trowbridge

Managing Cardiovascular Diseases

Ramblings of a Maniacal Frenetic: Pragmatic Reflections on Helping Patients Understand Their Illnesses and Treatments

by John Parks Trowbridge, MD, FACAM

John 2My father told me, in early 1979, that he was going to see a doctor about doing chelation therapy. I went only slightly berserk, insisting that I would have heard about it in my training or residency if it had any value for cardiovascular diseases. He “wisely” stayed away from that charlatan. Then my mother needed drastic surgery for a bleeding ulcer in the fall of 1982. As I needed to fill my days while seeing her in San Francisco, I visited the office of Robert Haskell, MD. We discussed nutritional medicine and dietary programs … and then he asked, “Well, you do chelation therapy, of course?” I explained my reservation about doing any treatments that were exaggerated in their claims of helping … especially with a wide variety of illnesses. He said simply: “Come with me.” We climbed up one flight of stairs. “Here,” he said, “is my nurse. And my charts. And my patients. Have a good day.” And what a day it was! I could barely believe the documented results of patients who had barely been able to walk due to shortness of breath or chest pains or calf pains. And I got to hear their stunning stories, in person – and to lay my hands on their bodies. I was hooked. I spent the next five months studying everything that I could find on chelation, so that I would “ace” the written exam. At the training, I met Warren Levin, MD, of New York City, clearly the best lecturer at the meeting. I spent two glorious learning days in his office; the same for Milan Packovich, MD, of Pittsburgh; also for Charles Farr, PhD, MD, of Oklahoma City; and for another eight doctors who generously offered to share their best ideas with me, so that I could strive from the start “to be the best.” H. Ray Evers, MD, of Dothan, Alabama, graciously hosted me for three days to see the best of the past. And thus began my saga, to “learn more and do better than anyone else.” At the very least, each of my parents and I myself benefited greatly.

Pump, Pipes, and Performance
Cardiovascular diseases (CVD), in order to be adequately evaluated and treated, need to be classified according to the likely etiology or explanation. Simply stated, CVD are associated with the pump (the heart), the pipes (arteries of whatever size and location), and performance (impaired function despite adequate anatomy). One last classification – pediatric – will be ignored for this article, since congenital heart diseases, as genetic or developmental irregularities, have their own unique considerations. When the “pipes” involve the venous system, such as with thrombophlebitis, this is treated as a special case of inflammation.

Hey, Buddy, Can You Really Treat That?
If we have incomplete or missing diagnoses, should you proceed with treatment? In fact, that complaint has been leveled at chelation therapists for years, that we fail to do “enough” diagnostic workup. If you want the details of your problem delineated down to the molecular level, go to your local university cardiologist. But if you want to feel better now and get on with your life, why not consider a treatment that works for most heart and blood vessel problems (and those of many other systems) that plague most people? Problems that don’t improve can continue to be evaluated. The only heart problems that don’t reliably show desired improvement are pediatric, because of their distorted anatomic features. The only peripheral (or central) blood vessel problems that don’t show expected improvement are ….. sorry, can’t recall any.

What Do People Really Need to Know?
For the most part, medical explanations use technical terms that confuse or oversimplifications that mislead. Using the framework presented here, concepts can easily be offered that lead patients into a fair understanding of the treatments proposed and what to expect. (Much of “doctoring” is teaching, which improves compliance dramatically.)

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Trowbridge, MD: Cardiovascular Chelation

John 2by John Parks Trowbridge, MD
Reprinted from the May 2010 Townsend Letter with permission

Personal Pollution and Matters of the Heart
“This can’t be happening” is often the first thought. Gripping, gnawing chest pains give way to a heavier, crushing feeling that generates fear. The idea of “indigestion” soon gives way to “impending doom.” In this setting, 9-1-1 is sometimes a reluctant last resort, after antacids and resting produce only a pitiful response.

The arrival of paramedics brings reassurances from technicians who methodically start oxygen, apply EKG leads, and prepare for transport. Nurses and doctors in the emergency room go about their duties calmly and with dispatch – starting IVs, administering medications that relieve the urgent worry. Transfer to the coronary care unit is swift and easy, and monitors beep with the soothing monotony of a metronome.

From A to Z, everything about the medical team responses engenders trust and dependence in the patient: “These folks really know what they’re doing. Thank God I got here in time.” Trusting eyes gaze into the cardiologist’s face, searching for any clues that the situation is worse than it might appear. Again, reassurance: “You’re here, you’re safe – we need to do some tests to figure out how best to fix you now.”

Slippery slope? Conveyor belt? One-way road to a “dead” end? Many terms have been applied to the “work-up” and “treatments” offered in modern cardiology and cardiovascular surgery. In point of fact, major studies 30 years ago showed that one in six bypass operations are life-saving, when high-grade blockage is worsening in the left main artery or early in the left anterior descending (LAD) artery (the “widow-maker” or “artery of sudden death”).1

Then what of the other five in every six patients? Therein lies the rub.

‘Treating’ with Tests
Everyone knows about the routine resting heart tracing: 12-lead EKG, often with a “rhythm strip” of several seconds. The predictive value is minimal in the absence of symptoms or an irregular pulse.2 A 24-hour (or longer) Holter monitor gives valuable insights into rhythm disturbances but has little use in confirming “ischemic” disease, where blood flow to regions of the heart muscle is becoming compromised. Worthy of comment is that ischemic patterns can be documented in patients without blockage in the heart arteries but with magnesium deficiency or other conditions creating episodes of heart artery spasm. Vasospasticity can constrict blood flow transiently, and chest pains, shortness of breath, weakness, pale complexion, and sweating can mimic heart “angina pains” or even “myocardial infarction (MI).”

Angina simply means reversible chest pain events, often responding to nitroglycerin-type medications. The success of these drugs produces further patient trust that the cardiologist “knows how to treat me.” Myocardial infarction results from sudden blockage of blood flow to a (small or large) portion of the heart muscle. A heart artery already narrowing from deposits of plaque is more easily blocked completely by sudden formation of a platelet plug, also called a “thrombosis” (ACS or “acute coronary syndrome”). More recent studies show that the gunk in plaque is more likely to break off if a smooth hardened surface has not formed (so-called vulnerable plaque). Such free-floating chunks will always find a smaller arteriole and lodge there, blocking blood flow beyond … a heart attack.3

Vasospastic episodes can occur in patients who have artery blockage disease and in those who do not. When tests show minimal blockage that should not be causing angina episodes, cardiologists are sometimes stumped and nevertheless recommend “revascularization” procedures: balloon angioplasty, stents, even heart artery bypass. Each of these operations is based upon a “Roto-Rooter” plumbing concept of heart disease: open the plugged pipes or simply route around them.

This “conventional cardiology concept” comes from the tests upon which they rely in figuring out how to fix heart disease.4 Simply stated, “If the only tool you have is a hammer, then all the problems you see look like nails.” Since many cardiology tests look at the “plumbing,” the treatments advised are designed to address flow blockages that can be seen. That viewpoint creates the fundamental restriction – blinders, if you will – preventing well-trained cardiologists from being able to see the value of treatments other than those in their “plumber’s toolkit.”

One of the most widely known heart tests is the “stress EKG.” A blood pressure cuff is applied, patches with electrical leads are placed on your body, you begin to walk on a treadmill, and the workout is gradually increased to a jog.5 If your legs become fatigued, if you become short of breath, or if the heart tracing shows certain changes – “flags” that indicate problems – then the test is concluded; otherwise, you race along to a calculated heart rate. Comparing your blood pressure changes to the exercise heart tracing gives a hint of how well your heart muscle is working; in other words, how well your blood is flowing to your heart and other muscles.

