安迪卡特勒关于铅中毒的帖子

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回复：关于铅中毒的问题 —— 向安迪提问

主题：回复：关于铅中毒的问题 —— 向安迪提问
发件人：安迪・卡特勒（AndyCutler）
日期：2001 年 7 月 25 日 星期三 06:59:39
雅虎消息编号：29340
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是的。关键是要做出正确诊断，并据此进行治疗。

由于二巯基丁二酸（DMSA）实际上是目前最佳的铅排毒药物，因此排毒方案中存在一定的 “容错空间”—— 即便同时存在铅、砷以及汞，它也能发挥作用。

安迪

“排毒方案中存在一定的容错空间” 是什么意思？

如果你去找一般的 “江湖郎中” 或 DAN! 医生，他们可能无法准确诊断孩子体内是汞、铅、砷、锑，还是这些金属的组合中毒。而 α- 硫辛酸（ALA）+DMSA 至少能覆盖 3 种金属的排毒需求。因此，只要他们确定孩子确实是 “中毒” 状态，即便对具体中毒金属（或多种金属）的判断不够明确（或不准确），最终也能达到治疗效果。

这是否意味着可以不用严格每 4 小时服用一次 DMSA 和 / 或 ALA？

不。必须每 4 小时服用一次。理想情况下，清醒时每 3 小时一次，睡眠时每 4 小时一次。

还是说你指的是剂量或辅助补充剂？

不。我指的是即便诊断不完全准确，该方案也能起到帮助作用。

我非常希望能得到澄清，因为我 4 岁的孩子似乎铅中毒了 —— 尿中的 δ- 氨基乙酰丙酸（d-ALA）和粪卟啉水平都升高了。我了解到前者升高是铅中毒特有的（而汞和其他重金属不会影响这一指标）。

教科书上确实这么说，但教科书并非总是准确的。

只要你使用 DMSA，体内的铅含量就会大幅降低。

我儿子的头发铅含量也曾很高，但现在已降至正常水平。我的理解是，这说明血铅水平较低，但铅仍是个大问题，因为 d-ALA 和粪卟啉的检测结果仍居高不下。

汞和许多其他毒素都可能导致粪卟啉升高。

还有证据表明砷含量较高，因为尿中的尿卟啉水平升高。

这并非砷中毒的明确指标。所有毒素有时都会导致尿卟啉升高。

至于汞，情况不太明确 —— 头发汞和尿汞排泄量都较低，但我知道这并不能排除汞中毒。不过，根据 “计数规则”，粪卟啉升高可能提示汞中毒，且矿物质转运已出现紊乱。

是的。这是一个强有力的佐证。

我对治疗有一个想法，想听听你的意见。由于铅中毒几乎可以确定，且 DMSA 与铅的结合优先于汞（如果我说错了请纠正）……

DMSA 能同时与两者良好结合。任何生物体内的铅和汞含量，都远低于即使是很小剂量的 DMSA 所能结合的量。

…… 那么或许有必要加大 DMSA 的使用力度，因为有足够多的铅可供 DMSA 结合。

我不太清楚铅与 DMSA 结合的动力学过程，但怀疑两者并非线性关系。因此，增加剂量只能适度提高铅的排出率，却会大幅增加副作用和风险。

如果 DMSA 正忙于处理铅，硫辛酸（ALA）在治疗中还有作用吗？

有作用。ALA 会处理汞和砷，而且虽然它可能不直接螯合铅，但已知它能让铅中毒的动物在用药期间更健康。

或许 ALA 会将血液中的汞推入大脑，而 DMSA 因忙着结合铅而无法清除这些汞？

不会，体内会有足够的 DMSA 来清除汞。

我们一直在同时使用 DMSA 和硫辛酸，但我在想是否应该停用硫辛酸，直到 DMSA 处理完铅之后再用。另外，能否先加大 DMSA 的剂量来优先处理铅和砷？

DMSA 对砷的效果并不好。

我不建议加大剂量，否则可能导致汞在体内扩散。

你认为铅中毒的恢复概率有多大？

非常高。

螯合疗法能纠正血红素合成障碍吗（即 d-ALA 和粪卟啉水平能降下来吗？需要多长时间？）

可以。需要几个月到一年。我个人就做过相关检测 —— 粪卟啉和尿卟啉在大约 8 个月的螯合治疗后，从超过正常上限 3 倍降至正常范围内。

顺便说一句，我儿子的血红蛋白水平正常，我不太明白这与 d-ALA 和粪卟啉所显示的血红素合成酶紊乱如何相符。你能解释一下吗？

身体会努力合成更多血红蛋白，而且合成过程并非 “受阻”，只是速度稍有减慢。

主流文献对铅中毒儿童的认知和行为恢复持非常悲观的态度。

但大多数文献都没有对接受螯合治疗的儿童进行神经心理学测试，他们研究的大多是持续处于中毒状态的儿童。

我所知道的唯一一份关于改善的记录来自《点铅成金》一书。

1. 这一点很令人担心：如果 DMSA 不能穿过血脑屏障，那它如何将大脑中的铅排出？还是说它无法排出大脑中的铅？

许多矿物质能穿过血脑屏障。虽然我没有确凿证据，但我认为铅能以一定速率穿过血脑屏障，这一点与汞或砷不同。

DMSA 不能直接穿过血脑屏障，但有一定理由认为铅能穿过，因此铅会从大脑中排出，供 DMSA 结合清除。

安迪

你能详细解释一下 “铅会（可能会）离开大脑” 这一观点吗？

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Re: Q's about Lead poisoning - questions for Andy
Subject: Re: Q's about Lead poisoning - questions for Andy
From: AndyCutler
Date: Wed, 25 Jul 2001 06:59:39 -0000
Yahoo! Message Number: 29340
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Yes. The idea is to get a correct diagnosis and treat based on
it.

