Research & Education

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. 
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 are 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 the Metametrix Interpretive Guide has to say about it:
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 interpretive guide describes gastrointestinal distress? Another vary 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

by Dr. Kara Fitzgerald



Dr. Fitzgerald received her doctorate of naturopathic medicine from National College of Natural Medicine in Portland Oregon. She completed the first CNME-accredited post-doctorate position in nutritional biochemistry and laboratory science at Metametrix Clinical Laboratory under the direction of Richard Lord Ph.D. Her residency was completed at Progressive Medical Center a large integrative medical practice in Atlanta Georgia. Dr. Fitzgerald is lead author and editor with J. Alexander Bralley Ph.D. of The Metametrix Institute's Case Studies in Integrative and Functional Medicine. She is a contributing author to Laboratory Evaluations for Integrative and Functional Medicine and the Institute for Functional Medicine's updated Textbook for Functional Medicine. She has also published in a number of peer reviewed journals. Dr. Fitzgerald is on faculty and a Curriculum Advisory Committee member at Institute for Functional Medicine. She is an adjunct faculty member at University of Bridgeport in the school of Human Nutrition and a member of The Institute for Therapeutic Discovery. Dr. Fitzgerald regularly lectures internationally for several organizations. Formerly at Advanced Diagnostic Pain Treatment Center at Yale-New Haven she is now in private practice in Sandy Hook Connecticut. She may be reached at or