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Blood, Urine, and Sweat (BUS) Study: Monitoring
and Elimination of Bioaccumulated Toxic Elements
Stephen J. Genuis •Detlef Birkholz •
Ilia Rodushkin •Sanjay Beesoon
Received: 1 July 2010 / Accepted: 27 September 2010
ÓSpringer Science+Business Media, LLC 2010
Abstract There is limited understanding of the toxic-
okinetics of bioaccumulated toxic elements and their
methods of excretion from the human body. This study was
designed to assess the concentration of various toxic ele-
ments in three body fluids: blood, urine and sweat. Blood,
urine, and sweat were collected from 20 individuals (10
healthy participants and 10 participants with various health
problems) and analyzed for approximately 120 various
compounds, including toxic elements. Toxic elements were
found to differing degrees in each of blood, urine, and
sweat. Serum levels for most metals and metalloids were
comparable with those found in other studies in the sci-
entific literature. Many toxic elements appeared to be
preferentially excreted through sweat. Presumably stored in
tissues, some toxic elements readily identified in the per-
spiration of some participants were not found in their
serum. Induced sweating appears to be a potential method
for elimination of many toxic elements from the human
body. Biomonitoring for toxic elements through blood and/
or urine testing may underestimate the total body burden of
such toxicants. Sweat analysis should be considered as an
additional method for monitoring bioaccumulation of toxic
elements in humans.
The interaction between humans and chemical compounds
may be described as a love–hate relationship, a liaison that
probably dates back to the dawn of civilization. Through-
out recorded history, chemical preparations have been used
as a means to effect healing and enhance beauty but also as
a means to induce harm. Hippocrates, sometimes referred
to as the ‘‘father of modern medicine,’’ wrote the Hippo-
cratic Oath in response to the recognition that some med-
ical practitioners were being bribed to poison rivals with
chemical potions. Paracelsus, oft called the ‘‘father of
toxicology,’’ subsequently introduced the idea that illness
may be the result of a chemical imbalance requiring res-
toration through therapeutic chemical intervention.
Through the centuries, humankind has endeavored to tame
existing chemicals and to develop new agents with specific
properties in a ceaseless quest for comfort, convenience,
and optimal health.
Since the Second World War tens of thousands of syn-
thetic chemicals have been unleashed into the environment
along with increasing emission of potentially toxic metal
elements and petrochemical products. Widespread aware-
ness of potential toxicity associated with exposure to some
noxious chemicals, however, has resulted in concern and
disdain in some circles for the chemical revolution that has
descended on humanity in the last half-century. Although
public sentiment in general tends to view naturally occur-
ring chemicals as safe and man-made chemicals as poten-
tially dangerous, some naturally occurring compounds,
including the toxic element arsenic found in soil sediments,
can be lethal at high concentrations, whereas judicious use
of some man-made pharmaceuticals can be life saving.
S. J. Genuis (&)D. Birkholz
University of Alberta, Edmonton, AB, Canada
e-mail: sgenuis@ualberta.ca
D. Birkholz
e-mail: Deib.Birkholz@ALSEnviro.com
I. Rodushkin
Lulea
˚University of Technology, Lulea
˚, Sweden
e-mail: Ilia.Rodushkin@alsglobal.com
S. Beesoon
Department of Laboratory Medicine, University of Alberta,
Edmonton, AB, Canada
e-mail: sbeesoon@yahoo.co.uk
123
Arch Environ Contam Toxicol
DOI 10.1007/s00244-010-9611-5
There is increasing evidence in recent scientific litera-
ture about potential adverse health sequelae associated with
naturally occurring toxic element bioaccumulation. With
increasing media reports of widespread exposure to metals
and metalloids emanating from contamination of everyday
products including lead in children’s toys, (Weidenhamer
2009) arsenic in rice, (Liang et al. 2010) aluminum in
deodorants (Michalke et al. 2009) and cookware, (Raj-
wanshi et al. 1997) cadmium in cigarette smoke (Lin et al.
2010) and automobile exhaust, (Ewen et al. 2009) as well
as mercury in dental amalgam (Michalke et al. 2009) and
most fish, (Counter and Buchanan 2004) the accrual of
potentially toxic elements in humans has become an issue
of intense study and public health attention. Various gov-
ernments and their medical research arms, such as the
Canadian Institute for Health Research, for example, are
currently supporting research to explore the health impact
of exposure to some heavy metals. (Sears and Bray 2008)
There is limited understanding thus far, however, about the
behaviour and toxicokinetics of bioaccumulated toxic ele-
ments, and there is minimal discussion in the scientific
literature about therapeutic interventions to remove
accrued toxicants, including toxic elements, from the
human body. (Genuis 2010).
In this article, we report the results of a study examining
levels of various toxic elements in three body fluids, blood,
urine, and sweat (BUS), in a group of study participants.
The objective of this research was twofold:
1. By comparing the chemical profiles of each body fluid
examined, we wished to identify the efficacy of each fluid
measurement as a biomonitoring tool to reflect the body
burden of specific elements.
2. By assessing the ratio of sweat to blood content of
specific toxic elements, we undertook to determine the
efficacy of induced perspiration as a means to excrete
metals and metalloids in order to potentially preclude or
overcome health affliction.
