What is the deal with Chuck Norris and gadolinium?

In My Humble Opinion (IMHO)
#1

Apparently Chuck Norris’ wife became very ill after receiving gadolinium contrast media for an MRI several years ago. Now the Norrises are suing three different companies for $10 million in damages: http://www.newsweek.com/what-gadolinium-chuck-norris-claims-it-poisoned-his-wife-704647. They claim there is evidence that gadolinium does not clear through the kidneys and actually stays in your brain and other tissues and can make you sick.

As far as I know, the official medical position is that gadolinium does clear the body through the kidneys and you would be more at risk pretty much only if you have kidney disease.

Does anyone here know of any studies that have been done on this? I must admit to being skeptical of the Norrises claims since they are #45 supporters and appeared on Sharyl Attkisson’s show to talk about this matter, which makes me think they may be prone to the conspiracy theory subset of the far right.

Also this was brought to my attention by a family member who is prone to believing in conspiracy theories and listens to x22 and believes that the elite are trying to kill the rest of us and will then escape earth on a spaceship after they destroy it, so. :smack:

Still, I am open to the possibility that gadolinium is more dangerous than previously thought. OTOH, any medical treatment or test carries risks, some of which can be unexpected and can happen to someone who appeared to be otherwise healthy, so I tend to think the Norrises are full of it.

#2

There is a risk of becoming ill after the use of gadolinium contrast media for an MRI. People with end stage renal disease are at highest risk of this, but there have been a few cases in people with no known renal disease. Gadolinium by itself is toxic, and it’s safe for use in MRI only by being chelated, which makes it easier for the kidneys to eliminate. Even so, this doesn’t happen instantly and gadolinium can be detected for quite some time after an MRI. It is certainly possible that some people are more sensitive to it than others. It is possible that Mrs. Norris was health with normal kidney function prior to the MRI and did become seriously ill afterward due to the gadolinium contrast media. It’s unlikely, but maybe she was one of the unlucky ones.

That said, it is still less likely to kill you or make you ill than x-ray and CAT scan contrast media. There are a lot riskier things done in medicine every day than injecting MRI contrast media. Given how many tens of thousands of people get MRI’s every year around the world it isn’t shocking that some would suffer side effects. As you noted, no medical procedure is 100% safe.

#3

Well stated, Broomstick. Gadolinium-based contrast agents are biologically active (https://www.physiology.org/doi/pdf/10.1152/ajprenal.00379.2014). These compounds exert detectectable effects on cultured human cells within hours.

“No matter what you have read, we don’t know the precise glomerular filtration rate [i.e., degree of kidney function] where the disease cannot occur—what we know has been based on retrospective, non-experimental case reports. We don’t know how gadolinium-based contrast agents trigger the disease; several different brands have been tied to the condition. We don’t know the threshold of the gadolinium contrast agent or the conditions that lend themselves to the disease,” (https://ajkdblog.org/2018/03/22/nephmadness-2018-gadolinium-toxicity-gaps-in-knowledge/).

“Gadolinium is not a physiological element, and we have no idea what threshold triggers pathologic consequences,” (http://www.ackdjournal.org/article/S1548-5595(17)30061-7/fulltext).

In the setting of compromised renal clearance (e.g., kidney disease), gadolinium-based contrast agents have an effect on bone marrow-derived cells which appears to promote disease (http://ajp.amjpathol.org/article/S0002-9440(12)00668-2/pdf). If bone marrow has been exposed to gadolinium-based contrast, it appears to have a ‘memory’ of this and re-exposure can lead to a more severe disease (http://www.fasebj.org/doi/pdf/10.1096/fj.201500188R).

Why the kidney function (and the precise level of dysfunction) has any bearing on susceptibility is unknown.

The September 8, 2017 FDA Medical Imaging and Drugs Committee meeting (https://www.fda.gov/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/MedicalImagingDrugsAdvisoryCommittee/ucm553470.htm) was convened to specifically address the safety of all gadolinium-based contrast agents as patients had been attributing symptoms to these and evidence that gadolinium from every class of agent is retained in the human body. This is evident by persistent T1-weighted signals in specific brain areas—the globus pallidus and the dentate nucleus, for example— Pierre Desche (Guerbet), concluded “that brain hyper intensities and [‘nephrogenic’ systemic fibrosis] are, in fact, part of the same continuum from gadolinium retention to gadolinium toxicity, and renal dysfunction acts as a catalyst,” (https://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/MedicalImagingDrugsAdvisoryCommittee/UCM584442.pdf).

Too much is unknown to call any agent “far safer” than another; until we know mare about the biologic effects of these agents, caution seems prudent.