Even a “negative” (“normal”) stress test is often followed by a “nuclear stress test,” simply because your cardiologist “wants to be sure.” This examination starts with a stress test followed immediately by a radioactive “tracer” injected just as a fancy Geiger counter is placed over your heart. About four hours later, you are placed under the Geiger counter again. Images “after exercise stress” and “at rest” are compared – if the tracer pictures after exercise show “holes” that later “fill,” you have blockage disease restricting the blood flow. If the “holes” don’t “fill” later at rest, then you have had one or more heart attacks where muscle tissue has been replaced by thickened scar. No “holes” after exercise? Then you appear to have adequate blood flow to your heart muscle.

Even a “negative” (“normal”) nuclear stress EKG is often followed by a “coronary angiogram” (heart artery “pictures” – also called an “arteriogram” or “catheterization”), simply because your cardiologist is “being complete” in your evaluation after being admitted for chest pains. Trusting your doctor – and reassured by your test reports so far – you naïvely consent to this much more invasive test. A catheter (tube) is placed into a large artery (as in your groin) and advanced to your heart, where X-ray dye can be injected to outline the pattern of your heart arteries. One tiny technicality: the severity of diameter narrowing is commonly overestimated by 30% to 60%.6 [As the “gold standard” for coronary artery disease, angiograms have several limitations. Recently developed computerized coronary angiography instruments (not yet widely available) will help to work around some of these errors of interpretation.]

Bingo! Narrowing is likely to be identified, since you did come in with chest pains. Now your cardiologist has a reason to recommend “balloon angioplasty” (another tube, this one with a blow-up tip that crushes blockage against the wall of the artery), often with placement of a “stent” (sort of a Chinese finger-trap in reverse, where it is inserted stretched out then “springs open” to press against the wall of the blood vessel). Modern stents are “radioactive” or coated with “chemotherapy,” to reduce your body’s attempt to cover over this strange device, thereby narrowing the artery again.

Balloons? Chemotherapy? Radio­activity? You might have a few questions, but your cardiologist is reassuring that you’ll probably be able to avoid “open heart surgery” (a bypass operation). Now that’s appealing! Once again, you innocently consent to another procedure, hoping that your future will be bright and comfortable. But the results from surgery can’t ever be guaranteed.

Speaking of surgery – what happens if your cardiologist invites a cardiovascular surgeon to discuss a bypass operation with you? For the vast majority of patients, the answer is simple: your lack of knowledge about options will mean that you trustingly agree to have the surgery. Americans are suffering in droves, like lemmings to the sea: in the US in 2005, 469,000 coronary artery bypass procedures were performed on 261,000 patients. An estimated 1,265,000 “stent” procedures were performed; approximately 69% of these were performed on men and approximately 50% on people aged 65, according to the National Center for Health Statistics. During 2006, some 2,192 heart transplantations were performed.7

But What If You’re ‘One of Those Five’?
If only one in six patients has a heart bypass operation8 that is life-saving or life-extending, what is the situation for those other five patients who also often undergo the surgery? Most survive, some do not, many feel better … but their improvements might well have been possible with modern medications and lifestyle changes alone.9 Virtually every “open-heart” patient will suffer some slight or significant degree of “pump syndrome,” neurological or mental changes associated with the heart-lung pump.10 About 1 in 20 bypass patients will die during or soon after surgery. Of those who survive, over half can be expected to suffer fairly dire concerns over the next 12 months: heart attack, stroke, heart rhythm disturbance, congestive heart failure, or rising blood pressure. And each of these events will force these patients back into the trusted arms of their cardiologists and consulting medical specialists.

Perhaps one of the best reviews of the limitations, side-effects, and outright hazards of angioplasty, stents, and bypass surgery can be found in several chapters of the book, Is Heart Surgery Necessary? What Your Doctor Won’t Tell You, by Julian Whitaker, MD.1 Before undergoing any of these procedures, every patient owes his family – and him- or herself – the time to read and understand these risks, in order to question his doctors appropriately and be able to give an actual informed consent, should he so choose.

What About Treating the Patient?
Wait! Can you actually afford to wait, do you have the time – the luxury – to read this and other books, to get the true details for yourself? While doctors sometimes give the impression that “you’re a ticking time bomb, we’ve got to move quickly,” published studies have shown quite the opposite conclusion. Harvard cardiologist Peter Graboys showed, 20 years ago, that patients who chose to wait before having bypass surgery suffered no deaths from heart disease over the next 2½ years.11 A second study showed only a 1.1% annual death rate from heart disease over the following five years for those who politely (or not so!) declined to have an angiogram, likely concluding that this was just “a map for surgery” that they were reluctant to undergo.12 This rate is far below an estimated up to 5% death rate for bypass surgery. Balloon angioplasty surgery offers an estimated 1% deaths, but recurrent procedures are quite likely.

Recognize that Harvard’s cardiology staff used only routine medications available at that time, along with “usual” lifestyle changes – diet, exercise, and so on. As conventional physicians, they had little interest (or faith) in integrative technologies such as nutritional supplements or chelation therapy. The combined use of (even more modern) medications now, along with specific “orthomolecular nutrition” and chelation, would be predicted to enhance further the startling results that they obtained with minimal effort, and clinical experience supports that expectation.

Rather than progressing rapidly to invasive and potentially risky tests, an integrative physician sometimes will order a set of echocardiograms, basically “sonar” ultrasound pictures of heart muscle performance. When valves and heart muscle function appear reasonably normal and the “ejection fraction” (percentage of blood pumped from the heart with each beat) is normal or almost so, then performance has been preserved even though blockage disease might be present. Activity or exercise might display reduced capacity, consistent with blood flow reduction. A patient with frequent angina, and especially with chest pains at rest, is more likely to have blockage changes best treated first by surgery unless he or she refuses and an aggressive nonsurgical treatment program is pursued.13

The recent availability of “heart scanners” (EBT, or electron beam tomography) has helped to quantify the degree of blockage present as well as its location. This 10-minute test uses minimal radiation and gives reasonably reliable pictures, from which a heart artery diagram of calcium-hardened blockage can be constructed. Again, “high-grade” (severe) blockages early in the left-side heart arteries can move a patient toward the “surgical option” for best survival, with follow-up chelation to treat the underlying cause.

An integrative physician offering chelation therapy will, of course, review and consider cardiology tests available from other specialists in order to best plan a treatment program. Angiogram pictures, though, will rarely be required.

Nonsurgical Treatment of Heart Disease?

Can blockage disease be effectively and safely treated without surgery? The answer, as demonstrated by dozens of clinical studies and case reports over the past 50 years, is an unreserved “Yes!”

However, reduction of blockage should be considered only a possible and desirable side effect and not the goal of a chelation treatment program. An early thought in the late 1950s was that chelation “worked” by removing artery blockage. This seemed a logical way to explain observed improvements in heart function, EKG patterns, congestive heart failure, chest X-ray images, angina chest pains, shortness of breath, and activity levels.14 Without question, some patients do show reduced blockage, as demonstrated by before-and-after-treatment heart scan images in two patients reported to the American Chemical Society in 1994.15 Of interest is that virtually 9 out of 10 patients show improved heart performance – but not all of those show reduced blockage disease by any test performed.16

Another factor to recognize is that our tests are less than precise in quantifying the degree of blockage present, whether improving or worsening patterns. Several assumptions are made in each test setting (heart, carotid neck arteries, abdominal aorta, legs, and so on). The presumed “gold standard” – such as heart angiograms – are difficult to interpret at best … and the same test can be read differently on different days … by the same cardiologist. If blockage doesn’t disappear with chelation, then what could explain the obvious and dramatic clinical improvements in the vast majority of patients? In actual fact, blockage probably is reduced in many arteries: a 10% to 15% increase in “cross-sectional diameter” (the area through which blood can flow, where larger diameters have less resistance to flow) produces double (or more) blood volume delivered to tissues downstream.17 Current tests fail to reliably detect such small reductions in blockage with increases in blood vessel diameter – but the patients can clearly feel and enjoy the improvements, as overwhelmingly noted with chelation therapy. The use of artery bypasses and stents is based upon increasing the diameter of a “feeding” vessel, but such operations involve many risks and the duration of improvements can be limited. Indeed, the diameter increases of bypasses and stents are noted only at the operation site and not generalized throughout the arterial system as with chelation therapy.