Background
With the recognition that certain chemical toxicants in the
environment can adversely affect human health, public
health efforts have focused mostly on two fronts. First,
several studies have explored the extent of bioaccumula-
tion through human biomonitoring as well as monitoring
wildlife and the surrounding environment. Second,
attempts at effect characterization have been undertaken
either through epidemiologic studies on exposed popula-
tions or through animal research.
Although present-day exposure to injurious chemicals
abounds, (Centers for Disease Control, Department of
Health and Human Services. Fourth National Report on
Human Exposure to Environmental Chemicals 2009;
Environmental Working Group 2005) current data on
potential harmful effects is incomplete, and limited
knowledge is available on modes of excretion for specific
xenobiotics. In this article, we briefly review known
adverse health effects associated with bioaccumulation of
some toxic elements and then explain and discuss our
research findings on the human excretion of such elements
by measuring BUS levels of these compounds. Although
this article will focus on data generated for metals and
metalloids, subsequent articles will address excretion of
other compounds, such as phthalates, bisphenol A, sol-
vents, flame retardants, chlorinated pesticides, perfluoro-
chemicals, and others.
As important constituents of the earth’s crust, metals are
extensively scattered in a wide variety of environmental
matrices. Human populations around the globe are regularly
exposed to high levels of toxic elements either directly
through medical, industrial, and agricultural practices or
inadvertently through food consumption and contamina-
tion of air, water, soil, and domestic products. Medical lit-
erature is rife with examples of adverse health effects
associated with toxic element bioaccumulation. (Genuis
2006a,b,2008; Schnaas et al. 2006; Lanphear et al. 2005;
Needleman et al. 1979; White et al. 2007; Nevin 2000;
Nevin 2007; Needleman et al. 1996; Fowler 1993; Goyer
1993; Schwartz et al. 2000; Grandjean and Landrigan 2006;
Canfield et al. 2003).
Lead
The most widely studied example of metal toxicity is lead
intoxication, known to cause myriad effects throughout the
life cycle. The developing brain is highly susceptible to the
toxic effects of lead with subsequent impact on learning
ability, (Michalke et al. 2009; Schnaas et al. 2006) IQ and
cognitive function, (Lanphear et al. 2005; Needleman et al.
1979; White et al. 2007) social behavior, (Needleman et al.
1979; Nevin 2000) and criminal intent. (Nevin 2007;
Needleman et al. 1996) Exposure to this toxic metal has also
been associated with kidney toxicity (Fowler 1993; Goyer
1993) as well as adult neurodegeneration. (Schwartz et al.
2000; Grandjean and Landrigan 2006) The impact of this
metal appears to be ongoing and widespread because the
presence of lead in some paints, toys, and various other
materials continues to inflict harm on children in various
jurisdictions, including Africa as well as North and South
America (Nevin 2007; Canfield et al. 2003; Clark et al. 2009).
Mercury
‘‘Mad Hatter syndrome’’ was a phrase initially coined to
describe the various symptoms, including irritability,
Arch Environ Contam Toxicol
123
depression, anxiety, and various personality changes, that
arose in individuals occupationally exposed to mercury in
the production of felt hats. (Fraser-Moodie 2003) Although
mercury has been used as a therapeutic and industrial agent
for centuries, it was not until 1940 when a seminal article
by Hunter et al. highlighted the severe effects of methyl
mercury on the human brain. (Hunter et al. 1940) Subse-
quently, there has been an accumulation of epidemiologic
and laboratory evidence of toxic effects, including neuro-
toxicity. Primarily originating from seafood and dental
amalgam, (Bigham et al. 2002; Oken and Bellinger 2008;
Guzzi et al. 2006) mercury bioaccumulation continues to
be a serious health issue, prompting public health organi-
zations such as Health Canada and the United States Food
and Drug Administration to issue recommendations to limit
some seafood intake in vulnerable patient groups, such as
children and pregnant women because of potential toxicity.
(Health 2007; United States Department of Health and
Human Services, Environmental Protection Agency 2004)
Another potential source of mercury exposure is the use of
nasal sprays, ophthalmic products, tattoo inks, and vacci-
nations containing mercury-based preservatives, such as
ethylmercury.
Aluminum
Aluminum is the most abundant metal in our natural
environment, and many studies have reported adverse
health effects associated with its bioaccumulation. Expo-
sure commonly occurs through use of underarm deodorants
as well as aluminum-containing food and beverages.
(Becaria et al. 2002) Aluminum bioaccumulation has been
associated with neurotoxicity leading to memory loss,
tremor, impaired coordination, and generalized convul-
sions, (Zatta et al. 2003) and it has been postulated to play
a role in the development of Alzheimer’s and Parkinson’s
disease. (Michalke et al. 2009; Nayak and Chatterjee 2001;
Corain et al. 1990) As well as posing neurologic compli-
cations, aluminum bioaccumulation has also been linked to
musculoskeletal damage, (Kerr et al. 1992) hepatobiliary
toxicity, (Augsten and Stein 1988; Galle et al. 1987) and
increased risk for cancer. (Spinelli et al. 2006).
