MEDICAL TESTING

Heavy Metal Toxicity- Urine

Assess toxic metal retention and essential element status/wasting
Monitor detoxification therapy
Analyze by ICP-MS
Provide result-specific commentary
Collect urine for variable periods

Urine toxic and essential elements analysis is an invaluable tool for the assessment of retention of toxic metals in the body and the status of essential nutrient elements. Toxic metals do not have any useful physiological function, they adversely affect virtually every organ system, and disrupt the homeostasis of nutrient elements.

Analysis of the levels of toxic metals in urine after the administration of a metal detoxification agent is an objective way to evaluate the accumulation of toxic metals. Acute metal poisoning is rare. More common, however, is chronic, low-level exposure to toxic metals that can result in significant retention in the body that can be associated with a vast array of adverse health effects and not chronic disease. One cannot draw valid conclusions about the adverse health effects of metals without assessing net retention. For an individual, toxicity occurs when net retention exceeds physiological tolerance. Net retention is determined by the difference between the rates of assimilation and excretion of metals. To evaluate net retention, one compares the levels of metals in urine before and after the administration of a pharmaceutical metal detoxification agent such as EDTA or DMPS. Different compounds have different affinities for specific metals, but all function by sequestering “hidden” metals from deep tissue stores and mobilizing the metals to the kidneys for excretion in the urine. Guidelines for collection periods after administration of the most commonly utilized agents are provided in the table below:

Common Agents	Half Life	Collection Period
EDTA	~4 hrs	8 – 24 hrs
DMPS (IV)	~3 hrs	4 – 12 hrs
DMPS (oral)	~9 hrs	12 – 48 hrs
DMPS (transdermal)	~4 hrs	8 – 24 hrs

It is important to perform both pre and post-provocation urinalysis to permit distinction between ongoing exposures to metals (pre-) and net bodily retention. The pre-provocation urine collection can also be utilized to assess the rate of creatinine clearance if a serum specimen is also submitted.

Many clinicians also request the analysis of essential elements in urine specimens to evaluate nutritional status and the efficacy of mineral supplementation during metal detoxification therapy. Metal detoxification agents can significantly increase the excretion of specific nutrient elements such as zinc, copper, manganese, and molybdenum.

Chromium metabolism authorities suggest that 24-hour chromium excretion likely provides the best assessment of chromium status. An early indication of renal dysfunction can be gleaned from urinary wasting of essential elements such as magnesium, calcium, potassium, and sodium in an unprovoked specimen.

Variability in urine volume can drastically affect the concentration of elements. To compensate for urine dilution variation, elements are expressed per unit creatinine for timed collections. For 24-hour collections, elements are reported as both units per 24 hours and units per creatinine.

Heavy Metal Toxicity – Hair

Measure toxic and essential elements
Provides an inexpensive and noninvasive option
Analyze by ICP-MS
Provide result specific commentary
Requires only 0.25 g hair
Extensive research established that scalp hair element levels are related to human systemic levels. The strength of this relationship varies for specific elements, and many researchers consider hair as the tissue of choice for toxic and several nutrient elements. Unlike blood, hair element levels are not regulated by homeostatic mechanisms. Thus, deviations in hair element levels often appear prior to overt symptoms and can thereby be a valuable preliminary tool for predicting the development of physiological abnormalities.

Since 1972, our testing facility has performed over four million hair elements tests for physicians and other healthcare providers, accumulating what is probably the largest database regarding this procedure. Why hair? With respect to its contained elements, hair is essentially an excretory tissue rather than a functional tissue. Hair element analysis provides important information which, in conjunction with symptoms and other laboratory values, can assist the physician with an early diagnosis of physiological disorders associated with aberrations in essential and toxic element metabolism.

As protein is synthesized in the hair follicle, elements are incorporated permanently into the hair with no further exchange or equilibration with other tissues. Scalp hair is easy to sample, and because it grows an average of one to two centimeters per month, it contains a “temporal record” of element metabolism and exposure to toxic elements.

