
UNDER CONSTRUCTION 2/6/2022
Science Provides Hope
In this section, I will explains the scientific reason why fixing systemic health issues can give you hope, far beyond taking Botox or Levodopa/Carbidopa for symptomatic relief. This is how I was able to recover my life. But first I will share some dark truths from my research, so you will not try to take the easy way out. No more taking a pharmaceutical for each symptom, especially symptoms caused by other pharmaceuticals.
The Dark Truths
One: If you only do symptomatic treatment, cervical dystonia and Parkinson’s are expected to be progressive. For example, with conventional treatment, Parkinson’s is expected to progress through the five stages of the Hoehn and Yahr scale. Each stage comes with greater functional disability, and risk of depression, delusions, and hallucinations.
With conventional treatment, cervical dystonia is expected to progress for 3-5 years and then plateau. Some people will experience progression to their vocal chords or other nearby muscle groups. In two years, I went from occasional involuntary neck movements to not being able to walk without my head bobbing up and down. Six months after that, I became completely disabled and couldn’t even stand up straight for more than 3 seconds. A $10,000 Botox injection into three neck muscles didn’t have any noticeable effect, except on my wallet.
Two: There is no magic pill. If there were, we wouldn’t have headlines like this: “Fossil fuel air pollution responsible for 1 in 5 deaths worldwide” [78]. Also, diabetes wouldn’t have reached epidemic proportions, affecting 1 in 11 people worldwide. And there wouldn’t be 500,000 people on dialysis in the US alone.
Three: Your health depends mostly on you. We can blame genetics all we want, but our ancestors didn’t have nearly our rate of diabetes and other “diseases of aging”. Before I was diagnosed by my naturopathic doctor, I had no idea how important my diet, gut health, and vitamin D levels (e.g. getting sunlight) were in my neck condition, so I did not take them seriously. The reality is that they are vitally important in both dystonias and Parkinson’s, and recent research proves it.
Fixing disease of aging requires you to find the right doctor, and just as importantly, work on your part, . You will need to stick to a healthier diet, reduce stress, work on getting good sleep, exercise when you can, and reduce your exposure to air pollution [8], heavy metals, pesticides, plastic residues, carbon monoxide, and mold. These are things your doctor can’t do for you, no matter how many visits you make. But the right doctor can help you fix gut, immune, and detoxification system issues, and help you correct vitamin D and other nutrient deficiencies that can’t be corrected by diet.
Impaired Detoxification and Neuroprotection are the Real Drivers Behind Many Systemic Diseases
After analyzing all my research, I’m going to make this assertion:
Despite the previous headline, fossil fuel air pollution does not kill 1 in 5 people. At least not directly.
If fossil fuel air pollution did kill 1 in 5 people, then people living near freeways or coal-fired power plants would be dropping dead left and right. Instead, the people who will die from air pollution likely have impaired detoxification and/or neuroprotection systems. Impaired detoxification allows toxins to slowly build up in our bodies instead of being continuously expelled. Any exposure level of toxins, such as in air pollution, can then become a risk. Impaired neuroprotection, usually caused by low levels of antioxidants such as glutathione and taurine, makes us especially sensitive to toxins collected in our bodies. Depending on the combination of toxins, antioxidants, and time, various systemic “diseases of aging” can occur. These include cardiovascular, lung, or neurologic disease such as Parkinson’s or Alzheimer’s, all of which are usually progressive and can result in early death
But… Science Shows Us that Systemic Disease Processes are Partially Reversible!
Fig. 1: Examples of Systemic Treatments for Dystonia and Parkinson's
- Gut Dysbiosis (Imbalance of beneficial & pathogenic bacteria in the gut)
- Treating gut dysbiosis in Parkinson’s patients with constipation resulted in significant improvements in motor and non-motor symptoms [6]. All 11 patients in the study reported a much higher quality-of-life. Some of the patients who started at stage 3 (moderate) Parkinson’s went to stage 1 (mild), 12 weeks after the one-time treatment.
- Treating gut dysbiosis in dystonia has not been formally tested yet. However, in 2021 it was discovered that the majority of dystonia patients had a specific type of gut dysbiosis, different and in some ways opposite from the type found in PD.
- Vitamin D Deficiency
- Vitamin D supplementation significantly reduced progression of PD in one common genetic subgroup during the 12 month trial period [79]. The patients in that group on average actually improved on their 1-5 Parkinson’s scale scores.
- Vitamin D supplementation can help break up alpha-synuclein clusters, which are commonly found in long term PD progression [14].
- Vitamin D supplementation has not been tested against dystonia yet, but has been used to successfully treat chronic neck pain and chronic back pain, common early symptoms of dystonia.
- Vitamin D supplementation has also been used to successfully treat depression, generalized anxiety disorder [80], restless legs syndrome, tics, pain from peripheral neuropathy, osteoporosis, dry eye, and autonomic dysfunction, all more common than usual in Parkinson’s and sometimes in dystonia.
- Vitamin D deficiency has also been associated with reduced melatonin production, short sleep, sleep apnea, autoimmune disease, gout, and 14 times the risk of severe COVID requiring hospitalization.
- Mitochondrial Dysfunction
- Mitochondrial dysfunction is commonly found in Parkinson’s and may be partially genetic [15]. Single substance treatments have been shown to be ineffective.
- Good dietary choices and supplementation have been shown to help reduce mitochondrial dysfunction in chronic disease [16].
- Liver Disease
- 52% of liver cirrhosis patients exhibited Parkinsonian movement disorders. Liver transplantation significantly reduced their Unified Parkinson’s Disease Rating Scale scores [67].
Why do these Treatments Help with Dystonia and Parkinson’s?
They help because the gut, vitamin D, mitochondria, and liver are all key components of our detoxification and neuroprotection systems.
In particular, impaired detoxification and neuroprotection from the metal manganese can cause cervical dystonia, musician’s dystonia, writer’s cramp, Parkinson’s disease and Parkinsonism. It can also cause issues with sleep, memory, thinking, and mood. Like the more commonly known magnesium, manganese is necessary in our bodies in trace amounts – about a rice grain’s worth in our entire bodies.
When our detoxification system for manganese is not working sufficiently, we are much more susceptible to manganese toxicity. Manganese inhaled from air pollution can then cause Parkinson’s disease [10][8], early onset Parkinsonism [28], or dystonia [27]. We can then also create localized toxic deposits of manganese through almost-exclusive usage of a single muscle group [33]. This can explain the much why musician’s dystonia is roughly 20 times more common in professional musicians than cervical dystonia is in adults.
Diagnosis
Unfortunately, even though more that 700 research papers have been written about “manganese toxicity” and Parkinson’s disease in the last two decades, we are still in the infancy of understanding manganese toxicity. There is no definitive way to recognize, diagnose or treat manganese toxicity in clinical practice. Most hospital labs don’t even offer a blood test. So this means manganese toxicity will almost always be diagnosed as an idiopathic (unknown or unproveable cause) form of dystonia or Parkinsonian disorder. Then we will be treated for symptoms using Levodopa / Carbidopa, Botox, antidepressants and so on. And we will progress through
Therefore, most hospitals don’t offer a blood test for manganese levels and doctors in conventional systems won’t order a test. It is easier to diagnose Neither of my neurolo
The weird thing is, at the proper levels, manganese is an essential part of protecting neurons from being damaged by daily use (metabolism). Perhaps we can understand this better by analogy: Manganese in the brain is like nails in a house construction project. Nails holding the house together are performing an important function. But if there are extra nails strewn about, they can cause various types of damage unless we clean them up.
A healthy person has a way to clean up extra manganese atoms from inside cells. It is for the cell’s mitochondria to produce a specialized manganese transporter protein called SLC30A10. Each SLC30A10 produced picks up one excess manganese atom and delivers it to the liver for disposal into the intestine. Severe genetic defects in SLC30A10 coding can cause blood and brain levels of manganese to become up to 5-10 times normal, resulting in childhood four-limb dystonias or adult-onset Parkinsonism. But those types of genetic defects are one in a million. A much more likely cause of manganese toxicity is that our neurons are not producing SLC30A10 fast enough to clear manganese entering the brain from sources such as air pollution.
Almost all we don’t produce SLC30A10 quickly enough, we are at risk for:
- Parkinson’s disease from decades of exposure to traffic [10] or ordinary air pollution [8]
- Parkinsonism from industrial air pollution after many years [28]
- Dystonia [27], and Parkinsonism [28].
For every extra manganese atom in a brain cell,
What does this Mean for You?
It means there are things you can do to reduce or even reverse the progression of idiopathic dystonias or Parkinson’s type movement disorders. It does not matter if manganese toxicity is involved in your movement disorder. I only mention manganese as an example of how systemic health issues can be a major driver for movement disorders and commonly associated symptoms. It is important to note that all of the treatments mentioned in figure 1 were non-specific for manganese. That is, the patients were treated on the basis of their symptoms, with no care of their manganese status except for the liver transplants.
Also, the patients were helped by a single-variable change and within a limited time frame. In the actual practice of my naturopathic doctors, we would usually fix 2-3 synergistic items at the same time. For example, fixing vitamin D deficiencies can help ensure that the immune system can maintain gut health improvements for years. Otherwise, some people are genetically predisposed to returning to poor gut health within months.
And that insufficient SLC30A10 production may be very correctable, starting with correcting gut dysbiosis or constipation, vitamin D deficiencies, and poor diets of over-processed foods, and reducing intake of toxins that damage the liver.
We need tiny amounts of metals such as iron, copper, manganese, zinc, and selenium for our neurons and other cells to operate correctly. However, excess metal atoms can be toxic, causing mitochondrial and other cellular malfunction, and driving “diseases of aging”. Excess manganese (not to be confused with magnesium) can cause almost all of the known disease processes for dystonia and Parkinson’s type movement disorders! While other metals can also cause movement disorders, reviewing the mechanism of manganese toxicity and healing should be sufficient for understanding the importance of fixing issues in our detoxification system.
Excess manganese drives dystonias and Parkinsonian disease processes by: [18]
- Decreasing tyrosine hydroxylase, needed to produce dopamine, but also paradoxically dysregulating dopamine release. Dopamine is used for initiating and coordinating movement.
- Causing oxidative stress damage, particularly to dopamine in the basal ganglia region of the brain.
- Dysregulating GABA release. The neurotransmitter GABA is needed to suppress motions.
- Driving aggregation of misfolded alpha-synuclein into Lewy bodies, a long-term hallmark of Parkinson’s disease.
- Hitching a ride with dopamine transporters [33] and causing dystonias that start with the most used muscles.
This last point has a huge implication that many idiopathic dystonias. In healthy people, excess manganese is removed from neurons by the manganese transporter SLC30A10 and carried to the liver for excretion in the bile.
may be driven by localized deposits of manganese in the basal ganglia, representing the most used muscles. If this excess manganese is not removed by an SLC30A10 manganese transporter produced by the body’s detoxification system, a local deposit of manganese can form where dopamine activity is highest. Thus, severely impaired detoxification of manganese (likely found in approximately 1-2% of people – see reference [27]) combined with high muscle activity or a manganese exposure source can lead to dystonias of the most-used muscles. For example:
- Cervical Dystonia is the most common dystonia in adults, affecting fewer than 0.1%. However, the risk is much higher for adults with almost exclusive use of one set of muscles, or a high exposure source for manganese:
- Musician’s Dystonia: 1% of professional musicians get a dystonia of their most-used hand (after more than 10,000 hours of practice). Cervical dystonia is extremely rare in professional musicians, except for string players.
- Writer’s Cramp: Writers most often get a dystonia of the most-used hand.
- Manganism: 1-4% of manganese smelters get a walking and shoulder/arm dystonia (high exposure)
- Teens most often get dystonia in the hands
- Children most often get dysttonia in the leg
- Cervical Dystonia is the most common dystonia in adults, affecting fewer than 0.1%. However, the risk is much higher for adults with almost exclusive use of one set of muscles, or a high exposure source for manganese:
- Excess manganese can also cause a number of other issues commonly associated with Parkinson’s and cervical dystonia, including disturbing sleep, mood, and cognition. We’ll go over those later.
Although the vast majority of our manganese intake is from food, a healthy gut and liver are able to absorb only the 2-5% of the manganese we need. However, we cannot expel airborne m Parkinson’s disease [10][8], dystonia [27], and Parkinsonism [28].
The key is to restore our bodies’ detoxification and neuroprotection systems to what nature intended it to be. Getting these excess metals (and other toxins) out is a key to reversing many disease processes, and in some cases allowing the body to repair itself.
Manganese Toxicity in Parkinson’s Disease
A 1999 research study estimated that 25-35% of idiopathic Parkinson’s disease diagnoses were incorrect, and actually movement disorders caused by manganese toxicity [77]. Back then, relatively little was known about low level exposure sources and mechanisms of disease. Especially little was known about why most people seemed to be entirely unaffected by manganese exposure while 1-2% would develop Parkinson’s type movement disorders and other issues. However, since 1999, more than 700 scientific research papers have been published discussing “manganese toxicity” in conjunction with Parkinson’s.
From my hundreds of hours just reviewing this research, discussions with Parkinson’s patients, and world-leading toxicology experts, it appears that misdiagnosis is likely even more common than we would think. This is for several reasons:
One, because even slightly elevated levels of manganese in the brain can be behind known Parkinson’s-related disease processes. These processes include a slow driving of aggregation of alpha-synuclein (a hallmark of long term Parkinson’s disease) and inhibition of tyrosine hydroxylase activity (which reduces normal dopamine production) [18]. This makes it almost impossible to differentiate manganese induced Parkinson’s disease processes from other disease processes, even with sophisticated scans such as DATScan.
Two, the amount of low level environmental manganese we are exposed to has increased greatly over the years. Most of the world has switched from leaded gasoline to manganese-containing gasoline [32], wildfires have increased, and more trains have been built (wheel shedding). These low level sources are linked to Parkinson’s disease development over decades [10][8][26].
Three, and probably most critical, is that declining systemic health of the general population makes us more vulnerable to manganese toxicity. The systemic health epidemic is most evident from diabetes, which now affects more than 9% of the world’s population. Notably, diabetes is far more prevalent in high-income countries than low income countries. The higher prevalence of systemic disease in some countries can be traced mostly back to poor food choices, overuse of antibiotics, poor sleep, sedentary lifestyles with less sun exposure, and higher toxic exposures.
Systemic disease leading to inadequate manganese excretion rate and insufficient antioxidants in the brain makes us far more vulnerable to low level manganese exposures and toxicity. The bright side is that if we recognize when systemic disease is driving manganese accumulation and Parkinson’s development, we can effect change. My research shows that getting back to a healthier lifestyle can usually reduce both motor and non-motor symptoms and improve quality of life.
Elevated manganese levels in manganese-induced Parkinson’s is only sometimes detectable in a Red Blood Cell manganese test. However, it is likely that patients will experience at least 2-3 other symptoms from the manganese toxicity symptom list in the next section.