Other Toxic Metals
Other metals and metalloids have been discussed in the
literature as well. Arsenic in the water supply continues to
cause serious health issues for exposed groups in India and
Bangladesh. (Chen et al. 2009; Chakraborti et al. 2009;
Samanta et al. 2007) This metalloid is recognized as a
peripheral neurotoxin, causing polyneuropathy in some
exposed individuals. (Vahidnia et al. 2007) Arsenic also
causes a dose-dependent decrease in glutathione (Rao and
Avani 2004) and is suspected to impact memory and verbal
skills. (Michalke et al. 2009) According to the American
Department of Health and Human Services, there is suffi-
cient data to conclude that cadmium is a human carcino-
gen, (Agency for Toxic Substances Disease Registry 2008)
and it has also been associated with higher risks of male
cardiovascular disease mortality, (Menke et al. 2009)
nephrotoxicity, (Suwazono et al. 2006) bone fragility,
(Jarup and Akesson 2009) and decreased visual ability.
(Michalke et al. 2009) High levels of manganese have been
linked to a spectrum of severe adverse health effects,
including neurodegeneration (Michalke et al. 2009; Asch-
ner and Aschner 1991; Michalke et al. 2007) and liver
damage (Butterworth et al. 1995) as well as carcinogenicity
and teratogenicity. (Gerber et al. 2002) Inhaled chromium,
a metal commonly encountered in some occupational
settings, has also been established as a human carcinogen.
(Langard and Vigander 1983; Langard 1990) Many of the
toxic elements, including aluminum, lead, mercury, and
cadmium, have metalloestrogenic properties, (Darbre
2006) which presents concern about endocrine disruption
in association with accrual of these types of compounds
(The Prague Declaration on Endocrine Disruption—126
Signatories. Meeting for international group of scientists
convened in Prague. May 1–12 2005). As knowledge about
the potential toxicity of various toxic elements continues to
unfold, the question arises as to whether bioaccumulation
of such compounds is a widespread and common concern.
The United States Centers for Disease Control and
Prevention recently performed the most comprehensive
study of toxicant exposure ever performed and found that
most American adults and children have bioaccumulated
many potentially injurious chemicals, including toxic ele-
ments. (Centers for Disease Control, Department of Health
and Human Services. Fourth National Report on Human
Exposure to Environmental Chemicals 2009) Research in
other jurisdictions, including Canada, has also shown
widespread toxic-element bioaccumulation. (Buechner
et al. 2004) The problem of chemical accrual is not limited
to those directly exposed: Most developing children in
utero are also at risk as a result of vertical transmission. A
recent study conducted by the Environmental Working
Group on cord blood taken by the American Red Cross
showed that the average sample at birth already contained
287 toxicants, including some toxic metals. (Environmen-
tal Working Group 2005).
With the recognition that it is not always possible to limit
exposure to lower than safe levels and that established safety
thresholds are often flawed, (Genuis 2006b) therapeutic
interventions to eliminate toxicants are being explored.
(Genuis 2010) Furthermore, with increasing cognizance by
the public at large about toxicant bioaccumulation, detoxi-
fication interventions to preclude or overcome health
Arch Environ Contam Toxicol
123
problems have gathered much attention. In response, there
has been the emergence of many unlicensed products and
techniques that purport to ‘‘detox’’ or ‘‘cleanse’’ the body,
and some have been marketed without credible scientific
support. Our study, on a cohort of 20 individuals and
approved by the Health Research Ethics Board of the Uni-
versity of Alberta, endeavored to provide evidence relating
to the excretion of toxic elements by the human body.
A primary goal of this work was to determine if
sweating through sauna therapy may facilitate the excre-
tion of some retained toxic elements. The impact of sauna
therapy is achieved by increasing the thermal load to the
body, which initiates an autonomic nervous system (ANS)
thermoregulatory heat-loss response, including enhanced
circulation to the skin from a baseline of 5–10% to a
maximum of 60–70% of cardiac output. (Leppaluoto
1988; Hannuksela and Ellahham 2001) Perspiration
ensues, with an excreted volume of B2 litres/h in some
individuals. (Eisalo and Luurila 1988) Inhibition of the
perspiration mechanism with minimal sweating may
result, however, from ANS impairment secondary to sig-
nificant bioaccumulation of toxicants. (Rea 1997) With
some cultures using sauna therapy as a preventive health
modality, sauna therapy has been recognized as a safe
approach to induce sweating in both the pediatric and
adult population, (Kukkonen-Harjula and Kauppinen 2006)
although children in general tend to sweat considerably
less than adults. (Falk et al. 1992) Although mechanisms
have not been identified, use of this modality has been
associated with short- and long-term amelioration of some
cardiovascular, rheumatologic, and respiratory afflictions.
(Hannuksela and Ellahham 2001; Kukkonen-Harjula and
Kauppinen 2006) Contraindications to sauna use, however,
include high-risk pregnancy, severe aortic stenosis, recent
cardiovascular events, and unstable angina. (Hannuksela
and Ellahham 2001; Kukkonen-Harjula and Kauppinen
2006).
Methods
Participant Recruitment
Nine men and 11 women with mean ages 44.5 ±14.4 and
45.6 ±10.3 years, respectively, were recruited to partici-
pate in the study. Ten were patients with various clinical
conditions, and 10 were otherwise healthy adults. Partici-
pants with health issues were recruited from the first
investigator’s clinical practice by invitation. Each partici-
pant in the study provided informed consent and volun-
teered to give one 200-ml random sample of blood, one
sample of first-morning urine, and one 100-ml sample of
sweat. Demographic and clinical characteristics of all
research participants are provided (Table 1).
