Saving a Million Hearts

In 2013 a group of ICIM members gathered to discuss an integrative, preventative approach to the Saving a Million Hearts initiative, including chelation therapy. Here are video clips of their conversations. The event was organized by Terry Chappell MD, and Jeannette Soriano MD is the facilitator.

Jeannette Soriano

Saving a Million Hearts Outline

Saving a Million Hearts Introduction from an Integrative Medicine Perspective

Dr. Terry Chappell, Dr. Lambert Parker, and Dr. James Carter discuss the “Saving a Million Hearts” initiative of the CDC and other medical groups. These three integrative doctors talk about the importance of going beyond pharmaceuticals.

Saving a Million Hearts: Stress and Lifestyle

Dr. John Wilson, Dr. James Carter, Dr. Ellie Campbell discuss diet, stress, and lifestyle as they relate to cardiovascular disease. Includes reference to an Alpha-Stim study by ICIM member William Eidleman MD.

Saving a Million Hearts: Informed Consent

Dr. Terry Chappell and Dr. Russ Jaffe discuss the importance of having informed consents as part of the patient education process for integrative medicine and chelation therapy for cardiovascular disease.

Saving a Million Hearts: Testing for Risk Factors

Dr. Conrad Maulfair, Dr. Ellie Campbell, Dr. Robban Sica, and Dr. Joe Hickey discuss what cardiovascular risk factors should be explored for effective prevention of heart attack and stroke.

Saving a Million Hearts: Metabolic Syndrome

Dr. Joe Hickey, Dr. Robban Sica, Dr. Ellie Campbell, Dr. Conrad Maulfair talk about the testing they do to screen for Metabolic Syndrome in their integrative practices, and discuss what treatments they recommend to their patients.

Saving a Million Hearts: Testing and Treating Cholesterol

Dr Rick Mason, Dr. Joe Hickey and Dr. Garry Gordon discuss cholesterol’s role in heart disease- to test or not to test! What is the dietary impact? What kind of cholesterol should we focus on? HDL, LDL, lipids, proteins, triglycerides… what wisdom will the future of medicine hold? Is there a cholesterol propaganda scheme? What are treatment strategies?

Saving a Million Hearts: Blood Pressure

Dr. Joe Hickey, Dr. Lambert Paker, Dr. Muhammad Ashraf discuss blood pressure tips for check ups, monitoring and treatment.

Saving a Million Hearts: Toxic Metals Q&A

Dr. Robin Bernhoft, Dr. Jim Smith, Dr. John Wilson answer questions from some of the most experienced chelation doctors in the country about diagnosing and treating heavy metal toxicity, with a focus on EDTA chelation.

Saving a Million Hearts: Chelation Protocols I

Dr. Robban Sica, Dr. Terry Chappell, and Dr. Garry Gordon discuss the IV chelation protocols that they have used.

Saving a Million Hearts: Chelation Protocols II

Dr. Robban Sica, Dr. Terry Chappell, and Dr. Garry Gordon discuss the IV chelation protocols that they have used.

Saving a Million Hearts: Micronutrients 

Dr. Chuck Mary and Dr. Rick Mason, CoQ10, Magnesium, Copper and other micronutrients’ role in the body and for prevention of cardiovascular disease.

Saving a Million Hearts: Women’s Health and Allergy Testing in Cardiovascular Disease

Dr. Robban Sica, Dr. Russell Jaffe, Dr. Ellie Campbell, and Dr. John Wilson discuss the role allergies can play in cardiovascular disease, laboratory testing, and special considerations for women’s health.

Dr. Chappell’s article “Saving a Million Hearts can be found here



Craig Gustafson: An Interview with L. Terry Chappell, MD

ChappellL. Terry Chappell, MD: Considering the Past and Promise of Chelation Therapy

Interview by Craig Gustafson


L. Terry Chappell, MD, is in private practice with Celebration of Health Association in the cities of Bluffton and Toledo, Ohio. He is board-certified in family practice, geriatrics, chelation therapy, pain management, and advanced longevity medicine. As past president of the International College of Integrative Medicine, past president of the American College for Advancement in Medicine, and as a volunteer assistant clinical professor of medicine at Wright State College of Medicine, he has taught chelation therapy and other integrative medicine to students and doctors from around the world. He has published widely on chelation therapy in scientific journals and in popu- lar books. He has served as a consultant for the National Institutes of Health on several occasions. He has devoted his practice to safe, natural techniques to improve function and help the body heal. He has assembled a high-quality nursing staff and recruited naturopath Bob Angus to work as a team to achieve the best results possible for each individual patient. (Altern Ther Health Med. 2014;20(3):56-60.)

Alternative Therapies in Health and Medicine (ATHM): Did you always know you wanted to be doctor? Was there a specific event in your life that pushed you in that direction?

Dr Chappell: No. When I went to college, I thought that would be about the last thing I was going to be. I had an upper-class roommate who convinced me to try a few class- es, and I tried it, liked it, and I found out I could stand the sight of blood so I went ahead.