Studies documenting patient improvements with chelation are well summarized elsewhere.18-20 What has received very little attention is how much these improvements can be attributed to decreased toxic metal burdens – coincidentally reducing inflammation – and other mechanisms. When platelets have less free radical inflammatory injury, they become less “sticky,” less likely to form sudden “clots” or “plugs” and completely block ailing arteries. When magnesium is provided in large doses, blood vessels more readily dilate to increase flow volume and have less spastic tendency to restrict flow. Vitamins B6 and C, amino acids lysine and proline, essential fatty acids, zinc – these and other nutritional supports that are provided during a series of chelation treatments clearly help to stimulate improved clinical function, detoxification, and tissue repair. Even nattokinase (or lumbrokinase), which lowers blood flow “viscosity” by reducing free-floating monomer fibrin strands, might help explain some of the benefits seen in advanced chelation programs.

What About ‘Personal Pollution’?
All chelating medications share in common one key property: forming a particular chemical bond with certain positively charged ions (metal atoms).21 This drug–metal complex allows for easier removal of the metals through the kidneys. In many cases, the chelating drug prefers to bond with so-called heavy metals that are toxic to the body. Reducing the presence of toxic metals allows for usual “physiologic” chemical reactions to proceed more normally.

Toxic metals insert themselves in place of appropriate metals (such as magnesium or zinc), “sitting” on active sites in enzymes and blocking needed chemical reactions. In addition, they stimulate a tremendous increase in the rate of production of “free radicals” (also described as “oxidants” or “ROTS,” “reactive oxygen toxic species”) that inflict lasting damage to body cell structures, especially those involved in the mitochondria, the tiny “energy-factories” that produce the ATP that powers all cell processes in all cells. (Antioxidant vitamins – such as vitamins C and E and beta-carotene – glutathione, and other molecules help to protect vital molecules from free radical injury.22) Another concept to describe free radical production is inflammation, the destructive and powerful process that creates the pain of arthritis, of heat and chemical burns, and basically all departures from normal function and physiology. Blockage within blood vessels, of course, is one of these “departures.”

A better understanding of how toxic metals lead to suffering and death is found in several observations over the past 40 years, almost from the time humans began in earnest to poison the planet. Animal studies have shown that heavy metals are uniformly neurotoxic, immunotoxic, carcinogenic, and directly harmful to all vital organ systems. The onset and severity of suffering depends, of course, on the dose and exposure patterns as well as cellular compartmentalization and tissue equilibration. Death follows slowly or rapidly based on the same criteria. Toxic heavy metals are throughout the environment (air, food, water, objects) and there is no way to avoid them entirely. Since they come into your body easily but leave much more slowly, all of them accumulate over time and increasingly interfere with body metabolism.

Every person will suffer some (slight or increasingly significant) degree of impairment among his or her many organ systems, based upon his or her exposures, nutritional status, biochemistry, physiology, and so on. Basically, the “weakest link” in each individual will begin to show toxic damage first. In a more global wholistic view, virtually all human ailments (including expression of genetic aberrations) can be aggravated by – or even directly attributed to – increasing burdens of toxic heavy metals.23 Since bioaccumulation from the environment cannot be avoided, attention must be directed to minimizing exposure and removing those that have gained entry. The medical procedure of removing them, of course, is called “chelation therapy.”

A general idea of the magnitude of “toxicity” can be gleaned from providing tainted cage water to rodents, where their only liquid source is laced with a heavy metal. Daily water intake is based on animal weight. Thus, calculations can be made regarding how much of a particular toxic metal was required to kill any individual animal. The lowest dose that killed the first one is noted. Amounts are recorded all the way up to the highest dose, the one that finally killed the last remaining animal in a group of 100. These name for this group of concentrations is lethal dose (LD), and a number is appended, to indicate the population percentage that has succumbed to that amount of toxic metal. For example, the LD1 is the concentration to kill the first animal; LD50 is enough dosage to kill half of the subjects (50 out of the 100). The LD100 dose is the amount that will kill all of the animals.

Of greater concern to people who think they have only minimal exposure to toxics is that small amounts of different toxic heavy metals can combine to create ever more destructive changes. The overwhelming majority of people are lulled into a false sense of security that they “don’t have too much toxics on board, their levels are really ‘low.'” One rodent study showed that combining the LD1 level of mercury with 1/20th the LD1 level of lead in the cage water did not kill just 2 animals (addition), it did not kill 4 or even 8 animals (multiplication) – this seemingly inconsequential combination killed all 100 of the rodents (amplification).24 Extending the implications to human beings is sobering, particularly when we are making our environment increasingly toxic. Modern medicine has no other method to remove toxic metals (as or after they enter) than the chemical process of chelation. Indeed, this is the only FDA-approved method of detoxifying from this heavy-metal toxic body burden.

Treating the ‘Personal Pollution’
The question, does chelation work? was well answered in the very earliest studies, in the 1950s, by Norman E. Clark Sr., MD, the “father of chelation therapy in America.”25 Subsequent studies have confirmed his early observations, with rare exception (and those often criticized as having faulty scientific design or controls). But two questions arise: first, will chelation help all blood vessel problems? And second, what about over-the-counter oral products that might work just as well as the intravenous treatments?

The range of occlusive (blockage) blood vessel disorders – in the heart, neck, brain, central core (including kidneys), and legs – has been widely studied. The results are uniformly positive, though the percentages of those areas that improve rise with increasing distance from the brain. As a clinical rule-of-thumb, “brain” and “eye” problems improve significantly about 75% of the time, heart problems about 88%, and leg problems about 92%. (Some studies have suggested even better results.26,27) The differences deserve further investigation, but suffice it to say that they probably relate in some degree to different forms of calcium deposition (“hardening”) in the different artery walls.

The most common diseases causing significant blood vessel blockages are diabetes (both types, especially when poorly controlled) and high blood pressure (“hypertension”). In both conditions – as in most others – the improvements with chelation can be startling. Legs scheduled for amputation – a frequent conclusion for diabetics – have been largely saved by chelation treatments.28,29 Clinical experience confirms that blood sugar control is often improved, sometimes dramatically, and dosages of insulin or oral hypoglycemics can be reduced for many patients … reducing side effects, of course.

