Geir Bjørklund

Early career

In 1995, Geir Bjørklund founded Tenner & Helse, which is the membership magazine of the Norwegian Dental Patient Association (Forbundet Tenner og Helse). He was editor of this magazine until the summer of 1999. Bjørklund was in the 1990s also freelance journalist for Sunnhetsbladet - the oldest popular medical journal in Norway. In the late 1990s, Bjørklund had consulting assignments for the Norwegian Board of Health (Statens helsetilsyn). He was coauthor of two of their expert reports on the use of dental filling materials. In 2001, Geir Bjørklund founded the Nordic Journal of Biological Medicine (Nordisk Tidsskrift for Biologisk Medisin). He was editor of this journal until its last issue was distributed in 2003.

Health effects of mercury and dental amalgams

Dental amalgam has ever since its introduction in the Western World in the 1830s been the subject of recurrent controversies because of its mercury content. Norway and Sweden have banned amalgam, reportedly due to environmental concerns. However, the use and toxic risk of dental amalgam fillings is still a subject of ongoing debate in many countries. Geir Bjørklund has published many articles in peer-reviewed medical journals about the health effects of mercury and dental amalgams. Some of the articles have also been featured in Norwegian newspapers.

In 1991, Bjørklund published in the Journal of the Norwegian Medical Association (Tidsskrift for Den norske lægeforening) a toxicological risk analysis of occupational diseases in dentistry that are related to chronic exposure to inorganic mercury, especially metallic mercury vapour. Available research data showed that dental work involving mercury may be an occupational hazard with respect to reproductive processes, glioblastoma (brain cancer), renal function changes, allergies, and immunotoxicological effects. This resulted in news coverage in Norwegian newspapers, and many dental assistants contacted him with health problems they associated with mercury exposure in their workplace.

Exposure of dental patients to mercury from amalgam fillings is caused by the material properties of amalgam, i.e. mainly by its corrosion, abrasion and ageing. New evidence indicates, according to a recent review article by Geir Bjørklund and a team of American researchers (2014) that mercury exposure from dental amalgam may cause or contribute to many chronic illnesses. Bjørklund has imparted knowledge about the research on mercury with regard to various brain diseases. The research indicates, according to him that mercury from dental amalgam fillings may be a potential factor in the development of Alzheimer's disease, Parkinson's disease, and multiple sclerosis.

Metal allergy in rheumatic diseases

Rheumatic disease is an umbrella term for conditions causing chronic, often intermittent pain affecting the joints and/or connective tissue. Common rheumatic diseases include rheumatoid arthritis, Sjögren’s syndrome, systemic lupus erythematosus, and fibromyalgia.

Stejskal, Reynolds, and Bjørklund (2015) examined the frequency of metal allergy in 38 patients with connective tissue disorders. Of these patients, 16 had rheumatoid arthritis, 13 had Sjögren’s syndrome, and nine had systemic lupus erythematosus. A control group of 43 healthy age and sex-matched subjects were included in the study. Metal allergy was evaluated using the optimized lymphocyte transformation test MELISA. For all subjects, the primary source of metal exposure was dental metal restorations. Most of the tested patients (87%) reacted to at least one metal, and many (63%) reacted to two or more of the tested metals. 43% of the healthy subjects in the study reacted to one metal, and 18% reacted to two or more metals. The increased frequency of metal allergy in the patient group compared with the control group was statistically significant (P < 0.0001). The most frequent allergens in the study were nickel, mercury, gold, and palladium.

Stejskal, Öckert, and Bjørklund (2013) studied the frequency and clinical relevance of metal allergy in 15 fibromyalgia patients. Metal allergy was measured by a lymphocyte transformation test, MELISA. Ten healthy age matched women were used as controls. Reduction of metal exposure in the fibromyalgia patients was achieved by replacement of dental metal restorations and by the avoidance of known sources of metal exposure. Objective health assessment was performed five years after treatment. Subjective health assessment was established by a questionnaire, completed two, five and in some cases ten years after the start of the study. Follow-up MELISA was also performed. All patients with fibromyalgia tested positive to at least one of the metals tested. Objective examination five years later showed that half of the patients no longer fulfilled the fibromyalgia diagnosis, 20% had improved and the remaining 30% still had fibromyalgia. All patients reported subjective health improvement.