ATHM: Where did you go to school, and how did your edu- cation affect your perspective on medicine?

Dr Chappell: I went to DePauw University in Greencastle, Indiana, for undergraduate school. It offered a liberal arts education; you get a good education with a wide back- ground. I think that is very helpful when you are a doctor. Then, I went to medical school at the University of Michigan. That is where my parents did some work, and later my

daughter went there. We have got a lot of connections with the University of Michigan.

ATHM: Were there any particular experiences that—or mentors who—influenced your development as a physician during your medical school years?

Dr Chappell: I would say it was more the broad experience. There was a movement in our medical school class to be of service to underprivileged people and I got involved with that. We established a free clinic, and that was a pretty important influence. I also met my wife through that; she was a nurse in that program. Student Health Organization was the name of it.

ATHM: How did you first come across complementary inte- grative medicine?

Dr Chappell: I first came across it through my wife, who was a registered nurse doing graduate work in psychiatric nurs- ing. Her training involved Lamaze natural childbirth, doing things as naturally as possible, and some nutritional support. That was my first real contact with it. I saw what you could do to relieve pain and stress by nondrug methods. I decided to learn about that. After that, my wife and I did some ser- vice in Appalachia. We found that many of the people there were suffering from pain and depression. They were pre- scribed pain pills and antidepressants, and were not getting anywhere. I looked for some alternatives to help them and they responded very well. They were very interested in it and got me excited about the whole process.

ATHM: What types of things did you find to help the people in Appalachia?

Dr Chappell: I started out by learning ear acupuncture as it is practiced in France. I also learned hypnosis and some basic nutritional tests and treatments. It worked out quite well.

L. Terry Chappell, MD: Considering the Past and Promise of Chelation Therapy Interview by Craig Gustafson


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ATHM: How much nutritional background did you get in medical school?

Dr Chappell: About half an hour. I have always joked that I was fortunate to get only half an hour of nutrition training because I found out later that most of what they taught was wrong—so I did not have as much to forget.

ATHM: How did you incorporate nutritional and preventive medicine into your practice?

Dr Chappell: I first got into nutritional work actually as a secondary concern. It started when one of my patients kept after me and kept after me to learn more about chelation therapy. We were living in Ohio at that time, where my wife is from. He had people who were working for him who were traveling all the way from Ohio to West Virginia to get chelation treatments. He was seeing great results and he really wanted me to get into it. I was pretty skeptical at that time, but I eventually did agree to visit a couple of doctors who were giving it. I was really impressed by the patients’ stories—how much better they were getting with the treatments. I went to the American Institute for Medical Preventives— later called American College for Advancement of Medicine, or ACAM— so I could learn more about this chelation thera- py. ACAM offered a tre- mendous opportunity to learn about nutritional therapy of all kinds. That is when I really got into it. I found it important to be sure about the quality and the availability of nutritional products. I started ordering them and providing them to my patients—who reaped the benefits. It was a really good move. I went to an intensive seminar by Jonathon Wright, MD, and Alan Gaby, MD. They give these seminars every year or two in which they go into great detail about the scientific paces of nutri- tional therapy. It was particularly fun for me to learn from Jonathan Wright because he was a classmate of mine at the University

of Michigan. We had not seen each other for quite a while, so it was really great to get back together with him and learn about the great work that he was doing.

ATHM: What role does chelation play within the spectrum of preventative medicine?

Dr Chappell: The beauty of chelation is that it removes toxic metals, and toxic metals can interfere with normal function- ing of the body and contribute to disease including immune diseases, circulation problems, and degenerative diseases of all kinds. We find that these are very important to look for. If we find toxic metals, we treat with chelation. Over and above that, chelation helps with circulation, and we believe that if you can improve circulation, you can help most diseases.

ATHM: Are those benefits attributed to the action of a particular chelation agent, or are different sub- stances used?

Dr Chappell: Chelation means to grab ahold of metals and take them out of the body. Some of those are normal metals that you have to replace, but there are chelating sub- stances that have a great affinity for toxic metals such as lead, mercury, cadmium, and arsenic. We use different chelating materials depending on what the toxicity is and what the purpose of treat- ment is. For vascular dis- ease, the best evidence is for EDTA. That was prov- en very nicely by the Trial to Assess Chelation Therapy, or TACT, which was finished a couple of years ago.

ATHM: Tell us about TACT.

Dr Chappell: TACT began as a mandate from US Representative Dan Burton of Indianapolis. He held con- gressional hearings about why the National Institutes of Health, or NIH, was not funding research on chelation therapy even though so many smaller studies pointed to its effectiveness. Eventually the NIH agreed to do the research

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and they called for proposals. TACT was a major double-blind RCT of patients who either got chelation or placebo. They also looked at high-dose vitamins versus low-dose vitamins, and patients received these treatments in addition to their treat- ment for vascular disease. Everybody in the study had suffered a heart attack, so everone had known vascular disease. They looked for cardiac events over 3 to 5 years. The cardiac events included death, new heart attacks, strokes, and hospitalization for severe heart problems. The study wound up with 1708 patients from the United States and Canada. It was a very impressive study and it came out with positive results. This is exactly the type of study that is required of medications to get approval by the FDA and to get accepted in medical circles. With chelation, as it has been a controversial therapy for quite a while, there is still some reluctance to accept it—even though there is proof.

