Articles

Evidence based

Evidence Based

This article is based on scientific evidence, written by experts and fact checked by experts.

Our team of licensed nutritionists and dietitians strive to be objective, unbiased, honest and to present both sides of the argument.

This article contains scientific references. The numbers in the parentheses (1, 2, 3) are clickable links to peer-reviewed scientific papers.

Are You Experiencing Heavy Metal Toxicity Symptoms?

Written by Dr. Michael Ruscio, DC on December 17, 2021

Written by Dr. Michael Ruscio, DC on December 17, 2021 — Reviewed by Dr. Hannah Hamlin

Common Signs and When and How to Test For and Treat Heavy Metal Toxicity 

• Heavy Metal Toxicity|
• Symptoms of Heavy Metal Toxicity|
• When to Consider Heavy Metal Toxicity|
• Effectiveness of Heavy Metal Testing|
• Chelation Therapy|
• Decreasing Toxic Load|

The most common symptoms of heavy metal toxicity are gastrointestinal issues such as stomach pain, fatigue, brain fog, depression, anxiety, confusion, and joint pain. 

At the same time, many other health conditions also have similar symptoms. This can make it difficult to know when and if to look into heavy metal toxicity to resolve your health symptoms.

In this article, we’ll help you identify common symptoms and risk factors for heavy metal toxicity, when and if to test for heavy metals, which tests are the most effective, and treatment options should you need them.  

Let’s dive in and look at the research to understand the biggest risks, when and how to test for heavy metal toxicity, and how to decrease exposure in your daily life. 

What Is Heavy Metal Toxicity?

The National Organization for Rare Disorders (NORD) defines heavy metal poisoning/toxicity as “the accumulation of heavy metals, in toxic amounts, in the soft tissues of the body 1.”  

Heavy metals are naturally found in our environment in the soil and the air. Additionally, humans are becoming more exposed to these metals due to drinking water, food crops which have become more contaminated from an increased use of heavy metals in several industrial, agricultural, domestic and technological applications, and older homes 2. Toxicity occurs when levels of a heavy metal become too high. This can happen from acute high exposure, or lower exposure over a long period of time 3.

The most common types of metals harmful to humans are 2 3 4:

• Mercury, most commonly found in some seafood, certain cosmetics, metal dental amalgams (fillings,) and in a few vaccines (not in children’s vaccines) such as thimerosal
• Lead, most commonly found in lead pipes and lead paint in older homes
• Cadmium, most commonly found in soil, water, contaminated foods such as rice and grains, and smoking
• Arsenic, most commonly found in contaminated food and water
• Thallium, most commonly found in industrial settings with coal combustion, exhaust fumes, and semiconductor manufacturing 
• Chromium (hexavalent chromium), most commonly found in food, water, and products containing chromium

It is important to remember that heavy metals are not all bad, and some are necessary for the function of our body, such as cobalt, copper, magnesium, iron, manganese, selenium, and zinc. In fact, even chromium, in safe levels, is needed for the body to function well 5. 

Mild exposure to more toxic metals is not a risk to health in most cases, as our body does clear out toxins. However, health risks can occur when the overall toxic load becomes too high for an individual. 

Heavy Metal Toxicity Symptoms

Heavy metal toxicity is associated with many chronic symptoms and an increased risk of some diseases. 

Some commonly reported symptoms are:

• Stomach pain and gastrointestinal symptoms
• Brain fog, memory loss, and confusion
• Fatigue
• High or low blood pressure
• Mood and behavior changes, including depression and anxiety
• Joint pain
• Autoimmunity 

Those are just a few of the symptoms, and symptoms vary depending on the type of metal that is causing the problem. Let’s take a closer look at each heavy metal, where they are found, and the most common symptoms associated with each one.

One difficulty with determining how risky heavy metal exposure is to health is that the research is not as strong and clear as we would like it to be. That means that many of the studies seeking to link heavy metal toxicity to negative health outcomes are small and/or are observational only and not randomized clinical trials (which are considered the highest quality of evidence). 

Knowing that, let’s look at some of the research:

• A meta-analysis of 14 observational studies suggested that occupational exposure to lead (most often pesticides or herbicides) was associated with a 50% relative increase in risk of developing neurological disorders of Alzheimer’s disease or ALS/Amyotrophic Lateral Sclerosis 9.
• One observational study of 20,000 participants found that mercury dental amalgams (fillings) may slightly increase the risk of multiple sclerosis. It did not show an increase in risk for chronic fatigue syndrome or kidney disease, even after 12 years of follow-up 10.
• Low levels of exposure to arsenic, lead, cadmium, and copper (but not mercury) were possibly associated with an increased risk of cardiovascular disease and high blood pressure 11 12.
• One meta-analysis of just nine observational studies on exposure to cadmium showed a moderate increased risk of death from all causes 13.
• Heavy metal toxicity has been associated with an increased risk of some cancers, such as lung and kidney cancers 3 8.