Manganese Toxicity in Cervical Dystonia and Parkinsonism
My research indicates that manganese toxicity driven cervical dystonia and/or early onset Parkinsonism requires higher levels of manganese exposure than in Parkinson’s disease. The higher exposure is usually called “manganism”, meaning occupationally-caused manganese movement disorders. In clinical practice, there is a common belief that only manganese miners and smelters can develop manganism. However, this belief is completely wrong and results in the majority of people diagnosed with idiopathic cervical dystonia to never be tested for red blood cell manganese levels. My exposure to manganese was only incidental; I worked in the same building as a small metalworking operation. But my red blood cell manganese levels were equivalent to someone with stage 4 liver cirrhosis.
If this manganese is cleared, and antioxidant systems restored, we can likely regain many of our movement abilities and have a lot less pain. I am proof of that. But first the manganese toxicity needs to be recognized as a contributor to our dystonia! I would expect that the majority of patients with manganese toxicity driven cervical dystonia would show significantly elevated red blood cell manganese levels. It is also likely that patients will experience at least 3-4 other symptoms from the manganese toxicity symptom list in the next section.
As I cleared the manganese out of my body, I slowly started being able to do things again in almost the opposite order that they had occurred. That is, the symptoms I had the longest tended to be the slowest to resolve. I expect that manganese-induced musician’s dystonia will be similar. And one thing to note, unfortunately, is that you will need to re-learn many coordinated muscle motions. I had to with my nec, and some of them took a couple of months.
In this case of musician’s dystonia or writer’s cramp caused by manganese toxicity, I would expect that red blood cell levels of manganese will usually be close to normal. Also, patients may not experience significant additional manganese toxicity symptoms, except possibly anxiety, insomnia or obsessive-compulsive disorders. However, the risk factors for impaired manganese clearance may be more common: Vitamin D deficiency, gut health issues such as constipation or excessive gas, mitochondrial dysfunction, or poor liver health. It would make sense to check for these things and resolve them if necessary.
- Then there’s me. If my wife hadn’t pushed me to see an ND, my only diagnosis from two neurologists would have been idiopathic cervical dystonia. I would have been permanently disabled, with Botox injections for partial symptomatic relief the rest of my life. But now that I followed the treatment plan in this website, it’s not only my neck that works and feels better. My health has improved in many surprising ways. I no longer need the sleep apnea pump I used to fight chronic fatigue syndrome for more than two decades. I no longer scuff my shoes when I walk, no longer have restless legs syndrome, don’t feel faint when I stand up in the morning, and my eyes and mouth are no longer dry. My thinking is clearer and I speak louder and enunciate more clearly. My skin color and condition is better. Finally, I am now rarely anxious or stressed by anything, and I sleep much better.
This could have been triggered by a single event, such as carbon monoxide poisoning or an infection. But impaired detoxification is far more likely to involve a combination of long term factors. This may include poor diet, gut dysbiosis (imbalance in the gut bacteria), inadequate sun exposure or having dark skin and living in a low-sunlight area, immune system overactivation, high stress, insufficient sleep, inadequate exercise, and so on. These are correctable factors, and my research shows clearly that fixing these
When we have impaired detoxification, the toxins we encounter in daily life slowly accumulate in our bodies over years. The toxins tend to impair our detoxification processes even further, and the build of toxins can accelerate if we do not remove our Depending on the type of toxins and other factors, this
Genetics can’t explain the rising incidence of Parkinson’s disease, or of systemic “diseases of aging” in general. Genetics also can’t explain the strong link between air pollution and Parkinson’s disease [10][8], dystonia [27], and Parkinsonism [28].
So I researched the environmental factors behind dystonia and Parkinsonism. I discovered that accumulation of metals in the brain has been found in almost all neurodegenerative disease. Excess metal atoms that don’t have a specific function in the brain are toxic to both neurons and neurotransmitters. The metal toxicity most associated with Parkinson’s and dystonias, by far, is manganese (not to be confused with magnesium). And manganese is a component of almost all air pollution today, including from car pollution, train wheel shedding, and industrial, especially steel making, metalworking, welding, and battery manufacturing. Living even a kilometer away from these industries can be a risk factor for Parkinson’s disease due to accumulated manganese dust in the soils.
Like iron, zinc, copper, and selenium, manganese is a necessary trace element in our bodies. But we only need a rice grain’s worth of manganese distributed through our entire body. Excess manganese in the brain can drive the core disease processes behind Alzheimer’s disease, Parkinson’s disease, Parkinsonism (including early-onset), and dystonias [18]. Excess manganese can also cause tics, anxiety, mood swings, and issues with sleep and cognition. Furthermore, a high degree of activity almost exclusively in one or two muscle group can localize excess manganese deposits over time and cause dystonias of the most-used muscles. Examples include musician’s dystonia or writer’s cramp. Cervical dystonia is also a dystonia of a most-used muscle group, but usually requires a manganese exposure source.
In case studies, dystonias and Parkinsonism caused by industrial exposure to manganese, called manganism, are always observed to be permanent and progressive. The progression is reminiscent of cervical dystonia and Parkinson’s disease progression, and can happen for years after removal of the manganese source. Conventional treatment is done with chelation drugs such as intravenous calcium EDTA. EDTA binds to free manganese in the blood and surface tissues and can slowly remove manganese from the body but not much from the brain. After many treatments, motor symptoms are observed to reduce somewhat. But the elevated blood manganese levels are almost always observed to return after a few months, and the progression continues.
In traditional clinical practice, manganese is almost always dismissed as a possible cause of cervical dystonia and Parkinson’s, for people not in a high risk occupation. My two neurologists were not interested in my manganese lab work ordered by my naturopathic doctor. Neither was a third research hospital interested in offering a second opinion.
Improving Systemic Health and Getting the Manganese Out
It turns out the main risk factor for manganese toxicity is not exposure to manganese. Manganese is present in almost all foods, and we eat roughly 30 times what we need. But in a healthy person, homeostasis systems tightly control the amount of manganese we absorb and levels in the blood and brain. Therefore, the main risk is when our homeostasis systems are broken. Then, exposure to manganese containing air pollution or water pollution can slowly drive up the amount of manganese in the brain, and the disease processes can start. Or, exclusive use of certain muscles can cause the localization issue. Cervical dystonia is probably some combination of these two – slightly elevated exposure combined with neck muscles being the most heavily used muscle group for most adults.
A secondary risk factor for excess manganese leading to Parkinson’s or dystonias is antioxidant levels. Antioxidants are various biochemicals in your brain and elsewhere that help protect against or repair the oxidative damage caused by excess manganese or other toxins. Antioxidants also protect us against toxic products of normal metabolism. An analogy for antioxidants is coating a piece of metal with oil to keep it from rusting. If we have too much oxidative reactions in our body, it is called oxidative stress, which is the main cause of aging.
What Breaks our Manganese Homeostasis Systems?
The most likely
Healing from Cervical Dystonia
As of today, I haven’t taken any pharmaceuticals for over two years. Instead, I followed a treatment plan from two NDs, including one experienced with detoxing heavy metals. and am healed to around 90% of what I hope to achieve. Treatment and healing was indeed a bumpy road but I have no regrets. I am sitting comfortably while creating this website.
The treatment involved getting my body to detox and repair like healthy people do every day:
- Fixing my gut issues
- Fixing my vitamin D deficiency
- Establishing a low sugar, high nutrient-density, protein-moderated, quality fats, low-toxin, reduced manganese absorption, high antioxidant diet, and avoiding immune-system triggering foods
- Supplementing magnesium, omega-3, iron, vitamin, and other key nutrients where diet was not sufficient
- Reducing sources of inflammation (immune system activation)
- Improving my sleep
- Reducing exposure to air pollution
- Reducing exposure to heavy metals, pesticides, and plastics
- IV EDTA chelation treatments (conventional medicine)
- Home saunas
After 6 months of this regimen, many of my cervical dystonia associated conditions had improved, like my jaw stopped clenching at night, and I had much fewer nightmares. But three of my neck muscles were still very tight, the pain was intense, and honestly, I scared as hell.
Then a COVID shutdown came along, and three things changed:
- I finally got my vitamin D levels up to the levels that my NDs wanted (it took a LOT of supplementation, mostly due to genetic factors)
- My air pollution intake went down further, because the manganese-spewing trains behind my house stopped running, and freeway traffic disappeared
- We stopped ordering all take-out food, which is usually delivered in containers that are toxic to liver function.
One month into the COVID shutdown, I slowly started being able to move my neck and sit up again! After a few weeks the trains and traffic restarted. Within a month of restart my dystonia slowly got worse again, but did not reach as bad as before. Since we hadn’t restarted take-out food or changed my vitamin D levels, I learned the hard way how bad it is to breathe in pollution even at levels we can’t even see or smell. So my family took reducing my air pollution intake much more seriously, and soon my second remission started.
I have now been in my second remission for a year and a half, and things are still ever so slowly improving. I have returned to an almost a normal life, am driving again, and the horrific pain is just a distant memory. Just as importantly, I no longer feel depressed, scared, or anxious. I will explain later how many of these moods are actually deeply related to gut health and vitamin D status.
Chronic Illness Research
It is now clear to me that I was not unlucky enough to have two rare diseases. Instead, chronic fatigue syndrome and cervical dystonia were different expressions of the same underlying systemic disease. This systemic disease started with gut issues, immune system over-activation, exposure and retention of toxins,, and suboptimal genetics such as inefficient detoxification processes and low vitamin D production. This was sufficient to cause to cause chronic fatigue syndrome in me. It is not surprising chronic fatigue syndrome usually starts before age 40.
My dystonia started a couple years after my gut issues came back. Gut issues (such as constipation), vitamin D deficiency [11], and mitochondrial dysfunction can severely reduce the body’s normal ability to detoxify manganese inhaled from air pollution. Excess manganese in the brain can then cause motor disorders by messing with dopamine and GABA release, damaging dopamine and dopamine channels, and encouraging the aggregation of misfolded proteins, behind Parkinson’s and Alzheimer’s diseases [36]. These processes take years to cause dystonias, and decades to cause Parkinson’s disease.
My research also shows that in people with insufficient manganese detoxification capability, excess manganese deposition will likely localize to the most-used muscles. This is because excess manganese in neurons, if not carried out in the normal detoxification process, can also be carried by dopamine transporters and be deposited where dopamine activity is the highest [33]. This localization to most-used muscles effect can explain why musician’s dystonia is 10-20 times more common in professional musicians than cervical dystonia is in adults. It can also explain why the most common dystonia in children is in the legs, teens in the hands, and adults in the neck. except for manganese mine workers who get dystonias in their arms, shoulders and legs. These are all dystonias of the most-used muscles.
Important Note
Please note I am not a doctor. I cannot diagnose nor treat any disease. It is important that you work with an doctor who can help you with your systemic health. This site is for educational purposes only. By using this website, you agree that I am not responsible for omissions or errors.
Dedications
This site is dedicated to my wife and children, who stood by me even in my darkest days and never gave up hope. Because of them, this site will always be free to anyone who needs help with chronic illness.
Why do these Treatments Help with Dystonia and Parkinson’s?
They help because the gut, vitamin D, mitochondria, and liver are all key components of our detoxification and neuroprotection systems.
In particular, impaired detoxification and neuroprotection from the metal manganese can cause cervical dystonia, musician’s dystonia, writer’s cramp, Parkinson’s disease and Parkinsonism. It can also cause issues with sleep, memory, thinking, and mood. Like the more commonly known magnesium, manganese is necessary in our bodies in trace amounts – about a rice grain’s worth in our entire bodies.
When our detoxification system for manganese is not working sufficiently, we are much more susceptible to manganese toxicity. Manganese inhaled from air pollution can then cause Parkinson’s disease [10][8], early onset Parkinsonism [28], or dystonia [27]. We can then also create localized toxic deposits of manganese through almost-exclusive usage of a single muscle group [33]. This can explain the much why musician’s dystonia is roughly 20 times more common in professional musicians than cervical dystonia is in adults.
Diagnosis
Unfortunately, even though more that 700 research papers have been written about “manganese toxicity” and Parkinson’s disease in the last two decades, we are still in the infancy of understanding manganese toxicity. There is no definitive way to recognize, diagnose or treat manganese toxicity in clinical practice. Most hospital labs don’t even offer a blood test. So this means manganese toxicity will almost always be diagnosed as an idiopathic (unknown or unproveable cause) form of dystonia or Parkinsonian disorder. Then we will be treated for symptoms using Levodopa / Carbidopa, Botox, antidepressants and so on. And we will progress through
Therefore, most hospitals don’t offer a blood test for manganese levels and doctors in conventional systems won’t order a test. It is easier to diagnose Neither of my neurolo
The weird thing is, at the proper levels, manganese is an essential part of protecting neurons from being damaged by daily use (metabolism). Perhaps we can understand this better by analogy: Manganese in the brain is like nails in a house construction project. Nails holding the house together are performing an important function. But if there are extra nails strewn about, they can cause various types of damage unless we clean them up.
A healthy person has a way to clean up extra manganese atoms from inside cells. It is for the cell’s mitochondria to produce a specialized manganese transporter protein called SLC30A10. Each SLC30A10 produced picks up one excess manganese atom and delivers it to the liver for disposal into the intestine. Severe genetic defects in SLC30A10 coding can cause blood and brain levels of manganese to become up to 5-10 times normal, resulting in childhood four-limb dystonias or adult-onset Parkinsonism. But those types of genetic defects are one in a million. A much more likely cause of manganese toxicity is that our neurons are not producing SLC30A10 fast enough to clear manganese entering the brain from sources such as air pollution.
Almost all we don’t produce SLC30A10 quickly enough, we are at risk for:
- Parkinson’s disease from decades of exposure to traffic [10] or ordinary air pollution [8]
- Parkinsonism from industrial air pollution after many years [28]
- Dystonia [27], and Parkinsonism [28].
For every extra manganese atom in a brain cell,
What does this Mean for You?
It means there are things you can do to reduce or even reverse the progression of idiopathic dystonias or Parkinson’s type movement disorders. It does not matter if manganese toxicity is involved in your movement disorder. I only mention manganese as an example of how systemic health issues can be a major driver for movement disorders and commonly associated symptoms. It is important to note that all of the treatments mentioned in figure 1 were non-specific for manganese. That is, the patients were treated on the basis of their symptoms, with no care of their manganese status except for the liver transplants.
Also, the patients were helped by a single-variable change and within a limited time frame. In the actual practice of my naturopathic doctors, we would usually fix 2-3 synergistic items at the same time. For example, fixing vitamin D deficiencies can help ensure that the immune system can maintain gut health improvements for years. Otherwise, some people are genetically predisposed to returning to poor gut health within months.
And that insufficient SLC30A10 production may be very correctable, starting with correcting gut dysbiosis or constipation, vitamin D deficiencies, and poor diets of over-processed foods, and reducing intake of toxins that damage the liver.
We need tiny amounts of metals such as iron, copper, manganese, zinc, and selenium for our neurons and other cells to operate correctly. However, excess metal atoms can be toxic, causing mitochondrial and other cellular malfunction, and driving “diseases of aging”. Excess manganese (not to be confused with magnesium) can cause almost all of the known disease processes for dystonia and Parkinson’s type movement disorders! While other metals can also cause movement disorders, reviewing the mechanism of manganese toxicity and healing should be sufficient for understanding the importance of fixing issues in our detoxification system.