ATHM: Did you participate in TACT?

Dr Chappell: Yes. I was one of the people who originally testified in the congressional hearing, and I was also involved with evaluating the different research proposals that came in. Eventually I did become an investigator in the study, and I did treat patients. We had 39 patients in the study. It was a very good experience.

ATHM: Who was the lead author for that?

Dr Chappell: Tony Lamas, MD. Dr Lamas is a research car- diologist on the faculty of Columbia University and associ- ated with the University of Miami in Florida. He has done several major research projects in the field of cardiology. He is very well respected and he made sure that the study was done without significant problems. It was very interesting because it was one of the first studies that NIH has funded which had university medical centers participating in it along with experienced clinicians out in the field. That coop- eration was very positive.

ATHM: You mentioned that chelation has had controversy surrounding its use. Can you describe why?

Dr Chappell: Chelation was first reported for vascular dis- ease in Detroit by Dr Norman Clarke. Initially, there was a fair amount of interest in it from cardiologists in the United States; this was back in the late 1950s. There was one group of cardiologists that did a study on it, and their conclusion— even though their data was positive for chelation—was that it was not any better than existing treatment. Unfortunately, that eliminated the interest in chelation, and conventional research was no longer done for many years after that. In fact, a small group of alternative doctors continued to use the therapy because they saw really good benefits from it. Quite a number of minor studies were done that supported its use. The AMA and some medical groups became quite criti- cal of the therapy. Finally, the AMA demanded a major study

be done in the early 1980s. Of course, the doctors who were doing chelation did not have the resources to do a large double-blind study. They were treating patients who came to them for help and for treatment, not for a study. It was very difficult to get that study going, though there were several attempts to do it. One started at Walter Reed Hospital, a US Army hospital, but that one fizzled during the Iraq War because the physicians who were doing the study were called off to the war and were not able to complete it. There were other universities that tried to do the studies; they just could not get it done for various reasons. During all this time, medical boards and other medical associations issued statements against the therapy. It was controversial, no doubt, but the NIH finally funded the study.

ATHM: If early trials had shown that it was no more effective than the current treatments, wouldn’t there still be some advantage to using it—considering potential side effects of drug therapy—if it were equally effective?

Dr Chappell: Yes. That is a good point and certainly could be the case. However, I will emphasize that in TACT, in order to prove its effectiveness, all the patients in the study got conventional treatment, so the improvement that they showed in TACT was over and above the conventional treat- ment. It was statistically significant that you could decrease cardiac events pretty substantially with chelation therapy during that trial.

ATHM: Can you comment on the findings coming out of TACT that had to do specifically with diabetic cofactors or comorbidity?

Dr Chappell: That was probably the biggest surprise to con- ventional physicians. Back in the 1960s, there was some work that indicated that diabetics did the best of all the patients, but that was just a couple of isolated studies. In TACT, you could separate out the patients who did have diabetes. The improvement of the patients who had both chelation plus high-dose vitamins decreased the subsequent cardiac events for these patients by 51%. That is a huge num- ber over just a 3- to 5-year period—much more than the usual medications and other treatments that are given for diabetes. The researches who are looking at diabetes are very interested in this, and they are looking at possible further research that might examine this in more detail.

ATHM: Efforts have been made to limit heavy metals in homes and workplaces. If that is the case, why should chela- tion be so important in medicine currently?

Dr Chappell: There is a reduction in lead and mercury in the environment, but there is still quite a bit there. In fact, those metals are both in the top 4 or 5 pollutants in the United States. The chemical toxicities occur and they have been linked to many diseases. Even small amounts of lead and

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mercury can be significant in diseases. This has been shown in many research projects published in the last few years. Unfortunately, up until this time, there has not been a lot of research on treating patients with toxic metals. Small amounts of lead are still big factors in the produc- tion of vascular disease. Why there is such reluctance to treat these patients, I have no idea. It sure makes sense that if you have a toxic substance and you can remove it, then it could make a big difference to that patient.

ATHM: Here in Minnesota, when you think of mercury, you think of fish. But the potential for exposure to mercury is quite a bit greater than most people assume. Where are those environmental exposures to mercury coming from?

Dr Chappell: The biggest one—and still controversial—is from amalgam fillings in teeth. It has been documented that if you have amalgam fillings in your mouth, the metals in them are silver and mercury. If you chew, you can vaporize enough of the mercury so that it can be measured—and it can be high, even toxic levels—just after chewing gum. The mercury amalgam issue is a big one. In some countries those types of fillings are outlawed. Other countries have limited them, but there is still that exposure, because there are an awful lot of people who have amalgam fillings in their mouth. There are other places in the environment: One of the biggest is from burning coal for power. If you breathe polluted air containing mercury, then you are going to absorb some of that into your system. Fish is a big factor, too. If you eat a lot of fish, you can develop a toxic level of mercury.