Table 1 Characteristics of participants in the BUS study
Participant no. Sex Age (y) Clinical diagnosis Technique used to collect sweat
1 M 61 Diabetes, obesity, hypertension Exercise
2 F 40 Rheumatoid arthritis Steam sauna
3 M 38 Addiction disorder Steam sauna
4 F 25 Bipolar disorder Steam sauna
5 F 47 Lymphoma Steam sauna
6 F 43 Fibromyalgia Steam sauna
7 F 48 Depression Steam sauna
8 F 40 Chronic fatigue Infrared sauna
9 F 68 Diabetes, fatigue, obesity Steam sauna
10 M 49 Chronic pain, cognitive decline Exercise
11 M 53 Healthy Exercise
12 M 23 Healthy Infrared sauna
13 M 21 Healthy Infrared sauna
14 F 47 Healthy Infrared sauna
15 M 53 Healthy Infrared sauna
16 F 43 Healthy Infrared sauna
17 F 51 Healthy Infrared sauna
18 M 46 Healthy Infrared sauna
19 M 57 Healthy Infrared sauna
20 F 50 Healthy Infrared sauna
Arch Environ Contam Toxicol
123
Sample Collection
All blood samples were collected at one Dynalife labora-
tory site in Edmonton, Alberta, Canada, through vacutainer
blood-collection sets (BD vacutainer
,
Franklin Lakes, NJ)
using 21-gauge stainless steel needles. Blood was collected
directly into plain 10-ml glass vacutainer tubes, allowed to
clot, and spun down 30 min later. After serum was sepa-
rated off, samples were picked up by ALS Laboratories
(approximately 3 km from the blood collection site) for
storage until analysis. When received at ALS, serum
samples were transferred to 4-mL glass vials and stored in
a freezer at –20°C until pending transfer to the analytic
laboratory. Trace metals and metalloids were quantified in
serum rather than whole blood in this study. From an
analytic-chemistry standpoint, the matrix effect from serum
is lower than that of whole blood.
For urine collection, participants were instructed to
collect a first-morning urine sample directly into a pro-
vided 500-ml glass jar container with a Teflon-lined lid
on the same day that blood samples were collected. Urine
samples were delivered by the participants directly to
Edmonton ALS Laboratories. Samples were transferred to
4-mL glass vials and stored in a freezer at –20°C, pending
transfer.
For sweat collection, participants were instructed to
collect perspiration from any site on their body directly into
the provided 500-ml glass jar container with a Teflon-lined
lid by placing the jar against their prewashed skin when
actively sweating or by using a stainless steel spatula
against their skin to transfer perspiration directly into the
glass jar. (Stainless steel, which is made up primarily of
iron, chromium, and nickel, was chosen because it is
composed of the same material as the needles used in
standard blood collections and is reported not to offgas or
leach at room or body temperature.) More than 100 cc of
sweat was provided in all but one case. Each of the glass
bottles used for sampling in this study was provided by
ALS laboratories and had undergone precleaning according
to a defined protocol: laboratory-grade phosphate-free
detergent wash, acid rinse, multiple hot and cold deionized
water rinses, oven drying, capping, and packing in quality-
controlled conditions. Sweat was collected within 1 week
before or after the blood was collected. No specifications
were given as to how long sweating had commenced before
collection. Ten participants collected sweat inside an
infrared sauna; seven collected sweat inside a regular steam
sauna; and three collected sweat during and immediately
after exercise. No specific instruction was given regarding
the type or location of exercise. Sweat was delivered by the
participants directly to ALS laboratories. Samples were
transferred to 4-mL glass vials and stored in a freezer at
–20°C until transfer.
All biologic samples were shipped frozen on dry ice to
ALS Laboratories in Sweden for analysis. No preservatives
were used in the jars provided for sweat and urine collec-
tion nor in the serum storage vials.
Analytic Methods
In each of the BUS body fluids, testing was undertaken for
18 different metals and metalloids, including arsenic, alu-
minum, bismuth, cadmium, cobalt, chromium, copper,
mercury, manganese, molybdenum, nickel, lead, antimony,
selenium, tin, thallium, uranium, and zinc. Closed-vessel
microwave-assisted digestion with concentrated nitric
acid was used for all body fluids under investigation.
(Rodushkin et al. 2000) An aliquot of sample (1 ml) was
digested with 1 ml HNO3 (Supra Pure grade) for 60 min at
600W power. After cooling to room temperature, the digest
was poured into acid-washed polypropylene auto-sampler
tubes and diluted to 10 ml with distilled, deionized water
followed by addition of internal standards indium and
lutetium. All manipulations with samples were performed
in clean (class 10000) laboratory areas. Two method blanks
were prepared with each batch of 10 samples by substi-
tuting body fluids with 1 ml water.
Sample digests were analysed by inductively coupled
plasma sector field mass spectrometry (ELEMENT2;
ThermoScientific) using synthetic blanks, method blanks,
control samples, and standards matching the sample solu-
tions in acid strength. (Rodushkin et al. 2004) Quantifica-
tion was performed by external calibration combined with
internal standardization (matrix effects correction). Com-
bination of instrumental high resolution and mathematical
corrections were used to deal with spectral interferences.
(Rodushkin and Odman 2001) Method detection limits were
calculated as three times the SD of method blanks. Perfor-
mance of analytic procedure was controlled by analysis of
reference material (International Atomic Energy Agency,
IAEA A-13 bovine blood) and control samples (trace
Elements in serum and urine from Sero AS, Norway) as
well by regular participation in performance test program
for clinical matrices managed by Centre de toxicologie du
Que
´bec (CTQ) (Canada).
