Transience vs Persistence of Heavy Metals in the body.

Transience vs persistence is an important consideration in treatment of many things, including presence of metals in the body. There are of course variations in the extent of persistence

In basic terms, transience is distinguished from persistence as transience is defined as a perturbation that spontaneously and effectively resolves within one week, whereas persistence extends beyond that. Most transient processes resolve within 24 hours. Persistence is a variable entity and can be further subcategorized by the durability of the perturbation and the fraction that persists over various time points. One year is a useful temporal landmark to define persistence as durable, and 1 month is an appropriate short term early analysis. Factors that contribute to persistence is the ability of the substance to insert itself into the matrix of the structure. The two most common insertions are the substitution for a native chemical (such as substitution of Lead or Gadolinium for Calcium in bone) or the ability to enter cells and stay contained within them.

I have found it not unusual in pre-chelation 24 hour urine samples some metals may have worrisome elevation. I have seen this with Arsenic and Bismuth. One critical observation that it is transient, such as from a recent meal of shellfish (arsenic) or recent taking of the anti-heartburn product Pepto Bismol (Bismuth) is high on pre-chelation 24 hour urine for heavy metals, taken a few days before the post chelation urine which then shows it is low. Ofcourse since temporally they are acquired within a very short interval, the metal of concern may well still be high,, even if the metal's presence is transient. Rather than panic, we repeat 24 hour urine pre- and post-chelation with the next chelation session. We have found that these metals when transient drop into the normal range. If the heavy metal in question is persistent, then the level of that metal stays high pre- and post-chelation urines, and over the course of a number of urine acquisitions. If that heavy metal is persistent, and DTPA is not removing it well, then inclusion on an additional chelator may be necessary.

Note that we normally get pre- and post-chelation urines for studying how the Gd elimination is going at every multiple of 5 chelation sessions. The reason is that the bone retention of Gd is so relatively large, and re-equilibration of Gd is so effective by 3-4 weeks, that the 24 hr urine for Gd does not really start dropping until the bone reservoir is becoming depleted, and there is not sufficient Gd in bones to restore a high level in soft tissues by 3 weeks. Remember as well, that the amount of Gd that comes out postchelation is heavily related to the length of interval between chelations. In general, the longer the interval the higher the Gd in post-chelation urine, because more time has been allowed for re-equilibration.

Transience vs persistence is a critical determination to make with heavy metals

Richard Semelka, MD