ATHM: The federal government is pushing one other source into our homes through compact fluorescent bulbs and end- ing the manufacture of incandescent light bulbs.

Dr Chappell: Yes, that is a scary one. If you break a light bulb, that can be a dangerous exposure. You really should call a company that deals with toxic exposures to clean it up. If you try to clean that up yourself, you are going to get a big exposure to mercury.

ATHM: There are several other heavy metals that we need to be aware of in our environment, correct?

Dr Chappell: Right. Arsenic is a big one, and third-world countries are particularly high in arsenic. India, especially, has a huge arsenic problem. Aluminum. Others we are just beginning to understand; one of them is gadolinium. Gadolinium is in the dye that they use for MRIs. When we do a challenge test and look for toxic metals, we can tell whether that individual has ever had an MRI in their lifetime because of high gadolinium levels. Gadolinium is a toxic metal. Tin is another very common one that we see, and nickel, too. Cadmium is very toxic, often related to cigarette smoke, but is also airborne in the environment. We find fre-

quently that people with eye problems have lead or cadmium at high levels. Antimony is another one that can be very toxic. That has been shown in cardiomyopathies; they might have very high levels of antimony. We are just in the beginning stages of understanding the effects of all these toxic metals. Each indi- vidual metal is toxic, but 2 or 3 of them together multiplies  the effect and that has not been studied. We certainly think it is a good thing to get rid of them as much as we can. Memory problems: Of course, these have been going up astronomically. Lead, aluminum, and mercury can all con- tribute to memory problems and other neurologic diseases. Often times, if we have patients who have these diseas- es—memory problems, neurologic problems of various kinds, sometimes even cancers—we do a challenge test to see if toxic metals are present. We try to improve their immune system and their neurologic function by removing the metals.

ATHM: You have written about testing for toxic metals and that some of the more obvious tests that have been used in the past may not be tremendously effective or may even be  misleading. How so?

Dr Chappell: The gold standard for toxic metals is to do a blood test. The problem is that these toxic metals do not stay in the blood very long. If you are working around them every day and worried you are getting a toxic load, this is fine because you will find elevated levels if there has been a recent exposure. In the body, these metals are stored in the bone, in the brain, and in the fat cells. They are not floating around in the blood. The best way to look for toxic metals is to do a challenge test, where you give a chelating substance and then you mea- sure the urine, or sometimes the stool, to see how many toxic metals you pull out over the next few hours. That is the best way to see if there is a toxic load. This can be really impor- tant. For example, if you have lead in the bone, and you have a bone injury or even maybe a bone surgery, like with a joint replacement, you are going to have leakage of the contents of that bone into the rest of the body and you might get a flood of lead that has been stored in that bone. That could cause adverse effects after a fracture or a surgery that could be very significant.

ATHM: Individuals are engaging in some pretty aggressive detoxification procedures, often without practitioners over- seeing their program. Could this lead to a massive release of heavy metal toxins within the body?

Dr Chappell: Possibly, yes. They have not been well studied, to my knowledge, but I would be concerned about that. You also have to be careful that whoever is doing it is knowledge- able about the chemistry of the substances. For example, EDTA is a very safe substance that is found in tiny amounts in cereals in our grocery store. In higher doses it is used as a chelating substance to pull out toxic metals. Fortunately, it

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becomes tightly bound to toxic metals and is excreted quick- ly. Only about 5% of the EDTA is absorbed orally. You are not going to get a very predictable detoxification with the EDTA given by mouth. Another problem with poor absorbtion of oral EDTA is that it might bind with normal metals and prevent their absorption. So you could get malnourished even though you are eating foods containing the normal metals that you need. It can be controversial. It can be difficult. It has potential for doing harm to a patient, if the person who is doing the treat- ment is not knowledgeable.

ATHM: How about a program where the contents of fat cells are flushed rapidly? They’re losing a tremendous amount of weight in a short amount of time and releasing the contents of those fat cells into the bloodstream.

Dr Chappell: I think that would be an important consider- ation, as well. You could possibly get a flood of toxic metals by releasing them from the contents of fat cells.

ATHM: Considering unavoidable environmental exposures, should there be some level of heavy metal detoxification built into your lifestyle?

Dr Chappell: Certainly regular exercise, particularly if you can build up to a sweat; that is a very good way to detoxify, gradu- ally. Another route is through your digestive tract. If you eat high-fiber foods, you might also benefit from detoxification and prevention of absorbing toxicants from your food supply. Generally with chemicals—and there have been many chemi- cals that have been identified that can be toxic to the body—the body has mechanisms to detoxify and handle those chemicals, but sometimes it does not keep up. I find that milk thistle is a good herb that can be used to enhance the detoxification effect.

