This is very interesting to see on here. My mother was the dissenting vote on an FDA panel on this. There are articles about it. I'll copy her words (as reported by something but seems legit)
> She said that the FDA's plan doesn't go far enough.
> "It's hard to dismiss an anecdotal report when you are the anecdote. When a patient is finally tested and found to have gadolinium retention, there's no FDA-approved antidote. So what does the patient do?"
And I want to reiterate that she was "the" no not "a" no. I don't know if her vote alone is what's caused more research into this. But it's probably the thing I brag about her the most. Even though everybody else said it was fine or abstained, she stood strong. If you look up the articles from the time of the panel (2017) you'll see a lot of articles about this panel and how she was the sole no vote. Included in that was a public post from Chuck Norris praising her. He was going to come out to meet us but I think it was a bad Texas hurricane season so that fell through
In case anyone is wondering what Chuck Norris has to do with all this:
> Chuck and Gena Norris filed a lawsuit against several medical companies in 2017, alleging that a gadolinium-based contrast agent used in Gena Norris's MRIs caused her to develop a condition called gadolinium deposition disease and resulted in debilitating symptoms like cognitive issues, pain, and muscle wasting. In January 2020, the Norrises, along with their attorneys, voluntarily dismissed the lawsuit with prejudice, meaning it cannot be refiled. The dismissal was made without a settlement payment, and each party paid their own legal costs.
It might give a glimpse into his worldview to mention that during the COVID pandemic Mr Norris shared an article on social media that claimed that the COVID vaccinations killed millions of people. [0]
His reaction is kind of the essence of populist backlash.
People are told that the authorities have it all under control and the experts can be trusted. Then they discover that the experts are human, fallible, and sometimes incompetent or corrupt.
Since the original message was one of unqualified absolute faith in the experts, the backlash is to flip over to believing that the experts are satan incarnate and pure evil and always wrong.
It reminds me psychologically of the arc of an immature relationship. First they’re perfect, everything about them is perfect, they’re going to be your soul mate forever. Then you catch them in a lie or they do something embarrassing. Then you get the screaming breakup. Everything about them is the worst now and you never want to see them again.
The fact that people are aware of the Norris's claims, but not aware that they dropped their suit without a settlement, is itself the subject of research about how celebrity publicity poisons the popular discourse regarding health care and science.
Every time I've gotten an MRI the doctors and techs have sworn up and down it's impossible for this stuff to stick around. Getting tired of not being able to believe what doctors say...
That's surprising, it's at least casually known that they're bio accumulative to some extent. I've joked to the techs before about gadolinium eventually accumulating enough to not be necessary if you do it with enough frequency. Realistically though any situation that you're doing the contrast you're probably at a lot more risk of whatever they've found than from the contrast agent.
I had to have contrast to diagnose a simple cyst, which is entirely asymptomatic and was discovered by accident in the background of a cardiac MRI (family history of SCD, but my own heart is fine).
You're making me feel lucky about what was otherwise a very unpleasant experience!
A chemist gave a great talk about this at a big MRI conference (ISMRM) in Paris 10ish years ago. His explanation was that gad behaves a lot like iron does in the body. It deposits where iron does and like iron it lacks a metabolic route for removal (though menstruating females lose iron).
He stated that deposition was entirely predictable. However the harm caused is still debated.
The article here says ‘ Dr Wagner theorized that nanoparticle formation could trigger a disproportionate immune response, with affected cells sending distress signals that intensify the body’s reaction.’
Emphasis on ‘theorised’.
Deposition is discussed in the below link, and the comparison with iron is briefly mentioned.
Maybe donate some plasma afterward. There was a study about firefighters exposed to microplastics that had a statistical reduction after regular donations.
> I was kind of annoyed I wasn't offered and MRI, and here we are.
This paper isn’t saying that MRI contrast agent is high risk in general.
There’s a risk in misinterpreting these niche papers to overstate their relative risk. This is a common mistake when people start reading medical papers and begin overweighting the things they’ve read about as the most significant risks.