Excess manganese drives dystonias and Parkinsonian disease processes by: [18]
- Decreasing tyrosine hydroxylase, needed to produce dopamine, but also paradoxically dysregulating dopamine release. Dopamine is used for initiating and coordinating movement.
- Causing oxidative stress damage, particularly to dopamine in the basal ganglia region of the brain.
- Dysregulating GABA release. The neurotransmitter GABA is needed to suppress motions.
- Driving aggregation of misfolded alpha-synuclein into Lewy bodies, a long-term hallmark of Parkinson’s disease.
- Hitching a ride with dopamine transporters [33] and causing dystonias that start with the most used muscles.
This last point has a huge implication that many idiopathic dystonias. In healthy people, excess manganese is removed from neurons by the manganese transporter SLC30A10 and carried to the liver for excretion in the bile.
may be driven by localized deposits of manganese in the basal ganglia, representing the most used muscles. If this excess manganese is not removed by an SLC30A10 manganese transporter produced by the body’s detoxification system, a local deposit of manganese can form where dopamine activity is highest. Thus, severely impaired detoxification of manganese (likely found in approximately 1-2% of people – see reference [27]) combined with high muscle activity or a manganese exposure source can lead to dystonias of the most-used muscles. For example:
-
- Cervical Dystonia is the most common dystonia in adults, affecting fewer than 0.1%. However, the risk is much higher for adults with almost exclusive use of one set of muscles, or a high exposure source for manganese:
- Musician’s Dystonia: 1% of professional musicians get a dystonia of their most-used hand (after more than 10,000 hours of practice). Cervical dystonia is extremely rare in professional musicians, except for string players.
- Writer’s Cramp: Writers most often get a dystonia of the most-used hand.
- Manganism: 1-4% of manganese smelters get a walking and shoulder/arm dystonia (high exposure)
- Teens most often get dystonia in the hands
- Children most often get dysttonia in the leg
- Cervical Dystonia is the most common dystonia in adults, affecting fewer than 0.1%. However, the risk is much higher for adults with almost exclusive use of one set of muscles, or a high exposure source for manganese:
- Excess manganese can also cause a number of other issues commonly associated with Parkinson’s and cervical dystonia, including disturbing sleep, mood, and cognition. We’ll go over those later.
Although the vast majority of our manganese intake is from food, a healthy gut and liver are able to absorb only the 2-5% of the manganese we need. However, we cannot expel airborne m Parkinson’s disease [10][8], dystonia [27], and Parkinsonism [28].
The key is to restore our bodies’ detoxification and neuroprotection systems to what nature intended it to be. Getting these excess metals (and other toxins) out is a key to reversing many disease processes, and in some cases allowing the body to repair itself.
Manganese Toxicity in Parkinson’s Disease
A 1999 research study estimated that 25-35% of idiopathic Parkinson’s disease diagnoses were incorrect, and actually movement disorders caused by manganese toxicity [77]. Back then, relatively little was known about low level exposure sources and mechanisms of disease. Especially little was known about why most people seemed to be entirely unaffected by manganese exposure while 1-2% would develop Parkinson’s type movement disorders and other issues. However, since 1999, more than 700 scientific research papers have been published discussing “manganese toxicity” in conjunction with Parkinson’s.
From my hundreds of hours just reviewing this research, discussions with Parkinson’s patients, and world-leading toxicology experts, it appears that misdiagnosis is likely even more common than we would think. This is for several reasons:
One, because even slightly elevated levels of manganese in the brain can be behind known Parkinson’s-related disease processes. These processes include a slow driving of aggregation of alpha-synuclein (a hallmark of long term Parkinson’s disease) and inhibition of tyrosine hydroxylase activity (which reduces normal dopamine production) [18]. This makes it almost impossible to differentiate manganese induced Parkinson’s disease processes from other disease processes, even with sophisticated scans such as DATScan.
Two, the amount of low level environmental manganese we are exposed to has increased greatly over the years. Most of the world has switched from leaded gasoline to manganese-containing gasoline [32], wildfires have increased, and more trains have been built (wheel shedding). These low level sources are linked to Parkinson’s disease development over decades [10][8][26].
Three, and probably most critical, is that declining systemic health of the general population makes us more vulnerable to manganese toxicity. The systemic health epidemic is most evident from diabetes, which now affects more than 9% of the world’s population. Notably, diabetes is far more prevalent in high-income countries than low income countries. The higher prevalence of systemic disease in some countries can be traced mostly back to poor food choices, overuse of antibiotics, poor sleep, sedentary lifestyles with less sun exposure, and higher toxic exposures.
Systemic disease leading to inadequate manganese excretion rate and insufficient antioxidants in the brain makes us far more vulnerable to low level manganese exposures and toxicity. The bright side is that if we recognize when systemic disease is driving manganese accumulation and Parkinson’s development, we can effect change. My research shows that getting back to a healthier lifestyle can usually reduce both motor and non-motor symptoms and improve quality of life.
Elevated manganese levels in manganese-induced Parkinson’s is only sometimes detectable in a Red Blood Cell manganese test. However, it is likely that patients will experience at least 2-3 other symptoms from the manganese toxicity symptom list in the next section.
Manganese Toxicity in Cervical Dystonia and Parkinsonism
My research indicates that manganese toxicity driven cervical dystonia and/or early onset Parkinsonism requires higher levels of manganese exposure than in Parkinson’s disease. The higher exposure is usually called “manganism”, meaning occupationally-caused manganese movement disorders. In clinical practice, there is a common belief that only manganese miners and smelters can develop manganism. However, this belief is completely wrong and results in the majority of people diagnosed with idiopathic cervical dystonia to never be tested for red blood cell manganese levels. My exposure to manganese was only incidental; I worked in the same building as a small metalworking operation. But my red blood cell manganese levels were equivalent to someone with stage 4 liver cirrhosis.
If this manganese is cleared, and antioxidant systems restored, we can likely regain many of our movement abilities and have a lot less pain. I am proof of that. But first the manganese toxicity needs to be recognized as a contributor to our dystonia! I would expect that the majority of patients with manganese toxicity driven cervical dystonia would show significantly elevated red blood cell manganese levels. It is also likely that patients will experience at least 3-4 other symptoms from the manganese toxicity symptom list in the next section.
As I cleared the manganese out of my body, I slowly started being able to do things again in almost the opposite order that they had occurred. That is, the symptoms I had the longest tended to be the slowest to resolve. I expect that manganese-induced musician’s dystonia will be similar. And one thing to note, unfortunately, is that you will need to re-learn many coordinated muscle motions. I had to with my nec, and some of them took a couple of months.
In this case of musician’s dystonia or writer’s cramp caused by manganese toxicity, I would expect that red blood cell levels of manganese will usually be close to normal. Also, patients may not experience significant additional manganese toxicity symptoms, except possibly anxiety, insomnia or obsessive-compulsive disorders. However, the risk factors for impaired manganese clearance may be more common: Vitamin D deficiency, gut health issues such as constipation or excessive gas, mitochondrial dysfunction, or poor liver health. It would make sense to check for these things and resolve them if necessary.
- Then there’s me. If my wife hadn’t pushed me to see an ND, my only diagnosis from two neurologists would have been idiopathic cervical dystonia. I would have been permanently disabled, with Botox injections for partial symptomatic relief the rest of my life. But now that I followed the treatment plan in this website, it’s not only my neck that works and feels better. My health has improved in many surprising ways. I no longer need the sleep apnea pump I used to fight chronic fatigue syndrome for more than two decades. I no longer scuff my shoes when I walk, no longer have restless legs syndrome, don’t feel faint when I stand up in the morning, and my eyes and mouth are no longer dry. My thinking is clearer and I speak louder and enunciate more clearly. My skin color and condition is better. Finally, I am now rarely anxious or stressed by anything, and I sleep much better.
This could have been triggered by a single event, such as carbon monoxide poisoning or an infection. But impaired detoxification is far more likely to involve a combination of long term factors. This may include poor diet, gut dysbiosis (imbalance in the gut bacteria), inadequate sun exposure or having dark skin and living in a low-sunlight area, immune system overactivation, high stress, insufficient sleep, inadequate exercise, and so on. These are correctable factors, and my research shows clearly that fixing these
When we have impaired detoxification, the toxins we encounter in daily life slowly accumulate in our bodies over years. The toxins tend to impair our detoxification processes even further, and the build of toxins can accelerate if we do not remove our Depending on the type of toxins and other factors, this
Genetics can’t explain the rising incidence of Parkinson’s disease, or of systemic “diseases of aging” in general. Genetics also can’t explain the strong link between air pollution and Parkinson’s disease [10][8], dystonia [27], and Parkinsonism [28].
So I researched the environmental factors behind dystonia and Parkinsonism. I discovered that accumulation of metals in the brain has been found in almost all neurodegenerative disease. Excess metal atoms that don’t have a specific function in the brain are toxic to both neurons and neurotransmitters. The metal toxicity most associated with Parkinson’s and dystonias, by far, is manganese (not to be confused with magnesium). And manganese is a component of almost all air pollution today, including from car pollution, train wheel shedding, and industrial, especially steel making, metalworking, welding, and battery manufacturing. Living even a kilometer away from these industries can be a risk factor for Parkinson’s disease due to accumulated manganese dust in the soils.
Like iron, zinc, copper, and selenium, manganese is a necessary trace element in our bodies. But we only need a rice grain’s worth of manganese distributed through our entire body. Excess manganese in the brain can drive the core disease processes behind Alzheimer’s disease, Parkinson’s disease, Parkinsonism (including early-onset), and dystonias [18]. Excess manganese can also cause tics, anxiety, mood swings, and issues with sleep and cognition. Furthermore, a high degree of activity almost exclusively in one or two muscle group can localize excess manganese deposits over time and cause dystonias of the most-used muscles. Examples include musician’s dystonia or writer’s cramp. Cervical dystonia is also a dystonia of a most-used muscle group, but usually requires a manganese exposure source.
In case studies, dystonias and Parkinsonism caused by industrial exposure to manganese, called manganism, are always observed to be permanent and progressive. The progression is reminiscent of cervical dystonia and Parkinson’s disease progression, and can happen for years after removal of the manganese source. Conventional treatment is done with chelation drugs such as intravenous calcium EDTA. EDTA binds to free manganese in the blood and surface tissues and can slowly remove manganese from the body but not much from the brain. After many treatments, motor symptoms are observed to reduce somewhat. But the elevated blood manganese levels are almost always observed to return after a few months, and the progression continues.
In traditional clinical practice, manganese is almost always dismissed as a possible cause of cervical dystonia and Parkinson’s, for people not in a high risk occupation. My two neurologists were not interested in my manganese lab work ordered by my naturopathic doctor. Neither was a third research hospital interested in offering a second opinion.
Improving Systemic Health and Getting the Manganese Out
It turns out the main risk factor for manganese toxicity is not exposure to manganese. Manganese is present in almost all foods, and we eat roughly 30 times what we need. But in a healthy person, homeostasis systems tightly control the amount of manganese we absorb and levels in the blood and brain. Therefore, the main risk is when our homeostasis systems are broken. Then, exposure to manganese containing air pollution or water pollution can slowly drive up the amount of manganese in the brain, and the disease processes can start. Or, exclusive use of certain muscles can cause the localization issue. Cervical dystonia is probably some combination of these two – slightly elevated exposure combined with neck muscles being the most heavily used muscle group for most adults.
A secondary risk factor for excess manganese leading to Parkinson’s or dystonias is antioxidant levels. Antioxidants are various biochemicals in your brain and elsewhere that help protect against or repair the oxidative damage caused by excess manganese or other toxins. Antioxidants also protect us against toxic products of normal metabolism. An analogy for antioxidants is coating a piece of metal with oil to keep it from rusting. If we have too much oxidative reactions in our body, it is called oxidative stress, which is the main cause of aging.
What Breaks our Manganese Homeostasis Systems?
The most likely
Healing from Cervical Dystonia
As of today, I haven’t taken any pharmaceuticals for over two years. Instead, I followed a treatment plan from two NDs, including one experienced with detoxing heavy metals. and am healed to around 90% of what I hope to achieve. Treatment and healing was indeed a bumpy road but I have no regrets. I am sitting comfortably while creating this website.
The treatment involved getting my body to detox and repair like healthy people do every day:
- Fixing my gut issues
- Fixing my vitamin D deficiency
- Establishing a low sugar, high nutrient-density, protein-moderated, quality fats, low-toxin, reduced manganese absorption, high antioxidant diet, and avoiding immune-system triggering foods
- Supplementing magnesium, omega-3, iron, vitamin, and other key nutrients where diet was not sufficient
- Reducing sources of inflammation (immune system activation)
- Improving my sleep
- Reducing exposure to air pollution
- Reducing exposure to heavy metals, pesticides, and plastics
- IV EDTA chelation treatments (conventional medicine)
- Home saunas
After 6 months of this regimen, many of my cervical dystonia associated conditions had improved, like my jaw stopped clenching at night, and I had much fewer nightmares. But three of my neck muscles were still very tight, the pain was intense, and honestly, I scared as hell.
Then a COVID shutdown came along, and three things changed:
- I finally got my vitamin D levels up to the levels that my NDs wanted (it took a LOT of supplementation, mostly due to genetic factors)
- My air pollution intake went down further, because the manganese-spewing trains behind my house stopped running, and freeway traffic disappeared
- We stopped ordering all take-out food, which is usually delivered in containers that are toxic to liver function.
One month into the COVID shutdown, I slowly started being able to move my neck and sit up again! After a few weeks the trains and traffic restarted. Within a month of restart my dystonia slowly got worse again, but did not reach as bad as before. Since we hadn’t restarted take-out food or changed my vitamin D levels, I learned the hard way how bad it is to breathe in pollution even at levels we can’t even see or smell. So my family took reducing my air pollution intake much more seriously, and soon my second remission started.
I have now been in my second remission for a year and a half, and things are still ever so slowly improving. I have returned to an almost a normal life, am driving again, and the horrific pain is just a distant memory. Just as importantly, I no longer feel depressed, scared, or anxious. I will explain later how many of these moods are actually deeply related to gut health and vitamin D status.
Chronic Illness Research
It is now clear to me that I was not unlucky enough to have two rare diseases. Instead, chronic fatigue syndrome and cervical dystonia were different expressions of the same underlying systemic disease. This systemic disease started with gut issues, immune system over-activation, exposure and retention of toxins,, and suboptimal genetics such as inefficient detoxification processes and low vitamin D production. This was sufficient to cause to cause chronic fatigue syndrome in me. It is not surprising chronic fatigue syndrome usually starts before age 40.
My dystonia started a couple years after my gut issues came back. Gut issues (such as constipation), vitamin D deficiency [11], and mitochondrial dysfunction can severely reduce the body’s normal ability to detoxify manganese inhaled from air pollution. Excess manganese in the brain can then cause motor disorders by messing with dopamine and GABA release, damaging dopamine and dopamine channels, and encouraging the aggregation of misfolded proteins, behind Parkinson’s and Alzheimer’s diseases [36]. These processes take years to cause dystonias, and decades to cause Parkinson’s disease.