“…I think everyone agrees that 1) we don’t know as much as we would like to [about gadolinium-based contrast agent effects/Gd retention] and 2) multiple further studies are clearly warranted,” Emmanuel Kanal, M.D.

#4

Apparently they don’t have a simple allergy skin test.

I had three IVP’s throughout the 80’s and 90’s. They always did an iodine sensitivity test on my forearm and waited 15 mins for the result.
https://www.google.com/amp/s/www.radiologyinfo.org/en/amp/ivp.html
CYA got so bad that they STILL insisted on an IV just in case they had to administer a drug to conteract the iodine. Somebody decided the iodine sensitivity test wasn’t good enough.

We have billions of people. 5% may be allergic to a drug or medical contrast. What are we supposed to do? Withold a a life saving test because 5% are allergic? What about the 95% that can take it?

#5

While I’m unable to access all the linked articles/postings that Brent supplied, much of this material addresses systemic fibrosis, a known serious complication associated with gadolinium contrast agents in a small subset of patients, mostly those with pronounced chronic kidney ailments on dialysis.

What has not been demonstrated is that deposition of small amounts of gadolinium in the central nervous system or elsewhere in the body additionally causes clinical symptoms or disease (as the Norris’ lawsuit claims). Both the FDA and European Medicines Agency have similarly weighed in to agree on this (some contrast agents have been withdrawn from use for precautionary reasons). We have experience stemming over a couple of decades in millions of patients, and “gadolinium deposition disease” with a multiplicity of peculiar symptoms has not been validated. Research continues (relevant commentary here).

Orac over at Respectful Insolence did an article last year on the Norris case, expressing great skepticism that Ms. Norris’ symptoms (including the statement that her “whole body” was “simply not properly functioning”) could be ascribed to gadolinium, and noting that the Norrises reportedly spent over $2 million on dubious therapies, including the purchase of a hyperbaric oxygen chamber and “detoxification” therapy that reportedly alleviated her symptoms (the mechanism involved is a mystery).

Evidently a couple of industries (quackery and personal injury lawyers) are so far benefiting from an ailment whose connection to reality is so far tenuous at best.

#6

While there is an issue with x-ray/CAT contrasts and iodine allergy, the problem with gadolinium is not that it provokes an allergic reaction but that it is a heavy metal with no known metabolic use and we have little knowledge of how it affects the body, other than “badly” when not properly chelated.

Yes, trace amounts do remain in the body tissues after an MRI, the big question is “how much?” and “how bad is it?” The answer at this point seems to be, for the vast majority of people “next to nothing” and “apparently no consequence”. Remember that ALL of us have some exposure to heavy metals simply by living on the planet and trace amounts of all sorts of things can now be detected in a person if you make the effort to look. Look hard enough you’ll find all sorts of things in your body, from lead to arsenic to mercury to PCB’s to Og knows what else, because bits of that are in the environment we live in, always have been, and we actually can tolerate teeny bits of that stuff because if we couldn’t our ancestors wouldn’t have lived long to reproduce.

As I said - it is entirely possible that Mrs. Norris is an unusually sensitive person to gadolinium. Or that she could have had a batch of contrast that wasn’t properly formulated (in which case where are the other adversely affected patients who also had a dose of the same batch?) or was improperly administered (which does sometimes happen). However, her symptoms are not consistent with the typical Major Side Effect of gadolinium, which causes skin thickening, contractures, and sometimes restricted motion in joints. It’s not impossible for her to be having a unique reaction, but any such claim with the sort of non-specific symptoms she’s displayed, and not backed up by conventional testing, is going to seen as dubious.

And, in fact,* millions *of people have had MRI’s with contrast (including yours truly) and very, very, very, very, very, very, very, very, very, very, very, very, very, very, very, very, very, very, very, very, very, very, very, very, very, very, very, very, very, very, very, very, very, very few of them have had bad reactions of any sort. Even among people with kidney problems or on dialysis such reactions are still statistically rare. As I said, you’re far more likely to suffer side-effects from x-ray/CAT scan contrast. Subject enough people to a medical procedures, no matter how safe or innocuous, and eventually something will go wrong.

Keep in mind, too, that people who get MRI’s get them because there is, or may be, something wrong with them. It’s not unreasonable that some of them go on to have a worsening of the condition(s) that resulted in them getting MRI’s in the first place. Mrs. Norris was sick, that’s why she was getting an MRI, and while it may be convenient to blame the gadolinium contrast her symptoms may, in fact, be a result of whatever lead to her doctors asking for images in the first place.