The sugar-control implications for “metabolic syndrome” (an inaccurate title for “insulin resistance syndrome”) are overwhelming. Also misnamed “cardiometabolic syndrome,” this pattern shows elevating blood pressure, blood sugar, and triglycerides, lowered HDL (“heart protective”) cholesterol, along with enlarging waistline. This cluster of disease findings is associated with higher incidences of heart attacks and strokes, two of the top three leading killers in the US. Chelation therapy produces impressive results in these patients. Results in other disease conditions (such as Raynaud’s phenomenon, scleroderma, sys­temic lupus, rheumatoid arthritis, Parkinson’s, and so on) are similarly encouraging.30

So the second question – “over-the-counter” items that might help – raises some interesting concerns. For example, when people order the latest hyped-up bottle from a newsletter or other brochure, are they really worsening inside while they delay seeking actual, scientific, evidence-based chelation therapy? Younger people, with lesser exposures to toxics and fewer degenerative issues, might “buy some time” with such readily obtained “nutritionals.” Older folks – especially those with degenerative diseases or (even unknown) history of prolonged or extraordinary exposures – are walking straight into the lions’ den. While any one individual might live a long and fruitful life without actual chelation, the vast majority are likely to succumb to the common killers, usually at the common ages. Even sequential “negative” (“normal”) test reports showing minimal blockage changes in arteries are no protection against sudden blockage from “sticky” platelets or other results of localized inflammation.

The longer-lived European (especially Mediterranean and Baltic) societies, particularly those whose citizens remain vital and active late in life, can offer some hints as to useful dietary counsel. Sulfur – found in onions, garlic, many grains, legumes, red meats, eggs, nuts and seeds, broccoli, cabbages, even milk and asparagus – readily binds with toxic heavy metals, but only weakly. Selenium – found in brazil nuts and a variety of meats – also can bind to heavy metals. When foods are grown (or animals are raised) in sulfur- or selenium-deficient soils, they have minimal amounts of these valuable minerals. Their use as significant “chelators” – even in the form of alpha-lipoic acid or methyl-sulfonyl methane (“MSM”) or N-acetyl-cysteine (“NAC”) – has not been adequately studied.

Some publicly promoted products have cilantro, chlorella or other algae, and other botanical nostrums and are widely touted as helping to remove toxic metals. Again, their use as significant “chelators” has not been persuasively studied. Claims are made for EDTA in various products administered orally, but none of these have been subjected to rigorous scientific studies in any ways that successful intravenous EDTA chelation has been evaluated. Indeed, a number of formulas also have the nutritional element chromium listed as an ingredient in the same capsule or tablet. Once EDTA “finds” the included chromium, it binds more strongly than with almost anything else and is only slowly released. So, you get virtually no benefit from the chromium or chelation value from the oral EDTA.

If neither foods nor over-the-counter “oral chelators” offer much prospect of demonstrable lasting improvement, then what options exist other than intravenous chelation therapy? Here we are treading on “unstudied ground” once again. Heavy toxic metals interfere in so many ways – blocking enzyme and other metabolism reactions, creating inflammation, making “sticky” platelets, “rusting” the inner linings of blood vessels and thereby encouraging blockage, damaging brain and nerve functions, impairing immune defenses, encouraging the development of cancer, and so on. Theoretically the reduction of the total body burden, by any means, should aid the restoration of more normal functions.

Several chelation medications – such as D-penicillamine and DMSA – have been given orally, safely, for many years. Perhaps the detoxification of heavy metals cannot work nearly as successfully as intravenous EDTA. However, speculation can be offered: carefully prescribed use of various oral chelation medications might, over long periods of time, offer important benefits to people unable or unwilling to take in-the-vein treatments; however, they might forego some (possibly critical) improvements with artery blockage disease. In the near future, this would be a fruitful area for study by the National Center for Complementary and Alternative Medicine (in the US National Institutes of Health).

When Hot Dogs Are Banned …
Based on the studies available over the past 60 years, should we be optimistic regarding chelation therapy – whether intravenous EDTA or various oral chelator medications – finally becoming available for the majority of Americans? Absolutely not.

At a recent trial, where I was serving as an expert witness for the defense, the state medical board attorney noted: “Since EDTA and other chelation medications are approved by the FDA for removal of toxic metals, then really their use is ‘conventional’ medicine practice, not ‘alternative’ or ‘integrative,’ right?” My reply: “Well, yes, except for one teeny-tiny technicality.” “What’s that?” asked the prosecutor. “The state medical boards.” “Why do you say that?” he asked, surprised. “Isn’t that why we’re in this trial? All of the medical boards ignore approval by the FDA, ignore the clear evidence found in the medical literature, and ignore the overwhelming reports of patient benefits from chelation – and they prosecute the doctors offering the treatment, just as you are today.”

A recent pediatrics study claims that 10,000 emergency-room visits are made each year for children who are choking on hot dogs. Some six dozen reportedly die. Each year. If that many patients suffered death as a result of chelation therapy properly administered, the treatment would have been banned several dozen years ago. In sharp contrast to the “wiener losers,” whenever any single patient complains of “side effects” or – as happens every few years, when a patient ill enough to finally seek chelation treatments dies anytime during the therapy program – the state launches a full-scale investigation, usually seeking to remove the “offending” doctor’s license to practice medicine.31 As a society, we tolerate dozens of deaths from the lowly hot dog – at the same time we tolerate dozens of millions of preventable deaths and untold suffering from heart attacks, strokes, high blood pressure, kidney failure, macular degeneration, and amputations for gangrene, among the many disease conditions that could have been helped by chelation. When will the public demand a change of policy that we can believe in?

Trowbridge, MD: Stepping Into the Next 60 Years, A Historical Commentary

caduceus-1245442-639x903Chelation Therapy: Stepping Into the Next 60 Years A Historical Commentary
by John Parks Trowbridge, MD

To preview or purchase this as an audio lecture from an ICIM conference, click here

Reprinted from the May 2013 Townsend Letter with permission

Mind-body medicine, a term well known in medicine, has major roots in observations made in the 1960s by one of my lab directors at Stanford, George Solomon, MD. Intensive study of the “relaxation response,” “healing touch,” “acupuncture,” and similar “soft science” technologies has led to widespread acceptance in the medical and lay communities. At about the same time, startling observations were being made of reversals of increasingly prevalent coronary and peripheral vascular maladies by chelation therapy with intravenous EDTA. Despite “hard science” showing that these beneficial discoveries have been replicated time and again, chelation remains largely unknown or, at worst, vigorously defiled. Paul Dudley White, MD, President Eisenhower’s cardiologist, encountered similar resistance for over two decades to his introduction of the EKG. René Laënnec was more fortunate in securing wide acceptance of the scientific results available with his new “stethoscope” within a decade in the early 1800s. Given a world increasingly aware of pollution with toxic heavy metals, and given a population with younger onset of serious degenerative diseases, and given 60 years of overwhelmingly successful results, why have conventional medicine and regulatory government tossed chelation aside, onto the trash heap of so-called fraudulent diversions?

Going to the Dogs – and Nowhere Else?
What we now unquestioningly call “modern medicine” was largely invented since the late 1940s. Houston cardiovascular surgeon Denton Cooley, MD, studied pediatric procedures in postwar Europe, and his research efforts have saved countless children. Coronary endarterectomy was tried for occlusive disease, but most patients had diffuse involvement and were poorly qualified. Other partners of Houston cardiovascular surgeon Michael Debakey, MD, were Ed Garrett Sr., MD, and Jimmy Howell, MD. In the early 1960s, they were in the forefront of perfecting a technique of removing a peripheral vein and inserting it as an aortocoronary bypass on the heart … of dogs. Endless hours spent in the dog lab led to skills and procedures hitherto unknown. Other complementary technologies were arising at the same time, including selective coronary angiography (to identify and locate high-grade occlusion), the cardiopulmonary bypass “pump” (“heart/lung” machine), and startling advances in anesthesia and antibiosis. Still, the dogs were their only bypass “patients,” and their survival was not the object of the research.

