Tuesday, June 19, 2012

OMG, Its Bleach! (Updated)

There are some days that the autism community drives me crazy.  It seems like it is impossible for any of the various factions to put aside their ideology and, just for once, communicate clearly and accurately about important issues.

Take for example the latest craze gripping the blogosphere - an autism "treatment" that goes by the name of "Miracle Mineral Solution", or MMS, that has been around for years but recently had a presentation at Autism One.

There were many presentations at Autism One that covered a wide range of subjects.  But which presentation does the remnant of the old neurodiversity movement focus on and hold up as the poster child of the conference?  MMS, of course, and how it is so dreadful that immediate action is needed to stop the horror.

The current coverage of MMS sounds awfully like the rhetoric about HBOT that was being spread by almost the same group of people several years back, so I spent some time looking at all of the current claims about MMS.  If you want to spare yourself some time and effort reading what follows, the best word to summarize the current claims is overblown.  Using MMS is, more likely than not, a bad idea but listening to all of the nonsense being said about it is also a bad idea.

Still here?  Well, don't say I didn't warn you that this was going to be a bit long.

If you haven't heard of MMS until now you are not alone.  I didn't know what it was until the stories about it started popping up all over the place.  According to the little bit of research I did, MMS is supposed to do many wondrous things by killing everything that it comes into contact with, except the things that it shouldn't, by summoning the magical scrubbing bubbles of ClO2.

Ok, that wasn't very clear or accurate, but I got as far as the word "Miracle" in the name and was immediately skeptical.  Miracle cures don't work unless you are Miracle Max.  But, if you seriously want to know the details of what this stuff is supposed to do, I suggest looking at here or at the presentation given at Autism One.

Now, let me be perfectly clear here.  I see absolutely no reason to think that using this stuff will do anything to help my children's autism and I see a lot of potential for harm.

The FDA said as much when they put out a warning about using it.  But, then again the FDA takes a dim view of anything claiming to have medicinal properties that has not gone through its review process, so harsh words from the FDA is not an automatic sign that a product doesn't work.

But I don't want to talk about the fact that MMS likely doesn't do anything helpful, that topic has been covered ad nauseam by many others.  No, what I wanted to talk about are the misleading statements such as  MMS is bleach, MMS is "industrial bleach (which means it's stronger)", and that using it is, as the (cough, cough) Thinking Person's Guide To Autism so nicely put it, "child abuse and tantamount to torture of autistic children".

The core of these claims is that giving MMS to your children is the same as giving them bleach and we all know that giving your child bleach is morally wrong.  And that line is both right, wrong, and completely irrelevant at the same time.

Just to set the ground rules, the standard that ANY treatment should be measured against is how well it works and how much damage it causes while working.  In a perfect world, all treatments would be both perfectly effective as well as perfectly safe.

We do not live in a perfect world.

In our imperfect world world, there are no perfectly effective treatments that have no side effects.  Almost every treatment to have some level of undesirable side effects to go along with any possible benefits.  So the goal of any treatment is to make sure the good that comes from a treatment outweighs the bad.

So for MMS, lets cut to the chase and assume that the stuff doesn't do anything good for you and look at the bad side to see if the harm rises to the level of torture.

The first claim on the harm side is that MMS is bleach.  Now, I don't know about you, but when I think of bleach, this is the stuff that comes to mind -

(Picture of bleach bottle removed) 

MMS is not the same as this stuff.

This stuff is (typically) a mixture of (roughly) 5% sodium hypochlorite while MMS is 28% sodium chlorite.  While the names sound quite similar, they are not the same thing nor do they have the same properties.  The best thing you can say is that they are similar chemicals that do similar things.

But most people aren't going to care (or understand) about the chemical differences between the two.  Most people are going to hear "MMS is bleach", make the automatic association to the stuff in the picture above, and react emotionally based on that.   As Wikipedia puts it "the solution of sodium hypochlorite [...] is so ubiquitous that many people just call it 'bleach'".

