Clinical Detoxification Case Study: Treating Multiple Inflammatory Symptoms

A 67-year-old woman presented in summer of 2019 with the chief concerns of multiple allergies and food sensitivities, irritable bowel syndrome (IBS), migraine headaches, arthritis, and osteoporosis. She also experienced recurrent blisters on mouth, head, and neck. Her blisters would be triggered by various identified foods, such as wine, gluten, sugar, and several other trigger foods.

In addition, the patient observed that some prescriptions she used for arthritis and allergies would also worsen the severity and frequency of blister outbreaks. Her headaches started during an extreme period of stress in her career over 15 years prior. She would get at least one headache per month that could last up to 10 days and reported that approximately 50 percent of calendar days each month are typically with either tension or migraine headaches.

Symptoms that would indicate a need for liver support are:

• Multiple allergies
• IBS
• Migraine
• Arthritis
• Osteoporosis

Her initial treatment plan consisted of digestive enzymes such as hydrochloric acid (HCL) and pepsin, with a soothing digestive formula with glutamine, aloe, and deglycyrrhized licorice (DGL). I also started her on an extract of Petasites hybridus (purple butterbur) for her migraines.

A nutritional focus on liver supportive foods such as greens, beets, beans, garlic, and onions were suggested. My initial testing consisted of salivary adrenal status hormone tests with stool tests for beneficial bacteria and pathogens. Her morning cortisol was slightly elevated, and borderline depressed DHEA, with normal progesterone, testosterone, and estrogen. Her pancreatic enzyme function marker of chymotrypsin came back borderline low. No parasites or pathogens detected, however there were some slight imbalances in her beneficial bacteria.

My initial focus on working to reset the bowel flora with antimicrobial herbs, probiotics and gentle liver supportive herbal formulas brought some relief to the headaches, but not resolution. Adrenal adaptogens to help balance cortisol were providing some improved energy and better sleep. Her blisters were slightly reduced in frequency but still prone for acute flare-ups.

After six months of digestive and stress related support, the patient reported that through biopsies done of the blisters by a dermatologist at a university hospital, that she was diagnosed with a rare autoimmune disease call Epidermolysis Bullosa Acquista (EBA). EBA is caused by antibodies targeting type VII collagen. She was offered prednisone therapy to suppress the blister outbreaks, however, she adamantly stated she would rather have the blisters than take the medication, due to the potential side effects. She was frustrated that prednisone would not treat the underlying cause of the disease, but only mask the symptoms. Because mercury is known to dysregulate the immune system, autoimmune disease is an automatic trigger for me to do body burden testing for mercury.

I ordered a DMSA provoked urine test for toxic metals. Results showed extremely high levels of mercury, at 69.13 ug/g creatine (reference should be 2.19 or less). Also, lead at 15.0 (reference 1.4 or less), barium at 30.9 (reference 6.7 or less), gadolinium 0.101 (reference 0.019 or less). She underwent six months of following my detoxification protocol, including chelation therapy with DMSA. In my experience, when mercury levels are less than 30 ug/g creatinine, two to three months of chelation therapy is generally effective. However, with levels higher than 30 ug/g creatinine, a patient will need at least 3 to 6 months of chelation therapy.

Clinically, the patient reported that during detoxification the blisters were intensified. With increased frequency, she reported eight to 10 blisters at once and longer duration,  with blisters lasting up to two weeks. Chelation therapy was prolonged for this patient because she would have to take breaks from actively using DMSA more frequently than the inherent planned breaks in the protocol. These longer breaks helped manage her inflammation levels. As toxins are removed from the stored tissues, it is not uncommon to see symptoms flare that are associated with the toxins. With focused attention to the support nutrients for liver function, frequent sauna, and a clean diet, the patient was able to proceed carefully.

Because mercury is a known to dysregulate the immune system, it is difficult to detoxify patients with such high levels. As the mercury circulates, rather than being sequestered, there is potential for increased inflammatory symptoms. The immune system is suppressed due to the mercury circulating in the system and she was most sensitive during this process. This is critical to educate and coach a patient through, as well as why detoxification protocols cannot simply be nutrients, herbs, and chelation agents. All aspects of the process must be addressed and leaned into when detoxification intensifies symptoms.

The patient experienced more relief by utilizing sauna, relaxation tools, journaling, meditation, and diligence with her nutrition. For this patient, after about six months, we retested the DMSA provoked urine test for toxic metals. Mercury reduced to 5.49, lead still elevated at 24.7, gadolinium still elevated at 0.160, but barium had also reduced to below range at 2.9.

Upon reviewing her follow up tests, which was fall of 2020, the patient reported improvements on all parameters. Mental clarity, energy and sleep were all remarkably better. Headaches were resolved, to a point she felt migraines were gone. While blisters used to last up to two weeks, now she might get one to two blisters sporadically that were gone by one to three days. Food restrictions of gluten and dairy were maintained, but the patient reported being able to eat banana for first time in years and had chosen to reintroduce coffee and occasional alcohol. She was tolerating well more variety of foods and reporting good digestion.

After the holiday season, with more indiscretion with food choices and high stress events, the patient had increased episodes and duration of blister outbreaks. Our clinical focus shifted to treatment to restore mucosal immunity within the gut, so that her immune system and inflammation levels can be more responsive to ongoing stable symptoms. This included digestive enzymes, intestinal repair nutrients, ongoing cortisol balancing formula, and a probiotic reset, preceded by four weeks of antimicrobial herbs.

By May of this year, the patient reports feeling good after the probiotic reset. Her bowels were moving great and her foods felt stabilized in that her capacity to tolerate more foods was strong. She still had to maintain a clean, wholefoods diet, but seemed more tolerant of stray ingestions of alcohol, sugar, or other indiscretions. Her blisters were described as more like a pinhead and last only two days. She reported that she doesn’t really get them unless she eats a trigger food. If she has an outbreak, she increases her dose of cortisol lowering formula, and observes it help resolve the blisters. Her headaches are rare and sporadic, reporting the if neck is stiff or sleeps wrong it can trigger her tension headache, but she is no longer using any migraine medicines because she is not getting them. She is also not using any of the previously used allergy medicines.

Editor’s Note: This is an excerpt from the e-book, An Introduction to Clinical Detoxification in Integrative Medicine. To access the full text, click here.