A woman rubbed
contaminated skin cream on her face.
This is what happened to her brain.
B.D. is a 46 year old woman, presenting
to the emergency room
with slurred speech and
blurred vision.
Two weeks earlier she was at the same
emergency room because her
hands had become weak, and
intense pins and needles feeling turned
them completely numb.
Back then, it didn't seem like anything
immediately life
threatening was happening
to her, but now that she can't see or
speak clearly, it means something
terrible is happening
to her.
A few years ago, B.D. believed that she
had problems with blemishes on her skin.
To her, these dark spots were terrible
signs of aging and sun
damage, and she had to do
something about this
before it was too late.
A friend had told her about
skin-lightening cream
that helps with this.
These contain special ingredients that
were ethically sourced
from various corners of
the world that gently inactivate certain
enzymes in the skin to
fix and prevent blemishes.
These were so effective that access to
this cream could only be
had through special ordering
channels, but B.D. was in luck.
Her friend had contact with the most
authoritative source on
importing these creams as she was
able to order a large
supply and start using them.
B.D. applied this cream to her face twice
daily, and the blemishes were going away,
but over time she started noticing
something was wrong.
One evening, B.D. suddenly emptied her
stomach from both ends.
When she rinsed out her mouth with water
afterwards, a metallic
taste pierced into her cheeks.
A burning sensation rolled over her
tongue, but she really
wasn't sure what this was.
It didn't hurt, and it would come and go.
B.D. didn't think too much about all of
this happening, and she
continued to apply the
skin-lightening cream to her face.
One day, B.D. noticed that
she kept dropping her phone.
Originally, she thought that maybe it was
just slippery, but a
pins and needles feeling
in her hands started
getting more and more intense.
It would wake her up at night.
In the emergency room, doctors didn't
find anything
immediately life-threatening.
They sent her home and scheduled an
appointment with a
different doctor who wanted her to
come back after a couple weeks to see how
she was doing, but B.D. wasn't going to
last a couple more weeks.
She started having trouble seeing, and
she couldn't drive anymore.
She had trouble speaking because her
family couldn't
understand what she was saying.
And she started having trouble walking,
bringing us back to the
emergency room where we are
now.
At examination, the medical team were
concerned about two things.
B.D. went from having weakness and
numbness in her hands, to
having blurred vision, unsteady
gait, and slurred speech, all
in the time span of two weeks.
The speed of her decline gives them clues
as to what's
happening, but not only this.
Where this is happening gives them a
second set of clues.
Clearly, B.D.'s problems are related to
her nerves, but where specifically?
Her problem is not just some of her
nerves, because it
devolved into a problem spanning
her entire body, from the way that she
moves to her senses.
This means that there could be something
wrong with her brain.
But an MRI reveals nothing wrong.
There's no visible
structural abnormalities.
Her brain isn't
swelling and folding on itself.
It doesn't have anything
abnormal growing out of it.
She also doesn't have a fever, so this
likely isn't an
infection like meningitis.
When the medical team took a routine
blood test, they find
that B.D. is normal.
As the days pass, they find that B.D.
would have random,
delirious episodes in between
long periods of silence where she would
sit there and stare into the void.
When sounds came out of her mouth, they
were just mumbles and screams.
One of the new doctors on the team
decided to order a blood
test, different from the
ones that had been done routinely.
The final cause of B.D.'s problems that
hadn't really been looked
through was a toxic one.
And when they looked at the results, they
find that B.D.'s mercury levels are 1,400
times the upper limit of normal.
And this explains
everything happening to her.
But what's in her blood is only a part of
what's in her body, meaning that there's
likely even more mercury
that's absorbed into her organs.
So how did she get this
much mercury in her blood?
This brings us to the idea of absorption.
Mercury is a metal.
It's the only one that's liquid at room
temperature on earth.
In this form, it
doesn't absorb into the skin.
You'll see that it rolls right off and
the bulk fluid doesn't enter the body.
This is why you'll hear people say that
they touched mercury from
a thermometer and they'll
ask why they didn't
get mercury poisoning.
It's because it doesn't absorb into the
skin, but rather in this
form, sometimes small amounts
of vapor can come up from the liquid and
get inhaled, and that
vapor can cause mercury
poisoning.
This would be considered elemental
mercury poisoning, but
it isn't what happened to
B.D.
When the medical team asked her family
more about when all of
this started, they learned
that B.D. had been using a
skin-lightening cream two
times daily for seven years.
And when the medical team saw that it had
no ingredients on its
label, they contacted
the state and the poison center for
further instructions.
In the laboratory, the public health
department analyzed the cream.
High levels of mercury were found, but
something was wrong.
