An unusual case of arthritis associated with exposure to manganese
As I have said, many times, I love my job because it is like being a crime scene investigator in the movies. I solve "health crimes". It's a fun challenge and the results can be most satisfying indeed!
This article reports an unusual case involving a very health-conscious man in his mid-40's who, despite all his best efforts, has begun to suffer progressive, serious knee arthritis and early signs of similar degeneration of the hip joints. He has visible bowing of one leg.
He was not a marathon runner, nor was he doing sports like kick boxing, he was not a miner, or roofing contractor. At 44 years he should have healthy joints, not the joints of an old man.
There was no credible medical explanation and the only treatment on offer was ongoing monitoring leading eventually to joint replacement surgery. Needless to say, he was not happy with having such limited options!
Is it in the genes?
What is fascinating is the stark difference between people with the rate at which a degenerative disease may progress and the contradictions that are often present.
Why can a rugby player who abused his knees, during his early years, still be mobile in old age, while a health conscious 44 year old, who cared better for his knees, end up struggling with advancing arthritis? The usual explanation is to attribute the rapid deterioration to "genetics".
Genetics, probably account for no more than 10% of a person's good and bad health, the remainder being controllable factors, such as nutrition, toxic exposures and stress - including over or under exercising.
It is wrong for a health professional to brush aside a patient's health issues as being "genetic". Unless this diagnosis that it is genetic is supported by a valid test, this is lazy medicine that does the patient no good.
Late last year, our subject completed an InterClinical Laboratories hair tissue mineral analysis (HTMA).
The results raised some intriguing questions.
Refer to the Nutritional Elements chart below.
What stands out is the elevated manganese (Mn).
By contrast, the majority of HTMA show low levels of manganese relative to other tissue elements. Elevated manganese is typically seen in people who are exposed to manganese occupationally, such as builders, farmers and metal workers. Not in White Collar workers.
What is the relevance of manganese to this man's joint problems?
All nutritional elements have a "Goldilocks Zone" - not too much - not too little - just right!
In most cases we are talking about quantities of an element in parts per million.
Manganese is no exception. It has a long list of health benefits but things can go horribly awry if it is in any more than being slightly in excess or if it is deficient. Just one point to keep in mind: a mineral such as manganese is, ideally, within the "reference range" on the HTMA chart above. You can see that this man's manganese is within the reference range but it is high relative to all the other minerals being measured. That is not a good sign.
This man has excess manganese relative to the other minerals
Manganese is mostly located in the mitochondria of the cells. The mitochondria is the "powerhouse" of the cell. Manganese is therefore crucial for almost every cellular function to do with health, either directly or indirectly, including for maintaining healthy bone and cartilage.
Of relevance to this case, manganese plays a crucial role in bone and joint health. An excess or a deficiency may result in bone and cartilage disorders, most commonly seen in the hip joints. Manganese disorders are also associated with joints, tendons and ligaments that tend to make audible popping and snapping sounds.
Manganese protects the cells from oxidative stress such as experienced during exhausting endurance exercise. It plays an important role in the production of manganese superoxide dismuthase (SOD), the most potent of all the cellular super antioxidants. It is typical to see low levels of manganese in exhausted endurance athletes and people who lead very busy lives to the state of exhaustion. Presumably they suffer from low levels of SOD.
By coincidence, I have noted an association of low manganese on the HTMA and a condition called "Femoral Acetabular Impingement", including the oft-associated snapping and catching of the psoas tendon deep in the hip, and snapping of the tensor fascia where it passes over the greater trochanter of the femur.
The HTMA nutritional elements chart, below, is more like what one expects in tired athletes (note the very low Mn) - not elevated Mn.
Manganese, arthritis and other joint diseases: where did the excess manganese come from?
That is the question that I put to him and the answer was most interesting.
It turns out that he had a business that operated out of a former manganese storage warehouse where it was being mined in Vanuatu. That was about 25 years ago. He described the manganese dust being every where and it got into everything.
In addition, he was a very liberal user of potent manganese anti-fungal sprays and, in retrospect, he was very casual with their use to the point of being very careless.
The spray is called Mancozeb which he got on his body and inhaled:
Bingo! We have two sources and the timing of these are such to be one of the drivers for the gradual deterioration of his joints - a process that happens over many years.
Corrective action being taken
Confident that the exposure to manganese is historic and not ongoing, the therapy consists of two strategies:
Do all we can to prevent further joint deterioration, including protecting all his unaffected joints, by taking a mix of joint care supplements.
Expediting the safe removal of excess manganese from his body with nutrients that gently help the mobilisation and excretion of this mineral.
Unfortunately, the damage done to the knees, in particular, may be past the "tipping point" and the only thing that we can hope for is to slow the rate of degeneration of these joints, thus delaying the need for joint replacement by a few years, or more.
We will be repeating this person's HTMA about six months after the first. We will issue a progress report then.
More reading about manganese:
Linus Pauling Institute http://lpi.oregonstate.edu/mic/minerals/manganese