My research also shows that in people with insufficient manganese detoxification capability, excess manganese deposition will likely localize to the most-used muscles. This is because excess manganese in neurons, if not carried out in the normal detoxification process, can also be carried by dopamine transporters and be deposited where dopamine activity is the highest [33]. This localization to most-used muscles effect can explain why musician’s dystonia is 10-20 times more common in professional musicians than cervical dystonia is in adults. It can also explain why the most common dystonia in children is in the legs, teens in the hands, and adults in the neck. except for manganese mine workers who get dystonias in their arms, shoulders and legs. These are all dystonias of the most-used muscles.
Important Note
Please note I am not a doctor. I cannot diagnose nor treat any disease. It is important that you work with an doctor who can help you with your systemic health. This site is for educational purposes only. By using this website, you agree that I am not responsible for omissions or errors.
Dedications
This site is dedicated to my wife and children, who stood by me even in my darkest days and never gave up hope. Because of them, this site will always be free to anyone who needs help with chronic illness.
Finding the Right Doctor for Your Systemic Health Needs
You can implement some of the suggestions on this website without a doctor. This includes improving your diet and sleep, reducing stress, and getting some sun and exercise. It also includes reducing exposure to air pollution, pesticides, metals, and long term liver-damaging toxins.
Some of the suggestions require the help of a doctor who is experienced with systemic health to implement properly. This could be a doctor you already see. However, if any of the below apply, I would strongly recommend searching for a doctor specifically to address systemic health needs:
- Your current doctor has never given you simple blood tests like vitamin D test and ferritin (iron stores) test.
- Your doctor treats constipation with antibiotics or other pharmaceuticals without talking about what you need to do, including dietary changes.
- Your doctor is unwilling or unable to order a red blood cell trace minerals test that includes manganese, such as: Quest Diagnostics: (35694) Mineral Profile, RBCs. Many of the regional hospitals and HMOs in my area do not have the capability to test for manganese, so doctors working in these systems won’t order them. Blood labs like Labcorp and Quest Diagnostics do these tests easily.
- Your doctor is not interested in OATS (organic acids) testing. OATs can non-invasively detect implied levels of dopamine and norepinephrine, gut-produced dopamine metabolization inhibitors such as p-cresol, other gut issues, and some mold exposures.
As I mentioned earlier, I saw two naturopathic doctor (ND) for my systemic health needs. NDs are licensed by my state and are required to pass a four year college education revolving around systemic health. NDs in my state are allowed to order lab testing, and mine also worked with an MD when needed, for example for my IV EDTA chelation treatment. They also coordinated with a geneticist, who helped us work around my genetic differences. I chose my primary ND based on his competence; he was the one who ended my bout with chronic fatigue syndrome in 2008 so I could triple my work hours. My secondary ND was further away, but she was very experienced with ways to slowly detox metals. In contrast, the university research hospital I asked for a second opinion on manganese couldn’t find an expert to write the opinion.
If you are more comfortable with MDs, there is a possibility. Some medical doctors (MDs) have been combining the conventional medicine model of “treating illness” with the naturopathic medicine model of “keeping the body healthy”. These MDs usually call themselves integrative or functional medicine MDs. Some MDs have even adopted naturopathic methods to cure themselves from chronic disease. Here is one example: https://www.jillcarnahan.com/my-story/. These MDs tend to have their own private practices, which is good because they can more easily order things like manganese RBC testing. However, the good ones are more likely to fall outside of insurance networks so therefore will have higher out of pocket expenses.
For the purposes of this website, I will refer to doctors treating your systemic health as naturopathic doctors or NDs, even though they may be MDs. For simplicity, I will refer to the methods used as naturopathic methods.
Lab Costs
The lab tests my ND ordered from Quest and Labcorp were covered by my PPO insurance. OATs testing was not covered, but could possibly have been if I had argued with my insurance enough. If you do not have insurance coverage for outside lab testing, many NDs have agreements with local labs for a discounted price. It is important to ask potential NDs about this. Alternatively, you can see how many tests your regular doctor is willing to do. You lab results ordered by any doctor belong to you, so it is important to ask for a copy for your records.
Important
Seeing a naturopathic doctor does not replace your need to see a neurologist and get an “idiopathic” diagnosis.
Compatibility of Naturopathic Treatments with Botox or Levodopa/Carbidopa
Since naturopathic treatments target different systems than Botox or Levodopa/Carbidopa, there should not be any interference between the two methods. If in doubt, ask both your ND and your neurologist. Your ND is not for replacing your neurologist. Your ND is to help reduce your symptoms and need for pharmaceuticals, and help you improve quality of life.
What are Cervical Dystonia, Parkinson's Disease, Parkinsonism, Musician's Dystonia, and Writers Cramp?
Cervical dystonia is a mysterious, progressive condition where one or more of our neck muscles contract involuntarily. This contraction can be brief, or last for minutes or hours, and is often triggered by a particular motion or even high stress. As you can imagine, cervical dystonia is embarrassing, and can become extremely painful or debilitating even though it usually stops progressing after 3-5 years. Cervical dystonia is hard to diagnose because it initially looks like a muscle condition. But it is actually caused by a condition involving the basal ganglia region of the brain. Cervical dystonia is extremely rare, affecting roughly 1 in 3500 people.
Musician’s Dystonia and Writer’s Cramp are dystonias of the most-used muscle groups. Musician’s dystonia normally occurs in the most-used hand, but can be in the neck for string players. Writer’s cramp starts in the dominant writing hand. Musician’s dystonia is observed to occur only after approximately 10,000 hours or more of practice (professional musicians). Its prevalence rate is roughly 1% of professional musicians, much higher than cervical dystonia is in adults.
Parkinson’s disease and Parkinsonism (Parkinson’s type movement disorders without a Parkinson’s diagnosis) are defined by the the inability to contract muscles in the intended way. This can lead to slow movement, tremors, and rigidity. Like dystonias, Parkinson’s disease and Parkinsonism also involve the basal ganglia. Parkinson’s disease affects 1-2% of people over age 65.
Neurotransmitter Alterations
Neurotransmitter alterations can affect movement, cognition, or mood. Since systemic issues can alter processing of many neurotransmitters, mood or cognition are often affected in motor disorders. Here’s an overview of the more-studied neurotransmitters:
- Dopamine is used to initiate motor activity or coordinate muscles, and also released in response to pleasurable activity. Dopamine production is low in Parkinson’s disease. In Parkinsonism and dystonia, general dopamine levels may be normal or high. Local production, transmission, and breakdown can be affected in many negative ways by manganese toxicity [33][36].
- Dopamine activity is also altered in autism spectrum disorders, leading to high use of dopamine-blocking drugs, dystonic movement, and elevated risk of Parkinson’s disease [30]. Use of dopamine-blocking drugs can lead to unwanted repetitive movement (dyskinesia). Genetically-determined manganese levels [36], exposure [37], and sensitivity [31] may be important factors in autism-related dopamine alterations and are important clues for reducing motor illness.
- Altered dopamine activity can also lead to addictive behaviors, hyperactivity, or ADHD.
- The use of Levodopa (an unregulated dopamine booster) by Parkinson’s patients can lead to repetitive movement (dyskinesia).
- GABA is the main inhibitory neurotransmitter for motor activity. Insufficient GABA signaling can lead to undesired movement. Manganese toxicity dysregulates GABA [36].
- Acetylcholine is needed for learning. Insufficient acetylcholine leads to poor short term memory. Manganese toxicity interferes with acetylcholine production [36].
- Serotonin levels affect mood, sleep, and obsessive-compulsive behaviors. The most common cause of serotonin disruption I could find is gut issues such as constipation or poor diet.
Symptomology
In this section, I will share some of the symptomology I have found from research. This section is not intended for self diagnosis, but rather for you to see whether you want to pursue getting help for systemic health issues from an ND. Note that my neurologists were not interested in my manganese blood tests nor the significance of non-motor symptoms associated with my cervical dystonia, and instead offered to sign me up for psychiatric counseling.
There is a significant amount of overlap in the symptoms listed for dysbiosis, vitamin D deficiency, and manganese toxicity. This is because they have a strong influence on each other. For instance, dysbiosis (especially if it causes constipation) or vitamin D deficiency can cause inadequate detoxification of manganese. The resulting manganese toxicity can damage mitochondria, leading to immune system dysfunction, and persistent dysbiosis. But these cycles can be broken with help, like reducing inhaled manganese, which can settle directly into the brain.
This website is for educational purposes only and I am not responsible for errors or omissions. I am not a doctor and cannot diagnose nor treat any disease. It is important for you to work with a doctor for analyzing symptoms, testing and treatment.
Manganese and Heavy Metal Toxicity
Manganese Toxicity Overview
Manganese Toxicity in Parkinson’s Disease
A 1999 research study estimated that 25-35% of idiopathic Parkinson’s disease diagnoses were incorrect, and actually movement disorders caused by manganese toxicity [77]. Back then, relatively little was known about low level exposure sources and mechanisms of disease. Especially little was known about why most people seemed to be entirely unaffected by manganese exposure while 1-2% would develop Parkinson’s type movement disorders and other issues. However, since 1999, more than 700 scientific research papers have been published discussing “manganese toxicity” in conjunction with Parkinson’s.
From my hundreds of hours just reviewing this research, discussions with Parkinson’s patients, and world-leading toxicology experts, it appears that misdiagnosis is likely even more common than we would think. This is for several reasons:
One, because even slightly elevated levels of manganese in the brain can be behind known Parkinson’s-related disease processes. These processes include a slow driving of aggregation of alpha-synuclein (a hallmark of long term Parkinson’s disease) and inhibition of tyrosine hydroxylase activity (which reduces normal dopamine production) [18]. This makes it almost impossible to differentiate manganese induced Parkinson’s disease processes from other disease processes, even with sophisticated scans such as DATScan.
Two, the amount of low level environmental manganese we are exposed to has increased greatly over the years. Most of the world has switched from leaded gasoline to manganese-containing gasoline [32], wildfires have increased, and more trains have been built (wheel shedding). These low level sources are linked to Parkinson’s disease development over decades [10][8][26].
Three, and probably most critical, is that declining systemic health of the general population makes us more vulnerable to manganese toxicity. The systemic health epidemic is most evident from diabetes, which now affects more than 9% of the world’s population. Notably, diabetes is far more prevalent in high-income countries than low income countries. The higher prevalence of systemic disease in some countries can be traced mostly back to poor food choices, overuse of antibiotics, poor sleep, sedentary lifestyles with less sun exposure, and higher toxic exposures.
Systemic disease leading to inadequate manganese excretion rate and insufficient antioxidants in the brain makes us far more vulnerable to low level manganese exposures and toxicity. The bright side is that if we recognize when systemic disease is driving manganese accumulation and Parkinson’s development, we can effect change. My research shows that getting back to a healthier lifestyle can usually reduce both motor and non-motor symptoms and improve quality of life.
Elevated manganese levels in manganese-induced Parkinson’s is only sometimes detectable in a Red Blood Cell manganese test. However, it is likely that patients will experience at least 2-3 other symptoms from the manganese toxicity symptom list in the next section.
Manganese Toxicity in Cervical Dystonia and Parkinsonism
My research indicates that manganese toxicity driven cervical dystonia and/or early onset Parkinsonism requires higher levels of manganese exposure than in Parkinson’s disease. The higher exposure is usually called “manganism”, meaning occupationally-caused manganese movement disorders. In clinical practice, there is a common belief that only manganese miners and smelters can develop manganism. However, this belief is completely wrong and results in the majority of people diagnosed with idiopathic cervical dystonia to never be tested for red blood cell manganese levels. My exposure to manganese was only incidental; I worked in the same building as a small metalworking operation. But my red blood cell manganese levels were equivalent to someone with stage 4 liver cirrhosis.
If this manganese is cleared, and antioxidant systems restored, we can likely regain many of our movement abilities and have a lot less pain. I am proof of that. But first the manganese toxicity needs to be recognized as a contributor to our dystonia! I would expect that the majority of patients with manganese toxicity driven cervical dystonia would show significantly elevated red blood cell manganese levels. It is also likely that patients will experience at least 3-4 other symptoms from the manganese toxicity symptom list in the next section.
Manganese Toxicity in Musician’s Dystonia and Writer’s Cramp
There is very little written about these dystonias which are generally regarded as being “caused” by over 10,000 hours of practice combined with excess brain plasticity. However, my research shows that excess manganese can be the underlying mechanism. Excess manganese, when not cleared by the body’s normal cellular clearance systems such as the protein SLC30A10, can travel with dopamine transporters and collect most densely in areas with high dopamine activity [33]. This can cause dystonias of heavily used muscles. The dystonia is likely to be functional, at least at first. That means we can use the muscles for some things much more easily than for others. This is exactly how my manganese-induced cervical dystonia progressed. At some point I eventually became unable to release three of my neck muscles.
As I cleared the manganese out of my body, I slowly started being able to do things again in almost the opposite order that they had occurred. That is, the symptoms I had the longest tended to be the slowest to resolve. I expect that manganese-induced musician’s dystonia will be similar. And one thing to note, unfortunately, is that you will need to re-learn many coordinated muscle motions. I had to with my nec, and some of them took a couple of months.
In this case of musician’s dystonia or writer’s cramp caused by manganese toxicity, I would expect that red blood cell levels of manganese will usually be close to normal. Also, patients may not experience significant additional manganese toxicity symptoms, except possibly anxiety, insomnia or obsessive-compulsive disorders. However, the risk factors for impaired manganese clearance may be more common: Vitamin D deficiency, gut health issues such as constipation or excessive gas, mitochondrial dysfunction, or poor liver health. It would make sense to check for these things and resolve them if necessary.
- Early symptoms of manganese toxicity may include insomnia or other sleep disturbances, depression, irritability/aggression, violent thoughts, mood swings [40], hearing loss, tinnitus [76], apathy, weak muscles, or constipation.
- Excess manganese can impair production of acetylcholine [18], which can cause difficulty learning, short term memory loss, and difficulty recalling common words.
- Longer term, if the manganese entered the body via air pollution, it can reduce sense of smell, often years before movement disorders occur. Skin disorders can occur when the body tries to detox through the skin.
- Motor symptoms besides dystonia and Parkinson’s can include restless legs syndrome [41], reduction in fine motor control, smaller handwriting, soft voice, tics, creaky, cog-like motion of certain muscles [40], gait abnormalities [40], toe-walking, postural instability [40], or balance issues.
- Miners with manganese toxicity were frequently reported to have trouble walking backwards, but I never experienced this symptom.
- Early on, I could walk OK but my head bobbed when walking and my back was tight. If you want to see what this looks like, search for Federico Bitti’s TedX talk – I looked almost identical to him.
- Manganese-induced dysregulation of dopamine can cause easy addiction [17], attention deficit disorder [29][41], mania, hyperactivity, audio or visual hallucinations [40], or delusions [40]. This effect is somewhat similar to but less much intense than cocaine, which enhances the effect of dopamine.
- Even slightly elevated manganese levels in children can cause risk of autism spectrum disorder [31]. Children with ASD often show dystonic movement patterns. Also, adults with ASD have a much higher than normal use of dopamine-blocking medications and incidence of Parkinsonism [30]. These links could be explained by genetically elevated manganese levels.
- Manganese toxicity can cause dizziness or autonomic / cardiovascular issues such as irregular heartbeat and feeling faint when standing up (orthostatic hypotension) [1].
- Excess manganese can increase risk of protein misfolding and Alzheimer’s disease [18].
