What is barium?
Barium is a metal used in various industrial applications. The most relevant sources of exposure in humans are food, air, water, occupations that handle barium, and medical imaging. If you’re not familiar with a barium enema exam, check this out. Your health provider may consider this imaging study when disease effecting your large intestine is suspected.
Is Barium bad for me?
In short, yes. But it isn’t a horse. You’ll understand what I mean when you get through this post.
In conventional land, the small amounts most of us are exposed to through in our food and water is not considered relevant in the incidence of disease. And there’s some reason to believe so. Both observational and intervention studies looking at chronic exposure to the amounts of barium you would be exposed to daily suggest there is not a clinically meaningful impact on health [1, 2]. Outside of acute exposure in an occupational setting, the amounts in food and drinking water in the average individual are way lower on the totem poll in terms of factors to address.
The most frequent health effects seen from acute exposure are upper respiratory irritation, paralysis, low or high blood potassium and resultant heart rhythm disturbance. Other symptoms include vomiting, diarrhea, cramping, muscle weakness, blood pressure alterations, facial numbness, and difficulty breathing have been observed.
There’s an interesting case study related of a 35-year-old male who ingested 16 small fireworks, who suffered vomiting, diarrhea, dysrhythmia and respiratory distress [3]. His serum barium was 100 times the upper end of the reference range, and his serum potassium was pretty low. Fortunately, he recovered. How’s that for barium exposure?
Low levels of barium likely do harm…
…but it’s hard to characterize the degree of harm from such low-level exposure. Part of the reason is because most people are resilient enough to handle these small insults from the environment. Susceptibility depends on genetics, nutritional status, and other health circumstances.
However, there needs to be more sensitivity surrounding investigation of environmental exposures. I might be a little biased here, because I’m a naturopathic clinician and we typically get the chronic cases, which conventional medicine has often failed. Part of that involves understanding how a particular toxicant interacts with human biochemistry.
Like other metals, barium interacts with proteins in our bodies that carry out all sorts of function. You can sort of think of these proteins as tools. Some act like scissors, some like carts, some like text messages and others like shields. These tools often require metals for their structure, or as part of the spark that initiates their function. Barium is thought to displace other good metals like calcium in our tools. What ends up happening is barium will take calcium’s spot and impact the function of the tool. And so, the text message saying “take out the trash” doesn’t get relayed. Or the wheels on the cart lock up. Or the scissors don’t cut. It’d be like replacing the appropriately-sized, threaded screw holding your kitchen shears together with a smaller, unthreaded screw. The scissors may or may not work. You might also cut yourself in the process!
Another way metals like barium do harm is they require resources needed to change their polarity, so that you can put them in the toilet. Resources being vitamins, minerals, and other compounds we derive from food. If you don’t have everything you need, these metals have a greater chance of hanging around in your body and messing up your kitchen shears. Additionally, if your status for certain nutrients is marginal or deficient, other processes suffer.
Calcium plays a vast role in your chemistry, meaning barium toxicity could be theorized to result in all sorts of maladies. The difficulty in all of this is finding a balance between these theories and science we have available.
Elevated urinary barium
If you read the caption of the Instagram post I attached to this article, you learned of a patient who was concerned that her heavy metal burden explained her chronic health concerns, which were fatigue and visual impairment. She was convinced by another clinician that her age-related macular degeneration was explained by lead toxicity and requested an assessment of her heavy metal burden. What you’re looking at below is an unprovoked urinary assessment. As you can see, her baseline level of barium was elevated. And when compared to the Centers for Disease Control data, about 8 times higher than the lower cutoff for the folks voiding the most barium [4].
So, what?
Some folks would look at this and jump right to an intervention targeting barium. That would be poor medicine. And sure, if you put someone on a bunch of detoxification supplements, clean up their diet and have them exercise, you’ll make them feel better. But it’s less likely that the result is explained by enhancing their ability to detoxify barium.
The first thing is looking at the clinical picture, which did not suggest barium is relevant. Her fatigue would more likely be explained by the fact that a previous provider poorly managed her hypothyroidism or the fact that she sleeps four hours a night. Or the fact that she frequently water fasts. Her visual concerns? Maybe, but there’s been no connection established between barium and macular degeneration.
Second is asking why there is more barium in her urine than the majority of the population. The patient has a history of colon cancer, but has never had a barium radiograph, which was the first thing I thought of. Bust!
What do peanuts, brazil nuts and thyroid have in common?
Actually, thyroid doesn’t really fit into this cleanly. But if someone with hypothyroidism was consulting Dr. Google on how to optimize their thyroid function, they’d likely read about selenium and brazil nuts. Brazil nuts and peanuts are both denser sources of barium than other foods. Yeah, I just butchered that… I can see the tomatoes flying.
An analysis of her diet is important. What we learned was that she was eating an atypical amount of brazil nuts. She had counted 24-28 of them some days. It’s the more is better mentality in the wild west. Funny thing is brazil nuts are often not a reliable source of selenium, but they are a potentially wonderful source of barium.
What is important to note about this urinalysis is that the barium level was elevated in the context of high brazil nut consumption, which implies that the patient is detoxifying barium just fine. What would be concerning is they were low in this context. In this way, we’re using this urine analysis in sort of an off-label way of assessing the pathways related to barium metabolism.
And so, part of the intervention was to back off the brazil nuts. Not only because of any potential relevant barium burden, but also because of the potential for an excessive amount of selenium. Seeing as how the content of selenium in brazil nuts can range from 0.2 to over 2500mcg per nut [5] and we only need around 50-70mcg per day, there is the potential for selenium toxicity. I don’t think either barium or selenium explains her chief concerns, but prevention is also an important part of medicine.
What you need to know
There’s plenty of information out there about all of these mysterious things labeled “toxins.” (For those who like the semantic rock throwing, they’re actually referred to as “toxicants.”) They have names and faces. Barium is one of them. But the amounts of barium we’re exposed to in food, air and water are likely irrelevant in most cases, and detection of barium upon investigation should first lead you to look at exposure through diet, occupation and medical procedures.
That being said, barium does do harm. But so too does breathing and eating. It’s a stressor on the body most of us can handle. You can ensure you have all the resources you need by doing all the basics including getting enough protein from organ meats and seafood, eating nutritious starches and plenty of vegetables. If you’re really all in on the basics and still not getting results… sleep, nutrition, destressing, playing and purpose, then these more exotic animals should be addressed.
Further Reading:
Collection of CDC data on barium toxicity
[1] https://www.atsdr.cdc.gov/toxprofiles/tp.asp?id=327&tid=57
World Health Organization report on barium in drinking water
[2] http://www.who.int/water_sanitation_health/dwq/chemicals/barium.pdf
An interesting means of celebrating the 4th of July
[3] Rhyee, Sean H., and Kennon Heard. “Acute barium toxicity from ingestion of “snake” fireworks.” Journal of medical toxicology 5.4 (2009): 209-213.
CDC data for urinary barium in the population. Used for interpretation of metal urine assay.
[4] https://www.cdc.gov/exposurereport/pdf/fourthreport.pdf
The Se content of brazil nuts is all over the place!
[5] https://honey-guide.com/2012/11/19/brazil-nuts-and-selenium/
The author:
Billy Mitchell is a medical student wrapping up his 4th year at Southwest College of Naturopathic Medicine. His areas of interest include rheumatology and environmental medicine.