ATHM: What about trying to support your body’s antioxi- dant system, like precursors for glutathione?

Dr Chappell: Glutathione is a wonderful antioxidant the body needs. It is essential for many bodily functions. N-acetylcysteine, or NAC, is one precursor that can be used, as well as vitamin E and selenium to help with the produc- tion of glutathione. Glutathione by itself is not very well absorbed into the body, so it is hard to get high levels that way, although there has been some research recently saying that if you use a liposomal preparation you can get much better absorption. There are more products being developed all the time to enhance antioxidant effects, and they are important defense mechanisms.

ATHM: You are currently trying to get the word out about a grant program for chelation therapy. Please describe the program and provide the details for applying.

Dr Chappell: In order to get complete acceptance of chela- tion for toxic metals as well as the use of EDTA for vascular disease, there needs to be another study to support TACT, which was just completed and published—although certain parts of it are still being published. There are not many orga- nizations right now that sponsor research in this area. The NIH is the major one that is a potential sponsor. However, in order to get a major contributor to finance a big study, a lot of work needs to be done. That involves preliminary work, study planning, statistical projections, and so forth. The International College of Integrated Medicine, or ICIM, which teaches doctors how to do chelation safely and effectively, decided to put forward money to stimulate that process. The ICIM has sent out a call for proposals for any- body who is interested in doing chelation therapy. ICIM will give a grant of $20 000 for putting together a proposal for a larger grant and study that can replicate the findings of TACT. This announcement has been received with a lot of enthusiasm, and we expect to get innovative proposals of different diseases that we can test that may support TACT. For example, one thing that has been proposed concerns diabetic patients who have been told that they need an amputation. A study could see if EDTA can prevent amputa- tions. There was a smaller study that actually did show that effect in Denmark. The deadline for the grant is May 31, and ICIM would like to receive as many proposals as possible.

ATHM: Where should the proposals be sent, and how?

Dr Chappell: The proposal should be sent to Any questions could be directed to her as well. She is the executive director of ICIM.

Chappell: Saving a Million Hearts

Saving a Million Hearts workshop at ICIM

By L. Terry Chappell


In September of 2011, the Department of Health and Human Services (DHHS), the Centers for Disease Control(CDC), and the Centers for Medicare and Medicaid Services(CMS)  jointly announced the Million Hearts Initiative(1,2).  The goal is to prevent 1 million heart attacks and strokes over the next five years.  Other groups such as the American Heart Association, the American College of Cardiology, the American Pharmacy Association, and Walgreen drug stores quickly joined the effort.

Unfortunately, the action plan to achieve this lofty goal as published is likely to fail.  Nevertheless, those of us in Integrative Medicine should embrace the overall goal and use all of our skills to formulate a plan to prevent even more heart attacks and strokes than the efforts put forth by these prestigious organizations.  This article analyzes the strengths and weaknesses of the Million Hearts Initiative(MHI) and shows how we can make it dramatically better.

Cardiovascular Disease as the Leading Cause of Death

In the United States there are about 2 million heart attacks and strokes each year with 800,000 fatalities.  Not only is this the leading cause of death, but also the overall medical cost of these diseases is estimated to be $450 billion per year.  From 1980 to 2000 there was a significant reduction in the death rate from cardiovascular disease, most of which was due to lifestyle changes and preventive medicine.  Yet cardiovascular disease is still by far the leading cause of death.  HHS Secretary, Kathleen Sebelius, states that heart disease is responsible for one of every three deaths in the U.S.

The MHI Plan to Prevent Heart Attacks and Strokes

The clinical interventions put forth by the MHI consist of four potential categories of drugs.  The treatment acronym is the ABC’S of prevention:  aspirin for high-risk patients, medications to control blood pressure, cholesterol management, and smoking cessation if needed (varenicline, nicotine patches, etc.).  In addition, the MHI calls for improved nutrition through a reduction in the intake of sodium and trans-fats.  The MHI hopes to coordinate activities with Obama’s Affordable Care Act.  Electronic health records and quality recognition programs offered by both the government and various private insurance plans should also be useful for recruitment of patients to participate.

At present, only 47% of patients at risk take aspirin, 46% have blood pressure under control, and 33% have LDLs below 100.  The specific goals of the MHI are to increase all of these numbers to 65% by 2017.  A fourth clinical goal is to reduce smoking prevalence from 19% to 17%(1).

Emphasizing four interventions that might require drug therapy certainly makes one wonder about the influence of the pharmaceutical industry in this effort. There are at least 30 million people in the U.S. whose blood pressure and/or cholesterol are not under control.  That is a pretty large target population, just with these two factors.  Overall, Forbes estimates that the MHI seeks to put half of our adult population on drugs prescribed by doctors.

