Goop, Gwyneth Paltrow’s “den of celebrity pseudoscience,” has been aptly described as “pure, unadulterated, blood-diamond free, organic-certified, biodynamic, moon-dusted bullshit” that “you should avoid . . . at all cost,” “stoking fears and selling unproven and mostly quack therapies,” “a reliably laughable source of pseudoscience” and peddling “fake empowerment through snake oil.” The Cleveland Clinic’s functional medicine guru, Dr. Mark Hyman, has been called out by SBM and others for his anti-vaccination and anti-fluoridation ideology, “chemical hypocrisy,” promotion and practice of so-called “functional medicine,” dubious “broken brain” advice, use of unvalidated diagnostic testing, selling dietary supplements of questionable value and anecdote-based “evidence,” as well as mangling autism and dementia science, systems biology, and cancer research. [New fun fact I learned about Dr. Hyman in researching this post: He wrote the forward to the Food Babe’s book.]
So, when I recently happened upon a Q&A with Dr. Hyman on Goop’s website entitled “What to Know about Heavy Metals”, I suspected I was in for a heavy helping of what science journalist Julia Belluz calls “Goopshit.” Turns out my prediction was correct.
That is not to say the article did not hold value, just not in the way Goop and Dr. Hyman likely intended: It shed some light on the occult practices of functional medicine, heretofore hidden behind a $15,000 paywall, protected from critical observation in the medical literature.
In submitting to Goop’s Q&A, Dr. Hyman sticks to his usual modus operandi, which is to avoid the scrutiny of actual scientists by pitching his dubious advice straight to consumers via outlets like The Huffington Post, TED talks, books, DVDs, and PBS infomercials, in lieu of publishing a cogent explication in, say, a respectable medical journal. As one physician critic pointed out, to support his fringe ideas,
Dr. Hyman has used what I refer to as a cut-and-paste technique; he takes isolated observations out of context to generate a theory not proven or justified by the findings.
As we shall see, the Goop article is no exception.
Faux “heavy metal toxicity”
First, the fearmongering. While it is true that heavy metal toxicity a dangerous medical condition, it is also rare (a fact even Goop’s introduction admits). That, however, is not what Dr. Hyman really means when he talks about “an unhealthy accumulation of heavy metals” in the body. What he is trying to sell us on is the notion that common conditions like chronic fatigue, depression, anxiety, insomnia, and digestive problems could be symptoms of this “unhealthy accumulation”. They can also be “a neglected factor in treating chronic disease”. Thus, in his view, “it is essential to look at heavy metals as a potential factor”. To add fuel to the fire, Dr. Hyman warns us that heavy metals “may contribute” to autoimmune diseases and that obesity, ADD, autism, Alzheimer’s, Parkinson’s, and heart disease have been “proposed to be affected by heavy metals”.
But, because “traditional physicians [presumably meaning those who adhere to evidence-based practices] have very limited training in diagnosing and treating patients with heavy metal poisoning”, he recommends a functional medicine (FM) practitioner because “they will be able to assist you in a safe detoxification process”. He suggests you check with the Institute of Functional Medicine (IFM), where he teaches and sits on the Board, or the American College for Advancement in Medicine (ACAM) to find a practitioner.
Thus, having planted the suggestion that you may have heavy metal poisoning based on any number of symptoms of common conditions that very likely have nothing to do with true heavy metal poisoning, he poisons the well by diverting you from seeking the advice of a “traditional” physician and reroutes you to a functional medicine or ACAM practitioner. What he doesn’t mention is that functional medicine lacks supporting evidence and is potentially dangerous, according to that bastion of “traditional” physicians, the American Academy of Family Physicians, and that ACAM is, in the words of former SBM regular Kimball Atwood, MD, a “pseudomedical pseudoprofessional organization” that “stands at the center of what is probably the largest and most insidious family of organizations hyping implausible practices and the ‘freedom’ to peddle them”. ACAM is also on Quackwatch’s list of questionable organizations.
Once you reach your FM or ACAM practitioner, “specialized tests” may be necessary to determine your assumed exposure, according to Dr. Hyman. The most common, he says, are blood tests to “detect your current heavy metal exposure”, hair testing, which “detects specific types of mineral imbalances and deficiencies in the body”, and chelation challenge testing “to find out your total body load of heavy metals.” He laments that chelation challenge testing and the “benefits of chelation” aren’t “taken more seriously” and are “not widely accepted in traditional medicine” “given the evidence of its effectiveness [citing this article] and safety [citing this article]”. In fact, he says he’s “used this test on tens of thousands of patients” [emphasis added] in his 30 years of practice.
