The functional medicine community swears by this test. I had a friend who had one of these done which allegedly showed off the chart mercury on his results. Naturally, his functional med doc wants to treat him with DMSA, which will allegedly “pull” out the metals? I’ve tried to read up on this and it’s above my mental comprehension. Please help so I can explain this to by buddy in a convincing manner!
In: Biology
From a National Institute of Health [article](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3846974/) on exactly this subject:
“Urine mobilization test,” “challenge test,” and “provoked urine test” are all terms used to describe the administration of a chelating agent to a person prior to collection of their urine to test for metals. There is no standard, validated challenge test. Despite recommendations by professional and government organizations against the use of provoked urine testing, the tests are still commonly used and recommended by some practitioners. Challenge testing utilizes a variety of chelating agents, including dimercaptosuccinic acid (DMSA), dimercaptopropanesulfonate (DMPS), and ethylenediaminetetraacetic acid (EDTA). The agents are given by a variety of routes of administration, doses used are inconsistent, and urine collection procedures vary. Additional problems with challenge tests include comparison of results to inappropriate reference ranges and creatinine correction of urine obtained within hours of chelator administration. Human volunteer studies demonstrate that mercury is detected in the urine of most people even in the absence of known exposure or chelator administration, and that urinary mercury excretion rises after administration of a chelator, regardless of exposure history and in an unpredictable fashion. Studies also demonstrate that challenge testing fails to reveal a “body burden” of mercury due to remote exposure. Chelating agents have been associated with adverse reactions. Current evidence does not support the use of DMPS, DMSA, or other chelation challenge tests for the diagnosis of metal toxicity. Since there are no established reference ranges for provoked urine samples in healthy subjects, no reliable evidence to support a diagnostic value for the tests, and potential harm, these tests should not be utilized.
Granted, the article is 11 years old and maybe things have changed in the interim, but the upshot is the tests aren’t (at least weren’t) a reliable indicator of anything because there is (was) no established test administration or results evaluation criteria, leading to a lack of diagnostic efficacy.
From a toxicologist at the University of Arizona School of (real) Medicine:
> Human volunteer studies demonstrate that mercury is detected in the urine of most people even in the absence of known exposure or chelator administration, and that urinary mercury excretion rises after administration of a chelator, regardless of exposure history and in an unpredictable fashion. Studies also demonstrate that challenge testing fails to reveal a “body burden” of mercury due to remote exposure. Chelating agents have been associated with adverse reactions. **Current evidence does not support the use of DMPS, DMSA, or other chelation challenge tests for the diagnosis of metal toxicity. Since there are no established reference ranges for provoked urine samples in healthy subjects, no reliable evidence to support a diagnostic value for the tests, and potential harm, these tests should not be utilized.**
https://link.springer.com/article/10.1007/s13181-013-0350-7
People who do not have a financial interest in these tests and study it purely from a scientific standpoint say not to use it, their only incentive is patient health and they have solid credentials.
The functional medicine people don’t care about evidence and just want to take your friend’s money. Everyone has mercury in their pee and it’s meaningless. There is no established reference range, so there is no such thing as “off the chart.”
This report (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3846974/) summarizes the criticisms of provoked heavy metal testing, though it does so in a rather technical way.
To try to summarize it simply: the “provoked” part of the testing involves the administration of a substance that will temporarily increase the excretion of heavy metals, especially mercury, into the collected sample (remember, we all have at least a little mercury in us, but this is fine and natural). This provoked sample is then compared to a baseline sample. Naturally, the provoked sample will show elevated levels of mercury – that was the whole point of the provocation! Furthermore, the people who administer this test have not committed to any particular result as indicating actual heavy metal poisoning and typically set standards far below what the CDC recognizes as dangerously elevated levels. It’s as if the doctor painted one of your arms blue, then told you that the skin on the blue arm was diseased because it is more blue than the skin on your other arm.
Everything in existence contains heavy metals like mercury and lead. Everything. The dirt contains heavy metals. The water contains heavy metals. Your food contains heavy metals. The bedsheets that you sleep on contain heavy metals. Your body is also part of that everything and also contains heavy metals. There is no way to avoid eating, drinking, sleeping in, or being made out of heavy metals.
Because life evolved under conditions where heavy metals are an unavoidable fact of reality, living things (such as humans) all have a pretty high tolerance for heavy metal contamination.
Provoked urine tests involve being administered an chemical that binds to one or more of heavy metals naturally present in your body, causing you to pee some of them out, temporarily depleting the stock of heavy metals normally in your body. The scam aspect of this comes in how urine tests work.
Your kidneys will normally remove a flat percentage of the amount of heavy metals in your body every day, so its normal to pee out some mercury, lead, etc… Because everyone’s kidneys are removing the same percentage of heavy metals, people with normal amounts of heavy metals will all have about the same *concentration* of heavy metals in their pee. So a 250 pound, 6’5″ dude may have 10 mg of mercury in his body and a 125 pound, 5’2″ girl may have 5 mg of mercury in her body, but they’re both probably going to have the same concentration of mercury in their pee.
In a provoked urine test you’re administered a chemical that binds to one or more of the heavy metals in your body and causes you to pee out a much higher percentage of that/those metals. The concentration of heavy metals that comes out in your pee after taking one of those tests depends on what you were administered, how much of it you were administered, how it was administered (did you eat it? what it injected?), how much of that chemical you absorbed, your body mass, and a bunch of other factors.
Because of all of those different factors, its very easy to manipulate the tests results to look bad, when in fact you just have a normal level of heavy metals in your body. Further complicating that is that most test providers will compare the results of a provoked test against the reference ranges for unprovoked tests.
IE, they take a urine sample where they know heavy metals will be present in much higher quantities than normal because you’ve been administered a chemical whose whole job is to create urine with a higher concentration of heavy metals than would normally be present. They then compare that to how much heavy metal should be in your urine if you haven’t been administered such a chemical.
In other words, they’re temporarily reducing the amount of heavy metals in your body by causing you to pee them out at a higher rate than you otherwise would, measuring how much came out in the pee, then comparing that to how much should have been in your pee under normal circumstances.
Because the people administering them have a vested interest in selling you “treatments” based on the results of these tests.
Any test looking for heavy metals in the human body WILL find them. The issues is whether the levels found pose a risk to life. These folks will tell you that ANY level of heavy metals is dangerous, but if you just buy THIS treatment (from them, naturally), all will be well.
It’s no different than the scammers pushing “alkaline water” for health.
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