Autism research

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by pervasive deficits in social interaction, impairment in verbal and non-verbal communication, and stereotyped patterns of interests and activities. The first article by Geir Bjørklund in the autism field was published in 1998. It was a review article about children with Asperger syndrome. In 2009, he presented a poster about the same subject at a university conference in Cluj-Napoca, Romania. He is currently particularly interested in research on the pathogenesis and pathophysiology of autism.

Autism research continues to receive considerable attention as the options for successful management are limited. The understanding of the ASD etiology has now progressed to encompass genetic, epigenetic, neurological, hormonal, and environmental factors that affect outcomes for patients with ASD. As neuroscience advances, biochemical treatments to correct brain chemistry become better defined. Nutrient therapy can be very potent and has minimal to no side effects, since no molecules foreign to the body are needed.

Mercury and autism

Mercury is a neurotoxicant, and potentially one of the main environmental triggers for ASD. Mercury accumulation may occur as a cause or consequence of metallothionein (MT) dysfunction in children with ASD. Metallothioneins are proteins with important functions in metal metabolism and protection.

Tachykinins (substance P, neurokinin A, and neurokinin B) are pro-inflammatory neuropeptides that may play an important role in some autoimmune neuroinflammatory diseases, including ASD. Geir Bjørklund and collaborators (2016) investigated the potentially causal relationship between levels of serum neurokinin A and blood mercury in ASD children. The researchers measured the levels of serum neurokinin A and blood mercury in 84 children with ASD, aged between 3 and 10 years, and 84 healthy-matched children. There was found a positive linear relationship between the Childhood Autism Rating Scale (CARS) and both serum neurokinin A and blood mercury. The autistic children in the study had significantly higher levels of serum neurokinin A than healthy controls (P < 0.001). Increased levels of serum neurokinin A and blood mercury were respectively found in 54.8% and 42.9% of the two groups. There was significant and a positive linear relationship between levels of serum neurokinin A and blood mercury in children with moderate and severe ASD, but not in healthy control children. It was found that 78.3% of the ASD patients with increased serum levels of neurokinin A had elevated blood mercury levels (P < 0.001). In conclusion, neuroinflammation, with increased levels of neurokinin A, is seen in some children with ASD, and may be caused by elevated blood mercury levels.

Bjørklund has together with American researchers (2015) published a systematic review of original studies on the potential relationship between mercury and ASD from 1999 to 2015. It was found that of the studies with public health and/or industry affiliation, 86% reported no relationship between mercury and ASD. However, among studies without public health and/or industry affiliation, only 19% found no relationship between mercury and ASD. The discrepancy in these results suggests a bias indicative of a conflict of interest. There is a broad coalition of entities for whom a conflict of interest arises. These include influential governmental public health entities, the pharmaceutical industry, and even the coal burning industry. Probably therefore, not all were happy that this article was published.

Zinc, copper, and autism

Studies by Bjørklund and collaborators indicate that autistic children appear to be at risk for zinc deficiency, copper toxicity, and often disturbed metallothionein (MT) system functioning.

In collaboration with a Romanian team, Geir Bjørklund investigated the levels of zinc and copper in whole blood, as well as the copper/zinc ratio in a group of 28 children with Autism. The patient group was compared with healthy age and sex matched control subjects. The concentrations of copper and zinc were measured in whole blood with inductively coupled plasma-mass spectrometry. They found that the zinc level was decreased (P<0.001), and the copper/zinc ratio increased (P<0.001) in children with ASD, compared with a healthy control group.

In collaboration with Chinese researchers, Bjørklund investigated the serum levels of zinc and copper in 60 Chinese children with Autism (48 boys, 12 girls) and a control group of 60 healthy sex-matched and age-matched individuals. The researchers also evaluated the severity of Autism using the Childhood Autism Rating Scale (CARS) score. The mean serum zinc levels and zinc/copper ratio in the study were significantly lower in the autistic children compared with the control group (P<0.001). At the same time were the serum copper levels significantly higher in the children with autism compared with the control group (P<0.001). It was in the study found a significant negative association between the zinc/copper ratio and CARS scores (r=-0.345, P=0.007).

Together with Slovenian researchers, Geir Bjørklund determined the serum levels of zinc and copper in a group of children with autism (N = 52, average age = 6.2 years) and a control group of children with other neurological disorders (N = 22, average age = 6.6 years), matched in terms of intellectual abilities. Compared to the control group, the autism group had significantly elevated serum copper/zinc ratio (95% confidence interval for children with ASD=1.86-2.26; 95% confidence interval for the control group=1.51-1.88).

