Provocation Testing

Why do we need provocation testing?

Without testing we cannot be sure that toxicity is actually present even though a lot of medicine is practiced without ever looking at what is causing the particular problem (for example, treatments for depression, anxiety, hypertension and other conditions). Patients can be exploited when they are told to buy dubious supplements that have never been proven effective for chelation; furthermore, without proper testing we cannot assume that toxicity is present. Patients can be tricked into using supplements that they do not need.

In the body, mercury is bound to a tissue, primarily the nervous cells, thus causing damage. A Provocation test can reveal the total burden to the body, i.e. how much mercury is in the whole body. It does not, however, specify which organ is affected. The test just gives an idea how severely the patient is affected by heavy metal toxicity. One of the best laboratories to do this testing is Doctor’s Data (http://doctorsdata.com).

A Provocation test should always be preceded by a Random Test. The test will show how much the body is able to excrete (get rid of) mercury through urine. Random and provocation tests are compared. If there is little difference between them it can be because:

  • Patient does not have an issue with heavy metal toxicity.
  • There was an error in collecting, processing the test, or the provocation agent was defective.
  • Patient has difficulty excreting heavy metals, even though he/she has toxicity suspected by the clinical picture (false negative results).

Kinesiological testing may be one of the most reliable indicators of toxicity. It can also point to organs where mercury is still present. The only drawback is that it is not formally tested in medical studies and is not accepted by the medical establishment.

Is the provocation test dangerous?

For testing, we are using medications that can potentially cause side effects. Most of the side effects, however, are caused by using DMPS intravenously for provocation; we are using DMPS orally, not intravenously. The potential benefits and side effects should be considered in the process of deciding whether or not to do the test. I require patients to sign a consent form before the procedure. In my personal experience, and in the experience of sever al other experienced practitioners such as Drs. Klinghardt and Wojcik, serious side effects are extremely rare when DMPS is used orally and not intravenously, as it had been in the past. Patients should have a complete blood work prior to testing to be sure that he/she has adequate kidney and liver function.

Agents used for provocation testing

  • DMPS in doses of 500 mg or less, according to body weight or physical status, with urine collection for 6 or 24 hours. (Instructions for DMPS provocation test) Side effects are infrequent when DMPS is given as an oral agent. This test has become a gold standard in the industry. Intravenous DMPS is used very rarely for provocation testing because it can cause undesirable side effects for patients with reduced kidney function.
  • DMSA in doses of 500 mg orally, with subsequent urine collection for 6 or 24 hours. DMSA has less affinity for mercury, so it is not as revealing.
  • EDTA is not an effective oral agent, but sometimes it is used intravenously as a provocation agent. I do not use it at all.

Laboratory indicators for mercury toxicity

Acute toxicity can be determined by a blood mercury level, but under regular circumstances it is almost never needed.

Chronic toxicity is determined if there is a 10 fold increase between the pre- and post- challenge urinary mercury levels; or the post-challenge test is >5 mcg/g Creatine. Other norms exist and depend on the laboratory testing involved. (M. Dauderer “Mobilization test for environmental metal poisoning” Forum des practische und Algenende Artes 28 (1989), 88-90(transl))

Specific Urinary Porphyrin Profile- assesses chronic exposure to Mercury. Hg changes activity of uroporphynogen decarboxylaze (UROD) and coproporphynogen oxidase (CPOX). This test is available in some US laboratories, but it is not approved for use in NY.

To arrange for an appointment concerning chronic mercury toxicity