Internal medicine specialist and her patients say they see direct relationship between fish consumption, high mercury levels and bizarre ailments

10/20/02

By BEN RAINES
Staff Reporter
 

SAN FRANCISCO --Jane Hightower, one of San Francisco's leading internal medicine specialists, a physician to rock stars, actors and writers, was at a loss to explain the unusual ailments afflicting her most health-conscious patients. Heart tests, CAT scans, spinal taps and blood work showed only that the patients took good care of themselves.

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Yet clearly they were sick.

A surgeon had tremors so bad she was afraid she'd have to give up operating. A geophysicist said he couldn't think anymore and was unable to do even simple subtraction. A mother, father and child living on a ranch in the rolling hills of wine country were losing their hair.

Ultimately, there were about 200 patients, dotted all over the hills around San Francisco, most enjoying the good life complete with nannies and private yoga instructors and sweeping views of the Golden Gate Bridge.

They were scientists, surgeons, CEOs, psychiatrists, wine-makers, writers and children, and the only thing they seemed to have in common were the persistent symptoms -- including severe memory loss, depression and a strange metallic taste in their mouths -- that might have a hundred causes but would not respond to any treatment.

Now, in a diagnosis rattling experts in San Francisco's medical community and beyond, Hightower has determined that all of those patients were suffering from mercury poisoning, and the mercury came from the fancy fish they ate.

She was set to present a paper describing her findings Saturday at a Vermont conference called "Methylmercury Contaminmation in Fish: Human Exposures and Case Reports," sponsored by the U.S. Environmental Protection Agency, the U.S. Centers for Disease Control and the American Academy of Pediatrics, among others.

The paper has been reviewed by her scientific peers and will be published in Environmental Health Perspectives, a medical journal produced by the National Institutes of Health.

Last year, Mobile Register-sponsored testing of 65 fish consumers on the Gulf Coast revealed that many had mercury levels some five to 10 times higher that the EPA's safe level. But would people with such mercury concentrations actually suffer ill effects? The scientific data was not definitive.

Hightower believes her work cuts through many of the ambiguities, and should cause concern anywhere that people eat large predator fish such as grouper, tuna, amberjack and swordfish.

"Jane's patient base is quite convincing in terms of exposure," said Kate Mahaffey, the EPA's top official regarding mercury, who has visited Hightower's clinic. "Now, it's time for scientists and physicians to study the effects she describes. In the exposure range she describes, we simply don't have a lot of published medical evaluations."

Hightower and her colleagues have linked sometimes devastating health problems to the consumption of tuna, Chilean sea bass, grouper and other popular fish known to have high levels of mercury in their flesh. Some women were found to have transferred excessive mercury to their infants solely through their breast milk.

Treating patients with elevated mercury levels since 1999, Hightower and doctors working with her observed a suite of health effects including depression, loss of scalp hair, metallic taste, headaches, arthritic pain in joints, irritability, tremors, and numbness and tingling in hands and feet. She also described cognitive problems such as pronounced memory loss, confusion and difficulties in talking. In some cases, those problems were so severe they interfered with the ability to earn a living or attend school.

In every case, the doctors say there have been dramatic improvements in the health of patients within a few months of cutting fish from their diets.

"The symptoms my patients were reporting are consistent with symptoms reported in medical literature from around the world when it comes to mercury poisoning," Hightower said. "I'm just a doctor that happened onto this, but it's so clear. When we pulled fish out of the diet, the mercury levels came down and the symptoms went away. In medicine, that's about as good as it gets for proving something is the culprit. And we've seen it over and over again."

Alan Stern, a New Jersey researcher, noted mercury authority and a member of the National Academy of Sciences, said he would have a "healthy skepticism" when looking at Hightower's clinical findings at this weekend's conference.

He also warned that the satellite of symptoms described by Hightower's patients could have a number of causes.

Still, he said of Hightower's findings, "I believe this is possible, but we don't have a lot of data. I'm not aware of any data that addresses the effects of low level adult exposure, so I'm very curious."

Hunting for symptoms:

"'You're crazy,' that was the most common diagnosis of these people before their mercury levels were known," Hightower said. "They had all these symptoms and it looked like they were making it up because no one could find a reason."

Hightower admits that she stumbled onto the fish and mercury connection after the ranch family members losing their hair were referred to her by Dr. Kathy Fields, a dermatologist who works in Hightower's medical group.

"I had heard on National Public Radio that heavy metals could make your hair fall out, so I ran a metals test on them," Fields said. "I called Jane and said, 'I've got this wild mercury level, see what you can do.'"

The family had extensive environmental testing performed on their property, searching for a mercury source in their well water, on their land and in their home. There was no mercury to be found.

On a hunch, Hightower asked about their diet and discovered they ate a lot of seafood, particularly big fish such as tuna and swordfish.

The wheels turned and Hightower picked up the phone and started calling some of her patients.