Nutrient elements including magnesium, chromium, zinc, copper, and selenium are obligatory co-factors for hundreds of important enzymes and also are essential for the normal functions of vitamins. The levels of these elements in hair are correlated with levels in organs and other tissues.

Toxic elements may be 200-300 times more highly concentrated in hair than in blood or urine. Therefore, hair is the tissue of choice for the detection of recent exposure to elements such as arsenic, aluminum, cadmium, lead, antimony, and mercury. The Center for Disease Control acknowledges the value of hair mercury levels as a maternal and infant marker for exposure to neurotoxic methylmercury from fish.

Through recent vast improvements in technology, instrumentation, and the application of scientific protocols, hair element analysis has become a valuable tool in providing dependable and useful data for physicians and their patients. The U.S. Environmental Protection Agency stated in a recent report that “…if hair samples are properly collected, and cleaned, and analyzed by the best analytic methods, using standards and blanks as required, in a clean and reliable laboratory by experienced personnel, the data are reliable.” (U.S.E.P.A. 600/4-79-049)

Hair; however, is vulnerable to external elemental contamination by means of certain shampoos, bleaches, dyes, and curing or straightening treatments. Therefore, the first step in the interpretation of a hair element report is to rule out sources of external contamination.

Hair element analysis is a valuable and inexpensive screen for physiological excess, deficiency, or maldistribution of elements. It should not be considered a stand-alone diagnostic test for essential element function and should be used in conjunction with patient symptoms and other laboratory tests.

Extensive research established that scalp hair element levels are related to human systemic levels. The strength of this relationship varies for specific elements, and many researchers consider hair as the tissue of choice for toxic and several nutrient elements. Unlike blood, hair element levels are not regulated by homeostatic mechanisms. Thus, deviations in hair element levels often appear prior to overt symptoms and can thereby be a valuable preliminary tool for predicting the development of physiological abnormalities.

Why hair?

With respect to its contained elements, hair is essentially an excretory tissue rather than a functional tissue. Hair element analysis provides important information which, in conjunction with symptoms and other laboratory values, can assist the physician with an early diagnosis of physiological disorders associated with aberrations in essential and toxic element metabolism.

As protein is synthesized in the hair follicle, elements are incorporated permanently into the hair with no further exchange or equilibration with other tissues. Scalp hair is easy to sample, and because it grows an average of one to two cm per month, it contains a “temporal record” of element metabolism and exposure to toxic elements.

Nutrient elements including magnesium, chromium, zinc, copper and selenium are obligatory co-factors for hundreds of important enzymes and also are essential for the normal functions of vitamins. The levels of these elements in hair are correlated with levels in organs and other tissues.

Toxic elements may be 200-300 times more highly concentrated in hair than in blood or urine. Therefore, hair is the tissue of choice for the detection of recent exposure to elements such as arsenic, aluminum, cadmium, lead, antimony, and mercury. The CDC acknowledges the value of hair mercury levels as a maternal and infant marker for exposure to neurotoxic methylmercury from fish.

Through recent vast improvements in technology, instrumentation, and the application of scientific protocols, hair element analysis has become a valuable tool in providing dependable and useful data for physicians and their patients. The U.S. Environmental Protection Agency stated in a recent report that “…if hair samples are properly collected and cleaned, and analyzed by the best analytic methods, using standards and blanks as required, in a clean and reliable laboratory by experienced personnel, the data are reliable.” (U.S.E.P.A. 600/4-79-049)

Hair, however, is vulnerable to external elemental contamination by means of certain shampoos, bleaches, dyes, and curing or straightening treatments. Therefore, the first step in the interpretation of a hair element report is to rule out sources of external contamination.

Hair element analysis is a valuable and inexpensive screen for physiological excess, deficiency or maldistribution of elements. It should not be considered a stand-alone diagnostic test for essential element function and should be used in conjunction with patient symptoms and other laboratory tests.