- Elevated manganese levels in the urine are associated with diabetes [39].
- Excess manganese can suppress tyrosine hydroxylase activity, which is the primary factor in Parkinson’s disease [18]. However, in rat testing, the removal of the toxic manganese source resulted in restored normal tyrosine hydroxylase activity after a few months [62]. This is in a rat which had no impairments in manganese excretion capability.
- Excess manganese dysregulates GABA, which can result in seizure activity [18]. Note that GABA boosters such as baclofen are sometimes used to treat dystonia or tardive dyskinesia [51].
Manganese Toxicity Science
A healthy body contains around 10-20 milligrams (around the weight of a grain of rice) of manganese to perform essential detoxification functions. We normally eat 3-6 milligrams of manganese in food per day, which is roughly 50 times what we need to replenish our needs. Therefore, most of the manganese we eat in food is not absorbed. Any overages absorbed into the bloodstream are quickly carried to the liver by the SLC30A10 transporter to the liver for excretion into the bile. A healthy person produces as much SLC30A10 as they need for this purpose.
However, manganese inhaled from airborne pollution bypasses most of this tight homeostasis (control) system. Inhaled air pollution, called PM2.5, primarily deposits into the lungs, where it is absorbed into the bloodstream. The tiny portion of manganese which lands on the olfactory bulb can be directly transported into the brain [40]. Scientists used to believe that manganese toxicity due to inhalation was only a risk factor for manganese miners and smelters. However, it is now recognized that a variety of situations can cause manganese toxicity [37], including inhalation of manganese containing traffic pollution [10].
My research shows that in most cases, manganese toxicity is not actually caused primarily by exposure to excess manganese. Instead, it is caused by the inability to excrete excesses quickly enough [42]. This excretion deficit can be caused by a combination of factors:
Potential Causes of Insufficient Manganese Excretion
- Inadequate production of SLC30A10, caused by a combination of:
- Vitamin D deficiency [11]
- Poor gut health
- Overactive immune system (inflammation)
- Poor diet
- Mitochondrial dysfunction
- Hereditary (genetic) differences in SLC30A10 [56]
- Liver dysfunction / cirrhosis [18], which can lead to elevated manganese levels and Parkinsonism or Parkinson’s disease [63]
- Constipation allows more excreted manganese (and other toxins) to be reabsorbed, requiring another cycle of excretion through the liver. This can contribute to liver disease. Notably, having less than one bowel movement a day increases risk of future Parkinson’s disease by 4 times, compared to having two bowel movements a day [5]. There is a similar risk multiplier for Alzheimer’s disease.
- Excessive heavy metals load in the body [57], which can disrupt manganese processing and excretion.
Potential Causes of Over-absorption of Manganese from Food
- Low blood iron
- Low iron stores
- Poor gut health (inflammation of dysbiosis)
Once manganese has built up in the body, detox is likely going to be slow since excess manganese damages the liver, which is the primary point of excretion. It appears some of this damage is reversible, but will take some time. Therefore, for people experiencing manganese toxicity, it is important to identify and reduce manganese intake from air and water pollution.
Toxic Manganese Sources
- Airborne (most toxic form), Highest Density First
- Working in ferromanganese processing, steel smelting, metal grinding, welding, or battery-manufacturing
- Digging or playing in the soils within 1 kilometer of factories involved in the above, or in the soils near train tracks (from wheel shedding)
- Working in the same building with any type of metal welding or grinding operation
- Forest fire pollution [34]
- Living next to an active railroad track
- Heavy traffic pollution [10] or working in a parking garage
- Other Bad Forms
- Agricultural work using manganese-containing pesticides or fungicides such as Maneb and Mancozeb. Mancozeb usage doubled risk of sleep issues for the following year [54].
- Use of psychostimulants (street drugs) containing manganese, e.g. “Russian Cocktail” [72].
- Stainless steel medical implant corrosion which releases directly into bloodstream, bypassing normal homeostatic mechanisms [73].
- TPN (IV nutrition) containing normal supplemental manganese of 400 micrograms/day was associated with abnormal basal ganglia manganese levels per MRI (81%), liver damage (31%), depression (66%), lack of concentration (42%), memory loss, and Parkinson’s disease (12.5%) [74]. These were not just elderly people; average age was 48. (For reference, 400 micrograms weighs around one tenth of a sesame seed).
- Dietary Forms (Not as Bad, Unless Coupled with Gut Dysbiosis)
- Contaminated well water
- Cooking acidic foods in stainless steel cookware (stainless steel is 1-2% manganese)
- Drinking acidic drinks out of stainless steel cups
- Eating food finely cut using stainless steel machinery
- Supplements containing manganese (normally 1-2 milligrams each = 1000 – 2000 micrograms each)
Red Blood Cell Manganese Levels in Response to Airborne Exposure
Red Blood Cell (RBC) levels of manganese will usually rise in response to high airborne exposure. In some studies, whole blood or plasma levels of manganese are measured instead of red blood cells. But RBC manganese levels are generally a better indicator of brain manganese levels from airborne exposure [27].
In research [27], people exposed to industrial levels of manganese (smelters) were compared to office workers in the same building, and to healthy controls. I’ve done a few rough calculations:
- Smelters: The smelters working directly with manganese smelting machinery inhaled an average of approximately 400 micrograms manganese per day. Their RBC manganese levels on average tripled. However, there was a wide range of RBC manganese levels, including 3 of 96 participants who experienced approximately an 8-fold increase. 1-2% of smelter workers eventually develop serious, progressive dystonias starting with their most used muscles (arms and legs) and Parkinsonism. The rest usually only develop minor fine motor deficiencies.
- Office workers: The office workers in the manganese smelter business had roughly one-tenth the exposure to airborne manganese as the smelters. Alarmingly, one out of the 122 office workers had an 8-fold increase in RBC manganese levels.
- I was in a similar situation as the office workers group. At my workplace, there was a small stainless steel welding and grinding operation in the opposite side of the building from me. (Almost all steels contain 0.5% – 2% manganese.) Many of the workers in that operation had more than 50 times the exposure to airborne manganese than I did. Most appeared healthy but a few seemed unreasonably emotionally unstable.
- My RBC manganese levels showed a 7-fold increase. At these levels, the first motor symptom usually takes many years to develop, starting with fine motor coordination deficits, and some people never show issues, perhaps due to antioxidant status and genetics. My first noticeable motor symptom was neck pain and occasional spasms of one neck muscle when under stress. I am a heavy computer user with forward head posture, so my neck muscles were definitely most-used.
- Control group: None of the control group had high RBC blood levels. However, normal RBC manganese levels do not mean that manganese toxicity will not be an issue. Living in an area with high manganese-containing traffic pollution can double the risk of development of Parkinson’s disease [10]. This is even though traffic pollution contains less than one five-hundreds of the manganese density inhaled by smelters. The manganese toxicity pathology is different than in smelters, likely due to manganese-driven aggregation of alpha-synuclein [18], which can take decades.
Given the numbers above, I would guess that the inability to excrete excess manganese, for instance from inadequate production of SLC30A10, is a much bigger risk than most routes of manganese exposure. Also, the numbers show manganese toxicity in the brain may not always show up in the blood. I confirmed this fact with one of the world’s leading researchers on manganese toxicity. For example, people with musician’s dystonia or writer’s cramp probably won’t have excessively high blood manganese levels. Instead, the excess manganese forms local deposits at areas of highest dopamine activity because of the almost exclusive use of a muscle group or two [33].
Blood Manganese Levels for Reference
When excess manganese does show up in blood tests, it is important to pay attention. Red Blood Cell (erythrocyte) levels of manganese, especially when iron levels are low, are a better predictor of levels in the brain than other measures [27]. Below are some reference numbers. Note these are converted to units commonly used in the USA. In some countries, you may need to use a units converter such as this one.
- Red Blood Cell Manganese Levels (micrograms/Liter)
- Healthy controls had 5.1 ± 4.0 mcg/L [27].
- My RBC manganese levels fluctuated, but the peak was 38 mcg/L. This is slightly above the average of people who have stage-4 liver cirrhosis.
- Labcorp’s 2.5 – 97.5 percentile reference range for RBC manganese was 4.7 – 20 mcg/L. Note that this is much higher than the healthy unexposed group for two probable reasons: Manganese is now added to gasoline (instead of lead) almost worldwide, which is causing manganese blood levels to go up. Also, mostly people with suspected manganese toxicity were likely to have been in the reference group.
- Quest changed their 2.5 – 97.5 percentile reference range for RBC manganese from 4.7 – 20 (same as Labcorp) in 2019 to 12 – 26 mcg/L in 2020. Again, this is probably because people’s manganese levels are rising.
- Whole Blood Manganese Levels (micrograms/Liter)
- Healthy controls had an average 7.5 mcg/L (range 6.1 – 12.8) versus those with liver disease having an average 20.5 mcg/L [64].
- Target range for people depending on IV nutrition packs (TPN) is 4 – 12 mcg/L to avoid development of Parkinson’s-type disorders [44]
- Whole blood manganese greater than 12 mcg/L increases autism risk by 6 times, in children whose GSTP1 glutathione (antioxidant) genetics are a certain common type [31].
- Presumably, this risk above 12 mcg/L would also occur with glutathione depletion. So, it is likely beneficial to keep whole blood manganese levels below 12 mcg/L.
- Quest’s 2.5-97.5 percentile reference range in 2020 was 4.2 – 16.5 mcg/L (too high per above).
Some people can have high blood levels of manganese, and yet suffer no apparent symptoms. This is probably a combination of genetics, good gut health, and antioxidant status. Antioxidants are biochemicals that fight oxidative stress injury. There are some antioxidants which have been found to be effective against manganese toxicity, which I will share in the treatments section.
Deep Brain Stimulation Targets – Coincidence?
Deep Brain Stimulation (DBS) is a therapy effective in some people for relieving motor symptoms of PD and is also being evaluated for cervical dystonia. DBS involves injecting electrical currents through implants into the globus pallidus internal or subthalamic nucleus (parts of the basal ganglia). The globus pallidus and subthalamic nucleus are among the areas most affected by manganese toxicity, partially due to electrophysiological (electrical property) changes such as calcium-channel gating of neurotransmitter release [55]. Given this information, it makes sense to me to get manganese levels under control before trying invasive DBS treatment.
Heavy Metals, Manganese, and Chelation
Some metals, such as lead, mercury, cadmium, arsenic, nickel, and aluminum have no purpose in the body and are purely toxic. They cause oxidative stress (various types of chemical reactions that breaks things down) wherever they settle. It takes the body a long time to get rid of heavy metals, often through hair, nails, skin, and urine. This can lead to hair falling out, brittle nails, dermatitis and other skin issues, or kidney damage. People with neurological diseases typically have a much higher body load of heavy metals [57], either because of exposure, excessive gut absorption, or excessive retention. The best way to fight heavy metals is to reduce our higher modern-day exposures, and to do whatever it takes to keep our guts and mitochondria healthy.
Also, to prevent excess absorption of heavy metals from food, especially if we are supplementing vitamin D, it is important to ensure our essential minerals, such as calcium, magnesium, and iron, are not deficient [59].
I did not find any heavy metals in which the primary feature would be either dystonia or Parkinson’s disease. All of the heavy metals are generally reported to cause other syndromes first, such as chronic fatigue syndrome. However, lead and mercury are known to dysregulate dopamine and GABA. Perhaps more importantly, the presence of heavy metals in the body can disrupt homeostasis (control) of essential minerals such as manganese, iron, and copper. Dyshomeostasis of these essential minerals leads to oxidative stress, which can contribute to Parkinson’s disease, Alzheimer’s, and Huntington’s disease [60].
Regaining homeostatic control of essential minerals is therefore extremely important in healing. The first step is testing. My ND ordered a test my red blood cell levels of chromium, selenium, zinc, manganese, copper, and cobalt on my first visit for neck issues. He said this testing used to be hard to get but was now routine. This was only partially true! It turns out the regional and HMO hospitals in my area can’t test for manganese. Also, both of the neurologists I saw were entirely not interested in any of my blood tests, nor my heavy metal exposure history.
Chelation
Chelation is a way to help the body get rid of heavy metals, aluminum, and also excessive trace elements. The chelation agent binds to ions (atoms) and the complex comes out in the urine. Pharmaceutical chelation agents such as calcium EDTA [58] can bind to a range of metals but can also deplete necessary trace minerals, so checlation can be tricky. Also, if there is a high body load of heavy metals, redeposit can damage kidneys. There is also a risk that the remaining heavy metals will redistribute and cause new problems. Natural chelation agents tend to be weaker, but gentler and less risky.
It is hard to test for heavy metals load in the body because blood levels tend to decrease by 6 months after exposure as the metals deposit into tissues. So historical exposures, and a review of symptoms, along with blood tests are useful. Urine tests can be done with and without provocation by a low dosage chelating agent to estimate body load and potential effectiveness of a chelation drug.
Chelation with intravenous calcium EDTA is the mainstay of treating severe, acute onset of manganese-induced dystonia or Parkinsonism in miners where blood levels of manganese are high. (But sodium PAS has been shown to be more effective in removing manganese from brain cells, but is no longer being manufactured.) EDTA is also commonly used to remove lead and even aluminum [61] from body tissues, but may not be able to get these metals out of the brain.
In manganese-induced dystonia or Parkinsonism, EDTA has been found to be only marginally effective in reducing motor symptoms, even after many 90 minute treatments. Also, high blood manganese levels and motor symptoms usually return 6-12 months after treatment cessation, but not necessarily as bad as previously. A decade ago, the return of high blood manganese levels was assumed to be from body stores of manganese. However, more recent data indicates that the high blood manganese may be partially from an individual’s inability to clear excess manganese quickly enough. This allows continuous accumulation of manganese from food, constipation, contaminated water, or air pollution, the same condition which allowed the build-up in the first place.
So it appears that restarting our natural manganese detoxification processes can be far more important than pharmaceutical chelation.
However, we did not know all this when I was first diagnosed by my ND. Also, since I had a history of lead exposure and chronic fatigue syndrome, and wanted to try to get some of the manganese out, I did roughly 18 IV EDTA treatments. On the first treatment, approximately 51 micrograms of manganese came out in 12 hours. This is a significant amount, but would likely have taken more than 400 treatments to get all the excess manganese out. Compare that to healthy smelter workers could detox 400 micrograms per day. So ultimately the EDTA did not seem very effective for removing manganese, but did remove several other heavy metals, including lead, cadmium, and gadolinium (probably from an MRI 25 years earlier). My blood manganese levels went down somewhat, but my RBC blood levels were apparently unchanged by the EDTA. My ND said that this might indicate that the EDTA could not easily bind manganese already absorbed into tissue (Red Blood Cells). My motor symptoms did not noticeably change during treatments.
Note that there aren’t many places that offer IV chelation treatment. My ND located a holistic MD who performed them.
Manganese and Heavy Metals Testing
Here are some of the less routine tests your doctor can order regarding manganese and heavy metals toxicity:
- MRIs: The “gold standard” for testing excess manganese in the basal ganglia is a special form of MRI. However, I would not do any MRIs because a heavy metal contrast agent is routinely injected before scan. This contrast agent is usually gadolinium [40], but there is a push to move to the “safer” contrast agent manganese! Supposedly, a healthy person will naturally get rid of the contrast agent over time. But if your body can’t even eliminate manganese naturally, how can it eliminate a heavy metal?
