Do fish fly?

Jeremy Piven abruptly quit his $15,000 a week gig in the Broadway revival of David Mamet’s Speed-the-Plow last week, when his doctor claimed he had mercury poisoning from all of the sushi he’d been eating.

For this story to be true, he would be the first human in recorded history* to get mercury poisoning from eating sushi in this country.

Is it time to contact the Guiness Book of World Records or is this story a little fishy?

While none of us knows Mr. Piven’s actual medical condition and can only go by what has been reported in the news, this theatrical story is fueling a lot of fears that sushi can cause mercury toxicity. That makes it worthwhile to bring some science to the sensation.

For the investors in the Broadway production, believing this popular food myth could cost them $3.5 million.

If, instead, they believed in science, they would know that it is biologically unfeasible for someone eating fish and seafood commercially available in the United States, or any developed country today, to eat so much to get mercury poisoning.

For the 2002 FDA scientific meetings on methylmercury, scientists at the U.S. Department of Agriculture’s Human Nutrition Information Services tried every possible combination — heavy fish consumption, eating commercial fish varieties with the highest methylmercury levels or any combination of measured levels, repeatedly eating the same fish, etc. — and try as they might, after 100,000 iterations they found it implausible for an adult woman to eat so much purchased fish to put herself or their unborn baby anywhere near dangerous levels of methylmercury.

How likely is it that Mr. Piven somehow came up with the magical 100,001^th iteration?

For more than 30 years, researchers at the University of Rochester Medical Center, in Rochester, New York, have closely followed populations eating large amounts of fish, including Samoans, Peruvians and residents of the Seychelles, and found no associated adverse effects in adults or children. Even people with the highest per capita consumption of fish in the world, the Seychelles, where the children get 10 to 20 times more methylmercury than U.S. children, the researchers have tested them for more than 14 years now, evaluating every possible measure of health, developmental and neurological function, and found no detectable adverse effects — let alone mercury toxicity.

And, not to split hairs, any Japanese sushi aficionado knows that sushi refers to the bite-size delicacies with vinegared rice. Sashimi is the raw saltwater fish.

The sushi angle makes this a fishy tale that doesn't fly.

Some news stories have reported his doctor saying that the Chinese herbs** he was taking could have contributed to is “mercury toxicity.” Well, that might be possible … theoretically, if he ingested two Chinese herbal balls a day that also happened to be tainted with mercury. In a letter to the editor of the New England Journal of Medicine, the level of mercury sulfides (not the form of mercury found in fish) reported in some herbal balls imported from China in 1995 could potentially be a health risk, according to the authors. These Chinese herbal balls are used among traditional herbalists, they noted, for conditions such as rheumatism, apoplexy (uncontrolled bleeding in the brain) and cataracts. Mr. Piven appears a bit too young and healthy to turn to such large amounts of Chinese herbs to treat things like that.

A search for reports of recent U.S. recalls of Chinese herbs for mercury contamination came up empty. The FDA has sent out warning letters to various Chinese herbal suppliers, though, for making illegal and unsupported medical claims that their herbs are effective for cancer. Health Canada reported in April that Singapore health authorities had recalled several Chinese herbs, used for treating things like constipation and inflammation, for exceeding permissible levels. But none of those products were found to have been imported and for sale or in the Canadian marketplace.

With the source of his purported diagnosis of mercury toxicity a medical mystery, it’s far more likely he doesn’t really have “high” mercury levels at all.

Popular mythologies about mercury scare a lot of people, but fears aren’t grounded in science. As with most fears of contaminants, mythologists not only fail to explain (or understand) the different types of mercury, but the difference between the benchmark dose and the reference dose in levels measured in the body.

The benchmark dose is the lowest amount considered safe from any effect over a lifetime of daily exposure in the most sensitive population of children, as Dr. Joseph Jacobson, of Wayne State University and a member of the National Academy of Sciences’ Committee on Methylmercury explained.

The FDA and EPA then add an arbitrary ten-fold safety cushion to that, to arrive at a “reference dose” — which the FDA uses for regulatory reporting (called its “Action Level”). This safety cushion is not a threshold where there is any possible health risk; but it is what those trying to scare the willies out of us often use to define "high."

Those investors could solve the mystery with a simple blood test and confirm that “high” definition.

Many alternative practitioners make their living testing people’s hair, urine or blood for chemicals and substances that we all naturally have in our bodies, attribute them to general symptoms we all naturally have, and then offer “treatments.” When researchers from the Harvard Medical School studied people who had been told they were “mercury toxic” after getting tests done at spas and integrative medicine clinics, they found that none of the people actually had mercury toxicity. The doctors cautioned that regular and heavy fish eaters may have higher mercury levels, but they’re still not at levels associated with any health problems.