CT is cheaper than MRI, and it's harder to get insurance to pay for the latter. There are some legitimate diagnostic reasons to prefer CT imagery, but I think cost may be a more common deciding factor.
The data until recently suggested that, so thats the risk you take. Would you rather be living in ancient greece and shoved full of hemlock leaves for arthritis? Or have a 19th century surgeon remove your appendix?
There's risk in life and odds-wise if you're in the developed West, you're going to get care and medicine that will greatly prolong your life.
Also this paper is super vague. What percent of people even get this? How long does it last? They havent even done a study to see how long it lasts yet. I have a feeling this isnt going to be our generation's asbestos or thalidomide.
That being said, you should decide your own risk profile. If MRI gives you concerns there are alternatives that dont involve contrast.
But given our track record, a little humility would go along way.
When a highly educated doctor tells you that something is safe, a person is going to assume that means that someone somewhere has proven that the substance is safe. If what they really mean is that no one really knows, but so far, no experiments have been able to prove danger, then we should say that instead.
Literally every single medical procedure, down to the most mundane, has risks.
That's why we don't give MRI's out the wazoo. We actually gatekeep them a lot, and most research will tell you that investigative MRIs without chief complaints are a bad idea and we don't do them.
I had cancer. I had no MRIs, but multiple CT and PET scans. CT scans and PET scans have risk - they don't just do those for kicks. But you know what else has risks? Cancer. So there's a calculus here.
Every single medical procedure, down to getting your blood drawn, has this calculus. Nothing is risk free.
Around 10 years ago, I had an brain MRI with contrast. I specifically googled it and found a paper saying it builds up in the brain. I asked the MRI specialist about it, she was surprised I knew this and said she was familiar with the research. She mentioned that her professor also knew about it, but that the paper had other motivations, some conflict of interest, and that I shouldn't be worried. FFS.
Thanks - I've put that link in the toptext above. I'm not sure it makes sense to swap out the submitted URL with it. Hopefully people will take a look at both.
You know what other metal stays in the body, permanently bound to bone and other organs? Bismuth, as in bismuth salycilate, aka Peptobismol. A tiny % actually stays in your body.
Does that cause any symptoms? Because apparently this can, and they tell you how to avoid it.
> Lead author Dr Brent Wagner told Newsweek he personally avoids vitamin C when undergoing MRI with contrast, citing its potential to increase gadolinium reactivity. “Metabolic milieu,” including high oxalic acid levels, could explain why some individuals experience severe symptoms while others do not, he said.
Avoiding high-oxalic foods for a few days before the MRI also seems like a good idea. Just check the diet for calcium oxalate kidney stones.
"After ingestion, bismuth is primarily found in trace amounts within organs such as the kidney, liver, spleen, and, in rare cases, the brain, where it accumulates intracellularly—especially in lysosomes and nuclear membranes—and extracellularly in basement membranes of blood vessels.[1-4] In normal therapeutic use, the amount of tissue-bound bismuth is extremely low and is not associated with adverse effects.
Potential consequences of tissue-bound bismuth are generally negligible at standard doses, but chronic or excessive exposure can lead to toxicity, most notably neurotoxicity (bismuth encephalopathy).[1][4-6] In cases of bismuth intoxication, histochemical studies have shown accumulation in neurons and glial cells, particularly in the cerebellum, thalamus, and hippocampus, with clinical manifestations including confusion, myoclonus, and encephalopathy.[1][4-6] However, these effects are reversible upon discontinuation of bismuth exposure, and recovery is typically complete within weeks.[5-6]
Animal studies confirm that bismuth binds to proteins such as ferritin and metallothionein, and is retained in lysosomes, nuclear membranes, and myelin-associated proteins.[2][4][7] The kidney is the primary site of accumulation and excretion, and tissue levels decline after cessation of exposure, with little evidence of permanent retention at therapeutic doses.[2-3]
In summary, permanent tissue binding of bismuth is minimal and clinically insignificant with standard use, but chronic high-dose exposure can result in neurotoxicity and other organ effects, which are reversible after stopping bismuth.[5-6][8-9]"
1.