Heavy Metal Toxicity – Fecal

Assess exposure to toxic metals and elements
Monitor natural route of metal detoxification in infants
Provides a convenient specimen collection procedure
Provide result specific commentary
Analyze by ICP-MS
Analysis of elements in feces provides indirect information about the potential for toxic metal burden. For many toxic metals, fecal (biliary) excretion is the primary natural route of elimination from the body. The fecal elemental analysis also provides a direct indication of dietary exposure to toxic metals. Specimen collection is convenient for the patient and only requires a single-step procedure.

Analysis of elements in feces provides a comprehensive evaluation of environmental exposure, the potential for accumulation in the body (Hg), and possibly endogenous detoxification of potentially toxic metals. For many toxic elements such as mercury, cadmium, lead, antimony, and uranium, biliary excretion into the feces is the primary natural route of elimination from the body. The primary process by which the body eliminates the insidious sulfhydryl reactive metals is through the formation of metal-glutathione complexes, of which greater than 90% are excreted into the bile. Evidence for the extent of exposure to mercury from dental amalgams is provided by the fact that fecal mercury levels are highly correlated with the number of amalgams in the mouth. It is also clear that fecal mercury levels for people with dental amalgams are remarkably similar from day to day, and approximately ten times higher than in people who do not have mercury amalgams. Administration of pharmaceutical metal binding agents results in the excretion of toxic metals primarily through the kidneys into the urine. In contrast, support of natural detoxification processes enhances the rate of excretion of toxic metals into the feces. Elemental analysis of fecal specimens can provide a valuable tool to monitor the efficacy of natural detoxification of metals in infants or patients who are on very limited and defined diets that do not contain contaminated solid foods. A preliminary study performed at our testing facility indicates that biliary/fecal excretion of mercury and lead may be markedly enhanced following high dose intravenous administration of ascorbic acid. Other orthomolecular or nutraceutical protocols may also enhance the fecal excretion of metals and hence potentially decrease the burden on the kidneys. Further research to identify and validate such therapies is warranted. A primary objective of preventive medicine is avoidance or removal of exposure to toxic substances. The rate of oral absorption of toxic metals varies considerably among elements, and among subspecies of a particular element. Fecal elemental analysis can provide a direct indication of dietary exposure. Orally, the percent absorption of nickel, cadmium, and lead is usually quite low but varies significantly in part due to the relative abundance of antagonistic essential elements in the diet. That is particularly evident for lead and calcium, and cadmium and zinc. Chronic, low-level assimilation of the toxic metals can result in significant accumulation in the body. The results of the fecal elemental analysis can help identify and eliminate dietary exposure to toxic metals.

The fecal metals test was not developed to replace the pre and post urinary toxic metals provocation test, but rather provides an alternative for infants, children, or adults for whom urine collection is problematic, or for individuals who do not tolerate the available pharmaceutical metal detoxification agents. Elements are measured by ICP-MS and expressed on a dry weight basis to eliminate variability related to the water content of the specimen.

Heavy Metal Toxicity – Blood

Measurement of toxic and functional intracellular elements
Analyze by ICP-MS
Provide result specific commentary
Requires unwashed packed red blood cells
Analysis of red blood cells provides the best diagnostic tool for assessing the status of elements that have important functions inside cells or on blood cell membranes. Blood cell element levels are useful for assessing cardiac influences, anti-inflammatory processes, anemia, immunological function, glucose tolerance, and other disorders that are associated specifically with zinc deficiency.

Red blood cell (RBC) analysis is an invaluable diagnostic method for assessing insufficiency or excess of elements that have important functions within cells or on blood cell membranes. An important feature is that the cells are not washed, because this would result in partial loss of some important elements that bind to the plasma membrane, for example, calcium.

RBC element levels are very useful for assessing: cardiotonic influences (magnesium, potassium); anti-inflammatory processes (selenium, copper, zinc); anemia (copper, iron); immunological function (zinc, copper, magnesium), and glucose tolerance (chromium, manganese, and possibly vanadium). Disorders specifically associated with zinc deficiency also are addressed by this analysis. These disorders include loss of visual acuity, dysgeusia, dermatitis and poor wound healing, alopecia, amino acid malabsorption, sexual impotence, decreased production of testosterone, depressed immune function, and growth retardation.