- Red Blood Cell Trace Minerals: Most hospital labs cannot do manganese blood testing, but a range of trace mineral testing is readily available in national blood labs. Multi-mineral tests include manganese, copper, zinc, selenium, etc., all of which can have a negative neurological impact if in excess. Make sure to use numeric lab codes when ordering manganese testing, otherwise people routinely confuse manganese with magnesium. Whole blood manganese is not as sensitive to airborne exposure as red blood cell manganese.
- Quest: https://testdirectory.questdiagnostics.com/test/test-detail/35694/mineral-profile-rbcs?cc=MASTER
- Labcorp: https://www.labcorp.com/help/patient-test-info/trace-minerals
- Doctor’s Data Mail-In: https://newsite.doctorsdata.com/Red-Blood-Cell-Elements. Ordering: https://www.walkinlab.com/products/view/dd-red-blood-cell-rbc-elements-blood-test-doctor-s-data-test-kit
- Blood Iron / Ferritin can indicate low iron, and low iron stores, which predispose towards increased manganese absorption.
- Organic Acids (OATs) is a urine test that can be used to check for levels of dopamine and norepinephrine metabolites, along with dopamine-modifying gut health indicators such as p-cresol. This can help distinguish between Parkinson’s disease with low dopamine and Parkinsonism with normal dopamine levels. This test is not usually covered by insurance but I believe was one of the most valuable tests my ND ordered.
- My dopamine metabolites DOPAC and HVA were at roughly 99th percentile levels, helping confirm that manganese dysregulation of dopamine may have been occurring
- My colleague with RBD sleep disorder, which almost always converts to true Parkinson’s disease, has similarly high levels of DOPAC and HVA.
- The alternative for tracking dopamine activity in the brain is a DaTscan. However, that test involves the injection of a radioactive agent and I would not do it if not absolutely necessary. The DaTscan will indicate relative level of dopamine transporter activity in the striatum (part of the basal ganglia) and can be used to help the diagnosis of Parkinson’s disease. Note that the striatum is damaged by excess manganese [47], so it would make sense that restoring the body’s manganese excretion systems would be a useful goal even with a Parkinson’s disease diagnosis.
- Liver Function tests can be useful if blood manganese levels are tested high,
- Mycotoxin Profiles can look for mold toxin metabolites in the urine if mold exposure is suspected.
- GPL Mycotox Profile: https://www.greatplainslaboratory.com/gplmycotox
- Blood Heavy Metals tests are usually only able to detect recent heavy metals exposure (< 6 months), but can be an important indicator when toxic exposures are still occuring.
- Urine Heavy Metals tests can be done unprovoked and provoked by a chelation agent to get an estimate body stores. Trace minerals such as manganese and zinc can be performed along with heavy metals, at an additional cost.
- Doctor’s Data Mail-In: https://www.doctorsdata.com/Urine-Toxic-and-Essential-Elements
Natural Treatments for Manganese and Heavy Metal Toxicity
This section contains potential ways for reducing manganese and heavy metal toxicity in three categories
- Improving manganese excretion capability. This subsection includes reducing plastics, solvents and other toxins which can damage the liver.
- Reducing intake of manganese and heavy metals
- Increasing antioxidant levels
Improving Manganese Excretion Capability
- Support SLC30A10 production [63] (important for all movement disorders)
- Boost vitamin D levels, which signal mitochondria to produce more SLC30A10 [11] . See section on vitamin D.
- Fix gut dysbiosis (so proteins can properly be broken down into amino acids). See section on gut dysbiosis.
- Have a good diet free of allergens, has a moderate, digestible level of protein, and supports healthy mitochondria. See section on diet.
- Reduce stress. Stress makes our bodies consume resources for fight or flight preparation, rather than healing processes.
- Support liver health [63] (especially if manganese levels are high or liver is diseased). The liver is the main excretion path for excess manganese. Liver disease can lead to high blood manganese levels, which can damage the liver further, and then drive Parkinson’s disease development. Liver transplants reduce manganese in the brain and Parkinson’s symptoms [67], but hopefully none of us will need that. Some suggestions for liver health:
- Reduce exposure to liver toxins
- No alcohol!
- Use glass or quality lead free ceramics to store food and drink whenever possible. Avoid using plastic water bottles.
- Never put plastic or paper towels in the microwave! Instead, transfer food to microwave-safe glass or lead-free ceramic. If covers are made of plastic, ensure food does not touch covers while heating.
- Avoid takeout containers made of styrofoam (Plastic #6 – PS Polystyrene), which release styrenes on contact with fats in food or hot liquids. Styrene is toxic to brain cells, liver, and hearing [65].
- Avoid takeout food wrappers and paper plates with slick coatings – these usually contain PFAS or PFOS, which can damage the liver for years, and also affect dopamine production [68].
- Have visible mold growth inside your living space professionally removed. Do not ignore! Get HEPA filters to reduce airborne mycotoxins and try to stay out of the areas with visible mold. N95 face masks can help filter out airborne mold toxins (mycotoxins). Mold toxins can seriously damage the liver and some are neurotoxic.
- Do not eat moldy food. Sort out grains and beans that look different. Throw out bad batches. There is no way to detoxify most mold toxins, even by cooking. Mold toxins can seriously damage the liver and some are neurotoxic.
- Talk with your ND about antioxidants that help protect the liver
- Silymarin (milk thistle extract) is an antioxidant which helps protect the liver from manganese and other oxidative stress damage [43]. There are low-alcohol organic tinctures available.
- Vitamin C is a general antioxidant which can help protect the liver from styrene and other solvent damage [66].
- Taurine is a body-wide antioxidant. It helps protect the liver against various oxidative-stress induced diseases such as fatty liver disease [69].
- NAC (N-Acetylcysteine) is an antioxidant which can help protect and heal the liver [70].
- Reduce exposure to liver toxins
- Try to have two bowel movements a day. Constipation allows more time for toxins excreted by the liver, such as manganese and heavy metals, to be reabsorbed through the intestine. Reabsorbed toxins can overload and damage the liver and make the constipation worse. Thus, it is important to break the constipation cycle. Remember that constipation when younger can increase the risk of developing Parkinson’s by 4 times [5], Alzheimer’s, and other neurodegenerative diseases. ###
- High fiber diet (whole plant foods) can help the constipation and are also important for health
- Resistant starch not only helped PD patients overcome constipation, it helped reduce non-motor symptoms and improve gut dysbiosis after only 8 weeks [71].
- Potatoes are high in resistant starch.
- Paleofiber RS has both fiber and resistant starch in it, and is my favorite product for this purpose.
- Prune juice (don’t overdo it because of the sugar), is a good temporary measure to encourage bowel movements and break the constipation cycle.
- Magnesium, such as magnesium citrate, can help reduce constipation. It can also help balance neurotransmitters and is sometimes used to treat restless legs syndrome. Magnesium also has many other important functions in the body.
Reducing Intake of Manganese and Heavy Metals
- Reduce exposure to manganese and metals-containing air pollution. Fine-particle air pollution, called PM2.5, can double PD risk due to manganese [10] and other metals content. For example, living in a postal code with an average “satisfactory” Air Quality Index (AQI) of 100 (per US EPA standards) can roughly double the risk of developing Parkinson’s disease over time [8]. Most people can easily detox this level of pollution. But people who already have a motor illness are likely slow at detox. So it can be very helpful to avoid unnecessary exposure to airborne manganese. In fact, if I had realized the impact of living next to a railroad track earlier [26], I would likely have recovered much sooner.
Antioxidants Effective Against Manganese Toxicity
- Melatonin production, necessary for sleep, declines with age. Melatonin is also an antioxidant, and has been shown to reduce manganese injury [24]. Some people with Parkinson’s have reported melatonin helps reduce their motor symptoms at bedtime.
- Glutathione (produced by the body and negatively affected by dysbiosis) protected DNA from oxidative damage [45].
- NAC (N-Acetylcysteine) protected DNA from oxidative damage due to manganese [45]. NAC supplies glutathione production inside cells.
- Quercetin attenuated oxidative stress and mitochondrial dysfunction due to manganese [46].
- Vitamin E helped protect cells in the striatum (part of the basal ganglia) from manganese-induced damage [47]. Higher dietary vitamin E intakes were also associated with a 32% lower risk of developing Parkinson’s [53]. Vitamin E supplementation has been used to reduce muscle cramps and finger twitching.
- Taurine is an amino acid and antioxidant which is highly prevalent in the brain. It helps protect against manganese-induced motor deficits [48] and manganese-induced mitochondrial damage [49]. It also helped restore acetylcholine production impaired by manganese toxicity, and thereby improved learning and memory [50]. It also helps normalize GABA, which reduces risk of seizure activity [52]. Taurine also helped restore tyrosine hydroxylase activity (dopamine production) in Maneb (manganese containing fungicide) exposed mice [52].
- In addition, taurine helps protect against diabetes, kidney issues, ADHD, and Alzheimer’s [52].
- Taurine can also help reduce risk of glutathione depletion, and promote neurogenesis [52]
Note that it is really important not to overdose on antioxidants, because this can be counterproductive or even lead to new, dangerous issues. I only shared them here for your ND’s reference all in one place.Have
Manganese Toxicity
Dysbiosis, vitamin D deficiency, and/or mitochondrial dysfunction can result in inadequate production of mineral transporters. Inadequate production of the manganese (not magnesium) transporter SLC30A10 can make us susceptible to excess manganese build up in the brain, particularly the basal ganglia [23].
Excess manganese in the basal ganglia is known to cause movement disorders. The excess manganese can damage neurons in muscle control circuits, mess with dopamine and GABA release, oxidatively damage dopamine, and help create misfolded protein clusters which drive Parkinson’s disease. In a healthy person, SLC30A10 production is increased in response to higher levels of manganese [23]. The SLC30A10 carry excess manganese out of the neurons to the liver for excretion, before significant issues occur.
When we can’t excrete the excess manganese, our risk of developing Parkinson’s disease is raised by decades of exposure to low levels of manganese in ordinary air pollution [8], traffic pollution [10], or train tracks [26]. Higher densities of manganese pollution, such as from nearby metalworking, welding, battery factories, or sometimes train tracks, can lead to dystonias of the most-used muscles [12] or Parkinsonism [28]. Dystonia of the most-used muscles usually means cervical dystonia in adults, but shoulder, arm, and walking dystonias in manganese mine workers, and arm/hand dystonias in teens.
From my research, it appears that musician’s dystonia and writer’s cramp are not likely from excessive exposure to manganese. They are more likely a combination of inadequate SLC30A10 production and an almost-exclusive coordination of a single muscle group for more than 10,000 hours. Dopamine moves when we coordinate these muscle groups. Manganese atoms can travel with this dopamine and form tiny local deposits in the most-used muscle control circuits. This local deposition process is so powerful that musician’s dystonia is roughly 30 times more common in professional musicians than cervical dystonia is in the general population! It is almost as common as Parkinson’s disease is in older adults (1-2%).
Early symptoms of manganese toxicity may include sleep disturbance, short-term memory loss, irritability/aggression, depression, apathy, mood disorders, or muscle weakness. Manganese toxicity can also lead to constipation, restless legs syndrome, small handwriting, soft speech, random tics, creaky, cog-like motion of certain muscles, gait abnormalities, and postural instability, or balance issues.
If the manganese entered the body from air pollution, it can cause mitochondrial damage and a reduced sense of smell long before movement disorders occur. Also, a wide variety of neurological symptoms can occur due to manganese-induced alterations in neurotransmitter production [18]. For example, impaired production of acetylcholine can cause difficulty learning, and recalling common words.
Excess manganese can dysregulate the release of dopamine, which can cause easy addiction [17], mania, hyperactivity, hallucinations, or delusions. This effect is similar to but less much intense than cocaine, which enhances the effect of dopamine.
Likely due to the dysregulation of dopamine, elevated manganese levels in children are correlated with attention deficit disorder [29] and autism spectrum disorder (ASD). The elevated manganese to ASD risk has been shown to be genetics-dependent [31], which gives us an important clue.
Children with ASD often show dystonic movement patterns. Adults with ASD have a much higher use of dopamine-blocking medications, and incidence of Parkinsonism than non-ASD adults [30]. These are all consistent with elevated manganese levels.
However, from my research, the link between manganese, ASD, dystonia, and Parkinsonism is not entirely controlled by genes. Genetic tendencies towards severe vitamin D deficiency and dysbiosis, both common in ASD, can be corrected. I know, because I have ASD.
In summary, we need sufficient SLC30A10 production (and a well functioning liver) to maintain manganese homeostasis in both the blood and brain. Sufficient SLC30A10 production requires a good diet, healthy microbiome, sufficient vitamin D [11][23], and healthy mitochondria, all things that naturopathic doctors care about.
Manganese-induced dystonia and Parkinsonism has long been thought to be irreversible, partially because patients tend to retain excess manganese long after exposure has ceased. My red blood cell manganese levels were at 600% of normal. However, since my naturopathic doctor treated the conditions above, the excess manganese is finally out of my body and my dystonia has resolved 90% of what I hope to achieve.
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Digestion / Gut Issues
Fixing any detectable gut issues is probably #1 on most naturopathic doctors’ target lists for treating systemic disease.
There are trillions of bacteria living in our gut, representing thousands of types of different bacteria, and these are essential for our health! Each type of bacteria has different functions and collectively these bacteria are called the microbiome. A healthy microbiome helps us digest proteins, produces a lot of the biochemicals our bodies need, reduces absorption of toxins from food, and keep our immune system calm. Pathogenic bacteria can be present in a microbiome, but in low quantities they are usually neither detectable nor a health issue. However, when a significant imbalance occurs in the microbiome, it is called dysbiosis.
The microbiome is so important to our long term health that Harvard University now has an entire school dedicated to studying the microbiome and dysbiosis. However, fixing any type of digestion issue, including dysbiosis, has long been a first order of business for naturopathic medicine. Dysbiosis is usually expressed as constipation, bloating, abdominal pain, excessive gas, excessive burping, or loose stools. Naturopathic doctors will try to avoid broad spectrum antibiotics whenever possible, because they can actually cause dysbiosis by killing off the diversity of bacteria in the gut.
Dysbiosis can drive the development of chronic disease. Dysbiosis is common in Parkinson’s, dystonias, chronic fatigue syndrome, multiple sclerosis, diabetes, cardiovascular disease, Alzheimer’s disease, schizophrenia, and many other diseases of aging. The type of dysbiosis can used to predict the disease that is likely to occur years later. In fact, researchers can predict if a patient with diabetes is likely to develop overgrowth of blood vessels on their retina (diabetic retinopathy) based on their specific type of dysbiosis!
Treating dysbiosis in patients with Parkinson’s disease who had constipation significantly improved their motor and non-motor symptoms [6]. Some of the 11 patients started the study at a “moderate” (stage 3 of 5) of Parkinson’s motor symptoms, and ended up at “mild” (stage 1 or 2) at week 12. More importantly, patient-reported Quality of Life improved greatly. These are huge results because they were obtained without any other treatments besides the one time FMT treatment, which implants a new microbiome into the patient. In real life, naturopaths would use additional treatments to help preserve the corrected microbiome and allow the healing processes to continue well beyond 12 weeks. This is a core principle of the naturopathic method – engaging and supporting the body’s natural healing processes.
