Measuring For Mercury In The Urine

People frequently contact me with questions abut their mercury test results, after being told that their mercury level is high.  They have often been told that they require a course of mercury chelation therapy.  Upon reviewing such laboratory reports, I frequently find that  urine was tested after an intravenous infusion of DMPS chelation.  The urine test result, however, is commonly reported incorrectly on a form using reference ranges derived from urine collected without a prior provocative chelation—without using DMPS or any other chelator.  The result therefore, is reported incorrectly and deceptively appears to be very high.  That type of report is meaningless and can frighten patients into a needless course of  treatment.

Everyone has some mercury in their body.  If DMPS, DMSA or any other mercury chelator is given, mercury excretion  increases greatly.  That will always occur, even in people with relatively low and nontoxic levels of mercury.  We need to know whether or not the amount of mercury detected is enough to cause symptoms of ill health.  Is it a toxic level?  The only way to do that is to compare measured results with ranges found using exactly the same type of provocative chelation on large number of people who do not have symptoms of mercury toxicity.  Many laboratories do not  seem able to provide that type of honest report.

Reference ranges for urine mercury, as printed on laboratory report forms, are frequently derived using urine collected without first giving a chelator to  bind  mercury and remove it the urine.  If that is the case, reference ranges printed on the report form will be much, much lower than even the lowest level measured after a provocative chelation.   Following a single dose of DMPS or DMSA (but not EDTA), urine mercury  will increase enormously, even if the person tested has relatively low and nontoxic amounts of mercury.   Test results should  be interpreted using ranges derived by that same laboratory from a large number of subjects tested in exactly the same way, measuring mercury output  after the same type of provocative chelation.  Mercury chelators will always greatly increase mercury in urine, regardless of the amount in the body.  The safe range will thus  be much higher after a chelator.  If proper procedure is followed, the majority of people tested will be in the nontoxic range.  As mercury testing is often now reported, everyone reads very high, frighteningly high.

It’s true that there’s no "good" level for mercury.  It’s a toxin.  But if tens of millions of people can live in good health and without toxic symptoms at a tolerably low level of mercury, it’s highly misleading to tell patients they have "mercury toxicity" and need to undergo a course of mercury chelation when they are at that same level.

To correctly interpret a test result and to know if you really do have a mercury problem, you must know the range of mercury levels measured by that same laboratory in the urines from a large population of typical Americans who suffer no symptoms of toxicity, and they must be tested after exactly the same method of provocative testing and specimen collection used in your own testing.  Ask the laboratory to provide you with the mean (average) level and the standard deviation of test results from a series of at least 100 consecutive test subjects using the same protocol you used.  At the mean (average) level, approximately 50% of all people tested will have more mercury.   At the mean level plus one standard deviation (SD), approximately 16% will be higher.  At the mean plus 2 SD, 2.5 % will be higher.  At mean plus 3 SD, less than 1% will be higher.  Those percentages will vary somewhat with the distribution of values, but this method allows an approximation.  It seems unjustified to me to diagnose metal toxicity at a level below the level of a significant  percentage of the population who have no symptoms of toxicity.   I recommend the cut-off point for toxicity to be at least 2 SD above the mean for most metals, which is the 97th percentile, and perhaps somewhat lower for mercury.  Healthy, non-toxic subjects should be used to derive safe ranges. That is the accepted scientific procedure laboratories are supposed to follow when establishing reference ranges for report forms.  If that level does not cause symptoms in all those other people (tens of millions of healthy Americans who are below the 97th percentile), then that same level is not likely to be causing symptoms for you.  I have found that patients in my practice with symptoms of bona fide mercury toxicity, and who improve with treatment,  have levels at least 3 to 5 SD higher than the mean.

Hair analysis is often used as a screening test, but hair is subject to external contamination and results are best confirmed by provocative urine testing before treatment is undertaken.  It’s not reliable to make a final diagnosis using hair analysis alone.   If the laboratory report on hair is accurate (not always the case), and if hair mercury is less than 1.5 to 2 standard deviations above the mean for that laboratory, then it is unlikely that mercury is a significant cause of symptoms.  If mercury is more than 1.5 standard deviations above the mean, a confirmatory DMSA provocative urine test will determine the extent to which mercury toxicity might be a problem and will rule out hair contamination.