"I'm driving down the freeway and Hightower calls me and says, 'How much fish do you eat?' It was the weirdest thing," said Will Smith, the geophysicist forced to quit work when his symptoms were at their worst. "I was eating tuna all the time, for lunches, business dinners. I was eating sushi a lot and canned tuna several days a week as a snack. I told her and she said, 'I think it's mercury.'"

Among patients who showed mercury-related symptoms, Smith's situation was the most extreme. But a few ailments were common to all.

"The metallic taste, that was ever present," said Smith. "My speech was severely impacted, slurred, so was my memory, my balance. I couldn't watch TV because I became dizzy. I was always losing my car. I had tremors. I was always tired. I couldn't concentrate."

Hightower told Smith to cut fish out of his diet and he started getting better almost immediately, though it has been a long, slow process. Neurological testing has revealed that he suffered permanent damage to the parts of his brain that control executive functions. Doctors said the type of brain damage Smith has is almost exclusively associated with heavy metal exposure.

Doug Anderson, the San Francisco psychiatrist who treated Smith for depression, said Smith routinely left his keys or jacket at his office after their sessions and frequently got lost in a city he has lived in for decades.

Anderson noted that Smith got progressively better as the mercury left his system.

"That is the most logical culprit," Anderson said as a cable car clanged past his row house office. "The fish seems to be the most likely agent."

He has treated a number of Hightower's patients.

"For someone to come in with major cognitive problems like Will had, we always look for treatable causes. At the bottom of a long list of potential things are pesticides and heavy metals," Anderson said. "At this point, if people eat significant amounts of fish, they should be tested -- if you have a depression that doesn't clear up quickly with traditional treatment like Prozac, if there are cognitive deficiencies. Some people just feel low. They may not be melancholic, tearful or suicidal, but they have a pervasive sense that they can't function."

A plastic surgeon, who spoke to the Register on condition of anonymity, had symptoms similar to Smith's, though she rarely ate fish. In fact, her seafood diet was limited to fresh tuna steaks two or three times a month, she said. Yet her mercury level was six to seven times the EPA's safe level.

"My hair was just falling out," said the surgeon, who described herself as a "meat and chicken kind of girl."

"I had tremors and numbness and tingling in my hands and feet," she said. "And I had serious memory problems. I've always had an excellent memory, that's what got me through medical school. But all of a sudden, I couldn't remember who I had operated on the week before. Literally."

Hightower made her give up the tuna, and the mercury level came down within months. The surgeon said the symptoms just disappeared.

Not all of the patients were adults, and Hightower and Fields said the effects in children may be the most long-lasting.

"In an adult, you can have a recovery, because the brain is already formed. But in a child, mercury affects the migration of nerve cells, and it kills them. It's tragic. We're talking about permanent damage," Fields said.

Recently, articles in national publications have noted an increase in autism among children, an increase some have linked to mercury contamination of a preservative -- Thimerosal -- commonly used in vaccines. Hightower said that among the children she has treated, Thime rosal was ruled out as a possible source of mercury, either because the kids had never received it, or because it had been several years since their vaccinations. All of the children, however, had been exposed to fish known to be contaminated with mercury.

A 7-year-old boy who ate canned tuna, fresh tuna and king mackerel regularly from the age of 3 was found to have a mercury level 15 times the EPA's safe level. After eight months without fish, his mercury level had dropped to within the normal range, but it was too late. Hightower said extensive neuropsychiatric testing confirmed that he suffered some degree of permanent brain damage.

After passing all normal developmental milestones up to around age 3, when he began eating fish, the boy showed a severe decline in mental development. His mother said he quit socializing with others, was no longer able to express complete thoughts and couldn't remember classmates' names.

"Up until we stopped the fish, he was just completely in a fog. He would sit there, all by himself, totally lost," said his mother, who did not want to be named in order to protect him. "It's just horrifying, because with better information from the government, we could have prevented this. I was even eating fresh tuna when I was pregnant, you know. My son's improved, steadily and markedly, since we got him off of fish, but he's not fully recovered and I don't know that he ever will be. Still, he can communicate now, and he can make friends again."

Four-year-old Sophie Waldman lives in Berkeley with her parents, novelists Ayelet Waldman and Michael Chabon, a Pulitzer Prize winner. Sophie, her mother said, loves canned tuna and used to eat tuna sandwiches a couple of days a week.

"Sophie was an early walker and an early talker," Ayelet said, curled up on a couch in her dark and woody Berkeley bungalow. "Then she sort of slowed down. She was starting to tie her own shoes and then all of a sudden, she couldn't do it anymore. And she was sounding out words, then she couldn't do it anymore. And her hair was really weird. It wouldn't really grow and felt strange."

When Hightower pulled her off of fish, she got better.

"When her mercury level came down, she could tie her shoes again and was suddenly able to read. She had this huge developmental upsurge, after a year of being sort of stagnant," said Waldman, a Harvard-educated former public defender. "I'm not some Berkeley-mom-food- Nazi. My kids live off sugar, you know. But, I saw a difference in my kid. Simple as that."

