Chelation Therapy: Is It Time Now?

The Western world is faced with a health-related dilemma in this day and age, pertaining to how can we best protect ourselves against chronic degenerative disease. The theories of aging are focussing on stress from free radical formation, known as oxidative stress, as causative in many of our current common chronic illnesses, including heart disease and neurologic conditions. The acceleration of free radical formation occurs in the face of environmental toxicity, from toxic metals exposure, to chemicals in our diet, to psychological stress, to air and water pollution.

Our dilemma, as our environment becomes more and more polluted, and knowing that we as organisms will be in balance with the condition of our environment, is how to reduce our toxic load from all sources, and how best to detoxify our systems so as to enjoy better health.

Clearly, healthy lifestyle choices are paramount, with our diets focussing as much as possible on nutrient-rich, unchemicalized food, as opposed to the empty calories consumed so prevalently in the Western diet. In a previous article I discussed the role of optimized intestinal and liver function to meet the need for excretion of accumulated toxins.

The topic of this article centres upon the controversial treatment known as “Chelation Therapy”, unrecognized by conventional Western medical doctors as a medical therapy but being used more frequently worldwide. In the context of cardiovascular disease, the most common in our society, I will outline the basic concepts of this therapy, as well as cardiac protection through sound nutrition practices.

ATHEROSCLEROSIS PRIMER

Atherosclerosis is a disease in which fatty material is deposited on the wall of your arteries, which narrows the arteries and forms “plaques”. The initial trigger may be an injury of some kind to the lining of the artery, caused by free radical damage or exposure to a noxious substance or infectious organism. Inflammation is also part of the process. Eventually, the fatty tissue can further irritate the wall of the artery, diminish the elasticity (stretchiness) of the artery, and interfere with the blood flow.

Calcium deposits are involved in atherosclerotic plaque, which causes the blood vessels to harden. This in turn further reduces blood flow and can increase blood pressure. Over time, pieces of the plaques can break off, resulting in strokes if the vessels are leading to the brain. They may also slowly cut off blood supply to the heart, brain or other organs.

Coronary artery disease (CAD) is a disease that affects the blood vessels that nourish the heart muscle. CAD is actually a result of atherosclerosis. When the coronary arteries become clogged or narrowed by these waxy “fats”, blood flow is restricted and the heart muscle does not receive adequate oxygen, which can lead to angina pectoris (chest pain), heart attack (if a clot develops) and/or even death.

Angina may be worse during exercise or stress when there are increased oxygen demands on the heart. Other signs that may signal a heart attack are pain that spreads from the shoulders, neck or arms, pressure in the chest, dizziness, nausea, and/or shortness of breath. In the U.S., 460 000 deaths per year are attributed to CAD. The incidence and prevalence of CAD increases with age and is higher in males than females. Certain risk factors may contribute to its onset and rate of development including:

• Obesity
• Elevated LDL cholesterol
• Decreased HDL cholesterol
• Age > 50 years
• Diabetes
• Psychological stress/Depression
• Sedentary lifestyle
• History of heart disease
• Post menopause
• Tobacco use
• High blood pressure
• High level of homocysteine (an amino acid) in the blood
  (estimates are that 10% of CAD deaths are attributable to high homocysteine)
• Low testosterone levels
• Perhaps dental pathology
• Family history

Patients with coronary artery disease (CAD) may also have atherosclerosis of other arteries, including peripheral arteries to the legs and brain. In fact, the 60 000 miles of arteries that traverse the human body and supply oxygen and nutrients to all tissues to some extent can become diseased. A systemic therapy to assist optimal function of these arteries in a complementary fashion to our conventional treatments should be researched and welcomed, one would think, given the huge burden of atherosclerosis on our society and health delivery systems.

HEART HEALTH AND NUTRITION

Conventional treatments for cardiovascular disease require long-term pharmaceutical drug use and/or possible heart by-pass surgery. Dietary recommendations are less espoused than perhaps they should for cardiac protection, despite the body of evidence which continues to grow in support of specific measures that can be taken to address cardiac risk factors and reduce blood vessel damage. Studies have also shown that specific nutrients can be added to a healthy diet to afford further protection from heart disease.

Prevention of heart disease needs to improve given the number of deaths related to CAD, remaining the leading cause of mortality in industrialized countries. The focus in prevention has been primarily on managing the related conditions of hypertension, diabetes and high cholesterol. Unfortunately, industrialized nations have dietary habits that contribute to, rather than prevent, the free radical damage implicated as the initial trigger in the disease process, whereby a vessel injury becomes the focus for inflammation and eventual clotting. Trans-fatty acids, from deep frying and margarines, can also be damaging, and high levels of homocysteine, normally reduced dramatically by adequate B vitamin intake, are not prevented due to an over consumption of white floured, nutrient deficient processed foods. Dean Ornish popularized a diet that actually allowed for the reversal of atherosclerosis in diseased arteries.

The Journal of the American Medical Association (JAMA) in November 2002 published (!) an article entitled “Optimal Diets For The Prevention of Coronary Heart Disease.” The conclusion of the study was as follows: “substantial evidence indicates that diets using nonhydrogenated unsaturated fats as the predominant form of dietary fat, whole grains as the main form of carbohydrates, an abundance of fruits and vegetables, and adequate omega-3 fatty acids [e.g. coldwater fish 2-3 times per week] can offer significant protection against CHD [coronary heart disease].” As for risk factor prevention, research at Toronto’s St. Michael’s Hospital showed the effectiveness of a soy-based diet with refined psyllium, whole grains oat and barley, and almond intake in lowering elevated cholesterol. The bottom line: choose to eat a wide variety of natural, unprocessed foods.