Autometallographic Tracing of Bismuth in Human Brain Autopsies.
Stoltenberg M, Hogenhuis JA, Hauw JJ, Danscher G.
Journal of Neuropathology and Experimental Neurology. 2001;60(7):705-10. doi:10.1093/jnen/60.7.705.
2.
Metallobiochemistry of Ultratrace Levels of Bismuth in the Rat II. Interaction of Bi With Tissue, Intracellular and Molecular Components.
Sabbioni E, Groppi F, Di Gioacchino M, Petrarca C, Manenti S.
Journal of Trace Elements in Medicine and Biology : Organ of the Society for Minerals and Trace Elements (GMS). 2021;68:126752. doi:10.1016/j.jtemb.2021.126752.
3.
Distribution of Bismuth in the Rat After Oral Dosing With Ranitidine Bismuth Citrate and Bismuth Subcitrate.
Canena J, Reis J, Pinto AS, et al.
The Journal of Pharmacy and Pharmacology. 1998;50(3):279-83. doi:10.1111/j.2042-7158.1998.tb06861.x.
4.
In Vivo Distribution of Bismuth in the Mouse Brain: Influence of Long-Term Survival and Intracranial Placement on the Uptake and Transport of Bismuth in Neuronal Tissue.
Larsen A, Stoltenberg M, Søndergaard C, Bruhn M, Danscher G.
1. The correction doesn’t invalidate that previous study at all
2. I fail to see how the previous study is an “underpinning” of the new paper. The new paper is a chemistry paper about dissociation of GBCAs in the presence of certain chemicals. Maybe people care because it is a potential explanation for toxicity, but the paper is very focused on the chemistry findings.
It is underpinning, as it is the most frequently cited in the entire paper.
It is underpinning, as the claims in both introduction and conclusion are precipitate to it.
The correction:
> After personal communication with the radiologists the administered Gd-contained contrast agent was documented in the MR examination reports of the mentioned nine patients incompletely and inexactly as Gd–DTPA by themselves. There is solely one MR contrast agent used in the described observation period: Gd–DTPA–BMA. Therefore, all mentioned nine patients received Gd–DTPA–BMA and not Gd–DTPA.
Means that Gd-DTPA is irrelevant. Guess which is analysed here?
I think the thing to remember with this, as with any kind of medical procedure, is the benefits versus the risks. In many cases, if you're getting this kind of MRI contrast, there's probably a good reason for it. So even if there's some risk, it might be better than say, the cancer or something else they're looking for. I feel like this is something that's often forgot in these discussions.
Yes. The problem is that it's common in the industry. But it's ultimately up to the patient. Maybe alone. Pretty much guaranteed scared. Undereducated, worrying about their likely life threatening potential illness or injury. That's basically under duress.
What are you proposing instead? Should patients just die of their illness instead?
Medical procedures have risk, some are small risk some are higher risk. There are none that are 100% safe. Doctors are supposed to evaluate if the risk is worth the value the procedure would supply.
What is the alternative to the status quo that you would propose?
When I had mine I got the form with warnings about side effects. When I saw the allergic reaction I was a bit concerned, I asked the tech and was told it wasn't a big deal. Since I was in the basement I didn't have service and I decided to trust them given the large number of my friends who've had MRIs. It was fine, but it seemed like a major thing to toss in the patients lap right before they get strapped down in a tube.
> Undereducated, worrying about their likely life threatening potential illness or injury. That's basically under duress
I was never communicated about gadolinium pollution. Not once.
And yes, on my recent MRI, I explicitly asked why there was metal particulate in my joint. "I dont know, sometimes it happens'... No you fucking tool of a doctor. Its gadolinium.
People getting MRIs frequently have bigger fish to fry.
When my wife was under cancer treatment she had them frequently. Risking some minor reaction, which in her case was disclosed many times, was well worth the value in managing the acute and long term treatment plan.