Multiple forms of exposure:

Fields and Hightower said they found that their patients were exposed to mercury in three major ways:

-- Adults and children ate popular fish such as fresh tuna, .

-- Fetuses were exposed as a result of the mother's fish consumption.

-- Infants nursed from mothers with high mercury levels.

In the case of one patient, the only apparent source of exposure was fish oil supplement pills.

Hightower said symptoms can occur in patients with high mercury levels as well as in patients whose mercury levels fall within the "safe" range set by some federal agencies. Although all patients with symptoms had mercury concentrations in excess of the EPA's safe level, many showed effects when their mercury concentrations were below the U.S. Food and Drug Administration's safe level, which is four times higher than the EPA's.

She said some patients with highly elevated mercury levels were symptom-free. Hightower suggested that people may have different thresholds for mercury in their bodies.

"It's important not to get too hung up on the levels. We've found the absolute mercury level does not correspond to the number of symptoms or their severity. The symptoms are what's important, and they can occur at any level," she said. "Think of mercury like a bee sting. You know, some people will die from one bee sting. Others can handle 40 stings or 100 stings, but everybody has a threshold where the bee stings will kill them. What kills you isn't the bee sting. What kills you is your body's reaction to the bee sting. I think that's the way mercury works."

Fields said that as more doctors learn of Hightower's work, it's likely they will begin to diagnose mercury poisoning in patients who eat a lot of fish and have similar symptoms that cannot otherwise be explained.

"Our mercury is no different than anyone else's," said Hightower. "I'm just a doctor who happened to discover these mercury levels in my patients."

Similar levels have been documented in research literature in places as diverse as Washington state, Wisconsin, Maryland, New Jersey and California.

"This is afflicting the people who are doing what they are supposed to do, eating a lot of fish to get those Omega-3 fatty acids that are good for your heart. The problem is, it turns out these big popular predator fish have a contaminant in them: mercury," Hightower said. "It's not how much fish you eat that's the problem, it's what kind of fish you eat. If you are eating a fish that is bigger than the pot you are cooking it in, get a smaller fish, not a bigger pot."

She continued, "People are buying steaks of tuna or swordfish or amberjack or whatever these days. The steaks have no bones, they are easy to prepare and the fish taste good. The problem is they have so much mercury...

"I've seen in my patients that mercury levels can fluctuate up and down weekly based on what they ate and what day of the week they ate it. And guess what? Their symptoms can come and go like clockwork based on when they ate fish."

Several women in the group were found to have transferred excessive amounts of mercury to their infants solely through breast milk. One breast-fed baby had three times the EPA's safe level for mercury by the time he was 4 months old.

Jeanine Harmon breast-fed her child twice a day and fed him salmon and sole frequently. By the time he was 19 months old, he was found to have four times the EPA's safe level for mercury. Harmon, whose son is one of Hightower's patients, said she ate canned tuna a couple of times a week during and after pregnancy and worries she may have caused her son permanent brain damage.

"He seems fine now, but I'm an elementary school teacher. If he's going to have cognitive problems, they may not even show up until third grade," Harmon said. "It was horrifying, knowing I couldn't get it out of my baby's body. It's unnerving knowing he had such a high mercury level for so long as he was growing, when his brain was building."

Dr. Leslie Kardos, an obstetrician who works in the same building as Hightower, was tested for mercury five months after her baby was born. She had mercury concentrations more than three times the EPA's safe level. Her infant daughter was twice the safe level, her sole exposure through her mother's breast milk.

"I'm terrified because I know mercury exposure is linked to a lessening of the IQ, and here I was feeding it to my baby in my breast milk," Kardos said. "I had to pump and dump my milk for three months because I didn't want mercury in my milk. You know, I'm buying fish in good places, it looks good, and yet it's poisoning me. Clearly the government is not doing its job here."

Her fellow obstetrician, Heidi Wittenberg, discovered a number of her pregnant patients had excessive mercury levels and agrees with Kardos that the government has let the public down.

"When my patients ask me if canned tuna is OK, I tell them no. If they want to get pregnant, I tell them to eat fish once every two weeks. No more," Wittenberg said. "They say we're scaring people unnecessarily but the truth is the government has no idea. Where is the FDA? Why hasn't the NIH funded a study? If you're finding these levels in average Americans, how can you not address it?

"Here I am, I'm not drinking wine, I'm not doing drugs, I'm not eating cheeseburgers and yet I'm hurting my baby. These are smart people, doing heart-healthy things and they are hurting themselves or their babies," Fields said. "This is life-changing stuff."

Hightower said that in her view the government can't afford to duck the mercury problem any longer.

"All I can say is I saw this in the field. I'm in the trenches with the patients. Now, it's time for the scientists to do the big studies and see if there are correlations," Hightower said. "It's really sad and distressing. We don't want to lose our tuna, but if people get ill for a long time and they cut it out and feel better than they have in years, they'll quit eating fish. Especially if they go back and eat some and feel sick again."