One of the strengths of the MHI plan is that it does not depend on intensive care by cardiologists and vascular surgeons.  In fact, several popular blogs written by these specialists have complained that cardiologists are being left out of the campaign.  Perhaps there is a reason for this omission.  The OAT trial(3) in 2006 demonstrated that opening totally occluded arteries with stents after uncomplicated myocardial infarctions involving those vessels actually increased the mortality rate when compared to medical management. Soon afterwards, the COURAGE trial(4) showed that angioplasty and stents for stable coronary artery disease were no more effective than proper medical management.  Before the COURAGE trial, 85% of all stents in the U.S. were surgically placed in patients with stable coronary artery disease. Both of these important studies have been virtually ignored in clinical practice.  Vascular specialists continue to place unnecessary stents in many patients each year.  A recent JAMA editorial(5) described this practice as an “expensive placebo”.   The authors further commented that “some entire medical subspecialties (might be) based on little evidence”.  No doubt there are valid indications for revascularization procedures and complex drug therapy.  Cardiologists are necessary.  Many of them would be more effective, however, if they focused more on nutritional biochemistry.

Of great interest is the study by Canto and associates(6) that analyzed 542,008 patients who had heart attacks from 1994 to 2006.  For those patients who suffered their first heart attack, the in-hospital mortality was inversely proportional to the number of traditional risk factors that were identified.  The risk factors they examined were hypertension, smoking, dyslipidemia, diabetes, and family history of heart disease.  Obviously, other factors were contributing to the increased mortality for these patients.  If we are to succeed, we must do a more thorough job of identifying risk factors and modifying them safely.

Criticism of the MHI Plan

The most obvious deficit in the MHI plan is that it does not include three commonly recognized lifestyle factors for the prevention of cardiovascular disease: regular exercise, stress coping measures, and weight reduction if needed.  Exercise alone is probably more effective than any drug one can take.  By excluding these important lifestyle factors it becomes highly unlikely that the MHI will succeed in real life.

The MHI appropriately states that we must reduce trans-fats and sodium in our diets, but it could do much more.  At the very least, patients at risk should avoid foods that are high in the glycemic index, aspartame, high-fructose corn syrup, processed foods, and fried foods.  We also could eat organic raw veggies as much as possible.  The use of unrefined salt would add beneficial trace minerals.  Not surprisingly, the potential benefits of nutritional and herbal supplements are not mentioned in the MHI.

Diabetes is another prominent risk factor for cardiovascular disease.  Weight control and low carbohydrate diets are important for prevention and treatment of diabetes.  Diet, exercise and supplements are often sufficient to achieve control of Type 2 disease without medications.

Poverty and inequality are factors that have been shown to increase cardiovascular disease.  Not only do these factors cause economic stress, but they also result in poor quality food and increased smoking as a stress-coping measure.  Such socioeconomic factors make it more difficult for the ABC’S of the MHI to succeed.  A more comprehensive approach as I describe is required to overcome the twin risk factors of poverty and inequality.

The MHI is careful to note that aspirin and statin drugs for cholesterol management are to be used only for high-risk patients.  However, that might serve to be the “fine print” that nobody reads.  Recent reports show that for primary prevention of cardiovascular disease the “number needed to treat” to prevent one heart attack with aspirin is 163 and for statin drugs is 200(7).  The “number needed to harm” for both of these interventions is much lower.  Thus the use of these drugs for primary prevention is highly questionable.  However, many physicians still prescribe them when not indicated, which is a waste of resources and the potential source of serious complications.

If we are going to succeed in saving a million hearts with our current socioeconomic and lifestyle stresses and our failure to change our therapies in response to definitive evidence, we should look at additional risk factors, especially ones whose remedies are much less likely to cause complications than the proposed drugs.  We should emphasize powerful lifestyle changes and safe, optimal supplements instead of diverting our attention toward aspirin, anti-hypertensive drugs, and statins. For this, we can rely on and offer our patients the insights and experience of integrative medicine.

Let’s Get Serious About Saving a Million Hearts

Obviously, we cannot save a million hearts and strokes all by ourselves.  But we can save way more than our share.  First, we should identify the hearts that need saving (although the case can be made that all hearts need saving).  We can determine if patients’ hearts are at risk mostly by performing a history and physical exam and gathering basic lab and other tests, some of which might have been previously been performed.  If patients have a history of documented vascular disease, hypertension, hyperlipidemia, diabetes, smoking in the previous 5 years, or a family history of heart attacks or strokes, they automatically qualify.

Computerized risk assessments, usually based on the Framingham Risk Assessment, might or might not be helpful.  They provide striking graphic displays that demonstrate the effect of improving basic risk factors.  However, they don’t include the cumulative effect of a comprehensive risk factor plan like we are discussing.  If patients are at least 50 years old or the physician suspects high-risk lifestyles, one or more screening tests to determine if they are beginning to develop plaque in their arteries is indicated.  If a resting EKG has non-specific ST/T-wave changes, their heart might be at risk.  A stress EKG can have false positives and false negatives, especially in women.  A stress echocardiogram is more accurate in females.  An ultra-fast CT scan for calcium score is a good screening test.  A carotid intima media thickness(CIMT) ultrasound test by CardioRisk( is also a very sensitive screening test that can be done by that company periodically in your office.  The ankle/brachial index is a reasonable screen for peripheral artery disease, although not very sensitive, in my experience.  If positive, however, there is an increased risk for heart attacks and strokes.