These studies show that heavy metal toxicity can be a contributing factor in chronic illness, but more research needs to be done to truly understand when levels are too high and if they are creating health problems in any one person.

While heavy metals may be a factor in poor health, it is important to look at more common causes of symptoms before jumping right to heavy metal toxicity.

When to Consider Heavy Metal Toxicity

You may want to consider heavy metal toxicity as a cause of your symptoms if…

• You’re experiencing persistent brain fog, fatigue, anxiety, depression, and/or other symptoms associated with heavy metal toxicity; 
• You have risk factors for heavy metal toxicity (such as possible chronic exposure to lead from an old home), and/or; 
• Your symptoms have not improved after addressing diet, lifestyle, gut health, thyroid health, and other possible causes. 

While the specific symptoms do vary, at our clinic, the pattern we most often see that indicates possible heavy metal toxicity is persistent brain fog, fatigue, and depression or anxiety that doesn’t improve with other treatments. Persistent autoimmunity is another key signal. There may also be an increased risk for post-menopausal females. 

With that said, we don’t see heavy metal toxicity very frequently. It’s much more likely that these symptoms are being caused by something else, like a gut imbalance, hormonal imbalance, a thyroid issue, or even another kind of environmental exposure like mold toxicity. 

While heavy metal toxicity does occur, it is not all that common. In 2018, fewer than 9,000 cases of toxicity were reported 14. Rates of toxicity may be higher than reported, but we don’t yet know how much higher they may be.

Further, testing for heavy metals can be quite expensive, and as we will cover later, testing is not standardized or always reliable.

What’s important to keep in mind is that while heavy metals may cause symptoms such as fatigue, headaches, poor concentration, and high blood pressure, these same symptoms are more likely to  be caused by many other things. In fact, we see many of the same symptoms in gut imbalances/conditions like SIBO (small intestinal bacterial overgrowth), IBS (irritable bowel syndrome), and IBD (irritable bowel disease). These symptoms may also be a result of food sensitivities or hormonal imbalances. 

If acute heavy metal poisoning has occurred, seek medical attention immediately. Otherwise, it’s important to create a strong foundation of health and rule out other, more common and easily treated causes before moving on to the possibility of heavy metal toxicity.

Follow these three steps to create a strong foundation of health:

1. Find the right diet that works for you.
2. Get your sleep in order.
3. Improve your gut microbiome. 

For most of my patients, we start with an elimination diet, such as the Paleo diet, to remove any common inflammatory foods that may be causing chronic symptoms. Try the diet for 3-4 weeks and see if your symptoms improve. 

Sleep is important for health. It can help clear toxins and waste in our brain that we encounter in our everyday environment 15 16. To get enough quality sleep, practice good sleep hygiene: 

• Sleep 7-8 hours a night.
• Go to bed and wake up at about the same time every day.
• Reduce the risk of waking up multiple times during the night by keeping your room cool, not eating within 1-2 hours before bed, and making sure small lights from electronics are off.

The gut microbiome is important in our overall health and for clearing toxins from the body as a healthy gut lining prevents toxins from going from the gut to the blood. An imbalance in the gut, possibly from SIBO or H. pylori, food sensitivities, or just from a general less than ideal mix of beneficial gut bacteria which can lead to leaky gut, can cause symptoms such as fatigue, joint pain, and brain fog. The simplest intervention to improve the gut is to add in a high quality probiotic as you are working on your diet and sleep 17. 

Not only will working on these three areas possibly resolve some other issue causing your symptoms. They will also improve your body’s ability to clear out the toxins we come in contact with. 

If improving diet, sleep, and your gut do not improve your symptoms and you and your doctor have ruled out other causes, then it may be time to check to see if heavy metal toxicity is contributing.

How Effective Is Heavy Metal Testing?

Testing for heavy metals has become more popular recently, but when is it needed and how accurate is it?

The short answer is that unprovoked urine tests (urine tests that do not involve the use of a chelating agent, as described below) and blood tests are the most widely accepted forms of heavy metal testing, should your healthcare provider feel testing is needed 4.

While provoked urine tests (sometimes referred to as “challenge tests”) are often used in integrative medicine, these tests lack standardization and clear testing ranges, making them a less reliable choice when it comes to assessing your heavy metal levels.

Hair and nail sample tests are also available, but these options are much less reliable 1.