Despite sharing with their cardiology colleagues the potential for success of their new surgical approach, no patients were forthcoming. Finally, cardiologist Ed Dennis, MD, endorsed a last-ditch effort to salvage patients moribund after their infarction. In 1964, Garrett led the team to perform the first successful coronary artery bypass procedure, at Baylor University. The early patients, already preterminal, failed to survive. With the prospect of revascularization too tantalizing to resist, stable patients with severe angina were then referred for surgery. The first two died. The third survived. And a new era of surgical success emerged.

But … Banished Forever to the Pound?
Intravenous EDTA chelation therapy was welcomed directly into patient practice in a most unusual way: in the emergency room. A child presented to the Georgetown University Hospital in 1952, clearly suffering with lead poisoning (from chewing paint off a window sill?). Pediatrician S. P. Bessman, MD, recalled a recent conference wherein neurology researcher Martin Rubin, PhD, described exchanging lead for calcium by a new “chelating” compound … in the test tube. “Can I use it in this kid? How do I dose it?” Serendipity led to clinical success and the child recovered. The case was reported in the Medical Annals, District of Columbia, later read by Norman E. Clarke Sr., MD, a cardiologist in Detroit. He was seeing plumbism (lead intoxication) in battery-factory workers, and thought to try this new chelation treatment. Soon, his patients were reporting less use of nitroglycerin, fewer angina pains, and increased activity without dyspnea. Why not, he thought, try this on “heart patients” who were not suffering with lead toxicity. They, too, dramatically improved with chelation. And a new era of medical success emerged … and was soon to be banished like an old dog.

The NIH TACT Results
Almost 60 years after the first discovery that EDTA chelation therapy could be effective in the treatment of heart and blood vessel diseases, results of the first large randomized double-blind trial were reported at the American Heart Association meeting in November 2012. A number of commentaries have identified “problems” with the 7-year-long National Institutes of Health (NIH) study, under the direction of cardiologist Gervasio Lamas, MD, of the Mt. Sinai Medical Center, Miami Beach, Florida. An 18% reduction of cardiovascular events in the entire treated group suggests a beneficial effect. However, one cadre accounted for substantial improvements: diabetic patients enjoyed a 39% decrease in adverse events compared with placebo (usual medical treatment) controls.

Given the increase in diabetes in the American population – including the younger age of onset for many victims – any treatment offering significant benefit should, in the best of possible worlds, be readily embraced.

Diabetic Complications
Research at the NIH in diabetics during the 1970s showed that normalization of blood sugars preserves endovascular and end-organ tissues, approaching the baseline health seen in normoglycemic populations. Over the past 30 years, there has been an alarming increase of obesity. Enlarging girth is often accompanied by the ominous signs of cardiometabolic syndrome, emphasizing the critical need for early and aggressive control of blood sugar. Nevertheless, ingrained societal patterns – including nutritional debasement in daily food selections – complicate efforts to achieve the lifestyle changes essential for nondrug hyperglycemic control. Drugs, of course, impose the risk of side effects and even hypoglycemic episodes, so many physicians are comfortable allowing patients to float with higher-than-normal fasting and postprandial patterns … and thus tolerating the commensurate development of occlusive changes affecting end organs.

Chronic renal dialysis is one of the most expensive repetitive procedures in modern medicine, and diabetics claim an inordinate volume of these resources. The NIH TACT trial excluded renal failure patterns in order to simplify data analysis. A seminal 2003 study by Lin and Lin-Tan, published in the New England Journal of Medicine, matched patients developing nondiabetic renal failure and carefully treated the intervention group with intravenous EDTA chelation. While the untreated observation group devolved toward dialysis, the treated patients improved toward normal kidney function, presumably due to reduction of lead in the kidneys. Many experienced chelation physicians have seen serum creatinine levels reduce over time in both their diabetic and nondiabetic patients, but a conclusive study remains to be done – and is sorely needed and could be done easily with pooled data.

Beyond Diabetes
Reports of chelation improvements in diabetics have been peppered throughout the medical literature over the past 50 years. In 1964, Carlos P. Lamar, MD, offered his diabetic patients a real chance at a more normal life, saving limbs scheduled for amputation, saving vision in those going blind, and lowering insulin dosages. Kansas City, Missouri, chelation specialists Ed W. McDonagh, DO, and Charles J. Rudolph, DO, PhD, were joined by research professional Emanuel Cheraskin, MD, DMD, to publish 31papers documenting their clinical practice experience over the 1980s and 1990s. Topics included significant improvements of vital importance to diabetics and nondiabetics alike: blood sugar, cholesterol, HDL cholesterol, triglycerides, kidney function and serum creatinine levels, artery blockage disease (even of the aorta), severe heart artery blockage, blockage of neck carotid arteries, hardening of the arteries, platelet clotting functions, fatigue, pulse rate and blood pressure, serum calcium and iron levels, trace element patterns in degenerative diseases, psychological status, and general “clinical change” (improvements) observed in chelation patients. Perhaps of more interest to many readersis the demonstrated reversal of macular degeneration (commonly seen in diabetics) reported by McDonagh and Rudolph’s group in 1994. Their evidence included retina photographs, documenting improvement consistent with increased circulation to the eyes. Pooled objective data from practicing ophthalmologists could easily document a pattern of improvement, offering hope where there is no other treatment.

Coronary Occlusive Disease
The “end organ” of most concern for diabetics and nondiabetics alike is the cardiac muscle. Heart disease “statistics” 60 years ago were generally reported as reduction in symptoms, in angina and infarction, and improvement in EKG patterns. For the past 20 years, we’ve had benefit of the ultrafast CT “heart scan,” helping outline the anatomy of calcified plaque in coronary vessels and allowing for earlier identification of those at risk. For over 50 years, selective coronary angiography has provided “a map for surgery” – but its extensive use in postoperative bypass patients has created an industry ripe for challenge as generally unnecessary and sometimes fallible. For almost 50 years, coronary artery bypass grafting (CABG) has been shown to provide a life-saving alternative for those with significant diffuse disease or “left main” or “left anterior descending” artery occlusion. The 50-year-old technologies of coronary “ballooning” and “stenting” – now impregnated for drug elution – remain popular despite the frequency of restenosis or other complications. The question of whether ultrafast CT is suitable for documenting improvements with chelation remains elusive, since some symptomatically successful patients continue to show advancing calcium scores. Collateral channels are not readily seen in these pictures or even in angiograms, so perfusion studies with stress-and-rest thallium scans can be more revealing.

Salvage of cardiac muscle is the sine qua non of all interventions. Indeed, kinase infusions within the early hours of acute infarction have preserved countless organs with minimal or no damage. Various drugs have found popularity in the conventional cardiology community as possibly reducing or delaying development of coronary occlusions. These include, of course, the “statin” drugs and antithrombotics such as clopidogrel. A number of concerns have been raised regarding their extensive side effects, including interruption of physiologic biochemistry (such as with statins, impaired synthesis of vitamin D, bile acids, coenzyme Q10, and so on). Chelation avoids these challenges to normal functions. Further, chelation has greatest success when occlusion has not progressed to tight stenosis or to the point where unstable plaque threatens to block distal flow. Coronary angiography is still risky, especially with regard to vulnerable plaque. Additionally, it is limited in not being able to discern plaque reduction that yields very slight increases in cross-sectional vessel caliber, a situation wherein fluid dynamics produces a much greater increase in flow volumes. Once again, clinical improvement is one of the best measures of success.

So the question remains: besides lifestyle changes to minimize risks, what actual treatments could enhance myocardial salvage? The almost 60-year history of consistent reports suggests that EDTA chelation has already established itself as an unrecognized but viable alternative, with patient satisfaction and clinical improvements routinely in the 90% range in published studies.