I find it odd that when I happen across an article talking about some negative links between x and y being discovered, there's always someone in the comments saying this was known for some decades.
My son had an MRI with gadolinium- turns out he is allergic to it, he developed a full-body itchy rash. There were like 20 interns in to see him, for the experience I guess. They were ready to send him to the ER in case it interfered with his breathing, luckily it didn't.
That would have been frightening. Did it require treatment beyond antihistamine?
I’ve given MR contrast to patients a lot of times (probably tens of thousands) and have seen hives and rashes a handful of times but vastly more often with iodinated contrast in X-ray procedures (usually CT).
Readit News
> She said that the FDA's plan doesn't go far enough.
> "It's hard to dismiss an anecdotal report when you are the anecdote. When a patient is finally tested and found to have gadolinium retention, there's no FDA-approved antidote. So what does the patient do?"
And I want to reiterate that she was "the" no not "a" no. I don't know if her vote alone is what's caused more research into this. But it's probably the thing I brag about her the most. Even though everybody else said it was fine or abstained, she stood strong. If you look up the articles from the time of the panel (2017) you'll see a lot of articles about this panel and how she was the sole no vote. Included in that was a public post from Chuck Norris praising her. He was going to come out to meet us but I think it was a bad Texas hurricane season so that fell through
> Chuck and Gena Norris filed a lawsuit against several medical companies in 2017, alleging that a gadolinium-based contrast agent used in Gena Norris's MRIs caused her to develop a condition called gadolinium deposition disease and resulted in debilitating symptoms like cognitive issues, pain, and muscle wasting. In January 2020, the Norrises, along with their attorneys, voluntarily dismissed the lawsuit with prejudice, meaning it cannot be refiled. The dismissal was made without a settlement payment, and each party paid their own legal costs.
It might give a glimpse into his worldview to mention that during the COVID pandemic Mr Norris shared an article on social media that claimed that the COVID vaccinations killed millions of people. [0]
[0] https://m.facebook.com/story.php?story_fbid=870953857718632&...
People are told that the authorities have it all under control and the experts can be trusted. Then they discover that the experts are human, fallible, and sometimes incompetent or corrupt.
Since the original message was one of unqualified absolute faith in the experts, the backlash is to flip over to believing that the experts are satan incarnate and pure evil and always wrong.
It reminds me psychologically of the arc of an immature relationship. First they’re perfect, everything about them is perfect, they’re going to be your soul mate forever. Then you catch them in a lie or they do something embarrassing. Then you get the screaming breakup. Everything about them is the worst now and you never want to see them again.
You're making me feel lucky about what was otherwise a very unpleasant experience!
A chemist gave a great talk about this at a big MRI conference (ISMRM) in Paris 10ish years ago. His explanation was that gad behaves a lot like iron does in the body. It deposits where iron does and like iron it lacks a metabolic route for removal (though menstruating females lose iron).
He stated that deposition was entirely predictable. However the harm caused is still debated.
The article here says ‘ Dr Wagner theorized that nanoparticle formation could trigger a disproportionate immune response, with affected cells sending distress signals that intensify the body’s reaction.’
Emphasis on ‘theorised’.
Deposition is discussed in the below link, and the comparison with iron is briefly mentioned.
https://pmc.ncbi.nlm.nih.gov/articles/PMC10791848/
Pretty much just diluting it out of your system.
I hold a different opinion to you though, I'm glad doctors are always learning more while generally operating with good /extremely good intentions.
This paper isn’t saying that MRI contrast agent is high risk in general.
There’s a risk in misinterpreting these niche papers to overstate their relative risk. This is a common mistake when people start reading medical papers and begin overweighting the things they’ve read about as the most significant risks.
I agree. Expecting perfection from humans, even experts, is not reasonable and is frankly counterproductive.
Willful ignorance is one thing, but people who genuinely attempt to do the right thing at worst just need to be steered slightly differently.
A year ago, one insisted vehemently—to the point of yelling—that I shouldn't be supplementing Vitamin K because my potassium levels were fine.