That is the first problem with the claims, the choice and usage of the word "bleach" almost seems designed to create confusion.  The structure of many of the references I have seen makes it seem like it is a reference to the stuff in the bottle above because the reference reads like "bleach" is a proper noun.

The say "MMS is bleach" the same way that a person would say "this bottle is bleach".

A better and less confusing way to rewrite the sentence is that MMS is a bleach to indicate that it is a bleach in the technical and more generic sense of the word.  As in (again, Wikipedia), a bleach is "a number of chemicals that remove color, whiten, or disinfect, often via oxidation."

So no, MMS is not bleach in the common use of the word, but you might be able to say that MMS is a bleach.

But then again, if you wanted to get really technical, the claim that MMS is a bleach is still partially wrong.  My chemistry is a little weak but, from what I understand, the sodium chlorite in MMS isn't a bleach by itself but needs to be combined with something else to form the actual bleach.   The same holds true for the stuff in the bottle; it isn't much of a bleach until the chlorine is separated from the sodium by some chemical reaction.

In the case of MMS, the real bleach is chlorine dioxide.  And, as I have learned over the past year of balancing the level of chlorine in a swimming pool and hot tub, not all forms of even chlorine are the same let alone bleaches that are different types.  For example, lithium forms of chlorine are about half as effective as sodium forms, even at the same concentration.

That last bit is kinda important, so it bears repeating.  The strength of a bleaching chemical is determined by the amount and type of bleach that is present in the final mixture, not by the initial concentration.  You can't assume that one form of a bleach (chlorine) is going to be equivalent to another, chemically different form of bleach (chlorine dioxide).  If you do even a little bit of research into the differences between chlorine and chlorine dioxide you would know that they aren't the same thing.

If all of that gets too technical, just go with what the FDA had to say about the process -
The product, when used as directed, produces an industrial bleach that can cause serious harm to health. The product instructs consumers to mix the 28 percent sodium chlorite solution with an acid such as citrus juice. This mixture produces chlorine dioxide, a potent bleach used for stripping textiles and industrial water treatment
Or basically, when used as directed, the end result is that MMS forms a chemical that can remove color, whiten, or disinfect, i.e. a bleach.

The FDA adds in additional "industrial" phrase, and that is true, chlorine dioxide is used in the textile as well as other industries.  But that also ignores the fact that chlorine dioxide is also used in making processed foods, in sanitizing water for human consumption, and (as sodium chlorite) in some personal care products.

Certain people also seem to be misreading the "industrial" word as meaning extremely strong instead of meaning the more literal meaning of used in industry.  Another example of the "industrial" uses of this product is making white flour - in some cases, flour is literally sprayed into the air in a room full of chlorine dioxide to remove the color (and all of the nutrients) from the flour.  If you ever wondered how flour turns white or why it has to be enriched after the fact it is because it was bleached.  So, if you eat white flour, you are possibly eating a food that has been bleached by the same bleach in MMS.

But lets forget about the "industrial" scare and the different types of bleach for a minute and talk about some of the other common uses of bleach.  Have you ever gone in a swimming pool or hot tub?  Then, chances are, you have gone swimming in bleach.  There is no difference between the chlorine in a swimming pool an the chlorine generated by a standard household bottle of bleach.  If you children have ever swallowed any pool water (I know mine do all of the time), they you have basically given your children bleach.

Other common household uses include personal care products such as toothpaste or mouthwash, sanitizing reverse osmosis water filters, and your everyday cleaners.  Do you let you kids eat off of a table after you just used a cleanser on it?  Congratulations, you probably just gave them some bleach.

And then there is the fact that many municipal water supplies (in the US at least) are sanitized using some level type of bleach.  There are detectable levels of bleach or bleach by-products (yes, those sometimes count as bleaches) in normal everyday tap water.