Heavy metal testing is the most effective with the right type of test for the right metal. Most often, urine and blood tests are ordered together in order to ensure the most accurate results 4. This is because different metals last for different amounts of time in the blood or urine.

For example, inorganic arsenic has a half-life (the time it takes for the amount of metal to reduce by one half) in the blood of 3-4 hours, while lead has a half-life in the blood of one to two months. So a blood test may be accurate for lead, whereas an unprovoked urine test may be better for inorganic arsenic if you are testing later than four hours after exposure.

Let’s take a look at some of the more common tests and what the research tells us about their accuracy.

Provoked vs Unprovoked Urine Testing

There are two types of urine tests for heavy metals: provoked and unprovoked. 

Again, in a provoked urine test, a chelating agent (a bonding agent that is used to bind to the heavy metals and remove them from the body) is administered before collecting a urine sample. The tests don’t yet have standardization or reliable lab ranges, and there is no consensus on the levels that indicate toxicity 18 19.

Additionally, when compared to regular (unprovoked) urine testing (where no chelating agent is used) the provoked tests do not seem to be any more accurate than a regular urine test 7 20 21. This is why unprovoked urine tests are the standard and the better choice for urine testing of heavy metals. 

Blood Testing

Blood testing is another acceptable method for heavy metal testing. Blood tests are becoming more popular, even being sold as at-home heavy metal test kits. 

Blood tests do show levels of heavy metals, but since the values that each lab uses for indicating toxicity differs, check with your doctor to find the most accurate lab 4. 

Because each metal has a different half-life in the blood, most practitioners order unprovoked urine and blood tests in order to get the most accurate results. 

Hair and Toenail Testing

Hair and toenail testing are not recommended as testing options. In hair and toenail testing, a strand of hair or a toenail clipping is sent in for testing. The issues with these tests is that they are not well standardized, and it is unclear how accurate they are at detecting current toxic load in the body 22. 

There are vast differences in how the hair is washed and decontaminated for testing. These can change results 23. One study found that hair samples were not a good way to detect mercury poisoning due to fish consumption, while in another small study, hair mercury was found to be a good detector of the more toxic methylmercury 24 25.

When to Get Tested

Just because testing is imperfect, that does not mean that tests should never be used. Blood and unprovoked urine tests are very useful when needed.  

Should you have acute symptoms of heavy metal poisoning, such as abdominal pain or vomiting, working immediately with a healthcare professional to get the right test and treatment for you can be life-saving. 

You may also want to consider testing if you live in an older home that you know has lead paint and/or lead pipes and you are having symptoms of lead poisoning such as a blue line on your gums, severe confusion, or anemia.

If you have worked on improving your health with diet and lifestyle changes, it may be helpful to find a functional medicine clinic that can look at heavy metals and other underlying causes of your chronic symptoms. Just remember, work with your medical professional to choose the best test for the metals you are testing for and processed from the most accurate lab. 

If you do end up needing treatment for heavy metal toxicity, the most common treatment is some form of chelation therapy. 

Chelation Therapy

Chelation therapy is when a chelating agent is used to bind to the heavy metals and remove them from the body. Chelation is typically done through intravenous (IV) therapy. There are also a few natural substances that may work as natural chelating agents. 

EDTA Chelation Therapy

In traditional chelation therapy, a solution of EDTA (ethylenediaminetetraacetic acid) is injected into the bloodstream through IV (intravenous) therapy to bind to the metals in the bloodstream. This type of intervention has been shown to reduce the levels of heavy metals in the body, improve kidney function in kidney disease, and reduce the risk of heart disease. In people with type 2 diabetes, the results are even more beneficial in reducing risk of heart disease 26 27 28.

Chelation therapy with EDTA is approved by the FDA for acute lead poisoning, but IV chelation for lower grade heavy metal toxicity is more controversial. Partly, it is costly and is not without risk. Each treatment of chelation therapy typically costs $75 to $125, and the infusions often take three hours each over a period of several months 29. 

Further, studies have shown some risk with low blood calcium levels when the chelation solution does not include calcium 26. In one study, researchers voiced concerns over possible, but very rare, risks such as heart arrhythmias, respiratory problems, and hypoglycemia 30.

Natural Chelation Therapy

There are some possible natural chelation agents, such as modified citrus pectin, selenium, jujube fruit, banana peel, garlic, and curcumin 31 32 33. However, more studies in humans would need to be done to support this hypothesis.

A few smaller studies have been done on using selenium or modified citrus pectin as chelation agents 34 35. In particular, modified citrus pectin (PectaSol-C®,) has been shown in a few studies to reduce metal levels 35 36 37 38.