It is not acceptable in medicine to make a final diagnosis of any disease or to begin a lengthy course of therapy based on a single laboratory test.  Laboratory error is too frequent to justify that.  For example, a physician should never begin a treatment for diabetes with only one blood sugar reading, or treat gout after a single uric acid test.

Accurate mercury testing is very difficult and not all laboratories have good quality control.  In the past I submitted multiple samples of the same hair and urine to several different laboratories at once in order to compare results.  The reports varied widely.   I have also submitted homogeneous portions the same specimen to the same laboratory at different times, also  with different results.  Many of those types of errors will be cancelled out if the laboratory is consistent and if the means and standard deviations for that laboratory are used to interpret results as described above.

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Using a single dose of DMSA by mouth on an empty stomach with a glass of water, preferably in the morning before breakfast, and then carefully collecting all urine for six hours, a wide range of toxic metals (mercury, lead, arsenic, cadmium, nickel and others) are measured by the King James Omegatech Laboratory, relative to urine creatinine.  I do not use 24 hour urines because they have been proven to have much greater collection errors.  If the mercury level measured with this test is less than 5 micrograms per gram of urine creatinine (which is close to the mean or average level for all Americans), there is probably no mercury toxicity.  The more concentrated the urine, as occurs with fasting, the higher the metal concentrations, which results in more accurate testing.   By reporting mercury relative to urine creatinine, which is excreted at a fairly constant rate throughout the day, correction for variable dilution with fluid intake occurs.  A reading of from 6 to 8 for mercury is suspicious but still doubtful.  If the result is higher than 8, I would suggest a course of DMSA by mouth, with repeat testing every 3 months until the level is below 5.   All chelation, including DMSA,  should be stopped at least 3 weeks before follow-up testing to allow equilibration throughout in the body.   I have posted the reference ranges used in my practice on this Website at the link below to help you in your own interpretation.  These are the ranges derived from my own patients using the King James Laboratory, using the above method.

http://www.drcranton.com/mercury/interpretation.htm

I have found that some laboratories tend to exaggerate toxicity levels with no valid scientific data to document that such low levels actually cause symptoms of toxicity.   It is recommended that you use the mean and standard deviation as described above and do you own interpretation.

In my opinion, DMPS is obsolete no longer has a place in medicine.  I have communicated with many patients who received DMPS elsewhere and were made quite sick by it.  Even if DMPS is used, it can effectively be given by mouth without intravenous infusions.  EDTA is a very weak chelator of mercury and is not an effective  treatment for mercury toxicity.   I recommend DMSA, which can be given by mouth, is safer, more effective, and much less expensive.

[Karl Note:  Note that one researcher claims that EDTA WILL chelate mercury, but that the mercury shows us in the feces, not the urine.]

DMSA removes mercury (and also lead) from the brain almost 3 times more effectively than DMPS (see research report below).   And DMPS is 3 times more toxic than DMSA (based on LD50).  The brain is where most toxicity occurs.   DMSA is so safe that the FDA  approves its use in small children with lead toxicity.  DMPS is not approved by the FDA for any use.

There are rumors that EDTA or DMSA can cause mercury to enter the brain.  That is totally false.  Those chelators bind tightly and inertly to metals and remove them from the body in the urine.

Developing countries in Asia and Eastern Europe that are attempting to cope with environmental disasters and widespread contamination with toxic metals,  including mercury, now use DMSA by mouth to treat exposed populations. 

Therapists who prefer to administer  intravenous DMPS chelation in their offices sometimes frighten patients with misleading statements about the relative merits of DMPS and falsely disparage DMSA.  Ask for the actual scientific data, recent data derived within the past 5 to 10 years.  DMSA is a simple, inexpensive oral medicine taken at home and does not require any fees paid to the doctors office.  Remember, DMSA is so safe that it has FDA approval for use in children and infants in the United States.

Author's conclusion: "DMSA may now be considered as the treatment of first choice in cases of acute or subacute lead poisoning and in mercury poisoning.  All experimental and clinical experiences show a low toxicity for this drug."