The point is that expose to or ingestion of bleaching chemicals is not some rare or horrific event.  It literally happens every day.  And, if you are really worried about chemical exposures, then you really should be more concerned about antibacterial soap, Bisphenol A, household cleaners, VOCs, and a host of other chemicals that children are being exposure to everyday.

Of course the counter argument here is that MMS is a "purer" form of bleach, and that is partially true.  You may be will be exposed to more of a bleaching chemical when you drink an MMS cocktail than when you shallow some water from an average residential swimming pool.  How much more (or less) depends on exactly how much MMS is used, what exactly it is mixed with, and how fluid much it is diluted in afterwards.

The target number that you are supposed to get to with MMS is 1 ppm (part per million) of chlorine dioxide.  Although since there are so many variables that determine the final amount of the bleaching chemical in the final mixture it would be pretty easy to make a mistake and make it far stronger than it should be.

For reference, residential tap water can contain up to 0.8 ppm of chlorine dioxide and a residential swimming pool typically has about 5 ppm of chlorine.

However, the variable strength of the mixture is one of the two large drawbacks to using MMS.  You should not need a degree in chemistry to be able to safely use an over the counter supplement.  The other drawback is, of course, that it is likely that drinking even a properly mixed MMS cocktail doesn't do anything good for you.

Regardless, assuming that you use the product "correctly", you would be exposed to not much more chlorine dioxide than is allowed in tap water and, on a ppm basis, less than what is in a typical swimming pool.  Again, my chemistry is a little weak, but I don't think that 1 ppm of chlorine dioxide is going to do much harm when tap water contains almost that much and a typical swimming pool contains 5 times that amount of a different type.

So, the idea that giving this mixture to a child is some sort of child abuse or torture is just plain silly.  If that level of exposure is torture, I would hate to see what these people would say about me letting my children spend hours in the pool everyday.

EDITED TO ADD : Ignore the crossed out text above, it is wrong. The bottom line is that even using a single drop of MMS is a standard sized glass is a little over six times stronger than pool water - roughly 32ppm.  And it gets worse the more drops that you use at a time or if you take it multiple times per day.  See this discussion for more details.

But lets side aside the whole "bleach" idea and look at what harm this stuff can do if you take it.  Remember, any treatment should be judged on the benefits it gives and the harm that it does.  Even if we agree that MMS doesn't do anything at beneficial, we can still look at the harm side to see whether it is just another pointless treatment or whether it is truly harmful.

If this idea seems contrived then just think of all of the mainstream treatments that are used every day that can have harmful side effects and yet give no real benefit.

 If you read the lists of potential side effects that are being published everywhere, this stuff sounds almost like straight poison.  But there is a difference between all of the theoretically possible side effects that are included in these lists and the ones that will happen on a regular basis.

So lets put these side effects into perspective.  The following items are "common" side effects from MMS, two drugs, and a supplement.  All of these things are commonly used yet have times that they are used when they might have few, if any, benefits.

See if you can figure out which one is which without peeking at the answers below.

1. Headache, nervousness, drowsiness, dizziness, heartburn, constipation, diarrhea, stomach pain, increased salivation, pain, especially in the arms, legs, or joints.

2. Nausea, vomiting, diarrhea, symptoms of severe dehydration,

3. Fever, nausea, vomiting, diarrhea, metallic taste, kidney and stomach damage.

4. Upset stomach, vomiting, diarrhea.

Figure it out?

The item in question are

1. Aripiprazole - a drug to treat irritability in autism
2. MMS
3. Zinc supplements
4. Amoxicillin, a commonly used antibiotic.

So, the side effects of MMS are very similar to those that can happen when using other common treatments.  Does that mean giving Aripiprazole to your child when it isn't clear that there will be benefits "child abuse"?  Does the medical profession's constant overuse of antibiotics qualify as torture?

Of course you can say that MMS doesn't have any potential benefits to offset the negatives.  You can say that all it does do is rid you of those couple of extra dollars that were floating around in your wallet.  But, in reality, you can't even say that.

There is a tiny little distinction in evidence based medicine that is commonly forgotten but is really important to the whole thing.