Not “widely accepted?” That hardly begins to describe it. As it turns out, there are good reasons why science-based medicine rejects these “specialized” tests. Fortuitously, I discovered that the inimitable Dr. Jen Gunter had read the article too and consulted a real expert, Dr. David Juurlink, who is board-certified in Medical Toxicology and head of the Division of Clinical Pharmacology & Toxicology at the University of Toronto. She quotes him in her post, “GOOP posts dangerous, bullshit article on heavy metals”.
Hair testing? According to Dr. Juurlink,
‘Hair testing for heavy metals is bullshit. I have seen people fall for this scam more times than I can remember.’ He added that the issue with hair testing is that the levels are almost always very high and that ‘any toxicologist worth his or her salt will tell you [the test] cannot be interpreted.’
What about the chelation challenge test? (For an explanation of how the test is done, see here.)
It’s not widely accepted because it’s uninformative and misleading. It’s not validated, the types and doses of chelating agents used are inconsistent, and depending on what’s being tested, urine levels will go up in normal people after a ‘challenge.’ This isn’t indicative of poisoning or the need for treatment, and it’s not a valid indicator of a given metal’s body burden. Provocation testing [another name for challenge testing] does not distinguish between poisoned and non-poisoned people and simply should not be done. [Emphasis added.]
Dr. Jurrlink’s assessment of hair and challenge testing is well-established in medical toxicology science. As the American College of Medical Toxicologists (ACMT) explains, we are all constantly exposed to metals and often have detectable levels without being poisoned. Indiscriminate testing may result in needless concern when a test result is outside the “normal” reference range. So, among AMCT’s “Ten Things Physicians and Patients Should Question” are three of Dr. Hyman’s testing recommendations:
- Don’t administer a chelating agent prior to testing urine for metals, a practice referred to as “provoked” urine testing.
- Don’t order heavy metal screening tests to asses non-specific symptoms in the absence of excessive exposure to metals.
- Don’t perform hair or nail testing for “metal poisoning” screening in patients with non-specific symptoms.
Nothing in the two articles cited by Dr. Hyman as supporting the purported effectiveness and safety of chelation challenge testing overcomes this overwhelming consensus among toxicology experts. (I’m not even sure what he means by the “effectiveness” of the chelation challenge test. If he’s trying to claim the test is clinically valid, it isn’t, according to both the FDA and Dr. Juurlink.) They do, however, provide excellent examples of what one critic called his “cut and paste” cherry picking of the evidence. To add insult to injury, the 2009 article he cites on “safety” touts widely discredited DMSA chelation for autistic children, a treatment SBM’s own neurologist, Steve Novella, labeled quackery. It was among the studies in a 2015 Cochrane Database review, which Hyman fails to mention, resulting in the conclusion,
. . . no clinical trial evidence was found to suggest that pharmaceutical chelation is an effective intervention for ASD. Given prior reports of serious adverse events, such as hypocalcaemia, renal impairment and reported death, the risks of using chelation for ASD currently outweigh proven benefits.
If by blood testing, Dr. Hyman means red blood cell testing (RBC) “offered by certain commercial laboratories (usually not mainstream clinical laboratories affiliated with hospitals)”, here’s what experts say about that:
Multiple searches of online medical databases were unable to uncover peer-reviewed scientific literature regarding the accuracy, methods, or usefulness of red blood cell testing of . . . metals [other than mercury].
RBC was a “reasonable proxy” for methylmercury exposure but “there was large inter-individual variation.”
But, let’s assume that a hapless patient has been convinced by his “certified” functional medicine practitioner (who could just as easily be a chiropractor or a naturopath as a physician) that he is indeed infested with heavy metals. What to do? According to Dr. Hyman, in addition to some anodyne advice on increasing the intake of “detoxifying foods” and avoiding exposure, he recommends dietary supplements, exercise and sweating via a “sauna, steam or bath” to “rid your body of toxins,” removing dental amalgam, and chelation.
Hyman prescribes IV or oral chelation “to remove lead and mercury from the body”.
I may prescribe chelation therapy for severe cases, such as chronic fatigue, depression, kidney failure, or a server autoimmune condition.
He explains that there are risks associated with chelation, but for “most patients, the risks outweigh the benefits”.