EDTA Chelation and Cardiac Disease
Beginning with Clarke’s initial reports in 1955, anecdotal papers have repeatedly documented that “heart patients” improve with a wide variety of symptoms. Angina episodes, dyspnea on exertion, blood pressure elevations, rhythm disturbances, electrocardiogram patterns – all these were shown to improve in reports over the first 10 years. Other small group reports over the past 50 years have continued to confirm these early findings. The usual critique is that they involve a small number of patients or that double-blinding is absent. These criticisms, of course, ignore that proposed CABG surgery was canceled in the majority as no longer needed, and that people are still walking on limbs scheduled for amputation.

The importance of a nonsurgical alternative for coronary disease is highlighted by a recent report on war fighter deaths over 10 years in the Middle East. Autopsies on 3832 service members, killed at an average age of 26, showed that almost 9% had some blockage forming in their heart arteries. About a quarter of these had severe blockage, yet they were asymptomatic and deployed into combat. As more sensitive diagnostic modalities are developed and widely employed, an increasing percentage of the population will “qualify” for treatment of their clinically silent diseases. In such cases, early and consistent use of chelation might dramatically lower medical care costs while improving overall health outcomes.

Anatomy vs. Microphysiology
Perhaps of greatest interest is the effort to understand why – or how – EDTA chelation is responsible for such dramatic cardiac (and other) benefits. Borrowing from the engineering concept of “opening the pipes,” such as with bypass or stenting, early explanations focused on a “Roto-Rooter” effect of “dissolving” the atherosclerotic blockage. While this effect has been observed and documented in some chelation patients over the years, such a view is probably severely limited.

Much more likely is that chelation acts in just exactly the way that it is “approved” by the Food and Drug Administration: it reduces the body burden of toxic heavy metals such as lead, arsenic, cadmium, mercury, and so on. Sadly, the conventional medical community sets the standards and those lab parameters are for acute intoxication (as reflected in blood levels) rather than for total body burden (as reflected in hair or nail clippings or by collecting urine after challenging with a chelating drug). Since the “acute exposure” tests fail to “show toxicity,” insurance carriers decline claims for reimbursement.

The significance of reducing toxic metals cannot be overstated. But the mechanisms by which this result could produce dramatic improvements remain open to rampant speculation.

An early explanation suggested that, in states of impaired antioxidant levels, cholesterol serves as an electron sponge to help protect the endothelium. Oxidized cholesterol, being a “sticky” molecule, then deposits along the vessel margin, especially at sites of branching or disrupted flow. Having a weak activity similar to that of vitamin D, oxidized cholesterol invites calcium to be deposited in a noncovalent binding. Over time, accretion of more cholesterol, calcium, and cellular detritus results in a discrete volume of occlusive plaque, subintimal and medial. Pathologist Rudolph Virchow, MD, called this metastatic calcium, since it was out of the bones and teeth but not bonded in place. Accordingly, EDTA was thought to “pinch” these available calcium atoms and thereby initiate dismantling and dissolution of the plaque. A more sophisticated view might relate to lowering of ionized calcium in circulation, stimulating release of parathyroid hormone, leading indirectly to mobilization of “releasable” calcium in hardened plaque and body tissues.

One fascinating result of such speculation is the inclusion of calcium as a toxic element when it is abnormally deposited in organs through a variety of aging and degeneration mechanisms. While babies are “soft and rubbery,” aging individuals are increasingly hardened and brittle. This one feature – reduction of metastatic calcium depositions, peppered throughout organelles and cells and interstitium as well as in plaque – might be “the key” to results with intravenous EDTA chelation. This speculation receives support from the realization that “sick mitochondria” accumulate excessive calcium and swell (especially in magnesium deficiency), disrupting the stereochemical alignment of the electron transport chain on the cristae shelves, markedly reducing the efficiency of oxidative phosphorylation and, hence, the health of the cell. One way that mitochondria “get sick” is through the selective deposition of lead and other heavy metals, disrupting mitochondrial DNA expression as well as energy production. Reversal of these mitochondrial modifications could explain many (if not most) of the clinical improvements demonstrated with EDTA treatments.

Chelation patients often report significant symptom improvement within the first half-dozen or dozen treatments, long before a major improvement in blood flow “through the pipes” is likely. When reviewing organ failings – as seen with liver, kidneys, and brain in addition to heart – such mitochondrial inefficiency might be a primary mechanism. Similarly, removal of toxic heavy metals by chelation is much more biologically cost effective than the body’s detoxification effort that leads to depletion of intracellular glutathione. Thus, chelation can help to preserve cellular antioxidant status and a more robust ability to regenerate vitamins C and E as electron donors.

Recall also that all other toxic metals are accumulating throughout the tissues as well – mercury, lead, cadmium, arsenic, and so on – with their separate contributions to free radical production and functional impairment. Iron is an essential element that can be present in excess (iron “storage” disorders, even polycythemia), where it also stimulates the generation of free radicals, which are especially toxic in metabolically active tissues such as liver and heart. Jukka T. Salonen, MD, PhD, MScPH, of Finland, reported in 1992 a large prospective study of men with no symptoms of heart disease. Over the next 3 years, the lifetime total of cigarettes smoked was the primary risk factor in those suffering myocardial infarction. The second factor was an elevated blood ferritin level (possibly correlated with a shift toward tissue acidosis). This provides an easy laboratory test to discover those at higher risk – levels rising higher above 100 ng/ml are directly associated with an increasing incidence of coronary events. The iron story is, however, complicated, and ferritin only slowly declines over dozens of EDTA chelation treatments.

A side issue is coming to the forefront: the expanding use of injectable diagnostic imaging contrast agents, such as gadolinium, iron (Feridex), and manganese (Teslascan). Urinary challenge tests with D-penicillamine in some patients have shown very high excretion levels of gadolinium. The clinical significance of these findings is unclear, but the use of chelation treatments in patients who have had repeated contrast studies might prove valuable. Gadolinium use has been linked to onset ofnephrogenic systemic fibrosis.

Another factor deserving study is the effect that chelation might have on the improvement of tissue perfusion by reducing constriction of the tiniest arterioles, which serve as a large bed of peripheral resistance vessels. Where increased arteriolar resistance opposes the systolic pressure, relaxation of these “flow-limiter” muscles can raise tissue perfusion volume considerably. Increasingly sensitive vascular lab studies and digital thermography are two inexpensive and noninvasive methods that can be used to document improved perfusion.

McDonagh and Rudolph, among others, have shown that chelation produces a more normal reduced platelet volume and increased pliability. Ease of flow through capillary beds provides increased perfusion and oxygenation help to maintain normal tissue alkalinization. Reduction of acidotic microenvironments slows the production of free-floating single fibrin fibrils from fibrinogen, further lowering viscosity in the narrow capillaries. Any combination of these microphysiologic changes could explain improved tissue viability and marked improvement in clinical symptoms and organ function.

Peripheral Vascular Disease
Being listed as a “labeled indication” by the Food and Drug Administration usually allows for insurance approval and reimbursement of treatment for a particular condition. Few people know that EDTA was listed in late-1950s editions of the Physician’s Desk Reference (PDR) as “indicated” for the treatment of peripheral vascular disease. A study with about half a dozen patients showing marked improvement had led to labeling approval. Then came the 1962 Kefauver-Harris Amendment to the Federal Food, Drug, and Cosmetic Act, requiring a review of both safety and efficacy in the approval process. When studies were considered insufficient to conform to the new standards, the indication was dropped from the label.

