. However, whether we like it or not, this expirement is being performed now, just without any good experiemental control. Safety and efficacy are likely agent, dose, age and dependent on actual presence (or absence) of metals. I also believe that another study was recently done that indicated amount of metals pulled was tied to autism severity; but in general the names associated with the study have so many problems that I won’t bother to try to find it.

    I guess the precautionary principle is just a phrase that gets used to question the vaccine program?

    While I do appreciate the sarcasm, I think I would be remiss if I didn’t point out that there are significant differences between a national health initiative and choices made by individual parents who believe (rightly or wrongly) that they are trying to help their disabled child. None the less, caution is warranted.

    You haven’t read the paper or the abstract lately, have you? Three autistic subjects excreted one metal in greater quantity during the provoked excretion than baseline.

    Have you read your own post lately?

    Chelators are chemicals which bind to metals in the body and allow them to be excreted more easily. Thus, if you give a chelator to a person, you expect their urine to show higher levels of heavy metals.

    If you agree with the American College of Mercury Toxicologists, we should expect everyone given a challenge to return higher levels of mercury, right? For some reason, Soden showed exactly the opposite of what they would expect! Out of 19 participants, 16 did not show showed any increase at all. And two of the three autistics that did show an increase were barely detectable (at least by Soden’s baseline).

    Three autistic subjects excreted one metal in greater quantity during the provoked excretion than baseline.Two of these were very close to the limit of detection.

    So again, either Soden’s methodology was wrong, or we need to do some serious caveats to the notion that “if you give a chelator to a person, you expect their urine to show higher levels of heavy metals”. Or was there somewhere in your post that indicated we should only expect increases post challenge in 15% of subjects that I missed?

    I suggest you read the title of the study where it says “pilot study”. Somehow I thought I didn’t need to point out the limitations involved in a pilot study to you.

    While I appreciate that you didn’t feel you needed to point that out to me (to start with), then I guess I’d be interested in why you put so much faith in their conclusion, which you posted, given the pilot nature of the study? Do you feel their rather strongly worded conclusion is warranted considering the pilot nature of the study?

    – pD

    ps – I got a very nicely formatted email regarding the acceptance and publication of my post earlier, but still nothing regarding responses. Keep it up, you are on the right track.

  17. passionlessDrone August 21, 2009 at 02:42 #

    Hi daedulus2u –

    Very interesting stuff. Thank you.

    Tragically, among the many things that I know nothing about, as opposed to just a little about, are the possible interplays between chromium, lead and cadmium. Do you have any WAGs as to the mechainsms of what was observed in the Turkey study? I’m willing to bet that you could tell me that NO disturbances could result in abnormal metal metabolism. (?)

    In particular, are there specific physiological relationships between cadmium, lead, and chromium? I realize this is a very open ended question, and one you may not have any information on. I only ask because it seems like other metal combinations, such as zinc / copper, seem to have a simlarly mysterious inverse relationship in autism.

    The plasma zinc/serum copper ratio as a biomarker in children with autism spectrum disorders

    My son showed high copper and low zinc blood levels in 2006, and our DAN told us at the time that she’d saw that combination all the time, but that normalizing these values was notoriously difficult to do. Probably because they didn’t have any good idea on how to do it, in hindsight. (We did start supplementing a little zinc though)

    – pD

  18. daedalus2u August 21, 2009 at 14:48 #

    pD, I don’t know that much about chromium metabolism, but it is not a thiol reactive metal the way that lead and cadmium are. Cadmium is similar to zinc, lead is similar to calcium (but binds to thiols in ways that calcium does not). Cadmium and lead are probably not necessary nutrients for humans.

    Zinc metabolism is extremely important. Zinc finger proteins are the largest class of transcription factors, about 900 in humans. A zinc atom acts to coordinate between multiple sulfur atoms in a protein molecule and cause it to fold into a certain shape where it fits (or not) onto certain DNA sequences either activating them or deactivating them, or maybe doing something else. There are a few thousand other zinc containing proteins, some of them use zinc as a structural component to get the right shape, some use zinc as part of the active site.