There are treatments that have evidence that show that they are effective.  These are the treatments you should, more likely than not, be using.

There are treatments that have evidence that shows that the treatment are not effective.  These are the treatments that, more likely than not, you should not be using.

And then there are the treatments that have no real evidence one way or the other.  You can say that these treatments don't have evidence that they work but you can't say that they have evidence that they don't work.  A lack of data is a lack of data - not evidence against the treatment.

I think it goes without saying but if you want to attempt to use a treatment from that last category, you should  do your homework and exercise extreme caution in doing so.  But, having said that, if you shy away from a possible autism treatment just because it is not completely supported by the evidence, then you don't have many treatment options to work with.

MMS clearly falls into that last category - there is nothing that says it works but there is nothing that says that is doesn't either.  So, if you are going to be one of the, uhm, brave souls to try it, you had best be very careful and be sure you understand exactly what it might do and the harm it could cause before even thinking about it.  And if you can't do the calculations to figure out what amount of sodium chlorite is needed with what type of acid to produce the required ppm of chlorine dioxide in your head then you shouldn't be using it.

In all seriousness, it is pretty likely that MMS doesn't do anything beneficial but it still has some very real side effects.  But, it is not as bad as everybody is making it seem.  MMS may be a type of bleach but it is a far cry from pouring pure, concentrated laundry bleach down a kids throat - which is what everybody seems to be implying.  And using it is certainly not a form of torture or child abuse.

And that is really the point of all of this.

A calm, non-emotional, and objective look at MMS shows that it likely does nothing that we want to do and it has some potentially problematic side-effects.  And that is the standard that should be used to judge ANY treatment for a child with autism - evidence based or not.

The standard should not be who can make the most absurd claims or who can get a nonsensical claim repeated the most.  It is in everybody's best interest to go for clear, accurate information and to forgo the polarizing rhetoric that seems to be far to common in the autism world.  These sorts of claims might be good for getting the troops all lines up and ready to go, but it does very little to actually help anybody.

So, how about we all turn down the rhetoric a little?

EDITED TO ADD: And in case you didn't get the point about MMS from what I already said above, here it is very simply put - don't use it.


  1. I hadn't heard anything about it until recently, but as I understand it the fuss is over the way it's being marketed to desperate, vulnerable parents. It seems to be a con like homeopathy. People get very angry about that sort of thing.

  2. From the NIH website:

    Side effects of ritalin
    nervousness,difficulty falling asleep or staying asleep, dizziness,nausea,vomiting,loss of appetite,stomach pain, diarrhea,heartburn,dry mouth,headache,muscle tightness, uncontrollable movement of a part of the body,restlessness, numbness, burning, or tingling in the hands or feet, decreased sexual desire, painful menstruation,

    Some side effects can be serious. If you experience any of the following symptoms, call your doctor immediately:

    fast, pounding, or irregular heartbeat
    chest pain
    shortness of breath
    excessive tiredness
    slow or difficult speech
    weakness or numbness of an arm or leg
    changes in vision or blurred vision
    believing things that are not true
    feeling unusually suspicious of others
    hallucinating (seeing things or hearing voices that do not exist)
    motor tics or verbal tics
    abnormally excited mood
    mood changes
    blistering or peeling skin
    difficulty breathing or swallowing

    Thank you for putting into words something I couldn't.

  3. These same people will argue forever that mercury in the form of thimerosal is not the same as mercury and therefore why are we worrying anyway?

    Double standard anyone?

    1. I think that is the thing that bothers me most about this entire issue. For years we have all had to listen to the endless discussions about all of the nuances of the different types of mercury and why this type, given in this specific way, isn't a problem.

      But then an issue like this comes along and the same people who spent years splitting hairs in the mercury debates can't even be bothered to learn the basics of what they are talking about and just keep repeating "its bleach!".

