Mercury also works effectively to produce a deficiency state of selenium. Restoring deficient selenium stores can lessen clinical mercury toxicity, although it does not directly promote the mobilization or elimination of mercury. Congestive cardiomyopathy secondary to selenium deficiency has been reported, and restoring depleted selenium levels can reverse it. [54-57] Based on the data above on mercury and IDCM, a cardiomyopathy associated with selenium deficiency is likely a cardiomyopathy due to the toxicity of excess mercury no longer being negated by a sufficient presence of selenium. Of note, too much supplemental selenium has its own toxicity, unlike many other nutrient supplements, and should not be overdone.
Aluminum: Aluminum phosphide, an agent used as a pesticide, induced a severe, but reversible, cardiomyopathy after accidental poisoning in an exterminator. [58] Intense supportive care to reverse low blood pressure was shown to facilitate the recovery of other individuals poisoned with aluminum phosphide that resulted in severe compromise of heart contractility. [59,60] In a hemodialysis patient who expired with heart failure, heavy aluminum deposits were seen in the heart cells upon electron microscope examination. [61] An animal study also showed that aluminum chloride could induce a largely reversible cardiomyopathy. [62] Organic acids (succinic, malic, or citric) and the iron chelator, desferrioxamine, are agents that can mobilize (solubilize) and eliminate aluminum accumulations. [63]
Cobalt/Chromium: Cobalt is another toxic heavy metal documented as a cause of congestive cardiomyopathy. Elevated blood cobalt levels have been identified in some metal hip implant patients. [64,65] Elevated blood chromium levels from the implants can be seen as well. [66,67] However, the presence of such elevations is not an assurance that a cardiomyopathy will result. [68] As noted above, IDCM often starts with an undiagnosed viral myocarditis. Such a myocarditis would appear to inflict the myocardial damage that triggers the almost sponge-like uptake of cobalt and other heavy metals, as described in the section on mercury accumulation in the heart. An animal study also showed that poor diet (protein restriction) further predisposed the heart to cobalt toxicity. [69] N-acetylcysteine is effective in significantly reducing the blood concentrations of both cobalt and chromium. [70] Alpha lipoic acid is another effective chelator of cobalt. [71]
Cadmium: A study examining blood, serum, and urine heavy metal levels found significantly higher cadmium levels in IDCM patients than in healthy controls. [72]
Gold/Silver: While gold and silver are not recognized as toxic substances in general, some care always needs to be exerted in a supplementation regimen, especially one involving metals. In a case report, a dilated congestive cardiomyopathy resulted from the excessive ingestion of colloidal gold for about three months, along with a history of intermittent colloidal silver ingestion over the prior seven years. In addition to an enlarged heart that was contracting poorly, a significant new heart conduction abnormality (left bundle branch block) resulted from this supplementation. Following chelation therapy (dimercaprol) the block disappeared and the ejection fraction of the heart improved from 20% to 50%, a very dramatic improvement. Of note, urine screening (no tissue levels measured) revealed no evidence of excess aluminum, arsenic, barium, beryllium, cadmium, copper, manganese, or thallium. [73]
Chemotherapy: Cancer chemotherapy utilizes some agents that are highly toxic to the heart. Anthracyclines (doxorubicin, idarubicin, epirubicin, mitoxantrone) often result in some heart enlargement and decreased contractility. [74,75] These are cardiac effects that are still considered to be largely irreversible, even though chelation therapy has been shown to be effective in preventing such cardiac damage. [76-79] Considering that multiple toxins and heavy metals are typically present in patients with IDCM, it should not be assumed that trying to remove as much of the toxin load from the body (and the heart) will be of no benefit. Cancer patients typically have other diseases as well, and it is reasonable to think that some of these patients (such as those with the copper accumulation often seen in diabetes) might have already been accumulating cardiac toxins before there was any evidence of cardiac compromise. As such, chelation therapy would have the potential to at least partially reverse the cardiac damage currently seen with chemotherapy.
To be Continuied in the next January 2024 issue of MOH.