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Toxicity, Neurotoxins, Cognitive Dysfunction:
Laboratory Testing and Practical Treatment
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Mark Schauss, DB
Lab Interpretation, LLC
Copyright 2008 Lab Interpretation LLC
Toxicity, Is it in you?
• When the topic of toxicity is discussed, we should
no longer wonder whether our patient is toxic or
not, but whether they are good excretors of
toxins.
• This is especially true when dealing with
petrochemical solvents as well as heavy metals.
• Other toxins like the byproducts of bacterial,
parasitic and viral metabolism should also be
monitored.
• The toxicity of stress is another issue that should
be monitored.
Toxicity, Is it in you?
• Tonight’s discussion will center on the appropriate
laboratory tests that will help you assess whether
your patient is properly excreting the toxins that
they are exposed to and the biochemically
individualized ways that you can help them
become efficient detoxifiers.
Detoxification
• Detoxification should be thought of as a threestep process.
• First step is to identify the toxins (never assume
there is only one) and begin a specific
detoxification protocol.
• This is where you determine the patient’s ability
to naturally detoxify, support whatever phase of
detoxification is efficient (if any) and bolster the
phase that is inefficient in an individualized
manner.
Detoxification
• The second step, the part I feel is most important
is to identify the source of the toxicity.
• If phthalates are the problem, look into the
sources like cosmetics, air fresheners, perfumes
and colognes, microwaving of plastics, etc…
• If it is stress, look into their lifestyles, behaviors,
home life, and their past to name a few.
• Have them do an inventory of their environment
to see where the toxins are and have them work
on eliminating them.
Detoxification
• The third step may be the hardest to convey.
• We no longer live in a world where “living clean”
makes you free of toxic exposure.
• Eating organic, making sure you avoid toxicity in
your home and work area is important but it does
not keep you safe.
• We live in a toxic world.
• Because of this concept, we need to become
efficient excretors of toxins for life.
Detoxification
• People need to have tools to become efficient
excretors and they need to do this on a daily basis.
• All of us, need to practice this on ourselves before we
practice it on our patients.
• Educating the patient that this is a life long change
that they need to commit to is critical to their ability to
achieve victory over this toxic world.
• Turning ones face to the onslaught of toxins and
denying it is an invitation to disease, morbidity and
eventually mortality.
Mitochondrial Insufficiency
• Mitochondrial diseases typically present as neurological
disorders but can manifest as other disorders such as
diabetes, myopathies, cardiovascular disease, stroke,
epilepsy and retinitis pigmentosa.
• These diseases are linked because of cellular damage
causing oxidative stress and the accumulation of
Reactive Oxygen Species (ROS).
• These oxidants then damage the mitochondrial DNA
resulting in mitochondrial dysfunction and cell death.
Mitochondrial Insufficiency
• In our discussions today, we are not going to
delve into the world of mitochondrial
myopathies (MM) which include:
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Kearns-Sayre syndrome (KSS)
Leigh's syndrome
mitochondrial DNA depletion syndrome (MDS)
mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes
(MELAS)
myoclonus epilepsy with ragged red fibers (MERRF)
mitochondrial neurogastrointestinal encephalomyopathy (MNGIE)
neuropathy, ataxia and retinitis pigmentosa (NARP)
Pearson syndrome
progressive external ophthalmoplegia (PEO)
Mitochondrial Insufficiency
• We will be delving into the impairment of the
proper and optimal functioning of the cells
powerhouse.
• First we need to talk about the major causes of
mitochondrial insufficiency.
– Nutrient Deficiencies – carnitine, Coenzyme Q10, taurine, trace
minerals, B vitamins, alpha lipoic acid, and NADH.
– Toxicity – heavy metals, organochloric and organophosphic
compounds, petrochemical solvents and others.
– Infections – bacterial and viral
– Stress
•
Kidd, PM, Neurodegeneration from Mitochondrial Insufficiency: Nutrients
Stem Cells, Growth Factors, and Prospects for Brain Rebuilding Using
Integrative Management, Alternative Medicine Review, Vol 10, Num 4,
December 2005.