Data Analysis
In addition to regular quality assurance and quality control,
comparison of concentrations in our study with large pop-
ulation based cross-sectional studies including the National
Health and Nutrition Examination Survey (NHANES) was
performed to enhance the validity and reliability of the data.
Urine/blood and sweat/blood ratios were calculated as
predictors of the efficiency of these urinary and dermal
Arch Environ Contam Toxicol
123
modes of trace element excretion. Descriptive statistics
were generated using SPSS 17.0 for Windows (SPSS,
Chicago, IL), and figures were generated using Microsoft
Excel 2007 (Redmond, Washington).
In this study, the term ‘‘blood’’ refers to the serum com-
ponent of the blood rather than whole blood or erythrocytes.
Serum was measured because this fluid compartment is
in closer proximity to sweat glands, whereas additional
endogenous mobilization is necessary to extract metals out
of erythrocytes before they can be taken up into the glands.
Although there appears to be approximate equivalency
between serum and whole blood concentrations for some
trace elements, some metals have an affinity for red cells
with a manifest disparity between serum, plasma, and whole
blood levels. (Barany et al. 2002; Goulle
´et al. 2005) In one
large study investigating the correlation between concen-
trations in whole blood and serum, for example, the median
whole blood lead level in the sample was approximately 50
times higher than the median serum lead level. (Barany et al.
2002) Toxic elements and xenobiotics in general may have
differing affinities for intracellular versus extracellular
environments as well as differing affinities for various body
compartments, including blood, interstitial fluid, specific
tissues, and assorted secretions. Nonetheless, the overall
objective of this research was not to comment on the total
load of toxic element bioaccumulation for each participant
but rather to assess the potential for excretion of toxic ele-
ments by induced sweating and to determine if sweat anal-
ysis might provide valuable information about the presence
of concealed accrued toxicants.
Results and Discussion
Demographic statistics, as well as the medical status of the
20 study participants, are listed in Table 1. Detection limits
of the different trace elements tested in BUS are listed in
Table 2, and the number of samples that have detectable
levels of trace metals and metalloids are listed in Table 3.
Frequency distributions for the 18 trace elements in BUS
are also provided (Table 4). It is immediately obvious in
most cases that the median is closer to the geometric mean
than to the arithmetic mean and thus the values follow a
log-normal distribution. The distribution includes some
outliers, and the sample size median is a preferred indicator
of distribution. For the purpose of comparison with other
studies, median values are used.
Although there is variability in analytic methods, sample
sizes, and populations investigated, serum levels of trace
elements (with the exception of aluminum) in healthy
adults enrolled in this study do not depart significantly
from those found in other studies (Goulle
´et al. 2005; Pasha
et al. 2010; Forrer et al. 2001; Rollin et al. 2009a; Gabos
et al. 2008; Institut National de Sante
´Publique du Que
´bec
2004) (Table 5). To check the discrepancy with aluminum,
Table 2 Detection limit of the different elements in BUS
Element Limit of detection (lg/L)
Serum Urine Sweat
Arsenic 0.2 0.2 0.2
Aluminium 2 2 2
Bismuth 0.05 0.05 0.05
Cadmium 0.02 0.02 0.02
Cobalt 0.05 0.05 0.05
Chromium 0.1 0.1 0.1
Copper 1 1 1
Mercury 0.1 0.2 0.1
Manganese 0.5 0.5 0.5
Molybdenum 0.5 0.5 0.5
Nickel 0.1 0.1 0.1
Lead 0.05 0.05 0.5
Antimony 0.6 0.6 0.5