A dystonia study published in 2021 showed that the most common type of dysbiosis, found in 51% of dystonia patients, significantly altered the levels of more than 200 biochemicals in the blood [7]. There are several mechanisms how these alterations could have contributed to dystonia, which I will share these in the Science section. Obviously, it is not possible to fix this number of alterations using a drug, or even a cocktail of drugs. Instead, it is vital to fix any form of dysbiosis.
Dysbiosis often destabilizes the production and metabolism (processing) of neurotransmitters such as serotonin, dopamine, norepinephrine, and epinephrine. This is why dysbiosis can lead to depression, anxiety, obsessive-compulsive disorder, easy addiction, lethargy, exercise intolerance, or autonomic disorders (uncontrolled heart rate [22], feeling faint when standing up, sleep apnea [21], dry mouth, etc.). For me, dysbiosis also led to chronic chest pain, which my naturopathic doctor fixed easily by giving me a simple exercise.
The naturopathic method to fixing dysbiosis avoids antibiotics whenever possible, and instead may use such things as probiotics, prebiotics, vitamin D supplementation, immune system supports, biofilm breakers such as vitamin C and NAC, and dietary changes. Here is more information on dysbiosis, and the importance of diet in fixing it: https://primehealthdenver.com/dysbiosis-diet/ .
Vitamin D Deficiency
Ensuring we have adequate vitamin D is probably #2 on most naturopathic doctors’ target lists for treating systemic disease. In fact, the three naturopaths I saw all wanted me to supplement my vitamin D3 deficiency until I got to a blood level at the upper end of people who spent all day in the sun. Note that this level is considered “potentially toxic” by our National Institutes of Health because too much vitamin D can lead to excessively high levels of calcium the blood (hypercalcemia). This is due to the more efficient calcium absorption from food.
In my experience, most MDs will avoid heavy vitamin D supplementation or ignore vitamin D testing altogether. On the other hand, my naturopathic doctor had me test my blood vitamin D level regularly to ensure I didn’t go too high. He also verified I was eating a healthy diet with enough vitamin K (from leafy vegetables, broccoli, cauliflower, fermented foods, chicken, etc.). Vitamin K allows the body to deposit the extra calcium into bone as nature intended. Therefore, vitamin D or vitamin K [9] deficiency can lead to osteoporosis, and more frequent falls and fractures.
Because untreated vitamin D deficiency is common in Parkinson’s disease patients, it is not surprising that osteoporosis, falls, and fractures are also common.
In research studies, vitamin D supplementation at pretty high levels has been used to successfully reduce Parkinson’s motor symptoms, restless legs syndrome, tics, ADHD, generalized anxiety disorder, depression, autonomic dysfunction, fatigue, balance issues, and many other symptoms. Vitamin D supplementation has not been tested against cervical dystonia, but has been successfully used to treat chronic neck pain and chronic back pain.
In 2022, it was found that vitamin D may help break up the alpha-synuclein clusters that drive many cases of Parkinson’s disease [14]. This is the holy grail of treating Parkinson’s disease – finding a substance that can break up alpha-synuclein! (Now we have two potentials. The other is mannitol, a readily available substance, and a component of cauliflower.)
Natural ways to boost vitamin D levels include eating fatty fish or getting more sunlight, which helps the body manufacture its own vitamin D. For reference, 1.5 hours of sun a day in children reduced risk of developing multiple sclerosis by more than 80%. I personally would not recommend fatty fish nowadays because of the risk of mercury toxicity. Mercury accumulation can be a serious problem to overcome in motor disease, because it destabilizes the normal metabolism of essential metals.
Mitochondrial Dysfunction
Naturopathic doctors always like to support mitochondrial health. Mitochondria are tiny organelles inside each cell that perform many functions necessary for the cell’s survival, and also manufacture gene-coded proteins. For example, mitochondria manufacture the protein spikes coded by mRNA vaccines.
Mitochondrial dysfunction has been implicated in Alzheimer’s disease, Parkinson’s disease, Parkinsonism, dystonias, tremor, tic disorders, restless legs syndrome, Huntington’s disease, and amyotrophic lateral sclerosis. Mitochondrial dysfunction can also be behind problems with vision or hearing, cardiovascular diseases, diabetes, mood disorders, chronic fatigue syndrome, autism spectrum disorder, and chronic infections [16].
Thus, mitochondrial dysfunction can express differently in every patient, especially if it was caused by a reaction to previous use of Cipro. Naturopathic doctors use various methods to support mitochondrial health. This may include dietary changes, eg high in broccoli (sulforaphane) and supplements, or chelation of heavy metals like mercury. Chelation can be done by pharmaceuticals, or can be done by slower, safer natural means as well. My ND arranged with a holistic MD who did IV EDTA chelation treatments to get lead out of my body. This was the only conventional medicine treatment I had besides the one Botox shot. Most hospitals don’t usually offer IV chelation, perhaps because there is little money in it.
Manganese Dyshomeostasis
Antioxidant / Glutathione Depletion
Various biochemicals called antioxidants protect our cells and structures from various types of oxidative stress (chemical breakdown) damage. Glutathione is the body’s most powerful antioxidant and additionally helps remove certain toxins from the body. Unlike most antioxidants, glutathione is produced within cells. However, glutathione can become depleted, which can lead to mitochondrial damage, early death of brain cells, and neurological issues such as ataxia (loss of coordination) or tics. Ataxia can present primarily as cervical dystonia. Longer term, glutathione depletion contributes to rapid aging, and can lead to development of Alzheimer’s, chronic fatigue syndrome, or Parkinson’s disease via alpha-synuclein aggregation [19].
Naturopathic doctors try to ensure that your antioxidants are at the right levels to protect you. They may work on ensuring you do not have glutathione depletion by a diet high in onions, garlic, and cruciferous vegetables, NAC supplements, and other means. They also make sure you don’t have too high levels of oxidative stress, which can cause glutathione depletion. High levels of oxidative stress may be caused by vitamin B12 deficiency, low level infections, inflammation, mitochondrial dysfunction, certain medications, dysbiosis, and other factors.
Preferably, most of our variety of antioxidants will come from a diet high in fruits and vegetables. What we can’t get from diet can come from supplements. For example, the antioxidant vitamin E has been used to treat tics and finger twitching. The antioxidant melatonin, which is produced in the brain and shepherds the sleep cycle, decreases as we age. Melatonin is an effective antioxidant against manganese toxicity and motor dysfunction [24]. So it should come as no surprise that some Parkinson’s patients have reported that melatonin helps reduce their night-time tremors, besides helping them sleep.
Summary
You may have noted there is a lot of overlap in the symptoms listed above. This is because the body’s systems are tightly intertwined. For example: Genetically low levels of vitamin D can cripple the immune system, allowing chronic dysbiosis, creating chemicals imbalances which cause mitochondrial dysfunction and neurotransmitter imbalances. Shortages of the neurotransmitter serotonin can make constipation worse, which increases absorption of toxins, which make everything, including the dysbiosis, worse. We may then stay indoors more, causing further deficiencies in vitamin D production.
In conventional medicine, the usual approach for multiple symptoms is to individually treat the worst symptoms (usually with pharmaceuticals) and ignore others.
In naturopathic medicine, the usual approach is to try to understand likely the systemic dysfunctions that are occuring based on the constellation of symptoms and lab test results. Then the treatment plan focuses on making mostly gentle adjustments to bring the systems back into balance. When balance is restored, the body’s systems become better at repairing themselves, and some of the adjustments can be ended. For me, I will continue heavy supplementation of vitamin D for the rest of my life, because of genetic enzyme deficiencies.
I hope by reading this section you had a chance to see if your constellation of symptoms are potentially a good fit for treatment by naturopathic medicine. As I said earlier, naturopathic medicine requires a commitment of time, money, and effort. If you’re not sure you want try naturopathic medicine yet, that is OK. As an alternative, you can start with a few non-medical things, and see if they help you feel better. For instance, you can improve your diet, take a few common supplements found helpful for Parkinson’s or dystonia (don’t overdo it, since testing is required to keep some oil-soluble vitamins in the safe range), take walks, get some sun, improve your sleep, reduce stressors in your life, get some HEPA filters, and stay indoors when purpleair.com says air quality is “Unsafe for Sensitive Groups”. Also, unless prescribed by your doctor, I would avoid any multimineral supplements containing manganese… and they almost all do!
More about Manganese (not magnesium) Toxicity
After putting together more than one thousand hours of research and discussions with experts, I have discovered several obscure but important links between manganese toxicity and movement disorders. I think these links are far too important for anyone diagnosed with idiopathic cervical dystonia, musician’s dystonia, writer’s cramp, Parkinson’s disease, or Parkinsonism to ignore. The links support the reason I was able to mostly naturally heal from a supposedly progressive and permanent cervical dystonia and other neurological symptoms. Please consider these carefully and I will explain each one:
- A high percentage of people with dystonia or Parkinson’s-type motor illness are likely experiencing some form of toxicity from excess manganese in the brain.
- Manganese can explain why dystonia usually occurs in most-used muscles. This includes cervical dystonia, gait dystonias, musician’s dystonia, and writer’s cramp.
- Manganese can explain why such disparate symptoms like sleep disorders, restless legs syndrome, reduced sense of smell, dry mouth, fatigue, anxiety, depression, and cognitive impairment are so common in conjunction with, and can occur before Parkinson’s disease. Many of these are also commonly reported with cervical dystonia.
- There is a bias in many healthcare systems against diagnosing manganese toxicity, and relying on symptomatic treatments instead (Levodopa/Carbidopa, Botox, antidepressants, etc.). A naturopathic doctor can help with manganese toxicity more directly.
- It is not surprising that an effective treatment called Deep Brain Stimulation targets the same areas as where manganese deposits are the densest.
- The inability to detox manganese normally is probably worse than exposure to manganese.
- There is a potential way to restore the body’s normal manganese detox mechanisms to reduce manganese levels, and thereby recover some motor function, raise mood, and improve cognitive function. I will share what I did, so you can discuss with your doctor.
Background
The body requires tiny amounts of many elements for various cellular and systemic processes to work. Magnesium (Mg on the periodic table), for example, is required in more than 300 processes. Insufficient magnesium can cause a variety of issues, including tics, so most people know about it, and magnesium supplements are common. Manganese (Mn on the periodic table) is much less well known. This section is entirely about manganese.
We do not need nearly as much manganese as we need magnesium. The entire human body contains 10-20 mg (milligrams) of manganese. This weighs less than a grain of rice. Manganese deficiency or excess can cause neurologic and motor diseases. Manganese deficiency is extremely rare, because we eat roughly fifty times more than we need in our food. In a healthy person, the intestine absorbs around 10 times more manganese than is needed, then the body’s homeostasis (control) mechanisms get rid of the excess by excreting it through the liver into the bile.
Constipation can put more demand on this manganese homeostasis mechanism, because some of the excreted manganese is reabsorbed. In a healthy person, this doesn’t matter
- There are a wide range of symptoms reported in patient case study research. This is partially because symptoms are heavily dependent on dose, source, and duration (years or decades) [34].
- Generally only patients in high risk occupations such as welding or manganese smelting are evaluated for excess manganese (manganism). The two neurologists I saw for my cervical dystonia were not even interested in looking at my cirrhosis-equivalent blood manganese tests because I was not in a high-risk occupation.
- Many hospital labs can’t perform a manganese blood test. None of my coworkers in HMOs were able to get tested.
- Excess manganese in the brain is not always detectable in a blood test. Parkinson’s disease can be caused by one-thousandths of the exposure a manganese smelter worker might get, so it may not show up in the blood. I also doubt people with musician’s dystonia or writer’s cramp would show excess manganese in the blood.
Also, a diagnosis of manganism is often seen as not useful. That’s because in research, manganism is always shown to be a progressive motor disease, sometimes for years or decades after removal from exposure. This is even with chelation treatment to remove some of the manganese, which is marginally effective to temporarily reduce motor symptoms.
This is because there are many mechanisms by which excess manganese can cause neurotoxicity [18], and excess manganese in the brain is not always detectable in the blood. Some of the neurotoxic mechanisms caused by excess dopamine which can also affect movement include:
- Dysregulation of dopamine release [33].
- Disruption of tyrosine hydroxylase activity, causing insufficient dopamine production.
- Dysregulation of GABA, needed to inhibit movement.
- Oxidative stress damage to neurons and dopamine, creating neurotoxic dopamine o-quinones.
- Damage to dopaminergic terminals controlling the most used muscles, since manganese can be carried by dopamine transporters to dopamine-rich regions of the basal ganglia.
- Induce aggregation of misfolded alpha-synuclein (Parkinson’s disease)
Slightly elevated manganese intake, usually from air pollution, is associated with autism spectrum disorder in children [31], ADHD in children [29], aggression, Parkinsonism [28], and Parkinson’s disease (after decades) [10][12]. High levels of airborne intake, such as in manganese mining or smelting, can cause serious walking and shoulder / arm dystonias, and Parkinsonism, in 2-4% of people exposed.
Cervical dystonia is rarely mentioned in conjunction with manganese exposure
Therefore, it is not surprising that adults with autism spectrum disorder are at much higher risk for developing Parkinsonism [30] or Parkinson’s disease.
I have collected these symptoms
This wide range of symptomologies, combined with the fact that excess manganese doesn’t always show up on blood tests, makes manganese toxicity very difficult to diagnose. Thus, regional and HMO hospitals in my area don’t even have the capability to test for blood levels of manganese. They have to resort to a special form of MRI scan in order to test for the “palladial index”, which is a single number indicating the approximate overall amount of manganese in the basal ganglia of the brain. Even using this approach, there’s almost certainly not enough sensitivity to pick up local deposits that could cause musician’s dystonia, writer’s cramp, or the low levels that can
can result in very different symptomology Airborne manganese, as a component of air pollution, is the worst form of manganese, because it can land on the olfactory nerve and enter the brain directly, bypassing most of the body’s homeostasis mechanisms. Although the vast majority of our manganese intake comes from food, it is not usually considered an issue.
Low level airborne manganese exposure is not generally known to cause mental retardation, but is more associated with autism spectrum disorder in children [31], ADHD [29], aggression, Parkinsonism [28], and Parkinson’s disease [10][12]. Therefore, it is not surprising that adults with autism spectrum disorder are also at much higher risk for developing Parkinsonism [30] or Parkinson’s disease.
In 1975 – 1996, the lead, a cheap performance booster, was phased out of gasoline in the USA. Only recently, the worldwide phase out of lead has been almost completed in developing countries [32].
Lead was phased out because it can cause mental retardation in children, and also drive violent crime [32]. In the body, lead, like all heavy metals, can mimic essential minerals and travel via mineral transports. Settled in tissues, heavy metals cause oxidative stress damage to cells and structures. The type of heavy metal determines where it is most likely to settle and what damage it is likely to cause. The body has very few ways of removing heavy metals, so they damage can go on for years as the heavy metals are slowly excreted, partially through hair and nails.