Mitochondrial Insufficiency
• The current thinking is that most mitochondrial diseases
are the result of one or more complex inheritance
patterns. Most mitochondrial diseases are the result of
mutations (changes) in DNA located in the nucleus of the
cell. Only mitochondrial disorders caused by mutations in
the mitochondrial DNA (a specific structure in living cells,
located outside the nucleus) are inherited exclusively from
mothers.
• What we will be discussing is where the mitochondria
become inefficient, unable to fully carry out their jobs and
how that affects optimal health.
Mitochondrial Insufficiency
• The Krebs Cycle aka Citric Acid Cycle is part of
the process that leads to the production of energy
(ATP for one example).
• In my research and review of thousands of lab
tests, toxins have a dramatic effect on the ability
to create energy within the Citric Acid Cycle.
• The implications on diseases like obesity and
neurological disorders are staggering.
Mitochondrial Insufficiency
#1
Homeostatic State
Good Health
#2
Toxic Exposure
#3
New Homeostatic
Acute Survival
#5
Return to
Good Health
#4
Detoxification
Intervention
Mitochondrial Insufficiency
• To test for disruptions to the Citric Acid Cycle and to find
out what detoxification interventions are needed, I
recommend two tests.
• The first is a urinary organic acid test from either
MetaMetrix or US Biotek.
• The second is an Environmental Pollutants Biomarker
urine test from US Biotek for the presence of metabolites
of petrochemical solvents.
• The use of the LabAssist™ interpretive report is the only
way to determine the level and area of disruption along
with the proper protocols of detoxification.
Mitochondrial Insufficiency
• Most solvents have similarities in detoxification
protocols with some minor and/or major
differences.
• One that needs a different approach for safety
reasons is in the detoxification of benzene.
• In a dysbiotic gut, taking either tyrosine or
phenylalanine could cause the production of
phenol compounds.
• These phenol compounds could cause an
increase in the carcinogenicity of benzene.
Mitochondrial Insufficiency
• One of the most important issues in today’s
society is aging.
• With our aging population, a lot of people want to
know how to slow down the process.
• Here is what we do know:
– Aging is about oxidation
• The use of anti-oxidants do not seem to slow down the aging
process all that much.
Mitochondrial Insufficiency
• You can cut back the speed at which you
age by cutting back on the amount of food
you eat drastically.
– Numerous studies suggest that it is the
quantity of food that is the key. When you eat
very little the cells last longer. Or is that the
real mechanism???
Mitochondrial Insufficiency
• The real key to living longer is reigning in inflammation.
• In an excellent, but hard read, Professor Caleb E. Finch
wrote the book – The Biology of Human Longevity:
Inflammation, Nutrition, and Aging in the Evolution of
Lifespans, 2007 Academic Press discusses the issue.
• Does the longevity research into low-calorie diets only
mean that the low intake is the sole anti-aging driver?
• Another possibility is that when you restrict you diet, you
avoid inflammatory foods.
Mitochondrial Insufficiency
• The LEAP MRT Food Sensitivity test is a good
way to find out what foods increase the
inflammatory response.
• By avoiding these foods, you can drastically
reduce inflammation which is beneficial not just in
slowing down the aging process but in a myriad
of inflammatory diseases ranging from coronary
heart disease, migraines, arthritis, irritable bowel
syndrome, and any neurodegenerative disease.
• We know that inflammation can also affect the
mitochondria so any time we can reduce
inflammation we protect the mitochondria.
Mitochondrial Insufficiency
• We know that chronic infections cause oxidative
stress (Wen et al, 2006).
• Monitoring the patient using a Comprehensive
Blood Chemistry is highly beneficial.
• The pattern in the differential of White Blood Cells
is helpful in determining the type of infection.
• The test should always include Uric Acid which
isn’t typically included.
Mitochondrial Insufficiency
• Uric Acid is one of the bodies natural antioxidants.
• Increased levels are typically caused by the bodies need
for antioxidant help.
• It is known to scavenge peroxynitrate.
• Multiple sclerosis patients have low Uric Acid and high
peroxynitrate.
• Lower serum Uric Acid levels in MS patients may
represent a primary, constitutive loss of protection against
Nitric Oxide.
• Stimulating xanathine oxidase through the use of
molybdenum may be beneficial.