Since DMSA is actually the best available lead detox drug, there
is
room for some slop in the detox protocol as it will take care of
lead
and arsenic if they happen to be there, along with mercury.

Andy

What do you mean by "there is room for some slop in the detox
protocol"?

If you go to the usual witch doctor or DAN! doctor, they probably
aren't that capable of making a good diagnosis as to whether your
child has mercury, lead, arsenic, antimony or some combination. ALA +
DMSA covers at least 3 bases. So as long as they are right you have
at TOXIC kid, you get there even if they aren't so sure (or are not
correct) about the metal(s) involved.


Does this mean you can be less concerned about giving DMSA and/or
ALA
every 4 hours

No. They must be given every 4 hours. Preferably every 3 during the
waking period, and every 4 during sleep.

or are you referring to dosages or the supporting
supplements?

No. I am referring to the ability to help even if the diagnosis is
not totally correct.


I would very much appreciate a clarification as my 4 year old seems
to be lead intoxicated as delta-aminolevulinic acid (d-ALA)in the
urine is elevated as are copropophyrins. I understand an elevation
of the former is uniqely caused by lead (whereas mercury and other
heavy metals do not affect this).

This is what the textbooks say. The textbooks are not always
accurate.

As long as you are using DMSA, whatever lead is there will be reduced
greatly in amount.


My son's hair lead has also been very high, although it has now
fallen to normal levels. I interpret this to be that blood lead is
low but that lead is still a big problem as testing for d-ALA and
copropohyrins remains high.

Mercury can elevate coporporphyrin, as can many other toxins.


There is also evidence that arsenic is high as uroporphyrins in
urine
are high.

This is NOT a clear indicator of arsenic. All the toxins will
sometimes elevate uroporphyrin.

As to mercury, the picture is less clear - hair mercury
and urinary excretions of mercury are low but I understand this
would
not rule out mercury. However, I understand high coproporhyrins
could indicate mercury and mineral transport has been disordered as
per the Counting Rules.

Yes. This is a strong case for it.


I have a view on therapy that I would like your opinion of. As lead
is pretty certainly a problem and because DMSA binds to lead before
mercury (correct me if this is wrong)

It binds to both just fine simultaneously. The amount of lead and
mercury in any living being is much less than is required to saturate
all the DMSA you give in even a very small dose.

then fairly aggressive use of
DMDSA might be warranted as there is plenty of lead for DMSA to
bind
to.

I don't know the kinetics of lead and DMSA off hand, but i doubt it is
linear. Thus increasing the dose only modestly increases lead removal


rates, but greatly increases side effects and risks.


Would there still be a role for lipoic acid in the therapy if the
DMSA is busy dealing with lead?

Yes, it will do the mercury and arsenic, and while it may not chelate
lead, it is known to make lead intoxicated animals healthier while it
is being given.

Maybe the ALA would push any blood
mercury into the brain as the DMSA is too busy binding with lead to
mop up mercury.

There will be lots of DMSA around to mop up the mercury.

We have been using both DMSA and lipoic but I have
been wondering whether to stop the lipoic until the DMSA has dealt
with the lead. Also, can one crank up the dosages of DMSA to deal
with the lead and the arsenic first?

DMSA is not very good for arsenic.

I would NOT jack the doses up or it will spash the mercury all over
the place.

Waht do you think are the chances of recovery from lead posioning.

Excellent.

Can the heme synthesis disturbance be corrected with chelation (ie
can the d-ALA levels and coproporhyrins come down and how long would
this take?).

Yes. A few months to a year. That is one of the tests I personally
had - coproporphyrin and uroporphyrin going from 3 times the normal


limit to within the normal range in about 8 months of chelation.

Incidentally, my son's haemoglobin levels have been OK
so I don't know how this squares with disruptions to the heme
synthetase evidence by d-ALA and the coproporphyrins. Can you
explain?

The body just tries to make more, and synthesis isn't BLOCKED, it is
just slowed down a bit.


Ther mainstream literature is very pessimistic about cognitive and
behavioural recoery for kids lead poisoned.

For the most part they don't have papers where they did
neuropsychological testing on chelated children. They mostly did it
on children who continued to be toxic.

The only account of
improvement I know is the Turning Lead into Gold book.


4. This is the scary one: if DMSA doesn't cross the blood brain
barrier,
then how does it get lead out of the brain or doesn't it?

Many minerals cross the blood-brain barrier. While I don't have
strong evidence of it, I believe lead is one of them that does so at a
reasonable rate. Unlike mercury or arsenic.


Not directly, but there is some modest reason to believe that lead
DOES ccross the bbb, so it will come out for the DMSA to get it.


Andy

Can you expand on your comment that lead will? may? leave the bra



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