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Chelation

An Overview of Chelation:

Chelation therapy is best known for its use in cases of lead toxicity. It is considered the treatment of choice when high levels of lead are detected within the body. It also has an affinity for other toxic metals such as nickel, cadmium, uranium and others. Developed by the military back in the 1940s, this amino-acid combination has been used by both conventional and natural physicians for over 60 years to address toxic metals and flow-related disturbances. Recently the NIH TACT trial (Trial to Assess Chelation Therapy) provided some validation to what practicing clinicians have experienced for years… that people with diabetes and previous anterior myocardial infarctions showed a statistically significant benefit from doing Chelation Therapy over placebo.

 

Cornerstone Progressive Health uses Doctors Data Labs for reliable testing. Some of the tests we may utilize are… (click on the links to read more details)

– Urine Iodine Pre/Post Loading

– Comprehensive Stool Analysis

– Red Blood Cell Elements

– Fecal Metals

– Urine Toxic & Essential Metal Elements

– Hair Elements

 
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Urine Iodine Pre/Post Loading

  • Assessment of essential iodine/iodide status
  • Variable urine collection periods
  • Traditional or load test options
  • Flexible dosing for load test
  • Patient friendly report
  • State-of-the-art analysis by ICP-MS

Iodine/Iodide is an essential element that is pivotal to normal function of the thyroid gland and the health and integrity of breast tissue. Iodine/Iodide intake has decreased significantly over the past thirty years and consequentially clinical symptoms have become apparent. Iodine/Iodide sufficiency can be readily assessed by analysis of urinary iodide excretion.

Specific tissues in the body utilize iodide and iodine. Adequate iodine status is essential for the production of normal levels of thyroid hormones and the integrity of thyroid and mammary glands, but iodine/iodide intake has decreased significantly over the past thirty years. Iodide, the reduced form of iodine, is highly concentrated in the thyroid gland where it is incorporated into thyroid hormones. Thyroid hormones regulate growth and metabolic rate, body heat and energy production, and neuronal and sexual development. Iodine is concentrated in the breasts where it is associated with protection against fibrocystic breast disease and cancer. Sub-clinical iodine/iodide deficiency has been associated with impaired mental function and loss of energy due to hypothyroidism.

Doctor’s Data, Inc. offers three urine iodine report formats and collection options to allow the practitioner a wide range of assessment options to fit an individual patient’s needs.

Traditionally, the level of urinary iodine from a twenty-four hour collection has been utilized to assess iodine intake. Alternatively, in situations where patient compliance is difficult, a random urine collection, preferably the first morning void, provides indication of iodine intake when expressed per mg creatinine. The urinary iodine value presented on both report formats represents iodine plus iodide oxidized to iodine. Patient results are plotted against reference values. Normative values for urinary iodine have been evaluated in large population studies in the U.S. over the past thirty-five years.

In more recent times a “24-hour iodine/iodide load test” has become a useful analysis for practitioners. A specified oral dose of iodine/iodide is given and urine is collected for the subsequent twenty-four hours. The Doctor’s Data, Inc. “load” report format leads the industry by permitting the practitioner to obtain individualized results based upon any oral dosage deemed appropriate for a given patient. The test is based on the concept that the body has specific and saturable mechanisms to take up iodine/iodide. When maximal retention is attained, the percentage of an iodine/iodide load that is retained decreases and the percentage urinary excretion increases. The percentage excretion is calculated by dividing the patient’s mg/24-hour iodine results by the oral iodine/iodide dosage (mg) provided on the requisition form by the practitioner, then multiplied by 100. The iodine excretion value represents iodine plus iodide oxidized to iodine. The load test requires a complete twenty-four hour urine collection.

 

Comprehensive Stool Analysis

  • Clostridium Culture
  • Result specific commentary provided
  • Expanded susceptibilities testing
  • 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 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 (CSA) is an invaluable non-invasive diagnostic assessment that permits practitioners to objectively evaluate the status of beneficial and imbalanced commensal bacteria including Clostridium species, pathogenic bacteria, yeast/fungus. Precise identification of pathogenic species and susceptibility testing greatly facilitates 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 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 irritable bowel syndrome (IBS) which is most commonly due to 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 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 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.

The CSA does not include analysis for parasites; for assessment of the presence for parasites, one should request the Comprehensive Stool Analysis with Parasitology (CSAP).

 

Red Blood Cell Elements

  • Measurement of toxic and functional intracellular elements
  • Analysis by ICP-MS
  • Result specific commentary provided
  • 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 is 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.

 

Fecal Metals

  • Assessment of exposure to toxic metals and elements
  • Monitor natural route of metal detoxification in infants
  • Convenient specimen collection procedure
  • Result specific commentary provided
  • Analysis 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. 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, 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 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 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 Doctor’s Data 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 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 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 water content of the specimen.
 

Urine Toxic & Essential Metal Elements

  • Assessment of toxic metal retention and essential element status/wasting
  • Monitors detoxification therapy
  • Analysis by ICP-MS
  • Result specific commentary provided
  • Variable urine collection 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, 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 a 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. Once cannot draw valid conclusions about 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, DMSA 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 ~1 hr

6 – 24 hrs

DMPS (IV) ~1 hr

2 – 6 hrs

DMPS (oral) ~9 hrs

6 – 9 hrs

DMSA 4 hrs

6 – 9 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. 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.
 

Hair Elements

  • Measurement of toxic and essential elements
  • Inexpensive, noninvasive
  • Analysis by ICP-MS
  • Result specific commentary provided
  • 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, Doctor’s Data, Inc. has performed over four million hair elements tests for physicians and other health care 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 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 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 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.

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