Mitochondrial Insufficiency
• Neutrophils are typically indicative of a bacterial infection
but an increase of the absolute numbers can occur with
inflammation.
• Eosinophils are typically seen in allergic responses but
also in infestations of parasites.
• Basophils are rarely seen but when they are elevated it is
indicative of an allergic response and correlates to
elevated histamine in the blood.
• Monocytes, the largest of the white blood cells are
phagocytic as they are viewed as scavengers but they
also produce the antiviral agent interferon.
Mitochondrial Insufficiency
• Lymphocytes are a primary defense against
viruses but they are also seen in the early and
late stages of inflammation.
• Looking at the pattern of these cells both in
percentages of the total and in absolute numbers
can give you a very accurate picture of what is
going on immunologically.
• With LabAssist™ we have already preprogrammed many of these patterns.
• Through that we have even been able to reveal a
case of Psittacosis.
Mitochondrial Insufficiency
• If you have a person that has done a saliva
hormone test and noticed that their cortisol levels
do not go down through the day as expected the
mechanism may be toxic in nature.
• In a study published in EHP this February, Gump et
al showed that lead levels, even low ones below 10
μg/dL can alter corticosteroid levels and interfere
with heightened reactivity to acute stress.
• This is also found quite often in large cities with
high powered executives.
• The higher lead levels in big cities like New York
may explain the higher stress readings of
inhabitants.
Infertility/Pregnancy
• At no time in human history has infertility reached such
epidemic proportions.
• The blame clearly has to lie at the feet of our toxic
environment.
• According to the Center for Disease Control’s National
Survey of Family Growth the fastest growing segment of
the population with “impaired fecundity (infertility) is
women under the age of 25.”
• In 2005 the CDC did a survey across America where the
average citizen had the presence of 148 chemicals in
their blood. The report is 475 pages long.
– Third National Report of Human Exposure to Environmental Chemicals, Centers
for Disease Control and Prevention 2005.
www.cdc.gov/exposurereport/pdf/thirdreport.pdf
Infertility/Pregnancy
• One line in the report struck me for different reasons than
it might strike others.
• Under Public Health Uses of the Report it states “To
establish reference ranges that can be used by physicians
and scientists to determine whether a person or group
has an unusually high exposure.”
• As we know with laboratory testing, often times reference
ranges are skewed due to an abnormal population. Case
in point TSH levels. Most labs use .5 to 5 as a range.
LabAssist™ uses 1.1 to 2.5 because so many in our
population are hypothyroid they skew the range.
Infertility/Pregnancy
• This report makes it so that it will somehow be used
to allow for an “acceptable level” of toxicity for each
of you and your patients.
• Some chemicals have an effect at low levels only.
• Polymorphisms in genes coding for metabolizing
enzymes contribute to interindividual variability and
may vary by more than 50-fold in humans
(Guengerich et al. 1991).
• What is a poison for you may not be for me.
Infertility/Pregnancy
• According to research done by the EPA on Bisphenol A
(BPA), they only looked at the changes to the weight of rat
brains to determine toxicity levels.
• Some studies found changes in rodents' reproductive organs
and brains at doses as low as 0.002 mg per kilogram of
body weight per day.
• is just one-25,000th the dose that the EPA said was the
lowest exposure having an observable adverse effect.
• Newer research into the subtle effects of BPA on hormone
levels indicates that far lower doses can have profound
effects on the development of human fetuses and on adult
health, especially women.
Infertility/Pregnancy
• In the 1970’s, Danish researcher Niels
Skakkebaek of the Copehagen University
Hospital showed links between testicular cancer
in adults and abnormalities in genital
development.
• At 3 months, baby boys experience a surge of
testosterone.
• In a study of 65 infants published in 2006, they
discovered that the higher the level of phthalates,
the greater the evidence of anti-androgenic
hormonal activity.
Infertility/Pregnancy
• Ana Soto of Tufts University School of Medicine was
studying the effect of estrogen on a breast cancer cell
line.
• Much to her chagrin, the cancer cells were proliferating
like crazy as if a bottle of estradiol had been dumped in
them.
• Turns out, the tubes storing a component of the medium
growing the cells had nonylphenol to improve impact
resistance.
• The chemical, injected into rats, made the epithelial lining
of the uterus proliferate – a sign of its being an estrogen.