  4. Heh. You've got a lot of stamina to get through that post.

    In fairness to the 'skeptics', I do think there are some other things on their side of the argument:

    1) Not only do we not have any evidence that MMS might work, we can't even speculate on a biologically plausible mechanism by which it might work. I suppose you could argue that it affects the microbiome, (it probably would!), but that's still a pretty weak argument when you can get there better and with a more well defined safety profile with a lot of drugs. Why would MMS be any better than antimicrobials and/or anti yeast agents? At least those aren't going to try to oxidize everything in their path.

    2) There seems to be a lot of discussion about 'building up' until your child pukes/has diarrhea. I didn't have the juice to bother looking up if the purveyors of MMS actually recommend this, or if what we are talking about is two bloggers who tried this or whatever, but that's a shitty way to determine the 'appropriate' dose.

    I think the real indicator of the 'overblowness' of this discussion is just how few people are actually using / defending MMS. The counts of the 'petitions' tell us what we really need to know, there are (thankfully) precious few people actually trying this.

    So tired.

    - pD

    1. I don't disagree with you, pD, I can't see any reason to use this stuff.

      The only thing I can see this stuff doing is basically killing everything that lives in your GI track and you really don't want to do that. But in that regard, how much more damage does it do than a typical oral antibiotic?

      Per your point 1, I don't know that chlorine dioxide is going to oxidize everything in its path. The specifics of the chemistry of bleaching is a little beyond me, but I do know the different types of bleaches act differently with respect to what they will oxidize, what they will leave alone, and what they leave behind. The simple measures of effects such as LD50 or oxidation potential (ORP) being tossed around don't really capture those nuances.

      Then again, you don't really want to be using your child's stomach as a chemistry experiment.

      But then again (again?), even tap water can have enough bleaching chemicals left to do some level of oxidation when you drink it. Just one of the many reasons to buy a good water filter.

      I guess the real point is that the over simplification to bleach = bad is rather hypocritical coming from people who spent years splitting hairs about the tiniest details concerning mercury.

      Per your second point, I don't know how common that scenario is either. I have read that claim in a couple of places but they all seem to be citing the same couple of examples. And I didn't have the stomach (or stamina) for reading the MMS "protocol" guide either.

      Hopefully people will get the point that using MMS isn't really a good idea and stop using it. But all of the hyperbolic "its bleach" rhetoric only makes it harder to make it harder to have a rational discussion about the subject.

    2. No. I will not turn down the rhetoric. If you are talking about using something like this, a potentially dangerous chemical as an enema or making them drink several times the amount that's in tap water I sure as hell will continue to rant about it. What are people THINKING doing something like this?
      This makes no dang sense.

  5. There was a woman in Australia or New Zealand who found out about it and was taking it as a "malaria preventive" and accidentally killed herself with it. The "to tolerance" and "if it makes you too sick, back down, and try to take it up again" advice, in the wrong person, can create issues with accidental death or severe issues.

    One of the things that can be dangerous is the frequency of dosing and the assurance from the presenter that nausea and diarrhea (and fevers) are a good thing, especially in a non-verbal patient! Personally, the lack of any real mechanism to explain it causing any improvement, as well as the risk of harm, makes it a dubious recommendation at best.

    I heard of MMS years ago - hubby was "turned on" to the product by alternative-loving friends. He used it for about two weeks, first saying it made him feel great, then gradually getting so debilitated with it that he gave it up (much to my relief after reading some of the accounts of harm I had found as well as finding some of Humble's explanation about how it cured 'everything' -never trust someone who cures everything with one product- seeming far-fetched). Seeing what it did to a healthy adult male is another reason I really don't think it's a good fit/treatment for anyone.

    Oh - and one last parting thing - products from water purification can be cancerous, and the cancerous byproducts increase the more water purification chemicals that are used. I know this from experience - the water treatment district I lived in was required by the EPA to send memos telling us that they had exceeded the federally accepted level of carcinogens in our water every time they had to over-chlorinate our water. Another reason to really be skeptical about anything in this being "miraculous."