The evidence from the research by Bjørklund and collaborators suggest that providing zinc to autistic children may be an important component of a treatment protocol, especially in children with zinc deficiency. Mercury accumulation may occur as a cause or consequence of metallothionein dysfunction in autistic children, which may be one of the causes of zinc deficiency. Metallothioneins are proteins with important functions in metal metabolism and protection. It is important to monitor and follow the values for both copper and zinc together during zinc therapy, because these two trace elements are both antagonists in function, and essential for living cells.

Increased acid glycosaminoglycan (aGAG) excretion in autism

Glycosaminoglycans (GAGs) are a family of linear, sulfated polysaccharides that are associated with central nervous system (CNS) development, maintenance, and disorders. Proteoglycans (PG) regulate diverse functions in the central nervous system. Heparan sulfate (HS) and chondroitin sulfate (CS) are two major GAGs present in the PGs of the CNS.

Given GAGs are involved in several neurological functions, and that its level can be somewhat modulated by the diet, Geir Bjørklund and collaborators evaluated the role of GAGs levels in autism symptoms. They evaluated both tGAG and its different fractions in the urine of autistic and healthy control children. As levels differed between groups, a second trial was conducted evaluating if diet could reduce tGAG levels and if this in turn decrease autistic symptoms.

The researchers found that tGAG concentration was significantly higher in the urine of children with autism compared to healthy control children and this was also evident in all GAG fractions. Within groups (controls and ASD), no gender differences in GAG excretion were found. The use of a 90 days elimination diet (casein-free, special carbohydrates, multivitamin/mineral supplement), had major effects in reducing urinary tGAG excretion in children with autism.

Vitamin D and autism

Vitamin D deficiency has been previously reported in autistic patients. However, the data on the relationship between Vitamin D deficiency and the severity of autism are limited. In collaboration with Egyptian researchers, Bjørklund (2015) performed a case-controlled cross-sectional analysis on 122 autistic children, to assess their vitamin D status compared to healthy control children and the relationship between the degree of vitamin D deficiency and the severity of autism. Fifty-seven percent of the autistic patients in the study had vitamin D deficiency, and 30% had vitamin D insufficiency. The vitamin D levels in the autistic children were significantly lower than those in children with mild/moderate autism. It was found that the vitamin D levels had significant negative correlations with the Childhood Autism Rating Scale (CARS) scores. 106 autistic children with low serum vitamin D levels (<30 ng/ml) then participated in an open-label trial of vitamin D supplementation. The children with autism were given 300 IU/kg/day (not to exceed 5000 IU/day) for three months. Eighty-three autistic patients completed three months of daily vitamin D treatment. 80.72% (67/83) of the autistic children who received vitamin D3 treatment had significantly improved outcome, which was mainly in the sections of the Childhood Autism Rating Scale and aberrant behavior checklist subscales that measure behavior, stereotype, eye contact, and attention span. Of the 16 parameters measured, ten showed highly statistically significant improvements. The researchers concluded that as vitamin D is inexpensive, readily available and safe it may have beneficial effects in autistic patients, particularly when the final serum level is more than 40 ng/ml.

Digestive enzymes and autism

There is growing evidence for a gut-brain connection associated with autism, which suggests a potential benefit for digestive enzyme therapy in autistic children. Working with an Egyptian team, Geir Bjørklund and collaborators performed a double-blind, randomized clinical trial on 101 children with autism (82 boys and 19 girls) aged from 3 to 9 years. The autistic children were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders 4th edition, text revision (DSM-IV-TR) diagnostic criteria. Structured interviews of at least one hour were first performed both with the parents and the children. In a later two hours session was the Childhood Autism Rating Scale (CARS) applied. After this, the children with autism were randomized to receive digestive enzymes or placebo. It was found that autistic children that received digestive enzyme therapy for three months had significant improvement in emotional response, general impression autistic score, general behavior, and gastrointestinal symptoms. These results indicate that digestive enzyme therapy in the future may be a possible option in the treatment protocols for autism.