Infertility/Pregnancy
• If the findings that chemicals like Bisphenol A (BPA) are
found in the drinking water, house dust, and ambient air
are true and at tiny levels they can affect estrogen
receptors think of the types of cancers our children will
have.
• In the 1950’s a woman’s lifetime risk of breast cancer was
1 in 22.
• Today it is 1 in 7.
• It is not a genetic epidemic, it is environmental, it is due to
endocrine disruption.
• BPA is worth $100 million an hour.
• Banning it will take enormous guts.
• Becoming good detoxifiers forever is therefore critical.
Infertility/Pregnancy
• I believe that for all people, male or female, it is
imperative to do an Environmental Pollutants Biomarker
test.
• Phthalates, xylene, toluene, benzene, styrene, and
dimethylbenzene are all developmentally toxic.
• Phthalates can damage male DNA in sperm.
• It can also cause shortening of pregnancies by up to two
weeks and according to research full-term babies have
markedly higher cognitive scores later in life (Larroque, et
al, The Lancet, Vol 371, pg 823).
• Urinary markers of phthalates are vastly superior to
serum.
–
Hogberg, J., A. Hanberg, et al. (2008). "Phthalate diesters and their metabolites in human breast milk, blood or serum, and urine as
biomarkers of exposure in vunerable populations." Environmental Health Perspectives 116(3): 334-9.
Infertility/Pregnancy
• Becoming an effective excretor of petrochemicals is an
important factor in developing a healthy fetus.
• In a study published by Hansen, Barnett, and Pritchard, in
EHP, March 2008, it was found that air pollution can
actually affect ultrasound measures during midpregnancy.
• Fetuses were physically affected in body measurement by
air pollution.
• While the study focused of measurements of ozone,
nitrogen dioxide, sulfur dioxide and particulate matter,
being a good excretor of any chemical would be
beneficial.
Infertility/Pregnancy
• For women, I would highly suggest doing two additional
tests.
• A Whole Blood Elements test from DDI would be #1 as
quite often women trying unsuccessfully to have a child
are very mineral deficient.
• Also, any toxic heavy metal load could decrease the
chances for a healthy pregnancy.
• In the March 2008 EHP journal, researchers led by
Leasure, et al, showed that gestational lead exposure
produced permanent male-specific effects including an
increase in obesity as well as motor deficit, and altered
dopamine.
• The responses were dose-dependent.
Infertility/Pregnancy
• Secondarily, a Plasma Amino Acid test often times show
broad deficiencies in both essential and conditionally
essential amino acids.
• With women, there have been some issues with
increased tryptophan and elevated serotonin (especially
with 5-HTP) and an increase in miscarriages,
dysmenorrhea and tubal spasms.
• With males, it may improve sperm viability.
• In a study by Schacter in 1973, 4 grams of arginine was
used on 178 men and 111 had significant improvement,
21 moderate and only 25 showed no improvement in
sperm motility and sperm counts.
Quick Insight
• Total Cholesterol levels are different depending
on the time of the year.
• In Spring and Summer, Cholesterol is lower than
in the Fall and Winter.
• When comparing Cholesterol levels be aware of
this difference which can be as high as 20%.
• If you were to design a study to prove your drug
was good at lowering Cholesterol you would take
the first measurement in the Winter and the
second in Late Spring, Early Summer.
Infertility/Pregnancy
• In the book “The Carnitine Miracle” by Robert Crayhon,
the role of carnitine was discussed in relation to its ability
to “defend the body from stress.”
• Also there is a higher quantity of carnitine in male sperm.
• A comprehensive blood chemistry is also a very important
tool to use, especially in women.
• Pre-eclampsia is an important issue to address for women
seeking to get pregnant or are pregnant.
• The LabAssist™ has a pattern developed to evaluate the
results of a CBC
Infertility/Pregnancy
• The pattern is as follows:
– Elevated: sGOT, sGPT, Alkaline Phosphatase,
Hematocrit, Potassium, Triglycerides, and Uric Acid.
– Normal: Hemoglobin
– Decreased: Albumin, CO2, Calcium, Glucose, Protein,
Sodium, Thyroxine, and BUN.