There's risk in life and odds-wise if you're in the developed West, you're going to get care and medicine that will greatly prolong your life.
Also this paper is super vague. What percent of people even get this? How long does it last? They havent even done a study to see how long it lasts yet. I have a feeling this isnt going to be our generation's asbestos or thalidomide.
That being said, you should decide your own risk profile. If MRI gives you concerns there are alternatives that dont involve contrast.
But given our track record, a little humility would go along way.
When a highly educated doctor tells you that something is safe, a person is going to assume that means that someone somewhere has proven that the substance is safe. If what they really mean is that no one really knows, but so far, no experiments have been able to prove danger, then we should say that instead.
Here in Germany you have to sign something if they give you "stuff" informing you of possible risks. Something that always exists.
Deleted Comment
That's why we don't give MRI's out the wazoo. We actually gatekeep them a lot, and most research will tell you that investigative MRIs without chief complaints are a bad idea and we don't do them.
I had cancer. I had no MRIs, but multiple CT and PET scans. CT scans and PET scans have risk - they don't just do those for kicks. But you know what else has risks? Cancer. So there's a calculus here.
Every single medical procedure, down to getting your blood drawn, has this calculus. Nothing is risk free.
Why? What are the risks of MRIs without contrast?
Dead Comment
https://www.frontiersin.org/journals/toxicology/articles/10....
> Lead author Dr Brent Wagner told Newsweek he personally avoids vitamin C when undergoing MRI with contrast, citing its potential to increase gadolinium reactivity. “Metabolic milieu,” including high oxalic acid levels, could explain why some individuals experience severe symptoms while others do not, he said.
Avoiding high-oxalic foods for a few days before the MRI also seems like a good idea. Just check the diet for calcium oxalate kidney stones.
Tinnitus.
"After ingestion, bismuth is primarily found in trace amounts within organs such as the kidney, liver, spleen, and, in rare cases, the brain, where it accumulates intracellularly—especially in lysosomes and nuclear membranes—and extracellularly in basement membranes of blood vessels.[1-4] In normal therapeutic use, the amount of tissue-bound bismuth is extremely low and is not associated with adverse effects. Potential consequences of tissue-bound bismuth are generally negligible at standard doses, but chronic or excessive exposure can lead to toxicity, most notably neurotoxicity (bismuth encephalopathy).[1][4-6] In cases of bismuth intoxication, histochemical studies have shown accumulation in neurons and glial cells, particularly in the cerebellum, thalamus, and hippocampus, with clinical manifestations including confusion, myoclonus, and encephalopathy.[1][4-6] However, these effects are reversible upon discontinuation of bismuth exposure, and recovery is typically complete within weeks.[5-6] Animal studies confirm that bismuth binds to proteins such as ferritin and metallothionein, and is retained in lysosomes, nuclear membranes, and myelin-associated proteins.[2][4][7] The kidney is the primary site of accumulation and excretion, and tissue levels decline after cessation of exposure, with little evidence of permanent retention at therapeutic doses.[2-3] In summary, permanent tissue binding of bismuth is minimal and clinically insignificant with standard use, but chronic high-dose exposure can result in neurotoxicity and other organ effects, which are reversible after stopping bismuth.[5-6][8-9]"
1. Autometallographic Tracing of Bismuth in Human Brain Autopsies. Stoltenberg M, Hogenhuis JA, Hauw JJ, Danscher G.
Journal of Neuropathology and Experimental Neurology. 2001;60(7):705-10. doi:10.1093/jnen/60.7.705.
2. Metallobiochemistry of Ultratrace Levels of Bismuth in the Rat II. Interaction of Bi With Tissue, Intracellular and Molecular Components. Sabbioni E, Groppi F, Di Gioacchino M, Petrarca C, Manenti S.
Journal of Trace Elements in Medicine and Biology : Organ of the Society for Minerals and Trace Elements (GMS). 2021;68:126752. doi:10.1016/j.jtemb.2021.126752.