Nutraceuticals, or nutrition supplements, also have a body of evidence that lends credence to their use in the prevention of CAD and other heart afflictions. A World Health Organization study concluded that low vitamin E levels were 100 times more statistically significant as predictors of death from heart disease than elevated cholesterol. Due to their effect in lowering homocysteine (a measurable blood test at all Ontario laboratories that anyone with a personal or family history of CAD or stroke should request), JAMA published in 1998 a study that showed folic acid and B6 supplementation lowering women’s risk of heart disease. In 1997, the British Medical Journal published : “Vitamin C Deficiency and Heart Disease”, a randomized study involving 1605 Finnish men which showed a 250% increase risk of heart attack in those with low levels of Vitamin C.

As for risk factor prevention, treatment with CoQ10 may help adults with Type 2 diabetes to stabilize blood sugar levels and lower their blood pressure, according to a study in the European Journal of Clinical Nutrition, published November 2002. The bottom line from these samplings of studies: nutrition supplements added to the healthy diet can further reduce the risk of cardiac disease. Recommended daily doses for heart protection from nutrition supplements as advocated by many are (not intended to replace medical advice from your personal physician):

Vitamin C 500 – 2000 mg
Vitamin E 400-800 IU (mixed, total)
CoQ10 100-300 mg
B6 50mg
B12 400 mcg
Folic acid 1-2 mg
Calcium 400 – 800 mg
Magnesium 500 Mg
Fish oil capsules 2 – 4 grams

Other supplements may be recommended depending on the individual case.

EDTA CHELATION THERAPY

An alternative form of therapy called “Chelation” does exist for coronary artery disease, which comes from the Greek word “chele” meaning claw. EDTA (ethylene diamine tetra acetic acid) binds to metals in the body forming a complex, which can then be easily and safely excreted naturally through the kidneys. As a result it helps to gradually break down calcium deposits, removes harmful metals, decreases damage caused by free radicals and prevents platelets from becoming too sticky. Overall, it improves circulation through the body by reducing debris along arterial walls, and by making the arteries more flexible.

The chelation cocktail, administered intravenously because EDTA is not well absorbed orally, also contains generous amounts of Vitamin C, postulated by Nobel Prize winner Linus Pauling and his proponents to be instrumental in the underlying cause of arterial disease. Also in the mixture are other minerals and vitamins, including B vitamins that reduce the aforementioned homocysteine toxicity, and magnesium, one of the most important minerals for heart function. Millions of North Americans receive this treatment every year with almost no reported side effects (i.e. the amount of EDTA in each treatment is said to be less toxic than taking one aspirin tablet).

The patient rests comfortably during the treatment, which is painless and lasts 3 hours. The course of Chelation therapy involves a series of infusions at regular intervals, usually weekly. The infusion is given through a tiny needle inserted in a vein, most often on the back of the hand. For patients with existing symptoms the usual course is 20-30 treatments, depending on the severity of the symptoms and whether or not the patient is a smoker. For preventative purposes an initial course of 10 treatments is usually adequate.

A LITTLE CHELATION HISTORY

Chelation therapy can be included as part of a comprehensive complementary approach for dealing with cardiovascular and other degenerative diseases. Its history in the treatment of angina goes back 40 years, when it was noted that patients being treated for lead poisoning (EDTA’s more traditional application) had improvement in angina symptoms. It was studied heavily in the 1960’s for treatment of cardiovascular and collagen-vascular diseases (e.g. scleroderma), with good results. When the patent on EDTA expired and wasn’t renewed by Abbott, a pharmaceutical company, in 1969, the treatment and research fell from sight. Since then, it has remained on the outskirts of traditional Western medicine.

The international protocol for the provision of Chelation therapy is regulated by the American College for the Advancement of Medicine (ACAM) and is derived from the knowledge gained in multiple research studies worldwide. Chelation therapy administered according to this protocol has an excellent safety record. As such, a system of evidence supports its use, but well-designed large clinical trials verifying effectiveness and safety, one of which will be underway in March 2003, are required to bring it to the North American mainstream.

The U.S. government’s National Institutes of Health (NIH) has granted $30 million dollars to study 2300 patients over a 5 year period, using ACAM’s chelation protocol in half of the subjects and a placebo cocktail in the other half. This will, indeed, be a landmark study, to determine if Chelation is a therapy whose time has come or one that will be relegated to the sidelines for more decades. The process to have a government agency sponsor such a study has been long and arduous, so the grant in itself is a victory for proponents. According to Stephen Straus, M.D., Director of the branch arm of NIH that oversees complementary/alternative medicine: “The public health imperative to undertake a definitive study of chelation therapy is clear…the overall impact of coronary artery disease convinced the NIH that the time is right to launch such a study.”

OTHER USES FOR CHELATION

The health hazards related to chronic tissue accumulation of toxic metals are well documented. Neurotoxicity, hormone dysregulation, immune system dysfunction are all potential impairments, with far reaching implications for a number of related health conditions. Others types of chelation therapy, similar to but not identical to the administration of EDTA, can be used if toxic metal syndrome is observed to be contributing to health deterioration. These are topics for another time.

Suffice it to say that the detoxification of toxic metals is one way to cope with the burden we have placed upon ourselves through our inability to control our environmental abuses. As our environment goes, so do we. As a society it is important that we recognize, given the unacceptable incidence of cancer and chronic degenerative diseases, how to best protect ourselves through sound nutrition. Our greatest defense against environmental toxins is nutrients, so unhealthy eating habits come with a huge cost. We can increase our awareness of what we are allowing to infiltrate our tissues, and of how to truly prevent disease and enjoy our desired quality of life, despite our genetics, to the best of our abilities. In this day and age, we must avail ourselves of that information.

Dr. Gannage practices Integrative and Functional Medicine in the Greater Toronto Area.