Indications

• Alopecia

• Bone Density

• Cardiovascular Disease

• Depression

• Dermatitis or Poor Wound Healing

• Detoxification Therapy

• Fatigue

• Gastrointestinal Symptoms

• Hypertension

• Immune Function

• Impaired Glucose Tolerance

• Inflammation

• Kidney Function

• Nutritional Deficiencies

• Parkinson's-like Symptoms

• Toxic Element Exposure

Overview

This test is traditionally used to evaluate exposure to potentially toxic elements. Additionally, the comparison of urine element concentrations before and after administration of a chelator can be used to estimate net retention of potentially toxic elements. Subsequent urine element analyses, also following the administration of a chelator, are useful for monitoring the efficacy of metal detoxification therapy. Results are expressed per 24 hours or creatinine corrected to account for urine dilution effects.

A pre-challenge urine test shows what metals are currently circulating in the body and being excreted by the kidney. It is important to make sure kidney function is intact prior to testing. If levels are high on an unprovoked test it means there is a current exposure to heavy 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 chronic disease.

One 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.

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.

Both the pre and the post tests have to be ordered separately.

Practical

Specimen requirements:

Urine

Single collection or timed, max 8 hours

Average processing time:

9 ±4 days

Research

• 24-hour provoked urine excretion test for heavy metals in children with autism and typically developing controls, a pilot study. Clin Toxicol. 2007;45:476-481.

• Adams J, Audhya T, McDonough-Means S et al. Toxicological Status of Children with Autism vs. Neurotypical Children and the Association with Autism Severity. Biological Trace Element Research. 2012;151(2):171-180.

• Adams J, Howsmon D, Kruger U et al. Significant Association of Urinary Toxic Metals and Autism-Related Symptoms—A Nonlinear Statistical Analysis with Cross Validation. PLOS ONE. 2017;12(1).

• Crinnion WJ. The benefits of pre- and Post challenge urine heavy metal testing; part II. Altern Med Rev. 2009;14(2):103-108

• Crinnion WJ. The benefits of pre- and post-challenge urine heavy metal testing: Part 1. Altern Med Rev. 2009;14(1):3-8.

• Desoto MC. A reply to Soden et al.: your data shows autistic children have higher levels of heavy metals. Clinical Toxicology. 2008;46(10):1098-1098.

• Molina-Villalba I, Lacasaña M, Rodríguez-Barranco M, et al. Biomonitoring of arsenic, cadmium, lead, manganese and mercury in urine and hair of children living near mining and industrial areas. Chemosphere. 2015;124:83-91.

• Pesch A, Wilhelm M, Rostek U, et al. Mercury concentrations in urine, scalp hair and saliva in children from Germany. Journal of Exposure Science & Environmental Epidemiology. 2002;12(4):252-258.