• In a healthy pregnancy, there are a number of
test results that are normal and expected that
would be considered abnormal otherwise.
• LDL, Total Cholesterol and Uric Acid should
actually be elevated.
Infertility/Pregnancy
• A urine iodine challenge is another critical test to
do for pregnant women.
• In the autism pesticide study (Roberts, et al, 2007
EHP), iodine deficiency may be the mechanism
by which the incidence of autism rose to exposed
mothers.
• Since many environmental toxins affect the
thyroid and the lack of iodine can adversely affect
the fetus, this is another very important test to
run.
Infertility/Pregnancy
• If there is a hesitation to do all of the testing here
are a few tried and true general recommendations.
• Since we all have petrochemically based toxins in
our system, both the mother and the father should
begin using a broad spectrum amino acid complex
with at least one gram of glycine per serving.
• Women should be put on a broad spectrum trace
mineral supplement.
• They should also be put on a balanced electrolyte.
• Add DHA/EPA combination.
Autism
• In my many years of work, it is striking that in the field
of autism more unnecessary tests are run on autistic
children than any other disease or syndrome which
testifies to the desperation of parents of autistic
children.
• My goal is to provide the least number of tests
necessary to make the greatest impact on children
with autism.
• Another important issue is not putting the children
through traumatic testing more often than is
necessary.
• Conservation of resources while improving outcome
is essential and should be the overriding principle.
Autism
• Here are a few tests I would avoid for the treatment of
most autistic children.
• RBC fatty acids
– Fatty acids are typically abnormal in most autistic children but
there is no evidence that targeting fatty acids through a test is
beneficial.
– Co-factors such as magnesium and vitamin B6 can lower
arachidonic acid which is not uncommonly high in autistics.
– There are better tests not requiring a blood draw that can give you
the same information.
– One researcher has astonishingly claimed that autistic children
have higher Omega 3 to 6 levels!
Autism
• Fatty acid metabolism can be negatively affected by
environmental toxins.
• Affecting the fatty acids does not address the toxicity
issue.
• It is minimally beneficial in removing heavy metals or
pollutants.
• When dealing with autistic children, if we can avoid a
blood draw, you reduce the stress on these children.
• A traumatic draw can change the results on a test.
– Levels of liver enzymes, hormones, electrolytes, blood cell counts
can all be negatively affected by the way the draw is done.
Autism
• Urinary porphyrin testing is the latest rage.
• It is theoretically useful if the specimen is handled
correctly.
• There in lies the rub.
– Porphyrin’s are highly light and air sensitive.
– Pee into a bucket with a fluorescent light and half the
analyte is gone.
– Shaking instead of gently rocking the specimen can
cause depletion of the porphyrin analyte.
• There is a very high incidence of false negatives with
this test.
• Even with proper handling, the false negative rate
reduces clinical utility.
Autism
• Urine heavy metal challenge tests are also commonly
used with children with autism.
• It’s clinical utility is questionable.
• The risk of developing side-effects due to the use of a
chelating substance is substantial.
• It does not indicate the burden and/or the disruption
of biochemical pathways due to mercury or other
heavy metals.
• A hair elements test, using the counting method
developed by Dr. Andrew Cutler and spelled out in his
books Hair Test Interpretation and Amalgam Illness
(available at www.noamalgam.com) is safer and
superior.
Autism
• According to the data from the DAN website,
chelation therapy has a very high positive
outcome with a low negative and relatively low no
effect rate.
• http://www.autism.com/treatable/form34qr.htm
• Out of 803 cases reported the positive response
rate was 74% with negative results being at 3%
and no response being the lowest of all
treatments at 23%.
Autism
• Urine Organic Acids (OAT) along with an
environmental pollutants biomarker test is a noninvasive, helpful test to assess abnormal
biochemical pathways in autistic children.
• Yeast markers among these children using an
OAT test has been vastly over blown.
• The markers Tartarate and Citramalic acid are not
markers for yeast.
• Tartaric Acid actually kills yeast and is not a
byproduct of yeast.
Autism
• So why do children with autism improve using anti-fungals
if yeast is not so prevalent?
• Many children with autism have upregulated Phase I
detoxification pathways and down regulated Phase II.
• The intermediary chemicals created in Phase I are more
neurologically toxic than the original chemical, especially
with petrochemical solvents.