Other fishy aspects of this story

As ABC News reported, his doctor is the medical director of Peak Wellness of Greenwich, Connecticut. He told ABC News that Piven’s levels of mercury were nearly six times normal and that he is now being treated with dietary supplements to help clear the mercury from his body. Wonder what dietary supplements he’s prescribed, since actual mercury poisoning isn’t treated with supplements. Mr. Piven’s mercury levels were reportedly tested after he complained of extreme fatigue and weakness, but that’s not the presenting symptom of mercury toxicity, according to the CDC, either.

While David Mamet reportedly laughed about Mr. Piven, saying he was leaving the show to “pursue a career as a thermometer,” it’s possible that Mr. Piven is a victim. He may have come to believe he really is suffering from mercury poisoning. The nocebo effect frequently explains physical symptoms experienced by people who have come to fear some contaminant or exposure is dangerous or been told that they have been exposed. It’s more common than people realize. And no one is immune from its effects, as a recent episode of House dramatized.

Peak Wellness is an integrative medicine clinic offering alternative modalities and contract clinical trials. It is headed by Piven’s doctor, Dr. Carlon Colker, M.D. With impressive credentials and affiliations, Dr. Colker may be most known as a bodybuilder, television personality, and author of Extreme Muscle Enhancement and The Greenwich Diet.

Does anyone remember this fad diet book from 2000? You can now get a copy of The Greenwich Diet on Amazon for a penny. It was another low-carb, high-protein diet that promised extraordinary weight loss, body fat loss, increased energy levels and healthier cholesterol levels. There were complicated rules, detailed lists of foods and meal plans that were supposed to change your metabolism and make your body a fat-burning machine. Dieters were told to avoid pasta, rice, potatoes, baked goods, fruits (except apples), all pork products, and soy. The most critical part of the diet was dietary supplements: whey protein (as found in Cheese Wiz) supplements, which were said to build muscle; and essential fatty acid supplements, which were said to lower blood pressure and act as a diuretic and improve digestion. And then there’s the water — our bodies contain about 12 gallons of water and yet most people are permanently dehydrated, Dr. Colker claimed. Dehydration is the primary reason fat women don’t lose weight, he said.

Dr. Coker, who was appointed chairman of the Scientific Advisory Board of Health Sciences Group, Inc., a neutraceutical and functional food supplement company, has had a bumpy past. Back in 1999, Cytodyne Technologies, which made the dietary supplement Xenadrine RFA-1, laced with ephedra, commissioned Dr. Colker and Peak Wellness to conduct a clinical trial showing its effectiveness. The paper was presented as an abstract at a 1999 meeting in Albuquerque, New Mexico, of the American Society of Exercise Physiologists and later published in the online Journal of Exercise Physiology. Only 23 of the 30 participants completed the 8 week trial, which claimed that those in the supplement group had an implausibly greater body weight and fat loss than those taking the placebo with no adverse health effects. In 2003, he was sued in three states for falsifying data in the clinical study to hide the dangerous effects of the dietary supplement. According to the New York Times, the lawsuits alleged that he and Peak Wellness clinic ran fraudulent tests, altered the results and hid dangerous adverse reactions suffered by test subjects. Forbes later reported that the San Diego Superior Court ruled against the dietary supplement company in the class action lawsuit, saying that Dr. Colker lacked credibility and ordered the dietary supplement company to pay $12.5 million to California consumers.

Hopefully, Mr. Piven will feel better soon and get the best medical care. A second opinion might also help. Anytime we’re given a diagnosis that has serious consequences, it never hurts to get a second opinion from an independent medical professional.

While this story is ongoing, the take home lesson for us is already clear. Follow the science and not let ourselves get caught up, without sound evidence, in scary news of yet another danger lurking out there.

© 2008 Sandy Szwarc

* The only cases in the scientific literature of mercury poisoning from eating fish on record were from fish tainted after an industrial chemical accident in Minamata Bay, Japan in the 1950s, which resulted in fish with methylmercury levels 40 to 1,000 times higher than the fish Americans, and most people around the world, eat.

** As the ATSDR at the CDC reports: “Some religions have practices that may include the use of metallic mercury. Examples of these religions include Santeria (a Cuban-based religion whose followers worship both African deities and Catholic saints), Voodoo (a Haitian-based set of beliefs and rituals), Palo Mayombe (a secret form of ancestor worship practiced mainly in the Caribbean), and Espiritismo (a spiritual belief system native to Puerto Rico). Not all people who observe these religions use mercury, but when mercury is used in religious, ethnic, or ritualistic practices, exposure to mercury may occur both at the time of the practice and afterwards from contaminated indoor air. Metallic mercury is sold under the name "azogue" in stores called "botanicas." Botanicas are common in Hispanic and Haitian communities, where azogue may be sold as an herbal remedy or for spiritual practices.”

But Mr. Piven is reportedly taking Chinese herbs and there are no reports that he has changed his religion to Voodoo or similar ancient form of worship.

In August, Boston researchers reported that 20% of Indian Ayurvedic herbal formulas sold via the internet contained lead, arsenic or mercury metals, but those aren’t Chinese herbs, of course.