Selenium 2 2 2
Tin 0.5 0.1 0.1
Thallium 0.02 0.02 0.02
Uranium 0.02 0.02 0.02
Zinc 2 2 2
Table 3 Number of samples in which trace elements were detected
Ngreater than detection limit Nfor valid ratios
Blood Urine Sweat U/B S/B (S/B)/(U/B)
Arsenic 17 20 20 17 17 17
Aluminum 20 20 20 20 20 20
Bismuth 8 19 19 8 7 7
Cadmium 11 4 18 3 11 3
Cobalt 20 20 20 20 20 20
Chromium 20 19 20 19 20 19
Copper 20 20 20 20 20 20
Mercury 16 16 20 13 16 13
Manganese 20 20 20 20 20 20
Molybdenum 20 20 20 20 20 20
Nickel 20 20 20 20 20 20
Lead 20 20 20 20 20 20
Antimony 1 1 19 0 1 0
Selenium 20 20 20 20 20 20
Tin 2 19 20 1 2 1
Thallium 20 20 20 20 20 20
Uranium 20 20 20 20 20 20
Zinc 20 20 20 20 20 20
Bblood, Uurine, Ssweat
Arch Environ Contam Toxicol
123
Table 4 TC[Frequency distribution of trace elements in BUS
Arsenic Aluminum Bismuth Cadmium Cobalt Chromium
BU SB U S BUSBUSBUSBUS
N 17 2020 20 20 208191911318202020201920
Mean 2.51 36.93 5.70 242.17 1359.90 5100.55 0.17 0.30 4.86 0.03 0.28 7.02 0.16 0.52 3.65 3.67 3.63 26.71
SD 2.77 52.93 5.20 162.86 1665.90 4949.65 0.18 0.66 6.83 0.01 0.09 9.50 0.12 0.80 5.31 3.30 2.15 20.09
Geometric mean 1.97 17.94 4.32 207.79 867.55 3293.05 0.13 0.13 2.19 0.03 0.27 3.14 0.13 0.29 2.15 2.79 3.02 20.90
Median 1.80 12.50 3.30 185.00 899.50 4650.00 0.11 0.11 1.55 0.03 0.27 2.86 0.12 0.23 1.81 2.68 3.56 20.75
Minimum 0.90 4.80 1.70 83.40 201.00 467.00 0.06 0.05 0.28 0.02 0.18 0.36 0.05 0.04 0.23 0.90 0.84 4.77
Maximum 13.00 200.00 22.00 729.00 7210.00 20500.0 0.60 2.91 27.50 0.07 0.39 35.80 0.51 3.70 24.30 15.20 8.06 90.20
Copper Mercury Manganese Molybdenum Nickel Lead
BUSBUS BUS BU SBUS BUS
N20 20 20 16 16 20 20 20 20 20 20 20 20 20 20 20 20 20
Mean 1126 12 681 0.61 0.65 0.86 1.55 2.09 57.37 2.41 50.58 5.43 2.30 5.01 100.84 0.74 1.82 31.04
SD 203 5 659 0.36 0.31 0.26 1.06 0.67 54.38 1.05 29.84 11.61 1.87 2.49 137.65 0.33 1.46 27.01
Geometric mean 1110 11 432 0.53 0.57 0.83 1.36 1.98 36.56 2.23 39.98 2.85 1.68 4.47 55.46 0.67 1.57 20.15
Median 1100 11 589 0.48 0.60 0.84 1.24 2.09 34.80 2.29 45.75 2.34 1.59 4.50 48.95 0.66 1.47 20.55
Minimum 852 6 6 0.26 0.23 0.48 0.80 1.06 1.92 1.09 3.96 1.20 0.18 1.30 3.02 0.39 0.91 1.50
Maximum 1640 22 2870 1.62 1.27 1.49 5.59 3.31 218.0 5.47 103.00 54.20 7.19 11.90 613.00 1.70 7.47 93.80
Antimony Selenium Tin Thallium Uranium Zinc
BUSB U SB US BUSBUSBUS
N1 1 19 20 20 20 2 19 20 20 20 20 20 20 20 20 20 20
Mean 1.60 0.61 2.78 136.00 75.10 14.72 0.66 1.65 38.41 0.04 0.22 0.11 0.04 0.02 0.25 945 807 1922
SD NR NR 1.86 17.89 50.46 6.71 NR 2.33 51.44 0.05 0.19 0.05 0.02 0.02 0.19 182 603 2296
Geometric mean NR NR 2.24 134.88 62.16 13.78 NR 0.93 20.26 0.03 0.17 0.09 0.04 0.02 0.20 926 600 1211
Median NR NR 1.93 130.00 59.00 13.50 NR 0.74 22.80 0.02 0.16 0.10 0.03 0.02 0.22 959 649 1120
Minimum NR NR 0.71 100.00 26.00 9.30 0.57 0.18 1.44 0.01 0.05 0.04 0.02 0.01 0.01 535 66 320
Maximum NR NR 6.47 170.00 220.00 39.00 0.75 9.59 215.0 0.20 0.93 0.26 0.08 0.07 0.99 1220 2160 9350
Although the terminology used here is ‘‘blood,’’ the actual matrix in which the metals were tested was serum. All concentrations are in lg/L
Nnumber of samples above the detection limit. NR not relevant
Arch Environ Contam Toxicol
123
Table 5 Trace metals concentrations (lg/L) in blood and/or serum: Comparison with recently published data
This Study Emsley
(2001)
Goulle
´et al (2005) Forrer et al (2001) Pasha et al (2010) Rollin et al (2009b) Gabos et al (2008) Institut Quebec (2004)
10 healthy adults (serum samples) Blood
samples
Plasma samples
from 100 healthy
adults (France)
Serum samples
from 110 healthy
adults (Switzerland)
Plasma samples
from 37 healthy
donors (Pakistan)
Whole blood
from 350 Pregnant
women (South Africa)
Pooled serum
from 28,484
pregnant women.