Unfortunately, in almost every part of the world, lead was replaced by manganese (MMT) as the cheap performance booster.
Adults with autism spectrum disorder also have a much greater chance of using dopamine-blocking drugs such as atypical neuroleptics. Low levels of excess manganese in neurons can generate small electrical currents, causing unintended release of dopamine [33] and GABA.
Some people think the only reason I was able to recover from my cervical dystonia is because I had the rare situation where my dystonia was due primarily to manganese toxicity. Therefore anything I say or did won’t help them, because they don’t have a diagnosis of manganese toxicity.
But please look at the “manganese dyshomeostasis” symptoms I shared earlier closely. I’ve gathered these symptoms from a dozens of research papers relating to manganese. Have you had some of these symptoms for years but forgotten about them? Have you experienced hallucinations or delusions? They become more common with later stages of Parkinson’s disease. I experienced occasional auditory hallucinations for a while, and they were scary. Luckily, now that the manganese is out, I don’t have auditory hallucinations, experience nightmares, nor kick myself awake any more.
Diagnosis
Manganese dyshomeostasis and toxicity doesn’t always show up in the blood. I confirmed this with one of the world’s leading researchers on manganese. He said you can have deposits in the brain without excessively high blood levels. The reason is that the entry route for excess manganese deposits in the brain is almost always inhaled from air pollution. The manganese depositing on the olfactory nerve may first damage the sense of smell, before entering the brain along with neurotransmitters. Once inside brain cells, even in a healthy person, it can take a couple months to get half of the excess manganese out.
This manganese can even come from ordinary air pollution [8][10], train tracks [26]
.
Manganese Toxicity Diagnosis
The fundamental reason why most people will never be diagnosed with manganese toxicity is because there are no definitive diagnostic criteria or biomarkers revealed in scientific literature. Manganese toxicity doesn’t always show up in blood tests. T1-weighted MRI scans are marginally better, but can only pick up pretty concentrated deposits in the Globus Pallidus internal (GPi) part of the brain, which is where excess manganese will most densely settle. The manganese is usually not detectable by MRI a few months after exposure. That doesn’t mean it’s gone, just less dense. (The GPi is part of the basal ganglia and the home of GABA, the neurotransmitter which helps inhibit motions.)
Another reason why people with cervical dystonia will not likely be diagnosed with manganese toxicity is because in scientific literature, manganism causes arm, shoulder, and walking dystonia, not cervical dystonia. But there’s a reason behind this: manganese causes dystonia of the most-used muscles first. And the only people with dystonia routinely tested for manganese toxicity are manganese miners and smelters – people who use their arms, shoulders, and legs all day. Computer and phone users who primarily use their necks all day and develop cervical dystonia are never tested for manganese toxicity, as far as I can tell.
In fact, hospital labs in my area don’t even have the capability to do a manganese blood test. So most general doctors in HMO or hospital systems won’t even think of ordering a test. In contrast, my ND ordered an red blood cell manganese test on my first visit, saying it was routine and inexpensive, and warranted by my motor symptoms. The testing was done by a national lab, and covered by insurance. We also had the results confirmed by another national lab, and did both a whole blood manganese test and an an RBC test. My RBC levels were 6 times normal, and the whole blood test was around 2-3 times normal. These were equivalent to the average seen in stage-4 liver cirrhosis.
I brought 5 months of manganese blood tests to both my neurologists. The first neurologist said, in no uncertain terms, “You are wasting your time chasing manganese.” The second neurologist, at a major university neuroscience center said that he couldn’t do anything with my blood tests, but could order an MRI instead. I declined because there was zero way I could keep my head in a normal position for half an hour, even strapped down.
So the entire statistics for manganese-induced dystonia is based on a population mostly manganese smelters, and some welders.
Thirdly, I’m sure I’m not the only person with dystonia caused by manganese toxicity, considering how closely the symptoms for manganese toxicity match those commonly found with dystonia and Parkinson’s. You have to read the symptom list to decide. Excess manganese cannot always be detected in the blood. I confirmed this with an manganese expert researcher. For example, aggression in children was found to correlate to manganese levels in toenails but not in blood. Also, consider the 5 stages of Parkinson’s disease that you are likely to get if the only treatment you get is symptomatic:
First of all, if I had gone down the normal route of care, my blood would never have been tested for manganese. Even the regional hospital labs around here can’t do the test, so doctors won’t order it. The neurologists I saw, including one at a world-renowned neuroscience center, dismissed my manganese blood tests and said Botox injections into my neck was the only solution for my idiopathic cervical dystonia. That is, the only solution until the Botox stopped working in 6-7 years.
Second
The hospital labs around here don’t even have the capability to test for blood manganese levels. I suggested to my coworkers that they ask their doctors for the test, and none of their doctors would order the test. So my family doctor (MD) would have the challenging job of diagnosing me with cervical dystonia, and then refer me to a neurologist. When I saw the first neurologist with five months of manganese blood tests in hand, he said “You are wasting you time chasing manganese.’ He then told me that I had idiopathic (unknown or unproveable cause) cervical dystonia, and the only treatment was Botox injections in my neck. This was every three months, for the rest of my life.
I will explain more details about manganese dyshomeostasis and toxicity, because it is so important in movement disorders. Ideally, my NDs would have been working alongside generalist MDs and neurologist MDs for diagnosis and treatment of manganese toxicity. But the two neurologists I saw weren’t interested in looking at any of my lab tests, or discussing manganese at all. Ultimately, this was OK, because I stuck with my ND treatment and my manganese levels are within normal range now.
I think the divide between many MD and NDs is that MDs usually want definitive diagnosis and treatment methods before proceeding on a path that may or may not yield results. Unfortunately, much of the scientific research into ways to restore manganese homeostasis mechanisms occured only recently; this 2021 research article [23] is an excellent example and it also provides summary of previous research. We are likely at least 10 years off for definitive manganese diagnosis and treatment methods. On the other hand, licensed NDs have studied evidence showing how important the body’s systems are to long term health, and don’t wait for proof of specific connections.
Research shows that when people have elevated manganese in the blood or brain, elevated levels of manganese can remain for years even after major sources of manganese exposure are removed. This is presumably caused by a combination of two things: body stores of manganese, likely in the lungs, and an individual’s inadequate production of SLC30A10. 98% of people can easily detox 400 micrograms of inhaled manganese air pollution a day. But at least 1% of people can’t even detox one-tenth that level of exposure [28]. So these people can have continuous redeposit of manganese, which is what caused their problem in the first place. This manganese can even come from ordinary air pollution [8][10], train tracks [26], or contaminated water.
Chelation treatments can be helpful, but ultimately have only limited success, and usually the symptoms return after months or a couple years. My first 3g IV EDTA treatment removed 51 micrograms of manganese – much more than would have come out of a healthy person, but nowhere near the 400 micrograms that a healthy person can eliminate in a day. At this rate, I would have needed several hundred treatments to remove the excess manganese stored in my body, and it would still be likely to come back.
So my ND’s approach was to work on my body systems. SLC30A10 is a complex protein nearly 500 amino acids long. It is produced as part of a gene transcription process: A healthy gut breaks down proteins into amino acids; vitamin D signals the mitochondria to produce transporters; the mitochondria reassemble the amino acids in the order encoded by your genes; an SLC30A10 transporter protein is produced.
Other trace mineral, such as calcium, transporters are also produced. That’s why overly high levels of vitamin D can lead to hypercalcemia due to more efficient absorption of calcium from food. Also, low vitamin D can lead to rickets, a bone developmental disease, in children. Vitamin D’s importance in SLC30A10 production is scientifically verified [11][23].
Amino acids in produced by a gene transcription process which requires vitamin D for signaling neurons
Potential Roadblocks to Naturopathic Care
There can be several roadblocks to getting naturopathic care. I will share a few of them and some suggestions.
Cost
In the USA, naturopathic or alternative care is no longer covered by many insurances. Also, many holistic or functional medicine MDs that truly adhere to naturopathic principles tend to fall outside insurance networks and cost more than going to in-network doctors. The insurance system in the USA is seriously flawed, and the national healthcare system for older people (medicare) would often rather pay for expensive pharmaceuticals than help people heal.
I talked to my ND about the cost issue. Their office has arrangements with national blood draw labs to get discounted prices not available to the general public. They were also able to perform blood draws and send to reputable, but less expensive labs like Doctor’s Data, or arrange with local blood draw labs to do the same. In any case, it is good to ask potential naturopathic doctor candidates about insurance acceptance, and suggestions for keeping costs manageable if you do not have PPO insurance.
The blood tests my ND ordered from national blood labs were covered by my PPO insurance. If you belong to an HMO, you can ask your regular doctor to perform some of the more common / routine tests, like Complete Blood Count, vitamin D, and iron levels. In the USA, lab test results belong to you, so you can request or download them. Note, however, that HMO hospitals usually do not have the capability to do all the tests that national labs can do. Even the large regional hospitals in my area can’t do manganese blood testing.
Vitamin D testing is around $55 USD (mail in) to $70 (lab) nowadays, and available without a prescription. However, it is probably even cheaper if your regular doctor orders the test. If your regular doctor won’t, you might consider changing doctors.
Also, consider this: If I had taken the “Botox forever” conventional route, I would have had to pay roughly $2400 in insurance deductible costs per year, for the rest of my life. And I would likely have been so disabled I would have needed around the clock support, for the rest of my life.
Quality supplements do cost money, so you could ask your naturopathic doctor to prioritize.
Healthy Food
It takes time and money to either prepare your own healthy food or have a caregiver prepare it. But a healthy diet is so vital, after you have been on a healthy diet for a while, you won’t want to switch back. If you need more convincing, please watch the movie “Forks Over Knives”.
Over time you can likely find some simple recipes for food that you enjoy and provide the broad range of micronutrients you will need to heal. I will search out some recipe resources and post on this website. I have so much energy these days, I can often cook gourmet meals for the family. Before, even on Botox, I could barely see my plate, and eating was so painful I just wolfed all my food down and went back to bed. This gave me gastric reflux and chest pain to boot!
M.D. / Neurologist Resistance
I went to see my first neurologist, the highest rated in my city, five months after getting diagnosed by my ND. I brought a carefully cataloged stack of lab tests. The neurologist diagnosed me with idiopathic cervical dystonia. I asked him if it could be caused by manganese. I already knew it could be because the “Spasmodic Torticollis Handbook”, published in 2003 by three MDs, said manganese was a possibility.
The neurologist disappeared for around 10 minutes, and then came back and said “I don’t know what to do with your manganese tests”. Then he added, speaking really slowly as if I were an idiot, “All c e r v i c a l d y s t o n i a i s i d i o p a t h i c .” “Botulinum toxin injection into the neck is the only treatment.” “You’re wasting your time chasing manganese.” He referred me to a world-renowned university neuroscience center, because he had never dealt with a case so complex. He never looked at my lab tests.
At the neuroscience center, the neurologist was a lot nicer and a better listener. But he said he couldn’t use my blood tests to diagnose manganese toxicity. He would have to order a special MRI test, which cost 50 times as much as the blood test, for a proper diagnosis. There’s no way I could hold my head straight and still for a half hour, so I had to decline. So all he could offer was Botox and counseling. He was not interested in looking at my lab tests.
Eight Keys to Success
It’s hard to stay on track even with things we believe in. It’s important to have the right mindset, commitment to self and loved ones, and an actionable plan.
Making a Decision and Commitment: Following the suggestions in this Survivor’s Guide is not going to be a walk in the park. It will take time, money, hard work, and a lot of support. So it is important to decide if you believe these things will help you, and that you are willing to commit to the effort. I suggest finding a trusted friend or family member to read through this guide and help you decide on a plan.
Finding the Right Doctor: Much of the information in this Survivor’s Guide is from research less than five years old – too recent to make it into common clinical practices. So it is important to find a doctor who is familiar with treating things like dysbiosis and metals toxicity to improve systemic and neurologic disease. This could potentially be your neurologist or general practitioner, but in the USA they are usually booked months in advance and don’t have the time or specialization.
The right doctor will also be open to learning and discussing recent research with you, and saying “I don’t know” when appropriate. My NDs were the most open to this, and constantly reading the latest research on systemic health anyway. NDs in my state are licensed, can order lab tests, and in college are required to spend much of their time studying the maintenance of healthy systems. If you prefer an MD, the proper specialization is usually called “functional medicine” or holistic/integrative.
Finding an Advocate: An advocate is a trusted friend or family member who is willing to help you. This help could include asking questions and developing friendly relationships with doctors, reviewing information, and helping you make decisions and plans.
Budgeting: The potential costs of following the suggestions in this guide include: Doctor’s visits, a few lab tests that insurance does not want to cover, air filters, healthier food ingredients, and supplements. These costs may be offset by various longer-term benefits. For instance, I now only need to see my doctor every few months, and I don’t have to pay the insurance deductible on $30,000/yearly Botox injections. More importantly, I am healthy enough to go back to work and my days are easy and pain free so I can do more in general. Finally, everyone in my family is healthier, happier, and more productive too due to the healthier lifestyles we’ve adopted.
Organizing and Planning: It is crucial to keep a hardcopy of your lab test results filed and organized, even if just for baseline data. In the USA and most countries, your lab results belong to you. Often they can be downloaded from the lab, or your doctor will provide them, sometimes for a small fee.
It is also important to keep a logbook of what you ate, supplements that you took, toxic exposures, and how you felt and slept. This is to help you identify things like food intolerances that activate allergies, destabilize your digestion, mess up your sleep, or make you feel good the next day! The logbook is also to help you communicate accurate information with others so you can make good decisions.
Practicing Moderation and Patience: My NDs told me repeatedly that some days I would likely feel better and some worse due to the detox process. They both estimated that it would take a couple years to detox after having taken decades to build up toxins and systemic dysfunctions. By my symptom changes and lab tests, they were right on both counts!
The single biggest mistake I made was not always being patient with my detox. So I took too much of certain supplements, and that often set me back. It is important to work with your doctor on certain supplements to slowly ramp up, allow your body to adjust, and then decide whether to continue or try something else. Rushing is like baking a cake at twice the temperature and hoping it will cook in half the time!
Being Kind: In almost all the neurologic diseases I have studied, there are disturbances to neurotransmitter production or metabolism. This can affect your mood or short term memory, and make you easily irritated. ON top of that, you may have no idea your mood or behavior is affected. I certainly didn’t know, but now two years later I am in such a happy and relaxed mood, the difference is obvious to me. Two years ago it was easy for me to obsess, talk dark thoughts, and ignore people. I no longer have a need to do that. Please try to be aware of this potential and take extra effort to treat people in your life well. This includes your doctors, who are only human.
Empowering Yourself: The fundamental key to surviving cervical dystonia and Parkinson’s disease is taking responsibility for your health, and taking action. Nobody knows how you feel better than you do. Nobody can force you to eat a healthy diet, sleep earlier, exercise, reduce exposures to toxins or change to a less stressful lifestyle. Only you can make this commitment to yourself and your loved ones. Remember to take one step at a time, and it is never too late to start.
References
1. Jiang, Y., & Zheng, W. (2005). Cardiovascular toxicities upon manganese exposure. Cardiovascular toxicology, 5(4), 345–354. https://doi.org/10.1385/ct:5:4:345
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