• Anti-fungal drugs down regulate Phase I which allows
Phase II to catch up.
• This is also why they do so poorly after removing the
drugs.
• Improving Phase II through the use of amino acids such
as Glycine will help upregulate Phase II.
Autism
• I see a high percentage of autistic children,
especially boys with high urinary phthalate levels.
• They also often times have other solvents such
as xylene, toluene, styrene, and benzene.
• Detoxifying these ubiquitous chemicals seems to
lower many of the common traits such as
stimming, head banging and hand flapping.
• This may be due to the upregulation of Phase II
detoxification from the detoxification protocols
reported in the LabAssist Interpretive Reports.
Autism
• A Plasma, Blood Spot or Urine Amino Acid test
would be beneficial in assessing these important
builders of neurotransmitters.
• LabAssistTM has developed a method to
customize the My Aminoplex based on a Plasma
or Blood Spot Amino Acid test.
• We see a number of children with autism with
dramatically abnormal amino acid profiles.
• Taurine is typically low and autistic children
benefit greatly from its supplementation.
Detoxification Tips
• Most people with petrochemical exposure (almost
everyone) would do well to take 1-2 grams of
glycine daily.
• Taurine at 1 gram a day is another highly
beneficial amino acid in a detoxification protocol.
• Probiotics are another almost universally
necessary supplement for toxic people.
• Electrolytes are critical in helping pump toxins
and nutrients in and out of cells.
Detoxification Tips
• One concept though is absolutely critical in giving
your patients the utmost ability to detoxify for the
short- and long-term.
• Treat them as biochemically individualized
people.
• There is no “one shoe size fits all” protocol.
• Lab testing is the only way to go and will increase
the effectiveness of any program you put together
for your patient.
Heavy Metal Neurotoxicity Effects
•
•
•
•
•
Promote lipid peroxidation
Inhibit antioxidative enzymes/processes
Affinity for sulfhydryl groups
Disrupt ion homeostasis (Ca, Na, K)
Disrupt neurotransmitter metabolism
Heavy Metal Neurotoxicity Effects
• Primary mechanisms of Pb neurotoxicity
are due to disruption of Ca metabolism
• Lead enters cells through Ca channels,
keeps Ca channels open about 5X longer
than Ca
Heavy Metal Neurotoxicity Effects
• Pb+2 and /or Ca+2  spontaneous NT release:
 responsiveness: distractibility,
impulsivity and motor restlessness
• Pb+2  dopamine uptake and serotonin levels
• Inhibits NMDA receptor
• Alters metabolism of dopaminergic, cholinergic,
and glutamanergic neurotransmitters
J Neurochem(1996)67:1540-50 Excellent
Review: Ann Rev Pharmacol
Toxicol(1995)35:391
Heavy Metal Neurotoxicity Effects
• Manganese Neurotoxicity
• Phase I
Psychiatric Abnormalities:
Hyperirritability, violence, compulsiveness, forced
laughter, apathy, sleep disturbance, paranoiac behavior
• Phase II
Neurological Disorder of Extrapyramidal Motor System:
Tremor, loss of speech/motion coherence, high-stepping
gait (“velcro feet”), mask-like face
• Phase III
Bradykinesia, rigidity
Heavy Metal Neurotoxicity Effects
 Mechanisms of Manganese toxicity
 Oxidative stress/damage
 Abberant neurotransmitter metabolism
 levels of dopamine and norepinephrine in
brain
 binding of serotonin to membranes
Heavy Metal Neurotoxicity Effects
• Accumulation of toxic metals can adversely affect virtually
every major organ system and instigate chronic diseases.
• Lead is still an important health issue for all ages.
• Middle-aged women are very vulnerable to “old” Pb.
• Selenium, zinc and iodide are important anti-cancer
elements.
• Early assessment and elimination of toxic metals should
be an integral component of all comprehensive medical
practices.
Contact Information
Dr. Mark Schauss, DB
Lab Interpretation LLC
18124 Wedge Parkway, Ste 432
Reno, NV 89511
775-851-3337
[email protected]
www.labinterpretation.com
www.CrayhonResearch.com
www.MarkSchauss.com
www.ToxicWorldBook.com