(Alberta Canada)
Serum from 471
healthy adults
(Quebec Canada)
NMean Median Geo
Mean
Range Unspecified Median
(range
a
)
Median (range
a
) Mean (range) Median Range Geometric mean
As 8 2.09 2 1.97 0.9–3.20 1.7–90 6.2 (4.4– 14.2) ND ND 0.86
Al 10 305 226 261 138–729 390 3.1 (1.2–17.3) 10.0 (5.66–18.66) 12–56
Bi 5 0.22 0.12 0.16 0.07– 0.60 &16 0.002 (0.002–0.401)
Cd 3 0.02 0.02 0.02 0.02–0.03 5.2 0.03 (0.01–0.05) \0.01 (\0.01–0.29) 0.232 (0.065–0.395) 0.54 ND 0.12 (median)
Co 10 0.17 0.11 0.13 0.08–0.51 0.2–40 0.49 (0.30–1.02) \0.01 (\0.01–0.155) 0.15 0.2–3.6 0.18 (median)
Cr 10 3.77 3.49 3.05 1.08–7.40 6–110 0.135 (0.024–0.352) 6.2 0.9–4.6
Cu 10 1040 986 1040 907–1310 1.01 1075 (852–1640) 915 (688–1803) 1.223 (0.075–3.17) 1700–2300
Hg 6 0.64 0.48 0.53 0.27–1.62 7.8 0.9 0.2–0.9 0.74
Mn 10 1.71 1.35 1.43 0.80–5.59 1.6–75 1.12 (0.63–2.26) 0.18 (\0.09–1.48) 2–21 0.66
Mo 10 97.9 3.21 10.8 1.09–423 &1 0.956 (0.67–1.68) \0.09 (\0.09–3.0) 1.1–4.3 1.29
Ni 10 1.78 1.33 1.54 0.68–3.71 1–50 2.20 (0.04–5.31) 4.97 (2.98–7.34) 0.586 (0.066–2.29) 0.4–5.5 0.99
Pb 10 0.64 0.55 0.61 0.44–0.98 0.21 0.062 (0.014–.25) 1.32 (0.056–3.89) 25 20.7 (blood)
Sb 1 NR NR NR NR 3.3 0.11 (0.03–0.15) 3–15
Se 10 140 140 139 120–160 171 112 (79– 141) 112 (87.3–143) 543 130–180 134
Sn 1 NR NR NR NR &380
Tl 10 0.06 0.03 0.04 0.02–0.20 0.48 0.06 (0.01–0.24) ND
U 10 0.04 0.03 0.04 0.02–0.07 0.5 0.007 (0.004–0.011) ND
Zn 10 913 940 889 535–1220 7000 726 (551– 925) 820 (637–1004) 2.37 (1.56–4.49) 1200–1560
a
Indicates that the calculated range is from the 5th percentile to the 95th percentile
NR not relevant, ND not detected
In the last column for Institut Quebec: for lead N= 441, and for manganese N= 403
Arch Environ Contam Toxicol
123
we scanned the literature and found that only one source
concurred with the levels reported in this article. (Pais and
Jones 1997) For comparison purposes, median urine levels
of some of the trace metals are compared with the 2008
figures published by the United States Centers for Disease
Control and Prevention, (United States Center for Disease
Control and Prevention 2010) and relevant data are
presented (Figs. 1,2).
There are few published data in the medical literature
examining levels of toxic trace elements in sweat (Hohn-
adel et al. 1973; Cohn and Emmett 1978; Hoshi et al. 2001)
(Table 6). It is apparent from the data presented that our
results approximate those reported for Americans but are
considerably different than Japanese population data. To
the investigators’ knowledge, our research is the first study
looking at levels of metals and metalloids simultaneously
in three body fluids in the same group of participants, thus
enabling us to compare the efficiency of excretion through
urine and sweat. It is evident from Figs. 3and 4that for
many toxic elements, including cadmium, lead, and alu-
minum, excretion in sweat far exceeds that in urine. Cad-
mium, for example, was detected in 11 blood, 4 urine, and
18 sweat samples with a sweat-to-blood ratio of 87.
Because cadmium was detected in only 4 urine samples, a
reliable BUS ratio could not be computed.
Fig. 1 Serum levels of trace elements in patients (D) and healthy
controls (Co). With the exception of As_D,As_Co, and Hg_Co, where
N=9, 8, and 6 respectively, N=10 for all others
Fig. 2 Median urine levels of trace elements in patients (D), healthy controls (Co), and healthy Americans (US)
Arch Environ Contam Toxicol
123
The findings from this study have three important
implications:
1. From a therapeutic standpoint, induced sweating may
have potential as a clinical intervention for elimination
of some toxic elements. However, the concomitant loss
of required trace minerals into sweat, which is also
evident from the data, serves to remind that sauna
users should secure adequate intake of required
minerals to compensate for losses and to replete
diminished reserves.
2. From a public health perspective, clusters of people,
such as firefighters, who by the nature of their
occupations are exposed to toxic elements, may be
advised to regularly undertake induced sweating.
Further research is required, however, to determine
whether induced sweating on the day of exposure is
beneficial or detrimental because enhanced circulation
to the skin associated with sauna may stimulate greater
absorption of toxicants on the skin.
3. From a biomonitoring perspective, perspiration may
serve as a more sensitive body fluid for measurement
compared with blood because some toxic elements,
including cadmium, bismuth, antimony, and tin, are
frequently not detected in serum but may be found in
sweat samples from the same individual (Table 3).
This latter observation affirms the fact that serum levels
of various xenobiotics do not necessarily reflect the total
body burden of such compounds because accrued toxicants
may store in tissues, and serum levels may belie actual
toxicant status. Furthermore, various immediate states in
the body, including activity level, caloric intake, hydration,
underlying nutrient status, and other factors, can cause
toxicant shifts between body compartments, (Genuis 2010;
Jandacek et al. 2005) with the potential to cause significant
variation in blood levels within the same person. This
realization is important because most biomonitoring stud-
ies of toxic elements and other xenobiotics are based on
snap-shot blood levels of such compounds. Furthermore, it
is evident from the results that sweat does not represent an
ultrafiltrate of blood plasma because concentrations of
various elements vary considerably between serum and
sweat.