While early studies concentrated on cardiac improvements, concurrent benefits for occluding leg arteries attracted attention. Carlos P. Lamar, MD, in 1964 reported on legs saved from amputation. H. Richard Casdorph, MD, and Charles H. Farr, MD, PhD, confirmed these improvements in a small series in 1983, as did James P. Carter, MD, DrPH, and Efrain Olszewer, MD, in a double-blinded study published in the Journal of the National Medical Association in 1990. McDonagh and Rudolph in the 1980s documented marked enhancement of the ankle/brachial index in 117 patients with occlusive disease. Carter and Olszewer reported in 1988 on a 28-month retrospective analysis of 2870 patients treated with intravenous EDTA: peripheral arterial disease patients showed marked improvement in 91% and good improvement in another 8%. Given that surgical success is lessened with smaller vessels and when near or crossing joints, chelation as a nonsurgical alternative offers hope to thousands.

Thermography specialist Philip P. Hoekstra III, PhD, reported privately to me in 2009 the results of his 13-year study of 19,147 patients with peripheral (leg and arm) artery stenosis, not yet severe enough to require amputation. Arterial perfusion of all extremities demonstrated significant “warming”in 86% of chelated patients.

Carotid Arteries
Carotid arteries act as a special case of the peripheral vascular bed – and their improvements with chelation have been documented repeatedly. Rudolph and McDonagh described in 1991 the striking and highly significant reversal of atherosclerotic stenosis of bothinternal carotid arteries in 30 patients treated with only 30 EDTA infusions over a 10-month period. Ultrasound imaging showed that overall obstruction was decreasedby 21% – and those who showed more severestenosis had even greater reductionof blockage. Their study had been planned after their 1990 case report of one patient having an original 98% occlusion reduced to only 33% after just 30 chelation therapy treatments. Given that strokes can occur as a complication of otherwise successful carotid endarterectomy, chelation can reduce such misadventures for many. Where surgical intervention is warranted, pretreatment with chelation theoretically can improve the postoperative result. Again, more sophisticated equipment can allow easy, inexpensive, and noninvasive documentation of improvement.

Intracranial circulation responds less well. Casdorph in 1981 documented marked improvement in brain arterial flow in a small series of patients. Carter and Olszewer’s 1988 retrospective review showed markedimprovement in 24% and goodimprovement in 30% of patients with cerebrovascular and other degenerative brain diseases. Surprising results are possible. One patient presented to me 18 months poststroke, still severely limited despite constant physical therapy. After 8 chelation treatments, he proudly showed that he could walk down the hall with an assistant holding his belt in the back, and he described having gotten into and out of the tub (with assist) for the first time since his CVA. “Small-vessel ischemic disease,” with or without dementia changes, generally shows stabilization or some improvement. Alzheimer’s dementia, especially when associated with significant toxic heavy metal patterns, can show encouraging benefits when treated early with chelation.

A Potpourri of Problems
Macular degeneration is a special case of vascular supply directly to a central nerve. Direct ophthalmic observation can show gradual deterioration … and gradual improvements. The most rewarding part, though, is having a patient resume reading or once again being able to thread a needle. I asked one patient, who received several dozen chelation treatments, to read this note on a chart cover: “PATIENT IS LEGALLY BLIND.” I then asked him to read whose chart … “Why, that’s mine!” Without glasses.

Atrial fibrillation is the most common arrhythmia, and its frequency elevates with advancing age. The risk of stroke increases considerably, so rhythm control has benefits beyond rising perfusion efficiency. Alfred Soffer, MD, reported on chelation for various heart rhythm disturbances in his 1964 monograph; results were variable but promising. Long-experienced chelation physicians have their anecdotal stories of patients reverting to and maintaining sinus rhythm.

Cardiac valvular sclerosis, sometimes proceeding to calcific stenosis restricting flow and allowing regurgitation, is a troubling problem. Although new percutaneous operations (using technology similar to angiography) are growing in popularity, their risks and success rates are still being evaluated. Theoretically, the decalcifying effect of EDTA chelation therapy should slow (perhaps even reverse?) sclerotic-to-stenotic change. At the very least, chelation should be expected to aid the intended surgical result by increasing the pliability of tissues. Neither angiography nor echocardiography is yet sensitive enough to detect slight reductions in calcium deposits.

Scleroderma is another special case, where distinctive arteriolar changes (in all organs but especially the skin) are associated with autoimmune patterns. Raynaud’s phenomenon appears to be prodromal in many patients. Conventional medications are often frustrating, and the addition of EDTA chelation therapy has been quite successful for many patients. Similarly, other autoimmune patterns – rheumatoid arthritis and systemic lupus erythematosus – have shown promising improvements with chelation. Benefits with “fibromyalgia” have routinely been reported by patients. These observations raise speculation that EDTA might be affecting membrane pathology, possibly related to or amplified by toxic heavy metals – induced through the mechanism of free radical attack? D-penicillamine, loosely called a “chelator” but acting by means of paired thiol groups, has long been used in conventional medicine to help with scleroderma and rheumatoid patterns.

Mitochondrial pathology has been recognized in many forms over the past decade, but the contribution of toxic heavy metals has been poorly appreciated. In the 1990s, laboratory studies by the Environmental Protection Agency showed startling changes in mitochondrial protein production seen in isolated organelles after exposure to “physiologic” levels of lead. Research into toxic heavy metal effects on mitochondria, endoplasmic reticulum, nuclear membranes, and cell-limiting membranes might offer the most fruitful future explanations for pathology and chelation benefits – but the laboratory funding required would be substantial.

Along Came A Spider …
A little-known effect of chelation is to neutralize biological venoms from snakes, spiders, scorpions, and the like. These poisons are a mixture of metalloenzymes, and inactivation occurs with displacement or removal of the critical metal cation. Appropriate research could lead to treatment protocols (intravenous, oral, topical) far more effective – and dramatically less expensive – than current antivenom preparations, which can cost thousands of dollars.

Venoms, as metalloenzymes, bring up a whole realm of possible treatments aimed at specific induction and function of enzymes throughout the body. In perhaps a third of instances, physiologic cations (magnesium, zinc, iron, manganese, molybdenum, copper, others) are positioned in the active site and help establish the functional conformation of the protein. As research shows which enzyme clusters are more sensitive to inhibition by toxic heavy metals displacing the expected cation, the prospect of targeted chelation could become a reality. One factor complicating targeted treatment is that chelators need to penetrate through the interstitial space into the cytoplasm and into mitochondria and even into the nuclear space. Similar concerns arise with penetrating the blood–brain barrier. Nanoparticle delivery systems, being developed for targeted chemotherapy, might be designed to enhance chelation efficiency at the “end-organelle” level rather than merely the “end-organ.” Again, laboratory and clinical expenses could be a major barrier.

Nutritional physiology is still poorly understood, and studies might reveal new ways to increase the benefits of chelation treatments. Mildred S. Seelig, MD, MPH, confirmed in the 1980s that higher blood levels of magnesium are correlated with reduced complications of myocardial infarction. Chelation therapists have long added extra magnesium to intravenous EDTA in order to amplify many of the cardiovascular benefits of treatment. Realizing that lower magnesium levels are common in diabetes, hypertension, atherosclerosis, cardiomyopathy, and a panoply of other pathologies opens an interesting door: what minerals (and vitamins), when supplemented specifically, might enhance the effectiveness of chelation treatments in particular clinical settings? Incidentally, in patients who appear to have an “allergic” reaction to a chelating drug, supplementation with molybdenum might blunt that response for the future.