3. Distribution of Bismuth in the Rat After Oral Dosing With Ranitidine Bismuth Citrate and Bismuth Subcitrate. Canena J, Reis J, Pinto AS, et al.
The Journal of Pharmacy and Pharmacology. 1998;50(3):279-83. doi:10.1111/j.2042-7158.1998.tb06861.x.
4. In Vivo Distribution of Bismuth in the Mouse Brain: Influence of Long-Term Survival and Intracranial Placement on the Uptake and Transport of Bismuth in Neuronal Tissue. Larsen A, Stoltenberg M, Søndergaard C, Bruhn M, Danscher G.
Basic & Clinical Pharmacology & Toxicology. 2005;97(3):188-96. doi:10.1111/j.1742-7843.2005.pto_973132.x.
5. Bismuth Encephalopathy- A Rare Complication of Long-Standing Use of Bismuth Subsalicylate. Borbinha C, Serrazina F, Salavisa M, Viana-Baptista M.
BMC Neurology. 2019;19(1):212. doi:10.1186/s12883-019-1437-9.
6. Bismuth Subgallate Toxicity in the Age of Online Supplement Use. Sampognaro P, Vo KT, Richie M, Blanc PD, Keenan K.
The Neurologist. 2017;22(6):237-240. doi:10.1097/NRL.0000000000000144.
7. Bismuth Tracing in Organotypic Cultures of Rat Hippocampus. Locht LJ, Munkøe L, Stoltenberg M.
Journal of Neuroscience Methods. 2002;115(1):77-83. doi:10.1016/s0165-0270(02)00004-3.
8. Bioactive Bismuth Compounds: Is Their Toxicity a Barrier to Therapeutic Use?. Gonçalves Â, Matias M, Salvador JAR, Silvestre S.
International Journal of Molecular Sciences. 2024;25(3):1600. doi:10.3390/ijms25031600.
9. Review Article: Safety of Bismuth in the Treatment of Gastrointestinal Diseases. Tillman LA, Drake FM, Dixon JS, Wood JR.
Alimentary Pharmacology & Therapeutics. 1996;10(4):459-67. doi:10.1046/j.1365-2036.1996.22163000.x.
Unfortunately, the article isn't much better. It has as an underpinning, a corrected paper: https://doi.org/10.1093/ndt/gfl294
2. I fail to see how the previous study is an “underpinning” of the new paper. The new paper is a chemistry paper about dissociation of GBCAs in the presence of certain chemicals. Maybe people care because it is a potential explanation for toxicity, but the paper is very focused on the chemistry findings.
It is underpinning, as the claims in both introduction and conclusion are precipitate to it.
The correction:
> After personal communication with the radiologists the administered Gd-contained contrast agent was documented in the MR examination reports of the mentioned nine patients incompletely and inexactly as Gd–DTPA by themselves. There is solely one MR contrast agent used in the described observation period: Gd–DTPA–BMA. Therefore, all mentioned nine patients received Gd–DTPA–BMA and not Gd–DTPA.
Means that Gd-DTPA is irrelevant. Guess which is analysed here?
Medical procedures have risk, some are small risk some are higher risk. There are none that are 100% safe. Doctors are supposed to evaluate if the risk is worth the value the procedure would supply.
What is the alternative to the status quo that you would propose?
I was never communicated about gadolinium pollution. Not once.
And yes, on my recent MRI, I explicitly asked why there was metal particulate in my joint. "I dont know, sometimes it happens'... No you fucking tool of a doctor. Its gadolinium.
And I finally find out here.
When my wife was under cancer treatment she had them frequently. Risking some minor reaction, which in her case was disclosed many times, was well worth the value in managing the acute and long term treatment plan.
Deleted Comment
I’ve given MR contrast to patients a lot of times (probably tens of thousands) and have seen hives and rashes a handful of times but vastly more often with iodinated contrast in X-ray procedures (usually CT).
Every square inch of my body was hives for 2 weeks
My kidney function was abnormal for 2 weeks as well and later I was like urinating out goop