When sweat/blood rations are calculated for matched
participants and the data stratified by sex and type of sauna
used, interesting patterns appear to emerge for some trace
elements (Table 7). For example, regarding the excretion
of cadmium, mercury, thallium, and uranium, women
appear to be more efficient at excreting trace metals
through sweat than men. In addition, infrared sauna
appears to work better for bismuth, cadmium, chromium,
mercury, and uranium, whereas steam sauna seems to be
more efficient for the other elements tested. Overall, the
Table 6 Trace elements concentrations (in lg/L) in sweat: Comparison with other published data
This study (2008) Hohnadel et al. (1973) Cohn et al. (1978) Hoshi et al. (2001)
10 healthy adults 30 healthy adults (United States) 9 healthy adults (United States) 10 healthy men (Japan)
(15 men and 15 women) 2 methods of collection
WBS WBS
ABS (ABS
NMean Median Minimum Maximum Mean ±SD (range) Mean ±SD (range) Mean ±SD
Chromium 10 22.33 20.75 4.77 43.40 10.7 ±25.1 [WBS]
4.5 ±6.7 [ABS]
Copper 10 652.49 609.00 5.89 1900.00 679 ±330 (250–1500) [M] 1360 ±314 860–1600 [WBS] 39.1 ±27.0 [WBS]
1350 ±660 (560–2480) [F] 2508 ±2090 660–6400 [ABS] 27.4 ±12.5 [ABS]
Manganese 10 42.78 29.10 1.92 119.00 20 ±9 10–30 [WBS] 10.2 ±4.3 [ABS]
72 ±48 20–150 [ABS] 5.1 ±2.1 [ABS]
Nickel 10 111.33 45.95 3.02 613.00 79 ±40 (17–162) [M] 55 ±16 40–80 [WBS]
163 ±92 (77–386) [F] 293 ±194 80–550 [ABS]
Lead 10 25.67 13.55 1.50 93.80 79 ±76 (23–336) [M] 60 ±33 40–120 [WBS]
274 ±187 (72–750) [F] 83 ±86 20–250 [ABS]
Zinc 10 1451.20 897.50 320.00 6160.00 674 ±374 (173–1180) [M] 773 ±332 400 –1200 [WBS] 366.9 ±378.1 [WBS]
1575 ±800 (527–5680) [F] 2185 ±1355 510 –4640 [ABS] 169.4 ±153.7 [ABS]
WBW whole-body sweat, ABS arm-bag sweat
Arch Environ Contam Toxicol
123
excretion rate for most available elements, other than lead,
appeared to be somewhat higher when sweat was collected
using sauna versus exercise-induced sweating, but the
number of participants using exercise for sweat collection
was too low to test for all elements and to provide a
definitive answer on relative concentrations.
Limitations
There are limitations of this research. Although reports of
clinical improvement after sauna therapy specifically for
toxicant exposure exist in the literature, (Parpalei et al.
1991) our study did not assess health outcomes associated
with induced sweating. Testing of other bodily excretions,
such as feces, breast milk, tears, or saliva, to assess rela-
tive concentrations of toxicants in other fluids was not
performed. It was not possible to determine if the sweat
fluid measured might have been tainted by elements orig-
inating from sebum as well as directly from skin tissue.
The process of sweating appears to facilitate excretion of
some toxic elements; the fluid released on sweating,
however, may represent a combination of perspiration,
sebum, and matter released directly from skin and not
exclusively sweat.
Methodologic limitations include the possibility that
sweat originating from different parts of the body may
excrete toxicants at different concentrations and that
excretion rates may also vary with the duration of sweat-
ing. Despite precautions, the possibility of inadvertent
contamination of samples is also a possibility. This appears
less likely because quality controls and blanks were ana-
lysed simultaneously; various samples showed no toxic
elements; reasonable consistency was found between ratios
Fig. 3 Comparison of
elimination of metals through
urine and sweat. The figures on
top of each bar represent the
median of the ratios of
concentrations of each metal in
urine/serum (grey bars) and
sweat/serum (black bars). The
number of data points used to
generate each bar is listed in
columns 5 and 6 of Table 3
Fig. 4 Comparison of median
excretion efficiency of metals
through sweat and urine. The
figure only shows the relevant
trace metals that have been
simultaneously detected in
BUS. Values \1 indicate that
elimination through urine is
more efficient that through
sweat. Values [1 indicate that
sweat is a more efficient
pathway of eliminating the
metal from the body. The
number of data points used to
generate each bar is listed in the
last column of Table 3
Arch Environ Contam Toxicol
123
of toxic elements in participants’ BUS; and general
consistency was evident with excretion ratios between
elements. Another limitation of the study is that serum
creatinine was not measured at the time of sweat collec-
tion; hydration status might influence concentration of
excreted elements.
Conclusion
According to the findings of this study, sweat analysis
provides an additional method for biomonitoring human
levels of many potentially toxic elements. Biomonitoring
based exclusively on measurements from blood and/or
urine can provide misleading conclusions about the state of
toxicant accrual and can underestimate the total body
burden of xenobiotics. Furthermore, with the abundance of
unsubstantiated information relating to detoxification, evi-
dence from this research demonstrates that there may be a
role for induced perspiration as a preventive and thera-
peutic measure to assist individuals and groups at health
risk resulting from exposure to and bioaccumulation of
toxic elements. Future studies should explore clinical
health outcomes of induced sweating programs in patients
with toxic element bioaccumulation.
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