Tuesday, June 29, 2010

The Ecstasy (and Agony) of Sushi

      Several years ago, a young woman came to me with neck and back pain, which had not yielded to acupuncture or physical therapy. There were tight bands in her neck and upper back muscles, yet trigger point injections, which usually alleviate this source of pain, provided no lasting relief.
      Reviewing her life style, I noted that she was a self-described "sushi addict," eating it as much as five times a week. Her blood work then showed abnormally high mercury levels.  I then made calls to three other patients who had similar symptoms.  They also were frequent consumers of Sushi.  All lived in the New York area so I called  the New York City Board of Health.  An inspector  confirmed that there were unacceptably high levels of mercury in some fish, affecting sushi served in restaurants.
     Eureka, a diagnosis: mercury poisoning. Mercury is a heavy metal that is found in the earth's crust of rocks and soil. It is released into the atmosphere by burning coal, by burning and improper disposal of manufactured products containing mercury, and from personal products such as batteries. As it gets into water, bacteria can change it into a highly toxic methylmercury, which builds up in fish, shellfish and animals that eat fish. As it moves up the food chain, with larger fish eating smaller ones, mercury can become highly concentrated. Sushi from fish at the top of the food chain, such as Tuna, Salmon, and Tile fish, can cause problems associated with mercury poisoning, which is often overlooked as it takes a while to manifest. Absorbed through the gut, methylmercury can alter critical enzyme function and affect muscles function and nerve cells in the brain and spinal cord. The result can be a gait disorder, back and neck pain, and mental-psychological problems.
     Once diagnosed, the solution was straightforward. My patients modified their sushi intake, and restricted their choices to sushi at the low end of the feed chain, such as squid, shrimp, and abalone. All the symptoms of tightness and pain subsided.
    While mercury poisoning is relatively rare in my practice, finding the source of pain often requires detailed review of a patient’s life: sleep, work ergonomics, exercise and diet. After all, when it comes to pain, we often suffer the unanticipated consequences of our life-style .