In fact, at our clinic, I have had success with lowering serum levels of lead in adults by using modified citrus pectin for 45-90 days. 

Does Heavy Metal Treatment Improve Symptoms?

Due to debate around testing accuracy and what levels of heavy metals pose significant health risks, there is also some question as to if chelation therapy improves heavy metal toxicity symptoms such as fatigue, brain fog, headaches, confusion, skin conditions, and stomach distress. 

The first question to answer is if heavy metal treatment, i.e. chelation therapy, actually decreases heavy metal levels in the body.

Does Chelation Therapy Decrease Heavy Metal Levels?

The largest and most interesting study supporting treatment for lowering metal levels in the body was the TACT trial (Trial to Assess Chelation Therapy). This was the first double-blind, randomized, controlled clinical trial to evaluate chelation therapy for heavy metals 27. 

In the trial, they found that with adults with a history of heart attack, chelation therapy was associated with a significant reduction in risk of cardiovascular events compared to placebo after an average follow-up of 55 months 27. The trial was so successful that a TACT2 trial is currently ongoing to dig deeper into the original results that found chelation therapy to be particularly effective at reducing cardiovascular events in people with diabetes 28.

There are other studies, although small, that show improved health outcomes with treatment for heavy metal toxicity.

• A randomized control trial with 50 participants with type 2 diabetes and high blood levels of lead showed significantly improved kidney function in the short term and significantly slower progression of diabetic kidney disease in the long term compared with placebo 39.
• A non-randomize, non-controlled clinical trial of 14 patients with coronary artery disease found chelation therapy resulted in a 36% reduction in urinary lead levels 30.
• Another nonrandomized/noncontrolled clinical trial involving 33 patients with cardiovascular disease found some evidence that chelation therapy may lead to lower urinary lead levels and improvement in blood pressure 40.

The TACT trial is encouraging, and the smaller studies show that bigger randomized control trials are needed to learn more about using chelation therapy to improve chronic conditions.

Does Chelation Therapy Resolve Heavy Metal Toxicity Symptoms?

Most of the research has tested for efficacy of treatment only looking at blood and urine levels of heavy metals, not reported symptoms. For this reason, it is unclear if treatment will resolve common symptoms such as fatigue, brain fog, and gastrointestinal issues. 

In one study with removal of dental amalgams, participants not only had a decrease in urine lead levels, but they self-reported a decrease in symptoms of memory loss, fatigue, and stomach problems 7. This is the only study that indicates any possible reduction of common heavy metal toxicity symptoms, but through removal of dental amalgams, not from chelation treatment.   

In clinical practice, we’ve found that heavy metal detoxification can help to reduce symptoms, but it’s important to remember that it’s not a first-line solution. 

Decreasing Your Heavy Metal Toxic Load

In general, it is helpful for our body and brain to reduce overall toxic load. Here are a few tips to decrease toxins in your life:

1. Diet: A whole foods Paleo diet can not only help with chronic health symptoms, but it also removes many of the common food sources of some heavy metals, such as rice and grains. For seafood, choose tuna and other fish from companies that test mercury levels, like Safe Catch or Wild Planet. 
2. Detox: The body clears some amount of heavy metals in part through maintaining good lymphatic flow and sweating. If you have access to a sauna, that can be a great way to improve detoxification 41. The contraction and relaxation of our muscles during exercise helps move the blood and lymph through our body, improving lymphatic drainage.
3. Environment: If you can, decreasing pesticide use in your yard and in your home may be a good idea. If your job places you near exhaust and other fumes and smoke, make sure you are supplied with protective gear. 

On the topic of decreasing toxic load, many people want to know if they should get their metal fillings removed. In general, the research is not entirely clear how much of a risk dental amalgams are 7.

At the same time, while removal of dental fillings did not show significant decrease in mercury levels in urine, people did self-report improvement of common heavy metal toxicity symptoms such as memory loss and stomach problems and after removal 7. You may choose to have your fillings removed or need them removed due to deterioration. If you do get your fillings removed, proper amalgam removal is important because most of the risk of mercury exposure is during placement and removal of metal fillings 42. 

Improving Health Outcomes

While we do not want to ignore the risks of heavy metals to our health, it is best to first support your health with the right diet, gut support, and sleep and see how well your symptoms improve. You can also support your health by decreasing overall toxic load in your daily life.

If you have done all of that and still have chronic symptoms you might want to speak with our clinic about heavy metal toxicity and your health. Take a minute to fill out our new patient form here. 

We hope that this article has helped you understand more about the risks of heavy metal toxicity and how to know if and when you need to get testing.