GET THE LEAD OUT!

Dorothy Merritt, MD

Lead –Who Is Affected The MostLead –Who Is Affected The Most

Blood-brain barrier is not complete Blood-brain barrier is not complete until 6 months of age so lead can until 6 months of age so lead can be absorbed by CNS of fetus and be absorbed by CNS of fetus and young childyoung child

((lead crosses placenta).lead crosses placenta).

Absorption of lead is estimated to be as much as Absorption of lead is estimated to be as much as FIVE FIVE TO TEN TIMES GREATERTO TEN TIMES GREATER in infants and young children in infants and young children than in adults.than in adults.

Needleman H. Ann Rev Med 2004;55:209-222Needleman H. Ann Rev Med 2004;55:209-222

Lead: Where does it come from?Lead: Where does it come from?

Soft vinyl lunchboxes- found to contain more Soft vinyl lunchboxes- found to contain more than 90 times legal limitthan 90 times legal limit

Candy imported from MexicoCandy imported from Mexico Imported children’s jewelryImported children’s jewelry Leaded gasoline- currently used in farm Leaded gasoline- currently used in farm

machinery, boats, racing carsmachinery, boats, racing cars

Lead: Where does it come from?Lead: Where does it come from?Billions of tons of lead has been unleased into the environment Billions of tons of lead has been unleased into the environment the last 100 years due to paint and gasoline additives that have the last 100 years due to paint and gasoline additives that have

now been banned in the US and Europenow been banned in the US and Europe

AirAir-- indoor dust exposure greater than soil or paint chipsindoor dust exposure greater than soil or paint chips

WaterWater- - 20% of daily exposure “lead-free” brass fixtures 5-7% lead20% of daily exposure “lead-free” brass fixtures 5-7% lead

ImportsImports- - lead-glazed dishware, leaded crystal. Lead solder lead-glazed dishware, leaded crystal. Lead solder in imported canned food,foods from Mexico, China, Spices, in imported canned food,foods from Mexico, China, Spices, WineWine

MedicineMedicine-- Ayurvedic and foreign medicinesAyurvedic and foreign medicines

Vinyl mini-blindsVinyl mini-blinds imported before 1996imported before 1996

Polyvinyl productsPolyvinyl products - -cords covering wirescords covering wires

Cosmetics -Cosmetics -lipstickslipsticks

Lead in WineLead in Wine

For 432 wines tested in the bottle, the lead For 432 wines tested in the bottle, the lead in domestic wines ranged from 1 to 521 in domestic wines ranged from 1 to 521 parts per billion, with an average of 41. parts per billion, with an average of 41. The level in imported wines ranged from 4 The level in imported wines ranged from 4 to 673 parts per billion with an average of to 673 parts per billion with an average of 94.94.

Lead glaze used on plate imported from Lead glaze used on plate imported from Portugal and sold at American Home Portugal and sold at American Home

FurnishingsFurnishings

Fatal Case of Lead Poisoning Fatal Case of Lead Poisoning from Injestion of Jewelryfrom Injestion of Jewelry

A 4-year old male died of acute encephalopathy 3 days after A 4-year old male died of acute encephalopathy 3 days after being admitted for intractable vomiting, stomach pain, and being admitted for intractable vomiting, stomach pain, and listlessness.listlessness.

A metal charm, seen in his stomach on radiograph and was A metal charm, seen in his stomach on radiograph and was later found to contain 99.1% lead.later found to contain 99.1% lead.

Reebok later recalled 500,000 of these charms, which they had Reebok later recalled 500,000 of these charms, which they had given away free with pairs of girl’s shoes. given away free with pairs of girl’s shoes.

MMWR. March 23, 2006 / 55(Dispatch);1-2MMWR. March 23, 2006 / 55(Dispatch);1-2

Occupations at risk for lead Occupations at risk for lead toxicitytoxicity

Electricians, plumbers, painters, Electricians, plumbers, painters, ceramicists,ceramicists, Munitions specialists, paint and ink Munitions specialists, paint and ink

manufacturing, etc.manufacturing, etc. Electrical tower and generating station Electrical tower and generating station

maintainancemaintainance..

http://www.haz-map.com/lead.htmhttp://www.haz-map.com/lead.htm

Services (3.3%)

Mining (7.6%)

Construction (17.1%)

Manufacturing (70.5%)

Other (1.5%) Total = 12,712

Section 44 of The Construction Chart Book, Fourth Edition, December 2007 -

Distribution of workers with BLLs greater than or equal to 25 µg/dL, by industry, 2003-2004

Number of workers with BLLs greater than or equal to 25 or 40 µg/dL, by detailed construction sector, 2003-2004

Other heavy & civil engineering

Building equipment

Nonresidential

Residential

Foundation, structure, & building

Utility

Highway, street, & bridge

Other specialty trade

Building finishing

Blood lead levels (BLLs)

25 µg/dL

40 µg/dL

1,051

406

412

92

70

41

41

39

14 Section 44 of The Construction Chart Book, Fourth Edition, December 2007

NOEL NOEL NNo o OObservable bservable EEffect ffect LLevel evel

Lead is unique as a toxicant in that there is agreement Lead is unique as a toxicant in that there is agreement among these governmental agencies as to its among these governmental agencies as to its toxicitytoxicity

CDC CDC Centers for Disease Control Centers for Disease Control ATSDRATSDR Agency for Toxic Substances and Disease Agency for Toxic Substances and Disease

RegistryRegistry EPAEPA Environmental Protection Agency: Environmental Protection Agency:

““There is no toxic threshold for lead. This means There is no toxic threshold for lead. This means there is no measurable level of lead in the body there is no measurable level of lead in the body below which no harm occurs.” below which no harm occurs.”