When creams like this have mercury, it's
usually in a salt form.
Table salt that we add to food is sodium
chloride, where sodium is
the part that's a metal.
But we don't think of sodium really as a
metal, because we think of it in the form
that floats around in our blood as an
electrically charged particle.
Instead of sodium, mercury
can be the metal in salt.
This is the form that you may have heard
of in old medicines like
a treatment for syphilis.
Salt forms like this tend to break up in
the body, leaving the
metal floating around as
a charged particle
ending in mercury poisoning.
The mercury found in B.D.'s
skin-lightening cream was a salt, but
it's more complex than
that.
Instead of just mercury ion as the metal,
it was a chemical called methylmercury.
Oil is a mixture of several different
hydrocarbons, and this
methyl hydrocarbon branch attached
to mercury was what B.D.
was rubbing onto her face.
This carbon-containing mercury
is called an organic mercury.
Mercury salt and organic mercury, unlike
elemental mercury, absorb
through the skin and into
the body.
So, B.D. applying this cream to her face
every day, twice daily,
accumulated mercury in her
body.
But what was it doing?
Mercury is a heavy metal.
When elements are heavy, it means that
they have a lot of mass.
The human body is made almost entirely of
six elements - carbon,
hydrogen, oxygen, nitrogen,
phosphorus, and sulfur.
None of these elements are heavy.
They're pretty light.
They're not massive, and this means that
they're typically stable.
But mercury isn't light.
It's relatively stable in its elemental
form, but that's not
the form in B.D.'s body.
This mercury has a tendency towards
instability, and in order to
stabilize itself, it's going
to interact with parts and structures in
the body, and this is where the permanent
damage happens.
Our physical form is made of proteins,
and proteins are
chains of 20 different amino
acids.
Amin, referring to nitrogen.
Some of these amino acids have sulfur,
and it's here where mercury
preferentially likes
to act.
Cells like to pump electrolytes in and
out so they can maintain balance.
But when mercury is present, it breaks
the pumps because those
pumps are made of proteins
that have sulfur.
Without balance, the
cells can't function properly.
Hair is made of proteins
that are rich in sulfur.
This sulfur is why burning hair smells
bad, but it's also why
mercury can be found in
hair.
When hair is tested, it can be used to
detect large mercury
ingestions, but hair binds to
environmental mercury, which never
entered the person's body.
At least in the United States, large
amounts of mercury
shouldn't be floating around in
the air, and it shouldn't be on surfaces.
But hair can collect it based on this
contact, so it could lead
one to believe that they've
ingested mercury when
in fact they haven't.
Cells need to break down chemicals when
they're done with them.
For example, when nerve signals are sent,
the neurotransmitters
that sent those signals
need to be taken away.
Enzymes do this breaking down, but
enzymes are proteins.
When someone is poisoned with mercury,
those enzymes don't work anymore.
Do you remember that oil is
made of hydrocarbon chains?
Well, oil doesn't mix with water, but it
mixes with other oils and fats.
Knowing that BD's Skin Lightning Cream
had methylmercury, a
hydrocarbon branch, we know
that it preferentially mixes
with fat tissue in the body.
But everything in the body has fat.
Cells have a lipid bilayer, and
methylmercury gets in and breaks the
enzymes inside causing
toxicity.
Is there a part of the body
that has more fat than others?
Well, the brain is 60% fat.
Because fat dissolves in fat and blood is
made of water, which
isn't fat, then mercury
gathered into her nerves and her brain.
BD had movement disorders.
This tells us that mercury has deposited
into the part of her
brain that controls movement
called the cerebellum.
And unfortunately, we have enough
information on methylmercury
poisoning to know that this
is typical.
In 1956, Minamata City in Japan, by the
water, a 5-year-old girl
presented to the emergency
room with difficulty walking, trouble
speaking, and seizures.
Two days later, her younger sister
presented with exactly the same symptoms.
Their mother told the doctors that their
neighbor's daughter also had been
experiencing the same
problems prompting public health
officials to investigate a
potential outbreak, and they
found 8 people in the neighborhood with
the same signs and symptoms.
Those who were investigating found that
cats living in the area
would have convulsions
before passing away, something that the
locals called "cat dancing disease."
Crows and other birds would suddenly fall
from the sky, their bodies unable to move
normally.
Fish would float up to the surface of the
water and become lifeless.
All of this started to make more sense
when they realized that
a local chemical factory
had been dumping wastewater into the bay,
and inside that
wastewater was methylmercury.
The fish absorbed it into
their bodies through the water.
The cats and the birds would eat the fish
and accumulate mercury,
causing the same problems
that happen in humans, because the locals
living in the town also ate the fish.