    What is the correct zinc level? That is a good question, the answer to which is unknown. Every cell needs zinc, every cell has a different profile of zinc containing proteins, every cell probably has a different zinc requirement and that zinc requirement probably changes as the cell’s needs for different proteins changes.

    Because each of those thousands of zinc containing proteins needs the “right” amount of zinc, the activity of all of those zinc containing proteins is coupled to the zinc level, which means they are coupled to each other. That coupling is very complicated, is non-linear, and changes depending on what the cell needs, which changes depending on what the tissue compartment needs, which changes depending on what the organism needs.

    What keeps the zinc level “just right” are the physiological pathways involved in regulation of zinc. Zinc levels are regulated better than our ability to measure them. Essentially the only internal fluid available for testing of zinc levels is blood. Blood is a small fraction of the body, and the partitioning of zinc between blood and different tissue compartments is actively regulated and is not understood completely.

    It is my opinion that trying to regulate something as fundamental as zinc physiology via external control with supplements or chelation will be not effective and is likely to be harmful. If zinc intake is within the range that physiological pathways can self-regulate, then physiology will self-regulate it.

    With all due respect to your DAN! practitioner, what level of zinc is normal or pathological for which individuals under what physiological state? What symptoms of zinc deficiency or excess is the individual exhibiting? Maybe the reason the levels your DAN! practitioner observes are hard to perturb artificially is because they are the “normal” levels that physiology is trying to reach given the physiological need for zinc under what ever physiological state that individual is in.

    I agree with Sullivan’s invocation of the precautionary principle here. My way of saying it is “fools rush in where angels fear to tread”.

  19. passionlessDrone August 21, 2009 at 16:35 #

    Hi Daedulus2u –

    Very interesting stuff, and again, just goes to show how much I have left to learn. Would it be a correct interpretation of some of what you said that zinc levels can have epigentetic effects through DNA folding (or unfolding)? Thank you.

    What keeps the zinc level “just right” are the physiological pathways involved in regulation of zinc. Zinc levels are regulated better than our ability to measure them.

    I believe one of the operational theories involved was trouble absorbing zinc, or possibly nutritional deficiency as a result of poor intake. My son’s diet at the time (and now) was not widely varied and vegetable poor. I’d be curious as to your thoughts concerning what we do know about autism and potential mechanisms by which the zinc pathways might be disturbed.

    With all due respect to your DAN! practitioner, what level of zinc is normal or pathological for which individuals under what physiological state?

    Hehe. Well, I’m not sure she defined it as pathological or not; but we were running standard red blood cell element tests from places like LabCorp that presumably had well established reference ranges. Luke’s zinc was > 2 SD low. What she told us was that this was relatively common in her experience (RDBC was a standard test she ran, I believe).

    Maybe the reason the levels your DAN! practitioner observes are hard to perturb artificially is because they are the “normal” levels that physiology is trying to reach given the physiological need for zinc under what ever physiological state that individual is in.

    Indeed. I can tell you that with after supplementation, subsequent tests revealed less of a decrease, though still at the low end of normal. Of course, it is possible this was due to other changes in his phsyiological state other than the supplementation. Other annectodally related signs of zinc deficiency, half moons under his fingernails, incessant nail biting, also dissipated alongside zinc supplementation. (?)

    I agree with Sullivan’s invocation of the precautionary principle here. My way of saying it is “fools rush in where angels fear to tread”.

    OK.

    – pD

  20. David N. Brown August 21, 2009 at 22:08 #

    I have a new article on this at evilpossum.weebly.com: “Lethal Fraud” (“Cures” page). This covers chelation fraud before its use as an autism treatment, and a published “protocol” which I am satisfied caused the death of Tariq Nadama. Major conclusion: Whatever the value of chelation, many if not most practitioners are unprincipled and/or incompetent.

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