He doesn’t recommend just any dietary supplements for your “detoxification” either. He touts those sold by his personal online store, including brands connected to his Institute for Functional Medicine compatriots: Jeffrey Brand, who “created the concept of functional medicine” and formerly found himself in the crosshairs of the FDA, and Dr. Robert Roundtree, who teaches several sessions of IFM’s “Detox Advanced Practice Module,” a subject we’ll return to in a moment. Bland started Hyman-recommended Metagenics (since sold to the same company that owns Amway) and Roundtree is the Chief Medical Advisor for Thorne, also recommended. That’s another advantage of publishing your ideas in pop culture media instead of the medical literature: no pesky financial interest disclosures.
Here again, we find Dr. Hyman’s advice runs counter to that of experts in medical toxicology. According to the ACMT’s “Choosing Wisely”:
- Don’t use homeopathic medications, non-vitamin dietary supplements or herbal supplements as treatments for disease or preventive health measures.
- Don’t recommend chelation except for documented metal intoxication which has been diagnosed using validated tests in appropriate biological samples.
- Don’t remove mercury-containing dental amalgams.
- Don’t recommend “detoxification” through colon cleansing or promoting sweating for disease treatment or prevention. . . Promoting sweating doesn’t produce clinically relevant toxin elimination. Methods to promote sweating may cause heat stroke, dehydration, burns, myocardial injury, carbon monoxide poisoning and liver or kidney damage, which might compromise toxin elimination.
I think Dr. Hyman just won American College of Medical Toxicologists bingo, having recommended fully seven out the ten things toxicology experts say you shouldn’t do.
As the ACMT explains further,
Even when used for appropriately diagnosed metal intoxication, chelating drugs may have significant side effects, including dehydration, hypocalcemia, kidney injury, liver enzyme elevations, hypotension, allergic reactions and essential mineral deficiencies. Inappropriate chelation, which may cost hundreds to thousands of dollars, risks these harms, as well as neurodevelopmental toxicity, teratogenicity and death.
(See also here.) Hardly worth it for a diagnosis based on bogus testing.
The ACMT, of course, is not alone rejecting Dr. Hyman’s recommendations. For one thing, ironically, herbal remedies and dietary supplements are actually a risk factor for heavy metal poisoning. (For a more detailed description of the scant evidence for, and risks associated with, dietary supplements recommended for elimination of toxic substances, see here.)
The American Dental Association, whose members could make a bundle extracting old fillings and replacing them if they wanted to scare-monger, after a review of the evidence (also here), concluded that
Dental amalgam is considered a safe, affordable and durable material that has been used to restore the teeth of more than 100 million Americans. Dental amalgam has been studied and reviewed extensively, and has established a record of safety and effectiveness.
Not surprisingly, Grant Ritchey, SBM’s semi-resident dentist, reached the same conclusion.
But, again shielding the gullible from anyone who might disagree with him (or call his ideas a “hot mess”, like Dr. Gunter did), Dr. Hyman’s recommended source for dental advice is the International Academy of Oral Medicine and Toxicology. That organization, as Dr. Ritchey points out, is chock full of anti-amalgam dentists. Dr. Ritchey also recommends this excellent review of the literature refuting like-minded claims.
consideration of chelation therapy for patients with suspected or confirmed metal exposures should be made in conjunction with a medical toxicologist or the local poison control center
. . . and not a functional medicine practitioner.
But, as I mentioned earlier, Goop’s article does have some value, in that it lifts the veil on the practice of functional medicine. One of the IFM’s courses for “certification” as a functional medicine practitioner is the previously-noted Detox Advanced Practice Module. Although the “Detox” course is vague about its content, the tropes of faux toxicity are all there:
Our expert faculty team will review the foundational biochemistry and genetics of biotransformation pathways, connect organ system dysfunctions to potential toxic exposures, and detail the available laboratory evaluations useful in working up a toxin-exposed patient. Once these important clinical connections are made, the team will detail specific treatment approaches.
The “expert faculty team” includes Hyman (in the form of a course pre-requisite), Thorne’s Dr. Robert Roundtree, a chiropractor who previously taught an IFM course on chelation, a dentist/naturopath whose practice includes amalgam removal, and Joseph Pizzorno, a naturopath whose textbook tells us that a whopping 25% of the U.S. public suffers from “heavy metal poisoning” and recommends chelation challenge testing.
Given the fact that actual heavy metal toxicity is rare, IFM’s devotion of a whole course (out of six modules) to “toxic exposures” is suspect. My guess is that IFM is teaching the same sort of discredited testing and treatments that Hyman espouses in Goop, then sending out its “certified” practitioners into the world to foist these expensive, unnecessary and potentially dangerous regimens on the public. If that is the case, then the Cleveland Clinic’s association with functional medicine and its functionaries is all the more ethically reprehensible. And the “detox” module shouldn’t get 17.5 CME credits via the ACCME either.