Accurate assessment of essential element status is highly recommended for the determination of appropriate supplementation. The absorption, transport, and metabolism of essential elements are highly integrated and regulated. Inappropriate supplementation or dietary imbalance of elements can have significant adverse health effects. For example, excess intake of zinc or molybdenum can result in copper deficiency and, although essential, excess retention of manganese can have serious neurotoxic effects. RBC element analysis is also useful for the assessment of ongoing or very recent exposure to specific toxic elements that accumulate preferentially in erythrocytes. These toxic elements include arsenic, cadmium, lead, methylmercury, and thallium. It is important to keep in mind that elevated levels of the toxic elements in these cells reflect only recent or ongoing exposure and do not provide information about the net retention of the metals in the body.

RBC element analysis should be performed prior to and intermittently throughout the course of detoxification/chelation therapy. Monitoring essential element status is necessary to identify needs for and effectiveness of supplementation. Replacement and maintenance of adequate levels of essential nutrients can markedly reduce the apparent adverse side effects associated with the use of detoxification agents, per se, and the general effects of mobilization of toxic elements. It is important to note that some diseases are associated with abnormal levels of blood cell elements that could be misleading with respect to nutritional status. For example, blood cell copper can be temporarily elevated during inflammatory response while liver levels are not.

CDSA – Stool Analysis

Provide result specific commentary
Provides true multiple specimen parasitology analysis
Provides expanded susceptibilities testing
Offers superb turnaround time
Value priced

Gastrointestinal (GI) complaints are among the most common reasons that patients seek medical care. Symptoms associated with GI disorders include persistent diarrhea, constipation, bloating, indigestion, irritable bowel syndrome, and malabsorption. The Comprehensive Stool Analysis with Parasitology x1, 2, or 3 (CSAP1, 2, 3) may be used to assess digestive and absorptive functions, the presence of opportunistic pathogens, and to monitor the efficacy of therapeutic remediation of GI disorders.

The Comprehensive Stool Analysis with Parasitology x1, 2, or 3 is an invaluable non-invasive diagnostic assessment that permits practitioners to objectively evaluate the status of beneficial and imbalanced commensal bacteria, pathogenic bacteria, yeast/fungus, and parasites. Precise identification of pathogenic species and susceptibility testing greatly facilitates the selection of the most appropriate pharmaceutical or natural treatment agent(s).

Important information regarding the efficiency of digestion and absorption can be gleaned from the measurement of the fecal levels of elastase (pancreatic exocrine sufficiency), muscle and vegetable fibers, carbohydrates, and steatocrit (% total fat)

Inflammation can significantly increase intestinal permeability and compromise the assimilation of nutrients. The extent of inflammation, whether caused by pathogens or inflammatory bowel disease (IBD), can be assessed and monitored by examination of the levels of biomarkers such as lysozyme, lactoferrin, white blood cells, and mucus. These markers can be used to differentiate between inflammation associated with potentially life-threatening inflammatory bowel disease (IBD), which requires life-long treatment and less severe inflammation that can be associated with the presence of enteroinvasive pathogens. Lactoferrin is only markedly elevated prior to and during the active phases of IBD, but not with IBS. Monitoring fecal lactoferrin levels in patients with IBD can therefore facilitate timely treatment of IBD, and the test can be ordered separately. Since the vast majority of secretory IgA (sIgA) is normally present in the GI tract where it prevents binding of pathogens and antigens to the mucosal membrane, it is essential to know the status of sIgA in the gut. sIgA is the only bona fide marker of humoral immune status in the GI tract.