ADHD, autism, and phenylketonuria

Researchers at Assiut University have in collaboration with Geir Bjørklund (2015) evaluated the neuropsychological status in 78 children with early and continuously treated phenylketonuria (PKU) in Assiut, Upper Egypt. Only 34 of the patients in the study met the inclusion criteria. The investigated patients were evaluated according to detailed history, psychiatric and neurological examination including electroencephalography and magnetic resonance imaging (MRI). Attention deficit hyperactivity disorder (ADHD) was present in six cases (17.6%), and autism was present in 8.8% of the cases. All the patients were diagnosed according to DSM-IV criteria and classified according to the CARS. The prognosis for early diagnosed patients with PKU that had been treated from the first weeks of life was generally good. However, these patients have an increased risk for neurological complications and behavioral problems. It is also indicated that PKU somehow may be associated with an increased risk for ADHD.

Heavy metal detoxification

Geir Bjørklund has since the 1990s been interested in the physical and chemical properties of mercury. He has also published articles about heavy metal detoxification. Heavy metal detox, or detoxification, is the removal of metallic toxic substances from the body. Bjørklund and Max Chartrand suggested recently (2016) in an editorial article that safe, inexpensive oral chelating therapies can be instituted for children exhibiting developmental disorders.

Metal chelators

The word chelator is derived from Greek chēlē, meaning "claw". Chelators remove, through a complex formation, metals from looser chemical compounds in the organism, such as iron and lead. The most commonly used metal chelators in clinical toxicology include meso-2,3-dimercapto-succinic acid (DMSA, succimer), sodium 2,3-dimercapto-1-propanesulfonate (DMPS, unithiol) and ethylene diamine tetraacetic acid (EDTA). Diagnostically, a provocation test involves taking a urine test before and after the application of a chelating agent. The provocation test with DMPS has according to Geir Bjørklund been found to provide a reliable estimate of body burden mercury, safer than dimercaprol and more potent than DMSA. A provocation test with calcium EDTA can be used when the blood lead levels have returned to normal by the time a diagnosis of lead poisoning is attempted. In such situations, this provocation test can increase the urinary excretion of the stored lead.

Both DMPS and DMSA increase the urinary excretion of copper and zinc, which in some patients give deficiency symptoms. According to Bjørklund it is, therefore, important to monitor copper and zinc levels in particular during chelator therapy. Copper and zinc are both antagonists in function and essential for living cells. He sees a low excretion of zinc in spontaneous urine as a warning signal that the chelator may provoke a more acute zinc deficiency. DMSA is less toxic and also disturbs less than DMPS the body's mineral balance. He, therefore, recommend DMSA to be used when the two chelating agents are otherwise considered to be equivalent.

Selenium and mercury

The essential trace element selenium is an antidote to mercury and should according to Geir Bjørklund always be used in the treatment of mercury intoxication.

Vitamin C and chelators

Some clinics use high dose intravenous vitamin C (IVC) in combination with metal chelators. Each case will require some level of clinical analysis to determine the best approach.

Other fields of interest

Other fields of Geir Bjørklund's interest and research also include general and addiction psychiatry, mental health, psychoneuroimmunology, medical anthropology, nutrition and epigenetics, urology, and reproductive health.

Council for Nutritional and Environmental Medicine

Bjørklund is founder and president of the Council for Nutritional and Environmental Medicine (CONEM). CONEM is a non-profit association founded and registered in Norway in 2013. The organization is established to facilitate research and information activities related to nutritional and environmental medicine. The fundamental mission is to promote the health of the public at large. CONEM has members in more than 60 countries. Members of the association are mainly dental, medical, and research professionals.

Other organizations

Geir Bjørklund is also a member of various other scientific organizations, including the Norwegian Association of Social Scientists, and the World Association of Medical Editors. He is associate member of the Norwegian Medical Association.

Journals

Bjørklund is founder and was the first editor of Tenner & Helse, and the Nordic Journal of Biological Medicine (Nordisk Tidsskrift for Biologisk Medisin). He has also been freelance journalist for Sunnhetsbladet (see Early Career). Today, Geir Bjørklund is a member of the editorial boards of numerous international scientific journals. He is also a reviewer of manuscripts for about 20 other peer-reviewed journals, including journals in the fields neurosciences, nutrition, biochemistry, environmental chemistry, and toxicology.

Awards and support

In 2003, the Albert Lindsay von Julin Foundation in Helsinki awarded Geir Bjørklund a scholarship of 10,000 Euros for his work to promote the understanding of biological medicine. He has also received support from, among others, OSO Eco Foundation and Rana Utviklingsselskap AS (the development company of the municipality of Rana, Norway). Bjørklund has been identified as being among the top 2.5% of all scientists worldwide by the independent monitoring agency Research Gate.