Circulation Circulation 2006;114;1347-13492006;114;1347-1349Tim S. Nawrot and Jan A. StaessenTim S. Nawrot and Jan A. Staessen

NHANES DATANHANES DATA

“ “ Low Level Environmental Low Level Environmental Exposure To Lead Unmasked Exposure To Lead Unmasked

As Silent Killer in US”As Silent Killer in US”Editorial in Circulation 2006 with Latest NHANES Study On Lead And

Vascular Disease

Lead Toxicity-Early SymptomsLead Toxicity-Early Symptoms

Diffuse muscle weaknessDiffuse muscle weakness General fatigue/lethargyGeneral fatigue/lethargy Attention deficit/ irritabilityAttention deficit/ irritability MyalgiaMyalgia Joint pain/arthritisJoint pain/arthritis Loss of appetiteLoss of appetite Unusual taste in mouth/change in taste Unusual taste in mouth/change in taste

of foodof food

Lead Toxicity SymptomsLead Toxicity Symptoms

HeadacheHeadache InsomniaInsomnia IrritabilityIrritability Diminished libidoDiminished libido Weight loss of 10 lbs or more without Weight loss of 10 lbs or more without

known causeknown cause TremulousnessTremulousness

Lead-Related SymptomsLead-Related Symptoms

Personality ChangesPersonality Changes Peripheral neuropathy in extensor Peripheral neuropathy in extensor

surfaces- most common neurological surfaces- most common neurological symptom in adultssymptom in adults

Abdominal pain/crampingAbdominal pain/cramping Nausea/vomitingNausea/vomiting Short-term memory lossShort-term memory loss DepressionDepression

Lead-Related SymptomsLead-Related Symptoms

IncoordinationIncoordination ParesthesiasParesthesias ConstipationConstipation Inability to concentrateInability to concentrate ImpotenceImpotence

Lead Toxicity in the US 2010

Blood lead levels: NHANES STUDIES

(Reflects 30-60 day exposure)

Bone lead levels : NIH STUDIES

(Reflects LIFETIME exposure)

Measured by urine “challenge” test

NIH StudyNIH StudyLead in BonesLead in Bones

Adult ImplictionsAdult Implictions

Lead stored in the bones from earlier in life is released Lead stored in the bones from earlier in life is released into the blood and soft tissues from 4-10x increased into the blood and soft tissues from 4-10x increased turnover of bones associated with normal agingturnover of bones associated with normal aging

90% of all the lead you have been exposed to is IN YOUR 90% of all the lead you have been exposed to is IN YOUR BONESBONES

Populations at risk for lead toxicity Populations at risk for lead toxicity from increased bone turnoverfrom increased bone turnover

Menopausal women/Andropausal menMenopausal women/Andropausal men

Hyperthyroidism in either sexHyperthyroidism in either sex

Cisplatin chemotherapyCisplatin chemotherapy

Patients with osteoporosis or osteopeniaPatients with osteoporosis or osteopenia

Vitamin D deficiency-50% of populationVitamin D deficiency-50% of population

Cardiovascular DiseaseCardiovascular Disease

Those in the highest tertile of blood lead:Those in the highest tertile of blood lead: ( 3.63-10.0 µg/dL ) vs (2ug)( 3.63-10.0 µg/dL ) vs (2ug)

- 2.52.5 times risk for stroke mortality vs 1.51 times risk for stroke mortality vs 1.51- 1.891.89 times risk for myocardial infarction times risk for myocardial infarction

mortality vs .81mortality vs .81- 1.701.70 times risk for cardiovascular disease times risk for cardiovascular disease mortality vs .55mortality vs .55

Circulation 2006;114:1347-1349Circulation 2006;114:1347-1349

SO WHAT DO YOU DO ?

Avoid new exposures Keep bones healthy Reduce medical risks of bone turnover Get your blood level of lead checked If your blood level is above 2 and you

have symptoms of lead toxicity, you may qualify to do “chelation” which removes the lead

What is “Chelation”

EDTA chelation has been FDA approved for treatment of lead toxicity since the 1950’s

Serial IV treatments with EDTA remove lead from the bone and the tissues

Ask your doctor for a brochure on chelation treatment to explain all the things it can do for you or go to

www.beleadfree.com

Check list for heavy metal symptoms used in our clinic

Dorothy Merritt, MD

Mainland PCP Chelation Center