Cornerstones of good health include proper digestion of food, assimilation of nutrients, exclusion of pathogens, and timely elimination of waste. To obtain benefits from food that is consumed, nutrients must be appropriately digested and then efficiently absorbed into the portal circulation. Microbes, larger-sized particles of fiber, and undigested foodstuffs should remain within the intestinal lumen. Poor digestion and malabsorption of vital nutrients can contribute to degenerative diseases, compromised immune status, and nutritional deficiencies. Impairment of the highly specific nutrient uptake processes, or compromised GI barrier function (as in “leaky gut syndrome”) can result from a number of causes including low gastric acid production, chronic maldigestion, food allergen impact on bowel absorptive surfaces, bacterial overgrowth, or imbalances (dysbiosis); pathogenic bacteria, yeast or parasites, and related toxic irritants, and the use of NSAID’s and antibiotics. Impairment of intestinal functions can contribute to the development of food allergies, systemic illnesses, autoimmune disease, and toxic overload from substances that are usually kept in the confines of the bowel for elimination. Efficient remediation of GI dysfunctions incorporates a comprehensive guided approach that should include consideration of elimination of pathogens and exposure to irritants, supplementation of hydrochloric acid, pancreatic enzymes and pre and probiotics, and repair of the mucosal barrier.

Genetic – Immunogenomics

This test evaluates genetic variations in genes that modulate immune and inflammatory activity. These variations can affect the balance between cell (Th-1) and humoral (Th-2) immunity, trigger potential defects in immune system defense, and stimulate mechanisms underlying chronic, overactive inflammatory responses.

IL-1B (interleukin – 1 beta)
TNF – alpha (tumor necrosis factor – alpha)
IL-4 (interleukin -4)
IL-6 (interleukin – 6)
IL-10 (interleukin – 10)
IL-13 ( interleukin – 13)

Genetic – Detoxigenomics

This test evaluates SNPs associated with increased risk of impaired detoxification capacity especially when exposed to environmental toxins. It also identifies individuals potentially susceptible to adverse drug reactions.

COMT V158M
CYP 1B1 N453S
CYP 1B1 V432L
CYP 2A6*2 L160H
CYP 2C19*2 2C192
CYP 2C19*3 2C193
CYP 2C9*2 R144C
CYP 2C9*3 I135L
CYP 2D6*3 A2637
CYP 2E1*5A P2E15
CYP 3A4*17 R162Q
CYP 3A4*1B 290AG
CYP 3A4*3 M445T
CYP1A1*2A MSPI
CYP1A1*2C I462V
GSTM1
NAT 1 R187Q
NAT 1 R64W
NAT 2 G286E
NAT 2 I114T
NAT 2 K268R
NAT 2 R197Q
NAT 2 R64Q
SOD 1 A4V
SOD 1 G93A
SOD 2 A16V
GSTP1, A104V and A113V
Adrenocortex Stress Profile (ASP)
Bacteriology, aerobic

Genetic – Cardiogenomics

This test evaluates genetic variations, called single nucleotide polymorphisms (SNPs), in genes that modulate blood pressure regulation, lipid balance, nutrient metabolism, inflammation, and oxidative stress.

APOE (Apolipoprotein E)
CETP (choletseryl ester transfer protein)
SELE (selection E)
MTHFR (methylenetetrahydrofolate reductase)
GNB3 (guanine nucleotide-binding protein)
AGT (angiotensin)
AGTR1 (angiotensin II receptor-1)
Factor 2 (prothrombin)
Factor 5 (Leiden)
PAI-1 (plasmiogen activator inhibitor-1)
GP3a(Glycoprotein 3)
CYBA*8 (cytochrome b-245-alpha) (cardio-damaging; accelerates atherosclerosis)
Cholesterol Regulation & Atherosclerosis
Methylation
Coagulation
Reduction-Oxidation Balance
Hypertension

Genetic – Neurogenomics

This test evaluates single nucleotide polymorphisms (SNPs) in genes that modulate methylation, glutathione conjugation, oxidative protection, and the potential to evaluate vascular oxidation.

MTHFR (methylenetetrahydrofolate reductase)
COMT
SOD-2 (Superoxide dismutase -2)
GSMT (glutathione-s-transferase, M, isoform
GSTP (glutathione-s-transferase, P, isoform)