Stem cell implants offer special considerations here – could they be more effective when combined with certain minerals … or after bathing in selective chelation solutions? Rotifers are primitive multicellular microscopic waterborne “animals” that accumulate calcium over their lifespan. Alfred M. Sincock, PhD, reported in 1975 on almost doubling the lifespan by bathing the organisms in various calcium-binding chelators. Similarly, the length of DNA telomeres – hence, the potential number of cell replications before genetic losses – might also be preserved by chelation treatments. The possible interactions of hormones and EDTA or other chelators is a field ripe for investigation. These cell physiology studies are technical and expensive, but the benefits might be unexpectedly rewarding.

Cost/Benefit Comparisons
Given the socioeconomic impact of medical and health choices, no discussion is complete without highlighting the “competing therapies” for cardiovascular and other diseases. Chelation treatments reasonably cost about $5 to $10,000 to produce outstanding benefit for about 90% of patients with coronary, carotid, or peripheral vascular disease. Or all three at the same time. While surgery addresses only a few inches of “blockage” with each operation, chelation works throughout the body – a real bargain for the majority of patients, who have diffuse disease. Charges for CABG range about $75 to $150,000 – for each operation – assuming no serious complications requiring extended hospitalization. A small but certain percentage of bypass patients (perhaps 2% to 3% or more, depending on many factors, especially comorbidities or more profound blockage) never return home. Many patients suffer with postoperative morbidity, including myocardial infarction, stroke, rhythm disturbances, worsening high blood pressure, and neurocognitive changes (“pump syndrome”). Repeat operations are frustratingly common, often within 10 years. (If it worked so well the first time, why is another operation needed?) Aorta and peripheral vascular operations usually cost one-third to one-half of heart bypass procedures. Balloon angioplasty and stenting are increasingly popular (with a failure rate of about 5%), reducing the need for open surgery of the chest or limbs except for those with critical ischemia. Perhaps 20% of patients require repeated angioplasty procedures, dramatically changing the cost profiles with each session ranging from about $30 to $50,000. L. Terry Chappell, MD, and John P. Stahl, MD, in 1993 published a meta-analysis of 19 carefully qualifying studies, concluding that almost 90% of cardiovascular patients showed objective clinical improvements. The savings possible with the early choice of chelation rather than the later choice of repeated operations will become increasingly important for an aging population.

Intracranial small vessel ischemic disease is virtually untreatable by conventional means, so even slight improvements with chelation therapy are a bargain at any price. Similarly, degenerative patterns such as scleroderma, rheumatoid arthritis, macular degeneration, distal peripheral arterial occlusion, and nondiabetic chronic renal failure are poorly treated with traditional approaches, making chelation appealing and very cost effective. Perhaps the “greatest value” is seen in vague or poorly diagnosable medical conditions – including fatigue, asthenia, delayed healing, a sense of “unwellness,” multiple sclerosis – wherein chelation can provide benefits not seen with aggressive drug treatments or even surgery. Stubborn infectious diseases, such as Lyme disease or even MRSA, can show improvement with chelation. While the mechanisms of action often remain obscure, the clinical benefits can be quite obvious in patients’ lives. A “chelation registry” might document improvements across a broad range of pathologies, but the effort would be expensive and likely of little value in convincing skeptics.

One other factor should be addressed: cancer prevention. Walter Blumer, MD, in Switzerland reported his experience in 1980 with calcium EDTA intravenous treatments administered over 10 years, showing a 90% reduction in cancer incidence in the 59 patients. His follow-up report showed a 90% reduction in cancer deaths over 18 years, compared with the untreated controls similarly exposed to lead from automobile exhaust, industrial pollution, and other carcinogens. When treating heart and vascular disease, magnesium EDTA is preferred, in order to “mobilize calcium and reduce blockage.” In a private communication related to me by Garry Gordon, DO, MD(H), Blumer noted that his patients “didn’t suffer with heart attacks.” These delightful results are most likely related to removal of toxic heavy metals, since calcium EDTA does not perturb ionized calcium levels, but unknown effects of EDTA might contribute as well. Considering that cancers of all cell types are the third leading cause of death in the US, what could be the true prevention benefit when the cost of chelation treatment is compared with that of traditional oncology care?

Any review of environmental toxic metal exposures shows the alarming explosion of pollution concentrating up the food chains in the biosphere. One area where unexpected progress is coming is with mercury exposure from dental amalgams. The just-completed World Mercury Treaty, a three-year project of the World Health Organization, proposes that countries completely phase out their reliance on mercury restorations in both children and adults. Controversial studies have related mercury to autism and Alzheimer’s dementia, among other problems. The startling fact is that many adults are unknowingly carrying around their primary source of the world’s most potent neurotoxin, in their “fillings” or root canals. This raises the specter of worsening environmental pollution through the water effluent from dental offices as these restorations are replaced, because mercury scavenging units – to be disposed of as biohazard waste – are not yet in widespread use. Boyd Haley, PhD, emeritus chair of chemistry at the University of Kentucky, assures us that newer chelating compounds are in development and that they could be used not only orally in humans but also to remediate mercury-contaminated rivers and bodies of water.

Blumer’s study, among others, provokes a critical question: If removal of toxic heavy metals is the most important factor in producing clinical results, how much can be accomplished by using oral “chelating” drugs, alone or in combination with intravenous chelation? Oral administration is much easier, has fewer risks, and can be applied across broad populations, especially in a preventive context or to address early pathophysiology. Since 1995, I’ve used customized combined programs of oral chelators along with intravenous EDTA. Our early studies suggested more rapid reductions in the body burden of toxic heavy metals. Further research into dithiol compounds as well as classical chelators might be very cost effective and exceptionally fruitful. If taste-enhancing technology can mask the noxious sulfur aroma of oral chelators, the potential exists for design of prescription “chelator foods,” vastly expanding the access for this treatment approach. These would be “drug-supplemented” foods, not merely sulfur-rich onions and garlic.

Some Final Thoughts
The great majority of our “medical” problems are directly related to “personal health choices,” known as lifestyle issues: tobacco use, alcohol excess, caloric surplus, nutritionally bereft foods, poor choice of food variety, sedentary habits, dental deterioration, limited sleep, unlimited stress, and so on. Unsuspected toxic heavy metal and chemical exposures challenge our organ performance at a rapidly expanding pace. Where personal responsibility fails to minimize our survival threats, what should be the societal commitment of resources to restore function and comfort?

The future face of medical care is difficult to predict. An enlarging patient base in the US poses increasing financial demands on already stressed budgets. Technological advances can be expected in virtually every arena, from diagnostic testing through treatment planning. CT scans, MRIs, and PET scans have sharpened our accuracy and understanding to allow earlier diagnosis and treatment, for better outcomes and longer survival. Same-day surgicenters and endoscopic procedures dramatically reduced the costs associated with many common procedures, such as cholecystectomy and most knee repairs. Will the changes still to come bring similar cost savings or will they, like organ transplant procedures, impose greater economic strains on a nation unprepared to ration “high-tech” care?

Victor Fuchs, PhD, in his seminal book Who Shall Live?, claimed in 1974 that we must deliver the very best care to the president because of his critical position in the society – but he cautioned that we simply cannot afford to deliver “presidential medicine” to the people. Just because we can do it – CABG surgery, angioplasty, total joint replacement, organ transplants – challenges us with the ethical question of whether we should do it. Or do it for some but not for others. Or do it for younger adults but not for “the elderly.” The reasonable cost and minimal resources required to offer chelation therapy “to the masses” suggest that this largely ignored treatment might soon evolve to play central roles in both preventive and therapeutic spheres in our emerging care system.