If we determine that a patient is at risk, a comprehensive cardiovascular risk factor evaluation is indicated.  For our patients who join the MHI, we often recommend a VAP cholesterol panel, including Lp(a)(8), HbA1C, ferritin, fibrinogen, CRPsensitive, red cell magnesium, 25 [OH] vitamin D3(9), and homocysteine test.  Virtually all of these tests and more are included in a comprehensive cardiovascular blood panel.  Two companies that offer such panels are Doctors Data( and Atherotech(  We also do a EDTA challenge test for heavy metals, with special attention to lead(10).  If available, heart rate variability testing frequently detects high sympathetic activity that is not balanced by parasympathetic output, even when the patient is unaware of excessive stress.   A saliva test strip for nitric oxide ( can detect low NO levels, which theoretically at least, can be improved with nutritional support.  Other tests for nutritional factors can certainly be ordered, but they are beyond the scope of this article.

In our report of findings, we estimate how much risk we think each patient has and how we feel we can improve that risk with various interventions.  Our individual patient data base is considerably larger than that of the MHI.  Our recommended treatment interventions include more aggressive lifestyle measures, nutritional supplements, herbal therapies, and other treatments as indicated.

Integrative Treatment Plan

Start with the ABC’S.  Instead of or in addition to aspirin, to reduce platelet aggregation, we can use fish oils, garlic, vitamin E (mixed tocopherols especially gamma), nattokinase, and/or lumbokinase.  Donating blood several times a year is another way to decrease blood viscosity.  One study showed an 88% reduction in the risk for myocardial infarction for 153 middle-aged men who donated blood in the previous 24 months(11)  That study has been criticized, but a more recent study(12) delineated a more complex mechanism and confirmed that blood donation might reduce the risk of vascular disease.  In addition to reduced blood viscosity, the resulting decrease in elevated ferritins substantially lowered free radical activity.  Rheologics (610-524-5427) makes a machine that measures blood viscosity.

The blood pressure might respond to garlic, potassium, magnesium, and other phytonutrients.  I have found rauwolfia with sandalwood and other herbs(BP Natural Relief) to be particularly effective(  Weight loss can often lower the blood pressure significantly. These measures might be sufficient by themselves, or they can be used in conjunction with medications to achieve good control.

For cholesterol, HDL, and LDL management, low carbs appears to be the most effective diet(13), especially if the triglycerides are high.  But this remains controversial.  The DASH, LEARN, Ornish and Mediterranean diets are alternatives.  Red yeast is a natural statin that can effectively lower cholesterol and LDL, with much fewer side effects than the drugs.  As with statin drugs, the main beneficial effect from red yeast rice might be to reduce arterial inflammation rather than to reduce LDL.  Always replace coenzymeQ10 when prescribing any kind of statin.  Both muscle inflammation and congestive heart failure have been attributed to low levels of coQ10, which is depleted by the statins.  Fish oils can help reduce cholesterol and so can cinnamon, niacin, berberine, and lecithin.  Intravenous essential phospholipids from lecithin have been used in Europe to treat coronary artery disease.  Proteolytic enzymes might also be effective to reduce inflammation.  Food allergies can be important, especially gluten and casein sensitivity.  A therapeutic trial of an elimination diet can be very helpful.

To stop smoking, hypnosis and acupuncture are somewhat effective. The medication varenicline(Chantix) might have its place, but the incidence of side effects is troubling.

For better fitness compliance an exercise prescription is mandatory, depending on the physical capacities of patients.  People often need to have specific goals to get the best results.  Al Sears’ PACE program with brief periods of intense exercise makes sense to me.  It is backed by the Harvard Professional Lifestyle Study(14).  Adequate fitness, however, can usually be achieved by walking for 30 minutes 5 days per week.

Always be aware of how important stress can be for cardiovascular disease.

One of the best-documented treatment programs is Heart Math(15), which is a home tutorial using biofeedback.  Yoga, meditation, progressive relaxation, visualization, deep breathing, emotional freedom technique, prayer and acupressure are procedures that can be utilized.  All patients in the MHI should form a plan to improve their stress-coping activities, especially if their heart rate variability results are abnormal.

Nutrient deficiencies are frequently detected with the comprehensive cardiovascular risk profile, particularly magnesium.  Antioxidants are indicated if an increased amount of oxidized LDL is detected.  Linus Pauling’s admonition to treat patients who have elevated Lp(a) levels with vitamin C, proline, and lysine still rings true.  The optimal level of 25 [OH] Vitamin D3 is 60-100 ng/ml, although the listed normal is usually as low as 30 ng/ml.  Calcium might be given to lower the risk of osteoporosis or colon cancer, but always balance it with at least half of the milligram dose of magnesium.  Do not prescribe the ultra-high doses of 1500-2000 mg of calcium a day.  Studies have shown that high-dose calcium can lead to calcification of the arteries.  Coenzyme Q10, d-ribose, and l-carnitine are helpful adjuncts, especially for congestive heart failure and fatigue.  Medium chain triglycerides from coconut oil are useful to preserve brain function.  The herb, apoaequorin(Prevagen) is particularly good to preserve memory, in my experience.  The physician formulation of apoaequorin is four times as strong as the product available over-the-counter.

