Cesium: Coming to a fish near you?

I am not at all interested in being an alarmist. We’ve got enough real-life drama already: storm Sandy last week with its massive devastation (and clear climate change influence), and the never-ending reams of high-quality research emerging that illustrate the contribution of everyday chemicals to most diseases. Seriously. It can feel quite overwhelming sometimes. That said, did you catch that New York Times article on 10-26-12 talking about contamination from the Fukushima nuclear disaster?

“The fact that many fish [in the ocean around Fukushima, Japan] are just as contaminated today with cesium 134 and cesium 137 as they were more than one year ago implies that cesium is still being released into the food chain,” Mr. Buesseler wrote.** This kind of cesium has a half-life of 30 years, meaning that it falls off by half in radioactive intensity every 30 years. Incidentally, radioactive cesium has also been found in Japanese baby formula (since removed from the market).

As I read that NYT article, the light of recognition prompted me to recall a patient who had a slightly elevated cesium level. She’s a lovely 30-year-old woman living in NYC. I’ll call her JT. JT came to see me for a second opinion regarding a complete thyroidectomy for multinodular goiter. The pathology report results didn’t indicate the need for removing the gland, although there were suspicious findings. I recommended a second biopsy, the results of which determined the nodules were benign. She didn’t need to have her thyroid removed after all. Thank God for second opinion.

With the thyroidectomy drama out of the way, we took a systems approach to identifying the underlying cause of the nodules. (Here’s a case example of what I mean by “systems approach” using the IFM Matrix.) JT responded well to treatment, the nodules appear stable, and she feels good today. Eventually, I’ll write her case up in greater detail, but right now I am focusing on the cesium connection.

As with most patients, I wanted to take a look at JT’s potential toxin exposures. The flag for me with JT was the fact that she relied heavily on sushi for her protein.

If not careful, we can exceed the EPA limit for mercury exposure with the intake of certain fish. And as I discussed last month, PCBs can be very high in farm-raised salmon, among other foods.

I ran a urine toxic and essential elements test on JT. As I suspected, JT’s mercury level was quite high. I advised JT to eat low mercury fish and gave her the EPA guidelines. We also started a treatment protocol to remove the mercury from her body.

In addition to the elevated mercury, I also noticed she had a high-normal level of cesium. Cesium? Huh? I pinged my brain, but received no reply…. Cesium just wasn’t in there. Here’s what this research paper has to say about it:

“Cesium is relatively safe; signs of its mild toxicity are gastrointestinal distress, hypotension, syncope, numbness, or tingling of the lips. Nevertheless, total cesium intakes of 6 g/day have been found to produce severe hypokalemia, hypomagnesemia, prolonged QTc interval, episodes of polymorphic ventricular tachycardia, with or without torsade de pointes, and even acute heart arrest. However, full information on its acute and chronic toxicity is not sufficiently known. Health care providers should be aware of the cardiac complications, as a result of careless cesium usage as alternative medicine.”

The CDC also notes that small amounts of the radioactive form are present in our environment from weapons testing in the 1950s and 60s, as well as in cancer radiation therapy equipment. This form can increase the risk for cancer.

Cesium
I thought to myself, where on earth is JT getting exposure to cesium?? I decided I would watch it, holding a secret hope that it was a fluke finding on a single test. Interestingly, however, she did have mildly reduced levels of magnesium (hypomagnesmia) and potassium (hypokalemia), issues associated with cesium exposure and a zillion other conditions. As with most findings associated with metals, they are very non-specific.

JT also had had some gastrointestinal complaints, but we had resolved those earlier. And who among our patients doesn’t complain of, as the above paper describes, “gastrointestinal distress”? Another very vague symptom we can’t readily link to cesium. My thinking at the time was that we had JT’s bases covered for a potential cesium exposure from who knows where. And if it was radioactive, I was glad we had her on a good antioxidant protocol, which was not based on the presence of cesium, but rather on the fact that oxidative stress is a likely contributing factor in thyroid disease.

So, as I read the NYT article last week and the dawn of recognition lit my grey matter, I wondered, could JT have gotten exposure from the fish she ate?

I emailed the laboratory to get their thoughts on it. First, it was established that the cesium measured on the test wasn’t a radioactive isotope. That was good news. But as the conversation continued, some of the lab’s “brain trust,” Terry Pollock, MS, and Richard Lord, PhD, both thought that non-radioactive cesium could be associated with the radioactive isotopes (isotopes tend to congregate), and therefore a radioactive exposure couldn’t be ruled out conclusively.

Damn. What now? (Again, I don’t want to be an alarmist. Remember, her exposure wasn’t frankly elevated but what I call “high-normal”; that is, when we looked at her results as compared to the population as a whole, she was higher than 80% of the population, but still within the so-called “normal limits” as compared to the standard laboratory reference range.)

I contacted JT a couple of days ago and suggested she stop all fish for the time being — she was still consuming limited amounts of the EPA-OK fish. It just seemed safer to stop while we monitor and treat, rather than to figure out what fish in the U.S., if any, has cesium.

I don’t have follow-up results on her yet, as we’ve just initiated these changes. However, I do think JT stands a better chance for a good outcome because of a systems approach to her treatment. So stay tuned. And by all means, comment away if you have thoughts. And yes, she continues to take a very high quality fish oil supplement. And yes, I do wonder what effect, if any, a potentially radioactive cesium exposure would have to do with her thyroid disease.
**Science 1 June 2012: Vol. 336 no. 6085 pp. 1115-1116