Typically, we refrain from naming
diseases after specific
locations because, in this
case, chemical factories can be anywhere,
and this mercury
poisoning can also happen
anywhere.
But when the medical team did BD's first
blood test finding
out that she had mercury
poisoning, her blood levels were 10 times
the average person who got sick from this
incident in Minamata City.
Do you remember that
mercury likes to bind to sulfur?
Well, that means that there might be a
way to remove the mercury from BD.
The medical team used succimer.
Technically, the sulfur here should be
able to surround the mercury.
It should be able to prevent it from
binding to any more
proteins in the body, further
preventing damage.
The problem is, succimer won't be able to
displace mercury
already absorbed into her
organs, and even worse, succimer won't be
able to reverse the
damage that mercury has
already done.
Methylmercury poisoning is scary because
it doesn't immediately produce symptoms.
The delayed onset appears to be due to
how it distributes into fat tissue.
The body takes longer to clear it out,
and it does so through the GI tract.
The studies suggest that it takes almost
a year to clear out
most of it from the blood,
but studies also suggest that once it
absorbs into
neurologic tissue, it changes.
Experiments and a separate autopsy of
someone who survived
methylmercury poisoning for 22
years showed that mercury was still
present in the brain all
those years later, and that
it had converted into inorganic mercury,
like from the salt form.
As the days pass, BD's continuously given
the succimer in an
effort to remove the mercury
from her blood.
She hadn't used the skin cream for
several weeks at this
point, but the medical team
determined that she needs to be
transferred to a hospital
that can take better care of
her.
But why was the mercury in the cream?
Well, some skin lightening
products utilize mercury.
The body uses metal
ions for various functions.
In normal function, copper ion is used in
the enzyme that
produces melanin, the substance
that produces hair,
eye, and skin pigmentation.
Mercury competes with this copper ion,
and as mercury does, it
inactivates the enzyme
inhibiting melanin production, resulting
in a skin lightening effect.
So some of these products already have
mercury in them, but
normally they have the inorganic
salt version.
So while BD's product probably was going
to have mercury in it,
her issue is that the
particular jar that she was using was
contaminated with organic methylmercury.
BD's case is significant because it was
the first time that
methylmercury was found to
be in these skin lightening
products that were imported.
But even more, the U.S. Food and Drug
Administration issued a consumer update
to warn that mercury
poisoning is now being more commonly
linked to skin products,
particularly ones that are
marketed as
anti-aging or skin lightening.
These products are often spread by word
of mouth, and they may be
used to treat age spots,
freckles, and blemishes
like what BD was looking to do.
And teenagers may use these
products to help with acne.
Sometimes these products will tell you
straight up on their label
that they contain mercury,
but sometimes these words aren't
immediately obvious, like
when it says "calomel," which
is a name for mercury
chloride, so it's the inorganic salt.
Other times, the label doesn't even list
any of the ingredients,
but in the worst cases,
the product is contaminated with
ingredients never listed in the first
place, which appears
to be what happened to BD.
In the United States, a federal law
requires that ingredients
be listed on the label of
any cosmetic.
When products are imported unlawfully,
sometimes they won't have
that label, but remember,
these skin creams will
have dermal absorption.
It wouldn't be abnormal for someone to
use them, and then somehow
touch a kitchen countertop
or handle food eaten by other members of
the household, which
would expose them too to
mercury, causing a toxic response.
And remember, mercury poisoning,
especially from the
carbon-containing organic mercury,
has a delayed onset.
By the time one experiences symptoms,
it's already too late,
because it's already absorbed
into their body, and there's no way to
reliably remove what's
settled in their organs.
Always check the label on cosmetics, and
always exercise caution
with products, especially
ones that may have been
brought into the country unlawfully.
For BD, after extensive succimer
treatment and a very long hospital stay
at various institutions,
she was still not able
to speak for herself.
She wasn't able to care for herself, and
she needed a feeding
tube because she wasn't
able to eat anymore, as she
could not make a recovery.
There's a lot of things that people will
somehow get into their
body that's unlawful, or maybe
it's semi-lawful.
Some of them I can more directly talk
about, like this video, which I have
available exclusively
on Nebula.
Nebula is a streaming service that was
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videos early ad-free on Nebula.
But this isn't just videos that you'll
find on YouTube earlier,
it's also exclusives and
originals.
In an afternoon I watched all of Joe
Scott present
Mysteries of the Human Body.
Speaking of things that somehow get into
people's bodies, I really
like this episode, Weird
Stuff That Might Be Inside You Right Now.
And also the scientific aspect of this
episode, Why Can't We Stop Death?
And there's more than just science
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Thanks so much for watching.
Take care of yourself, and be well.