For many years, integrative physicians have found intravenous EDTA chelation therapy to be very effective in treating and preventing cardiovascular disease.  This is especially true if a build-up of toxic metals is detected.  Lead is the best-documented toxic heavy metal(10).  It has been linked to heart disease, cancer and autoimmune problems.  If mercury is found, DMPS or DMSA might be needed in addition to EDTA.  The published intravenous EDTA protocol appears to be effective, even if heavy metals are not found.  The author and associates demonstrated a dramatic decrease in subsequent cardiac events in high-risk patients who had received chelation therapy(16).  The results of the Trial to Assess Chelation Therapy (TACT) are due to be published this summer.

An under-appreciated advantage of enrolling a patient in a course of chelation therapy is that the treatments are given once or twice a week during the basic course.  That means that each week, the nurse has a teaching opportunity to reinforce diet, exercise, stress-coping, supplement compliance, and habit control, all of which are important for saving hearts.  Our staff helps the patient set goals and identify barriers to reaching the goals.  As with any class or program, repetition is key.  It often helps to bring a friend.  When patients share their experiences and goals with others, results can be better than trying to follow the program by themselves.  Group visits to deal with risk factors and lifestyle might be a useful service to offer.

Monitoring and maintenance are two key concepts for a successful program.  The risk factors identified must be monitored often enough to assure that interventions are effective.  Too often the patient and the physician identify risk factors, correct them temporarily, but fail to be sure that the factors remain under control.  Non-invasive vascular tests should be repeated to monitor progress.  Lab biomarkers should be repeated at specified intervals.  The CIMT and the heart rate variability are particularly good monitoring tests.  However, the ultra-fast CT scan is not.

A summary of the integrative approach in seven steps is outlined in Table 1.

Research and New Frontiers

Several avenues of research are currently taking place, including genomics, molecular targeting, stem cell biology, and regenerative medicine(17).  Both conventional and integrative medicine are active in these areas of interest.  Progress is anticipated within the five-year target period of the MHI.  For example, stem cells harvested from autologous bone marrow are being tested to treat myocardial infarction(18).  Initial results were not impressive, but the authors were optimistic that revisions in protocol might yield better results.  Mikirova and associates(19) recently showed that chelation of heavy metals improved the number of stem/progenitor cells in circulation.  Our version of the MHI should be a fluid plan that can be improved as new evidence emerges.

One criticism of integrative medicine is that there are few large clinical trials to support the therapies that are utilized.  Harvard professors Groopman and Hartzband in their book, Your Medical Mind (7), point out that too often the larger the clinical trial, the less significant the results.  Their reason is that it takes a large study to have sufficient statistical significance to prove a minimal effect.  Smaller studies with larger effects are often more useful.

On March 31, 2012 in Lexington, Kentucky, the International College of Integrative Medicine will hold a forum on the Million Hearts Initiative for clinicians experienced in the use of chelation therapy and other integrative techniques.  Round table discussions by the experts will explore further the ideas presented in this article.  Readers are invited to attend.  The proceedings will be published in the Townsend Letter.


How much effort is required to prevent a heart attack or a stroke?  How about a million heart attacks and strokes?  We applaud the conventional medical community and government for setting the MHI as a lofty goal.  Unfortunately, it is unlikely that goal will be reached with the plan that has been put forth.  On the other hand, utilizing a comprehensive, integrative approach, we can make a huge impact for those one million individual hearts and brains that we want to save.  Not infrequently, hypertension and hyperlipidemia can be controlled by detoxification of heavy metals, exercise, a healthy diet and stress management without the use of medications that might cause more adverse affects than beneficial ones.  Nutritional and herbal supplements, as needed, can be added with greater safety than many medications, with similar benefits.

Patients must be presented with all the evidence in an unbiased manner.  Then it is their responsibility to choose the therapies that suit them best. Individual treatment plans are more effective than rigid guidelines.  Our goal is to reduce their chances of having heart attacks or strokes over the long term to the lowest incidence possible.  With this effort, I am confident that we will prevent many heart attacks and strokes, while helping patients live longer.  Many patients will have a better quality of life as well.  Let’s start immediately, by providing comprehensive plans for our patients and letting the word spread, wide and far.


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  1. Mikirova N,  Casciari J, Hunninghake R.  Efficacy of oral DMSA and intravenous EDTA in chelation of toxic metals and improvement of the number of stem/progenitor cells in circulation.  Translational Biomedicine 2011;2.  Available from http:www,